Evaluation of a clinical screening instrument to identify states of thiamine deficiency in inpatients with severe alcohol dependence syndrome.

AIMS: To develop a Thiamine Deficiency Questionnaire (TDQ), and to assess its reliability in the identification of Thiamine deficiency, in patients with severe alcohol dependence. METHODS: 58 severely alcohol dependent patients underwent socio-demographic, medical, psychiatric, and alcohol use assessment, including administration of the Thiamine Deficiency Questionnaire (TDQ). The Red Blood Cell Thiamine Pyrophosphate concentration provided the 'gold standard' to test the validity of the instrument. Univariate 2 x 2 diagnostic test tables and multivariate analysis were performed. RESULTS: A set of eight questionnaire items had an overall predictive power of 73.7%. Two of these were highly specific: 'missed meals due to lack of funds', and the clinical co-occurrence of medical conditions potentially related to poor nutrition. The Michigan Alcohol Screening Test and serum gamma glutamyl transferase were moderately predictive. CONCLUSIONS: Screening that combines socio-demographic, clinical and biological factors, and/or standardized questionnaires, could improve early recognition of thiamine deficiency.

Randomisation in clinical trials.

BACKGROUND: Several studies of papers published in non-psychiatric medical journals that report on randomised controlled trials (RCTs) indicate that there is inadequate reporting of the process by which randomisation is carried out. AIMS: To examine the adequacy of the reporting of the procedure of randomisation in clinical trials of parallel design published in the British Journal of Psychiatry (BJP) and the American Journal of Psychiatry (AJP). METHODS: All issues of the BJP and the AJP published between January 1990 and December 1998 were surveyed, and papers that reported on RCTs were examined to judge the adequacy of the reporting of the process of randomisation. RESULTS: We found 183 papers which claimed to report on RCTs (73 in the BJP and 110 in the AJP). Nine (8.2%) of those in the AJP and six (8.2%) in the BJP described the technique of creating the randomisation sequence. Two (1.8%) of those in the AJP and 11 (15.1%) of those in the BJP described the mechanism of allocating treatment. One paper in the AJP and five papers in the BJP described both the generation of random numbers and allocation. CONCLUSIONS: Adequate reporting of the method of randomisation was uncommon. The RCT status of some of the papers must therefore be in doubt.

Childhood hyperkinetic disorder/attention deficit disorder grown up.

There is growing evidence for the validity of the diagnosis of Attention Deficit Hyperkinetic Disorder (ADHD) in adults, as well as evidence that conduct disorder in adolescents and dissocial personality disorder in adult life are linked to ADHD in childhood. Methylphenidate is an effective treatment of ADHD in adolescents and young adults and it is possible that dissocial personality disorder will respond to methylphenidate. There is no evidence that methylphenidate reduces symptoms of conduct disorder in adolescents or of dissocial personality disorder in young adults, because no studies have evaluated methylphenidate in these conditions. We recorded a dramatic improvement in symptoms, predominantly of conduct disorder, in an adolescent with a previous history of ADHD. Trials of methylphenidate are required in adolescents with conduct disorder and young people with dissocial personality disorder, when there is a past history of probable ADHD.