bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability and Validity of the Chinese Version of the Calgary Depression Scale for Schizophrenia
Authors: Xiao Weidong , Liu Hao , Zhang Hongyan , Liu Qi , Fu Peixin , Chen Jingxu , Wang Xiaoping , Wang Gaohua , Li Lingzhi , Shu Liang
Published: December 2009

Objective: The aim of the present study was to determine the reliability and validity of the Chinese version of the Calgary Depression Scale for Schizophrenia (CDSS-C) in schizophrenia patients.

Method: One hundred and one inpatients from four mental health units who met DSM-IV criteria for schizophrenia were enrolled. The Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS-24), Simpson–Augus Rating Scale (SAS), and Barnes Acathisia Rating Scale (BARS) were administered by the first rater, whereas the CDSS-C was assessed by a second independent rater.

Results: The internal consistency (Cronbach's α = 0.80) and the inter-rater reliability (κ coefficient >0.79) were good. The test–retest reliability was high (r = 0.927). The scale had good construct validity, with statistically significant correlations with the HDRS-24, G6 item (depression) of PANSS, and significant weak correlations with the general psychopathology subscale of PANSS. The CDSS-C showed no correlation with the positive and negative subscale of PANSS, the SAS and the BARS.

Conclusion: The Chinese version of CDSS is a valid and reliable instrument for the assessment of depression in schizophrenia.
Effect of Restricting Access to a Suicide Jumping Site
Authors: Skegg Keren , Herbison Peter
Published: December 2009

Objective: The road to a headland that had become a suicide jumping hotspot was temporarily closed because of construction work. This created an opportunity to assess whether loss of vehicular access would lead to a reduction in suicides and emergency police callouts for threatened suicide at the site.

Method: Deaths at the headland were ascertained for a 10 year period before road closure and for 2 years following closure using records from the local police inquest officer, the coroner's pathologist and Marine Search and Rescue. Police provided a list of police callouts for threatened suicide at the site for a 4 year period before closure and for 2 years following closure. Simple rates were compared and incident rate ratios were calculated where possible.

Results: There were 13 deaths at the headland involving suicide or open verdicts in the 10 years before access was restricted, and none in the 2 years following road closure. This difference was statistically significant (incident rate difference = 1.3 deaths per year, 95% confidence interval (CI) = 0.6–2.0). No jumping suicides occurred elsewhere in the police district following the road closure. Police callouts for threatened suicide also fell significantly, from 19.3 per year in the 4 years prior to road closure to 9.5 per year for the following 2 years (incident rate ratio = 2.0, 95%CI = 1.2–3.5).

Conclusions: Preventing vehicular access to a suicide jumping hotspot was an effective means of suicide prevention at the site. There was no evidence of substitution to other jumping sites.
Reliability of the Mood Disorder Questionnaire: Comparison with the Structured Clinical Interview for the DSM-IV-TR in a Population Sample
Authors: Dodd Seetal , Williams Lana J. , Jacka Felice N. , Pasco Julie A. , Bjerkeset Ottar , Berk Michael
Published: December 2009

Objective: The Mood Disorder Questionnaire (MDQ) is a widely used self-report screening instrument for the detection of bipolar disorder in clinical populations. The aim of the present study was therefore to investigate the reliability of this instrument.

Methods: Screening results using the MDQ were compared with results obtained using the Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition (SCID) in a community-based sample of 1066 women. Trained personnel, who were blind to the results of the MDQ screen, conducted clinical interviews.

Results: Using the MDQ, 21 women screened positive for bipolar disorder, and using the SCID diagnoses, 24 women were confirmed with a diagnosis of bipolar disorder. Six women were detected on both instruments. Compared to the SCID, the sensitivity for the MDQ was 25%, specificity 99%, positive predictive value 28%, negative predictive value 98%, and a demonstrated kappa of 0.25. The MDQ failed to detect any of the 11 participants in the study with bipolar II disorder and missed seven of 13 participants with bipolar I disorder or bipolar not otherwise specified. Of the 21 women who screened positive using the MDQ, 19 had current or past psychopathologies other than bipolar disorder.

Conclusion: The MDQ has substantial limitations for detection of bipolar disorder, in particular bipolar II disorder, in non-clinical populations.
Personality and Self-Reported Treatment Effectiveness in Depression
Authors: Parker Gordon , Crawford Joanna
Published: December 2009

Objective: The aim of the present study was to examine the associations between eight personality styles and retrospective self-reported response to a wide range of treatments for depression, including pharmacological, psychological and alternative strategies.

Method: An online survey posted on the Black Dog Institute website was completed by 3486 respondents reporting a history of treatment for depression. Inclusion criteria resulted in a sample of 2692 respondents. Participants completed the Temperament and Personality Questionnaire, which assesses eight personality dimensions: anxious worrying, perfectionism, personal reserve, irritability, social avoidance, rejection sensitivity, self-criticism and self-focus.

Results: A series of linear regressions quantified that the personality dimensions – as well as age and gender – accounted for very little of the variance in self-reported treatment effectiveness (1–7%). Self-criticism was associated with a poorer response to most treatments, and social avoidance was associated with a poorer response to psychological treatments (e.g. cognitive behaviour therapy) and behavioural strategies (e.g. exercise). Several other weak associations are reported.

Conclusion: The association between personality style and retrospective self-reported treatment response was overall weak at most. The association between a personality style of self-criticism and poor treatment response warrants clarification.
The word class effect in the picture–word interference paradigm
Authors: Janssen Niels , Melinger Alissa , Mahon Bradford Z. , Finkbeiner Matthew , Caramazza Alfonso
Published: December 2009

The word class effect in the picture–word interference paradigm is a highly influential finding that has provided some of the most compelling support for word class constraints on lexical selection. However, methodological concerns called for a replication of the most convincing of those effects. Experiment 1 was a direct replication of Pechmann and Zerbst (2002; Experiment 4). Participants named pictures of objects in the context of noun and adverb distractors. Naming took place in bare noun and sentence frame contexts. A word class effect emerged in both bare noun and sentence frame naming conditions, suggesting a semantic origin of the effect. In Experiment 2, participants named objects in the context of noun and verb distractors whose word class relationship to the target and imageability were orthogonally manipulated. As before, naming took place in bare noun and sentence frame naming contexts. In both naming contexts, distractor imageability but not word class affected picture naming latencies. These findings confirm the sensitivity of the picture–word interference paradigm to distractor imageability and suggest the paradigm is not sensitive to distractor word class. The results undermine the use of the word class effect in the picture–word interference paradigm as supportive of word class constraints during lexical selection.
Discontinuation Symptoms with Nefazodone
Authors: Rajagopalan Mani , Little John
Published: December 2009

Objective: We report a patient who developed discontinuation symptoms following nefazodone cessation.

Clinical picture: The patient experienced nausea, vomiting, diarrhoea, ataxia, insomnia, marked agitation, headache and flu-like symptoms.

Treatment: She was reluctant to recommence nefazodone and was symptomati-cally treated with oxazepam.

Outcome: The patient recovered completely in 10 days.

Conclusions: Nefazodone discontinuation can result in withdrawal symptoms and therefore needs to be tapered gradually. Those who have experienced discontinuation symptoms with other antidepressants in the past may be at increased risk.
The Relevance of Herbal Treatments for Psychiatric Practice
Authors: Walter Garry , Rey Joseph M.
Published: December 2009

Objective: The aim of this paper is to inform psychiatrists about the basic priniciples, terminology, schools of thought, efficacy, safety and regulatory issues regarding herbal treatments for mental illness.

Method: Information was obtained by computerised and manual searching of medical and botanical data bases, and by discussions with experts in herbal medicine and regulatory aspects of the pharmaceutical industry.

Results: Herbal medicines are commonly used in developed and developing countries for psychiatric illness. The main schools of herbal medicine in Australia are Western herbal medicine, traditional Chinese medicine and ‘Ayurveda’ (Indian herbal medicine). Herbs used for psychiatric or neurological disorders are termed ‘nervines’. Three nervines which have attracted considerable attention recently are St John's Wort, Gingko biloba and Valeriana officinalis. In Australia, most herbal drugs are classed as ‘listed drugs’ which are required to satisfy less rigorous safety and efficacy criteria than ‘registered drugs’. The popularity of herbal remedies has a number of clinical and research implications for psychiatry.

Conclusions: Psychiatrists should not endorse treatments that are unsupported by sound research, nor remain ignorant about alternative approaches to mental illness. The extent of use of herbal treatments for mental illness suggests that psychiatrists should become more knowledgeable about developments in this area.
Norms and the Effects of Demographic Variables on a Neuropsychological Battery for Use in Healthy Ageing Australian Populations
Authors: Collie Alexander , Shafiq-Antonacci Ruxsana , Maruff Paul , Tyler Peter , Currie Jon
Published: December 2009

Objective: The current study examined the performance of a healthy ageing population on the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological test battery in order to determine norms for use in an Australian setting. The effects of age, education, gender and mood on cognitive performance in healthy older individuals were also explored.

Method: The CERAD neuropsychological battery was administered to a sample of healthy elderly subjects (n = 243). Subjects also completed an anxiety inventory and a depression scale. Means and standard deviations of different age, gender and education groups are reported as normative data. A Principal Components Analysis (PCA) was also calculated. Linear regression was applied to the five factors extracted from the PCA using age, education, gender and mood as independent variables.

Results: All recorded means were within 1 SD of those reported in the original CERAD normative study. Five factors that loaded on measures of memory and learning, language, praxis and executive function were extracted. The independent variables age, education and gender all had significant effects on cognitive performance. However, mood had no such effect.

Conclusions: Risk factors for cognitive decline indicated by the CERAD battery include age, education and gender. Anxiety and depression are not associated with CERAD cognitive performance. The CERAD battery is a valid and reliable neuropsychological tool that may assist in the detection and diagnosis of Alzheimer's disease in Australian populations.
Inhibition of Hypervigilance in the Treatment of Traumatic Simple Phobias: Three Case Examples
Authors: Lee Anna , Vaughan Kevin , Armstrong Michael
Published: December 2009

Objective: In traumatic simple phobia (TSP) fear of retraumatisation tends to be enduring and may show little reduction with time despite frequent and prolonged exposure. This paper describes how hypervigilant behaviour may account for this enduring response by interfering with exposure.

Method: Three case histories illustrating the clinical features of TSP and its treatment using in vivo exposure coupled with direct inhibition of hypervigilance are presented.

Result: In all three cases, reduction of anxiety occurred with spontaneous generalisation of improvement.

Conclusions: The efficacy of in vivo therapeutic exposure for fear of retraumatisation may be enhanced by the use of strategies to inhibit hypervigilant behaviour.
Does the Use of Psychiatrists as Sources of Information Improve Media Depictions of Mental Illness? A Pilot Study
Authors: Nairn Raymond
Published: December 2009

Objective: The aim of this study is to determine whether mental illnesses are depicted in less negative ways in print media when psychiatrists rather than lay persons are the source of information.

Method: Seven items from a special report on mental health, four derived from lay sources and three from psychiatrists, were subjected to a discourse analysis informed by knowledge of media practices.

Results: The psychiatrists were clearly distinguished and deployed as experts in contrast to lay sources. Two of the psychiatrists presented mental illnesses in less negative ways than in the other items. These more positive depictions were undermined by the devices that the journalists used to give authority to the portrayals of mental illness and by the need to create ‘newsworthy’ items.

Conclusion: If psychiatrists and other mental health professionals are to have a positive effect on how media depict mental illness, they will have to develop closer relationships with journalists and a better appreciation of media priorities and practices.
Prolonged Fatigue, Anxiety and Depression: Exploring Relationships in a Primary Care Sample
Authors: Koschera Annette , Hickie Ian , Hadzi-Pavlovic Dusan , Wilson Andrew , Lloyd Andrew
Published: December 2009

Objective: While prolonged fatigue states are frequently comorbid with other forms of distress, they are now the subject of independent aetiological and treatment research. The objective of this study was to use principal component analysis to clarify the relationships between proposed measures of prolonged fatigue and anxiety and depression in data obtained from patients attending primary care.

Method: Self-report measures of prolonged fatigue and psychological distress (anxiety and depression) were administered to consecutive ambulatory care patients attending primary care.

Results: Data from 1593 subjects were obtained. A two-factor principal component solution (varimax rotation) demonstrated a clear separation between fatigue-related items (Cronbach's α = 0.81) as compared with those items describing anxiety and/or depression (Cronbach's α = 0.95). A four-factor solution produced similar results with two factors describing general psychological distress (contrasting anxiety and depression), with two other factors describing the profiles of mental and physical fatigue.

Conclusions: The results lend weight to the argument that prolonged fatigue states can be measured independently of conventional notions of anxiety and depression in patients attending primary care. Epidemiological, aetiological and treatment research in psychiatry may need to focus greater attention on such prolonged fatigue states.
Psychotherapy with Borderline Patients: I. A Comparison Between Treated and Untreated Cohorts
Authors: Meares Russell , Stevenson Janine , Comerford Anne
Published: December 2009

Objective: The aim of this study is to compare the clinical outcome of patients with borderline personality disorder (BPD) who had received outpatient psychotherapy for 1 year with BPD patients who received no formal psychotherapy for the same period.

Method: Thirty patients with BPD were treated by trainee psychotherapists working according to clearly described therapeutic principles. They received intensive audiotaped supervision. Patients were seen twice weekly for 1 year. They were compared with 30 patients subsequently referred to the clinic, for whom no therapist was available and who remained on a waiting list for 1 year, receiving their usual treatment. The outcome measure was a score derived from DSM criteria. It was taken at the beginning and end of the year's treatment, in the former case, and after at least 1 year on the waiting list in the latter. (The average waiting period was 17.1 months.)

Results and Conclusions: Patients who received psychotherapy were significantly improved in terms of the DSM score. Thirty percent of treated patients no longer fulfilled DSM-III criteria for BPD. The untreated patients were unchanged.
Does Reducing Safety Behaviours Improve Treatment Response in Patients with Social Phobia?
Authors: Morgan Hugh , Raffle Catriona
Published: December 2009

Objective: This study assessed the efficacy of instructions to drop ‘safety behaviours’ during exposure tasks in a cognitive-behaviour therapy (CBT) group treatment program for social phobia.

Method: Fourteen subjects with social phobia received a standardised CBT treatment program and were compared to 16 subjects with social phobia who were given additional instructions to drop safety behaviours.

Results: Repeated measures of ANOVA between groups on a specific social phobia measure (SPAI) demonstrated significant benefit when instructions to drop safety behaviours were added to the treatment program.

Conclusions: The addition of instruction to drop safety behaviours in exposure tasks in the course of CBT treatment for social phobia may be useful. This result supports the cognitive model of social phobia developed by Clark and Wells (1995), which postulates that anxiety and negative beliefs about social situations are in part maintained by engaging in safety behaviours. Further replication with larger samples is required and warranted on the basis of the present study.
Absconding Behaviour: an Exploratory Investigation in an Acute Inpatient Unit
Authors: Meehan Tom , Morrison Paul , McDougall Sue
Published: December 2009

Objective: The aim of this study is to identify patient and environmental characteristics associated with absconding behaviour, and to gain an understanding of the behaviour from the patients' perspective.

Method: A prospective analysis of 77 consecutive incidents of absent-without-leave (AWOL) behaviour (n = 51 patients) was undertaken to develop a profile of patient and environmental characteristics associated with absconding behaviour. In addition, semi-structured interviews were carried out with a subsample of 14 patients within 24 h of returning to hospital from being AWOL.

Results: Those who absconded were male (58%), under 40 years of age (74%), admitted involuntarily (78%), and had a diagnosis of schizophrenia (42%). One-third of all AWOL incidents resulted from repeated absconding by the same individuals. The first 7 days post admission was a high-risk period for absconding behaviour. Issues raised in the interviews with patients identified a number of situational and environmental factors which are likely to increase the risk of absconding.

Conclusions: Situational and environmental factors are more likely than patient characteristics to be predictive of absconding behaviour.
The Senior Psychiatrist Survey III: Attitudes Towards Personal Ageing, Life Experiences and Psychiatric Practice
Authors: Draper Brian , Gething Lindsay , Fethney Judith , Winfield Stephanie
Published: December 2009

Objective: The aim of this study is: to explore whether there is a relationship between the effects of gender, age and perceptions of personal health on psychiatrist's reactions to personal ageing; and to determine the effects of psychiatrist's reactions to personal ageing upon their approach to clinical practice, retirement planning and post-retirement activities.

Method: A postal survey was conducted. Respondents were Fellows of the Royal Australian and New Zealand College of Psychiatrists resident in Australia or New Zealand. Of 1086 eligible subjects, 529 participated. The main outcome measures were: Reactions to Ageing Questionnaire (RAQ); self-rated health; location and type of psychiatric practice; the perceived benefits and drawbacks of age on psychiatric practice and case selection; and retirement plans.

Results: Positive attitudes towards personal ageing were significantly associated with old age, males and good or excellent self-rated health. Negative attitudes were associated with working in universities and anticipated retirement due to poor health. Field of practice, anticipated post-retirement activities and approach to clinical practice were not found to have a significant effect on attitudes towards personal ageing.

Conclusions: The effects of life experiences on psychiatrists' attitudes towards personal ageing are complex. Attitudes towards personal ageing have little impact on psychiatric practice.
Psychiatric Comorbidity of Adolescents with Sleep Terrors or Sleepwalking: A Case-Control Study
Authors: Gau Shur-Fen , Suen Soong Wei-T
Published: December 2009

Objective: This study investigated the psychiatric comorbidity, personality traits and family history of adolescents with sleep terrors and/or sleepwalking.

Method: Thirty students with sleep terrors and/or sleepwalking and 30 classroom controls were selected on the basis of a sleep habit questionnaire. After completing the Junior Eysenck Personality Inventory (JEPI), the 60 subjects were interviewed by the first author with the Chinese-version Kiddie-SADS-E (Schedule for Affective Disorders and Schizophrenia for Children—Epidemiology Version). All subjects and their parents were interviewed for the subjects' sleep habits, sleep disorders, and personality characteristics in the previous year. The case and the control groups were divided based on whether the sleep terrors and/or sleepwalking had occurred in the previous year. There were 21 case and 30 control subjects in the final data analysis.

Results: The case group had more psychiatric diagnoses and problems; there were statistically significant differences in overanxious disorder, panic disorder, simple phobia and suicidal thoughts between the two groups. The case group had more sleeptalking and nightmares during the previous year as well as more enuresis in earlier years. From their parents' perspective, the case group was more nervous and pessimistic. The results of the JEPI showed a high neuroticism score in the case group. There was an increased familial occurrence of these two sleep disorders.

Conclusions: Adolescents with sleep terrors and sleepwalking were found to have an increased prevalence of other sleep disorders, neurotic traits, and psychiatric disorders and problems. Whereas sleep terrors and sleepwalking in childhood are related primarily to genetic and developmental factors, their persistence and, especially, their onset in adolescence may be related to psychological factors.
Alcohol Consumption and Psychological Distress in Recently Widowed Older Men
Authors: Byrne Gerard J. A. , Raphael Beverley , Arnold Elizabeth
Published: December 2009

Objective: The relationship between severe adverse life events and subsequent health-related behaviour is not well established for older people. To address this issue, we studied self-reported alcohol consumption in recently widowed older men and matched married men.

Method: We carried out a double cohort study in community-residing men aged 65 years and over. Recently widowed men (n = 57; mean age = 74.5 years) were identified from the death records of their wives and assessed at 6 weeks, 6 months and 13 months post-bereavement. Matched married men (n = 57; mean age = 75.4 years) were identified from the electoral roll and assessed at similar intervals. Self-report measures of alcohol consumption, grief and state anxiety were employed.

Results: Similar proportions of older widowers and married men reported that they consumed some alcohol, although recently widowed older men reported significantly greater frequency (χ2 = 4.64, df = 1, p = 0.031) and quantity (χ2 = 7.75, df = 1, p = 0.005) of alcohol consumption than matched married men. A significant minority of subjects reported hazardous levels of alcohol consumption with 18.9% of widowers and 8.3% of married men reporting that they drank five or more standard drinks per drinking day. However, among widowers, self-reported alcohol consumption was not significantly correlated with levels of either self-reported grief or state anxiety.

Conclusions: Hazardous alcohol consumption occurs commonly among recently widowed older men, but is not related to their levels of self-reported grief or psychological distress. Loss of spousal care and control may be an alternative explanation for this drinking behaviour. Older widowers should be regarded as a high-risk group for hazardous alcohol consumption and would be a suitable target group for preventive interventions.
Life Stress, Social Support and Coronary Heart Disease
Authors: Tennant Christopher
Published: December 2009

Objective: The aim of this paper is to review the relationship between life-event stress, social support and coronary heart disease.

Method: A literature search from 1978 to early 1999 using Medline, PsychINFO and EMBASE databases was performed. It focused largely on prospective studies.

Results: Both life-event stressors and inadequate social supports assessed by a variety of indicators are risk factors for acute coronary heart disease events. Poor social support does not particularly appear to moderate the relationship of life stress to coronary heart disease but rather both appear to be independent risk factors.

Conclusion: While life-event stress and poor social supports are risk factors, the exact mechanism by which they impact on heart disease is not as yet well elicited, although disturbance in mood would appear to be the most likely intervening variable.
The Psychiatrist's Dilemma: A Conflict of Roles in legal Executions
Authors: Freedman Alfred M. , Halpern Abraham L.
Published: December 2009

In the United States, a critical controversy is taking place in regard to psychiatrists' and other physicians' participation in legal executions. Under pressure from the criminal justice system and legislatures to expedite executions, some forensic psychiatrists have succeeded in loosening traditional prohibitions against such participation. Further, there has been a weakening of the prohibition against treatment designed to facilitate immediate execution of those condemned to death. The rationale offered for these departures from current psychiatric ethical codes is the novel notion that when a psychiatrist acts in the court or criminal justice situation, that individual is no longer a psychiatrist and is not bound by psychiatric ethics. Rather, the forensic psychiatrist, termed a ‘forensicist’, serves as an assistant in the ‘administration of justice’ or ‘an agent of the State’ and thus works in a different ethical framework from the ordinary psychiatrist. This justification has similarities to the rationale offered by physicians involved in human experiments and other criminal acts in Nazi Germany, as well as psychiatrists in the former Soviet Union who explained their involvement in psychiatric abuse as a result of being agents of the State and thus not responsible for carrying out orders. Clearly, this controversy could be eliminated by a campaign for the abolition of capital punishment, characterised by the American Psychiatric Association as ‘anachronistic, brutalizing [and] ineffective’. Such a campaign should serve as a call for psychiatrists and other physicians to join in the struggle to uphold ethical and moral principles.
Long-Acting Antipsychotic Medication, Restraint and Treatment in the Management of Acute Psychosis
Authors: Fitzgerald Paul
Published: December 2009

Objective: Zuclopenthixol acetate (ZA) is the first parenteral antipsychotic medication introduced for clinical use in the treatment of aggression and agitation that has a relatively prolonged duration of action. The aim of this paper is to explore a number of important ethical and clinical issues that are raised by the use of this novel therapeutic formulation.

Method: Relevant literature is explored and several issues are identified from which arguments for and against the use of medication of this type are raised. These issues are considered in general and with the use of a number of stylised clinical scenarios.

Result: The use of long-acting antipsychotic medication is complicated by its impact upon patient autonomy, by considerations of informed consent and by the need to provide justice to all patients and staff in a psychiatric treatment setting. The use of ZA in the emergency treatment of psychotic patients may only be justified under specific clinical circumstances and its use is not appropriate as routine chemical restraint.

Conclusions: Zuclopenthixol acetate is a novel and potentially useful treatment alternative in the acutely disturbed patient. Institutions in which ZA is used in emergency settings should develop protocols to guide clinicians in its appropriate use and provide monitoring.
Development of a Satisfaction with Therapy and Therapist Scale
Authors: Oei Tian P. S. , Shuttlewood Greg J.
Published: December 2009

Objective: While much work has gone into developing measures of specific factors in psychotherapy for depression, measures for non-specific factors have been lacking. This paper aims to develop a scale for a non-specific factor called ‘Satisfaction with Therapy and Therapist Scale’.

Method: Sixty-seven patients with major depression completed the questionnaires during the fourth session of cognitive therapy. The patients went through an assessment clinical interview using a SCID. They also completed the ATQ, BDI and DAS questionnaires during the fourth session.

Results: Principal component factor analysis with varimax rotation showed that the scale possesses two factors, ‘Satisfaction with Therapy’ and ‘Client Evaluation of Therapist’, accounting for 64.7% of the total variance. The alpha Cronbach for the two factors is 0.91 and 0.80 with the total scale alpha at 0.90. The scale also possesses good concurrent and disciminant validity.

Conclusion: The Satisfaction with Therapy and Therapist Scale is an adequate measure for measuring a non-specific factor in psychotherapy.
A Study of Client-Focused Case Management and Consumer Advocacy: The Community and Consumer Service Project
Authors: O'Donnell Maryanne , Parker Gordon , Proberts Miriam , Matthews Robert , Fisher Danielle , Johnson Bruna , Hadzi-Pavlovic Dusan
Published: December 2009

Objective: The study investigated the provision of client-focused services to community-based clients with schizophrenia and bipolar disorder. It hypothesised that the delivery of more client-focused services would improve client outcome in terms of functioning, disability and satisfaction with services. Client-focused services were developed using an empowerment model of case management and by the addition of consumer advocates.

Method: Clients referred for case management were randomly allocated to one of three groups: standard case management (n = 35), client-focused case management (n = 39), or client-focused case management plus consumer advocacy (n = 45). Measures of functioning, disability, quality of life, burden of care and service satisfaction were measured at baseline and 12 months. Outcome data were collected concerning number and duration of hospital readmission, crisis intervention and compliance with treatment and services.

Results: While there were no differences between the groups on quantitative measures of functioning, disability, quality of life, service satisfaction and burden of care, there were significant between-group differences on qualitative measures of satisfaction with services.

Conclusions: Several methodological difficulties hampered interpretation of the findings. Although clients did not differ on outcome measures of functioning and disability, the group receiving client-focused case management reported greater satisfaction with service delivery.
Electroconvulsive Treatment of Neuroleptic Malignant Syndrome: A Review and Report of Cases
Authors: Trollor Julian N. , Sachdev Perminder S.
Published: December 2009

Objective: Neuroleptic malignant syndrome (NMS) is a potentially lethal adverse effect of neuroleptic medication, with no satisfactory treatment currently available. Electroconvulsive therapy (ECT) has been anecdotally reported to be effective in its treatment. We review 45 published case reports of ECT for NMS and describe nine new cases, to examine its effectiveness, the likelihood of adverse reactions, and the theoretical implications of such treatment.

Method: The authors used Medline to identify reports in the English literature where ECT was used in cases of suspected NMS. In addition, the charts of patients referred to the second author for treatment of NMS were reviewed and cases in which ECT used were identified.

Results: The case reports suggest that ECT is effective in many individuals with NMS, even when drug therapy has failed. The response is usually apparent after a few treatments, generally up to six. The response is not predictable on the basis of age, gender, psychiatric diagnosis or any particular feature of NMS including catatonia. Electroconvulsive therapy is a relatively safe treatment in NMS, although the risk of cardiovascular complications should be considered. Malignant hyperthermia due to the anaesthesia associated with ECT has not been reported in patients with NMS, and succinylcholine has been used safely with the exception of one report of fever and raised creatine kinase levels and another report of hyperkalemia.

Conclusions: Electroconvulsive therapy is the preferred treatment in severe NMS, cases where the underlying psychiatric diagnosis is psychotic depression or catatonia, and in cases where lethal catatonia cannot be ruled out. The effectiveness of ECT for the treatment of NMS has theoretical implications for the relationship between NMS and catatonia, and the possible pathophysiological mechanisms that underlie these disorders.
Clozapine in Community Practice: A 3-Year Follow-Up Study in the Australian Capital Territory
Authors: Drew Leslie R. H. , Hodgson Donna M. , Griffiths Kathleen M.
Published: December 2009

Objective: This paper aims to present the first data on the long-term use of cloza-pine in an entire cohort of patients encountered in a community, the Australian Capital Territory. It examines the clinical and financial outcomes 3 years after the prescription of clozapine to a cohort of 37 patients.

Method: Experience during the 2 years before clozapine was prescribed was compared with experience in the following 3 years on the basis of a retrospective review of official records. Data included hospital and hostel bed use and an estimate of treatment costs. In addition, changes in living circumstances and employment status were assessed and treating psychiatrists reported the presence of side effects and their impressions of clinical change since clozapine was prescribed.

Results: Compared with the preclozapine period, there were significant reductions postclozapine in hospital admissions (year 3) and hospital bed-days (year 2) by the total cohort and in hospital bed-days and hospital expenditure for those patients (n = 25) who remained on clozapine (years 2 and 3). There was no significant increase or decrease postclozapine in the estimated combined cost of treatment attributable to bed use (hospital or hostel), clozapine tablets, blood monitoring, and the employment of a Clozapine Coordinator. Clinically, all patients who stayed on clozapine were reported to be moderately or markedly improved. Five of nine patients who were not taking clozapine at study's end were unimproved or deteriorated.

Conclusions: The findings of significant clinical improvement without evidence of increased cost lend support for the selective use of clozapine in community practice.
Are Antidepressants All the Same? Surveying the Opinions of Australian Psychiatrists
Authors: Hickie Ian B. , Scott Elizabeth M. , Davenport Tracey A.
Published: December 2009

Objective: Controlled trials do not suggest differences in efficacy between antidepressant compounds. Psychiatrists, however, frequently express the view that real differences do exist and are relevant to clinical practice. Since multiple comparative trials are not feasible, an alternative method for expanding the evidence base is to survey regularly the opinions of practising psychiatrists.

Method: Two surveys of psychiatrists' opinions were conducted. Participants in the first survey were drawn from contact with ‘SPHERE: A National Depression Project’, while those in the second survey responded to a brief questionnaire distributed with Australasian Psychiatry.

Results: Reported volumes of scripts written, ratings of efficacy and tolerability, and preferences in specific clinical situations indicate that clinical psychiatrists now strongly prefer the newer antidepressant agents. They rate serotonin and noradren-alin re-uptake inhibitors (SNRIs) and selective serotonin re-uptake inhibitors (SSRIs) highest for antidepressant efficacy, serotonin receptor subtype 2 (5HT2) antagonists and some SSRIs highest for anti-anxiety efficacy, and some SSRIs and reversible inhibitors of monoamine oxidase inhibitor-A (RIMAs) lowest for side-effect burden. Further, SSRIs were their first preferences for most clinical situations. Serotonin and noradrenalin re-uptake inhibitors were the preferred choice for treatment-resistant depression and patients who had failed to respond to one SSRI. Serotonin receptor subtype 2 antagonists were the second choice to SSRIs for mixed anxiety and depression, and major depression with sleep disturbance. Reversible inhibitors of monoamine oxidase inhibitor-A were the second choice to SSRIs for adolescents with major depression, patients aged over 65 years, patients with serious medical illnesses and patients with chronic fatigue. Tricyclic antidepressants (TCAs) were the preferred choice for patients with chronic pain, and second choice to SSRIs for patients with major depression with panic disorder, postnatal disorders and patients with psychotic depression.

Conclusion: Psychiatrists believe that important differences do exist between available antidepressant compounds. Such opinions are divergent from limited controlled data but may be influenced by a wide range of factors other than direct clinical experience. The role of such surveys in ongoing evaluation of clinical practice is emphasised.
Ethical Issues in the Prevention of Suicide in Prison
Authors: Bell Douglas
Published: December 2009

Objective: The aim of this paper is to discuss ethical issues that arise in the care of suicidal patients within a prison context. Such a discussion provides a suitable framework for exploration of the broader question of how coercion may be exercised by psychiatrists in a morally justifiable, as opposed to abusive, manner.

Method: Literature relevant to the abuse of psychiatric power is reviewed. The means for immediate containment of highly suicidal patients in certain prison contexts is described and the paucity of relevant empirical research literature relating to this is identified. A framework is proposed to assist clinicians in making an ethical evaluation of coercive interventions that is applicable not only in the prevention of prisoner suicide, but also in the practice of psychiatry as a whole.

Results: Due regard for the moral dimensions of the relationship between psychiatrist and prisoner has the potential to radically transform the way the exercise of power is subjectively experienced by each of them.

Conclusion: Coercion can be exercised by psychiatrists within an ethical framework which is not abusive. There will always be a risk that coercion will become an unhealthy habit of life within which the psychiatrist feels too comfortable.
Mental Health Disorders in Children and Young People: Scope, Cause and Prevention
Authors: Zubrick Stephen R. , Silburn Sven R. , Burton Paul , Blair Eve
Published: December 2009

Objective: To review the scope and characteristics of mental health disorders in children and young people in Australia; detail some emerging concepts of the causal pathways of mental health disorders in children and young people; and discuss aspects of the prevention of mental health disorders and the promotion of mental health in children and young people.

Method: An integrated review of selected literature.

Results: (i) While as many as one in five Australian children aged from four to 17 have significant mental health problems there remains a need for prevalence estimates in subsections of the population, notably children and young people of Aboriginal and Torres Strait Islander descent; (ii) appropriate studies of gene-environment interaction will require better measurement and developmental exposition of those risk exposures that are known to be on the causal pathway to mental health disorder; and (iii) universal, selective and indicated prevention trials and evaluations directed at anxiety, depression and conduct disorder are needed.

Conclusion: Preventive intervention and promotion in mental health must entail effective collaboration at national, state and local levels between health, welfare and education sectors. These sectors must be informed by high quality epidemiology and a knowledge of the causal pathways of mental health disorders. Such intervention must also improve the movement of scientific knowledge to political policy on one hand and to praxis on the other. This will require a clear and persistent vision of the urgency, costs and consequences of mental health disorders in children and young people coupled with effective leadership and political resolve.
Lesbians in New Zealand: Their Mental Health and Satisfaction with Mental Health Services
Authors: Welch Sarah , Collings Sunny C. D. , Howden-Chapman Phillippa
Published: December 2009

Objectives: To describe the mental health of lesbians in New Zealand, and to document their accounts of their experience of mental health services.

Method: This is a descriptive cross-sectional study. A postal questionnaire, the Lesbian Mental Health Survey, was distributed via lesbian newsletters to 1222 women throughout New Zealand. Mental health measures included the General Health Questionnaire (GHQ-28), Interview Schedule for Social Interaction (ISSI), and respondents' histories of sexual abuse and psychiatric histories. Experiences of mental health services were sought.

Results: The estimated response rate was 50.8%%. The respondent group were predominantly New Zealand European, highly educated, urban women between 25 and 50 years of age. Three-quarters had identified as lesbian for more than 5 years. Recent self-identification as lesbian was associated with higher GHQ score, as was being younger than 35, having a history of sexual abuse, and not living with a partner. Eighty percent of respondents had used mental health services sometime in their lives and nearly 30 percent of users had received ‘lesbian-unfriendly’ treatment at some point. One-sixth of respondents had experienced discrimination from service providers in the previous 5 years.

Conclusion: While the mental health of lesbians is influenced by factors similar to those influencing women's mental health in general, because of social factors, such as stigma and isolation, lesbians may be more vulnerable to common mental illnesses. Health professionals, mental health professionals in particular, need to raise their awareness of the issues lesbians face in dealing with their sexuality, therapeutic relationships and mental health services. Increased training about sexuality for health professionals, as well as further research into areas such as stress and stigma, sexual abuse and attempted suicide among lesbian women, is recommended.
Contrasting Views and Experiences of Health Professionals on the Management of Comorbid Substance Misuse and Mental Disorders
Authors: Kavanagh David J. , Greenaway Lea , Jenner Linda , Saunders John B. , White Angela , Sorban Josie , Hamilton Gail
Published: December 2009

Objectives: To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders.

Method: We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential solutions had been generated by focus groups.

Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79%% and 42%% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98%% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70%% of staff. Another set of problems involved coordination of client care across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities.

Conclusions: A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.