Biomedical subjects

K Hawton

Publications and source records attributed to K Hawton.

At least 127 records · Page 7Linked to original sources

PubMed1990

The relationship between intellectual impairment and mood disorder in the first year after stroke.

In a community-based study of patients with a first-ever stroke, intellectual impairment (as defined by scores on a common screening test for dementia, the Mini-Mental State Examination) was found in 26% at 1 month post-stroke, and in 21% at 6 and 12 month follow-up. Low scores on the screening test were associated with greater age, physical disability before the stroke, larger stroke lesion volumes as measured on CT scan, and non-stroke changes such as atrophy and white matter low attenuation on the CT scan. There was a negative correlation between scores on the Mini-Mental State Examination and symptom levels on two measures of mood disorder. However, there was no evidence of a specific relationship between major depression and low scores on the Mini-Mental State. We examined various aspects of the relationship between mood symptoms and low scores on the Mini-Mental State, but found no evidence to support the suggestion that this relationship represented an example of depressive pseudodementia. We discuss the significance of our findings for clinical psychiatry and neuropsychology.

Adolescent↗

PubMed1990

Mood disorders in long-term survivors of stroke: associations with brain lesion location and volume.

Sixty surviving patients from a community-based stroke register who had CT scan evidence of a single brain lesion and neurological signs appropriate to it were interviewed three to five years following their first-ever stroke. Mood disorder (anxiety and depression), physical disability, and intellectual impairment were assessed using standardized measures. The position and volume of the brain lesion was determined from CT scans performed soon after the stroke. The prevalence of depressive disorder was lower in this sample than that reported in previous studies (DSM-IIIR major depression 8.3%; all DSM-IIIR depressive disorders 18.3%). Reports by other workers for an association of depressive disorder either with left-sided brain lesions, or with anteriorly placed lesions in the left cerebral hemisphere, were not supported. Neither was there evidence of a correlation between symptom score and proximity of the lesion to the anterior pole of the left cerebral hemisphere. Psychiatric symptom scores were however greater with larger volume brain lesions. Anxiety disorders, especially agoraphobia, were relatively common (20% if diagnosed in the presence of depressive disorder), but were not related to lesion location or volume.

Activities of Daily Living↗

PubMed1990

Mood disorders after stroke and their relation to lesion location. A CT scan study.

In a community-based study of stroke survivors, we identified 73 consecutive patients with a stroke, the first ever in a lifetime, who had a CT scan which showed a neurologically appropriate single stroke lesion, and who did not have a psychiatric disorder in the year preceding the stroke. A detailed follow-up study of these patients using standardized psychiatric assessments failed to confirm a number of recent claims about poststroke depressive disorders. We found no evidence that left-sided lesions were associated with more severe or persistent depressive symptoms, or that right-sided lesions were associated with hypomania. The DSM III syndrome of major depression was much less common than has previously been reported, and was not specifically associated with lesions placed anteriorly in the left hemisphere. There was a weak correlation between mood symptom scores and the proximity of the stroke lesion to the frontal pole of the hemisphere, but no evidence of a difference between right and left hemisphere strokes in the nature of the relationship between lesion distribution and mood symptoms. We suggest that previous studies have different findings because of differences in the conventions applied to the definition and measurement of psychiatric disorders after stroke, and because other studies have concentrated on selected inpatient populations.

Adolescent↗

PubMed1990

Reliability of routine hospital data on poisoning as measures of deliberate self poisoning in adolescents.

STUDY OBJECTIVE: The aim was to assess the extent to which routinely collected data on poisoning in adolescents reflected deliberate self poisoning and, in doing, so to assess the accuracy of the diagnostic information on poisoning in the routine hospital abstracts which form the joint data base of Hospital Activity Analysis and the Oxford Record Linkage Study (ORLS). DESIGN: A comparison was made (a) of all eligible ORLS records during the study period with an independent source of records; and (b) of a random sample of records from an independent source with ORLS. SETTING: Records of patients admitted to the John Radcliffe Hospital in Oxford were used. SUBJECTS: These were (a) patients aged 10-20 years between 1980 and 1985 with a diagnosis of poisoning by drugs and medicaments in ORLS; (b) a random sample of 500 patients selected from the self harm monitoring files at the hospital (12 patients were not eligible for inclusion in ORLS and were therefore excluded from the rest of the study). MEASUREMENTS AND MAIN RESULTS: The recorded diagnosis was compared on the records selected from the two files. Of the 1123 events of poisoning identified in ORLS, 1081 (96.3%) were correctly coded as poisoning and 1065 (95%) of these were deliberate self poisoning. Of the 488 cases from the monitoring files, 467 (95.7%) of all cases had a correct diagnosis of injury or poisoning on the ORLS file. Of the 453 poisoning cases 436 (96.2%) were correctly recorded in ORLS. CONCLUSIONS: Deliberate self poisoning in adolescents can be identified through routinely collected hospital statistics. A very high percentage of the diagnostic information on poisoning in ORLS files is correctly recorded.

Adolescent↗

PubMed1990

Life events and difficulties preceding stroke.

Life events and difficulties were recorded for the year before stroke, using a standardised semi-structured interview, in 113 surviving patients seen after their first ever in a lifetime stroke. An age and sex-matched control group (n = 109) was also interviewed about the preceding year. The stroke patients reported fewer non-threatening events and events with only a short-term threat, while difficulties were reported with equal frequency by the two groups. However, events which were severely threatening in the long-term were significantly more common in the stroke patients (in the 52 weeks before stroke 26% versus 13%, odds ratio 2.3, 95% confidence interval 1.1-4.9). The increased rate was apparent throughout the year and not just in the weeks immediately before stroke onset. The number of stroke patients experiencing severe events in the follow up year fell to the level found in the control group. Recognised risk factors for stroke were found equally in those patients with and without severe events before onset, except that hypertension was rather less common in the patients who had experienced a severe event. It therefore appears that severe life events may be one of the determinants of stroke onset.

Adolescent↗

PubMed1990

Couples referred to a sexual dysfunction clinic. Psychological and physical morbidity.

Two hundred couples referred to a sexual problems clinic were assessed in a standardised way for their suitability for sex therapy. The assessment focused on the nature of the sexual dysfunction, motivation for treatment, marital and relationship problems, psychiatric status, and physical problems. Approximately one-third of the couples were found to have significant marital and relationship problems, and more than 30% were suffering from psychiatric disorders, although these were usually of mild to moderate intensity. A third of males and 18% of females were suffering from physical disorders likely to contribute to the sexual dysfunction. Patients who were offered sex therapy and who completed their course of treatment were more likely to show high levels of motivation and an absence of physical disorders, marital relationship problems and psychiatric disorder. There should be careful assessment of couples suffering from sexual dysfunction before specific treatment is offered.

Adolescent↗

PubMed1990

Single-photon emission computerised tomography (SPECT) in schizophrenia.

SPECT studies were carried out on three occasions in a woman with schizophrenia. Marked 'hypofrontality' was demonstrated during an acute phase of illness. A study during remission was within normal limits, but some return of the original defect was noted in a subsequent relapse. These findings parallel those found in PET studies of schizophrenia.

Adult↗

PubMed1990

Self-poisoning in adolescents. Hospital admissions and deaths in the Oxford region 1980-85.

Linked hospital and death records for 10-20-year-olds admitted with a diagnosis of poisoning were analysed. Between 1980 and 1985 there was a significant decline in admission rates, which was mainly attributable to a decline among 16-20-year-old females. There was no evidence of a decline in the admission rates among 12-15-year-olds. Ten per cent of the study population had at least one further hospital admission for poisoning during the mean follow-up period of 3.6 years. Female admission rates were substantially higher than those in males but readmission rates, given a first admission, were similar. The death rate in the study cohort was significantly higher than would be expected in the general population of this age and nearly all the deaths were from violent or unnatural causes.

Adolescent↗

PubMed1989

Emotionalism after stroke.

OBJECTIVE: To estimate the prevalence of emotionalism after stroke, to assess its relation with other mood disorders, and to identify clinical variables with which it is associated. DESIGN: Descriptive study of a cohort of patients consecutively entered on a community stroke register. SETTING: Community based research project. PATIENTS: A total of 128 patients who had suffered first ever stroke. INTERVENTIONS AND END POINTS: Patients were interviewed by a psychiatrist at 1, 6, and 12 months after stroke. Mood state was assessed by standardised semistructured interview (present state examination) and self report (Beck depression inventory). Intellectual impairment was assessed by mini mental state examination and Frenchay aphasia screening test. In addition, stroke lesions were localised by computed tomography. MAIN RESULTS: Emotionalism was reported by 13 of 89 patients (15%) at one month, 25 of 119 (21%) at six months, and 12 of 112 (11%) at 12 months after stroke. Patients with emotionalism had higher scores on both measures of mood disorder (at 6 months: mean Beck score 10.5 v 6.4; present state examination score 7.2 v 5.1) and more diagnosable psychiatric disorder (at 6 months: 40% v 14%; odds ratio 4.2, 95% confidence interval 1.5 to 11.9). Almost all episodes were provoked by clearly identified and appropriate emotional experiences. Patients with emotionalism also had more intellectual impairment and larger lesions on computed tomography. Lesions in the left frontal and temporal regions were particularly associated with emotionalism: at 6 months 8 of 14 patients (57%) with such lesions had emotionalism compared with 10 of 52 (19%) of those with lesions elsewhere (odds ratio 5.6, 95% confidence interval 1.4 to 22). CONCLUSIONS: Emotionalism is common after stroke. It is neither emotionally meaningless and inappropriate, nor is it found mostly in patients with bilateral brain damage. Emotionalism is associated with symptoms of a more general mood disturbance and is found especially in patients with left frontal and temporal lesions.

Affective Symptoms↗

PubMed1989

Methods of identifying mood disorders in stroke patients: experience in the Oxfordshire Community Stroke Project.

Four simple methods for assessing mood disorders were examined in a cohort of stroke patients: the Beck Depression Inventory; a visual analogue mood scale; a nurses' depression rating; and a carers' depression rating. None of the measures was entirely satisfactory, either because of inaccuracy when compared to a standardized psychiatric interview, or because of low response rates. A review of their case records showed that the patients' general practitioners were aware of nearly all those with severe persistent mood disorders. The implications of these findings for clinical practice are discussed.

Cerebrovascular Disorders↗

PubMed1989

Alcoholism, alcohol and attempted suicide.

Attempted suicide patients referred to a general hospital over a 10 year period were studied with regard to alcoholism and drinking in association with suicide attempts. Alcoholism was diagnosed in 7.9% of patients (14.6% of males and 4.2% females), and this diagnosis became proportionately more common in both sexes during the study period. However, only male alcoholic attempters showed an increase in absolute numbers during the study period, the increase in the proportion of females diagnosed as alcoholic being due to a decline in attempts by non-alcoholics. Particularly high rates of alcoholism were found in the unemployed of both sexes and in housewives. Alcoholic attempters were at greatly increased risk of making repeat attempts. Alcohol consumption shortly before a suicide attempt and as part of the act was extremely common, especially among alcoholics. In addition to increasing the likelihood of an attempt, alcohol may add considerably to the danger of overdoses. Careful investigation of drinking patterns should be an integral part of the assessment of all attempted suicide patients, and there should be close liaison between general hospital services for such patients and local alcoholism treatment services.

Adolescent↗

PubMed1988

Sexual dysfunction among middle aged women in the community.

In a community survey of women aged 35-59 sexual functioning was studied in the 436 women with partners. One third of these women had operationally defined sexual dysfunction: impaired sexual interest was identified in 17% of women (68/406), vaginal dryness in 17% (73/434), infrequency of orgasm in 16% (60/379), and dyspareunia in 8% (30/379). Sexual dysfunctions were statistically significantly associated with increasing age and also with psychiatric disorder, neuroticism, and marital disharmony. One in 10 women regarded themselves as having a sexual problem. These women were no older than women with sexual dysfunction who did not regard themselves as having a sexual problem. Nevertheless, they differed from the rest of the sample in having more psychiatric disorder, neuroticism, marital disharmony, and (in women still menstruating) psychological symptoms of the premenstrual syndrome. In the whole sample 16 women (4%) said that they would like help for a sexual problem. The prevalence of sexual dysfunction in this series of women suggests that general practitioners should increase their alertness to the problem in their patients.

Adult↗

PubMed1988

What happens to medical patients with psychiatric disorder?

Medical, psychiatric and social outcome were examined in medical in-patients previously identified as suffering from psychiatric disorder. One third of patients with an affective (emotional) disorder on admission were still psychiatrically ill four months after discharge. Persistent disorder was associated with continuing physical illness. During the year following admission those with affective disorder on admission continued to make greater demands on medical, social and psychiatric services than matched controls and had double the mortality rate (not significant). Patients with organic mental states on admission had a high mortality and morbidity, and made considerable continuing use of general hospital social and psychiatric services. Improved recognition of psychiatric disorder during hospital admission could result in better overall care of medical patients' psychiatric and social difficulties and more effective use of medical resources.

Adult↗

PubMed1988

Recent clinical and epidemiological trends in parasuicide in Edinburgh and Oxford: a tale of two cities.

This is a report of clinical and epidemiological trends in parasuicide in Edinburgh and Oxford over the period of 1976 to 1984. Rates of parasuicide declined in both cities, but more markedly among women than men. Male rates tended to be higher in Edinburgh and female rates higher in Oxford. Age-specific rates were similar for the two cities in 1983-84, with peak rates for females among 15-19 year olds and those for males among 20-24 year olds in Edinburgh and 25-34 year olds in Oxford. Parasuicide incidence was higher in lower social class groups and among the unemployed in both cities. During the study period there was a massive decline in barbiturate overdoses, a more modest decline in minor tranquillizer overdoses but, in Oxford, a marked increase in self-poisoning with paracetamol. By the end of the study period the proportion of patients receiving a diagnosis of drug addiction had doubled in Edinburgh, although it had remained fairly constant in Oxford. There were differences in patterns of aftercare offered to patients in the two cities; these almost certainly reflect differing clinical policies.

Adolescent↗

PubMed1988

Suicide, and other causes of death, following attempted suicide.

The number of deaths in a large series of suicide attempters followed up after their attempts was 3.3 times greater than expected. Suicide or probable suicide occurred in 2.8% by the end of the eighth year of follow-up, the rate of suicidal deaths being 26.9 times the expected rate. The highest risk of suicide was during the first 3 years, especially in the first 6 months, following an attempt. Factors identified at the time of the attempts which were associated with suicide risk included: being male, advancing age (females only), psychiatric disorder (especially schizophrenia), long-term use of hypnotics, poor physical health, and repeat attempts. Recent disruption of a relationship with a partner and major rows rarely preceded the attempts of those who later killed themselves. Factors predicting long-term risk of suicide also predicted short-term risk. There were more than double the expected number of deaths from natural causes, the excess being greatest in females. Markedly high death rates were found for endocrine, circulatory and respiratory diseases, and accidents.

Adolescent↗

PubMed1988

Female unemployment and attempted suicide.

Unemployment became more common among females attempting suicide in Oxford between 1976 and 1985, although the rise was less than expected from the increased general-population female unemployment rate. Rates of attempted suicide among unemployed women between 1979 and 1982 were 7.5-10.9 times higher than those of employed women, and were particularly high in women unemployed for more than a year. Many more unemployed than employed women attempting suicide had a history of psychiatric difficulties, were suffering from alcoholism, and made repeat attempts. Two possible explanations are: firstly, the secondary consequences of unemployment increase the risk of suicidal behaviour; and, secondly, women already predisposed to psychiatric difficulties and hence attempted suicide are more likely to become unemployed.

Adolescent↗

PubMed1988

Erectile dysfunction and premature ejaculation.

In parallel with the increased recognition of organic causes of erectile dysfunction, several new physical methods of treatment have been developed for this problem. These include intracavernosal injections of vasodilators, penile prostheses, vascular surgery, vacuum condoms, and medication. However, psychological treatment approaches are still of considerable importance in the treatment of both erectile dysfunction and premature ejaculation.

Ejaculation↗

PubMed1987

Evaluation of out-patient counselling compared with general practitioner care following overdoses.

In a randomized prospective treatment study, 80 overdose patients (not requiring intensive psychiatric intervention) received either brief out-patient counselling or were returned to the care of their general practitioners with advice on management. There was little difference in outcome between the two groups. However, two sub-groups of patients benefited more from out-patient counselling than from general practitioner care, these were: (a) women, and (b) patients with dyadic problems. Counselling following overdoses should be focused on groups of patients such as these who are most likely to benefit from it. Further work is needed to identify treatment approaches that will help other groups who take overdoses, especially men.

Adult↗