Have the Cross-Informant Syndromes of the CBCL any practical value in identifying grouped ICD10 diagnoses?

120 children referred to a child and adolescent psychiatric service in a university clinic were studied with the aim of deriving predictors for grouped ICD10 diagnoses using the CBCL Cross-Informant-Syndromes (CISs). CIS7 (Delinquent Behaviour) and CIS8 (Aggressive Behaviour) were shown to significantly separate Disruptive Behaviour Disorders from all other disorders. As cross-validation, a separate clinical sample of 118 children from a similar service in another part of the country was used to see to what extent the CIS predictors from the first sample held up in the second sample. Positive and Negative Predictive Powers, all corrected for chance, confirmed that the Disruptive Behaviour Disorder group could be usefully separated from all other disorders using the Delinquent Behaviour and the Aggressive Behaviour Cross-Informant Syndrome scores. There was no good evidence that Emotional (Anxiety-Mood) Disturbance could be usefully separated in the same way using the Anxious-Depressed Syndrome (CIS3) or any other syndrome. Discriminant Function Analysis showed that there was no significant improvement in prediction when more elaborate linear combinations of the syndromes were used.

Patterns of neuropsychological impairment in dementia of the Alzheimer type and multi-infarct dementia.

Patterns of performance on 22 neuropsychological tests were examined in 58 patients with presumed dementia of the Alzheimer type (DAT) and 58 patients with presumed multi-infarct dementia (MID). Few differences between patterns of performance in DAT and MID were found when overall level of performance was taken into account. Within the DAT group, there were some age-related differences in performance that in themselves might support other studies suggesting clinical and neuropathological differences between subtypes of DAT that are related in part to the age at which the condition occurs. However, similar age-related patterns were found in the MID group and the DAT and MID groups did not differ significantly in this respect. Considerable inter-individual variability in pattern of performance was apparent within each group. A proportion of patients were re-assessed 10 months after initial assessment: the extent of decline over time was not predictable from patients' characteristics or test performances at initial assessment. 'De-differentiation' in patterns of impairment, over time or with increasing severity of impairment, was not observed.

The Edinburgh Primary Care Depression Study: personality disorder and outcome.

BACKGROUND: Little is known about the impact of personality pathology on the treatment outcome of major depressive illness in primary care in the UK. METHOD: Patients meeting criteria for DSM-III major depressive disorder were randomly allocated to one of four treatments each lasting 16 weeks, then followed up for 18 months. Assessments were made of depressive symptoms, personality and social functioning. Personality was assessed at maximum improvement or 16 weeks. RESULTS: The prevalence of personality disorder (PD) in the sample of 113 patients was 26%. Patients with a PD were significantly younger and rated more depressed at entry than patients with no personality disorder (NoPD). On completion of treatment patients with a PD were significantly more depressed and had poorer social functioning than the NoPD group. After 18 months there were no differences in ratings of depression or social functioning between the groups. CONCLUSIONS: There was substantial improvement in both the PD and NoPD groups. The presence of personality pathology delays recovery from major depressive illness.

Schizoid personality in girls: a follow-up study--what are the links with Asperger's syndrome?

Child psychiatric records of 33 girls given a diagnosis of "schizoid" personality in childhood, were compared with records of a control group of other referred girls and with those of 32 pairs of "schizoid" and control boys. Seventeen "schizoid" girls were seen again in adult life and compared with 32 "schizoid" boys previously followed up at the same age. The features of "schizoid" girls in childhood and adult life were very similar to those of the boys. A striking finding, possible due to referral bias, was the high rate of antisocial conduct in "schizoid" girls, both in childhood and later life. The dilemmas of diagnostic classification of this group of patients are discussed.

'Schizoid' personality in childhood and adult life. II: Adult adjustment and the continuity with schizotypal personality disorder.

In a controlled follow-up study into adulthood of 32 children diagnosed 'schizoid', three-quarters fulfilled DSM-III criteria for schizotypal personality disorder and two developed schizophrenia. Overall their psychosocial adjustment was somewhat, but not markedly, worse than that of other attenders at a child psychiatry clinic, although as a group they remained more solitary, lacking in empathy, oversensitive, with odd styles of communicating, and often with circumscribed interests.

Rehabilitation status--dysfunction and treatment outcome in a psychiatric day hospital.

Two groups of patients representing the common objectives of Day Hospitals, namely steady progress and maintenance in the community, were studied. The Morningside Rehabilitation Scale was used to measure dependency, inactivity, isolation and the effects of current symptoms on the patient's life-style. Small but significant changes including in some cases crucial changes which involve working capacity were observed. There is discussion on the value of standardised measurement and the expression of results in terms of levels of functioning. The effect on multi-professional communication and on the possibilities of comparison and planning of services is discussed.

Scottish survey of chronically ill day patients: 3-year follow-up.

Chronically ill day patients were followed up 3 years after identification in the catchment areas of 13 psychiatric hospitals serving 54% of the Scottish population. Five per cent had died, 6% were in-patients, 56% remained day patients and 14% were supported by community psychiatric nurses or attended an out-patient clinic; contact had been lost with 19%. Over 3 years, 32% had had at least one admission to in-patient care; a wide range of other services was also used. There was little change in the level of disability; a typical patient in contact at follow-up was single, schizophrenic, and rather disabled.

Rehabilitation status: a measure of medicosocial dysfunction.

The Edinburgh Rehabilitation Status Scale (ERSS) measures four dimensions in which changes may occur in the course of a disabling illness or during rehabilitation: independence; activity; social integration; and effects of symptoms on lifestyle. It provides a profile of measures, the scores of which can be summated to indicate the overall level of performance of individuals or groups. Studies of its inter-observer reliability and of its application in various disability groups indicate that the ERSS reliably defines the characteristics of individual patients and of groups. The scale can be used conveniently by professional staff working independently or by a multiprofessional rehabilitation team to assess status and changes in patients. It can also be used for measurement of the effectiveness of services and for purposes of research, teaching, and administration.

Selective effects of ECT on hypothalamic-pituitary activity.

The hypothesis that ECT produces selective effects on hypothalamic-pituitary activity was investigated by determining the effect of ECT on pituitary hormone release in nine depressed patients. After ECT there were massive and rapid increases in the plasma concentrations of nicotine- and oestrogen-stimulated neurophysin (NSN and ESN), prolactin (PRL) and adrenocorticotropin (ACTH), smaller increases in plasma luteinizing hormone (LH) and cortisol, a significant decrease in plasma growth hormone (GH) concentration but no change in plasma thyrotropin (TSH). There was significant attenuation of PRL responses with repeated ECT. The hormonal responses to ECT cannot simply be attributed to stress, since a similar pattern of increases in plasma hormone concentrations did not occur in psychologically normal patients in whom plasma hormone concentrations were measured during induction of anaesthesia and abdominal incision for cholecystectomy. Analysis of these hormonal responses in terms of the knowledge available on the neurotransmitter control of pituitary hormone release suggests that some of these hormonal responses to ECT may be mediated by the activation of serotonergic neurones, while others are probably due to direct stimulation of the neuroendocrine neurones themselves.

Response competition in recognition memory in three amnesic groups.

Experimental studies have suggested that a feature of the memory defect in some amnesic conditions may be a failure to inhibit competing responses at retrieval. It is not known whether this feature is present equally in different syndromes involving amnesia. Employing a recognition memory paradigm with varying numbers of response alternatives (based on Miller, 1978), three amnesic groups (Korsakov's, senile dementia, and multi-infarct dementia) were compared using four types of test material. The groups were not differentially affected by increasing numbers of response alternatives.

Day-to-day mood changes after childbirth: further data.

The depression and lability of mood which have been previously reported on the fifth day after childbirth are largely restricted to women with high neuroticism scores. The pattern of day-to-day mood changes is the same after Caesarian section as after vaginal delivery, but there is no 'day five' phenomenon after hysterectomy. Post-partum mood disturbance is less prominent in women who return home 48 hours after delivery.

The measurement of psychiatric rehabilitation status. A review of the needs and a new scale.

The recognition of rehabilitation as a special interest in psychiatry, and its practice by professional teams, raises the need for some uniformity in examining patient outcome. The features required in a scale designed for this purpose are considered and the Morningside Rehabilitation Status Scales, which have been prepared specifically for psychiatric rehabilitation, have their development and use described. They measure the dimensions of dependency, inactivity in occupation and leisure, social integration/isolation, and current symptoms and deviant behaviour. The measures can be expressed as a profile of the dimensions, with the total a measure of overall level of functioning; reliability has been established, and validity assessed. The scales are not difficult to apply when the patients are known to the staff using them. They should be useful to rehabilitation teams for defining the current status of patients, measuring changes produced by rehabilitation programmes, deciding areas where treatment or service deficits may exist which the team should be attempting to remedy, as well as for teaching purposes.

Emotional impact of diagnosis and early treatment of lymphomas.

Psychiatric morbidity, relevant symptoms and satisfaction with communication were assessed in patients suffering from malignant lymphoma. Before treatment started 15 of 40 patients had clinically significant psychiatric morbidity. Treatment, in its early stages, was not associated with a significant change in mean psychiatric morbidity scores but there was a decrease in ratings of concern about illness and an increase in ratings of nausea. Eleven of 31 patients seen for a second interview reported dissatisfaction with some aspect of communication with the medical staff. The findings suggest that emotional distress can be contained with a policy of frank communication; nevertheless dissatisfaction is common, being associated with initial less concern, good general health and neurotic personality traits. Personality assessment should be incorporated in future studies of doctor-patient communication.

Recurrence of affective illness after withdrawal of long-term lithium treatment.

Clinical outcome following discontinuation of long-term maintenance therapy with lithium and manic-depressive patients was studied. Although the majority showed recurrence of affective episodes, the relapses tended to be spread over a period of months. There was no evidence of immediate and inevitable "rebound" of psychotic episodes following lithium withdrawal. This finding is discussed in the light of results from other lithium discontinuation studies.

Prospective study of the psychiatric disorders of childbirth by self report questionnaire.

Two self report questionnaires, the Anxiety and Depression scales of Bedford and Foulds (SAD), and 10 visual analogue scales were each administered on several occasions during pregnancy and the puerperium to a representative sample of 425 childbearing women. Those women who each completed the analogue scales during pregnancy at 12 and 23 weeks and at 1 week and 5 months after childbirth (N = 230) showed no association between depression or anxiety and either the gravidity or method of delivery on any of the four occasions. Depression, anxiety and tearfulness on the visual analogue scales increased significantly 1 week after delivery, when compared with the other 3 occasions. The SAD failed to detect an increase in depression or anxiety at this time and its validity during pregnancy was also not satisfactory. Only 3 women were referred to a psychiatrist during the study, none of whom had an affective illness.

Plasma lithium levels and therapeutic outcome in the prophylaxis of affective disorders: a retrospective study.

Patients receiving prophylactic lithium therapy for primary affective disorder during a four year period were studied for recurrence of affective illness. Patients who had affective episodes during this period did not differ from those who remained well in age, sex or diagnosis. Those with a favourable outcome had spent significantly less time at serum lithium levels above 0.9 mmol/litre than those who had a recurrence of affective episodes.

Mood changes in the first three weeks after childbirth.

Eighty one women were asked to rate their mood on a set of 6 visual analogue scales every day for the first 3 weeks after childbirth. The 6 scales were concerned with happiness, depression, tears, anxiety, irritability and lability. Ratings on the depression, tears and lability scales rose to a sharp peak on the 5th post partum day and declined steadily thereafter. This day 5 peak was the same in primiparae and multiparae, and in breast-and bottle-feeders, and was largely independent of the day of leaving hospital. Women who became clinically depressed later in the puerperium had higher depression and lability ratings, and a more pronounced day 5 peak, than those who did not.

The introduction of problem-based learning projects into a clinical correlation course in the first year of the Edinburgh medical curriculum.

Thirty hours were allotted to problem-based learning projects in the first year of a new medical curriculum in Edinburgh. Those projects have been very successful in encouraging student initiative and in satisfying the students' desire for contact with patients, relatives and medical staff early in the curriculum. The difficulties involved in this form of teaching and the shortcomings of the exercise are discussed.

Reality orientation and dementia: a controlled trial of two approaches.

Classroom Reality Orientation was investigated with a sample of dements drawn from a psychogeriatric hospital and an old people's home. Treatment effects were examined on a range of cognitive and behavioural measures, and compared with the effects of a specific behaviourally directed orientation training in the ward. Class RO improved cognitive functioning but not behaviour, irrespective of degree of dementia. Highly significant behavioural change was demonstrated for ward behaviour orientation training and this technique is not only cheaper but has potential in managing dements.