bluuebunny/crossref_metadata_2025 huggingface dataset:
Secondary Mania in Patients with HIV Infection
Authors: Ellen Steven R. , Judd Fiona K. , Mijch Anne M. , Cockram Alex
Published: March 2003

Objective: The aim of this study was to identify a cohort of patients with mania secondary to HIV infection, to describe the clinical and radiological features of HIV-related mania, and to describe the treatment outcome of the patients.

Method: All patients referred to the HIV consultation-liaison psychiatry service over the 29-month period from January 1993 to June 1995 were screened for the presence of manic symptoms. Diagnosis of mania was made according to DSM-III-R. Cases were defined as secondary mania if there was no clear history of mood disorder, and no family history of mood disorder. Cases were interviewed by the treating psychiatry registrar and psychiatrist to obtain information regarding present and past psychiatric history and family history of psychiatric disorder. The psychiatry registrar and consultant determined treatment.

Results: Twenty-three patients with mania were identified; 19 were considered to have secondary mania. The prevalence of secondary mania over the 29 months was 1.2% for HIV-positive patients, and 4.3% for those with AIDS. The clinical characteristics and response to treatment appeared to be similar to mania associated with bipolar affective disorder (primary mania). Neuroradiological abnormalities were common, occurring in 10 of the 19 patients, but did not appear to be clinically relevant. Cognitive impairment developed in five of the 15 patients where follow-up was possible.

Conclusions: Mania occurring in advanced HIV disease appears to be more common than expected from epidemiological data regarding bipolar affective disorder. Differentiating secondary from primary mania has implications for the management and prognosis of mania.
An Evaluation of a Surveillance System for Patients Discharged from the Acute Psychiatry Unit in Southern Tasmania
Authors: Sladden Michael J. , Thomson Alexander N.
Published: March 2003

Objectives: The aim is to evaluate the current community follow-up, or health surveillance, system for patients discharged from the acute psychiatry unit into the community in southern Tasmania.

Method: We developed a conceptual model which considered community mental health follow-up as analogous to an epidemiological surveillance system. The surveillance system was evaluated by prospectively following recorded contacts between the system and a cohort of 100 patients consecutively discharged from the acute psychiatry unit. Main outcome measures were attendance at follow-up appointments, patient re-engagement and hospital readmission.

Results: There is no formal system of follow-up and no policy relating to non-attenders of follow-up appointments after psychiatric hospitalisation. There is no defined role for private medical practitioners and agencies in the community. Of the 97 patients considered to need community follow-up, 11 patients were lost to follow-up after 3 months, while another 15 remained in the system because of hospital readmission. Afurther seven patients returned to the system during the following 2 years (six in year 1 and one in year 2) due to readmission. There is appropriate policy about the content and timing of discharge summaries; most summaries were sent promptly.

Conclusions: After discharge from the acute psychiatric unit, there was inadequate community follow-up of those patients for whom follow-up was considered necessary. Research is needed to determine whether increased patient follow-up is beneficial. Stakeholders should decide whether formal follow-up or health surveillance is necessary.
The Place for the Tricyclic Antidepressants in the Treatment of Depression
Authors: Boyce Philip , Judd Fiona
Published: March 2003

Objective: The new generation antidepressants have been an important advance in the treatment of depression. Since their introduction, their use has become widespread and the role of the older tricyclic antidepressants (TCAs) has been suggested only as a second-line choice. This assumption is questioned and the role of the TCAs as a first-line treatment for severe depression is discussed.

Method: The relevant literature concerning the efficacy, tolerability and safety of the antidepressant drugs is reviewed, particularly those studies which compare the newer antidepressant agents with the TCAs.

Results: The newer agents are equally as efficient as the tricyclics in the treatment of mild to moderate depression. There are indications that the TCAs are more efficacious for severe depression. The tolerability of the drugs appear about equivalent in terms of discontinuation rates; however, the side effects are different and clinicians need to be mindful of drug interactions and the potential of the serotonin syndrome with the selective serotonin re-uptake inhibitors (SSRIs), problems not found with the TCAs. The TCAs are potentially lethal in overdose; however, appropriate clinical management appears to be a more important issue than the toxicity of the medication.

Conclusions: The newer antidepressant agents are important advances in the treatment of depression. However, the TCAs still have an important place as the first-line treatment for patients with severe (melancholic/endogenous) depression.
The Measurement of Improvement During Hospitalisation for Acute Psychiatric Illness
Authors: Trauer Tom , Callaly Tom , Hantz Paul
Published: March 2003

Objective: The aim of this paper is to compare clinical changes and lengths of stay of patients with schizophrenic and affective disorders in public and private hospital settings.

Method: Recently published Australian work using the Health of the Nation Outcome Scales (HoNOS) was compared with new data collected in a public setting. Changes in HoNOS scores between admission and discharge were analysed against length of stay. Individual HoNOS items were also examined.

Results: Public facilities tended to show greater improvements, owing to higher admission severities, and their lengths of stay tended to be shorter. Certain HoNOS items, notably the self-harm item, were significantly more severe in both diagnostic groups on admission in the public facilities.

Conclusions: The findings are discussed in terms of the fact that self-harm is a criterion for involuntary hospitalisation, and private facilities do not treat involuntary patients. Certain problems assessed by the HoNOS are more amenable to rapid reduction than others, and this may contribute to differences in length of stay. Implications for outcome measurement are discussed.
An Early Settler in Sickness and in Health
Authors: Sheehan Garry
Published: March 2003

Objective: This paper is an examination of an early Australian settler's states of mind in episodes of psychosis and some issues from her life which may have contributed to the psychoses.

Method: Hospital records of her psychoses and her diary entries in the months surrounding the onset of illness were investigated from a psychoanalytic perspective, and inferences about her underlying personality are drawn from a recent publication about her diaries.

Results: An historical interpretation of her life and states of mind based on the documents is presented.

Conclusions: Failure to resolve psychic conflict led to restrictions in how she and her family lived, and left her susceptible to decompensation.
Use of Antipsychosis and Adjunctive Medications by an Inner Urban Community Psychiatric Service
Authors: Keks Nicholas A. , Altson Kylie , Hope Judy , Krapivensky Natalie , Culhane Christine , Tanaghow Amgad , Doherty Peter , Bootle Anne
Published: March 2003

Objective: The aim of this paper is to survey patterns of use of new generation and conventional antipsychosis and adjunctive drugs by an inner urban community psychiatric service.

Method: All prescriptions for antipsychosis medications and all patients receiving these drugs in May 1998 were identified. Case record review yielded demographic and diagnostic data. Information was also obtained directly from prescribers.

Results: Of 859 patients, 77% received antipsychosis medication; 53% of prescriptions for antipsychotics were for new generation drugs: risperidone (42%), olanzapine (37%) and clozapine (21%). Mean doses were 4.1 ± 2.5 mg (risperidone), 14.7 ± 8.2 mg (olanzapine) and 377.4 ± 178.9 mg (clozapine). Doses for men tended to be higher than those for women, but the differences were not significant. DSM-IV diagnosis was schizophrenia for 74% of patients on atypicals, but patients with other diagnoses were also being treated with these drugs. Risperidone was more commonly used in combination with benzodiazepines and anticholinergics than olanzapine and clozapine, while clozapine was less likely to be combined with antidepressants and mood stabilisers. Of the conventionals, 66% were in depot form, mostly because of non-compliance. Combinations of antipsychotics were prescribed to 13% of patients.

Conclusion: New generation antipsychosis medications were prescribed more commonly than conventional drugs in this service for a wide range of diagnoses. Adjunctive medications were commonly utilised. These findings underline the clinical complexity of antipsychotic treatment in a changing environment.
Dementia with Lewy Bodies
Authors: McKeith Ian , O'Brien John
Published: March 2003

Objective: The aim of this paper is to summarise recent clinical and research findings with regard to dementia with Lewy bodies (DLB).

Method: A literature review (Medline) was carried out, as well as a review of reports of recent DLB symposia of international meetings and of other relevant papers and data known to the authors.

Results: Dementia with Lewy bodies, as the disorder should be known, is the second commonest form of degenerative dementia, accounting for up to 20% cases in the elderly. It is characterised by fluctuating cognitive impairment, spontaneous parkinsonism and recurrent visual hallucinations. Consensus clinical and neuro-pathological criteria have been published. The clinical criteria have been shown to have high specificity, but may still lack sensitivity. Recognition of DLB is clinically important in view of the high incidence (60%) of adverse and life-threatening reaction to antipsychotics, the difference in prognosis and, possibly, the differential treatment response to cholinergic therapy. Neuroimaging changes have not been well described in DLB but some show promise as potential markers to differentiate DLB from AD. These include relative preservation of temporal lobe structures on magnetic resonance imaging and loss of pre- and postsynaptic dopaminergic markers on single photon emission tomography.

Conclusions: Dementia with Lewy bodies is a common cause of cognitive impairment in late life which appears to be clinically and neuropathologically distinct from AD. All clinicians should be aware of the typical triad of clinical features (fluctuating cognitive impairment, visual hallucinations and parkinsonism) which characterise the disorder and either avoid antipsychotics or prescribe them with extreme caution in such patients. Further research is likely to result in advances in diagnostic methods and therapeutics in the near future.
Treatment of Psychogenic Polydipsia: Comparison of Risperidone and Olanzapine, and the Effects of an Adjunctive Angiotensin-II Receptor Blocking Drug (Irbesartan)
Authors: Kruse David , Pantelis Christos , Rudd Ray , Quek Joy , Herbert Penny , McKinley Michael
Published: March 2003

Objective: Our objective was to determine the outcome of novel strategies in managing a case of severe polydipsia.

Clinical picture: The patient was a 39-year-old male with a 20-year history of paranoid schizophrenia who, despite only mild residual psychotic symptoms, had been hospitalized for the previous 10 years because of severe polydipsic behaviour complicated by water intoxication.

Treatment: Novel antipsychotic agents, risperidone and olanzapine, as well as the specific angiotensin-II receptor blocking drug, irbesartan were employed at selected intervals in a study lasting nearly 3 years. A strict behavioural management programme was ongoing, in which diurnal weight change and the number of breaches of weight limits, requiring management in a low-stimulus environment, were documented on a daily basis. Summary measures of diurnal weight change and behavioural intervention were charted against changes in treatment.

Outcome: Polydipsic behaviour improved on risperidone up to 4 mg daily, but was not sustained. Olanzapine was similarly successful in stabilizing polydipsia, and improvement was achieved with the addition of irbesartan.

Conclusion: We suggest that the D2-sparing profiles of receptor binding achieved with low-dose risperidone and olanzapine may account for this beneficial effect. The benefit derived with irbesartan implicates the involvement of brain angiotensin systems centrally in helping to regulate drinking behaviour.
Improving Services for People with a Psychotic Disorder and Problematic Substance Use: A Multifaceted Approach to Project Evaluation
Authors: Siegfried Nandi , Sainsbury Peter
Published: March 2003

Objective: The objective of this study was to conduct a multifaceted formative evaluation of the Central Sydney Area Health Service (CSAHS) Psychosis and Substance Use Project.

Method: Four evaluative methods were used: (i) description and interpretation of the Project's documented processes and outcomes; (ii) a benchmark comparison of the Project processes and outcomes against three of the 11 National Standards for Mental Health Services; (iii) a survey of the Project's key stakeholders; and (iv) interviews with 12 purposefully sampled key informants.

Results: The Project achieved its aim to develop a strategy to improve services for people with comorbid psychosis and problematic substance use. Three of the five Project objectives were fully achieved: examination of current clinical services, development of a clinical services plan, and development of a staff education programme. The Project partially achieved two objectives: development of an information system, and a research agenda. The Project and CSAHS performed well when measured against three of the National Mental Health Standards. Project participants perceived the Project to have been successful and worth continuing, identified some shortcomings and made recommendations for the second phase.

Conclusions: The participatory approach to the Project and the evaluation was successful. With some improvements the Project is worth continuing into a second phase. A multifaceted approach and qualitative research methods are useful for formative evaluation of health service programmes.
The Gender Identity Disorder in the DSM-IV Classification: A Critical Evaluation
Authors: Bower Herbert
Published: March 2003

Objective: The DSM-IV classification in its definition and description of the gender identity disorder omits a number of diagnostically significant features. This paper attempts to correct the deficiencies.

Method: The text under the headings: ‘Diagnostic features’, ‘Specifiers’, ‘Associated disorders’, ‘Laboratory findings’, ‘Prevalence’, ‘Course’ and ‘Differential diagnosis’ is subjected to a detailed scrutiny, using the author's experience as consultant psychiatrist to the Monash University Gender Dysphoria Clinic over a period of 25 years as source and background. Results of two studies of male-to-female and female-to-male transsexuals are given in the Table.

Results: DSM-IV criteria are augmented and the symptomatology focused. The existing gaps in the delineation of specifiers and associated features are closed by providing additional clinical material. The description of the course and the differential diagnosis are enriched.

Conclusions: Although the critical analysis of the DSM-IV classification of the gender identity disorder has shown the manual to be adequate, it nevertheless has shortcomings which may impede exact diagnosis.
A Pessimistic Attitude Towards the Future and Low Psychosocial Functioning Predict Psychiatric Diagnosis Among Treatment-Seeking Adolescents
Authors: Laukkanen Eila , Korhonen Veijo , Peiponen Sirkka , Nuutinen Marjatta , Viinamäki Heimo
Published: March 2003

Objective: The objective was to study factors associated with psychiatric diagnosis among adolescents (n = 164) seeking psychiatric care for mental symptoms.

Method: Psychiatric diagnosis was confirmed by a structured diagnostic interview. Psychosocial functioning was assessed with the Global Assessment of Functioning Scale, and the Beck Depression Inventory and Offer Self-Image Questionnaire were also used. Background data were gathered.

Results: A majority (76%) of the adolescents met DSM-III-R criteria for psychiatric diagnosis. The self-image was more negative and the Beck score was higher among these adolescents than the others. All who had attempted suicide had a psychiatric disorder. Those diagnosed as having a psychiatric disorder consumed alcohol in order to get drunk more often than others. Continual conflicts with parents and smoking were not associated with the existence of a psychiatric disorder. In logistic regression analysis, low psychosocial functioning (OR = 3.9) and an uncertain or pessimistic attitude towards the future (OR = 9.1) proved to be independent risk factors for psychiatric disorders.

Conclusions: Health service staff should be aware of factors associated with psychiatric disorders in adolescents so that they can identify those at high risk.
Measuring Mental Health Outcomes in a Private Psychiatric Clinic: Health of the Nation Outcome Scales and Medical Outcomes Short Form SF-36
Authors: Page Andrew C. , Hooke Geoffrey R. , Rutherford Elizabeth M.
Published: March 2003

Objective: This study reports on data collected from the routine use of the Health of the Nation Outcome Scales (HoNOS) and the Medical Outcomes Short Form (SF-36). Three main aims were addressed in using these measures: (i) to establish patient disability levels; (ii) to determine the level of treatment effectiveness; and (iii) to explore the ability of these instruments to predict length of stay and mood change.

Method: The clinician-rate HoNOS and the patient-rated SF-36 were included in the assessment battery, at admission and discharge, of consecutive inpatients (n = 754) at one private psychiatric facility over a 2-year period.

Results: The sample, on admission, was comparable in illness severity to levels reported at other Australian private psychiatric facilities. Treatment was shown to be effective, and the degree of changes in HoNOS ratings compared favourably with other private psychiatric facilities. Certain factors underlying the structure of the HoNOS and the SF-36 only weakly predicted length of stay and changes in depression and anxiety levels.

Conclusion: The HoNOS and the SF-36 provided valid and reliable data on patient function, with the HoNOS being most sensitive to treatment change. However, neither instrument proved useful in predicting length of stay or levels of depression and anxiety at discharge.
SPECT Scan in Somatization Disorder Patients: An Exploratory Study of Eleven Cases
Authors: Garcia-Campayo Javier , Sanz-Carrillo Concepcion , Baringo Teresa , Ceballos Concepción
Published: March 2003

Objective: There are no previous studies using single photon emission computed tomography (SPECT) scans in somatization disorder (SD) patients. The aim of this paper is to assess SPECT imaging abnormalities in SD patients and study any relation to laterality.

Method: Eleven SD patients from the Somatization Disorder Unit of Miguel Servet University Hospital, Zaragoza, Spain, not fulfilling criteria for any other psychiatric disorder and showing normal computed tomography (CT) and magnetic resonance imaging (MRI) images were studied with SPECT. Patients with DSM-IV axis I comorbidity were ruled out because it has been demonstrated that SPECT scans can show abnormalities in patients with depression and anxiety disorders. The technique used for SPECT was 99mTc-D,1,hexamethylpropyleneamide- oxime (99mTc-HMPAO) in four patients and 99mTc-bicisate in the other seven. The SPECT scans were evaluated without knowledge of clinical data and entirely by visual inspection.

Results: Seven out of 11 (63.6%) SD patients showed hypoperfusion in SPECT imaging. In four cases there was hypoperfusion in the non-dominant hemisphere and the predominance of pain symptoms took place in the contralateral hemibody. In the other three patients hypoperfusion was bilateral. The anatomical regions affected were cerebellum (four cases), frontal and prefrontal areas (three cases), temporoparietal areas (two cases) and the complete hemisphere (one case).

Conclusions: A proportion of SD patients may present hypoperfusion in SPECT images, uni- or bilaterally, in different brain areas. Possible aetiological explanations for this finding are discussed. Controlled studies are necessary to confirm or refute this hypothesis.
Prevalence of Psychological Distress and Psychiatric Disorders Among Homeless Youth in Australia: A Comparative Review
Authors: Kamieniecki Gregory W.
Published: March 2003

Objective: To review the prevalence literature on psychological distress and psychiatric disorders among homeless youth in Australia, and to compare these rates with Australian youth as a whole.

Method: Computerized databases were utilized to access all published Australian studies on psychological distress (as measured by standardized symptom scales and suicidal behaviour) and psychiatric disorders among homeless youth; in addition, unpublished Australian studies were utilized whenever accessible. A total of 14 separate studies were located, only three of which have included non-homeless control groups. In the current review, prevalence data from uncontrolled youth homelessness studies are compared with data from Australian community and student surveys.

Results: Homeless youth have usually scored significantly higher on standardized measures of psychological distress than all domiciled control groups. Youth homelessness studies have also reported very high rates of suicidal behaviour, but methodological limitations in these studies make comparisons with community surveys difficult. Furthermore, rates of various psychiatric disorders are usually at least twice as high among homeless youth than among youth from community surveys.

Conclusions: Homeless youth in Australia have extremely high rates of psychological distress and psychiatric disorders. As homeless youth are at risk of developing psychiatric disorders and possibly self-injurious behaviour the longer they are homeless, early intervention in relevant health facilities is required.
Psychiatric Assessment in Remote Aboriginal Communities
Authors: Sheldon Mark
Published: March 2003

Objective: The objective of this study was to describe the psychiatric assessment of Aboriginal patients from remote Aboriginal communities in Central Australia.

Method: The method consisted of a summary of the experiences gained during a dissertation year placement as senior registrar with the Northern Territory Remote Area Mental Health Team.

Results: Remote area Aboriginal psychiatry entails learning a whole new set of skills in terms of history taking and the mental state examination, a knowledge of the importance of extended kinship ties and cultural issues, the use of Aboriginal mental health workers as partners in assessing and managing patients via their families and accepting referrals from a wide range of sources.

Conclusions: Working on a service providing psychiatric care to remote area Aboriginal communities can be a deeply rewarding personal and professional experience.
Timing, Space and ADHD: The Dopamine Theory Revisited
Authors: Levy Florence , Swanson James M
Published: March 2003

Objective: The objective of this study was to review the dopamine theory of attention deficit hyperactivity disorder (ADHD) in terms of advances made over the last decade.

Method: ‘Hyper’ and ‘hypo’ dopaminergic theories are discussed, as well as noradrenergic and neuropsychological findings in ADHD. A model incorporating both anterior and posterior attention systems, involved in orienting, inhibition, vigilance and working memory, is described. Neuropsychological studies of covert orienting are reviewed.

Results: The dopamine theory is supported by neuroimaging, genetic and stimulant medication studies, which confirm an inhibitory dopaminergic effect at striatal/prefrontal level. Work in rodents and primates, as well as humans has shown that noradrenergic systems are also important in prefrontal regulation, in particular α2A noradrenergic agonists have a beneficial effect on cognitive tasks. Neuropsychological studies implicate posterior parietal mechanisms in the orienting of attention. Working memory may require integration of spatial and temporal information, involving anterior and posterior systems.

Conclusions: Anterior and posterior attention systems are involved in inhibition, working memory and orientation. Attention deficit hyperactivity disorder symptoms and subtypes are likely to reflect deficits in both inhibition and working memory, and may be heterogenous. While the dopamine theory is supported by genetic and stimulant medication studies, the work of Arnsten and colleagues suggests a potential role for α2 noradrenergic agonists such as guanfacine.
Predictors of Partially Met or Unmet Need Reported by Consumers of Mental Health Services: An Analysis of Data from the Australian National Survey of Mental Health and Wellbeing
Authors: Parslow Ruth A. , Parslow Ruth A. , Jorm Anthony F.
Published: March 2003

Objective: We examined data from the 1997 National Survey of Mental Health and Wellbeing to identify factors associated with consumers of mental health help reporting that their needs were unmet or only partially met. Predictor factors included sociodemographic variables, psychological morbidity measures and type of health practitioner seen.

Method: Five types of mental health help were considered: information, medication, psychological therapy, social interventions and skills training. A respondent's unmet need for each type of mental health help was given one of three values: 0: no unmet need reported; 1: some but not enough help of this type provided; and 2: no help of this type provided although it was needed. Multiple ordered logistic regressions were undertaken to identify predictor variables associated with reporting unmet need for each type of help.

Results: Few sociodemographic factors were found to be associated with consumers reporting unmet need for mental health help. Those with less education were more likely to report unmet need for medication. Being male, living alone and being unemployed were associated with unmet need for skills training. Having seen a general practitioner for mental health reasons was found to be associated with reporting unmet need for both information and social interventions. Self-identifying, or being diagnosed, as having an anxiety disorder was associated with reporting unmet need for four of the five types of help.

Conclusions: In this exploratory analysis, we examined factors associated with consumers of mental health help reporting that their needs were unmet or partially met. We found that the needs of those with anxiety problems were not generally well met. Our findings also indicate there is a need to continue to improve collaboration between the medical and community services sectors.
Suicidal Behaviour in People with HIV/AIDS: A Review
Authors: Komiti Angela , Judd Fiona , Grech Paul , Mijch Anne , Hoy Jenny , Lloyd John H. , Street Alan
Published: March 2003

Objective: To review the existing literature on suicidal behaviour in people with HIV/AIDS infection.

Method: A search on the Index Medicus/MEDLINE database was performed, for articles that investigated and/or reviewed suicidal behaviour in people with HIV at any stage of the illness. Only articles written in English were used in this review.

Results: Most studies have been done on homosexual/bisexual groups, with little data available for heterosexual populations or women. Studies show an increased rate of suicidal ideation, suicide attempts and completed suicide in individuals with HIV/AIDS. Of note, there is a high prevalence of psychiatric illness and substance abuse in those with suicidal behaviour.

Conclusions: The increased rate of suicidal behaviour in HIV-infected persons is consistent with findings in other medically ill groups with chronic, life-threatening disorders. However, assessment of any possible direct effect of HIV/AIDS on suicidal behaviour is confounded by methodological limitations of many of the studies. More longitudinal studies encompassing other affected groups including heterosexual populations and women are needed to elucidate the relationship between suicidal behaviour and HIV/AIDS.
Types of Patients in a Psychiatric Intensive Care Unit
Authors: Wynaden Dianne , Mcgowan Sunita , Chapman Rose , Castle David , Lau Peter , Headford Craig , Finn Michael
Published: March 2003

Objective: This paper reports the findings of a descriptive study of a patient population over a three-month period on an eight bed psychiatric intensive care unit (PICU) in Western Australia. The report provides a quantitative insight into the profile of patients in PICUs. It provides information on patients’ diagnoses, presenting signs, symptoms and/or behaviours, legal codes assigned to patients, treatment interventions and management.

Method: Data were collected prospectively from August to October 1999. A total of 122 patients were admitted to the PICU during the review period. Data were entered into an Access program then exported to SPSS (Version 9 for Windows) for analysis and frequency distributions were obtained.

Results: The results confirmed that the majority of patients admitted to the PICU were assessed as a high level of risk or needed containment. This finding is in line with the admission criteria developed by staff working in the PICU. It also supports the view that staff working in these units require expertise and confidence to communicate with and manage potentially aggressive and highly aroused patients.

Conclusion: This study demonstrates the importance of ongoing evaluations of patient populations in promoting best practice initiatives in psychiatric care.
The Identification and Treatment of Depression by General Practitioners
Authors: Krupinski Jerzy , Tiller John W.G.
Published: March 2003

Objective: To assess the level of recognition and knowledge about treatment of depression by General Practitioners (GPs).

Method: Analysis of questionnaires completed by participants commencing a series of workshops aimed at improving their knowledge of the diagnosis and treatment of depression. Of the 3289 GPs involved in the program 2500 (76%% respondent rate) completed the questionnaires in a group situation. There was no difference between respondents and nonrespondents in terms of age, gender and year of graduation.

Results: The majority of GPs believe they have a satisfactory competence in the recognition and treatment of depression, although a sizeable minority based their diagnosis predominantly on somatic symptoms. The GPs felt confident about their knowledge and skills in counselling and the use of antidepressant medication, but not in dealing with children and suicidal or pregnant patients. The most common symptoms used to identify ‘depression’ were sleep disorders and only 54%% listed depressed mood as a symptom on which the diagnosis is based. Only 28%% reported sufficient symptoms to meet criteria for DSM-IV major depressive disorder, which supports views that these criteria are inappropriate for general practice. Fifty-seven percent of doctors used medicine together with nonpharmacological treatment in the majority of patients, and medications doses were almost all within the range recommended in the product information.

Conclusions: There is a need to improve GPs knowledge in diagnosing depression, in child psychiatry and in dealing with pregnant and suicidal patients.
Reduction of Trauma Symptoms Following Group Therapy
Authors: Nisbet Wallis Denise A.
Published: March 2003

Objective: We examined the effect of a group programme for the treatment of adults suffering the sequelae of childhood abuse and/or neglect. Symptom reduction was the indicator of whether this group programme was an effective treatment modality.

Method: This was an experimental field study using a prepost design and General Linear Model (GLM) analyses. The group programme was conducted for adult survivors of child abuse and neglect and took place at Specialty Clinics, Central Coast Mental Health Services. There were 83 participants, comprising 64 women and 19 men; 56 were in the experimental group, and 17 in the control (waitlist) group. The Trauma Symptom Inventory (TSI) was administered to both experimental and control groups prior to receiving treatment and again three months later.

Results: General Linear Model analyses indicated there was a reduction of trauma symptoms for the experimental group on seven of the 10 scales of the TSI and on the three composite scales; no similar reduction was found for the control group.

Conclusions: The study indicates that this group programme may have been an effective treatment modality for abuse survivors. The level of symptomatology was reduced for those in the group programme compared with the control group for whom there were no changes.
Depictions of Mental Illness in Print Media: A Prospective National Sample
Authors: Coverdale John , Nairn Raymond , Claasen Donna
Published: March 2003

Objective: Because there are no published reports of depictions of mental illness in print media based on national samples, we set out to prospectively collect and analyse a near complete New Zealand sample of print media.

Methods: A commercial clipping bureau was contracted to provide cuttings of all items with any mental health or illness aspect over a four week period. These items were analysed for potentially positive and negative depictions and how mental illness was represented within each item. An independent search for additional newspaper items concerning one prominently featured topic indicated that the rate of identification of relevant stories was at least 91%.

Result: The collection consisted of six hundred print items which were most commonly news or editorial pieces (n = 562, 93.7%). Negative depictions predominated, with dangerousness to others (n = 368, 61.3%) and criminality (n = 284, 47.3%) being the most common. Positive depictions, including human rights themes, leadership and educational accomplishments occurred in 27% (n = 164) of all items. Generic mental illness terminology without reference to specific diagnostic categories was present in 47% of all items (n = 284).

Conclusions: Negative depictions that predominate confirm the stereotypic understanding of mental illness that is stigmatizing. These findings underscore the challenge facing us as mental health professionals attempting to change attitudes towards mental disorders when the stereotypes are so regularly reinforced.
Parent and Child Report of Family Functioning in a Clinical Child and Adolescent Eating Disorders Sample
Authors: Mcdermott Brett M , Batik Mary , Roberts Lynne , Gibbon Peter
Published: March 2003

Objective: To investigate parent and self-report of family dysfunction in children and adolescents with eating disorders. Further, to investigate family functioning differences across the eating disorders diagnostic groups; anorexia nervosa, eating disorders not otherwise specified (EDNOS) and bulimia nervosa, and between the restricting and binge-purge eating disorders behavioural subtypes.

Methods: The Family Adjustment Device General Functioning Scale (FAD-GFS) was administered to 100 children and their parents who presented consecutively at an eating disorders assessment clinic. DSM-IV eating disorders diagnoses in this group included 42 children diagnosed with anorexia nervosa, 26 with EDNOS, 12 with bulimia nervosa and 20 diagnosed as having no eating disorder.

Results: Both the parent and child FAD-GFS report demonstrated high internal consistency supporting the suitability of this instrument for research with this sample. Parent and child reports were moderately positively correlated. Total scores for all eating disorders diagnostic categories were significantly higher than community norms. Anorexia nervosa, EDNOS and bulimia nervosa groups did not significantly differ on parent or child reports. FAD-GFS profiles for restricters and binge-purgers suggest higher levels of family dysfunction in the families of binge purgers.

Conclusions: The FAD-GFS has suitable psychometric properties for use as a summary instrument with young people diagnosed with an eating disorder. However, more informative instruments assaying a greater range of constructs, especially in the impulsive, dyscontrol domain, are required to investigate differences among eating disorders diagnostic groups and behavioural subtypes.
A Cognitive Remediation Programme for Adults with Attention Deficit Hyperactivity Disorder
Authors: Stevenson Caroline S , Whitmont Stephanie , Bornholt Laurel , Livesey David , Stevenson Richard J
Published: March 2003

Objective: This is the first systematic examination of the efficacy of a cognitive remediation programme (CRP) for management of adult Attention Deficit Hyperactivity Disorder (ADHD). The CRP was designed to target problems commonly associated with adult ADHD, namely, attention problems, poor motivation, poor organizational skills, impulsivity, reduced anger control and low self-esteem.

Method: In a randomized, controlled trial, a representative sample of adults with ADHD (some medicated, some not) were assigned to either a CRP (n = 22) or a waiting list control (n = 21). The CRP was delivered in an intensive format with eight two-hour, weekly sessions with support people who acted as coaches, and participant workbooks with homework exercises.

Results: Participants who completed the CRP reported reduced ADHD symptomatology (effect size (d) = 1.4), improved organizational skills (d = 1.2) and reduced levels of anger (d = 0.5). Clinically significant improvements in ADHD symptomatology (d = 1.4) and organizational skills (d = 1.3) were maintained one year after the intervention.

Conclusions: These findings suggest that the CRP provides a practical way of enhancing daily functioning for adults with ADHD.
The Social and Cultural Context of the Mental Health of Filipinas in Queensland
Authors: Thompson Samantha , Manderson Lenore , Woelz-Stirling Nicole , Cahill Amanda , Kelaher Margaret
Published: March 2003

Objective: To describe the social and cultural context of risk surrounding the mental health of Filipino women living in Queensland, Australia and elicit the meaning and experience of mental health and illness for these women.

Methods: One hundred and thirty-nine in-depth interviews and 7 focus group discussions (FGDs) were nested within the baseline survey of the Filipina cohort of the Australian Longitudinal Study on Women's Health. Seventy-four in-depth interviews and 8 FGDs were conducted at follow-up. A semi-structured interview guide that included sections on emotional health, social support and changes guided these. A subset of responses was fully transcribed and analysed for ethnographic content and themes.

Results: ‘Mental’ problems are highly stigmatized, in comparison to ‘emotional’ problems that are believed to result largely from the absence of close family ties. The loss of these ties and the transition from a collectivist to individualist society are key themes related to emotional distress in Filipinas.

Conclusions: This understanding of meaning and context of mental health and its risk factors in migrants is important for informing public health and clinical practice and for the improvement of quantitative research instruments.
Demoralization: Its Phenomenology and Importance
Authors: Clarke David M. , Kissane David W.
Published: March 2003

Objective: Demoralization, as described by Jerome Frank, is experienced as a persistent inability to cope, together with associated feelings of helplessness, hopelessness, meaninglessness, subjective incompetence and diminished self-esteem. It is arguably the main reason people seek psychiatric treatment, yet is a concept largely ignored in psychiatry. The aim here is to review and summarize the literature pertaining to demoralization in order to examine the validity of the construct.

Method: A narrative review of demoralization and the related concepts of hope, hopelessness, and meaning is presented, drawing on a range of empirical and observational studies in the medical and psychiatric literature.

Results: An examination of the concepts of the ‘Giving Up–Given Up’ syndrome (George Engel), ‘suffering’ (Eric Cassell), and demoralization (Jerome Frank), demonstrate considerable convergence of ideas. Demoralization has been commonly observed in the medically and psychiatrically ill and is experienced as existential despair, hopelessness, helplessness, and loss of meaning and purpose in life. Although sharing symptoms of distress, demoralization is distinguished from depression by subjective incompetence in the former and anhedonia in the latter. Demoralization can occur in people who are depressed, cancer patients who are not depressed and those with schizophrenia. Hopelessness, the hallmark of demoralization, is associated with poor outcomes in physical and psychiatric illness, and importantly, with suicidal ideation and the wish to die.

Conclusions: Demoralization is an important construct with established descriptive and predictive validity. A place needs to be found for it in psychiatric nomenclature.
A Clinical and Neurobehavioural Review of High-Functioning Autism and Asperger's Disorder
Authors: Rinehart Nicole J. , Bradshaw John L. , Brereton Avril V. , Tonge Bruce J.
Published: March 2003

Objective: To compare, contrast and review clinical and neuropsychological studies of highfunctioning autism and Asperger's disorder.

Method: This paper reviews past and contemporary conceptualizations of autism and Asperger's disorder, together with epidemiological information, genetic and neurobehavioural findings. This paper focuses on neurobehavioural studies, in particular, executive functioning, lateralization, visual-perceptual and motor processing, which have provided an important source of information about the potential neurobiological dissociation that may exist between autism and Asperger's disorder.

Results: The clinical profiles of autism and Asperger's disorder contain a mixture of psychiatric and neurological symptoms: for example, movement abnormalities (i.e. stereotyped behaviours, hand flapping, toe walking, whole-body movements), atypical processing of parts and wholes, verbal and non-verbal deficits, ritualistic/compulsive behaviour, disturbances in reciprocal social interaction and associated depression and anxiety. The considerable clinical overlap between autism and Asperger's disorder has led many to question whether Asperger's disorder is merely a mild form of autism, or whether it should be considered as a separate clinical entity.

Conclusion: In light of the growing body of epidemiological information, genetic, and neurobehavioural evidence that distinguishes autism from Asperger's disorder, it is premature to rule out the possibility that these disorders may be clinically, and possibly neurobiologically separate.
Motherhood and Schizophrenic Illnesses: A Review of the Literature
Authors: Bosanac Peter , Buist Anne , Burrows Graham
Published: March 2003

Objective: To provide an overview of the current knowledge on the impact of motherhood on women with schizophrenia and schizoaffective disorder.

Method: The published literature was selectively reviewed and assessed, based on a complete MEDLINE and PsychLIT (1971 to current) search, including English and non-English journals and books.

Results: Research to date into motherhood and schizophrenic illnesses has been limited by a number of methodological constraints, limiting the ability to draw conclusions and the prevention of relapses and mother-infant difficulties. These constraints have included: a paucity of prospective studies with initial, antenatal recruitment; variable definitions of the length of the puerperium; significant changes in psychiatric classification; the heterogeneity of postpartum psychotic disorders, with the majority being mood or schizoaffective disorder rather than schizophrenia; selection biases inherent in studying mother-baby unit inpatients; difficulties in life events research in general, such as its retrospective nature and confounding, illness factors; and the specificity versus non-specificity of childbirth as a unique or discrete life event.

Conclusions: Further study is required to explore: the impact of child care, parenting and having a partner on the course of women with schizophrenic and schizoaffective disorders during the first postpartum year; whether women with postpartum relapses of these mental illnesses are likely to have slower recoveries than those women with the same diagnoses but without young children; and protective factors against postpartum relapse.
Vascular Risk to Late-Life Depression: Evidence from a Longitudinal Community Study
Authors: Hickie Ian , Hickie Ian , Simons Leon , Naismith Sharon , Simons Judith , Mccallum John , Pearson Kerrie
Published: March 2003

Objective: To determine prospectively relationships between minor cerebrovascular episodes and depressive symptoms in a community cohort of older persons.

Method: In 1988–1989, baseline measurements of vascular risk factors and depressive symptoms were obtained in older community residents (mean age = 67). At 10-year followup, three subgroups of subjects still residing in the community were re-assessed: those who had suffered a transient ischaemic attack (TIA) (n = 16) in the intervening period; those with hypertension but no TIAs (n = 38); and, those with neither TIAs nor hypertension (n = 40).

Results: Of the 16 persons with depressive symptoms at 10-year follow-up, only three had reported depressive symptoms initially. Subjects who had experienced TIAs during the longitudinal phase had higher rates of depressive symptoms than the subjects from the other two groups (38% vs 13%, p < 0.05).

Conclusions: This study supports the notion that cerebrovascular incidents predispose to late-onset depression in older persons residing in the community. Intrinsically, this provides epidemiological support for the validity of the concept of ‘vascular depression’.
Age-at-First-Registration and Heterogeneity in Affective Psychoses
Authors: Welham Joy L. , Thomis Richard , Mcgrath John J.
Published: March 2003

Background: Previous research into age of onset in affective disorders has produced conflicting results. This paper examines the influence of heterogeneity on the age-at-firstregistration distribution for the ICD-9 diagnostic group ‘affective psychosis’.

Method: For 1979–1991, data for age-at-first-registration for 4985 individuals diagnosed with affective psychosis (ICD-9 296.x) were extracted from a name-linked mental health register. These data were divided into (i) ‘296.1 only’, a category used to code unipolar depression (males = 700; females = 1321); and (ii) ‘296 other’, all 296 cases other than 296.1 (males = 1280; females = 1684). Inception rates for each 5-year age division were adjusted for the background population age-structure as a rate per 100 000 population.

Results: The age-at-first-registration distribution for affective psychosis has a wide age range, with women outnumbering men. There is a near-linear increase in inception rates for both men and women with 296.1 only, while the bulk of those with affective psychoses (296 other) have an inverted U-shaped age distribution. Males have an earlier modal age-atfirst-registration for 296 other compared to females.

Conclusion: The heterogeneity in terms of subtypes and sex in affective psychosis clouds the interpretation of age-at-first-registration. Separating those with unipolar psychotic depression from other subclassifications and differentiating by sex may provide clues to factors that precipitate the onset of affective psychosis.