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In a total of 22 169 parasuicides over 19 years, there was evidence for a seasonal cycle in parasuicide admissions among women, with an increase during the summer and a fall over the winter, including a pronounced December nadir. Further analysis of the winter trough suggests a sociological explanation, the focal point being Christmas. There was no evidence for monthly or seasonal variation among men.
Thirty-one patients with schizophrenia and 33 normal control subjects underwent MRI. The BPRS was used to rate clinical symptoms and the NART to estimate premorbid IQ. All were right handed. The temporal lobe was significantly smaller on the left than the right in both the control and schizophrenic groups. The amygdala was smaller on the left than the right in controls but not in schizophrenics. The parahippocampal gyrus was smaller on the left side in the schizophrenic group but not in controls. In the schizophrenic group, ventricular enlargement and cerebral atrophy were significantly related to severity of symptoms. Patients with marked negative symptoms had a bilateral reduction in the size of the head of caudate and the two measures were significantly correlated. Patients with marked positive symptoms had larger VBRs and again the clinical and morphometric changes were significantly correlated. There were no morphometric differences between patients with short duration (two years or less) and chronic symptoms.
Of 510 patients consecutively admitted and diagnosed as schizophrenic, 310 who failed to meet research criteria for schizophrenia were labelled as having ‘atypical psychosis'. This heterogeneous group of patients was then subtyped into more homogeneous subgroupings according to their clinical characteristics, independent of their family data. One subgroup resembled schizophrenia, one resembled affective disorders and a third (n = 57), which did not resemble either schizophrenia or affective disorder, was defined as ‘schizoaffective’. Comparing the morbidity risks for schizophrenic and affective disorders in the relatives of this schizoaffective group with those of the relatives of ‘typical’ groups of schizophrenia and affective disorder, showed that this group was different from those with schizophrenic and affective disorders.
Pre-morbid schizoid and schizotypal traits and social adjustment were assessed blind to diagnosis by interviewing the mothers of 73 consecutively admitted patients with DSM–III schizophrenia or affective psychosis. Analysis of factors associated with pre-morbid deficits showed a highly significant interaction of diagnosis with sex, such that schizophrenic men showed much greater pre-morbid impairment than either schizophrenic women or men with affective disorder. Poor pre-morbid adjustment predicted an early age at first admission. The results can be explained by a neurodevelopmental disorder in some schizophrenic males.
Two classifications, DSM–III and catego4–derived ICD–8, included in the CIDI, are compared in 63 in-patients and out-patients with a broad range of psychiatric illness. Agreement for main diagnosis between these classifications was statistically significant for two time frames, the present state and lifetime. However, while diagnostic assignment by catego4 remained fairly constant between time frames, there was a marked shift in DSM–III-assigned diagnosis, with cases changing from anxiety state diagnosis (present state) to affective disorder (lifetime). Thirty-nine subjects were assigned a DSM–III diagnosis of affective disorder for lifetime illness compared with 21 assigned to this diagnostic group by catego4.
Acutely ill patients presenting for admission in two district psychiatric services were randomly allocated to day-hospital or in-patient care. In both services a quarter of all admissions could not be allocated because they were too ill (half of these were compulsory admissions); these patients were predominantly manic and schizophrenic patients with pronounced psychotic symptoms and disturbed behaviour. In one service 80% (41/51) of patients randomly allocated to day-hospital treatment were successfully engaged in treatment compared with 54% (19/35) in the other service. This difference arose because only patients with mildly disturbed behaviour could be treated at the second day hospital. For patients who were successfully allocated, the outcome of treatment was similar in terms of psychiatric symptoms and social functioning. The results of a treatment trial for acutely ill patients in one district service cannot be generalised to other district services without due attention to the factors, such as staffing levels, which determine the degree of disturbed behaviour that can be tolerated in the day hospital.
Using the Community Placement Questionnaire, the long-stay populations of five hospitals were surveyed. The results suggest that there is little need for large hospitals if adequate community provision is made. However, a small number of patients continue to accumulate for whom community placement is hard to envisage. Investigating the characteristics of the ‘new long-stay’ patients suggests that the usual definition should be extended to include those over 65 years old with no diagnosis of dementia and those in hospital for 1–10 years. About 20% of ‘new long-stay’ patients have organic diagnoses and the needs of this group require assessment.
A videotape lecture and written hand-out containing factual information about lithium were given to 30 attenders at a lithium clinic. A further 30 patients acted as a control group and were not given the programme until later in the study. The educational programme resulted in substantial and significant increases in patient knowledge about lithium, such that knowledge increased from a baseline comparable with that of social workers to a level similar to that of community psychiatric nurses. Patients' attitudes to lithium also became more favourable after education.
During a controlled education programme, the medication compliance of 60 attenders at a lithium clinic was tested using reported tablet omissions and intra-erythrocytic lithium levels. Both measures improved, along with patients' knowledge and attitude. These effects were examined and related to aspects of obsessional trait and health locus of control.
Until recently, research on borderline disorder in children has sought the common denominator of the symptoms. In recent years there have been attempts to circumscribe the definition with the help of DSM–III criteria and the DIB. This approach appears fruitful. The scanty data on schizotypal children suggest that the validity of this diagnosis in childhood should be investigated. In adolescence it is possible to discern those with borderline and schizotypal disorders whose symptoms meet both DIB and DSM–III–R criteria respectively. No data exist, however, concerning the predictive validity of such disorders in adolescents. Classification on an empirical basis is advocated in order to refine the diagnosis of these and related disorders in children and adolescents.
A representative sample of 855 Hong-Kong Chinese children aged 36–48 months were assessed using the BSQ and the PBCL. Good reliability for both instruments were found. For the BSQ and PBCL, 12.75% and 27.5% were above the cut-off points of 10+ and 12 + respectively and 5.9% were above both cut-off points. In the second stage, 234 subjects were recruited by stratified random sampling according to the results of the screening stage. A clinician interviewed the parent, child and teacher before making a diagnosis. The prevalence of behaviour disorder was: nil, 53.7%; dubious, 23.1 %; mild, 18.0%; moderate, 4.5%; and severe, 0.7%. There were significantly more boys in the categories mild, moderate and severe.
A survey of 204 south-Asian and 355 Caucasian schoolgirls was conducted in Bradford using the EAT-26 and the BSQ. At interview, seven Asian girls and two Caucasian girls met DSM–III—R criteria for bulimia nervosa, yielding a prevalence of 3.4% and 0.6% respectively. One Asian girl met DSM–III–R criteria for anorexia nervosa. Factor analyses of the EAT and BSQ supported their cross-cultural conceptual equivalence in this south-Asian population. Among the Asians, high EAT and BSQ scores were associated with a more traditional cultural orientation and not with greater Westernisation. It is probable that these findings reflect the cultural and familial difficulties faced by these Asian girls growing up in Britain.
Four cases of anorexia nervosa occurring in Asian children are described. These case histories are set against the recent increase in eating disorders in patients of different racial origin. The role of sociocultural conflict in immigrant Asian families to Western countries is raised as a possible contributor to the emergence of eating disorders and the need to be aware of anorexia nervosa in such childhood populations is stressed.
Twenty-seven families, 14 with a history of child physical abuse and 13 with no such history, were studied over the course of intensive in-patient treatment. The families in the former group differed significantly from those in the latter group in terms of current circumstances and background histories. Families where abuse was admitted benefited significantly more from treatment than families where abuse was suspected but not admitted. The ability of mothers to remember good relationships from childhood and to establish good relationships during treatment was an important prognostic factor for successful treatment.
During the first ten years of a group started in February 1977 by the Avon Probation Service for the treatment of non-violent sex offenders, many of the offenders have shown a high degree of commitment to the group, and attendance levels have run consistently at over 70%. Of 63 men who came to the group during the ten-year study period, 33 completed their stay at the group, 11 left the group prematurely, and 11 never engaged satisfactorily. The remaining eight were still attending the group at the end of the study period. Of the 55 men whose contact with the group had ended, 36 (65%) had not been convicted of further sex offences by the end of the study period.
A cross-sectional survey of the drinking habits of 877 mentally handicapped in-patients revealed 31 patients (prevalence 3.5%) who, in the opinion of nurses, drank five litres or more daily. Low urine specific gravity was a less useful indicator of polydipsia. Polydipsia appeared to be significantly associated with a borderline level of handicap and with a diagnosis of schizophrenia, autism or severe personality/behaviour disorder. Of five cases of water intoxication associated with polydipsia, one was fatal. In two cases excess drinking improved with increased neuroleptic medication. Lithium and demeclocycline were used in two cases to prevent hyponatraemic episodes.
One hundred randomly selected residents of a mental handicap hospital originating from Dundee were interviewed using a standardised assessment based on the modified Standardised Clinical Interview Schedule. Information on certain behavioural items and self-care skills was obtained from nursing staff and case records. An ICD–9 diagnosis could be made for 80 individuals, including diagnoses usually reserved for children. Thirty subjects were regarded as needing long-term psychiatric mental handicap hospital care. All but one of the remaining 70 subjects required a staffed residential placement and all but 15 some form of out-patient or short-term in-patient provision from specialist health services. The findings indicate a need for approximately 30 psychiatric mental handicap beds per 100 000 population.
An exploratory factor analysis of the HAD was carried out in 568 cancer patients. Two distinct, but correlated, factors emerged which corresponded to the questionnaire's anxiety and depression subscales. The factor structure proved stable when subsamples of the total sample were investigated. The internal consistency of the two subscales was also high. These results provide support for the use of the separate subscales of the HAD in studies of emotional disturbance in cancer patients.
Among 307 adults with OCD, early onset (age 5–15 years) was more common in men and later onset (age 26–35 years) in women. Early onset was associated with more checking, and late onset with more washing. More women than men had a history of treated depression; 12% of the women but none of the men had a history of anorexia. More women than men were married. Gender-divergent features may reflect differential aetiological factors. Our sample resembled others in the literature in its slight overall female preponderance, low rate of marriage and low fertility, onset mainly before age 35 years, chronicity, and common present and past depression.
“In a prospective, randomised, controlled trial to determine whether comprehensive lifestyle changes affect coronary atherosclerosis after 1 year, 28 patients were assigned to an experimental group (low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise) and 20 to a usual-care control group. 195 coronary artery lesions were analysed by quantitative coronary angiography. The average percentage diameter stenosis regressed from 40.0 (SD 16.9)% to 37.8 (16.5)% in the experimental group yet progressed from 42.7 (15.5)% to 46.1 (18.5)% in the control group. When only lesions greater than 50% stenosed were analysed, the average percentage diameter stenosis regressed from 61.1 (8.8)% to 55.8 (11.0)% in the experimental group and progressed from 61.7 (9.5)% to 64.4 (16.3)% in the control group. Overall, 82% of experimental-group patients had an average change towards regression. Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year, without use of lipid-lowering drugs.”