bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Associated with Repeat Suicide Attempts among Adolescents
Authors: Vajda Jacqualine , Steinbeck Kate
Published: December 2009

Objective: To determine potential risk factors associated with repeat suicide attempts among adolescents.

Method: Retrospective medical record review of all patients aged 13–20 years who presented to the emergency department at an inner city tertiary hospital after attempted suicide between 1994 and 1996. Subjects were identified using the International Classification of Diseases (ICD-9) codes E950.0 to E959.9 for attempted suicide. Study variables included demographic parameters, chronic medical conditions/illnesses, psychiatric and substance abuse disorders, history of sexual abuse and previous and subsequent suicide attempts. Variables univariately associated with repetition at p < 0.25 were entered into a multiple regression analysis.

Results: Eighty seven per cent of patients presented with a drug overdose. Seventy-six per cent of all subjects attempted suicide in the context of a dispute or relationship break-up. At least one psychiatric disorder was present in 76% of subjects at the index attempt. The most frequently diagnosed disorders were depression (45.5%) and drug (34%) and alcohol abuse (27%). Variables predicting repetition within 12 months were drug (OR = 3.891, p = 0.02) and alcohol abuse (OR = 3.56, p = 0.05), non-affective psychotic disorders (OR = 3.81, p = 0.04), and chronic medical conditions/illness (OR = 3.29, p = 0.03). A history of sexual abuse was almost significant (OR = 3.03, p = 0.06).

Conclusions: Adolescents most likely to re-attempt suicide with 12 months present with either substance abuse, non-affective psychotic disorders, chronic medical conditions, or a history of sexual abuse. All adolescents with a possible suicide attempt should receive a comprehensive mental health and psychosocial assessment. Closer scrutiny of the role of chronic illnesses and sexual abuse in both future research and clinical management is urged. A broad based, multidisciplinary intervention approach is recommended.
Nonconvulsive Generalised Status Epilepticus Following Electroconvulsive Therapy
Authors: Srzich Alexander , Turbott John
Published: December 2009

Objective: To describe a case of nonconvulsive generalised status epilepticus (NGS) following electroconvulsive therapy (ECT).

Clinical picture: A 40-year-old woman suffering from a major depressive episode was treated with ECT following treatment with clonazepam, haloperidol and paroxetine. After her fifth treatment she became acutely confused. An electroencephalogram (EEG) at the time was consistent with NGS.

Treatment and outcome: Initially intravenous diazepam and phenytoin were administered with an improvement in both her mental state and EEG. An oral anti-convulsant was continued.

Conclusions: NGS is a rare though treatable cause of confusional states following ECT and should be considered in the differential diagnosis.
Costing Depression and Its Management: An Australian Study
Authors: Parker Gordon , Roy Kay , Mitchell Philip , Wilhelm Kay , Eyers Kerrie
Published: December 2009

Objective: To examine the cost impact of referral to a Mood Disorders Unit (MDU), by comparing pre-service and post-service costs, and MDU and control samples.

Method: We studied tertiary referral MDU patients and a control group of consultants' depressed patients, with the principal comparison intervals being: (i) 12 months prior to and (ii) 6 months following baseline assessment, with costs annualised to allow the impact of assessment and treatment recommendation to be determined. In addition, we assessed any ‘personal cost’ of depression.

Results: Following baseline assessment, MDU referrals showed a reduction in costs, while controls' costs increased, largely driven by contrasting directions in hospitalisation and social welfare costs. We identify variables associated with high and increased costs, including features of the earlier stages of the disorder, whether social welfare was received, diagnostic subtype and personality dysfunction, with multivariate analyses refining the variable sets. Self-report data indicated that patients judged the ‘personal cost’ of depression to exceed more formal cost parameters, so that to experience depression is itself depressogenic.

Conclusions: This first Australian attempt to cost depression and its management in the clinical setting more provides a methodology for wider application in service evaluation studies rather than delivers an unequivocal answer to whether a specialist Mood Disorders Unit is cost efficient or not.
The Gatehouse Project: A Systematic Approach to Mental Health Promotion in Secondary Schools
Authors: Patton George C. , Glover Sara , Bond L. , Butler Helen , Godfrey Celia , Pietro Gayle Di , Bowes Glen
Published: December 2009

Objective: The objective of this paper is to outline the conceptual background and strategy of intervention for a systematic and sustainable approach to mental health promotion in secondary schools.

Method: The conceptual origins of the Gatehouse Project are described in terms of the epidemiology of adolescent mental health problems, attachment theory, education reform research and health promotional theory and practice. The elements of health promotional work are described in terms of structural change and priority setting; implementation at multiple levels within the participating schools is described.

Results: The conceptual framework of the Gatehouse Project emphasises healthy attachments with peers and teachers through the promotion of a sense of security and trust, effective communication and a sense of positive self-regard based on participation in varied aspects of school and community life. A school social climate profile is derived from a questionnaire survey of students. An adolescent health team uses this information to set priorities for change within the school. Interventions may focus on the promotion of a positive social climate of the whole school or in the classroom. Curriculum-based health education is also used and based on materials that are relevant to the normal developmental experiences of teenagers. These are integrated into the mainstream curriculum and incorporate a strong component of teacher professional development. Lastly, the intervention promotes linkage between the school and broader community with a particular emphasis on the needs of young people at high risk of school drop-out.

Conclusions: Educational environments are complex systems undergoing continuous and simultaneous changes. The Gatehouse Project will provide unique information on the relationship between the social environment and the emotional wellbeing of young people. More importantly it outlines a sustainable process for building the capacity of schools to promote the social and emotional development of young people.
Therapeutic Day Programs in the Treatment of Adolescents with Mental Illness
Authors: Weir Robert P. , Bidwell Susan R.
Published: December 2009

Objectives: This study aims to assess the effectiveness of day programs against other treatment modalities in adolescents with mental illnesses (including substance abuse). It also aims to identify patient and program factors associated with favourable outcomes for adolescents with mental illness treated in therapeutic day programs.

Method: An extensive database search of published literature was conducted, supplemented by hand-searching of references of retrieved articles, and a search by author. There was no restriction by study design. Relevant studies were identified and appraised using standardised criteria.

Results: Of the 231 studies identified in the search, 26 were relevant to this review. The majority of studies identified day programs as effective. There was a lack of adequate comparisons between day programs and other organisational arrangements.

Conclusions: The quality of the studies identified was low. Twenty-two of the 26 studies did not have an adequate control group. Higher-quality research is required in the evaluation of the effectiveness of day programs, and the identification of other factors promoting successful outcome in the treatment of adolescent mental illness.
The National Survey of Mental Health and Wellbeing: The Child and Adolescent Component
Authors: Sawyer Michael G. , Kosky Robert J. , Graetz Brian W. , Arney Fiona , Zubrick Stephen R. , Baghurst Peter
Published: December 2009

Objective: This paper describes the Child and Adolescent Component of the National Survey of Mental Health and Wellbeing.

Method: The aims of the study, critical decisions in planning for the study, progress to date and key issues which influenced the course of the study are described.

Results: The Child and Adolescent Component of the National Survey of Mental Health and Wellbeing is the largest study of child and adolescent mental health conducted in Australia and one of the few national studies to be conducted in the world. Results from the study will provide the first national picture of child and adolescent mental health in Australia.

Conclusions: Large-scale epidemiological studies have the potential to provide considerable information about the mental health of children and adolescents. However, having a clear set of aims, ensuring that the scope of the study remains within manageable proportions and paying careful attention to the details of fieldwork are essential to ensure that high-quality data is obtained in such studies.
Cognitive-Behaviour Therapy as a Treatment for Irritable Bowel Syndrome: A Pilot Study
Authors: Boyce Philip , Gilchrist Jemma , Talley Nicholas J. , Rose Donna
Published: December 2009

Objective: The irritable bowel syndrome (IBS) is a chronic and often disabling functional bowel disorder. Psychological treatments, in particular cognitive and behavioural interventions, have been shown to be effective for this disorder. The aim of this study was to test the efficacy of a cognitive-behaviour program.

Method: Eight participants (seven female, one male) aged between 24 and 71 years, with a diagnosis of IBS according to the Rome criteria, were recruited from among the gastroenterology outpatients at Nepean Hospital, in Sydney, Australia. Participants were administered pretreatment on measures of psychological function and bowel symptom severity. Following a 2-week baseline period, participants began a structured psychological treatment comprising eight sessions of cognitive-behaviour therapy. Throughout treatment, participants maintained daily records of symptom severity and completed homework assignments to ensure treatment compliance. The pretreatment assessment measures were repeated 1 week post-treatment.

Results: After treatment, five of the eight patients no longer met the Rome diagnostic criteria for IBS. There was no significant reduction in bowel symptom frequency. There were, however, significant improvements in the distress and disability associated with bowel symptoms. Anxiety and depression were also significantly reduced.

Conclusions: Cognitive-behaviour therapy reduced the distress and disability associated with IBS, but not the frequency of bowel symptoms. This supports the proposed cognitive model for IBS, and cognitive-behaviour therapy appears to have its effect by altering the cognitive response to visceral hypersensitivity.
Deinstitutionalisation for Long-Term Mental Illness: An Ethnographic Study
Authors: Newton L. , Rosen A. , Tennant C. , Hobbs C. , Lapsley H.M. , Tribe K.
Published: December 2009

Objective: Deinstitutionalisation of seriously mentally ill people in the developed world, including Australia, has occurred since the middle of this century. Evaluation of the effects of this change on the lives of individuals is of paramount importance to ensure that policies are acceptable and effective. Increasingly, multifaceted studies are considered essential for comprehensive health research. The qualitative aspect of this study complements the clinical and economic components.

Method: An ethnographic approach enabled contextual, qualitative data to be gathered from within the social world of 47 hospital residents as they moved to the community. A social anthropologist acting explicitly as a participant observer undertook fieldwork over two and a half years both pre- and post-discharge. Qualitative data were collected, stored and analysed separately from quantitative and economic data.

Results: Ethnographic findings generally supported and, in many cases, mirrored clinical results. Of the total cohort of 47 patients transferred to the community, the 40 who continue to live outside of hospital all reported a preference for community living. The importance of freedom and simple liberties cannot be underestimated as factors that enabled this resilient group of people to work creatively through difficult periods.

Conclusion: Properly planned and resourced deinstitutionalisation not only maintains people with a prolonged mental illness outside of hospital, it also enhances their quality of life. Subjective descriptive material focusing on personal experiences adds meaning to quantitative research data allowing health professionals to more fully understand the implications of health policy on the lives of individuals.
Deinstitutionalisation for Long-Term Mental Illness: A 2-Year Clinical Evaluation
Authors: Hobbs Coletta , Tennant Christopher , Rosen Alan , Newton Lesley , Lapsley Helen M. , Tribe Kate , Brown Judith E.
Published: December 2009

Objective: The closure of a long-stay psychiatric hospital in Sydney caused the transfer of an initial 40 very long-term patients to four community residences, each with 10 beds, for a continuing process of deinstitutionalisation. Community psychiatric service support and 24-h supervision were provided. This paper describes the residents' clinical progress which was assessed over a 2-year period.

Method: This study employed a quasi-experimental longitudinal design. Evaluation commenced prior to discharge and continued for 2 years following community relocation using the Brief Psychiatric Rating Scale, Life Skills Profile, Social Behaviour Scale, Montgomery Asberg Depression Rating Scale and Quality Of Life measures. Readmission, demographic, case history and medication data were also collected.

Results: Of the 40 patients initially transferred to the community, seven required long-term readmission to hospital (either prior to or after amalgamation) and one patient died of medical causes. Additional patients transferred from the hospital to the community following the readmissions. Three of these additional patients had achieved a 2-year community tenure during the study period and were included in the clinical evaluation. The 35 residents in total who remained in the community for 2 years, demonstrated a significant improvement in psychotic symptoms, without significant change in the level of neuroleptic medication. Importantly, the 2 years of community living resulted in a significant increase in the residents' life satisfaction. There were no statistically significant changes in residents' living skills, depressive symptoms or social behaviour problems over the 2 years, indicative of the need for supervision and community service support following deinstitutionalisation. Over the 2-year period, some 37% of the residents required temporary readmission.

Conclusion: This study demonstrates the clinical effectiveness of deinstitutionalisation, when planned within a mental health system with adequate community resources.
Family Environment in Attention Deficit Hyperactivity, Oppositional Defiant and Conduct Disorders
Authors: Rey Joseph M. , Walter Garry , Plapp Jon M. , Denshire Elise
Published: December 2009

Objective: This study aims to ascertain whether there were differences in family environment among patients with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder and conduct disorder.

Method: The records of 233 patients, selected for high or low scores on a scale that taps ADHD symptoms, were reviewed by three clinicians who made DSM-IV diagnoses and rated the family environment with the Global Family Environment Scale (GFES). Self-report data obtained from the parent and child versions of the Child Behaviour Checklist were also used. The quality of the family environment was then compared between the various diagnostic groups.

Results: A poorer family environment was associated with conduct disorder and oppositional defiant disorder and predicted a worse outcome (e.g. admission to a non-psychiatric institution, drug and alcohol abuse). Quality of the family environment did not vary according to ADHD diagnosis or gender.

Conclusions: There seems to be no association between the quality of the family environment and a diagnosis of ADHD among referred adolescents. However, there is an association with conduct disorder. Interventions that improve family environment in the early years of life may prevent the development of conduct problems.
Cohort Trends in Youth Suicide in Australia 1964–1997
Authors: Lynskey Michael , Degenhardt Louisa , Hall Wayne
Published: December 2009

Objective: This paper examines trends in the rate of suicide among young Australians aged 15–24 years from 1964 to 1997 and presents an age-period-cohort analysis of these trends.

Method: Study design consisted of an age-period-cohort analysis of suicide mortality in Australian youth aged between 15 and 24 for the years 1964–1997 inclusive. Data sources were Australian Bureau of Statistics data on: numbers of deaths due to suicide by gender and age at death; and population at risk in each of eight birth cohorts (1940–1944, 1945–1949, 1950–1954, 1955–1959, 1960–1964, 1965–1969, 1970–1974, and 1975–1979). Main outcome measures were population rates of deaths among males and females in each birth cohort attributed to suicide in each year 1964–1997.

Results: The rate of suicide deaths among Australian males aged 15–24 years increased from 8.7 per 100 000 in 1964 to 30.9 per 100 000 in 1997, with the rate among females changing little over the period, from 5.2 per 100 000 in 1964 to 7.1 per 100 000 in 1997. While the rate of deaths attributed to suicide increased over the birth cohorts, analyses revealed that these increases were largely due to period effects, with suicide twice as likely among those aged 15–24 years in 1985–1997 than between 1964 and 1969.

Conclusions: The rate of youth suicide in Australia has increased since 1964, particularly among males. This increase can largely be attributed to period effects rather than to a cohort effect and has been paralleled by an increased rate of youth suicides internationally and by an increase in other psychosocial problems including psychiatric illness, criminal offending and substance use disorders.
Health Insurance Status and Mood During Pregnancy and Following Birth: A Longitudinal Study of Multiparous Women
Authors: Kermode Michelle , Fisher Jane , Jolley Damien
Published: December 2009

Objective: The objective of this study was to investigate the relationship between health insurance status and mood during pregnancy and following childbirth.

Method: 320 women were recruited in the early stage of pregnancy to participate in a longitudinal, prospective study of the psychological aspects of childbirth among multiparous women. Study volunteers were surveyed during each trimester of pregnancy and 2 and 8 months following childbirth. A range of self-administered psychometric tests were used to assess mood (Profile of Mood State), locus of control, defence style and partner support. Demographic information including health insurance status was noted at study entry.

Results: Public patients consistently had a more disturbed mood compared with private patients. This difference reached statistical significance during the second and third trimesters of pregnancy and 8 months after birth. Multivariate analysis was undertaken to identify predictors of mood during pregnancy and following birth. A better mood score was positively associated with private health insurance, a more caring partner and mature defence style, and negatively associated with external locus of control and immature defence style. A distinct mood pattern during pregnancy and following childbirth was observed and is described.

Conclusions: Public patients have a more disturbed mood during pregnancy and following childbirth compared with private patients. This information is relevant when planning social, psychological and psychiatric services that target childbearing women.
Trends in Maori Mental Health in Otago
Authors: Edmonds Liza K. , Williams Sheila , Walsh Anne E.S.
Published: December 2009

Objective: This paper outlines the methods used, and preliminary descriptive data collected, in a study on a cohort of Maori and non-Maori patients admitted to the inpatient psychiatric services in Otago between 1990 and 1992.

Method: The notes of 42 Maori and 217 non-Maori first admissions to psychiatric inpatients were reviewed. Information concerning this admission was entered onto a database and analysed.

Results: The Maori admission rate was 4 per 1000 compared with 1 per 1000 for non-Maori people. This was higher than expected based on Otago population figures. Rates of family psychiatric history did not differ between Maori and non-Maori. Although Maori were found to have higher rates of social welfare support and were more likely to have no academic qualifications the differences were not significant. The sources of referral for Maori admissions were more likely to be from the law, and Maori were more likely to have had prior psychiatric inpatient treatment. The most common diagnosis for Maori and non-Maori was depressive disorders, and suicidal behaviour was common.

Conclusions: Maori are overrepresented among first psychiatric inpatient admissions in Otago. They appear to be a more disadvantaged group with respect to financial support, academic qualifications and other health problems. The most common diagnosis did not differ between Maori and non-Maori cohorts.
Signal Transmission, Rather Than Reception, is the Underlying Neurochemical Abnormality in Schizophrenia
Authors: Dean Brian
Published: December 2009

Objective: This review aims to summarise the outcome of studies on changes in the molecular architecture of the brain of subjects with schizophrenia and formulate a hypothesis on mechanisms involved in the pathology of the illness.

Method: The outcomes from key studies using neuroimaging techniques and tissue obtained post-mortem that have been directed toward identifying abnormalities in the molecular architecture of the brain in subjects with schizophrenia were summarised. Using the results from these studies hypotheses were formulated on the underlying pathological process that precipitate schizophrenia.

Results: Studies using neuroimaging techniques or tissue obtained post-mortem have revealed changes in the dopaminergic, serotoninergic, glutamatergic, GABAergic and cholinergic systems of the brain in schizophrenia. Some of these studies have identified abnormalities in presynaptic proteins or functioning that may be central to the pathology of schizophrenia.

Conclusions: There appears to be diverse changes in the molecular cytoarchitecture of the brains from subjects with schizophrenia. It could be that it is by affecting these multiple systems that the atypical antipsychotic drugs produce their improved clinical outcomes. Abnormal functioning of presynaptic processes could be central to the pathology of schizophrenia. If the ‘presynaptic’ hypothesis is proven, future antipsychotic drug design should be directed away from post-synaptic receptor antagonism toward the modulating the functions of presynaptic neurones.
Reactive Psychoses Revisited
Authors: Ungvari Gabor Sandor , Mullen Paul Edward
Published: December 2009

Objective and Method: This paper describes the overlap between reactive (psychogenic) psychosis and other brief psychotic episodes, and explores the gradual disappearance of reactive psychoses as a distinct nosological entity from international classifications. Clinical and conceptual issues concerning reactive psychosis are examined on the basis of a critical review of major classical and modern papers. A brief illustrative case history is also provided.

Results: Reactive psychoses are conceptualised as severe disturbances of mental state, on occasion chameleon-like in their shifting form and content, arising in response to a stressful event or life situation. Reactive psychoses have an abrupt onset and usually run their course to complete resolution in a matter of days or weeks. Precipitants include overwhelming fear, threat of imminent destruction, social isolation (as can occur with imprisonment, immigration or deafness), bereavement and intense sexual or interpersonal conflicts. The emergence of a reactive psychosis usually occurs against the background of a predisposing vulnerability in terms of personality disorder, organic impairment, or a history of sensitising experiences, occasionally operating in combination.

Conclusions: The increasing failure to recognise reactive psychoses diminishes clinical psychiatry because it removes an important opportunity for understanding mental disorder in terms of an integration, and totalisation, of developmental history, psychological makeup, social context and current realities, and in so doing lessens our awareness of the links between psychosis and our common humanity.
Diurnal Variation in Cotard's Syndrome (Copresent with Capgras Delusion) Following Traumatic Brain Injury
Authors: Butler Peter V.
Published: December 2009

Objective: The aim of this paper is to document regular nocturnal intensification of delusional nihilistic and persecutory ideas (Cotard delusion) linked with extreme depersonalisation and hypervivid dreaming.

Clinical Picture: A 17-year-old man presented with Cotard and Capgras delusions after sustaining multiple cognitive impairments secondary to traumatic brain injury.

Treatment and outcome: Delusional ideation fully resolved within 14 days of commencement of olanzapine 5 mg daily.

Conclusion: This patient's experience of perceptual abnormalities and impairments in meta-abilities related to self-monitoring and critical inferencing lends support to multicomponent sensory processing accounts of brain injury related, content-specific delusional syndromes.
Public Beliefs About the Helpfulness of Interventions for Depression: Effects on Actions Taken When Experiencing Anxiety and Depression Symptoms
Authors: Jorm Anthony F. , Medway Jo , Christensen Helen , Korten Ailsa E. , Jacomb Patricia A. , Rodgers Bryan
Published: December 2009

Objective: Previous research has shown that the public have different beliefs to mental health professionals about the helpfulness of interventions for mental disorders. However, it is not known whether the public's beliefs actually influence their behaviour when they develop psychiatric symptoms.

Method: A postal survey of 3109 Australian adults was used to assess beliefs about the helpfulness of a broad range of interventions for depression, as well as respondents' current level of anxiety and depression symptoms and any history of treated depression. A follow-up survey of 422 persons who had a high level of symptoms at baseline was conducted 6 months later. These people were asked which interventions they had used to reduce their symptoms. An analysis was carried out to see whether beliefs and other factors at baseline predicted subsequent use of interventions.

Results: There were some major discrepancies between the ranking of interventions as likely to be helpful and the ranking of how frequently they were actually used. Interventions involving mental health professionals were often rated as likely to be helpful, but were rarely used in practice. Other simple, cheap and readily available interventions were used the most frequently, but were not the most likely to be rated as helpful. The most consistent predictors across all interventions used were gender, history of treatment, current symptoms and belief in a particular intervention. Of particular interest was the finding that beliefs in the helpfulness of antidepressants predicted their use. However, beliefs were not predictors of use for all interventions.

Conclusions: Beliefs about the helpfulness of an intervention did not always predict actual use of that intervention, although beliefs did predict use of antidepressants. Therefore, campaigns that change public beliefs about effective treatments may also influence actual use of treatments. Interventions preferred by professionals are not frequently used at present. Most people with anxiety and depression symptoms rely primarily on simple self-help interventions, the effectiveness of which has been little researched.
The Cost of Being Perfect: Perfectionism and Suicide Ideation in University Students
Authors: Hamilton Teresa K. , Schweitzer Robert D.
Published: December 2009

Objective: The aim of the study was to assess the relationship between dimensions of perfectionism and suicide ideation in a tertiary student population in Australia.

Method: The methodology involved 405 students completing the General Health Questionnaire (GHQ-28) which includes a subset of questions which can be used to assess suicide ideation, and the Multidimensional Perfectionism Scale.

Results: The presence of suicide ideation was associated with higher scores on total perfectionism and two perfectionism dimensions, and total GHQ scores. There were significant differences between participants with high levels of perfectionism and participants with moderate to low levels of perfectionism on a measure of suicide ideation. Neither gender nor age were associated with differences in the scores, with results indicating high levels of perfectionism may indicate a vulnerability to suicide ideation.

Conclusions: Perfectionism is a valued attribute in high-achieving populations. The question needs to be asked, however, at what cost? The findings indicate that high levels of perfectionism may be associated with an increased vulnerability to suicide ideation. Future research is needed to gain a better understanding of the complex interrelationship between personality and temperament, environmental factors and self-destructive behaviour.
Transsexualism in Female Monozygotic Twins: A Case Report
Authors: Sadeghi Majid , Fakhrai Ali
Published: December 2009

Objective: A case report is presented of a gender identity disorder involving a pair of female monozygotic twins who requested sex reassignment. As far as we know, this case is the first in psychiatric literature and supports a genetic aetiology of this disorder.

Clinical picture: The patients were two 18-year-old female monozygotic twins who had showed symptoms of transsexualism since early childhood. They had no other physical or psychiatric disorder except borderline mental functioning.

Treatment: The patients were referred for sex reassignment.

Outcome: They were lost to follow up after initial evaluation.

Conclusion: In addition to other possible (yet not confirmed) causes of trans-sexualism, a genetic basis for this disorder is suggested by this case.
Effect of Somatic Comorbidity on Alleviation of Depressive Symptoms
Authors: Viinamäki Heimo , Tanskanen Antti , Hintikka Jukka , Haatainen Juha , Antikainen Risto , Honkalampi Kirsi , Haatainen Kaisa , Koivumaa-Honkanen Heli , Saarinen Pirjo , Lehtonen Johannes
Published: December 2009

Objective: The aim of this study was to investigate whether somatic comorbidity (SC) impedes recovery from depression.

Method: The study design was naturalistic. Diagnosis of depression was confirmed by means of the Structured Clinical Interview for DSM-III-R (SCID). Changes in the symptom scales for those patients with somatic comorbidity (n = 75) were compared with corresponding changes in depressive patients without somatic comorbidity (n = 41) in a 6-month follow up.

Results: Measured on the Hamilton and Beck scales, recovery rates of those with SC was only slightly lower to that of the others. The difference was statistically significant only in relation to the Hamilton scale. Forty-four per cent of those with SC and 42% of the other patients recovered from their depression (BDI score < 10 on follow up). Logistic regression analysis showed no independent association between recovery and somatic comorbidity.

Conclusions: Moderate somatic comorbidity has only a minor effect on recovery from depression.
Issues Associated with the Identification of Cognitive Change Following Coronary Artery Bypass Grafting
Authors: Symes Emma , Maruff Paul , Ajani Andrew , Currie Jon
Published: December 2009

Objective: Coronary artery bypass grafting (CABG) is a surgical procedure used to treat individuals with ischaemic heart disease and to relieve angina. Disruption to the central nervous system (CNS) has frequently been reported by patients who have undergone CABG.

Method: The following paper is a review of the literature that has examined the effects of CABG on the CNS.

Results and Conclusions: It becomes apparent that issues about the incidence and severity of post-CABG cognitive decline are still unresolved. First, the cause of post-CABG CNS change has not yet been established, although the presence of changes to brain microvasculature as a result of the presence of microemboli appears to be a likely factor. Second, while some studies have reported high rates of poor performance on neuropsychological tests postoperatively, these reports are often subject to confounds such as variability in postoperative testing intervals, the definition of decline and the neuropsychological test batteries used. Finally, improvements in surgical techniques and changes in patient characteristics may have changed the real nature and prevalence of post-CABG cognitive decline. The review finishes with a series of recommendations for the neuropsychologlical study of CABG.
Attention Deficit Hyperactivity Disorder: Current Progress and Controversies
Authors: Vance Alasdair L. A. , Luk Ernest S. L.
Published: December 2009

Objective: Attention deficit hyperactivity disorder (ADHD) is a common chronic and disabling condition in children. This paper reviews the taxonomic issues and the major comorbid conditions, neurobiological correlates, treatment and public health issues associated with ADHD.

Method: Pertinent recent papers are reviewed from the psychological and psychiatric literature.

Results: The two major taxonomies now define a similar group of children with ADHD of a combined type/hyperkinetic disorder. Advances in the understanding and treatment of ADHD demonstrate the complex multidimensional links between neurobiology, psychology and behaviour. Careful assessment of individual factors in treatment planning and ongoing monitoring of psychostimulant medication treatment in the longer term are recommended.

Conclusions: There is much still to learn about ADHD, and increased levels of clinical research and treatment resources are required.
Liveliness
Authors: Korner Anthony
Published: December 2009

Objective: The objective of this study is to explore the significance of the experience of liveliness in psychotherapeutic interactions and its relevance to the practice of psychotherapy.

Method: Stern's notion of ‘vitality affects’ and Emde's concept of a ‘primary affective core’ are employed in developing a concept of liveliness, or an enlivening-deadening axis of experience. A critique of Freud's ‘principles of mental functioning’ is made in the light of this concept. Clinical examples are provided as illustrations of the relevance of considering the ‘sense of liveliness’, and its sustainability, in psychotherapy.

Results and Conclusions: A sense of liveliness relates closely to activity within a system of interpersonal resonance with non-linear characteristics. The experience of, and responses to, vitality affects may be an important basis of a sense of liveliness. Sudden shifts towards experiences of deadness are a matter for concern in psychotherapy. This sphere of experience, although occurring largely outside verbal awareness, may constitute a distinct type of mental process. Three types of mental activity or process are postulated: (i) emergent, pre-representational activity characterised by the sense of liveliness; (ii) Play-related thought or activity typically experienced as enlivening; and (iii) work-related or adaptational thought or activity.
Community Treatment Orders: Relationship to Clinical Care, Medication Compliance, Behavioural Disturbance and Readmission
Authors: Vaughan Kevin , McConaghy Neil , Wolf Cherry , Myhr Craig , Black Terry
Published: December 2009

Objective: The objective of this study was to investigate the readmission rate, and the level of patient disturbance and community care associated with readmission following Community Treatment Orders (CTOs) in New South Wales, Australia.

Method: The readmission rates of all patients given CTOs within a 4-year period and a matched comparison group were investigated. The following factors were compared before, during and following a CTO: medication non-compliance, number of clinical services and duration of disturbed behaviour preceding hospitalisations.

Results: Of 123 patients on CTOs (mean length, 288 days; SD, 210 days), 38 were readmitted during the CTO, the majority in the first 3 months and a further 21 patients were readmitted following termination of the CTO. Evidence of lower severity of illness in the comparison patients prevented meaningful evaluation of the readmission rates of the two groups. While on CTOs, patients receiving depot medications showed high compliance and a significantly reduced readmission rate compared with that of patients receiving oral medications. In the 2 months prior to hospitalisations during CTOs, compared with those before or after CTOs, patients received more frequent consultations and showed a shorter duration of medication non-compliance and disturbed behaviour. The level of services in the 3 months following discharge were comparable for patients on CTOs and the comparison group.

Conclusions: CTOs may reduce rehospitalisations by use of depot medication. Earlier and possibly more frequent readmissions in the CTO group shortened the disturbance associated with illness recurrence. It would appear that to establish a control group with equivalent severity of disorder necessary to evaluate the impact of CTOs requires a random allocation design.
Interrater Reliability of the Camberwell Assessment of Need Short Appraisal Schedule
Authors: Andresen Retta , Caputi Peter , Oades Lindsay G.
Published: December 2009

Objective: Australian mental health policy aims to introduce evidence-based practice within a community care approach. This aim requires reliable measures that can be used by a wide variety of professionals. The interrater reliability of the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) was assessed under routine conditions.

Method: Three interviewer-observer dyads assessed the needs of 14 inpatients and 18 day patients of a psychiatric rehabilitation unit in New South Wales, Australia.

Results: Agreement on the identification of an area of need was high. However, agreement was higher on patient ratings than on staff ratings. Correlations on staff ratings of met needs were also moderate (r = 0.53), suggesting discrepancies in rating the level of need.

Conclusion: Differences in staff ratings may be attributed to ambiguity in the definition of need and levels of need and/or the sources of information used by the rater making the assessment. An approach to establishing an operational definition of need is suggested, and an increase in the number of levels of need is recommended. Implications for Australian mental health policy are noted.
Measuring Disability, Need and Outcome in Australian Community Mental Health Services
Authors: Gallagher Jill , Teesson Maree
Published: December 2009

Objective: This study trialled routine measurement of disability, need and outcome in mental health services within Sydney.

Method: Fifteen community mental health clinicians with a combined caseload of 283 patients participated in the study. The Health of the Nation Outcome Scales (HoNOS) was used to assess disability and outcome and the patient and staff versions of the Camberwell Assessment of Need (CAN) were used to assess need.

Results: The HoNOS and CAN appear to be promising contenders for routine use. Patients receiving assertive case management were rated as having higher levels of disability and need than patients receiving standard case management. Significant change in outcome was demonstrated with the HoNOS.

Conclusions: To ensure the continued measurement of consumer outcome, issues such as staff education, training, and the development of computerised information systems should be addressed.
Capgras Syndrome: Possibly More Common Among the Maori of New Zealand
Authors: Mackirdy Catherine , Shepherd Debbie
Published: December 2009

Objective: The report describes an apparently greater incidence of Capgras syndrome among the Maori population compared with the European population, in the most easterly catchment area served by Tauranga Hospital in New Zealand's Bay of Plenty.

Method: Over the last year we have become aware of five cases of Capgras syndrome in our catchment area. This area (population nearly 21 000) consists of a rapidly expanding new suburb of the city of Tauranga and a rural area extending 55 km east of the city. These figures were compared with those of the westerly catchment area served by Tauranga Hospital, where the psychiatric team is not aware of any examples of Capgras syndrome among their population. The 1996 census figures were obtained in order to calculate a population ethnicity breakdown.

Results: Five cases of Capgras syndrome were identified in the most easterly catchment area where 19% of the population identified as Maori, 75% as European and 6% as other or non-specified. All of the cases occurred in Maori patients. This compares with no identified cases of Capgras syndrome in the most westerly catchment area where 12% of the population identified as Maori, 87% as European and 1% as other or non-specified. Four out of five cases were female. Two cases had a history of cannabis use. Three cases had exhibited dangerous behaviour towards family members.

Conclusions: There is an apparently greater incidence of Capgras syndrome among the New Zealand Maori population compared with the European population in the most easterly catchment area served by Tauranga Hospital. In our population Capgras syndrome is a common, not rare, feature of psychotic illness, and the cases support a previously reported association of this syndrome with dangerousness.
Australian and New Zealand Clinical Practice Guidelines for the Treatment of Panic Disorder and Agoraphobia
Authors:   Royal Australian and New Zealand College Of Psychiatrists Clinical Practice Guidelines Team For Panic Disorder And Agoraphobia
Published: December 2009

Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority.

Method: For these guidelines, the CPG team reviewed the treatment outcome literature, consulted with practitioners and patients and conducted a meta-analysis of recent outcome research.

Treatment recommendations: Education for the patient and significant others covering: (i) the nature and course of panic disorder and agoraphobia; (ii) an explanation of the psychopathology of anxiety, panic and agoraphobia; (iii) rationale for the treatment, likelihood of a positive response, and expected time frame.

Cognitive behaviour therapy (CBT) is more effective and more cost-effective than medication. Tricyclic antidepressants (TCAs) and serotonin selective reuptake inhibitors are equal in efficacy and both are to be preferred to benzodiazepines. Treatment choice depends on the skill of the clinician and the patient's circumstances. Drug treatment should be complemented by behaviour therapy.

If the response to an adequate trial of a first-line treatment is poor, another evidence-based treatment should be used. A second opinion can be useful. The presence of severe agoraphobia is a negative prognostic indicator, whereas comorbid depression, if properly treated, has no consistent effect on outcome.
Does Ethnicity Affect Need for Mental Health Service Among New Zealand Prisoners?
Authors: Simpson Alexander I. F. , Brinded Philip M. , Fairley Nigel , Laidlaw Tannis M. , Malcolm Fiona
Published: December 2009

Objective: The National Study on Psychiatric Morbidity in New Zealand Prisons identified undiagnosed mental illness and unmet treatment needs for mentally disordered offenders. As approximately 50% of prisoners are of Maori and 8.3% Pacific Island ethnicity, we analyzed the data to determine if there were any differences in the rates of major mental disorders between ethnic groups.

Method: A census of all female prisoners, all remand male prisoners and an 18% random sample of the sentenced male prisoners were interviewed employing the diagnostic interview for mental illness (CIDI-A), screening diagnostic interview for relevant personality disorders (PDQ) and suicide screening questions. Self-identified ethnicity was recorded. Ethnic groups were compared for sociodemographic variables, morbidity for mental disorder, treatment experience and suicidality.

Results: The ethnic groups were largely similar in age and current prevalence for mental disorders, although there was some evidence of differing sociodemographic factors, especially younger age among the Maori prisoners. Maori report fewer suicidal thoughts, but acted suicidally at the same rate as non-Maori. Treatment for mental disorder was less common among Maori and Pacific Island prisoners than others, both in prison and in the community.

Conclusion: Criminogenic factors present in the developmental histories of prisoners might also increase the risk of mental disorders. Ethnic groups were not different in the rate at which they manifest mental disorders in the face of such factors. Younger prisoners were disproportionately more likely to be of Maori or Pacific Island ethnicity. Both prior to and after entry to prison, services must improve responsiveness to Maori and Pacific Island people.
Can Recovery-Focused Multimodal Psychotherapy Facilitate Symptom and Function Improvement in People With Treatment-Resistant Psychotic Illness? A Comparison Study
Authors: Randal Patte , Simpson Alexander I. F. , Laidlaw Tannis
Published: December 2009

Objective: To assess whether recovery-focused multimodal psychotherapy can facilitate symptom and function improvement in people with treatment-resistant psychotic illness.

Method: Nine people with treatment-resistant schizophrenia or schizoaffective disorder whose symptoms and level of functioning necessitated inpatient care were engaged in individual multimodal psychotherapy for up to 21 months. In addition to the multimodal therapy they also received standard inpatient care. Twelve people retrospectively matched for diagnosis, age, sex, and chronicity of illness, formed a comparison group. They also received standard inpatient care. The standard inpatient care for both experimental and comparative groups consisted of custodial care, predominantly atypical antipsychotic drug therapy, and ongoing care from a key worker.

Results: The treatment group showed clinically significant improvements in the overall Positive and Negative Symptom Scale (PANSS) scores which was significantly better than the changes found in the comparison group (p = 0.037). There was a 43% reduction in positive symptoms, a 30% reduction in negative symptoms, a 27.5% reduction in general psychopathology symptoms and a 30% reduction in overall scores on the PANSS. General behaviour scores on the Rehabilitation Evaluation of Hall and Baker were clinically improved, with a 32% reduction, as were deviant scores, with a 93.3% reduction. The change in the deviant scores was significantly better in the treatment group (p = 0.025).

Conclusion: Recovery-focused multimodal psychotherapy may facilitate symptom and function improvement in people with treatment-resistant psychotic illness.