Acta Psychiatrica Scandinavica

Objective: To quantify the risk of developing dementia in those with mild cognitive impairment (MCI).

Method: Meta‐analysis of inception cohort studies.

Results: Forty‐one robust cohort studies were identified. To avoid heterogeneity clinical studies, population studies and clinical trials were analysed separately. Using Mayo defined MCI at baseline and adjusting for sample size, the cumulative proportion who progressed to dementia, to Alzheimer’s disease (AD) and to vascular dementia (VaD) was 39.2%, 33.6% and 6.2%, respectively in specialist settings and 21.9%, 28.9% and 5.2%, respectively in population studies. The adjusted annual conversion rate (ACR) from Mayo defined MCI to dementia, AD and VaD was 9.6%, 8.1% and 1.9%, respectively in specialist clinical settings and 4.9%, 6.8% and 1.6% in community studies. Figures from non‐Mayo defined MCI and clinical trials are also reported.

Conclusion: The ACR is approximately 5–10% and most people with MCI will not progress to dementia even after 10 years of follow‐up.

Objective:  To review the research addressing the relationship of childhood trauma to psychosis and schizophrenia, and to discuss the theoretical and clinical implications.

Method:  Relevant studies and previous review papers were identified via computer literature searches.

Results:  Symptoms considered indicative of psychosis and schizophrenia, particularly hallucinations, are at least as strongly related to childhood abuse and neglect as many other mental health problems. Recent large‐scale general population studies indicate the relationship is a causal one, with a dose‐effect.

Conclusion:  Several psychological and biological mechanisms by which childhood trauma increases risk for psychosis merit attention. Integration of these different levels of analysis may stimulate a more genuinely integrated bio‐psycho‐social model of psychosis than currently prevails. Clinical implications include the need for staff training in asking about abuse and the need to offer appropriate psychosocial treatments to patients who have been abused or neglected as children. Prevention issues are also identified.

Objective: Lifetime and 12‐month prevalence of traumatic events and DSM‐IV post‐traumatic stress disorder as well as risk factors and comorbidity patterns were investigated in a representative community sample (n=3021, aged 14–24 years).

Method: Traumatic events and PTSD were assessed with the Munich Composite International Diagnostic Interview (CIDI).

Results: Although 26% of male subjects and 17.7% of female subjects reported at least one traumatic event, only a few qualified for a full PTSD diagnosis (1% of males and 2.2% of females). Traumatic events and PTSD were strongly associated with all other mental disorders examined. PTSD occurred as both a primary and a secondary disorder.

Conclusion: The prevalence of PTSD in this young German sample is considerably lower than reported in previous studies. However, the conditional probability for PTSD after experiencing traumas, risk factors and comorbidity patterns are quite similar. Traumatic events and full PTSD may increase the risk for other disorders, and vice versa.

To facilitate the systematic description of catatonic signs, we developed a catatonia rating examination, rating scale and screening instrument. We constructed a 23‐item rating scale and a truncated 14‐item screening instrument using operationalized definitions of signs ascribed to catatonia in published sources. Inter‐rater reliability was tested in 44 simultaneous ratings of 28 cases defined by the presence of ≥2 signs on the 14‐item screen. Inter‐rater reliability for total score on the rating scale was 0.93, and mean agreement of items was 88.2% (SD 9.9). Inter‐rater reliability for total score on the screening instrument was 0.95, and mean agreement of items was 92.7% (SD 4.9). Diagnostic agreement was high based on criteria for catatonia put forth by other authors. Seven per cent (15/215) of consecutively admitted patients to an academic psychiatric in‐patient facility met criteria for catatonia. It is concluded that catatonia is a distinct, moderately prevalent neuropsychiatric syndrome. The rating scale and screening instrument are reliable and valid. Their use facilitates diagnosis, treatment protocols, and cross‐study comparisons.

Objective:  The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening tool for postpartum depression (PPD). We systematically reviewed the published evidence on its validity in detecting PPD and antepartum depression (APD) up to July 2008.

Method:  Systematic review of validation studies of the EPDS included 1987–2008. Cut‐off points of 9/10 for possible PPD, 12/13 for probable PPD and 14/15 for APD were used.

Results:  Thirty‐seven studies met the inclusion criteria. Sensitivity and specificity of cut‐off points showed marked heterogeneity between different studies. Sensitivity results ranged from 34 to 100% and specificity from 44 to 100%. Positive likelihood ratios ranged from 1.61 to 78.

Conclusion:  Heterogeneity among study findings may be due to differences in study methodology, language and diagnostic interview/criteria used. Therefore, the results of different studies may not be directly comparable and the EPDS may not be an equally valid screening tool across all settings and contexts.

Schmidtke A, Bille‐Brahe U, DeLeo D, Kerkhof A, Bjerke T, Crepet P, Haring C, Hawton K, Lönnqvist J, Michel K, Pommereau X, Querejeta I, Phillipe I, Salander‐Renberg E, Temesvary B, Wasserman D, Fricke S, Weinacker B, Sampaio‐Faria JG. Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989–1992. Results of the WHO/EURO Multicentre Study on Parasuicide.

Acta Psychiatr Scand 1996: 93: 327–338. © Munksgaard 1996.

The World Health Organization/EURO Multicentre Project on Parasuicide is part of the action to implement target 12 of the WHO programme, ‘Health for All by the Year 2000’, for the European region. Sixteen centres in 13 European countries are participating in the monitoring aspect of the project, in which trends in the epidemiology of suicide attempts are assessed. The highest average male age‐standardized rate of suicide attempts was found for Helsinki, Finland (314/100000), and the lowest rate (45/100000) was for Guipuzcoa, Spain, representing a sevenfold difference. The highest average female age‐standardized rate was found for Cergy‐Pontoise, France (462/100000), and the lowest (69/100000) again for Guipuzcoa, Spain. With only one exception (Helsinki), the person‐based suicide attempt rates were higher among women than among men. In the majority of centres, the highest person‐based rates were found in the younger age groups. The rates among people aged 55 years or over were generally the lowest. For the majority of the centres, the rates for individuals aged 15 years or over decreased between 1989 and 1992. The methods used were primarily ‘soft’ (poisoning) or cutting. More than 50% of the suicide attempters made more than one attempt, and nearly 20% of the second attempts were made within 12 months after the first attempt. Compared with the general population, suicide attempters more often belong to the social categories associated with social destabilization and poverty.