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Most people with schizophrenia live in low- and middle-income countries in
which clinicians/policy makers are not the first targets of marketing.
Because it is years after a drug is first launched that the full effects
become known with confidence, the evidence upon which to base practice in
low- and middle-income countries may be less biased than that in richer
Concern exists that antidepressants can cause suicidality in youths with
To determine the pooled risk of self-harm and suicidal behaviour from
randomised trials of newer antidepressants.
A meta-analysis was carried out to calculate odds ratios for the combined
Self-harm or suicide-related events occurred in 71 of 1487 (4.8%) of
depressed youths treated with antidepressants v. 38 of
1254 (3.0%) of those given placebo (fixed effects odds ratio 1.70, 95% CI
1.13–2.54, P=0.01). There was a trend for individual
suicidal thoughts, attempts and self-harm to occur more often in youths
taking antidepressants than in those given placebo, but none of these
differences was statistically significant.
Antidepressants may cause a small short-term risk of self-harm or
suicidal events in children and adolescents with major depressive
Studies of conversion from mild cognitive impairment to dementia suggest
a linear progression over time. Conversion rates during lifetime may
extend to 80–90%.
This study examines the time-dependent evolution from mild cognitive
impairment to dementia. Current assumptions regarding yearly and lifetime
conversion rates are challenged.
A community sample of 1045 dementia-free individuals aged 75 years and
over was examined by neuropsychological testing based on 6 years of
Approximately 60–65% of people with mild cognitive impairment develop
clinical dementia during their life. Progression from mild cognitive
impairment to dementia appears to be time dependent, occurring primarily
within the initial 18 months.
Further long-term studies are needed to examine the time-dependent
evolution from mild cognitive impairment to dementia and to establish
age-specific conversion rates during lifetime.
Music therapy may provide a means of improving mental health among people
with schizophrenia, but its effects in acute psychoses have not been
To examine the feasibility of a randomised trial of music therapy for
in-patients with schizophrenia, and explore its effects on mental
Up to 12 weeks of individual music therapy plus standard care were
compared with standard care alone. Masked assessments of mental health,
global functioning and satisfaction with care were conducted at 3
Of 115 eligible patients 81 (70%) were randomised. Two-thirds of those
randomised to music therapy attended at least four sessions (median
attendance, eight sessions). Multivariate analysis demonstrated a trend
towards improved symptom scores among those randomised to music therapy,
especially in general symptoms of schizophrenia.
A randomised trial of music therapy for in-patients with schizophrenia is
feasible. The effects and cost-effectiveness of music therapy for acute
psychosis should be further explored in an explanatory randomised
Very few studies have examined the cross-national prevalence of suicidal
ideation in the general population or variables associated with it.
To examine the risk factors for suicidal ideas in the general
As part of a five-country two stage epidemiological study of depressive
disorder (the ODIN study) a random sample of over 12 000 people were
screened using the Beck Depression Inventory (BDI). There followed
detailed analysis of item 9 of the BDI, which measured the severity of
Age, marriage, concern by others and severity of depressed mood
independently increased or decreased the odds of suicidal ideation
overall. An interaction between life events and social supports was
identified, although this differed between men and women. Only concern by
others and severity of depression were independently associated with
serious suicidal ideation. The study does not allow for interpretation of
the direction of the association.
A number of social, clinical and demographic variables were independently
associated with all suicidal ideation and with serious suicidal ideation.
Longitudinal studies are required to confirm whether these are risk
factors for or the result of suicidal ideation or have some other
No ecological studies have examined the relationship between area
characteristics, individual characteristics and self-harm repetition.
To investigate the association between area-level factors and incidence
and repetition of self-harm, and to identify which area-level factors are
independently associated with repetition after adjustment for individual
Prospective cohort study using the Manchester Self-Harm database. Adults
who were resident in Manchester and presented to an emergency department
following self-harm between 1997 and 2002 were included
(n=4743). The main outcome measure was repeat
self-harm within 6 months of the index episode.
Four individual factors (previous self-harm, previous psychiatric
treatment, employment status, marital status) and one area-based factor
(proportion of individuals who were of White ethnicity) were
independently associated with repetition.
Repetition of self-harm may be more strongly related to individual
factors than to area characteristics. We need to better understand the
processes underlying ecological associations with suicidal behaviour
before embarking on area-based interventions.
Depression rises markedly in adolescence, a time when increased and new
genetic influences have been reported.
To examine ‘new’ and ‘stable’ genetic and environmental factors on
depressive symptoms in adolescence and young adulthood.
A questionnaire survey investigated a sample of twin and sibling pairs at
three time points over an approximately 3-year period. Over 1800 twin and
sibling pairs reported depressive symptoms at the three time points. Data
were analysed using multivariate genetic models.
Depressive symptoms at all time points were moderately heritable with
substantial non-shared environmental contributions. Wave I genetic
factors accounted for continuity of symptoms at waves 2 and 3. ‘New’
genetic effects at wave 2 also influenced wave 3 symptoms. New non-shared
environmental influences emerged at each time point.
New genetic and environmental influences may explain age-related
increases in depression across development.
Earlier studies have indicated poor long-term outcomes for patients with
To study health and social outcomes of adolescent in-patients with
anorexia nervosa in relation to prognostic factors.
A register study based on socio-economic and health data was conducted
for a national cohort of female residents in Sweden born between 1968 and
1977, including 748 in-patients with anorexia nervosa.
At follow-up 9–14 years after hospital admission, 8.7% of patients with
anorexia nervosa had persistent psychiatric health problems demanding
hospital care and 21.4% were dependent on society for their main income;
the stratified relative risks were 5.8 (95% CI 4.7–7.6) and 2.6 (2.3–3.0)
respectively compared with the general female population. The mortality
rate for patients with anorexia nervosa was 1.2% and the stratified risk
ratio for maternity was 0.6 (95% CI 0.5–0.7). Long duration of hospital
care and psychiatric comorbidity were predictors of persistent
psychiatric problems and financial dependency on society.
The outcome in this cohort of adolescent in-patients with anorexia
nervosa was considerably better than that reported in previous
There is little information on the comparative effectiveness of
second-generation antipsychotic agents.
To determine if any of five second-generation antipsychotics or
haloperidol is more effective in treating acutely ill patients with
schizophrenia, schizoaffective disorder or schizophreniform disorder.
A sample of 327 newly admitted patients were randomised to open-label
treatment with aripiprazole, haloperidol, olanzapine, quetiapine,
risperidone or ziprasidone for a minimum of 3 weeks. Measures of
effectiveness were improvement in mental status so that the patient no
longer required acute in-patient care, and changes in Brief Psychiatric
Rating Scale (BPRS) scores.
By the first measure, haloperidol (89%), olanzapine (92%) and risperidone
(88%) were significantly more effective than aripiprazole (64%),
quetiapine (64%) and ziprasidone (64%). Changes in BPRS ratings were not
significant among treatments.
Haloperidol, olanzapine and risperidone are superior to aripiprazole,
quetiapine and ziprasidone for the acute treatment of psychosis in
hospitalised patients with schizophrenia, schizoaffective disorder or
Introduction of crisis resolution/home treatment teams has been
associated with a reduction in hospital admissions in trials. Between
2001 and 2004 there was a rapid expansion in the numbers of these teams
To examine whether national implementation of these teams was associated
with comparable reductions in admissions.
Observational study using routine data covering working age adult
patients in 229 of the 303 local health areas in England from 1998/9 to
Admissions fell generally throughout the period, particularly for younger
working age adults. Introduction of crisis resolution teams was
associated with greater reductions for older working age women (35–64
years); teams always on call were associated with additional reductions
for older men and younger women. By the end of the study admissions had
fallen by 10% more in the 34 areas with crisis resolution teams in place
since 2001, and by 23% more in the 12 of these on call around the clock
than in the 130 areas without such teams by 2003/4. Reductions in bed use
were smaller. Introduction of assertive outreach teams was not associated
with overall reductions in admissions.
Introduction of crisis resolution teams has been associated with
reductions in admissions.
Despite considerable research investigating the relationship between a
long duration of untreated psychosis (DUP) and outcomes, there has been
much less considering predictors of a long DUP.
To investigate the clinical and social determinants of DUP in a large
sample of patients with a first episode of psychosis.
All patients with a first episode of psychosis who made contact with
psychiatric services over a 2-year period and were living in defined
catchment areas in London and Nottingham, UK were included in the ÆSOP
study Data relating to clinical and social variables and to DUP were
collected from patients, relatives and case notes.
An insidious mode of onset was associated with a substantially longer DUP
compared with an acute onset, independent of other factors. Unemployment
had a similar, if less strong, effect. Conversely family involvement in
help-seeking was independently associated with a shorter duration. There
was weak evidence that durations were longer in London than in
These findings suggest that DUP is influenced both by aspects of the
early clinical course and by the social context.
Persistent neuropsychological impairments have been reported in the
euthymic phase of bipolar affective disorder. However, the findings have
been confounded by multiple episodes, chronic illness and residual mood
To assess sustained attention and executive functioning in euthymic young
people with bipolar I disorder who had had no more than two affective
Thirty euthymic patients (with illness duration of less than 5 years and
no more than two affective episodes) and 30 matched healthy individuals
were assessed for sustained attention and executive functioning.
The bipolar group (mean age 22.4 years, s.d.=2.52; duration of illness
20.87 months, s.d.=14.72), showed impairment on tasks of attention and
executive functioning. Multivariate logistic regression analysis
demonstrated that deficits in executive functioning differentiated cases
from controls. There was no correlation between residual depressive
symptoms and neuropsychological performance.
Deficits in attention and executive functioning were present in young
people who had experienced only a few episodes of bipolar disorder,
suggesting that the deficits are possibly trait abnormalities. Whether
these deficits worsen with progression of illness needs to be examined in
Klinefelter's syndrome, characterised by a 47, XXY chromosomal pattern, has
largely been associated with physical abnormalities. Here, we report high
levels of schizophrenia-spectrum pathology in 32 men with this syndrome in
comparison with 26 healthy controls. This may have implications for
treatment of Klinefelter's syndrome and suggests that the X chromosome may
be involved in the aetiology of schizophrenia.
Avolition affects quality of life in chronic schizophrenia. We investigated
the effect of modafinil upon unconstrained motor activity in 18 male
patients. In a randomised crossover design study wrist-worn actigraphic
monitors were used to objectively record motor activity over a 20 h period.
Patients' total activity was significantly greater when given the drug.
These data suggest that modafinil increases quantifiable motor behaviour in
schizophrenia and may have an impact on avolition.
We examined neuropsychological functioning at age 13 years in adolescents
who later developed schizophreniform disorder, compared with healthy
controls and with adolescents diagnosed as having had a manic episode or
depression or anxiety disorder. Participants were from an unselected birth
cohort. Attentional, executive and motor impairments at age 13 were found in
those who later fulfilled diagnostic criteria for schizophreniform disorder,
suggesting that these impairments may be the earliest emerging
neuropsychological impairments in schizophrenia-related disorders.
China is the only country in which the suicide rate is higher among women
than men. We provide a demographic perspective on the gender differential in
suicide in China. This shows that the male/female ratio of suicide increased
between 1991 and 2001 and there is reason to believe this trend will
continue. Among the population subgroups, only young women living in rural
areas had much higher suicide rates than their male counterparts. It is
argued that consideration of the gender ratio of suicide in China must take
age-, gender- and region-specific suicide patterns and the population
structure into account. The increasing urbanisation of China is likely to be
associated with more male suicides and we predict that before long the male
suicide rate will overtake that of females.