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We sought evidence on quantifiable offspring outcomes, including problems, needs and strengths, associated with their experience of major parental psychiatric disorder(s), focusing on schizophrenia, affective illnesses and personality disorder(s). We were motivated by the absence of any systematic exploration of the needs of offspring of parents in secure hospitals. Seven electronic databases were searched to identify systematic reviews of studies quantifying offspring outcomes when a parent, or parent surrogate, has major psychiatric disorder(s). Our search (updated in February 2018) identified seven high-quality reviews, which incorporated 291 unique papers, published in 1974-2017. The weight of evidence is of increased risk of poor offspring outcomes, including psychiatric disorder and/or behavioural, emotional, cognitive or social difficulties. No review explored child strengths. Potential moderators and mediators examined included aspects of parental disorder (eg, severity), parent and child gender and age, parenting behaviours, and family functioning. This clinical review is the first review of systematic reviews to focus on quantifiable offspring problems, needs or strengths when a parent has major psychiatric disorder(s). It narratively synthesises findings, emphasising the increased risk of offspring problems, while highlighting limits to what is known, especially the extent to which any increased risk of childhood problems endures and the extent to which aspects of parental disorder moderate offspring outcomes. The absence of the reviews' consideration of child strengths and protective factors limits opportunity to enhance offspring resilience. [ABSTRACT FROM AUTHOR]

The growing understanding that mood disorders are dynamic in nature and fluctuate over variable epochs of time has compelled researchers to develop innovative methods of monitoring mood. Technological advancement now allows for the detection of minute-to-minute changes while also capturing a longitudinal perspective of an individual's illness. Traditionally, assessments of mood have been conducted by means of clinical interviews and paper surveys. However, these methods are often inaccurate due to recall bias and compliance issues, and are limited in their capacity to collect and process data over long periods of time. The increased capability, availability and affordability of digital technologies in recent decades has offered a novel, non-invasive alternative to monitoring mood and emotion in daily life. This paper reviews the emerging literature addressing the use of digital mood tracking technologies, primarily focusing on the strengths and inherent limitations of using these new methods including electronic self-report, behavioural data collection and wearable physiological biosensors. This developing field holds great promise in generating novel insights into the mechanistic processes of mood disorders and improving personalised clinical care. However, further research is needed to validate many of these novel approaches to ensure that these devices are indeed achieving their purpose of capturing changes in mood. [ABSTRACT FROM AUTHOR]

Background Fewer than half of individuals with a mental disorder seek formal care in a given year. Much research has been conducted on the factors that influence service use in this population, but the methods generally used cannot easily identify the complex interactions that are thought to exist. In this paper, we examine predictors of subsequent service use among respondents to a population health survey who met criteria for a past-year mood, anxiety or substance-related disorder. Methods To determine service use, we use an administrative database including all physician consultations in the period of interest. To identify predictors, we use classification tree (CART) analysis, a data mining technique with the ability to identify unsuspected interactions. We compare results to those from logistic regression models. Results We identify 1213 individuals with past-year disorder. In the year after the survey, 24% (n=312) of these had a mental health-related physician consultation. Logistic regression revealed that age, sex and marital status predicted service use. CART analysis yielded a set of rules based on age, sex, marital status and income adequacy, with marital status playing a role among men and by income adequacy important among women. CART analysis proved moderately effective overall, with agreement of 60%, sensitivity of 82% and specificity of 53%. Conclusion Results highlight the potential of data-mining techniques to uncover complex interactions, and offer support to the view that the intersection of multiple statuses influence health and behaviour in ways that are difficult to identify with conventional statistics. The disadvantages of these methods are also discussed. [ABSTRACT FROM AUTHOR]

Background: There is increasing interest on whether the current global economic uncertainties have an influence on the population’s mental health. In this paper, we examined the association of negative socioeconomic changes, job loss and household income reductions with incident mental disorders. The moderating effect of gender was assessed. Methods: Data come from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a representative population-based, longitudinal study. Individuals with a paid job and without a 12-month mental disorder at baseline were selected and reassessed 3 years later (2007–2009/2010–2012). Substantial household income reductions and not being at a paid job anymore were self-reported at follow-up. Multivariate logistic models were utilised to investigate the association between these negative socioeconomic changes and the incidence of mood, anxiety and substance use Diagnostic and Statistical Manual-IV disorders assessed by the Composite International Diagnostic Interview 3.0. Results: After 3 years, 6% had lost their job, 11% had a substantial household income reduction and 12.2% had developed a mental disorder. Household income reductions increased the risk of any mental disorder (aOR=1.77), particularly the risk of mood (aOR=2.24). Job loss increased the risk of mood disorders (aOR=2.02). Gender modified the relationship: job loss increased the risk of any mental disorder among men (aOR=3.04) and household income reductions did so among women (aOR=2.32). Conclusions: Negative socioeconomic changes occurring within a short time period significantly increased the risk of incident mental disorders, particularly of mood disorders. Effective interventions to alleviate the public mental health impact of negative socioeconomic changes on men and women are needed. [ABSTRACT FROM AUTHOR]

The article reports that a review of a number of studies reveal that depression screening and management programmes with staff assistance can decrease the incidence of depression of a patient. The review was initiated due to observed social trends, such as reduction in size of the family unit, prevalent use of alcohol and drugs, and spreading urbanisation, which are said to make depression as the future leading cause of disabilities worldwide.

The author reflects on starting out in the early years of chronic fatigue syndrome (CFS) with his first proper paper comparing the condition with neuromuscular and affective disorders. He says that the pattern of fatigue in CFS patients was similar to those in the affective controls. He adds that the paper concludes primary muscle disease as an unlikely explanation for the disability and symptoms exhibited by the patients.

The article presents a study related to the effectiveness of lithium in preventing suicide in unipolar and bipolar mood disorders. It states that suicide risk is highest in people with mood disorders though it is associated with all psychiatric disorders. The study concludes that lithium was more effective than placebo in reducing the number of suicides in patients with unipolar depressive disorder.

The article discusses a study on the mood disorder as the complication of stroke. It informs that that experimentally induced strokes in rats caused alteration in cerebral metabolism of catecholamines that correlated with behavioral changes in the rats that mimicked depression. The study concluded that stroke was not alone reason for depression and it is estimated that 33 percent of stroke patients suffer from depression which leads to mortality.

The article focuses on the research paper "Functional Impairment Recovers After Episodes of Major Depression," published in the 2004 issue of the Journal of Affective Disorder. The paper focuses on a mental health survey held in Netherlands. The study found that in the majority of people who suffered a major depressive episode, levels of functioning returned to premorbid levels following recovery. For those people whose functioning did not improve after their depressive episode, poorer physical functioning was significantly associated with age, neuroticism, and social support.

The article focuses on the research paper "Prognostic Association of Depression Following Myocardial Infarction With Mortality and Cardiovascular Events: A Meta-Analysis," published in the 2004 issue of the journal Psychosomatic Medicine. The paper presents studies comparing cardiac prognosis in depressed versus non-depressed people admitted for a myocardial infarction. It concludes that all-cause and cardiac mortality plus cardiovascular events are more common in depressed versus non-depressed people after a myocardial infarction.

Background: A proportion of patients with behavioural variant frontotemporal dementia (bvFTD) develop amyotrophic lateral sclerosis (ALS). It is currently unknown whether the behavioural and cognitive syndrome in bvFTD with ALS (ALS-FTD) is indistinguishable from that of bvFTD alone.Methods: A retrospective cohort of 241 patients with clinical diagnoses of bvFTD (n=185) or ALS-FTD (n=56) was examined with respect to behavioural, cognitive and neuropsychiatric symptoms. Features were rated as present or absent based on information recorded from clinical interviews and detailed neuropsychological assessment.Results: A number of behavioural and affective changes were reported more frequently in bvFTD than ALS-FTD: social disinhibition (p<0.001), inertia (p<0.001), loss of sympathy and empathy (p=0.008), repetitive behaviours (p<0.001) and dietary changes (p<0.001). Warmth of affect demonstrated in the clinic setting was reported more often in ALS-FTD than bvFTD (p<0.001). Executive impairments occurred equally in both groups. Language impairments were more common in ALS-FTD than bvFTD: agrammatism (p<0.017) and impaired sentence comprehension (p<0.036). Psychotic features were relatively rare and did not distinguish the groups.Conclusions: Our findings suggest differences between bvFTD and ALS-FTD. In particular, while changes in social behaviour are prominent in bvFTD alone, there may be a comparatively greater degree of language impairment in ALS-FTD. Prospective exploration of the pattern of differences between these groups will be essential. Identification of a distinct neuropsychological phenotype in ALS-FTD may have clinical implications for early diagnosis, disease management and care planning and theoretical implications for our understanding of the relationship between ALS and FTD. [ABSTRACT FROM AUTHOR]

Objective: An imbalance of neuroactive kynurenine pathway metabolites has been proposed as one mechanism behind the neuropsychiatric sequelae of certain neurological disorders. We hypothesized that concussed football players would have elevated plasma levels of neurotoxic kynurenine metabolites and reduced levels of neuroprotective metabolites relative to healthy football players and that altered kynurenine levels would correlate with post-concussion mood symptoms.Methods: Mood scales and plasma concentrations of kynurenine metabolites were assessed in concussed (N=18; 1.61 days post-injury) and healthy football players (N=18). A subset of football players returned at 1-week (N=14; 9.29 days) and 1-month post-concussion (N=14, 30.93 days).Results: Concussed athletes had significantly elevated levels of quinolinic acid (QUIN) and significantly lower ratios of kynurenic acid (KYNA) to QUIN at all time points compared with healthy athletes (p's<0.05), with no longitudinal evidence of normalization of KYNA or KYNA/QUIN. At 1-day post-injury, concussed athletes with lower levels of the putatively neuroprotective KYNA/QUIN ratio reported significantly worse depressive symptoms (p=0.04), and a trend toward worse anxiety symptoms (p=0.06), while at 1-month higher QUIN levels were associated with worse mood symptoms (p's<0.01). Finally, concussed athletes with worse concussion outcome, defined as number of days until return-to-play, had higher QUIN and lower KYNA/QUIN at 1-month post-injury (p's<0.05).Conclusions: These results converge with existing kynurenine literature on psychiatric patients and provide the first evidence of altered peripheral levels of kynurenine metabolites following sports-related concussion. [ABSTRACT FROM AUTHOR]

Objectives: Executive and behavioural changes are well-recognised in classical amyotrophic lateral sclerosis (ALS), indicating a subclinical behavioural-variant frontotemporal dementia (bvFTD) in some patients. Social cognitive deficits in ALS have been recently described and an impairment was identified on a simple Theory of Mind (ToM) test, which assesses the judgement of the preference of another through direction of eye gaze. The present study further delineated this deficit, by distinguishing between Affective and Cognitive subcomponents, and determining the relationship to behavioural change, levels of empathy and self-awareness.Methods: The Cognitive-Affective Judgement of Preference Test was administered to 33 patients with ALS and 26 controls. Furthermore, a comprehensive neuropsychological battery and detailed behavioural assessment, with measures of empathy and awareness, were included.Results: Patients with ALS showed a significant impairment in Affective ToM only when compared with healthy controls, with a deficit in 36% of patients; 12% showed an isolated Affective ToM deficit while 24% showed more generic ToM dysfunction. A Cognitive ToM deficit was found in 27% of patients, with 3% showing an isolated Cognitive ToM deficit. The patients with ALS showed reduced empathy (Fantasy scale) and increased behavioural dysfunction with high levels of apathy. In addition, patients with either an Affective and/or Cognitive ToM deficit exhibited poor self-awareness of their performance and abnormalities on verbal fluency, while those with an Affective ToM deficit also displayed higher levels of apathy and a naming deficit.Conclusions: Dysfunctional ToM is a prominent feature of the cognitive profile of ALS. This specific difficulty in identifying and distinguishing the feelings and thoughts of another from a self-perspective may underpin the social behavioural abnormalities present in some patients with ALS, manifest as apathy and loss of awareness. [ABSTRACT FROM AUTHOR]

Background Homeless young people represent one of the most vulnerable and underserved populations. Objective To assess the prevalence of psychiatric disorder and comorbidity among a UK sample, and examine the longitudinal relationship between psychiatric conditions and different types of health service use. Methods 90 young people with experiences of homelessness were interviewed using a full psychiatric assessment. Participants were followed up 8–12 months later and completed an interview that included information about recent health service use (mental health, emergency room, general practitioner, hospital for physical problems, drug or alcohol services). Findings The prevalence of psychiatric disorder (88% current; 93% lifetime) and psychiatric comorbidity (73%) was high and that of mental health service use low in comparison (31%). Mood disorders, psychosis and suicide risk were significantly associated with mental health service use (OR 5.21, 95% CI 1.64 to 16.58; OR 10.0, CI 1.58 to 94.58; OR 6.25, CI 1.82 to 21.43, respectively). Emergency department use was predicted by mood disorders (OR 5.19, CI 1.68 to 16.0), psychosis (OR 7.33, CI 1.24 to 43.29), anxiety disorder (OR 2.88, CI 1.04 to 7.97), high-suicide risk (OR 3.42, CI 1.86 to 13.67) and comorbidity (OR 1.41, CI 1.05 to 1.90). Discussion and clinical implications The prevalence of psychiatric disorders in homeless young people was high and considerably higher than that reported for this age group in the general population. There is a need for improved uptake of services delivering longer term treatment of psychiatric problems among vulnerable groups of socially excluded young people. [ABSTRACT FROM AUTHOR]

The author discusses the portability of the drug called lithium meant for people with suicidal tendencies. He asserts that the lithium proved its worth about 60 years ago but its role in preventing suicides was not specified till 1970. He refers to a trial consisting of 6647 patients revealing that lithium was more viable than another drug placebo in mitigating suicide events and mortality rate. He also suggests that the drug can not sustain its longevity in modern psychiatry.

The author reflects on the selection of atypical antipsychotics drugs for people with bipolar mania. He argues that ones choice is guided by the efficacy of the drug to treat the condition. An overview of the clinical study of atypical antipsychotics to treat bipolar mania including the use of screening tools. He suggests that the drug choice depends on factors like tolerability, side effects, patient acceptability and compliance to treatment.

Evidence-based cognitive behavioural therapy (CBT) practices were first developed in the 1960s. Over the decades, refinements and alternative symptom foci resulted in the development of several CBT protocols/manuals for each of the many disorders, especially in the affective disorders. Although shown to be effective in highly trained providers, the proliferation of CBT protocols also has shown to demonstrate challenges in dissemination and implementation efforts due to the sheer number of CBT protocols and their related training requirements (eg, 6 months per protocol) and their related cost (eg, over US$2000 each; lost days/hours at work). To address these concerns, newer transdiagnostic CBT protocols have been developed to reduce the number of disorder-specific CBT protocols needed to treat patients with affective disorders. Transdiagnostic treatments are based on the notion that various disorder-specific CBT protocols contain important but overlapping treatment components that can be distilled into a single treatment and therefore address the symptoms and comorbidities across all of the disorders at once. 3 examples of transdiagnostic treatments include group CBT of anxiety, unified protocol for transdiagnostic treatment for emotional disorders and transdiagnostic behaviour therapy. Each transdiagnostic protocol is designed for a different set of disorders, contains a varied amount of CBT treatment components and is tested in different types of samples. However, together, these 3 transdiagnostic psychotherapies represent the future of CBT practice. [ABSTRACT FROM AUTHOR]

Background: Babies of mothers with psychotic disorders are known to have higher rates of poor obstetric outcome, including higher mortality rates. Objective: To estimate risks of stillbirth and neonatal death by specific causes in babies of mothers with histories of severe mental illness, relative to the general population. Methods: A cohort of 1.45 million live births and 7021 stillbirths during 1973-98 was identified from Danish national registers. These registers were linked to identify babies who were stillborn or died neonatally after exposure to maternal psychiatric illness. Results: Risks of stillbirth and neonatal death were raised for virtually all causes of death for all of the maternal psychiatric diagnostic categories. For most causes of death, offspring of women with schizophrenia and related disorders had no greater risks of stillbirth or neonatal death than offspring of women with other maternal psychiatric disorders (eg, neonatal death (NND) due to immaturity: relative risks (95% CI) schizophrenia and related disorders: 1.1 (0.4 to 3.5), affective disorders: 2.0 (1.2 to 3.5)). There was a greater risk of fatal congenital malformation associated with a history of maternal affective disorder (stillbirth 2.4 (1.1 to 5.1), NND 2.1 (1.4 to 3.3)) or schizophrenia and related disorders (stillbirth 2.4 (0.8 to 7.6), NND 2.2 (1.1 to 4.1)) than with maternal alcohol/drug-related disorders (stillbirth 1.2 (0.4 to 3.8), NND 1.1 (0.6 to 2.2)). Conclusions: Higher risk of perinatal loss may be linked to factors associated with maternal psychiatric illness in general, such as insufficient attendance for antenatal care and unhealthy lifestyles rather than the maternal mental illness itself. [ABSTRACT FROM AUTHOR]

The article discusses finding of a research which suggests that rapid cycling bipolar disorder is associated with female gender and bipolar type II subgroup. Rapid cycling is clinically significant and understudied variant of bipolar disorder. There is controversy regarding definition of rapid cycling. The importance of rapid cycling refelects defferences in clinical features, course and outcome is covered in this article. Association of antidepressants with rapid cycling has been argued to reflect the depressive predominance in rapid cycling.

Background: The use of self-report measurements in clinical settings has increased. The underlying assumption for self-report measurements is that the patient understands the questions fully and is able to give a reliable assessment of his or her own health status. This might be problematic in patients with limitations that interfere with reliable self-assessment such as cognitive impairment or serious mood disturbances, as may be the case in multiple sclerosis. In these situations proxies may provide valuable information, provided we can be certain that proxies and patients give consistent ratings. Objective: To examine whether patients with multiple sclerosis and their partners agree on the impact of multiple sclerosis on the daily life of the patient by using the Multiple Sclerosis Impact Scale (MSIS-29). Methods: 59 patients with multiple sclerosis and their partners completed the MSIS-29. Agreement was examined, comprehensively at scale score levels and item functioning, using both traditional and less conventional psychometric methods (Rasch analysis). Results: Agreement between patients and partners was good for the physical scale, and slightly less but still adequate for the psychological scale. Mean directional differences did not show considerable systematic bias between patients and proxies. Intraclass correlation coefficients (ICCs) satisfied the requirements for agreement, but were higher for the physical scale (0.81) than for the psychological scale (0.72). These findings were supported by Rasch analyses. Conclusion: In this sample, albeit small, partners provided accurate estimates of the impact of multiple sclerosis. This supports the value of self-rating scales and indicates that partners might be useful sources of information when assessing the impact of multiple sclerosis on the daily life of patients. [ABSTRACT FROM AUTHOR]

Background: Most empirically derived antidepressants increase monoamine levels. The nuclei of cells synthesising these monoamines are located in the brainstem, and projection tracts such as the medial forebrain bundle reach virtually all other brain areas. Two studies of unipolar depressive illness using transcranial ultrasound have reported reduced echogenicity of the brainstem midline in unipolar depressed patients. This may be consistent with disruption of white matter tracts, including the medial forebrain bundle, and it has been suggested that the effect of such disruption could be reversed by antidepressants.Objective: To replicate these findings in a group of unipolar depressed patients and controls.Methods: Fifteen unipolar depressed patients and 15 controls were studied using transcranial ultrasound imaging and diffusion tensor magnetic resonance imaging (DT-MRI).Results: No difference in echogenicity of the brainstem midline of unipolar depressed patients was found. A possible trend (Cohen's d = 0.39) in the direction of previous studies was found. Although the echogenicity of the brainstem midline of the control group was found to be similar to previous reports, there was no reduction in the patient group. Additionally, no structural abnormality of the brainstem was identified using DT-MRI.Conclusions: While these data do not replicate the findings of previous studies reporting a significant reduction in the echogenicity of the brainstem midline in unipolar depressed patients, the ultrasound investigation indicated that there may be a trend in this direction. Given the importance of identifying the causes of depressive illness, it is important that other groups attempt similar studies. [ABSTRACT FROM AUTHOR]

Aims: To examine the informativeness of the Child Behavior Checklist (CBCL) as a screening tool to identify comorbid and non-comorbid cases of attention deficit hyperactivity disorder (ADHD) in a paediatrically referred population. It was hypothesised that specific scales of the CBCL would help identify specific comorbidities within ADHD cases in the primary care selling. Methods: The sample consisted of children and adolescents 6-17 years old of both genders with ADHD (n = 121). A receiver operating curve (ROC) approach was used to determine which CBCL scales best differentiated between ADHD cases with and without its comorbidities with conduct, anxiety, and mood disorders. Results: ROC analysis showed that the CBCL Delinquent Behavior and Aggressive Behavior scales predicted the structured interview derived diagnoses of conduct and bipolar disorder, the Anxious/ Depressed and Aggressive Behavior scales predicted major depression, and the Anxious/Depressed and Attention problems scales predicted anxiety disorders. Conclusions: These results extend to a paediatrically referred population with previously reported findings in psychiatric samples documenting good convergence between structured interview diagnoses and syndrome congruent CBCL scales. These findings support the utility of the CBCL as a screening tool for the identification of psychiatric comorbidity in ADHD youth in the primary care selling. [ABSTRACT FROM AUTHOR]

Objective: To assess the validity, responsiveness, and test-retest reliability of DISCs (Depression Intensity Scale Circles) as a simple screening tool for depression in patients with cognitive or communicative deficits following acquired brain injury.Design: Cohort analysis of consecutive patients entered into an integrated care pathway for screening and management of depression in the context of rehabilitation.Setting: Regional neurological rehabilitation service in the UK.Participants: 114 patients with complex disabilities caused by acquired brain injury (mean (SD) age, 42.8 (14.5) years).Main Outcome Measures: DISCs (a graphic rating scale depicting six circles with increasing proportion of dark shading), Numbered Graphic Rating Scale (NGRS), Yale single question ("Do you often feel sad or depressed"), Beck Depression Inventory-II (BDI-II), DSM-IV criteria for depression.Results: At initial assessment the DISCs correlated with total BDI-II scores (Spearman rho = 0.66, p < 0.001), NGRS (rho = 0.87, p<0.001), and DSM-IV (rho = 0.59, p<0.001). A DISCs score > or =2 identified depression (major or minor) according to DSM-IV criteria with 60% sensitivity, 87% specificity, 75% positive predictive value, and 77% negative predictive value. Test-retest reliability after 24 hours (n = 66) showed "excellent" level of agreement (weighted kappa = 0.84). In 45 patients who received intervention for depression, the DISCs showed a significant change in response to treatment (Wilcoxon; p<0.001).Conclusions: DISCs had acceptable convergent validity, reliability, and responsiveness as a simple graded tool for screening and assessment of depression in patients with complex disabilities following acquired brain injury. It warrants further investigation in patients with more profound language and cognitive deficits for which it is primarily intended. [ABSTRACT FROM AUTHOR]

Background: Whereas apathy is increasingly recognised as a frequent abnormal behaviour in dementia, its overlap with depression remains poorly understood. Aims: To assess the psychometric characteristics of a structured interview for apathy, and to examine the overlap between apathy and depression in dementia. Methods: A total of 150 patients with Alzheimer's disease (AD) underwent a comprehensive psychiatric and cognitive assessment. Results: Twelve per cent of the sample met criteria for both apathy and depression, 7% met criteria for apathy only, and 31 % met criteria for depression only. Apathy (but not depression) was significantly associated with more severe cognitive deficits. Apathy and anxiety scores accounted for 65% of the variance of depression scores in dementia, and the diagnosis of apathy had a minor impact on the rating of severity of depression. Conclusions: The Structured Interview for Apathy demonstrated adequate psychometric characteristics. Using a novel structured interview for apathy in AD we demonstrated that whereas the construct of depression primarily consists of symptom clusters of apathy and anxiety, apathy is a behavioural dimension independent of depression. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence and clinical associations of a history of events during sleep in patients with psychogenic non-epileptic seizures (PNES, pseudoseizures), and to compare the prevalence of a history of sleep events with that in poorly controlled epilepsy.Methods: Prospective study by semistructured interview of the history of event patterns and their clinical associations in 142 patients with video EEG confirmed PNES, and 100 patients with poorly controlled epilepsy.Results: 84/142 patients with PNES (59%) and 47/100 with epilepsy (47%) gave a history of events during sleep (p = 0.062). In patients with PNES, significant associations were found between a history of sleep events and: convulsive clinical semiology, antiepileptic drug treatment, fatigue, suicide attempts, mood disorder, and physical abuse. A particularly strong association with social security benefit was also found (odds ratio 4.0, p<0.001).Conclusions: The prevalence of a history of sleep events is similar in PNES and epilepsy, and is of no value in discriminating between the two, although a history of events occurring exclusively during sleep does suggest epileptic seizures. The clinical associations found indicate that a combination of psychopathological and external influences may be important in determining whether or not a patient with PNES gives a history of events during sleep. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with neurologically unexplained symptoms (NUS) often have a previous history of other medically unexplained symptoms. A past history of such symptoms can help make a positive diagnosis of a somatoform or affective disorder, and enable appropriate management strategies. However, information on past medical diagnoses is primarily obtained from patient interviews and may be inaccurate, particularly in patients with NUS. OBJECTIVE: To assess the reliability of past medical diagnoses reported by patients with NUS compared with patients with confirmed neurological disease (ND) without suspicion of somatoform illness. METHODS: 21 patients with NUS and 16 patients with ND were interviewed about their current and past medical problems and diagnoses. The accuracy of the reported diagnoses was assessed through examination of their complete general practice notes. RESULTS: The median number of previous diagnoses reported by patients with NUS was significantly higher than in controls (7 v 3, p = 0.001). There was no difference in the median number of confirmed diagnoses between the two groups (2 v 2.5); however, the median percentage of reported diagnoses confirmed by investigations was significantly smaller in the NUS group (22% v 80%, p = 0.001). The additional diagnoses reported by patients with NUS not only comprised functional syndromes such as irritable bowel syndrome or non-cardiac chest pain (6% v 0%, p = 0.01), but also organic diagnoses which had either been unequivocally excluded (5% v 0%, p = 0.006), were based on equivocal findings often found after multiple investigations (9% v 0%, p = 0.01), or had not been investigated before a clinical diagnosis was made (50% v 18%, p = 0.04). CONCLUSION: Reported previous diagnoses should not be taken at face value when the current differential diagnosis includes a functional/somatoform neurological syndrome, particularly if the list of past medical diagnoses is long. Confirmation of previous diagnoses from alternative sources may contribute to a diagnosis of somatoform disorder, allowing appropriate management strategies for the current (and past) complaints to be initiated. [ABSTRACT FROM AUTHOR]

Investigates the role of hydroxytryptamine receptors in the aetiology of bipolar affective disorder in Taiwan. Involvement of genes in serotonin transmission; Indication of findings on the involvement of multiple genetic factors; Analysis of the effect of several genes on one phenotype.

Background-Several reports indicate that physical activity can reduce the severity of symptoms in depressed patients. Some data suggest that even are single exercise bout may result in a substantial mood improvement. Objective-To evaluate the short term effects of a training programme on patients with moderate to severe major depression. Methods-Twelve patients (mean (SD) age 49 (10) years; five men, seven women) with a major depressive episode according to the Diagnostic and Statistical Manual of the American Society of Psychiatry (DSM IV) criteria participated. The mean (SD) duration of the depressive episode was 35 (21) weeks (range 12-96). Training consisted of walking on treadmill following an interval training pattern and was carried out for 30 minutes a day for 10 days. Results-At the end of the training programme, there was a clinically relevant and statistically significant reduction in depression scores (Hamilton Rating Scale for Depression: before, 19.5 (3.3); after, 13 (5.5); p = 0.002. Self assessed intensity of symptoms: before, 23.2 (7); after, 17.7 (8.1); p = 0.006. Values are mean (SD)). Subjective and objective changes in depression scores correlated strongly (r = 0.66, p = 0.01). Conclusions-Aerobic exercise can produce substantial improvement in mood in patients with major depressive disorders in a short time. [ABSTRACT FROM AUTHOR]

The article presents evidence from studies on the importance of a developmental approach to early identification of recurrent mood disorders in youth. Topics discussed are the natural history of recurrent and mood disorders in high-risk offspring, the development clinical staging model of bipolar disorder and its implications including the identification of vulnerability indicators and markers of illness risk and development of specialized assessment, treatment and surveillance services.

Thirty six patients (31 male, 5 female) who had suffered severe closed head injury were re-examined at an average of 39.3 (SD 12.8, range 7-66) months after the injury. Behavioural symptoms were measured using the Giessen test. The relatives' reports were used for data analysis to ensure that results were valid. The neurophysical impairment subscale of the Glasgow assessment schedule was completed by two neurologists, and the number connection test was completed by each patient. The adjective mood scale was completed by each relative. All patients were investigated by single photon emission computerised tomography (SPECT). Exploratory factor analysis using the principal components method was carried out separately for SPECT results and psychological measures and correlations were sought between the resulting factors. Factor analysis of the data from the Giessen test identified social isolation, disinhibition, and aggressive behaviour as major components of post-traumatic personality changes; it indicates that these behavioural features are independent of the level of neurological and neuropsychological impairment, which loaded on a single independent factor. Relatives' psychic health seemed to be relatively resistant to physical and cognitive disability and was mainly affected by disinhibitive behaviour. The highest correlation was between frontal flow indices and disinhibitive behaviour (p less than 0.01): the severity of disinhibition increased with lower frontal flow rates. There was a significant but somewhat weaker correlation (p less than 0.05) between flow indices of the left cerebral hemisphere and social isolation. Low flow values of the right brain regions were related to aggressive behaviour (p less than 0.05). Neurological and cognitive impairment correlated negatively with the thalamus; worse neurological and cognitive performance indicate by raised scores on the neurophysical scale and on the number connection test was associated with low thalamic flow values. The results support the importance of lesion location in the production of post traumatic behavioural disorders. [ABSTRACT FROM AUTHOR]

Repetitive transcranial magnetic stimulation (rTMS) has been reported to demonstrate slight effects in the treatment of depression. Hence, a novel bilateral versus unilateral and sham stimulation design was applied to further assess rTMS' antidepressant effects. Forty one medication free patients with major depression, admitted to a psychiatric unit specialising in affective disorders, were consecutively randomised into 3 groups. Group A1 (n = 12) received unilateral active stimulation consisting of high frequency (hf) rTMS over the left dorsolateral prefrontal cortex (LDLPC) and subsequent sham low frequency (lf) rTMS over the right dorsolateral prefrontal cortex (RDLPC). Group A2 (n = 13) received simultaneous bilateral active stimulation consisting of hf-rTMS over the LDLPC and lf-rTMS over the RDLPC. Group C (n = 13) received bilateral sham stimulation. Stimulation was performed on 10 consecutive workdays. All patients received antidepressant medication on the first day of stimulation, which was continued during and after the stimulation period. As no significant difference in antidepressant outcome between group A1 and A2 was found, the two groups were pooled. The time course of the outcome variables Hamilton depression rating scale (HDRS(21)) and Beck depression inventory (days 0, 7, 14, 28) by repeated measures analysis of variance revealed no significant group differences (in terms of a group by time interaction), whereas there was a significant effect of time on all three outcome variables in all groups. The results suggest that rTMS as an "add on" strategy, applied in a unilateral and a bilateral stimulation paradigm, does not exert an additional antidepressant effect. [ABSTRACT FROM AUTHOR]

The authors comment on the medical study "Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders." by Bamelis LL et al. They evaluate the schema therapy's effectiveness in the treatment of patients with personality disorders (PDs) in terms of dropout rate and outcome, assess the evidence that it is more reliable than other procedures such as treatment as usual, and discuss the study's significance for their practices.

The article discusses a study on the usefulness of data from magnetic resonance imaging to improve the prediction of dementia incident, by Blossom C. M. Stephan and colleagues, which appeared within the issue. Topics covered include the unclear objective for predicting dementia in older people without cognitive complaints and the complexity of the interpretation of findings on the discrimination performance in dementia.

The article aims to identify the risk factors in young people for episodes of deliberate self-harm (DSH) by linking hospital administrative records with cross-sectional survey data on 2,736 children living in Perth, Western Australia from 1993 to 2007. It cites emotional problems and inconsistent parenting as among the key risk factors for DSH. It also uncovered an association between primary carer smoking and hospitalization for DSH in young children, which may be connected to mental health problems and socio-economic deprivation.

The article focuses on the psychiatric symptoms of Huntington disease (HD) as shown in the study of Camille L. Julien and colleagues. It states that early symptomatic gene carriers have showed great occurrence of depression and temper. It likewise claims that HD is distinguished by a three movement disorders, cognitive decline and various psychiatric disturbances. Moreover, it discusses the psychiatric histories of a large group of individuals with affective disorder.

The article focuses on the study concerning the significance of intermittent explosive disorder (IED) towards the other mental disorders development in the U.S. The study shows that the IED among American people started at the age 15 years old. Interpersonal violence recognizes as the main element towards IED people. IED defines as an anger attack of more than three or more that result property destruction. American men, and teenagers ages from 18-19 years old feature higher lifetime IED.