Mental Disorder

Weight gain induced by antipsychotics is the second most frequently given reason for noncompliance with pharmacologic therapy; excessive sedative effects rank first, with extrapyramidal side effects ranking third. Frequently, weight gain leads to inconsistent pharmacologic treatment; this exposes patients to the risk of recurrent symptoms. In fact, one of the key contributors to good clinical outcomes in schizophrenic patients is compliance with pharmacologic treatment. The goals of this study were to evaluate weight gain in a group of patients treated with olanzapine, diet modifications, and moderate physical activity and to compare the findings with those from a second group of patients who were given only olanzapine treatment. For 8 wk, investigators followed 2 groups of patients suffering from schizophrenia and hypomania in bipolar disorder, according to the nosographic criteria of The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The first group (A) of 18 patients (9 female, 9 male) affected by manic episodes in bipolar disorder received olanzapine (10-20 mg/d), jogged lightly for 30 min 3 times a week, and complied with a diet that consisted of 500 kcal/d less than usual. The second group (B) of 10 patients (4 female, 6 male) with schizophrenia received only olanzapine (10-20 mg/d). All patients from both groups were weighed at the beginning 123 Advances in Therapy ®

BACKGROUND CONTEXT: Optimal treatment of nonmalignant chronic spinal disorders (CSDs) may require the use of one or more nonopioid psychotropic medications. Vast research literature has documented high rates of psychiatric disorders in patients with CSDs. Psychotropic medications are one type of effective treatment for these disorders. Many medications of this type are also used as adjuvants to primary analgesic medications. PURPOSE: Physicians treating CSDs may have little training and experience in prescribing psychotropic medications. Further, they may possess limited information about the efficacy of these types of medications in treating psychiatric disorders comorbid with CSDs or as adjunctive analgesics. Because of the wide variety (antidepressants, anxiolytics, sleep-promoting agents, anticonvulsants, neuroleptics, muscle relaxants) and numerous indications for psychiatric medications, a concise review of the use of psychotropic medications with CSD patients is offered for the spine specialist. STUDY DESIGN: A systematic review of the contemporary English literature on psychotropic medications in the CSD population. METHODS: A computerized search of MEDLINE was performed on all English literature published from 1982 to August 2002. RESULTS: Psychotropic medications have been found to be very efficacious in the large subgroup of patients with CSDs with psychiatric comorbidity, particularly patients with the common constellation of depression, anxiety, excessive somatic complaints, insomnia and irritability. Although the type of medication indicated depends on the particular psychiatric syndrome(s), antidepressants have been found to be extremely useful with the constellation described above. There is less evidence to support the use of nonopioid psychotropic medications in the treatment of nociceptive pain, although clinical experience indicates that some individuals demonstrate a marked analgesic response. Research support for the efficacy of particular psychotropic medications in treating neuropathic pain is stronger, although more controlled research is clearly needed. CONCLUSIONS: Psychotropic medications are extremely useful in the treatment of psychiatric disorders comorbid with CSDs and modestly useful as analgesic adjuvants, particularly with pain of neuropathic etiology. Familiarity with these medications will aid the primary treating physician in optimizing outcomes in this difficult group of patients. Ć

The importance of self-esteem in the development and maintenance of psychotic experiences has been shown in previous research. However, there has been little research into the role this plays in individuals with psychosis and forensic histories. The current study investigated the effectiveness of a standardized group programme for improving selfesteem in individuals with psychosis living in high security settings. Fifteen participants were included in the group programme and measures were taken to record changes in self-esteem and symptomatology. The results demonstrated significant improvements in self-esteem over the course of the group intervention, with some effects maintained at 3-month follow-up. Improvements in depressed mood were also found. The results demonstrated the effectiveness of a group intervention for self-esteem in individuals with psychosis. The findings of this study, alongside implications for further research, are discussed.

Objective: To measure the frequency of depression and its risk factors in patients under going hemodialysis. Methodology: It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1 st January 2006 to 30 th April 2006. All patients getting regular hemodialysis for more than three months were included. Beck’s Depression Inventory- II (BDI-II; adapted in Urdu) was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers (Anti HCV and HbsAg). Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV) for correlation of psychological variables with clinical, hematological and biochemical parameters. Results: Eighty nine patients were enrolled which included fifty two (58.4%) were male and seventy seven (86.5%) were married. Major causes of renal...

Policy decisions at the organizational, corporate, and governmental levels should be more heavily influenced by issues related to well-being—people’s evaluations and feelings about their lives. Domestic policy currently focuses heavily on economic outcomes, although economic indicators omit, and even mislead about, much of what society values. We show that economic indicators have many shortcomings, and that measures of well-being point

Introduction In routine clinical dental treatment dentists have the opportunity to treat patients who may be suffering from mental disorders. In this study the current status of dental patients with mental disorders was examined and a classification of the patients was indicated and applied. Methods A total of 135 patients who consulted the department of Occlusion & Liaison at Kanagawa Dental College Hospital were investigated in this study. Mental disorders of the dental patients were determined according to the diagnostic and statistical manual of mental disorders 4 th text revision (DSM-IV-TR) criteria. The original patient classification was performed from the relation of a patient's main complaint, dental findings and mental disorders and a new orientation to dental treatment is presented. Results The present subjects were 135 patients (18 men, 117 female: mean age 50.4 ± 13.7 years, range 21-80 years, median 52 years) (Fig. 2) and the number of patients diagnosed as mental disorders of DSM-IV-TR was 99 out of 135 patients. The categories of mental disorders found in this study were somatoform disorders, mood disorders, anxiety disorders, personality disorders, adjustment disorders, sleep disorders, schizophrenia and delusional disorders. The Miyaoka-Wake (M-W) classification was assigned according to the relationship between objective symptoms and subjective symptoms. Treatment orientation to the chief complaint was indicated as three categories, namely, active dental treatment, transitive dental treatment and negative dental treatment. Conclusions Patients who consulted the department of Occlusion & Liaison had a high frequency of mental disorders. It became clear that patients in the group with mental disorders were consulting more clinics and hospitals compared with those in the group with no mental disorders. Patients were classified into A, B, C, D and E (M-W classification) and treatment orientations were reported according to the chief complaint, i.e. active dental treatment, transitive dental treatment and negative dental treatment. This study may be useful for treatment orientation of the dental patients having mental disorders.

Over the past decade, national surveys of psychiatric disorders have been carried out in three European countries, the USA and Australia, in probability samples of the general population (1-5). They have shown that mental disorders are frequent and associated with a wide range of

The Supreme Court's decision in Kansas v. Hendricks suggests that few constitutional limitations will be imposed. This article discusses the four elements imposed by the Court in Hendricks, and then discusses the likely implications of the decision, using civil commitment laws currently on the books and actual post-Hendricks decisions. The article concludes that the imbalance between commitments and discharges will cause commitment populations to grow over the foreseeable future. Eventually the huge costs of commitment schemes will force serious assessment of whether the facial logic of these programs hides seriously distorted resource allocation and anti-therapeutic side-effects.

Background: There is an increasing probability that the psychiatrist will, willingly or not, come into contact with mentally ill offenders in the course of their practice. There are increasing rates of violence, substance abuse and other psychiatric disorders that are of legal importance. Therefore, the aim of this work was to investigate the rates of different mental disorders in 100 court reports and to investigate the characteristics of mentally ill offenders. Methods: All cases referred from different departments of the legal system to the forensic committee for assessment of legal accountability over 13-months duration were included. A specially designed form was prepared for data collection. Cases were classified into five groups: murder, robbery, financial offences, violent and simple offences and a group for other offences. Data were subjected to statistical analysis and comparisons between different groups of subjects were performed by analysis of variance (ANOVA).

Research in Brief discusses the survey strategy and findings, as well as innovative programs and policies identified during site visits to 10 jails selected on the basis of survey results. Issues and Findings Discussed in this Research in Brief: Findings from an NIJ-sponsored survey and selected site visits undertaken to identify innovative policies and practices to address the needs of mentally disordered offenders detained in the Nation's jails. Key issues: In today's overcrowded jails, an alarmingly high number of inmates are afflicted with acute serious mental disorders requiring mental health treatment and services. Few jails are equipped to provide a comprehensive range of mental health services, yet they are legally and morally bound to meet at least a minimum standard of care. Key findings: Most jails have no policies or procedures for managing and supervising mentally disordered detainees. Numerous challenges to providing treatment for them are indicated by the following findings: q Approximately 84 percent of survey respondents reported that mental health services were received by one-tenth or fewer of their inmates. q Smaller jails (those with capacities of up to 99) tend to provide screening and suicide prevention services but little else, while jails with capacities of more than 1,000 can offer comprehensive programs with multiple service components.

The objectives of the National Survey of American Life (NSAL) are to investigate the nature, severity, and impairment of mental disorders among national samples of the black and non-Hispanic white (n = 1,006) populations in the US. Special emphasis in the study is given to the nature of race and ethnicity within the black population by selecting and interviewing national samples of African-American (N = 3,570), and Afro-Caribbean (N = 1,623) immigrant and second and older generation populations. National multi-stage probability methods were used in generating the samples and race/ethnic matching of interviewers and respondents were used in the largely face-to-face interview, which lasted on average 2 hours and 20 minutes. The Diagnostic and Statistical Manual (DSM) IV World Mental Health Composite Interview (WHO-CIDI) was used to assess a wide range of serious mental disorders, potential risk and resilience factors, and help seeking and service use patterns. This paper provides an overview of the design of the NSAL, sample selection procedures, recruitment and training of the national interviewing team, and some of the special problems faced in interviewing ethnically and racially diverse national samples. Unique features of sample design, including special screening and listing procedures, interviewer training and supervision, and response rate outcomes are described. Copyright © 2004 Whurr Publishers Ltd.

The purpose of the study was to assess the association of obstetric complications with risk for mental disorders resulting in hospitalization before the age of 15. Records from all births in Denmark from 1973 through 1993 were linked to records of all psychiatric hospitalizations. Diagnoses were grouped into seven broad categories. A reference population of 10% of births in Denmark from 1973 to 1990 was used for comparison. Obstetric complications were associated with the range of mental disorders occurring in childhood. The strongest predictors were a variable indicating the interaction of birth weight with speed of growth and the 5-minute Apgar score. There was no diagnostic group that stood out as different with respect to obstetric complications. These results are consistent with the hypothesis of the continuum of reproductive casualty.

This study evaluated the efficacy of nutritional management with and without fluoxetine (FLX) in anorexia nervosa diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Twenty-one patients, with a mean body mass index (BMI) of 15.21 ± 2.33 kg/m 2 , were treated with nutritional management and FLX at a mean dosage of 30.00 ± 9.35 mg (pharmacological group); seventy-four patients, with a mean BMI of 14.24 ± 2.16 kg/m 2 , were treated only with nutritional management (nutritional group). Clinical evaluation was carried out under single-blind conditions at basal time and after 3, 6, and 12 months by a structured clinical interview, the Eating Disorder Interview based on Longitudinal Interval Follow-Up Evaluation (EDI-LIFE) and using a self-reported questionnaire, the Eating Disorder Inventory (EDI). BMI significantly increased in both the two treatment groups. In addition, the increase shown by the pharmacological group appeared near the beginning of treatment (i.e., at T1) and it was significantly higher than the increase shown by the nutritional group. Physical exercise showed a significant decrease in the pharmacological treatment group. On the other hand, fear of fatness and the scores of the subscales of the EDI significantly decreased in the nutritional treatment group. In terms of weight, the pharmacological group presented the higher amount of therapeutic success.

Objective: To provide a summary of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guideline for the Management of Anorexia Nervosa (AN). Conclusions: Anorexia nervosa affects only a small proportion of the Australian and New Zealand population but it is important because it is a serious and potentially life-threatening illness. Sufferers often struggle with AN for many years, if not for life, and the damage done to their minds and bodies may be irreversible. Anorexia nervosa is characterized by a deliberate loss of weight and refusal to eat. Overactivity is common. Approximately 50% of patients also use unhealthy purging and vomiting behaviours to lose weight. There are two main areas of physical interest: the undernutrition and mal-nutrition of the illness and the various detrimental weight-losing behaviours themselves. Basic psychopathology ranges from an over-valued idea of high salience concerning body shape through to total preoccupatio...

A vast amount of research has documented an association between trait emotional intelligence (EI) and mental health. Several pathways could account for this relationship. First, it is possible that the association between trait EI and mental health is merely an artefact of the methods and measures used (response bias pathway). Second, trait EI may reduce the susceptibility to mental disorders via a succession of biological mechanisms (neuroendocrine pathway). Third, trait EI may reduce one's susceptibility to psychological disorders by minimizing mood alterations in difficult circumstances (affective pathway). This experimental study aims at documenting the third pathway. It presents three experimental studies investigating the moderating role of trait emotional intelligence (trait EI) on mood deterioration following laboratoryinduced stress. The incremental validity of trait EI to predict mood changes over and above social desirability, alexithymia, resilience and the five-factor model of personality was also examined. Multiple regressions, performed on the three samples as well as on the combined sample (N = 196), showed that a) trait EI significantly moderated the Int J Clin Health Psychol, Vol. 9. Nº 3 456 MIKOLAJCZAK et al. Trait emotional intelligence and stress impact of the experimental stressor on subsequent mood deterioration, b) the effect held after controlling for social desirability and c) trait EI had incremental validity to predict mood deterioration over and above the other predictors.

Cerebellar pathology commonly shows important motor signs and less evident cognitive dysfunction. The ’cerebellar cognitive affective syndrome’ is characterised by impairment on executive function, spatial cognition, language and behaviour. We report the case of a man with acute onset of transitory motor features and severe mental disorders. Cranial CT and brain MRI revealed extended cerebellar lesions. Neuropsychological assessment disclosed deficits of attention, executive function and memory. Auditory event–related potentials showed abnormal P300. These data suggest a pure “cerebellar cognitive affective syndrome” and strengthen the hypothesis of cerebellar cognitive function modulation.

This article reviews the principles and skills involved with psychosomatic medicine and their potential ability to improve global health care. New awareness of the escalating global public health impact of noncommunicable diseases, including chronic medical conditions and mental disorders, has stimulated interest in determining how best to organize health services. Home to the biopsychosocial model, the field of psychosomatic medicine is well-suited to inform such efforts by virtue of its emphasis on crossdisciplinary collaboration and specialized knowledge at the interface of medicine and psychiatry that takes into account individual and contextual influences on health. Consistent with the principles of psychosomatic medicine, promising strategies to improve global health care include integrating mental health care into primary care, applying the chronic care model in programs aimed at enhancing disease selfmanagement, and using innovative models such as Internetbased therapy and telemedicine to increase access to quality care.

To determine which factors impact on the efficacy of cognitive behavioural therapy (CBT) for depression and anxiety. Factors considered include those related to clinical practice: disorder, treatment type, duration and intensity of treatment, mode of therapy, type and training of therapist and severity of patients. Factors related to the conduct of the trial were also considered, including: year of study, country of study, type of control group, language, number of patients and percentage of dropouts from the trial. Method: We used the technique of meta-analysis to determine an overall effect size (standardized mean difference calculated using Hedges' g) and meta-regression to determine the factors that impact on this effect size. We included randomized controlled trials with a wait list, pill placebo or attention/psychological placebo control group. Study participants had to be 18 years or older and all have diagnosed depression, panic disorder (with or without agoraphobia) or generalized anxiety disorder (GAD). Outcomes of interest included symptom, functioning and health-related quality of life measures, reported as continuous variables at post-treatment. Results: Cognitive behavioural therapy for depression, panic disorder and GAD had an effect size of 0.68 (95% CI = 0.51-0.84, n = 33 studies, 52 comparisons). The heterogeneity in the effect sizes was fully explained by treatment, duration of therapy, inclusion of severe patients in the trial, year of study, country of study, control group, language and number of dropouts from the control group. Disorder was not a significant predictor of the effect size. Conclusions: Cognitive behavioural therapy is significantly less effective for severe patients and trials that compared CBT to a wait-list control group found significantly larger effect sizes than those comparing CBT to an attention placebo, but not to a pill placebo. Further research is needed to determine whether CBT is effective when provided by others than psychologists and whether it is effective for non-English-speaking patient groups.

Although anxiety disorders and headaches are comorbid conditions, there have been no studies evaluating the prevalence of primary headaches in patients with generalized anxiety disorder (GAD). The aim of this study was to analyze the lifetime prevalence of primary headaches in individuals with and without GAD. A total of 60 individuals were evaluated: 30 GAD patients and 30 controls without mental disorders. Psychiatric assessments and primary headache diagnoses were made using structured interviews. Among the GAD patients, the most common diagnosis was migraine, which was significantly more prevalent among the GAD patients than among the controls, as were episodic migraine, chronic daily headache and aura. Tension-type headache was equally common in both groups. Primary headaches in general were significantly more common and more severe in GAD patients than in controls. In anxiety disorder patients, particularly those with GAD, accurate diagnosis of primary headache can improve patient management and clinical outcomes.

Objective: The objectives were (1) to examine whether 3 eating disorder subgroups, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) classification system, exhibit a specific profile in terms of early maladaptive schema (EMS) factors, and (2) to investigate the relationship between body mass index (BMI) and EMS factors in each of the individual eating disorder subgroups. Methods: The presence of EMS was measured by the Young Schema Questionnaire Long Form among patients affected by restrictive anorexia nervosa, binge/purging-type anorexia nervosa, and bulimia nervosa. Principal component factor analysis was used to investigate the factor structure of the EMS across eating disorder subgroups. General linear model analysis was applied to examine the differences of the subgroups in terms of their EMS factors. Differential association between BMI and schema factors was tested by analysis of covariance. Results: Four EMS factors were extracted, which accounted for approximately 72% of the variance. The 3 eating disorder subgroups differed in terms of their EMS factor profiles. The analysis of covariance resulted in a significant negative relationship between BMI and EMS factor 2 in the bulimia nervosa group ( P b .0099), indicating that higher severity on defectiveness, failure, dependence, enmeshments, subjugation, approval-seeking (EMS factor 2) was associated with lower values on BMI. Conclusion: The findings of this study indicate that EMSs based on Young's conceptualization of EMS, as measured by the Young Schema Questionnaire, differ significantly among eating disorder subgroups defined by the phenomenological approach used by the DSM-IV diagnoses. These results are consistent with the notion that dysfunctional cognitions may play an important role in the development and maintenance of the symptoms that underlie the DSM-IV classification of the eating disorder subtypes. D

Article abstract-objectiue: To determine the prevalence of AD and other dementias in a rural elderly Hindi-speaking population in Ballabgarh in northern India. Design: The authors performed a community survey of a cohort of 5,126 individuals aged 55 years and older, 73.3% of whom were illiterate. Hindi cognitive and functional screening instruments, developed for and validated in this population, were used to screen the cohort. A total of 536 subjects (10.5%) who met operational criteria for cognitive and functional impairment and a random sample of 270 unimpaired control subjects (5.3'10) underwent standardized clinical assessment for dementia using the Diagnostic and Statistical Manual of Mental Disorders-fourth edition diagnostic criteria, the Clinical Dementia Rating Scale (CDR), and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable and possible AD. Results: We found an overall prevalence rate of 0.84% (95% CI, 0.61 to 1.13) for all dementias with a CDR score of at least 0.5 in the population aged 55 years and older, and an overall prevalence rate of 1.36% (95% CI, 0.96 to 1.88) in the population aged 65 years and older. The overall prevalence rate for AD was 0.62% (95% CI, 0.43 to 0.88) in the population aged 55+ and 1.07% (95% CI, 0.72 to 1.53) in the population aged 65+. Greater age was associated significantly with higher prevalence of both AD and all dementias, but neither gender nor literacy was associated with prevalence. Conclusions: In this population, the prevalence of AD and other dementias was low, increased with age, and was not associated with gender or literacy. Possible explanations include low overall life expectancy, short survival with the disease, and low age-specific incidence potentially due to differences in the underlying distribution of risk and protective factors compared with populations with higher prevalence.

The proportion of women in militaries is growing; however, many studies in the area of military mental health have been conducted with majority male samples. The present study examined sex differences in trauma exposure, work stress, and mental disorders in the Canadian Community Health Survey e Canadian Forces Supplement, a representative sample of 5155 regular force personnel and 3286 reservists ages 16e54. Past-year DSM-IV mental disorders (depression, generalized anxiety disorder, panic disorder, social phobia, PTSD, and alcohol dependence), lifetime exposure to 28 traumatic events, and work stress were assessed. Regular and reserve female personnel were less likely than males to experience deployment-related traumas, accidents, and several events involving violence (adjusted odds ratio [AOR] range 0.10e0.62). Women were more likely to endorse sexual trauma, partner abuse, and being stalked (AOR range 3.60e13.63). For work stress, regular force women reported higher levels of job demand and stress around social support than men, whereas regular and reserve force women reported less physical exertion. After adjusting for a range of covariates, regular female personnel were more likely than males to have PTSD (AOR 1.88, 99% CI 1.01e3.50), while reservist women were more likely than men to have depression, panic disorder, and any mood or anxiety disorder (AOR range 1.87e6.98). Both regular and reservist women had lower rates of alcohol dependence (AOR range 0.30e0.34). Clinicians working with female personnel should screen for trauma/stressors and mental disorders that are particularly common in this population.

We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.

The limited number of systematic, controlled studies that assess the safety and efficacy of psychotropic medications for children reinforce the hesitation and reluctance of parents to administer such medications. The aim of this study was to investigate the attitudes of parents of children with psychiatric disorders, towards psychotropic medication.

Social bias is an issue of concern t o both practitioners and clinical researchers. This article considers race and ethnic prejudice as a prominent clinical feature in three psychotherapy cases. Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnoses, General Adaptive Functioning ratings, and Minnesota Multiphasic Personality Inventoy scores are considered in terms of the level of patient disturbance and severity of outgroup prejudice. Two cases exemplify chronic adverse outgroup ideation, d e c t i n g a constellation of traits of personality disturbance, disinhibition, and adverse behavioral response (e.g., panic, hostility, and/or aggression) to integroup contact, while one case evidences prejudicial ideation as a transitory, conditioned response t o traumatic victimization by a member of a racial outgroup. Prejudice is considered as a clinical syndrome, with treatment strategy considered in terms of the severity and chronicity of prejudicial ideation.

Managers, doctors, nurses, occupational therapists, social workers, psychologists, unqualified staff and service users were interviewed for a qualitative study of risk management and rehabilitation in an inner city medium secure forensic mental health care unit. Different professional orientations to service user problems were identified. Doctors focused primarily on the diagnosis of mental disorder, which they managed mainly through pharmaceutical interventions. Psychologists were principally concerned with personal factors, for example service user insight into their biographical history. Occupational therapists concentrated mainly on daily living skills, and social workers on post-discharge living arrangements. Some front line nurses, held accountable for security lapses, adopted a criminogenic approach. Service users were more likely than professionals to understand their needs in terms of their wider life circumstances. These differences are explored qualitatively in relation to four models of crossdisciplinary relationships: monoprofessional self-organisation combined with restricted communication; hermeneutic reaching out to other perspectives; the establishment of interdisciplinary sub-systems; and transdisciplinary merger. Relationships between professions working in this unit, as portrayed in qualitative interviews, corresponded mainly to the first model of monoprofessional self-organisation. Reasons for restricted crossdisciplinary understanding, particularly the wide power/status differences between the medical and other professions, and between staff and patients, are discussed.

The belief that rigidity across relationships is related to greater symptoms and poorer functioning commonly informs the practice of many psychodynamic and interpersonal therapists. Using a profile correlation approach, we tested this hypothesis in a sample of 250 clients and 90 undergraduate control participants. Symptoms and functioning were assessed with the Inventory of Interpersonal Problems (IIP), Global Assessment of Functioning scale, and Brief Symptom Inventory. A revised version of the empirically-derived Central Relationship Questionnaire (CRQ) was used to measure interpersonal patterns. Revisions were made to the CRQ to increase the interpersonal dimensions it captured, reduce its length, and model a higher-order factor structure. The psychometric properties of the revised CRQ were found to be adequate. Rigidity as measured with the CRQ was not related to rigidity measured with the IIP (amplitude) and did not differ significantly among individuals with different interpersonal problems or DSM-IV diagnoses. Contrary to theory, however, greater rigidity across relationships was related to fewer symptoms and interpersonal problems. These relations did not appear due to the valence or the extremeness of the interpersonal patterns used in the estimation of rigidity.

W e have evaluated an infant with a striking combination of craniofacial anomalies, arachnodactyly, and severe developmental failure. She died at the age of 5 months during a recurrent apneic episode. She also had protruding eyes, downward slant of palpe-bra1 fissures, short upturned nose, midface hypoplasia, micrognathia, extreme underdevelopment of the epiglottis, and severe feeding difficulties. The patient closely resembled four other previously reported patients. It is suggested that these five patients represent the same malformation syndrome, a well-recognizable separate entity. Our patient also had a pericentric inversion of chromosome 10; a possible association of this with the phenotype cannot be excluded.

Our aim was to observe if patients with panic disorder (PD) and patients with major depression with panic attacks (MDP) (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) respond in a similar way to the induction of panic attacks by an oral caffeine challenge test. We randomly selected 29 patients with PD, 27 with MDP, 25 with major depression without panic attacks (MD), and 28 healthy volunteers. The patients had no psychotropic drug for at least a 4-week period. In a randomized double-blind experiment performed in 2 occasions 7 days apart, 480 mg caffeine and a caffeine-free (placebo) solution were administered in a coffee form and anxiety scales were applied before and after each test. A total of 58.6% (n = 17) of patients with PD, 44.4% (n = 12) of patients with MDP, 12.0% (n = 3) of patients with MD, and 7.1% (n = 2) of control subjects had a panic attack after the 480-mg caffeine challenge test (v 2 3 = 16.22, P = .001). The patients with PD and MDP were more sensitive to caffeine than were patients with MD and healthy volunteers. No panic attack was observed after the caffeine-free solution intake. The patients with MD had a lower heart rate response to the test than all the other groups (2-way analysis of variance, group by time interaction with Greenhouse-Geisser correction: F 3,762 = 2.85, P = .026). Our data suggest that there is an association between panic attacks, no matter if associated with PD or MDP, and hyperreactivity to an oral caffeine challenge test.

Self-help Internet interventions have the potential to enable consumers to play a central role in managing their own health. This paper contains a systematic review of 15 randomised controlled trials of the effectiveness of self-help Internet interventions for mental disorders and related conditions. Conditions addressed by the interventions included: depression, anxiety, stress, insomnia, headache, eating disorder and encopresis. Most interventions were reported to be effective in reducing risk factors or improving symptoms, although many of the studies had methodological limitations. Three of the interventions that reported positive outcomes are available without charge to the public.

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Objective To compare gambling behaviors in a random sample of community residents with and without mental disorders identified by the Composite International Diagnostic Interview (CIDI). Method A large national community survey conducted by Statistics Canada included questions about problems arising from gambling activities as per the Canadian Problem Gambling Index (CPGI). We compared respondents within three gambling severity categories (non-problem, low severity and moderate/high severity gambling) across three diagnostic groupings (mood/anxiety disorders, substance dependence/harmful alcohol use, no selected psychiatric disorder). Results Of the 14,934 respondents age 18-64 years who engaged in at least one type of gambling activity in the previous 12 months, 5.8% fell in the low severity gambling category while 2.9% fell in the moderate/high severity category. Females accounted for 51.7% of the sample. The risk of moderate/high severity gambling was 1.7 times higher in persons with mood or anxiety disorder compared to persons with no selected disorder. For persons with substance dependence or harmful alcohol use, the risk of moderate/high severity gambling was 2.9 times higher. Persons with both mood/anxiety and substance/ alcohol disorders were five times more likely to be moderate/high severity gamblers. The odds ratio for females was 0.6 and for those with less than post-secondary education it was 1.52. Differences in age and personal income were not significant.

Although numerous authors have associated metal music with social problems such as suicide, self-destruction and Satanism, few studies have been undertaken to examine the mental health of fans of heavy metal music. This study attempts to determine if there is a link between mental health and the enjoyment of this type of music in France. The researchers surveyed 333 fans of metal music. Their mental health was evaluated by the Hospital Anxiety and Depression Scale (HADS), a widely used instrument that measures anxiety and depression. The scores of the sample of metal music fans were then compared to the scores that reveal possible, probable, or severe mental disorders. Qualifying variables included age, gender, status, education, motivation and participation in metal music culture. The results indicated that fans of metal music are mainly young adults (median age = 22.67, SD = 5.29) and tend to be male (87.85 percent). As a whole, metal music fans have levels of anxiety and depression that are similar to and lower than levels in the general population. Specifically, \5 percent of metal music fans surveyed showed pathological symptoms. Subjects that scored higher levels of anxiety and depression were those that had literary and/or arts backgrounds rather than scientific backgrounds, that wrote metal music lyrics, that consumed alcohol and that engaged in the body modification practice of scarification. This study suggests that opponents of metal music should re-examine the basis for their criticism. More scholarly research is needed to better understand the effects of metal music on fans and on society.

This text examines how conceptions of free will impact on legal systems and forensic psychiatry: free will is generally regarded as a prerequisite for responsibility, criminal responsibility included, while forensic psychiatry to a large extent deals with the limits imposed on responsibility by mental disorder. First we discuss the question of whether there is and has been such an impact. The answer is yes: different conceptions of free will have inspired different systems of law and forensic psychiatry, as becomes clear when looking at the accountability doctrine as compared to the unique Swedish system rejecting this doctrine. However, there is no necessary connection between doctrines of responsibility and conceptions of free will, since the former primarily says something about when someone should be held responsible and the latter says something about when someone really is free in a sense relevant to responsibility. This leads to the second question: should conceptions of free will have an impact on law and forensic psychiatry? We argue: that they should not, given the implausibility the normative theory retributivism, which posits a direct connection between free will and punishment. More importantly, questions of free will are complicated and unresolved philosophical issues that are better left out of the everyday decision-making incumbent on the legal and psychiatric systems. Instead, we recommend using an empirically useful and gradual conception of autonomy to facilitate the determination of legal responsibility. This autonomy conception, being neutral on the question of free will, eliminates the need to take a stand on it.

The prevalence of psychiatric disorders among incarcerated juveniles in Mississippi was examined. A total of 482 adolescents completed a diagnostic questionnaire and a subset (N = 317) was assessed with face-to-face semi-structured interview. Most of the study participants met criteria for one mental disorder, 71–85% depending on assessment method, one-third have co-occurring mental health and substance abuse disorders. Gender and placement site differences in rates of some psychiatric disorders were also noted. Routine mental health screening should be performed on all juveniles placed in secure detention facilities to identify those who need treatment services.

Background Stigma and discrimination toward mentally disabled persons might exist within the medical environment and may form a barrier for patients to receive appropriate care. The aim of this study is to determine the attitudes of medical students toward mentally disabled people and to understand the impact of schooling on attitude difference by evaluating second and sixth year medical students. Method The study was carried out among 452 students from all the three public medical schools located in Istanbul, Turkey. Attitudes were assessed through a Likert scale by presenting vignettes for depression and schizophrenia. Results In both men and women, the scores of last year students for depression and schizophrenia scales were better compared with those of the second graders, and the differences were statistically significant (p<0.05). However, the proportion of students who did not perceive schizophrenia as "temporary" and "curable" and the perceived likelihood of dangerousness for schizophrenia were higher among the last year students compared with the second graders. Conclusion As a result of this study, it was determined that last year students had improved attitudes toward the mentally ill; however, they still had striking stigmatizing opinions and judgments. The improvement in the attitude score between the second and the sixth graders is considered a result of the students' contact and interaction with persons having mental disorders throughout their medical education. The challenge is to maintain a social environment that aims to reduce the distance between the patient and the medical staff through introducing a holistic approach in medical schools.

Research indicates that parents and other family members often grieve their child or relative's mental illness. This grief appears resultant from a profound sense of loss, which has been described as complicated and nonfinite (e.g.This paper reviews existent research in this emerging field, with a focus on parents' grief experience in relation to their adult child's mental disorder. Studies that explore parents' and family members' grief, using both qualitative and quantitative methodologies, are considered. Research evidence for the association between parents' and family members' grief and other outcomes are discussed. Findings concerning the prediction of grief in parents and family members who have a child or relative with a mental disorder will be reviewed. Finally, this paper considers methodological and theoretical issues associated with existent research and presents options for further study.