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Biomedical subjects

S Wessely

Publications and source records attributed to S Wessely.

At least 109 records · Page 6Linked to original sources
PubMed1998

Reviewing the reviews: the example of chronic fatigue syndrome.

OBJECTIVE: To test the hypothesis that the selection of literature in review articles is unsystematic and is influenced by the authors' discipline and country of residence. DATA SOURCES: Reviews in English published between 1980 and March 1996 in MEDLINE, EMBASE (BIDS), PSYCHLIT, and Current Contents were searched. STUDY SELECTION: Reviews of chronic fatigue syndrome (CFS) were selected. Articles explicitly concerned with a specialty aspect of CFS and unattributed, unreferenced, or insufficiently referenced articles were discarded. DATA EXTRACTION: Record of data sources in each review was noted as was the departmental specialty of the first author and his or her country of residence. The references cited in each index paper were tabulated by assigning them to 6 specialty categories, by article title, and by assigning them to 8 categories, by country of journal publication. DATA SYNTHESIS: Of 89 reviews, 3 (3.4%) reported on literature search and described search method. Authors from laboratory-based disciplines preferentially cited laboratory references, while psychiatry-based disciplines preferentially cited psychiatric literature (P = .01). A total of 71.6% of references cited by US authors were from US journals, while 54.9% of references cited by United Kingdom authors were published in United Kingdom journals (P = .001). CONCLUSION: Citation of the literature is influenced by review authors' discipline and nationality.

Authorship↗
PubMed1998

Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study.

OBJECTIVE: To test the hypotheses that children with abdominal pain have anxious parents and come from families with high rates of physical illness and that they grow up to suffer from high rates of medically unexplained symptoms and psychiatric disorders. DESIGN: Population based birth cohort study. SETTING: General population. SUBJECTS: Participants in the Medical Research Council (MRC) national survey of health and development, a population based birth cohort study established in 1946. MAIN OUTCOME MEASURES: Abdominal pain present throughout childhood in the absence of defined organic disease, and measures of physical symptoms and psychiatric disorder at age 36 years. RESULTS: There were high rates of complaints about physical health among the parents of children with persistent abdominal pain, and the mothers had higher neuroticism scores. Children with persistent abdominal pain were more likely to suffer from psychiatric disorders in adulthood (odds ratio 2.72 (95% confidence interval 1.65 to 4.49)) but were not especially prone to physical symptoms once psychiatric disorder was controlled for (odds ratio 1. 39 (0.83 to 2.36)). CONCLUSIONS: Persistent abdominal pain is associated with poor health and emotional disorder in the parents. Children with abdominal pain do not necessarily continue to experience physical symptoms into adulthood but are at increased risk of adult psychiatric disorders.

Abdominal Pain↗
PubMed1998

Predictors of suicide, accidental death, and premature natural death in a general-population birth cohort.

BACKGROUND: Whether putative suicide risk factors, such as conduct and emotional disorders, are specific to suicide or are general associations of a continuum between subintentional and intentional self-destruction is not clear. We undertook an investigation of this issue in a UK population-based birth cohort. METHODS: Using competing-risks analysis, we examined links between prospectively collected childhood and adolescent temperamental and behavioural variables and the risk of natural, accidental, and suicidal death, occurring between the ages of 16 and 50 years. Of the 5362 members of the cohort, full data were available for 3591. A panel of psychiatrists scored deaths on likely suicidal intention. These scores were used in a weighted logistic regression to examine independence of risk factors for (sub)intentional self-destruction. FINDINGS: There were 167 deaths among the risk-set between the 16th and 50th birthdays. 120 were due to natural causes; of the other 47, the panel of psychiatrists judged that 36 were accidental deaths and 11 were suicides (certainty rating > or = 51%). Adolescent emotional instability and conduct problems had different associations with the various causes of premature death, being lowest for natural death (odds ratio 1.0 [95% CI 0.8-1.2] and 1.2 [1.0-1.5]), intermediate for accidental death (1.1 [0.8-1.5] and 1.3 [1.0-1.7]), and highest for suicidal death (2.0 [1.2-3.6] and 1.8 [1.3-2.5]). Emotional instability (boys 1.3 [1.0-1.7], girls 1.4 [1.0-1.9]) increased risk for subintentional or intentional self-destruction, as did low anxiety in adolescence (1.7 [1.3-2.5]) and nocturnal enuresis at age 4 (1.4 [1.2-1.7]) in boys, and conduct problems in girls (1.4 [1.0-2.0]). INTERPRETATION: Suicide shares important risk factors with other causes of premature death. These findings suggest an aetiological continuum of self-destruction from subintentional to intentional. Research on premature mortality associated with psychological disorder should include all causes of death.

Accidents↗
PubMed1998

The Camberwell Study of Crime and Schizophrenia.

I report a population-based longitudinal study of all incident cases of schizophrenia (n = 538) in the London Borough of Camberwell between 1964 and 1984. The rates of criminal convictions are compared with those in a control sample representative of non-schizophrenic mental disorders matched for age, sex and period. The results show that women with schizophrenia have an increased rate of offending across all offence categories (rate ratio = 3.3). There is no overall increase for males, but a specific increase for violent convictions (rate ratio = 3.8). Looking at the risk of acquiring a first conviction, there is an independent but modest effect of schizophrenia (hazard ratio = 1.4), but the effects of gender, substance abuse, ethnicity and age at onset were more substantial.

Adult↗
PubMed1998

Illness beliefs and treatment outcome in chronic fatigue syndrome.

Longitudinal studies have shown that physical illness attributions are associated with poor prognosis in chronic fatigue syndrome (CFS). Speculation exists over whether such attributions influence treatment outcome. This study reports the effect of illness beliefs on outcome in a randomized controlled trial of cognitive-behavior therapy versus relaxation. Causal attributions and beliefs about exercise, activity, and rest were recorded before and after treatment in 60 CFS patients recruited to the trial. Physical illness attributions were widespread, did not change with treatment, and were not associated with poor outcome in either the cognitive-behavior therapy group or the control group. Beliefs about avoidance of exercise and activity changed in the cognitive behavior therapy group, but not in the control group. This change was associated with improved outcome. These findings suggest that physical illness attributions are less important in determining outcome (at least in treatment studies) than has been previously thought. In this study, good outcome is associated with change in avoidance behavior, and related beliefs, rather than causal attributions.

Attitude to Health↗
PubMed1998

Suicide acceptability in African- and white Americans: the role of religion.

Rates of suicidal behavior are lower among African- than white Americans. We analyzed the association of suicide acceptability with religious, sociodemographic, and emotional variables in representative samples of African- and white Americans (1990). Adjusted for ethnic response bias, the former were less accepting of suicide than the latter (odds ratio .60; 95% confidence interval .41, .88). Orthodox religious beliefs and personal devotion predicted rejection of suicide best; this effect was equally strong in both groups. The comparatively low level of suicide acceptability among African-Americans was mostly attributable to their relatively high levels of orthodox religious beliefs and devotion, as opposed to practice and affiliation, although sociodemographic and emotional differences contributed as well. These results are interpreted using the cognitive dissonance model. Given rapid secularization among the young in the United States, these findings may help explain the rising suicide rates among white and, especially, African-American young people.

Black or African American↗
PubMed1998

Deliberate self harm assessment by accident and emergency staff--an intervention study.

OBJECTIVE: To examine the impact of specific training for accident and emergency (A&E) staff on the quality of psychosocial assessment of deliberate self harm patients. METHODS: A non-randomised intervention study that compared the psychosocial assessment of deliberate self harm patients before and after a one hour teaching session for the A&E departments nursing and junior medical staff. Adequacy of psychosocial assessment was judged by examining A&E case notes. The records of the hospital's parasuicide team were examined to assess administrative changes. Staff attitude to and knowledge of deliberate self harm were also measured before and after the intervention. RESULTS: 45 of 52 nurses and all 15 junior medical staff attended the teaching session. Sixteen (13%) of 125 sets of records before and 58 (46%) of 127 sets of records after the intervention were judged to be adequate. In the postintervention period, notes were more likely to be judged adequate when a proforma was used as part of the assessment (52 of 66 with a proforma and six of 61 without a proforma, chi2 = 60, p < 0.01). Following the intervention, communication between A&E staff and the hospitals parasuicide team improved. CONCLUSIONS: An intervention that provides teaching to A&E staff can lead to improvements in the quality of psychosocial assessment of patients with deliberate self harm.

Chi-Square Distribution↗
PubMed1998

Salivary cortisol profiles in chronic fatigue syndrome.

Salivary cortisol profiles (hourly sampling over a 16-hour period) of 10 patients with chronic fatigue syndrome (CFS) but without concurrent depressive disorder were compared with those of 10 healthy volunteers matched for age, sex and menstrual cycle. The mean saliva cortisol concentration over the 16-hour period was slightly but significantly greater in the patients than the controls (p < 0.05). These findings are at variance with earlier reports that CFS is a hypocortisolaemic state and suggest that in CFS the symptom of fatigue is not caused by hypocortisolaemia.

Adolescent↗
PubMed1998

Meta-analysis of trials comparing antidepressants with active placebos.

BACKGROUND: Unblinding effects may introduce bias into clinical trials. The use of active placebos to mimic side-effects of medication may therefore produce more rigorous evidence on the efficacy of antidepressants. METHOD: Trials comparing antidepressants with active placebos were located. A standard measure of effect was calculated for each trial and weighted pooled estimates obtained. Heterogeneity was examined and sensitivity analyses performed. A subgroup analysis of in-patient and out-patient trials was conducted. RESULTS: Only two of the nine studies examined produced effect sizes which showed a consistent significant difference in favour of the active drug. Combining all studies produced pooled effect size estimates of between 0.41 (0.27-0.56) and 0.46 (0.31-0.60) with high heterogeneity due to one strongly positive trial. Sensitivity analyses excluding this and one other trial reduced the pooled effect to between 0.21 (0.03-0.38) and 0.27 (0.10-0.45). CONCLUSIONS: Meta-analysis is very sensitive to decisions about exclusions. Previous general meta-analyses have found combined effect sizes in the range 0.4-0.8. The more conservative estimates produced here suggest that unblinding effects may inflate the efficacy of antidepressants in trials using inert placebos.

Adolescent↗
PubMed1998

Temporal relationships between physical symptoms and psychiatric disorder. Results from a national birth cohort.

BACKGROUND: Physical symptoms and psychiatric disorder are associated. We aimed to investigate which comes first. METHODS: Data from the Medical Research Council National Survey of Health and Development, a population-based birth cohort study were used at two time points: 36 and 43 years. Six physical symptoms were reported at both time points. The Present State Examination and Psychiatric Symptom Frequency interviews were administered at 36 and 43 years respectively. Odds ratios corrected for a variety of confounders were used to describe the associations between physical symptoms and psychiatric disorder across these two time points. RESULTS: Psychiatric disorder increased the odds of reporting symptoms 3-7-fold. The relationship strengthened when the outcome was defined as suffering from multiple symptoms. Population attributable risk of psychiatric disorder and subsyndromal disorder in causing multiple somatic symptoms was 40.3%. Prospectively, psychiatric disorder at 36 years was a predictor for five of the six physical symptoms. Three physical symptoms at 36 years predicted new onset of psychiatric symptoms at 43 years. CONCLUSIONS: Psychiatric disorder is strongly related to physical symptoms. The direction of causality may operate in both directions. Assuming a causal relationship, psychiatric disorder (including sub-threshold disorders) could account for at most 40% of cases of multiple physical symptoms.

Abdominal Pain↗