Risk of transition to schizophrenia following first admission with substance-induced psychotic disorder: a population-based longitudinal cohort study.

BACKGROUND: The potential for drugs of abuse to induce acute psychotic symptoms is well recognised. However, the likelihood of transition from initial substance-induced psychotic disorder (SIPD) to chronic psychosis is much less well understood. This study investigated the rate of SIPD transition to schizophrenia (F20), the time to conversion and other possible related factors. METHODS: Using data from the Scottish Morbidity Record, we examined all patients (n = 3486) since their first admission to psychiatric hospital with a diagnosis of SIPD [International Classification of Diseases, Tenth Revision (ICD-10) codes F10-F19, with third digit five] from January 1997 to July 2012. Patients were followed until first episode of schizophrenia (ICD-10 code F20, with any third digit) or July 2012. Any change in diagnosis was noted in the follow-up period, which ranged from 1 day to 15.5 years across the groups. RESULTS: The 15.5-year cumulative hazard rate was 17.3% (s.e. = 0.007) for a diagnosis of schizophrenia. Cannabis, stimulant, opiate and multiple drug-induced psychotic disorder were all associated with similar hazard rates. The mean time to transition to a diagnosis of schizophrenia was around 13 years, although over 50% did so within 2 years and over 80% of cases presented within 5 years of SIPD diagnosis. Risk factors included male gender, younger age and longer first admission. CONCLUSIONS: SIPD episodes requiring hospital admission for more than 2 weeks are more likely to be associated with later diagnosis of schizophrenia. Follow-up periods of more than 2 years are needed to detect the majority of those individuals who will ultimately develop schizophrenia.

Monitoring quality of audit in obstetrics and gynaecology.

OBJECTIVE: To develop a questionnaire to assess audit activity and to use it to evaluate systematically the quality of audit in obstetrics and gynaecology within NHS hospitals in the UK. DESIGN: Retrospective review of 212 consecutive questionnaires completed at hospital recognition committee visits for training accreditation, between 1 January 1993 and 31 August 1998, validated against hospital trust annual audit reports. MAIN MEASURES: Use of seven quality criteria developed within the Royal College of Obstetricians and Gynaecologists clinical audit unit and also assessment of support for audit and participation in regional and national audit. Results were compared between 1993/4 (n = 72), 1995/6 (n = 72), and 1997/8 (n = 68) for evidence of improvement. RESULTS: After modifications to the questionnaire the version used from 1993 proved to be a satisfactory tool with minimal need for subsequent change. The results showed that there has been a significant improvement in the quality of obstetric and gynaecology audit with time (p < 0.0001) with 36 (53%) of departments in the previous two year period meeting all seven criteria. Similarly by this stage, 60 (88%) of departments had reached the stage of re-audit and 55 (81%) had conducted patient satisfaction surveys, both of these having significantly improved with time. Critical incident monitoring also became used more widely with time. Validation of topics audited was possible for 45% of hospitals where trust annual audit reports were available and these showed a high level of correlation. CONCLUSIONS: It has proved possible to conduct an audit of audit using the current system of hospital recognition visits for training accreditation. This has shown a great variety in the depth and breadth of audit that is being undertaken within individual obstetric and gynaecology departments. Since 1993 there has been an improvement in the quality of audit programmes undertaken, in particular in the number of hospitals carrying out critical incident monitoring, patient satisfaction surveys, and re-audit. This should be associated with improvements in staff training and in patient care.

Reduced in vivo binding to the serotonin transporter in the cerebral cortex of MDMA ('ecstasy') users.

BACKGROUND: The use of MDMA ('ecstasy') is common among young people in Western countries. Animal models of MDMA toxicity suggest a loss of serotonergic neurons, and potentially implicate in the development of significant psychiatric morbidity in humans. AIMS: To test whether long-term use of MDMA can produce abnormalities in cerebral serotonin, but not dopamine, transporter binding measured by single photon emission computed tomography (SPECT). METHOD: Ten male regular ecstasy users and 10 well-matched controls recruited from the same community sources participated in SPECT with the serotonin transporter (SERT) ligand [123I] beta-CIT. Dopamine transporter binding was determined from scans acquired 23 hours after injection of the tracer. RESULTS: Ecstasy users showed a cortical reduction of SERT binding, particularly prominent in primary sensory-motor cortex, with normal dopamine transporter binding in lenticular nuclei. CONCLUSIONS: This cross-sectional association study provides suggestive evidence for specific, at least temporary, serotonergic neurotoxicity of MDMA in humans.

From ministry to market. Catholic healthcare can survive in an age of commercialization.

Large, for-profit healthcare corporations now dominate hospital and physician services in many parts of the nation. Such organizations are under unrelenting pressure to produce profits; news stories show that these pressures can lead for-profits to engage in questionable, even illegal activities. Also, for-profits are unlikely to provide much care for the poor and uninsured. Unfortunately, Catholic providers have several disadvantages when competing with for-profits, and one is the fact that they do provide care for the poor. Catholic providers are handicapped also by: Problems with their geographic locations. Difficulties in creating partnerships with physicians. Lack of access to capital. Loss of political influence. On the other hand, Catholic healthcare providers have several advantages over for-profits. Among them are: A reservoir of public goodwill. Experience in forming networks The potential for prudent growth. A common vision. Access to Church pulpits. The influence of women and men religious Given theses advantages, Catholic health ministry leaders could boldly restructure their own organizations, and, in doing so, mitigate the commercialization of healthcare in the United States.

Initiation of self-grooming in resting rats by local PVH infusion of oxytocin but not alpha-MSH.

The present study was designed to discriminate between factors that initiate and/or prolong self-grooming. The study of factors initiating the grooming response is complicated by the fact that rats may groom already as a consequence of the injection procedure, due to release of endogenous substances after needle insertion or just handling of the animal. Therefore we used an infusion technique that allowed the rats to settle down quietly after they had been connected to an infusion pump, before the actual infusion of the peptide took place. In a previous report, we showed that direct injections of ACTH1-24 and alpha-melanocyte-stimulating hormone (alpha-MSH) into the paraventricular nucleus of the hypothalamus (PVH) prolong self-grooming caused by the injection procedure. Whether these peptides can also initiate grooming, however, is not yet clear. In this report, we compare the effects of alpha-MSH and oxytocin after infusion into the PVH in resting animals. Oxytocin is abundantly present in the PVH and is known to be involved in the regulation of grooming behavior. Slow infusions of oxytocin (0.1 microgram) do initiate grooming, but alpha-MSH (0.1 microgram) is without any behavioral effect. This suggests that oxytocin in the PVH is involved in the initiation of self-grooming, whereas alpha-MSH and probably ACTH do maintain grooming initiated otherwise, either by mechanical activation of the PVH and/or by the handling procedures. Infusion of substances in resting animals apparently is a way to avoid interactions between ongoing overt behavior and peptide-induced effects.