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Biomedical subjects

M Hotopf

Publications and source records attributed to M Hotopf.

At least 19 recordsLinked to original sources
PubMed2000

Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study.

OBJECTIVES: To explore the relation between ill health after the Gulf war and vaccines received before or during the conflict. To test the hypothesis that such ill health is limited to military personnel who received multiple vaccines during deployment and that pesticide use modifies any effect. DESIGN: Cross sectional study of Gulf war veterans followed for six to eight years after deployment. SETTING: UK armed forces. PARTICIPANTS: Military personnel who served in the Gulf and who still had their vaccine records. MAIN OUTCOME MEASURES: Multisymptom illness as classified by the Centers for Disease Control and Prevention; fatigue; psychological distress; post-traumatic stress reaction; health perception; and physical functioning. RESULTS: The response rate for the original survey was 70.4% (n=3284). Of these, 28% (923) had vaccine records. Receipt of multiple vaccines before deployment was associated with only one of the six health outcomes (post-traumatic stress reaction). By contrast five of the six outcomes (all but post-traumatic stress reaction) were associated with multiple vaccines received during deployment. The strongest association was for the multisymptom illness (odds ratio 5.0; 95% confidence interval 2.5 to 9.8). CONCLUSION: Among veterans of the Gulf war there is a specific relation between multiple vaccinations given during deployment and later ill health. Multiple vaccinations in themselves do not seem to be harmful but combined with the "stress" of deployment they may be associated with adverse health outcomes. These results imply that every effort should be made to maintain routine vaccines during peacetime.

Confidence Intervals↗
PubMed2000

Selective serotonin reuptake inhibitors versus tricyclic and heterocyclic antidepressants: comparison of drug adherence.

BACKGROUND: Selective serotonin reuptake inhibitors are thought to have better discontinuation rates (i.e. less people dropping out) than tricyclic and heterocyclic antidepressant drugs. It is important to quantify the drop-out rates of different antidepressant drugs in order to have a better understanding of the relative tolerability of these drugs. OBJECTIVES: To assess the comparative tolerability of selective serotonin reuptake inhibitors and tricyclic/heterocyclic antidepressant drugs. SEARCH STRATEGY: We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (1997 to 1999), MEDLINE (1966 to 1999), EMBASE (1974 to 1999) We also searched specialist journals, the reference lists of relevant papers and previous systematic reviews, conference abstracts and government documents. Representatives of the pharmaceutical industry were contacted. SELECTION CRITERIA: Parallel group randomised controlled trials comparing selective serotonin reuptake inhibitors with tricyclic or heterocyclic antidepressants in people with depression. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and a third reviewer checked any cases of disagreement. MAIN RESULTS: We included 136 trials. The selective serotonin reuptake inhibitors showed less participants dropping out compared to the tricyclic/heterocyclic group (odds ratio 1.21, 95% confidence interval 1.12 to 1.30). A statistically significant difference was found in total drop-outs between the selective serotonin reuptake inhibitors and the old tricyclics as well as the newer tricyclics. When the selective serotonin reuptake inhibitors were compared to the heterocyclic antidepressants, there was a non significant difference favouring the selective serotonin reuptake inhibitors. The poor tolerability profile of the old tricyclics was explained by differences in drop-outs for side-effects, but not for inefficacy. REVIEWER'S CONCLUSIONS: Whilst selective serotonin reuptake inhibitors do appear to show an advantage over tricyclic drugs in terms of total drop-outs, this advantage is relatively modest. This has implications for pharmaco-economic models, some of which may have overestimated the difference of drop-out rates between selective serotonin reuptake inhibitors and tricyclic antdepressants. These results are based on short-term randomised controlled trials, and may not generalise into clinical practice.

Antidepressive Agents↗
PubMed2000

Medically unexplained symptoms: how often and why are they missed?

We assessed risk factors affecting the provisional diagnosis of medically unexplained symptoms made by physicians in new patients, in 526 clinical encounters. Comparisons were made between the doctor's initial assessments regarding the nature of symptoms, and the final diagnosis. Physicians were more likely to err on the side of diagnosing the symptoms as medically explained rather than unexplained. When physicians perceived the interaction with the patient to be positive, they were more likely to make a provisional diagnosis that the symptoms were explained. Conversely, a negative perception of the interaction was associated with an increased likelihood of viewing symptoms as medically unexplained. Physicians should be aware of the effect of their own perceptions on their diagnostic behaviour.

Adolescent↗
PubMed2000

Occupational risk factors for ill health in Gulf veterans of the United Kingdom.

OBJECTIVES: To study the association between occupational factors specific to the Armed Forces (rank, functional roles, Service, regular or reservist status and deployment factors) and symptomatic health problems in Gulf veterans, after sociodemographic and lifestyle factors have been accounted for. DESIGN: A postal cross sectional survey of randomly selected UK Gulf veterans was conducted six to seven years after the Gulf conflict. Physical ill health was measured using the Fatigue Questionnaire and a measure of the Centers for Disease Control and Prevention (CDC) multi-symptom syndrome. Psychological ill health was measured using the General Health Questionnaire and a post-traumatic stress measure. SETTING: Population of servicemen who were serving in the UK Armed Forces during the Gulf conflict between 1 September 1990 and 30 June 1991. PARTICIPANTS: 3297 Gulf veterans. MAIN RESULTS: In multivariate logistic regression, there was an inverse relation between higher rank and psychological and physical ill health (test of trend: General Health Questionnaire, p=0.004; post-traumatic stress, p=0.002; fatigue, p=0.015; CDC case, p=0.002). Having left the Armed Forces was associated with a two to three times increase in reporting ill health. Of the deployment factors, there was a weak association between being deployed as an individual reinforcement in a combat role and post-traumatic stress but there was no association between receiving pre-deployment training or post-deployment leave and ill health. Marital status and smoking were associated with psychological and physical ill health. CONCLUSIONS: Rank was the main occupational factor associated with both psychological and physical ill health in Gulf veterans. This may parallel the associations between socioeconomic status and morbidity in civilian populations. Ill health seems to be greater in those who return to civilian life. Sociodemographic factors also seem to be important in ill health in Gulf veterans.

Adult↗
PubMed2000

Childhood predictors of adult medically unexplained hospitalisations. Results from a national birth cohort study.

BACKGROUND: It has been suggested that adults with medically unexplained physical symptoms experienced greater ill-health then others (either in themselves or their families) during childhood. AIMS: To test these hypotheses. METHOD: We used data from the Medical Research Council (MRC) National Survey of Health and Development, a population-based cohort study established in 1946 (n = 5362). Subjects were followed from birth in 1946 until 1989 (age 43 years). As outcome, we used operationally defined medically unexplained hospital admissions at age 15-43 years. Exposure variables included childhood illness, and illness in parents during the childhood of the subjects. RESULTS: The risk set (n = 4603) comprised individuals still in the Survey at age 15. Ninety-five unexplained hospital admissions were identified. Subjects whose mothers reported below-average health in the father were at increased risk of subsequent unexplained admissions. Below average reported health in the mother was not associated with this increased risk. Defined physical diseases in childhood were not associated, but persistent abdominal pain at age 7-15 years was. CONCLUSIONS: Unexplained hospital admissions are associated with certain childhood experiences of illness, but defined physical illness in childhood is not a risk factor.

Abdominal Pain↗
PubMed2000

Changing patterns in the use of the Mental Health Act 1983 in England, 1984-1996.

BACKGROUND: The Mental Health Act 1983 (MHA) is due to be revised by Parliament in the near future. AIMS: To explore changes in the use of the Act since its introduction. METHOD: The Department of Health and the Home Office routinely collect data on the numbers of patients admitted to psychiatric hospitals under the MHA. We present absolute figures, by year, for the total numbers admitted under each section of the Act. We used the total psychiatric hospital admissions and total prison populations as denominator data. RESULTS: Formal admissions rose from 16,044 in 1984 to 26,308 in 1996, a 63% increase. Admissions under the MHA have increased as a proportion of all admissions. The increase is mainly accounted for by changes in the use of Part II of the Act, in particular sections 2 and 3. The use of forensic sections (Part III) has also increased, with a marked increase of sections 47 and 48. Use of Part X of the Act (sections 135 and 136) declined in the late 1980s but rose again in the 1990s. CONCLUSIONS: Formal admissions are more common than they were in 1984, despite there being fewer psychiatric beds. This is probably due to changes in the provision of psychiatric services, and changing societal pressures on psychiatrists away from libertarianism and towards coercion.

Commitment of Persons with Psychiatric Disorders↗
PubMed1999

Health of UK servicemen who served in Persian Gulf War.

BACKGROUND: Various symptoms in military personnel in the Persian Gulf War 1990-91 have caused international speculation and concern. We investigated UK servicemen. METHODS: We did a cross-sectional postal survey on a random sample of Gulf War veterans (Gulf War cohort, n=4248) and, stratified for age and rank, servicemen deployed to the Bosnia conflict (Bosnia cohort, n=4250) and those serving during the Gulf War but not deployed there (Era cohort, n=4246). We asked about deployment, exposures, symptoms, and illnesses. We analysed men only. Our outcome measures were physical health, functional capacity (SF-36), the general health questionnaire, the Centers for Disease Control and Prevention (CDC) multisymptom criteria for Gulf War illness, and post-traumatic stress reactions. FINDINGS: There were 8195 (65.1%) valid responses. The Gulf War cohort reported symptoms and disorders significantly more frequently than those in the Bosnia and Era cohorts, which were similar. Perception of physical health and ability were significantly worse in the Gulf War cohort than in the other cohorts, even after adjustment for confounders. Gulf War veterans were more likely than the Bosnia cohort to have substantial fatigue (odds ratio 2.2 [95% CI 1.9-2.6]), symptoms of post-traumatic stress (2.6 [1.9-3.4]), and psychological distress (1.6 [1.4-1.8]), and were nearly twice as likely to reach the CDC case definition (2.5 [2.2-2.8]). In the Gulf War, Bosnia, and Era cohorts, respectively, 61.9%, 36.8%, and 36.4% met the CDC criteria, which fell to 25.3%, 11.8%, and 12.2% for severe symptoms. Potentially harmful exposures were reported most frequently by the Gulf War cohort. All exposures showed associations with all of the outcome measures in the three cohorts. Exposures specific to the Gulf were associated with all outcomes. Vaccination against biological warfare and multiple routine vaccinations were associated with the CDC multisymptom syndrome in the Gulf War cohort. INTERPRETATION: Service in the Gulf War was associated with various health problems over and above those associated with deployment to an unfamiliar hostile environment. Since associations of ill health with adverse events and exposures were found in all cohorts, however, they may not be unique and causally implicated in Gulf-War-related illness. A specific mechanism may link vaccination against biological warfare agents and later ill health, but the risks of illness must be considered against the protection of servicemen.

Adult↗
PubMed1999

Psychiatric disorder and the use of benzodiazepines: an example of the inverse care law from Brazil.

BACKGROUND: A cross-sectional survey was conducted in Pelotas, southern Brazil, to assess the relationship between the use of benzodiazepines (BZD), minor psychiatric disorders (MPD) and social factors. METHODS: A representative sample (n = 1277) was interviewed using the Self-Reporting Questionnaire (SRQ-20) for MPD. Subjects were asked about the use of BZD in the preceding 2 weeks and were also asked for socioeconomic details. RESULTS: A total of 152 (11.9%; 95% CI 10.1-13.7) subjects had taken psychotropic drugs, with BZD being the most commonly reported (8%). The prevalence of MPD was 22.7% (95% CI 20.4-25.0): males 17.9% and females 26.5%. An inverse relationship was seen between level of income, schooling and prevalence of MPD (P < 0.001), but a positive relationship was found between income and BZD consumption (P < 0.05). CONCLUSIONS: These data suggest that the inverse care law operates in prescribing psychotropic medications for MPD.

Adolescent↗
PubMed1999

Recognition of medically unexplained symptoms--do doctors agree?

The aim of this study was to investigate the interrater reliability of the recognition of medically unexplained symptoms by medical investigators. The casenotes of 56 consecutive secondary care out-patient attenders were examined by three medical investigators. The investigators determined whether the presenting symptoms were medically unexplained (not, probable, or definite) and the results were tested for interrater reliability. The combined kappa for the three investigators was 0.76, indicating substantial agreement. This suggests that casenote examination is a reliable method of determining whether a symptom is medically unexplained.

Diagnosis, Differential↗
PubMed1999

Is fibromyalgia a distinct clinical entity? Historical and epidemiological evidence.

Most medical specialities have defined medically unexplained syndromes such as fibromyalgia, to categorize patients with prominent but unexplained symptoms. Other such syndromes include irritable bowel syndrome, chronic fatigue syndrome and atypical chest pain. In this chapter we present evidence to suggest that fibromyalgia is not a unique clinical entity, but shares much with these other syndromes. We use historical, clinical and epidemiological evidence to illustrate this idea. The historical data emphasize the essentially arbitrary way in which fibromyalgia developed. The clinical evidence shows the considerable overlap between patients with fibromyalgia and those with other unexplained syndromes. From an epidemiological perspective we emphasize the strong associations between symptoms such as myalgia and fatigue. We conclude by suggesting that fibromyalgia is one of many medically unexplained syndromes which have more similarities than differences between them.

Fatigue Syndrome, Chronic↗
PubMed1999

Childhood risk factors for adults with medically unexplained symptoms: results from a national birth cohort study.

OBJECTIVE: The purpose of this study was to test the hypothesis that the prior experience of physical illness in childhood is associated with later experience of medically unexplained symptoms. METHOD: A nested case-control study was performed within a prospective birth cohort study: the Medical Research Council National Survey of Health and Development. The 5% most symptomatic individuals at age 36 years were identified and screened for physical illness. Subjects without defined physical diagnoses (N = 191) were compared with the remainder of the sample (N = 3,107) for childhood exposures. RESULTS: There was a powerful relationship between poor reported health of the parents when subjects were aged 15 years and symptoms at age 36; the relationship was independent of current psychiatric disorder. Medically unexplained symptoms were associated with abdominal pain in childhood but not with defined childhood diseases. CONCLUSIONS: Medically unexplained symptoms appear to be related to prior experience of illness in the family and previous unexplained symptoms in the individual. This may reflect a learned process whereby illness experience leads to symptom monitoring.

Adolescent↗
PubMed1999

Pragmatic randomised controlled trials in psychiatry.

BACKGROUND: Randomised controlled trials (RCTs) are the most important method of evaluating new treatments and treatment policies. Despite this, there are relatively few large pragmatic RCTs in psychiatry. AIMS: To explore the main advantages of large pragmatic RCTs and the obstacles to performing them in psychiatry. METHOD: A narrative review of literature on pragmatic RCTs with examples drawn from psychiatry and other medical specialities. RESULTS: Obstacles to performing pragmatic RCTs in psychiatry include the complexity of psychiatric interventions, the complexity of outcomes used in psychiatry and the difficulties of blinding subjects and investigators to some psychiatric interventions. CONCLUSIONS: Researchers need to frame questions in a form that is relevant to clinicians and to convince clinicians to cooperate in simple large pragmatic trials.

Cluster Analysis↗
PubMed1998

Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study.

OBJECTIVE: To test the hypotheses that children with abdominal pain have anxious parents and come from families with high rates of physical illness and that they grow up to suffer from high rates of medically unexplained symptoms and psychiatric disorders. DESIGN: Population based birth cohort study. SETTING: General population. SUBJECTS: Participants in the Medical Research Council (MRC) national survey of health and development, a population based birth cohort study established in 1946. MAIN OUTCOME MEASURES: Abdominal pain present throughout childhood in the absence of defined organic disease, and measures of physical symptoms and psychiatric disorder at age 36 years. RESULTS: There were high rates of complaints about physical health among the parents of children with persistent abdominal pain, and the mothers had higher neuroticism scores. Children with persistent abdominal pain were more likely to suffer from psychiatric disorders in adulthood (odds ratio 2.72 (95% confidence interval 1.65 to 4.49)) but were not especially prone to physical symptoms once psychiatric disorder was controlled for (odds ratio 1. 39 (0.83 to 2.36)). CONCLUSIONS: Persistent abdominal pain is associated with poor health and emotional disorder in the parents. Children with abdominal pain do not necessarily continue to experience physical symptoms into adulthood but are at increased risk of adult psychiatric disorders.

Abdominal Pain↗
PubMed1998

What's in a name? A comparison of four psychiatric assessments.

The Hamilton Depression Rating Scale, Beck Depression Inventory, Clinical Interview Schedule and General Health Questionnaire have been designed to detect and measure severity of psychiatric disorders in different settings. We aimed to determine the relationship between each assessment within a mixed primary care population. The questionnaires and interviews were administered to a sample of 49 patients attending an urban general practice. The total score for each scale correlated closely with every other one (correlation coefficients = 0.70-0.79). Factor analysis suggested that all of the scales were measuring a single underlying construct with reliabilities of 0.68-0.78. The implications of these findings are discussed in relation to the assessment of severity of depression and other neurotic symptoms. We suggest that the Clinical Interview Schedule is a feasible alternative to the Hamilton Rating Scale for Depression and discuss reasons why it might be preferable within clinical trials of depression.

Adolescent↗