Clinical Practice and Epidemiology in Mental Health - Latest articles

Admission to a psychiatric unit and changes in tobacco smoking

Suzy Ker and David Owens — 2008-05-06

Smoking and withdrawal from smoking complicates the assessment and treatment of mental illness. We aimed to establish whether psychiatric inpatients smoke different amounts after admission than beforehand and, if so, to find out why. Forty-three inpatients on a working age adult psychiatry ward completed self-report questionnaires about smoking habits. Those who smoked a different amount after admission had a follow-up interview to find out why they thought this had occurred. The interview incorporated qualitative and quantitative aspects which were analysed accordingly. Fifty-six percent of participants were smokers before admission, rising to 70% afterwards. Of the smokers, 17% smoked less after admission, and 63% smoked more. The average number of cigarettes smoked per person per day increased from five to thirteen. The main reasons for smoking more were boredom, stress and the wish to socialise.

Clozapine and co-prescribed psychotropics: a short report

Maneesh Gupta — 2008-04-25

Clozapine is the drug of choice in treatment resistant schizophrenia. It reduces hospitalizations. Patients on clozapine are often co-prescribed other psychotropics. This report looks at a sample of twenty patients on clozapine. It finds that almost two thirds were on a psychotropic along with clozapine. Eight individuals were on an antidepressant; seven on an antipsychotic and five were on co-prescribed valproate. The clinical implications are discussed and a need to look at health services involving clozapine is suggested.

The factor structure of the twelve item General Health Questionnaire (GHQ-12): the result of negative phrasing?

Matthew Hankins — 2008-04-24

Background: The 12-item General Health Questionnaire (GHQ-12) is used routinely as a unidimensional measure of psychological morbidity. Many factor-analytic studies have reported that the GHQ-12 has two or three dimensions, threatening its validity. It is possible that these 'dimensions' are the result of the wording of the GHQ-12, namely its division into positively phrased (PP) and negatively phrased (NP) statements about mood states. Such 'method effects' introduce response bias which should be taken into account when deriving and interpreting factors. Methods: GHQ-12 data were obtained from the 2004 cohort of the Health Survey for England (N = 3705). Following exploratory factor analysis (EFA), the goodness of fit indices of one, two and three factor models were compared with those of a unidimensional model specifying response bias on the NP items, using structural equation modelling (SEM). The hypotheses were (1) the variance of the responses would be significantly higher for NP items than for PP items because of response bias, and (2) that the modelling of response bias would provide the best fit for the data. Results: Consistent with previous reports, EFA suggested a two-factor solution dividing the items into NP and PP items. The variance of responses to the NP items was substantially and significantly higher than for the PP items. The model incorporating response bias was the best fit for the data on all indices (RMSEA = 0.068, 90%CL = 0.064, 0.073). Analysis of the frequency of responses suggests that the response bias derives from the ambiguity of the response options for the absence of negative mood states. Conclusion: The data are consistent with the GHQ-12 being a unidimensional scale with a substantial degree of response bias for the negatively phrased items. Studies that report the GHQ-12 as multidimensional without taking this response bias into account risk interpreting the artefactual factor structure as denoting 'real' constructs, committing the methodological error of reification. Although the GHQ-12 seems unidimensional as intended, the presence of such a large response bias should be taken into account in the analysis of GHQ-12 data.

Animal-assisted therapy with farm animals for persons with psychiatric disorders: effects on self-efficacy, coping ability and quality of life, a randomized controlled trial

Bente Berget, Øivind Ekeberg and Bjarne O Braastad — 2008-04-11

Background: The benefits of Animal-Assisted Therapy (AAT) for humans with mental disorders have been well-documented using cats and dogs, but there is a complete lack of controlled studies using farm animals as therapeutic agents for psychiatric patients. The study was developed in the context of Green care, a concept that involves the use of farm animals, plants, gardens, or the landscape in recreational or work-related interventions for different target groups of clients in cooperation with health authorities. The present study aimed at examining effects of a 12-week intervention with farm animals on self-efficacy, coping ability and quality of life among adult psychiatric patients with a variety of psychiatric diagnoses. Methods: The study was a randomized controlled trial and follow-up. Ninety patients (59 women and 31 men) with schizophrenia, affective disorders, anxiety, and personality disorders completed questionnaires to assess self-efficacy (Generalized Self-Efficacy Scale; GSE), coping ability (Coping Strategies Scale), and quality of life (Quality of Life Scale; QOLS-N) before, at the end of intervention, and at six months follow-up. Two-thirds of the patients (N = 60) were given interventions; the remaining served as controls. Results: There was significant increase in self-efficacy in the treatment group but not in the control group from before intervention (SB) to six months follow-up (SSMA), (SSMA-SB; F1,55 = 4.20, p= 0.05) and from end of intervention (SA) to follow-up (SSMA-SA; F1,55 = 5.6, p= 0.02). There was significant increase in coping ability within the treatment group between before intervention and follow-up (SSMA-SB = 2.7, t = 2.31, p = 0.03), whereas no changes in quality of life was found. There were no significant changes in any of the variables during the intervention. Conclusion: AAT with farm animals may have positive influences on self-efficacy and coping ability among psychiatric patients with long lasting psychiatric symptoms.

Development, reliability and factor analysis of a self-administered questionnaire which originates from the World Health Organization's Composite International Diagnostic Interview – Short Form (CIDI-SF) for assessing mental disorders

Antonella Gigantesco and Pierluigi Morosini — 2008-04-10

Background: The Composite International Diagnostic Interview – Short Form consists of short form scales for evaluating psychiatric disorders. Also for this version training of the interviewer is required. Moreover, the confidentiality could be not adequately protected.This study focuses on the preliminary validation of a brief self-completed questionnaire which originates from the CIDI-SF.Sampling and MethodsA preliminary version was assessed for content and face validity. An intermediate version was evaluated for test-retest reliability. The final version of the questionnaire was evaluated for factor exploratory analysis, and internal consistency. Results: After the modifications by the focus groups, the questionnaire included 29 initial probe questions and 56 secondary questions. The test retest reliability weighted Kappas were acceptable to excellent for the vast majority of questions. Factor analysis revealed six factors explaining 53.6% of total variance. Cronbach's alpha was 0.89 for the questionnaire and 0.89, 0.67, 0.71, 0.71, 0.49, and 0.67, for the six factors respectively. Conclusion: The questionnaire has satisfactory reliability, and internal consistency, and might be efficient for using in community research and clinical practice. In the future, the questionnaire could be further validated (i.e., concurrent validity, discriminant validity).

Executive function abnormalities in pathological gamblers

2008-03-27

Background: Pathological gambling (PG) is an impulse control disorder characterized by persistent and maladaptive gambling behaviors with disruptive consequences for familial, occupational and social functions. The pathophysiology of PG is still unclear, but it is hypothesized that it might include environmental factors coupled with a genetic vulnerability and dysfunctions of different neurotransmitters and selected brain areas. Our study aimed to evaluate a group of patients suffering from PG by means of some neuropsychological tests in order to explore the brain areas related to the disorder. Methods: Twenty outpatients (15 men, 5 women), with a diagnosis of PG according to DSM-IV criteria, were included in the study and evaluated with a battery of neuropsychological tests: the Wisconsin Card Sorting Test (WCST), the Wechsler Memory Scale revised (WMS-R) and the Verbal Associative Fluency Test (FAS). The results obtained in the patients were compared with normative values of matched healthy control subjects. Results: The PG patients showed alterations at the WCST only, in particular they had a great difficulty in finding alternative methods of problem-solving and showed a decrease, rather than an increase, in efficiency, as they progressed through the consecutive phases of the test. The mean scores of the other tests were within the normal range. Conclusion: Our findings showed that patients affected by PG, in spite of normal intellectual, linguistic and visual-spatial abilities, had abnormalities emerging from the WCST, in particular they could not learn from their mistakes and look for alternative solutions. Our results would seem to confirm an altered functioning of the prefrontal areas which might provoke a sort of cognitive "rigidity" that might predispose to the development of impulsive and/or compulsive behaviors, such as those typical of PG.

Obsessive compulsive disorder comorbidity in DBA

2008-03-10

Diamond-Blackfan Anemia (DBA) is a congenital erythroid aplasia characterized as a normochromic macrocytic anemia with a selective deficiency in red blood cell precursors in otherwise normocelullar bone marrow. DBA is known to be associated with mental retardation and learning disabilities. Although comorbidities with other psychiatric conditions have not been reported in the existing literature, we report in this paper a case of a DBA patient with previously undiagnosed comorbidity of obsessive compulsive disorder (OCD), successfully treated with sertaline 200 mg/day and valproic acid 600 mg/day. This case of comorbid presentation has clinical, therapeutic and pathophysiological implications. Given the difficulty of distinguishing among mental retardation, learning disabilities and OCD and the importance of precocious diagnosis in treating OCD especially since there are treatment methods interfering with anemia symptoms, physicians should adapt an adequate screening tool treating a child with DBA and comorbid mental disorder.

Post-traumatic stress disorder among people exposed to the Ventotene street disaster in Rome

2008-03-05

ObjectiveTo test five hypotheses on Post-traumatic stress disorder (PTSD): 1) Is PTSD the most prevalent disorder after trauma? 2) Is the proximity to the disaster related to the risk of PTSD? 3) Is PTSD associated with child mourning or separation, previous stress, or familiarity for psychiatric disorders? 4) Does the exposition to trauma increase substance abuse or somatization? 5) Can episodic trauma cause long-lasting psychiatric morbidity? Methods: Clinical assessment of subjects exposed to an explosion in a building caused by a gas-leak. Best estimate clinical diagnoses were made according to DSM-IV-TR criteria. The Zung Depression Rating Scale, the Zung Anxiety Rating Scale, and the Clinician Administered Post Traumatic Stress Disorder Scale were used in the clinical assessment. Statistical analysis was performed by means of t-test with Bonferroni's correction on continuous variables and χ2 or Fisher test on categorical variables. Results: PTSD was the most prevalent disorder after trauma, diagnosed in 32 (36.8%) subjects. The subjects who had not seen dead or injured people were more likely to receive no psychiatric diagnosis. Civil status, parenthood, death of relatives in the disaster, personal injuries, history of child mourning or separation, of previous stress, as well as familiarity for any psychiatric disorder or substance use disorder were not related with the rate of ascertained psychiatric diagnoses. Nearly two years after trauma, most of patients who had suffered PTSD still met PTSD criteria. Conclusion: The 1st and the 5th hypotheses were corroborated, the 3rd and the 4th hypotheses were not confirmed. The 2nd hypothesis was partially confirmed.

The relationship between anxiety, depression and illness perception in tberculosis patients in Pakistan

2008-02-26

ObjectiveAs the rates of TB world over have increased during the past 10 years, there has been a growing awareness of depression and its role in the outcome of chronic disorders. Though depression is common in patients with TB no study as yet has examined the prevalence of depression in this group in Pakistan. We aimed to determine the presence of depression, anxiety and illness perceptions in patients suffering from Tuberculosis (TB) in Pakistan. Methods: 108 consecutive outpatients with tuberculosis completed the Hospital Anxiety and Depression scale (HADS) and the Illness Perception Questionnaire (IPQ). Results: Out of 108 patients, 50 (46.3%) were depressed and 51 (47.2%) had anxiety. Raised depression and anxiety scores were associated with an increase in the number of symptoms reported (HADS Depression: r = 0.346, p = < 0.001), more serious perceived consequences (HADS Depression: r = 0.279, p = 0.004, HADS Anxiety: r = 0.234, p = 0.017) and less control over their illness (HADS Depression: r = 0.239, p = 0.014, HADS Anxiety: r = 0.271, p = 0.005). Conclusion: We found that about a half of patients in our sample met the criteria for probable depression and anxiety based on HADS score. Negative illness perceptions were clearly related to reports of mood symptoms. As depression and lack of perceived control over illness in those suffering from tuberculosis are reported to be independent predictors of poor adherence further studies to investigate their relationship with medication adherence are required.

The link between neurosteroids and syndromic/syndromal components of the mood spectrum disorders in women during the premenstrual phase

Maria Carolina Hardoy, Claudia Sardu, Liliana Dell'Osso and Mauro Giovanni Carta — 2008-02-26

ObjectivesFemales with a lifetime diagnosis of major mood disorder (Bipolar Disorder BD, Major Depressive Disorder MMD) investigated during the luteal phase of their menstrual cycle and in a condition of clinical well-being showed higher blood serum concentrations of progesterone and allopregnanolone compared to healthy controls. Women with BD presented even higher levels than those affected by MDD. This study attempted to verify, in line with a dimensional approach, if the possible differences in neurohormonal levels may be directly linked to some syndromal clusters (dimensions) of the mood spectrum disorders indipendently of diagnosis. Methods: Premenstrual concentrations of allopregnanolone, THDOC, progesterone, and cortisol were measured in 3 groups of women: 17 BD and 14 MDD outpatients, and 16 control subjects. Psychiatric evaluation was performed with the SCID-I interview and the SCI-MOODS-SR questionnaire. The correlation between steroid levels and mood disorder syndromal cluster (SCI-MOODS-SR domains and sub-domains) was evaluated by means of analysis of main components with Varimax rotation and Kaiser's normalization (which provided for inclusion of all components with an Eigen value >1). Results: Analysis of the main components evidenced the presence of 3 components: 1) mania, 2) depression both with mixed component 3) steroid + manic cognitivity and suicidal ideas. Conclusion: Levels of allopregnanolone and progesterone do not correlate with the association of the depressive and manic syndromes, but rather with mixed symptomatological aspects, and in particular with cognitive manic and depressive (with suicidal thoughts) dimensions. Further studies should be carried out to confirm these findings.

Validity and reliability of the Structured Clinical Interview for the Trauma and Loss Spectrum (SCI-TALS)

2008-01-28

Background: DSM-IV identifies three stress response disorders (acute stress Disorder (ASD), post-traumatic stress Disorder (PTSD) and adjustment disorders (AD)) that derive from specific life events. An additional condition of complicated grief (CG), well described in the literature, is triggered by bereavement. This paper reports on the reliability and validity of the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) developed to assess the spectrum of stress response. The instrument is based on a spectrum model that emphasizes soft signs, low-grade symptoms, subthreshold syndromes, as well as temperamental and personality traits comprising clinical and subsyndromal manifestations. Methods: Study participants, enrolled at 6 Italian Departments of Psychiatry located at six sites, included consecutive patients with PTSD, 44 with CG and a comparative group of 48 unselected controls. Results: We showed good reliability and validity of the SCI-TALS. Domain scores were significantly higher in participants with PTSD or CG compared to controls. There were high correlations between specific SCI-TALS domains and corresponding scores on established measures of similar constructs. Participants endorsing grief and loss events reported similar scores on all instruments, except those with CG who scored significantly higher on the domain of grief reactions. Conclusion: These findings provide strong support for the internal consistency, the discriminant validity and the reliability of the SCI-TALS. These results also support the existence of a specific grief-related condition and the proposal that different forms of stress response have similar manifestations.