bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Tryptophan Depletion. Part II: Clinical Effects and Implications
Authors: Bell Caroline J. , Hood Sean D. , Nutt David J.
Published: December 2009

Objective: This is the second of two articles reviewing the modern dietary technique of acute tryptophan depletion (ATD), a method of transiently reducing central serotonin levels in both healthy volunteers and clinical populations. This article details the clinical studies to date and discusses the implications of this research methodology.

Method: The authors present a review of clinical ATD studies collated from a MEDLINE search, unpublished communications and the authors' considerable experience with this paradigm.

Results: Following from the initial use of ATD in subjects with depressive illness, studies of anxiety disorders and other psychiatric illnesses have been reported. Sleep, aggressive and cognitive effects are also active areas of research and are reviewed here.

Conclusions: Acute tryptophan depletion remains a useful psychiatric research tool. The findings from the clinical studies reviewed here are summarized and implications for future research detailed.
Maintenance Therapies in Bipolar Disorder: Focus on Randomized Controlled Trials
Authors: Muzina David J. , Calabrese Joseph R.
Published: December 2009

Objective: Lithium remains the cornerstone of maintenance therapy for bipolar disorder despite growing use of other agents, including divalproex, lamotrigine, carbamazepine and the atypical antipsychotics. Lithium has the largest body of data to support its continued use as a prophylactic agent; however, most of this data comes from early studies that did not use contemporary analytic methods. Alternatives to lithium are needed because of the relatively high rate of non-response to lithium monotherapy and the drug's frequent side-effects. This article reviews available data with an emphasis on double-blind, placebo controlled studies that examine the efficacy of lithium and other putative mood stabilizers: carbamazepine, divalproex, lamotrigine and olanzapine.

Method: The authors reviewed key literature using Medline searches using key words: bipolar disorder, controlled trials, mood stabilizer, lithium, lomotrigine, divalproex, olanzapine, carbamazepine.

Results: Lithium remains the gold standard for overall preventative efficacy in bipolar disorder, especially to decrease manic or hypomanic relapse. Of the mood stabilizers that have marked prophylactic antimanic properties, lithium appears to possess the greatest antidepressant effect. Divalproexmay also prevent recurrent bipolar mood episodes but the relative lack of controlled maintenance studies makes this less certain. There now exists an extensive and well-designed research database supporting the use of lamotrigine in the acute and prophylactic management of bipolar I disorder. Lamotrigine offers a spectrum of clinical effectiveness that complements lithium, in that it appears to stabilize mood ‘from below baseline’ by preventing episodes of depression and has been shown to be effective in rapid-cycling bipolar II disorder. Carbamazepine may be a useful alternative to lithium, divalproex and lamotrigine, particularly for patients with a history of mood-incongruent delusions and other comorbidities, but controlled data is more equivocal and it may lose some of its prophylactic effect over time. Emerging data continue to support the growing use of atypical antipsychotics, particularly olanzapine.

Conclusions: Any monotherapy for use as a maintenance therapy of bipolar disorder appears to be inadequate for long-term use in the management of the majority of patients with bipolar disorder. Combination therapy has become the standard of care in the treatment of bipolar disorder and particularly in patients with treatment-refractory variants such as those with rapid-cycling. The emerging consensus is that patients on monotherapy, if followed for sufficiently long periods, will eventually require concomitant treatment to maintain a full remission. There exists a need for controlled trials that use random assignment to parallel arms including combination therapy followed by data analyses that include both relapse rate and survival techniques.
Cost-Effectiveness of Cognitive–Behavioural Therapy and Drug Interventions for Major Depression
Authors: Vos Theo , Corry Justine , Haby Michelle M. , Carter Rob , Andrews Gavin
Published: December 2009

Objective: Antidepressant drugs and cognitive–behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness – Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression.

Method: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods.

Results: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below $A10 000 per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from $A17 000 to $A20 000 per DALY) but still well below $A50 000, which is considered the affordable threshold.

Conclusions: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.
Assessing Cost-Effectiveness in Mental Health: Vocational Rehabilitation for Schizophrenia and Related Conditions
Authors: Chalamat Maturot , Mihalopoulos Cathrine , Carter Rob , Vos Theo
Published: December 2009

Objective: Existing evidence suggests that vocational rehabilitation services, in particular individual placement and support (IPS), are effective in assisting people with schizophrenia and related conditions gain open employment. Despite this, such services are not available to all unemployed people with schizophrenia who wish to work. Existing evidence suggests that while IPS confers no clinical advantages over routine care, it does improve the proportion of people returning to employment. The objective of the current study is to investigate the net benefit of introducing IPS services into current mental health services in Australia.

Method: The net benefit of IPS is assessed from a health sector perspective using cost–benefit analysis. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis of the net benefit, defined as the benefits of IPS (comprising transfer payments averted, income tax accrued and individual income earned) minus the costs. The second stage involves application of ‘second-filter’ criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using the multivariate probabilistic sensitivity analysis.

Results: The costs of IPS are $A10.3M (95% uncertainty interval $A7.4M–$A13.6M), the benefits are $A4.7M ($A3.1M–$A6.5M), resulting in a negative net benefit of $A5.6M ($A8.4M–$A3.4M).

Conclusions: The current analysis suggests that IPS costs are greater than themonetary benefits. However, the evidence-base of the current analysis is weak. Structural conditions surrounding welfare payments in Australia create disincentives to full-time employment for people with disabilities.
Assessing Cost-Effectiveness in Mental Health: Helping Policy-Makers Prioritize and Plan Health Services
Authors: Vos Theo , Haby Michelle M. , Magnus Anne , Mihalopoulos Cathrine , Andrews Gavin , Carter Rob
Published: December 2009

Objective: We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward ‘best practice’ cost-effective services.

Method: We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account ‘second-filter criteria’ of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia.

Results: There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive–behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost A$68 million less than current practice. These savings would more than cover the estimated A$36M annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost A$121M annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment.

Conclusions: Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.
Performance of Routine Outcome Measures in Adult Mental Health Care
Authors: Eagar Kathy , Trauer Tom , Mellsop Graham
Published: December 2009

Objective: To examine the performance of two widely used outcome measures in public adult mental health services.

Method: As part of a larger study, clinical staff in eight New Zealand District Health Board areas collected consumer outcomes data for a period of 6 months. Among other measures, the Health of the Nation Outcome Scales (HoNOS) and Life Skills Profile (LSP-16) were completed at the start and end of episodes of care, as well as at 90-day reviews.

Results: The performance of these twomeasures was examined in relation to compliance with the data collection protocol, item completion rates, certain psychometric properties, the relationship between them and the relationship of each instrument to the age, sex, principal psychiatric diagnosis and legal status of the consumer. Compliance with the HoNOS was superior to the LSP-16, but the reverse was true for completion. The two instruments were strongly correlated, but not enough to suggest that one may substitute for the other. A five-subscale structure for the HoNOS was supported. Certain HoNOS subscales were associated with age, but the total score was not, and differences between the sexes were small. Some large diagnostic differences were observed on both instruments. All LSP-16 summary scores and all HoNOS summary scores apart from Depression were higher (worse) in involuntary episodes. Only one LSP-16 item, relating to work potential, was related to age and men generally scored higher (worse) than women.

Conclusion: From a technical perspective, the HoNOS and LSP-16 appear suitable for routine collection. New Zealand has adopted the HoNOS for routine use but not the LSP-16 because of local concerns about its appropriateness and acceptability. The clinician-rated measures reported here need to be complemented by both consumer-rated and family/carer measures.
Assessing Reliable and Clinically Significant Change on Health of the Nation Outcome Scales: Method for Displaying Longitudinal Data
Authors: Parabiaghi Alberto , Barbato Angelo , D'avanzo Barbara , Erlicher Arcadio , Lora Antonio
Published: December 2009

Objective: Many authors recommended that reliable and clinically significant change (RCSC) should be calculated when reporting results of interventions. To test the reliability of the Health of the Nation Outcome Scales (HoNOS) in identifying RCSC, we applied the Jacobson and Truax model to two HoNOS assessments in a large group of people evaluated in 10 community mental health services in Lombardy, Italy, in 2000.

Method: The HoNOS was administered to 9817 patients; of these, 4759 (48%) were re-assessed. Reliable change (RC) was calculated using Cronbach's alpha ( α), as a parameter of the reliability of the measure. Clinical significance cut-offs were calculated using a classification of severity based on HoNOS items.

Results: In the whole sample, the clinical improvement cut-off was 11 and the remission cut-off was 5. Considering the severe patients, the clinical improvement cut-off was 12. The RC index calculated on the whole group and on the subgroup of severe patients indicated that eight-point and seven-point changes, respectively, were needed to be confident that a real change had occurred. Longitudinal changes were depicted on two-dimensional graphs as examples of reporting RCSC on HoNOS total scores in a routine data collection: 91.6% of the whole sample (4361) was stable, 5.6% (269) improved and 1.8% (129) worsened.

Conclusion: Our study proposes a methodological framework for computing RCSC normative data on a widely used outcome scale and for identifying different degrees of clinical change.
Study of the Integrated Cognitive Model of Depression Among Latin-Americans
Authors: Oei Tian P.S. , Hibberd Evelyn , O'brien Andrea J.
Published: December 2009

Objective: The objective of the present study is to test the validity of the integrated cognitive model (ICM) of depression proposed by Kwon and Oei with a Latin-American sample. The ICM of depression postulates that the interaction between negative life events with dysfunctional attitudes increases the frequency of negative automatic thoughts, which in turns affects the depressive symptomatology of a person. This model was developed for Western Europeans such as Americans and Australians and the validity of this model has not been tested on Latin-Americans.

Method: Participants were 101 Latin-American migrants living permanently in Brisbane, including people from Chile, El Salvador, Nicaragua, Argentina and Guatemala. Participants completed the Beck Depression Inventory, the Dysfunctional Attitudes Scale, the Automatic Thoughts Questionnaire and the Life Events Inventory. Alternative or competing models of depression were examined, including the alternative aetiologies model, the linear mediational model and the symptom model.

Results: Six models were tested and the results of the structural equation modelling analysis indicated that the symptom model only fits the Latin-American data.

Conclusions: Results show that in the Latin-American sample depression symptoms can have an impact on negative cognitions. This finding adds to growing evidence in the literature that the relationship between cognitions and depression is bidirectional, rather than unidirectional from cognitions to symptoms.
Diseases of White Matter and Schizophrenia-Like Psychosis
Authors: Walterfang Mark , Wood Stephen J. , Velakoulis Dennis , Copolov David , Pantelis Christos
Published: December 2009

Objective: To analyse the available data regarding the presentation of psychosis in diseases of central nervous system (CNS) white matter.

Method: The available neurological and psychiatric literature on developmental, neoplastic, infective, immunological and other white matter diseases was reviewed.

Results: A number of diseases of the white matter can present as schizophrenia-like psychoses, including leukodystrophies, neoplasms, velocardiofacial syndrome, callosal anomalies and inflammatory diseases.

Conclusions: Production of psychotic symptoms may result from functional asynchrony of interdependent regions, due to alterations in critical circuits as a result of pathology. The nature, location and timing of white matter pathology seem to be the key factors in the development of psychosis, especially during the critical adolescent period of association area myelination. Diseases that disrupt the normal formation of myelin appear to cause psychosis at higher rates than those that disrupt mature myelinated structures. Diffuse rather than discrete lesions, in particular those affecting frontotemporal zones, are also more strongly associated with schizophrenia-like psychosis. These illnesses point to the central role that white matter plays in maintaining CNS connectivity and to how pathology of the white matter may contribute to the neurobiology of psychosis.
Neuroimaging in Psychopathy
Authors: Pridmore Saxby , Chambers Amber , Mcarthur Milford
Published: December 2009

Objective: The biological basis of psychopathy remains to be fully elucidated. Evidence suggests a genetic contribution and dysfunction of the serotonin system. The objective of this article is to review the contribution of the neuroimaging of the last decade to our understanding of psychopathy.

Method: A literature search was conducted using PubMed and the words psychopath, antisocial personality disorder, dissocial personality disorder, violence, image and imaging. In addition, the reference lists of the identified papers, and recent textbooks, were perused for additional sources.

Results: Five structural and 15 functional neuroimaging studies were selected and examined. Structural studies have reported decreased prefrontal grey matter, decreased posterior hippocampal volume and increased callosal white matter, but to this point, these have not been replicated. Functional studies suggest reduced perfusion and metabolism in the frontal and temporal lobes. Abnormalities of function have been reported, predominantly in frontal and temporal lobe structures during classical conditioning and response inhibition tasks, and in the processing of emotional words and pictures.

Conclusion: Functional neuroimaging strongly suggests dysfunction of particular frontal and temporal lobe structures in psychopathy. However, there are difficulties in selecting homogeneous index cases and appropriate control groups. Further studies are necessary. Responses depend on genetic endowment, early life experience, the sociocultural context and the significance of any stimulus to the individual.
Obsessive–Compulsive Behaviour: A Disorder of Decision-Making
Authors: Sachdev Perminder S. , Malhi Gin S.
Published: December 2009

Objective: Compulsive individuals are habitually indecisive, and indecision reaches its pathological apex in obsessive–compulsive disorder (OCD). With the increasing interest in the neurobiology of decision-making, it may be useful to conceptualize OCD as a disorder of decision-making.

Method: A selective review of the neurobiological studies of the decision-making process was performed, and the convergence with the understanding of the neurobiology of OCD examined.

Results: The dorsolateral, orbitofrontal and anterior cingulate cortices are engaged in multiregion neural subsystems that interact with each other to retain information online, manipulate options, make choices and maintain goals. These interact with the limbic regions, especially the amygdala, in relation to history of reward and emotional valence relating to a choice, and the basal ganglia for behavioural execution. Abnormalities in these regions also characterize OCD and related disorders, therefore leading to problems in making some decisions that are affect-laden by nature or association.

Conclusion: Conceptualizing OCD as a disorder of decision-making leads to new approaches for its investigation, and novel strategies for both physical and behavioural– cognitive treatments.
Operationalization of Biopsychosocial Case Complexity in General Health Care: The INTERMED Project
Authors: de Jonge Peter , Huyse Frits J. , Slaets Joris P.J. , Söllner Wolfgang , Stiefel Friedrich C.
Published: December 2009

Objective: Lack of operationalization of the biopsychosocial model hinders its effective application to the increasingly prevalent problems of comorbidities in clinical presentations. Here, we describe the INTERMED, an instrument to assess biopsychosocial case complexity in general health care, and provide an overview of its psychometric evaluation.

Method: Review and summary of our publications to date, and re-analysis of findings.

Results: The INTERMED has face-validity, is brief and easy to use, and several research reports support its reliability and validity. It has the capacity to detect patients at risk for poor clinical outcome and quality of life.

Conclusions: The INTERMED project is relevant to various agents involved in the care process. It provides a basis for effective multidisciplinary treatment of patients with a high case complexity.
Are Psychological Skills Necessary in Treating All Physical Disorders?
Authors: Mayou Richard
Published: December 2009

Objective: To explore both the wider issue of the need for psychological skills in the management of allphysical disorders and that of the role of liaison psychiatry in providing care and in working with medical colleagues.

Method: The author draws on the literature in general, and specifically on his extensive research and clinical experience of patients with acute and chronic physical symptoms and associated psychological symptoms, particularly accident victims and those with chest pain and diabetes. He also draws on his experience in establishing national and international organizations for consultation–liaison psychiatry.

Results: It is argued that psychological skills are fundamental in the management of all physical disorders.

Conclusions: Liaison psychiatry must ensure that psychological skills are part of the treatment of all physical disorders.
Rethinking the Place of the Psychein Health: Toward the Integration of Health Care Systems
Authors: Kathol Roger G. , Clarke David
Published: December 2009

Objective: To review the value provided when health care systems independently manage medical and psychiatric care.

Method: The authors draw on data from the world literature, their own experiences and reflections (one author as an international consultant in the coordination of physical and behavioural health care), and input from colleagues throughout the world who face similar challenges to improve outcomes for complex, high cost patients in their own health care systems.

Results: Most health care systems in the world approach the administration and delivery of mental health care separately from that of general medical care. This practice is no longer supported as effective, efficient or inexpensive. Rather accumulating data indicates that concurrent and coordinated medical and psychiatric care, which can only be accomplished by integrating physical and behavioural health through infrastructure change, should replace the present system of independently provided sequential care; that is, one which provides first medical and then psychiatric treatment, or vice versa, with little communication between clinicians in the two sectors.

Conclusions: By making mental health treatment an integral part of general medical care through reorganization of the funding system, a higher percentage of those now untreated for their psychiatric disorders, both within and outside of the medical setting, can have their mental health needs addressed in coordination with their physical disorders. At the same time, the number of patients that can be treated within the same budget will be expanded.
Hurly-Burly of Psychiatric Ethics
Authors: Hughes Julian C. , Fulford K.W.M. (Bill)
Published: December 2009

This is the introductory paper to the special issue on ethics in psychiatry. We introduce the other papers that follow and set them in a context. Inevitably, they represent only a thin slice of the work going on in psychiatric ethics. But they serve to show two unique features of this discipline. First, it has a tendency to dig deep and to make connections with other philosophical concepts. So, for example, in a number of ways the papers that follow touch on the nature of personhood. We examine this notion. Second, psychiatric ethics, because of its content and its embededness in the real world, tends to hit upon diverse and sometimes conflicting values. We introduce the idea of values-based medicine, which provides both a theoretical framework and a practical approach to the common dilemmas of psychiatric practice. The need to think deeply, but also clearly and coherently, combined with the need to engage with the hurly-burly of the world of patients, users and carers, suggests the reasons why psychiatric ethics offers a paradigm for practical ethics generally.
Narrative, Ethics and People with Severe Mental Illness
Authors: Baldwin Clive
Published: December 2009

Starting from the premise that people are essentially narrative beings, I argue that the onset of severe mental illness compromises the narrative enterprise of being able to construct one's Self and one's relationships in meaningful and coherent ways. This is due to both the curtailment of opportunities for narrative engagement and the dispossession of those whose narratives do not conform to the current conceptualization of narrative and narrativity. In these circumstances, supporting the narrative enterprise is an ethical endeavour that requires that we examine not only which narratives we construct, but also how we construct them. This requires a re-thinking of what might constitute narrative and how we might facilitate or enhance the narrativity of people with severe mental illness. Following this, I suggest four means to support the narrativity of people with severe mental illness: through maintaining narrative continuity, maintaining narrative agency, countering master narratives and attention to small stories.
Capacity for Decision-Making in Alzheimer's Disease: Selfhood, Positioning and Semiotic People
Authors: Sabat Steven R.
Published: December 2009

The aim of this article is to explore some of the ethical issues surrounding the assessment and determination of capacity of people with dementia in light of their meaning-making ability as shown through discourse. Discourse analysis, two illustrative cases, social construction theory and positioning are used to highlight some of the ethical dilemmas involved in basing a determination of capacity on the diagnosis of dementia and neuropsychological tests of cognitive function. Although neuropsychological tests have their place in assessing some aspects of cognitive function, aspects cognition such as meaning-making ability and selfhood cannot be assessed in a standard format. In dementia, there can be a differential impairment of recall memory while the personality, values and substantial long-term memory remain intact, as does implicit memory for recent events. People with dementia are vulnerable to being negatively positioned, thereby unfairly undermining their rights to make decisions about aspects of their lives. Assessing the capacity of a person with dementia to engage in decision-making is presently in need of examination so as to take into account the person's meaning-making ability and selfhood. Incorrect negative positioning, based on the diagnosis and defects in recall memory, can obscure intact cognitive abilities that allow a person to make decisions about aspects of living, creating the possibility of lasting harm being inflicted on the person with dementia.
Cognitive Behavioural Therapy for Depression, Panic Disorder and Generalized Anxiety Disorder: A Meta-Regression of Factors that May Predict Outcome
Authors: Haby Michelle M. , Donnelly Marie , Corry Justine , Vos Theo
Published: December 2009

Objective: To determine which factors impact on the efficacy of cognitive behavioural therapy (CBT) for depression and anxiety. Factors considered include those related to clinical practice: disorder, treatment type, duration and intensity of treatment, mode of therapy, type and training of therapist and severity of patients. Factors related to the conduct of the trial were also considered, including: year of study, country of study, type of control group, language, number of patients and percentage of dropouts from the trial.

Method: We used the technique of meta-analysis to determine an overall effect size (standardized mean difference calculated using Hedges' g) and meta-regression to determine the factors that impact on this effect size. We included randomized controlled trials with a wait list, pill placebo or attention/psychological placebo control group. Study participants had to be 18 years or older and all have diagnosed depression, panic disorder (with or without agoraphobia) or generalized anxiety disorder (GAD). Outcomes of interest included symptom, functioning and health-related quality of life measures, reported as continuous variables at post-treatment.

Results: Cognitive behavioural therapy for depression, panic disorder and GAD had an effect size of 0.68 (95% CI=0.51–0.84, n=33 studies, 52 comparisons). The heterogeneity in the effect sizes was fully explained by treatment, duration of therapy, inclusion of severe patients in the trial, year of study, country of study, control group, language and number of dropouts from the control group. Disorder was not a significant predictor of the effect size.

Conclusions: Cognitive behavioural therapy is significantly less effective for severe patients and trials that compared CBT to a wait-list control group found significantly larger effect sizes than those comparing CBT to an attention placebo, but not to a pill placebo. Further research is needed to determine whether CBT is effective when provided by others than psychologists and whether it is effective for non-English-speaking patient groups.
The Nonlinear Theory of Schizophrenia
Authors: Breakspear Michael
Published: December 2009

Objective: Nonlinear properties exist within the brain across a hierarchy of scales and within a variety of critical neural processes. Only a few studies of brain activity in schizophrenia, however, have used nonlinear methods. This review paper evaluates the contribution of the nonlinear sciences towards understanding schizophrenia.

Method: Applications of nonlinear methods to the study of schizophrenia symptoms and to healthy and schizophrenia functional neuroscience data are reviewed. The main flaws of nonlinear algorithms and recent methods to correct these are also appraised.

Results: Initial research methods utilized in the study of nonlinearity in schizophrenia have fundamental methodological limitations. In the last decade, many of these problems have been addressed, facilitating future progress. Research incorporating these improvements has been applied to normal electroencephalogram (EEG) data and to the symptoms of schizophrenia, but not systematically to brain imaging data collected from patients with schizophrenia.

Conclusion: There is strong statistical evidence for weak nonlinearity in normal EEG and in the fluctuations of the symptoms of schizophrenia. However, the contribution of nonlinear processes to brain dysfunction in schizophrenia is yet to be properly established or accurately quantified. Despite this, recent methodological advances suggest that a ‘nonlinear theory’ of schizophrenia may be helpful in understanding this disorder.
Stigma about Depression and its Impact on Help-Seeking Intentions
Authors: Barney Lisa J. , Griffiths Kathleen M. , Jorm Anthony F. , Christensen Helen
Published: December 2009

Objective: Research has shown that people are reluctant to seek professional help for depression, especially from mental health professionals. This may be because of the impact of stigma which can involve people's own responses to depression and help-seeking (self stigma) as well as their perceptions of others' negative responses (perceived stigma). The aim of this article was to examine community help-seeking intentions and stigmatizing beliefs associated with depression.

Method: A total of 1312 adults randomly sampled from the Australian community completed a questionnaire providing a depression vignette and measures of selfand perceived-stigmatizing responses, source-specific help-seeking intentions, current depressive symptoms and depression experience, and demographics.

Results: Many people reported they would feel embarrassed about seeking help from professionals, and believed that other people would have a negative reaction to them if they sought such help. Some expected professionals to respond negatively to them. Responses varied according to the sources of professional help. Self-embarrassment and expectations that others would respond negatively predicted the likelihood of help-seeking from professional sources.

Conclusion: Self- and perceived-stigmatizing responses to help-seeking for depression are prevalent in the community and are associated with reluctance to seek professional help. Interventions should focus on minimizing expectations of negative responses from others and negative self-responses to help-seeking, and should target younger people.
Comorbid Behavioural Problems in Tourette's Syndrome are Positively Correlated with the Severity of Tic Symptoms
Authors: Zhu Yan , Man Leung Kai , Liu Po-Zi , Zhou Ming , Su Lin-Yan
Published: December 2009

Objective: We studied the comorbid behavioural and mood problems in children with nonpsychiatric Tourette's syndrome (TS) and their relationship with severity of tic disorder.

Method: Sixty-nine TS children and 69 healthy controls were assessed by Child Behavior Checklist (CBCL) and Yale Global Tic Severity Scale (YGTSS). The relationships between behavioural problems and severity of tic symptoms were analysed statistically by comparison, correlation and multiple linear regression.

Results: Tourette's syndrome patients scored significantly lower (p<0.01) on the CBCL competency subscales and total score, and higher on all behavioural problem subscales and total score (p<0.01). Expectedly, the TS children had lower social competence than normal children. Among the TS children, the severity of tic symptoms is positively correlated with the severity of overall impairment in school and social competence. When the behavioural and mood problems commonly associated with TS were studied in detail, we found that delinquent behaviour, thought problems, attention problems, aggressive behaviour and externalizing are positively correlated with severity of tic symptoms.

Conclusion: The findings indicated that children with TS-only also had a broad range of behavioural problems, and some of these were related to the severity of tic symptoms.
Obsessive–Compulsive Spectrum of Disorders: A Defensible Construct?
Authors: Castle David J. , Phillips Katharine A.
Published: December 2009

Objective: To explore critically whether there is a robust basis for the concept of an obsessive–compulsive (OC) spectrum of disorders, and if so, which disorders should be included.

Method: Selective literature review concentrating on three proposed members of the OC spectrum, namely body dysmorphic disorder, hypochondriasis and trichotillomania.

Results: Obsessive–compulsive disorder (OCD) itself is a heterogeneous condition or group of conditions, and this needs to be appreciated in any articulation of a ‘spectrum’ of OC disorders. The basis for ‘membership’ of the spectrum is inconsistent and varied, with varying level of support for inclusion in the putative spectrum.

Conclusion: A more fruitful approach may be to consider behaviours and dimensions in OCD and OC spectrum disorders, and that this should be encompassed in further developments of the OC spectrum model.
Quality of Life: Eating Disorders
Authors: Abraham Suzanne F. , Brown Tani , Boyd Catherine , Luscombe Georgina , Russell Janice
Published: December 2009

Objective: There is a lack of measurements with predictive validity that are specific for quality of life (QOL) in patients with eating disorders.

Method: A total of 306 eating disorder patients treated as inpatients completed the Quality of Life for Eating Disorders (QOL ED): 109 at both admission and discharge from hospital, 65 at both admission and after 12months. Patients also completed well-validated measures of eating disorders, psychological dysfunction and general physical and mental QOL. QOL ED consists of 20 self-report questions that provide scores for the domains of behaviour, eating disorder feelings, psychological feelings, effects on daily life, effects on acute medical status and body weight, and a global score.

Results: QOL ED domain scores correlated appropriately with previously validated wellknown measures of eating disorders, psychological dysfunction, general QOL and behaviour and body weight (p < 0.001). The QOL ED shows high reliability (Cronbach's alpha=0.93). All scores changed significantly and appropriately during inpatient hospital treatment and between admission and 12 months after discharge from hospital (p < 0.001). The scores differed for anorexia nervosa, bulimia, eating disorder not specified (EDNOS) and no diagnosis. All no diagnosis (recovered) domain and global scores were significantly different from all diagnoses scores (p < 0.001).

Conclusion: This quick, simple instrument fulfils all potential uses for QOL assessments in the clinical and research settings associated with eating disorders, including outcome.
Trauma, Post-Migration Living Difficulties, and Social Support as Predictors of Psychological Adjustment in Resettled Sudanese Refugees
Authors: Schweitzer Robert , Melville Fritha , Steel Zachary , Lacherez Philippe
Published: December 2009

Objective: This paper explores the impact of pre-migration trauma, post-migration living difficulties and social support on the current mental health of 63 resettled Sudanese refugees.

Method: A semistructured interview including questionnaires assessing sociodemographic information, pre-migration trauma, anxiety, depression and posttraumatic stress, post-migration living difficulties and perceived social support were administered assisted by a bilingual community worker.

Results: Resettled refugees from Sudan evidenced a history of trauma. Less than 5% met criteria for posttraumatic stress but 25% reported clinically high levels of psychological distress. The results indicate that social support – particularly perceived social support from the migrant's ethnic community – play a significant role in predicting mental health outcomes. Pre-migration trauma, family status and gender were also associated with mental health outcomes.

Conclusions: Refugees in Australia may constitute a particularly vulnerable group interms of mental health outcomes. Culturally specific sequelae in terms of social isolation and acculturation may be particularly problematic for these migrants.
Genetic, Developmental and Personality Correlates of Self-Mutilation in Depressed Patients
Authors: Joyce Peter R. , McKenzie Janice M. , Mulder Roger T. , Luty Suzanne E. , Sullivan Patrick F. , Miller Allison L. , Kennedy Martin A.
Published: December 2009

Objective: To examine whether the T allele of G protein β3 (GNβ3) is associated with self-mutilation in depressed patients.

Method: A history of self-mutilation was systematically inquired about when recruiting depressed patients for a long-term treatment trial. Risk factors such as borderline personality disorder and childhood abuse experiences were systematically assessed, and patients were genotyped for polymorphisms of GNβ 3.

Results: The T allele of GNβ 3, borderline personality disorder and childhood sexual abuse were all significantly associated with self-mutilation in depressed patients. These associations were significant in both univariate andmultivariate analyses, and as predicted were stronger in young depressed patients than in depressed patients of all ages.

Conclusions: If the association between the T allele of GNβ 3and self-mutilation can be replicated, this may provide clues to understanding the neurobiology of self-mutilation.
A Comparison of Australian Men with Psychotic Disorders Remanded for Criminal Offences and a Community Group of Psychotic Men who have not Offended
Authors: White Paul , Chant David , Whiteford Harvey
Published: December 2009

Background: People remanded into custody by the courts have a substantially higher rate of severe mental disorder than other prisoners and the general population. Knowledge of their prevalence, needs and characteristics and an analysis of pathways to care may be necessary to provide mental health care effectively and efficiently. Previous prison studies focusing on psychotic offenders have suffered from the use of instruments not validated in a forensic setting and lack of a relevant comparison group.

Method: The Diagnostic Interview for Psychosis (DP) is a composite semi-structured standardized interview schedule. It combines social and demographic descriptors with measures of functioning adapted from the World Health Organisation Disability Assessment Schedule (DAS). The remand centre surveyed had 466 cells and is the main remand and reception centre for males for the southern region of the state of Queensland, Australia. Of the 621 men screened, 65 answered yes to at least one question in the DP and were interviewed.

Results: Six hundred and twenty-one remandees were screened and of these 61 were interviewed as screened positive for psychotic disorder. Thirty-five per cent had been homeless for an average of 32 weeks during the previous year. Most had had little contact with families or close friends. Eighty-one per cent were receiving no treatment at the time of offence. Seventy-eight per cent were unemployed and in receipt of a pension. Eighty per cent were dependent on alcohol, cannabis or amphetamines. Statistical issues of power are detailed in the text.

Conclusions: The simplistic ‘prison, hospital or community treatment’ debate is misleading. Instead, the development of flexible preventative, management and accommodation services for people with severe mental disorder who have committed offences is a priority.
Mental Disorders in Australian Prisoners: a Comparison with a Community Sample
Authors: Butler Tony , Andrews Gavin , Allnutt Stephen , Sakashita Chika , Smith Nadine E. , Basson John
Published: December 2009

Background: The plight of those with mental health problems and the possible role of prisons in “warehousing” these individuals has received considerable media and political attention. Prisoners are generally excluded from community-based surveys and to date no studies have compared prisoners to the community.

Objective: The objective was to examine whether excess psychiatric morbidity exists in prisoners compared to the general community after adjusting for demographics.

Method: Prison data were obtained from a consecutive sample of reception prisoners admitted into the state's correctional system in 2001 (n=916). Community data were obtained from the 1997 Australian National Survey of Mental Health and Wellbeing (n=8168). Mental health diagnoses were obtained using the Composite International Diagnostic Interview and a number of other screening measures. Weighting was used in calculating the 12-month prevalence estimates to control for demographic differences between the two samples. Logistic regression adjusting for age, sex and education was used to compare the prison and community samples.

Results: The 12-month prevalence of any psychiatric illness in the last year was 80% in prisoners and 31% in the community. Substantially more psychiatric morbidity was detected among prisoners than in the community group after accounting for demographic differences, particularly symptoms of psychosis (OR=11.8, 95% CI 7.5–18.7), substance use disorders (OR=11.4, 95% CI 9.7–13.6) and personality disorders (OR=8.6, 95% CI 7.2–10.3). Mental functioning and disability score were worse for prisoners than the community except for physical health.

Conclusions: This study found an overrepresentation of psychiatric morbidity in the prisoner population. Identifying the causes of this excess requires further investigation.
Mindfulness-Based Psychotherapies: A Review of Conceptual Foundations, Empirical Evidence and Practical Considerations
Authors: Academic Mindfulness Interest Group Melbourne , Academic Mindfulness Interest Group Melbourne
Published: December 2009

Objective: This paper, composed by an interest group of clinicians and researchers based in Melbourne, presents some background to the practice of mindfulness-based therapies as relevant to the general professional reader. We address the empirical evidence for these therapies, the principles through which they might operate, some practical questions facing those wishing to commence practice in this area or to refer patients into mindfulness-based therapies, and some considerations relevant to the conduct and interpretation of research into the therapeutic application of mindfulness.

Method: Databases (e.g. PsycINFO, MEDLINE) were searched for literature on the impact of mindfulness interventions, and the psychological and biological mechanisms that underpin the effects of mindfulness practice. This paper also draws upon the clinical experience of the author group.

Results: Mindfulness practice and principles have their origins in many contemplative and philosophical traditions but individuals can effectively adopt the training and practice of mindfulness in the absence of such traditions or vocabulary. A recent surge of interest regarding mindfulness in therapeutic techniques can be attributed to the publication of some well-designed empirical evaluations of mindfulness-based cognitive therapy. Arising from this as well as a broader history of clinical integration of mindfulness and Western psychotherapies, a growing number of clinicians have interest and enthusiasm to learn the techniques of mindfulness and to integrate them into their therapeutic work. This review highlights the importance of accurate professional awareness and understanding of mindfulness and its therapeutic applications.

Conclusions: The theoretical and empirical literatures on therapeutic applications of mindfulness are in states of significant growth and development. This group suggests, based on this review, that the combination of some well-developed conceptual models for the therapeutic action of mindfulness and a developing empirical base, justifies a degree of optimism that mindfulness-based approaches will become helpful strategies to offer in the care of patients with a wide range of mental and physical health problems.