bluuebunny/crossref_metadata_2025 huggingface dataset:
Hysteroscopy is superior to hysterosalpingography in infertility investigation
Authors: Golan Abraham , Eilat Eran , Ron‐el Rafael , Herman Arieh , Soffer Yigal , Bukovsky Ian
Published: November 2007

Background. The development of advanced endoscopic instrumentation in recent years has demonstrated the superiority of direct visual examination over radiographic demonstration of various body cavities. Just as laparoscopy has gradually taken a primary role in the surgical investigation of the ovulatory infertile patient, the role of intrauterine endoscopy in comparison to hysterosalpingography (HSG) needs to be reevaluated.

Methods. Four hundred and sixty‐four infertile women had undergone both hysterosalpingography and a diagnostic hysteroscopy and the findings were analysed.

Results. Compared to hysteroscopy the sensitivity of HSG was 98%, but its specificity only 15%, the positive predictive value 45%, and negative predictive value 95%. On hysteroscopy a normal uterine cavity was found in 53% of the cases with a filling defect and in 56% of those with uterine wall irregularity on HSG.

Conclusions. Hysteroscopy, a safe and rapid direct visualisation of the uterine cavity, is superior to HSG in the identification of intrauterine pathology. In view of the low positive predictive value and the low specificity of the HSG, we believe it should be replaced by the diagnostic hysteroscopy as a first line infertility investigation.
Induced abortions and childbirths: trends in Estonia, Latvia, Lithuania, Russia, Belarussia and the Ukraine during 1970 to 1994
Authors: Mogilevkina Irina , Markote Solvita , Avakyan Yuri , Mrochek Ludmila , Liljestrand Jerker , Hellberg Dan
Published: November 2007

Background, To analyse trends in childbirth, induced abortions and maternal morbidity from 1970 to 1994 in Estonia, Latvia, Lithuania, Russia, Belarussia and the Ukraine.

Methods. Official health statistics from the six countries were compiled and analysed.

Results. High abortion rates (up to 142 per 1000 women of fertile ages and years) were seen in all countries analysed, but since 1980 a continuing decrease is noted for Estonia, Latvia and Kaliningrad with a lowest rate of 50 abortions/1000 women/year in Latvia in 1994. Teenage abortions and childbirths are increasing. Maternal mortality, including complications of abortions, is still a reality in all the countries studied.

Conclusion. The high abortion frequencies in all countries studied here indicate that national abortion prevention programs are needed. Such programs should focus on education, both of medical professionals, teenagers, fertile women and males. Concomitantly, the availability of cheap and modern contraceptives must increase, especially to defined risk groups.
Serum endometrial IgG antibodies and soluble CD23 concentrations in patients with endometriosis
Authors: Odukoya Olusegun , Bansal Amolak , Cooke Ian
Published: November 2007

Objective. Serum endometrial antibodies have been found inconsistently in patients with endometriosis. Soluble CD23 is elevated in diseases associated with B cell activation. We evaluated serum levels of soluble CD23 and endometrial IgG antibodies in patients with endometriosis to determine whether there is B cell activation in this condition.

Design. Fifty‐seven patients with pelvic pain diagnosed as endometriosis and 40 patients without pelvic pain or endometriosis who had laparoscopic sterilisation were sequentially recruited into the study. Blood was collected and the sera assayed by ELISA for endometrial IgG antibodies and soluble CD23.

Results. There was a significant difference between endometriosis and control group in both the serum IgG endometrial antibodies (p<0.05) and soluble CD23 (p<0.05). There was significant but weak correlation between endometrial antibodies and soluble CD23 (r=0.3, p= 0.039), particularly in mild but not severe endometriosis.

Conclusions. These data suggest the existence of B cell activation in patients with endometriosis with a significant correlation between endometrial antibodies and soluble CD23. Mild endometriosis appears to be immunologically more active than the severe form. The value of soluble CD23 in the management of endometriosis needs further evaluation.
Validity of a scored urological history in detecting detrusor instability in female urinary incontinence
Authors: Klovning Atle , Hunskaar Steinar , Eriksen Bjarne Chr. Sollie
Published: November 2007

Background. Kauppila and co‐workers published in 1982 a detrusor instability score (DIS) for women with urinary incontinence. The aim of this study was to determine the validity of the DIS in an outpatient clinic for urogynecology.

Methods. The DIS questionnaire was incorporated as part of an independent history at the first consultation. The DIS was compared with clinical diagnosis in 250 patients consecutively referred for evaluation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of the DIS in diagnosing genuine stress incontinence (GSI) were calculated using the gynecologist's clinical diagnosis based on urodynamic findings as the gold standard. An ROC‐curve was constructed for determining the optimum cut‐off point for the DIS for women with GSI.

Results. A cut‐off point at 7 for the DIS, yielded sensitivity=0.77, specificity=0.52, PPV=0.74, NPV=0.52 and an overall accuracy=0.68. Optimum cut‐off point for GSI according to the ROC‐curve was at a DIS‐value of 5, yielding sensitivity=0.60, specificity=0.77, PPV=0.82, NPV=0.52 and overall accuracy=0.66.

Conclusions. A cut‐off point at 7 diagnosed 159 women (64%) as having GSI, 41 of them (16% of 250) having a false positive DIS. Similarly, a cut‐off point at 5 diagnosed 112 women (45%) as having GSI, 20 of them (8% of 250) having a false positive DIS. These women, if otherwise feasible and indicated, might perhaps undergo continence surgery without preoperative urodynamics. A lower cut‐off point than originally proposed ought therefore to be used if the DIS is to become a useful preoperative tool for this kind of surgery.
The effect of intravascular transfusion for severely anemic fetuses on umbilical artery doppler flow velocity waveforms
Authors: Gungor Mete , Ekici Eyup , Kuscu Esra , Arslan Selcuk , Danisman Nuri , Gokmen Oya
Published: November 2007

Background. To evaluate whether the doppler flow velocity waveforms reflect the fetal hematocrit and to assess the changes of the umbilical artery doppler indices before and after the puncture of the umbilical cord.

Material and methods. In this prospective‐study, Pulsed‐Doppler examinations of blood flow velocities in the umbilical artery were carried out before and after 22 diagnostic cordocentesis and 14 fetal blood transfusions into the umbilical vein.

Results. There were decreases in the systolic/diastolic ratio (p<0.001), the pulsatility index (PI) (p<0.001), and the resistance index (RI) (p<0.003) after cordocentesis but not after fetal blood transfusion. There were no correlations between the initial hematocrit and the umbilical artery doppler indices in both fetal blood transfusion group and fetal blood sampling group. There was no correlation between the increase in hematocrit and changes in umbilical artery blood‐velocity waveform indices following fetal blood transfusion. The umbilical artery doppler flow‐velocity indices did not predict the fetal hematocrit.

Conclusion. These findings suggest that acute changes in blood viscosity following intravascular transfusion are not associated with an increase in resistance to flow as assessed by doppler velocimetry. Umbilical blood sampling per se may be associated with a humorally mediated reduction in placental vascular resistance to flow.
A randomized, double blind, controlled trial of tocolysis to assist external cephalic version in late pregnancy
Authors: Chung Tony , Neale Edmund , Lau Tze Kin , Rogers Michael
Published: November 2007

Background. External cephalic version at term is not always successful. This trial was done to ascertain whether tocolysis has any effect on the success rate.

Methods. A randomized, double blind, controlled trial, with continuous paired sequential analysis. Fifty‐one consecutive patients with a singleton fetus in a breech presentation between 36 and 38 weeks gestation, external version being attempted on each. Ritodrine infusion or placebo was infused before attempt at external cephalic version.

Setting. A university teaching hospital with 8000 confinements annually.

Results. Version was successful in 17 of the 25 patients given tocolysis, but in only eight of the 25 given placebo (p<0.01). A positive benefit for tocolysis was shown after version had been completed in 10 pairs of patients. However the trial was continued until 25 pairs had been analyzed. The benefit deteriorated during analysis of the last 15 pairs suggesting that the initial benefit may reflect a learning curve for the procedure.

Conclusion. Tocolysis is likely to improve the success rate of external cephalic version in late pregnancy, especially in nulliparous mothers or where doctors are learning the technique.
Evaluating Treatment Effectiveness
Authors: Andrews Gavin
Published: November 2007

When deciding which treatments are of benefit, results from placebo-controlled trials are conventionally preferred above all others, and treatments not supported by such trials are viewed sceptically. In this paper it is argued that while randomised controlled trials are desirable they are not always informative. Other, less robust, research designs can be acceptable when they provide independent evidence that their results are not invalidated by remission, regression to the mean, or placebo effect, particularly if they provide post-treatment follow-up assessments. Even when there are difficulties with a research design one can reasonably conclude that the treatment was responsible for the improvement provided a standard treatment was delivered, patient compliance was good, and a dose-response relationship was identified.
Transformations of Narcissism
Authors: Bragan Ken
Published: November 2007

The self's contrary needs for separateness and for belonging are introduced as a significant polarity in the developmental process, and one which narcissistic persons have failed to resolve in a particular way resulting in a sense of self-distinction but with increasing alienation. Clinical material and material from literature are used to demonstrate this, as well as to raise the possibility that transformations of narcissism sometimes can occur quite quickly. The theoretical implications of this possibility are considered and Jungian ideas put forward as a possible explanation. Finally, brief consideration is given to the practical consequences for therapy that could follow if this understanding has some validity.
School Refusal: Graduated and Rapid Behavioural Treatment Strategies
Authors: King Neville J. , Ollendick Thomas H.
Published: November 2007

School refusal is a complex phenomenon that has been subject to definitional and diagnostic confusion. The aetiology of school refusal remains incompletely understood; heterogeneity rather than homogeneity prevails. In the behaviour management of school refusal, the clinician may plan either a gradual or rapid school return. Although a graduated return to school may be necessary in certain cases, secondary complications are minimized by an immediate return to school. Both graduated and rapid treatment require a flexible and integrative approach drawing on classical, operant and vicarious conditioning principles. Little research has been conducted on the effectiveness of the behavioural management of school refusal, as well as psychological adjustment to school.
Predicting Child Abuse and Neglect in New Zealand
Authors: Muir Roy C. , Monaghan Sheila M. , Gilmore Ruth J. , Clarkson John E. , Crooks Terence J. , Egan Tony G.
Published: November 2007

We describe the three stages of our attempt to predict parenting problems and child abuse antenatally. In the first stage, we made an intuitive check list of ten items from 173 risk factors drawn from the literature. The check list was useful in predicting who would relinquish care or have majorparenting difficulty in two different samples drawn four years apart and before and after some major sociocultural changes in New Zealand. In the second stage we used statistical techniques rather than intuition to maximise the predictive ability of the checklist and produced a new one of 9 items. In the third stage we validated the new list in a random sample of pregnant mothers. It was effective in predicting parenting difficulty In the 2 years after childbirth. We recommend it for routine use in a New Zealand setting. We do not know how useful the checklist will be in other cultural settings.
The General Health Questionnaire: Reliability and Validity for Australian Youth
Authors: Winefield Helen R. , Goldney Robert D. , Winefield Anthony H. , Tiggemann Marika
Published: November 2007

General Health Questionnaire (GHQ) results are given for a large (N = 1013) sample of South Australian young people (average age 19.6 years), to compare the usefulness of the 12-, 28-, and 30-item forms of the GHQ. Internal reliabilities are generally adequate and the Likert scoring method produces significant correlations with psychological measures such as self-esteem. the case-prevalence rate using the binary scoring method was comparable with other studies, but misclassification rates were unacceptably high when DSM-Ill Axis I diagnosis was used as the criterion for the presence of any psychiatric disorder.
Phobic Disorders and Anxiety States: How do they Differ??
Authors: Oei Tian P.S. , Gross Peter R. , Evans Larry
Published: November 2007

A review of the clinical literature to date has shown that the nature of the relationship between phobic disorders and anxiety states is still unclear. As a wide range of symptoms are shared by patients with all DSM-III anxiety disorder diagnoses, at this stage there is still a need to investigate the latent dimensions which distinguish the anxiety disorder subtypes. In the present study 176 patients with the DSM-III diagnoses of agoraphobia with panic attacks, social phobia, panic disorder and generalized anxiety disorder completed the Fear Survey Schedule, Fear Questionnaire, Hostility and Direction of Hostility Questionnaire, Maudsley Personality Inventory, and the Hamilton Anxiety and Depression Scales. Group membership was significantly predicted by a discriminant analysis which yielded a Fear Questionnaire agoraphobia function and a social phobia function. the results from discriminant analysis suggests that agoraphobia and anxiety states may be closely related. Classification errors were also determined, providing further evidence with which to refute the claim that agoraphobia has “all or none” characteristics.
A Tormented Mind: Clinical and Theoretical Implications of Overwhelming Life Events
Authors: Watson Paddy Burges
Published: November 2007

A case study illustrates the aim of this paper, which is to discuss the clinical and theoretical implications of adult patients who have experienced extreme or catastrophic stress in their distant past which may not be immediately “recognisable”. A close relationship between Post-Traumatic Stress Disorder and Borderline Personality Disorder (as defined in DSM-III-R) is suggested.
The Differential Diagnosis of Negative Symptoms in Chronic Schizophrenia
Authors: Whiteford Harvey A. , Peabody Cecilia A.
Published: November 2007

Negative symptoms in schizophrenic patients can have many causes. This paper briefly reviews some of those factors which may contribute to negative symptoms apart from the schizophrenic illness itself. Making these distinctions is crucial for accurate diagnosis, management and prognosis.
Psychiatric Illness in the New Zealand Maori
Authors: Sachdev P. S.
Published: November 2007

This paper compares psychiatric illness in the contemporary Maori with that in the non-Maori New Zealander. The ethnic data available are all from secondary sources. The limitations of this and the problems of achieving a satisfactory definition of “a Maori” are discussed. The data suggest that the Maori have a slightly greater risk of psychiatric hospitalization than the non-Maori. First admission rates for schizophrenia are higher for the Maori, as are the readmission rates. First admission rates for major affective illness are roughly comparable in the two groups, and those for neuroses and neurotic depression are lower in the Maori. Rates of admission for alcohol abuse, alcohol dependence and personality disorders are much higher for the Maori male aged 20–40 years and this group is at greatest risk of psychiatric hospitalization. A larger proportion of Maori are admitted involuntarily, especially under the Criminal Justice Act. The median stay in hospital is not longer for the Maori but their re-admissions are more frequent. The Maori have shown an increase in first psychiatric admission rates since the 1950s, with rapid increases in the early 60s and the 80s. The rates for psychotic disorders have been relatively constant and the most significant changes have been for alcohol abuse, alcohol dependence and personality disorders. The author relates this historical change to socioeconomic and politico-cultural factors, particularly the stress of rapid urbanization.
Comprehensibility of Patient Education Literature
Authors: le Bas James
Published: November 2007

A survey of the mental health information literature available in NSW was made using the Flesch Formula for Reading Ease. It was found that ten out of thirteen were written at a level of complexity unintelligible to up to 60% of the general public. The literature is therefore falling far short of its potential. It is recommended that a serious attempt be made to write pamphlets in Plain English style. This process should include a Reading Ease estimation.
Treatment of Seasonal Affective Disorder with Light: Preliminary Australian Experience
Authors: McIntyre Iain M. , Armstrong Stuart M. , Norman Trevor R. , Burrows Graham D.
Published: November 2007

Six patients with a history of Seasonal Affective Disorder (SAD) were treated with bright artificial light. Patients presented with at least two consecutive years of loss of energy, difficulty in working, loss of interest in activities, difficulty in concentrating, increased somnolence, over-eating (carbohydrate craving) and depressed mood. All received seven consecutive days of full-spectrum bright light with an intensity greater than 2,500 lux at a distance of three feet. Evening exposure for two hours resulted in significant clinical improvement. The main improvements were a return to normal sleeping patterns, a reduction in eating habits, improved energy level, a desire to continue with interests and activities and an improvement in mood. Possible mechanisms for the clinical effects of bright light treatment are discussed.
A Family Panics
Authors: Hickie Ian , Silove Derrick
Published: November 2007

We report the treatment of a family in which both spouses developed panic disorder, and their son school phobia, soon after the death of a close relative. The interactional style observed within this family suggested that interpersonal factors were important in the generation of anxiety in each member. Detailed case histories such as the one we report underscore the importance of a systemic perspective when assessing individuals who present with anxiety disorders.
Memories of Vietnam: Post-Traumatic Stress Disorders in Australian Veterans
Authors: Tennant Christopher , Streimer Jeffrey H. , Temperly Helen
Published: November 2007

We compared a random sample of Australian Vietnam veteran inpatients suffering from Post Traumatic Stress Disorder (PTSD) (N=13) with veteran inpatients with other neurotic diagnoses. Those with PTSD had experienced substantially higher levels of combat stress, were more likely to have manifested conduct disorder in childhood, and had poorer work adjustment. Only three had been diagnosed as having traumatic or war neuroses by their original treating psychiatrist in the Veterans Affairs Department. Post traumatic stress disorder (or war neurosis) has possibly been under-diagnosed by treating psychiatrists in the Veterans Affairs Department, especially in the pre-DSM-III era.
Can Overuse of Psychotropic Drugs by the Elderly be Prevented?
Authors: Lyndon Robert W. , Russell Janice D.
Published: November 2007

Despite increasing awareness of the problems associated with long term psychotropic use, consumption by the elderly remains high. This study examines some of the reasons for this with a view to prevention. Fifty seven elderly patients using psychotropic medication were interviewed to determine the prevalence of psychiatric illness, patterns of drug use, the reasons for the initial prescription and any relationship to life events. Attitudes to continued use were also assessed. The results suggest that levels of psychotropic use by the elderly could be reduced by improved management of life crises and insomnia.
The Integrative Approach to Psychiatry
Authors: Lipowski Z. J.
Published: November 2007

From the early days of psychiatry as a distinct field of knowledge and clinical practice two competing approaches to the etiology and treatment of mental disorders have vied for dominance: the somatic and the psychic (“moral”) [l]. We are witnessing the same struggle today. To speak metaphorically, we can opt for either brainless or mindless psychiatry, as Szasz [2] proposed. He failed to consider a third option, however, one that may be called an integrative approach. The latter is neither mindless nor brainless but rather encompasses both the mind and the brain in its theoretical and practical consideration [1,3,4]. I will formulate the integrative approach in this paper and argue that it has a distinct advantage for both the study and treatment of mental disorders.
Too Shameful to Remember: Psychogenic Amnesia a 17-Year-Old Chinese Boy With
Authors: Wong C. K.
Published: November 2007

A case of psychogenic amnesia in a 17-year-old Chinese boy is presented. The case is unusual in that the amnesia lasted as long as six weeks without any pseudodementia or fugue. The patient can be best understood from the abnormal sick role and the communication models of hysteria. The family was preoccupied with physical illness and relied on non-verbal rather than verbal language in communicating distress and negative emotions. Shame was the central psychodynamic aetiology; it was too shameful for the patient to talk about or withdraw himself from the predicaments in which he was trapped. Preceding the onset of amnesia he had suffered from multiple conversion symptoms for seven months. His message and predicaments not understood, he was unnecessarily investigated and treated by numerous doctors, making matters much worse. The prices paid included five hospital admissions, countless consultations at accident and emergency departments and with general practitioners, and an appendectomy for a normal appendix.
Screening the Elderly in the Community for Psychiatric Disorder
Authors: Mowry B. J. , Burvill P. W.
Published: November 2007

The use of the 30-item GHQ as a screening instrument in a community population aged 70 years and older was examined. An acceptable sensitivity (70%) and specificity (84%) was obtained. As in the younger age groups, the GHQ was not good at detecting chronic, generalised anxiety disorders. The GHQ is best used in combination with the MMSE to screen out cases of dementia in an elderly population.
A Research Seminar Programme for Doctoral Candidates in Psychiatry
Authors: Raphael Beverley , Dunne Michael , Byrne Gerard
Published: November 2007

A worldwide trend towards fewer clinician-researchers in the medical specialties has been identified. The ratio of clinicians to non-clinicians in academic departments is declining. Possible responses to these trends are briefly surveyed and an innovative research seminar programme for doctoral students in psychiatry is described.
On Doing the “Impossible”: Inferring that a Putative Causal Relationship does not Exist
Authors: Hall Wayne , Einfeld Stewart
Published: November 2007

A simple heuristic is proposed for drawing a warranted inference that a causal relationship does not exist between two events. It is illustrated by a study of the putative indirect causal relationship between Autistic Disorder and the Fragile X syndrome. This study was designed to ensure that a failure to find such a relationship provided good reasons for concluding that it was unlikely there was a relationship between Autistic Disorder and the Fragile X syndrome.
Intensive Neurodiagnostic Monitoring in Psychiatry
Authors: Sachdev Perminder S.
Published: November 2007

A series of technological advances have made it possible to closely monitor electrophysiological and behavioural manifestations of episodic clinical events over prolonged periods of time, with the ability to review the records at leisure or to submit them to computer analysis. The more promising techniques are time-locked video/EEG monitoring, cable telemetry, radiotelemetry, ambulatory cassette recording, intensive plasma anti-epileptic drug monitoring and continuous neuropsychological monitoring. The greatest promise of these techniques is for the diagnosis, research and management of epilepsy. For psychiatry, they offer additional help in the differential diagnosis of non-epileptic events from epilepsy, the most important of which are psychogenic seizures and episodes of aggression. This paper discusses the potential role of these techniques in the assessment of non-epileptic events and transient cognitive impairment in clinical psychiatry.
A Survey of ECT in a General Hospital Psychiatry Unit
Authors: Gassy J. Eric , Rey Joseph M.
Published: November 2007

A review of the 2,256 admissions to a general hospital psychiatry unit between April 1982 and December 1987 showed that 129 (6%) had been treated with electro-convulsive therapy (ECT); 91% of these had a diagnosis of mood disorder. Most patients were taking concurrent psychotropic medication and received an average of 9 treatments per course of ECT. Men and patients taking benzodiazepines had shorter convulsions. However, there were no differences in seizure length and number of treatments between younger and older patients and between those taking and not taking tricyclic antidepressants.
Can Reliance be Placed on a Single Meta-Analysis?
Authors: McConaghy Nathaniel
Published: November 2007

Meta-analysis replaced statistical significance with effect size in the hope of resolving controversy concerning evaluation of treatment effects. Statistical significance measured reliability of the effect of treatment, not its efficacy. It was strongly influenced by the number of subjects investigated. Effect size as assessed originally, eliminated this influence but by standardizing the size of the treatment effect could distort it. Meta-analyses which combine the results of studies which employ different subject types, outcome measures, treatment aims, no-treatment rather than placebo controls or therapists with varying experience can be misleading. To ensure discussion of these variables meta-analyses should be used as an aid rather than a substitute for literature review. While meta-analyses produce contradictory findings, it seems unwise to rely on the conclusions of an individual analysis. Their consistent finding that placebo treatments obtain markedly higher effect sizes than no treatment hopefully will render the use of untreated control groups obsolete.
The Prevalence of Psychiatric Morbidity in General Hospital Inpatients
Authors: Clarke David M. , Minas I. Harry , Stuart Geoffrey W.
Published: November 2007

The aim of this study was to examine the prevalence of psychiatric morbidity in a sample of medical and surgical inpatients in an Australian general hospital. Using the 60-item General Health Questionnaire, the estimated prevalence was 30% (previous studies have yielded estimates generally between 20 and 50%). The prevalence of morbidity was significantly higher in medical (45%) than in surgical (23%) inpatients. Twelve percent of patients (20% of medical patients and 8% of surgical patients) satisfied DSM-Ill criteria for a current Major Depressive Episode. Anxiety scores on the State-Trait Anxiety Inventory were higher than those reported in general population samples. There were no significant differences between males and females on any scores. The problems associated with the definition and identification of depressive and anxiety syndromes in medical and surgical inpatients are discussed, whilst the importance of this task is emphasized.
Big Cities, Small Towns and Adolescent Mental Health in New Zealand
Authors: McGee Rob , Stanton Warren , Feehan Michael
Published: November 2007

We examined the relationship between measures of mental health and residential locations with differing population densities in a large sample of New Zealand adolescents. There were no significant differences across residential locations in the prevalence of DSM-Ill disorders, poor social competence and level of help-seeking behaviours. However, adolescents from larger population centres reported more life event stresses. Those adolescents who experienced more frequent changes of residence were at risk for mental health problems.
The Garry David Case
Authors: Parker Neville
Published: November 2007

A prisoner with an antisocial personality disorder had almost completed his sentence for attempted murder and there was considerable public concern over his imminent release. The article discusses the many attempts made by the Victorian Government during the past six months to detain him. A recommendation was made to change the Mental Health Act 1986 by including personality disorders as a form of “mental illness”. The outcome of such advice has enormous implications for the practice of psychiatry in Victoria.
The Changing Nature of Psychiatry
Authors: Andrews Gavin
Published: November 2007

The traditional role of psychiatrist as the central figure in the delivery of mental health services is changing. First, the advent of structured diagnostic interviews means that the diagnosis of mental disorders is no longer the exclusive preserve of psychiatrists; second, the growth of community mental health services staffed by non-psychiatrists means that psychiatrists now treat a minority of the patients with mental disorders; and third, the psychiatrists' continued endorsement of dynamic psychotherapy means they are becoming identified with an unproven and very expensive treatment. These changes should be seen against the broader background of a profession that is well-trained, active in evaluating performance, supported by a burgeoning research base in cognitive science and neuroscience, and delivering services efficiently and inexpensively.
Cognitive-Behavioural Group Therapy for Hong Kong Chinese Adults with Mental Health Problems
Authors: Luk Siu-Luen , Kwan Cecilia S.F. , Hui Jenny M.C. , Bacon-Shone John , Tsang Adolf K. T. , Leung Anita C. , Tang Kitty K.M.
Published: November 2007

Ninety-one Chinese in the community, aged between 18 and 45, with mental health problems ranging from mild to moderate degree, were treated by cognitive behavioural group therapy (CBGT) for a period of 3 months. All subjects were assessed on multiple measures at 4 time points: screening, pre-treatment (after 3 months), post-treatment and at 3-month follow-up. Attendance was good. A standard practice manual was developed to ensure consistent treatment by 2 group workers. After controlling for the placebo effect in the waiting period, treatment effect was demonstrated which was sustained after a three month period. The all-round improvement included a decrease in psychiatric symptoms, improvement in self-assessment, better and more social activities and being more able to cope with problems. In terms of psychiatric diagnosis, depressed subjects gained the most benefit and personality disorder subjects the least. Parents seemed to benefit more than non-parents.
Bed Requirements for an Area Psychogeriatrlc Service
Authors: Snowdon John
Published: November 2007

Psychiatric services for the elderly are being developed in various areas in Australia, but guidelines on the number of beds needed are largely based on overseas experience. A review of all admissions of elderly people to the three psychiatric units in one part of Sydney over a ten-year period (1977–1987) allows an estimate of acute and medium-stay bed requirements. There were 444 male and 952 female admissions of persons aged 65 or more during the ten years. Mean length of stay was estimated to be 33.5 days, those with depressive disorders staying longest (41.7 days). Caution is needed when drawing conclusions about bed requirements, since they vary according to management practices, alternative support services, demographics, etc. Tentatively it is suggested that for a population of 32,000 persons aged 65 or more a minimum of 22 acute psychiatric beds are required.
The Rating of Psychiatric Impairment in Forensic Practice: A Review
Authors: Mendelson George
Published: November 2007

One of the questions often asked of the psychiatric expert witness is to rate the extent of psychiatric impairment as part of the evaluation of a plaintiff in personal injury litigation, or of a claimant for statutory benefits. At present, there is no generally agreed upon or validated scale for the rating of psychiatric impairment, and the guides to the rating of permanent impairment which are available have not been adequately researched. This article reviews the few rating scales which have been published. It is concluded that, because of the increasing need for objective and valid rating of psychiatric impairment for legal and administrative purposes, there is an urgent need for research to determine the reliability and validity of psychiatric impairment rating scales. Nevertheless, the rating scales currently available do provide a structured approach to the rating of psychiatric impairment and offer a degree of objectivity, and therefore they should be utilized more frequently as clinical judgment within the often adversary setting of forensic practice may be influenced by non-clinical factors which may undermine the validity of the assessment.
Continuing Medical Education in Psychiatry
Authors: Wright J. Murray
Published: November 2007

The increasing importance of continuing medical education (CME) in psychiatry is discussed. The need to take account of the principles of adult education (AE) and also of the diversity of current psychiatric practice and individual differences when developing CME programmes is emphasised. The relevance of mandatory CME to the assessment of practitioner performance is also discussed.
The Dopamine Theory of Attention Deficit Hyperactivity Disorder (ADHD)
Authors: Levy Florence
Published: November 2007

Clinical, animal and neuroanatomical studies of differential isomer and dosage effects of CNS stimulant medications on behaviour are reviewed. Wender's hypothesis that an underlying biochemical abnormality and a disorder of reinforcement was the primary deficit in “MBD” children is restated in terms of a disorder of polysynaptic dopaminergic circuits, between prefrontal and striate centres. Wender's notion of a disorder of reinforcement is broadened to include a disorder of planning and correction of behaviour, including capacity for cortical control of automatic instinctual motor programmes. The dopamine hypothesis of Attention Deficit Hyperactivity Disorder (ADHD) is examined from the point of view of differential dose effects of CNS stimulant medications, and theories of neural control. Clinical, animal and neurophar-macological studies are reviewed. Implications of the findings for understanding clinical and side effects in ADHD children of stimulants are discussed.
General Practitioners' Reported Knowledge about Depression and Dementia in Elderly Patients
Authors: Bowers Jennifer , Jorm Anthony F. , Henderson Scott , Harris Peter
Published: November 2007

Previous studies have shown that general practitioners often fail to detect dementia and depression in their elderly patients. The present study aimed to find out how much knowledge general practitioners have of these disorders. The knowledge of 36 general practitioners was assessed and it was found that they had a limited knowledge of the symptoms and signs of dementia and depression. Furthermore, almost 60% of the general practitioners did not know that Alzheimer's disease is the most common dementing disorder.
Attitudes of Medical Professionals towards Patients with Eating Disorders
Authors: Fleming Judith , Szmukler George I.
Published: November 2007

A questionnaire examining attitudes to patients with eating disorders was completed by 352 medical and nursing staff in a general hospital. Patients with eating disorders were less liked than patients with schizophrenia and were seen as responsible for their illness almost to the same degree as recurrent overdose takers. Factor analysis showed a first factor in which patients with eating disorders were construed as vulnerable to external pressures (from others, the media) while also self-inducing their illness, and this was associated with treatment recommendations for education, urging the patient to take self-control and psychotherapy. The professions differed significantly in attitudes.
The First Lithium Clinic in Hong Kong: A Chinese Profile
Authors: Lee Sing
Published: November 2007

A study of 50 Chinese patients referred to the first lithium clinic in Hong Kong revealed a high prevalence of recurrent mania and rarely unipolar depression. A history of delusions and hallucinations, and re-diagnosis from schizophrenia to manic depressive psychosis, were common. Lithium was prescribed after 3.9 episodes of illness, and at a dosage of 1,191 mg despite a moderate serum level of 0.63 mmol/l. Laboratory monitoring was haphazard, and polypharmacy was common. This might pose unnecessary risks to some patients.
The Psychological Adjustment of Offspring of Adults with Obsessive-Compulsive Disorder: A Brief Report
Authors: Sawyer Michael Gifford , Slocombe Colin , Kosky Robert , Clark Jennifer , Mathias Jane , Burfield Susan , Faranda Irene , Hambly Helen , Mahar Annabel , Tang Boon Nee , Baghurst Peter
Published: November 2007

This study describes the prevalence of emotional and behavioural problems in the offspring of parents who are members of the Obsessive-Compulsive Neurosis Support Group in South Australia. The results suggest that the offspring of adults with obsessive-compulsive disorder do not have more problems than other children and adolescents in the community. The study also highlights potential benefits of collaborative research conducted by research groups and self-help organisations.
A Community Study of Mental Disorders in Elderly Singaporean Chinese Using the Gms-Agecat Package
Authors: Kua Ee Heok
Published: November 2007

A random sample of 612 elderly Chinese aged 65 and over living in the community in Singapore was assessed with the community version of the Geriatric Mental State (GMS) and the data analysed by the AGECAT program to provide computerised diagnoses. The prevalence of organic disorder (dementia) was 2.3%, depression 5.7%, neuroses 1.5% and paranoid disorder 0.5%. The results were generally lower compared to the study of elderly people in Liverpool using the GMS-AGECAT package. Concordance between AGECAT and the psychiatrist's diagnoses for organic disorder, depression, neuroses and paranoid disorder achieved kappa values of 0.87,0.88,0.58 and 1.0 respectively.
Consent and Treatment
Authors: Ridley Graham
Published: November 2007

I found Dr Wallace's letter (Journal, 1992, 26:330-33 1) most interesting. I am familiar with mental health legislation in both the English and Victorian systems, and both of these — in common, I suspect with many other such systems — have the similar problems of being unable to cater for voluntary patients willing to be in hospital but unable to give informed consent to treatment.
New White Elephants for Old Sacred Cows: Some Notes on Diagnosis
Authors: Ellard John
Published: November 2007

Professor Andrews has long been an ornament to our profession. Amongst his many achievements has been the construction of an abattoir for the processing of sacred cows. Since so much psychiatric theory has been manufactured by the accumulation of positive associations, rather than by the refutation of testable hypotheses and their replacement by better ones, there was a great need for such a facility. Already the manure produced by the cows and their spouses, if not less in quantity, is of a better quality and packaged more attractively. True it is that occasionally Professor Andrews has been discovered leading useful, profane cows to the slaughter, but this is as nothing beside his tours de force.
The Emergence of Clinical Psychology Departments in Australian Teaching Hospitals
Authors: Touyz Stephen , Blaszczynski Alex , Digiusto Erol , Byrne Donald
Published: November 2007

Over recent years, clinical psychological services have diversified within the health sector, leading to a breakdown in the traditional nexus between clinical psychology and psychiatry, and to the emergence of the interdisciplinary field of behavioural medicine. From their earlier limited role as providers of psychometric assessments in educational and psychiatric hospital settings, clinical psychologists now provide a wide range of therapeutic services and research skills to general hospitals, universities, community health centres, and the private sector. This evolving trend has significant implications for the future structure and direction of clinical practices in clinical psychology, psychiatry and medicine.
Obstructive Sleep Apnoea and Depression — Diagnostic and Treatment Implications
Authors: Kaplan Robert
Published: November 2007

Sleep apnoea (OSA), a common sleep disorder, is well recognised as a cause of morbidity including psychiatric disorders. There is increasing recognition of the link between OSA and depression. Sleep changes are intrinsic to depressive disorders, most notably disturbances of REM sleep; OSA causes predominantly REM sleep disturbances. The neuro-vegetative features of depression are similar or identical to the symptoms of OSA — an issue which has not achieved wide clinical recognition. A growing number of studies confirm the statistical link between the two conditions. The implications are twofold: OSA needs to be excluded in cases of chronic or resistant depression and treatment of OSA will make it easier to treat the primary depressive disorder. A new method of treatment for OSA, the Sullivan continuous positive airway pump (CPAP), raises the theoretical possibility of treating depression by this means as well.
Suicide Precautions for Psychiatric Inpatients: A Review
Authors: Cheung Peter
Published: November 2007

This paper reviews the literature on the assessment and management of suicide risk of psychiatric inpatients. Even though a large number of scales have been developed to assist the prediction of suicide for patients admitted for suicide ideas and attempts, none of them were designed to predict suicide in the short term. However the Modified Suicide Intent Scale and the Hopelessness Scale appear to have the potential to predict immediate suicide risk. Risk factors associated with specific psychiatric conditions were all derived retrospectively and their predictive validities have not been established by prospective studies. Important issues relating to the management of suicidal inpatients, such as staff-patient relationships, use of constant observation and medical-legal aspects are reviewed.
Youth Suicide and Gender in Australia and New Zealand Compared with Countries of the Western World 1973–1987
Authors: Pritchard Colin
Published: November 2007

Based upon standardised mortality figures, between 1973–1987, Australian male suicide rose by 39%, and New Zealand male suicide by 53%. In both countries there were even greater increases in male youth suicides (15–24 years), 66% and 127% respectively. The female suicide statistics were more varied with a fall of −24% in Australia, but an increase of 26% in New Zealand. In both countries however, female youth suicide, relative to their general rates, increased. A comparison of youth suicide in the western world demonstrated that Australia and New Zealand were unique as they were the only countries in which male and female youth suicide levels were higher than their average rates.
Phobic Reactions of Mothers to their Own Babies
Authors: Sved-Williams Anne E.
Published: November 2007

A systematic review was carried out of all patients admitted to a specialised mother-baby unit who had significant phobic avoidance of their own infants. Demographic and diagnostic information on this group showed phobic avoidance to be common and associated with a range of psychiatric illnesses. There was a trend towards association with relatively prolonged admission. The relationship of such avoidance to attachment behaviour from mother to child is discussed. It is recommended that phobic symptoms warrant early recognition and treatment in their own right, simultaneously with treatment of the major illness.
Case Report of a Female-to-Male Transsexual Homicide Offender
Authors: Lawrence Joan M.
Published: November 2007

A 22 year old female-to-male half-Aboriginal transsexual had been exposed to gross neglect and violence, separation and inconsistent cultural supports during childhood. Her mother had also been convicted of homicide in a context of alcohol and violence. Transsexual identification, antisocial behaviours, self mutilation, substance abuse and unmet dependency needs were evident from childhood or early adolescence. The killing was a confrontational peer group stabbing in a brawl under influence of alcohol — the male mode of homicide. This is the first known case in world literature of a female-to-male transsexual guilty of homicide.
Stability of Psychiatric Diagnoses in New Zealand Psychiatric Hospitals
Authors: Stanton Malcolm W. , Joyce Peter R.
Published: November 2007

This study examines the stability over a five year follow-up of first admission psychiatric diagnoses assigned in New Zealand psychiatric hospitals in 1980 and 1981. Diagnostic stability is a measure of the degree to which psychiatric diagnoses remained unchanged at a later hospital admission. Reasonably high levels of stability were found for the initial diagnoses of substance abuse disorders (86% stable), anorexia nervosa (70%), schizophrenia (67%), and affective disorder (67%). Poor levels of stability were noted for the initial diagnoses of personality disorder (36%), other psychosis (excluding schizophrenia and affective psychosis) (22%), and other neurosis (excluding neurotic depression) (20%). The major trends in diagnostic change are described. Factors influencing diagnostic instability are also examined. For patients with an initial diagnosis of schizophrenia, a change in hospital is found to be the strongest factor causing diagnostic instability, with time between admissions and age at first admission also having a significant influence. The implications of these findings are discussed.
Mortality of Public Mental Health Patients: A Singapore Experience
Authors: Lim Lionel Chee-Chong , Sim Li-Ping , Chiam Peak-Chiang
Published: November 2007

This study reports the Standardised Mortality Ratio (SMR) by age and sex among public mental health patients in Singapore. The authors also examine the differences between those who were classified as “inpatient deaths” and those who were classified as “outpatient deaths”. Mortality was 5.1 times that of the general population and the SMR was most accentuated in the younger, female patients. Of the 217 deaths documented over two years, schizophrenia was the most common diagnosis. Inpatient deaths (N = 120) occurred in older patients with prior physical illness who died of natural causes. In contrast, outpatient deaths (N = 97) involved younger patients with no previous illness and the majority jumped to their deaths. Mortality studies are necessary in monitoring the efficacy of mental health provisions.