Showing papers in "Psychological Medicine in 2001"
TL;DR: The cognitive processes that are thought to lead to the formation and maintenance of the positive symptoms of psychosis are set out and a fuller integration with the findings of biological research will be required.
Abstract: In the last 10 years a consensus has developed that the symptoms of psychosis may be better understood by linking the steps between the phenomenological experiences and social, psychological and neurobiological levels of explanation. Cognitive models of psychosis are an important link in this chain. They provide a psychological description of the phenomena from which hypotheses concerning causal processes can be derived and tested; social, individual, and neurobiological factors can then be integrated via their impact on these cognitive processes. In this paper, we set out the cognitive processes that we think lead to the formation and maintenance of the positive symptoms of psychosis and we attempt to integrate into our model research in social factors. If this model proves useful, a fuller integration with the findings of biological research will be required (Frith, 1992).
1,419 citations
TL;DR: Results of this study suggest that the self-report version of the LSAS compares well to the clinician-administered version and may be validly employed in the assessment of social anxiety disorder.
Abstract: Background. The clinician-administered version of the Liebowitz Social Anxiety Scale (LSAS-CA) is a commonly used assessment device for the evaluation of social anxiety disorder and has been shown to have strong psychometric characteristics. Because of its apparently straightforward rating format and potential savings in time and effort, interest in the use of the LSAS as a self-report (LSAS-SR) measure has increased, and the LSAS-SR has been used in a number of studies. However, the psychometric properties of the LSAS-SR have not been well established.Methods. This study examined the psychometric properties of the LSAS-SR in comparison to the LSAS-CA in a sample of 99 individuals with a primary diagnosis of social anxiety disorder and 53 individuals with no current psychiatric disorder.Results. There was little difference between the two versions of the LSAS on any scale or subscale score. Both forms were internally consistent and the subscale intercorrelations for the two forms were essentially identical. Correlations of each LSAS-SR index with its LSAS-CA counterpart were all highly significant. Finally, the convergent and discriminant validity of the two forms of the LSAS was shown to be strong.Conclusion. Results of this study suggest that the self-report version of the LSAS compares well to the clinician-administered version and may be validly employed in the assessment of social anxiety disorder.
755 citations
TL;DR: R rape and sexual molestation were the traumatic events most likely to be associated with PTSD, and a high level of Axis 1 co-morbidity was found among those persons with PTSD.
Abstract: Background. We report on the epidemiology of post-traumatic stress disorder (PTSD) in the Australian community, including information on lifetime exposure to trauma, 12-month prevalence of PTSD, sociodemographic correlates and co-morbidity. Methods. Data were obtained from a stratified sample of 10641 participants as part of the Australian National Survey of Mental Health and Well-being. A modified version of the Composite International Diagnostic Interview was used to determine the presence of PTSD, as well as other DSM-IV anxiety, affective and substance use disorders. Results. The estimated 12-month prevalence of PTSD was 1.33%, which is considerably lower than that found in comparable North American studies. Although females were at greater risk than males within the subsample of those who had experienced trauma, the large gender differences noted in some recent epidemiological research were not replicated. Prevalence was elevated among the never married and previously married respondents, and was lower among those aged over 55. For both men and women, rape and sexual molestation were the traumatic events most likely to be associated with PTSD. A high level of Axis I co-morbidity was found among those persons with PTSD Conclusions. PTSD is a highly prevalent disorder in the Australian community and is routinely associated with high rates of anxiety, depression and substance disorders. Future research is needed to investigate rates among other populations outside the North American continent.
678 citations
TL;DR: Evidence thus far suggests that DUP may be related to ease of reducing psychotic symptoms once treatment begins for first episode patients, but there is no evidence of a relationship to likelihood of relapse.
Abstract: Background. The concept of duration of untreated psychosis (DUP) has recently attracted much interest because of its possible relationship to treatment outcome and implications for preventive efforts with reference to psychotic disorders, especially schizophrenia. In this paper we review critically the literature concerning the concept and its importance.Methods. Articles concerned with measuring DUP and those that have been suggested to provide indirect or direct evidence of the effect of DUP on treatment outcome are reviewed.Results. Evidence thus far suggests that DUP may be related to ease of reducing psychotic symptoms once treatment begins for first episode patients, but there is no evidence of a relationship to likelihood of relapse. There has been little investigation of the relationship of DUP to other long-term outcomes such as negative symptoms and cognitive functioning neither have the possible confounds of DUP been widely investigated or controlled.Conclusions. It is important that there should be more thorough investigations of DUP, its correlates, and the extent to which it does mediate any advantages of earlier intervention.
495 citations
TL;DR: Suicides and medically serious suicide attempts are two overlapping populations that share common psychiatric diagnostic and history features, but are distinguished by gender and patterning of psychiatric disorder.
Abstract: Background. Few studies have examined the extent to which populations of suicides and attempted suicides are similar, or dierent. This paper compares suicides and serious suicide attempts in terms of known risk factors for suicidal behaviour. Methods. Using case‐control methodology, risk factors for suicidal behaviour were examined in 202 individuals who died by suicide, 275 individuals who made medically serious suicide attempts and 984 randomly selected control subjects. Based on data from significant others, measures used spanned sociodemographic factors, childhood experiences, psychiatric morbidity and psychiatric history, exposure to recent stressful life events and social interaction. Results. Multiple logistic regression identified the following risk factors that were common to suicide and serious suicide attempts: current mood disorder; previous suicide attempts; prior outpatient psychiatric treatment; admission to psychiatric hospital within the previous year; low income; a lack of formal educational qualifications; exposure to recent stressful interpersonal, legal and work-related life events. Suicides and suicide attempts were distinguished in the following ways: suicides were more likely to be male (OR fl 1‐9, 95% CI 1‐1, 3‐2); older (OR fl 1‐03, 95% CI 1‐02, 1‐04); and to have a current diagnosis of non-aective psychosis (OR fl 8‐5, 95% CI 2‐0, 35‐9). Suicide attempts were more likely than suicides to have a current diagnosis of anxiety disorder (OR fl 3‐5, 95% CI 1‐6, 7‐8) and to be socially isolated (OR fl 2‐0, 95% CI 1‐2, 3‐5). These findings were confirmed by discriminant function analysis, which identified two functions that described the three subject groups: the first function discriminated the two suicide groups from control subjects on a dimension corresponding to risk factors for suicide; the second function discriminated suicide from suicide attempt subjects on a series of factors including gender, non-aective psychosis and anxiety disorder. Conclusions. Suicides and medically serious suicide attempts are two overlapping populations that share common psychiatric diagnostic and history features, but are distinguished by gender and patterning of psychiatric disorder.
407 citations
TL;DR: In the US, a strong association exists between child sexual abuse and suicidal behaviour, mediated by psychopathology, and there is a substantial proportion of suicide risk attributable to childSexual abuse beyond the presence of psychopathology and other adversities.
Abstract: Background. Research shows that psychopathology, child sexual abuse and other childhood adversities are risk factors for suicide. However, few have investigated their joint and independent roles in the pursuit of a reliable, predictive model of suicidal behaviour.Methods. Data are from the National Comorbidity Survey (N = 5877), a nationally representative study of prevalence, risk factors, and social consequences of psychiatric disorders in the US. Discrete time survival analysis and population attributable risk methodologies were utilized.Results. Among those sexually abused as children, odds of suicide attempts were 2–4 times higher among women and 4–11 times higher among men, compared with those not abused, controlling for other adversities. Odds ratios were reduced but most remained statistically significant after adjusting for lifetime psychiatric illnesses preceding suicide attempts. In the same predictive equation, 79% of serious suicide attempts among women could be attributed to psychiatric disorders while 12% was attributable to rape and 7% to molestation. The highest probability of a first attempt was during early adolescence for those who were sexually abused and had a lifetime disorder, but it was 8–12 years older for those sexually abused without any disorders.Conclusions. In the US, a strong association exists between child sexual abuse and suicidal behaviour, mediated by psychopathology. There is a substantial proportion of suicide risk attributable to child sexual abuse beyond the presence of psychopathology and other adversities. From a clinical standpoint, abuse survivors represent a high-risk population for suicidal behaviour. Further research into this preventable antecedent of suicide attempts is necessary.
380 citations
TL;DR: There is a clear association between ToM impairment and behavioural signs in schizophrenia and toM impairments in schizophrenia are less severe than in autism, but are specific and not a reflection of general cognitive deficits.
Abstract: Background Several studies have examined the ability of schizophrenic patients to represent mental states ('theory of mind': ToM). There is consensus that some patients have impaired ToM, but there is disagreement about the relation between ToM and symptomatology, and about the severity and specificity of the deficit. Methods Two first-order and one second-order false belief tests of ToM were given to groups of schizophrenic patients and psychiatric and normal controls. The relation between ToM and symptomatology was explored using regression and symptom subgroup analyses. Severity was investigated by using the same task methodology as in autism research, to enable direct comparison with that disorder. Specificity was investigated using matched control tasks which were as difficult as the ToM tasks, but did not require ToM. Results Symptom subgroup analysis showed that schizophrenic patients with behavioural signs were impaired relative to controls on ToM, and that remitted patients and a single case with passivity symptoms performed as well as controls. Regression analysis showed that ratings of behavioural signs predicted impaired ToM in schizophrenia. There was weak evidence that a subgroup with paranoid symptoms had ToM impairments, although these were associated with low IQ. Schizophrenic patients only showed ToM deficits on the second-order task. No impairments appeared on the matched control tasks which did not require ToM. Conclusions There is a clear association between ToM impairment and behavioural signs in schizophrenia. Deficits in paranoid patients are harder to detect with current tasks and may be compensated for by IQ-dependent problem-solving skills. ToM impairments in schizophrenia are less severe than in autism, but are specific and not a reflection of general cognitive deficits.
343 citations
TL;DR: Unemployment is strongly related to suicide, but this relationship is more enduring and stronger among women than among men, and the unemployment effect is stronger at earlier years of follow-up.
Abstract: Background. The purpose of the study was to examine the effect of employment status measured at baseline on the risk of suicide by years of follow-up, using a large nationally representative sample of the US population.Methods. Cox regression models were applied to data from the National Longitudinal Mortality Study, based on the 1979–1989 follow-up. In estimating the effect of baseline employment status on suicide, adjustments were made for baseline demographic and socio-economic variables.Results. After 3 years of follow-up, unemployed men were a little over twice as likely to commit suicide as their employed counterparts. Among men, the lower the socio-economic status, the higher the suicide risk. Among women, in each year of follow-up, the unemployed had a much higher suicide risk than the employed. After 9 years of follow-up unemployed women were over three times more likely to kill themselves than their employed counterparts.Conclusions. Unemployment is strongly related to suicide, but this relationship is more enduring and stronger among women. For men, the unemployment effect is stronger at earlier years of follow-up. In women, unemployment increases the risk of suicide regardless of the number of follow-up years. The finding with regard to women disconfirms earlier research reports suggesting that unemployment affects suicide only in men.
336 citations
TL;DR: Recovery is still possible for anorexic patients after a period of 21 years, but patients can relapse, becoming symptomatic again despite previously achieving recovery status, therefore, it is recommended that these patients should be monitored regularly and offered treatment whenever possible.
Abstract: Background. Given our poor understanding of the very long-term course of anorexia nervosa, many questions remain regarding the potential for recovery and relapse. The purpose of the present study was to investigate long-term outcome and prognosis in an anorexic sample 21 years after the initial treatment. Method. A multidimensional and prospective design was used to assess outcome in 84 patients 9 years after a previous follow-up and 21 years after admission. Among the 70 living patients, the follow-up rate was 90%. Causes of death for the deceased patients were obtained through the attending physician. Predictors of a poor outcome at the 21-year follow-up were selected based on the results of a previous 12-year follow-up of these patients. Results. Fifty-one per cent of the patients were found to be fully recovered at follow-up, 21% were partially recovered and 10% still met full diagnostic criteria for anorexia nervosa. Sixteen per cent were deceased, due to causes related to anorexia nervosa. The standardized mortality rate was 9·8. The three groups also showed significant differences in psychosocial outcome. A low body mass index and a greater severity of social and psychological problems were identified as predictors of a poor outcome. Conclusions. Recovery is still possible for anorexic patients after a period of 21 years. On the other hand, patients can relapse, becoming symptomatic again despite previously achieving recovery status. Only a few patients classified as having a poor outcome were found to seek any form of treatment, therefore, it is recommended that these patients should be monitored regularly and offered treatment whenever possible.
335 citations
TL;DR: The results suggest that chronic aircraft noise exposure is associated with impaired reading comprehension and high levels of noise annoyance but not mental health problems in children.
Abstract: Background. Previous research suggests that children are a high risk group vulnerable to the effects of chronic noise exposure. However, questions remain about the nature of the noise effects and the underlying causal mechanisms. This study addresses the effects of aircraft noise exposure on children around London Heathrow airport, in terms of stress responses, mental health and cognitive performance. The research also focuses on the underlying causal mechanisms contributing to the cognitive effects and potential confounding factors.Methods. The cognitive performance and health of 340 children aged 8–11 years attending four schools in high aircraft noise areas (16h outdoor Leq>66dBA) was compared with children attending four matched control schools exposed to lower levels of aircraft noise (16h outdoor Leq<57dBA). Mental health and cognitive tests were group administered to the children in the schools. Salivary cortisol was measured in a subsample of children.Results. Chronic aircraft noise exposure was associated with higher levels of noise annoyance and poorer reading comprehension measured by standardized scales with adjustments for age, deprivation and main language spoken. Chronic aircraft noise was not associated with mental health problems and raised cortisol secretion. The association between aircraft noise exposure and reading comprehension could not be accounted for by the mediating role of annoyance, confounding by social class, deprivation, main language or acute noise exposure.Conclusions.These results suggest that chronic aircraft noise exposure is associated with impaired reading comprehension and high levels of noise annoyance but not mental health problems in children.
329 citations
TL;DR: The distinct patterns of observed impairment in manic and depressed patients suggests that the nature and extent of cognitive impairment differ between these two groups, consistent with a role for the ventromedial prefrontal cortex in mediating mood–cognition relationships.
Abstract: Background. Despite markedly different clinical presentations, few studies have reported differences in neuropsychological functioning between mania and depression. Recent work has suggested that differences may emerge on cognitive tasks requiring affective processing, such as decision-making. The present study sought to compare decision-making cognition in mania and depression in order to clarify the current profiles of impairment for these disorders and to contribute to our more general understanding of the relationship between mood and cognition.Methods. Medicated manic patients, depressed patients, and normal healthy controls completed a computerized decision-making task. All subjects were asked to win as many points as possible by choosing outcomes based on variably-weighted probabilities and by placing ‘bets’ on each decision.Results. Both patient groups were impaired on this task, as evidenced by slower deliberation times, a failure to accumulate as many points as controls and suboptimal betting strategies. Manic, but not depressed, patients made suboptimal decisions – an impairment that correlated with the severity of their illness.Conclusions. These findings are consistent with a growing consensus that manic and depressed patients are characterized by significant impairments in cognitive and particularly executive, functioning. Furthermore, the distinct patterns of observed impairment in manic and depressed patients suggests that the nature and extent of cognitive impairment differ between these two groups. Viewed in the context of other recent studies, these findings are consistent with a role for the ventromedial prefrontal cortex in mediating mood–cognition relationships.
TL;DR: Using broad but not narrower definitions of illness, genetic factors play a greater role in the aetiology of MD in women than in men, raising the possibility that the impact of some loci on risk for MD will differ in men and women.
Abstract: Background. Although women are at consistently greater risk for major depression (MD) than men, it is unclear whether sex modifies the aetiological impact of genetic factors on MD. Is the heritability of MD different in men and women? Do the same genetic risk factors predispose to MD in the two sexes?Methods. We obtained a lifetime history of MD by personal interview on two occasions from 6672 individual twins and 2974 complete twin pairs. Three diagnostic criteria of increasing narrowness were employed: DSM-III-R, DSM-III-R plus impairment and Washington University. To increase power by controlling for unreliability of assessment, we evaluated sex differences on genetic risk for MD using a structural equation measurement model.Results. Using DSM-III-R criteria, but not the two narrower definitions, heritability of MD was significantly greater in women than in men. In the three diagnostic systems, the genetic correlation in liability to MD in men and women was estimated at between +0·50 and +0·65. These estimates differed significantly from unity for the two broader definitions.Conclusion. Using broad but not narrower definitions of illness, genetic factors play a greater role in the aetiology of MD in women than in men. The genes that influence risk for MD in the two sexes are correlated but are probably not entirely the same. These results raise the possibility that, in linkage and association studies, the impact of some loci on risk for MD will differ in men and women.
TL;DR: Support was found for the hypothesis that emotional distress is linked to the content of delusional beliefs; it is speculated that prior emotional distress influences thecontent of delusions, and that delusion content in turn influences levels of emotional distress.
Abstract: Background. The objective of the study was to develop the cognitive understanding of persecutory delusions. It was hypothesized that safety behaviours contribute to the persistence of persecutory delusions by preventing disconfirmation. It was further hypothesized that emotional distress is associated with aspects of the content of delusions. An investigation was designed to establish whether individuals with persecutory delusions use safety behaviours, and to test predicted associations between delusion content and emotional distress. Method. A cross-sectional investigation was conducted on 25 individuals with persecutory delusions. A detailed assessment was made of the presence of safety behaviours, the content of delusions and emotional distress. Results. All participants had used at least one safety behaviour in the last month, most typically avoidance. Higher levels of anxiety were associated with greater use of safety behaviours. New data were obtained on the content of persecutory delusions. Aspects of the content of the delusions were associated with levels of depression, self-esteem, anxiety and delusional distress. Conclusions. Individuals with persecutory delusions use safety behaviours. The findings may develop the understanding of delusion persistence, acting upon delusions and the negative symptoms of schizophrenia. There are implications for cognitive interventions for psychosis. Support was also found for the hypothesis that emotional distress is linked to the content of delusional beliefs; it is speculated that prior emotional distress influences the content of delusions, and that delusion content in turn influences levels of emotional distress.
TL;DR: Women were approximately three times more likely than men to experience major depression in response to any stressful life event, and stressful life events overall pose a greater risk for depression among women compared to men.
Abstract: Background. This study sought to determine if women are more likely than men to experience an episode of major depression in response to stressful life events.Method. Sex differences in event-related risk for depression were examined by means of secondary analyses employing data from the Americans' Changing Lives study. The occurrence and time of occurrence of depression onset and instances of stressful life events within a 12-month period preceding a structured interview were documented in a community-based sample of 1024 men and 1800 women. Survival analytical techniques were used to examine sex differences in risk for depression associated with generic and specific stressful life events.Results. Women were approximately three times more likely than men to experience major depression in response to any stressful life event. Women and men did not differ in risk for depression associated with the death of a spouse or child, events affecting their relationship to a spouse/partner (divorce and marital/love problems) or events corresponding to acute financial or legal difficulties. Women were at elevated risk for depression associated with more distant interpersonal losses (death of a close friend or relative) and other types of events (change of residence, physical attack, or life-threatening illness/injury).Conclusion. Stressful life events overall, with some exceptions among specific event types, pose a greater risk for depression among women compared to men.
TL;DR: The pattern of results provides strong support for the claim that the NART primarily indexes prior (rather than current) intellectual ability.
Abstract: Background. The National Adult Reading Test (NART) is widely used in research and clinical practice as an estimate of pre-morbid or prior ability. However, most of the evidence on the NART’s validity as a measure of prior intellectual ability is based on concurrent administration of the NART and an IQ measure. Method. We followed up 179 individuals who had taken an IQ test (the Moray House Test) at age 11 and administered the NART and the Mini-Mental State Examination (MMSE) at age 77. A subset (N fl 97) were also re-administered the original IQ test. Results. The correlation between NART performance at age 77 and IQ age 11 was high and statistically significant (r fl 0‐73; P ! 0‐001). This correlation was comparable to the correlation between NART and current IQ, and childhood IQ and current IQ, despite the shared influences on the latter variable pairings. The NART had a significant correlation with the MMSE but this correlation fell to near zero (r fl 0‐02) after partialling out the influence of childhood IQ. Discussion. The pattern of results provides strong support for the claim that the NART primarily indexes prior (rather than current) intellectual ability.
TL;DR: The results suggest an association between delusions and impaired judgements about ambiguous sensory stimuli and the specific tendency of hallucinators to misattribute their distorted voice to someone else may reflect impaired awareness of internally generated verbal material.
Abstract: Background. Contemporary cognitive models of auditory verbal hallucinations propose that they arise through defective self-monitoring. We used a paradigm that engages verbal self-monitoring to investigate this theory in patients with schizophrenia. Methods. Ten patients with auditory verbal hallucinations and delusions (hallucinators), eight patients with delusions but no hallucinations (non-hallucinators), and 20 non-psychiatric control subjects were tested. Participants read single adjectives aloud, under the following randomized conditions: reading aloud; reading aloud with acoustic distortion of their own voice; reading aloud with alien feedback (someone else’s voice); and reading aloud with distorted alien feedback. Immediately after articulating each word, participants identified the source of the speech they heard (‘self’}‘other’}‘unsure’), via a button press. Response choice and reaction time were recorded. Results. When reading aloud with distorted feedback of their own voice, patients in both groups made more errors than controls; they either misidentified its source or were unsure. Hallucinators were particularly prone to misattributing their distorted voice to someone else, and were more likely to make errors when the words presented were derogatory. Both patient groups made faster decisions than controls about the source of distorted or alien speech, but faster responses were only associated with errors in the former condition. Conclusions. Impaired verbal self-monitoring was evident in both hallucinators and nonhallucinators. As both groups had delusions, the results suggest an association between delusions and impaired judgements about ambiguous sensory stimuli. The specific tendency of hallucinators to misattribute their distorted voice to someone else may reflect impaired awareness of internally generated verbal material.
TL;DR: Memory complaints do reflect perceptions of past memory performance and are also an early manifestation of memory impairment, however, current negative affect shows the greatest association with memory complaints.
Abstract: Background. There is considerable dispute about the validity of memory complaints. While some studies find that complaints are an early indicator of dementia or cognitive decline, there are also many studies showing that complaints are more closely associated with negative affect (depression, anxiety and neuroticism). The present paper used three-wave longitudinal data to test three hypotheses: (1) that memory complaints reflect an evaluation of present and past memory performance; (2) that memory complaints predict future memory performance; and (3) that memory complaints predict current and future negative affect.Methods. A longitudinal study was carried out with a community sample of people aged 70 and over. Participants were assessed for memory complaints, memory performance and negative affect at three waves separated by 3·6 years and 4·0 years. There were 331 persons with data on all relevant variables. The data were analysed using structural equation modelling.Results. Significant paths in the structural model were found from memory performance to future memory complaints, as well as from memory complaints to future memory performance, supporting hypotheses 1 and 2. Memory complaints were associated with current negative affect, but did not predict future negative affect.Conclusions. Memory complaints do reflect perceptions of past memory performance and are also an early manifestation of memory impairment. However, current negative affect (anxiety and depression symptoms) shows the greatest association with memory complaints.
TL;DR: Depression and schizophrenia may share personality risk-increasing and risk-reducing factors and Coping styles associated with particular personality traits may determine whether isolated symptoms progress to full-blown illness.
Abstract: Background. Neuroticism has been shown to increase the risk of depression whereas extraversion is associated with a reduction of risk. These personality traits play a central role in aetiological theories of affective disorder but their role in schizophrenia is unclear. In this study, the risk for schizophrenia associated with neuroticism and extraversion was examined and quantified.Methods. Neuroticism and extraversion rated at the age of 16 years were examined in relation to adult schizophrenia in a national birth cohort of 5362 individuals.Results. Neuroticism increased the risk of later schizophrenia independent of the level of affective symptoms in adult life (odds ratio over three levels: 1·93, 95% CI 1·09–3·43), whereas extraversion reduced the risk (OR: 0·44, 95% CI 0·23–0·84).Conclusions. Depression and schizophrenia may share personality risk-increasing and risk-reducing factors. Coping styles associated with particular personality traits may determine whether isolated symptoms progress to full-blown illness.
TL;DR: Investigation of health problems and impairment associated with bulimia nervosa and binge eating disorder among female primary care and obstetric gynaecology patients found anxiety disorders, mood disorders and diabetes were much more common among women with BN or BED than among women without these eating disorders.
Abstract: Background Although psychiatric patients with eating disorders are known to be at risk for a variety of health problems, relatively little is known about eating disorders and associated health problems in other populations. An epidemiological study was conducted to investigate health problems and impairment associated with bulimia nervosa (BN) and binge eating disorder (BED) among female primary care and obstetric gynaecology patients. Methods Psychiatric disorders, physical illnesses, disabilities, functional status and stress were assessed among 4651 female patients (age range:18 to 99 years) at 8 primary care and 7 obstetric gynaecology clinics throughout the United States. Results Two hundred eighty-nine women (62%) were diagnosed with BN or BED. The prevalence of BN was approximately 1% among young and middle-aged women. The prevalence of BED increased steadily from early (3.3%) through middle (8.5%) adulthood. Anxiety disorders, mood disorders and diabetes were much more common among women with BN or BED than among women without these eating disorders. Women with BN or BED reported markedly poorer functioning and much higher levels of disability, health problems, insomnia, psychosocial stress and suicidal thoughts than did women without BN or BED, after co-occurring psychiatric disorders were controlled statistically. Yet, fewer than one of ten cases of BN or BED was recognized by the patients' physicians. Conclusions Patients with BN or BED often experience considerable disability, impairment, distress and co-occurring illnesses. Increased recognition of eating disorders may be a crucial step towards encouraging more patients to seek treatment for these disabling conditions.
TL;DR: Mental disorder and family discord were the two major risk factors for suicide among elderly men and women among elderly persons in Sweden.
Abstract: Background. Stressful life events, such as family conflicts, separation, bereavement, somatic illness and financial problems are common antecedents of suicide. Studies on suicide among younger persons dominate the literature, despite the fact that a large proportion of suicides occur among elderly persons. Methods. The occurrence of stressful life events was investigated among elderly suicide cases and population controls. The study was conducted in the southwestern part of Sweden and included 85 persons (46 males and 39 females) 65 years and above who had committed suicide from January 1994 to May 1996. Population controls (84 males and 69 females) were randomly selected. Interviews were carried out with the controls and with informants for the suicide cases. Questions on sociodemographic background, mental and somatic health status, and life events (0-6, 7-12 and 13-24 months preceding suicide/interview) were included in the interviews. Results. Somatic illness, family discord and financial trouble were significant risk factors during all three time periods. Other risk factors were mental disorder, lower education, feelings of loneliness and previous suicide in the family. Factors associated with a decreased risk included active participation in organizations and having a hobby. Variables that remained in the multivariate logistic regression model were mental disorder (men, odds ratio (OR) = 62.4, 95 % CI 17.9-217.5; women, OR = 559, 95% CI 14.1-222.3) and family discord (men, OR = 10-0, 95% CI 1.7-59.8; women, OR = 9.2, 95% CI 1.9-44.8). Conclusions. Mental disorder and family discord were the two major risk factors for suicide among elderly men and women.
TL;DR: Regression analysis suggests that depression in Parkinson's disease is more strongly influenced by the patients' perceptions of handicap than by actual disability, and the treatment of depression should therefore be targeted independently of treatment of the motor symptoms of Parkinson’s disease.
Abstract: Background. Depression is a common problem in patients with Parkinson’s disease, but its mechanism is poorly understood. It is thought that neurochemical changes contribute to its occurrence, but it is unclear why some patients develop depression and others do not. Using a community-based sample of patients with Parkinson’s disease, we investigated the contributions of impairment, disability and handicap to depression in Parkinson’s disease. Methods. Ninety-seven patients seen in a population-based study on the prevalence of Parkinson’s disease completed the Beck Depression Inventory (BDI). Clinical and historical information on symptoms and complications of Parkinson’s disease were obtained from the patients by a neurologist. In addition, clinician and patient ratings of disability on the Schwab and England scale were obtained and a quality of life questionnaire was completed. Results. Moderate to severe depression (BDI & 18) was reported by 19‐6% of the patients. Higher depression scores were associated with advancing disease severity, recent self-reported deterioration, higher akinesia scores, a mini-mental score of ! 25 and occurrence of falls. Disability as rated by the neurologist accounted for 34% of the variance of depression scores. Self-reported impairment of cognitive function and the feeling of stigmatization accounted for " 50% of the variance of depression scores. Conclusions. Depression in patients with Parkinson’s disease is associated with advancing disease severity, recent disease deterioration and occurrence of falls. Regression analysis suggests that depression in Parkinson’s disease is more strongly influenced by the patients’ perceptions of handicap than by actual disability. The treatment of depression should therefore be targeted independently of treatment of the motor symptoms of Parkinson’s disease, and consider the patients’ own perception of their disease.
TL;DR: Findings support previous research indicating significant genetic and non-shared environmental influences on AN syndromes.
Abstract: Background. Genetic and environmental influences on broadly-defined anorexia nervosa (AN) syndrome were examined in a population-based twin sample. Methods. AN syndrome was assessed in 672 female 17 year-old twins using structured interviews and a self-report questionnaire. Results. Twenty-six probands with AN syndrome were identified. Biometrical model-fitting analyses indicated that genetic and non-shared environmental factors accounted for 74% and 26% of the variance in AN syndrome, respectively. Conclusions. Findings support previous research indicating significant genetic and non-shared environmental influences on AN syndromes.
TL;DR: There is a need to raise awareness about mental disorders in late-life in the community and among health professionals, and to improve access to appropriate health care for the elderly with mental illness, in Goa, India.
Abstract: BACKGROUND: While there is a growing body of epidemiological evidence on the prevalence of mental illnesses in late-life in developing countries, there is limited data on cultural perceptions of mental illnesses and care arrangement for older people. METHOD: This qualitative study used focus group discussions with older people and key informants to investigate the status of older people and concepts of late-life mental health conditions, particularly dementia and depression, in Goa, India. RESULTS: Vignettes of depression and dementia were widely recognized. However, neither condition was thought to constitute a health condition. Dementia was construed as a normal part of ageing and was not perceived as requiring medical care. Thus, primary health physicians rarely saw this condition in their clinical work, but community health workers frequently recognized individuals with dementia. Depression was a common presentation in primary care, but infrequently diagnosed. Both late-life mental disorders were attributed to abuse, neglect, or lack of love on the part of children towards a parent. There was evidence that the system of family care and support for older persons was less reliable than has been claimed. Care was often conditional upon the child's expectation of inheriting the parent's property. Care for those with dependency needs was almost entirely family-based with little or no formal services. Unsurprisingly, fear for the future, and in particular 'dependency anxiety' was commonplace among older Goans. CONCLUSIONS: There is a need to raise awareness about mental disorders in late-life in the community and among health professionals, and to improve access to appropriate health care for the elderly with mental illness. The study suggests directions for the future development of locally appropriate support services, such as involving the comprehensive network of community health workers.
TL;DR: Suicidal ideation is a common and important antecedent to suicide attempts and deserves more attention in community and general medical settings.
Abstract: Background. Utilizing a prospectively designed community sample, we set out to estimate the rate of newly-incident suicidal ideation and attempts (non-fatal suicide behaviour) in a community sample, to evaluate antecedent sociodemographic characteristics and psychiatric disorders, and to assess use of mental health services in relation to non-fatal suicide behaviour.Method. Prospectively-gathered data was utilized from 3481 continuing participants in the 13-year follow-up of the Baltimore sample of the NIMH Epidemiologic Catchment Area survey interviewed in 1981, 1982 and 1993/6.Results. The incidence of suicide attempts was estimated at 148·8 per 100000 person-years and ideation at 419·9 per 100000 person-years. Persons in the youngest age group, in the lowest socio-economic status, and previously married persons were at increased risk for non-fatal suicide behaviour during the follow-up interval. Persons who reported suicidal ideation at baseline were more likely to report having attempted suicide at follow-up (RR = 6·09, 95% CI 2·58–14·36). Psychiatric disorders, especially depression and substance abuse, were associated with new-onset of non-fatal suicidal behaviour. While persons who reported newly-incident suicidal behaviour were more likely to report use of mental health services, few said that suicidal ideation or attempts were the reason for the visits.Conclusions. Suicidal ideation is a common and important antecedent to suicide attempts and deserves more attention in community and general medical settings.
TL;DR: The use of CT in subjects with bipolar disorders is more complex than in unipolar disorders and requires a high level of therapist expertise, but the therapy may prove to be particularly useful in the treatment of bipolar depression.
Abstract: Background. The efficacy and effectiveness of cognitive therapy (CT) is well established for unipolar disorders, but little is known about its utility in bipolar disorders. This study aimed to explore the feasibility and efficacy of using CT as an adjunct to usual psychiatric treatment in this patient population.Method. Subjects referred by general adult psychiatrists were assessed by and independent rater and then randomly allocated to immediate CT (N=21) or 6-month waiting-list control, which was then followed by CT (N=21). Observer and self-ratings of symptoms and functioning were undertaken immediately prior to CT, after a 6-month course of CT and a further 6-months later. Data on relapse and hospitalization rates in the 18 months before and after commencing CT were also collected.Results. At 6-month follow-up, subjects allocated to CT showed statistically significantly greater improvements in symptoms and functioning as measured on the Beck Depression Inventory, the Internal State Scale, and the Global Assessment of Functioning than those in the waiting-list control group. In the 29 patients who eventually received CT, relapse rates in the 18 months after commencing CT showed a 60% reduction in comparison with the 18 months prior to commencing CT. Seventy per cent of subjects who commenced therapy viewed CT as highly acceptable.Conclusion. Although the results of this study are encouraging, the use of CT in subjects with bipolar disorders is more complex than in unipolar disorders and requires a high level of therapist expertise. The therapy may prove to be particularly useful in the treatment of bipolar depression.
TL;DR: GAD and agoraphobia share a common familial aetiology with OCD, and the other anxiety and affective disorders investigated may emerge as a consequence of the OCD or as a more complex syndrome.
Abstract: Objective This study investigates the relationship of specific anxiety and affective disorders to obsessive–compulsive disorder (OCD) in a blind, controlled family studyMethod Eighty case and 73 control probands, as well as 343 case and 300 control first-degree relatives of these probands, participated in the study Subjects were examined by psychologists or psychiatrists using the Schedule for Affective Disorder and Schizophrenia-Lifetime Anxiety version (SADS-LA) Two experienced psychiatrists independently reviewed all clinical materials, and final diagnoses were made according to DSM-IV criteria, by consensus procedureResults Except for bipolar disorder, all anxiety and affective disorders investigated were more frequent in case than control probands Substance dependence disorders were not more frequent Generalized anxiety disorder (GAD), panic disorder, agoraphobia, separation anxiety disorder (SAD) and recurrent major depression were more common in case than control relatives These disorders occurred more frequently if the relative was diagnosed with OCD Only GAD and agoraphobia were more frequent in case relatives independent of OCDConclusion GAD and agoraphobia share a common familial aetiology with OCD The other anxiety and affective disorders, when comorbid with OCD, may emerge as a consequence of the OCD or as a more complex syndrome
TL;DR: Problem-solving therapy for DSH patients appears to produce better results than control treatment with regard to improvement in depression, hopelessness and problems, which is desirable that this finding is confirmed in a large trial.
Abstract: Background. Brief problem-solving therapy is regarded as a pragmatic treatment for deliberate self-harm (DSH) patients. A recent meta-analysis of randomized controlled trials (RCTs) evaluating this approach indicated a trend towards reduced repetition of DSH but the pooled odds ratio was not statistically significant. We have now examined other important outcomes using this procedure, namely depression, hopelessness and improvement in problems. Method. Six trials in which problem-solving therapy was compared with control treatment were identified from an extensive literature review of RCTs of treatments for DSH patients. Data concerning depression, hopelessness and improvement in problems were extracted. Where relevant statistical data (e.g. standard deviations) were missing these were imputed using various statistical methods. Results were pooled using meta-analytical procedures. Results. At follow-up, patients who were offered problem-solving therapy had significantly greater improvement in scores for depression (standardized mean difference = -0.36; 95% CI -0.61 to -0.11) and hopelessness (weighted mean difference = -3.2; 95% CI -4.0 to -2.41), and significantly more reported improvement in their problems (odds ratio = 2.31; 95% CI 1.29 to 4.13), than patients who were in the control treatment groups. Conclusions. Problem-solving therapy for DSH patients appears to produce better results than control treatment with regard to improvement in depression, hopelessness and problems. It is desirable that this finding is confirmed in a large trial, which will also allow adequate testing of the impact of this treatment on repetition of DSH.
TL;DR: Dysfunctions of sensory-perceptual analysis and working memory for spatial information distinguished the siblings of schizophrenia patients from the siblings with bipolar disorder, suggesting a common impairment of the fronto-hippocampal system.
Abstract: Background The aim of this study was to assess visual information processing and cognitive functions in unaffected siblings of patients with schizophrenia, bipolar disorder and control subjects with a negative family historyMethods The siblings of patients with schizophrenia (N = 25), bipolar disorder (N = 20) and the controls subjects (N = 20) were matched for age, education, IQ, and psychosocial functioning, as indexed by the Global Assessment of Functioning scale Visual information processing was measured using two visual backward masking (VBM) tests (target location and target identification) The evaluation of higher cognitive functions included spatial and verbal working memory, Wisconsin Card Sorting Test, letter fluency, short/long delay verbal recall and recognitionResults The relatives of schizophrenia patients were impaired in the VBM procedure, more pronouncedly at short interstimulus intervals (14, 28, 42 ms) and in the target location task Marked dysfunctions were also found in the spatial working memory task and in the long delay verbal recall test In contrast, the siblings of patients with bipolar disorder exhibited spared performances with the exception of a deficit in the long delay recall taskConclusions Dysfunctions of sensory-perceptual analysis (VBM) and working memory for spatial information distinguished the siblings of schizophrenia patients from the siblings of individuals with bipolar disorder Verbal recall deficit was present in both groups, suggesting a common impairment of the fronto-hippocampal system
TL;DR: This pattern of spatially distributed grey matter deficit in the right hemisphere is compatible with the hypothesis that ADHD is associated with disruption of a large scale neurocognitive network for attention.
Abstract: Background. Previous neuroimaging studies of children with attention deficit hyperactivity disorder (ADHD) have demonstrated anatomic and functional abnormalities predominantly in frontal and striatal grey matter. Here we report the use of novel image analysis methods, which do not require prior selection of regions of interest, to characterize distributed morphological deficits of both grey and white matter associated with ADHD. Methods. Eighteen children with a refined phenotype of ADHD, who also met ICD-10 criteria for hyperkinetic disorder (mean age 10‐4 years), and 16 normal children (mean age 10‐3 years) were compared using magnetic resonance imaging. The groups were matched for handedness, sex, height, weight and head circumference. Morphological dierences between groups were estimated by fitting a linear model at each voxel in standard space, applying a threshold to the resulting voxel statistic maps to generate clusters of spatially contiguous suprathreshold voxels, and testing cluster ‘mass’, or the sum of suprathreshold voxel statistics in each 2D cluster, by repeated random resampling of the data. Results. The hyperkinetic children had significant grey matter deficits in right superior frontal gyrus (Brodmann area (BA) 8}9), right posterior cingulate gyrus (BA 30) and the basal ganglia bilaterally (especially right globus pallidus and putamen). They also demonstrated significant central white matter deficits in the left hemisphere anterior to the pyramidal tracts and superior to the basal ganglia. Conclusions. This pattern of spatially distributed grey matter deficit in the right hemisphere is compatible with the hypothesis that ADHD is associated with disruption of a large scale neurocognitive network for attention. The left hemispheric white matter deficits may be due to dysmyelination.
TL;DR: Repetitive transcranial magnetic stimulation has demonstrable beneficial effects in depression and there now needs to be randomized controlled trials to compare rTMS directly with standardized electroconvulsive therapy in order to take this subject forward.
Abstract: Introduction Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a possible alternative to electroconvulsive therapy for the treatment of selected patients with depression, bipolar affective disorder and schizophrenia. The aim of this study was to evaluate the evidence for the effectiveness of rTMS in mood disorders and schizophrenia. Methods Studies were identified using MEDLINE (1966 to January 2000), EMBASE/Excerpta Medica (1980 to January 2000), Biological Abstracts and Index to Scientific and Technical Proceedings. A number of biomedical and TMS related websites were also searched. We estimated the number needed to treat to show beneficial effect of rTMS when compared with the placebo controlled group. Results Seven controlled trials of rTMS depression were identified. Five of these were suitable for meta-analysis and show a beneficial effect of rTMS compared to placebo, with a number needed to treat of 2-3 with a 95 % confidence interval 1.6 to 4.0, total; 81 patients. A single trial of rTMS has also been performed in mania, which shows a beneficial effect of right hemisphere stimulation when compared with left hemisphere stimulation. A controlled trial in schizophrenia failed to show any benefit of rTMS. Discussion rTMS has demonstrable beneficial effects in depression. The extent and the duration of the anti-depressant effect of rTMS has yet to be defined. There now needs to be randomized controlled trials to compare rTMS directly with standardized electroconvulsive therapy in order to take this subject forward. With regard to the treatment of other mood disorders and schizophrenia, we are at an early stage in the assessment of further studies that are needed to examine any potential role for rTMS.