Original Article
The spectrum of suicidal ideation in Great Britain: comparisons across a 16–74 years age range
- MICHAEL DENNIS, SARAH BAILLON, TRAOLACH BRUGHA, JAMES LINDESAY, ROBERT STEWART, HOWARD MELTZER
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- Published online by Cambridge University Press:
- 09 February 2007, pp. 795-805
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Background. Previous studies have examined suicidal ideation in older populations and emphasized the strong association with the presence of psychiatric disorder. However, associations with the presence of psychiatric disorder across the age range are unclear. Representative epidemiological estimates are needed.
Method. In a national survey of psychiatric morbidity in Great Britain, 8580 randomly selected adults were interviewed. Three questions were asked to assess suicidal ideation, and psychiatric disorder was identified using the revised Clinical Interview Schedule (CIS-R).
Results. Suicidal ideation was up to three times commoner in younger adults than in those aged 55–74 years but the odds of depression in those with suicidal thoughts was significantly greater in the older age group (p<0·01). Tiredness with life (p<0·01) and thoughts of death (p<0·01) were also more strongly associated with depression in the older age group. Other major associations of suicidal ideation for all ages were: smaller social support group, being divorced or separated, poor self-rated general health, and limitations in activities of daily living (ADL). Being single was an important factor for younger age groups, and widowhood for older people. Life events were also important in younger people, but not in those aged 55–74 years.
Conclusions. Suicidal thoughts and death wishes are comparatively more unusual in older people; however, they are more likely to be associated with clinical depression. In terms of suicide prevention this study emphasizes the importance of improving rates of recognition and treatment of depression in older people.
Puberty moderates genetic influences on disordered eating
- KELLY L. KLUMP, PATRICK S. PERKINS, S. ALEXANDRA BURT, MATT McGUE, WILLIAM G. IACONO
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- Published online by Cambridge University Press:
- 05 March 2007, pp. 627-634
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Background. Previous research suggests that genetic influences on disordered eating may be greater in pubertal than pre-pubertal girls. Although these findings are consistent with pubertal activation of genetic influences on disordered eating, earlier studies were unable to directly test this hypothesis. The purpose of the present study therefore was to directly examine this possibility by investigating whether pubertal development moderates genetic influences on disordered eating.
Method. Participants were 510 female adolescent twins from the Minnesota Twin Family Study. Disordered eating was measured with the Total Score of the Minnesota Eating Behavior Survey, while pubertal status was assessed with the Pubertal Development Scale.
Results. Consistent with our hypothesis, model-fitting indicated significant increases in genetic influence on disordered eating with advancing pubertal development.
Conclusions. These findings suggest that puberty influences the expression of genes for disordered eating.
The temporal dynamics of relationships between cannabis, psychosis and depression among young adults with psychotic disorders: findings from a 10-month prospective study
- LOUISA DEGENHARDT, CHRIS TENNANT, STUART GILMOUR, DAVID SCHOFIELD, LOUISE NASH, WAYNE HALL, DIANA McKAY
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- Published online by Cambridge University Press:
- 09 February 2007, pp. 927-934
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Background. The aim was to examine the temporal relationships over 10 months between cannabis use and symptoms of psychosis and depression in people with schizophrenia and related disorders. The design was a prospective study of 101 patients with schizophrenia and related disorders who were assessed monthly over 10 months on medication compliance, cannabis and other drug use, symptoms of depression and symptoms of psychosis.
Method. Linear regression methods to assess relationships between cannabis use and symptoms of psychosis and depression while adjusting for serial dependence, medication compliance and other demographic and clinical variables.
Results. Cannabis use predicted a small but statistically significant increase in symptoms of psychosis, but not depression, after controlling for other differences between cannabis users and non-users. Symptoms of depression and psychosis did not predict cannabis use.
Conclusion. Continued cannabis use by persons with schizophrenia predicts a small increase in psychotic symptom severity but not vice versa.
The different origins of stability and change in antisocial personality disorder symptoms
- S. ALEXANDRA BURT, MATT McGUE, LATANYA A. CARTER, WILLIAM G. IACONO
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- Published online by Cambridge University Press:
- 19 October 2006, pp. 27-38
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Background. Although adult antisocial personality disorder is generally preceded by a pattern of childhood/adolescent conduct problems, only a subset of those who manifest these developmental precursors go on exhibit significant antisocial behavior in adulthood. To date, however, researchers have yet to resolve the origins of either stability or change in antisocial behavior from childhood/adolescence to adulthood.
Method. The present study sought to fill this gap in the literature, making use of a sample of 626 twin pairs from the ongoing Minnesota Twin Family Study (MTFS). Participants were assessed three times between late adolescence and early adulthood. We made use of biometric Cholesky decomposition and latent growth curve modeling techniques, which allow researchers to disambiguate processes of stability and change and evaluate their respective etiologies (i.e. genetic or environmental).
Results. Our results revealed that genetic forces were largely responsible for the stability of adult symptoms of antisocial behavior (AAB) from late adolescence through mid-adulthood, while non-shared environmental influences were primarily responsible for change. Importantly, however, although some of the latter represented systematic and long-lasting influence, much of this non-shared environmental variance appeared transient and idiosyncratic.
Conclusions. Such findings highlight the enduring impact of genetic influences on AAB, and offer insights into the nature of non-shared environmental influences on development.
Two-phase survey of eating disorders in gifted dance and non-dance high-school students in Taiwan
- MEG MEI-CHIH TSENG, DAVID FANG, MING-BEEN LEE, WEI-CHU CHIE, JEN-PEI LIU, WEI J. CHEN
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- Published online by Cambridge University Press:
- 12 March 2007, pp. 1085-1096
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Background
Despite a growing body of literature reporting eating disorders (EDs) in non-Western countries in recent years, most of these studies are limited to questionnaire-based surveys or case-series studies. This study aimed to investigate the prevalence and correlates of EDs in Taiwanese high-school students.
MethodsThe study subjects consisted of all the female high-school students enrolled in the gifted dance class in 2003 in Taiwan (n=655) and non-dance female students randomly chosen from the same school (n=1251). All the participants were asked to complete self-report questionnaires, including the 26-item Eating Attitudes Test (EAT-26) and the Bulimic Investigatory Test Edinburgh (BITE). All the screen positives and an approximate 10% random sample of the screen negatives were then interviewed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Version (SCID-I/P).
ResultsThe prevalence of individual EDs was much higher in the dance [0·7% for anorexia nervosa (AN), 2·5% for bulimia nervosa (BN) and 4·8% for EDs, not otherwise specified (EDNOS)] than in the non-dance (0·1, 1·0 and 0·7% respectively) students. Multivariate logistic regression analyses revealed that being in the dance class, higher concern about body shape and lower family support were correlates of EDs for all students, whereas lower parental education level was associated with EDs only for non-dance students.
ConclusionEDs were more prevalent in the weight-concerned subpopulation. Although AN is still rare, BN has emerged as a comparable prevalent disorder in Taiwan, as in Western countries.
Attitudes to depression and its treatment in primary care
- SCOTT WEICH, LOUISE MORGAN, MICHAEL KING, IRWIN NAZARETH
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- Published online by Cambridge University Press:
- 11 June 2007, pp. 1239-1248
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Background
Undertreatment of depression in primary care is common. Efforts to address this tend to overlook the role of patient attitudes. Our aim was to validate and describe responses to a questionnaire about attitudes to depression and its treatment in a sample with experience of moderate and severe depressive episodes.
MethodCross-sectional survey of 866 individuals with a confirmed history of an ICD-10 depressive episode in the 12 months preceding interview, recruited from 7271 consecutive general practitioner (GP) attendees in 36 general practices in England and Wales. Attitudes to and beliefs about depression were assessed using a 19-item self-report questionnaire.
ResultsFactor analysis resulted in a three-factor solution: factor 1, depression as a disabling, permanent state; factor 2, depression as a medical condition responsive to support; and factor 3, antidepressants are addictive and ineffective. Participants who received and adhered to antidepressant medication and disclosed their depression to family and friends had significantly lower scores on factors 1 and 3 but higher scores on factor 2.
ConclusionsPeople with moderate or severe depressive episodes have subtle and divergent views about this condition, its outcome, and appropriate help. Such beliefs should be considered in primary care as they may significantly impact on help seeking and adherence to treatment.
The correspondence between persistent self-reported post-traumatic problems and general practitioners' reports after a major disaster
- ANNELIEKE N. DROGENDIJK, ANJA J. E. DIRKZWAGER, LINDA GRIEVINK, PETER G. VAN DER VELDEN, FRANS G. H. MARCELISSEN, ROLF J. KLEBER
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- Published online by Cambridge University Press:
- 23 October 2006, pp. 193-202
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Background. Little is known about the correspondence between persistent self-reported disaster-related psychological problems and these problems reported by general practitioners (GPs). The aim of this study is to analyse this correspondence and to identify the factors associated with GPs' detection of persistent psychological problems.
Method. This study was conducted in a sample of 879 adult disaster-affected victims, taken from two longitudinal sources: the Enschede Firework Disaster Study and the GP-Monitor Study. Participants filled out a questionnaire 2–3 weeks and 18 months post-disaster and these data were combined with data from a GP-monitor collected up to 18 months post-disaster. The correspondence between persistent self-reported and GP-reported psychological problems was analysed with cross-tabulations. Logistic regression analyses were performed to identify variables which predicted GPs' detection of psychological problems.
Results. The correspondence rate among victims who visited their GP 18 months post-disaster was 60·4% for persistent intrusions and avoidance reactions, 72·6% for persistent general psychological distress and less than 20% for persistent depression and anxiety symptoms or sleep disturbances. Characteristics that predict GPs' identification of post-traumatic reactions or psychological distress were the level of self-reported post-traumatic symptoms/mental health, the number of contacts the victims had with their GP and the level of the victims' disaster-related experiences.
Conclusions. In general, there is a considerable correspondence between GP-reported and persistent self-reported incidences of post-traumatic stress and general psychological distress in disaster-affected victims. However, the correspondence declines in the case of more specific psychological symptoms.
Reaction time performance in ADHD: improvement under fast-incentive condition and familial effects
- PENNY ANDREOU, BEN M. NEALE, WAI CHEN, HANNA CHRISTIANSEN, ISABEL GABRIELS, ALEXANDER HEISE, SHEERA MEIDAD, UELI C. MULLER, HENRIK UEBEL, TOBIAS BANASCHEWSKI, IRIS MANOR, ROBERT OADES, HERBERT ROEYERS, ARIBERT ROTHENBERGER, PAK SHAM, HANS-CHRISTOPH STEINHAUSEN, PHILIP ASHERSON, JONNA KUNTSI
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- Published online by Cambridge University Press:
- 31 May 2007, pp. 1703-1715
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Background
Reaction time (RT) variability is one of the strongest findings to emerge in cognitive-experimental research of attention deficit hyperactivity disorder (ADHD). We set out to confirm the association between ADHD and slow and variable RTs and investigate the degree to which RT performance improves under fast event rate and incentives. Using a group familial correlation approach, we tested the hypothesis that there are shared familial effects on RT performance and ADHD.
MethodA total of 144 ADHD combined-type probands, 125 siblings of the ADHD probands and 60 control participants, ages 6–18, performed a four-choice RT task with baseline and fast-incentive conditions.
ResultsADHD was associated with slow and variable RTs, and with greater improvement in speed and RT variability from baseline to fast-incentive condition. RT performance showed shared familial influences with ADHD. Under the assumption that the familial effects represent genetic influences, the proportion of the phenotypic correlation due to shared familial influences was estimated as 60–70%.
ConclusionsThe data are inconsistent with models that consider RT variability as reflecting a stable cognitive deficit in ADHD, but instead emphasize the extent to which energetic or motivational factors can have a greater effect on RT performance in ADHD. The findings support the role of RT variability as an endophenotype mediating the link between genes and ADHD.
Inhibitory deficits for negative information in persons with major depressive disorder
- MARK A. LAU, BRUCE K. CHRISTENSEN, LANCE L. HAWLEY, MICHAEL S. GEMAR, ZINDEL V. SEGAL
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- Published online by Cambridge University Press:
- 24 April 2007, pp. 1249-1259
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Background
Within Beck's cognitive model of depression, little is known about the mechanism(s) by which activated self-schemas result in the production of negative thoughts. Recent research has demonstrated that inhibitory dysfunction is present in depression, and this deficit is likely valence-specific. However, whether valence-specific inhibitory deficits are associated with increased negative cognition and whether such deficits are specific to depression per se remains unexamined. The authors posit the theory that inhibitory dysfunction may influence the degree to which activated self-schemas result in the production of depressive cognition.
MethodIndividuals with major depressive disorder (MDD, n=43) versus healthy (n=36) and non-depressed anxious (n=32) controls were assessed on the Prose Distraction Task (PDT), a measure of cognitive inhibition, and the Stop-Signal Task (SST), a measure of motor response inhibition. These two tasks were modified in order to present emotionally valenced semantic stimuli (i.e. negative, neutral, positive).
ResultsParticipants with MDD demonstrated performance impairments on the PDT, which were most pronounced for negatively valenced adjectives, relative to both control groups. Moreover, these impairments correlated with self-report measures of negative thinking and rumination. Conversely, the performance of the MDD participants did not differ from either control group on the SST.
ConclusionsImplications of these findings for understanding the mechanisms underlying the development and maintenance of depressive cognition are discussed.
Identifying correlates of suicide attempts in suicidal ideators: a population-based study
- JELENA BREZO, JOEL PARIS, RICHARD TREMBLAY, FRANK VITARO, MARTINE HÉBERT, GUSTAVO TURECKI
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- Published online by Cambridge University Press:
- 31 May 2007, pp. 1551-1562
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Background
Identification of factors that distinguish between ideators who act on their suicidal thoughts from those who do not is an important clinical and research objective.
MethodWe examined correlates of suicide attempts in suicidal ideators, members of a French-Canadian, school-based cohort. Suicidal thoughts were evaluated in adolescence and early adulthood in the total sample of suicidal ideators, who were then stratified into subgroups consisting of persistent ideators, male ideators and female ideators.
ResultsIn addition to persistent suicidal ideas [odds ratios (ORs) 2·1–2·8], Axis I psychopathology, female gender and childhood sexual abuse (CSA) were the most consistent correlates of suicide attempts. Externalizing disorders were significant contributors in persistent ideators [drug misuse: OR 2·8, 95% confidence interval (CI) 1·1–6·9] and in male ideators in particular (disruptive disorders: OR 5·9, 95% CI 2·2–16·0). In women, psychiatric co-morbidity also had a significant effect (OR 1·6, 95% CI 1·1–2·1). CSA was of relevance in both women (OR 1·2, 95% CI 1·1–1·4) and persistent ideators (OR 1·3, 95% CI 1·1–1·5). Personality traits showed gender-specific contribution with affective instability (OR 1·1, 95% CI 1·01–1·1) and anxiousness (OR 1·3, 95% CI 1·1–1·7) contributing in men and disruptive aggression (OR 1·1, 95% CI 1·03–1·3) in women.
ConclusionsCorrelates of suicide attempts in suicidal ideators vary as a function of the persistence of suicidal ideas and gender. This heterogeneity across subgroups of suicidal ideators may be attributed, at least in part, to differences between the sexes, early environmental adversity, maladaptive personality, and psychiatric symptoms. Further exploration and continued prospective follow-up is necessary to examine these possibilities.
Testing the self-medication hypothesis of depression and aggression in cannabis-dependent subjects
- MIKKEL ARENDT, RABEN ROSENBERG, LONE FJORDBACK, JACK BRANDHOLDT, LESLIE FOLDAGER, LEO SHER, POVL MUNK-JØRGENSEN
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- Published online by Cambridge University Press:
- 04 January 2007, pp. 935-945
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Background. A self-medication hypothesis has been proposed to explain the association between cannabis use and psychiatric and behavioral problems. However, little is known about the reasons for use and reactions while intoxicated in cannabis users who suffer from depression or problems controlling violent behavior.
Method. We assessed 119 cannabis-dependent subjects using the Schedules of Clinical Assessment in Neuropsychiatry (SCAN), parts of the Addiction Severity Index (ASI), and questionnaires on reasons for cannabis use and reactions to cannabis use while intoxicated. Participants with lifetime depression and problems controlling violent behavior were compared to subjects without such problems. Validity of the groupings was corroborated by use of a psychiatric treatment register, previous use of psychotropic medication and convictions for violence.
Results. Subjects with lifetime depression used cannabis for the same reasons as others. While under the influence of cannabis, they more often experienced depression, sadness, anxiety and paranoia, and they were less likely to report happiness or euphoria. Participants reporting problems controlling violent behavior more often used cannabis to decrease aggression, decrease suspiciousness, and for relaxation; while intoxicated they more often reacted with aggression.
Conclusions. Subjects with prior depression do not use cannabis as a mean of self-medication. They are more likely to experience specific increases of adverse symptoms while under the influence of cannabis, and are less likely to experience specific symptom relief. There is some evidence that cannabis is used as a means of self-medication for problems controlling aggression.
Parental separation, loss and psychosis in different ethnic groups: a case-control study
- CRAIG MORGAN, JAMES KIRKBRIDE, JULIAN LEFF, TOM CRAIG, GERARD HUTCHINSON, KWAME McKENZIE, KEVIN MORGAN, PAOLA DAZZAN, GILLIAN A. DOODY, PETER JONES, ROBIN MURRAY, PAUL FEARON
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- Published online by Cambridge University Press:
- 21 November 2006, pp. 495-503
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Background. Numerous studies have reported high rates of psychosis in the Black Caribbean and Black African populations in the UK. However, few studies have investigated the role of specific risk factors in different ethnic groups. We sought to investigate the relationship between long-term separation from, and death of, a parent before the age of 16 and risk of adult psychosis in different ethnic groups.
Method. All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK and a series of community controls were included in the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study. Data relating to clinical and social variables, including parental separation and loss, were collected from patients and controls.
Results. Separation from, and death of, a parent before the age of 16 were both strongly associated with a two- to threefold increased risk of psychosis. The strength of these associations were similar for White British and Black Caribbean (but not Black African) subjects. Separation from (but not death of) a parent was more common among Black Caribbean controls than White British controls.
Conclusions. Early separation may have a greater impact in the Black Caribbean population, because it is more common, and may contribute to the excess of psychosis in this population.
Clustering of eating disorder symptoms in a general population female twin sample: a latent class analysis
- ALEXIS E. DUNCAN, KATHLEEN KEENAN BUCHOLZ, ROSALIND J. NEUMAN, ARPANA AGRAWAL, PAMELA A. F. MADDEN, ANDREW C. HEATH
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- Published online by Cambridge University Press:
- 02 May 2007, pp. 1097-1107
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Background
Previous studies have reported that the current DSM-IV eating disorder (ED) criteria do not adequately describe ED symptomatology. The objective of the current study was to examine the clustering of ED symptoms in a general population sample using latent class analysis (LCA).
MethodED symptoms from 3723 female young adult twins (mean age 22) were analyzed using LCA, and resulting classes were compared on external validators reflecting ED and other co-morbid psychiatric diagnoses, substance use disorders (SUDs), and suicidality.
ResultsThe optimal solution consisted of five latent classes characterized as: (1) Unaffected; (2) Low Weight Gain; (3) Weight Concerned; (4) Dieters; and (5) ED. Members of the ED class had significantly higher prevalence of co-morbid psychiatric disorders, SUDs, and suicidality than the Unaffected and Low Weight Gain classes, and elevated rates of suicidality and major depression compared to the Weight Concerned and Dieter classes, which differed from each other primarily in terms of current body mass index (BMI). Dieter class members were more likely to be overweight and obese and less likely to be underweight than Weight Concerned class members. The majority of women with an ED diagnosis were assigned to the ED class, and few differences were found between ED class members with and without an ED diagnosis.
ConclusionsThe results add to the evidence that many women with significant ED psychopathology are not being identified by the DSM-IV ED categories.
Obsessive–compulsive disorder, tics and anxiety in 6-year-old twins
- DEREK BOLTON, FRÜHLING RIJSDIJK, THOMAS G. O'CONNOR, SEAN PERRIN, THALIA C. ELEY
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- Published online by Cambridge University Press:
- 26 September 2006, pp. 39-48
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Background. Previous reports of genetic influences on obsessive–compulsive disorder (OCD) symptoms have suggested moderate heritability. Family history studies of co-morbidity have found familial aggregation with tics, especially for early-onset OCD, and familial aggregation with anxiety disorders.
Method. Heritability of OCD and familial aggregation of OCD, tics and anxiety disorders were investigated in a community sample of 6-year-old twins using a two-phase design in which 4662 twin pairs were sampled and 854 pairs were assessed in the second phase by maternal-informant diagnostic interview using DSM-IV criteria.
Results. In the multivariate model combined additive genetic and common environmental effects were estimated as 47% for sub-threshold OCD, and the model was unable to distinguish these sources of familial aggregation. There were strong familial aggregations between sub-threshold OCD and tics and between sub-threshold OCD and other anxiety disorders (80% and 97% respectively), although again specific sources could not be distinguished.
Conclusions. The findings are consistent with the hypothesis of a tic-related early-onset OCD phenotype, but also with the hypothesis of an anxiety-related early-onset OCD phenotype.
A sham-controlled trial of the efficacy and safety of twice-daily rTMS in major depression
- COLLEEN K. LOO, PHILIP B. MITCHELL, TARA F. McFARQUHAR, GIN S. MALHI, PERMINDER S. SACHDEV
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- Published online by Cambridge University Press:
- 19 December 2006, pp. 341-349
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Background. Studies of repetitive transcranial magnetic stimulation (rTMS) in depression have mostly involved once-daily treatment, with positive but modest clinical results. This study tested the efficacy and safety of twice-daily rTMS over 2 weeks.
Method. Thirty-eight depressed subjects enrolled in a double-blind, sham-controlled trial of twice-daily rTMS (left prefrontal cortex, 10 Hz, 110% intensity, 1500 stimuli per session) over 2 weeks. Mood and neuropsychological functioning were assessed weekly by blind raters, using the Montgomery–Asberg Depression Rating Scale (MADRS) as the primary outcome measure, plus the Hamilton Rating Scale for Depression (HRSD) and self-report measures. After the blind period, 22 subjects continued with once-daily rTMS to receive a total of 6 weeks of active rTMS.
Results. Subjects were moderately treatment resistant. Active treatment resulted in significantly greater improvement than sham over the 2-week blind period on one outcome measure only (MADRS p<0·05). Subjects showed further improvement over the 6 weeks of active rTMS. Neuropsychological test scores did not change significantly.
Conclusions. rTMS given twice daily was effective and safe, with no adverse neuropsychological effects.
A randomized controlled study of single-session behavioural treatment of earthquake-related post-traumatic stress disorder using an earthquake simulator
- METİN BAŞOĞLU, EBRU ŞALCIOĞLU, MARIA LIVANOU
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- Published online by Cambridge University Press:
- 23 October 2006, pp. 203-213
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Background. Brief interventions are needed in dealing with traumatic stress problems in large survivor populations after devastating earthquakes. The present study examined the effectiveness of a single session of exposure to simulated tremors in an earthquake simulator and self-exposure instructions in reducing post-traumatic stress disorder (PTSD).
Method. Participants were consecutively recruited from among survivors screened during field surveys in the disaster region in Turkey. Thirty-one earthquake survivors with PTSD were assigned either to a single session of behavioural treatment (n=16) or to repeated assessments (RA; n=15). Assessments in the treatment group were at 4, 8, 12, 24 weeks and 1–2 years post-treatment. The RA cases were assessed at baseline and 4 and 8 weeks after trial entry, after which they received the same treatment and were followed up at 4, 12, 24 weeks and 1–2 years.
Results. Between-group treatment effects at week 8 were significant on measures of fear, PTSD and self- and assessor-rated global improvement. Improvement rates were 40% at week 4, 72% at week 12, 80% at week 24, and 80% at 1–2-years' follow-up, with large effect sizes on fear and PTSD measures. Post-session reduction in fear of earthquakes and increased sense of control over fear at follow-up related to improvement in PTSD.
Conclusion. The study provided further evidence of the effectiveness of a single session of behavioural treatment in reducing fear and PTSD in earthquake survivors. Future research needs to examine the usefulness of earthquake simulators in increasing psychological preparedness for earthquakes.
Neighbourhood-level effects on psychoses: re-examining the role of context
- JAMES B. KIRKBRIDE, CRAIG MORGAN, PAUL FEARON, PAOLA DAZZAN, ROBIN M. MURRAY, PETER B. JONES
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- Published online by Cambridge University Press:
- 02 May 2007, pp. 1413-1425
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Background
The incidence of schizophrenia varies by individual-level characteristics and neighbourhood-level attributes. Few specific socio-environmental risk factors (SERFs) have been identified at the neighbourhood level. Cross-level interactions are poorly understood. We investigated these issues using data from the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study.
MethodAll incidence cases of ICD-10 schizophrenia (F20) and other non-affective psychoses (F21–29), aged 16–64 years, across 33 wards in Southeast London were identified over a 2-year period (1997–1999). Census data provided the denominator for each ward. Multilevel Poisson regression simultaneously modelled individual- and neighbourhood-level SERFs, including socio-economic deprivation, voter turnout (proxy for social capital), ethnic fragmentation (segregation) and ethnic density.
ResultsA total of 218 subjects were identified during 565 576 person-years at risk. Twenty-three per cent of variance in incidence of schizophrenia across wards could be attributed to neighbourhood-level risk factors [95% confidence interval (CI) 9·9–42·2]. Thus, 1% increases in voter turnout [incidence rate ratio (IRR) 0·95, 95% CI 0·92–0·99] and ethnic segregation (IRR 0·95, 95% CI 0·92–0·99) were both independently associated with a reduced incidence of 5%, independent of age, sex, ethnicity, deprivation and population density. This was similar for other non-affective psychoses. There was some evidence that ethnic minority individuals were at greater risk of schizophrenia in areas with smaller proportions of minority groups (p=0·07).
ConclusionSERFs at individual and neighbourhood levels were implicated in the aetiology of psychosis, but we were unable to determine whether these associations were causal. Individual risk may be mediated by social capital, which could operate as a protective factor, perhaps moderating social stress in the onset of psychoses.
Shared genetic and environmental risk factors between undue influence of body shape and weight on self-evaluation and dimensions of perfectionism
- TRACEY D. WADE, CYNTHIA M. BULIK
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- Published online by Cambridge University Press:
- 19 December 2006, pp. 635-644
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Background. Theory and evidence strongly suggest that perfectionism may be a risk factor for eating disorders. The purpose of the current study was to investigate a model that would explain the relationship between the cognitive diagnostic criterion for both anorexia nervosa and bulimia nervosa, namely undue influence of body weight or shape on self-evaluation, and dimensions of perfectionism. The model of particular interest was the common cause model, which hypothesizes that the phenotypes are caused by the same underlying genetic and environmental risk factors.
Method. Female twins (n=1002) from the Australian Twin Registry (ATR), aged 28 to 39 years, were interviewed using the Eating Disorder Examination (EDE). In addition, questions relating to the Equal Environment Assumption (EEA) and the Frost Multidimensional Perfectionism Scale, namely concern over mistakes (CM), personal standards (PS) and doubts about actions (DA), were assessed.
Results. There was no evidence of violation of the EEA for any of the four phenotypes. Univariate models showed all phenotypes to be influenced by both genetic and non-shared environmental action, where genetic estimates ranged from 25% to 39% of the variance. Multivariate analyses suggested the best explanation of covariation among the phenotypes was an independent pathways, rather than a common pathways, model.
Conclusions. Undue influence of body weight or shape on self-evaluation shared about 10% of its sources of genetic and environmental variance with perfectionism, thus suggesting that a common cause model does not represent the best explanation of the relationship between perfectionism and this cognitive diagnostic criterion for eating disorders.
Suicide ideation, plans and attempts in Ukraine: findings from the Ukraine World Mental Health Survey
- EVELYN J. BROMET, JOHAN M. HAVENAAR, NATHAN TINTLE, STANISLAV KOSTYUCHENKO, ROMAN KOTOV, SEMYON GLUZMAN
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- Published online by Cambridge University Press:
- 09 February 2007, pp. 807-819
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Background. Because the suicide rates in Eastern Europe have increased, the epidemiology of suicide behaviors in this part of the world is in urgent need of study. Using data from the Ukraine site of the World Mental Health (WMH) Survey Initiative, we present the first population-based findings from a former Soviet country on the descriptive epidemiology of suicide ideation, plans and attempts, and their links to current functioning and service utilization.
Method. In 2002, a nationally representative sample of 4725 adults in Ukraine was interviewed with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Risk factors included demographic characteristics, trauma, smoking, and parental and personal psychiatric disorders. Current functional impairments and recent service utilization were assessed.
Results. The lifetime prevalence of suicide ideation was 8·2%. The average age of onset was 31. The key risk factors were female sex, younger age, trauma, parental depression, and prior alcohol, depressive and intermittent explosive disorders, especially the presence of co-morbidity. Ideators had poorer functioning and greater use of health services. One-third of ideators had a plan, and one-fifth made an attempt. Among ideators, young age, smoking and prior psychiatric disorders were risk factors for these behaviors.
Conclusions. Together with the increasing suicide rate, these results suggest that suicide intervention programs in Ukraine should focus on the generation of young adults under 30. The associations with co-morbidity, impairments in current functioning and greater service use indicate that a physician education program on suicidality should be comprehensive in scope and a public health priority in Ukraine.
Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder
- K. LAMPE, K. KONRAD, S. KROENER, K. FAST, H. J. KUNERT, S. C. HERPERTZ
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- Published online by Cambridge University Press:
- 17 May 2007, pp. 1717-1729
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Background
Although attention-deficit/hyperactivity disorder (ADHD) is thought to be an inhibitory disorder, the question remains of how specific the inhibitory deficit is in adults and whether it distinguishes ADHD from borderline personality disorder (BPD), with which it shares several clinical features, particularly impulsiveness.
MethodThe study assessed various motor and cognitive inhibitory functions (inhibition of prepotent, ongoing and interfering responses) in addition to working memory in adult ADHD patients with and without BPD, compared to subjects with BPD alone and controls. In addition, questionnaire data on various aspects of impulsiveness and anger regulation were assessed in all groups.
ResultsADHD patients performed worse than BPD individuals and controls in two inhibitory tasks: the stop signal task and the conflict module of the Attentional Network Task (ANT). In addition, they exhibited longer reaction times (RTs) and higher intra-individual variance in nearly all attentional tasks. The co-morbid group exhibited poor performance on the stop signal task but not on the conflict task. The BPD group barely differed from controls in neuropsychological performance but overlapped with ADHD in some behavioural problems, although they were less severe on the whole.
ConclusionsImpaired inhibition is a core feature in adults with ADHD. In addition, slow RTs and high intra-individual variance in performance may reflect deficits in the regulation of activation and effort in ADHD patients. ADHD and BPD share some symptoms of behavioural dysregulation without common cognitive deficits, at least in the attentional realm.