bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding of subordinate clauses in the language of dysphasic children
Authors: Lazarevic Emilija , Tenjovic Lazar
Published: January 2008

This paper presents the results of the research of peculiarities of syntactic development, as an element of language structure on the grammatical level of children suffering from developmental dysphasia, after the completed speech pathology treatment of many years. Syntactic level at younger school age was studied by assessing language competence in the accomplishment of communicative sentence with subordinate clause. The research was performed on the samples of children at school age in regular primary schools in Belgrade. The sample comprised 160 respondents who were divided in two groups: target and comparative. The target group consisted of 60 respondents (children suffering from developmental dysphasia after the completed speech pathology treatment of many years), and the comparative group consisted of 100 respondents from regular primary school "Gavrilo Princip" in Zemun. Research results show that grammatical development of children suffering from developmental dysphasia takes place at a considerably slower rate and entails substantially more difficulties in accomplishing predication in subordinate clauses. This paper discusses the consequences which the difficulties in grammatical development can have on school achievement.
Investigation of passively mode-locked erbium doped fiber ring laser due to nonlinear polarization rotation
Authors: Nikodem M. , Budnicki A. , Tomczyk G. , Abramski K.
Published: January 2008

Passively mode-locked erbium doped fiber ring laser was investigated. We present optimization of laser configuration where nonlinear polarization rotation was used for modes synchronization. Simulations of pulse propagation inside a laser cavity were applied in order to confirm the optimisation technique. Experimental results are presented and more than 32-nm spectral width of the output frequency comb was obtained.
Relative Entropy for States of von Neumann Algebras II
Authors: Araki Huzihiro
Published: January 2008

Earlier definition of the relative entropy of two faithful normal positive linear functionals of a von Neumann algebra is generalized to non-faithful functionals. Basic properties of the relative entropy are proved for this generalization.
Adverse Experiences in Psychiatric Training. Part 2
Authors: Kozlowska Kasia , Nunn Kenneth , Cousens Pennelope
Published: January 2008

Objective: To examine the perceptions of New South Wales (NSW) psychiatric trainees in relation to their training, the adverse events they experienced and the role and quality of the consultant registrar relationship.

Method: A self-report questionnaire was developed to probe trainee perceptions of the consultant-trainee relationship and adverse events during training in all those who had completed at least 1 year of training in psychiatry (n = 138) in NSW, as well as all consultants who had completed their training in the last 5 years (n = 95). All subjects were asked to rate the frequency and relative impact of 20 adverse experiences with the opportunity to proffer adversities not listed. They were also asked to rate their experience of their consultants in relation to the adversity.

Results: The results from The Training Impact Study exploring adverse events experienced by NSW trainees are presented. Assault by a patient and suicide of a patient are identified as the most stressfull adversities of training in psychiatry. However, more general concerns such as educational and emotional neglect by upervisors, observing consultant maltreatment of patients, exam failure and conflict between consultants were also identified and discussed.

Conclusions: The high response rate of both trainees and consultants gives these results a level of representative validity. Recommendations in relation to future training and research are put forward. Specific training in the management of potentially assaultive patients and facilitating trainee recovery from assault or threat of assault should be a priority of the Royal Australian and New Zealand College of Psychiatrists. Support and education in relation to patient suicide is also important. Training and recognition of teachers within the College should be encouraged.
The Comorbidity of Anxiety and Depression
Authors: Rodney James , Prior Nigel , Cooper Betty , Theodoros Mike , Browning Joanne , Steinberg Ben , Evans Larry
Published: January 2008

Objective: This study explored the effect of comohid anxiety disorders in patients admitted to an inpatient specialist Mood Disorders Unit for the treatment of a primary major depressive episode.

Method: Subjects were assessed on admission and discharge. DSM-Ill-R diagnoses for major depression and anxiety disorders were established using CIDI-Auto; cornorbid anxiety disorders were coexistent in time with the major depression, with both conditions meeting diagnostic criteria at the time of assessment. Severity of illness was assessed using the Hamilton DepressiodMelancholia Scale, the revised Hamilton Anxiety Scale and the revised Beck Depression Inventory.

Results: For the analysis, the study cohort was divided into three groups: depression alone (n = 33), one comorbid anxiety disorder (n = 15), and two or more comorbid anxiety disorders (n = 24). No particular anxiety disorder predominated. Interestingly, the presence or absence of comorbid anxiety with severe major depression made no significant difference to treatment choice or outcome results. Specifically, there was no significant difference between the three groups in the utilisation of electroconvulsive therapy and pharmacotherapy (including antidepres-sants, benzodiazepines and neuroleptics); all subjects improved significantly on both depression and anxiety ratings, and length of inpatient stay did not vary significantly between the three groups.

Conclusions: The existence of comorbid anxiety disorders in those patients who presented for treatment of a primary major depressive episode did not significantly effect choice of treatment or treatment outcome, suggesting that there is a close interrelationship between the two conditions.
The Effect of a New Integrated Mental Health Service on Hospitalisation
Authors: Mellsop Graham W. , Blair-West George W. , Duraiappah Vasanthi
Published: January 2008

Objective: The purpose of the present study was to partially evaluate a new integrated mental health service by monitoring inpatient lengths of stay. We hypothesised that the median cumulated length of stay for inpatients would decrease, and that the frequency of readmissions would not increase.

Method: Data was collected for two 6-month periods before and after the introduction of an integrated mental health service (IMHS). Two functionally identical wards (G and E) were studied. Ward G was then integrated with the regional community psychiatry service, while Ward E remained non-integrated.

Results: Following integration, the median cumulative length of stay in the IMHS's Ward G was more than halved in comparison with both its own baseline and with the non-integrated ward. The average length of stay of overdose patients at the regional general hospital that was serviced by the IMHS was also reduced from 2.6 days to 1.5 days. The non-IMHS ward had a non-significant increase in admissions and no change in cumulative length of stay.

Conclusion: The hypotheses of this study were supported by the results. Twelve beds were subsequently closed as a result of the efficiencies generated by integration. These findings support the model of true integration trialled here.
Integrated Mental Health Care: Practitioners' Perspectives
Authors: Allen Ruth E.S. , Read John
Published: January 2008

Objective: Integrated mental health care (IMHC) is a community-based model that considers the patient and informal carers to be the major contributors to stable recovery from severe mental health problems. This study investigates the implementation of IMHC by 35 New Zealand practitioners 1 year after being trained in the model. It also explores their experiences and perceptions regarding the model.

Method: Quantitative and qualitative data were gathered by combining a questionnaire survey with in-depth interviews.

Results: Few of the trainees had been able to implement the model as much as they would have liked. A primary barrier to implementation was created by the resource constraints that impede most innovative community care initiatives even when demonstrated to be more cost-effective than traditional hospital-based approaches. Concerns particular to IMHC included issues relating to flexibility, time-intensiveness and applicability to New Zealand. Many practitioners found some of the specific intervention strategies and the clear overall structure of the model useful. Its psychosocial emphasis had a positive impact on many practitioners' beliefs about the causes and prognosis of severe mental health problems.

Conclusions: Participants offer a range of recommendations as to how IMHC might be applied and adapted. Consultation with staff, consumers, families and Maori, as well as a strengthening of the psychosocial components, are recommended.
Substance use Disorders among Men in Prison: A New Zealand Study
Authors: Bushnell John A. , Bakker Leon W.
Published: January 2008

Objective: This study set out to determine the extent of alcohol and drug disorder among male prisoners prior to their incarceration in a New Zealand prison. Method: Sections of the Diagnostic Interview Schedule that assess alcohol and drug disorders according to DSM-III criteria were administered to 100 sequential new arrivals at a male medium/minimum security prison.

Results: Eighty-one percent of the prisoners had a lifetime alcohol disorder, and 39% of them had symptoms in the 6 months prior to incarceration. Half of the prisoners had met criteria for an alcohol-dependence syndrome. Thirty percent had a lifetime drug use disorder with 14% showing symptoms in the last 6 months prior to incarceration. One-quarter had been drug dependent. After adjustment of the lifetime prevalence estimates for the differing age distribution within the prison, alcohol disorder was more than twice as common among prisoners as in the general population, and drug use disorder was eight times as common.

Conclusions: Since high rates of alcohol and drug disorder are found among sentenced prisoners, both in the 6 months prior to incarceration and over their lifetime, resources within the prison may need to be directed towards minimising the harm from substance use disorder and associated risk behaviour.
Interaction of Serotonin Re-Uptake Inhibitors with Perhexiline
Authors: Alderman Christopher P. , Hundertmark James D. , Soetratma Tanya W.
Published: January 2008

Objective: To report two cases of perhexiline toxicity associated with selective serotonin re-uptake inhibitor (SSRI) treatment.

Clinical picture: Serum perhexiline concentrations progressively increased after a 69-year-old man was concurrently prescribed paroxetine for the treatment of depression. An 84-year-old woman was admitted to hospital with severe, symptomatic perhexiline toxicity associated with fluoxetine treatment.

Treatment: In both cases, perhexiline therapy was suspended and treatment with SSRIs was withdrawn.

Outcome: Serum perhexiline concentrations declined following the withdrawal of paroxetine in one case, but in the case of the second patient perhexiline concentrations were extremely slow to decrease, resulting in referral to a rehabilitative care unit for convalescence.

Conclusions: Serum perhexiline concentrations may be elevated during concurrent treatment with SSRIs, potentially resulting in severe toxicity.
Is Pre-Psychotic Intervention Realistic in Schizophrenia and Related Disorders?
Authors: Yung Alison R. , McGorry Patrick D.
Published: January 2008

Objective: The aim of this paper is to discuss the logistic and ethical questions related to the possibility of intervention prior to the onset of first-episode psychosis (i.e. during the prodromal phase).

Method: The method involved examination of the published literature on prevention of psychotic disorders and other mental disorders, and critical evaluation of current practice in treating pre-psychotic individuals.

Results: Issues of possibly unnecessary or premature labelling, stigma and treatment arise. The question of whether such early intervention merely diagnoses the disorder earlier but does not actually improve outcome is also discussed, as are the economic implications of shifting emphasis from treatment of established disorders to preventive interventions.

Conclusions: There are many legitimate concerns related to intervening in pre-psychotic individuals which must be understood by those involved in planning preventive interventions. Policies should be developed incorporating some of the ethical and economic concerns, and these need to be evaluated and changed in response to ongoing research. However, these issues need not stand in the way of the development of innovative preventive approaches to the treatment of schizophrenia and other psychotic disorders.
Tests in Psychiatry
Authors: Ellard John
Published: January 2008

Objective: This essay examines the proposition that clinical psychiatrists should make more use of the ancillary tests available to them. It argues that many of the tests are of doubtful validtty and are more concerned with sorting patients into categories which are both impermanent and insubstantial than with clinical usefulness.

Method: Consideration is given to the way in which many psychiatrists use those tests of mental status which are available to them, often showing little awareness of the scoring procedures, norms and limitations of the tests being used. Many of the questionnaires available restrict the field of enquiry to achieve reliability at the cost of validity. Careful examination of some commonly used measures has shown that they do nothing to improve diagnostic accuracy and can be misleading. Simple direct questions can be more useful and more valid.

Results and Conclusions: The ancillary tests available to psychiatrists do little to assist them and the important problems of clinical management. In general, they are more concerned with attaching labels to patients than throwing light on the nature of their disorders and how they may be managed.
A Comparison of the Eating Disorder Examination and a General Psychiatric Schedule
Authors: Wade Tracey , Tiggemann Marika , Martin Nicholas , Heath Andrew
Published: January 2008

Objective: The aim of this study is to investigate the adequacy of a general interview schedule for the purpose of assessing bulimia net vosa.

Method: In two waves of data collection 18–24 months apart, 250 women were assessed for disordered eating. The first interview was typical of that included in many psychiatric interview schedules and was used to screen women for selection in a subsequent interview. This latter interview, using the Eating Disorder Examination, represents the ‘gold standard’ for the assessment of disordered eating.

Results: While the psychiatric interview satisfactorily assessed disturbed eating in general, it seemed less capable of accurately assessing cases of bulimia nervosa in particular, the major weakness being the overestimation of binge-eating.

Conclusions: Structured psychiatric interviews are suitable for screening purposes to identify women with disordered eating, but identification of bulimia nervosa requires further assessment with a suitable instrument.
Disordered Water Homeostasis in Asian Patients with Schizophrenia
Authors: Chong Siow-Ann , Tan Lay-Ling , Wong Mun-Chong , Woo Siew-Choo , Tan Chay-Hoon , Ng Li-Ling
Published: January 2008

Objective: The aim of this study was to determine the prevalence of polydipsia-hyponatremia among patients with schizophrenia in an Asian mental hospital.

Method: Seven hundred and twenty-eight inpatients with schizophrenia were assessed for polydipsia-hyponatremia using case notes reviews, specific gravity of urine, normalised diurnal weight gain, and serum sodium levels.

Results: One hundred and three (13.8%) patients had polydipsia, 30 (4.1%) had polydipsia-hyponatremia and 14 (13%) had a history of water intoxication. Eight of the 30 patients were receiving carbamazepine, three were on tricyclic antidepres-sants and two had diabetes mellitus and were on sulfonylureas.

Conclusion: The prevalence of water intoxication among polydipsic patients was low compared to Western studies. This could be due to different methods of assessing polyuria, or ethnic differences and/or the prohibition of smoking in our patients. Certain medications might have also contributed to hyponatremia.
Depression in Hepatolenticular Degeneration (Wikon's Disease)
Authors: Walter Garry , Lyndon Bill
Published: January 2008

Objective: To describe the course of depression in a patient with hepatolenticular degeneration (Wilson's disease).

Clinical picture: A 21 -year-old male with hepatolenticular degeneration is described in whom depression was the earliest manifestation. Insomnia and psychomotor slowing were prominent.

Treatment: The mood disturbance showed limited response to tricyclic antidepres-sants, mianserin, lithium augmentation and initial decoppering therapy. Introduction of the chelating agent tetrathiomolybdate was followed by normalisation of mood and improvement in non-psychiatric symptoms.

Outcome: Three years after the disorder was first diagnosed the patient was euthymic and fully functional.

Conclusions: Although hepatolenticular degeneration is rare, it commonly presents with psychiatric symptoms. It is important for psychiatrists to be aware of the condition and its psychiatric manifestations.
Clozapine: A Mimicry of Phaeochromocytoma
Authors: Li June K.Y. , Yeung Vincent T.F. , Leung C. M. , Chow C. C. , Ko Gary T.C. , So W. Y. , Cockram C. S.
Published: January 2008

Objective: To report a case of clozapine-induced hypertension with raised urinary catecholamines.

Clinical picture: A 27–year-old man fulfilling DSM-Ill-R criteria for catatonic schizophrenia was treated with clozapine. He later developed both hypertension and raised urinary catecholamines which mimicked phaeochromocytoma.

Treatment: Clozapine was withdrawn.

Outcome: Both blood pressure and urinary catecholamines normalised.

Conclusions: Clozapine may induce sympathetic hyperactivity.
Media Depictions of Mental Illness: An Analysis of the Use of Dangerousness
Authors: Allen Ruth , Nairn Raymond G.
Published: January 2008

Objective: To explore how the commonsense understanding, that those with a mental illness are dangerous, is deployed in a small sample of print media.

Method: The print media sample was subjected to a discourse analysis informed by knowledge of media practices. Materials were read closely and references to mental illness were identified, classified and analysed.

Results: This non-sensational material was shown to provide repeated confirmations of the commonsense understanding that mental illnesses make people unpredictable and dangerous. Close study of the lead article suggested that it was written so that readers had to draw on such understandings to make sense of the account it presented.

Conclusion: The study challenges the notion that media present negative depictions of mental illnesses either because journalists are poorly informed or because ‘sensation sells’. It is concluded that media practices directed at engaging readers require the use of cases and a style of writing that forces readers to draw upon commonsense knowledge of mental illness to understand the text. It is argued that this is a deliberate effort to enlist readers as co-creators of the text and thereby increase their interest.
Liaison Psychiatry in an HIV/AIDS Unit
Authors: Judd Fiona K. , Cockram Alexandra , Mijch Anne , McKenzie Dean
Published: January 2008

Objective: To provide an overview of the work of a liaison psychiatry service to an HIV/AIDS inpatient unit, and particularly to examine the identification of mood and related disorders by referring doctors.

Method: The micro-cares prospective clinical database system was used to obtain data on all patients referred to the HIV/AIDS consultation–liaison psychiatry service in an infectious diseases hospital in Melbourne.

Results: Three hundred and ninety-two inpatient referrals were made in the 2 years from 1993–1995: a referral rate of 16.7%. The most frequent reasons for referral were evaluation of coping problems (42%), assessment of possible depression (31%), and assessment of psychotropic medication (24.5%). The most common psychiatric diagnoses were mood disorders (36.5%), psychoactive substance use disorders (22.7%) and organic mental disorders (18.1%). Overall concordance of recognition of depression by the referring doctor and diagnosis of depression by the consultant psychiatrist was 79%; 20% false positive rate, 23% false negative rate.

Conclusions: Psychiatric comorbidity is common in patients with HIV/AIDS. Reasons for referral vary from those seen in other inpatient settings. Previously noted problems such as the misdiagnosis of psychiatric disorder and the mislabelling of the syndrome recognised by psychiatrists as depression were noted here.
Bilateral Ulnar Nerve Paralysis: An Unreported Complication of Drug-Induced Extrapyramidal Rigidity
Authors: Sampath Govindarajan , Pandurangi Ananda K.
Published: January 2008

Objective: This case report describes a very unusual consequence of drug-induced extrapyramidal side effects.

Clinical picture: The patient developed bilateral ulnar nerve paralysis.

Treatment: The treatment consisted of anticholinergic medication and physiotherapy.

Outcome: The patient made a complete recovery over a period of 8 months.

Conclusions: There is a need to ensure compliance with anticholinergic medication when using depot neuroleptic medication.
Risk Factors for Posttraumatic Stress Disorder in Australian Vietnam Veterans
Authors: O'toole Brian I. , Marshall Richard P. , Schureck Ralph J. , Dobson Matthew
Published: January 2008

Objective: The aims of this paper are to determine the risk factors for combat-related posttraumatic stress disorder (PTSD) and to examine the relative contribution of pre-military factors, pre-trauma psychiatric diagnoses, military factors such as combat posting, and combat and casualty stress exposure.

Method: An epidemiological cohort study using standardised psychiatric, social and health interviews was undertaken with a national random sample of male Australian Army Vietnam veterans. Multivariate logistic regression was used to examine the relative contribution of factors derived from interview and from military records in four categories: pre-enlistment circumstances including home life, education, major life stress; pre-Vietnam psychiatric diagnoses; military experiences before and during Vietnam; and combat and stress experiences.

Results: Of the 128 data items examined, significant associations were found for 39, in addition to combat stress. Pre-enlistment items accounted for about 3% of the deviance towards PTSD diagnosis, pre-enlistment psychiatric diagnosis about 13%, military variables about 7% and combat stress about 18%; all factors together accounted for 42%.

Conclusions: The results confirm that pre-military and military variables make only a small but significant contribution to PTSD either alone or after controlling for combat stress; that psychiatric diagnoses of depression, dysthymia and agoraphobia make strong contributions to PTSD; but that combat stress makes the largest contribution even after controlling for the effects of other variables. Psychiatric diagnoses and combat stress appear to be independent in their effects on PTSD.
Optimal Treatment Strategies to Enhance Recovery from Schizophrenia
Authors: Falloon Ian R.H. , Held Tilo , Roncone Rita , Coverdale John H. , Laidlaw Tannis M.
Published: January 2008

Objective: The aim of this paper is to examine the base for integrating biomedical, psychological and social strategies in the management of schizophrenia. Method: A review of the literature on schizophrenia with particular emphasis in management considerations.

Results: Effective treatment components include psychoeducation, medication strategies, carer-based stress management training, community-based intensive treatment, living skills training, and specific drug and cognitive-behavioural strategies for residual symptoms.

Conclusions: Treatment for schizophrenia is best provided by integrating the various and specific psychosocial intervention strategies in addition to the optimal use of medication. Methods for implementing these strategies in outpatient settings include the use of a comprehensive assessment and treatment plan, the training of mental health professionals, and periodic review with assessment packages.
Neuroleptic Management of Schizophrenia: A Survey and Commentary on Australian Psychiatric Practice
Authors: Parker Gordon , Lambert Tim , McGrath John , McGorry Patrick , Tiller John
Published: January 2008

Objective: We seek to assess Australian psychiatrists' views and practices concerning provision of neuroleptic medication to patients with schizophrenia, and to determine whether such management strategies are likely to have changed over time and the extent to which they correspond to published treatment guidelines.

Method: A sample of 139 psychiatrists based in three Australian capital cities was derived, with respondents completing a brief questionnaire by choosing from a limited-option answer set. Co-authors of this paper comment on the extent to which responses are in line with contemporary recommendations driven by experts or empirical studies.

Results: Overall, survey findings indicate that there has been considerable change in clinical practice over the last decade and provide some estimate of the extent to which Australian management practices are congruent with contemporary recommendations. We identify a number of issues of concern (more in relation to dose levels of neuroleptic medication rather than treatment duration) revealed by survey data and make recommendations for addressing a number of practical clinical issues.

Conclusions: As this report focuses on central issues involved in managing schizophrenia, and integrates a number of treatment guidelines, we suggest that it should be of assistance for practice review by clinicians.
An Aetiological Model of Non-Melancholic Depression: Study Design and Validity of the Measures
Authors: Parker Gordon , Gladstone Gemma , Wilhelm Kay , Hickie Ian , Mitchell Philip , Hadzi-Pavlovic Dusan , Austin Marie-Paule , Eyers Kerrie
Published: January 2008

Objective: The aim of this paper is to describe an approach to sub-typing non-melancholic depression and to determine which raters from a variety of backgrounds provided the most valid information on study variables.

Method: A sample of non-melancholic depressed patients is described. Multiple raters (i.e. patients, psychiatrists, referrers and corroborative witnesses) completed measures of the patient's trait anxiety levels, severity of recent life event stressors and personality functioning.

Results: The study and representative data are reported. Congruence between several measures employed indicated that psychiatrist rating of disordered personality was superior to corroborative witness report. Assessment of anxiety traits indicated reasonable agreement between referrers and corroborative witnesses but poor agreement between those ratings and interview-elicited ratings. There were also discrepancies in quantifying “severity” of life event stress, with patients and their corroborative witnesses rating such events as more severe than either the interviewing psychiatrist or psychiatrists involved in consensus rating sessions. Importantly, the psychiatrists' capacity to quantify the relative contribution of disordered personality, anxiety and life-event stress to the particular depressive episode was supported.

Conclusions: Results indicate some of the difficulties in operationalising determinants that may contribute to and sub-type the non-melancholic depressions, and demonstrate the advantages of using a range of rating strategies and raters. In this study, psychiatrist-generated judgements are clearly favoured, although the advantages of also assessing trait anxiety and life-event stress impact by self-report strategies are conceded. Some techniques for estimating the contribution of disordered personality function, anxiety and life-event stress are offered for both their research and their clinical utility.
Psychiatry and Paedophilia: A Major Public Health Issue
Authors: Glaser Bill
Published: January 2008

Objective: The aim of this study was to provide a brief review of current perspectives on paedophilia as well as some suggestions regarding the place of psychiatry in dealing with the problem.

Method: A literature survey was conducted.

Results: Child sexual abuse has unfortunately been ignored and minimised by psychiatry until recently. The current evidence strongly indicates that it is a common event which is highly likely to cause both short-and long-term harm to its victims. The perpetrators generally are psychiatrically otherwise “normal” men who are skilled at both planning their offending behaviours and denying their existence.

Conclusions: Psychiatrists have an important role to play in assessment and treatment of both offenders and victims, although they may have to learn new clinical skills. Their preventative role is also important, particularly in the field of public education.
The Relationship between Fatigue, Psychological and Immunological Variables in Acute Infectious Illness
Authors: Bennett Barbara K. , Hickie Ian B. , Quigley Bronwyn , Brennan Catherine M. , Vollmer-Conna Ute S. , Wakefield Denis , Douglas Michael P. , Hansen Geoffrey R. , Tahmindjis Alex J. , Lloyd Andrew R.
Published: January 2008

Objective: The aim of this paper is to explore the longitudinal relationships between physical and psychological symptoms and immunological factors following acute infective illnesses.

Method: Preliminary data from a prospective investigation of patients with serologically proven acute infectious illnesses due to Epstein-Barr virus (EBV), Ross River virus (RRV) or Q fever are reported. Patients were assessed within 4 weeks of onset of symptoms and then reviewed 2 and 4 weeks later. Physical illness data were collected at interview. Psychological and somatic symptom profiles were assessed by standardised self-report questionnaires. Cell-mediated immune (CMI) function was assessed by measurement of delayed-type hypersensitivity (DTH) skin responses.

Results: Thirty patients who had been assessed and followed over the 4–week period (including 17 patients with EBV, five with RRV and eight with Q fever) were included in this analysis. During the acute phase, profound fatigue and malaise were the most common symptoms. Classical depressive and anxiety symptoms were not prominent. Initially, 46% of cases had no DTH skin response (i.e. cutaneous anergy) indicative of impaired cellular immunity. Over the 4–week period, there was a marked improvement in both somatic and psychological symptoms, although fatigue remained a prominent feature in 63% of subjects. The reduction in reported fatigue was correlated with improvement in the DTH skin response (p = 0.001) and with improvement in General Health Questionnaire (GHQ) scores (p < 0.01).

Conclusions: Acute infectious illnesses are accompanied by a range of nonspecific somatic and psychological symptoms, particularly fatigue and malaise rather than anxiety and depression. Although improvement in several symptoms occurs rapidly, fatigue commonly remains a prominent complaint at 4 weeks. Resolution of fatigue is associated with improvement in cell-mediated immunity.
The Health of the Nation Outcome Scales in Psychiatric Hospitalisation: A Multicentre Study Examining Outcome and Prediction of Length of Stay
Authors: Goldney Robert D. , Fisher Laura J. , Walmsley Sonja H.
Published: January 2008

Objective: The Health of the Nation Outcome Scales (HoNOS) is a reliable instrument, useful in detecting change in symptoms and functioning during psychiatric hospitalisation. The present study examines its utility in predicting length of stay of patients in six private psychiatric hospitals in four Australian States.

Method: The HoNOS was administered on admission and discharge in six private psychiatric hospitals in Australia.

Results: There were significant differences in total score and in all sub-scales between admission and discharge. There were no significant associations between total HoNOS scores and length of stay, either for individual hospitals or for specific diagnosis-related groups. There were only very weak associations, of doubtful practical clinical significance, between length of stay of all patients and individual HoNOS sub-scales.

Conclusion: While the HoNOS is of some value in providing a readily administered and understood measure for clinicians, on the basis of these findings it is unlikely to be of utility in predicting length of stay or in offering a “gate-keeping” service in decision-making in regard to the allocation of resources for individual patients.
A Longitudinal Study Comparing Bereavement Phenomena in Recently Bereaved Spouses, Adult Children and Parents
Authors: Middleton Warwick , Raphael Beverley , Martinek Nada , Burnett Paul
Published: January 2008

Objective: The study investigated previous research findings and clinical impressions which indicated that the intensity of grief for parents who had lost a child was likely to be higher than that for widows/widowers, who in turn were likely to have more intense reactions than adult children losing a parent.

Method: In order to compare the intensities of the bereavement reactions among representative community samples of bereaved spouses (n = 44), adult children (n = 40) and parents (n = 36), and to follow the course of such phenomena, a detailed Bereavement Questionnaire was administered at four time points over a 13–month period following the loss.

Results: Measures based on items central to the construct of bereavement showed significant time and group differences in accordance with the proposed hypothesis. More global items associated with the construct of resolution showed a significant time effect, but without significant group differences.

Conclusions: Evidence from this study supports the hypothesis that in non-clinical, community-based populations the frequency with which core bereavement phenomena are experienced is in the order: bereaved parents bereaved spouses bereaved adult children.
Comorbidity of Bipolar and Personality Disorder
Authors: Barbato Nazareno , Hafner R. Julian
Published: January 2008

Objective: The aims of this study were to determine the prevalence of personality disorder in a sample of patients with well-documented bipolar disorder, and to assess the effects of cormorbidity.

Method: The sample (n = 42) was drawn from patients currently case-managed within a community treatment program who fully met DSM-IV criteria for bipolar I disorder. The International Personality Disorder Examination, a structured interview, was used to diagnose personality disorder. The Brief Symptom Inventory assessed overall levels of psychological symptoms.

Results: Seven of the 13 men (55%) in the sample had 10 personality disorder diagnoses and 12 of the 29 women (41%) had 28 diagnoses, an overall prevalence of 45%. Hospital admission rates and all measures of psychological symptoms and impairment were significantly elevated in the comorbid group, who found medication significantly less helpful.

Conclusions: Comorbid personality disorder was common in the sample studied, which was representative of Australian patients treated in public community psychiatry programs. However, only three (7%) had a personality disorder diagnosis recorded in their case notes, reflecting clinicians' reluctance to apply what is widely viewed as a pejorative and therapeutically nihilistic label. New treatments for personality disorder have proven effective within both public and private psychiatric settings, so that underdiagnosis represents undertreatment. The findings suggest that clinicians should be more vigilant for comorbid personality and bipolar disorder, and less reluctant to diagnose it.
Predictability of Rehospitalisation over 5 Years for Schizophrenia, Bipolar Disorder and Depression
Authors: Daniels Brett A. , Kirkby Kenneth C. , Hay David A. , Mowry Bryan J. , Jones Ivor H.
Published: January 2008

Objective: The aim of this study was to examine the rate of rehospitalisation for schizophrenia, bipolar disorder and depression over a 5-year period in Tasmania, and to identify predictors of the number and duration of readmissions.

Method: The Tasmanian Mental Health Register was used to study the 5-year pattern of rehospitalisation for all patients admitted to a Tasmanian public psychiatric inpatient facility with a primary diagnosis of schizophrenia, bipolar disorder or depression, in 1983 or 1984.

Results: Seventy-one percent of patients receiving a diagnosis of schizophrenia were readmitted in the 5-year period, compared to 59% for bipolar disorder and 48% for depression. For all three diagnoses, the number of prior admissions was a predictor of the number of readmissions and the total number of days spent in hospital in the follow-up period. Age and sex also had significant effects, which varied across diagnostic groups.

Conclusions: A substantial proportion of patients hospitalised for schizophrenia, bipolar disorder or schizophrenia were rehospitalised during the next 5 years. Patients with more previous admissions had more readmissions than those with fewer previous admissions.
Withdrawal Reactions Associated with Venlafaxine
Authors: Parker Gordon , Blennerhassett Jenny
Published: January 2008

Objective: The aim of this paper is to describe discontinuation syndromes associated with abrupt and tapered withdrawal of venlafaxine, and to document that withdrawal symptoms may occur after missing a single dose. Clinical picture: We report on two patients prescribed venlafaxine. One developed a broad range of serious side effects after reaching a dose of 300 mg a day, and a severe withdrawal syndrome (including hallucinations) during a slow taper regime. The second had severe discontinuation symptoms during and aborting a slow taper regime, and described withdrawal responses after missing a single dose of venlafaxine.

Conclusions: As for the short-acting selective serotonin re-uptake inhibitors, severe discontinuation reactions may occur with venlafaxine, seemingly marked most distinctly by headache, nausea, fatigue, dizziness and dysphoria, and may make cessation of the drug extremely difficult. Two strategies for addressing the concern are considered.
Outcomes Focused Service Delivery: Developing an Academic-Management Partnership
Authors: Tobin Margaret , Hickie Ian
Published: January 2008

Objective: Current mental health policies emphasise the need for services to be integrated and to develop outcomes-based evaluation systems. An overview of the challenges faced by service managers and clinical academics who develop the appropriate financial, personnel and academic infrastructure for these tasks is presented.

Method: By drawing on experiences within the St George Service and references to other services, we propose a model for a successful partnership between the academic and management components of a district service.

Results: Major logistic impediments to the development of a partnership are identified, although the long-term scientific and service delivery benefits are highlighted. Key areas within both academic practice and managerial approaches requiring transformation are discussed.

Conclusions: A successful long-term partnership between management and an academic department within a district service may provide the opportunity for rapid progress in population-based service evaluation and health outcomes research.
Childhood Abuse, Postpartum Depression and Parenting Difficulties: A Literature Review of Associations
Authors: Buist Anne
Published: January 2008

Objective: The aim of this paper is to obtain an understanding of the links between maternal postpartum depression, poor parenting and childhood abuse, and the subsequent development of adult psychopathology in children from these families. Method: A literature review was undertaken of studies on postpartum depression looking at parental childhood abuse, parenting and child outcomes, as well as childhood abuse and its association with adult depression and parenting difficulties. Results: Considerable overlap is noted in predisposing factors for major depression, postpartum depression, inadequate parenting and childhood abuse. Links appear to begin in early infancy, suggesting postpartum depression as a possible mechanism for intergenerational transmission of psychopathology.

Conclusions: Further research is required to look at the outcome of children of women who are at high risk of chronic or recurrent depression and of difficulties parenting; the postpartum period is the optimum time for identification and intervention.
Gender and Schizophrenia: Association of Age at Onset with Antecedent, Clinical and Outcome Features
Authors: Gureje Oye , Bamidele Rotimi W.
Published: January 2008

Objective: There is evidence that gender and age at onset may have a bearing on schizophrenia. The extent to which this differential age at onset influences the clinical features of schizophrenia and its outcome in males and females is not clear. Method: One hundred and twenty outpatients with DSM-III-R schizophrenia were studied to determine the association of antecedent, historical, clinical and 13–year outcome features with age at onset in females (n = 64) and in males (n = 56). Results: Males were significantly younger at illness onset but were not otherwise different from females in antecedent features of illness. For males, age at onset bore little relationship to outcome after 13 years. Females with early onset of illness were more likely to have experienced obstetric complications, to evidence poorer premor-bid functioning, and to have a worse clinical, social and functional outcome than females with late onset.

Conclusions: Even though females may have a more benign illness than males, among females, those with early age at onset may be characterised by neurodevel-opmental deviance and worse illness outcome.
Psychiatric Disorder in HIV Infection
Authors: Kelly Brian , Raphael Beverley , Judd Fiona , Perdices Michael , Kernutt Graeme , Burrows Graham D. , Burnett Paul C. , Dunne Michael
Published: January 2008

Objective: This study aimed to investigate rates of psychiatric disorder in human immunodeficiency virus (HIV) infection, in an Australian sample of homosexual and bisexual men.

Method: A cross-sectional study of a total of 65 HIV sero-negative (HIV-) and 164 HIV sero-positive men (HIVt) (79 CDC stage 1 1/1 11 and 85 CDC stage IV) was conducted in three centres. Lifetime and current prevalence rates of psychiatric disorder were evaluated using the Diagnostic Interview Schedule Version lllR (DIS-IIIR). Results: Elevated current and lifetime rates of major depression were detected in both HIV negative and HIV positive homosexual/bisexual men. Lifetime rates of alcohol abuseldependence were significantly elevated in HIV positive men (CDC group IV) when compared with HIV negative men. Among the HIV positive group the majority of psychiatric disorders detected were preceded by a pre-HIV diagnosis of psychiatric disorder. Major depression represented the disorder most likely to have first onset after HIV infection diagnosis.

Conclusions: Lifetime rates of major depression were elevated in this sample of HIV-negative and HIV-positive men, In the HIV-positive men, psychiatric disorder was significantly associated with the presence of lifetime psychiatric disorder prior to HIV infection diagnosis, The findings indicate the importance of evaluation of psychiatric history prior to HIV infection and the clinical significance of depressive syndromes in this population.
Temporal Variation in Parasuicide among Singaporean Chinese
Authors: Ho Brian K.W. , Kua E. H. , Hong Clarice
Published: January 2008

Objective: The aim of this study was to determine whether there is any temporal variation in the incidence of parasuicide within the Chinese community and, if possible, to correlate the findings with prevailing cultural and social influences. Method: All patients of Chinese origin referred to a teaching hospital in Singapore between 1990 and 1994 were included in the study. The cases were divided by sex and aggregated for the month and day of the week in which the parasuicides occurred.

Results: Cases of parasuicide peaked on Mondays, while the lowest incidences occurred on Saturdays. The peak months were June, August and September with a trough in December and January.

Conclusions: The findings may not be amenable to any single explanation but the peak months coincided with the month of the Hungry Ghosts, which is believed to be a particularly inauspicious period, while the trough occurred during a festive period. Similarly, looking at the student population, the peaks coincided with the examination period. It appears that social and cultural factors play a significant role in the temporal variation in parasuicide in Singapore.
Dissociative Identity Disorder: An Australian Series
Authors: Middleton Warwick , Butler Jeremy
Published: January 2008

Objective: Series of patients fulfilling diagnostic criteria for Dissociative Identity Disorder (DID), otherwise known as multiple personality disorder, have particularly been reported on in North America and increasingly in other countries. The present study investigated the trauma and past treatment histories, symptom profiles and dissociative phenomenology of 62 patients fulfilling diagnostic criteria for DID seen in Brisbane (Queensland, Australia).

Method: From 1992, systematic assessments, including the Dissociative Experience Scale and the Dissociative Disorders Interview Schedule, were performed with a personal series of 57 patients with DID seen by one of the authors (WM) and five patients seen by the second author (JB).

Results: The histories of childhood trauma, the clinical profiles and dissociative indices of these patients closely approximate those described in series reported in other countries.

Conclusions: Patients fulfilling diagnostic criteria for DID are regularly seen in Australian inpatient and outpatient settings. The dissociative symptomatology of the patients examined in the present study represents a significant component of a complex syndrome associated with a history of severe ongoing developmental trauma dating from early childhood.
Delirium in Hospital: Does it Increase Length of Stay?
Authors: Stevens Lee E. , de Moore Gregory M. , Simpson Judy M.
Published: January 2008

Objective: To determine the effect of delirium, as a comorbid diagnosis in hospitalised patients, on patient length of stay (LOS).

Method: Prospective study comparing LOS of delirious patients with controls matched by age, gender, principal diagnosis and date of admission. Medical and surgical inpatients of Westmead Hospital with delirium were identified from a Consultation Liaison (CL) psychiatry database and were matched with controls from the hospital medical records.

Results: Delirious patient LOS was found to be significantly longer (2.2-fold; 95% confidence interval 1.5-3.3) than matched controls.

Conclusions: Delirium, as a comorbid diagnosis in general hospital patients, is associated with an increased use of resources. Its early diagnosis may limit this and morbidity.
Sport Psychiatry
Authors: Macleod A. D.
Published: January 2008

Objective: The aim of this article is to provide an overview of the literature on psychiatry for elite athletes.

Method: Relevant literature was presented to the general psychiatrist.

Results: The prevalence of drug misuse, eating disorders and brain injury in elite and professional athletes is stressed. The uniquely troublesome adverse effects of psychopharmacology in this group of subjects is commented upon.

Conclusions: Elite athletes may require competent and informed psychiatric opinion and management.