bluuebunny/crossref_metadata_2025 huggingface dataset:
Alcoholics Anonymous: Cult or Cure?
Authors: Vaillant George E.
Published: December 2009

Objective: To discuss the mechanism of action, the efficacy and the safety of Alcoholics Anonymous (AA) in the treatment of alcoholism.

Method: The published works on effective treatments for alcoholism is briefly reviewed and a prospective multidisciplinar y follow-up of recovery from alcoholism in two community cohorts of adolescent males followed from 1940 until the present day is reviewed.

Conclusions: The suggested mechanism of action of AA is that it employs four factors widely shown to be effective in relapse prevention in addictions: external supervision, substitute dependency, new caring relationships and increased spirituality. In addition, AA serendipitously follows the principles of cognitive behaviour therapy in relapse prevention. Alcoholics Anonymous appears equal to or superior to conventional treatments for alcoholism, and the skepticism of some professionals regarding AA as a first rank treatment for alcoholism would appear to be unwarranted. Alcoholics Anonymous is probably without serious side-effects.
Obstetric Complications and Transition to Psychosis in an ‘Ultra’ High Risk Sample
Authors: Yun Yang , Phillips Lisa J. , Cotton Sue , Yung Alison R. , Francey Shona M. , Pan Yuen Hok , Mcgorry Patrick D.
Published: December 2009

Objective: An association between birth and pregnancy complications and the later development of schizophrenia has been described for decades and obstetric complications (OCs) have been proposed as a vulnerability marker for psychosis in line with the neurodevelopmental hypothesis of psychotic disorders. Previous studies of OCs have focused on established schizophrenia. In this study, the association between OCs and the development of psychotic disorder was studied in a group of 74 young people identified as being at very high risk for the first onset of psychosis.

Method: The ‘ultra’ high risk (UHR) cohort was identified by the presence of subthreshold psychotic symptoms, or a combination of first-degree relative with a psychotic disorder and recent functional decline. Thirty-eight per cent of the cohort developed an acute psychotic episode over the 12-month period after recruitment. As a component of a larger research study, the level of OCs experienced by the UHR cohort was assessed at intake.

Results: Obstetric complicationswere not associated with the later development of psychosis in the UHR group included in this study.

Conclusions: This study does not suppor t a role for OCs as a risk factorfor the later development of psychosis; however, we cannot conclude that they should be completely ignored as a candidate risk factor for onset of psychosis. A number of weaknesses of the study suggest that it may be premature to dismiss OCs as a risk factor for the development of psychosis and further research is urged in this area.
Expressed Emotion as Predictor of Relapse in Patients with Comorbid Psychoses and Substance use Disorder
Authors: Pourmand Diba , Kavanagh David J. , Vaughan Kevin
Published: December 2009

Objective: Expressed emotion (EE) and substance use disorder predict relapse in psychosis, but there is little research on EE in comorbid samples. The current study addressed this issue.

Method: Sixty inpatients with a DSM-IV psychosis and substance use disorder were recruited and underwent diagnostic and substance use assessment. Key relatives were administered the Camberwell Family Interview.

Results: Patients were assessed on the initial symptoms and recent substance use, and 58 completed the assessment over the following 9 months. High EE was observed in 62% of households. Expressed emotion was the strongest predictor of relapse during follow-up and its predictive effect remained in participants with early psychosis. A multivariate prediction of a shorter time to relapse entered EE, substance use during follow-up and (surprisingly) an absence of childhood attention deficit hyperactivity disorder.

Conclusions: Since high EE is a common and important risk factor for people with comorbid psychosis and substance misuse, approaches to address it should be considered by treating clinicians.
Nutritional Intervention to Prevent Weight Gain in Patients Commenced on Olanzapine: A Randomizedcontrolled Trial
Authors: Evans Sherryn , Newton Richard , Higgins Sally
Published: December 2009

Objective: Olanzapine is the most commonly prescribed atypical antipsychotic medication in Australia. Research repor ts an average weight gain of between 4.5 and 7 kg in the 3 months following its commencement. Trying to minimize this weight gain in a population with an already high prevalence of obesity, mor tality and morbidity is of clinical and social importance. This randomized controlled trial investigated the impact of individual nutrition education provided by a dietitian on weight gain in the 3 and 6 months following the commencement of olanzapine.

Method: Fifty-one individuals (29 females, 22 males) who had star ted on olanzapine in the previous 3 months (mean length of 27 days 20) were recruited through Peninsula Health Psychiatric Services and were randomly assigned to either the intervention (n = 29) or the control group (n = 22). Individuals in the intervention group received six 1 hour nutrition education sessions over a 3-month period. Weight, waist circumference, body mass index (BMI) and qualitative measures of exercise levels, quality of life, health and body image were collected at baselineat 3 and 6 months.

Results: After 3 months, the control group had gained significantly more weight than the treatment group (6.0 kg vs 2.0 kg, p≤0.002). Weight gain of more than 7% of initial weight occurred in 64% of the control group compared to 13% of the treatment group. The control group's BMI increased significantly more than the treatment group's (2 kg/m2 vs 0.7 kg/m2, p ≤0.03). The treatment group reported significantly greater improvements in moderate exercise levels, quality of life, health and body image compared to the controls. At 6 months, the control group continued to show significantly more weight gain since baseline than the treatment group (9.9 kg vs 2.0 kg, p≤0.013) and consequently had significantly greater increases in BMI (3.2 kg/m2vs 0.8 kg/m2, p ≤0.017).

Conclusion: Individualnutritional intervention provided bya dietitian is highly successful at preventing olanzapine-induced weight gain.
Relative Contributions of Psychiatric Symptoms and Neuropsychological Functioning to Quality of Life in First-Episode Psychosis
Authors: Wegener Signy , Redoblado-Hodge Marie Antoinette , Wegener Signy , Redoblado-Hodge Marie Antoinette , Lucas Sara , Fitzgerald Dianne , Harris Anthony , Brennan John
Published: December 2009

Objective: To repor t on the relationship between quality of life (QOL), psychiatric symptoms and neuropsychological functioning in a sample of young people who have experienced a first episode of psychosis 2–3 years following initial presentation.

Method: Fifty-one participants aged 15–27 years old completed the short form of the World Health Organization Quality of Life scale (WHOQOL-Brèf), a self-repor t instrument assessing physical, psychological, social and environmental aspects of QOL. A comprehensive neuropsychological batterywas administered. Measures of psychiatric symptoms including depression (as assessed by the Calgary Depression Scale), positive, negative and general psychopathology (as assessed by the Positive and Negative Syndrome Scale) were obtained.

Results: Multiple regression analyses were used to evaluate the ability of neuropsychological measures and psychiatric symptoms to predict QOL. When neuropsychological variables were considered on their own, cognitive flexibility, verbal fluency, verbal ability and sustained attention explained up to 28% of the variance in the four domains of QOL. However, in the presence of psychiatric symptoms, neuropsychological variables were no longer significant predictors for physical and psychological QOL; depression, general psychopathology and negative symptoms together explained up to 43% of the variance in QOL, with neuropsychological variables remaining significant for social and environmental QOL.

Conclusions: In young people with their first episode of psychosis, QOL is more strongly related to levels of psychopathology, particularly depression, than neuropsychological deficits. This finding replicates previous studies in chronic schizophrenia that have suggested QOL is more strongly related to levels of psychopathology than the presence of neuropsychological deficits.
Investigation of Consumer Satisfaction with Cognitive-Behaviour Therapy and Sertraline in the Treatment of Adolescent Depression
Authors: Dudley Amanda L. , Melvin Glenn A. , Williams Nicola J. , Tonge Bruce J. , King Neville J.
Published: December 2009

Objective: A new instrument, the Adolescent Depression Treatment Satisfaction Questionnaire (ADTSQ) was devised to measure the consumer satisfaction of depressed adolescents and their parents. The objectives of the paper were to present the psychometric proper ties ofthe ADTSQ and to investigate the relative consumer satisfaction with cognitive-behavioural therapy (CBT), sertraline (SRT) and a combined treatment of CBT and SRT (COMBINED) for the treatment of adolescent depression. In addition, participants were asked to rank their most preferred treatment from the following approaches: medication, individual counselling, group program and family therapy.

Method: Thirty-eight adolescents with a unipolar depressive disorder and 37 parents who participated in a randomized clinical trial of CBT versus SRT versus COMBINED completed the ADTSQ following the completion of acute treatment.

Results: The ADTSQ was found to have high internal consistency and exploratory factor analysis detected three underlying factors. High levels of consumer satisfaction were reported by both adolescents and parents in all three treatments. Those treated with CBT treatments reported higher levels of skill acquisition than those treated with SRT. Of the four treatment approaches, most parents and adolescentsrated individual counsellingas their first preference.

Conclusions: The ADTSQ is a useful measure of consumer satisfaction for depressed adolescents and their parents. CBT, SRT and COMBINED were shown to have high consumer satisfaction with CBT's higher skills training content reflected in the participants' reports. Individual counselling was perceived as the most favourable choice of treatment for adolescent depression. Although limitations associated with the measurement of consumer satisfaction and of the study are acknowledged, it is recommended that the inclusion of consumer satisfaction measures be considered in clinical trials that examine treatment efficacy.
Queensland Centre for Mental Health Research: The First 17 Years
Authors: Mcgrath John , Mcgrath John , Mowry Bryan , Whiteford Harvey
Published: December 2009

Objective: To reflect on the establishment and evolution of the Queensland Centre for Mental Health Research.

Method: Narrative historical review.

Results: First established as an inpatient research unit in December 1987, the focus of the Centre evolved in concert with the skills of the staff. After the structure was revised in 1996 and 1999, the Centre has evolved into a group with four main research streams – epidemiology, developmental neurobiology, genetics and policy and economics. Although the group maintains a strong focus on serious mental disorders such as schizophrenia, our policy and economic work has a wider perspective. The Queensland Centre for Mental Health Research is based in an historic mental health service, with laboratories in collaborating universities and institutes. Key lessons learnt by the group along the way relate to the importance of focusing on a restricted range of research topics in order to build a critical mass.

Conclusions: Given a facilitating environment, hospital-based research groups can prosper. Over the last 17 years, a cost-efficient, focused and productive research group has evolved that has made contributions to international research.
Techniques for the Identification of Genes Involved in Psychiatric Disorders
Authors: Blair Ian P. , Mitchell Philip B. , Schofield Peter R.
Published: December 2009

Objective: Most psychiatric disorders are complex genetic traits involving both genetic and environmental risk factors. This paper aims to review the gene identification strategies being applied bymolecular geneticists in their efforts to elucidate the genetic and molecular basis of psychiatric disorders. Future strategies will also be canvassed.

Method: The psychiatric genetic literature was reviewed to identify current strategies applied to gene identification, with examples provided where available. The future strategies and applications that will arise from genome projects, including the International Haplotype Mapping Project, are also discussed.

Results: Many advances in the techniques of gene discovery, and the increasing resources available, are rapidly being adopted by researchers and applied to the complex problem of identifying susceptibility genes for mental illnesses. Perhaps the single most important advance to date is the Human Genome Project and all that has stemmed from the vast quantity of information that this endeavour has provided. With these technological advances and the massive increase of publicly available genetic resources, several genes have recently been implicated in the susceptibility to psychiatric illnesses including schizophrenia and depression. After many years of fruitless endeavours, these recent reports indicate that the labours of researchers in psychiatric genetics are beginning to show exciting results.

Conclusions: Identification of these susceptibility genes holds great promise, with the unravelling of the molecular and biochemical basis of some conditions now being a more realistic and tangible goal. The increasing number of genes being identified augers well for the future treatment of psychiatric disorders. The genes identified, and the pathways of genes and proteins that they implicate, will provide potential novel targets for new therapeutic drugs. Psychiatric genetics appears to be poised for significant advances in our knowledge and understanding of the molecular genetic basis of mental illness.
Importance of Animal Models in Schizophrenia Research
Authors: Van Den Buuse M , Garner B , Gogos A , Kusljic S
Published: December 2009

Objective: This review aims to summarize the importance of animal models for research on psychiatric illnesses, particularly schizophrenia.

Method and Results: Several aspects of animal models are addressed, including animal experimentation ethics and theoretical considerations of different aspects of validity of animal models. A more specific discussion is included on two of the most widely used behavioural models, psychotropic drug-induced locomotor hyperactivity and prepulse inhibition, followed by comments on the difficulty of modelling negative symptoms of schizophrenia. Furthermore, we emphasize the impact of new developments in molecular biology and the generation of genetically modified mice, which have generated the concept of behavioural phenotyping.

Conclusions: Complex psychiatric illnesses, such as schizophrenia, cannot be exactly reproduced in species such as rats and mice. Nevertheless, by providing new information on the role of neurotransmitter systems and genes in behavioural function, animal ‘models’ can be an important tool in unravelling mechanisms involved in the symptoms and development of such illnesses, alongside approaches such as post-mortem studies, cognitive and psychophysiological studies, imaging and epidemiology.
Acute Tryptophan Depletion. Part I: Rationale and Methodology
Authors: Hood Sean D. , Bell Caroline J. , Nutt David J.
Published: December 2009

Objective: Acute tryptophan depletion (ATD) is an experimental technique that has been widely used over the last decade to investigate the role of serotonin (5-HT) in a variety of disorders. This review, the first of two articles, describes the rationale behind this technique and provides detail on how it is applied in research settings.

Method: The authors outline the development of this technique with reference to the seminal literature and more recent findings from neuroimaging and neuroendocrine studies. This is supplemented by the authors' clinical experience of over 5 years of continuous experimental work with this paradigm in over 50 subjects.

Results: Acute tryptophan depletion is a method that significantly reduces central 5-HT in human subjects. Non-serotonergic explanations of the effects of ATD have not been confirmed, supporting the specificity of this method.

Conclusions: The ATD technique is a valid method of manipulating central 5-HT levels. The second article in this series will review the application of ATD in depression, anxiety and other psychiatric conditions.
Can We Track the Impact of Australian Mental Health Research?
Authors: Hickie Ian B. , Hickie Ian B. , Christensen Helen , Davenport Tracey A. , Luscombe Georgina M.
Published: December 2009

Objective: Arguments are being made to increase research and development funding for mental health research in Australia. Consequently, the methods used to measure the results of increased investment require review. This study aimed to describe the status of Australian mental health research and to propose potential methods for tracking changes in research output. Specifically, we describe the research output of nations, Australian states, Australian and New Zealand institutions and Australian and New Zealand researchers using citation rates.

Method: Information on research output was sourced from two international databases (Institute for scientific information [ISI] Essential Science Indicators and ISI Web of Science) and the ISI list of Highly Cited Researchers.

Results: In an international setting, Australia does not perform as well as other comparable countries such as New Zealand or Canada in terms of research output. Within Australia, the scientific performance of institutions apparently relates to the strength of some individual researchers or consolidated research groups. Highly cited papers are evident in the fields of syndrome definition, epidemiology and epidemiological methods, cognitive science and prognostic or longitudinal studies.

Conclusions: Australian researchers need to consider the success of New Zealand and Canadian researchers, particularly given the relatively low investment in health and medical research in New Zealand. Although citation analyses are fraught with difficulties, they can be effectively complemented by other measures of responsiveness to clinical or population needs and community expectations and should be conducted regularly and independently to monitor the status of Australian mental health research.
Low Hospital Inpatient Readmission Rate in Patients with Borderline Personality Disorder: A Naturalistic Study at Southern Health, Victoria, Australia
Authors: Wong Michael T.H. , Wong Michael T.H. , Tye Christine
Published: December 2009

Objective: To study how the standard management protocol and the special management contract relate to the clinical profile of patients with borderline personality disorder and their hospital admission pattern.

Method: A retrospective review was undertaken using naturalistic data from the Client Management Interface over a 2-year period. The standard management protocol patient group and the special treatment contract patient group were compared with respect to variables which included basic demographic data, number of admissions, length of stay and comorbidity.

Results: Eighty patients received a diagnosis of borderline personality disorder. The majority (81.2%) were managed with the standard management protocol and only 41.5% had more than one admission. For those who received a special treatment contract (18.8%), 93.3% of them had more than one admission. The special treatment contract group had a significantly higher total number of admissions (p<0.001), a higher number of admissions when they received (p<0.001) and did not receive (p=0.001) a diagnosis of borderline personality disorder, a higher number of comorbidities (p=0.004) but not more presentations to the emergency department.

Conclusions: Most patients with borderline personality disorder treated with the standard management protocol had a low readmission rate. The small group of patients with comorbidities managed with a special treatment contract had multiple readmissions but not more crisis presentations to the emergency department. Further studies are required to elucidate the therapeutic mechanism of the standard management protocol and special treatment contract and how that impacts on presentations and admissions to a hospital.
Adverse Mental Health Effects of Cannabis Use in Two Indigenous Communities in Arnhem Land, Northern Territory, Australia: Exploratory Study
Authors: Clough Alan R. , D'abbs Peter , Cairney Sheree , Gray Dennis , Maruff Paul , Parker Robert , O'reilly Bridie
Published: December 2009

Objective: We investigated adverse mental health effects and their associations with levels of cannabis use among indigenous Australian cannabis users in remote communities in the Northern Territory.

Method: Local indigenous health workers and key informants assisted in developing 28 criteria describing mental health symptoms. Five symptom clusters were identified using cluster analysis of data compiled from interviews with 103 cannabis users. Agreement was assessed (method comparison approach, κ-statistic) with a clinician's classification of the 28 criteria into five groups labelled: ‘anxiety’, ‘dependency’, ‘mood’, ‘vegetative’ and ‘psychosis’. Participants were described as showing ‘anxiety’, ‘dependency’ etc., if they reported half or more of the symptoms comprising the cluster. Associations between participants' self-reported cannabis use and each symptom cluster were assessed (logistic regression adjusting for age, sex, other substance use).

Results: Agreement between two classifications of 28 criteria into five groups was ‘moderate’ (64%, κ=0.55, p<0.001). When five clusters were combined into three, ‘anxietydependency’, ‘mood-vegetative’ and ‘psychosis’, agreement rose to 71% ( κ=0.56, p<0.001). ‘Anxiety-dependency’ was positively associated with number of ‘cones’ usually smoked per week and this remained significant when adjusted for confounders (p=0.020) and tended to remain significant in those who had never sniffed petrol (p=0.052). Users of more than five cones per week were more likely to display ‘anxiety-dependency’ symptoms than those who used one cone per week (OR=15.8, 1.8–141.2, p=0.013). A crude association between the ‘mood-vegetative’ symptom cluster and number of cones usually smoked per week (p=0.014) also remained statistically significant when adjusted for confounders (p=0.012) but was modified by interactions with petrol sniffing (p=0.116) and alcohol use (p=0.276). There were no associations between cannabis use and ‘psychosis’.

Conclusions: Risks for ‘anxiety-dependency’ symptoms in cannabis users increased as their level of use increased. Other plausible mental health effects of cannabis in this population of comparatively new users were probably masked by alcohol use and a history of petrol sniffing.
Samoan and Psychiatrists' Perspectives on the Self: Qualitative Comparison
Authors: Bush Allister , Collings Sunny , Tamasese Kiwi , Waldegrave Charles
Published: December 2009

Objectives: To compare psychiatrists' perspectives on the meaning of self, in general adult public practice psychiatry in the Wellington region of New Zealand, with a Samoan view of self and to discuss the implications for the practice of psychiatry with Samoan people in New Zealand.

Method: A focus group of psychiatrists was convened for three sessions. A Samoan view of self was presented to the participants. Transcripts of the focus groups were analysed using inductive content analysis and a process of cultural accountability was included in the research design.

Results: Individual and secular notions of self dominated the psychiatrists' perspectives and contrasted with the primacy of relational and spiritual notions of self in Samoan culture. Psychiatrists experienced a sense of cultural ‘dissonance’ on first exposure to the Samoan views. The Samoan notion of self was considered to challenge the universalist assumptions of Western psychiatric theories as understood by the participants. The Samoan relational notion of self had implications for clinical interviewing, understanding of phenomenology, formulation and treatment planning with Samoan patients and their families.

Conclusions: Dedicated Samoan or Pacific Island mental health services would allow culture-specific concepts central to an understanding of mental health to be embedded in service delivery. The process used in this study and the notion of dialectical tension could be used in the cultural education of mental health clinicians. The cultural accountability process models an important aspect of such training.
Adverse Childhood Experiences, Stressful Life Events or Demographic Factors: Which are Important in Women's Depression? A 2-Year Follow-Up Population Study
Authors: Honkalampi Kirsi , Honkalampi Kirsi , Hintikka Jukka , Haatainen Kaisa , Koivumaa-Honkanen Heli , Tanskanen Antti , Viinamäki Heimo
Published: December 2009

Objective: The aim of this study was to simultaneously test adverse background factors, namely adverse childhood experiences (ACEs), stressful life events and prior depressive symptoms, for their ability to predict recovery and non-recovery from depression in women among the general population.

Method: A stratified random sample of women (n=835) from the general population was collected at baseline in 1999. Depression (Beck Depression Inventory, BDI-21), ACEs and background factors were assessed by postal questionnaire at baseline. Two years later, stressful life events during the study phase, social support, use of health services and current depression (BDI≥13) were similarly assessed.

Results: Adverse childhood experiences were common among depressed women and these past experiences together with the use of health services were associated with recovery from depression. Financial difficulties and a poor subjective health status associated with non-recovery and current stressful life events increased the likelihood of depression on follow-up. Furthermore, the important variables explaining depression on follow-up were the quality of social support and the existence of prior depressive symptoms at baseline.

Conclusions: Our results suggest that women's current depression especially associates with stressful life events, insufficient social support, poor subjective health and financial difficulties. It seems possible that past adverse experiences predispose women to depression, but current stressful events actualize these symptoms. In addition, use of health services are associated with recovery in women who had ACEs.
Considerations in the Management of Bipolar Disorder in Women
Authors: Barnes Caryl , Barnes Caryl , Mitchell Philip
Published: December 2009

Objective: Recent research has emphasized important gender differences in the epidemiology, course, comorbidity and treatment of bipolar disorder. This article aims to provide an overview of these important findings in order to assist the clinician in treating women with bipolar disorder. Complex issues regarding the treatment of bipolar disorder during pregnancy and the post-partum period are discussed.

Method: A literature review was undertaken using Medline (1966–current), PsychInfo and PubMed databases. Search terms used were gender, sex, women, bipolar disorder, suicide, epidemiology, rapid cycling, mixed episode, treatment, mood stabilizers, antidepressants, antipsychotics, pregnancy, post-partum, menopause, lactation and breast-feeding.

Results: The lifetime prevalence of bipolar I disorder is equal in men and women; however, bipolar II appears to be more common in women. Gender differences have been reported in the phenomenology, course and outcome of this condition. Some comorbid disorders, such as thyroid disease and anxiety disorders have more relevance to women. Increasingly, sex differences in the pharmacokinetics and pharmacodynamics of medications used in bipolar disorder are being reported.

Conclusions: There is increasing evidence for gender differences in a number of clinical features of bipolar disorder that have relevance to management. Although more studies are needed, it is important for clinicians to be aware of these issues to optimize treatment of women with this condition.
Bipolar I and II Disorders in a Random and Representative Australian Population
Authors: Goldney Robert D. , Fisher Laura J. , Dal Grande Eleonora , Taylor Anne W. , Hawthorne Graeme
Published: December 2009

Objective: To assess the prevalence of bipolar I and II disorders in an Australian population.

Method: The Mood Disorder Questionnaire (MDQ) was administered to 3015 respondents in a random and representative sample in South Australia. Health status, quality of life and demographic data were also collected.

Results: There was a 2.5% lifetime prevalence of bipolar I and II disorders delineated by the MDQ. Those people had a significantly greater use of services and a poorer health status and quality of life than those who were MDQ-negative.

Conclusions: These results in an Australian population are consistent with other international studies showing a greater prevalence of bipolar disorders than hitherto appreciated.
Evidence for a Possibly X-Linked Trait Related to Affective Illness
Authors: Vaillant George E. , Vaillant George E. , Batalden Maren , Orav John , Roston Diane , Barrett James E.
Published: December 2009

Objective: The present report attempts to replicate on the probands' brothers, a previously reported (1992) negative relationship between maternal grandfather longevity (MGFL) and affective illness in grandsons. Hitherto this finding had not been replicated. To provide further evidence that the association may be recessive and X-linked, we also examined the association between MGFL and affective illness in the probands' mothers. Finally, in order to examine why MGFL might be a predictor of affective illness, the report examines the association of the probands' affective illness and their own mortality.

Method: A 60-year prospective study of men selected in 1940 and followed until the present day provided good information on depressive illness in relatives and longevity of ancestors. To overcome the uncertainty of depressive diagnoses, we assessed affective illness in the probands categorically, dimensionally, operationally and with the Lazare Personality Inventory.

Results: Presence of affective illness in brothers was negatively associated with MGFL (p=0.003) but maternal affective illness was independent of MGFL. Test items suggesting emotional lability in the probands were significantly and negatively associated with MGFL. Consistent with the association of increased MGFL with low affective distress in the probands, the 70 probands showing the least evidence of affective distress before age 50 had twofold (p<0.001) lower mortality at 80 than the rest of the sample. The 31 probands manifesting the greatest affective distress manifested twofold higher mortality before age 65 (p<0.001) than the rest of the sample.

Conclusion: The strong negative association of proband affective distress – and equally important – the positive association of proband mental health with MGFL and the lack of association of maternal longevity and depression with MGFL points to the possibility of a recessive X-gene or genes playing a role in depressive illness.
Screening for Postnatal Depression in Routine Primary Care: Properties of the Edinburgh Postnatal Depression Scale in an Australian sample
Authors: Milgrom Jeannette , Ericksen Jennifer , Negri Lisa , Gemmill Alan W.
Published: December 2009

Objectives: First, to explore the utility of the Edinburgh Postnatal Depression Scale (EPDS) in routine primary care through a large community screening program. Next, to compare administration of a second EPDS versus the Beck Depression Inventory (BDI) in identifying postnatal depression in the prescreened population.

Method: Screening with the EPDS through Maternal and Child Health Centres at 4 months post-partum. Women scoring ≥12 were assessed against DSM-IV criteria and completed a BDI and a second EPDS. These data were subjected to receiver operating characteristic (ROC) analyses.

Results: Of 4148 screened, 533 (12.8%) scored ≥12. Of these, 344 were assessed against DSM-IV criteria: 193 (56%) – major depressive disorder; 67 (20%) – other diagnoses that incorporated depression. Positive predictive value at screening was therefore 76%. Another 45 (13%) had non-depressive disorders and 39 (11%) were psychiatric non-cases. The BDI was the better diagnostic instrument in the prescreened population, having a significantly higher efficiency as quantified by ROC curve analysis, though the absolute difference in efficiency was small (approximately 6%).

Conclusions: Screening with the EPDS integrated well into routine primary care. Twostep screening offers one way of achieving acceptable balances of operational simplicity and diagnostic accuracy.
Self-Harming in Depressed Patients: Pattern Analysis
Authors: Parker G , Parker G , Malhi Gin. , Mitchell Philip , Kotze Beth , Wilhelm Kay , Parker Kay
Published: December 2009

Objective: As deliberate self-harm (DSH) is a common concomitant of depressive disorders, we undertook a study examining the relevance of possible determinants and correlates of DSH.

Method: Three separate samples of depressed outpatients were studied to determine consistency of identified factors across samples, with principal analyses involving gender, age and diagnosis-matched DSH and non-DSH subjects.

Results: Across the samples, some 20% of subjects admitted to episodes of DSH. Women reported higher rates and there was a consistent trend for higher rates in bipolar patients. Univariate analyses examined the relevance of several sociodemographic variables, illicit drug and alcohol use, past deprivational and abusive experiences, past suicidal attempts and disordered personality functioning. Multivariate analyses consistently identified previous suicide attempts and high ‘acting out’ behaviours across the three samples, suggesting the relevance of an externalizing response to stress and poor impulse control.

Conclusions: Results assist the identification and management of depressed patients who are at greater risk of DSH behaviours.
Children of a Cohort of Depressed Patients 25 Years on: Identifying Those at Risk
Authors: Peisah Carmelle , Brodaty Henry , Luscombe Georgina , Anstey Kaarin J
Published: December 2009

Objective: Factors associated with psychological outcome in children of patients with depression have been examined piecemeal, with emphasis on young rather than adult children. We hypothesized that psychological morbidity in adult children of patients with depression would be associated with characteristics of the children, their parents and their family relationships.

Method: Factors predicting psychopathology in children (n = 94) of a cohort of patients with depression, admitted to a teaching hospital 25 years earlier, were examined using logistic regression.

Results: Psychological morbidity in children was predicted by their being younger at parent's admission, their perception of the depressed parent as more controlling and chronicity of the parent's depression. Correlations between child characteristics, parent illness and family relationship variables showed systemic interactions between parental illness, child psychopathology and family relationships.

Conclusion: Chronicity (though neither recurrence nor severity) of parent depression and younger children's age at the time of parental admission for depression were associated with psychological morbidity in the children in adulthood. The interaction between child psychopathology, parental illness and family relationships emphasizes the need for a systemic, family focus in the treatment of depression.
Classification of Somatization and Functional Somatic Symptoms in Primary Care
Authors: Fink Per , Rosendal Marianne , Olesen Frede
Published: December 2009

Objective: A substantial proportion of patients found in primary care complain of physical symptoms not attributable to any known conventionally defined disorder, that is, medically unexplained or functional somatic symptoms. The objective of this paper is to outline the problems with the current classification and propose a classification more suitable for primary health care.

Method: We refer to and discuss relevant literature including papers on our own research on the topic in the light of our experiences from major projects on somatizing patients in primary health care.

Results: Functional somatic symptoms may impose severe suffering on the patient and are costly for society because of high health-care utilization, lost working years and social expenses. At present, studies on functional somatic symptoms and disorders and their treatment are hampered by lack of a valid and reliable diagnostic classification. The diagnostic categories of somatoform disorders are overlapping. Thus, the present situation is that patients with identical symptoms and clinical pictures may receive different diagnostic labels depending on the focus of interests of the assessing physician. A particular problem in primary care is that the somatoform diagnostic categories only include persistent cases and do not offer the opportunity for classification of the patients with short-symptom duration found in this setting. We present a framework for a new descriptive classification of functional somatic symptoms and unfounded illness worrying, and outline a new classification that covers the whole spectrum of severity seen in clinical practice.

Conclusion: A precondition for an appropriate management of patients with functional somatic symptoms is a valid taxonomy common for all medical specialties facilitating cooperative care. Classification systems as outlined in this paper may be a candidate for such a system, but it should be subject to further evaluation in research.
Psychiatry and Psychosomatic Medicine in Germany: Lessons to be Learned?
Authors: Diefenbacher Albert
Published: December 2009

Objective: To describe the reshaping of the German system of psychiatric services in the wake of the international social psychiatric movement and the beginnings of separate consultation–liaison (C-L) psychiatry and C-L psychosomatics services, to outline the differences and similarities of these two disciplines, and to see whether there are lessons to be learned from this unique development that may be relevant to other countries.

Method: The author draws on material published in German and international publications, and on his experience as co-chair of the Section of Behavioral Medicine and Consultation Liaison Psychiatry of the German Society for Psychiatry, Psychotherapy and Neurology.

Results: Consultation–liaison psychiatry services are provided in virtually all German general hospitals, mainly by the medical specialty of psychiatry and psychotherapy and to a lesser extent by the specialty of psychosomatics and psychotherapeutic medicine, exclusively so in 5%. The latter specialty includes non-psychiatric physicians. The unique history of combined neurology and psychiatry training until 1992, and of mandated psychotherapy training in both specialties shapes the service provided but also sets up tensions.

Conclusions: Lack of empirical evidence prevents objective assessment of the advantages and/or shortcomings of this two-stranded system, but its existence may sharpen the ongoing debate about how C-L services should be structured in other countries.
Does Psychological Treatment Help Only Those Patients with Severe Irritable Bowel Syndrome Who Also Have a Concurrent Psychiatric Disorder?
Authors: Creed Francis , Guthrie Elspeth , Ratcliffe Joy , Fernandes Lakshmi , Rigby Christine , Tomenson Barbara , Read Nicholas , Thompson David G.
Published: December 2009

Objective: We have previously reported improved health-related quality of life in patients with severe irritable bowel syndrome (IBS) following psychological treatments. In this paper, we examine whether this improvement was associated with improvement in psychological symptoms and was confined to those patients who had concurrent psychiatric disorder.

Method: Two hundred and fifty-seven patients with severe IBS entering a psychological treatment trial were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. At entry to the trial and 15 months later, patients were also assessed using the Hamilton Depression Rating Scale, Symptom Cheecklist-90 (SCL-90) and Short Form-36 (SF36) physical component summary score as the main outcome measure. Partial correlation was used to compare changes in SF36 score and changes in psychological scores while controlling for possible confounders, treatment group and baseline scores. Multiple regression analysis was used to examine whether changes in psychological scores, changes in pain and a history of abuse could account for most of the variance of change in SF36 physical component score.

Results: Of 257 patients with severe IBS, 107 (42%) had a depressive, panic or generalized anxiety disorder at trial entry. There were moderate but significant correlations (0.21–0.47) between change in the psychological scores and the change in SF36 physical component scores. The correlation coefficients were similar in the groups with and without psychiatric disorder. The superiority of psychotherapy and antidepressant groups over treatment as usual was similar in those with and without psychiatric disorder. Multiple regression found significant independent effects of change in depression, anxiety, somatization and abdominal pain but there was still variance explained by treatment group.

Conclusions: In severe IBS improvement in health-related quality of life following psychotherapy or antidepressants is correlated with, but not explained fully by reduction of psychological scores. A more complete understanding of how these treatments help patients with medically unexplained symptoms will enable us to refine them further.
Patterns and Predictors of Substance use Disorders and Daily Tobacco use in First-Episode Psychosis
Authors: Wade Darryl , Harrigan Susy , Edwards Jane , Burgess Philip M. , Whelan Greg , Mcgorry Patrick D.
Published: December 2009

Objective: To investigate the patterns and predictors of substance use disorders (SUD) and daily tobacco use in first-episode psychosis (FEP).

Method: In this study, consecutive admissions of 126 patients with an initial presentation for FEP were recruited from three psychiatric services. Each patient was assessed with a comprehensive assessment package in order to collect demographic information, to diagnose psychotic disorders and SUD, to estimate the duration of untreated psychosis and to assess premorbid functioning and the severity of psychiatric symptoms.

Results: The rates of lifetime SUD and daily tobacco use were 71% and 77%, respectively. The onset of SUD pre-dated the onset of positive psychotic symptoms in 91% of relevant cases. In multivariate analyses, male gender, younger age, Australian birth and unemployed status were the most consistent demographic predictors of SUD and daily tobacco use. There were no associations found between SUD and symptom severity, premorbid adjustment, psychotic disorder diagnosis or hospitalization.

Conclusions: Male gender and younger age are reliable predictors of SUD in FEP. Patients with and without SUD appear to have similar clinical characteristics at initial presentation.
Relationships Between Self-Reported Potentially Traumatizing Events, Psychoform and Somatoform Dissociation, and Absorption, in Two Non-Clinical Populations
Authors: Näring Gérard , Nijenhuis Ellert R.S.
Published: December 2009

Objective: Some authors have suggested that the personality characteristic ‘fantasy proneness’ may mediate the correlation between reported potentially traumatizing events and dissociative symptoms. Other authors question the reported magnitude of this correlation in non-clinical samples, because these are usually derived from student samples and may therefore suffer from a restriction of range. The primary aim of this study is to assess the relationship between a self-report measure of traumatization and psychoform dissociation as well as somatoform dissociation in a non-clinical population, while accounting for the influence of fantasy proneness.

Method: Two random non-clinical samples, that is, a student and an adult non-student sample, completed a range of relevant self-report questionnaires. Absorption was used as an index of fantasy proneness.

Results: The range of reported potentially traumatizing events was restricted in students, compared to non-students. In both samples a significant correlation was found between reported potentially traumatizing events and dissociation. After partialling out absorption, the relationship between reported potential traumatization and psychoform dissociation diminished substantially in both samples. The magnitude of the correlation with somatoform dissociation decreased to a lesser degree, so that it remained significant in both samples.

Conclusions: The correlation between somatoform dissociation and reported traumatization, after partialling out absorption, gives a reliable estimate of the magnitude of the relationships between potentially traumatizing events and dissociation. Findings regarding traumatization and dissociation in students should be generalized to the general population cautiously.
Australia's National Mental Health Strategy and Deinstitutionalization: Some Empirical Results
Authors: Doessel Darrel P , Scheurer Roman W , Chant David C , Whiteford Harvey A
Published: December 2009

Objective: To determine the role of the National Mental Health Strategy in the deinstitutionalization of patients in psychiatric hospitals in Queensland.

Method: Regression analysis (using themaximumlikelihood method) has been applied to relevant time-series datasets on public psychiatric institutions in Queensland. In particular, data on both patients and admissions per 10 000 population are analysed in detail from 1953–54 to the present, although data are presented from 1883–84.

Results: These Queensland data indicate that deinstitutionalization was a continuing process from the 1950s to the present. However, it is clear that the experience varied from period to period. For example, the fastest change (in both patients and admissions) took place in the period 1953–54 to 1973–74, followed by the period 1974–75 to 1984–85.

Conclusions: In large part, the two policies associated with deinstitutionalization, namely a discharge policy (‘opening the back door’) and an admission policy (‘closing the front door’) had been implemented before the advent of the National Mental Health Strategy in January 1993. Deinstitutionalization was most rapid in the 30-year period to the early 1980s: the process continued in the 1990s, but at amuch slower rate. Deinstitutionalization was, in large part, over before the Strategy was developed and implemented.