Magnetic resonance spectroscopy in psychiatry: basic principles and applications

In vivo magnetic resonance spectroscopy (MRS) is a safe and non-invasive tool which can be used to study aspects of brain chemistry and metabolism. Although a relatively recent technique in the field of psychiatric research, it has already been used in the study of anxiety and affective disorders, dementia, schizophrenia, and neurodevelopmental disorders. This review outlines the basic principles of MRS and summarises the research findings in psychiatric disorders. Although mostly preliminary, these findings highlight the capacity of MRS to detect subtle neurobiological abnormalities in mental disorders. They also suggest a future role for MRS in differential diagnosis and monitoring illness progression. Initial MRS studies have also focused on the metabolic effects of psychiatric treatments and could provide information about their relationship to clinical variables.     

Effects of establishment of community psychiatry in Aalborg]

The aim of the present study was to illustrate the effects of community-based psychiatry. The catchment area was divided into three homogeneous districts, East, North and West. Teams were established on 1.9. 1990, 1.10.91 and 1.5.1992, respectively. Social, diagnostic and treatment related data were gathered from two cross-sectional investigations (I: February 1992 and II: February 1993) and from in-patients and out-patients files. In cross-section I a majority of long-term ward patients and hospital-based employment offers was found in the district where the community district team had not yet been established. In the district where the first community district team was established most primary target patients were treated. In cross-section II the hospital-based psychiatric service were more homogeneously distributed between the districts. The establishment of community-based psychiatric teams resulted in new referrals, and increasing numbers of patients becoming attached to the psychiatric teams, but crowding and use of compulsory measures in hospital also increased.     

Imaging neuroscience: principles or maps?

This article reviews some recent trends in imaging neuroscience. A distinction is made between making maps of functional responses in the brain and discerning the rules or principles that underlie their organization. After considering developments in the characterization of brain imaging data, several examples are presented that highlight the context-sensitive nature of neuronal responses that we measure. These contexts can be endogenous and physiological, reflecting the fact that each cortical area, or neuronal population, expresses its dynamics in the context of interactions with other areas. Conversely, these contexts can be experimental or psychological and can have a profound effect on the regional effects elicited. In this review we consider experimental designs and analytic strategies that go beyond cognitive subtraction and speculate on how functional imaging can be used to address both the details and principles underlying functional integration and specialization in the brain.     

The statute of deinstitutionalization in Great Britain

The aim of this article is to explain the current status of deinstitutionalisation and of community care development by studying the extent to which community care can or should take over the functions of the asylum. These functions include those that are manifest, or explicit, and those that are latent, or unintended but implicit (Bachrach 1976). The continuing relevance of both sets of functions is argued to be exerting a powerful influence on the processes of asylum closure and community care development. The results include delayed asylum closures and transinstitutionnalisation, the shift of some patients from asylums to other institutions, which stifle the development of community care by concentrating spending in hospitals.     

Federal mental health policymaking: An assessment of deinstitutionalization.

Argues that significant advances in psychopharmacology and psychology have occurred in the last 3 decades and that the technologies of treating serious mental disorders have improved accordingly. The authors describe the emerging issues of efficacious and cost-effective applications of these technologies to an increasingly complex system of needs and populations, their potential role in public policy, and their relationship to recent federal policy decisions. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Repetition deficit in rapid-serial-visual-presentation displays: Encoding failure or retrieval failure?

The repetition deficit associated with rapid serial visual presentation (RSVP) has been explained as a repetition-induced blindness, that is, as a perceptual or encoding failure. The repetition deficit was replicated in a standard free-recall RSVP task, and it was shown that participants were able to report the lost item when they were prompted with a retrieval probe. The authors argue that both copies of the repeated items were available in memory but that they were not accessible for report. Hence, they conclude that the repetition deficit in the RSVP task reflects a retrieval failure, not a perceptual failure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Policy research: Lessons from the implementation of deinstitutionalization.

Discusses problems created by the deinstitutionalization of mental patients. The solutions that researchers have proposed have rarely affected policy. Society has attempted to solve these problems satisfactorily (but not optimally) through social, political, and economic transactions that are under no particular rational control (e.g., by treating mental patients in general hospitals and nursing homes). Policy researchers have rarely acknowledged the legitimacy of these solutions and have contributed little to them. They have also failed to understand the ideologies implicit in their own work and in policy. As a result, they have proposed solutions that are inconsistent with the social system that must implement them. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deinstitutionalization and women: Assessing the consequences of public policy.

Reviews and analyzes the literature concerning deinstitutionalization and women and highlights specific ways in which a major public policy initiative has affected the lives of both chronically mentally ill women and women who have been charged with the responsibility of caring for the chronically mentally ill. Special effects of deinstitutionalization on mentally ill women are evident in such areas as sexual exploitation and violence, homelessness, diversion into the criminal justice system, and stigmatization. A group of studies points to special circumstances pertaining to sexual behavior and reproductive control in a deinstitutionalized female population. It is suggested that the expectations of women's behavior based on societal role definitions have affected service planning for this population and that the use of such criteria for program planning runs the risk of injuring patients of both sexes. The need for more conceptual work and research on deinstitutionalization is stressed; however, because deinstitutionalization is an exceedingly complex phenomenon, the importance of remaining sensitive to the wide variety of circumstances that contribute to its outcomes is emphasized. (72 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deinstitutionalization and schizophrenia in Finland: I. Discharged patients and their care

Finland has experienced one of the most rapid psychiatric deinstitutionalization processes in the world. Since 1980, the use of psychiatric beds has decreased about one-third. The effects of this deinstitutionalization were studied in the national Discharged Schizophrenia Patient Project. The study used three representative samples of patients with schizophrenia who were discharged from mental hospitals in 1982, 1986, and 1990, and followed them for 3 years. Patients with schizophrenia discharged at the beginning of the 1990s were older and more disturbed, and had been ill for a longer time than patients discharged at the beginning of the 1980s. The use of outpatient care increased and that of hospital care decreased, but because of the increased residential outpatient care, the total amount of residential care did not change during the study period. However, readmissions to the hospital increased. In patients with a long duration of illness, the increase in readmissions was exceptionally high; these patients also seemed to be losing their share of the residential outpatient services. On the whole, from the point of view of the psychiatric treatment system, deinstitutionalization seemed to have proceeded fairly successfully. The system proved able to redirect and use the available resources more effectively and to modify the structure of services according to the changing needs of patients discharged from hospitals. The well-developed social services have also supported this adaptation to the decreasing use of mental hospital beds.     

Hospital psychiatry in transition. From the therapeutic community toward a rational eclecticism

Concepts derived from the paradigm of the therapeutic community have provided the main organizing principles for general inpatient psychiatry in the past 20 years. Increasingly, however, scientific studies have thrown doubt on the efficacy of current hospital practices. Changes in the broader social milieu have occurred as well since the therapeutic community was originally conceptualized, which raise questions about the "fit" between milieu therapy principles and current psychiatric needs. No current therapeutic paradigm is sufficient to encompass current inpatient psychiatric practice. There is a need for flexibility in utilizing various organizing principles for various aspects of the problems at hand. The paradigm of "problem-solving," derived from the research findings comparing group vs individual problem-solving, is an example of one way of examining and organizing data that could be applied to certain aspects of hospital care.     

Deinstitutionalization of chronic mental patients in the Canadian context.

A review of the literature shows that deinstitutionalization of mental patients has been occurring as rapidly in Canada as in the US and that this process has sometimes resulted in problems. A reexamination of the deinstitutionalization literature suggests that chronic mental patients fare no worse and sometimes fare better in the community than in institutions when adequate community support is provided. It is suggested that more Canadian research on deinstitutionalization is required. (French abstract) (54 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of community based management in failure to thrive: randomised controlled trial

OBJECTIVE: To evaluate the effectiveness of a health visitor led intervention for failure to thrive in children under 2 years old. DESIGN: Controlled trial, randomised by primary care practice. SETTING: Newcastle upon Tyne health district. INTERVENTION: Structured health visitor management, with dietetic, paediatric, and social work input as required. SUBJECTS: 229 children (120 in intervention practices and 109 in control practices) were identified as failing to thrive by population screening during the first 2 years of life. Follow up was by home visit of a research nurse and review of the childrens' records at age 3 years. MAIN OUTCOME MEASURES: Follow up weight and height and number of routinely collected weights. RESULTS: 95 of the 97 families offered intervention completed at least the initial assessment. At follow up, 187 (82%) records were reviewed, and these suggested that 15 (16%) controls were lost to follow up immediately after the screening weight was taken compared with only one child in the intervention group. In the 134 (58%) families who consented to home visits, children in the intervention group were significantly heavier and taller and were reported to have better appetites than childen in the control group, although both groups were equally satisfied by the services they had received. When the children were last weighed, 91 (76%) in the intervention group had recovered from their failure to thrive compared with 60 (55%) in the control group (P<0.001). CONCLUSION: In failure to thrive, health visitor intervention, with limited specialist support, can significantly improve growth compared with conventional management.