bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-Traumatic Stress Disorder and Health Problems Among Medically Ill Canadian Peacekeeping Veterans
Authors: Richardson J. Don , Pekevski Jordan , Elhai Jon D.
Published: December 2009

Objective: The aim of the present study was to examine the relationship between post-traumatic stress disorder (PTSD) symptom severity and four significant health conditions (gastrointestinal disorders, musculoskeletal problems, headaches, and cardiovascular problems).

Method: Participants included 707 Canadian peacekeeping veterans with service-related disabilities, from a random, national Canadian survey, who had been deployed overseas.

Results: PTSD severity was significantly related to gastrointestinal disorders, musculoskeletal problems, and headaches, but not to cardiovascular problems. Controlling for demographic factors did not affect PTSD's relationships with the three significant health conditions.

Conclusions: The present study supports previous work in finding consistent relations between PTSD severity and specific types of medical problems.
Changing Utilization of Pro Re Nata (‘As Needed’) Sedation in a Child and Adolescent Psychiatric Inpatient Unit
Authors: Dean Angela J. , McDermott Brett M. , Scott James
Published: December 2009

Objective: The primary purpose of the present study was to examine changes in utilization of pro re nata (PRN; ‘as required’) sedation over time within a child and adolescent psychiatric inpatient unit. The secondary purpose was to assess whether changes in PRN sedation were related to changing patient characteristics.

Methods: A retrospective chart review examined 257 medical charts from a child and youth mental health inpatient service over two time periods (wave I, n = 122; wave II, n = 135) and collected data on PRN sedation, patient characteristics and routine medications.

Results: Over time a significant reduction was observed in the proportion of patients prescribed PRN sedation from 70% to 54% (p < 0.01), and a reduction in the proportion of patients given PRN sedation from 46% to 26% (p < 0.01). The most commonly administered drug was chlorpromazine in wave I, and diazepam in wave II. Multivariate analysis indicated that reductions in PRN sedation occurred independently of changes in patient characteristics.

Conclusions: High utilization rates of PRN sedation are not inevitable in a child and adolescent psychiatric inpatient unit and may be reduced over time. Changing utilization of PRN sedation occurred independently from changing patient characteristics. More treatment outcome studies are required to optimize use of PRN sedation in young people.
Anterior Hippocampus in Schizophrenia Pathogenesis: Molecular Evidence from a Proteome Study
Authors: Nesvaderani Maryam , Matsumoto Izuru , Sivagnanasundaram Sinthuja
Published: December 2009

Objective: The purpose of the present study was to identify differentially expressed proteins in the anterior and posterior hippocampus of brains of schizophrenia patients compared to neurologically healthy controls.

Method: Proteins extracted from fresh frozen post-mortem posterior and anterior hippocampus for nine schizophrenia and nine control individuals, and seven schizophrenia and seven control individuals, respectively, were screened for differential expression using 2-D gel electrophoresis and mass spectrometry.

Results: A significantly larger number of protein spots were differentially expressed in the anterior (n = 43) compared to the posterior (n = 16) hippocampus, representing 34 and 14 unique proteins, respectively. These proteins are involved in cytoskeleton structure and function, neurotransmission and mitochondrial function.

Conclusion: Based on the aberrant protein expression profiles, the anterior hippocampus appears to be more involved in schizophrenia pathogenesis than the posterior hippocampus. Furthermore, consistent with previous findings, we found molecular evidence to support abnormal neuronal cytoarchitecture and function, neurotransmission and mitochondrial function in the schizophrenia hippocampus.
Validation of an Australian Sign Language Instrument of Outcome Measurement for Adults in Mental Health Settings
Authors: Munro Louise , Rodwell John
Published: December 2009

Objective: There are currently no adult mental health outcome measures that have been translated into Australian sign language (Auslan). Without a valid and reliable Auslan outcome measure, empirical research into the efficacy of mental health interventions for sign language users is unattainable. To address this research problem the Outcome Rating Scale (ORS), a measure of general functioning, was translated into Auslan and recorded on to digital video disk for use in clinical settings. The purpose of the present study was therefore to examine the reliability, validity and acceptability of an Auslan version of the ORS (ORS-Auslan).

Method: The ORS-Auslan was administered to 44 deaf people who use Auslan as their first language and who identify as members of a deaf community (termed ‘Deaf’ people) on their first presentation to a mental health or counselling facility and to 55 Deaf people in the general community. The community sample also completed an Auslan version of the Depression Anxiety Stress Scale-21 (DASS-21).

Results: t-Tests indicated significant differences between the mean scores for the clinical and community sample. Internal consistency was acceptable given the low number of items in the ORS-Auslan. Construct validity was established by significant correlations between total scores on the DASS-21-Auslan and ORS-Auslan. Acceptability of ORS-Auslan was evident in the completion rate of 93% compared with 63% for DASS-21-Auslan.

Conclusions: This is the only Auslan outcome measure available that can be used across a wide variety of mental health and clinical settings. The ORS-Auslan provides mental health clinicians with a reliable and valid, brief measure of general functioning that can significantly distinguish between clinical and non-clinical presentations for members of the Deaf community.
Management of Depression by General Practitioners: Impact of Physician Gender
Authors: Parker Gordon B. , Hyett Matthew P.
Published: December 2009

Objective: The aim of the present study was to determine whether anecdotal claims of gender differences in the treatment of depression by general practitioners (GPs) existed in practice.

Method: Referral letters from 100 GPs to a specialized psychiatric depression clinic were analysed by word count and gender of referrer. Second, a Web-based survey of 517 participants examined the impact of GP gender in terms of levels of management nuances.

Results: The first study established that female GPs wrote distinctly longer referral letters. The second study identified that female GPs were seen as distinctly more caring over a range of parameters and identified the impact of some GP–patient gender differences.

Conclusions: Reasons why female GPs are viewed as more caring – and any impact on the management of those with a depressive disorder – would benefit from refined investigation.
2004 Tsunami: Long-Term Psychological Consequences for Swiss Tourists in the Area at the Time of the Disaster
Authors: Kraemer Bernd , Wittmann Lutz , Jenewein Josef , Schnyder Ulrich
Published: December 2009

Objective: Most of the data on psychological outcome and the mental health treatment available following natural disasters originate from the indigenous population of the region destroyed. Examining tourists returning from the area affected by the 2004 tsunami presents an opportunity of studying the impact of natural disasters on psychological outcome and mental health treatment in their countries of origin. The aim of the present study was to extend the current knowledge on psychiatric morbidity and potential positive outcomes, as well as subsequent mental health treatment following a natural disaster, based on the results from a sample of home-coming Swiss tourists.

Method: Tourists who had been potentially affected by the 2004 tsunami were assessed using the Post-traumatic Diagnostic Scale, the Hospital Anxiety and Depression Scale, and the Post-traumatic Growth Inventory. Outcome variables were related to the degree of tsunami exposure. In addition, mental health treatment before and after the tsunami was assessed.

Results: Of the 342 respondents, 55 (16.8%) fulfilled the criteria of post-traumatic stress disorder (PTSD). Evidence of anxiety or depressive disorder was found in 17.8% and 8.0%, respectively. The tsunami victims who had been directly affected showed significantly more symptoms of anxiety, depression and PTSD, as well as post-traumatic personal growth, than tourists who were indirectly affected or unaffected. A total of 12.3% of untreated respondents fulfilled the criteria for PTSD and 38% of respondents who had received psychiatric treatment were still fulfilling PTSD criteria 2½ years after the tsunami.

Conclusion: A marked percentage of respondents reported symptoms of PTSD but they remained untreated or were treated insufficiently. We recommend that tourists returning from regions affected by natural disasters be informed about PTSD and that careful screening be given to those found to be at risk of PTSD. An open-door policy of mental health services is particularly needed for tourists returning home who have been affected by large-scale disasters.
Effectiveness of Psychoanalytic Psychotherapy for Adolescents with Serious Mental Illness: 12 Month Naturalistic Follow-Up Study
Authors: Tonge Bruce John , Pullen Jill Marie , Hughes Georgina Catherine , Beaufoy Jeanette
Published: December 2009

Objective: The aim of this naturalistic longitudinal study was to examine the effectiveness of individual psychoanalytic psychotherapy in reducing symptoms and improving overall functioning for adolescents with severe mental illness beyond the changes observed with treatment as usual. Changes to family functioning were also examined.

Method: Participants at 12 month follow up were 55 of an initial group of 80 Child and Adolescent Mental Health Services patients with complex, severe mental illness (32 female, mean age = 15.11 years). At initial assessment 40 participants were offered psychoanalytic psychotherapy when a psychotherapist became available; 23 accepted and received once- or twice-weekly psychoanalytic psychotherapy for 4–12 months. Out of the initial 57 participants who received Child and Adolescent Mental Health Services treatment as usual, 33 were reassessed at 12 months. Self-reported depressive symptoms, parent-reported social and attention problems and researcher-evaluated overall functioning and family functioning were measured at initial assessment and 12 months later.

Results: At 12 months, psychotherapy was associated with a greater reduction in depressive, social and attention problems than treatment as usual, alone, if these problems were initially in the clinical range. There was no effect on participant overall functioning or family functioning.

Conclusions: This naturally occurring sample of seriously ill adolescents referred to Child and Adolescent Mental Health Services for assessment were suffering complex mental illness and poor mental health. Empirical evidence is presented that psychoanalytic psychotherapy is an effective addition to Child and Adolescent Mental Health Services treatment as usual for mental illness in adolescence, particularly for more severe and complex cases. The naturalistic study design and participant attrition are possible study limitations.
Sleepwalking in Psychiatric Patients: Comparison of Childhood and Adult Onset
Authors: Lam Siu-Ping , Fong Samson Yat-Yuk , Yu Mandy Wai-Man , Li Shirley Xin , Wing Yun-Kwok
Published: December 2009

Objectives: In contrast to the ‘benign and self-limiting nature’ of childhood sleepwalking, some population and case studies have suggested that adult sleepwalking is more likely to be associated with psychopathology and psychotropic medications. There is a paucity, however, of systematic study in adult psychiatric populations, and the aim of the present study was therefore to compare the impact of psychopathology and medication usage on sleepwalking with reference to age of onset.

Methods: Clinical characteristics, sleep symptoms, psychiatric diagnosis and psychotropic usage in 66 childhood- and adult-onset sleepwalkers as identified from a psychiatric clinic, were studied.

Results: There was a higher proportion of adult-onset sleepwalking in the psychiatric population. In comparison with childhood-onset sleepwalkers, adult-onset sleepwalkers had higher peak frequency of attacks and a high comorbidity with sleep-related eating features. Factors including frequent insomnia (odds ratio (OR) = 5.39, 95% confidence interval (CI) = 1.58–18.40, p = 0.007) and lifetime usage of regular zolpidem (OR = 5.58, 95%CI = 1.65–18.84, p < 0.006) were associated with a higher risk of adult-onset sleepwalking.

Conclusions: Adult-onset sleepwalking in a psychiatric sample has unique clinical characteristics and specific risk factors. These patients were more likely to present with sleep-related eating features, comorbid insomnia, had and lifetime usage of non-benzodiazepine hypnotics, especially zolpidem. A heightened awareness of the presence of sleepwalking and their associated risk factors among the adult psychiatric population is needed.
Reliability of Psychiatric Evidence in Serious Criminal Matters: Fitness to Stand Trial and the Defence of Mental Illness
Authors: Large Matthew , Nielssen Olav , Elliott Gordon
Published: December 2009

Objective: The criminal justice system relies on the opinions of expert witness to assist in decisions about fitness to stand trial (FST) and verdicts of not guilty by reason of mental illness (NGMI). The aim of the present study was to assess the level of agreement between experts about these legal issues using a consecutive series of serious criminal matters in New South Wales.

Methods: Pairs of reports from 110 consecutive criminal matters completed by the New South Wales Office of the Director of Public Prosecutions between 2005 and 2007 were examined. The opinions of experts about FST and NGMI were recorded.

Results: Agreement about FST was fair–moderate (experts engaged by opposite sides, κ = 0.293; experts engaged by the same side, κ = 0.471), although there was a higher level of agreement in homicide matters. Agreement about NGMI was moderate–good (experts engaged by opposite sides, κ = 0.508; experts engaged by the same side, κ = 0.644) and there was a higher level of agreement when the experts also agreed about the diagnosis of schizophrenia. Further analysis using generalized estimating equations did not find a higher level of agreement about FST or NGMI in pairs of reports containing the opinion of experts from the same side.

Conclusions: Little evidence was found for bias in expert opinions about either FST or NGMI, but the comparatively low level of agreement about FST suggests the need for reform in the way that FST is assessed.
More Us Than Them: Positive Depictions of Mental Illness on Australian Television News
Authors: Henson Connie , Chapman Simon , McLeod Lachlan , Johnson Natalie , McGeechan Kevin , Hickie Ian
Published: December 2009

Objective: The aim of the present study was to review television news coverage of mental illness including self-depictions from people with mental illness, and views expressed by mental health experts and politicians in all 538 news and current affairs items related to mental illness broadcast on free-to-air Sydney television, May 2005–October 2007.

Methods: Content and frame analysis was done of news actors (those with mental illnesses, experts and politicians) of whether depictions were positive ‘one of us’, or negative ‘one of them’.

Results: Only 6% of all items with a main focus on a specific health condition, focused on mental health. Individuals with mental illness were present in 264 (49%) of 538 items, with most (174, 66%) of these self-depictions categorized as either neutral or positive. Experts and politicians overwhelmingly represented and described people with mental illnesses in neutral or positive ways (95% and 84%, respectively). Overall news angle included 299 items (55%), which were categorized as positive ‘recovery focused’ items. Another 156 items (29%) were neutral, and 62 items (12%) were classified as negative. Twenty-one (4%) had unclear or mixed themes.

Conclusions: The present findings differ from previous descriptions of media depiction of mental illness, which have been largely negative. The present study provides support for the importance of involving those with histories of mental illness in news coverage.
Evaluation of Treatment in 35 Cases of Bipolar Suicide
Authors: Keks Nicholas A. , Hill Christine , Sundram Suresh , Graham Annette , Bellingham Kylee , Dean Brian , Opeskin Ken , Dorissa Arrigo , Copolov David L.
Published: December 2009

Objective: The aim of the present study was to evaluate clinical factors relevant to suicide prevention (including treatment) in cases of bipolar suicide with available therapeutic histories.

Method: Victorian Coroner's Office data enabled identification of suicides that occurred between March 1993 and December 2001. Cases involving sufficient clinical notes to enable diagnosis of DSM-IV bipolar disorder and review of treatment were de-identified and assessed by an expert clinical panel.

Results: From 3752 suicides, 35 eligible bipolar subjects (22 men, 13 women) aged 40.3±1.8 years were identified. Duration of illness was 11.9±1.1 years. A total of 86% had made at least one previous suicide attempt, and 83% were in the depressed phase of illness. A total of 63% manifested psychosis at some time during lifetime illness. Fourteen per cent were inpatients, and 26% suicided within 6weeks of hospital discharge. The panel's retrospective risk assessment concluded that only 48% of cases could have been assessed as high risk. In the 4 weeks prior to suicide, treatment was rated as not reaching benchmark standards in 60% of cases. Electroconvulsive therapy had been given to 11%, lithium to 43% (but definitely therapeutic in only 11%), 31% had never been treated with lithium, and psychosocial interventions did not reach adequate standards in 57% during the previous year.

Conclusions: In the majority of bipolar suicide cases in the present case series the subjects did not receive treatment at or above a benchmark standard, often due to illness and situational factors, but also possibly due to inadequate clinical interventions. Strategies to improve treatment may reduce suicide in bipolar disorder.
Clinician-Assisted Internet-Based Treatment is Effective for Depression: Randomized Controlled Trial
Authors: Perini Sarah , Titov Nickolai , Andrews Gavin
Published: December 2009

Objective: The aim of the present study was to determine the efficacy of an Internet-based clinician-assisted computerized cognitive behavioural treatment (CaCCBT) programme for depression.

Method: Forty-five individuals meeting diagnostic criteria for depression were randomly assigned to the Sadness programme or to a waitlist control group. In the clinician-assisted Sadness programme, participants complete six online lessons, weekly homework assignments, receive weekly email contact from a clinical psychologist, and contribute to a moderated online discussion forum with other participants. An intention-to-treat model was used for data analyses.

Results: A total of 20 (74%) treatment group participants completed all lessons within the 8 week programme, and post-treatment data were collected from 18/27 treatment group and 17/18 waitlist group participants. Treatment group participants reported significantly reduced symptoms of depression as measured by the Beck Depression Inventory–second edition and the Patient Health Questionnaire–Nine Item. Treatment group participants each received an average of eight email contacts (111 min of therapist time]. Mean within- and between-group effect sizes (Cohen's d) across the two measures of depressive symptoms were 0.98 and 0.75, respectively. Participants found the treatment programme acceptable and satisfactory.

Conclusions: These results replicate those from the pilot trial reported by Perini et al. and are consistent with literature indicating that Internet-based programmes for depression and other mental disorders combined with clinical guidance can result in clinically significant improvements. These data provide further support for the development of Internet-based treatment for common mental disorders.
Estimating the Effect of Word Predictability on Eye Movements in Chinese Reading Using Latent Semantic Analysis and Transitional Probability
Authors: Wang Hsueh-Cheng , Pomplun Marc , Chen Minglei , Ko Hwawei , Rayner Keith
Published: December 2009

Latent semantic analysis (LSA) and transitional probability (TP), two computational methods used to reflect lexical semantic representation from large text corpora, were employed to examine the effects of word predictability on Chinese reading. Participants’ eye movements were monitored, and the influence of word complexity (number of strokes), word frequency, and word predictability on different eye movement measures (first-fixation duration, gaze duration, and total time) were examined. We found influences of TP on first-fixation duration and gaze duration and of LSA on total time. The results suggest that TP reflects an early stage of lexical processing while LSA reflects a later stage.
Is the Australian National Survey of Mental Health and Wellbeing a Reliable Guide for Health Planners? A Methodological Note on the Prevalence of Depression
Authors: Goldney Robert , Hawthorne Graeme , Fisher Laura
Published: December 2009

Objective: To consider whether the prevalence of depression reported in the Australian National Survey of Mental Health and Wellbeing is a reliable guide for mental health planners.

Method: A comparison of methodologies for the detection of depression in the Australian National Survey and a South Australian survey.

Results: The Australian National Survey using the Composite International Diagnostic Interview (CIDI) reported considerably less depression than a South Australian survey, which used the mood module of the PRIME-MD 1000 study. Although the PRIME-MD may over-diagnose depression, it is probable that the preclusion criteria of the CIDI result in an under-reporting of depression.

Conclusions: It is probable that the Australian National Survey under-estimates the prevalence of depression in the community. This has implications not only in assessing the morbidity and economic burden of depression, but also for the planning of future mental health services.
Assessing Attachment: Convergent Validity of the Adult Attachment Interview and the Parental Bonding Instrument
Authors: Manassis Katharina , Owens Mary , Adam Kenneth S. , West Malcolm , Sheldon-Keller Adrienne E.
Published: December 2009

Objective: The aim of this study was to determine whether or not the Parental Bonding Instrument (PBI) can provide information about parent-child attachment that is comparable to information obtained from the Adult Attachment Interview (AAI), a more complex measure of attachment.

Method: One hundred and thirty emotionally and/or behaviourally disturbed adolescents (73 male, 57 female; ages 13–19 years, × = 15.3 ± 1.47 years) participating in a study of attachment and suicidality completed the PBI and the AAI. Data from these measures were compared within participants.

Results: Maternal care and overprotection on the PBI differed significantly by AAI attachment classification (F3,122 = 2.79, p = 0.012), with autonomous participants showing the most optimal and unresolved participants the least optimal PBI results. Maternal love and maternal involvement/role reversal on the AAI were significant predictors of maternal care and maternal overprotection, respectively, on the PBI (R2 = 0.15; R2 = 0.16). These predictions improved when AAI scales measuring idealisation and involving anger towards the mother were included in the regression analyses (R2 = 0.35; R2 = 0.20). Autonomous participants on AAI showed the highest scale correlations across instruments.

Conclusions: Attachment information obtained from the PBI and the AAI is comparable in participants with optimal attachment histories, but not in participants showing idealisation or anger towards their mothers. Caution is, therefore, advisable when using the PBI to obtain attachment information in clinical samples where suboptimal attachment histories are likely.
Training for the Mental Health Workforce: A Review of Developments in the United Kingdom
Authors: Lambert Gordon , Gournay Kevin
Published: December 2009

Objective: Implementation of the National Mental Health Strategy has important implications for education and training of the Australian mental health workforce. This paper discusses relevant developments in the United Kingdom that may provide some lessons for Australia.

Method: A review was undertaken of a number of specific clinical education and training programs for mental health workers in the United Kingdom which have been subjected to published evaluation.

Results and conclusions: A finite mental health resource base dictates that education and training activity should: (i) be evaluated; (ii) target those clients most in need; (iii) include evidence-based approaches such as assertive community treatment, medication management, cognitive—behaviour therapy and family interventions; and (iv) prepare mental health workers in the core competencies needed to implement these approaches. Two programs, developed in the United Kingdom, which meet these criteria are presented as examples of best practice: the nurse therapy model established by Isaac Marks; and the Thorn initiative established in association with the Institute of Psychiatry, London and the University of Manchester.
Schizophrenia and Hypocalcaemia: Variable Phenotype of Deletion at Chromosome 22q11
Authors: Chow L. Y. , Garcia-Barcelo Merce , Wing Y. K. , Waye Mary M. Y.
Published: December 2009

Objective: The aim of this paper is to report the diagnosis of velo-cardio-facial syndrome (VCFS) in a patient presenting with schizophrenia and hypocalcaemia. Screening of deletion 22q11 in patients with schizophrenia is discussed.

Clinical picture: We report a schizophrenic patient presenting with hypocalcaemia as the only feature of VCFS. Deletion 22q11 was confirmed by fluorescent in situ hybridisation (FISH).

Treatment: The patient was treated with haloperidol 3 mg/day with resolution of psychotic symptoms.

Outcome: The patient harboured some residual psychotic symptoms probably related to her irregular compliance.

Conclusions: The wide range of phenotypic variability of VCFS makes screening of 22q11 deletion in schizophrenia difficult. It is proposed that screening of 22q11 deletion in schizophrenia should be selectively targeted only at patients with specific features of VCFS highly predictive of the presence of 22q11 deletion.
Integrated Drug and Alcohol Intervention: Development of an Opportunistic Intervention Program to Reduce Alcohol and other Substance use among Psychiatric Patients
Authors: Sitharthan Thiagarajan , Singh Subba , Kranitis Paul , Currie Jon , Freeman Pauline , Murugesan Ganapathi , Ludowici Joan
Published: December 2009

Objective: This paper describes the rationale, aims and processes involved in developing and implementing an opportunistic intervention program to reduce substance misuse detected among psychiatric patients.

Method: In this randomised, opportunistic intervention program, eligible patients recruited from a large psychiatric hospital and its associated community mental health centres are assigned to receive an integrated drug and alcohol intervention (IDAI) or alternatively allocated to a minimal intervention condition (MI). The IDAI is based on motivational enhancement and cognitive-behavioural principles, and incorporates harm-reduction approaches. This clinical program is based on the research findings and recommendations of the mental health and the drug and alcohol literature.

Results: A collaborative partnership between the Mental Health Services and the Drug and Alcohol Services was formed. Following a relatively short training period, mental health staff were trained to opportunistically detect drug and alcohol problems among psychiatric patients and offer appropriate integrated clinical care.

Conclusion: The process of implementing an integrated opportunistic intervention program is achievable and can be readily incorporated in psychiatric hospitals and community mental health clinics.
The Senior Psychiatrist Survey I: Age and Psychiatric Practice
Authors: Draper Brian , Winfield Stephanie , Luscombe Georgina
Published: December 2009

Objective: The aim of this study is to determine the effects of age on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP).

Method: A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: age; location and type of psychiatric practice; hours of work; attitudes towards re-accreditation; changes in work practices over the career; and the perceived benefits and drawbacks of age to psychiatric practice and case selection.

Results: Of 1086 eligible subjects, 629 participated. The mean age of the sample was 52.7 years (SD = 13.5). Those psychiatrists favouring re-accreditation were younger. Psychiatrists practising psychotherapy, forensic psychiatry or general psychiatry; working in psychiatric hospitals and private practice were more likely to be older. Older psychiatrists worked shorter hours. There was largely no association between case selection and age. Psychiatrists reporting increased credibility and respect as a benefit of their current age upon their psychiatric practice were older, as were those identifying fatigue and an inability to keep up to date as a drawback of age. Psychiatrists reporting a lack of credibility and respect were younger, as were those who reported increased enthusiasm and optimism.

Conclusions: Age is associated with benefits and drawbacks to the practice of psychiatry and this may be reflected in the different practice profiles of older and younger psychiatrists.
The Senior Psychiatrist Survey II: Experience and Psychiatric Practice
Authors: Draper Brian , Luscombe Georgina , Winfield Stephanie
Published: December 2009

Objective: The aim of this study is to determine the effects of experience on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP).

Method: A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: years of psychiatric experience; higher medical qualifications; location and type of psychiatric practice; attitudes about senior psychiatrists and mentorship; changes in work practices over the career; and the perceived benefits and drawbacks of experience on psychiatric practice and case selection.

Results: Of 1086 eligible subjects, 629 participated. Over 96% of respondents, particularly the younger and less experienced, believed that senior psychiatrists have wisdom to offer to junior colleagues. This wisdom principally related to mentor-ship/supervision. Increased ‘respect and tolerance’ of patients as a benefit of experience was more likely to be reported by respondents who were more experienced. Respondents more confident about treating younger patients and treating functional psychoses were more likely to be less experienced, as were those reluctant to take on psychotherapy cases. Those respondents reluctant to take on ‘dangerous or acting-out patients’ were more experienced. The field of psychiatric practice significantly influenced case selection.

Conclusions: Senior psychiatrists have accumulated wisdom through experience that is sought by junior colleagues via mentorship. It is recommended that the RANZCP should specifically address the needs of early career and senior psychiatrists.
Criteria for Involuntary Hospitalisation
Authors: McLachlan A. J. , Mulder R. T.
Published: December 2009

Objective: The aim of this paper is to provide an overview of the ethical bases of compulsory commitment legislation.

Method: The ethical principles of beneficence and autonomy are examined and used to identify criteria for the commitment of mentally ill patients.

Results: Two aspects of beneficence, medical paternalism and social paternalism, are discussed. It is argued that social paternalism is insufficient ethically to warrant involuntary admission, and that the basis for compulsory hospitalisation is medical paternalism.

Conclusion: The central role of autonomy in medical ethics suggests a patient should have a diminished capacity for autonomous decision-making and a potential to benefit from hospitalisation, as well as a risk of harm to self (including self-neglect) to warrant committal. In specific circumstances, the risk of harm to others may also justify committal. These ethical principles may be at odds with public attitudes.
Way Out of Tune: Lessons from Shine and Its Exposé
Authors: Rosen Alan , Walter Garry
Published: December 2009

Objective: The depiction of David Helfgott's life presented in the movie Shine is at odds with other public accounts, notably one by his sister, Margaret. These significant discrepancies have sparked a prolonged media debate and provide the opportunity to examine cinema's apparent ground rules governing depictions of psychiatry in film, the media values and pressures which are claimed to limit the scope of these portrayals, and the implications for psychiatry.

Method: Information was obtained from a number of sources, including Shine, books about the movie and Shine film paraphernalia, other films about mental illness, the psychiatric papers on cinema, media images of mental illness and media values, and through discussions with fellow mental health professionals, consumers, carers and media specialists.

Results: David Helfgott emerges as an undoubtedly remarkable and resilient individual, who, together with his family, was vulnerable to, and may have experienced, exploitation and violation through the cinema.

Conclusions: Filmmakers should reconcile media values and constraints with considerations of ethics and public accountability. Marrying these considerations is both possible and compatible with good filmmaking and audience appeal. There is the potential for a story about those who have mental illness to be told from multiple points of view without compromising dramatic power.
Methods of Youth Suicide in New Zealand: Trends and Implications for Prevention
Authors: Beautrais Annette L.
Published: December 2009

Objective: One commonly suggested approach to reducing suicide is to restrict access to potentially lethal means of suicide. This paper summarises recent trends in methods of suicide among young people in New Zealand and examines the feasibility of suicide prevention through restricting access to methods of suicide.

Method: Data derived from official mortality statistics were used to examine trends, from 1977 to 1996, in methods of suicide among young people aged 15–24 years.

Results: During the last two decades, male youth suicide rates in New Zealand doubled, from 20.3 per 100 000 in 1977 to 39.5 per 100 000 in 1996. This increase was accounted for, almost entirely, by increased use of hanging (71% of total increase) and vehicle exhaust gas (26% of total increase). Suicide rates among young females also increased, from 4 per 100 000 in 1977 to 14.3 per 100 000 in 1996. As for males, the increased female suicide rate was largely accounted for by increased rates of hanging and vehicle exhaust gas.

Conclusions: The marked increases in rates of youth suicide in New Zealand during the past two decades are accounted for, almost wholly, by increases in rates of suicide by hanging and, to a lesser extent, vehicle exhaust gas. In 1996 the majority (79.7%) of youth suicides were accounted for by these two methods: hanging (61.5%) and vehicle exhaust gas (18.2%). Both methods are widely available and difficult to restrict, implying that limiting access to means of suicide is a strategy which is unlikely to play a major role in reducing suicidal behaviour among young people in New Zealand.
Antidepressants Versus Placebo for the Treatment of Bulimia Nervosa: A Systematic Review
Authors: Bacaltchuk Josue , Hay Phillipa , Mari Jair Jesus
Published: December 2009

Objective: The objective of this study was to valuate the effectiveness, tolerability and acceptability of various classes of antidepressants compared with placebo in the treatment of bulimia nervosa.

Method: A meta-analysis including 16 randomised controlled trials and 1300 bulimic patients was performed. Dichotomous outcomes were analysed by calculating relative risks, and continuous outcomes by calculating effect sizes. Methodological quality, heterogeneity in the results and selective publication were assessed.

Results: Short-term remission in bulimic symptoms was statistically more likely on antidepressants than placebo (Relative Risk = 0.88, 95%% Cl = 0.83–0.94, p < 0.0001). Drop-out rates were high but no statistical difference was found between treatment groups (34.6%% and 31.4%% for drug and placebo; RR = 1.03, 95%% CI = 0.80–1.32, p = 0.8). No difference in efficacy could be demonstrated among different classes of antidepressants.

Conclusions: The use of a single antidepressant agent was clinically effective for the treatment of bulimia nervosa when compared with placebo, with an overall greater remission rate and a higher rate of drop-outs. No differential effect regarding efficacy and tolerability among the various classes of antidepressants could be demonstrated.
Alcohol- and Drug-Use Disorders in Australia: Implications of the National Survey of Mental Health and Wellbeing
Authors: Teesson Maree , Hall Wayne , Lynskey Michael , Degenhardt Louisa
Published: December 2009

Objective: This study reports the prevalence and correlates of ICD-10 alcohol- and drug-use disorders in the National Survey of Mental Health and Wellbeing (NSMHWB) and discusses their implications for treatment.

Method: The NSMHWB was a nationally representative household survey of 10 641 Australian adults that assessed participants for symptoms of the most prevalent ICD-10 and DSM-IV mental disorders, including alcohol- and drug-use disorders.

Results: In the past 12 months 6.5%% of Australian adults met criteria for an ICD-10 alcohol-use disorder and 2.2%% had another ICD-10 drug-use disorder. Men were at higher risk than women of developing alcohol- and drug-use disorders and the prevalence of both disorders decreased with increasing age. There were high rates of comorbidity between alcohol- and other drug-use disorders and mental disorders and low rates of treatment seeking.

Conclusions: Alcohol-use disorders are a major mental health and public health issue in Australia. Drug-use disorders are less common than alcohol-use disorders, but still affect a substantial minority of Australian adults. Treatment seeking among persons with alcohol- and other drug-use disorders is low. A range of public health strategies (including improved specialist treatment services) are needed to reduce the prevalence of these disorders.
Obstacles to a Randomised Controlled Trial of Intensive Dynamic Psychotherapy: An Account of the New South Wales Section of Psychotherapy Outcomes Project
Authors: White Richard T. , Walden Maxine A.
Published: December 2009

Objective: This paper examines the obstacles to a randomised controlled trial (RCT) of intensive dynamic psychotherapy (IDP) by reference to the fate of the New South Wales Section of Psychotherapy outcomes project.

Method: Planning was complete and the final research protocol was about to be implemented when funding difficulties led to suspension of the project. The opinions of the research subcommittee regarding the main obstacles to the ultimate success of the project are now analysed in the expectation that better research strategies will follow.

Results: With hindsight, six of the eight members of the research subcommittee reported that the project was not feasible. By choice of questionnaire items they identified the greatest threats to a successful trial as: standardisation of the procedures, termination at 24 months, the availability of funding and the choice of treatment procedures. The most frequently volunteered concerns related to the enlistment and cooperation of the trial therapists (5), standardisation of the experimental therapy (3), probable shortfall in trial subjects (3) and the availability of funding (2).

Conclusions: The most powerful general obstacles to success of the project related to the standardisation of procedures and the failure to maintain sufficient cooperation of trial therapists. The protocol required IDP therapists to terminate procedures at 24 months, which contradicted their usual practices and led to some alienation from the project. Amendments to the protocol might improve the possibility of a successful trial. However, one might also conclude that it is premature to attempt a naturalistic RCT of IDP.
Nosological Implications of Psychotic Symptoms in Patients with Established Posttraumatic Stress Disorder
Authors: Chan Angelina Oi Mei , Silove Derrick
Published: December 2009

Objective: We describe three patients with chronic posttraumatic stress disorder (PTSD) who later developed psychotic symptoms. The nosological implications are discussed.

Clinical picture: All three patients had no prior history of psychotic illness. The content of the psychotic symptoms was restricted to core features of the traumatic experiences which initially led to PTSD.

Treatment: The patients received low-dose antipsychotic medications in addition to other treatments for PTSD and/or depression.

Outcome: All three patients developed severe extrapyramidal side effects, particularly akathisia, and discontinued drug treatment.

Conclusion: Psychotic symptoms occasionally can complicate chronic PTSD, but uncertainty remains about their aetiology and nosological status.
The Development of Clinical Indicators for a Consultation–Liaison Service
Authors: Holmes Alex C.N. , Judd Fiona K. , Lloyd John H. , Dakis Jennifer , Crampin Emma F. , Katsenos Spiri
Published: December 2009

Objective: The aim of this paper is to describe the development and implementation of clinical indicators in the consultation–liaison service at Royal Melbourne Hospital (RMH).

Method: A working party lead by the University of Melbourne was established in 1998 to develop clinical indicators and a database for the RMH consultation–liaison service. Core parameters for measuring service functioning and six clinical indicators were developed. The system was implemented using a data collection form and computerised database operating within a system of regular clinical reviews.

Results: The clinical indicators, database and review system were found to be a feasible, useful and efficient addition to a consultation–liaison service at a major general hospital.

Conclusions: Clinical indicators may be used within specialist psychiatry services to enhance clinical care and aid in service development and teaching.
The Health of the Nation Outcome Scales: Validating Factorial Structure and Invariance Across Two Health Services
Authors: Preston Neil Joseph
Published: December 2009

Objective: The Health of the Nation Outcome Scale (HoNOS) was developed in the mid-1990s as an inclusive and comprehensive instrument to measure patient outcomes in four main factors: behaviour, impairment, symptoms and social problems. This paper attempts to investigate whether similar health services rate the HoNOS with equivalent psychometric calibration.

Method: The purpose of this study was to test for invariant construct interpretation of the instrument across two equivalent health services, using simultaneous confirmatory factor analysis.

Results: Although the four-factor model of the HoNOS was confirmed, structural non-invariance occurred, casting doubt on the equivalent interpretability and generalisability of the instrument across similar heath services.

Conclusions: Over-inclusiveness, lack of specificity and questionable independence of observations may have contributed to the non-invariant factor structure between the two health services. Such results shed some doubt on the ability of the HoNOS and like observational instruments to provide equivalent comparisons between health services.
The Internal and External Boundaries of Obsessive–Compulsive Disorder
Authors: Castle David J. , Groves Aaron
Published: December 2009

Objective: This study aims to explore the internal and external boundaries of obsessive–compulsive disorder (OCD).

Method: Selected literature is reviewed.

Results: Prevalence and incidence estimates for OCD vary markedly according to diagnostic criteria applied. External boundaries of the disorder are permeable, with a large degree of overlap with other psychiatric disorders, and an association with certain neurological disorders. Some cases of OCD appear to have a neurodevelopmental origin.

Conclusions: Further delineation of disorders characterised by obsessional and compulsive symptoms can inform models of aetiology, pathophysiology and treatment.
Cannabis, Vulnerability, and the Onset of Schizophrenia: An Epidemiological Perspective
Authors: Hambrecht Martin , Häfner Heinz
Published: December 2009

Objective: Second to alcohol, cannabis is the most frequently misused substance among patients with schizophrenia. The aim of this paper is to examine at early onset of psychosis whether the high comorbidity of schizophrenia and cannabis abuse is due to a causal relationship between the two disorders. Previous studies have mostly included chronic patients or samples with mixed stages of the psychotic illness.

Method: In a German catchment area with a population of 1 500 000, a representative first-episode sample of 232 patients with schizophrenia was included in the Age, Beginning and Course of Schizophrenia Study. By means of a structured interview, the Retrospective Assessment of the Onset of Schizophrenia, the onset and course of schizophrenic symptoms and of substance abuse was systematically assessed retrospectively. Information given by relatives validated the patients' reports.

Results: Thirteen per cent of the sample had a history of cannabis abuse, which was twice the rate of matched normal controls. Male sex and early symptom onset were major risk factors. While cannabis abuse almost always preceded the first positive symptoms of schizophrenia, the comparison of the onset of cannabis abuse and of the first (prodromal) symptoms of schizophrenia differentiated three approximately equal groups of patients: group 1 had been abusing cannabis for several years before the first signs of schizophrenia emerged, group 2 experienced the onset of both disorders within the same month, and group 3 had started to abuse cannabis after the onset of symptoms of schizophrenia.

Conclusions: The vulnerability-stress-coping model of schizophrenia suggests possible interpretations of these findings. Group 1 might suffer from the chronic deteriorating influence of cannabis reducing the vulnerability threshold and/or coping resources. Group 2 consists of individuals which are already vulnerable to schizophrenia. Cannabis misuse then is the (dopaminergic) stress factor precipitating the onset of psychosis. Group 3 uses cannabis for self-medication against (or for coping with) symptoms of schizophrenia, particularly negative and depressive symptoms. These patients probably learn to counterbalance a hypodopaminergic prefrontal state by the dopaminergic effects of cannabis. The implications of these very preliminary results include issues of treatment and prognosis, but replication studies are needed.