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Biomedical subjects

D J Castle

Publications and source records attributed to D J Castle.

At least 19 recordsLinked to original sources
PubMed1996

The incidence of mania: time trends in relation to gender and ethnicity.

In order to investigate conflicting reports about possible changes in the incidence of mania, we established first contact rates for mania in the defined area of Camberwell between 1965 and 1984. There was some evidence for an increase in the first contact rate of mania, especially in females. This rise may be associated with the influx into Camberwell of individuals of Afro-Caribbean origin who showed significantly higher rates than the white group [adjusted rate ratio 3.1; 95% confidence interval (CI) 1.4-6.9] and more often displayed mixed manic and schizophrenic symptomatology (risk ratio 2.2; 95% CI 1.1-4.3). We conclude that the incidence of mania has not decreased and may actually have increased. High rates of mental illness among members of ethnic minorities are not specific to schizophrenia, suggesting that a risk factor common to both manic and schizophrenic illness is more prevalent among these groups.

Adolescent↗
PubMed1996

Psychotic illness in ethnic minorities: clarification from the 1991 census.

Age and sex-adjusted first admission rates for operationally-defined schizophrenia and other non-affective psychosis in different ethnic groups were calculated over the period 1988-1992 in a defined catchment area in South London. Standardized rates for schizophrenia, corrected for age- and gender-related under-reporting in the 1991 census and a 20% underestimate of the size of the ethnic minority populations in the area, were not only higher in the Afro-Caribbean group (SMR: 3.1; 95% C1:2.0-4.7), but also in the African group (SMR: 4.2; 95% C1: 2.8-6.2). It was further found that higher rates were not specific to schizophrenia. These findings suggest that some common factor associated with ethnic minority membership is important in producing an excess of psychotic illness.

Adolescent↗
PubMed1995

Premorbid abnormalities in mania, schizomania, acute schizophrenia and chronic schizophrenia.

The aim of this study was to examine the hypothesis that differences in outcome among affective and non-affective psychoses are associated with differences in the degree of developmental deviance. We conducted a retrospective survey of first contact cases treated over a 20-year period in a psychiatric hospital serving a catchment area in South London. All patients with non-depressive functional psychosis residing in the catchment area who received their first psychiatric treatment between 1965 and 1984 were included in the study. Cases were classified according to the relative chronicity of their illness into four non-overlapping groups: mania, schizomania, acute schizophrenia and chronic schizophrenia. There was a linear trend in the association between illness chronicity and proxy measures of development deviance, such as premorbid unemployment, single status and poor academic achievement. Compared to individuals with mania, schizophrenic patients had a 3-6 times increased risk of premorbid abnormality. For patients with schizomania and acute schizophrenia, the risk was 1.5-3 times greater than for manic subjects. We conclude that the prevalence of premorbid abnormalities is highest among chronic schizophrenia, but similar disturbances also occur, to a lesser degree, in less disabling affective and non-affective psychotic disorders.

Acute Disease↗
PubMed1995

Gender differences in schizophrenia: hormonal effect or subtypes?

Compared with their male counterparts, females with schizophrenia, on average, show better premorbid functioning, later onset, and a more benign course of illness. They are also more likely to have a family history of schizophrenia and/or affective illness, to exhibit "atypical" and affective features, and to show a seasonal pattern of hospital admission that mimics that of patients with mania. However, there exists a paradox. Although schizophrenia in females has much in common with affective disorder, the "schizophrenogenic" effect of maternal influenza also appears to be more significant in female than in male schizophrenia. Perhaps females with a predisposition to affective psychosis who have also been subject to the effects of maternal viral infection during gestation develop some subtle neurodevelopmental damage that renders their psychosis schizophrenia-like.

Female↗
PubMed1995

Gender differences in obsessive compulsive disorder.

We investigated gender differences in 219 patients with obsessive compulsive disorder consecutively referred to a centre specialising in the behavioural treatment of anxiety disorders. Females had a later mean onset-age, and were more likely to be married and to have children; they were also marginally more likely to have a past history of an eating disorder or depression, while males were more likely to have a history of anxious or meticulous personality traits. Family loading for psychiatric disorders did not differ significantly between the sexes. The results are discussed in the context of the epidemiological literature on gender differences in OCD.

Adolescent↗
PubMed1994

The subtyping of schizophrenia in men and women: a latent class analysis.

Latent class analysis on an epidemiologically based series of 447 first contact patients with a broad diagnosis of schizophrenia revealed evidence for two subtypes: a 'neurodevelopmental' type characterized by early onset, poor pre-morbid social adjustment, restricted affect and a male:female ratio of 7:3; and a 'paranoid' type characterized by later onset, persecutory delusions and an almost equal sex ratio. A third 'schizoaffective' subtype, whose existence was less clear cut, was almost entirely confined to females and characterized by dysphoria and persecutory delusions, and had negligible familial risk of schizophrenia. The aetiological, biological and clinical significance of this typology remains to be tested.

Adolescent↗
PubMed1994

Obsessive-compulsive disorder: prediction of outcome from behavioural psychotherapy.

Prediction of outcome after behavioural psychotherapy was determined in 178 outpatients with obsessive-compulsive disorder. For women (n = 103), factors significantly associated with good outcome included paid employment at time of assessment, having a co-therapist and low initial ratings on global phobia, work and home activity impairment and the compulsion checklist. In men, the only factor to approach statistical significance as a predictor of outcome was solitary abode, associated with "less improved" status.

Adolescent↗
PubMed1994

Which patients with non-affective functional psychosis are not admitted at first psychiatric contact?

BACKGROUND: We wished to explore the sociodemographic and clinical characteristics associated with admission to hospital in patients with a non-organic non-affective psychosis. METHOD: Subjects were 484 first-contact patients with a non-affective functional psychosis from an inner-city catchment area over 20 years from the mid-1960s. Sociodemographic and clinical characteristics associated with admission to hospital were analysed. RESULTS: Around 20% of patients were not admitted, and the proportion did not change significantly over the years. Ethnicity, sex, and marital and employment status did not predict admission. Factors associated with admission included police involvement, and violence to self or others. A diagnosis of schizoaffective disorder, and persecutory delusions, auditory hallucinations, and bizarre behaviour were all more common in patients admitted to hospital. CONCLUSIONS: The study indicates biases which might arise in research based exclusively on patients admitted to hospital.

Adolescent↗
PubMed1993

Does social deprivation during gestation and early life predispose to later schizophrenia?

We employed a case-control study design to investigate whether schizophrenic patients differed from non-psychotic psychiatric patients in terms of place of birth and paternal occupation. "Cases" were first-contact schizophrenic patients ascertained from the Camberwell Cumulative Psychiatric Case Register. "Controls" were the next (non-psychotic) patient on the Register matched for age and sex. In comparison with controls, cases were more likely to have: (1) been born in the deprived inner-city Camberwell catchment area (odds ratio 2.3), and (2) had fathers who had "manual" as opposed to "non-manual" occupations (odds ratio 2.1). The results were compatible with the notion that socio-economic deprivation during gestation and early life predisposes to later schizophrenia.

Case-Control Studies↗
PubMed1993

Heterogeneity in schizophrenia: an extended replication of the hebephrenic-like and paranoid-like subtypes.

Hebephrenic-like (H) and paranoid-like (P) subtypes of schizophrenia have previously been described by Farmer et al. (1983, 1984). The stability of this subtypology of schizophrenia was explored using multivariate statistical techniques on a large independent data set. Both a discriminant function analysis and an admixture analysis produced strong evidence for a bimodel distribution of scores consistent with the H-like and P-like subtypes.

Adult↗
PubMed1993

The epidemiology of late-onset schizophrenia.

We report an analysis of a large catchment area sample of patients with nonaffective functional psychoses presenting across all ages at onset. The male:female ratio was 1.56:1 in the 16-25-year age group; it reached unity around 30 years of age and declined to 0.38:1 in the 66-75-year group. Contrary to expectation, a higher proportion of patients with onset of illness after 45 years than of younger onset patients fulfilled DSM-III-R criteria for schizophrenia (52% vs. 38%). The distribution by age at onset was much the same irrespective of stringency of diagnosis. The highest rates were in the 16-25-year age group, with a slight second peak in the 46-55-year group, and a third (more emphatic) peak in the over-65 group. A closer analysis of demographic and phenomenologic variables revealed distinct differences between patients with early and late (after 44 years) onset of illness.

Adolescent↗
PubMed1993

Sex and schizophrenia: effects of diagnostic stringency, and associations with and premorbid variables.

In a case-record study, all first-contact patients with non-affective functional psychosis from a defined area over 20 years were diagnosed according to operational criteria of varying stringency and emphasis, and incidence rates for each set of criteria determined by sex and age at onset; data on premorbid adjustment were also analysed by sex and age at onset. The overall first-contact incidence of non-affective functional psychosis was approximately equal in men and women; however, the ratio of male to female incidence rates rose progressively when RDC (1.2), DSM-III-R (1.3), DSM-III (2.2), and Feighner (2.5) criteria for schizophrenia were applied. Schizophrenia was most common in young males and least common in older males, with females occupying an intermediate position. Schizophrenia in young males, particularly when stringently defined, was especially likely to be associated with single status, poor work and social adjustment, and premorbid personality disorder. The results suggest that schizophrenia syndrome is heterogeneous, and young males are especially prone to a severe neurodevelopmental form of illness associated with premorbid deficits.

Adult↗
PubMed1992

A neurodevelopmental approach to the classification of schizophrenia.

The conventional distinction between schizophrenia and manic depression has received little objective support from recent studies of phenomenology, outcome, or familial homotypy. Instead, much clinical, epidemiological, and morphological evidence suggests that within the broad range of Schneiderian schizophrenia there exists one form (congenital schizophrenia) that can be distinguished from other types, the manifestations of which are confined to adult life. We hypothesize that congenital schizophrenia is a consequence of aberrant brain development during fetal and neonatal life. Such patients show structural brain changes and cognitive impairment, and in their male predominance, early onset, and poor outcome, they reflect Kraepelin's original description of dementia praecox. We contend that adult-onset schizophrenia is itself heterogeneous. One important component is a relapsing and remitting disorder that is more frequent in females than in males, exhibits positive but not negative symptoms, and has much in common etiologically with affective psychosis. There also exists a very-late-onset group in which degenerative brain disorder is implicated.

Bipolar Disorder↗
PubMed1991

Carotid artery disease in young adults.

The angiographic and clinical findings in 17 young adults (14-39 years) with stenosis and/or occlusion of at least one of the common or internal carotid arteries were reviewed to determine the spectrum of carotid artery disease in this age group. Five aetiological groups were identified: atherosclerosis (3 patients), arteritis (4), non-inflammatory arteriopathies (6), compression by neoplasm (1), and occlusions of undetermined cause (3). Over a mean follow-up time of 19.7 months, 2 patients died (12.5%) and further cerebrovascular events occurred in 4 others (25%). We conclude that carotid angiography plays a meaningful role in providing a definitive diagnosis in young adults with carotid artery disease and thus may assist with therapy and prognosis.

Adolescent↗