Associations between psychosis endophenotypes across brain functional, structural, and cognitive domains.

BACKGROUND: A range of endophenotypes characterise psychosis, however there has been limited work understanding if and how they are inter-related. METHODS: This multi-centre study includes 8754 participants: 2212 people with a psychotic disorder, 1487 unaffected relatives of probands, and 5055 healthy controls. We investigated cognition [digit span (N = 3127), block design (N = 5491), and the Rey Auditory Verbal Learning Test (N = 3543)], electrophysiology [P300 amplitude and latency (N = 1102)], and neuroanatomy [lateral ventricular volume (N = 1721)]. We used linear regression to assess the interrelationships between endophenotypes. RESULTS: The P300 amplitude and latency were not associated (regression coef. -0.06, 95% CI -0.12 to 0.01, p = 0.060), and P300 amplitude was positively associated with block design (coef. 0.19, 95% CI 0.10-0.28, p 0.38). All the cognitive endophenotypes were associated with each other in the expected directions (all p < 0.001). Lastly, the relationships between pairs of endophenotypes were consistent in all three participant groups, differing for some of the cognitive pairings only in the strengths of the relationships. CONCLUSIONS: The P300 amplitude and latency are independent endophenotypes; the former indexing spatial visualisation and working memory, and the latter is hypothesised to index basic processing speed. Individuals with psychotic illnesses, their unaffected relatives, and healthy controls all show similar patterns of associations between endophenotypes, endorsing the theory of a continuum of psychosis liability across the population.

High service users: does the clinical psychologist have a role?

OBJECTIVE: To assess the impact of psychological intervention on high users of the GP service. DESIGN: A sample of high-attenders was offered the opportunity to attend an interview with a clinical psychologist. A three-year (one year before and two years after psychological intervention) survey of patient records was carried out to determine the pattern of patient attendances. In addition, GP and patient satisfaction questionnaires were utilised to rate the psychological service. SETTING: A GP surgery situated in the coastal region of Scotland. SUBJECTS: All adult patients, who had consulted over 12 times in the 12 months prior to the beginning of the study except those who had ongoing medical problems that the GP felt were being dealt with adequately, were invited to a psychological interview. In all, 174 invitations were sent, and 101 agreed to psychological intervention. RESULTS: After three months both the GPs and patients positively rated the input of the psychologist. There were short-term benefits from the psychological intervention in terms of attendance rates, which were not in evidence in the long term. For the participating group there was a significant decrease in attendance rate three months after psychological intervention compared to the non-participating group (P < 0.001). However, at 12 and 24 months after intervention both groups reduced attendance at a similar rate. CONCLUSION: Psychologist intervention had a short, but not long term, benefit, in reducing attendance rates. However, both GPs and patients found the provision of a report from the psychologist useful.

Thyroid disease and abnormal thyroid function tests in women with eating disorders and depression.

Forty-two female patients with an eating disorder and major depression were compared with 48 female patients with major depression in a retrospective chart study for the prevalence of thyroid disease and laboratory thyroid function abnormalities in the absence of thyroid disease. Eating disorder patients, aged 30-80 years, had a significantly higher incidence in thyroid diseases (53%) then those with major depression alone (17%). The incidence of thyroid disease did not differ between the two groups among patients aged 11-29 years. Abnormal thyroid screening values occurred in 40% of euthyroid eating disorder patients and 34% of those with major depression. While the overall prevalence of thyroid disease in depressed females (15%) was similar to that in the general population (10.5%), thyroid disease in the eating disordered/depressed patients was twice the rate expected (24%) in the general population. Female patients who require psychiatric hospitalization should be routinely evaluated for thyroid function, especially those diagnosed with an eating disorder and depression.

Smoking attitudes amongst nursing tutors and their students.

We have compared the smoking habits, and attitudes towards the habit, in 51 nurse tutors and 649 of their students. There were similar proportions of never-smokers, but rather more ex-smokers among the tutors. Only nine (17.6%) of the smoking and ex-smoking tutors admitted to having started smoking before the age of 18, compared with 75.5% of the students. Seven tutors and a similar proportion of students believed that smoking was not very harmful. Social behaviour differed between the two groups, the students tending to smoke in pubs and the tutors at home and over coffee. Reasons for having stopped also differed; in tutors cost was cited most often, whereas in students smell on clothes and future health damage ranked most highly. Cost, future health damage and smell were given as the main reasons for wanting to stop by smokers in both groups. We suggest that slightly different anti-smoking strategies might be required in students and tutors.

Bulimia nervosa. Four uncommon subtypes.

The histories and psychological profiles of more than 500 patients meeting DSM-III-R criteria for bulimia nervosa were reviewed. A total of 310 patients demonstrated the most characteristic pattern of bulimia, with finger-induced purging and occasional diet pill, diuretic, or laxative abuse. Seventeen patients reported binge eating with no self-induced vomiting but with severe laxative abuse (i.e., greater than or equal to 50 laxatives daily). A total of 126 patients reported bulimia with finger-induced purging and regular mild (i.e., 2-3 daily) laxative abuse. Eight patients reported bulimia without finger-induced purging, diuretic, or laxative abuse but with the regular abuse of ipecac as a means of inducing vomiting. Four clinical subtypes of bulimia were seen. These were overt bulimia, which occurred in 8.9% of the sample; obsessive-ritualistic bulimia, which occurred in 2% of the sample; sexually evocative bulimia (Fatal Attraction Syndrome), which occurred in 2.9% of the sample; and masochistic bulimia, which occurred in 4.9% of the sample. Each of these subtypes of bulimia are described and defined. The characteristic psychologic profile, clinical features, and implications for treatment and research are discussed.

Psychological treatment in general practice: its effect on patients and their families.

Rates of consultations and prescriptions for patients referred to clinical psychologists, and for these patients' immediate families, were investigated for three-year periods both before and after referral. Patients and their children consulted more and had more medication prescribed before referral than control groups, this tendency being particularly prevalent in the year before referral. After the contact with the psychologist there was a decrease in all these indices in the short term, and there were long-term decreases in psychotropic drug prescriptions for patients and in both consultations and prescriptions for their children.