bluuebunny/crossref_metadata_2025 huggingface dataset:
Projections of Future Numbers of Dementia Cases in Australia with and Without Prevention
Authors: Jorm Anthony F , Dear Keith B.G. , Burgess Nicole M
Published: December 2009

Objective: To produce projections of the number of dementia cases in Australia from 2000 to 2050. These projections examine the effects of an ageing population on number of dementia cases and also the potential impact of preventive strategies that delay age of dementia onset.

Method: Data from several meta-analyses of dementia prevalence and incidence were combined with age-specific population projections to arrive at estimates of future numbers of cases. A statistical model of dementia incidence was developed and used to estimate the effects of delaying onset by up to 5 years.

Results: Without prevention, prevalence of dementia is estimated to increase from 172 000 in 2000 to 588 000 in 2050. Over the same period, the incidence of dementia is estimated to increase from 43 000 to 143 000 new cases a year. Delaying onset by 5 years would decrease prevalence in 2050 by 44%. Even a 6-month delay would reduce prevalence by 6%.

Conclusions: Ageing of the population will lead to a rapid increase in number of dementia cases and an increasing burden for the working-age population. However, even modest prevention efforts could lessen the impact.
Mapping the Onset of Psychosis: The Comprehensive Assessment of At-Risk Mental States
Authors: Yung Alison R. , Yung Alison R. , Pan Yuen Hok , Mcgorry Patrick D. , Phillips Lisa J. , Kelly Daniel , Dell'olio Margaret , Francey Shona M. , Cosgrave Elizabeth M. , Killackey Eoin , Stanford Carrie , Godfrey Katherine , Buckby Joe
Published: December 2009

Objective: Recognizing the prodrome of a first psychotic episode prospectively creates the opportunity of intervention, which could delay, ameliorate or even prevent onset. Valid criteria and a reliable methodology for identifying possible prodromes are needed. This paper describes an instrument, the Comprehensive Assessment of At-Risk Mental States (CAARMS), which has been designed for such a purpose. It has two functions: (i) to assess psychopathology thought to indicate imminent development of a first-episode psychotic disorder; and (ii) to determine if an individual meets criteria for being at ultra high risk (UHR) for onset of first psychotic disorder. This paper describes the pilot evaluation of the CAARMS.

Method: Several methodologies were used to test the CAARMS. First, CAARMS scores in a group of UHR young people and the association between CAARMS scores and the risk of transition to psychotic disorder, were analysed. Second, CAARMS scores in a UHR group were compared to a control group. To assess concurrent validity, CAARMS-defined UHR criteria were compared to the existing criteria for identifying the UHR cohort. To assess predictive validity, the CAARMS-defined UHR criteria were applied to a sample of 150 non-psychotic help-seekers and rates of onset of psychotic disorder at 6-month follow-up determined for the CAARMS-positive (i.e. met UHR criteria) group and the CAARMS-negative (i.e. did not meet UHR criteria) group. The inter-rater reliability of the CAARMS was assessed by using pairs of raters.

Results: High CAARMS score in the UHR group was significantly associated with onset of psychotic disorder. The control group had significantly lower CAARMS scores than the UHR group. The UHR criteria assessed by the CAARMS identified a similar group to the criteria measured by existing methodology. In the sample of non-psychotic help-seekers those who were CAARMS-positive were at significantly increased risk of onset of psychotic disorder compared to those who were CAARMS-negative (relative risk of 12.44 (95% CI=1.5–103.41, p=0.0025)). The CAARMS had good to excellent reliability.

Conclusions: In these preliminary investigations, the CAARMS displayed good to excellent concurrent, discriminant and predictive validity and excellent inter-rater reliability. The CAARMS instrument provides a useful platform for monitoring sub threshold psychotic symptoms for worsening into full-threshold psychotic disorder.
Integrating Approaches to Psychotherapy in Psychosis
Authors: Margison Frank
Published: December 2009

Objective: The evidence base for specific psychological treatments for psychosis is now well established, but many practitioners see themselves as integrationist in approach. The basic tenets of integration are explored with an emphasis on understanding how different levels of need can be conceptualized and then used to ‘adapt’ a treatment to meet those needs in an individual. The needs are then incorporated into an integrated treatment formulation.

Method: The evidence base is strongest for cognitive behavioural and family approaches, but the present paper summarizes concepts from two specific models of therapy that are intrinsically integrational in their approach: cognitive analytic therapy and psychodynamic interpersonal therapy.

Results: Both approaches show aspects of integration. However, following this approach to integration to its limit would ultimately lead to one undifferentiated therapy.

Conclusions: Both approaches share a common set of values of developing specific ways of increasing collaboration and working together, and these values are shown to underpin adaptive ways of working with psychosis, but further critical analysis of the development of integrative models is needed.
Mental Health Practice: Can Philosophy Help?
Authors: Campbell Alastair V.
Published: December 2009

Traditionally, philosophy has been regarded as operating at a level above practical application. However, the discipline can offer mental health policy and practice some valuable aid. First, its logical rigour can help to clarify concepts and expose inconsistency and prejudice; second, its wealth of theory about morality can enrich the concepts that guide mental health practice. By avoiding simplistic solutions (such as reliance on the ‘four principles’ of biomedical ethics) those who turn to the discipline of philosophy may learn how to be more critical of accepted policies and practices.
Justice and Welfare: Two Ethical Paradigms in Forensic Psychiatry
Authors: Adshead Gwen , Sarkar Sameer P.
Published: December 2009

Forensic psychiatry, as a medical specialty, perhaps understandably leans toward beneficence or welfare as its main ethical underpinning. However, the special nature of the art or science of forensic psychiatry makes it imperative that beneficence is not the only ethical principle that guides the ‘good’ forensic psychiatrist. Indeed, the commonest ethical dilemmas in forensic psychiatry arise from a conflict between two ethical principles: beneficence, or promotion of welfare, and respect for justice. These two paradigms dominate discussions about the moral role and ethical duties of forensic psychiatrists and, in effect, give rise to two different practices in forensic psychiatry, each of which can also be said to have acquired a national identity. We discuss these competing principles and offer some thoughts about what this means for the ethics and values of forensic psychiatry.
Moral Responsibility, Consciousness and Psychiatry
Authors: Mcmillan John , Mcmillan John , Gillett Grant
Published: December 2009

This article discusses the connection between consciousness and responsibility. Moral responsibility plays a crucial, but often implicit role in psychiatry in that it is often a therapeutic aim as well as an important evaluative concept. This article explains one of the more influential ‘psychological’ theories of moral responsibility, developed by Harry Frankfurt. In the second part of this article, a modified version of this account is applied to a range of psychiatric phenomena.
Mental Health First aid Training: Review of Evaluation Studies
Authors: Kitchener Betty A. , Jorm Anthony F.
Published: December 2009

Objective: To review studies evaluating mental health first aid (MHFA) training.

Method: Review of three published trials: one uncontrolled with members of the public in a city, one randomized controlled efficacy trial in a workplace setting and one cluster randomized effectiveness trial with the public in a rural area.

Results: Most mental health first aiders tend to be middle-aged women whose work involves people contact. All trials found the following statistically significant benefits 5– 6months post-training: improved concordance with health professionals about treatments, improved helping behaviour, greater confidence in providing help to others and decreased social distance from people with mental disorders. Only one trial evaluated the mental health benefits to participants and this found positive effects.

Conclusions: Although MHFA training has been found to change knowledge, attitudes and helping behaviours, and even benefit the mental health of participants, there has not yet been an evaluation of the effects on those who are the recipients of the first aid.
Changes in Depression Awareness and Attitudes in Australia: The Impact of Beyondblue: The National Depression Initiative
Authors: Jorm Anthony F. , Christensen Helen , Griffiths Kathleen M.
Published: December 2009

Objective: To assess changes in depression awareness and attitudes in Australia and the effect that beyondblue: the national depression initiative has had on these.

Method: Data from national surveys of mental health literacy in 1995 and 2003–2004 were analysed to see if states and territories that funded beyondblue (the high-exposure states) had greater changes than those that did not (the low-exposure states). In both surveys, participants were shown a depression vignette and asked whether they themselves or family or friends had ever had a similar problem, whether they thought the person would be discriminated against, and questions about the likelihood of long-term positive and negative outcomes for the person. Participants were also assessed for symptoms of psychological distress in the past month.

Results: There was an increase in the percentage of people who said that they or their family or friends had a problem like the person in the vignette. This increase was greater in the high-exposure states. However, therewas no change in reports of current psychological distress, suggesting that there is greater depression awareness or openness rather than a real increase in symptoms. People in the high-exposure states also showed an increase in the belief that discrimination would occur. There was little change in beliefs about longterm outcomes, apart from people in high-exposure states believing that a depressed person would be more understanding of other people's feelings.

Conclusions: The data are consistent with beyondblue having had an effect on awareness of depression and of discrimination against depressed people.
Changes in Psychological Distress in Australia over an 8-Year Period: Evidence for Worsening in Young Men
Authors: Jorm Anthony F. , Butterworth Peter
Published: December 2009

Objective: To assess whether psychological distress has changed in the Australian population.

Method: Data were obtained from national household surveys of 1964 Australian adults in 1995 and 3507 in 2003–2004. Psychological distress was measured using the 4-NS, which asks about symptoms of depression, anxiety, irritability and nervousness in the past month. The data were analysed by gender and by age group, from 20–24 years to 70–74 years.

Results: Psychological distress was found to have increased in men aged 20–29 years. This change was observed even when the same cohorts were compared. No change was found in women or in other male age groups.

Conclusions: These data show the need for routine population monitoring of mental health to determine subgroups requiring priority action.
Free Range users and One Hit Wonders: Community Users of an Internet-Based Cognitive Behaviour Therapy Program
Authors: Christensen Helen , Griffiths Kathy , Groves Chloe , Korten Ailsa
Published: December 2009

Objective: Little is known about the predictors of symptom change or the methods that might increase user ‘compliance’ on websites designed to improve mental health outcomes. The present paper: (i) examines predictors of expected final depression and anxiety scores on the MoodGYM website as a function of user characteristics; and (ii) compares the compliance rates of the original site with the new public version of the site (MoodGYM Mark II). The latter site requires compulsory completion of ‘core’ online assessments and may increase completion of site questionnaires.

Method: MoodGYM Mark I participants were 19 607 visitors (public registrants) between April 2001 and September 2003 plus 182 participants who had been randomly assigned to MoodGYM in an earlier trial (The BlueMood Trial). MoodGYM Mark II participants were 38 791 public registrants of the MoodGYM Mark II site collected between September 2003 and October 2004. Symptom assessments are repeated within the website intervention to allow the examination of change in symptoms. Outcome variables were gender, initial depression severity scores, number of assessments completed and final anxiety and depression scores.

Results: Men are predicted to be 0.19 units (SE = 0.095) higher than women on depression, controlling for the initial depression level and number of modules completed. For initial depression scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. For initial anxiety scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. Mark II registrants were more likely than to Mark I registrants to complete onsite assessments.

Conclusions: Visitors to the MoodGYM site are likely to have better psychological outcomes if they complete more of the site material. Compulsory completion of core sections increases assessment completion. There is a need to examine further the significance of attrition from online interventions, to develop methods of handling missing data, and to investigate strategies to improve visitor dropout.
Who Treats whom? An Application of the Pathways to Care Model in Australia
Authors: Issakidis Cathy , Andrews Gavin
Published: December 2009

Objective: The present paper applies Goldberg and Huxley's Pathways to Care (PTC) model to the Australian health-care system to ask: who is treated in each sector and what does this tell us about the performance of the health-care system? It examines the factors associated with reaching primary care, outpatient and inpatient sectors, as well as private and public mental health services.

Method: Data from the Australian National Survey of Mental Health and Wellbeing were used to determine the proportion of the population treated in each sector. Sociodemographic and clinical characteristics were examined and logistic regression was used to determine which factors were associated with use of different sectors of care.

Results: Of the total population, 80.5% reached primary care, 8.2% primary care for mental health problems, 6.5% outpatient care and 0.4% reached the mental health inpatient sector. Clinical severity increased across these sectors and was an important determinant of access to care. Those consulting private practitioners were clinically similar to those consulting in the public sector. Sociodemographic characteristics were important determinants of access to primary, specialist and private mental health care. Being aged over 55 years or living in a rural area was associated with lower access to several sectors.

Conclusions: Although at a broad level the health-care system is performing as expected, limited access among some groups is cause for concern. Applying the PTC model to a population sample offered useful insights into the performance of the Australian healthcare system.
Cannabis use and the Mental Health of Young People
Authors: Hall Wayne D.
Published: December 2009

Objective: To review the evidence on the mental health and psychosocial consequences of rising rates of cannabis use among young people in developed countries.

Method: This paper critically reviews epidemiological evidence on the following psychosocial consequences of adolescent cannabis use: cannabis dependence; the use of heroin and cocaine; educational underachievement; and psychosis. Leading electronic databases such as PubMed have been searched to identify large-scale longitudinal studies of representative samples of adolescents and young adults conducted in developed societies over the past 20 years.

Results: Cannabis is a drug of dependence, the risk of which increases with decreasing age of initiation. Cannabis dependence in young people predicts increased risks of using other illicit drugs, underperforming in school, and reporting psychotic symptoms. Uncertainty remains about which of these relationships are causal although the evidence is growing that cannabis is a contributory cause of psychotic symptoms.

Conclusions: We face major challenges in communicating with young people about the most probable risks of cannabis use (dependence, educational underachievement and psychosis) given uncertainties about these risks and polarized community views about the policies that should be adopted to reduce them.
Prevalence and Long-Term Course of Lifetime Eating Disorders in an Adult Australian Twin Cohort
Authors: Wade Tracey D. , Bergin Jacqueline L. , Tiggemann Marika , Bulik Cynthia M. , Fairburn Christopher G.
Published: December 2009

Objective: Few studies exist that have examined the spectrum and natural long-term course of eating disturbance in the community. We examine the lifetime prevalence and long-term course of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) in an adult female twin population.

Method: Female twins (n = 1002) from the Australian Twin Registry, aged 28–39 years, were assessed using the Eating Disorder Examination, revised to yield lifetime diagnostic information. For women with lifetime eating disorders, the assessment occurred, on average, 14.52 years (SD = 5.65) after onset of their disorder.

Results: In accordance with other community studies, we found a 1.9% lifetime prevalence of AN, with an additional 2.4% who met the criteria for ‘partial AN’ (absence of amenorrhea). Criteria for BN were met by 2.9% of the women, an additional 2.9% of women met criteria for binge eating disorder, while 5.3% met criteria for purging disorder unaccompanied by binge eating (EDNOS-p). Eleven (7%) of the women with lifetime eating disorders had a current eating disorder. Each diagnostic group continued to be differentiated by current eating pathology from women without lifetime eating disorders. Although approximately 75% of the women had a good outcome, less than 50% of each diagnostic group was asymptomatic.

Conclusions: Eating disorders tend to improve over time often reaching subdiagnostic levels of severity, but only a minority of sufferers becomes asymptomatic. The DSM-IV diagnosis EDNOS needs to be considered in studies of the prevalence and course of eating disorders.
The Prevalence of Eating Disorders Among University Students and the Relationship with Some Individual Characteristics
Authors: Kugu Nesim , Akyuz Gamze , Dogan Orhan , Ersan Erdal , Izgic Ferda
Published: December 2009

Objective: The purpose of this study was to determine the prevalence of eating disorders (EDs) among university students in a rural area of Turkey and to compare groups based on the sociodemographic data, history of child abuse and neglect, family roles and selfesteem with a normal control group regarding EDs.

Method: Subjects who were chosen by simple random sampling method were consisted of 980 Cumhuriyet University students who agreed to participate out of the 1003 total students and were given a sociodemographic information form and an Eating Attitudes Test (EAT). Students who scored above a cutoff level on the EAT were interviewed using the Structured Clinical Interview for DSM-IV axis I Disorders (SCID-I), Clinical Version. The Rosenberg Self-Esteem Scale, Family Assessment Device (FAD) and Childhood Abuse and Neglect Questionnaire Form were given to subjects in the control and study groups.

Results: Seventy-one of the 951 students (492 female, 459 male) who correctly filled out the EAT had a score above the cutoff level of 30 or higher. Of these 71 students, 21 (2.20%) were found to have an eating disorder based on the SCID-I. No subjects were found to have anorexia nervosa. Eighteen of the 21 subjects were female. Of these 18 female students, 15 (1.57%) were found to have bulimia nervosa and three (0.31%) were found to have binge eating disorder (BED). All of the three male subjects were diagnosed with BED (0.31%). The self-esteem of those in the study group was lower than those in the control group (p < 0.001). Subjects in the study group had more frequent histories of sexual and emotional abuse in childhood (p < 0.05). Also, in the study group scores showing communication in FAD families, unity and emotional attachment were statistically significantly lower than the control group (p < 0.001).

Conclusions: It has been observed from the results of this research that the frequency of bulimia nervosa and BED in this sample is so similar to Western samples. Besides that, self-esteem, child abuse and neglect, and family functions must be examined in detail because they are risk factors for EDs and affect the course of treatment.
Eating Disorder Attitudes and Psychopathology in Caucasian Australian, Asian Australian and Thai University Students
Authors: Jennings Piangchai S , Forbes David , Mcdermott Brett , Hulse Gary , Juniper Sato
Published: December 2009

Objective: To examine eating disorder attitudes and psychopathology among female university students in Australia and Thailand.

Method: Participants were 110 Caucasian Australians, 130 Asian Australians and 101 Thais in Thailand. The instruments included the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI).

Results: Eating disorder attitudes and psychopathology scores in the Thai group were found to be highest. The Asian Australian group did not have significantly higher scores on the EAT-26 than the Caucasian Australian group, but had higher scores in some subscales of the EDI-2. That the Thai group had the highest scores in susceptibility to developing an eating disorder and eating disorder psychopathology may be partially explained in sociocultural terms, with pressure to be thin more extreme in Thailand than in Australia. The evidence suggested that unhealthy eating disorder psychopathology is not limited to Western societies but is already present in Thai and other Asian societies.
Illicit Drug use and Dependence in a New Zealand Birth Cohort
Authors: Boden Joseph M. , Fergusson David M. , John Horwood L.
Published: December 2009

Objective: To describe the patterns of illicit drug use in a birth cohort studied to the age of 25 years.

Method: The data were gathered during the Christchurch Health and Development Study. In this study a cohort of 1265 children born in the Christchurch, New Zealand urban region in mid-1977 have been studied to the age of 25 years. Information was gathered on patterns of illicit drug use and dependence during the period 15–25 years.

Results: By age 25 years, 76.7% of the cohort had used cannabis, while 43.5% had used other illicit drugs on at least one occasion. In addition, 12.5% of the cohort met DSM-IV criteria for dependence on cannabis, and 3.6% of the cohortmet criteria for dependence on other illicit drugs at some time by age 25. There was also evidence of substantial poly-drug use among the cohort, with hallucinogens and amphetamines being the most commonly used illicit drugs (excluding cannabis). Illicit drug use and dependence was higher in males, in Māori, and in those leaving school without qualifications. Key risk factors for illicit drug use and dependence included adolescent risk-taking behaviours including cigarette smoking and alcohol consumption, affiliation with substance-using peers, novelty-seeking, and conduct problems in adolescence. Other key risk factors included parental history of illicit drug use and childhood sexual abuse.

Conclusions: Levels of cumulative illicit drug use in this cohort were relatively high, with the majority of respondents having tried illicit drugs by age 25. For the majority of illicit drug users, drug use did not lead to problems of dependence. Nonetheless, nearly 15% of the cohort showed symptoms of illicit drug dependence by the age of 25 years, with cannabis dependence accounting for the majority of illicit drug dependence.
Coexisting Psychiatric Disorders in a New Zealand Outpatient Alcohol and other Drug Clinical Population
Authors: Adamson Simon J. , Todd Fraser C. , Douglas Sellman J , Huriwai Terry , Porter Joel
Published: December 2009

Objective: To describe the extent of psychiatric disorder and mental health service utilization in a representative outpatient alcohol and other drug (AOD) treatment sample in New Zealand.

Method: A total of 105 patients were randomly recruited from two outpatient AOD treatment services in New Zealand and completed a diagnostic interview within the first 2 months of treatment. Axis I psychiatric diagnoses were made using the computerized Composite International Diagnostic Interview (CIDI-Auto), and were supplemented by the South Oaks Gambling Scale (SOGS) and the conduct disorder and antisocial personality disorder section of the Diagnostic Interview for Genetic Studies (DIGS).

Results: Seventy-four per cent of the sample had a current non-substance or gambling axis I disorder, with a lifetime rate of 90%. The most commonly diagnosed of these coexisting psychiatric disorders were major depressive episode (34%), social phobia (31%) and posttraumatic stress disorder (31%). Past contact with mental health services was common, while contact at the time of baseline assessment was uncommon.

Conclusions: Coexisting psychiatric disorder was the rule and not the exception in this sample. AOD patients are clearly part of the larger population of mental health patients. AOD services need to be capable of comprehensive assessment and treatment planning, which includes coexisting psychiatric disorders, and should work toward better integration with other mental health services.
Brain Activation During Craving for Alcohol Measured by Positron Emission Tomography
Authors: Olbrich Hans M. , Valerius Gabriele , Paris Christine , Hagenbuch Friedemann , Ebert Dieter , Juengling Freimut D.
Published: December 2009

Objective: Craving for alcohol is probably involved in acquisition and maintenance of alcohol dependence to a substantial degree. However, the brain substrates and mechanisms that underlie alcohol craving await more detailed elucidation.

Method: Positron emission tomography was used to map regional cerebral blood flow (CBF) in 21 detoxified patients with alcohol dependence during exposure to alcoholic and non-alcoholic beverages.

Results: During the alcohol condition compared with the control condition, significantly increased CBF was found in the ventral putamen. Additionally, activated areas included insula, dorsolateral prefrontal cortex and cerebellum. Cerebral blood flow increase in these regions was related to self-reports of craving assessed in the alcoholic patients.

Conclusions: In this investigation, cue-induced alcohol craving was associated with activation of brain regions particularly involved in brain reward mechanisms, memory and attentional processes. These results are consistent with studies on craving for other addictive substances and may offer strategies for more elaborate studies on the neurobiology of addiction.
Pharmacological Treatment in the Early Phase of Bipolar Disorders: What Stage are we at?
Authors: Conus Philippe , Berk Michael , McGorry Patrick D.
Published: December 2009

Objective: To review available guidelines, explore treatment strategies currently applied, identify critical issues and propose direction for new developments.

Method: Literature review based on Medline search and hand search of relevant literature.

Results: Pharmacological treatment of the early phase of bipolar disorders lacks specific guidelines. Mood stabilizers are often prescribed after many years of illness, antipsychotic medications are frequently prescribed and often for extensive periods of time, and adherence to medication is relatively poor. In addition, mania is frequently misdiagnosed, and there is limited knowledge on which to base identification of bipolar depression and identification of the initial prodrome to bipolar disorders.

Conclusions: There is an urgent need for more research in the early phases of bipolar disorders to develop means to identify patients earlier and to develop approaches that would address the specific needs of this population in a more adequate manner.
Rural Suicide—People or Place Effects?
Authors: Judd Fiona , Cooper Anne-Marie , Fraser Caitlin , Davis Julian
Published: December 2009

Objective: To examine factors that may contribute to elevated rates of suicide among rural communities in Australia.

Method: A wide-ranging literature search reviewed possible factors that may contribute to the geographical variation in suicide. Literature was organized to enable examination of compositional and contextual explanations, as well as collective social functioning and social practices.

Results: A variety of factors may contribute to elevated rates of suicide in rural compared with urban areas. Collective and contextual (place) factors seem to be of particular importance as possible contributors to the elevated rate of suicide among rural males. These include rural socioeconomic decline; facilitators and barriers to service utilization such as service availability and accessibility, rural culture, community attitudes to mental illness and help seeking; and exposure to firearms.

Conclusions: Compositional, contextual and collective factors are hypothesized to influence the elevated rate of suicide in rural compared with urban areas. These factors need to be tested in empirical studies that consider both individual and community-based risk factors, and are designed to enable exploration of likely within-rural differences.
Regionally Specific Changes in Levels of Cortical S100β in Bipolar 1 Disorder but not Schizophrenia
Authors: Dean Brian , Gray Laura , Scarr Elizabeth
Published: December 2009

Objective: To determine if levels of the glial-derived proteins S100β and glial acidic fibrillary protein (GFAP) and the pro- and antiapoptotic proteins p53 and Bcl-2 were altered in the cortex of subjects with schizophrenia or bipolar 1 disorder.

Method: Levels of S100β, GFAP, p53 and Bcl-2 were measured in cortex (Brodmann's Areas (BAs) 9, 10, 46 and 40) of control subjects and subjects with schizophrenia, bipolar 1 disorder and in the cortex of rats treated with haloperidol or lithium using protein-specific antibodies and western blot analysis.

Results: Levels of S100β were decreased in BA 9 and increased in BA 40 from subjects with bipolar 1 disorder. Levels of this protein were not altered in other CNS regions, in schizophrenia or in the cortex of rats treated with haloperidol or lithium. No changes in levels of the other three proteins were detected across diagnoses.

Conclusions: Regionally selective changes in cortical S100β may be associated with the pathology of bipolar 1 disorder and may reflect derangements in neuronal death or survival.
Postnatal Depressive Symptoms Among Pacific Mothers in Auckland: Prevalence and Risk Factors
Authors: Abbott Max W. , Williams Maynard M.
Published: December 2009

Objective: To assess the prevalence of and risk factors for postnatal depressive symptoms in a cohort of mothers of Pacific Island infants in Auckland, New Zealand.

Method: The data were gathered as part of the Pacific Island Families Study, in which 1376 mothers were interviewed when their babies were 6 weeks old. The interview included the Edinburgh Postnatal Depression Scale (EPDS).

Results: 16.4% of mothers were assessed as probably experiencing depression. Prevalence rates varied from 7.6% for Samoans to 30.9% for Tongans. In addition to ethnicity, risk factors identified by stepwise multiple logistic regression included low Pacific Island acculturation, first birth, stress due to insufficient food, household income less than $40 000, difficulty with transport, dissatisfaction with pregnancy, birth experience, baby's sleep patterns, partner relationship and home. A large prevalence difference between Tongans and other groups remained when the effects of other risk factors were controlled statistically.

Conclusions: The prevalence of depressive symptoms among Pacific mothers is at the upper end of the range typically reported. Focus on the overall rate, however, obscures substantial variation between groups. Risk factors are generally similar to those identified in previous research.

Implications: The findings have implications for prevention and treatment and caution against assuming homogeneity within ethnic categories. Further research is required to explain differences in prevalence between Tongan and other Pacific Island groups.
Actions Taken to Cope with Depression in Patients Seeking Specialist Care
Authors: Wilhelm K. , Niven H. , Mitchell P. , Malhi G. , Wedgwood L. , Austin M-P. , Kotze B. , Parker G.
Published: December 2009

Objective: To assess the rates and perceived effectiveness of actions used to cope with depression and the factors influencing these in an outpatient sample seeking help for depression.

Method: One hundred and seventy-six patients (74 male, 102 female) aged 16–82 years (M=42, SD=14.4 years) with a major depressive episode (DSM-IV criteria) were assessed using a number of measures that covered sociodemographics, history of psychiatric illness, actions taken to alleviate depression and their perceived effectiveness. Logistic regression analyses assessed age, gender and illness characteristics associated with the use and perceived effectiveness of strategies adopted to manage depression.

Results: Medical interventions were used and perceived to be effective in alleviating depressive symptoms by most of the sample, as were self-help and complementary therapies. Sociodemographic and illness-related characteristics had a significant influence, with younger age and having experienced an episode of anxiety disorder found to be the strongest predictors for the use of coping strategies. Being female was the strongest predictor for their effectiveness.

Conclusion: A range of actions for depression, including medical and complementary interventions, were used and found to be helpful in a sample that had sought professional help for depression. Gender, age, depression and anxiety factors were all found to predict the use and perceived effectiveness of these strategies.
Explicating Links between Acute Coronary Syndrome and Depression: Study Design and Methods
Authors: Parker Gordon , Heruc Gabriella , Hilton Therese , Olley Amanda , Brotchie Heather , Hadzi-Pavlovic Dusan , Owen Catherine , Friend Cheryl , Walsh Warren F.
Published: December 2009

Objective: To describe a regional study seeking to replicate the suggested strong links whereby lifetime and post-coronary infarction depression are associated with a significant increase in mortality and cardiac morbidity, and consider the comparative influence of both depression and anxiety.

Method: We detail relevant international studies and describe both the methodology as well as baseline and 1-month data from our study.

Results: Over a 3-year period we recruited 489 subjects admitted to a Sydney cardiac unit with an Acute Coronary Syndrome (ACS), and assessed by a range of cardiac variables and measures of current and lifetime depression. Ninety-eight per cent of the sample were assessed one month after baseline recruitment to establish depression rates. Long-term outcome reviews of mortality and morbidity and hospitalization rates are proceeding. For those subjects who were depressed in the post-ACS period and, even more so for those who had experienced lifetime depression, distinctly higher scores on anxiety variables (and lifetime caseness for anxiety disorders) were established.

Conclusions: The strong interdependence between anxiety and depression in this sample of patients admitted with an ACS will allow examination of the comparative extent to which expressions of ‘depression’ and ‘anxiety’ contribute to post-ACS morbidity.
Quality of Life and Psychopathology: Investigations into their Relationship
Authors: Masthoff Erik D. , Trompenaars Fons J. , Van Heck Guus L. , Hodiamont Paul P. , De Vries Jolanda
Published: December 2009

Objective: Quality of life (QOL) has become a topic of growing interest in medical and psychiatric practice in general, and in research in particular. Although the body of knowledge about the complex relationship between QOL and psychiatric disorders is growing, understanding this relationship still remains difficult. Therefore, the aim of the present study was to get more and new insights into this relationship. It was hypothesized that QOL would be negatively related to the presence as well as the severity of psychopathology.

Method: A random sample of Dutch adult psychiatric outpatients (n=410) completed the World Health Organization Quality of Life assessment instrument, abbreviated version (WHOQOL-Bref). In addition, DSM-IV axis I and II diagnoses were obtained. Comparisons were made between scores of the psychiatric outpatients, diagnostic subgroups within this population, and the scores of a general population.

Results: Compared with the general population, psychiatric outpatients scored significantly worse on all aspects of QOL. Within the group of outpatients, participants with DSM-IV diagnoses had worse scores than those without. Participants with comorbidity had the worst QOL.

Conclusions: It is concluded that QOL scores are negatively related to both the presence and the severity of psychopathology, and that the presence of a personality disorder plays a role in subjectively experienced QOL.
Transition to Psychosis: 6-Month follow-up of a Chinese High-Risk Group in Hong Kong
Authors: Lam May M.L. , Hung Se-Fong , Chen Eric Y.H.
Published: December 2009

Objectives: The identification of individuals at high risk of becoming psychotic within the near future creates opportunities for early intervention before the onset of psychosis. This study sets out to identify a group of symptomatic young people in a Chinese population with the high likelihood of transition to psychosis within a follow-up period of 6 months, and to determine the rate of transition to psychosis in this group.

Method: Symptomatic individuals with a family history of psychotic disorder, subthreshold psychotic symptoms or brief transient psychotic symptoms were identified using the operationalized criteria of an ‘At Risk Mental State’. The individuals were prospectively assessed monthly on a measure of psychopathology for 6 months.

Results: Eighteen out of 62 individuals (29%) made the transition to frank psychosis within a 6 month follow-up period, with the majority occurring within 3 months. In addition, significant differences were found in the intake Positive and Negative Syndrome Scale, Comprehensive Assessment of ‘At Risk Mental State’ and Global Assessment of Functioning scores between the group that ultimately became psychotic and the group that did not.

Conclusion: The period of the highest risk of transition to psychosis was within the 3 months after the study began. Thus, distressed youths in our outpatient clinic, who meet the high-risk criteria should be monitored most closely in the initial 3 months, particularly those individuals with high levels of psychopathology and functional decline.
Detection of Non-Adherent Behaviour in Early Psychosis
Authors: Hui Christy L.M. , Chen Eric Y.H. , Kan C.S. , Yip K.C. , Law C.W. , Chiu Cindy P.Y.
Published: December 2009

Objective: Adherence to antipsychotic treatment is an important aspect of the long-term management of schizophrenia. The evaluation of adherence is often dif?cult in the clinical setting. This study compared patient self-reporting and clinician judgment of adherence behaviour in patients with early and chronic schizophrenia.

Method: Clinician-rated questionnaires and parallel patient self-rated questionnaires were administered to 229 patients with early schizophrenia (illness duration < 5 years) and 255 patients with chronic schizophrenia. Items in the questionnaires addressed two forms of adherence behaviour (forgetting to take medication and deciding to stop medication) as well as attitudes toward medication.

Results: Signi?cant non-adherent behaviour was reported by patients, particularly in the early schizophrenia group. Non-adherent behaviour was related to feelings of embarrassment about taking medication. Both non-adherence and embarrassment were under-recognized by clinicians. Starting from a prior probability of 0.24, knowledge of the patients' attitudes increased the posterior probability to 0.33, whereas clinicians' detection of non-adherence (deciding to stop medication) improved the posterior probability to 0.65. When both clinicians' evaluations and patients' attitudes were known, the posterior probability improved to 0.68.

Conclusion: Non-adherence is a widespread phenomenon in early schizophrenia. Increasing clinicians' sensitivity to patients' feelings of embarrassment may be an important factor in the detection of non-adherence. When taking a base rate of nonadherence into consideration, clinicians' evaluations appeared to be more effective in detecting non-adherence than simple information obtained from patients on their attitudes toward medication. Pragmatic real-life estimation of non-adherence has important implications for the possibility of intervention.
Community-Based Vocational Rehabilitation: Effectiveness and Cost Impact of a Proposed Program Model
Authors: Jaeger Judith , Jaeger Judith , Berns Stefanie , Jaeger Judith , Berns Stefanie , Douglas Estelle , Jaeger Judith , Berns Stefanie , Douglas Estelle , Creech Bonnie , Jaeger Judith , Berns Stefanie , Douglas Estelle , Creech Bonnie , Glick Bruce , Jaeger Judith , Berns Stefanie , Douglas Estelle , Creech Bonnie , Glick Bruce , Kane John , Jaeger Judith , Berns Stefanie , Douglas Estelle , Creech Bonnie , Glick Bruce , Kane John
Published: December 2009

Objective: To study the vocational, service use and relative cost impact for schizophrenia or schizoaffective disorder of an innovative community-based vocational rehabilitation program.

Method: Participants were consecutive enrollees in a community-based vocational rehabilitation program who had remained in the program for at least 1 year. Lifetime vocational history and mental health service utilization for 2 years prior and up to 4 years subsequent to program enrolment were studied. Retrospective data were collected using a questionnaire completed by the patient and available family and case workers, patient interview and chart review.

Results: Months in paid work increased after enrolment, while earned income did not (most work was low wage and/or part-time). Annual inpatient days decreased precipitously, a change which could not be explained by hospitalization trends during the same period. Average relative cost units, based on charges for mental health services used, dropped over 70% following enrolment.

Conclusions: Community-based vocational rehabilitation may be cost-effective in this population, largely as a result of its impact on hospitalizations and utilization of the most costly services. Such programs represent an important alternative to supported employment that may be particularly suited to cognitively or functionally impaired patients unwilling or unable to work in a competitive environment.
Enhancing Employment Services for People with Severe Mental Illness: The Challenge of the Australian Service Environment
Authors: King Robert , Waghorn Geoffrey , Lloyd Chris , Mcleod Pat , Mcmah Terene , Leong Cliff
Published: December 2009

Objectives: Comparatively few people with severe mental illness are employed despite evidence that many people within this group wish to obtain, can obtain and sustain employment, and that employment can contribute to recovery. This investigation aimed to: (i) describe the current policy and service environment within which people with severe mental illness receive employment services; (ii) identify evidence-based practices that improve employment outcomes for people with severe mental illness; (iii) determine the extent to which the current Australian policy environment is consistent with the implementation of evidence-based employment services for people with severe mental illness; and (iv) identify methods and priorities for enhancing employment services for Australians with severe mental illness through implementation of evidence-based practices.

Method: Current Australian practices were identified, having reference to policy and legal documents, funding body requirements and anecdotal reports. Evidence-based employment services for people with severe mental illness were identified through examination of published reviews and the results of recent controlled trials.

Results: Current policy settings support the provision of employment services for people with severe mental illness separate from clinical services. Recent studies have identified integration of clinical and employment services as a major factor in the effectiveness of employment services. This is usually achieved through co-location of employment and mental health services.

Conclusions: Optimal evidence-based employment services are needed by Australians with severe mental illness. Providing optimal services is a challenge in the current policy environment. Service integration may be achieved through enhanced intersectoral links between employment and mental health service providers as well as by co-locating employment specialists within a mental health care setting.
Examining Geographical and Household Variation in Mental Health in Australia
Authors: Butterworth Peter , Rodgers Brian , Jorm Anthony F.
Published: December 2009

Objective: International research has failed to demonstrate area effects in the distribution of common mental disorders. In contrast, strong and robust household effects are evident, though relatively rarely examined. This study investigated household and area effects in the distribution of mental health scores using Australian data.

Method: Analysis of data from the first wave of the Household, Income and Labour Dynamics in Australia Survey: a large representative survey of 13 969 Australian adults. Multilevel regression methods were used to model variance in the mental health scale and mental component summary scale of the Short-Form 36 at the individual, household and area (Census Collection District) levels. A number of risk factors at various levels of the model were also examined.

Results: Very little variance in mental health scores occurred at the area level (1.5%), whereas significant and substantial variance occurred at the household level (23.0%). The variance at the household level remained highly significant following the inclusion of a range of risk factors at the individual, household and area levels.

Conclusions: The results confirm the absence of substantial area-level variation in mental health using Australian data. The findings highlight the importance of focusing on household-level characteristics in future research.