Diagnostic stability in subjects with multiple admissions for psychotic illness

Background. Although studies investigating changes in diagnosis between psychotic episodes have differed in design, some consistent findings have emerged. This study seeks to clarify and extend these findings by describing and comparing clinical and operationally defined diagnostic stability in a group of subjects with multiple episodes of functional psychotic illness.Methods. The OPCRIT programme was applied to case notes of 204 subjects with multiple admissions for psychotic illness. Clinical and operationally defined diagnoses were compared and the spread and stability of diagnoses determined.Results. An increase in the frequency of diagnosis of schizophrenia from initial to subsequent episodes was demonstrated. High levels of stability were found for schizophrenia (58 to 98%), moderate levels for affective disorders (24 to 83%), low levels for other non-organic psychotic conditions (27 to 54%) and atypical psychosis (27 to 53%), and very low levels for schizoaffective disorder (5 to 39%) and other conditions (0 to 4%).Conclusions. The stability levels for schizophrenia and affective disorders are adequate, but the low levels for a range of other psychotic conditions raise questions regarding their predictive validity

Life events in suicide and undetermined death in south-east Scotland: a case-control study using the method of psychological autopsy

Background: Adverse life events have been associated with increased risk of suicide. Mental disorders are also major risk factors for suicide. Matching cases and controls for mental disorder is thus appropriate in studies of suicide. This procedure was used to study the degree to which excess adversity was more common in cases who committed suicide as opposed to living controls matched for mental disorder. Methods: The study formed part of a retrospective case-control comparison of cases of suicide/undetermined death with living controls using psychological autopsy in south-east Scotland. Cases and controls were matched for age, sex and mental disorder. Informants were those closest to cases and controls. Cases and controls were assessed for life events using the Interview for Life Events. The subjects were 45 cases of suicide/undetermined death and 40 living controls. Results: Cases and controls did not differ significantly in severity of mental disorder. Adverse interpersonal events within the family (P=0.01) with an odds ratio (OR) of 9.0 (95% CI, 1.3–399) and adverse physical health-related events (OR 5.0, 95% CI 1.1–47, P=0.04) were significantly more common in cases than controls. Conclusions: Cases had significantly more adverse life events than controls overall. The categories accounting for these differences were interpersonal family adversity and physical ill-health. There were no significant differences in either the number or severity of ongoing difficulties between cases and controls. Recent adverse life events contribute to the increased risk of suicide even when age, sex and mental disorder are controlled for. Future research should examine interactions between social support and acute and chronic adversity

Reducing persistent auditory hallucinations by wearing an ear-plug

Copyright British Psychological Society [Full text of this article is not available in the UHRA]Peer reviewe

Combination tricyclic antidepressant and lithium maintenance medication in unipolar and bipolar depressed patients

Original article can be found at: http://www.sciencedirect.com/science/journal/01650327 Copyright Elsevier Inc. DOI: 10.1016/0165-0327(90)90054-C [Full text of this article is not available in the UHRA]In a small study of up to 3 years' duration comparison of the value of amitriptyline alone versus amitriptyline + lithium in unipolar cases (27 patients) and of that of lithium alone versus amitriptyline + lithium in bipolar cases (13 patients) showed no advantage for the combination treatments in terms of efficacy in reducing depressive relapses. There was no effect of treatment, developing depression or developing hypothyroidism upon the psychological tests which were conducted during this prolonged study. Observer and self ratings detected an increase in depression before relapse was clearly present, but of the various psychological assessments conducted only arousal showed changes in association with developing and definite relapse. The prescription of lithium but not amitriptyline + lithium or amitriptyline alone was associated with significant increases in blood pressure.Peer reviewe

The Northwick Park Functional Psychosis Study : diagnosis and outcome

Copyright Cambridge University Press [Full text of this article is not available in the UHRA]Peer reviewe

A factor model of the functional psychoses and the relationship of factors to clinical variables and brain morphology

Background. Despite more than 100 years of study, there remains no definitive diagnostic validation of the functional psychoses. Factor analysis suggests the presence of three or more psychopathological syndromes in functional psychoses as a whole. The relationship between these factors and cerebral anatomy has been investigated in schizophrenia only. This study aimed to address the relationship of symptom factors to clinically important variables and cerebral anatomy in a sample of psychotic patients with a spread of diagnoses. Methods. In a sample of patients with functional psychoses, symptom data was obtained on four consecutive admissions using the OPCRIT symptom checklist. OPCRIT data was used to generate operational diagnoses in accordance with pre-set criteria and a principle components analysis was performed on symptom data. Factor loadings were compared between each admission to examine factor stability over time. Factor scores at first admission were also correlated with clinical variables obtained from patients' case notes. From the sample of 204 patients, 64 subjects were recruited and underwent an MRI scan of the brain. Regional anatomical volumes were compared with diagnosis and factor loadings at first admission. Results. A principal components analysis gave a four-factor solution of ‘manic’, ‘depressive’, ‘disorganization’ and ‘reality distortion’ factors at each admission. Factors showed a high degree of stability over the four admissions studied. The factors were significantly associated with several clinical variables. Three of the four factors were associated with a specific pattern of cerebral anatomy. Conclusions. This study suggests that factors may correspond to relatively specific disease processes underlying functional psychotic illness. We propose that the use of symptom factors may facilitate the investigation of the underlying mechanisms of psychotic illness