Morris Bernadt - Academia.edu (original) (raw)

Papers by Morris Bernadt

Research paper thumbnail of Rapid Tranquillisation. Author's Replies

British Journal of Psychiatry, 1992

Research paper thumbnail of Depot and oral antipsychotics: The patient's perspective

Research paper thumbnail of patients with somatisation disorder patients Sharing medical records: comparison of general psychiatric

Research paper thumbnail of The English market model is not fit for export

International Psychiatry, 2011

Commissioning of health services has become an intensely political issue in the UK and there is n... more Commissioning of health services has become an intensely political issue in the UK and there is no reason to believe that the conflicts that have arisen domestically would not be mirrored overseas. A key ideological issue in the UK concerns the relative merits of public and private provision of services. In their guest editorial in this issue, ‘Governance, choice and the global market for mental health’, Sugarman & Kakabadse take a particular ideological stance: they write on the one hand of commercial-style efficiency and on the other of monopoly state provision risking inefficiency and ineffectiveness. This perspective is addressed here.

Research paper thumbnail of Psychoanalytic prison. Author's reply

The American Journal of Psychiatry, 2003

Research paper thumbnail of A discriminant-function analysis of screening tests for excessive drinking and alcoholism

Journal of Studies on Alcohol, 1984

Research paper thumbnail of Raised endogenous monoamine oxidase inhibitor output in postwithdrawal alcoholics: effects of L-dopa and ethanol

Biological psychiatry, 1982

Urinary output of endogenous monoamine oxidase inhibitor was significantly greater in a group of ... more Urinary output of endogenous monoamine oxidase inhibitor was significantly greater in a group of postwithdrawal alcoholics than in controls. An oral dose of 0.5 g of L-dopa reduced output to control values in the alcoholics, but in the controls themselves output was unaffected. A similar excretion pattern to unextracted samples was observed in ethyl acetate extracts of these urine samples, acidified to pH 1. In a second group of postwithdrawal alcoholics, where the L-dopa effect was confirmed, ethanol administration brought about a small but not significant reduction in inhibitor output.

Research paper thumbnail of Current genetic and biological approaches to alcoholism

Psychiatric developments, 1983

Three out of 4 adoption and 2 out of 3 twin studies imply a genetic contribution to alcoholism in... more Three out of 4 adoption and 2 out of 3 twin studies imply a genetic contribution to alcoholism in males. A recent study of moderate drinking in male twins suggests that familial factors account for some two-thirds of the variance in alcohol consumption, and that the genetic component slightly outweighs the effects of the within family culture. There has been little support for the notion of a genetic entity which expresses itself as alcoholism in males and depressive illness in females, but among normal male twins anxiety and depression are genetically correlated with alcohol consumption. Increased liability to form acetaldehyde and the potentially additive tetrahydroisoquinolines could be one factor predisposing to alcoholism but human studies have been less convincing than their animal counterparts.

Research paper thumbnail of Access to health records: psychiatric patients and patients with diabetes compared

Psychiatric Bulletin, 1998

This study was undertaken to assess whether psychiatric patients respond more adversely to readin... more This study was undertaken to assess whether psychiatric patients respond more adversely to reading their own records than non-psychiatric patients. Seventy-three psychiatric out-patients and 84 out-patients with diabetes were posted their main clinical summary with a questionnaire about it. For seven of the eight questions, more than 70% of both patient groups gave favourable ratings. However, the psychiatric patients gave significantly less favourable responses than the patients with diabetes on five of the eight questions. Fourteen of 73 (19%) psychiatric patients were upset by reading the clinical summary about themselves compared with four of 84 (5%) patients with diabetes.

Research paper thumbnail of Statistics in clinical trials

The Lancet, 1990

CLINICAL AND IMMUNOLOGICAL DATA *Systemic features, tHistory of vascular events erythrocyte sedim... more CLINICAL AND IMMUNOLOGICAL DATA *Systemic features, tHistory of vascular events erythrocyte sedimentation rates, together with the absence of antibodies in the five without arteritis, does argue for a pathogenic role, and suggests a rationale for the use of immunosuppressive therapy. ACA should be sought in patients with ischaemic optic neuropathy.

Research paper thumbnail of Psychoanalysis

Research paper thumbnail of Sharing medical records: comparison of general psychiatric patients with somatisation disorder patients

Psychiatric Bulletin, 1997

Research paper thumbnail of Drinking histories: Are they accurate?

Research paper thumbnail of Depot and oral antipsychotics: patient preferences and attitudes are not the same thing

Journal of Psychopharmacology, 2008

Some clinicians believe that antipsychotic depot injections are unacceptable to patients. This cr... more Some clinicians believe that antipsychotic depot injections are unacceptable to patients. This cross-sectional study investigated patients’ attitudes regarding antipsychotics, and included within-participant comparisons. Two hundred and twenty-two out-patients with schizophrenia/schizoaffective disorder completed the Drug Attitude Inventory (DAI-10), scales on insight, side effects and treatment preferences. Formulation preference was associated with current medication formulation: depots were preferred by 43% (33/76) on depot vs 6% (8/146) on orals ( P < 0.001). Attitudes (DAI scores) regarding current formulation were influenced by illness duration, extrapyramidal symptoms and insight but not by formulation (depot vs oral). For those with experience of both formulations, participants currently on tablets scored depots less favourably than oral (4.27 vs 6.89, P < 0.001); those on depot did not differentiate. When voluntary patients on maintenance antipsychotics are asked abou...

Research paper thumbnail of Are depot antipsychotics more coercive than tablets?

Journal of Psychopharmacology, 2009

Some clinicians consider depot antipsychotics to be stigmatising, coercive and unacceptable to pa... more Some clinicians consider depot antipsychotics to be stigmatising, coercive and unacceptable to patients. This cross-sectional study investigated patients’ perspectives of coercion for depot and oral antipsychotics. In all, 72 participants with chronic mental illness on voluntary maintenance antipsychotic medication were interviewed for their views on oral and depot medication and experiences of coercion. The MacArthur Admission Experience (short form) was adapted to explore coercion regarding medication. Mean total coercion levels were higher for those on depot (depot: mean 4.39; oral: 2.80, P = 0.027), as were perceived coercion (2.52 vs 1.73, P = 0.041) and negative pressures subscales (1.17 vs 0.33, P = 0.009). No significant differences were found for the ‘voice’ subscale and affective reactions. Specifically, more participants on depot felt that people try to force them to take medication (30% vs 2%, P< 0.001). Depots were perceived as more coercive than oral antipsychotics....

Research paper thumbnail of A Cross-Sectional Study of Patients' Perspectives on Adherence to Antipsychotic Medication

The Journal of Clinical Psychiatry, 2008

Antipsychotic depot medications improve medication adherence by reducing covert nonadherence, but... more Antipsychotic depot medications improve medication adherence by reducing covert nonadherence, but some clinicians believe that they are unacceptable to patients. This cross-sectional study investigated patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perspectives on factors influencing adherence to antipsychotics, from both those taking depots and those taking tablets in ongoing voluntary outpatient care. The study is novel in also encompassing such factors as injection phobia and perceived coercion regarding medication in relation to self-reported adherence. Seventy-three patients with schizophrenia/schizoaffective disorder (ICD-10 criteria) completed structured clinical interviews that included the Rating of Medication Influences (ROMI) scale as well as instruments that assessed patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; functioning, psychopathology, insight, extrapyramidal symptoms, quality of life, needle anxiety, experience of coercion, and beliefs about medication. Participants taking depot (vs. oral) medication had higher ROMI noncompliance mean scores (15.7 vs. 14.4, p = .019). Predictive factors for influences on noncompliance included certain beliefs regarding medication (concern and overuse) but not extrapyramidal symptoms. There were no differences between the 2 formulation groups on the ROMI compliance subscale. Further predictive factors associated with influences on compliance included perceived necessity. Previously, side effects were considered to be a reason for nonadherence to depot more than for oral medications, but our findings do not support this. Rather, beliefs and attitudes are more important than side effects in predicting self-reported adherence and influencing factors thereof. Prescribing a depot medication to enhance relapse prevention will not in itself ensure adherence and therefore must also be accompanied by discussion regarding adherence and associated personal benefits.

Research paper thumbnail of Outcome in refractory depression

Journal of Affective Disorders, 1999

Background: Failure to respond to first-line antidepressant treatment can occur in up to 40% of p... more Background: Failure to respond to first-line antidepressant treatment can occur in up to 40% of patients with depressive illness. A proven strategy for managing this refractory depression is lithium augmentation. The long-term outcome and optimal management of patients treated with lithium augmentation remains unclear. We describe a 4-8 year naturalistic follow-up of patients treated with lithium augmentation in two controlled studies of its efficacy in refractory depression. Method: Cases were followed up with personal interview where possible, and by telephone and general practitioner contact otherwise. Lifetime clinical status was ascertained using the Schedule for Affective Disorders and Schizophrenia-Lifetime (SADS-L). Results: We obtained outcome data on 53 of the original eligible 76 patients. There was a good outcome in 38 (72%) patients. Good outcome was associated with a less endogenous nature of depression and an absence of previous hospitalisations. Conclusions: There do not seem to be any specific prognostic indicators of long-term outcome to lithium augmentation beyond those recognised to be relevant in the outcome of depression generally. Limitations: The conclusions are limited by incomplete follow-up of the total original sample and lack of objective illness and medication data for the intervening period.

Research paper thumbnail of Intense Suicidal Thoughts and Self-Harm Following Escitalopram Treatment

Indian Journal of Psychological Medicine, 2011

Research paper thumbnail of A comparison of psychiatric and diabetic patients given access to their own medical records

European Psychiatry, 1996

no causal association seems to be most frequent, but results of the literature and individual fin... more no causal association seems to be most frequent, but results of the literature and individual findings suggest the possibility that diffuse multifocal CNS while matter inflammation may be associated with the development of a diversity of psychiatric symptoms. These can be present as the initial manifestation. At the time of the first diagnostic evaluation of MS, pharmacological interferences or difficulties in coping with this chronic disabelling disease are in general irrelevant. although the role of environmental factors must always be explored in parallel. Conclusions: One has to consider that clinical syndromes indistinguable from "primary, endform" psychiatric disorders might occur as a direct resuh of the demyelinating disease and that an organic psychotic onset of MS is possible. Therefore psychiatric patients, especially those who are seen for their first psychotic decompensation should have a careful physical examination to check for coexisting neurological abnormalities and also should have proper differentialdiagnostic assessment. Etiological considerations have to include the encephalitic form of MS. Although correlations between psychopathological abnormalities and Magnetic Resonance Imaging findings as a marker of the disease's activity are not very close, cerebral MRI scan and CSF analysis should be investigated routinely in patients with psychotic illness to rule out chronic CNS inflammations. To improve knowledge in the epidemiology of psychiatric aspects of MS and related therapeutic issues further studies using a standardized setting and a definite population basis are recommended.

Research paper thumbnail of Patients access to their own records: A comparison of patients with somatisation disorder (SD) and general psychiatric outpatients

European Psychiatry, 1996

ERASMA is an extensive survey which was conducted on more than 1800 depressed patients, who under... more ERASMA is an extensive survey which was conducted on more than 1800 depressed patients, who underwent hospital treatment between January and June 1993. It was a naturalistic survey which aimed to explore real performances of antidepressants prescribed within the context of everyday hospital use. Design Protocol Inclusion criteria: • man or woman > 18 years old • major depressive episode according to DSM-III-R • MADRS : Score ~ 25. major depress ion. of moderate to severe intensity • patient whose condition requires hospitalisation for at least 12 days and oral antidepressant treatment • ant idepressant prescription details and any concomitant treatments are left to the discretion of the practitioner Evaluation criteria from Day 0 to Day 60: MADRS scale/COVI scale/CGI scale Overall improvement/Clinical index of assessment/Adverse events Patient self-assessment visual scale Results: MAORS scale: percentage of patients with a 50% improvement in score : it can be seen that nearly half of them achieved this level on 012. 80% on 030 and 88% on 060. At the end point. 74% of patients had improved by 50%. which is consistent with the efficacy rates usually observed with antidepressants. Apart from prov iding a substantial amount of information concerning current practice in the treatment of depression in hospitals. the survey supports many others so far carr ied out which have not demonstrate any differences in the time to onset of therapeutic effects, just at global efficacy level. between the various therapeutic classes of antidepressants currently on the market. However. a very clear synergy appears between drug treatment and hospital care. which is crucial for the depressed patient. since any delay in the provision of effective care can lead to an exacerbation or chronicity of the symptomatology. or even to suicide. Conclusion: For any furture survey of this type. it would be a good idea to attempts to make a better assessment of the importance of these non-pharmacological factors which most definitely lie in the relational dimension of care. It should therefore be possible to take into account, at least in part. the importance of relational and psychological factors. which are often. if not always. not taken into account in conventional therapeutic studies.

Research paper thumbnail of Rapid Tranquillisation. Author's Replies

British Journal of Psychiatry, 1992

Research paper thumbnail of Depot and oral antipsychotics: The patient's perspective

Research paper thumbnail of patients with somatisation disorder patients Sharing medical records: comparison of general psychiatric

Research paper thumbnail of The English market model is not fit for export

International Psychiatry, 2011

Commissioning of health services has become an intensely political issue in the UK and there is n... more Commissioning of health services has become an intensely political issue in the UK and there is no reason to believe that the conflicts that have arisen domestically would not be mirrored overseas. A key ideological issue in the UK concerns the relative merits of public and private provision of services. In their guest editorial in this issue, ‘Governance, choice and the global market for mental health’, Sugarman & Kakabadse take a particular ideological stance: they write on the one hand of commercial-style efficiency and on the other of monopoly state provision risking inefficiency and ineffectiveness. This perspective is addressed here.

Research paper thumbnail of Psychoanalytic prison. Author's reply

The American Journal of Psychiatry, 2003

Research paper thumbnail of A discriminant-function analysis of screening tests for excessive drinking and alcoholism

Journal of Studies on Alcohol, 1984

Research paper thumbnail of Raised endogenous monoamine oxidase inhibitor output in postwithdrawal alcoholics: effects of L-dopa and ethanol

Biological psychiatry, 1982

Urinary output of endogenous monoamine oxidase inhibitor was significantly greater in a group of ... more Urinary output of endogenous monoamine oxidase inhibitor was significantly greater in a group of postwithdrawal alcoholics than in controls. An oral dose of 0.5 g of L-dopa reduced output to control values in the alcoholics, but in the controls themselves output was unaffected. A similar excretion pattern to unextracted samples was observed in ethyl acetate extracts of these urine samples, acidified to pH 1. In a second group of postwithdrawal alcoholics, where the L-dopa effect was confirmed, ethanol administration brought about a small but not significant reduction in inhibitor output.

Research paper thumbnail of Current genetic and biological approaches to alcoholism

Psychiatric developments, 1983

Three out of 4 adoption and 2 out of 3 twin studies imply a genetic contribution to alcoholism in... more Three out of 4 adoption and 2 out of 3 twin studies imply a genetic contribution to alcoholism in males. A recent study of moderate drinking in male twins suggests that familial factors account for some two-thirds of the variance in alcohol consumption, and that the genetic component slightly outweighs the effects of the within family culture. There has been little support for the notion of a genetic entity which expresses itself as alcoholism in males and depressive illness in females, but among normal male twins anxiety and depression are genetically correlated with alcohol consumption. Increased liability to form acetaldehyde and the potentially additive tetrahydroisoquinolines could be one factor predisposing to alcoholism but human studies have been less convincing than their animal counterparts.

Research paper thumbnail of Access to health records: psychiatric patients and patients with diabetes compared

Psychiatric Bulletin, 1998

This study was undertaken to assess whether psychiatric patients respond more adversely to readin... more This study was undertaken to assess whether psychiatric patients respond more adversely to reading their own records than non-psychiatric patients. Seventy-three psychiatric out-patients and 84 out-patients with diabetes were posted their main clinical summary with a questionnaire about it. For seven of the eight questions, more than 70% of both patient groups gave favourable ratings. However, the psychiatric patients gave significantly less favourable responses than the patients with diabetes on five of the eight questions. Fourteen of 73 (19%) psychiatric patients were upset by reading the clinical summary about themselves compared with four of 84 (5%) patients with diabetes.

Research paper thumbnail of Statistics in clinical trials

The Lancet, 1990

CLINICAL AND IMMUNOLOGICAL DATA *Systemic features, tHistory of vascular events erythrocyte sedim... more CLINICAL AND IMMUNOLOGICAL DATA *Systemic features, tHistory of vascular events erythrocyte sedimentation rates, together with the absence of antibodies in the five without arteritis, does argue for a pathogenic role, and suggests a rationale for the use of immunosuppressive therapy. ACA should be sought in patients with ischaemic optic neuropathy.

Research paper thumbnail of Psychoanalysis

Research paper thumbnail of Sharing medical records: comparison of general psychiatric patients with somatisation disorder patients

Psychiatric Bulletin, 1997

Research paper thumbnail of Drinking histories: Are they accurate?

Research paper thumbnail of Depot and oral antipsychotics: patient preferences and attitudes are not the same thing

Journal of Psychopharmacology, 2008

Some clinicians believe that antipsychotic depot injections are unacceptable to patients. This cr... more Some clinicians believe that antipsychotic depot injections are unacceptable to patients. This cross-sectional study investigated patients’ attitudes regarding antipsychotics, and included within-participant comparisons. Two hundred and twenty-two out-patients with schizophrenia/schizoaffective disorder completed the Drug Attitude Inventory (DAI-10), scales on insight, side effects and treatment preferences. Formulation preference was associated with current medication formulation: depots were preferred by 43% (33/76) on depot vs 6% (8/146) on orals ( P < 0.001). Attitudes (DAI scores) regarding current formulation were influenced by illness duration, extrapyramidal symptoms and insight but not by formulation (depot vs oral). For those with experience of both formulations, participants currently on tablets scored depots less favourably than oral (4.27 vs 6.89, P < 0.001); those on depot did not differentiate. When voluntary patients on maintenance antipsychotics are asked abou...

Research paper thumbnail of Are depot antipsychotics more coercive than tablets?

Journal of Psychopharmacology, 2009

Some clinicians consider depot antipsychotics to be stigmatising, coercive and unacceptable to pa... more Some clinicians consider depot antipsychotics to be stigmatising, coercive and unacceptable to patients. This cross-sectional study investigated patients’ perspectives of coercion for depot and oral antipsychotics. In all, 72 participants with chronic mental illness on voluntary maintenance antipsychotic medication were interviewed for their views on oral and depot medication and experiences of coercion. The MacArthur Admission Experience (short form) was adapted to explore coercion regarding medication. Mean total coercion levels were higher for those on depot (depot: mean 4.39; oral: 2.80, P = 0.027), as were perceived coercion (2.52 vs 1.73, P = 0.041) and negative pressures subscales (1.17 vs 0.33, P = 0.009). No significant differences were found for the ‘voice’ subscale and affective reactions. Specifically, more participants on depot felt that people try to force them to take medication (30% vs 2%, P< 0.001). Depots were perceived as more coercive than oral antipsychotics....

Research paper thumbnail of A Cross-Sectional Study of Patients' Perspectives on Adherence to Antipsychotic Medication

The Journal of Clinical Psychiatry, 2008

Antipsychotic depot medications improve medication adherence by reducing covert nonadherence, but... more Antipsychotic depot medications improve medication adherence by reducing covert nonadherence, but some clinicians believe that they are unacceptable to patients. This cross-sectional study investigated patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perspectives on factors influencing adherence to antipsychotics, from both those taking depots and those taking tablets in ongoing voluntary outpatient care. The study is novel in also encompassing such factors as injection phobia and perceived coercion regarding medication in relation to self-reported adherence. Seventy-three patients with schizophrenia/schizoaffective disorder (ICD-10 criteria) completed structured clinical interviews that included the Rating of Medication Influences (ROMI) scale as well as instruments that assessed patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; functioning, psychopathology, insight, extrapyramidal symptoms, quality of life, needle anxiety, experience of coercion, and beliefs about medication. Participants taking depot (vs. oral) medication had higher ROMI noncompliance mean scores (15.7 vs. 14.4, p = .019). Predictive factors for influences on noncompliance included certain beliefs regarding medication (concern and overuse) but not extrapyramidal symptoms. There were no differences between the 2 formulation groups on the ROMI compliance subscale. Further predictive factors associated with influences on compliance included perceived necessity. Previously, side effects were considered to be a reason for nonadherence to depot more than for oral medications, but our findings do not support this. Rather, beliefs and attitudes are more important than side effects in predicting self-reported adherence and influencing factors thereof. Prescribing a depot medication to enhance relapse prevention will not in itself ensure adherence and therefore must also be accompanied by discussion regarding adherence and associated personal benefits.

Research paper thumbnail of Outcome in refractory depression

Journal of Affective Disorders, 1999

Background: Failure to respond to first-line antidepressant treatment can occur in up to 40% of p... more Background: Failure to respond to first-line antidepressant treatment can occur in up to 40% of patients with depressive illness. A proven strategy for managing this refractory depression is lithium augmentation. The long-term outcome and optimal management of patients treated with lithium augmentation remains unclear. We describe a 4-8 year naturalistic follow-up of patients treated with lithium augmentation in two controlled studies of its efficacy in refractory depression. Method: Cases were followed up with personal interview where possible, and by telephone and general practitioner contact otherwise. Lifetime clinical status was ascertained using the Schedule for Affective Disorders and Schizophrenia-Lifetime (SADS-L). Results: We obtained outcome data on 53 of the original eligible 76 patients. There was a good outcome in 38 (72%) patients. Good outcome was associated with a less endogenous nature of depression and an absence of previous hospitalisations. Conclusions: There do not seem to be any specific prognostic indicators of long-term outcome to lithium augmentation beyond those recognised to be relevant in the outcome of depression generally. Limitations: The conclusions are limited by incomplete follow-up of the total original sample and lack of objective illness and medication data for the intervening period.

Research paper thumbnail of Intense Suicidal Thoughts and Self-Harm Following Escitalopram Treatment

Indian Journal of Psychological Medicine, 2011

Research paper thumbnail of A comparison of psychiatric and diabetic patients given access to their own medical records

European Psychiatry, 1996

no causal association seems to be most frequent, but results of the literature and individual fin... more no causal association seems to be most frequent, but results of the literature and individual findings suggest the possibility that diffuse multifocal CNS while matter inflammation may be associated with the development of a diversity of psychiatric symptoms. These can be present as the initial manifestation. At the time of the first diagnostic evaluation of MS, pharmacological interferences or difficulties in coping with this chronic disabelling disease are in general irrelevant. although the role of environmental factors must always be explored in parallel. Conclusions: One has to consider that clinical syndromes indistinguable from "primary, endform" psychiatric disorders might occur as a direct resuh of the demyelinating disease and that an organic psychotic onset of MS is possible. Therefore psychiatric patients, especially those who are seen for their first psychotic decompensation should have a careful physical examination to check for coexisting neurological abnormalities and also should have proper differentialdiagnostic assessment. Etiological considerations have to include the encephalitic form of MS. Although correlations between psychopathological abnormalities and Magnetic Resonance Imaging findings as a marker of the disease's activity are not very close, cerebral MRI scan and CSF analysis should be investigated routinely in patients with psychotic illness to rule out chronic CNS inflammations. To improve knowledge in the epidemiology of psychiatric aspects of MS and related therapeutic issues further studies using a standardized setting and a definite population basis are recommended.

Research paper thumbnail of Patients access to their own records: A comparison of patients with somatisation disorder (SD) and general psychiatric outpatients

European Psychiatry, 1996

ERASMA is an extensive survey which was conducted on more than 1800 depressed patients, who under... more ERASMA is an extensive survey which was conducted on more than 1800 depressed patients, who underwent hospital treatment between January and June 1993. It was a naturalistic survey which aimed to explore real performances of antidepressants prescribed within the context of everyday hospital use. Design Protocol Inclusion criteria: • man or woman > 18 years old • major depressive episode according to DSM-III-R • MADRS : Score ~ 25. major depress ion. of moderate to severe intensity • patient whose condition requires hospitalisation for at least 12 days and oral antidepressant treatment • ant idepressant prescription details and any concomitant treatments are left to the discretion of the practitioner Evaluation criteria from Day 0 to Day 60: MADRS scale/COVI scale/CGI scale Overall improvement/Clinical index of assessment/Adverse events Patient self-assessment visual scale Results: MAORS scale: percentage of patients with a 50% improvement in score : it can be seen that nearly half of them achieved this level on 012. 80% on 030 and 88% on 060. At the end point. 74% of patients had improved by 50%. which is consistent with the efficacy rates usually observed with antidepressants. Apart from prov iding a substantial amount of information concerning current practice in the treatment of depression in hospitals. the survey supports many others so far carr ied out which have not demonstrate any differences in the time to onset of therapeutic effects, just at global efficacy level. between the various therapeutic classes of antidepressants currently on the market. However. a very clear synergy appears between drug treatment and hospital care. which is crucial for the depressed patient. since any delay in the provision of effective care can lead to an exacerbation or chronicity of the symptomatology. or even to suicide. Conclusion: For any furture survey of this type. it would be a good idea to attempts to make a better assessment of the importance of these non-pharmacological factors which most definitely lie in the relational dimension of care. It should therefore be possible to take into account, at least in part. the importance of relational and psychological factors. which are often. if not always. not taken into account in conventional therapeutic studies.