Psychological medicine. Monograph supplement最新文献

Ticehurst House, a private asylum, flourished during the nineteenth century as the most expensive of such establishments, being owned and run by the Drs Newington over five successive generations. The discovery of the full set of patient casebooks begun in 1845-6 made it possible to review in detail the clinical features of a complete cohort of patients admitted to the asylum between 1845 and 1890. Six-hundred-and-one patients were thus analysed in terms of their age, sex, length of stay, symptoms, treatment and outcome. Modern operational diagnoses were used, and 80% of the cohort were found to conform to Research Diagnostic Criteria, in particular to the categories for schizophrenia and manic-depressive disorder. An additional finding was the high prevalence of movement and postural disorder among the schizophrenic group, as well as a significant trend towards the selection of a treatable, good-outcome group of patients with manic-depressive illness. These results are discussed by comparison with other modern studies of the asylum period, and in the contemporary context of Victorian psychological medicine. It is suggested that the violence, physicality and chronicity of psychotic illness must be seen as central to the debate about the rise of the asylum in nineteenth-century Britain. Furthermore, the similarity in core symptoms found in such patients and those seen in the 1980s indicates that the categories 'schizophrenia' and 'manic-depressive disorder' have a robust validity that is not confined to the social parameters of a particular time period.

Noise, a prototypical environmental stressor, has clear health effects in causing hearing loss but other health effects are less evident. Noise exposure may lead to minor emotional symptoms but the evidence of elevated levels of aircraft noise leading to psychiatric hospital admissions and psychiatric disorder in the community is contradictory. Despite this there are well documented associations between noise exposure and changes in performance, sleep disturbance and emotional reactions such as annoyance. Moreover, annoyance is associated with both environmental noise level and psychological and physical symptoms, psychiatric disorder and use of health services. It seems likely that existing psychiatric disorder contributes to high levels of annoyance. However, there is also the possibility that tendency to annoyance may be a risk factor for psychiatric morbidity. Although noise level explains a significant proportion of the variance in annoyance, the other major factor, confirmed in many studies, is subjective sensitivity to noise. Noise sensitivity is also related to psychiatric disorder. The evidence for noise sensitivity being a risk factor for psychiatric disorder would be greater if it were a stable personality characteristic, and preceded psychiatric morbidity. The stability of noise sensitivity and whether it is merely secondary to psychiatric disorder or is a risk factor for psychiatric disorder as well as annoyance is examined in two studies in this monograph: a six-year follow-up of a group of highly noise sensitive and low noise sensitive women; and a longitudinal study of depressed patients and matched control subjects examining changes in noise sensitivity with recovery from depression. A further dimension of noise effects concerns the impact of noise on the autonomic nervous system. Most physiological responses to noise habituate rapidly but in some people physiological responses persist. It is not clear whether this sub-sample is also subjectively sensitive to noise and whether failure to habituate to environmental noise may also represent a biological indicator of vulnerability to psychiatric disorder. In these studies noise sensitivity was found to be moderately stable and associated with current psychiatric disorder and a disposition to negative affectivity. Noise sensitivity levels did fall with recovery from depression but still remained high, suggesting an underlying high level of noise sensitivity. Noise sensitivity was related to higher tonic skin conductance and heart rate and greater defence/startle responses during noise exposure in the laboratory. Noise sensitive people attend more to noises, discriminate more between noises, find noises more threatening and out of their control, and react to, and adapt to noises more slowly than less noise sensitive people.(ABSTRACT TRUNCATED AT 400 WORDS)

Community-based psychiatry has attracted a wide interest in the last 20 years. However, the evidence in the literature on monitoring and evaluating community psychiatric services for a long period of time is scanty. The aim of this monograph is to present the results of a number of evaluative studies, covering a ten-year period, conducted in South-Verona, an area of 75,000 inhabitants in Northern Italy, where a new community-based system of care, the South-Verona Community Psychiatric Service (CPS), has operated since 1978. This system, which is based on the provisions of the Italian psychiatric reform, is alternative to the old hospital-centred system of care, and provides care and support to all types of patients, without back-up from the mental hospital, where only a few old long-stay in-patients continue to reside. In the first part of the monograph, trends in the provision of psychiatric care in the period 1979-1988 are presented, using the South-Verona Psychiatric Case Register (PCR). Both one-day and one-year prevalence figures and incidence rates are lower than in other register areas outside Italy, partly because of the smaller number of specialized out-patient services available in South-Verona and partly because of less use of in-patient care in our area. Moreover, there is a tendency in Italy to care for elderly patients in geriatric institutions outside the psychiatric system. Most of the patients seen in any year are treated without in-patient care. This applies to all diagnostic groups, except affective psychosis. Rates of compulsory admission dropped dramatically after the reform. The total number of admissions to all in-patient psychiatric facilities (including private hospitals) in 1988 is only 8.4% lower than that found in 1977 (one year prior to the reform), while the mean number of occupied beds in 1988 was 47% lower than in 1977. In South-Verona point-prevalence of long-stay in-patients has slowly decreased over the years and there is a negligible build-up of new long-stay in-patients. The South-Verona CPS is now taking care of most psychiatric patients who, before the reform, would have been admitted to the mental hospital and become long-stay. These patients, who may be defined as long-term patients in the community, have consistently accumulated since 1981 and are making high use of psychiatric community services.(ABSTRACT TRUNCATED AT 400 WORDS)