Range Of Mental Disorders Research Articles

Who Cares? A Profile of People who Care for Relatives with a Mental Disorder

To profile the Australian adults who are caring for a relative with a mental disorder. Data came from the 2007 National Survey of Mental Health and Wellbeing 2007 (NSMHWB), a nationally representative household survey of 8841 individuals aged between 16 and 85 years. Many people act as carers: 15% of the Australian adult population, or nearly 2.4 million individuals. The strongest predictors of being a carer are being female and being in a relatively older age bracket. Carers provide a range of emotional and practical supports to close relatives with a range of mental disorders, most notably high prevalence disorders. Their relatives' health problems cause them considerable worry, anxiety and depression, and their caring role can be associated with high financial costs. Carers are significant stakeholders in the mental health system. Providing support for carers is crucial, particularly because their own mental health and well-being may be affected by their care-giving role. The nature of this support should take into account their large numbers, their profile and the role they perform.

Intelligence in Early Adulthood and Subsequent Hospitalization for Mental Disorders

Lower intelligence is a risk factor for several specific mental disorders. It is unclear whether it is a risk factor for all mental disorders, and whether it might be associated with illness severity. We examined the relation of premorbid intelligence with risk of hospital admission and with total admission rates, for the whole range of mental disorders. Participants were 1,049,663 Swedish men who took tests of intelligence on conscription into military service and were followed up with regard to hospital admissions for mental disorder, for a mean of 22.6 years. International Classification of Diseases diagnoses were recorded at discharge from the hospital. Risk of hospital admission for all categories of mental disorder rose with each point decrease in the 9-point IQ score. For a standard deviation decrease in IQ, age-adjusted hazard ratios (95% confidence interval) were 1.60 for schizophrenia (1.55-1.65), 1.49 for other nonaffective psychoses (1.45-1.53), 1.50 for mood disorders (1.47-1.51), 1.51 for neurotic disorders (1.48-1.54), 1.60 for adjustment disorders (1.56-1.64), 1.75 for personality disorders (1.70-1.80), 1.75 for alcohol-related (1.73-1.77), and 1.85 for other substance-use disorders (1.82-1.88). Lower intelligence was also associated with greater comorbidity. Associations changed little on adjustment for potential confounders. Men with lower intelligence had higher total admission rates for mental disorders, a possible marker of clinical severity. Lower intelligence is a risk factor for the whole range of mental disorders and for illness severity.

Braking the Bandwagon: Scrutinizing the Science and Politics of Empirically Supported Therapies

ABSTRACT Proponents of empirically supported therapies (ESTs) argue that because manualized ESTs have demonstrated efficacy in treating a range of psychological disorders, they should be the treatments of choice. In this article, the author uses a hypothetical treatment for obesity to highlight numerous flaws in EST logic and argues for common factors as a more clinically relevant but empirically challenging approach. The author then explores how political variables may be contributing to the expansion of EST and the resulting restriction of practitioner autonomy. Last, the author argues that EST is best viewed as 1 component of a more comprehensive evidence-based practice framework. The author concludes with some cautionary statements about the perils of equating the EST paradigm with the scientist–practitioner ideal.

A model for community mental health services in South Africa

To provide a model to estimate human resource needs for community-based mental health services in South Africa. A situation analysis was conducted of current community-based mental health service provision in South Africa, which comprise outpatient and emergency services, residential care and day care. Service utilisation rates and staffing needs were estimated for two levels of service coverage, using data from the situation analysis, local epidemiological studies and consultation with key stakeholders. For a population of 100,000 people, 7.3-23.8 full-time equivalent staff would be required to provide services in outpatient services, 14.9-41.6 in day care and 11.5-23.0 in residential care at minimum and full coverage levels respectively. The model can facilitate rational planning by requiring transparency and accountability in the assumptions used. This method can be adapted to a range of countries, by entering relevant country data. The model fills a gap, particularly in low- and middle-income countries, where community-based mental health services are sparse, and decisions regarding allocations to them are hampered by a lack of good quality data. The results of the model are limited by the quality of data and the assumptions upon which the modelling are based.

Superstitious perception: Response-independent reinforcement and punishment as determinants of recurring eccentric interpretations

This study provided controlled observations of a potential mechanism for the determination of the repetitive, aberrant perceptions or interpretations of everyday events that figure prominently in a range of psychological disorders: the adventitious reinforcement of acts of cognition by the actual consequences of concurrent motor acts. Adults made a series of two-choice brightness discriminations; on 60% of trials, choosing the brighter stimulus produced a “correct” signal while errors produced an aversive sound. On 40% of trials, the choice stimuli did not in fact differ in brightness; the consequences of responding on these “identical stimuli” trials differed across blocks of trials. Thus, on these trials perceptual judgments were directly followed by events that they did not produce. When all choices on identical stimuli trials were punished with the “error” sound, subjects showed little preference for the left-side or right-side identical stimuli, but when all choices of identical stimuli were reinforced with the “correct” light, individual preferences for the left-side or the right-side stimuli substantially increased. As the consequences of responding on identical stimuli trials were independent of the stimuli chosen, these findings provide evidence for superstitious perception, the reinforcement of perceptual acts by events that do not depend upon their occurrence.

Peptic Ulcer and Mental Disorders Among Adults in the Community: The Role of Nicotine and Alcohol Use Disorders

Previous studies have documented links between peptic ulcer disease (PUD) and mood and anxiety disorders among adults in the community. Several substance use disorders (e.g., nicotine and alcohol dependence) are highly comorbid with mood/anxiety disorders and have been also linked with PUD. No previous study has examined the potentially explanatory role of substance use disorders in the link between mood and anxiety disorders and PUD. The objective of the study is to examine relationships between a range of mental disorders and PUD among adults in the United States and to examine the potentially explanatory role of substance use disorders in these links. Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of US adults 18 years of age and over (n = 43,098). Diagnostic and Statistical Manual for Mental Disorders IV diagnoses of mood, anxiety, and substance use disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV, and PUD status was assessed via self-report. Findings show that mood/anxiety disorders were associated with PUD. Specifically, generalized anxiety disorder (GAD) (Odds ratio (OR) = 3.43) was most strongly associated with PUD, followed by panic disorder (OR = 3.11), dysthymia (OR = 3.59), and bipolar disorder (OR = 2.91). The relationships between most mood/anxiety disorders and PUD were substantially attenuated after adjusting for nicotine and alcohol dependence. Mood/anxiety disorders are associated with increased rates of PUD; nicotine and alcohol dependence seems to play a substantial role in explaining the link with PUD.

Post-Partum Psychosis: Which Women Are at Highest Risk?

A range of psychological disorders occur in women in the post-partum period. These include “the blues”, which occurs in the first days after birth and which is very common and self-limiting; severe psychoses often associated with mania or bipolar illness, occurring in the first weeks after birth [1]; and mild to moderate depression, occurring weeks to months after birth.

Mental disorders and cardiovascular disease among adults in the United States

Objective Numerous population-based studies have found an association between major depression and CVD, though these studies did not assess anxiety disorders. Patient samples have shown associations between anxiety disorders and cardiovascular disease (CVD), but without consideration of depressive disorders. Therefore, it remains unclear whether: (a) both anxiety and depressive disorder are associated with CVD; (b) these associations are generalizable to adults in the community. Materials and Methods Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 43,093 civilian non-institutionalized participants aged 18 and older. Results CVD (total prevalence 3.3%) was associated with increased likelihood of any anxiety disorder (OR = 1.43, (1.20, 1.71)), after adjusting for depressive disorders, as well as Generalized Anxiety Disorder (OR = 1.48 (1.09, 2.01)), Panic disorder (OR = 1.46 (1.12, 1.91)), and specific phobia (OR = 1.29 (1.04, 1.59)). CVD was significantly associated with any mood disorder (OR = 1.34 (1.13, 1.58)) after adjusting for anxiety disorders, though neither the link with major depression, nor other specific mood disorders remained significant after adjustment. Conclusions Our findings suggest that anxiety disorders, mood disorders, and CVD are highly comorbid among adults in the United States, and demonstrate the importance of including anxiety disorder assessment in studies of mental and physical comorbidity. These results reveal how the lack of investigation into specific relationships between CVD and the range of mental disorders in population-based studies of risk factors for CVD may obscure important relationships.

Teens Who Get Moving Leave Mental Illness Behind

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessTeens Who Get Moving Leave Mental Illness BehindJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:21 Dec 2007https://doi.org/10.1176/pn.42.24.0020Regular physical activity is associated with a substantially reduced risk for some, but not all, mental disorders, Andreas Stroehle, M.D., an assistant professor of psychiatry at Charity-University Medicine Berlin, and colleagues reported in the November Psychological Medicine.Their study appears to be the first large-scale one to explore prospectively the relationship between exercise and a range of mental disorders. The study also focused on the age group most vulnerable to the development of mental illness—youth.More than 2,500 subjects were randomly selected for the study from the 1994 government registries of all residents aged 14 to 24 in metropolitan Munich and surrounding counties. The subjects were assessed with the DSM-IV Composite International Diagnostic Interview both at the start of the study and in the subsequent four years. This instrument covers anxiety, eating, mood, somatoform, and substance disorders.Subjects were also evaluated at the start of the study regarding the amount of physical exercise in which they engaged. The researchers rated them as“ regular exercisers” if they engaged in exercise daily or several times a week, as “non-regular exercisers” if they engaged in exercise one to four times a month, or as “non-exercisers” if they engaged in exercise less than once a month or not at all. At the start of the study, half the subjects were found to be regular exercisers, 15 percent non-regular exercisers, and 35 percent non-exercisers.The researchers then looked for links between the amount of exercise subjects engaged in at the start of the study and the development of various mental disorders over the next four years.Compared with subjects who did not exercise, subjects who engaged in regular exercise or in non-regular exercise had a significantly lower incidence of any mental disorder, and specifically a significantly lower incidence of agoraphobia with or without panic disorder, any anxiety disorder, any somatoform disorder, a specific phobia, dysthymia, and posttraumatic stress disorder. Moreover, major depressive disorder and substance use disorders were lower in the regular and non-regular exercisers than in the non-exercisers, although the differences were not statistically significant. These findings held even when educational status, body mass index, other mental disorders, and impairment days due to physical problems were taken into account.However, there was no significant link between physical exercise and eating disorders. And subjects who exercised regularly or non-regularly at the start of the study were actually found to be at a significantly greater risk of being diagnosed with bipolar disorder than were those subjects who did not exercise at the start of the study.Thus, physical exercise may help safeguard people from some types of mental illnesses, but not others, Stroehle and his team concluded. “Further examination of the evidently complex mechanisms and pathways underlying these associations might reveal promising new research targets and procedures for targeted prevention,” they added.“This is an interesting study,” Ronald Kamm, M.D., said in an interview. Kamm is a sport psychiatrist based in Oakhurst, N.J., and the immediate past president of the International Society for Sport Psychiatry. One of the findings that surprised him, he said, was that teens who were physically inactive were no more prone to major depression than were teens who were physically active. “Maybe teenagers are more immune than older people to the effect of inactivity in bringing on depression,” he said.Another finding that surprised him, he said, was that teens who engaged in physical activity were at significantly greater risk of being diagnosed with bipolar disorder than were teens who were physically inactive. Stroehle and his group suspect that people prone to bipolar disorder may have a predisposing personality trait to be physically active. Kamm does, too. Moreover, this finding raises a provocative question, he pointed out: Might exercise bring on recurrences of mania or depression in persons who already have the disorder? This possibility “should be explored,” he believes.On the whole, this large prospective study confirms what other smaller, retrospective studies have found—“that there is a beneficial effect of physical activity on most emotional problems,” Kamm concluded. And since people who start exercise programs often don't maintain them, Kamm has found a simple way to get patients in need of physical activity to get moving. He asks patients to wear a pedometer each day not only to determine the extent of their physical activity, but to increase it a little each day.The study was funded by the German Ministry of Research and Technology and the German Research Society.An abstract of “Physical Activity and Prevalence and Incidence of Mental Disorders in Adolescents and Young Adults” is posted at<http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1379132&fu...>.▪ ISSUES NewArchived

Cannabis use and cannabis use disorders and their relationship to mental disorders: A 10-year prospective-longitudinal community study in adolescents

Background Whereas the role of externalizing disorders is relatively well established in predicting the onset of cannabis use (CU) or cannabis use disorder (CUD), the status of anxiety and mood disorders in predicting CU and CUD remains controversial. Objective (1) To examine cross-sectional and prospective associations of CU and CUD with a range of mental disorders and whether anxiety and mood disorders are associated with CU/CUD after adjusting for externalizing disorders. Methods N = 1395 community subjects aged 14–17 at baseline were followed-up at three waves prospectively over 10 years. Substance use, substance disorders and mental disorders were assessed using the DSM-IV/M-CIDI. Results (1) The baseline prevalence rates where 19.3% at t 0 for CU and 2.6% for CUD. Cumulative incidence rates at t 3 were 54.3% for CU and 13.7% for CUD. (2) In cross-sectional and prospective analyses other substance use disorders, mood and anxiety disorders were associated with CU and CUD. (3) Associations of panic-anxiety with CU and of depressive and bipolar disorders with CU and CUD were significant after controlling for externalizing disorders. Conclusion A range of psychopathological conditions, including depressive, bipolar and less consistently anxiety disorders as well as the degree of their comorbidity are significantly associated with incident CU and progression to CUD, even when controlling for externalising disorders. A better understanding of this complex interplay may result in better aetiological models and intervention strategies.

Personal Social Networks and Dual Disorders: A Literature Review and Implications for Practice and Future Research

ABSTRACT Objectives: To review and examine the literature on social networks and dual disorders, and the separate literatures on social networks in relation to mental illness and substance abuse respectively, and to consider implications for practice and research. Methods: Papers selected for review included empirical studies of social networks and/or social support of adults with diagnosed substance use and/or mental disorders. Results: Thirty-six studies met the criteria for review which is organized around three themes: structural characteristics of social networks, network composition, and the impact of social networks on treatment and recovery. Conclusions: Social networks function both as a predictor as well as an outcome of mental illness and substance use. Understanding and assessment of social networks is important to understanding addictive behaviors. Further research is needed in the following areas: the role of social networks in readiness for treatment, entry into and participation in treatment, and support for recovery; the impact of treatment and peer support programs on social networks; social networks in relation to a wider range of mental disorders (e.g., depression, anxiety and post traumatic stress disorder); and the impact of race, ethnicity, and gender on social networks of adults with dual disorders. In addition, the role that families play in treatment and recovery as well as the impact of clients' dual disorders upon family members needs examination.

Effects of transient reduction of endogenous 5-HT levels on 11C-DASB and 11C-MDL100907 specific binding: Implications for finding a serotonergic radiotracer vulnerable to endogenous competition in humans

Serotonin (5-HT) neurotransmission is involved in the normal regulation of affect and cognition, and its dysfunction is implicated in a range of mental disorders. However, there is currently no method to directly assess 5-HT synaptic levels in the living human brain. In the human dopamine (DA) system, baseline receptor occupancy by endogenous DA can be estimated by measuring the effects of DA depletion on the binding of certain radioligands through endogenous competition, particularly in striatum. For example, the measured increase in 11C-raclopride and 123I-IBZM binding following acute DA depletion implies a baseline D2 receptor occupancy of 10% in healthy humans. Brain 5-HT can be transiently and safely reduced by rapid tryptophan depletion (RTD), a technique involving the ingestion of an amino acid mixture lacking L-tryptophan, the dietary precursor of 5-HT. We have used RTD in healthy humans in an attempt to demonstrate a measurable effect of reduced 5-HT on the specific binding of the selective 5-HT transporter (SERT) ligand 11C-DASB and the selective 5-HT2A receptor antagonist ligand 11C-MDL100907. However, values of regional specific binding were not significantly different between the reduced endogenous 5-HT and control conditions for either tracer. These results suggest that PET with 11C-DASB or 11C-MDL100907 is not sensitive to the decreased concentration of synaptic 5-HT following RTD, and that neither tracer has the potential for measuring changes in synaptic levels of 5-HT in vivo. Imaging techniques relying on endogenous competition would ideally require a brain region with high synaptic levels of, and significant baseline receptor occupancy by, endogenous neurotransmitter. However, in vivo microdialysis studies in non-human primates suggest that extracellular 5-HT concentration is very low (< 0.5 nM) across brain regions and is 1 – 2 orders of magnitude lower than striatal DA levels. In the case of the 5-HT2A receptor, this concentration is significantly below the estimated KD of 5-HT for the receptor configured in a state of high affinity for agonists ( 1.3 nM). Moreover, in vitro studies suggest that the proportion of receptors configured in a state of high affinity for agonists, and therefore potentially available to endogenous 5-HT, is low ( 13%). Together, these values suggest that baseline occupancy of 5-HT2A receptors by 5-HT may be only approximately 2%, making changes following increased or decreased 5-HT unmeasurable by current techniques in humans. Agonist serotonergic radioligands may be expected to be superior for endogenous competition studies, but have so far been unsuccessful in humans. Efforts to experimentally increase baseline receptor occupancy (for example by pretreatment with selective 5-HT reuptake inhibitor medication) prior to RTD may be of interest. However, the insensitivity of current tracers to endogenous competition implies that they may be used to measure differences in SERT or 5-HT2A receptor availability between populations or during therapy without the need to consider concomitant changes in neurotransmitter concentration.

A Cognitive Theory and Therapy for Chronic Insomnia

The aim of this article is to review progress toward developing a cognitive theory of and therapy for chronic insomnia. The article will begin with a brief overview of cognitive behavior therapy for insomnia (CBT-I), the current treatment of choice, which devotes approximately one session to cognitive therapy. On the basis of (a) the conclusion from a recent review of psychological treatments for insomnia that cognitive therapy has received insufficient attention and evaluation and (b) the evidence that cognitive therapy for a range of other psychological disorders has improved treatment outcome, the remainder of the article describes another approach to the treatment of insomnia: cognitive therapy for insomnia (CT-I). This treatment is derived from a cognitive model that specifies five processes that function to maintain insomnia: worry (also known as cognitive arousal), selective attention and monitoring, distorted misperception of sleep and daytime deficits, unhelpful beliefs about sleep, and counterproductive safety behaviors. The aim of the treatment is to reverse all five maintaining processes during both the day and the night. Keywords: cognitive therapy; insomnia; sleep; attention; beliefs Since the groundbreaking work of Aaron T. Beck and his colleagues (e.g., 1976), cognitive theories and therapies have led to a much enhanced understanding of a wide range of psychological disorders (see Salkovskis, 1996). The aim of the present article is to review progress toward developing a cognitive theory of, and therapy for, chronic insomnia. The article will begin with a brief overview of what is currently regarded as the treatment of choice for insomnia; cognitive behavior therapy for insomnia or CBT-I. CBT-I is a multicomponent treatment that is conducted over 4 to 10 weekly sessions (Morin & Espie, 2003), with one of these sessions typically devoted to cognitive therapy. The remainder of the article will describe a different approach to the treatment of insomnia. This will be referred to as cognitive therapy for insomnia, or CT-I. CT-I is driven by one cognitive model of the maintenance of insomnia and every session is devoted to using core cognitive therapy skills to reverse the cognitive maintaining processes specified by the cognitive model. WHAT Is INSOMNIA? Insomnia is a chronic difficulty that involves problems getting to sleep, maintaining sleep, or waking in the morning not feeling restored. It is one of the most prevalent psychological health problems, reported by 10% of the population (Ancoli-Israel & Roth, 1999). The consequences for the sufferer are severe and include functional impairment, work absenteeism, impaired concentration and memory, and increased use of medical services (Roth & Ancoli-Israel, 1999). Further, there is evidence that insomnia significantly heightens the risk of having an accident (Ohayon, Caulet, Philip, Guilleminault, & Priest, 1997) and the risk of subsequently developing another psychological disorder, particularly an anxiety disorder, depression, or substance-related disorder (Harvey, 2001; McCrae & Lichstein, 2001). It is therefore regarded as a serious public health problem. In this paragraph a distinction is drawn between the original cause/s or precipitant/s of insomnia (i.e., the distal cause/s) and the causes that are active at the time the client is seeking treatment (i.e., the proximal cause/s). The former will be referred to as precipitant/s and the latter as maintaining process/es. Although in this paper we are primarily concerned with the processes that maintain insomnia, rather than the precipitating factors, it is emphasized that the precipitants are likely to be heterogeneous and may include physical disorders, substances, circadian rhythm disturbances, psychological factors, and poor sleep habits (Bootzin, Manber, Perlis, Salvio, & Wyatt, 1993). The reason for focusing on the maintaining processes is that the relative contribution of precipitating and maintaining processes is likely to vary over the course of a disorder with the precipitating processes (e. …

Effects of reduced endogenous 5‐HT on the in vivo binding of the serotonin transporter radioligand 11C‐DASB in healthy humans

Although abnormal serotonin (5-HT) function is implicated in a range of mental disorders, there is currently no method to directly assess 5-HT synaptic levels in the living human brain. The in vivo binding of some dopamine (DA) radioligands such as (11)C-raclopride is affected by fluctuations in endogenous DA, thus providing an indirect measure of DA presynaptic activity. Attempts to identify a serotonergic radiotracer with similar properties have proved unsuccessful. Here, we investigated in humans the effects of reduced synaptic 5-HT on the in vivo binding of the 5-HT transporter (SERT) radioligand (11)C-DASB, using Positron Emission Tomography (PET) and the rapid tryptophan depletion (RTD) technique. Eight (8) subjects (5M, 3F) were scanned with (11)C-DASB under control and reduced endogenous 5-HT conditions, in a within-subject, double-blind, counterbalanced, crossover design. Regional distribution volumes (V(T)) were calculated using kinetic modeling and metabolite-corrected arterial input function. (11)C-DASB specific binding was estimated as binding potential (BP) and specific to nonspecific equilibrium partition coefficient (V(")(3)), using the cerebellum as reference region. RTD caused small but significant mean reductions in (11)C-DASB V(T) (-6.1%) and BP (-4.5%) across brain regions, probably explained by a concomitant reduction in (11)C-DASB plasma free fraction (f(1)) of similar magnitude. No significant change in (11)C-DASB V(")(3) was observed between control and reduced 5-HT conditions. Nor was there a significant relationship between the magnitude of tryptophan depletion and change in BP and V(")(3) across individual subjects. These results suggest that (11)C-DASB in vivo binding is not affected by reductions in endogenous 5-HT.

Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS).

The German National Health Interview and Examination Survey (GHS) is the first government mandated nationwide study to investigate jointly the prevalence of somatic and mental disorders within one study in the general adult population in Germany. This paper reports results from its Mental Health Supplement (GHS-MHS) on 4-week 12-month, and selected lifetime prevalence of a broad range of DSM-IV mental disorders, their co-morbidity and correlates in the community. The sample of the GHS-MHS (n=4181; multistage stratified random sample drawn from population registries; conditional response rate: 87.6%) can be regarded as representative for the German population aged 18-65. Diagnoses are based on fully structured computer assisted clinical interviews (M-CIDI), conducted by clinically trained interviewers. 12-month prevalence for any DSM-IV study disorder is 31% (lifetime: 43%; 4-week: 20%) with anxiety disorders, mood disorders and somatoform syndromes being the most frequent diagnoses. Retrospective age of onset information reveals that most disorders begin early in life. Co-morbidity rates among mental disorders range from 44% to 94%. Correlates of increased rates of mental disorders and co-morbidity were: female gender (except for substance disorders), not being married, low social class, and poor somatic health status. Health care utilization for mental disorders depended on co-morbidity (30% in 'pure', 76% in highly co-morbid cases) and varied from 33% for substance use disorders to 75% for panic disorder. Results confirm and extend results from other national studies using the same assessment instruments with regard to prevalence, co-morbidity and sociodemographic correlates, covering a broader range of DSM-IV disorders [i.e. somatoform disorders, all anxiety disorders (except PTSD), mental disorders due to substance or general medical factor, eating disorders]. Intervention rates were higher than in previous studies, yet still low overall.

Panic attacks and psychopathology among youth.

To determine the association between panic attacks and mental disorders among youth in the community. Data were drawn from the Methods for the Epidemiology of Child and Adolescent Mental Disorders study (n = 1285), a community-based sample of youth aged 9-17. Multiple logistic regression analyses were used to determine the association between panic attacks and the range of mental disorders, diagnosed with the Diagnostic Interview Schedule for Children 2.3. Panic attacks were prevalent among 3.3% of the sample. Panic attacks were associated with an increased likelihood of any anxiety disorders [OR = 4.6 (2.5, 8.5)] and any affective disorder [OR = 5.8 (2.8, 11.7)], as well as social phobia [OR = 2.3 (1.0, 5.4)], specific phobia [OR = 3.4 (1.1, 10.1)], agoraphobia [OR = 2.9 (1.1, 7.6)], generalized anxiety disorder [OR = 4.8 (1.9, 12.1)], separation anxiety disorder [OR = 3.1 (1.3, 7.7)], major depression [OR = 3.6 (1.6, 8.3)], dysthymia [OR = 6.7 (2.9, 15.5)], and hypomania [OR = 26.1 (5.5, 124.1)]. These data are consistent with, and extend, previous clinical findings by showing that panic attacks are associated with increased likelihood of a range of affective and anxiety disorders, but not substance use disorders, among youth in the community. The use of longitudinal study designs in future investigations may be useful in increasing our understanding of the mechanisms underlying these associations.

Mental disorders and asthma in the community.

To determine the association between asthma and mental disorders among adults in the community. Germany. Representative sample of the general population aged 18 to 65 years. Diagnoses of current (the past 4 weeks) and lifetime asthma were based on physician diagnosis; current and lifetime DSM-IV mental disorders were assessed using the Composite International Diagnostic Interview. Current severe asthma (the past 4 weeks) was associated with a significantly increased likelihood of any anxiety disorder (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.35-5.18), specific phobia (OR, 4.78; 95% CI, 2.35-4.05), panic disorder (OR, 4.61; 95% CI, 1.09-9.4), and panic attacks (OR, 4.12; 95% CI, 1.32-12.8). Lifetime severe asthma was associated with the increased likelihood of any anxiety disorder (OR, 2.09; 1.3-3.36), panic disorder (OR, 2.61; 95% CI, 1.29-5.25), panic attacks (OR, 2.84; 95% CI, 1.66, 4.89), social phobia (OR, 3.28; 95% CI, 1.42, 7.59), specific phobia (OR, 2.93; 95% CI, 1.71-5.0), generalized anxiety disorder (OR, 5.51; 95% CI, 2.29-13.22), and bipolar disorder (OR, 5.64; 95% CI, 1.95-16.35). Current nonsevere asthma was associated with the increased likelihood of any affective disorder (OR, 2.42; 95% CI, 1.03-5.72); and lifetime nonsevere asthma was associated with increased odds of any anxiety disorder (OR, 1.51; 95% CI, 1.0-2.32), anxiety disorder not otherwise specified (OR, 2.08; 95% CI, 1.03-4.23), and any somatoform disorder (OR, 1.7; 95% CI, 1.14-2.53). To our knowledge, these findings are consistent with and extend the findings of previous reports by providing the first available information on the association between physician-diagnosed asthma and DSM-IV mental disorders in a representative population sample of adults. Our results suggest an association between asthma and a range of mental disorders. Longitudinal studies that can examine the sequence of onset and the role of genetic and environmental factors in the association between asthma and affective and anxiety disorders are needed next to further elucidate possible shared causative mechanisms.

Suicide attempts among patients with psychosis in a Chinese rural community

There are about over 300000 suicides in Chinaper year and this makes suicide the fifth mostimportant cause of death in the country, andmakesthesuiciderateinChinaoneofthehighestin the world (1, 2). Unlike the situation in othercountries(3,4),suicideoccursmoreofteninruralthaninurbanareasinChina,andtherearemoresuicide deaths among young females than males(2, 5). Moreover, a number of studies havesuggested that individuals who attempt suicideor who die by suicide have high rates of a rangeof mental disorders (5–10). Of those who madeserious suicide attempts, over 90% had a mentaldisorderatthetimeoftheattempt(6).Theriskofdying by suicide in patients with psychosis isincreasedbythepresenceofdepression(11,12).Alarge number of patients with schizophreniaattempt suicide, with estimates of lifetime occur-rence ranging from 18 to 55% (13). Althoughmost suicide attempts do not result in death, ahistory of suicide attempts is common in patientswithschizophreniawhodieofsuicide(40to61%of cases) (14, 15).However, suicidal attempts have not been sys-tematicallyexaminedacrossthebroadspectrumofpatients with psychotic disorders in the commu-nity. The relationship between psychosis andseriousattemptedsuicideisstillunclear(6,16).In the Chinese context, as suicide has not beenseen as a problem that should be addressedprimarily by the mental health system (2, 3),suicide attempts among patients with psychoticdisordershavenot beenstudiedcarefully. We areawareofnoresearchonthenaturalprevalenceofattempted suicide among individuals with psy-choticdisordersintheruralcommunityinChina.Doyoungfemalepatientsstillmakemoresuicideattempts than male patients? What are the char-acteristics of psychotic patients who attemptsuicide?

The pattern of psychiatric disorders among the aged in a selected community in Nigeria.

To describe the common mental disorders in elderly Nigerians living at home. A house-to-house survey of a rural community was conducted to identify subjects who were aged 60 years and above. The subjects were interviewed with the Self-Reporting Questionnaire (SRQ-24) and the Geriatric Mental State Schedule (GMS). Psychiatric syndromal diagnoses were made with the Clinical and Research ICD-10 manuals (ICD-10/ICD-10, DCR). The overall rate of major mental disorders was 23.1%, with depression constituting 79% of all the diagnoses. Specific dementia disorders were not found in any of the subjects (N=164), but 20.7% complained of forgetfulness. Use of tobacco (snuff), (local) alcohol, and other substances were common. No subject with any identified disorder was receiving any medical attention. The study reveals the same range of mental disorders as in studies carried out elsewhere. This suggests that if similar methodologies are used, the mental morbidity rates among the elderly in different parts of the world may be about the same. There is a need for adequate planning to accommodate the social security and mental health needs of old Nigerians.

The Nature of Schizophrenia: Signposts to Prevention

Objective To describe the characteristics of schizophrenia relevant to conducting indicated preventive interventions. Method A systematic review of the literature informed by experiences at the Personal Assistance and Crisis Evaluation (PACE) clinic. Results Primary prevention requires a sophisticated knowledge of key causal risk factors relevant to the expression of a disorder. The causal risk factors most useful from an intervention standpoint may turn out to be somewhat removed from the neurobiology of the disorder and may even be relatively non-specific, so that tackling them could reduce the risks for a range of mental disorders. The frontier for more specific prevention in schizophrenia and related psychosis is currently represented by indicated preventive interventions for subthreshold symptoms. Again, these may be relatively broad spectrum early in the prepsychotic phase but more proximal to onset, greater treatment specificity can be explored. However, this can be viewed more as preventively orientated treatment rather than primary prevention per se. Early detection of first episode psychosis and optimal intensive treatment of first episodes and the critical early years after diagnosis also represent increasingly attractive preventive foci in psychotic disorders. Conclusion As evidence accumulates, implementation of evidence-based practice in real work settings is a major challenge as it is throughout the mental health service system. The momentum of preventively orientated treatment must be maintained through the 2nd National Mental Health Strategy and in the face of recent misleading polemic regarding the treatability of psychotic disorders, especially schizophrenia. The evidence demonstrates that schizophrenia and related disorders have never been more treatable.