bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Outlines for Paranoid, Schizotypal and Schizoid Personality Disorders
Authors:   The Quality Assurance Project
Published: November 2007

Treatment outlines for paranoid, schizotypal and schizoid personality disorders were developed by having nominated experts consider their own views in the light of the treatment literature and the responses of practising psychiatrists. In the detailed recommendations it is clear that while patients with all three disorders often present for treatment in a crisis and often see no issue other than the resolution of the crisis, patients with schizoid personality disorder can use long-term psychotherapy to develop and change to the extent of no longer being handicapped.
The Power of Mercy
Authors: Burton-Bradley Burton G.
Published: November 2007

Throughout history heads of state have reserved for themselves the prerogative to exercise mercy and pardon not only for serious crimes but for lesser ones as well. The newly emerging state of Papua New Guinea is no exception. My experience as the psychiatrist member of the advisory committee on such executive clemency since its inception twelve years ago will be discussed.
There's no Quick Fix for AIDS
Authors: Eisenberg Leon
Published: November 2007

The epidemiology of AIDS reflects interactions among biological, psychological and social factors. The immune response to the infectious agent is relatively ineffectual; the course of the disease it produces is chronic. The long interval between HIV infection and the appearance of clinical disease maximizes “silent” transmission. The infection is transmitted behaviourally; that is, primarily via specific sexual acts and contaminated paraphernalia employed by IV drug users. The virus entered human populations in an era when such behaviours had become very much more prevalent in response to social change. The public health response to the epidemic was seriously compromised by the stigma attached to the persons victimized by the disease; thus, the mobilization of adequate resources was markedly delayed. Irrational fears of contamination led to proposals for mandatory population-wide screening, in utter disregard of the high false to true positive ratio in screening tests when prevalence is low. Welcome as a vaccine to prevent HIV infection would be, it is not likely to be available, if it can be produced at all, before the end of the century. Control of the epidemic demands that stigma be vigorously combated and that all groups of the population be educated about ways to minimize the likelihood of becoming infected and of transmitting the virus.
Illness Behaviour as a Determinant of Referral to a Psychiatric Consultation/Liaison Service
Authors: Clarke David M. , Minas I. Harry , McKenzie Dean P.
Published: November 2007

Recognition of psychiatric disturbance and rate of referral to psychiatric units in general hospitals falls far short of the prevalence of psychiatric morbidity in such hospitals. This study has sought to determine whether particular patterns of “illness behaviour” contribute to the decision to refer. A group of patients referred to a psychiatric service was compared to a group of non-referred patients using the General Health Questionnaire (GHQ) as a general measure of morbidity, the Inventory to Diagnose Depression (IDD), the State-Trait Anxiety Inventory (STAI) and the Illness Behaviour Questionnaire (IBQ). The rate of referral to the service was 2.9%. The estimated prevalence of psychiatric morbidity was 30%. Referred patients scored more highly on all measures of morbidity (GHQ, IDD, STAI) and on the IBQ scale Affective Disturbance, and scored lower on the Denial Scale. Data are reported which suggest that patients with a strong somatic focus are less likely to be referred for psychiatric assessment despite the presence of significant psychiatric morbidity. The implications for health care delivery and identification of psychiatric morbidity are discussed.
Research into Psychiatric Disorder after Stroke: The Need for Further Studies
Authors: Johnson G. A.
Published: November 2007

Attention is drawn to some shortcomings of previous findings with regard to the nature, prevalence and aetiology of psychiatric disorder after stroke, and in particular post-stroke depression. Reasons for and drawbacks of the emphasis on depression in studies to date are discussed. Inconsistencies amongst previous findings are examined and it is suggested that many further studies in the area are warranted providing methodological difficulties are addressed adequately.
Robert Lowell: The Search for the Father in Madness and Poetry
Authors: Powell Craig
Published: November 2007

This paper draws upon a recent biography of the American poet Robert Lowell and suggests a common theme linking his family, his mental illness and the content and structure of his poems.
Fenfluramine Augmentation of Clomipramine Treatment of Obsessive Compulsive Disorder
Authors: Judd Fiona K. , Chua Phyllis , Lynch Camel , Norman Trevor
Published: November 2007

Recently, much research interest has been directed to demonstrating a possible biological basis to obsessive compulsive disorder. In particular, dys-regulation in brain serotonin is suggested to be important. Two cases are described in which fenfluramine, a presynaptic 5 HT-releasing agent and 5HT-reuptake inhibitor was used to augment clomipramine treatment for OCD.
Psychological Distress and Psychiatric Morbidity in Women Prisoners
Authors: Hurley William , Dunne Michael P.
Published: November 2007

The population of a women's prison (n=92) was screened for psychological distress and psychiatric morbidity with the 12-item General Health Questionnaire, the Hamilton Depression Rating Scale, a Recent Stressful Life Events questionnaire and the Structured Clinical Interview for DSM-III-R. High levels of symptoms of psychological distress were recorded. Distress was correlated with recent stressful life events and was more severe in women awaiting trial. Fifty-three per cent of the prisoners were diagnosed as current cases of a psychiatric disorder and the most frequent diagnoses were adjustment disorder with depressed mood and personality disorders. Lifetime prevalence of psychoactive substance use disorders was 54 per cent. Aboriginal women were over-represented in this prison population. A follow-up survey after 4 months showed no fall in the prevalence of psychological distress and psychiatric morbidity.
Psychosocial Needs of Torture Survivors
Authors: Silove Derrick , Tarn Ruth , Bowles Robin , Reid Janice
Published: November 2007

Growing recognition that the world faces a modern epidemic of torture has stimulated widespread interest amongst mental health professionals in strategies for the treatment of survivors. In this article we outline the distinctive experiences of torture survivors who present for treatment in western countries. These survivors are usually refugees who, in addition to torture, have suffered a sequence of traumatic experiences and face ongoing linguistic, occupational, financial, educational and cultural obstacles in their country of resettlement. Their multiple needs call into question whether “working through” their trauma stories in psychotherapy will on its own ensure successful psychosocial rehabilitation. Drawing on our experience at a recently established service [1], we propose a broader therapeutic aim.
Neuroleptic Toxicity Syndromes: A Clinical Spectrum
Authors: Reilly John J. , Crowe Simon F. , Lloyd John H.
Published: November 2007

The neuroleptic malignant syndrome (NMS) has undergone a number of changes since it was first described in the 1960s. This paper presents a review of these changes from the traditional approach of rigid categorization through the more flexible operational definitions to a spectrum of neuroleptic toxicity. This spectrum spans neuroleptic-induced extrapyramidal side effects, possible stages of neuroleptic toxicity, and the full blown neuroleptic malignant syndrome. Different theoretical concepts of the syndrome have contributed to diagnostic confusion among clinicians and thus to difficulties in management. The concept of a spectrum of neuroleptic toxicity provides a coherent theoretical base for understanding NMS and thus allows for more rapid identification of the potential threat of NMS. Three cases are presented and discussed to highlight the utility of the concept of a clinical spectrum.
Changing Patterns of Electroconvulsive Therapy Use: Results of a Five-Year Survey
Authors: Galletly Cherrie A. , Field Colin D. , Ormond Cheryl L.
Published: November 2007

Despite its proven efficacy and safety, electroconvulsive therapy (ECT) continues to be a controversial treatment. Ongoing scrutiny is therefore particularly important. We reviewed 315 patients who received 3903 ECT treatments over a five year period, and found a gradual decline in the use of ECT, due mainly to a reduction in ECT for schizophrenic patients. Eighty percent of treatments were given with bilateral electrode placement, although we did find the incidence of adverse effects to be greater with bilateral ECT. Most patients concurrently received medications which raise the seizure threshold. The administration of ECT to patients unable or unwilling to give informed consent raises ethical and medicolegal issues. We found that such difficulties had arisen with at least 16% of patients.
Opposite Sex Behaviours Correlate with Degree of Homosexual Feelings in the Predominantly Heterosexual
Authors: McConaghy Nathaniel , Silove Derrick
Published: November 2007

There is extensive evidence that subjects who identify as homosexual show opposite sex-linked behaviours. However no attempt has been made to investigate whether a similar association exists between such behaviours and the presence of homosexual feelings in the predominantly heterosexual. Eighty medical students completed an anonymous questionnaire reporting the ratio of their heterosexual to homosexual feelings and the presence of sex-linked behaviours in their earlier life and currently. As in previous studies correlations between opposite sex behaviours and subjects' degree of homosexual feelings were found in the male subjects. Correlations remained present, though mainly at a weaker level, in the predominantly heterosexual students. It is suggested this evidence of a dimensional relationship between opposite sex-linked behaviours in childhood and degree of homosexual feeling in adulthood renders irrational the classification of such behaviours as a gender identity disorder of childhood when homosexuality in adults is not regarded as a disorder.
Tardive Dyskinesia in Elderly Psychiatric Patients in Singapore
Authors: Tan Chay Hoon , Tay Lian Kai
Published: November 2007

The prevalence of tardive dyskinesia (TD) in 514 psychiatric patients who were 60 years and above in Singapore was found to be 27.6%. This is low compared with other studies done on elderly psychiatric patients in the West. Among the different ethnic groups, the Eurasians have the highest prevalence of 53.8% compared to the Chinese, Malays or Indians. Inpatients have a higher prevalence (31.5%) than outpatients (10.5%). Higher prevalence was also found in women, who were 2.2 times more common than men. 50% of the mentally retarded patients were found to have TD.
ACNE as a Risk Factor for Anorexia Nervosa in Chinese
Authors: Lee Sing , Leung C. M. , Wing Y. K. , Chiu H. F. K. , Chen Char-Nie
Published: November 2007

Acne is a highly visible and common skin disorder which is potentially disfiguring and associated with adverse emotional responses in adolescents, who are markedly sensitive to body image changes. Two psychologically vulnerable Chinese girls are reported, in whom traditional health concepts reinforced dieting behaviour, led to weight loss, regression of acne and eventually anorexia nervosa. The intricate interactions of acne, health beliefs, dieting behaviour and eating disorders are discussed.
The Diagnostic Validity of Paraphrenia
Authors: Hassett Anne M. , Keks Nicholas A. , Jackson Henry J. , Copolov David L.
Published: November 2007

It remains a matter of conjecture as to whether a schizophrenia-like syndrome commencing in old age differs from the early-onset disorder in any substantial way. This article reviews both the historical background to the concept of defining paraphrenia as a distinct entity, as well as the current controversies concerning whether it should remain a separate entity: the latter is important as paraphrenia has not been included in the DSM Ill-R and ICD 10 classification systems. Clinical parameters and aetiological factors relevant to an understanding of the syndrome are discussed under the rubrics of descriptive and construct validity. Of particular importance are the role of cerebral organic factors and the pathoplastic effect of the ageing process and how both interface with the development of psychotic symptoms. Whilst the course of this syndrome has been considered relatively benign, outcome studies have yet to establish consistent features that provide a basis to determine predictive validity.
A Study of Coroner's Records of Suicide in Young People, 1986–88 in Western Australia
Authors: Graham Carolyn , Burvill Peter W.
Published: November 2007

Coroner's records of 25 consecutive suicides aged 15–19 years and 43 aged 20–24 years were compared with 68 suicides aged 45–59 years to identify associated clinical and psychosocial factors. Male: female ratios were 2.6:1, 5.1:1 and 3.5:1 respectively. The most common method of suicide in males in all three age groups was CO poisoning using motor vehicles. In females the teenage group used mainly active methods, whilst in the 20–24 and 45–49 years age groups the most common method was over dosage. Over 90% of each age group had some identifiable psychiatric symptomatology. In each age group the commonest symptoms were minor affective symptoms. In each group the pattern was mainly of associated multiple rather than single psychosocial factors. In each group disruption of interpersonal relationships (boy-girlfriend, de facto, marital, family) was the predominant stressor. Compared with the 45–59 year group the following associated factors were significantly greater in (a) 15–19 years: personality/conduct disorders, unemployment and legal/disciplinary problems, and (b) 20–24 years: drug abuse and unemployment. Although the two younger groups had significantly more unemployment than the older group, only the 20–24 years group had significantly more unemployment compared with community age norms. Preventive implications of the findings are discussed.
Clinical Assessment of Psychiatric Symptoms in Mentally Retarded Individuals
Authors: Einfeld Stewart L.
Published: November 2007

Mentally retarded Australians with emotional and behavioural disorders are seriously under-served by psychiatrists, despite such individuals being as prevalent as those with schizophrenia. These disorders have serious consequences for the individual, family and carers, and the community as a whole. In the psychiatric assessment of mentally retarded persons, a key principle is that while intellectual handicap increases vulnerability to psychiatric illness, it does not of itself cause psychopathology. A biopsychosocial framework provides a model whereby those factors which are contributing to psychopathology can be systematically elucidated. Biological factors include brain pathology associated with particular mental retardation syndromes, drug side-effects and epilepsy. Psychological factors include temperament, a history of abuse, and current life stresses. Social factors include distortions in family roles and hostel or workshop conflicts. Although clinical assessment can be challenging, and confident syndrome diagnosis is not always possible, a systematic approach to the analysis of symptoms will provide a guide to useful interventions.
Mania and Aids: A Psychodynamic Emphasis
Authors: Vamos Marina J.
Published: November 2007

Two cases of mania in homosexual men with AIDS are presented. Particular emphasis is placed on the psychodynamic and psychosocial factors thought to be aetiologically significant. AIDS is seen both as an example of a terminal illness, and also as creating unique difficulties. It is suggested that integrative rather than reductionist thinking is needed in cases which under DSM-Ill-R would simply be classified as “organic mood disorder”, that is, that all causal and contributory factors need to be considered in affective disorder occurring in the physically ill.
Kleine-Levin Syndrome: A Case Report
Authors: Russell Janice , Grunstein Ronald
Published: November 2007

Kleine-Levin Syndrome is an unusual sleep disorder occurring predominantly, but not exclusively, in late adolescent males. A case is described which illustrates some of the difficulties in diagnosis and management.
Staff Response to Inpatient and Outpatient Suicide: What Happened and What do We Do?
Authors: Little J. D.
Published: November 2007

Inpatient or outpatient suicide may have a marked effect on the staff or therapist. After reviewing the literature, a practical, clinically-based protocol for managing such an event is described. Additionally, it places one event, the psychological autopsy, within the general context of post-suicide management.
Alcohol-Related Problems in New Zealand Women
Authors: Romans-Clarkson Sarah E. , Walton Valerie A. , Herbison G. Peter , Mullen Paul E.
Published: November 2007

As total alcohol consumption has increased this half century in most developed countries, alcohol-related problems have become more frequent. Most research has either studied only men or failed to mention gender. This study examined the prevalence of alcohol problems and their socio-demographic associations in a random sample of New Zealand women. Women of younger age, who were unmarried, well educated, in employment, with child care support and who lived in rural communities saw themselves as having more problems with alcohol. Women who had experienced physical or sexual abuse as adults had increased rates of alcohol problems as did those with more psychiatric morbidity as assessed by the General Health Questionnaire and the short Present State Examination. However, women with multiple social roles, particularly caring responsibilities, were less likely than women with one or two social roles to view themselves as having alcohol problems. The data provided no support for the role strain hypothesis of alcohol abuse. It is argued that the findings support a social explanation for alcohol problems based on varying social sanctions on drinking and alcohol availability rather than a psychoanalytic one of unconscious conflicts over femininity, sexuality or female social roles.
The Evolution of Community Psychiatry
Authors: Dax E. Cunningham
Published: November 2007

Community Psychiatry is sometimes regarded as a separate and even as a recent study. The history of its evolution in Australia shows it to have resulted from a logical progression since the earliest days of the psychiatric services. The demand for care completely outstripped the accommodation available so two separate but parallel methods of dealing with this problem were evolved. The first explored how the numbers in the overcrowded hospitals could be reduced, and the second, the ways in which admission could be avoided. Both methods resulted in the expansion of community services. Present day activities must be viewed in this light and community services recognised to be an indivisible portion of a professionally organised total mental health organisation.
Sex and Gender and the Impaired Therapist
Authors: Quadrio Carolyn
Published: November 2007

A brief review of the problem of impaired therapists is followed by a more comprehensive review of sexual relationships arising in and following psychotherapy. The prevalence of this latter problem is approximately 10%. Offenders are predominantly male, one half are said to be “ruthless” and “exploitative”, whilst the remainder are often “lovesick”. The author relates these phenomena to processes of repudiation of the relational/feminine self of the highly masculinised clinician. Characteristics of offenders and consequences for patients are presented and issues of detection, sanctions, legislation, and prevention are addressed. Studies suggest that the vast majority of patients are harmed by the experience and that neither improved training, licensing, personal therapy, nor supervision of therapists will guarantee against its occurrence.
Adult Attachments and Sexuality: Implications for Understanding Risk Behaviours for HIV Infection
Authors: Feeney Judith A. , Raphael Beverly
Published: November 2007

In response to the AIDS epidemic, there has been an intensification of interest in human sexuality research in general and “safe sex” practices in particular. Most research models have been somewhat mechanistic in focus, however, with little recognition of the significance of affectional needs in the formation and maintenance of sexual relationships. In this paper we propose that relationship issues are central to an understanding of the expression of sexuality, and that attachment theory provides a useful perspective on human sexual bonds. It is suggested that future research could usefully extend the conceptualisation of adult attachment styles by exploring the meaning of attachment relationships for gay and heterosexual couples, and the implications of attachment style for the behaviours associated with sexual relationships, including the negotiation of safe sex practices. Such research would have direct relevance for prevention programs relevant to HIV/AIDS.
Attributions of Symptomatology: An Exploration of Family Factors Associated with Expressed Emotion
Authors: Harrison Christine A. , Dadds Mark R.
Published: November 2007

This study explored family factors associated with Expressed Emotion (EE) in families with a member diagnosed with schizophrenia. Drawing on an attributional model of expressed emotion it was predicted that high EE relatives would have less knowledge of the illness and would attribute negative symptoms to the personality, rather than the illness, of the sufferer. Thirty-one caregivers of schizophrenic patients were interviewed. Results indicated that EE status was related to knowledge, coping and causal attributions of negative symptoms. Low EEs, as compared with High EEs, tended to have more knowledge of the illness and to cope better with the patient, and were less likely to attribute the cause of negative symptoms to the sufferer's personality. Support was therefore obtained for the utility of an attributional model in attempting to understand the determinants of levels of EE.
Long Term Secure Care in Tasmania
Authors: Pridmore Saxby A. , Jones Ivor H.
Published: November 2007

The aim was to determine the requirement in Tasmania for long term (greater than 28 days) secure ward beds, and to characterise the patients who use them. There was complete enumeration over an 18 month period. The results included that 3.6 long term secure beds were used per 100,000 general population. Compared to those who were discharged during the survey, those who were not discharged were older, had spent longer in psychiatric hospitals and were more likely to be male and to suffer from schizophrenia. All patients were white Australians. The conclusions included that for planning purposes a minimum of 4.6 long term secure beds was required per 100,000 general population. Also, Aboriginal people and people from non-English speaking backgrounds were not over represented in long term secure care in Tasmania. Finally, “good” and “poor” prognosis groups were identified and further work is required to determine how these can best be managed.
Is Tardive Anorexia a Discrete Diagnostic Entity?
Authors: Russell Janice , Gilbert Megan
Published: November 2007

A study is described in which patients in three diagnostic groups were compared in an effort to delineate features of tardive anorexia (late onset anorexia nervosa). There were 18 patients in each diagnostic group. Patients with “classical” anorexia nervosa of less than 5 years duration were compared with patients older than 25 who had been chronically ill for more than 5 years and with those in whom the symptoms had begun de novo after the age of 25. Statistically significant differences were found to distinguish the third group as a distinct diagnostic entity. The association of loss precipitants and depressive symptoms has practical implications in the management of true anorexia tardive.
Psychiatric Morbidity in a Chinese Primary School in Hong Kong
Authors: Wong C. K. , Lau Joseph T.F.
Published: November 2007

The psychiatric morbidity among 718 Chinese primary school children from a lower middle social class area in Hong Kong was studied, using a two-stage design. The screening procedures included two parts, a multi-component scale and a battery of probing questions. The screening procedures achieved an overall sensitivity of 75% and a specificity of 97%. The findings on prevalence were: (i) a total prevalence of all definite psychiatric cases of 16.3%; (ii) prevalence according to diagnostic categories: emotional disorder, 8.8%; conduct disorder, 2.0%; mixed disturbance of emotion and conduct, 3.0%; hyperkinetic syndrome, 1.0%; hyperkinetic conduct disorder, 1.0%; and Gilles de la Tourette's syndrome, 0.4%; (iii) boys 2.7 times more affected than girls; (iv) emotional disorder much more common than conduct disorder, even in boys; and (v) the prevalence of borderline cases was 19.5%. The mean duration of morbidity for all definite cases was 41.7 months. About half of all definite cases were seriously impaired in one or more areas of functioning and the other half moderately impaired. These results were compared with findings obtained from studies done in other countries.
Serious Suicide Attempts among Adolescents in Custody
Authors: Lawlor D. , Kosky R.
Published: November 2007

The Royal Commission into Aboriginal Deaths in Custody has focused attention on people who are held in custody in police cells, prisons, remand centres and detention centres. A series of research papers has been released by the Royal Commission which delineates some important aspects of the needs of these people. Nearly half of the deaths which occur in these custodial settings appear to be self-inflicted. Suicide seems to be particularly common among younger age groups of those in custody [1,2]. This pattern parallels suicide levels among young people in the Australian community generally, so that suicide is now a leading cause of death among young Australians [3,4].
Diffuse Lewy Body Disease and Progressive Dementia in a Young Woman
Authors: Crowe Simon F. , Peppard Richard F. , Borenstein Ruth , Lloyd John H.
Published: November 2007

This report details the emergence of a progressive parkinsonian syndrome, dementia and behavioural disturbance in a 33 year-old woman which can be dated to the delivery of her first child. The findings of this case indicate that cortical Lewy body disease should be considered in any patient with temporoparietal dementia and idiopathic Parkinson's disease irrespective of the age of onset.
Definitions and Defining Responsibility
Authors: Dignam Paul
Published: November 2007

In the older nosologies under which I first studied psychiatry the terms “character neurosis” and “symptom neurosis” served to highlight the possibility of interaction or continuity between personality and illness. DSM-111 sought to clarify the relationship by establishing separate axes. This stratified model has real value in conceptualising diagnosis and organizing treatment, but reifies a distinction that is far from proven, and seems even to be fading as time passes: witness the various studies linking social phobia and avoidant PD, affective disorders and borderline PD, obsessive-compulsive disorder and personalty, and of course schizotypal PD and schizophrenia, to name a few. This is hardly surprising considering the complex and overlapping origins of both personality and disorder.
Phenomenology and the History of Psychiatry
Authors: Beumont P. J. V.
Published: November 2007

Phenomenology is a word much abused in psychiatry. It has come to mean the objective description of the symptoms and signs of psychiatric illness, a synonym for clinical psychopathology as opposed to that other psychopathology which derives from psychoanalytic theory. Thus it is sometimes stated that the phenomenology of a condition is remarkably consistent although its psychopathology is varied. In truth, phenomenology is a technical term in psychiatry with a specific meaning quite distinct from and in a way opposite to that of objective psychopathology. The inappropriate use of the word is unfortunate not only for semantic reasons but also because there is a real danger that the concept to which it refers will be forgotten.
Anxiety, Depression and HIV Related Symptomatology across the Spectrum of HIV Disease
Authors: Perdices Michael , Dunbar Nicola , Grunseit Anne , Hall Wayne , Cooper David A.
Published: November 2007

Levels of anxiety and depression were assessed for 207 HIV seropositive homosexual/bisexual men (AIDS = 34, ARC = 72, asymptomatic HIV infection = 101), and 36 seronegative controls. Lymphocyte subset enumeration, history of opportunistic infections, and occurrence of HIV-related symptoms were recorded at the time of assessment. No differences between groups were found on age, educational level, state/trait anxiety or depression scores. Neither the number of symptoms reported, their duration, severity, frequency of occurrence, nor the proportion of patients who reported a specific symptom was different between the three HIV seropositive groups. Severity of anxiety and depression was related to the magnitude of symptomatology, but not associated with either degree of immunodeficiency, number of opportunistic infections or diagnostic group. Principal component analysis extracted five symptom factors (cognitive, affective, psychosocial, neurological and physical), none of which predicted state anxiety scores. However, affective and psychosocial symptom factors predicted trait anxiety and depression scores. The results indicate that ratings of anxiety and depression are independent of stage of HIV infection, may be in part mediated by constitutional and physical symptoms of HIV disease, but are primarily associated with the presence of psychological and psychosocial symptoms.
Assaults by Patients: The Experience and Attitudes of Psychiatric Hospital Nurses
Authors: Baxter Eion , Hafner R. Julian , Holme Gwili
Published: November 2007

Four hundred and twenty-five nurses working in a 420 bed metropolitan psychiatric hospital were asked to complete a questionnaire about their experience of physical assault by patients and their attitude toward the problem. 61% returned the questionnaire. The overall mean annual rate of assault per nurse was 2.0, with student psychiatric nurses (mean 6.7) significantly more at risk than any other group. Nurses working in the psychogeriatric area reported more than double the rate of assaults reported by nurses working in rehabilitation services. 60% of respondents were female; there were very few sex differences in attitudes to assault. Overall, nurses reported a high tolerance for assault, although they recognised it as an experience that was often very traumatic psychologically. Views about managing assaultiveness differed widely, and this lack of consensus probably hinders the development of optimal strategies to deal with what is a major problem in many psychiatric units.
Antipsychotic Drug Doses in a Schizophrenia Inpatient Unit
Authors: Galletly Cherrie A.
Published: November 2007

Dose-effect studies have found that 600 mg/day of chlorpromazine (or its equivalent) is generally sufficient to treat acute psychosis. This paper reports on the doses of antipsychotic medication prescribed for inpatients in a Schizophrenia Unit at an Australian state hospital. Fifty five percent of patients received daily doses equivalent to more than 600 mg of chlorpromazine and 26% received daily doses equivalent to more than 1500 mg of chlorpromazine. Low potency drugs were prescribed in lower doses than high potency drugs. Patients prescribed depot medication tended to receive higher doses of medication than those prescribed oral medication only.
The Clinical Significance of the Thyrotropin-Releasing Hormone Test in Alcoholic Men
Authors: Sellman J. Douglas , Joyce Peter R.
Published: November 2007

Sixty-six alcoholic men who had been abstinent from alcohol for at least four weeks were assessed clinically and then investigated in terms of Thyroid-Stimulating Hormone (TSH) and prolactin responses to a Thyrotropin-Releasing Hormone (TRH) challenge. Consistent with other studies, a third of the subjects had a blunted TSH response to TRH. This blunted response was not associated with a family history of alcoholism, or current depressive symptoms, past history of depression or family history of depression. However, subjects with a blunted TSH response were more likely to have had an earlier onset of alcoholism and to have had shorter alcoholic remissions in the past.
Suicide in Singapore, 1986
Authors: Peng Lee Kok , Choo Aw Soh
Published: November 2007

Three hundred and forty-two cases of suicide in Singapore (1986) were studied. The rates were highest among Indians males. Jumping from a height was the method used by 60% of the subjects, and the predominant associated factor as ascertained by the coroner was illness (51%), both physical and mental. About 40% had seen a doctor in the year prior to their death, and 20% had a history of a previous suicide attempt. The majority of cases killed themselves during the daylight hours.
Psychiatrists and Their Patients — Confidential Information in the Wake of Spycatcher
Authors: Smith Stephen
Published: November 2007

This article examines a recent decision of the English Court of Appeal. It concerned a psychiatrist who examined and reported on a convicted murderer in a secure hospital. The report was commissioned by the patient's solicitors as evidence in support of his release. The report was emphatically unfavourable and the doctor insisted that it be revealed to the hospital authorities. The solicitors refused and litigation ensued. The courts were forced to rule on the conflict between the patient's right to privacy and the public interest in revealing the report.
Sexual Abuse in Chinese Children in Hong Kong: A Review of 134 Cases
Authors: Ho T. P. , Mak F. Lieh
Published: November 2007

This is a retrospective study of 134 cases of sexual abuse in Chinese children aged 16 years or under in Hong Kong. The data with respect to the victim's age, sex, severity and type (intra- or extrafamilial) of abuse, perpetrator's characteristics and family disturbances were analysed. The overall profile is similar to that reported in the West. The reasons for the apparently low prevalence, younger age of victim and low proportion of male victims are discussed.
Treatment of Childhood Anxiety Disorders Using Behaviour Therapy and Pharmacotherapy
Authors: King Neville J. , Tonge Bruce J.
Published: November 2007

Although the treatment of childhood anxiety disorders can be approached from numerous theoretical perspectives, the concentration of research has been on the efficacy of behaviour therapy. Behaviour therapy procedures are briefly described and evaluated, including systematic desensitisation, flooding, modelling, reinforcement and cognitive procedures. We also review research findings on pharmacotherapy, focusing on benzodiazepine and antidepressant usage. Finally, several conclusions are drawn concerning the scientific and clinical status of these treatment approaches for childhood anxiety disorders.
Differences between Reports from Children, Parents and Teachers: Implications for Epidemiological Studies
Authors: Sawyer Michael Gifford , Baghurst Peter , Clark Jennifer
Published: November 2007

This study describes the different prevalences obtained when varying combinations of informants were used to identify emotional and behavioural disorders in a representative sample of 336 children living in two-parent families in the community of Adelaide, South Australia. When different informants were used to identify children with disorders, the estimated prevalences ranged from 3.3±1.6% to 17.9±4.1% for younger children, and 6.0±2.9% to 19.9±4.9% for older children. Results from the study highlight potential methodological problems which arise in epidemiological studies due to differences between reports from children, parents, and teachers describing childhood emotional and behavioural problems.
Psychotic Symptoms Preceding Ocular Deviation in a Patient with Tardive Oculogyric Crises
Authors: Sachdev Perminder , Tang Wai Mun
Published: November 2007

This report describes a patient with schizophrenia who developed episodes of ocular dystonia as a delayed side effect of neuroleptic medication. Each episode was preceded and accompanied by marked agitation, stereotypic behaviour and exacerbation of hallucinations. Both the psychotic and dystonic symptoms responded to anticholinergic medication. The theoretical and practical implications of this observation are discussed.
Amygdalo-Hippocampectomy for Pathological Aggression
Authors: Sachdev Perminder , Smith John Sydney , Matheson John , Last Peter , Blumbergs Peter
Published: November 2007

Two patients are reported, one with severe brain damage and epilepsy, and the other with limbic epilepsy, who were treated with unilateral microsurgical amygdalo-hippocampectomy for the control of rage and aggression. Both had significant improvement in their aggressiveness, and the second patient also improved in the frequency of his seizures and psychotic episodes. The significance of these observations for our understanding of the morphophysiological basis of rage and aggression is discussed.
The Relationship between Psychosocial Factors and Developmental Outcome for Very Low and Extremely low Birthweight Infants: A Review
Authors: Gyler Louise , Dudley Michael , Blinkhorn Susan , Barnett Bryanne
Published: November 2007

Over the last quarter century, the improved survival rate of very low birthweight infants has sharpened questions about their residual disabilities. Longitudinal studies have devoted attention to the cognitive and neurodevelopmental outcome of these infants, but much less is known about their long-term social and emotional development. Psychiatrists consulting to neonatal intensive care units and assessing these infants in their families, will be assisted by a better understanding of the developmental and psychological outcomes of such infants. This paper reviews the state of knowledge in both of these areas. It argues the paramount importance of psychosocial factors to the infants' developmental outcome, and the importance of longitudinal research in further clarifying the predictive value of these factors. In a subsequent paper, we consider the efficacy of interventions with this group.
The Snake on the Caduceus: Dimensions of Medical and Psychiatric Responsibility in the Third Reich
Authors: Hunter Ernest
Published: November 2007

The literature on the activities of medical professionals during the tumultuous years of the Third Reich has, over the last decade, increased substantially. However, many questions remain unanswered and the subject is likely to receive further attention following recent access to previously restricted archival material in Eastern Europe. In this paper, based on the English language literature, the author explores the role of medicine, and in particular psychiatry, in defining the bio-medical vision that was central to Nazi ideology.
The Concepts of Selfobject Function and Empathy in Couples Therapy
Authors: Gilhotra J.
Published: November 2007

A model is advanced for couples therapy that uses a dyadic approach in which the partners bring about change in themselves as well as in the other by learning to tolerate and support that change. The model utilises concepts of selfobject function and empathic interaction between the partners; these are taken from Kohut's theory of human development.
Supervision in the Training of a Psychiatrist
Authors: Clarke D. M.
Published: November 2007

Supervision is the cornerstone of psychiatric training and yet receives scant attention either in the psychiatric literature or in training institutions. It is frequently a focus of ambivalence for those involved. This paper discusses the functions of supervision and the roles of the supervisor in the belief that attention to these issues will help resolve a number of ambiguities that exist in the supervisory relationship.
Sexual Misconduct: Is Censure Enough?
Authors: Wilson Andrew , Hume Frank
Published: November 2007

Although sexual relationships between medical practitioners and their patients have been forbidden by most professional and statutory bodies, the reported prevalence of sexual misconduct does not appear to have altered in the last 20 years. A recent Australian study has also suggested that psychiatrists are over-represented in comparison to others in the medical workforce. The reasons that may account for this finding are discussed, and issues which require further debate by the profession are outlined. These include the acceptability of post-termination relationships, the applicability of criminal statutes, the role of treatment in the management of offenders, and whether mandatory reporting of sexual misconduct should be considered.
Inquiries at Lakeside and Aradale Hospitals: Lessons and Advances?
Authors: Tobin Margaret J.
Published: November 2007

The release of reports of inquiries into two related psychiatric hospitals (Lakeside and Aradale) in Victoria occurred in 1991. These inquiries identified deficiencies in patient care standards and organisational dynamics. Knowledge of institutional dysfunction was available from similar Australian and overseas inquiries but nonetheless this knowledge had not prevented organisational inertia and decline in these two psychiatric hospitals. This paper examines the possible contribution of a failed medical hegemony model to organisational dysfunction and discusses organisational life-cycles. It reaches the conclusions that politically motivated inquiries do not achieve long term positive outcomes and that there is a need for academic research into the organisation of psychiatric services and staff productivity and morale.
Chlorpromazine Turns Forty
Authors: Mitchell Philip
Published: November 2007

It is difficult for the contemporary psychiatrist to comprehend the impact that the introduction of chlorpromazine had on psychiatric practice in the early 1950s. With potent psychotropic medications largely taken for granted, our awareness of the limitations of these agents blinds us to the therapeutic revolution which they introduced.
Early Intervention in Schizophrenia
Authors: Birchwood Max , MacMillan Fiona
Published: November 2007

The management of schizophrenia may be characterised by two paradigms. The first approaches the schizophrenias as episodic relapsing disorders, where treatment is provided through both acute (crisis) care and to achieve prophylaxis. The second paradigm, sometimes arising from a failure of the first, is of “rehabilitation’, involving amelioration of disabilities, occasionally within a framework of relative asylum. We would propose a third paradigm of “early intervention”, involving a combination of medical and psychosocial interventions targeted at young, vulnerable people with the aim of preventing or limiting likely social, psychological and mental deterioration. Vigorous intervention early in the course of illness, early recognition and treatment of relapse and the promotion of psychological adjustment to psychotic illness are proposed as key elements of this third paradigm.
Cigarette Smoking and Psychiatric Morbidity in Women
Authors: Romans S. E. , McNoe B. M. , Herbison G. P. , Walton V. A. , Mullen P. E.
Published: November 2007

A random community survey of psychiatric morbidity in adult New Zealand women, the Otago Women's Health Survey, investigated the association of cigarette smoking with mental health. Of the women interviewed, just over one quarter (26.1%) smoked, with one third of these smokers consuming more than 20 cigarettes per day.

Demographic factors associated with smoking were younger age, lower socioeconomic status, poor education, caring for preschool children, dissatisfaction with female caring roles and financial strife. Psychiatric morbidity as measured by the short PSE was statistically associated with smoking. The unexpected finding reported here is a higher rate of recovery from their psychiatric morbidity amongst women who smoked. This result fits with previously reported data indicating that women use cigarette smoking to regulate mood and cope with the pressures of relentless child care in the context of strained financial resources.

The profile of the woman who smokes differed substantially from that of the woman who drinks alcohol in a hazardous manner. Different preventive strategies are therefore required for these two risky behaviours.
Hostility and Anger Measures in Coronary Heart Disease
Authors: Atchison Michelle , Condon John
Published: November 2007

Recent research addressing the link between psychological factors and risk of coronary heart disease (CHD) has focused on the areas of hostility and anger and produced sometimes contradictory results. This study makes use of four questionnaire measures of hostility and anger, which were administered to matched groups with and without CHD. Quicker experiences of anger with greater verbal expression best predicted CHD. The difficulties in teasing out the relative contributions of emotional expression, experience and personality using available questionnaires are discussed.
Depression, Introversion and Mortality following Stroke
Authors: Morris Philip L.P. , Robinson Robert G. , Samuels Jack
Published: November 2007

In this study, we examined the influence of clinical depression and personality introversion on 15-month mortality following stroke. Ninety-four stroke inpatients were examined two months post-stroke for clinical depression and pre-stroke personality characteristics of neuroticism and introversion. Fifteen months later, the vital status of 84 of these patients was able to be determined. Seven (8%) of the 84 patients died. Mortality rate increased from non-depressed to minor depressed and to major depressed patients (1 /48 [2%], 2/21 [10%] and 3/13 [23%], respectively) (χ2[trend] = 6.6, df = 1, p = 0.01). Patients who died had higher depression symptom scores (mean ± SD) than survivors (17.7 ± 6.0 versus 9.9 ± 7.1) (p = 0.006). Non-survivors were more introverted (i.e. had lower extroversion scores) than survivors (1.7 ±1.4 versus 4.2 ± 2.1) (p = 0.004). In multivariate analyses, introversion and depression were independently associated with mortality. We conclude that personality introversion and depression are associated with increased mortality following stroke.