bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychotic-Like Experiences in a Community Sample of Adolescents: Implications for the Continuum Model of Psychosis and Prediction of Schizophrenia
Authors: Yung Alison R. , Nelson Barnaby , Baker Kathryn , Buckby Joe A. , Baksheev Gennady , Cosgrave Elizabeth M.
Published: December 2009

Objective: Studies conducted in community samples suggest that psychotic-like experiences are common in the general population, leading to suggestions that they are either variations of normal personality or are different expressions of underlying vulnerability to psychotic disorder. Different types of psychotic symptoms may exist, some being normal variants and some having implications for mental health and functioning. The aim of the present study was to determine if different subtypes of psychotic-like experiences could be identified in a community sample of adolescents and to investigate if particular subtypes were more likely to be associated with psychosocial difficulties, that is, distress, depression and poor functioning, than other subtypes.

Method: Eight hundred and seventy-five Year 10 students from 34 schools participated in a cross-sectional survey that measured psychotic-like experiences using the Community Assessment of Psychic Experiences; depression using the Centre for Epidemiologic Studies Depression Scale; and psychosocial functioning using the Revised Multidimensional Assessment of Functioning Scale. Factor analysis was conducted to identify any subtypes of psychotic experiences.

Results: Four subtypes of psychotic-like experiences were identified: Bizarre Experiences, Perceptual Abnormalities, Persecutory Ideas, and Magical Thinking. Intermittent, infrequent psychotic experiences were common, but frequent experiences were not. Bizarre Experiences, Perceptual Abnormalities and Persecutory Ideas were strongly associated with distress, depression and poor functioning. Magical Thinking was only weakly associated with these variables. Overall these findings may suggest that infrequent psychotic-like experiences are unlikely to be a specific risk factor for onset of a psychotic disorder in community samples.

Conclusions: Given that the different subtypes had varying associations with current difficulties it is suggested that not all subtypes confer the same risk for onset of psychotic disorder and poor outcome. Bizarre Experiences, Perceptual Abnormalities and Persecutory Ideas may represent expressions of underlying vulnerability to psychotic disorder, but Magical Thinking may be a normal personality variant.
Dopamine vs Noradrenaline: Inverted-U Effects and ADHD Theories
Authors: Levy Florence
Published: December 2009

The aim of the present study was to review the dopamine theory of attention-deficit–hyperactivity disorder (ADHD), in light of recent use of noradrenergic therapies. A historical review of pharmacological theories of ADHD was conducted, including inverted-U, spatial working memory and neural circuit aspects. Pharmacological advances, including animal and human studies of dopaminergic and noradrenergic mechanisms at the prefrontal cortex (PFC), indicate that α-2A adrenoreceptor stimulation results in increased dendritic firing during delay periods for preferred directions, while moderate levels of D1 receptor stimulation result in reduction of delay-related firing to non-preferred directions, allowing representational control in the PFC. Recent studies of the COMT val/met gene and stimulant medication response may help explain variation in inverted-U responses in individuals. Further studies utilizing delay-related firing paradigms should be useful in the investigation of attentional syndromes, and responses to newer pharmacological treatments.
Differences in Neuropsychological Performance Between Subtypes of Obsessive–Compulsive Disorder
Authors: Nedeljkovic Maja , Kyrios Michael , Moulding Richard , Doron Guy , Wainwright Kylie , Pantelis Chris , Purcell Rosemary , Maruff Paul
Published: December 2009

Objective: Neuropsychological studies have suggested that frontal–striatal dysfunction plays a role in obsessive–compulsive disorder (OCD), although findings have been inconsistent, possibly due to heterogeneity within the disorder and methodological issues. The purpose of the present study was therefore to compare the neuropsychological performance of different subtypes of OCD and matched non-clinical controls (NCs) on the Cambridge Automated Neuropsychological Test Battery (CANTAB).

Methods: Fifty-nine OCD patients and 59 non-clinical controls completed selected tests from CANTAB examining executive function, visual memory and attentional-set shifting. Depression, anxiety and OCD symptoms were also assessed.

Results: From 59 OCD patients, four subtypes were identified: (i) washers; (ii) checkers; (iii) obsessionals; and (iv) mixed symptom profile. Comparisons between washers, checkers, obsessionals and NCs indicated few differences, although checkers were generally found to exhibit poorer performance on spatial working memory, while obsessionals performed poorly on the spatial recognition task. Both checkers and the mixed subgroups showed slowed initial movement on the Stockings of Cambridge planning task and poorer pattern recognition relative to NCs.

Conclusion: Overall the results suggested greater impairments in performance on neuropsychological tasks in checkers relative to other subtypes, although the observed effects were small and the conclusions limited by the small subtype samples. Future research will need to account for factors that influence neuropsychological performance in OCD subtypes.
Psychiatric Symptoms and Dissociation in Conversion, Somatization and Dissociative Disorders
Authors: Espirito-Santo Helena , Pio-Abreu José Luís
Published: December 2009

Objective: Conversion, dissociation and somatization are historically related in the long established concept of hysteria. Somewhere along the way they were separated due to the Cartesian dualistic view. The aim of the present study was to compare these pathologies and investigate whether symptoms of these pathologies overlap in their clinical appearance in a Portuguese sample.

Method: Twenty-six patients with conversion disorder, 38 with dissociative disorders, 40 with somatization disorder, and a comparison group of 46 patients having other psychiatric disorders answered questions about dissociation (Dissociative Experiences Scale), somatoform dissociation (Somatoform Dissociation Questionnaire), and psychopathological symptoms (Brief Symptom Inventory).

Results: Dissociative and somatoform symptoms were significantly more frequent in dissociative and conversion disorder than in somatization disorder and controls. There were no significant differences between dissociative and conversion patients.

Conclusions: Conversion disorder is closely related to dissociative disorders. These results support the ICD-10 categorization of conversion disorder among dissociative disorders and the hypothesis of analogous psychopathological processes in conversion and dissociative disorders versus somatization disorder.
Excessive Exercise in Eating Disorder Patients and in Healthy Women
Authors: Mond Jonathan M. , Calogero Rachel M.
Published: December 2009

Objective: In order to elucidate the nature of excessive exercise among individuals with eating disorders, exercise behaviours were compared between eating disorder patients receiving specialist treatment and healthy women, and between subgroups of patients.

Methods: Self-report measures of obligatory exercise, motivation for exercise and frequency of hard exercise for weight or shape reasons were completed by eating disorder patients (n=102) and healthy women (n=184).

Results: The experience of intense guilt when exercise is missed and exercising solely or primarily for reasons of weight, shape or physical attractiveness, were the exercise behaviours that most clearly differentiated between women with eating disorders and healthy women. Patients with the purging form of anorexia nervosa (n=13) and those with bulimia nervosa (n=41) tended to have higher scores on measures of these behaviours than those with the restricting form of anorexia nervosa (n=15).

Conclusions: Research addressing the prevalence and correlates of excessive exercise in eating disorder patients would benefit from a broader assessment of exercise behaviour than has typically been used in previous studies. In addition, the findings may indicate specific targets for the clinical management of excessive exercise as well as for community-based health promotion initiatives.
Desire for Social Distance from People with Mental Disorders
Authors: Jorm Anthony F. , Oh Elizabeth
Published: December 2009

The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to make sense of this confusion, the present review focuses on research on the most commonly measured component: social distance. The review examines measurement of social distance; characteristics of people who desire greater social distance; experiences that affect social distance; characteristics of people that elicit social distance; the effects of psychiatric labelling; the effects of causal explanations for mental disorders; and interventions to reduce social distance. It is concluded that future research on social distance needs to focus on better evaluation of interventions and examine discriminatory and supportive behaviours in real life rather than in hypothetical situations.
Randomized Controlled Trial of an Early Intervention Programme for Adolescent Anxiety Disorders
Authors: Hunt Caroline , Andrews Gavin , Sakashita Chika , Crino Rocco , Erskine Alicia
Published: December 2009

Objective: To assess the effectiveness of an indicated early intervention and prevention programme for anxiety disorders when conducted by school staff.

Method: A total of 260 students in their first year of high school with self-reported anxiety symptoms >1 SD above the mean score of a normative sample were randomly allocated on the basis of their school to an intervention condition led by school staff or to a monitoring condition.

Results: There was little difference between conditions at the 2 year and 4 year follow up on self-reported symptoms, and no difference on diagnosis or health-care use.

Conclusions: Outcomes associated with indicated prevention programmes led by school staff may not be as strong as those produced by specialist mental health staff. More work is needed to delineate models by which evidence-based treatments can be effectively used in schools.
Emotion Categorization Perception in Schizophrenia in Conversations with Different Social Contexts
Authors: Huang Jia , Chan Raymond C. K. , Lu Xiaobin , Tong Zishun
Published: December 2009

Objective: The aim of the present study was to investigate whether the boundaries between the happy and angry emotions of schizophrenia would be influenced by social context and the difference in emotion categorization boundaries between schizophrenia patients and healthy controls.

Method: Eighteen patients with schizophrenia and 16 healthy controls were given a forced-choice emotion identification task in which they were required to listen to a series of conversations with different social contexts. The stimuli were linear morphed facial expressions between ‘happy’ and ‘angry’ emotions. For each type of social context, the shift point was used as the parameter to estimate when the subjects began to perceive the morphed facial expression as angry. The response slope was used to estimate how abruptly this change in perception occurred.

Results: There was no significant difference in the schizophrenia group in the shift point of emotion categorization perception for four categories of conversations occurring in different social contexts. Compared with the healthy controls, the schizophrenia group demonstrated a steeper response slope at the shift point regardless of the conversation type.

Conclusion: The patients with schizophrenia were less discriminative in their categorization of emotion perception in conversations with different social contexts. The schizophrenia patients, however, were more alert to angry facial expressions in the process of facial expressions morphing from happy to angry, independent of the social context.
Caseload Management, Work-Related Stress and Case Manager Self-Efficacy Among Victorian Mental Health Case Managers
Authors: King Robert
Published: December 2009

Objective: In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services.

Method: A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy.

Results: The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring.

Conclusion: Routine monitoring of caseload, especially by a workplace supervisor, may be effective in reducing work-related stress and enhancing case manager personal efficacy.
Factors Associated with Dropout and Diagnosis in Child and Adolescent Mental Health Services
Authors: Johnson Emily , Mellor David , Brann Peter
Published: December 2009

Objective: Dropout from child and adolescent mental health services has ramifications for children, families and the services themselves. Understanding the factors that are associated with dropout for different diagnoses has the potential to assist with tailoring of services to reduce dropout. The aim of the current study was to identify such factors.

Method: A file audit was conducted for all referrals to a child and adolescent mental health service over a 12 month period, yielding 520 subjects for analysis (264 male, 256 female, mean age = 12.6 years). Parent, child and service variables of interest were recorded as were diagnoses, which were categorized into 25 superordinate categories.

Results: Almost 50% of subjects dropped out of treatment. Factors associated with dropout varied across diagnosis, and no factor was associated with dropout for all diagnoses.

Conclusion: There are differences in the factors that were associated with dropout for different disorders. This is a useful finding in terms of understanding and preventing dropout in child and adolescent mental health settings, but more research is needed.
Ethnomethodological Study of the Values of Australian Psychiatrists: Towards an Empirically Derived RANZCP Code of Ethics
Authors: Robertson Michael , Kerridge Ian , Walter Garry
Published: December 2009

Objective: The aim of the present study was to identify the core values of Australian psychiatrists to ascertain how these are reflected in the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Code of Ethics.

Method: An ethnomethodological study was conducted on a non-purposive sample of Australian psychiatrists using a non-probabilistic theoretical sampling method. Data obtained at interview were analysed using a qualitative computer-assisted thematic analysis paradigm. The themes generated using this coding strategy were refined into a rich description of the core values held by Australian psychiatrists.

Results: Four main values emerged from the data: the value of the patient, the value of sophisticated understanding, the value of reflexivity, and the value of advocacy.

Conclusions: The four main values identified in the present study were well reflected in the main principles of the RANZCP Code of Ethics. In the light of the data, some additional annotations to the document are suggested, to better reflect this value system.
Removing Bridge Barriers Stimulates Suicides: An Unfortunate Natural Experiment
Authors: Beautrais Annette L. , Gibb Sheree J. , Fergusson David M. , Horwood L. John , Larkin Gregory Luke
Published: December 2009

Objectives: Safety barriers to prevent suicide by jumping were removed from Grafton Bridge in Auckland, New Zealand, in 1996 after having been in place for 60 years. This study compared the number of suicides due to jumping from the bridge after the reinstallation of safety barriers in 2003.

Methods: National mortality data for suicide deaths were compared for three time periods: 1991–1995 (old barrier in place); 1997–2002 (no barriers in place); 2003–2006 (after barriers were reinstated).

Results: Removal of barriers was followed by a fivefold increase in the number and rate of suicides from the bridge. These increases led to a decision to reinstall safety barriers. Since the reinstallation of barriers, of an improved design, in 2003, there have been no suicides from the bridge.

Conclusions: This natural experiment, using a powerful a-b-a (reversal) design, shows that safety barriers are effective in preventing suicide: their removal increases suicides; their reinstatement prevents suicides.
Illness Aetiology Constructs, Health Status and Use of Health Services among Cambodians in New Zealand
Authors: Cheung Peter , Spears George
Published: December 2009

Objective: The objectives of this study were to determine, among all adult Cambodians living in Dunedin: prevalence of illness aetiology beliefs; psychiatric and physical health status; pattern of use of health services; relationships between use of health services and demographic factors, illness aetiology constructs and health status; and problems encountered and improvements desired in the local health services.

Method: 223 (i.e. 93.3% of all) adult Cambodians living in Dunedin were assessed, using a structured interview, in relation to their sociodemographic status, illness aetiology beliefs, physical health status and use of health services. The 28-item version of the General Health Questionnaire was used to assess psychiatric status.

Results: Subjects held multiple indigenous and Western illness aetiology constructs. Psychiatric morbidity using the 28item of the General Health Questionnaire (GHQ28) cutoff of 3/4 was 15.7% despite this only six subjects had ever used specialist psychiatric services. Malaria, intestinal parasitic infestations and heart conditions were the three most frequently reported physical problems. Most subjects had used traditional services in Cambodia but very few had used them in New Zealand. Health service was related to duration of stay in New Zealand. Socio-economic status, both physical and psychiatric health status and some illness aetiology constructs. One hundred and forty-two (63.7%) subjects reported problems with use of health services in Dunedin.

Conclusion: Despite methodological limitations, some useful preliminary data on factors pertaining to use of and satisfaction with health services among Cambodians were collected. Future research should examine family characteristics and the decision-making processes that determine service use.
Sissiness, Tomboyism, Sex-Role, Sex Identity and Orientation
Authors: McConaghy Nathaniel , Zamir Ruth
Published: December 2009

Masculinity and femininity have been studied by self-ratings in independent areas of research: one investigating personality traits considered masculine (M) or feminine (F); the other, behaviours statistically more common in one than in the other sex (sex-linked behaviours). The two approaches were compared for the first time in the present study of 66 male and 51 female medical students. Consistent with previous findings using the second approach, male but not female subjects' opposite sex-linked “sissy” and “tom-boyish” behaviours correlated significantly with their reported ratio of homosexual to heterosexual feelings (Ho/Het). Ho/Het did not correlate with either sex's M and F scores, but high M scores in women correlated strongly with several “tomboyish” behaviours. As “tomboyish” behaviours are shown more strongly by women exposed prenatally to increased levels of opposite sex hormones compared to controls, the findings have implications for the biological theory attributing Ho/Het to such prenatal hormonal exposure.
Evaluation of a Rural Telepsychiatry Service
Authors: Greenwood James , Chamberlain Christie , Parker Gordon
Published: December 2009

Objective: To evaluate a telepsychiatry clinical service to Wagga Wagga in rural New South Wales, comprising a face-to-face interview with a psychiatrist followed by a telepsychiatry interview with a Sydney-based psychiatrist.

Methods: Thirty-one patients were referred to a specialist mood disorder clinic in a rural setting for consultation and assessment. A retrospective evaluation was made to determine the acceptance of the teleconferenced psychiatry and face-to-face psychiatry, as well as the overall patient response.

Results: Twenty participants completed all evaluation components. Their results indicated a satisfaction level of 95% with the consultation process as a whole, with 80% happy to use telepsychiatry again and 60% preferring telepsychiatry over travelling to a larger centre for face-to-face consultation. The face-to-face component was satisfactory for 85% of patients while the telepsychiatry component was satisfactory for 72%.

Conclusions: Although face-to-face psychiatry was preferred by this sample, the telepsychiatry component was highly rated and preferred over travel to larger centres for face-to-face consultation, by residents of rural and remote locations. Certain issues are of more concern in telepsychiatry than face-to-face psychiatry, including confidentiality, rapport, explanation and education.
Repetitive Transcranial Magnetic Stimulation and Electroconvulsive Therapy: Complementary or Competitive Therapeutic Options in Depression?
Authors: Fitzgerald Paul
Published: December 2009

Objective: To examine issues pertaining to the potential clinical roles of repetitive transcranial magnetic stimulation (rTMS) and the relationship of these to the use of electroconvulsive therapy (ECT).

Methods: A review of studies was carried out comparing the use of rTMS and ECT, with consideration of issues relating to the populations in which rTMS may be applied.

Results: There have been a number of randomized comparisons of rTMS and ECT. There are limitations with these studies, but in general they indicate that in non-psychotic patients rTMS appears to have a similar rate of response to ECT and certainly seems to have meaningful clinical effects. There are a number of clinical subpopulations in whom rTMS, but not ECT, is suitable, and assessment of the effectiveness of TMS in these populations is required.

Conclusions: Repetitive TMS and ECT are likely to prove to be complementary clinical tools and the introduction of clinical programmes with rTMS will enhance patient options rather than replace the use of ECT.
Admissions of Elderly Patients from English-Speaking and Non-English-Speaking Backgrounds to an Inpatient Psychogeriatric Unit
Authors: Hassett Anne , George Kuruvilla , Harrigan Susan
Published: December 2009

Objective: The aim of this study was to compare differences between elderly patients from non-English-speaking backgrounds (NESB) and English-speaking backgrounds (ESB) admitted to an acute psychogeriatric unit.

Method: Sociodemographic and clinical variables were collated from inpatient files for a 12-month period and analysed according to NESB and ESB status. The 1996 Australian Census data were used for comparison of catchment area representation of different ethnic groups.

Results: With a few exceptions, admission rates for elderly patients from NESB reflected the representation of that ethnic group in the catchment area population figures. No significant differences were found between the two groups for mean age, length of stay and previous admissions to the unit. Patients from NESB were less likely to be admitted voluntarily and less likely to be diagnosed with affective disorder. These differences were more marked for males, who were more likely to be diagnosed with dementia.

Conclusions: These findings suggest that further investigation is required into the accessibility of psychiatric hospitalisation for elderly patients from NESB. Under recognition of disorders such as depression and reluctance to accept necessary inpatient management are two possible factors that should concern mental health service providers for the ethnic elderly. A subsequent analysis will examine if differences also exist between elderly patients from NESB and ESB who receive community-based psychiatric treatment. Implications for mental health service provision for the elderly from NESB are discussed.
Post-Stroke Mania Late in Life Involving the Left Hemisphere
Authors: Fenn David , George Kuruvilla
Published: December 2009

Objective: Although post-stroke depression is well recognised, post-stroke mania has rarely been reported and researched. Most reported cases have involved lesions of the non-dominant hemisphere. We report a case of late-onset mania following stroke with a lesion in the dominant hemisphere.

Clinical picture: A 78-year-old, right-handed man developed sudden cognitive deficits and manic symptoms. Investigations revealed lesions in the dominant hemisphere.

Treatment: Pharmacological intervention was complicated by side effects. Outcome: His symptoms resolved gradually over 2 months and he was back to normal in 4 months.

Conclusions: We would encourage further study in the area of post-stroke mania and especially in relation to the site of the lesion in the brain.
Actigraphic Predictors of Depressed Mood in a Cohort of Non-Psychiatric Adults
Authors: Mendlowicz Mauro V. , Jean-Louis Girardin , von Gizycki Hans , Zizi Ferdinand , Nunes João
Published: December 2009

Objective: Depressed mood is one of the essential features for the diagnosis of major depression. Evidence from the three-site Epidemiologic Catchment Area study (EcA, Baltimore, Durham and Los Angeles) suggests a prevalence of 4.4% of depressive symptoms in the community. In this study, we examined whether depressed mood, as coded in the Alzheimer's Disease Assessment Scale, would be correlated with actigraphic-derived daytime activity and sleep/wake parameters in a non-psychiatric sample.

Method: Consenting volunteers were monitored at home for 5 days with a wrist actigraph. On the last day of the recording, they were given a neuropsychological battery including the Alzheimer's Disease Assessment Scale.

Results: Daytime activity level was the best predictor of depressed mood as indicated by a logistic regression analysis. The regression model further suggested that sleep onset latency, total time asleep, and time in bed were also significant predictors of depressed mood.

Conclusion: This investigation demonstrates that daytime activity level could be used as an index of depressed mood even in a non-psychiatric sample. Further, the results support the notion that depression should be considered more as a continuum rather than as a set of rigid categories.
Cannabis Use in Psychotic Patients
Authors: Sembhi Sati , Lee Joseph W.Y.
Published: December 2009

Objective: The purpose of this study was to examine the level of cannabis use in psychotic patients admitted to two acute admission wards in New Zealand. Symptomatology was investigated using the Brief Psychiatric Rating Scale (BPRS).

Method: During a 1-month period, all acute admissions to Tokanui Hospital with psychosis were interviewed and symptoms rated on the BPRS (n = 35). Cannabis use was recorded with a questionnaire and urine test. Those positive for cannabis were compared to those negative.

Results: Thirty patients (86%) had tried cannabis at least once and 11 (31%) were positive on urine screen. Those with positive urine tests were significantly more likely to use cannabis most days (p < 0.001). This positive urine test group was less likely to be thought disordered, suspicious or deluded (as measured by the BPRS).

Conclusions: Cannabis use was widespread in this sample of patients with psychosis and may affect their symptomatology. Larger studies are needed to examine these associations in more detail.
Dissociation, Abuse and the Eating Disorders: Evidence from an Australian Population
Authors: Brown Lisa , Russell Janice , Thornton Christopher , Dunn Stewart
Published: December 2009

Objective: Anumber of European and Northern American studies have investigated a possible association between dissociative phenomena, eating disorders, child sexual abuse and self-mutilation. However, there has been little confirmation from other countries and cultures, and the Australian experience of these interrelationships has not previously been studied.

Method: Dissociative symptomatology and self-reported history of abusive experiences, physical and sexual, were retrospectively studied in a sample of Australian eating disordered patients using a self-report measure, the Dissociation Questionnaire (DIS-Q).

Results: As hypothesised, dissociative symptoms were particularly frequent in those who reported child and adult sexual abuse and in those who self-mutilated. A correlation between multiple forms of abuse and higher dissociation scores was only partially upheld.

Conclusions: Interrelationships between victimisation and dissociation are discussed within the context of current knowledge in the field, and brief suggestions for therapeutic strategies are offered.
A Randomised, Double-Blind, Placebo-Controlled Trial of Dexamphetamine in Adults with Attention Deficit Hyperactivity Disorder
Authors: Paterson Roger , Douglas Charles , Hallmayer Joachim , Hagan Michael , Krupenia Zyron
Published: December 2009

Objective: The aim of this paper is to determine the efficacy of dexamphetamine in adult attention deficit hyperactivity disorder (ADHD) in a naturalistic setting.

Method: A randomised, double-blind, placebo-controlled study of dexamphetamine was conducted by two psychiatrists in private practice who saw a total of 68 consecutive referrals of patients thought to have ADHD by their referring general practitioners. Patients were admitted to the study if their current level of ADHD symptoms satisfied DSM-IV criteria (modified for use in adults), and were not currently comorbid for major mood disturbance or substance abuse. Response to medication was assessed by repeated administration of these modified DSM-IV criteria, self- and relatives' rating, as well as clinician rating using the Clinical Global Impressions Scale. More general outcome measures included the Brief Symptom Inventory and a patient satisfaction questionnaire. Medication side effects were recorded, including monitoring blood pressure and weight change. Urinalysis monitored concurrent substance usage and compliance.

Results: Dexamphetamine had a significant therapeutic response exceeding the placebo response (p = 0.045). The response was similar in both genders and across the age range. It was detected by patients, their relatives and the two clinicians. The only significant side effect was weight loss. One patient on dexamphetamine discontinued the trial because of an event possibly related to the medication.

Conclusions: In the short term, dexamphetamine appears to be efficacious in treating adult ADHD. As this is the first study in the literature, the result requires replication. Given that stimulant medication use in adult ADHD appears to be long-term, studies of long-term efficacy need to be carried out.
Psychological Factors in Severe Chronic Asthma
Authors: Vamos Marina , Kolbe John
Published: December 2009

Objective: Levels of psychological distress, social support factors, and emotional adjustment to illness were measured in a sample of patients with severe asthma. These were then examined in terms of their interrelationships and their ability to predict self-management knowledge.

Method: A sample of 80 patients was recruited from a hospital-based asthma clinic designed for patients with severe asthma. Thirty-four percent of consecutive attenders approached took part. Morbidity and asthma management were recorded from case records. Anxiety, depression, social support, emotional adjustment to asthma and asthma knowledge were measured using self-report instruments selected for their acceptability and ease of administration.

Results: Twenty-five percent of the sample had possible or definite caseness for anxiety; 10.3% had possible or definite caseness for depression. Twenty-five percent had inadequate social support in some way. Three independent attitudinal factors were found: emotional maladjustment to asthma, the doctor-patient relationship, and asthma-related stigma. Level of asthma knowledge was very low. None of the measures of psychosocial function chosen were predictive of asthma knowledge.

Conclusions: Levels of asthma knowledge were dangerously low, despite apparently adequate educational intiatives. In addition, patients with severe asthma have high levels of distress, particularly of anxiety, even between attacks. Their attitudes to their illness are multifactorial, and are significantly correlated with emotional distress, morbidity indices and some demographic factors. While this may point the way to interventions designed to relieve patients' distress, the hypothesis that this might in turn relate to practical asthma knowledge was not confirmed.
Psychotherapy with Borderline Patients: II. A Preliminary Cost Benefit Study
Authors: Stevenson Janine , Meares Russell
Published: December 2009

Objective: The aim of this study was to conduct a preliminary cost benefit study of the effect of outpatient psychotherapy, twice a week for 1 year, in 30 borderline patients.

Method: Costs to the health system in terms of inpatient care for the year before treatment were compared with the costs for the year following treatment.

Results: The cost of hospital admissions for the 30 patients for the year before treatment was $684 346 (range = $0–$143 756/patient). The cost of hospital admissions for the year after treatment was $41 424 (range = $0–$12 333/patient). These figures represent an average decrease in costs per patient of $21 431. By using the schedule fee as the basis, the estimated cost of therapy per patient was approximately $13 000, representing a saving/patient of $8431 or approximately $250 000 over the total cohort in the first year after treatment.

Conclusion: This study suggests that there is a significant cost benefit in the appropriate treatment of borderline patients.
Measurement of Need for Care: A Trial of the Camberwell Assessment of Need and the Health of the Nation Outcome Scales
Authors: Issakidis Cathy , Teesson Maree
Published: December 2009

Objective: The accurate assessment of the individual needs of clients has been the focus of increasing discussion in mental health service delivery and evaluation. There is evidence to suggest that clinicians and clients differ in their perceptions of need and that staff assessments alone may not be sufficient for determining need for care. This study addresses these discrepancies in an Australian setting.

Method: The Camberwell Assessment of Need (short version) and the Health of the Nation Outcome Scales (HoNOS) were completed on a sample of 78 clients of a mental health service in inner Sydney.

Results: Clinicians identified a mean number of 7.3 needs per client (SD = 5.0) compared with 6.0 (SD = 2.4) identified by clients. The mean kappa coefficient for agreement between clinicians and clients in identification of the 22 need areas was 0.18 (range = 0–0.45), indicating poor to moderate agreement. Similarly, client ratings of need were only moderately correlated with clinician ratings of disability on the HoNOS (Pearson's r = 0.35). Clinician ratings of disability and unmet need were highly correlated (Pearson's r = 0.80), whereas ratings of disability and met need were moderately correlated (Pearson's r = 0.52).

Conclusions: Individual needs assessments using the CAN are applicable in this Australian setting. Staff and clients differ in their assessment of need. It is important to consider both the role of the rater and the context in which they are making the ratings when applying need and disability assessments in clinical practice.
Australia's Mental Health: An Overview of the General Population Survey
Authors: Henderson Scott , Andrews Gavin , Hall Wayne
Published: December 2009

Objectives: The objectives of this study were to estimate the 1-month and 1-year prevalence of mental disorders in the Australian adult population; to determine the amount of disablement associated with this; and to determine the use of health and other services by persons with common mental disorders.

Method: For the Adult Survey, a household sample of 10 600 persons aged 18 years and over were interviewed across Australia by experienced field staff of the Australian Bureau of Statistics. This was 78%% of the target sample. The interview consisted of the composite international diagnostic interview in its automated presentation (CIDI-A) and other components to determine disablement, use of services and satisfaction with services received. The diagnostic classifications used in the analyses were both ICD-10 and DSM-IV. Only the results from ICD-10 are reported here.

Results: A total of 17.7%% of the sample had one or more common mental disorders, anxiety, depression, alcohol or substance abuse and neurasthenia. This morbidity was associated with considerable disablement in daily life: 3 days of impaired social role performance in the previous 4 weeks, compared with 1 day for the general population. Of all cases, 64.6%% had had no contact with health services in the previous year; 29.4%% had seen GPs and 7.5%% had seen psychiatrists.

Conclusion: Australia now has its own national estimates of psychiatric morbidity. The morbidity is associated with considerable disablement, but most of it is untreated. General practitioners encounter by far the largest proportion of those reaching services.
Risk Factors for Suicide and Attempted Suicide among Young People
Authors: Beautrais Annette L.
Published: December 2009

Objective: Suicide rates in young people have increased during the past three decades, particularly among young males, and there is increasing public and policy concern about the issue of youth suicide in Australia and New Zealand. This paper summarises current knowledge about risk factors for suicide and suicide attempts in young people.

Method: Evidence about risk factors for suicidal behaviour in young people was gathered by review of relevant English language articles and other papers, published since the mid-1980s.

Results: The international literature yields a generally consistent account of the risk factors and life processes that lead to youth suicide and suicide attempts. Risk factor domains which may contribute to suicidal behaviour include: social and educational disadvantage; childhood and family adversity; psychopathology; individual and personal vulnerabilities; exposure to stressful life events and circumstances; and social, cultural and contextual factors. Frequently, suicidal behaviours in young people appear to be a consequence of adverse life sequences in which multiple risk factors from these domains combine to increase risk of suicidal behaviour.

Conclusions: Current research evidence suggests that the strongest risk factors for youth suicide are mental disorders (in particular, affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology, indicating that priorities for intervening to reduce youth suicidal behaviours lie with interventions focused upon the improved recognition, treatment and management of young people with mental disorders.
Demoralisation, Depression and Desire for Death: Problems with the Dutch Guidelines for Euthanasia of the Mentally Ill
Authors: Kissane David W. , Kelly Brian J.
Published: December 2009

Objective: Given the recent publication of Dutch guidelines for euthanasia of the mentally ill, our aim in this paper is to review the clinical role of the psychiatrist in assessing patients who seek euthanasia or physician-assisted suicide.

Method: Three areas are examined that are informative of the role of the psychiatrist in assessing patients who desire death: recent surveys of psychiatrists' attitudes, empirical and clinical studies, and treatment issues.

Results: Demoralisation and depression emerge as pertinent clinical issues worthy of psychiatric intervention. The role of the psychiatrist is complex and includes issues of assessment, systems, countertransference and treatment.

Conclusions: Dutch guidelines for physician-assisted suicide in the mentally ill generate serious concern given the uncertainty of prognosis, potential range and variability of outcome of treatments of suicidality and the boundary violations that are involved for the psychiatrist. The guidelines have the potential to dangerously alter the practice of psychiatry and should be condemned.
Medicine, Psychiatry and Euthanasia: An Argument Against Mandatory Psychiatric Review
Authors: Parker Malcolm
Published: December 2009

Objective: The paper critically appraises the argument that requests for active assistance to die should be subject to mandatory psychiatric assessment.

Method: The argument for mandatory psychiatric assessment is usually supported by an appeal to the need for safeguards against errors and omissions in both the diagnosis of psychiatric conditions affecting the terminally ill and the exploration of the meanings of their requests. This intuitively appealing view is challenged through a broader analysis which examines connections between medicine's traditional adherence to the moral distinction between acts and omissions and the following issues: the historical relationship between medical practice and dying, the recent development of research into treatment-withdrawal decisions, the scientific status of psychiatry, the logic of rationality and decision-making competence.

Results: The analysis reveals a number of hitherto unexamined and unacknowledged influences which would make psychiatric review of requests for assisted death a much less objective and impartial process than is assumed.

Conclusion: Mandatory psychiatric review is an instance of the medicalisation of death and dying which could abridge the freedom of certain individuals to make decisions about their deaths.
Psychotic Disorders in Urban Areas: An Overview of the Study on Low Prevalence Disorders
Authors: Jablensky Assen , McGrath John , Herrman Helen , Castle David , Gureje Oye , Evans Mandy , Carr Vaughan , Morgan Vera , Korten Ailsa , Harvey Carol
Published: December 2009

Objective: This paper reports on a study designed within the framework of the National Survey of Mental Health and Wellbeing to: estimate the prevalence of psychoses in urban areas of Australia; identify profiles of symptomatology, impairments and disabilities; collect information on services received and needed; and explore quality of life issues in a broadly representative sample of people with psychotic illnesses.

Method: The study was conducted over four areas in the Australian Capital Territory, Queensland, Victoria and Western Australia, as a two-phase survey: (i) a census and screening for psychosis of all individuals who made contacts with mental health services during a period of 1 month in 1997; and (ii) interviews with a stratified random sample (n = 980) of the screen-positive individuals (n = 3800) using a standardised instrument.

Results: The point prevalence (1 month) of psychotic disorders in the urban population aged 18–64 is in the range of 4–7 per 1000 with a weighted mean of 4.7 per 1000. People with psychotic disorders experience high rates of functional impairments and disability, decreased quality of life, persistent symptoms, substance-use comorbidity and frequent side effects of medication. Although the utilisation of hospital-based and community mental health services, as well as of public and non-governmental helping agencies, is high, the majority live in extreme social isolation and adverse socioeconomic circumstances. Among the many unmet needs, the limited availability of community-based rehabilitation, supported accommodation and employment opportunities is particularly prominent.

Conclusions: The so-called ‘low-prevalence’ psychotic disorders represent a major and complex public health problem, associated with heavy personal and social costs. There is a need for a broad programmatic approach, involving various sectors of the community, to tackle the multiple dimensions of clinical disorder, personal functioning and socioeconomic environment that influence the course and outcome of psychosis and ultimately determine the effectiveness of service-based intervention.
How High a Dose of Stimulant Medication in Adult Attention Deficit Hyperactivity Disorder?
Authors: Sachdev Perminder S. , Trollor Julian N.
Published: December 2009

Objective: This paper examines clinical and neuroscientific evidence to address the question whether high doses of stimulant drugs offer additional advantages in the treatment of adult attention deficit hyperactivity disorder (ADHD) and at what cost. It attempts to arrive at a reasonable upper limit of dosage for clinical purposes.

Method: The study involves a selective review of the treatment studies of ADHD in children and adults and an examination of the pharmacokinetic and pharmaco-dynamic data on psychostimulants in humans and animals.

Results and Conclusions: The clinical and experimental data justify the use of chronic low-dose stimulant treatment of ADHD in adults, with the recommended upper limit of dose being 1 mg/kg for methylphenidate and 0.5 mg/kg for dexamphetamine. There is no empirical evidence of greater improvement with higher doses and any beneficial effect is likely to be compromised by the adverse effects, some of which can be very serious. The recommended doses should be exceeded only after careful consideration and objective documentation of beneficial and adverse consequences. Monitoring of drug levels in blood may be of some value for compliance or pharmacokinetic considerations, as there is a direct relationship between blood and brain levels as well as dopamine transporter occupancy. These recommendations are tentative and further clinical research is warranted.