Papers by Cornelius Katona
British Journal of Psychiatry, 2002
BackgroundNumbers of immigrant elders are increasing and it is unclear whether they can access se... more BackgroundNumbers of immigrant elders are increasing and it is unclear whether they can access services.AimsTo examine service utilisation of older immigrants compared with their UK-born counterparts and relate it to health difficulties.MethodCross-sectional study in inner London measuring service use, mental health and disability.ResultsA total of 1085 people aged β©Ύ65 years were interviewed. Independent predictors of contact with a general practitioner included being born in Cyprus. Cypriots were the only immigrant population to report significantly more somatic symptoms than those born in the UK (P=0.005). Africans and Caribbeans used daycare and other social services most frequently.ConclusionsImmigrants could access services. Africans and Caribbeans appear to have poorer physical health and thus have greater contact with services. Cypriots who experience depression may present with prominent somatic symptoms. This is likely to be due to a different idiom of distress.
European Psychiatry, 2013
Introduction Studies point to an adverse effect of detention on the mental health of asylum seeke... more Introduction Studies point to an adverse effect of detention on the mental health of asylum seekers, yet the use of detention has been rising in several recipient countries. In general, many asylum seekers suffer from psychological disorders and symptoms, and a large percentage has been subjected to torture. The UNHCR recommends that torture survivors generally should not be detained. Due to a lack of systematic screening it is often unknown whether the asylum seeker is a torture survivor. This causes several hindrances for the protection of this vulnerable group from potentially harmful factors such as deprivation of liberty. Objectives To examine the impact of detention on the mental health of adult torture survivors. Aims To produce a comprehensive review of the literature and bring attention to a potentially harmful praxis. Methods The systematic review follows the PRISMA guidelines. The search was made in PubMed (Medline), PsychINFO, PILOTS and IBSS. A screening of reference lists identified additional studies. The search was broadened to βasylum seekersβ as very few studies were found on torture survivors specifically. Results Presently (Oct. 2012) the review is in the stage of analyzing, thus results are preliminary. Currently the identified studies amount to 26. All studies report mental health problems among the asylum seekers and some identify detention itself as a contributing factor to these problems. Conclusions Detention does pose a risk factor in regard to deteriorating the mental health of asylum seekers. Although torture survivors might be an especially vulnerable group, research is almost non-existent.
European Psychiatry, 2013
Introduction Studies point to an adverse effect of detention on the mental health of asylum seeke... more Introduction Studies point to an adverse effect of detention on the mental health of asylum seekers, yet the use of detention has been rising in several recipient countries. In general, many asylum seekers suffer from psychological disorders and symptoms, and a large percentage has been subjected to torture. The UNHCR recommends that torture survivors generally should not be detained. Due to a lack of systematic screening it is often unknown whether the asylum seeker is a torture survivor. This causes several hindrances for the protection of this vulnerable group from potentially harmful factors such as deprivation of liberty. Objectives To examine the impact of detention on the mental health of adult torture survivors. Aims To produce a comprehensive review of the literature and bring attention to a potentially harmful praxis. Methods The systematic review follows the PRISMA guidelines. The search was made in PubMed (Medline), PsychINFO, PILOTS and IBSS. A screening of reference lists identified additional studies. The search was broadened to βasylum seekersβ as very few studies were found on torture survivors specifically. Results Presently (Oct. 2012) the review is in the stage of analyzing, thus results are preliminary. Currently the identified studies amount to 26. All studies report mental health problems among the asylum seekers and some identify detention itself as a contributing factor to these problems. Conclusions Detention does pose a risk factor in regard to deteriorating the mental health of asylum seekers. Although torture survivors might be an especially vulnerable group, research is almost non-existent.
The evaluation utilizes a within-subjects design to evaluate: glycaemic control (HbA1c), choleste... more The evaluation utilizes a within-subjects design to evaluate: glycaemic control (HbA1c), cholesterol, depression, self-efficacy, health-related quality of life and illness perceptions before and after therapy.
Value in Health, 2010
The cost-utility analysis was based on 5-year Markov cohort simulations. The model evaluated the ... more The cost-utility analysis was based on 5-year Markov cohort simulations. The model evaluated the impact of memantine on time to Full-Time-Care (FTC), Quality-Adjusted-Life-Years (QALYs) and costs, in pre-FTC patients compared with standard care, i.e. no pharmacotherapy or background treatment with acetylcholinesterase inhibitors. FTC was defi ned based on locus of care and patient's physical and functional dependency status. Transition probabilities, baseline characteristics, resource utilization volumes, health utility weights and mortality rates were derived from the 4.5-year London and SouthEast Region (LASER-AD) epidemiological study. Effectiveness estimates came from a meta-analysis of six large randomised clinical trials. Costs covered routine patient management, hospitalization, social community services, institutionalization, and medications. Results were reported in EUR (GBP), 2009. The model underwent extensive stochastic and one-way sensitivity analyses, testing the model assumptions and changes in input parameters. RESULTS: Over fi ve years, patients receiving standard care spend on average 78.8 weeks in the pre-FTC state. Overall costs in this group were c117,960 (Β£98,810). QALYs were estimated at 1.49 (30% of full health). Memantine was associated with a longer time-to-FTC of 11.2 weeks, QALY gains of 0.07 and cost-savings of c5930 (Β£4970). Lower costs in the memantine group were due to prolonged pre-FTC period. Memantine was more effective and less costly strategy relative to standard care in 99.98% of simulations. The estimated benefi ts and cost savings were almost twice higher than those previously estimated in all moderate and severe AD patients, largely due to enhanced effi cacy of memantine in APS patients, who, when left untreated, rapidly deteriorate. CONCLUSIONS: The model showed that memantine yielded higher benefi ts at no additional costs relative to its alternative.
Psychological Medicine, 2000
Background. Although there have been many follow-up studies of severe puerperal psychiatric illne... more Background. Although there have been many follow-up studies of severe puerperal psychiatric illness, few have been very long-term.Methods. Sixty-four subjects from 85 (75Β·3%) in an unselected sample of women admitted to a psychiatric hospital within 6 months of childbirth were successfully followed up a mean of 23 years (range 17β28) later. Most subjects were interviewed in detail, with further information obtained from general practice and hospital records. Data included subsequent illnesses and diagnoses, subsequent childbirth, longitudinal social function, current symptoms and social function.Results. Seventy-five per cent of subjects had further psychiatric illnesses, most of them unrelated to childbirth, and 37% had at least three subsequent episodes. The risk of puerperal psychiatric illness was 29% in subsequent pregnancies. At outcome interview the majority of subjects were well, with satisfactory social adjustment. Diagnoses in subsequent psychiatric illnesses showed consid...
Clinical Medicine, 2005
This article presents the findings of a focused literature review and consensus meetings on the d... more This article presents the findings of a focused literature review and consensus meetings on the definition and clinical significance of painful symptoms in patients with depression. About 50% of depressed patients report pain, and many types of pain occur more frequently in people with depression than in those without. There is some evidence that pain in depressed patients is associated with a poor response to treatment. Pain and depression may share common pathways and may both respond to treatment with certain antidepressants. Doctors need to be alert to pain in depressed patients and be prepared to treat it.
Journal of Psychopharmacology, 2000
A revision of the British Association for Psychopharmacology guidelines for treating depressive d... more A revision of the British Association for Psychopharmacology guidelines for treating depressive disorders with antidepressants was undertaken in order to specify the scope and target of the guidelines and to update the recommendations based explicitly on the available evidence. A consensus meeting, involving experts in depressive disorders and their treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is given which identifies the quality of evidence followed by recommendations, the strength of which are based on the level of evidence. The guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing, management when initial treatment fails, continuation treatment, maintenance treatment to prevent recur...
Psychiatric Bulletin, 1990
Nuclear Medicine Communications, 2001
Medical Teacher, 1992
This study describes a simple set of statistical parameters for assessing the reliability and val... more This study describes a simple set of statistical parameters for assessing the reliability and validity of oral examinations (OE). Traditional feedback to examiners tends to categorize them as 'hawks' or 'doves' on the basis of whether their personal mean mark is above or below the group mean. Our study shows that the mean OE mark on its own is not a good measure of examiner performance. We suggest that inter-rater reliability between examiner pairs is a more satisfactory indicator of reliability and face validity. The correlation between the OE marks given by an examiner and the student's subtotal from written parts of the exam (SUBTOT) is suggested as a useful indicator of OE validity. These measures, as applied to our own student exam results, suggest that our OE examiners are performing at an acceptable standard of agreement (Cohen's Kappa for pass/fail 0.74, p < 0.0001), and support the use of the OE as a method of student assessment.
The Lancet, 1999
With the dopaminergic presynaptic ligand FP-CIT and single photon emission tomography we have sho... more With the dopaminergic presynaptic ligand FP-CIT and single photon emission tomography we have shown a severe dopaminergic degeneration in a patient with a necropsy confirmed diagnosis of dementia with Lewy bodies (DLB). We suggest that functional imaging of the nigrostriatal dopamine pathway helps to distinguish DLB from Alzheimer's disease during life.
Lancet, Jan 30, 2011
Depression is common in dementia but the evidence base for appropriate drug treatment is sparse a... more Depression is common in dementia but the evidence base for appropriate drug treatment is sparse and equivocal. We aimed to assess efficacy and safety of two of the most commonly prescribed drugs, sertraline and mirtazapine, compared with placebo.
European Psychiatry, 2007
Background Dementia with Lewy bodies (DLB) is a common form of dementia. The presence of Alzheime... more Background Dementia with Lewy bodies (DLB) is a common form of dementia. The presence of Alzheimer's disease (AD) pathology modifies the clinical features of DLB, making it harder to distinguish DLB from AD clinically during life. Our aim was to determine, in a series of patients with dementia in whom autopsy confirmation of diagnosis is available, whether functional imaging of the nigrostriatal pathway improves the accuracy of diagnosis compared to diagnosis by means of clinical criteria alone. Methods A SPECT scan was carried out with a dopaminergic pre-synaptic ligand [123I]-2beta-carbometoxy-3beta- (4-iodophenyl)-N- (3-fluoropropyl) nortropane (FP-CIT) on a group of patients with a clinical diagnosis of DLB or other dementia. An abnormal scan was defined as one in which right and left posterior putamen binding, measured semi-quantitatively, was more than 2 standard deviations below the mean of the controls. Results Over a ten year period it has been possible to collect twenty patients who have been followed from the time of first assessment and time of scan through to death and subsequent detailed neuropathological autopsy. Eight patients fulfilled neuropathological diagnostic criteria for DLB. Nine patients had AD, mostly with co-existing cerebrovascular disease. Three patients had other diagnoses. The sensitivity of the FP-CIT scan for the diagnosis. Conclusions FP-CIT SPET scans substantially enhanced the accuracy of diagnosis of DLB by comparison with clinical criteria alone.
The British Journal of Psychiatry, 2013
Background Depression is a common and costly comorbidity in dementia. There are very few data on ... more Background Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes. Aims To evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia. Method A pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0β13 weeks and 0β39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods. Res...
The British Journal of Psychiatry, 2005
Advances in Psychiatric Treatment, 1998
Dementia with cortical Lewy bodies (LBD) was first described by Okazaki et al in 1961 and is now ... more Dementia with cortical Lewy bodies (LBD) was first described by Okazaki et al in 1961 and is now recognised as a relatively common cause of the dementia syndrome. The true prevalence of LBD is unknown. In post-mortem studies of patients diagnosed as having dementia in life, the mean frequency of Lewy body dementia is 12.5% (Byrne, 1997). Clinically diagnosed LBD (using operational clinical criteria) is found in 10β23% of patients presenting to, or in the care of, psychogeriatric services (Collerton et al, 1996). What is not yet certain is its nosological status; opinion is divided between regarding it as a variety of Alzheimer's disease (the Lewy body variant), a distinct disease (senile dementia of the Lewy body type) or a spectrum disorder related to both Parkinson's disease and to Alzheimer's disease (Byrne, 1992).
Psychiatric Bulletin, 1998
Background: The number of asylum seekers, refugees and internally displaced people worldwide has ... more Background: The number of asylum seekers, refugees and internally displaced people worldwide has increased dramatically over the past 5 years. Many countries are continuing to resort to detaining asylum seekers and other migrants, despite concerns that this may be harmful. In light of the considerable body of recent research, this review aims to update and expand on a 2009 systematic review on the mental health consequences of detention on adult, adolescent and child immigration detainees, which found (on the basis on 9 studies) that there was consistent evidence that immigration detention had adverse effects on mental health. Methods: Three databases were searched using key terms relating to immigration detention and mental health. Electronic searches were supplemented by reference screening. Studies were included if they were quantitative, included individuals detained for immigration purposes, reported on mental health problems and were published in peer-reviewed journals. Two reviewers independently screened papers for eligibility, and a further two reviewers completed quality appraisals for included studies. Results: Twenty-six studies (21 of which were not included in the 2009 review) reporting on a total of 2099 participants were included in the review. Overall, these studies indicated that adults, adolescents and children experienced high levels of mental health problems. Anxiety, depression and post-traumatic stress disorder were most commonly reported both during and following detention. Higher symptom scores were found in detained compared to non-detained refugees. In addition (and more clearly than was evident in 2009), detention duration was positively associated with severity of mental symptoms. Greater trauma exposure prior to detention was also associated with symptom severity. Conclusions: The literature base reviewed in this paper consistently demonstrated severe mental health consequences amongst detainees across a wide range of settings and jurisdictions. There is a pressing need for the proper consideration of mental health and consequent risk of detention-related harm in decisions surrounding detention as well as for improved care for individuals within detention facilities. Recommendations based on these findings are presented, including increased focus on the identification of vulnerability and on minimising the duration of detention.
Current Opinion in Psychiatry, 2001
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Papers by Cornelius Katona