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Biomedical subjects

L Appleby

Publications and source records attributed to L Appleby.

At least 55 records · Page 3Linked to original sources
PubMed1998

The psychological autopsy approach to studying suicide: a review of methodological issues.

The psychological autopsy approach to studying suicide is becoming an increasingly used research method. It presents considerable methodological problems. In order to assist future researchers in this field and to help readers assess reports of psychological autopsy studies the authors have reviewed these issues on the basis of their own experience and those of other workers. The areas covered include research design, identification of subjects, sources of information and the particular issues concerned with approaching relatives and other informants, choice and recruitment of controls, the difficulties of conducting psychological autopsy interviews with relatives, problems for interviewers, the selection of appropriate measures to obtain information, and achieving valid and reasonably reliable conclusions from diverse information sources.

Autopsy↗
PubMed1998

Randomised, double-blind, placebo-controlled treatment trial of fluoxetine and graded exercise for chronic fatigue syndrome.

BACKGROUND: The Joint Working Group of the Royal Colleges of Physicians, Psychiatrists and General Practitioners (1996) recommended graded exercise and antidepressants for patients with chronic fatigue syndrome. We assessed efficacy and acceptability of these treatments. METHOD: Six-month prospective randomised placebo and therapist contact time controlled trial with allocation to one of four treatment cells: exercise and 20 mg fluoxetine, exercise and placebo drug, appointments only and 20 mg fluoxetine, appointments and placebo drug. Drug treatment was double blind and patients were blind to assignment to exercise or appointments. RESULTS: Ninety-six (71%) of 136 patients completed the trial. Patients were more likely to drop out of exercise than non-exercise treatment (P = 0.05). In an intention to treat analysis, exercise resulted in fewer patients with case level fatigue than appointments only at 26 weeks (12 (18%) v. 4 (6%) respectively P = 0.025) and improvement in functional work capacity at 12 (P = 0.005) and 26 weeks (P = 0.03). Fluoxetine had a significant effect on depression at week 12 only (P = 0.04). Exercise significantly improved health perception (P = 0.012) and fatigue (P = 0.028) at 28 weeks. CONCLUSIONS: Graded exercise produced improvements in functional work capacity and fatigue, while fluoxetine improved depression only.

Adult↗
PubMed1998

Suicide and other causes of mortality after post-partum psychiatric admission.

BACKGROUND: The risk of suicide in postnatal women is low and those suicides that occur appear to be associated with severe psychiatric illness. No previous study has specifically studied the risk of suicide following post-partum psychiatric disorder. METHOD: We calculated standardised mortality ratios (SMRs) for suicide, unnatural deaths and deaths from natural causes for women admitted to psychiatric hospital in the first year after childbirth, using computerised cross-linkages between the Danish Psychiatric Case Register and the Danish registers of birth and causes of death for 1973-1993. RESULTS: During the study period 1567 women were admitted to psychiatric hospital of whom 107 (6.8%) died. The SMRs (compared with 100) were 1719 (95% CI1284-2254) for suicide, 1329 (95% CI1038-1676) for all unnatural causes and 238 (95% CI167-329) for natural causes. Suicides and deaths from all unnatural causes were most likely to occur in the first year after childbirth, the SMR for suicide within one year being 7216 (95% CI 3945-12 108). CONCLUSIONS: Although postnatal women as a whole appear to have a low rate of suicide, severe post-partum psychiatric disorder is associated with a high rate of deaths from natural and unnatural causes, particularly suicide. The risk is especially high in the first postnatal year, when the suicide risk is increased 70-fold. Close clinical supervision at this time is indicated.

Case-Control Studies↗
PubMed1998

Efficiency and validity of commonly used substance abuse screening instruments in public psychiatric patients.

BACKGROUND: The more commonly used screening instruments for substance abuse were largely developed for addictive populations. We compared several alcohol and drug abuse scales to determine their efficiency and validity for psychiatric patients. METHOD: The subjects were 100 consecutively admitted patients to a public psychiatric facility. DSM-III-R diagnoses, obtained from the alcohol and drug scales of the SCID-P, were the criterion measure. Methods of reliability included inter-rater agreement, estimates of internal consistency, and repeat test administration. Sensitivity, specificity and more infrequently used accuracy indices, such as likelihood ratios and Receiver Operating Characteristic (ROC) analysis, were utilized to assess scale validity. RESULTS: First, the reliability of all scales was high. Second, the instruments generally demonstrated highly acceptable levels of screening accuracy. Third, the intake evaluation was as reliable and valid as screening after admission on the unit. Finally, instruments were least discriminating for current problems (past 30 days). CONCLUSIONS: Lifetime measures were found to be reliable and valid for public psychiatric patients but further research is need on increasing the accuracy of screening for current substance abuse problems and the effectiveness of multiple screening approaches.

Adult↗
PubMed1997

A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression.

OBJECTIVE: To study the effectiveness of fluoxetine and cognitive-behavioural counselling in depressive illness in postnatal women: to compare fluoxetine and placebo, six sessions and one session of counselling, and combinations of drugs and counselling. DESIGN: Randomised, controlled treatment trial, double blind in relation to drug treatment, with four treatment cells: fluoxetine or placebo plus one or six sessions of counselling. SUBJECTS: 87 women satisfying criteria for depressive illness 6-8 weeks after childbirth, 61 (70%) of whom completed 12 weeks of treatment. SETTING: Community based study in south Manchester. MAIN OUTCOME MEASURES: Psychiatric morbidity after 1, 4, and 12 weeks, measured as mean scores and 95% confidence limits on the revised clinical interview schedule, the Edinburgh postnatal depression scale and the Hamilton depression scale. RESULTS: Highly significant improvement was seen in all four treatment groups. The improvement in subjects receiving fluoxetine was significantly greater than in those receiving placebo. The improvement after six sessions of counselling was significantly greater than after a single session. Interaction between counselling and fluoxetine was not statistically significant. These differences were evident after one week, and improvement in all groups was complete after four weeks. CONCLUSIONS: Both fluoxetine and cognitive-behavioural counselling given as a course of therapy are effective treatments for non-psychotic depression in postnatal women. After an initial session of counselling, additional benefit results from either fluoxetine or further counselling but there seems to be no advantage in receiving both. The choice of treatment may therefore be made by the women themselves.

Adult↗
PubMed1997

Attitudes toward motherhood in postnatal depression: development of the Maternal Attitudes Questionnaire.

This article describes the development of the Maternal Attitudes Questionnaire (MAQ), a 14-item self-report instrument measuring cognitions relating to role change, expectations of motherhood, and expectations of the self as a mother in postnatal women. This questionnaire was found to have good test-retest and internal reliability. In a large sample of women (n = 483) at 6-8 weeks postpartum, scores on the questionnaire were highly correlated with scores on the Edinburgh Postnatal Depression Scale (EPDS) and the Revised Clinical Interview Schedule (CIS-R). Cluster analysis demonstrated that, among depressed women with similar symptom scores on the CIS-R, the MAQ discriminated a group with low MAQ scores and a group with high MAQ scores. This finding supports the hypothesis that women who are depressed postnatally are cognitively heterogeneous; such differences may be important in understanding the etiology and determining the treatment of postnatal depression.

Adult↗
PubMed1997

Cognitive performance and complaints of cognitive impairment in chronic fatigue syndrome (CFS).

Patients with chronic fatigue syndrome (CFS) complain that they have difficulties with concentration and memory but studies to date have not found consistent objective evidence of performance deficits. Two groups of CFS patients, depressed and non-depressed, and healthy controls, were asked about concentration problems in general and specifically when reading. CFS subjects were more likely than controls to report that they had concentration problems when reading, that they needed to re-read text and that they failed to take in what they were reading. Subjects then performed a task in which their reading behaviour and text recall was measured. While all CFS subjects complained of general cognitive failures and of difficulties with reading, only depressed CFS subjects recalled significantly less of the text than controls. Severity of complaints about reading problems was not related to amount of text recalled, but was related to severity of depressed mood. However, subjects were able to evaluate accurately their ability to remember the text immediately after reading it and before being tested for recall. Additionally, subjects performed a paired-associate learning task on which no significant differences between the subject groups was found. It is concluded that deficits in cognitive functioning in CFS patients are more likely to be found on naturalistic than on laboratory tasks.

Adult↗
PubMed1997

Assessing substance use in multiproblem patients: reliability and validity of the Addiction Severity Index in a mental hospital population.

The Addiction Severity Index (ASI) is the most widely used measure of substance use in the field. Its reputation has been supported by reliability and validity studies. Despite its success, the psychometric properties of the ASI have not been examined in mental hospital populations. Our intent was to replicate prior studies and expand upon the validity of the ASI in a sample of 100 public psychiatric patients selected for a larger study. Findings revealed that a) reliability was acceptable, but there was only moderate agreement on the psychiatric scale severity score; b) the relationship between extent of rater training and reliability requires further study; c) despite some overlap, the scales were largely independent of each other; d) modification of the employment scale was necessary because of low correlations between the composite and severity score; e) raters are more responsive to client subjective ratings in psychiatric settings; f) ASI drug and alcohol scales correlate well with other substance use instruments and with DSM-III-R diagnoses; and g) the ASI can identify meaningful types of patient problems through cluster analysis. These findings, on the whole, support the use of the ASI drug and alcohol scales in public psychiatric hospitals.

Adult↗
PubMed1997

The impact of substance use screening on a public psychiatric inpatient population.

OBJECTIVE: This study sought to determine the impact of a formal screening program for substance use disorders among psychiatric inpatients. Both identification of these disorders and referrals to aftercare were measured. METHODS: A total of 193 patients admitted to a state psychiatric facility during a two-month period before screening was initiated were compared with 183 patients admitted during the same two months a year later when screening was in place. Patients were screened using the Chemical Use, Abuse, and Dependence Scale. Data were collected from hospital and statewide computerized files. RESULTS: Consistent with findings of previous studies, the formal screening procedure increased the identification of substance use disorders, even among those who were not screened during the screening period. However, despite heightened awareness of staff, referrals to outpatient treatment in the community after discharge did not increase. In fact, patients who did not have a comorbid substance use disorder were more frequently referred to aftercare than were dually diagnosed patients. CONCLUSIONS: Access to services for dually diagnosed patients may be limited by both staff and patient barriers. Underdiagnosis may be partly overcome by formal screening procedures, but staff bias may influence use of screening tools as well as aftercare referrals. In turn, individuals with a comorbid disorder who are not referred to aftercare may be more resistant to treatment and follow-up care. These issues must be clinically addressed by educating and sensitizing staff, as well as by administrative means.

Adult↗
PubMed1997

Identifying homeless mentally ill veterans in jail: a preliminary report.

Increasing evidence exists that suggests associations between mental illness, homelessness, and criminal activity and arrest. This article describes a program for identifying and providing treatment and housing for homeless mentally ill veterans detained at the Cook County Jail in Chicago. Preliminary data are provided describing characteristics of the veterans assessed in the jail, as well as those veterans who follow up with services upon release. The usefulness of an urban jail as a site for outreach efforts targeting homeless mentally ill veterans is discussed.

Adult↗
PubMed1996

Research on cognitive complaints and cognitive functioning in patients with chronic fatigue syndrome (CFS): What conclusions can we draw?

People with chronic fatigue syndrome (CFS) complain of difficulties with concentration and memory yet studies suggest that they do not suffer gross deficits in cognitive functioning. Depressed patients make similar cognitive complaints, and there is symptomatic overlap between CFS and depression. Cognitive complaints and depressed mood are positively correlated in CFS patients but, except on tasks which are particularly sensitive to depression, cognitive performance and depression are not. The inconsistency between cognitive complaints and results of tests of cognitive functioning resembles that found in other subject groups and may be due in part to the inappropriate use of laboratory memory tests for assessing "everyday" cognitive functioning. Even when cognitive capacity is intact, cognitive performance may be affected by factors such as arousal, mood, and strategy. In CFS patients, everyday cognitive tasks may require excessive processing resources leaving patients with diminished spare attentional capacity or flexibility.

Cognition Disorders↗
PubMed1996

Utility of the chemical use, abuse, and dependence scale in screening patients with severe mental illness.

The Chemical Use, Abuse, and Dependence (CUAD) Scale was administered with other scales to 100 consecutive admissions to a psychiatric hospital. Moderately high correlations with other measures of drug and alcohol use were obtained. Although more research with the CUAD is necessary, it may be potentially useful in screening for substance use among severely mentally ill patients.

Adult↗