Comprehensive behavioral analysis of pituitary adenylate cyclase-activating polypeptide (PACAP) knockout mice

Pituitary adenylate cyclase-activating polypeptide (PACAP) is a neuropeptide acting as a neurotransmitter, neuromodulator, or neurotrophic factor. PACAP is widely expressed throughout the brain and exerts its functions through the PACAP-specific receptor (PAC(1)). Recent studies reveal that genetic variants of the PACAP and PAC(1) genes are associated with mental disorders, and several behavioral abnormalities of PACAP knockout (KO) mice are reported. However, an insufficient number of backcrosses was made using PACAP KO mice on the C57BL/6J background due to their postnatal mortality. To elucidate the effects of PACAP on neuropsychiatric function, the PACAP gene was knocked out in F1 hybrid mice (C57BL/6J × 129SvEv) for appropriate control of the genetic background. The PACAP KO mice were then subjected to a behavioral test battery. PACAP deficiency had no significant effects on neurological screen. As shown previously, the mice exhibited significantly increased locomotor activity in a novel environment and abnormal anxiety-like behavior, while no obvious differences between genotypes were shown in home cage (HC) activity. In contrast to previous reports, the PACAP KO mice showed normal prepulse inhibition (PPI) and slightly decreased depression-like behavior. Previous study demonstrates that the social interaction (SI) in a resident-intruder test was decreased in PACAP KO mice. On the other hand, we showed that PACAP KO mice exhibited increased SI in Crawley's three-chamber social approach test, although PACAP KO had no significant impact on SI in a HC. PACAP KO mice also exhibited mild performance deficit in working memory in an eight-arm radial maze (RM) and the T-maze (TM), while they did not show any significant abnormalities in the left-right discrimination task in the TM. These results suggest that PACAP has an important role in the regulation of locomotor activity, social behavior, anxiety-like behavior and, potentially, working memory.

Mental disorders in primary care

Current estimates indicate that 50% of the population experience at least one mental disorder in their lifetime and that at least 25% have suffered a mental disorder in the past year. recognition, diagnosis, treatment, and referral depend overwhelmingly on general practitioners, at least one third of whose consultations have a direct and explicit psychological component. Yet despite this intensive familiarization with the presentation of mental pathology, and the appropriateness of the primary care setting to its management, even the most recent surveys indicate that performance is best described by the rule of diminishing halves: only half the patients with a thresh-old disorder are recognized; only half of those recognized are treated; and only half of those treated are effectively treated. There is no single solution to this problem, only multiple solutions, which must be aimed, consistently and simultaneously, at the patient, practitioner, practice, and research levels.

Neurobiological findings in posttraumatic stress disorder: a review

Since posttraumatic stress disorder (PTSD) was first recognized as a psychiatric disorder, it has generated a great deal of scientific interest. Recent studies on the neurobiology of PTSD provide evidence that PTSD is biologically distinct from other types of traumatic and nontraumatic stress responses. This paper reviews three important directions of neurobiological research in PTSD: noradrenergic axis changes and associated alterations in autonomic responsivity neuroendocrine changes involving the hypothalamic-pituitary-adrenocortical (HPA) axis, and neuroanatomy changes involving the hippocampus. Each section reviews the salient aspects of preclinical research on the biology of stress and their bearing on the understanding of PTSD, and summarizes prominent findings from clinical biological studies of PTSD, Tentative models that integrate current findings from the clinical study of PTSD are reviewed. To conclude, the important methodological and empirical issues that need to be addressed by future studies are indicated.

Nepotistic patterns of violent psychopathy: evidence for adaptation?

Psychopaths routinely disregard social norms by engaging in selfish, antisocial, often violent behavior. Commonly characterized as mentally disordered, recent evidence suggests that psychopaths are executing a well-functioning, if unscrupulous strategy that historically increased reproductive success at the expense of others. Natural selection ought to have favored strategies that spared close kin from harm, however, because actions affecting the fitness of genetic relatives contribute to an individual's inclusive fitness. Conversely, there is evidence that mental disorders can disrupt psychological mechanisms designed to protect relatives. Thus, mental disorder and adaptation accounts of psychopathy generate opposing hypotheses: psychopathy should be associated with an increase in the victimization of kin in the former account but not in the latter. Contrary to the mental disorder hypothesis, we show here in a sample of 289 violent offenders that variation in psychopathy predicts a decrease in the genetic relatedness of victims to offenders; that is, psychopathy predicts an increased likelihood of harming non-relatives. Because nepotistic inhibition in violence may be caused by dispersal or kin discrimination, we examined the effects of psychopathy on (1) the dispersal of offenders and their kin and (2) sexual assault frequency (as a window on kin discrimination). Although psychopathy was negatively associated with coresidence with kin and positively associated with the commission of sexual assault, it remained negatively associated with the genetic relatedness of victims to offenders after removing cases of offenders who had coresided with kin and cases of sexual assault from the analyses. These results stand in contrast to models positing psychopathy as a pathology, and provide support for the hypothesis that psychopathy reflects an evolutionary strategy largely favoring the exploitation of non-relatives.

Development of mental disorders one year after exposure to psychosocial stressors; a cohort study in primary care patients with a physical complaint

BACKGROUND

Mental disorders, common in primary care, are often associated with physical complaints. While exposure to psychosocial stressors and development or presence of principal mental disorders (i.e. depression, anxiety and somatoform disorders defined as multisomatoforme disorders) is commonly correlated, temporal association remains unproven. The study explores the onset of such disorders after exposure to psychosocial stressors in a cohort of primary care patients with at least one physical symptom.

METHOD

The cohort study SODA (SOmatization, Depression and Anxiety) was conducted by 21 private-practice GPs and three fellow physicians in a Swiss academic primary care centre. GPs included patients via randomized daily identifiers. Depression, anxiety or somatoform disorders were identified by the full Patient Health Questionnaire (PHQ), a validated procedure to identify mental disorders based on DSM-IV criteria. The PHQ was also used to investigate exposure to psychosocial stressors (before the index consultation and during follow up) and the onset of principal mental disorders after one year of follow up.

RESULTS

From November 2004 to July 2005, 1020 patients were screened for inclusion. 627 were eligible and 482 completed the PHQ one year later and were included in the analysis (77%). At one year, prevalence of principal mental disorders was 30/153 (19.6% CI95% 13.6; 26.8) for those initially exposed to a major psychosocial stressor and 26/329 (7.9% CI95% 5.2; 11.4) for those not. Stronger association exists between psychosocial stressors and depression (RR = 2.4) or anxiety (RR = 3.5) than multisomatoforme disorders (RR = 1.8). Patients who are "bothered a lot" (subjective distress) by a stressor are therefore 2.5 times (CI95% 1.5; 4.0) more likely to experience a mental disorder at one year. A history of psychiatric comorbidities or psychological treatment was not a confounding factor for developing a principal mental disorder after exposure to psychosocial stressors.

CONCLUSION

This primary care study shows that patients with physical complaints exposed to psychosocial stressors had a higher risk for developing mental disorders one year later. This temporal association opens the field for further research in preventive care for mental diseases in primary care patients.

The Singapore Mental Health Study: an overview of the methodology

The Singapore Mental Health Study (SMHS) is a population-based, cross-sectional, epidemiological study on the Singapore multi-ethnic adult population. This article provides an overview of the research design and methods used which took into consideration the unique characteristics of the country and its multi-ethnic population. A face-to-face household survey of Singapore residents aged 18 years and above was undertaken from 2009 to 2010. The nationally representative probability sample was derived using a disproportionate stratified sampling method. In order to increase precision for subgroup estimations the design was stratified with over-sampling of Malays, Indians and those aged 65 years and above. Respondents were assessed using the English, Chinese (computerized) and Malay (paper and pencil based) version of the Composite International Diagnostic Interview (CIDI) 3.0 to establish lifetime and 12-month prevalence of mental disorders, the current use of mental health services (both Western and traditional services), the treatment gaps and loss of role functioning.

Gastrointestinal inflammation and associated immune activation in schizophrenia

Immune factors are implicated in normal brain development and in brain disorder pathogenesis. Pathogen infection and food antigen penetration across gastrointestinal barriers are means by which environmental factors might affect immune-related neurodevelopment. Here, we test if gastrointestinal inflammation is associated with schizophrenia and therefore, might contribute to bloodstream entry of potentially neurotropic milk and gluten exorphins and/or immune activation by food antigens. IgG antibodies to Saccharomyces cerevisiae (ASCA, a marker of intestinal inflammation), bovine milk casein, wheat-derived gluten, and 6 infectious agents were assayed. Cohort 1 included 193 with non-recent onset schizophrenia, 67 with recent onset schizophrenia and 207 non-psychiatric controls. Cohort 2 included 103 with first episode schizophrenia, 40 of whom were antipsychotic-naïve. ASCA markers were significantly elevated and correlated with food antigen antibodies in recent onset and non-recent onset schizophrenia compared to controls (p≤0.00001-0.004) and in unmedicated individuals with first episode schizophrenia compared to those receiving antipsychotics (p≤0.05-0.01). Elevated ASCA levels were especially evident in non-recent onset females (p≤0.009), recent onset males (p≤0.01) and in antipsychotic-naïve males (p≤0.03). Anti-food antigen antibodies were correlated to antibodies against Toxoplasma gondii, an intestinally-infectious pathogen, particularly in males with recent onset schizophrenia (p≤0.002). In conclusion, gastrointestinal inflammation is a relevant pathology in schizophrenia, appears to occur in the absence of but may be modified by antipsychotics, and may link food antigen sensitivity and microbial infection as sources of immune activation in mental illness.

The role of self-help in the treatment of mild anxiety disorders in young people: an evidence-based review

Anxiety disorders are the most common mental health problems experienced by young people, and even mild anxiety can significantly limit social, emotional, and cognitive development into adulthood. It is, therefore, essential that anxiety is treated as early and effectively as possible. Young people are unlikely, however, to seek professional treatment for their problems, increasing their chance of serious long-term problems such as impaired peer relations and low self-esteem. The barriers young people face to accessing services are well documented, and self-help resources may provide an alternative option to respond to early manifestations of anxiety disorders. This article reviews the potential benefits of self-help treatments for anxiety and the evidence for their effectiveness. Despite using inclusive review criteria, only six relevant studies were found. The results of these studies show that there is some evidence for the use of self-help interventions for anxiety in young people, but like the research with adult populations, the overall quality of the studies is poor and there is need for further and more rigorous research.

Prevalence of mental disorders among high school students in National Guard Housing, Riyadh, Saudi Arabia

BACKGROUND

Adolescents experience rapid biological, psychological, and social transitions that can be associated with mental health problems. During the high school period there are also more academic stressors.

OBJECTIVE

(1) To study the prevalence of mental disorders in high school (grade 12) students. (2) To study some related sociodemographic data.

MATERIALS AND METHODS

A cross-sectional study, using GHQ-28, that included 354 students randomly selected from grade 12 in four high schools - two male and two female high schools - in the National Guard Housing (Iskan), in Kashmalaan (suburb of Riyadh).

RESULTS

The overall prevalence of mental disorders was found to be 48% (41% in males and 51% in females); more than 80% of these cases were mild to moderate. Females showed significantly more severe disorders than males (P = 0.017) and students with excellent performance degrees showed a significantly lower rate of mental disorders than others (P = 0.021). However, our study did not show a significant association between psychiatric disorders and other social variables (family size, birth order, and polygamous family) or smoking.

CONCLUSION

The adolescent age groups in our community had high rates of mental disorders, which required more attention from the family, as well as the educational and health institutes in our country.

Burnout Syndrome and associated factors among medical students: a cross-sectional study

OBJECTIVES

To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors.

METHODS

A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS) and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis.

RESULTS

The prevalence of burnout was 10.3% (n = 369). The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio-OR = 6.47), those who felt uncomfortable with course activities (OR = 5.76), and those who did not see the coursework as a source of pleasure (OR = 4.68).

CONCLUSION

There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted.

Suppression of alcohol dependence using baclofen: a 2-year observational study of 100 patients

AIMS

The purpose of this study was to examine the long-term effects of baclofen in a large cohort of alcohol-dependent patients compliant to baclofen treatment.

METHODS

A hundred patients with alcohol dependence, resistant to usual treatments, were treated with escalating doses of baclofen (no superior limit). Alcohol consumption (in grams) and craving for alcohol were assessed before treatment and at 3, 6, 12, and 24 months. Assessments were simply based on patients' statements. The outcome measure was the consumption of alcohol, rated according to the World Health Organization criteria for risk of chronic harm.

RESULTS

While all patients were rated "at high risk" at baseline, approximately half of them were rated "at low risk" at 3, 6, 12, and 24 months. The sum of patients who were at "low risk" and at "moderate risk" (improved patients) was 84% at 3 months, 70% at 6 months, 63% at 1 year, and 62% at 2 years. The constancy of improvement over the 2-years was remarkable. The average maximal dose of baclofen taken was 147 mg/day. Ninety-two percentage of patients reported that they experienced the craving-suppressing effect of baclofen. Significant relationships were found between the amount in grams of alcohol taken before treatment and the maximal dose of baclofen required, and between the existence of a mental disorder and a lesser effect of baclofen.

CONCLUSION

Baclofen produces an effortless decrease or suppression of alcohol craving when it is prescribed with no superior limit of dose. Potential limitations in the effectiveness of baclofen include the coexistence of a mental disorder, the concomitant use of other psychotropic drugs, a lack of real motivation in patients to stop drinking, and the impossibility to reach the optimal dose of baclofen because of unbearable side-effects (sometimes possibly related to too sharp a protocol of dose escalation).

The importance of primary care psychiatry: an Australian perspective with global implications

This paper provides a review of the importance of primary care psychiatry within an Australian context. The aims of this review are: (1) to emphasize the integral role of mental health in overall health and well-being, (2) to elucidate the factors that make the provision of primary care psychiatry essential, and (3) to review the impact of the Australian government's mental health policy initiatives on the mental health of the Australian population as well as on the practice of primary care psychiatry. From this review, it is evident that the discipline of psychiatry is integral to the overall health of the community. Furthermore, it is apparent that primary care psychiatry has a large and pivotal role to play in the prevention, treatment, and early detection of mental disorders in Australia and worldwide. The article concludes with some simple, actionable recommendations for the practice of primary care psychiatry.

Suicide means used by Chinese rural youths: a comparison between those with and without mental disorders

Reports on Chinese rural youth suicide indicated patterns different from those of the West. Only about 30% to 70% young victims had had diagnoses of psychiatric illnesses (Phillips et al., Lancet 359:835-840, 2002; Xiao et al., Chin J Psychiatry 36:129-131, 2003), and more than 60% of them used pesticides as suicide means (Wang et al., Lancet 372:1765-1773, 2008). To prevent suicides in rural China, it is important to know the choice of means by Chinese young suicide victims with and without mental disorders. Data on suicide cases in China's rural areas gathered from a big psychological autopsy study were studied for demographic characteristics, suicide methods, and the presence of mental disorders. The findings in the suicide victims with and without mental disorders showed significant differences in suicide method selecting. Victims with mental disorders tended to select violent methods compared with those without mental disorders (31.4% vs. 16.2%). Hanging is method more likely chosen by the mentally disordered victims (13.3%) than those without a mental disorder (7.8%). Mental status affects the means choice among the Chinese rural young suicide victims. Among them, the female victims without mental disorders tended to act on impulsivity and used nonviolent means such as pesticide consumption for suicide. This study informs suicide prevention measures in both China and rest of the world.

Ten years of integrated care for mental disorders in the Netherlands

Background and problem statement

Integrated care for mental disorders aims to encompass forms of collaboration between different health care settings for the treatment of mental disorders. To this end, it requires integration at several levels, i.e. integration of psychiatry in medicine, of the psychiatric discourse in the medical discourse; of localization of mental health care and general health care facilities; and of reimbursement systems.

Description of policy practice

Steps have been taken in the last decade to meet these requirements, enabling psychiatry to move on towards integrated treatment of mental disorder as such, by development of a collaborative care model that includes structural psychiatric consultation that was found to be applicable and effective in several Dutch health care settings. This collaborative care model is a feasible and effective model for integrated care in several health care settings. The Bio Psycho Social System has been developed as a feasible instrument for assessment in integrated care as well.

Discussion

The discipline of psychiatry has moved from anti-psychiatry in the last century, towards an emancipated medical discipline. This enabled big advances towards integrated care for mental disorder, in collaboration with other medical disciplines, in the last decade.

Conclusion

Now is the time to further expand this concept of care towards other mental disorders, and towards integrated care for medical and mental co-morbidity. Integrated care for mental disorder should be readily available to the patient, according to his/her preference, taking somatic co-morbidity into account, and with a focus on rehabilitation of the patient in his or her social roles.

Internet-based depression prevention over the life course: a call for behavioral vaccines

Technology-based approaches for the prevention of depression offer considerable benefits including easy access, patient autonomy, and "nonconsumable" services that are autonomous from traditional (face-to-face) interventions. The authors have previously worked to develop Internet interventions based on the frameworks for conventional, face-to-face effective community-based interventions, and propose to integrate these models into a "behavioral vaccine model" aptly applicable to technology-based delivery. This article reviews the literature on Internet-based depression prevention programs using this behavioral vaccine development model, reviewing literature relevant to each component of the model in turn.

Telemental Health and Web-based Applications in Children and Adolescents

The authors conducted a review of the literature with regard to child and adolescent mental health intervention, from which they identified 20 unique publications and 12 separate interventions. These interventions encompassed depression, anxiety, substance abuse, eating disorders, and mental health promotion. Studies were heterogeneous, with a wide range of study designs and comparison groups creating some challenges in interpretation. However, modest evidence was found that Internet interventions showed benefits compared with controls and preintervention symptom levels. Interventions had been developed for a range of settings, but tended to recruit middle-class participants of European ethnicity. Internet interventions showed a range of approaches toward engaging children and incorporating parents and peers into the learning process.

Violent victimization of psychiatric patients: a Swedish case-control study

OBJECTIVES

To report the rate of violent victimization of psychiatric patients 1 year before interview and to examine the relative rate in comparison to the general population.

METHOD

Cases were recruited from two public psychiatric hospitals in Stockholm County (n = 390). The controls comprised gender- and age-matched people interviewed in an annual national survey of living conditions (n = 1,170).

RESULTS

Twenty percent of the patients had been victimized during the preceding year. The relative rate was six times higher than that of the controls. Women appeared to be most vulnerable with a tenfold risk increase.

CONCLUSIONS

The findings stress that psychiatric patients are vulnerable to other people's violent behaviour.

Free will and mental disorder: exploring the relationship

A link between mental disorder and freedom is clearly present in the introduction of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It mentions "an important loss of freedom" as one of the possible defining features of mental disorder. Meanwhile, it remains unclear how "an important loss of freedom" should be understood. In order to get a clearer view on the relationship between mental disorder and (a loss of) freedom, in this article, I will explore the link between mental disorder and free will. I examine two domains in which a connection between mental disorder and free will is present: the philosophy of free will and forensic psychiatry. As it turns out, philosophers of free will frequently refer to mental disorders as conditions that compromise free will and reduce moral responsibility. In addition, in forensic psychiatry, the rationale for the assessment of criminal responsibility is often explained by referring to the fact that mental disorders can compromise free will. Yet, in both domains, it remains unclear in what way free will is compromised by mental disorders. Based on the philosophical debate, I discuss three senses of free will and explore their relevance to mental disorders. I conclude that in order to further clarify the relationship between free will and mental disorder, the accounts of people who have actually experienced the impact of a mental disorder should be included in future research.

Neurobehavioral manifestations of developmental impairment of the brain

Individual characteristics of human nature (e.g. introversion, extroversion, mood, activity, adaptability, aggressiveness, social ability, anxiety) do not need to be primarily innate. They can be determined by the action of various influences and their interactions on functional development of the brain. There is ample epidemiological and experimental evidence that chemical and/or physical factors acting during sensitive time windows of the brain development can cause mental, behavioral, emotional and/or cognitive disorders. Environmental pollutants, addictive substances, drugs, malnutrition, excessive stress and/or hypoxia-ischemia were reported to induce functional maldevelopment of the brain with consequent neurobehavioral disorders. The article provides review on most significant neurobehavioral manifestations of developmental impairment of the brain during prenatal, perinatal and early postnatal period. The most known adverse factors causing developmental neurobehavioral dysfunctions in humans as well as in experimental animals are discussed.

Prevalence and correlates of mental disorders in a school-survey sample

Background:

Most of the adult mental disorders have their origins early in life. As the epidemiology of childhood psychiatric disorder in Italy has not been extensively investigated, we have evaluated the prevalence of mental disorders and their association with socio-familiar variables in a representative sample of children aged 6 to 11.

Method:

The study was conducted on a school- sample of 1028 children, aged 6 to 11, attending 12 primary schools in Florence (Italy). The diagnoses were made according to DSM IV diagnostic criteria, integrated by the description of each symptom, using specially trained teachers as lay-interviewers. Odds ratios with 95% C.I. chi squares and a stepwise binary logistic analysis have been performed.

Results:

Nine hundred ninety nine children (506 males; 493 females) were studied. Of them, 10.5% received a psychiatric diagnosis, with a higher prevalence in males (66.7% vs.33.3, p<0.01). The most prevalent groups of mental disorders were the behavioural/impulse control (7.2%) and anxiety (6.4%) disorders. Attention Deficit with Hyperactivity Disorder was the most represented diagnosis (5.6% of the children). All the other mental disorders were relatively rare, with only separation anxiety and overanxious disorder exceeding 1% prevalence.

Male gender, organic disease, having mother divorced, not present or dead, attending school full-time, cohabitation in the family were associated with an increased risk for any childhood mental disorder.

Conclusions:

About one in ten children aged 6-11 suffers from a mental disorder. Male gender, loss of mother and lower socio-economic status are associated with mental disorders in children. Further long-term prospective studies are needed, in order to clarify the epidemiological and psychopathological relationships between childhood and adult mental disorders.

The clinical use of quantitative EEG in cognitive disorders

The primary diagnosis of most cognitive disorders is clinically based, but the EEG plays a role in evaluating, classifying and following some of these disorders. There is an ongoing debate over routine use of qEEG. Although many findings regarding the clinical use of quantitative EEG are awaiting validation by independent investigators while confirmatory clinical follow-up studies are also needed, qEEG can be cautiously used by a skilled neurophysiologist in cognitive dysfunctions to improve the analysis of background activity, slow/fast focal activity, subtle asymmetries, spikes and waves, as well as in longitudinal follow-ups.

Experiencing mindfulness meditation-a client narrative perspective

The study was based on the non-participant involvement of the researcher in four six-to-eight weeks' mindfulness meditation training courses led by chartered psychologists. The participants suffered from stress/sleeplessness, depression or agoraphobia in the presented cases. They were selected on the basis of recommendations by the psychologist who was the course instructor, who described them as positive and suitable. The participants wrote diaries on a weekly basis, and they were interviewed at the beginning, middle and end of the course. An in-depth analysis of three individual cases will be presented in the form of narratives constructed from their own words. The narratives demonstrate the unique and embodied changes of the individual participant's experiences during the training course. The purpose was to illustrate richly what happens and how changes happen during these weeks of learning and practicing mindfulness meditation. It is not the intention to give evidence about the effectiveness of mindfulness meditation in general, but to present the whats and hows of cases where mindfulness meditation appears to improve quality of life, health and well-being.

A study of psychiatrists' concepts of mental illness

BACKGROUND

There are multiple models of mental illness that inform professional and lay understanding. Few studies have formally investigated psychiatrists' attitudes. We aimed to measure how a group of trainee psychiatrists understand familiar mental illnesses in terms of propositions drawn from different models.

METHOD

We used a questionnaire study of a sample of trainees from South London and Maudsley National Health Service (NHS) Foundation Trust designed to assess attitudes across eight models of mental illness (e.g. biological, psychodynamic) and four psychiatric disorders. Methods for analysing repeated measures and a principal components analysis (PCA) were used.

RESULTS

No one model was endorsed by all respondents. Model endorsement varied with disorder. Attitudes to schizophrenia were expressed with the greatest conviction across models. Overall, the 'biological' model was the most strongly endorsed. The first three components of the PCA (interpreted as dimensions around which psychiatrists, as a group, understand mental illness) accounted for 56% of the variance. Each main component was classified in terms of its distinctive combination of statements from different models: PC1 33% biological versus non-biological; PC2 12% 'eclectic' (combining biological, behavioural, cognitive and spiritual models); and PC3 10% psychodynamic versus sociological.

CONCLUSIONS

Trainee psychiatrists are most committed to the biological model for schizophrenia, but in general are not exclusively committed to any one model. As a group, they organize their attitudes towards mental illness in terms of a biological/non-biological contrast, an 'eclectic' view and a psychodynamic/sociological contrast. Better understanding of how professional group membership influences attitudes may facilitate better multidisciplinary working.

The relationship between fatigue and psychiatric disorders: evidence for the concept of neurasthenia

OBJECTIVE

Fatigue and psychiatric disorders frequently occur comorbidly and share similar phenomenological features. There has been debate as to whether chronic fatigue, or neurasthenia, should be considered an independent syndrome distinct from psychiatric disorders. We aimed to establish whether persistent fatigue can occur independently from psychiatric disorders and to test the hypothesis that fatigue without comorbid psychiatric symptoms has unique premorbid risk factors. We also aimed to investigate the psychological outcome of any individuals with fatigue.

METHODS

The MRC National Survey of Health and Development was used to prospectively follow 5362 participants from birth. A sample of nonfatigued individuals without psychiatric disorder was selected at age 36 and followed until age 43 years (n=2714). At age 43, the presence of new onset fatigue and/or psychiatric disorder was assessed. Information on a number of potential premorbid risk factors was collected between ages 0 and 36 years. Individuals with fatigue but no comorbid psychiatric disorder were then followed up at age 53 years.

RESULTS

At age 43 years, 201 (7.4%) participants reported significant levels of new onset fatigue in the absence of comorbid psychiatric disorder. Despite the absence of case level psychiatric disorder, these individuals did report increased levels of some psychological symptoms. Excessive childhood energy (adjusted OR 2.63, 95% CI 1.55-4.48, P<.001) and being overweight at age 36 (adjusted OR 1.62, 95% CI 1.05-2.49, P=.03) were specific risk factors for fatigue without psychiatric disorder but not fatigue with comorbid psychiatric illness. Neuroticism was a risk factor for fatigue both with and without comorbid psychiatric disorder. Negative life events and a family history of psychiatric illness were only risk factors for fatigue when it occurred comorbidly with psychiatric illness.

CONCLUSIONS

A significant proportion of the adult population will suffer from fatigue without comorbid psychiatric disorder. While fatigue and psychiatric disorders share some risk factors, excessive energy in childhood and being overweight as an adult appear to be specific risk factors for fatigue. Our results confirm the significant overlap between fatigue and psychiatric disorders, while also providing evidence for neurasthenia as a separate diagnosis.

Treatment of mental disorder in the primary care setting in the Netherlands in the light of the new reimbursement system: a challenge?

Introduction

Different professionals provide health care for mental disorder in the primary care setting. In view of the changing reimbursement system in the Netherlands, information is needed on their specific expertise.

Method

This study attempts to describe this by literature study, by assessment of expert opinions, and by consulting Associations of the relevant professions.

Results

There is no clear differentiation of expertise and tasks amongst these professionals in primary care. Notably, distinction between different psychotherapeutic treatment modes provided by psychologists is unclear.

Discussion

Research is needed to assess actual treatment modules in correlation with patient diagnostic classification for the different professions in primary care. An alternative way of classifying patients, that takes into account not only mental disorder or problems but especially the level of functioning, is proposed to discern which patients can be treated in primary care, and which patients should not. Integrated care models are promising, because many professionals can be involved in treatment of mental disorder in the primary care setting; especially for collaborative care models, evidence favours the treatment of common mental disorders in this setting.

Conclusion

Integrated care models, such as collaborative care, provide a basis for multidisciplinary care for mental disorder in the primary care setting. Professional responsibilities should be clearly differentiated in order to facilitate integrated care. The level of functioning of patients with mental disorder can be used as indication criterion for treatment in the primary care setting or in Mental Health Institutions. Research to establish the feasibility of this model is needed.

Depression in children and adolescents

INTRODUCTION

Prevalence rates for depression in children and adolescents are estimated up to 8.9%. Symptoms in this age group are different from those of depression in adults. Both neurobiological and psychosocial factors are involved in its development.

METHODS

Selective literature review.

RESULTS

Of note are both the high rate of spontaneous remissions in childhood (33%), and the high rate of depressions continuing into adulthood (80%). In addition far fewer evidence based treatments are available than for adults. Fluoxetine is currently the only medication licensed for use in children and adolescents for this indication. Tri- and tetracyclic antidepressants have not been shown in meta-analyses to be effective in children and adolescents. Most antidepressants lead to age related side effects, including attention deficit and in particular behavioral toxicity, which has to be taken seriously wherever there is a suicide risk.

DISCUSSION

The treatment of depression in childhood and adolescence should be based on multimodal interventions including psychotherapy, including cognitive behavioral therapy, which has proven effectiveness, psychosocial interventions and medications in severe cases. Patients with severe depression, especially suicidal minors, should be treated in patients units.

Risk factors for the incidence and persistence of suicide-related outcomes: a 10-year follow-up study using the National Comorbidity Surveys

BACKGROUND

We report prospective associations of baseline risk factors with the first onset and persistence of suicide-related outcomes (SROs; ideation, plans, gestures, and attempts) over a 10-year interval among respondents who participated in both the 1990-02 National Comorbidity Survey (NCS) and the 2000-02 National Comorbidity Survey follow-up (NCS-2).

METHODS

A total of 5001 NCS respondents were re-interviewed (87.6% of baseline sample) in the NCS-2. Three sets of baseline (NCS) risk factors were considered as predictors of the first onset and persistence of SROs: socio-demographics, lifetime DSM-III-R disorders, and SROs.

RESULTS

New onsets included 6.2% suicide ideation, 2.3% plan, 0.7% gesture, and 0.9% attempts. More than one-third of respondents with a baseline history of suicide ideation continued to have suicide ideation at some time over the intervening decade. Persistence was lower for other SROs. The strongest predictors of later SROs were baseline SROs. Prospective associations of baseline mental disorders with later SROs were largely limited to the onset and persistence of ideation.

LIMITATIONS

Although data were gathered prospectively, they were based on retrospective reports at both baseline and follow-up.

CONCLUSIONS

Baseline history of SROs explained much of the association of mental disorders with later SROs. It is important clinically to note that many of the risk factors known to predict onset of SROs also predict persistence of SROs.

The concept of mental disorder: diagnostic implications of the harmful dysfunction analysis

What do we mean when we say that a mental condition is a medical disorder rather than a normal form of human suffering or a problem in living? The status of psychiatry as a medical discipline depends on a persuasive answer to this question. The answers tend to range from value accounts that see disorder as a sociopolitical concept, used for social control purposes, to scientific accounts that see the concept as strictly factual. I have proposed a hybrid account, the harmful dysfunction (HD) analysis, that incorporates both value and scientific components as essential elements of the medical concept of disorder, applying to both physical and mental conditions. According to the HD analysis, a condition is a disorder if it is negatively valued ("harmful") and it is in fact due to a failure of some internal mechanism to perform a function for which it was biologically designed (i.e., naturally selected). The implications of this analysis for the validity of symptom-based diagnostic criteria and for challenges in cross-cultural use of diagnostic criteria are explored, using a comparison of the application of DSM diagnostic criteria in the U.S. and Taiwan.

Development of antisocial personality disorder in detained youths: the predictive value of mental disorders

Antisocial personality disorder (APD) is a serious public and mental health concern. Understanding how well conduct disorder (CD) and other mental disorders predict the development of APD among youths involved in the juvenile justice system is critical for prevention. The authors used a stratified random sample of 1,112 detained youths to examine the development of APD at a 3-year follow-up interview. Nearly one fifth of male juvenile detainees later developed APD; approximately one quarter of male juvenile detainees with CD at baseline later developed APD. Significantly more males than females developed APD; no differences were found by race/ethnicity. Having 5 or more symptoms of CD, dysthymia, alcohol use disorder, or generalized anxiety disorder was significantly associated with developing modified APD (M-APD; APD without the CD requirement). Some disorders were strong predictors of APD; however, none were adequate screeners for identifying which detainees would later develop M-APD. The findings of this study have implications for interventions and further research in developmental psychopathology.

Mental disorders among parents/caretakers of American Indian early adolescents in the Northern Midwest

BACKGROUND

This study reports prevalence and comorbidity of five DSM-III-R diagnoses (alcohol abuse, alcohol dependence, drug abuse, major depressive episode, and generalized anxiety disorder) among American Indian and Canadian First Nations parents/caretakers of children aged 10-12 years from the Northern Midwest United States and Canada. Lifetime prevalence rates were compared to adults in the National Comorbidity Survey (NCS) and Southwest and Northern Plains cultures from the AI-SUPERPFP study.

METHOD

Native interviewers used computer-assisted personal interviews to administer the University of Michigan Composite International Diagnostic Interview (UM-CIDI) to 861 tribally enrolled parents and caretakers (625 females; 236 males) of 741 tribally enrolled children aged 10-12 years. Fathers/male caretakers ranged in age from 21 years to 68 years with an average age of 41 years; mothers/female caretakers ranged in age from 17 years to 77 years with an average of 39 years.

RESULTS

About three-fourths (74.6%) of the adults met lifetime criteria for one of the five disorders; approximately one-third (31.6%) met lifetime criteria for two or more of the five disorders. Prevalence of the substance use disorders was higher than those in the general population (NCS); prevalence of internalizing disorders (major depressive disorder and generalized anxiety disorder) was very similar to those in the general population. Prevalence rates for alcohol abuse among the Northern Midwest adults were higher than those reported for Southwest and Northern Plains Tribes, but rates of alcohol dependency were very similar across cultures.

CONCLUSIONS

The higher prevalence rates for some mental disorders found for the Northern Midwest are discussed in terms of potential method variance. The Northern Midwest results reflect unique patterns of psychiatric disorders in the ubiquity of substance abuse disorders and the co-occurrence of substance abuse disorders with internalizing disorders. Reducing lifetime occurrences of substance abuse disorders would have an enormous positive impact on the mental health of this population.

Mental disorder ethics: theory and empirical investigation

Mental disorders and their care present unusual problems within biomedical ethics. The disorders themselves invite an ethical critique, as does society's attitude to them; researching the diagnosis and treatment of mental disorders also presents special ethical issues. The current high profile of mental disorder ethics, emphasised by recent political and legal developments, makes this a field of research that is not only important but also highly topical. For these reasons, the Wellcome Trust's biomedical ethics programme convened a meeting, "Investigating Ethics and Mental Disorders", in order to review some current research, and to stimulate topics and methods of future research in the field. The meeting was attended by policy makers, regulators, research funders, and researchers, including social scientists, psychiatrists, psychologists, lawyers, philosophers, criminologists, and others. As well as aiming to inspire a stronger research endeavour, the meeting also sought to stimulate an improved understanding of the methods and interactions that can contribute to "empirical ethics" generally. This paper reports on the meeting by describing contributions from individual speakers and discussion sections of the meeting. At the end we describe and discuss the conclusions of the meeting. As a result, the text is referenced less than would normally be expected in a review. Also, in summarising contributions from named presenters at the meeting it is possible that we have created inaccuracies; however, the definitive version of each paper, as provided directly by the presenter, is available at http://www.wellcome.ac.uk/doc.WTX025116.html.

Estimating RNA editing efficiency of five editing sites in the serotonin 2C receptor by pyrosequencing

Accumulating evidence suggests that altered RNA editing of the serotonin 2C receptor (HTR2C) is involved in the pathophysiology of mental disorders and the action of antidepressants. Estimating RNA editing of HTR2C in various samples is a first step to understanding its pathophysiological roles. Here, we developed a high-throughput quantification method of RNA editing efficiency by pyrosequencing. By optimizing the dispensation order, the RNA editing efficiency of all five RNA editing sites including consecutively ordered sites in HTR2C was obtained. More importantly, our method made it possible to determine the content of partial HTR2C isoforms, which enabled us to monitor possible functional changes of HTR2C. This method was validated in both oligonucleotide and RT-PCR product templates, and showed good correlation with conventional cloning-sequencing analysis. Our method could be a valuable tool in the rapid assessment of RNA editing status, including assessment of natural variations, alterations in disease tissues, and responses to drugs.

Misdiagnosing the problem: mental health profiles of incarcerated juveniles

Aggression, antisocial and delinquent behavior frequently result in the incarceration of a large number of young people, but these problems pale in comparison to the mental health challenges faced by many of these youth. Recent studies show a high prevalence of mental disorders among adolescents within the justice system. These findings have led researchers, clinicians and policy-makers to re-evaluate the assessment and treatment options that are available for youth within correctional facilities. This article provides a concise review of the most recent research related to mental health disorders among incarcerated juveniles within Canada and the United States. Rates of some of the most common mental health disorders among juveniles, including depression, anxiety, attention deficit hyperactivity and substance use are summarized. Throughout the review, issues related to co-morbidity and gender differences are highlighted. The implications of mental health disorders for juvenile justice policy and practice are discussed.

Neurobiological findings in posttraumatic stress disorder: a review

Since posttraumatic stress disorder (PTSD) was first recognized as a psychiatric disorder, it has generated a great deal of scientific interest. Recent studies on the neurobiology of PTSD provide evidence that PTSD is biologically distinct from other types of traumatic and nontraumatic stress responses. This paper reviews three important directions of neurobiological research in PTSD: noradrenergic axis changes and associated alterations in autonomic responsivity neuroendocrine changes involving the hypothalamic-pituitary-adrenocortical (HPA) axis, and neuroanatomy changes involving the hippocampus. Each section reviews the salient aspects of preclinical research on the biology of stress and their bearing on the understanding of PTSD, and summarizes prominent findings from clinical biological studies of PTSD, Tentative models that integrate current findings from the clinical study of PTSD are reviewed. To conclude, the important methodological and empirical issues that need to be addressed by future studies are indicated.