bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparative Mental Health Literacy Survey of Psychiatrists and Other Mental Health Professionals in Singapore
Authors: Parker Gordon , Chen Helen , Kua Joshua , Loh Jennifer , Jorm Anthony F.
Published: December 2009

Objective: The objectives of this study are, first, to replicate and extend an Australian approach to assessing mental health literacy by studying a sample of Singapore mental health professionals, and to focus on differences between judgements made by the psychiatrists in comparison with the other mental health professionals. Second, to compare the psychiatrists' judgements with those of Australian psychiatrists.

Method: The Australian questionnaire, assessing responses in relation to vignettes of major depression and to schizophrenia was extended by adding a third vignette of mania, and by the addition of several region-specific response options. Nearly 500 questionnaires were distributed to representative staff (psychiatrists, nurses and allied health) of a large psychiatric institution in Singapore, with a response rate of 81%. Psychiatrists' judgements were compared with all other hospital staff, and with Australian psychiatrists' judgements.

Results: The two principal contrast groups (Singapore psychiatrists and other Singapore mental health professionals) differed slightly in terms of diagnostic accuracy. The psychiatrists differed in favouring a more professionally focused model of intervention, while both professional groups viewed traditional healers and their practices as distinctly unhelpful. Direct comparison of psychiatrist ratings generated in Singapore and in Australia revealed quite similar response profiles.

Conclusions: In addition to generating data of some intrinsic importance, comparison with Australian survey data allows the potential impact of regional and cultural differences, as well as of varying psychiatric practices, to be identified. Responses identified more similarities than differences in the judgements of the psychiatrists from the two countries.
Comparative Efficiency Ratings Between Public and Private Acute Inpatient Facilities
Authors: Hugo Malcolm
Published: December 2009

Objectives: The aims of this study are to compare clinical outcomes and efficiency ratings in an acute psychiatric inpatient facility with findings from other studies, and to examine relationships between symptom severity, admission medico-legal status and length of stay.

Method: The Health of the Nation Outcome Scales was administered at admission and discharge and analysed against admission medico-legal status and length of stay. Efficiency ratings were calculated and compared with those from other acute psychiatric inpatient settings.

Results: Clinical outcomes and efficiency ratings were similar to those from other public acute inpatient facilities, with greater admission severities and higher efficiency ratings than those found in private facilities. Involuntary hospitalisation was found to be associated with higher admission severities and longer lengths of stay.

Conclusions: Outcome or effect size is enhanced by higher admission severities, however, mean outcome per 10 days of stay is decreased by involuntary admission legal status. Factors unrelated to admission legal status effect differences in efficiency ratings found between public and private acute psychiatric inpatient facilities.
What is the Role of Procedural Justice in Civil Commitment?
Authors: McKenna Brian G. , Simpson Alexander I.F. , Coverdale John H.
Published: December 2009

Objective: To determine best practice management strategies in the clinical application of civil commitment.

Method: All relevant literature on the topics of ‘civil commitment', ‘coercion’ and ‘procedural justice’ were located on MEDLINE and PsychUT databases and reviewed. Literature on the use of Ulysses contracts and advance directives in mental health treatment was integrated into the findings.

Results: Best practice evidence that guides management strategies is limited to the time of enactment of civil commitment. Management strategies involve enhancing the principles of procedural justice as a means of limiting negative patient perception of commitment. In the absence of evidence-based research beyond this point of enactment, grounds for the application of the principles of procedural justice are supported by reference to ethical considerations. Ulysses contracts provide an additional method for strengthening procedural justice.

Conclusions: Procedural justice principles should be routinely applied throughout the processes of civil commitment in order to enhance longer term therapeutic outcomes and to blunt paternalism.
Defining Effective Community Support for Long-Term Psychiatric Patients According to Behavioural Principles
Authors: Evans Ian M. , Moltzen Natasha L.
Published: December 2009

Objective: The purpose of this article is to define the characteristics of effective support in community mental health settings for patients with serious and persistent mental illness.

Method: A broad literature providing empirical evidence on competent caregiver behaviours and styles is selectively reviewed. Relevant findings from family caregiver research and studies of social environments that enhance skill development in people with intellectual disabilities are incorporated, within a cognitive-behavioural framework.

Results: Six important domains are identified which represent positive caregiver styles: acceptance, creating a positive atmosphere, expectations of change, responsiveness, normalisation and educativeness.

Conclusion: The characteristics hypothesised to be critical for caregivers and support workers are defined in a general way that can allow for individualisation according to the goals of the programs and the cultural priorities of staff and patients. Further empirical validation of these characteristics would enable community mental health services to provide more specialised clinical treatments.
MindMatters, a Whole-School Approach Promoting Mental Health and Wellbeing
Authors: Wyn Johanna , Cahill Helen , Holdsworth Roger , Rowling Louise , Carson Shirley
Published: December 2009

Objective: MindMatters is an innovative, national mental health promotion program which provides a framework for mental health promotion in Australian schools. Its objectives are to facilitate exemplary practice in the promotion of whole-school approaches to mental health promotion; develop mental health education resources, curriculum and professional development programs which are appropriate to a wide range of schools, students and learning areas; trial guidelines on mental health and suicide prevention and to encourage the development of partnerships between schools, parents, and community support agencies to promote the mental wellbeing of young people.

Method: A team of academics and health education professionals, supported by a reference group of mental health experts, developed MindMatters. The program was piloted in 24 secondary schools, drawn from all educational systems and each State and Territory in Australia. The pilot program was amended and prepared for dissemination nationally.

Results: The program provides a framework for mental health promotion in widely differing school settings. The teacher professional development dimension of the program is central to enhancing the role of schools in broad population mental health promotion.

Conclusions: Promoting the mental health and wellbeing of all young people is a vital part of the core business of teachers by creating a supportive school environment that is conducive to learning. Teachers need to be comfortable and confident in promoting and teaching for mental health. Specific, targeted interventions, provided within a whole-school framework, address the needs of the minority of students who require additional support.
The Reliability and Validity of the Health of the Nation Outcome Scales: Validation in Relation to Patient Derived Measures
Authors: Brooks Robert
Published: December 2009

Objective: The Health of Nation Outcome Scales (HoNOS) was developed to assess mental health outcomes. The aim of the studies is to examine the psychometric properties, reliability and validity of the HoNOS.

Method: Three studies were conducted within St John of God Hospitals in New South Wales, Australia. They examined the reliability and the validity of the HoNOS. The first study examined the interrater reliability of the HoNOS, before and after staff training in the use of the HoNOS. The second study examined the validity of the HoNOS with the Symptom Checklist 90 Revised (SCL90-R) and the third study examined the validity of the HoNOS with the Short-Form 36 (SF-36).

Results: The first study showed an improvement in the interrater reliability (IRR) of the HoNOS due to training. However, a generally unsatisfactory IRR (range 0.50–0.65) was achieved. The second study found no correlation between the SCL90-R and the HoNOS on admission (r = 0.04) and discharge (r = 0.06). The third study found no significant correlation between the Mental Component Score of the SF-36 and the HoNOS on admission (r = −0.033) nor on discharge (r = −0.104).

Conclusions: The HoNOS has at best moderate interrater reliabilities. Further, the validity of the HoNOS is under question, that is, it does not correlate with a major measure of mental health symptoms, nor with a major measure of health status. As such, it is concluded that the psychometric properties of the HoNOS do not warrant its use as a routine measure.
Cognitive-Behavioural Assessment and Treatment of Maladaptive Help-Seeking Behaviour in a Patient with Schizophrenia
Authors: Norris Gus , Laube Roy
Published: December 2009

Objective: Maladaptive help-seeking behaviour in psychiatric patients is a significant problem for public mental health services, yet it is not addressed in the mainstream literature. We present a report on the successful treatment of a person with schizophrenia who displayed this common dilemma for patients and clinicians.

Clinical picture: A 31-year-old man with borderline intellectual functioning had a 10-year history of schizophrenia marked by negative features. He frequently presented in crisis to public mental health services, the local hospital, and his general practitioner; this resulted in excessive use of services, including admissions.

Treatment: The patient was reassessed from a cognitive-behavioural perspective rather than a syndromal perspective. Specific behaviours were modified, cognitions were identified, challenged and restructured, and other service providers were provided with an alternative to admission or acute community care.

Outcome: At 24 months the maladaptive behaviour remains in remission.

Conclusions: Behavioural problems in persons with chronic schizophrenia may be effectively treated by reconceptualising the behaviour as distinct from the major diagnosis.
The Future of Australasian Psychiatrists: Online or Out of Touch?
Authors: Yellowlees Peter M.
Published: December 2009

Objective: The aim of this paper is to examine the delivery of mental health care which will be enabled by the various communications technologies over the next 5 to 10 years.

Method: A literature review, reviews of multiple Internet websites and the author's personal experience and opinions are combined to provide a commentary on the group of new technologies for communication available within health, and how they will affect the practice of psychiatry and psychiatrists over the next decade. The driving forces for these changes are the rise of consumerism, technological change and financial necessity, and it is evident that patients will have in future much greater choice of access to their therapists than at present. The health-care environment of the future will be different to today, as will the roles of psychiatrists, who will increasingly have to work as members of teams in an expert capacity rather than in traditional one-to-one practice.

Conclusions: It is concluded that it is essential for psychiatrists to become involved in online health care, and in particular to join their patients on the Internet, and that there are major opportunities for Australasian psychiatrists to provide high quality psychiatric care across national boundaries, particularly into the Asia-Pacific region.
Youth Mental Health Promotion in the Hunter Region
Authors: Waring Trevor , Hazell Trevor , Hazell Philip , Adams Jane
Published: December 2009

Objective: To describe the work of the Hunter Institute of Mental Health, with special emphasis on its role in mental health promotion and prevention with adolescents.

Method and Results: The Ottawa Charter for Health Promotion is used as a framework to describe the varied functions of this organisation. Four youth mental health promotion programs are given as examples of the Institute's work. Results of preliminary evaluation of the Youth Suicide Prevention — National University Curriculum Project are provided.

Conclusion: The Hunter Institute of Mental Health, a self-funding unit of the Hunter Area Health Service, provides innovative health promotion programs as part of its role as a provider of mental health education and training. The model may be particularly applicable to mental health services in regional Australia.
Chronic Fatigue Syndrome and Australian Psychiatry: Lessons from the UK Experience
Authors: Couper Jeremy
Published: December 2009

Objective: The aim of this paper is to outline the opportunities and dangers the chronic fatigue syndrome (CFS) issue presents to Australian psychiatry.

Method: The scientific literature of the last 50 years on CFS in adults was reviewed and samples of recent media portrayals of CFS in the UK and Australia were collected. The author has worked in both the UK and Australia managing adult CFS patients in specialist outpatient consultation–liaison (C–L) psychiatry settings.

Results: Chronic fatigue syndrome has been at the heart of an acrimonious debate in the UK, both within the medical profession and in the wider community. UK psychiatry has been drawn into the debate, at times being the target of strong and potentially damaging criticism, yet UK psychiatry, especially the C–L subspecialty, has played a crucial role in clarifying appropriate research questions and in devising management strategies. The issue has served to enhance and broaden psychiatry's perceived research and clinical role at the important medicine–psychiatry interface in that country.

Conclusions: Handled properly, the CFS issue offers Australian psychiatry, especially C–L psychiatry, an opportunity to make a useful contribution to patient care in a clinically difficult and contentious area, while at the same time serving to help broaden psychiatry's scope in the Australian medical landscape.
Youth Suicide Trends in Australian Metropolitan and Non-Metropolitan Areas, 1988–1997
Authors: Wilkinson David , Gunnell David
Published: December 2009

Objective: The objective of this study was to examine trends in suicide among 15–34-year-olds living in Australian metropolitan and non-metropolitan areas between 1988 and 1997.

Method: Suicide and population data were obtained from the Australian Bureau of Statistics. We calculated overall and method-specific suicide rates for 15–24 and 25–34-year-old males and females separately, according to area of residence defined as non-metropolitan (≤ 20 000 people) or metropolitan.

Results: Between 1988 and 1997 suicide rates in 15–24-year-old non-metropolitan males were consistently 50% higher than metropolitan 15–24-year-olds. In 1995–1997, for example, the rates were: 38.2 versus 25.1 per 100 000 respectively (p < 0.0001). The reverse pattern was seen in 25–34-year-old females with higher rates in metropolitan areas (7.5 per 100 000) compared with non-metropolitan areas (6.1 per 100000, p = 0.21) in 1995–1997. There were no significant differences according to area of residence in 25–34-year-old males or 15–24-year-old females. Over the years studied we found no clear evidence that suicide rates increased to a greater extent in rural than urban areas. Rates of hanging suicide have approximately doubled in both sexes and age groups in both settings over this time. Despite an approximate halving in firearm suicide, rates remain 3-fold higher among non-metropolitan residents.

Conclusion: Non-metropolitan males aged 15–24 years have disproportionately higher rates of suicide than their metropolitan counterparts. Reasons for this require further investigation. Hanging is now the most favoured method of non-metropolitan suicide replacing firearms from 10 years ago. Although legislation may reduce method-specific suicide the potential for method-substitution means that overall rates may not fall. More comprehensive interventions are therefore required.
A Cognitive-Behavioural, Group-Based Intervention for Social Anxiety in Schizophrenia
Authors: Halperin Stephen , Nathan Paula , Drummond Peter , Castle David
Published: December 2009

Objective: The objective of this study was to investigate the efficacy of group-based cognitive-behavioural therapy (CBT) for social anxiety in schizophrenia.

Method: Patients with schizophrenia (20) with comorbid social anxiety were randomly assigned to the group-based CBT or wait-list control condition. Pre-, post- and 6-week follow-up ratings included measures of social anxiety and avoidance, mood and quality of life.

Results: The intervention group improved on all outcome measures and the control group showed no change in symptomatology.

Conclusions: Group-based CBT is effective in treating social anxiety in schizophrenia.
Enhancing Case Managers' Skills in the Assessment and Management of Antipsychotic Medication Side-Effects
Authors: Morrison Paul , Meehan Tom , Gaskill Deanne , Lunney Paul , Collings Paul
Published: December 2009

Objective: Our goal was to reduce the prevalence of antipsychotic medication side-effects by providing a short-term training program on the assessment and management of side-effects to case managers.

Method: Forty-four patients in receipt of community-based mental health services were allocated to comparison (n = 20) and intervention (n = 24) groups based on the health service district in which they resided. While case managers working with the intervention group attended a short-term training program to improve their assessment and management of neuroleptic side-effects, case managers providing services to the comparison group received no additional training. Side-effects were assessed pre- and postintervention using the Liverpool University Neuroleptic Side-effect Rating Scale (LUNSERS).

Results: A reduction in the overall prevalence of side-effects in both groups was observed, however, only those patients in the intervention group reported a statistically significant reduction in mean side-effect scores between the pre- and post-measures (Wilcoxon Matched Pairs Signed-ranks Test, z = −2.8411, two-tailed, p < 0.01). In addition, qualitative data collected during the second survey revealed that patients in the intervention group had acquired some positive management strategies for dealing with unwanted side-effects. The strategies were elicited from eight different patients distributed across six of the 12 case managers who took part in the training program.

Conclusions: Training cases managers in the assessment and management of side-effects may help to reduce their impact on the lives of people prescribed neuroleptic medication.
Characterising Psychosis in the Australian National Survey of Mental Health and Wellbeing Study on Low Prevalence (Psychotic) Disorders
Authors: Rosenman Stephen , Korten Ailsa , Medway Jo , Evans Mandy
Published: December 2009

Objective: This study examines the factorial structure of symptoms and signs in psychosis in data from the Study on Low Prevalence (psychotic) Disorders which is part of the National Survey of Mental Health and Wellbeing, Australia 1997–1998.

Method: The present study examined a wide variety of symptoms taken from the Schedules for Clinical Assessment in Neuropsychiatry items and the substance use items in the Diagnostic Interview for Psychosis, an instrument specially constructed for the national study. The instrument was applied to 980 community and hospital subjects with a wide range of psychotic illness diagnoses. The data were factor analysed and scales of ‘domains of psychopathology’ derived.

Results: The data were best fitted by five principal factors (‘domains’) which can be approximately labelled dysphoria, positive symptoms, substance use, mania and negative symptoms/incoherence. These factors together explained 55.4% of variance in symptoms. Solutions with more numerous factors did not improve the representation.

Conclusion: The five domains successfully characterise a large part of the variance in psychopathology found in the present study of low prevalence (psychotic) disorders. The approach allows sufferer's symptom range and severity to be well expressed without multiple comorbid diagnoses or the limits imposed by categorical diagnosis. Knowledge of alternative dimensional representations of psychopathology may usefully complement our use of categories, enhance awareness of symptoms and ensure that important psychopathology is heeded in practice and research.
Adolescent Depressive Disorder: A Population-Based Study of ICD-10 Symptoms
Authors: Patton G. C. , Coffey C. , Posterino M. , Carlin J. B. , Wolfe R.
Published: December 2009

Objective: Earlier studies have suggested that symptoms of depressive disorder in adolescents may differ from those found in adults. Even so, diagnostic criteria developed in adults have come to be widely applied to younger subjects. This study examines the frequency of ICD-10 symptoms in depressive disorder and their association with severity in a large community sample of adolescents aged 15 to 18 years.

Method: A six-wave prospective study of adolescent health and emotional wellbeing in 2032 Australian secondary school students provided an opportunity to conduct a two-phase study of adolescent onset depression. A self-administered computerised form of the revised Clinical Interview Schedule (CIS-R) was used as a first phase diagnostic measure. Second phase assessment using the Composite International Diagnostic Interview (CIDI) allowed the delineation of a group fulfilling criteria on both instruments. The ICD-10 symptoms and severity profiles for depression were generated with standard algorithms.

Results: 1947 (95.8%) out of 2032 subjects in the designated sample completed phase 1 assessment at least once. Participation rates at phase 2 interviews were 93%. Over the 30-month study period 69 subjects (10 male, 59 female) fulfilled criteria for ICD-10 depressive episodes on both the CIS-R and CIDI. Thirty-one per cent (n = 21) had experienced a severe episode, 46% (n = 32) moderate and 23% (n = 16) mild episodes. Loss of interest and pleasure, decreased energy and fatigue, sleep disturbance, suicidal ideation and diminished concentration most clearly distinguished adolescents with depressive disorder from controls. Self-reproach and guilt, psycho-motor agitation and/or retardation and appetite disturbance with weight change showed the clearest increase in frequency with increasing severity of episode. The somatic syndrome was reported by close to one in three of those with a severe depressive episode, but was uncommon in those with mild and moderate episodes.

Conclusions: The ICD-10 diagnostic criteria are applicable to depressive disorder in older adolescents. With the exception of depressed mood, found in one in five non-cases, all other symptoms were common in cases and uncommon in non-cases. Practitioner awareness of symptoms indicating the presence and severity of disorder should enhance early identification and choice of treatment in adolescent depression.
Towards a Psyche for Psychiatry
Authors: Meares Russell
Published: December 2009

Objective: To draw attention to the absence of a concept of personal existence in standard psychiatric approaches to mental illness.

Method: To sketch a shift in Western consciousness which occurred suddenly before World War I, involving a banishment of such notions as self and the awareness of inner life from the discourse of psychiatry, psychology and philosophy, leaving a fundamental vacancy at the heart of these disciplines.

Results and Conclusion: The positivist–behaviourist hegemony of the twentieth century involved an implicit devaluation of that which is essentially human. The influence of this tradition brings with it the risk of an understanding and treatment of mental illness which leaves out issues at the core of humanity. I suggest we need to recover something of the manner of thinking of the great figures in psychological thought who were writing before the rise of behaviourism and who were contributing to the origins of dynamic psychiatry. A study of the phenomena of human consciousness was central to their work. Main figures mentioned include: Hughlings Jackson, the great neurologist who considered a career in philosophy; Pierre Janet, a philosopher turned psychiatrist; and William James, a physiologist who became a psychologist and philosopher.
An International Collaborative Database: Its Use in Predicting Length of Stay for Inpatient Treatment of Anorexia Nervosa
Authors: Maguire Sarah , Surgenor Lois J. , Abraham Suzanne , Beumont Peter
Published: December 2009

Objective: We describe the establishment of an Australasian multisite research database for inpatient treatment of anorexia nervosa (AN). Using this database, the second aim of this study is to investigate the extent to which length of stay (LOS) in participating facilities could be predicted at admission from patient, clinical, and site variables.

Method: Standardized demographic and clinical data were collated for 213 admission episodes involving 154 participants over a 20 month period from five Australian and one New Zealand specialist treatment centres.

Results: While nine variables significantly predicted LOS on univariate analysis, linear regression determined that only body mass index, and having had 2–3 previous admissions made significant independent contributions to LOS.

Discussion: Multisite databases offer a viable means by which to conduct clinical research, particularly in regard to low prevalence disorders such as AN. Their additional advantage is that of involving front-line practitioners recruiting participants more likely to be representative of cases seen across treatment centres. At just under a fifth of the total variance predicted by the best-fit model, LOS in hospital remains an aspect of AN treatment difficult to predict, and future studies need to explore variables other than the obvious demographic or clinical issues at admission. The clinical and planning implications are discussed
Right Unilateral Electroconvulsive Therapy at Six Times Seizure Threshold
Authors: Little John D. , Munday Jo , Lyall Gordon , Greene Dennis , Chubb Graeme , Orr Michelle
Published: December 2009

Objective: To examine the clinical practice of right unilateral electroconvulsive therapy (ECT) administered at six times seizure threshold (6 × RUL ECT).

Method: A retrospective review of all patients who received 6 × RUL ECT between July 2000 and June 2002.

Results: Twenty-one patients across a range of ages and diagnostic groups received D'Elia unilateral ECT at a seizure dosage at or above 388.8 milliCoumbs (mC). In order to sustain predetermined criteria for seizure adequacy, energy was increased in 71% of patients. Final seizure lengths of 45 s electroencephalographic (EEG) activity, 28 s motor activity (cuffed) and a post-ictal suppression index (PSI) of 83% were recorded. Eighty percent of patients responded after a mean of 7.0 treatments. Cognitive side-effects were noted in 21% of patients. Fifty-two percent relapsed on average 6.3 months after the last treatment despite continuation pharmacotherapy.

Conclusions: 6 × RUL ECT was found to be clinically effective, associated with cognitive side-effects and relapse. The debate over electrode placement is likely to continue.
Fifty Years of the Double Helix and its Impact on Psychiatry
Authors: Mcguffin Peter , Mcguffin Peter , Southwick Linda
Published: December 2009

Objective: To discuss the impact of Watson and Crick's double helix discovery on the field of psychiatry.

Method: Psychiatric research studies using molecular genetic techniques are summarized. The implications of these findings in terms of our understanding and treatment of mental illness are discussed.

Results: There now exists growing evidence of candidate gene sites for a variety of psychiatric disorders ranging from schizophrenia to reading disability.

Conclusions: The field of psychiatric genetics has become one of the most vital and productive areas of psychiatric research. New findings are continually coming to light, bringing us ever closer to understanding these complex disorders at a molecular level. Such knowledge could lead to improved drug treatments, screening of at-risk individuals and even a reduction in the stigma attached to psychiatric disorders.
Atypical Antipsychotic Weight Gain: A Major Clinical Challenge
Authors: Sharpe Jenny-Kay , Hills Andrew P.
Published: December 2009

Objective: The major aim of this paper is to review findings from weight management intervention studies to consider clozapine and/or olanzapine induced weight gain. A parallel aim is to summarize the challenges facing future research and provide an overview of best practice in the management of weight in mental health patients.

Method: A systematic literature search was conducted using Medline, Cinahl and PsychINFO data bases and reference lists from relevant published articles. Five studies which reported weight control practices in patients taking atypical antipsychotic medications were located and reviewed.

Results: The studies reviewed provide some important descriptive clinical insights; however, common shortcomings include small subject numbers and methodological drawbacks such as lack of a control group.

Conclusions: There is some evidence that weight gain associated with atypical antipsychotic medication can be ameliorated by lifestyle changes such as improved nutritional practices and increased physical activity. Lifestyle interventions for individuals with psychotic disorders may need to be adapted to be most effective; for example, using strategies to counter increased appetite and to enhance physical activity. Clinicians need to be vigilant and persistent in monitoring and intervening if weight gain occurs. A standardized screening tool and clinical pathway would help clinicians to target appropriate interventions for each person prescribed atypical antipsychotic medication.
Generic Versus Specialist Clinical Work Roles of Occupational Therapists and Social Workers in Mental Health
Authors: Lloyd Chris , King Robert , Mckenna Kryss
Published: December 2009

Objective: There has been limited research in Australia examining the extent of generic and specialist work activities carried out by occupational therapists and social workers since the introduction of mental health reform. The aim of the project was to: (i) identify specific clinical work activities of occupational therapists and social workers; and (ii) identify whether they are performing a greater proportion of generic than specialist clinical or discipline specific core skills.

Method: A cross-sectional survey of 304 (response rate 76.6%) occupational therapists and social workers working in mental health was conducted. For the purposes of the study a new instrument was developed to cover broad categories of clinical work activities.

Results: The majority of the respondents were female, under the age of 30 years, who had worked in their current position less than 5 years. Generic work activities were the primary activities of the two professional groups, with nine of the 10 activities undertaken most frequently being generic in nature. Social work respondents performed more work activities while occupational therapists undertook more specialist clinical activities.

Conclusions: Occupational therapists and social workers are required to have common competencies in addition to discipline-specific competencies in order to undertake broadspectrum mental health service activities. This has implications for the skill mix, education and training and recruitment of staff.
Understanding the Relationships Between Wellbeing, Goal-Setting and Depression in Children
Authors: Street Helen , Nathan Paula , Durkin Kevin , Morling Jonathan , Dzahari Mohamed Azahar , Carson Joel , Durkin Evelyn
Published: December 2009

Objectives: This study investigates children's conceptions of happiness and wellbeing in relation to goal choice. It examines the prevalence and impact of Conditional goal setting (CGS) on levels of wellbeing and depression. Conditional goal setting describes commitment toward an important goal resulting from a conception that happiness is an end-point achieved through the attainment of this goal. Conditional goal setting has been identified as a significant factor in the development and maintenance of depression in adults. This study examines these same concepts among children.

Method: Combined interpretative and quantitative methodology is used. Thirty-six children aged 10–12 years participated in six focus groups discussing their understandings of happiness, important goals and beliefs concerning CGS. Children each attended one of three primary schools in the Perth metropolitan district. They also completed CGS and depression questionnaires.

Results: Responses were categorized into a number of common themes. Response content and the number of responses in each theoretical area were identified and discussed. The majority of participants conceptualized happiness as a goal dependant upon something extrinsic to themselves (such as an achievement or event). Statistical analyses suggested a significant relationship between goal setting styles, conceptualizations of happiness and depression. Depressed children were more likely than non-depressed children to be conditional goal setters.

Conclusions: Findings suggest that some children conceptualize happiness as an outcome that is dependent on their important achievements and acquisitions. This conceptualization is related to depression. Alternatively, non-depressed children tended to conceptualize happiness as a process independent of goal achievement or failure.
Psychiatric Disorders in Homeless Men and Women in Inner Sydney
Authors: Teesson Maree , Hodder Tracey , Buhrich Neil
Published: December 2009

Objective: To determine the 12-month prevalence of mental disorders among homeless people in inner Sydney and compare this data with data collected on homeless populations in other Western cities.

Method: Representative sample of 210 homeless men and women in Sydney were interviewed using the Composite International Diagnostic Interview (2.0).

Results: Seventy-three percent of men and 81% of women met criteria for at least one mental disorder in the past year and 40% of the men and 50% of the women had at least two mental disorders. The prevalence rate of schizophrenia among men and women was 23% and 46%, respectively. There was considerable comorbidity between mental disorders with one in five men (20%) and 29% of women meeting criteria for two mental disorders. The prevalence of any mental disorder is four times higher among homeless men and women in inner Sydney than within the Australian general population. International comparisons demonstrated significant cross-cultural differences in the prevalence of mental disorders among the homeless.

Conclusions: This paper highlights the need for comparable epidemiological data when examining an international problem such as homelessness.
Medication Options in the Treatment of Treatment-Resistant Depression
Authors: Pridmore Saxby , Turnier-Shea Yvonne
Published: December 2009

Aim: Less than half of those suffering major depressive episodes achieve remission with the first antidepressant provided and one-third of all patients suffering depression have a chronic condition. Clinical experience indicates that a substantial proportion of patients suffer treatment-resistant depression (TRD). Our aim is to explore the literature reporting the drug treatment of TRD, and to present such information as would be of interest to clinical psychiatrists.

Method: Literature searches were conducted using PubMed and entering the words antidepressant, augmentation, combined antidepressants, treatment resistant depression and the names of individual antidepressant medications.

Results: Most authors recommended that TRD should be first approached by reassessing the diagnosis, adding psychotherapy and attending to psychosocial factors. Details of the following pharmacological options were identified: (i) augmentation of the currently employed antidepressant with a medication which is not an antidepressant; (ii) change of antidepressant; and (iii) addition of a second antidepressant to the current antidepressant, or commencement of a combination of two antidepressants.

Conclusions: When monotherapy provided at the maximum manufacturer-recommended doses for 3–4 weeks has failed to provide remission in depression, the diagnosis should be confirmed, psychotherapy added and psychosocial factors should receive attention. In the sustained absence of remission, a better outcome may be obtained by augmenting the antidepressant, changing from a single-action to a double- or multiple-action drug, or by combining antidepressants.
Impact of Demographic Factors, Early Family Relationships and Depressive Symptomatology in Teenage Pregnancy
Authors: Quinlivan Julie A. , Tan Louisa H. , Steele Angela , Black Kirsten
Published: December 2009

Aim: Teenage pregnancy has been well studied from a demographic risk perspective, but less data examining the early interpersonal family experiences of teenage mothers are available. We aimed to explore the relative impact of demographic, early interpersonal family relationships and depressive symptomatology as associations for teenage, as compared to non-teenage, childbearing.

Method: A prospective cross-sectional cohort study was undertaken. Institutional ethics committee approval and informed consent were obtained. Data from consecutive teenage (teenage) and non-teenage (control) subgroups of antenatal women were compared. Subjects were interviewed and completed the following questionnaires: demographic, drug use and lifestyle; early life experiences; Hospital Anxiety and Depression Scale (HADS); and General Health Questionnaire-28.

Results: In multivariate analysis, the following factors had a significant independent association with younger age of motherhood in order of magnitude: a history of parental separation/divorce in early childhood; exposure to family violence in early childhood; illicit drug use (ever or in pregnancy); idealization of the pregnancy; low family income; a positive HADS-A or HADS-D subscale score; and a low level of education.

Conclusion: Interventions to reduce the rate of teenage births need to be multifocal and should include strategies to address early childhood exposure to parental separation and violence, reduce idealization of pregnancy, diagnose psychological symptomatology and offer alternative career choices to children defaulting in the education system.
Academic Consumer Researchers: A Bridge Between Consumers and Researchers
Authors: Griffiths Kathleen M. , Jorm Anthony F. , Christensen Helen
Published: December 2009

Objective: To describe the contributions that consumers, and academic consumer researchers in particular, can make to mental health research.

Method: A literature survey and a systematic consideration of the potential advantages of consumer and academic consumer researcher involvement in health research.

Results: Consumer researchers may contribute to better health outcomes, but there are significant barriers to their participation in the research process. To date, discussion has focused on the role of nonacademic consumers in the health research process. There has been little recognition of the particular contributions that consumers with formal academic qualifications and research experience can offer. Academic consumer researchers (ACRs) offer many of the advantages associated with lay consumer participation, as well as some unique advantages. These advantages include acceptance by other researchers as equal partners in the research process; skills in research; access to research funding; training in disseminating research findings within the scientific community; potential to influence research funding and research policy; capacity to influence the research culture; and potential to facilitate the involvement of lay consumers in the research process. In recognition of the value of a critical mass of ACRs in mental health, a new ACR unit (the Depression and Anxiety Consumer Research Unit [CRU]) has been established at the Centre for Mental Health Research at the Australian National University.

Conclusions: Academic consumer researchers have the potential to increase the relevance of mental health research to consumers, to bridge the gap between the academic and consumer communities and to contribute to the process of destigmatizing mental disorders.
Violence in Male Patients with Schizophrenia: Risk Markers in a South African Population
Authors: Koen L. , Kinnear C. J. , Corfield V. A. , Emsley R. A. , Jordaan E. , Keyter N. , Moolman-Smook J. C. , Stein D. J. , Niehaus D. J. H.
Published: December 2009

Objective: We investigate the role of functional variants in the catecholamine-O-methyl transferase gene ( COMT) and the monoamine oxidase-A gene ( MOA-A), as well as previously identified non-genetic risk factors in the manifestation of violent behaviour in South African male schizophrenia patients.

Method: A cohort of 70 acutely relapsed male schizophrenia patients was stratified into violent and non-violent subsets, based on the presence or absence of previous or current violent behaviour. Standardized violence rating scales were also applied and the COMT/NlaIII and MAO-A promoter region variable number of tandem repeats (VNTR) polymorphisms were genotyped.

Results: A multiple logistic regression model based on the clinical, genetic and sociodemographic variables indicated that delusions of control (OR = 3.7, 95% CI = 1.21–11.61) and the combined use of cannabis and alcohol (OR = 6.89, 95% CI = 1.28–37.05) were two significant predictors of violent behaviour in this schizophrenia population. No association was found between the tested polymorphisms and violent behaviour.

Conclusions: Although the sample size may have limited power to exclude a minor role for these specific gene variants, such a small contribution would have limited clinical relevance given the strong significance of the non-genetic markers. These findings suggest that currently proactive management of violent behaviour in this schizophrenia population should continue to be based on clinical predictors of violence.
Changes in Semantic Uses of First Person Pronouns as Possible Linguistic Markers of Recovery in Psychotherapy
Authors: Van Staden C. W. , Fulford K. W. M.
Published: December 2009

Objective: To examine changes in linguistic markers in the course of psychotherapy, drawing on Frege's logic of relations to define semantic variables distinct from syntactic variables.

Method: From a sample of 73 patients, 10 patients with the best and 10 patients with the worst outcomes were selected. Forty transcribed sessions of each outcome group were compared statistically for change between commencement and termination of psychotherapy in: (i) the syntactic usage of first person pronouns (‘I’, ‘me’, ‘we’, ‘us’, ‘implied I’, ‘implied me’); (ii) semantic usage of first person pronouns (expressing alpha, omega, or unclear positions); and (iii) non-pronoun linguistic variables (passive voice, negative, copula, auxiliary verbs expressing a sense of obligation).

Results: There were no significant differences between the best and worst outcome groups in the change of either syntactic usage, or of the non-pronoun linguistic variables. However, the outcome groups differed significantly in the change of their semantic usage (alpha: p = 0.002; omega: p = 0.028): The best outcome group showed an increase of alpha positions and a decrease of omega positions, whereas the worst outcome group showed the inverse (i.e. decrease of alpha and increase of omega positions).

Conclusions: Results suggest only semantic, that is meaning-driven, usage of first person pronouns marks recovery in the course of psychotherapy. If replicated, this finding could be used to monitor treatment responses. Replication in other kinds of treatment could mean these semantic changes are markers of recovery more generally than in psychotherapy.
Enhancing Medication Adherence: Clinician Outcomes from the Medication Alliance Training Program
Authors: Byrne Mitchell K. , Deane Frank P. , Lambert Gordon , Coombs Tim
Published: December 2009

Objective: Patient nonadherence to psychiatric medication is a key cause of relapse but clinicians do not appear to possess specific adherence skills. We sought to demonstrate that a brief training program on medication adherence strategies could improve the adherence skills, attitudes and knowledge of mental health clinicians.

Methods: Twenty-three Tasmanian mental health workers were provided a 3 day training workshop on strategies to enhance patient adherence to medications (Medication Alliance). Pre- and post-training measures were taken of clinician knowledge about adherence strategies, ability to identify predictors of nonadherence, attitudes toward working with nonadherent patients, and optimism about treatment outcomes for patients. Videotapes of clinicians demonstrating key adherence therapy skills were also collected before and after training and blind-rated by two experienced therapists.

Results: A series of paired samples t-tests indicated significant improvements in skills, knowledge and attitudes.

Conclusions: Compared with similar studies in the UK, Medication Alliance was found to be an effective and efficient training program. However, there is a need for further research to assess maintenance of training effects over time and patient outcomes.
Pre-Existing Antidepressants and the Outcome of Group Cognitive Behaviour Therapy for Social Phobia
Authors: Rosser Stephanie , Erskine Alicia , Crino Rocco
Published: December 2009

Objective: This is a naturalistic treatment outcome study investigating the impact of preexisting antidepressant use on the effectiveness of group cognitive behaviour therapy (CBT) for social phobia.

Method: Of the 133 participants who completed the CBT program, 49 reported taking antidepressants (CBT ++ AD group), while 84 reported not taking antidepressants (CBT group). The treatment program involves 40 h of structured, group-based CBT over 7 weeks. The dependent measures included the Social Phobia Scale and Social Interaction Anxiety Scale, the Fear of Negative Evaluation Scale, the Depression, Anxiety and Stress Scale and the Short Form-12.

Results: Both the CBT ++ AD group and the CBT group improved significantly across treatment on all dependent measures. There were no significant differences between the groups on any outcome measure and the rate of improvement from pre- to post-treatment for both groups did not differ.

Conclusions: Pre-existing antidepressants did not significantly enhance or detract from the positive treatment outcome of a structured, group-based CBT program for social phobia.