Chris Thompson

A comparison of normal, bipolar and seasonal affective disorder subjects using the seasonal pattern assessment questionnaire

The Seasonal Pattern Assessment Questionnaire is an instrument for retrospective self-rating of change in mood and vegetative functions with the seasons. It has been used in studies to identify and characterise patients with Seasonal Affective Disorder (SAD) in three countries. In this paper, the test-retest reliability of all items and the sensitivity to differences between groups have been investigated. Clear differences were found between the SAD group and a normal group. A group of bipolar affective disorder patients had intermediate scores on reported seasonal changes between the normal and SAD groups. All groups reported significant changes in mood and vegetative functions during the winter in the direction symptomatic for SAD suggesting that SAD patients may suffer an exaggerated form of a normal seasonal variation.

The Seasonal Health questionnaire: a preliminary validation of a new instrument to screen for Seasonal Affective Disorder

BACKGROUND The main screening tool for Seasonal Affective Disorder (SAD) is the Seasonal Pattern Assessment Questionnaire, but its reliability and validity have been thrown into doubt by several studies. METHOD In this study we developed a new questionnaire, the Seasonal Health Questionnaire (SHQ), which is scored by computer to derive the four main operational criteria for diagnosis of SAD. A group of clinically diagnosed SAD patients was contrasted with a group of patients with recurrent non-seasonal depressive disorder using the SPAQ and the SHQ. RESULTS The SHQ could be completed without difficulty by patients with long histories of recurrent mood disorder. The SPAQ and the Rosenthal Criteria were the least specific of the criteria for identifying SAD - misclassifying many non-seasonal patients. CONCLUSIONS After further development the SHQ may be a more appropriate screening instrument for SAD. The SPAQ should no longer be used for this purpose as it gives misleadingly high estimates of prevalence.

A longitudinal study of the neuropsychiatric consequences of HIV-1 infection in gay men. II. Psychological and health status at baseline and at 12-month follow-up.

The aim of this study was to determine whether HIV infection is associated with increased psychosocial distress in the asymptomatic and early symptomatic stages of disease and to determine the factors associated with reporting health symptoms. Subjects included 61 gay men (41 HIV--, 20 HIV+) who were assessed at the time of requesting their first HIV test and again 12 months later. Measures included a detailed standardized psychiatric interview (Present State Examination, PSE), a range of psychosocial self-report measures and a physical symptom checklist. There were no differences between the HIV+ and HIV-- groups in terms of self-reported symptoms. Multiple regression analysis showed that the symptom reporting was not associated with clinical or immunological markers of disease progression but was associated with measures of psychosocial distress. Although both groups showed elevated levels of psychosocial distress at the time of HIV testing, there were no differences between serostatus groups at follow-up. Multiple regression analysis indicated that the best predictors of PSE scores at follow-up were baseline PSE score and a history of psychiatric illness. Early HIV disease is not associated with increased psychosocial distress and symptom reporting is more closely related to psychological measures than to clinical or immunological markers of disease.

The Hampshire Depression Project: development and piloting of clinical practice guidelines and education about depression in primary health care

This paper describes the development and piloting of a comprehensive educational programme about recognition and management of depressive illness in primary care. Full evaluation of the effectiveness of the programme is currently underway in a randomized controlled trial, the Hampshire Depression Project (HDP), involving 56 general practices. The programme consists of clinical practice guidelines, practice‐based seminars and follow‐up sessions. Each part of the programme has been designed to be flexible, clinically oriented and relevant to all members of the multidisciplinary primary care team. The pilot study established the need for a systematic approach to the access of practices and practice teams, and the organization and process of the seminars. Application of this approach was associated with excellent attendance in the main programme.

NEUROPSYCHIATRIC ASPECTS OF HIV-1 INFECTION IN GAY MEN - CONTROLLED INVESTIGATION OF PSYCHIATRIC, NEUROPSYCHOLOGICAL AND NEUROLOGICAL STATUS

The aim of this study was to determine whether HIV infection is associated with psychiatric morbidity or neuropsychological impairment in asymptomatic and early symptomatic stages of disease in gay men. The subjects were 100 gay men (68 HIV-ve, 32 HIV+ve, 6 being CDC IV). All subjects were recruited at the time of requesting their first HIV test and the assessment was double-blind to HIV serostatus. There were no differences in psychiatric status or neuropsychological performance between the HIV-ve and HIV+ve groups. Multiple regression analysis and logistic regression were used to identify factors associated with psychiatric morbidity, neuropsychological impairment and subjective reporting of memory problems and physical symptoms for all 100 subjects. Previous psychiatric history and current illegal (non-dependent) drug use were associated with psychiatric morbidity, poor education was associated with neuropsychological impairment and psychiatric status (score on HAD and PSE) was associated with subjective reporting of memory problems and physical symptoms.

A randomized controlled trial of problem solving for anxiety, depression and life difficulties by community psychiatric nurses among general practice patients: Background and method

It is not clear whether treatment for anxiety, depression and life difficulties by community psychiatric nurses in primary care is effective or cost-effective. Community psychiatric nurses are asked to focus their attention on patients with a diagnosis of severe and enduring mental health problems. The one previous study of community psychiatric nurses in primary care found no difference in outcome at 6 months, but patients with community psychiatric nurse care had fewer days off work over the study period. Problem solving by general practitioners (GPs) and community nurses has been shown to be effective for emotional disorders and depression in primary care. Treatment by community psychiatric nurses may have advantages in that it could reduce GP time and prescribing. Patients may prefer community psychiatric nurse care to psychiatric referral and community psychiatric nurses may prefer mixed case loads. This study was designed in order to inform policy on this issue. This paper describes the design of a randomized controlled trial and economic evaluation comparing community psychiatric nurse problem-solving treatment, generic community psychiatric nurse care and usual GP care for patients with anxiety, depression and life difficulties. If referral to community psychiatric nurses proves not to be effective or cost-effective GPs should be advised against referring patients with these types of problems. If community psychiatric nurse intervention is more effective and cost effective than GP treatment then models of care appropriate for delivering in primary care should be considered.

A longitudinal study of the neuropsychiatric consequences of HIV-1 infection in gay men. I: Neuropsychological performance and neurological status at baseline and at 12-month follow-up

The aim of this study was to determine whether HIV infection is associated with neurological or neuropsychological impairment in the asymptomatic and early symptomatic stages of disease. Subjects included 61 gay men (41 HIV-, 20 HIV+) who were assessed at the time of requesting their first HIV test and again 12 months later. The assessments at baseline were conducted double-blind to HIV serostatus. Measures included a neuropsychological battery, neurological examination and full psychiatric assessment. There were no differences between the asymptomatic HIV+ and HIV- groups at baseline or at follow-up in terms of mean scores on neuropsychological tests. Mean scores were within the normal range for all neuropsychological tests for both groups. Multiple regression analysis was used to predict each individuals performance at follow-up on the basis of their baseline performance, psychiatric state, neurological history and drug use for each of the neuropsychological tests. HIV+ subjects were more likely than control subjects to perform at a significantly lower level at follow-up on one or more tests than predicted on the basis of their baseline performance.

Must “second victims” always be in the wrong?

Edrees and Federico discuss the support of clinicians after medical error—the “second victims.”1 The concept of second victims seems to revolve around medical error and the psychological consequences of these events on the clinician. A surgeon’s usual duties meet criterion A of the Diagnostic and Statistical Manual of Mental Disorders , 5th edition (DSM-5) for post-traumatic …

The future of mental health research in primary care settings.

Since the Declaration of Alma Ata (World Health Organization, 1978) there has been a steady move world wide for health care to be primary care led, with secondary care offering specialist knowledge and increasingly sophisticated investigation and treatment in support. The vast majority of illness and disease is managed in primary care, but paradoxically, while general practice contributes the greatest activity and most prescriptions, it has until recently produced but a small fraction of the knowledge base for practice (Orme et al., 1990). Application of results from research in secondary care settings to primary care may be quite inappropriate due to differences in severity and natural history of disease among those patients reaching secondary care. At the end of the 20th Century we remain unclear about the epidemiology and response to treatment of many conditions in the community, and this applies particularly to mental health problems of all kinds. There are two main reasons for this; on the one hand, is the complex nature of mental illness and disease, and the lack of aetiological clarity, leading to difficulty in defining cases at the research level in primary care. On the other, is the nature of primary care, its organisation and delivery, which poses challenges to research design, intervention development and delivery, and valid and reliable outcome assessment. As a result it remains an open question as to how to provide care most cost effectively to patients with schizophrenia through primary care. Equally the optimal detection and management strategies for the range of depression in primary care is unclear.

Adult survivors of child sex abuse. Group therapies are also effective.

Group therapies are also effective EDITOR,--In their paper on the pilot service, Breakfree, for adult survivors (both men and women) of childhood sexual abuse David Smith and colleagues leave some points unclear.1 How many support workers were there, and how professionally trained were they? They were “initially supervised,” but by whom and for how long? The average duration of a counselling session was 1.8 hours (no range was given), sometimes twice weekly. This seems a lavish use of …