Royal Cornhill Hospital

Aberdeen, United Kingdom

Royal Cornhill Hospital

Aberdeen, United Kingdom
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Simonsen H.,Royal Cornhill Hospital | Shand A.J.,Royal Cornhill Hospital | Scott N.W.,University of Aberdeen | Eagles J.M.,Royal Cornhill Hospital
Journal of Affective Disorders | Year: 2011

Background: There is evidence of seasonality in bipolar affective disorder (BAD) and the preponderance of atypical symptoms in bipolar depressive episodes is also seen in winter type Seasonal Affective Disorder. Differences in seasonal symptoms between BAD and appropriate comparison populations have been scrutinised only in small studies. Methods: Symptoms described on the Seasonal Pattern Assessment Questionnaire (SPAQ) were compared between 183 patients with BAD and 468 patients consulting their general practitioners. Statistical analyses were adjusted for differing age and gender distributions between the two groups. Results: Compared with the general practice patients, subjects with BAD reported greater seasonal fluctuations in mood (p = 0.003). On one measure BAD subjects reported increased seasonal changes in social activity (p < 0.001) and greater weight fluctuation over the year (p = 0.001). The most striking differences were in sleep patterns; BAD subjects slept significantly more throughout the year, and slept for a mean of 1.8 h more in winter than in summer (versus a 1.0 h difference in the general practice group, p < 0.001). Against 20% of the general practice group, 46% of BAD patients rated seasonal changes in well-being to be at least a moderate problem. Limitations: The SPAQ was designed as a screening instrument for Seasonal Affective Disorder, not for studies of this nature. Some of the reported differences, notably in social activity and weight changes, may reflect secondary psychosocial effects of BAD. Conclusions: Seasonal changes, most notably winter hypersomnia, should be identified in patients with BAD. These symptoms may respond to treatments such as light therapy that are used in recurrent winter depression. © 2011 Elsevier B.V. All rights reserved.

Asif M.,Royal Cornhill Hospital | Soiza R.L.,University of Aberdeen | Soiza R.L.,Woodend Hospital | McEvoy M.,University of Newcastle | And 2 more authors.
Current Alzheimer Research | Year: 2013

There is good epidemiological evidence that vascular disease predisposes to cognitive decline and dementia. The impact of vascular disease on dementia is likely to increase further because of the poor diagnosis and management of vascular risk factors, the increase in life expectancy, and the improved survival following major cardiovascular events, e.g. acute stroke. It is estimated that the adequate management of vascular risk factors, with pharmacological and/or nonpharmacological interventions, might result in a 50% reduction in the forecasted dementia prevalence. The exact mechanisms by which vascular risk factors and vascular disease adversely affect brain function remain unclear, but it is hypothesized that endothelial dysfunction plays an important role. Reduced synthesis and availability of endothelial nitric oxide (NO) may contribute to the development of dementia by at least two mechanisms: 1) favoring the onset and progression of atherosclerosis, vasoconstriction, and impaired cerebral blood flow regulation; and 2) reduced neuroprotection. Several studies have shown that asymmetric dimethylarginine (ADMA), an endogenous methylated form of the amino acid L-arginine, inhibits NO synthesis and favors oxidative stress and vascular damage. Unlike NO, ADMA concentrations are relatively stable and can be accurately measured in plasma. There is good evidence that higher plasma ADMA concentrations favor atherosclerosis and independently predict adverse cardiovascular and cerebrovascular outcomes in several patient groups. ADMA might represent a unifying pathophysiological pathway linking the presence of vascular risk factors with the onset and progression of cognitive decline and dementia. This review discusses the biological role of ADMA, its potential contribution to the onset and progression of dementia through vascular disease and atherosclerosis, the available evidence linking ADMA with cognitive impairment and dementia, and the strategies to characterize the predictive role of ADMA in cognitive impairment in epidemiological studies. Therapeutic implications and suggestions for future research directions are also discussed. © 2013 Bentham Science Publishers.

Shand A.J.,Royal Cornhill Hospital | Scott N.W.,University of Aberdeen | Anderson S.M.,Royal Cornhill Hospital | Eagles J.M.,Royal Cornhill Hospital
Journal of Affective Disorders | Year: 2011

Background: In contrast with recurrent unipolar depression, relatively little is known about the seasonality of depressive episodes in bipolar affective disorder (BAD). Method: We compared responses on the Seasonal Pattern Assessment Questionnaire (SPAQ) between a cohort of 183 patients with BAD and a large sample of patients in primary care (N = 4746). Comparisons were adjusted for age and gender. Results: 27% of the BAD patients fulfilled SPAQ criteria for Seasonal Affective Disorder (SAD. This gave an adjusted odds ratio of 3.73 (95% confidence intervals 2.64 to 5.27) in comparison with the rate among the primary care samples. Global seasonality scores were significantly higher among BAD patients (adjusted mean difference 1.73, 95% CI 0.97 to 2.49, p < 0.001). Limitations: The SPAQ was originally designed as a screening instrument rather than as a case-finding instrument. Conclusions: Vigilance for seasonal symptom recurrence in BAD may be important with regard to management and relapse prevention. © 2011 Elsevier B.V. All rights reserved.

Eagles J.M.,Royal Cornhill Hospital | Lee A.J.,University of Aberdeen | Raja E.A.,University of Aberdeen | Millar H.R.,Royal Cornhill Hospital | Bhattacharya S.,University of Aberdeen
Psychological Medicine | Year: 2012

Background When women have a history of anorexia nervosa (AN), the advice given about becoming pregnant, and about the management of pregnancies, has usually been cautious. This study compared the pregnancy outcomes of women with and without a history of AN. Method Women with a confirmed diagnosis of AN who had presented to psychiatric services in North East Scotland from 1965 to 2007 were identified. Those women with a pregnancy recorded in the Aberdeen Maternal and Neonatal Databank (AMND) were each matched by age, parity and year of delivery of their first baby with five women with no history of AN. Maternal and foetal outcomes were compared between these two groups of women. Comparisons were also made between the mothers with a history of AN and all other women in the AMND. Results A total of 134 women with a history of AN delivered 230 babies and the 670 matched women delivered 1144 babies. Mothers with AN delivered lighter babies but this difference did not persist after adjusting for maternal body mass index (BMI) in early pregnancy. Standardized birthweight (SBW) scores suggested that the AN mothers were more likely to produce babies with intrauterine growth restriction (IUGR) [relative risk (RR) 1.54, 95% confidence interval (CI) 1.11-2.13]. AN mothers were more likely to experience antepartum haemorrhage (RR 1.70, 95% CI 1.09-2.65). Conclusions Mothers with a history of AN are at increased risk of adverse pregnancy outcomes. The magnitude of these risks is relatively small and should be appraised holistically by psychiatric and obstetric services. © 2012 Cambridge University Press.

Curtis-Barton M.T.,University of Aberdeen | Eagles J.M.,Royal Cornhill Hospital
Psychiatrist | Year: 2011

Aims and method: This cross-sectional study investigated the evolution of intentions among medical students to pursue a career in psychiatry and the factors that might discourage them from becoming a psychiatrist. A questionnaire survey was sent to medical students in years 1-5 at Aberdeen University. Results: From 918 students, 467 (51%) returned useable responses. Proportions of students across the 5-year groups who definitely or probably intended to become psychiatrists remained fairly stable at 4-7%. In their final year, psychiatry remained a possible career option for a further 17% of students. The most potent discouraging factor was the perception of poor prognoses among psychiatric patients. Perceptions of a lack of scientific/evidence base reduced enthusiasm for becoming a psychiatrist. Issues relating to the prestige of the specialty were also important. Implications If recruitment to the specialty is to improve, these negative perceptions among students should be addressed by their teachers and more widely within psychiatry.

Phillips L.H.,University of Aberdeen | Scott C.,University of Aberdeen | Henry J.D.,University of New South Wales | Mowat D.,Royal Cornhill Hospital | Bell J.S.,Royal Cornhill Hospital
Psychology and Aging | Year: 2010

Difficulties in understanding emotional signals might have important implications for social interactions in old age. In this study we investigated emotion perception skills involved in decoding facial expressions of emotion in healthy older adults, compared with those with Alzheimer's disease (AD) or late-life mood disorder (MD). Although those with MD were mildly impaired in identifying emotional expressions, this was not caused by negative biases in choosing labels. Emotion decoding performance in AD was much more impaired, particularly when relatively subtle expressions were presented. Difficulties in choosing between labels to describe an emotional face were predicted by executive dysfunction, whereas impaired ability to match 2 emotional faces was related to general difficulties with face perception. Across all 3 groups, problems with emotion perception predicted quality of life independently of variance predicted by cognitive function and mood, indicating the potential importance of emotion decoding skills in the well-being of older adults. © 2010 American Psychological Association.

Simpson S.G.,University of South Australia | Simpson S.G.,Royal Cornhill Hospital | Slowey L.,University of Edinburgh
Clinical Practice and Epidemiology in Mental Health | Year: 2011

Both eating and weight disorders are prevalent in our society but many sufferers do not have access to specialist treatments, especially those living in remote and rural areas. Video therapy is proposed as a potential solution, allowing therapists to deliver psychological treatments without the costs associated with travel. Furthermore, there is a gap in the evidence base for those with co-morbid obesity and atypical eating disorders, but it is likely that treatments which focus on linking past and present patterns of behaviour and emphasise cognitive, behavioural and emotional change will be most effective. A naturalistic single case design was used to pilot the feasibility of providing video therapy using the schema therapy mode model, which involves a range of 'active' techniques including chair work and imagery. Results suggest that videoconferencing may be well suited to the delivery of experiential psychotherapy, leading to change across several domains. Scores on the EDE-Q showed a 77% improvement and the client was abstinent from vomiting during the last 28 days of treatment. The findings from this study indicate that video therapy may be effective for this co-morbid diagnostic group and highlight the need for further larger scale research. © Simpson and Slowey.

Duthie A.,Royal Cornhill Hospital | Chew D.,Woodend Hospital | Soiza R.L.,Woodend Hospital
QJM | Year: 2011

The burden of medical comorbidity in individuals with Alzheimer's disease is greater than that observed in matched individuals without dementia. This has important implications for all clinicians and healthcare providers who deal with this common condition. The prevalence of vascular risk factors and vascular disease is particularly high. Additionally, associations with a number of other chronic medical conditions have been described, including thyroid disorders, sleep apnoea, osteoporosis and glaucoma. This review gives an overview of evidenced medical (non-psychiatric) comorbidity associated with Alzheimer's disease and briefly explores the underlying mechanisms that may account for these associations. © The Author 2011. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.

Gradin V.B.,University of Dundee | Waiter G.,Biomedical Imaging Center | O'Connor A.,University of St. Andrews | Romaniuk L.,University of Edinburgh | And 4 more authors.
Psychiatry Research - Neuroimaging | Year: 2013

Theories of schizophrenia propose that abnormal functioning of the neural reward system is linked to negative and psychotic symptoms, by disruption of reward processing and promotion of context-independent false associations. Recently, it has been argued that an insula-anterior cingulate cortex (ACC) salience network system enables switching of brain states from the default mode to a task-related activity mode. Abnormal interaction between the insula-ACC system and reward processing regions may help explain abnormal reinforcer processing and symptoms. Here we use functional magnetic resonance imaging to assess the neural correlates of reward processing in schizophrenia. Furthermore, we investigated functional connectivity between the dopaminergic midbrain, a key region for the processing of reinforcers, and other brain regions. In response to rewards, controls activated task related regions (striatum, amygdala/hippocampus and midbrain) and the insula-ACC salience network. Patients similarly activated the insula-ACC salience network system but failed to activate task related regions. Reduced functional connectivity between the midbrain and the insula was found in schizophrenia, with the extent of this abnormality correlating with increased psychotic symptoms. The findings support the notion that reward processing is abnormal in schizophrenia and highlight the potential role of abnormal interactions between the insula-ACC salience network and reward regions. © 2012 Elsevier Ireland Ltd.

Morris J.,Royal Cornhill Hospital
Clinical Psychology and Psychotherapy | Year: 2012

Over the past two decades, Interpersonal Psychotherapy (IPT) has shown itself to be one of only two evidence-based psychotherapies for the treatment of depression in adolescence-an age group where the prescribing of antidepressant medication is limited and where morbidity and recurrence are high. We review the literature on the development and research studies of the IPT model for depressed adolescent patients, as well as recent developments expanding its use to other cultures and different diagnostic areas. An overview is provided of the model in action, using a fictionalized case vignette. Finally, we consider the future of IPT for the treatment and prevention of affective disorders in the under 18 age group and in the context of other generations in vulnerable families. © 2012 John Wiley & Sons, Ltd.

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