bluuebunny/crossref_metadata_2025 huggingface dataset:
Is There a Role for Child Psychiatry in Vietnam?
Authors: McKelvey Robert S. , Sang David L. , Tu Hoang Cam
Published: January 2008

Objectives:(i) To describe the need for child psychiatric services in Vietnam; (ii) to review child psychiatry's present role within the Vietnamese health care system; (iii) to identify cultural, economic and manpower obstacles to the development of child mental health services; and (iv) to recommend a course for the future development of child psychiatry in Vietnam.

Method:The existing literature relevant to the Vietnamese health and mental health care systems, traditional practices and beliefs regarding health and mental health, and the current status of psychiatry and child psychiatry in Vietnam was reviewed. In addition, discussions regarding these topics, and the future of child psychiatry in Vietnam, were held with leading Vietnamese health and mental health professionals.

Results:The current role of child psychiatry in Vietnam is limited by the health care system's focus on infectious diseases and malnutrition, and by cultural, economic and manpower factors. Treatment is reserved for the most severely afflicted, especially patients with epilepsy and mental retardation. Specialised care is available in only a few urban centres. In rural areas treatment is provided by allied health personnel, paraprofessionals and community organisations.

Conclusions:While the present role of child psychiatry in Vietnam is limited, it can still make important contributions. These include:research defining the need for child and adolescent mental health services, identifying priority child psychiatric disorders and assessing the effectiveness of priority disease treatment; and training to enhance the skills of primary health care providers in the treatment of priority disorders.
Fluoxetine and Involuntary Recall of Remote Memories
Authors: Robertson Andrew R.
Published: January 2008

Objective: To describe a striking, and hitherto unreported, side-effect of fluoxetine.

Clinical Picture:Four patients given fluoxetine developed involuntary vivid recall of earlier life events.

Treatment and Outcome:The side-effect ceased after fluoxetine was discontinued.

Conclusions:The implications of this finding are discussed, particularly with regard to the nature of long-term memory.
Morbid Jealousy as a Variant of Obsessive-Compulsive Disorder
Authors: Parker Gordon , Barrett Elaine
Published: January 2008

Objective:To present a representative case vignette and review several previous reports, and to then suggest that a percentage of those with morbid jealousy may have a variant of obsessive—compulsive disorder (OCD).

Clinical picture:A patient presented volunteering a diagnosis of depression and anxiety following recent work and marital stresses, before describing recent jealousy and harassment of his wife over an earlier relationship. Obsessional thinking patterns and compulsive behaviours are described, and it is proposed that the picture supports a diagnosis of obsessive—compulsive disorder.

Treatment and outcome:The patient was treated as if he had an obsessive-compulsive disorder, and reported dissipation of his concerns after cognitive—behavioural intervention.

Conclusions:The proposition is an important one as a diagnosis of morbid jealousy often invites therapeutic pessimism, and as managements effective for OCD (both drug and behavioural) may well be helpful.
Point of View: Should There be a Clinical Typology of Posttraumatic Stress Disorder?
Authors: Alarcon Renato D. , Deering Catherine G. , Glover Susan G. , Ready David J. , Eddleman H. Clay
Published: January 2008

Objective: The current classification of posttraumatic stress disorder in acute, chronic and delayed-onset types is incomplete and of limited usefulness. The present paper explores the possibilities of a clinically-based typology that would reflect both the patients' syndromic presentation and modern research findings.

Method: Review of current clinical and research literature, with a critical examination of proposed typologies, parameters utilised, applicability and relevance; elaboration of theoretical and practical bases of a clinical typology of posttraumatic stress disorder.

Results: None of the existing posttraumatic stress disorder typologies presents a clinically comprehensive scope. A typology supported by literature findings and clinical observations is proposed. The six clinical types are depressive, dissociative, somatomorphic, psychotomorphic, organomorphic and ‘neurotic-like’. Substance abuse and personality disorder-like variants remain as areas of investigation.

Conclusions: The proposed typology, while accepting the nuclear manifestations of posttraumatic stress disorder, highlights prominent coexisting symptoms that define the clinical appearance of different patients. The typological approach in posttraumatic stress disorder does not carry the ambiguities of comorbidity, and facilitates a more specific and appropriate management of the cases.
Psychiatry: An Impossible Profession?
Authors: Bloch Sidney
Published: January 2008

Objective: To examine the disconcerting question as to whether psychiatry is a fully-fledged profession or not.

Method: A review of pertinent literature regarding the criteria of a profession, the vulnerability of psychiatry to abuse, and potential models for the proper practice of psychiatry.

Results: Psychiatry lost its professional anchorage entirely with its misuse to suppress dissent in the former Soviet Union and in the so-called euthanasia program in Nazi Germany. It remains vulnerable to abuse unless psychiatrists recognise the professional criteria they must satisfy. A new symbol, a humble stool, is proposed. Its three legs represent the three equally significant dimensions of psychiatric practice: science, art and ethics.

Conclusion: Psychiatry just ‘scrapes home’ in constituting a profession but only subject to three provisos: namely (i) that psychiatrists appreciate the need to achieve a coherent body of special knowledge through a genuine creative process which necessarily results in uncomfortable tension from time to time; (ii) that we promote the art of psychiatry by cultivating an ethos of caring and sensitivity; and (iii) that we function within an articulated ethical framework with respect for codes of ethics as guidelines.
Characteristics of Childhood Sexual Abuse and Adult Psychopathology in Female Psychiatric Patients
Authors: Pettigrew Jill , Burcham Joyce
Published: January 2008

Objective: The present study investigated the relationship of characteristics of childhood sexual abuse and subsequent psychopathology.

Method: Referrals to a female psychiatrist in private practice in an urban working class area provided 73 adult female subjects who reported having been sexually abused in childhood. Data were collected on age at onset, duration, physical invasiveness of the abuse, violence, and the number and relationship of abusers.

Results: Having had multiple abusers in childhood was significantly (p < 0.01) associated with every outcome measure of severe psychopathology: an initial Global Assessment Functioning score of 50 or below; both single and repeated incidents of deliberate self-harm; overdose; self-mutilation; and psychiatric hospital admission.

Conclusions: Notably, having had multiple abusers was the only characteristic showing a reliable independent association with any of these measures. Subjects who had had multiple abusers were significantly more likely to have an earlier age of onset and longer duration of abuse, and to have experienced violent abuse.
Values in Psychotherapy
Authors: Holmes Jeremy
Published: January 2008

There is a tension between those who hold that psychotherapy is a scientific discipline and therefore ‘value-free’, and those who believe that values are inherent in the nature of psychotherapy. Psychoanalysis has moved from a science-based ideology, through the ethical concerns of Melanie Klein, to a recognition of the ‘aesthetic’ dimension: the creation of suitable forms which can contain psychological distress. From this latter perspective the antagonism between religion and psychotherapy, initiated by Freud, becomes less acute. Action-based ethical systems, which ignore the inner world, are critically scrutinised. The evidence suggesting that there is a relationship between good outcome in psychotherapy and shared values between therapist and client is reviewed. It is suggested that through examination of the ‘ethical countertransference’ therapists should become aware of their own value systems and how they influence practice.
A Review of the Use of Augmentation Therapy for the Treatment of Resistant Depression: Implications for the Clinician
Authors: Schweitzer Isaac , Johnson Gordon , Tuckwell Virginia
Published: January 2008

Objective: To critically review the literature on augmentation therapy in resistant depression in order to assist the clinician to make a reasoned choice. Augmentation therapy is defined as the addition of a second agent to an existing antidepressant regimen with the aim of achieving improved clinical response.

Method: The available literature which related specifically to currently popular augmentation strategies in treatment resistant depression for the past 20 years was examined. The scientific evidence supporting the efficacy of these regimens and their safety was reviewed.

Results: Considerable research on lithium augmentation has been undertaken, and on triiodothyronine augmentation to a lesser degree. A number of other drugs have been trialled as augmentation agents with claims of success; however, most of the evidence supporting these agents is anecdotal and in the form of case reports. There are very few well-performed double-blind placebo-controlled studies of augmentation therapy.

Conclusions: Because of possible complex pharmacodynamic and pharmacokinetic interactions, augmentation therapy is not without its potential complications. Lithium augmentation of tricyclic antidepressants can be recommended as a safe and effective strategy and there is a body of scientific evidence supporting the addition of T3 as an effective augmentation agent. Recent research with pindolol augmentation of selective serotonin re-uptake inhibitors (SSRIs) is encouraging, but these findings require replication. There is no empirical evidence supporting buspirone, carbamazepine, sodium valproate, methylphenidate or amphetamine as effective augmentation agents, or that adding a tricyclic to a SSRI has usefulness in relieving depressive symptoms. There is a need for considerable research in this area, with more prospective well-controlled placebo studies.
Experiences of Physical and Sexual Abuse in Australian General Practice Attenders and an Eating Disordered Population
Authors: Brown Lisa , Russell Janice , Thornton Christopher , Dunn Stewart
Published: January 2008

Objective: To determine the reported rates of child physical and sexual abuse experienced by hospitalised eating disordered patients compared to a control group of women attending general practitioners.

Method: A retrospective survey using the self-report Finkelhor Sexual Life Events Inventory and clinical reports.

Results: Nearly one-half of eating disordered patients reported a history of child sexual abuse and one-quarter reported child physical abuse. These rates were significantly higher than those reported by the control group.

Conclusions: Direct questioning regarding trauma histories is warranted when assessing patients with eating disorders and attention to such issues should be incorporated into the total management plan.
Is Clozapine Safe in the Elderly?
Authors: Herst Laurence , Powell Geoff
Published: January 2008

Objective: The aim of this paper is to assess the risk/benefit ratio of clozapine in the elderly.

Method: MedLine and Internet searches, followed by cross-checking for further articles, identified the references. Reports on efficacy as well as side effects were examined. Five psychogeriatric patients treated by the authors are presented.

Results: The review of the literature highlighted the lack of studies on the use of clozapine in the elderly. Retrospective studies and case reports dominate. There is only one double-blind placebo-controlled study of six patients extant. Although efficacy seemed to parallel that in the younger age groups, the incidence of leukopenia, agranulocytosis, postural hypotension and confusion was greater in the elderly. Two of the five patients reported by the authors developed agranulocytosis, bringing the Australian experience of agranulocytosis in patients over 65 years of age to 4/55.

Conclusion: The risk/benefit ratio in the elderly is distinctly higher than found in the younger population. With specific reference to agranulocytosis alone, the frequently quoted risk of 1% for patients is likely to be 5–10 times higher in the over 65 population. Caution is advised when prescribing clozapine in the psychogeriatric population.
Confirmation of the Diagnosis of Schizophrenia after Death Using DSM-IV: A Victorian Experience
Authors: Roberts Susan B. , Hill Christine A. , Dean Brian , Keks Nicholas A. , Opeskin Ken , Copolov David L.
Published: January 2008

Objective: This study examines the reliability of antemortem diagnoses of schizophrenia using DSM-IV criteria.

Method: The case histories of 83 subjects with a provisional diagnosis of schizophrenia at autopsy were retrospectively reviewed using a semi-structured chart review and application of DSM-IV criteria. Agreement between antemortem and postmortem diagnoses of schizophrenia was examined, as well as the concordance between DSM-IV diagnoses and previously obtained diagnoses using DSM-Ill-R and ICD-10 criteria for schizophrenia.

Results: According to DSM-IV, 30.1% of cases did not have schizophrenia, compared to 36.1% using DSM-Ill-R criteria and 51.8% of cases using ICD-10 criteria. Concordance between DSM-IV and DSM-Ill-R diagnoses of schizophrenia was excellent (k = 0.81), but only fair between DSM-IV and ICD-10 (k = 0.57). Of the cases that did not meet the formal criteria for schizophrenia, the majority were reassigned diagnoses of schizoaffective disorder and affective disorder.

Conclusions: The use of human brain tissue in postmortem studies of schizophrenia must be linked to standardised diagnostic assessment procedures. Diagnoses can be upgraded with the development of new criteria, providing sufficient clinical data is available in case histories.
Directions of Aetiologic Research on Attention Deficit Hyperactivity Disorder
Authors: Levy Florence , Ban Cathy , Sunohara Glen
Published: January 2008

Objective: The aim of this paper is to review and integrate recent literature on aetiological factors that have been postulated for attention deficit hyperactivity disorder (ADHD).

Method: Recent studies relating to perinatal brain damage, intra-uterine toxic effects, neurochemical, brain imaging and genetic studies are reviewed, and those considered most significant are discussed. Where possible, recent findings are integrated and directions of future research are suggested. Clinical implications are briefly discussed.

Results: Perinatal studies indicate that children with a birth weight under 750 g may be disadvantaged for attentional skills. Magnetic resonance imaging (MRI) and steady state visually evoked potential studies show differences in prefrontal, caudate and parietal areas in ADHD children, suggesting right hemispheric dysfunction. Functional MRI studies hold promise in further elucidating attentional systems in the central nervous system that are involved in ADHD. Genetic studies suggest genes related to dopaminergic systems may be important.

Conclusions: Recent research on ADHD has made considerable advances, particularly in the areas of brain imaging and genetic studies. Genetic studies should provide further aetiological understandings of ADHD, leading to more targeted treatments.
The Relationship between Admission to Hospital with Chest Pain and Psychiatric Disorder
Authors: Kisely Stephen R.
Published: January 2008

Objective: Psychosocial variables have been identified as important predictors of outcome in patients with chest pain. Most attention has focused on patients with ischaemic heart diseases or those in outpatient settings. This paper compares focuses on inpatients, and compares patients with ischaemic heart disease to those with non-specific chest pain.

Method: A search of the literature on chest pain and psychiatric disorder from 1972 onwards using Medline, Index Medicus and the bibliographies of retrieved articles.

Results: One-third of patients admitted with acute chest pain have psychiatric disorder as measured by standardised interviews. Patients who have had psychiatric symptoms prior to admission and those with non-specific pain appear to be most at risk of continuing psychiatric morbidity. In patients with ischaemic heart disease, psychiatric symptoms on admission are more strongly related to subsequent social outcome than variables such as severity of infarct or the presence of angina. Psychiatric symptoms may also effect physical morbidity and possibly mortality, although further research is required to clarify the latter finding. In patients with nonspecific pain, further research is indicated to identify aetiological and maintaining factors for continued non-specific pain. There is, however, a strong association with alcohol and cigarette use.

Conclusions: The prediction of outcome requires careful assessment of previous or current psychiatric symptoms in patients admitted with chest pain, irrespective of underlying diagnosis. Early intervention with psychological treatment for patients with non-specific chest pain is indicated; this may also involve help to reduce smoking. There is also further evidence that mortality following myocardial infarction is closely linked to psychiatric disorder, although prior psychiatric disorder may be more important than “post-infarction” depression. Larger and more methodologically rigorous studies are required to further clarify these findings.
The Relationship between Psychiatric Illness and the Circadian Pattern of Heart Rate
Authors: Stampfer Hans G.
Published: January 2008

Objective: The aim of this study was to investigate the relationship between psychiatric status and the circadian pattern of heart rate.

Method: Serial 24–hour recordings of minute average heart rate were obtained from 30 normal volunteers and 200 patients representing a range of DSM-III-R diagnoses. Records were compared in terms of their circadian “morphology” and grouped into different pattern types. The distribution of patterns in different diagnoses was analysed statistically.

Results: It was found that states such as generalised anxiety and depression are strongly associated with a distinctive circadian pattern, whereas others such as somatoform disorder show more variation in this regard. Serial recordings show that the relationship between psychiatric status and circadian pattern is state-dependent; a change in clinical status leads to a change in the circadian pattern.

Conclusions: The presented findings together suggest that there is a systematic relationship between psychiatric status and heart rate in which core physiological differences between certain states are reflected in distinctively different circadian patterns of activity. The state-dependent nature of this relationship suggests obvious practical applications, and examples are given of how these adjunct data can provide objective indices of clinical status and change. At a theoretical level, the physiological dimension revealed by these data may help to define more reliable syndromal distinctions between various clinical manifestations and hence contribute to a more robust nosology.
Learning Organisations: A Suitable Model for Improving Mental Health Services?
Authors: Birleson Peter
Published: January 2008

Objective: The aim of this paper was to describe an organisational model that has created interest in recent business management literature as supporting learning, adaptation and continuous improvement.

Method: Some key features of the literature on learning organisations are outlined, including the values and processes involved, together with a structural and cultural template that has been applied to a community child and adolescent mental health service. Some blocks to learning and the leadership skills required to develop adaptive services are described.

Results: The experience of applying the model has led to a change in mental health service organisational structure and culture towards greater support for research, quality improvement, experimentation and adaptation.

Conclusions: The learning organisation model offers a more comprehensive framework for designing adaptive mental health services and supporting quality management practices than any other recent organisational form.
The Community Treatment Order: Clinical and Ethical Issues
Authors: McIvor Ronan
Published: January 2008

Objective: In the light of recent legislation, this paper reviews the implementation of the Community Treatment Order (CTO) in terms of clinical efficacy and ethical issues involved in its use. The debate surrounding the introduction of CTOs in other countries is explored.

Method: A Medline search was conducted and references of recent articles followed up, with attention to Australian, New Zealand and international trends. A review of relevant legislation and government reports was conducted.

Results: There has been limited debate in the Australian and New Zealand literature concerning the operation of CTOs. Despite their increasing and widespread use, there is a paucity of research on the efficacy of CTOs. Concerns about their negative effects on civil liberties have been stressed in the United Kingdom and American literature.

Conclusions: If the continued use of CTO is to be justified, both clinically and from the civil liberties perspective, controlled research needs to be carried out to identify whether CTOs are more effective than comprehensive assertive community outreach programs in reducing relapse rates and hospitalisation, and increasing compliance. Clinical guidelines concerning who is most likely to respond to such orders need to be developed. Alternatives to the CTO are explored, and future directions in research are outlined.
Obsessional Symptoms Associated with Risperidone Treatment
Authors: Mahendran Rathi
Published: January 2008

Objective: The aim of this paper is to report the occurrence of obsessional symptoms with risperidone treatment in a patient with no past history of obsessive-compulsive symptoms.

Clinical picture: A 26–year-old, single, Chinese lady with a chronic untreated schizophrenic illness was prescribed risperidone after she experienced side effects with other antipsychotic medication. After the second week on risperidone, she developed obsessional symptoms.

Treatment and Outcome: The obsessional symptoms responded to treatment with low dose clomipramine.

Conclusion: The potential for the newer antipsychotic medication to precipitate or exacerbate obsessive-compulsive symptoms during treatment for schizophrenia must be borne in mind.
Psychological Distress and Suicidal Ideation among 15–24–Year-Olds Presenting to General Practice: A Pilot Study
Authors: McKelvey Robert S. , Davies Lisa C. , Pfaff Jon J. , Acres John , Edwards Stephen
Published: January 2008

Objectives: The study sought to determine: (i) the prevalence rates of psychological distress and suicidal ideation among 15–24–year-old patients presenting to general practice; and (ii) the relationship between patients' presenting complaints and their levels of psychological distress and suicidal ideation. Method: This was a pilot study designed to sample patients aged 15–24 years presenting consecutively to general practitioners during a 4–week period. The study was set among five general practices in the western suburbs of Perth, Western Australia. Participants included five general practitioners and 69 patients aged 15–24 years. Main outcome measures were the General Health Questionnaire (GHQ-12), the Centre for Epidemiological Studies Depression Scale (CES-D) and the Depressive Symptom Inventory-Suicidality Subscale (DSI-SS).

Results: One-third of patients scored above the cut-off of the GHQ-12,31.9% above the cut-off of the CES-D and 20.3% above the cut-off of the DSI-SS. The majority of patients (87.5%) presented with medical complaints. Of these, 26.8%, 23.2% and 21.4% scored above the cut-offs of the GHQ-12, CES-D and DSI-SS, respectively. Patients presenting with psychological complaints (12.5%) were significantly more likely to score above the cut-off of the CES-D.

Conclusions: In this pilot study, patients aged 15–24 presenting to five general practices had relatively high levels of psychological distress and suicidal ideation. Of most concern were those presenting with medical complaints and who also had high levels of unreported psychological distress.
Sex, Lies and Training Programs: The Ethics of Consensual Sexual Relationships between Psychiatrists and Trainee Psychiatrists
Authors: Ryan Christopher James
Published: January 2008

Objective: The aim of this paper is to chart the ethical territory surrounding the issue of consensual sexual relationships between psychiatrists and doctors training in psychiatry.

Method: The arguments for and against the prohibition of such relationships are critically examined both in general and in a number of specific circumstances. Results: There should not be a general prohibition against such relationships, but a prohibition should apply in certain special circumstances. Such circumstances include occasions when the psychiatrist is currently supervising the trainee, when a particular psychiatrist has repeated sexual relationships with trainees and when a group of psychiatrists voluntarily pledge to abstain from such relationships. Conclusions: Institutions involved in psychiatric training should develop guidelines for dealing with such relationships, adopting a generally permissive attitude toward them with clear exceptions in special cases.
Bilingual Professionals in Community Mental Health Services
Authors: Mitchell Penny , Malak Abd , Small David
Published: January 2008

Objective: This paper presents results from research that explored the roles of bilingual professionals in community mental health services in the Sydney metropolitan area of New South Wales. There were two main objectives to the research: (i) to identify and describe the roles of bilingual professionals that are important in improving the quality of community mental health services for clients from non-English-speaking backgrounds (NESB); and (ii) to identify and describe the factors that facilitate and inhibit the conduct of these roles.

Method: Data collection involved indepth interviews with bilingual professionals and team leaders in community mental health services and various other community health services; and various staff responsible for policy and service development with regard to cultural diversity.

Results: Bilingual mental health workers were found to have at least four critical roles. These were (i) direct clinical service provision to NESB clients; (ii) mental health promotion and community development; (iii) cultural consultancy; and (iv) service development. Respondents reported that the latter three roles were seriously underdeveloped compared to the clinical service provision role. Conclusions: It is critical that service managers implement strategies to make better use of the linguistic and cultural skills of bilingual professionals. In addition to their role in clinical service provision ways must be found to facilitate the community-focused, cultural consultancy and service development roles of bilingual professionals employed in mental health services.
Childhood Abuse, Parenting and Postpartum Depression
Authors: Buist Anne
Published: January 2008

Objective: While the potential negative effects on children of maternal depression has been documented, the influence of a maternal history of childhood abuse on child development is unclear. This study, the first stage of a 3–year follow-up study, looks at childhood abuse in women with depression in the postpartum period. Method: Fifty-six women admitted with postpartum depressive disorders were assessed with respect to their wellbeing, relationships and infant interaction. Twenty-eight women had a history of sexual abuse before the age of 16, nine physical/ emotional abuse and 19 had no history of abuse.

Results: The mother-infant relationship was seen to be impaired in the sexually abused group (p = 0.007). The significance increased when all abused women were compared to controls (p = 0.001). In addition, abuse was associated with more severe depression on the Beck Depression Inventory (p = 0.046), and a trend to higher anxiety and longer lengths of stay (p = 0.05 for physical abuse). Partners rated themselves as being more skilled and confident parents.

Conclusions: The effect of childhood abuse was indistinguishable between emotional and physical abuse in postpartum depressed women. The most significant effect was a deleterious one on the mother-infant relationship in those women with a history of abuse.
Chronic Fatigue Syndrome: An Immunological Perspective
Authors: Vollmer-Conna Uté , Lloyd Andrew , Hickie Ian , Wakefield Denis
Published: January 2008

Objective: The aim of this study is to review research examining an immunological basis for chronic fatigue syndrome (CFS) and to discuss how a disturbance in immunity could produce central nervous system (CNS)-mediated symptoms. Method: Data relevant to the hypothesis that abnormal cytokine release plays a role in the pathogenesis of CFS are reviewed as well as recent evidence relating to potential mechanisms by which immune products may enter the brain and produce a disturbance in CNS processes.

Results: Examinations of cytokine levels in patients with CFS have produced inconclusive results. Recent evidence suggests that abnormal release of cytokines within the CNS may cause neural dysfunction by a variety of complex mechanisms.

Conclusion: Neuropsychiatric symptoms in patients with CFS may be more closely related to disordered cytokine production by glial cells within the CNS than to circulating cytokines. This possibility is discussed in the context of unresolved issues in the pathogenesis of CFS.
The Clinical Use of Plasma Clozapine Levels
Authors: Bell Ron , McLaren Andrew , Gaianos Jason , Copolov David
Published: January 2008

Objective: This review examines the evidence supporting the proposition that a threshold clozapine plasma level can predict clinical response. In addition, it provides a brief overview of the pharmacokinetics, side effects, drug interactions and assay methodology of clozapine.

Method: A comprehensive search of relevant literature was made with respect to the above criteria. The findings were collated and analysed to produce an overview of the usefulness of using clozapine levels in clinical practice. Results: Most researchers find that, although the correlation between dose of cloza pine and clinical effect is not high, a threshold plasma level of 350–420 ng mL of clozapine is associated with an increased probability of a good clinical response to the drug. Results vary, however, with the study design.

Conclusions: The data reviewed present a case for increasing the dose of cloz apine in non-responsive patients to achieve a plasma level of at least 350–420 ng mL−1. Non-response at these levels, however, should not preclude a further upward titration of dose. This should occur unless (i) clinical response is obtained at a lower dose, (ii) intolerable side effects occur, or (iii) a daily dose of 900 mg is reached.
Early Intervention in Schizophrenia in the Elderly
Authors: Burke David , Shome Sushmita
Published: January 2008

Objective: The aim of this paper is to briefly review the literature on early intervention in schizophrenia in the elderly, and to present six cases of schizophrenia in the elderly which highlight the need for assertive management of the type encouraged widely for early onset illness in younger patients.

Method: Six case histories are presented.

Results: All six patients were diagnosed with DSM-IV schizophrenia, all were single and all were socially isolated. They required involuntary admission, treatment with depot antipsychotics, extensive psychosocial intervention and community treatment orders. The use of these treatment strategies led to a positive outcome in each case.

Conclusion: The authors argue that assertive treatment of elderly patients with schizophrenia should be pursued with the enthusiasm often reserved for younger, early onset patients, and that therapeutic optimism is required and warranted.
Deliberate Exposure to Motor Vehicle Exhaust Gas: The Psychosocial Profile of Attempted Suicide
Authors: Skopek Michaela A. , Perkins Richard
Published: January 2008

Objective: Deliberate exposure to motor vehicle exhaust gas has become the second most commonly used method of suicide in Australia. In an attempt to understand the factors contributing to the rise in popularity of this method, the psychosocial profiles, factors influencing method choice and circumstances of the act of self-harm were examined in a group of survivors.

Method: A cross-sectional cohort study of 30 patients presenting for hyperbaric oxygen treatment having survived deliberate exposure to car exhaust gas was undertaken. A structured clinical interview was administered together with scales measuring depression, hopelessness and suicidal intent. Daily assessment of mental state and cognitive function was performed.

Results: Factors common to the majority of subjects included male gender, age group of 20–50 years, and alcohol abuse. Relationship discord was the most common precipitating factor. Reasons given for choice of this method included the availability and accessibility of motor vehicles, painlessness, awareness that the method was lethal, knowledge of another person's successful suicide by this method and awareness of the method through media portrayal. Most of the cars used did not have engines fitted with catalytic converters, substantially increasing the risk of toxicity. Regret of the attempt, denial of further suicidal ideation after the event, and the absence of a suicide note were common findings. Most denied excessive time spent planning. The most common diagnosis in this group was adjustment disorder with depressed mood. Suicide intent scores were not high, inconsistent with the majority of patients being aware of the lethality of the method.

Conclusion: Sociodemographic findings resemble those of psychological autopsy studies of subjects completing suicide by this method. Survival in this group was due to failure of the method or unexpected discovery rather than patient factors. This population described the method as highly acceptable and accessible emphasising the urgent need for reduction of access to this means of suicide in Australia.
Length of Stay, Leave and Re-Offending by Patients from a Queensland Security Patients Hospital
Authors: Green Bob , Baglioni Anthony J.
Published: January 2008

Objective: The release of patients from a security patients hospital has been the subject of public controversy. The present study uses empirical data to examine the length of stay, leave, and re-offending of patients from a security hospital.

Methods: Survival analysis was used to examine factors that may be predictive of length of stay and time under restriction, as well as time to first overnight leave. Data on re-offending were obtained from a variety of sources and were compared with seriousness of index offences.

Results: Consistent with international research, patients with more serious offences had longer hospitalisations. Patients with more serious offences were also hospitalised for longer periods before leave was granted. Compared with international studies, re-offending was in the lower range.

Conclusions: Despite concerns raised in the media regarding patient ‘dangerousness’, time spent in hospital and the granting of leave, patients with serious offences were more likely to be hospitalised longer, which suggests decision makers do take into account public safety.
Relationship History and Relationship Attitudes in Gay Males and Lesbians: Attachment Style and Gender Differences
Authors: Ridge Stacy R. , Feeney Judith A.
Published: January 2008

Objective: The objective of the present study was to assess the applicability of attachment theory to the relationships of gay males and lesbians, with particular emphasis on parental relationships, relationship satisfaction, sexual attitudes and ‘coming out’ as being homosexual.

Methods: Gay males (n = 77) and lesbians (n = 100) completed questionnaires assessing attachment style, working models of attachment, early relationships with parents and relationship history, status and functioning. A comparison sample of heterosexual participants completed measures of attachment style and relationship history.

Results: Relative frequencies of attachment styles were similar for homosexual and heterosexual samples. Contrary to previous research using largely heterosexual respondents, no link between early parenting and attachment style was found. However, homosexual males reported more positive early relationships with mothers than did females. Associations of attachment style with working models, relationship variables and sexual attitudes largely supported those based on heterosexual samples. Gender and attachment style differences were found in reported effects of ‘coming out’ on relationships with parents.

Conclusions: Overall, the results suggest that insecure attachment may not be over-represented in gay and lesbian samples, but that insecurity is associated with less relationship satisfaction and with problems related to the disclosure of sexual orientation. The implications of these findings for research and clinical practice are addressed.
Religious—Sociocultural Psychotherapy in Patients with Anxiety and Depression
Authors: Razali S. M. , Hasanah C. I. , Aminah K. , Subramaniam M.
Published: January 2008

Objective: To show the effectiveness of incorporating religious–sociocultural components in the management of patients with generalised anxiety disorders and major depression who have strong religious and cultural backgrounds as compared with a normal psychotherapeutic approach.

Methods: One hundred and three cases of anxiety and 100 cases of depression with strong religious and cultural backgrounds were randomly assigned to the study or control groups. Both groups received standard treatment for their respective illnesses. The study group was given additional religious–sociocultural psychotherapy. They were followed for 6 months and were assessed in a double-blind fashion using the Hamilton Anxiety Rating Scale or the Hamilton Depression Rating Scale.

Results: Patients receiving additional religious–sociocultural psychotherapy responded significantly faster than those who received standard treatment. However, the difference became non-significant at the end of 6 months.

Conclusions: Incorporating a religious and sociocultural component in the treatment program rapidly improved anxiety and depressive symptoms in patients with strong religious and cultural backgrounds. The present study demonstrates a need for more sensitivity to religious–sociocultural issues in the field of mental health.
Mental Health Professionals' Attire
Authors: Rajagopalan Mani , Santilli Mario , Powell David , Murphy Megan , O'brien Marice , Murphy John
Published: January 2008

Objective: Our aim was to obtain mental health patients' views on psychiatrists' and case managers' attire

Methods: Eighty-six patients treated at a community mental health service were surveyed. Various types of commonly worn attire were listed. Respondents were asked to choose what they thought was most appropriate for their psychiatrist and case manager to wear.

Results: Over 50% of respondents felt that psychiatrist or case manager dress was not an important issue. However, those who felt that it was preferred less formal attire.

Conclusions: Psychiatrists and case managers in a community mental health team could consider adopting less formal attire. This conclusion is limited by the small sample and may be relevant to rural areas only. Further research is needed in urban centres. Implications of these findings are discussed.
Neuroleptic Malignant Syndrome Associated with Olanzapine
Authors: Johnson Vanessa , Bruxner George
Published: January 2008

Objective: The aim of the present paper is to report a case of Neuroleptic Malignant Syndrome (NMS) occurring 2 days after olanzapine was added to the treatment regimen of an elderly patient with Schizoaffective Disorder. The patient had a previous history of NMS associated with risperidone.

Clinical picture: Two days after commencement of olanzapine, the patient presented in a stuporous state with dysarthria and increased muscle tone with cogwheeling. His level of consciousness fluctuated over the following 24 h with worsening rigidity, the onset of a mild fever, tachycardia and elevated blood pressure. Biochemical screening revealed markedly elevated creatine kinase.

Treatment: Olanzapine was ceased and intravenous fluid replacement commenced. Hourly physical observations were instigated, as was regular serum monitoring of creatine kinase level.

Outcome: Over the subsequent 48 h, there was gradual clinical improvement with resolution of dysarthria, ataxia, rigidity and fever. The patient was returned to the psychiatric ward 3 days after his admission to the medical ward.

Conclusions: Olanzapine therapy can be associated with NMS. To our knowledge, there are no previous reports of this in the literature.
Comment: ‘Devining’ The Role of the Consultant Psychiatrist in a Public Mental Health Service
Authors: Rosen Alan
Published: January 2008

We admitted to ourselves, …and to our colleagues that we cannot treat people with severe and persistent mental illness as independent practitioners, and asked to be key players on the multidisciplinary team (Extract from A 12-Step Recovery Program for Psychiatrists [1]).
Conceptual Foundations of Schizophrenia: II. Disintegration and Division
Authors: Barrett Robert J.
Published: January 2008

Objective: This is the second of two papers that aim to identify some cultural themes and institutional processes that shaped the development of schizophrenia as a disease concept.

Method: A number of domains within 19th century European history are explored for evidence of the concept of the divided or disintegrated person. These include German academic psychiatry, Mesmerism and hypnosis, neurology and neurophysiology, psychoanalysis and German Romantic literature, and its descendants within a wider European literature.

Results: Representations of division or disintegration are evident in all these domains, enjoying widespread currency and penetration throughout the 19th century.

Conclusions: These culturally based ideas, combined with the idea of degeneration, were important elements in the foundation of the schizophrenia concept.
Comment
Authors: McGorry Patrick
Published: January 2008

It is rare to find an aspect of human endeavour in which there has been a comparable level of conceptual stagnation for so long as we have seen in the nosology of psychotic disorders. During the late 19th century, German intellectuals dominated most fields of human activity. Since then their ideas have been complemented or superseded everywhere by contributions from other parts of the world, except in psychotic illness. Why? What is the basis for the tenacious grip the concept of dementia praecox has held on the minds of psychiatrists for over a century? Barrett, an anthropologist, psychiatrist, and now an archaelogist, takes us on a ‘dig’ of late 19th century thought to try to find an answer. These papers are extracted from part of his now classic study of the social construction of schizophrenia in a hospital setting, which has been published recently as a monograph [1].
Rejoinder
Authors: Barrett Robert J.
Published: January 2008

These two commentaries are quite distinct. I will respond to one in detail and the other in brief.
Recognition and Classification of Psychopathology in Preschool Children
Authors: Pavuluri Mani N. , Luk Siu-Luen
Published: January 2008

Objective: The aim of this paper is to offer a critical overview of research on preschool psychopathology, and to propose a working classification based on the empirical evidence.

Method: All of the existing factor and cluster analytic studies, and those studies that attempted to establish the reliability and validity of the subcategories in preschool behaviour disorder were reviewed. Applicability of the current classifications (DSM-IV and ICD-10) to preschool age was examined.

Results: Empirical evidence suggests a well-established, externalising and internalising dichotomy, and a developmental problems factor where the instrument included these problems. There was also a strong tendency for the externalising and internalising symptoms to overlap. Within the externalising factor, there is evidence suggesting that attention deficit hyperactivity should be separated out and recognised. Categories in the DSM-IV and ICD-10 classification did not correspond with the statistically derived groups.

Conclusion: A classification of preschool psychopathology that incorporates the age-specific disorders and risk factors is proposed. This is likely to increase the awareness of researchers, taxonomists and clinicians of psychopathology in preschool children, thereby leading to an early recognition.
Emotional and Behavioural Problems and Competencies among Immigrant and Non-Immigrant Adolescents
Authors: Davies Lisa C. , McKelvey Robert S.
Published: January 2008

Objective: The aim of this study was to compare levels of emotional and behavioural problems and competencies among immigrant and non-immigrant adolescents, and to determine factors that may contribute to any differences reported.

Method: Subjects were selected randomly from students aged 12-16 years attending a high school with a high proportion of immigrants in Perth, Western Australia. Parents completed the Child Behaviour Checklist (CBCL), and students completed the Youth Self-Report (YSR) and a Personal History Questionnaire.

Results: On univariate analyses, non-immigrant adolescents had significantly higher CBCL and YSR scores than immigrant adolescents. Multivariate analyses suggested that CBCL scores were predicted by a number of variables other than immigration, including family intactness, socioeconomic status (SES) and gender. Higher YSR scores were predicted by non-intact families, school setting and non-immigrant status, and higher competencies scores were predicted by higher SES and parents not being immigrants.

Conclusions: In assessing the effects of immigration on adolescent mental health, it is important to control for factors associated with adolescent behavioural and emotional problems and to use multiple informants. Overall, immigrant adolescents report fewer total and externalising problems and fewer competencies than native-born adolescents. This finding may reflect strict immigration policies or cultural differences in definitions of psychopathology and the social expectations for adolescents' behaviour.