bluuebunny/crossref_metadata_2025 huggingface dataset:
Intravenous Sedation of Involuntary Psychiatric Patients in New South Wales
Authors: Nielssen Olav , Buhrich Neil , Finlay-Jones Robert
Published: January 2008

Objective: Intravenous sedation of involuntary psychiatric patients is practised in almost all hospitals in New South Wales. Despite its widespread use, little has been published about the medications used or their safety and efficacy. The present study reports the frequency and reasons for intravenous sedation, the medications used, and the incidence of adverse effects.

Method: Eighteen of 21 acute psychiatric admission units in the State were reviewed. The medical records of a random sample of 495 patients admitted involuntarily during 1990 were examined and information from the progress notes, drug charts and physical observations was recorded and subjected to statistical analysis.

Results: Of the 495 patients, 132 (27%) were intravenously sedated. Eighty-six per cent (86%) of patients received a combination of haloperidol or diazepam, usually 20 mg of each drug. The threat of violence was the most significant patient characteristic predicting the use of intravenous sedation. Patients with mania or intoxication were relatively more likely to be intravenously sedated than other diagnostic categories. Patients admitted via accident and emergency departments and those admitted to teaching and metropolitan general hospitals compared to rural and large psychiatric hospitals were significantly more likely to receive intravenous sedation. The most common complications of intravenous sedation were dystonia (37%), hypotension (8%) and confusion (5%). The incidence of phlebitis and other extrapyramidal side-effects was probably under-reported.

Conclusion: About one in four involuntary psychiatric patients receive intravenous sedation in NSW. Intravenous sedation is more likely when patients are admitted through accident and emergency departments to teaching or metropolitan hospitals, and pose a threat of violence. Intravenous sedation was shown to be a safe procedure given certain precautions.
Seasonal Affective Disorder in Australia: Is Photoperiod Critical?
Authors: Murray Gregory W. , Hay David A.
Published: January 2008

Objectives: Seasonal affective disorder (SAD) is a variant of recurrent depression in which episodes are linked to a particular season, typically winter. SAD is understood as the extreme end of a continuum of seasonality in the general population. Photoperiod (the timing and duration of daylight) has been assumed to be aetiologically critical. The present research used a survey design to investigate the assumed centrality of photoperiod for SAD/seasonality in Australia. Two hypotheses were tested: that self-reported seasonality does not increase further from the equator and that seasonality does not stand alone from non-seasonal neurotic complaints.

Method: The sampling frame used was adult females on the Australian Twin Registry roll. A sample of 526 women residing across the latitudes of Australia responded to a survey based around the Seasonal Pattern Assessment Questionnaire (SPAQ). The SPAQ asks respondents to retrospectively report on season-related changes in mood and behaviour. The survey also contained three questionnaire measures of neurotic symptoms of anxiety and depression: the General Health Questionnaire (GHQ), the Community Epidemiological Survey for Depression (CES-D) and the State-Trait Anxiety Inventory—Trait (STAI-T).

Results: Self-reported seasonality did not correlate with latitude (r=0.01, NS). On the other hand, a substantial relationship was found between seasonality and each of the measures of non-seasonal complaints: GHQ (r=0.35, p<0.001); CES-D (r=0.35, p<0.001); and STAI-T (r=0.30, p<0.001).

Conclusions: Within the limitations of a design based on retrospective self-report, the findings of the present study suggest that the diathesis for SAD/seasonality may not be photoperiod-specific. At least in Australia, there is provisional support for the proposal that human seasonality may have a broader psychological component. The findings are discussed in terms of established research into normal mood, trait personality and non-seasonal depression.
Sexually Transmitted Disease and Family Planning Counselling of Psychiatric Patients in New Zealand
Authors: Coverdale John , Falloon Ian , Turbott Sarah
Published: January 2008

Objective: We aimed to determine the attitudes and behaviours of mental health professionals (MHPs) including psychiatrists towards identifying and reducing their own patients' risk for sexually transmitted diseases and unwanted pregnancies.

Method: 102 of all of the 162 mental health professionals serving predominantly chronically psychiatrically ill adult outpatients and inpatients in Waitemata district responded to an anonymous questionnaire (response rate = 63%), concerning their own attitudes and behaviours towards identifying and counselling patients on their risk for sexually transmitted diseases and unwanted pregnancies.

Results: Mental health professionals reported that, on average, they had counselled 14% of their own male patients and 21% of their own female patients on sexually transmitted diseases, including AIDS prevention, and that more of their own patients were at risk than were counselled. They also reported that they had counselled 5% of their own male patients and 17% of their own female patients about family planning. Forty-two per cent of mental health professionals indicated that they had insufficient knowledge about sexually transmitted diseases to educate patients, 72% indicated that when it came to risky sexual behaviours chronic psychiatric patients were much the same as other people, and 33% or more felt uncomfortable discussing topics of condom use and patients' sexual preferences.

Conclusion: These results suggest that family planning and sexually transmitted diseases risk preventive interventions for psychiatric patients need to overcome mental health professionals' own barriers to risk prevention.
Inpatient Suicides in an Australian Mental Hospital
Authors: Shah Ajit K. , Ganesvaran Thirunavakarasu
Published: January 2008

Objective: Suicide rates among psychiatric inpatients are higher than in the general population. Mental health professionals are poor at predicting suicide risk.

Method: One hundred and three inpatient suicides, over a 21-year period, in a large psychiatric hospital in Melbourne were examined. The characteristics, including demographic and clinical data, for 60 of these suicides were compared with a matched comparison group stratified for the time of admission. Violent methods (including jumping in front of trains, trams and road traffic, jumping off buildings, hanging and drowning) were most frequently used.

Results: Over one-third of the suicides occurred during periods of approved leave and a similar number occurred after absconding from the hospital. Suicide was associated with a diagnosis of schizophrenia, increased duration of admission, more frequent prescription of neuroleptics and antidepressants, previous deliberate self-harm, suicidal ideation at the time of admission and during the admission, suicide attempts during the admission, unstable (fluctuating) suicidal ideation during the admission and a greater number of ward transfers.

Conclusions: Psychiatric units should be developed away from readily available methods of suicide. Patients with previous or intra-admission suicidal ideation or attempts, or unstable suicidal ideation, should be carefully observed to avoid absconding. Suicide risk should be carefully evaluated in such patients prior to approving periods of leave.
Is There an Adult form of Separation Anxiety Disorder? A Brief Clinical Report
Authors: Manicavasagar Vijaya , Silove Derrick
Published: January 2008

Objective: The aim of this clinical report is to investigate whether symptoms of separation anxiety disorder can occur in adulthood.

Clinical picture: Three cases are described to illustrate that adults may experience: wide-ranging separation anxiety symptoms, such as extreme anxiety and fear, when separated from major attachment figures; avoidance of being alone; and fears that harm will befall those close to them. Symptoms of panic appeared to be secondary to separation anxiety, and none of the patients fulfilled criteria for dependent personality disorder.

Treatment: Group cognitive behavioural treatment focusing on preventing panic attacks and generalised anxiety did not appear to have an impact on core separation anxiety symptoms.

Outcome: Exacerbations of separation anxiety appeared to be closely linked to actual or threatened ruptures to primary bonds.

Conclusions: Separation anxiety disorder may be a neglected diagnosis in adulthood. Formal nosological systems such as the DSM may need to be revised to incorporate adult manifestations of the disorder.
Lessons to be Learned from the Study of Sexual Boundary Violations
Authors: Gabbard Glen O.
Published: January 2008

Objective: This paper illustrates certain recurrent themes occurring in the evaluation of sexual boundary violations that provide valuable lessons for all psychotherapists.

Method: By reviewing patterns found in nearly 80 cases of sexual misconduct by psychotherapists, I have been able to delineate common errors of clinical judgement that lead to serious boundary violations.

Results: Several issues deserve attention by all therapists: (i) the therapist's conscious and unconscious intent may be at odds with one another; (ii) feelings of love for a patient may defend against hostility and aggression; (iii) supportive psychotherapy requires careful attention to boundary issues; and (iv) therapists who withhold secrets from supervisors or consultants are at high risk for enacting boundary violations.

Conclusions: There is a confluence of clinical error and ethical misconduct in the development of sexual boundary violations during psychotherapy. The study of such cases reveals a number of important lessons to be learned by all psychotherapists. These lessons, as well as their implications for prevention in terms of training and supervision, are discussed.
The Assessment of Depression in the Postnatal Period: A Comparison of Four Self-Report Questionnaires
Authors: Condon John T. , Corkindale Carolyn J.
Published: January 2008

Objective: The objective of this study was to ascertain the degree of agreement between four self-report depression scales, with particular emphasis on whether each scale would identify the same subgroup of women as being ‘most depressed’.

Method: The questionnaires were administered to a sample of approximately 200 postnatal women at 4 weeks, 4 months and 8 months after delivery. The instruments were: the Edinburgh Postnatal Depression Scale; the depression subscale of the Hospital Anxiety Depression Scale; the Zung Self-Rating Depression Scale; and the depression subscale of the Profile of Mood States.

Results: Agreement between pairs of instruments, in terms of identifying the most depressed subgroup of women in the cohort, only averaged approximately 40%. Agreement between the three instruments was only about 25%.

Conclusions: This poor level of agreement most likely reflects the different emphasis in item content of the questionnaires, which in turn reflects different notions of ‘depression’ held by the designers of the instruments. The implications of the findings for research and clinical practice are discussed.
Vietnamese and Arabic Women's Responses to the Diagnostic Interview Schedule (Depression) and Self-Report Questionnaires: Cause for Concern
Authors: Matthey Stephen , Barnett Bryanne E. W. , Elliott Amanda
Published: January 2008

Objective: The original study aimed to determine the best cut-off scores to screen for postnatal depression on translated versions of the Edinburgh Postnatal Depression Scale (EPDS) for Vietnamese and Arabic women. This research was conducted using the depression module of the Diagnostic Interview Schedule (DIS) to determine caseness. This paper reports on the suitability of this diagnostic interview as a criterion measure of depression in these women with a non-English speaking background.

Method: Vietnamese and Arabic women in south-west Sydney completed the EPDS and a General Health Questionnaire (GHQ-30) antenatally. At 6–8 weeks postpartum they completed an EPDS, the GHQ-30 and a Faces Scale, and were interviewed using the depression module of the DIS. Members of a small convenience sample of women were asked about the cultural appropriateness of each of the instruments.

Results: Vietnamese women admitted to few depressive symptoms on the DIS, whereas they appeared more open to reporting these on the EPDS and the GHQ-30. Arabic women responded more openly to the questionnaires and the interview, although they too were reluctant to report specific symptoms on the DIS.

Conclusion: The usefulness of the DIS in determining rates of major depression in the Vietnamese and Arabic community in Australia is questionable. Further studies designed specifically to investigate this are needed.
Nutrition and Obesity in the Chronic Mentally ILL
Authors: Wallace Bridget , Tennant Chris
Published: January 2008

Objective: The aim of this study was to determine the need for nutrition intervention in a group of people living in mental health residential houses in the Northern Sydney Area.

Method: A nutrition assessment was conducted by the researcher using a face-to-face interview with mental health residents and a survey on medical background completed by case managers.

Results: The prevalence of overweight and obesity was significantly greater than that reported for the general population. Respondents also had a significantly higher prevalence of abdominal obesity than the general population. No respondent met the minimum core food group requirements as outlined in the 12345+ Food and Nutrition Plan.

Conclusions: The needs assessment has shown that nutrition promotion is required in this group. The task ahead is to motivate the group to change their food and nutrition behaviours, where many barriers to a healthy lifestyle exist.
A Critical Review of the Biopsychosocial Model
Authors: McLaren N.
Published: January 2008

Objective: The aim of this review is to provide an analysis of the epistemic status of the biopsychosocial model.

Method: A critical comparison of the biopsychosocial model with the general concept of models.

Results: In its present form, the biopsychosocial model is so seriously flawed that its continued use in psychiatry is not justified.

Conclusion: Further development of theory-based models in psychiatry is urgently needed.
Staff Response to Abuse Histories of Psychiatric Inpatients
Authors: Read John , Fraser Allen
Published: January 2008

Objective: In the context of numerous studies demonstrating that a significant proportion of psychiatric inpatients have been sexually or physically abused at some point in their lives this study ascertained the responses of staff in a psychiatric inpatient unit to knowledge that patients had been subjected to sexual or physical abuse, in childhood or adulthood.

Method: The medical records of 100 consecutive admissions were examined. Staff response was measured in terms of: (i) acquiring information about previous treatment for, or disclosure of, abuse; (ii) providing information, support or counselling during hospitalisation; (iii) reporting to legal authorities; and (iv) referring for ongoing abuse counselling.

Results: Of the 32 patients who were documented as having disclosed abuse 11 files included documentation of previous treatment or disclosure; none were reported to have received support, counselling or information while in hospital; and three referrals were made for ongoing counselling. None of the 52 separate instances of abuse were reported to the authorities. Demographic, diagnostic, clinical and treatment variables, as well as the four abuse categories, were analysed for possible linkage to probability of staff response in each of the four response categories.

Conclusions: It was hypothesised that the low staff response rate is not unique to the particular unit evaluated here. Recommendations are offered regarding the need for unit policies ensuring routine abuse inquiry and for staff training about how to respond to abuse disclosures.
The Implications of Legislative Change on the Future of Psychiatric Nursing in Victoria
Authors: Happell Brenda
Published: January 2008

Objective: The aim of this paper is to explore the potential implications of the Nurses Act introduced in 1993 upon psychiatric nursing in Victoria. Essentially this Act abolished the existing separate undergraduate education for psychiatric nursing. The focus of this paper is to explore the potential implications of this legislative change to the psychiatric nursing profession, particularly in light of relevant research findings.

Method: In order to ascertain the impact of legislative change, a survey of psychiatric nursing content was conducted in Schools of Nursing throughout Victoria.

Results: A 100% response rate was achieved. The responses indicated that little alteration had been made to existing general nursing courses to incorporate the change in legislation. The compulsory psychiatric nursing content varies from nil to 17.4% of the total curriculum.

Conclusions: The theory and practice of psychiatric nursing constitute only a small proportion of undergraduate curricula. In view of the comparative unpopularity of psychiatric nursing as a career option for undergraduate students, the implications of this situation for the future psychiatric nursing workforce are serious.
Paedophilia: A Review of the Evidence
Authors: McConaghy Nathaniel
Published: January 2008

Objective: The aim of this study was to critically review the literature concerning the nature and prevalence of paedophilia.

Method: The literature of the past 30 years was examined in relation to the author's clinical experience and with emphasis on methodologically appropriate empirical studies.

Results: Concern and reporting of child-adult sexual activity has increased markedly in the last decade, although its prevalence has not increased at least since the 1960s. The prevalence in women can be as high as 60%, depending on the definition and method of enquiry used, and female compared to male victims report more negative effects, although a percentage of both men and women report the experience as positive. Validation of effects requires multivariate statistical analysis. Current pro-active procedures to identify paedophiles detect those who victimise boys but do not detect the much greater number of paedophiles who victimise girls. Perpetrators are known to the majority of their female and male victims, and those reported are almost all male; most boys do not consider their prepubertal experiences with older women abusive. Relapse prevention, the current most popular treatment, has been shown to be ineffective for incarcerated child molesters.

Conclusions: Child-adult sexual activity should be opposed as an infringement of children's rights rather than requiring a false belief that it is invariably harmful; whether it should be mandatory for therapists to report it requires examination. Scientifically appropriate evaluation should be an essential component of current treatment programs.
A Pilot Study of Computer-Aided Vicarious Exposure for Obsessive-Compulsive Disorder
Authors: Clark Augustino , Kirkby Kenneth C. , Daniels Brett A. , Marks Isaac M.
Published: January 2008

Objective: This study reports the use of an interactive computer program to instruct vicarious exposure and ritual prevention for obsessive-compulsive disorder (OCD). Method: Thirteen OCD volunteers and 10 non-OCD volunteers completed three 45-minute sessions at weekly intervals. Subjects with OCD completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Padua Inventory (PI) and the Beck Depression Inventory (BDI) 1 week prior to and 1 week after the three computer treatment sessions. Non-OCD subjects only completed these measures at baseline, allowing confirmation that they had no significant level of OCD symptomatology.

Results: In the OCD subjects, scores fell significantly on the PI and BDI, and Y-BOCS scores fell non-significantly. Engagement in vicarious exposure with ritual prevention improved from sessions 1–3. Compared to the non-OCD participants, OCD subjects did less vicarious exposure in session 1 but not sessions 2 and 3. Performance of vicarious exposure by OCD subjects in session 1 correlated with pre-post improvement in PI and BDI scores.

Conclusions: The vicarious exposure program may have a role to play as an adjunct in behaviour therapy.
Puerperal Psychosis: Associated Clinical Features in a Psychiatric Hospital Mother-Baby Unit
Authors: Mowry Bryan J. , Lennon David P.
Published: January 2008

Objective: Current psychiatric diagnostic systems do not regard puerperal psychosis as a separate entity. However, there is continuing debate about the validity and clinical utility of this concept. This paper aims to investigate the prognostic importance of a number of clinical features in a sample of patients with puerperal psychosis.

Method: A retrospective case note study was conducted on 42 consecutive admissions to a mother-baby unit in a psychiatric hospital. Data were collected on a range of variables, and diagnoses made according to DSM-III-R and RDC criteria for puerperal psychosis.

Results: Maternal hostility toward the baby was the only studied variable to increase the likelihood of the baby being cared for by someone other than the mother, indicating the mother's inability to safely care for the baby.

Conclusions: These findings tentatively suggest that it is maternal hostility toward the baby, not puerperal psychosis per se that is associated with foster care.
Hyponatraemia Associated with the Use of Selective Serotonin Re-Uptake Inhibitors
Authors: Strachan John , Shepherd John
Published: January 2008

Objective: The aim of this study is to examine the frequency and severity of hyponatraemia in a psychogeriatric inpatient population taking selective serotonin re-uptake inhibitors (SSRls).

Method: Casenotes for 1 year were reviewed and 53 patients with 55 admissions were identified. Eighteen were treated with fluoxetine and 37 with paroxetine. Five (28%) of the patients on fluoxetine and eight (22%) on paroxetine were, or became, hyponatraemic.

Results: The SSRl was discontinued in two symptomatic patients. Serum sodium returned to normal in nine patients maintained on the SSRI. Two patients maintained on an SSRl remained hyponatraemic but asymptomatic.

Conclusions: Hyponatraemia may be a relatively common early asymptomatic side effect of SSRls, especially in older women. Serum sodium should be measured before commencing an SSRl and monitored during the first month. Any patient who exhibits symptoms of hyponatraemia, or whose depression apparently worsens, while on an SSRl must have their serum sodium measured. Discontinuation of the SSRl may be avoidable if serum sodium levels can be closely monitored.
Issues in the Assessment of Outcome in Mental Health
Authors: Trauer Tom
Published: January 2008

Objective: The purpose of this paper is to examine a number of issues in the assessment of outcome in mental health.

Method: Issues are considered in terms of a number of dichotomies or choices. These include: intervention-dependent versus intervention-independent definitions of outcome, focussing on inputs or processes versus outcomes; individual versus organisational outcomes; outcomes for patients versus outcomes for significant others; pure versus mixed outcomes; care versus cure; direct versus indirect measures; objective versus subjective measures; descriptive versus prescriptive measures; global versus specific assessment; and assessing at significant times points versus assessing at fixed intervals.

Conclusions: Guiding principles are formulated in terms of the foregoing issues.
Medicine and the Manic Defence
Authors: Schimmel Paul
Published: January 2008

Objective: The aim of this paper is to explore the relevance of the concept of the manic defence to understanding the treatment behaviours of doctors, and psychiatrists in particular.

Method: The manic defence and manic reparation are defined. Treatment approaches by doctors in physical and psychiatric medicine are examined within the perspective offered by these concepts.

Results: Evidence for the operation of a manic defence can often be discerned in treatment approaches to psychological and psychosomatic disorders. Widespread reliance on the prescribing of antidepressant medication for depression provides an example.

Conclusions: In the face of psychological and psychosomatic presentations, doctors may resort to reductionist aetiological formulations which promote active but reductionist treatments. Such approaches represent the enactment of a manic defence against depressive anxieties that might otherwise be experienced by patient and/or practitioner.
Correlates of Aggressive Behaviour in Schizophrenia: An Overview
Authors: Cheung Peter , Schweitzer Isaac
Published: January 2008

Objective: This review aims to critically evaluate the reported biological, psychological and social correlates of aggression in schizophrenia and to delineate those correlates which could be of use clinically and those which require further research. Method: The literature from 1974–1996 was searched using Psychlit and supplemented by suggestions from senior members of the authors' Department. Results: Past history of aggression, psychopathology, extrapyramidal side effects of neuroleptic medications, substance abuse, reduced serotonin function, antisocial and impulsive personality traits, neurological/neuropsychological deficits, electroen-cephalography, neuroimaging abnormalities and environmental factors were all found to be correlated with aggressive behaviour in schizophrenia. However, there are many methodological limitations of previous studies in this field, often leading to inconsistent and inconclusive findings.

Conclusions: Some tentative conclusions regarding clinically useful predictors of aggression in schizophrenia can be drawn at this stage. There is a need for methodological limitations of previous studies to be overcome before more firm conclusions can be reached.
Comparison between Register and Structured Interview Diagnoses of Schizophrenia: A Case for Longitudinal Diagnostic Profiles
Authors: Kirkby Kenneth C. , Hay David A. , Daniels Brett A. , Jones Ivor H. , Mowry Bryan J.
Published: January 2008

Objective: Mental health registers contain diagnoses from serial contacts with mental health facilities over many years. This study examines the relationship between longitudinal diagnostic profiles and structured interview diagnoses. The aim is to improve the definition of diagnoses drawn from clinical case registers. Method: The Tasmanian Mental Health Case Register includes 1922 individuals, each with at least one diagnosis of schizophrenia between 1965 and 1990. A representative subsample of 29 individuals were assessed by the structured diagnostic interview for DSM-Ill-R (SCID). Diagnostic agreement between Register and SClD diagnoses was compared.

Results: Twenty-four subjects (82.8%) received a lifetime diagnosis of schizophrenia on the SCID. For each subject, ‘schizophrenia diagnostic dominance’, the percentage of register entries with schizophrenia diagnoses over total entries, was calculated. Agreement between register and SClD correlated positively with schizophrenia diagnostic dominance and negatively with register mood diagnoses. Conclusions: Longitudinal diagnostic profiles on databases may be superior to cross-sectional clinical diagnoses in predicting structured interview diagnoses, and may be useful in defining caseness in epidemiological studies using register diagnoses.
Lowering the Language Barrier in an Acute Psychiatric Setting
Authors: Stolk Yvonne , Ziguras Stephen , Saunders Trish , Garlick Robyn , Stuart Geoffrey , Coffey Guy
Published: January 2008

Objectives: The aim of this paper is to investigate the effectiveness of a training and policy strategy to improve communication opportunities in an acute inpatient unit for patients of non-English-speaking background (NESB) with low English proficiency.

Method: A pre- and post-intervention design involved: (i) a survey of the multilingual skills of 80 clinical staff: (ii) recording of patients' ethnic background and proficiency; (iii) pre- and post-intervention data collection of the main outcome measure (communications with patients in a language other than English [LOTE]); and (iv) staff training, and active encouragement, in interpreter use. English proficiency was assessed using the population census proficiency question.

Results: Of 257 admissions, 33% were of NESB and 19% preferred to speak a LOTE. The staff survey yielded a 49% return rate and showed that, of 11 LOTEs spoken by patients, seven were also spoken by 17 of the staff. Twenty-nine percent of staff were not clinically proficient in these languages. Compared to the NESB population, a higher proportion of NESB patients rated low on proficiency. Following the intervention, interpreter bookings and booking duration increased significantly.

Conclusions: A standard training package and a policy promoting interpreter use improved communication opportunities in an acute setting where language needs are typically poorly met. Failure to ensure effective communicate raises risks of mis-diagnosis and inappropriate treatment. By measuring patients' proficiency directly, the present study identified a higher level of need for interpreter services than estimated by past reports.
Carbamazepine Treatment in a Case of Musical Hallucinations with Temporal Lobe Abnormalities
Authors: Terao Takeshi , Tani Yukio
Published: January 2008

Objective: The aim of this paper is to describe a case of musical hallucinations with temporal lobe abnormalities responding to carbamazepine treatment. Clinical picture: A 63–year-old woman suffered from musical hallucinations accompanied by mild left temporal spike activity. Treatment: She received carbamazepine treatment.

Outcome: Four weeks of carbamazepine treatment diminished her musical hallucinations in parallel with the normalisation of her mild left temporal spike activity.

Conclusions: These findings suggest that carbamazepine can be an effective treatment for musical hallucinations with temporal lobe abnormalities.
Lithium Augmentation of Venlafaxine in Adolescent Major Depression
Authors: Walter Garry , Lyndon Bill , Kubb Rosie
Published: January 2008

Objective: Studies on the pharmacotherapy of adolescent major depression are limited but suggest that the illness is often resistant to drug treatment. We aim to report the use of lithium augmentation of venlafaxine in two teenagers with major depression.

Clinical picture: Two 16–year-olds with major depression are described. Treatment: In both patients, the treatment involved trials of a selective serotonin re-uptake inhibitor, venlafaxine, and psychotherapy preceded lithium augmentation of venlafaxine. The trial of venlafaxine alone had been short in one patient. Outcome: Combining lithium and venlafaxine was rapidly followed by marked improvement in mood and function.

Conclusions: Augmentation of antidepressants should be considered in young depressed patients who fail to respond to adequate trials of new antidepressants alone.
The Nameless Father in the Poetry and Life of Francis Webb
Authors: Powell Craig
Published: January 2008

Objective: A brief biographical review of the poet Francis Webb was carried out, with reference to his mental illness and recurring themes in his poetry.

Method: Material is drawn from a recent biography and the author's personal encounters with the poet. Reference is also made to Lacan's theory of psychosis and Winnicott's construct of the “transitional object”.

Results: The poetry may be seen in part as a transitional object whereby the poet sought to repair deficits in the structure of the self and contain psychotic chaos.

Conclusions: The poems have a beauty and power beyond any psychoanalytic theorising, but may also be read as a vital striving toward self-healing on the part of the poet.
A Comparison of Estimates of the Prevalence of Heavy Drinkers in Local Regions of Queensland
Authors: Crook Gabrielle M. , West Mark E. , Oei Tian P.S.
Published: January 2008

Objective: This study developed and compared separate estimates of the number of heavy drinkers (the in-need population for alcohol treatment interventions) across eight local regions in Queensland.

Method: Estimates were based on: (i) a self-report population survey of alcohol consumption; and (ii) an application of the Ledermann log-normal distribution of consumption model to liquor sale figures.

Results: Estimates based on the 1989–1990 National Health Survey (NHS) data indicated that 10.98% (n = 83 880) of adult male drinkers and 1.25% (n = 6581) of adult female drinkers in Queensland (total = 90 461) were on average drinking the equivalent of six or more standard drinks a day in the week prior to the survey (4.74% of Queensland adult drinkers, n = 90,461). Estimates based on the Ledermann model indicated that 12.18% of adult Queensland drinkers (n = 232,283) were drinking six or more standard drinks a day. Estimates based on the Ledermann model were 157% larger than estimates based on NHS data (i.e. a difference of 141 821 heavy drinkers), with large variations in the two estimates across local regions.

Conclusion: The NHS data appears to underestimate the population of heavy drinkers, whereas the Ledermann model overestimates it. In this situation, it seems preferable to use the more conservative self-report survey estimates.
Severe Morbid Onychophagia: The Classification as Self-Mutilation and a Proposed Model of Maintenance
Authors: Wells Jennifer H. , Haines Janet , Williams Christopher L.
Published: January 2008

Objectives: The aim of this review is to make a distinction between a mild and a severe form of onychophagia (nailbiting) that has not been adequately recognised in clinical research. Furthermore, the aim is to emphasise the need for greater under standing of the motivation for such self-injury as occurs in the severe form. The purpose of making the distinction is to evaluate whether a label of self-mutilation can be applied to the severe form. If this is the case, the tension-reduction model of self-mutilation can be proposed as the mechanism which may maintain the behaviour in the face of serious social and physical consequences.

Method: Examination was made of the literature relating to onychophagia and to self-mutilation. Treatment studies of onychophagia were examined to evaluate the mechanisms by which the behaviour may be maintained. Results: Considering the self-mutilative nature of the severe form and the common theme of tension reduction in the literature on onychophagia, application of the tension-reduction model of self-mutilation is warranted.

Conclusion: There is a need for empirical research as to the tension-reducing nature of severe onychophagia.
(You Gotta Have) Faith
Authors: Korner Anthony
Published: January 2008

Objective: The modern scientific tendency to disavow the relevance of faith is questioned, particularly in relation to psychiatric practice. An experience-near approach to psychiatric practice, inclusive of human values such as faith, is highlighted.

Method: Drawing upon the philosophical work of Jaspers and the developmental psychology of Stern, a model is built up of the flow of lived experience that relies to a large extent on what can be “taken on faith” rather than “known about”. An argument is presented that from this standpoint of “lived reality”, the separation of fact and value inherent in modern scientific thought is not valid.

Conclusions: It is found that lived experience is infused with faith in three senses: that of faith-in-oneself, that of faith-in-the-other; and that of transcendent faith. Each of these is shown to be relevant to praxis in psychiatry. Failure to include faith in psychiatric thinking may lead to a distancing of the discipline from the level of everyday experience. Key words: fact, faith, lived reality, transcendence, value.
Intensive Case Management: A Cost-Effectiveness Analysis
Authors: Johnston Susan , Salkeld Glenn , Sanderson Kristy , Issakidis Catherine , Teesson Maree , Buhrich Neil
Published: January 2008

Objective: The objective of this study was to compare the outcomes and costs of intensive case management with routine case management for a group of severely disabled patients with a mental illness.

Method: A cost-effectiveness analysis was conducted alongside a randomised con trolled trial. Seventy-three patients, who reside in the eastern suburbs of Sydney, were randomly allocated to either intensive or routine case management. Staff pro viding intensive case management had substantially lower caseloads than staff pro viding routine case management. The main health outcome measured was patients' level of functioning as measured by the Life Skills Profile. Costing data were collect ed from hospital services, mental health services, general health services, community services and informal carers.

Results: At 12 months, outcome and costing data were analysed on 58 patients and hospitalisation data were analysed on 68 patients. Significantly more patients in the intensive case management group remained in treatment (χ2 = 6.00, df = 1, p < 0.01) and showed a clinically significant improvement in functioning from base line to 12 months (χ2 = 4.50, df = 1, p < 0.05). The mean cost per patient was $7745 more in the intensive group than in the routine group (t = 1.49, df = 56, p > 0.01) over 12 months. The cost-effectiveness ratio indicated a cost of $27 661 per year for one additional patient in the intensive case management group to make a clinically significant improvement in functioning.

Conclusion: Intensive case management led to an increased rate of retention in treatment and a clinically significant improvement in functioning. Further comparative cost-effectiveness studies are required to determine whether $27 661 per year for one patient to make a clinically significant improvement in functioning is a cost-effective use of mental health resources.
Liability in Prescribing Choice: The Example of the Antidepressants
Authors: Beerworth Ellen E. , Tiller John W.G.
Published: January 2008

Objective: The aim of this study is to review issues of legal liability in prescribing choice. Prescribing not only occurs in a medical setting, but also in a social and legal context in this era of evidence-based medicine and greater consumer awareness. Prescribers may be unaware of the legal consequences of medical decision-making and prescribing choice. This issue affects all areas of medicine and can be illustrated by antidepressant choice for major depression.

Method: A review was undertaken of liability issues that may arise in the context of prescribing, with particular reference to prescribing antidepressants. Results: There are legal precedents which illustrate prescribers' potential liability. These impose duties on the prescriber including those of care, to inform, and to respond to patients' wishes. In particular, the duty of care requires that if medicines are of equal efficacy, one should prescribe the best tolerated and least toxic medicine that is most likely to be taken at an effective dose for an adequate duration. While older and newer antidepressants are generally of equal efficacy, the newer agents have higher tolerability, lower toxicity and are less likely to be associated with treatment failure (due to sub-therapeutic dose regimens, or the patient discontinuing medication), disabling psychomotor impairment, dietary interaction or fatal overdose.

Conclusions: There needs to be compelling reasons for prescribing medicines with a greater likelihood of adverse outcomes such as the older antidepressants (e.g. tri-cyclics) rather than the newer antidepressants such as RIMAs, SSRls, SNRls and 5HT2 receptor antagonists. The higher likelihood of an adverse outcome of treatment where an older antidepressant has been prescribed raises the potential for professional negligence claims to be brought against medical practitioners who prescribe such medicines for reasons other than established medical need.
Faith-Assisted Cognitive Therapy of Obsessive—Compulsive Disorder
Authors: Gangdev Prakash S.
Published: January 2008

Objective: The aim of this paper is to report the rapid resolution of obsessions when the patient invoked Christ to treat her obsessions.

Clinical picture: A 25–year-old female presented with obsessions (doubts) that: (i) while driving she will knock down a pedestrian; and (ii) she will be charged with sex abuse.

Treatment and Outcome: Cognitive therapy (cognitive restructuring and thought-stopping) was offered. After a single session a complete remission was reported when she replaced her doubts with firm convictions that “Christ will help me drive safely” and “Christ will not let me do anything wrong”. She was reported to have remained well at the end of 5 months at which time she relocated and was then lost to follow-up.

Conclusion: Religious faith can have a healing effect, and cognitive therapy is not incompatible with religion. Although unusual in standard clinical practice, rapid resolution of obsessions is possible.
Wei han zheng (Frigophobia): A Culture-Related Psychiatric Syndrome
Authors: Ng Beng-Yeong
Published: January 2008

Objective: The aim of this paper is to describe a clinical case of wei han zheng (frigophobia) in Singapore.

Clinical picture: A 45–year-old Chinese housewife had morbid fears of cold, in terms of temperature, and food of a cold ( yin) nature, and a variety of somatic symptoms. She stopped working, adopted various measures to avoid exposure to cold air and wind, and took dietary precautions.

Treatment and outcome: She received intermittent follow-ups over the following 8 years. An episodic, albeit recurrent, course was documented. Treatment consisted of symptomatic relief using low dose anxiolytics and antidepressants, and psycho logical interventions.

Conclusion: Frigophobia is closely related to, and strongly influenced by, cultural beliefs. In therapy, it would be pertinent to consider the patient's own cultural beliefs about the illness as compared to the therapist's model of illness, and how matching of these could be negotiated.
The Diagnosis of Depression in Disorder
Authors: Van Praag H. M.
Published: January 2008

Objective: My purpose is to critically evaluate psychiatry's current approach to the diagnosis of depression.

Methods: I have closely examined trends in diagnosing depression, especially since DSM-III, and have considered alternative options.

Results/Conclusions: Psychiatric taxonomy is currently based on invalid nosological premises that have worked as a straitjacket for conceptual progress and related biological and psychopharmacological research. A fresh approach that replaces nosological analysis with the concepts of functionalisation and verticalisation is essential.
Psychiatrists and Compulsion: A Map of Ethics
Authors: Rosenman Stephen
Published: January 2008

Objective: The aim of this study is to analyse the ethical underpinning of involuntary treatment and to create a guide for psychiatric practice which clarifies its relationship with modern mainstream clinical ethics.

Method: Literature on ethics, involuntary treatment, civil commitment, diagnosis and law was searched and examined.

Result: Hospitalisation for involuntary treatment and control has blurred two important discriminations: the discrimination between clinical and social constructions of mental illness and the discrimination between therapeutic actions and policing control. Plotting these discriminations creates a map of ethics in involuntary treatment. Although there are clinical roles throughout involuntary treatment, the ethical issues vary according to whether clinical actions are taken on clinically or socially constructed diagnosis and whether the purpose of the actions is therapy or control.

Conclusion: Paternalist involuntary treatment should be undertaken more readily when it is for clinically defined illness and for the benefit of the patient. Where the conditions are defined by social behaviours alone, where treatment is not useful to the patient, or where actions have policing intent, particular ethical approaches need to be taken to defend the patient, the clinician-patient relationship and the reputation of the profession.
Classification and phytogeographical differentiation of broad‐leaved ravine forests in southeastern Europe
Authors: Košir Petra , Ccaron;arni Andrazcaron; , Di Pietro Romeo
Published: January 2008

Question:

How do broad‐leaved ravine forests in SE Europe differentiate phytogeographically? Do they differ from analogous European forests? What is their distribution pattern?

Location:

southeastern Europe, Apennine‐Balkan province.

Methods:

The initial data set of 2189 relevés was stratified geographically and phytosociologically; 614 relevés remaining after stratification were classified with aTWINSPAN and cluster analysis, wich resulted in four clusters and eight subclusters. Average Pignatti indicator values for releves of each subcluster were subjected to PCA to show ecological relationships among the clusters. The spectra of geoelements and sociological species groups of individual subclusters were calculated to show phytogeographical and sociological relationships between them. The diagnostic species combination was calculated by a fidelity measure (φ‐coefficient) and presented in a synoptic table.

Results:

Broad‐leaved ravine forests in southeastern Europe form a separate group within the European broad‐leaved ravine forests. They are well differentiated by the species with a southeast European distribution, as well as by many other species that reflect their different ecological affinities.

Conclusions:

The phytosociological and phytogeographical relationships between the Apennines and the Balkan peninsula that have already been recognized for other vegetation types have been confirmed for broad‐leaved ravine forests. According to the numerical analysis, two suballiances of broad‐leaved ravine forests in southeastern Europe are proposed, both belonging to the alliance Tilio‐Acerion. an amphi‐Adriatic xerothermo‐philous suballiance Ostryo‐Tilienion platyphylli suball. nova and a mesophilous suballiance Lamio orvalae‐Acerenion suball. nova, the latter appearing only on the Balkan Peninsula.
Skull morphology and its neurosurgical implications in the Hippocratic era
Authors: Dimopoulos Vassilios G. , Kapsalakis Ioannis Z. , Fountas Kostas N.
Published: January 2008

✓Differences in skull morphological characteristics among various human populations were first described by Herodotus of Halicarnassus. The Hippocratic treatise On Head Wounds (Περι των εν κεφαλη τρωματων) provided the first detailed description of human skull anatomy. The Hippocratic author presented the first systematic attempt to create a classification system of skull and cranial suture morphology. Detailed descriptions of various human skull types and cranial sutures were provided along with information regarding the macroscopic structure and thickness of different parts of the skull. The significance of skull thickness in patients with head injuries was also presented in the Hippocratic text. The authors discuss the influence of this treatise on the later development of descriptive skull anatomy and on the development of modern neurosurgery.
Medieval neurosurgery: contributions from the Middle East, Spain, and Persia
Authors: Rahimi Scott Y. , McDonnell Dennis E. , Ahmadian Amir , Vender John R.
Published: January 2008

✓Modern neurological and spinal surgical techniques have been developed on the foundations established by predecessors. Modern 21st century neurosurgery begins in the Babylonian period, with the Edwin Smith papyrus. Throughout history, periods of enlightenment have resulted in advances in knowledge and understanding that have served as stepping stones for generations to come. As in other fields, in neurosurgery these periods of “enlightenment” have occurred in a variety of civilizations and time periods.