Rhizomelic chondrodysplasia punctata: 16-year follow-up of a child from birth

A boy with rhizomelic chondrodysplasia punctata, diagnosed on the laboratory evidence of a high plasma concentration of phytanic acid and a low erythrocyte concentration of plasmalogens, has been followed from birth to the age of 16 years. The clinical pattern (somatic, skeletal and neurological) tallies with published findings in this disease. Unusual findings are the associated epilepsy, confirmed by EEG, and the long survival. CT brain scan and MRI showed cortical and subcortical atrophy but not gyral abnormalities or demyelination.     

Male siblings with tibia-metacarpal type of chondrodysplasia punctata without maternal factors

We report male siblings with tibia-metacarpal type of chondrodysplasia punctata, which was diagnosed by radiographic findings and clinical appearances. This is the first report of siblings without maternal systemic lupus erythematosus or medications during both pregnancies.     

A 16-year follow-up of a child inpatient population

The purpose of this study was to evaluate long-term outcomes of children who had been inpatients in a child psychiatry unit. Fifty children, who were consecutive admissions to a Dublin inpatient child psychiatry unit between November 1978 and July 1980, were followed up 16 years later. We obtained some direct information on 33 subjects; of these, 4 subjects had died and 11 subjects (33%) were living abroad. A poor outcome as defined by death, imprisonment, adult psychiatric disorder or unemployment was present in 18 of the 24 subjects (79%) on whom this information was available. We conclude that more support and increased availability of services post discharge are needed. Accepted: 23 August 1999     

Acute and transient psychotic disorder: a 1-year follow-up study

A study sample consisting of 51 patients suffering from acute and transient psychotic disorder (ATPD) (ICD-10) on initial examination was evaluated at 1-year follow-up. The findings show a diagnostic change in half of the patients (48%), most often to schizophrenia (15%) and affective disorder (28%). From index admission to follow-up, patients with an unchanged diagnosis of ATPD manage fairly well with regard to psychosocial functioning, and no deteriorating development is observed. In the majority of cases no personality disorder (PD) (ICD-10, 54%; DSM-IV, 71%) is apparent, and the ATPD is not related to any specific PD. With regard to diagnostic stability, no significant demographic, social or clinical predictors were found. The findings highlight the need for validation of the concept of ATPD, and point to the fact that brief psychotic episodes with an acute onset may be an early manifestation of severe mental disorder (schizophrenia and affective disorder).     

Generalized anxiety disorder: a 40-year follow-up study

OBJECTIVE: There is insufficient knowledge of the long-term course of generalized anxiety disorder (GAD). We studied the course of this disorder in patients who were followed up for 40 years. METHOD: Patients admitted with the diagnosis of anxiety states ('anxious thymopathy' ) to the Lopez Ibor Neuropsychiatric Research Institute between 1950 and 1961 were examined between 1984 and 1988 (n = 65). The retrospective diagnosis of GAD was made according to DSM-III-R criteria during 1984-1988 (first examination). A re-examination was performed by the same psychiatrist in the period 1997-2001 (n = 59; second examination). RESULTS: At first and second examinations 20% and 17% of subjects were diagnosed as GAD. Improvement was observed in 83%. GAD tended to disappear around age 50, but was replaced by somatization disorders. Lack of regular treatment compliance, female sex, and onset of GAD before age 25 were variables associated with a worse outcome. Undifferentiated somatization disorder was the most prevalent clinical status at follow-up. CONCLUSION: After several decades, participants improve with regard to GAD, although most continue to present somatizations.     

Definitions of recovery and outcomes of major depression: results from a 10-year follow-up

Objective: Consensus operational definitions for symptomatic remission and recovery of a major depressive episode have been proposed but only irregularly followed. Method: We examined the predictive validity of different definitions of recovery in a multi‐center 10‐year follow‐up study of an inception cohort of untreated unipolar major depressive episodes (n = 95). Time to recovery and time to recurrence after recovery were estimated by Kaplan–Meier survival analyses for alternative definitions requiring 2, 4, 6 or 12 months of remission to declare recovery. Results: The median time to recovery was 3.0, 4.0, 4.0 and 12.0 months respectively. The index episode lasted longer than 24 months in 9.4%, 9.2%, 12.6% and 24.5%. The median time to subthreshold recurrence was 16.0, 32.0, 42.0 and 74.0 months. Conclusion: Either 4‐ or 6‐month duration of remission defined a change point before which the episode was continuous and after which the recurrence was reasonably unlikely.     

Suicide mortality in mental retardation:a 35-year follow-up study

OBJECTIVE: We investigated suicide mortality among people with mental retardation (MR) over a period of 35 years. METHOD: The nationwide, population-based cohort of 2369 people with MR was followed-up from a representative sample of 9.4% of the population in Finland in 1962. The standardized mortality ratio of suicides was calculated and case studies of all MR suicides based on all available data were performed. RESULTS: Women with MR had an equal suicide risk to Finnish women in general, while men had only one-third of the population risk. Risk factors for suicide were similar to those in the general population. Most suicide victims had mild MR and were hospitalized for comorbid mental disorders. Suicide methods were passive and alcohol was involved in only one case. CONCLUSION: Suicide mortality in MR is significantly lowered among males. Suicide prevention in MR should be focused on people with comorbid mental disorders. Problems in adjustment to new circumstances need to be recognized. Appropriate and adequate treatment of comorbid depression is emphasized.     

Posttraumatic stress and other health consequences of catastrophic avalanches: A 16-year follow-up of survivors

To date, no study has investigated the effects of avalanches on survivor's health beyond the first years. The aim of this study was to examine long-term health status 16 years after exposure to avalanches using a matched cohort design. Mental health, sleep quality and somatic symptoms among avalanche survivors (n = 286) and non-exposed controls (n = 357) were examined. Results showed that 16% of survivors currently experience avalanche-specific PTSD symptoms (PDS score > 14). In addition, survivors presented with increased risk of PTSD hyperarousal symptoms (>85th percentile) (aRR = 1.83; 98.3% CI [1.23–2.74]); sleep-related problems (PSQI score > 5) (aRR = 1.34; 95% CI [1.05–1.70]); PTSD-related sleep disturbances (PSQI-A score ≥ 4) (aRR = 1.86; 95% CI [1.30–2.67]); musculoskeletal and nervous system problems (aRR 1.43; 99% CI 1.06–1.93) and gastrointestinal problems (aRR 2.16; 99% CI 1.21–3.86) compared to the unexposed group. Results highlight the need for treatment for long-term PTSD symptoms and sleep disruption in disaster communities.     

Conversion disorder in children and adolescents: a 4-year follow-up study

OBJECTIVE: To assess the outcome of conversion disorder in children and adolescents and to identify factors affecting the prognosis. METHOD: Forty adolescents with conversion disorder were reevaluated 4 years after their initial interview. Changes in demographic and clinical data and the presence of any mood and anxiety disorders were recorded using the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). In addition, Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were applied. RESULTS: Thirty-four patients (85%) had completely recovered from their conversion symptoms and two patients had improved (5%), whereas only four (10%) were unchanged. Fourteen (35%) patients received the diagnosis of mood and/or anxiety disorder. Favourable outcome was associated with early diagnosis (P=.04) and good premorbid adjustment (P=.01). CONCLUSION: Conversion disorder has a favourable outcome in children and adolescents. However, mood and/or anxiety disorders are encountered at a considerable rate in these patients even after recovery from conversion symptoms. Long clinical follow-up seems appropriate in children and adolescents with conversion disorder.     

Verbal learning and memory in depression: a 9-year follow-up study

Memory impairment is often associated with depression. However, the literature is not uniform whether such impairment constitutes state and/or trait characteristics. One-hundred-and-twelve clinically depressed (CDs), previously depressed (PDs), and never depressed (NDs) subjects (T2 diagnostic status),were assessed with the California Verbal Learning Test (CVLT) at T1 and re-assessed 9 years later with the revised version, CVLT-II. At T1 no deficit in verbal memory between CDs and PDs compared to NDs was found, in which the majority of the subjects were younger adults. At follow-up the majority of CDs and PDs had suffered one or several recurrent depressive episodes. Repeated-measures analysis of variance showed, in particular and irrespective of group, a significant decline in recall measures over time. CDs, PDs and NDs showed the same pattern of verbal memory performance over time with the exception of Short Delayed Free Recall, in which CDs and PDs showed a significant decline in performance at follow-up compared to NDs. Likewise, subjects with recurrent depression performed comparable to subjects with a single episode over the course of follow-up. Our results suggest that individuals with mild to moderate unipolar depression may not be significantly affected by verbal memory impairments over the long-term course. The comparability of the versions of the CVLT is addressed.     

Obsessive-compulsive disorder: a 3-year prospective follow-up study of patients treated with serotonin reuptake inhibitors OCD follow-up study

This study aimed to evaluate the long-term course of obsessive-compulsive disorder (OCD) in patients treated with serotonin reuptake inhibitors (SRIs) and to identify predictors of clinical outcome. Seventy-nine patients fulfilling DSM-IV criteria for OCD were followed prospectively for 3 years. Baseline information was collected on demographic and clinical characteristics, using standardized instruments. During the follow-up period, the clinical status of each patient was evaluated monthly in the first year and bimonthly thereafter by means of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Hamilton Rating Scale for Depression (HDRS). The cumulative probability of achieving at least partial remission from obsessive-compulsive (OC) symptoms during the 3-year period was 65%. The probability of full remission was 38%. For subjects who achieved at least partial remission, the probability of subsequent relapse was 60%. Significant predictors of poor outcome included a longer duration of illness, a greater severity of OC symptoms at intake, and the presence of comorbid schizotypal personality disorder. The findings confirm that the course of illness in OCD is usually continuous with fluctuations in the intensity of OC symptoms. Despite adequate SRI therapy, relatively few patients achieve a completely asymptomatic state, and of those who achieve at least a partial remission, a substantial proportion subsequently relapse. One third of OCD patients is treatment-resistant. Further studies with large samples are required to adequately identify predictors of long-term outcome of OCD in order to optimize the choice among the existing treatment modalities. The development of alternative strategies is needed to improve the treatment approaches for treatment-resistant OCD patients.     

Suicide attempts in a cohort of drug abusers: a 5-year follow-up study

A group of 125 drug abusers admitted consecutively for detoxification and short-term rehabilitation were followed up 5 years after discharge. They were asked about possible suicide attempts in a semi-structured face-to-face interview. Nearly half of the group (45%) reported having attempted suicide at some point in their life. The most common reasons given were the loss of a person whom they loved, and feelings of loneliness. Only three respondents reported using their drug of choice in the attempt(s). The suicide attempters were more often found to have been in child psychiatric treatment earlier, and to have experienced loss of significant others in childhood, than those who did not report attempting suicide. At follow-up the suicide attempters indicated that they experienced more depressive moods and more severe psychological problems than those who had never made a suicide attempt. The importance of assessing the risk of suicide attempts among drug addicts in order to be able to take measures to prevent future suicidal behaviour is emphasized.     

Cognitive-behavioral group therapy for obsessive-compulsive disorder: a 1-year follow-up

OBJECTIVE: The aim of this study was to evaluate the results of cognitive-behavioral group therapy (CBGT) for obsessive-compulsive disorder (OCD) over a 1-year follow-up period. METHOD: Forty-two OCD patients, who completed 12 sessions of CBGT, were followed for 1 year. Measures of the severity of symptoms were obtained at the end of the acute treatment and at 3, 6, and 12 months post-treatment using the Yale-Brown obsessive-compulsive scale (Y-BOCS) and the clinical global impression (CGI). RESULTS: The reduction in the severity of symptoms observed at the end of the treatment was maintained during 1 year (F2,41=1.1; P=0.342). Eleven patients (35.5%) relapsed in the follow-up period. The intensity of improvement (log rank=12.97, GL=1, P=0.0003) and full remission (log rank=6.17; GL=1; P=0.001) were strong predictors for non-relapsing. CONCLUSION: The CBGT is an effective treatment for OCD and its results are maintained for 1 year. However, further long-term randomized controlled trials are needed in order to confirm this finding.     

Changes of associative performance in hospitalized schizophrenics: a 16-year follow-up.

After a mean test-retest interval of 16.6 years a sample of 72 initially acute/subacute as well as chronic schizophrenic patients showed a significant normalisation of performance with respect to associative commonality, idiosyncratic responses, and response latency. The findings are attributed chiefly to effects of psychotropic drugs and improved psychiatric treatment.     

A 16-year follow-up of a case of severe anorexia nervosa

A 16-year follow-up of a case of extreme anorexia nervosa treated exclusively by operant conditioning techniques is presented. The present status of the patient is reviewed with respect to her eating habits, weight, physical and social activity and her general adaptation to life.     

Cause-specific mortality of people with intellectual disability in a population-based, 35-year follow-up study

The aim of the present study was to investigate cause‐specific mortality in people with intellectual disability (ID). It was based on a 35‐year follow‐up study of a nation‐wide population of 2369 subjects aged between 2 and 97 years. The 1095 deceased people had accumulated 64 539 person‐years. The research took the form of a prospective cohort study with mortality follow‐up. Observed and expected deaths were calculated as standardized mortality ratios using the Finnish general population as the reference. Cause‐specific mortality ratios were calculated by the level of ID, sex and age. The three most common causes of death were cardiovascular diseases, respiratory diseases and neoplasms. Disease mortality was high up to 40 years of age, but did not increase thereafter. The difference between sexes in cause‐specific mortality was smaller than in the general population. Cause‐specific mortality differed significantly from the general population, with reduced mortality from neoplasms and external causes, but ageing individuals with mild ID had similar mortality patterns to the general population. The disparities in the cause‐specific mortality between younger people with ID and the general population fade with advancing age, producing similar health risks. In preventative work, special attention should focus on common diseases and accidents in the community.     

Antipsychotic medication, psychiatric diagnosis and children with intellectual disability: a 12-year follow-up study

This study is a follow-up to an original survey carried out in the early 1980s of all children with an identified intellectual disability in Cornwall, England. The purpose of this second study was to review the use of antipsychotic medication in these children and to relate it to their various diagnoses. This is a relatively under-researched area, and the few comparable studies in children have not been designed to specify diagnoses, psychiatric or otherwise. A positive relationship between the diagnosis of autistic spectrum disorders in children and the use of antipsychotic medication was one of the important findings which emerged from the research. The possible reasons for this association are discussed.     

A 15-year follow-up study of patients with panic disorder

BACKGROUND: Panic disorder (PD) is generally regarded as a chronic condition with considerable variation in severity of symptoms. AIMS: To describe the long-term outcome of naturalistically treated PD. METHODS: Fifty-five outpatients with PD, who participated in a placebo-controlled drug trial of the efficacy of alprazolam and imipramine 15 years ago were reassessed with the same instruments used in the original study. RESULTS: Complete recovery (no panic attacks and no longer on medication during the last 10 years) was seen in 18% of patients, and an additional 13% recovered but were still on medication. Fifty-one percent experienced recurrent anxiety attacks whereas 18% still met diagnostic criteria for PD. The incidence of agoraphobia decreased from 69% to 20%. Patients with agoraphobia at admission tended to have a poorer long-term outcome according to daily functioning compared with patients without agoraphobia at admission, although both groups reported improved daily functioning at follow-up. Maintenance medication was common. No benzodiazepine abuse was reported. CONCLUSION: PD has a favourable outcome in a substantial proportion of patients. However, the illness is chronic and needs treatment. The short-term treatment given in the drug trial had no influence on the long-term outcome.