Psychiatric morbidity among women prisoners in England and Wales.
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Biomedical subjects
Publications and source records attributed to H Meltzer.
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The prevalence of pervasive developmental disorders (PDD) is not well established and needs monitoring. We investigated the prevalence of PDDs in the 1999 nationwide British survey of child and adolescent mental health. A randomized stratified sample of children (n = 12,529) aged 5-15 was generated from Child Benefit Records. Trained interviewers interviewed parents and youths aged 11 or older with a standardized diagnostic interview (Development and Well-Being Assessment) and questionnaire data (Strengths and Difficulties Questionnaire) were obtained from teachers and parents who also completed self-report measures of psychological distress. A team of experienced clinicians using all data sources achieved final diagnostic determination. A total of 10,438 (83%) interviews were conducted. There were two girls with Rett syndrome (weighted prevalence: 3.8/10,000 girls) and 27 children with other PDDs (weighted prevalence: 26.1/10,000). Compared to children with a psychiatric disorder other than PDD, social but not behavioural problems were more frequent in the PDD group. Parents of children with PDDs had higher rates of psychological distress than those from the two comparison groups. Consistent with other recent surveys, PDD rates are higher than those reported 30 years ago. The burden associated with PDDs is very high.
Child psychiatric disorders are common and treatable, but often go undetected and therefore remain untreated. To assess the Strengths and Difficulties Questionnaire (SDQ) as a potential means for improving the detection of child psychiatric disorders in the community, SDQ predictions and independent psychiatric diagnoses were compared in a community sample of 7984 5-15 year olds from the 1999 British Child Mental Health Survey. Multi-informant (parents, teachers, older children) SDQs identified individuals with a psychiatric diagnosis with a specificity of 94.6% (95% Cl, 94.1-95.1%) and a sensitivity of 63.3% (59.7-66.9%). The questionnaires identified over 70% of individuals with conduct, hyperactivity, depressive, and some anxiety disorders, but fewer than 50% of individuals with specific phobias, separation anxiety and eating disorders. Sensitivity was substantially poorer with single-informant rather than multi-informant SDQs. Community screening programmes based on multi-informant SDQs could potentially increase the detection of child psychiatric disorders, thereby improving access to effective treatments.
The self-report version of the Strengths and Difficulties Questionnaire (SDQ) was administered to two samples of 11-16 year olds: 83 young people in the community and 116 young people attending a mental health clinic. The questionnaire discriminated satisfactorily between the two samples. For example, the clinic mean for the total difficulties score was 1.4 standard deviations above the community mean, with clinic cases being over six times more likely to have a score in the abnormal range. The correlations between self-report SDQ scores and teacher--or parent rated SDQ scores--compared favourably with the average cross informant correlations in previous studies of a range of measures. The self-report SDQ appears promising and warrants further evaluation.
Obsessive-compulsive disorder (OCD) is a disorder that appears to be under-diagnosed and under-treated, despite the evidence for effective treatments. There are variable estimates of OCD prevalence in the under-16s and published rates give little indication of age trends. The aim of this study was to establish the prevalence and associates of OCD in young people aged 5-15 years. The method was a nationwide (UK) epidemiological study of rates of psychiatric disorder in 5-15 year olds (1999 British Child Mental Health Survey): 10,438 children were assessed. Twenty-five children with OCD were identified (weighted overall prevalence 0.25%; 95% CI 0.14-0.35), with prevalence rising exponentially with increasing age. Compared with normal controls, children with OCD were more likely to be from lower socio-economic class and of lower intelligence. Only three of these children had been seen by specialist children's services. Although OCD is rare in young children, the rate increases towards the adult rates at puberty. Children with OCD have additional psychosocial disadvantage. The majority of the childhood cases identified in this survey appear to have been undetected and untreated.
The findings described in this report and summarized here focus on the prevalence of mental disorders among 5-15 year olds and on the associations between the presence of a mental disorder and biographic, sociodemographic, socio-economic, and social functioning characteristics of the child and the family. Causal relationships should not be assumed for any of the results presented in this report.
PURPOSE: Our goal was to determine whether functional MRI on a standard 1.5 T system can localize activation during a visual vigilance sustained attention task and whether this corresponds to results described in a PET investigation of a similar task. METHOD: Sixteen volunteers were studied on a 1.5 T system using a gradient echo technique. A single axial section was oriented within a stereotaxic coordinate space, 40 mm superior to the anterior-posterior commissure line. Images with eyes closed were followed by images during subject concentration on a small dim spot. Motion correction and pixel-by-pixel statistical analysis were performed. Talairach grids were applied for summary statistical analysis and comparison to PET data, with analysis using a series of planned contrasts within a repeated measures analysis of variance. RESULTS: Predominantly right-sided frontal and parietal activation was observed, with statistical significance across subjects in the right frontal lobe (F > or = 5.9, p < or = 0.041). Comparison with previously reported PET data yielded a very similar pattern of activation (F = 13.2; df = 1,8; p = 0.007). CONCLUSION: Activation of the right middle frontal gyrus and right parietal lobe during visual vigilance is detectable across functional imaging modalities.