Catatonia, schizophrenia, and affective disorders - Diagnostic associations in different cultural settings.

The nosological status of catatonia in modern classificatory systems and the influence of culture on its presentation are not fully understood. A secondary analysis of the data collected for another study that looked at the incidence of catatonia in India and Wales was performed to examine the association of catatonia to ICD 10 F diagnostic categories in two different cultural settings. The most common clinical diagnosis assigned by clinicians in India was from ICD10 F 20, while in Wales it was from ICD10 F30. The differences between the two settings were found in the F20 group. Association of catatonia appears to be more consistent with affective disorders in the two settings, but not with schizophrenia spectrum disorders. The findings are subjected to the limitations of secondary analysis.

The Health Informatics Trial Enhancement Project (HITE): Using routinely collected primary care data to identify potential participants for a depression trial.

BACKGROUND: Recruitment to clinical trials can be challenging. We identified anonymous potential participants to an existing pragmatic randomised controlled depression trial to assess the feasibility of using routinely collected data to identify potential trial participants. We discuss the strengths and limitations of this approach, assess its potential value, report challenges and ethical issues encountered. METHODS: Swansea University's Health Information Research Unit's Secure Anonymised Information Linkage (SAIL) database of routinely collected health records was interrogated, using Structured Query Language (SQL). Read codes were used to create an algorithm of inclusion/exclusion criteria with which to identify suitable anonymous participants. Two independent clinicians rated the eligibility of the potential participants' identified. Inter-rater reliability was assessed using the kappa statistic and inter-class correlation. RESULTS: The study population (N = 37263) comprised all adults registered at five general practices in Swansea UK. Using the algorithm 867 anonymous potential participants were identified. The sensitivity and specificity results > 0.9 suggested a high degree of accuracy from the algorithm. The inter-rater reliability results indicated strong agreement between the confirming raters. The Intra Class Correlation Coefficient (Cronbach's Alpha) > 0.9, suggested excellent agreement and Kappa coefficient > 0.8; almost perfect agreement. CONCLUSIONS: This proof of concept study showed that routinely collected primary care data can be used to identify potential participants for a pragmatic randomised controlled trial of folate augmentation of antidepressant therapy for the treatment of depression. Further work will be needed to assess generalisability to other conditions and settings and the inclusion of this approach to support Electronic Enhanced Recruitment (EER).

Suicides among seafarers in UK merchant shipping, 1919-2005.

BACKGROUND: Little has been reported on suicides among seafarers and how they have changed over time. AIMS: To establish the causes, rates and trends in suicides at work among seafarers in UK merchant shipping from 1919 to 2005 and to compare suicide rates with the general UK population and with seafarers employed in non-UK shipping. METHODS: Examination of seafarers' death inquiry files, death registers and death returns (for a total population of 11.90 million seafarer-years); literature reviews and national suicide statistics. RESULTS: The suicide rate (for suicides at work and unexplained disappearances at sea) in UK shipping fell from 40-50 per 100,000 in the 1920s to <10 per 100 000 in recent years, with an interim peak during the 1960s. Suicide rates were higher for ratings (all ranks below officers) than for officers, for Lascars (Asian seafarers) than for British seafarers and for older than for younger seafarers and were typically lower than those in Asian and Scandinavian merchant fleets. The suicide rate (for suicides at work) among seafarers was substantially higher than the overall suicide rate in the general British population from 1919 to the 1970s, but following reductions in suicide mortality among seafarers, it has become more comparable since. CONCLUSIONS: Although merchant seafaring was previously a high-risk occupation for suicides at work, there has been a sharp fall in the suicide rate in the past 40 years. Likely reasons for this include reductions over time in long intercontinental voyages and changes over time in seafarers' lifestyles.

Presentation and frequency of catatonia in new admissions to two acute psychiatric admission units in India and Wales.

BACKGROUND: There are no modern cross-cultural comparative studies of the frequency and clinical presentation of catatonia in a Western country and India using standardized rating instruments and diagnostic criteria. METHOD: A total of 104 consecutively admitted patients in Wales and in India were screened for catatonic features using the same standardized rating instrument by the same psychiatrist to generate DSM-IV and other diagnostic criteria for catatonia, and a profile of signs in catatonia. Inter-rater reliability for the ratings made by the research psychiatrist was established with local psychiatrists at each unit. RESULTS: The frequency of DSM-IV criteria catatonia was 13.5% in India versus 9.6% in Wales ( N . S .). The severity of catatonia did not differ between the two units. However, retarded catatonia was more common in India (12.5%) versus Wales ( p <0.05) whereas the frequency of excited catatonia was equally common in both units. Catatonia was found in many different mental disorders not just schizophrenia and affective disorder. CONCLUSIONS: Catatonia is commonly found among psychiatric in-patients with a similar frequency and severity but differing clinical presentations in Wales and India. Some classic signs of catatonia like posturing, catalepsy, staring and stupor were more frequent among psychiatric admissions in India than Wales. The differing clinical presentations may be due to differences in demographic features rather than cultural or aetiological factors.

Service utilization in 1896 and 1996: morbidity and mortality data from North Wales.

The 1896 and 1996 populations of North-West Wales are similar in number, ethnic and social mix and rurality, enabling a study of the comparative prevalence of service utilization, as well as the morbidity and mortality associated with mental illness in 1894-96 and 1996. The 1996 data reveal a 15 times greater prevalence of admissions for all diagnoses, and three times greater prevalence of admissions by detention, compared with 1896. Patients now spend more time in a service bed than they did 100 years ago. Death as a direct consequence of mental illness is commoner now than 100 years ago. There is therefore a major disjunction between the rhetoric and the reality of mental health service utilization. General factors related to changing health care and expectations and specific factors linked to the mental health appear to have led to an increased rate of service utilization in the modern period.