Inflation of 430-parsec bipolar radio bubbles in the Galactic Centre by an energetic event.

The Galactic Centre contains a supermassive black hole with a mass of four million Suns1 within an environment that differs markedly from that of the Galactic disk. Although the black hole is essentially quiescent in the broader context of active galactic nuclei, X-ray observations have provided evidence for energetic outbursts from its surroundings2. Also, although the levels of star formation in the Galactic Centre have been approximately constant over the past few hundred million years, there is evidence of increased short-duration bursts3, strongly influenced by the interaction of the black hole with the enhanced gas density present within the ring-like central molecular zone4 at Galactic longitude |l| < 0.7 degrees and latitude |b| < 0.2 degrees. The inner 200-parsec region is characterized by large amounts of warm molecular gas5, a high cosmic-ray ionization rate6, unusual gas chemistry, enhanced synchrotron emission7,8, and a multitude of radio-emitting magnetized filaments9, the origin of which has not been established. Here we report radio imaging that reveals a bipolar bubble structure, with an overall span of 1 degree by 3 degrees (140 parsecs × 430 parsecs), extending above and below the Galactic plane and apparently associated with the Galactic Centre. The structure is edge-brightened and bounded, with symmetry implying creation by an energetic event in the Galactic Centre. We estimate the age of the bubbles to be a few million years, with a total energy of 7 × 1052 ergs. We postulate that the progenitor event was a major contributor to the increased cosmic-ray density in the Galactic Centre, and is in turn the principal source of the relativistic particles required to power the synchrotron emission of the radio filaments within and in the vicinity of the bubble cavities.

PQM--Psychiatry Quality Measurement.

As a consequence of an increased awareness of quality management in psychiatry the Lundbeck Institute has developed a software program called Psychiatry Quality Measurement (PQM). This is an electronic documentation and quality measurement system with a large data-collecting function to record longitudinal data of the full psychiatric visit, covering all aspects of an evaluation and follow-up. Using the full ICD-10 and DSM-IV classifications, the system has been designed to assist with quality measurement in all psychiatric diagnoses. A full statistical package is included in the program to calculate outcomes of treatment (including relapse rates, improvements in psychopathology, severity and frequency of side-effects, and costs of treatment) as tables and graphs ready for presentation in a Powerpoint format. The system is fully translatable and flexible for various implementation settings, including stand-alone PCs or hospital network systems, all ICD-10 or DSM-IV diagnoses, and the possibility of the use of over 20 psychopathology and side-effect scales to measure the quality of care of all psychiatry patients.

Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder.

BACKGROUND: Symptoms of depression and anxiety are frequently encountered in the course of schizophrenia and are of considerable clinical importance. They may compromise social and vocational functioning, and they are associated with an increased risk of relapse and suicide. Various treatment approaches have been reported to be successful. METHOD: The sample comprised 177 patients with DSM-III-R or DSM-IV schizophrenia or schizophreniform disorder who were participants in multinational clinical drug trials at our academic psychiatric unit over a 7-year period and who were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Analysis was performed on baseline PANSS scores. The depression/anxiety score was compared in the men and women, first-episode and multiple-episode patients, and those with predominantly positive and negative syndromes. Correlations were sought between depression/anxiety scores and age, total PANSS score, positive score, negative score, general psychopathology score, and treatment outcome. Multivariate analysis was applied to determine contributions of individual variables toward depression/anxiety and outcome scores. RESULTS: Depression and anxiety symptoms were more severe in women (p = .007), first-episode patients (p = .02), and those with predominantly positive symptoms (p < .0001). Depression/anxiety scores were significantly correlated to age (r = -0.31, p < .0001), PANSS positive scores (r = 0.39, p < .0001), and treatment outcome (r = 0.25, p = .006). Multivariate analysis bore out these results, with the exception that first episode was not a significant predictor of depression and anxiety scores. CONCLUSION: PANSS depressive/anxiety scores were generally low in our sample, perhaps because patients with schizoaffective disorder were excluded. The finding that these symptoms were more prominent in women and first-episode patients is in keeping with previous literature. The higher scores in first-episode patients are likely due to the higher positive symptom scores in these patients. The association between depressive/anxiety scores and positive symptoms but not with negative symptoms points to a specific relationship between affective symptoms and the positive symptom domain of schizophrenia. The presence of depressive and anxiety symptoms may predict a more favorable outcome to treatment, although this may only apply to the acute exacerbations of the illness.

Sharing the responsibility for improved care: the example of the Lundbeck International Psychiatric Institute.

The Lundbeck International Psychiatric Institute was founded as an independent forum for discussions by international psychiatrists on the treatment of mood disorders and schizophrenia with the aim to improve the treatment of patients suffering from CNS-diseases. The Institute has presented 18 schizophrenia seminars until the end of 1998. These seminars address various aspects of the treatment plan of schizophrenia, including psychopharmacology, psychoeducation and quality management. All the discussions are focused on evidenced-based psychiatry and international treatment guidelines. In this paper the data collected from participants of the schizophrenia seminars are presented. These data are comparisons of the psychiatrists' treatment habits and knowledge about schizophrenia before the seminars and 2 weeks and 6 months after attending the seminars. The results presented include changes in the participants' treatment habits in relation to optimal doses for antipsychotics during the acute treatment phase, minimum doses during the maintenance phase, duration of treatment in the maintenance phase, and use of classic versus new generation antipsychotics. The Lundbeck Institute hopes to improve the treatment outcome for patients with CNS-diseases. The schizophrenia seminars seem to be changing psychiatrists' treatment habits and their knowledge about the disease.

Epilepsy and the law.

Epilepsy, and the treatment thereof, has effects on many aspects of life, with far-reaching implications for the patient, his family and the community. Epilepsy causes a great deal of social difficulties and restrictions due to the associated stigma and prejudice. It is not a rare condition and is associated with many other conditions, such as schizophrenia, mental retardation, autism, and terminal Alzheimer's disease. Other associated disorders may include cognitive difficulties, personality disturbances or psychoses of various types and durations. Only by the 1850's was epilepsy defined as a "neurological" disease.