bluuebunny/crossref_metadata_2025 huggingface dataset:
PLANNING OF A COMMUNITY‐BASED APPROACH TO INJURY CONTROL AND SAFETY PROMOTION IN A RURAL COMMUNITY
Authors: Loos Colleen , Oldenburg Brian , O'Hara Lily
Published: March 2003

This paper describes the planning of a community‐based approach to injury control and safety promotion, the Kolan Injury Prevention Program. The process involved the establishment of a local steering committee, 11 months of injury surveillance, a critical review of the evidence base, community consultations and assessment of community resources. There were 412 recorded injury cases during the surveillance period, with higher rates among men, manual workers, those aged 15–34 years, sport/leisure activities and around the home and farm. Salient issues for residents included a lack of access to safety information and skills, particularly with regard to first aid and bush fire for isolated residents and rurally inexperienced new residents. While injury prevention was identified as an important issue for the community, the rapidly changing size and nature of the community and its infrastructure made this a particularly challenging issue. Challenges included limited availability of volunteers from key sectors, lack of formal data collection systems, difficulties in mobilising support for a broad issue like injury, limited communication networks and the negative impact of distance and role uncertainty on community ownership of the program. This case study illustrates the steps involved in an effective community‐based needs assessment addressing injury prevention. Such an approach, if carried out systematically, will help ensure that the strategies and programs developed will be both appropriate and likely to obtain the support of the local community.
FARM INJURY IN TASMANIA
Authors: Mather Carey , Lower Tony
Published: March 2003

The aim of the study was to provide information about the type and severity of farming injury. Data were collected from industrial members of the Tasmanian Farmers and Graziers Association, using a valid and reliable self administered retrospective questionnaire covering the previous 2 years. A total of 506 responses were obtained, with 38% indicating there had been at least one injury sustained on their farm during this period. Of those reporting an injury, 18% were admitted, 30% attended an Emergency Department, 43% of injuries were seen by GPs at their surgery, 4% received first aid on the farm, 4% reported no treatment and 2% utilised another source. The results suggest that the sheep industries bear a disproportionate amount of the injury burden (30.5%) within Tasmanian agriculture. Information from this study can be used by other agricultural and health stakeholders to provide direction about the development of appropriate farm injury prevention strategies within rural communities in Tasmania.
INDIGENOUS MEN TAKING THEIR RIGHTFUL PLACE IN SOCIETY? A PRELIMINARY ANALYSIS OF A PARTICIPATORY ACTION RESEARCH PROCESS WITH YARRABAH MEN'S HEALTH GROUP
Authors: Tsey Komla , Patterson David , Whiteside Mary , Baird Leslie , Baird Bradley
Published: March 2003

ABSTRACT: Men's groups are increasingly being accepted as an important strategy in improving health and well‐being, especially in Indigenous communities. However, it is hard to find systematic documentation and evaluation of such initiatives in the literature. This paper analyses the formative stages of a participatory action research (PAR) process which aims to engage and support the members of the Yarrabah Men's Health Group plan, implement and evaluate their activities. Data for the paper are based on a combination of a review of relevant literature, analysis of project documentation, participant observation and discussion and reflection with the participants of the men's group. The paper highlights the importance of (a) using a reflective approach, such as PAR, to engage men's support groups to clearly define the principles and values which both define them and to which they aspire and (b) personal development, education and employment, as a prerequisite for Indigenous men taking greater control and responsibility for their lives.

 These types of micro‐level studies have important implications for the way community development is perceived and approached in Indigenous settings. There are also implications for the roles that academic researchers can play in supporting and adding value to community‐driven initiatives to the mutual benefit of both parties.
Contraceptive practice of women with opiate addiction in a rural centre
Authors: Harding Catherine , Ritchie Jan
Published: March 2003

This study aimed to explore the contraceptive practices of women in methadone treatment for opiate use in rural New South Wales and the reasons for those practices. Demographic characteristics, including age, marital status, sexual activity and contraceptive use, of all 23 women on a rural methadone program were documented. A smaller subgroup of seven women was interviewed using a semi‐structured qualitative technique and issues around contraception explored in more depth. The study found that women who did not use contraception often had a low perceived risk of pregnancy for a variety of reasons including past infertility, menstrual irregularities and effect of drugs. The women had concerns about, and often felt guilty about, the effect of drug use on their children. They also had concerns about the side‐effects of contraception. The study has implications for education and counselling of women when they enter drug treatment programs. Problems associated with opiate use are not just restricted to metropolitan areas but are part of rural health.
Therapeutic sclerokeratoplasty versus therapeutic penetrating keratoplasty in refractory corneal ulcers
Authors: Panda Anita , Sharma Namrata , Angra Surender K , Singh Rajvir
Published: March 2003

Purpose: To assess the efficacy of newer surgical technique of sclerokeratoplasty in cases of refractory corneal ulcers of the cornea and to compare it with therapeutic penetrating keratoplasty.

Methods: A randomized, prospective clinical trial in 20 eyes with refractory corneal ulcers was undertaken. Ten eyes each underwent sclerokeratoplasty (group I) or therapeutic penetrating keratoplasty (group II). Infections were considered cured if there was no evidence of corneal infiltration for 1 month following keratoplasty. Postoperative complications, visual acuity (VA), keratometry and graft status were evaluated with both the procedures after a minimum follow up of 1 year.

Results: Postoperative complications included epithelial defects, shallow anterior chamber, uveitis and secondary glaucoma, which were present following both procedures, with no significant difference in the frequency of complications between the two techniques (P < 0.05). Graft clarity and VA with both procedures were comparable. Significantly reduced astigmatism of < 1 D was seen in six eyes in group II in comparison with group I, where astigmatism of > 1.5 D was present in six eyes. Two eyes in group II developed re‐infection, of which one was re‐operated on, and the other developed endophthalmitis.

Conclusions: Sclerokeratoplasty is a useful alternative to therapeutic penetrating keratoplasty in cases of refractory corneal ulcers with optimum clinical and useful visual outcome.
Posttraumatic Stress Disorder, Dissociative Fugue and a Locator Beacon
Authors: Macleod A. D.
Published: March 2003

Objective: The aim of this paper is to report an aspect of the management of a case of dissociative fugue.

Clinical picture: A Vietnam veteran was suffering post-traumatic stress disorder.

Treatment: Treatment involved the provision of a locator beacon worn in a neck chain.

Outcome: This treatment resulted in the curtailment of the dissociative fugue episodes.

Conclusion: The locator device proved a useful component of a multimodal treatment regime.
Pathological Jealousy Appearing After Cerebrovascular Infarction in a 25-Year-Old Woman
Authors: Westlake Robert J. , Weeks Sara M.
Published: March 2003

Objective: To report pathological jealousy (Othello syndrome) occurring in a young woman with a right hemisphere cerebrovascular infarction and to review diagnosis and possible organic mechanisms for the generation of this syndrome.

Clinical picture: A 20-year-old woman was admitted to hospital with a right hemisphere stroke associated with a history of severe migraine and the use of oral contraceptives. The patient made a good recovery with minimal neurological deficits but 5 years later developed the syndrome of morbid jealousy with depression and a near fatal overdose.

Treatment and outcome: Morbid jealousy subsided, almost completely disappearing over a 6-week period of treatment with a selective serotonin re-uptake inhibitor (SSRI).

Conclusions: Case reports of the Othello syndrome and other content specific delusions following right hemisphere cerebrovascular infarction have appeared in geriatric psychiatry literature. The occurrence of a similar association in a young patient lends support to the suggestion of a causal relationship and has implications for diagnosis, clinical care and research.
An Integrated Treatment Algorithm for Pharmacotherapy and Psychotherapy
Authors: Kisely Stephen R. , Jones Judy
Published: March 2003

Objective: As in Australia, demand for psychotherapy is rising in Britain, and the wide variety of psychological treatments available within the National Health Service (NHS), the independent sector, and voluntary agencies leads to uncertainty about which patients are most suitable for which type of psychotherapy, as well as the appropriate balance between psychological and pharmacological interventions. This paper describes how Birmingham Health Authority (HA), the largest HA in England and Wales with a population of just under one million, developed and implemented an evidence-based strategy for the use of psychotherapy services.

Method: A literature search and health needs assessment for psychotherapy in Birmingham was performed.

Results: It was possible to estimate the need for evidence-based psychotherapy services using routinely available epidemiological data. By matching specific techniques to individual diagnosis and estimating the size of the population for whom this was appropriate, demand for psychotherapy exceeded service provision by a factor of four.

Conclusions: The following steps were undertaken: (i) setting priorities for the commissioning of psychotherapy on the basis of the scientific literature including greater use of brief and focused forms of integrative therapy from a variety of psychotherapeutic schools; (ii) targeting interventions on the basis of objective criteria to ensure that patients were referred for the appropriate level and intensity of psychological intervention using the full range of available services within the NHS, the independent sector, and voluntary agencies; (iii) agreeing on an integrated treatment algorithm (ITA) for the use of the most cost-effective treatments while ensuring that a range of alternative interventions was available for patients for whom a first line therapy was not suitable. Such an ITA could be adapted to assist general practitioners in their management and referral decisions; (iv) sharing skills between specialist psychotherapy services and members of primary and mental health teams through training, supervision and consultation–liaison.
A Patient-Based Voucher System for Brief Hospitalisation
Authors: Little John , Stephens David
Published: March 2003

Objective: The aim of this study was to demonstrate the clinical use of a patient-based voucher system for brief hospitalisation.

Clinical picture: A 31-year-old male, chronically disabled, with schizophrenia, poly-substance, and borderline personality disorders presented concerns for the treating team.

Treatment: Management was community based except for a single admission in which the patient chose the timing and duration via a predetermined set of vouchers.

Outcome: In contrast to previous admissions, a patient-chosen, voucher-based admission was single, brief and uneventful.

Conclusions: Novel approaches to chronically disabled patients with psychiatric illness enable change from therapeutic pessimism. A patient-based voucher system seemed to be of use in one patient.
Schizoaffective Disorder in a Fragile-X Carrier
Authors: Al-Semaan Yousef , Malla Ashok K. , Lazosky Andrea
Published: March 2003

Objective: Here we report the case of a schizoaffective psychosis in a female carrier of fragile-X (CGG sequence > 200).

Clinical picture: The patient presented with symptoms of psychosis (hallucinations, delusions and disorganised thinking) and mania, preceded by decline in intellectual and social functioning.

Treatment and outcome: Initial treatment with antipsychotic drugs alone or in combination with sodium valproate was only partially effective, but the addition of lithium resulted in a complete remission.

Conclusions: One year later the patient presented predominantly with deficit symptoms and profound deficits in memory and executive functions. It is likely that the intellectual deterioration around the time of puberty associated with fragile-X increased her vulnerability to a schizoaffective disorder and eventually to poor functioning.
Trauma-Induced Dissociative Amnesia in World War I Combat Soldiers. II. Treatment Dimensions
Authors: Brown Paul , Hart Onno van der , Graafland Mariétte
Published: March 2003

Objective: This is the second part of a study of posttraumatic amnesia in World War I (WW I) soldiers. It moves beyond diagnostic validation of posttraumatic amnesia (PTA), to examine treatment findings, and relates these to contemporary treatment of dissociative amnesia, including treatment of victims of civilian trauma (e.g. childhood sexual abuse).

Method: Key WW I studies are surveyed which focus on the treatment of PTA and traumatic memories. The dissociation-integration and repression-abreaction models are contrasted.

Results: Descriptive evidence is cited in support of preferring Myers' and McDougalls' dissociation-integration treatment approach over Brown's repression-abreaction model.

Conclusion: Therapeutic findings in this paper complement diagnostic data from the first report. Although effective treatment includes elements of both the dissociative-integrative and abreactive treatment approaches, cognitive integration of dissociated traumatic memories and personality functions is primary, while emotional release is secondary.
The Impact of Posttraumatic Stress Disorder on Partners and Children of Australian Vietnam Veterans
Authors: Westerink Jan , Giarratano Leah
Published: March 2003

Objective: This study explored the emotional and physical health of a group of families of Australian Vietnam veterans suffering posttraumatic stress disorder (PTSD). The aim was to study the impact of PTSD upon the families of the sufferers.

Method: The families of a random sample of Vietnam veterans receiving treatment at a specialist PTSD Unit were invited to participate in this study. Partners of the veterans and children over the age of 15 years were eligible to participate. Four selfreport psychometric inventories were administered assessing psychological distress, social climate within their families, self-esteem, and a range of lifestyle issues, including physical health. A control group, consisting of a sample of volunteers, was also surveyed.

Results: The partners of the Vietnam veterans showed significantly higher levels of somatic symptoms, anxiety and insomnia, social dysfunction and depression than the control group. They reported significantly less cohesion and expressiveness in their families and significantly higher levels of conflict. The partners also had significantly lower levels of self-esteem. The children of the veterans reported significantly higher levels of conflict in their families. However, the children showed no significant differences on measures of psychological distress and self-esteem from their matched counterparts.

Conclusions: These findings support overseas studies that indicate that the families of PTSD sufferers are also impacted by the disorder. In this study, the families of Australian Vietnam veterans experienced more conflict and their partners were significantly more psychologically distressed (i.e. somatic symptoms, anxiety, insomnia, social dysfunction, depression and low self-esteem) than a matched control group.
Are the Newer Antidepressant Drugs as Effective as Established Physical Treatments? Results from an Australasian Clinical Panel Review
Authors: Parker Gordon , Mitchell Philip , Wilhelm Kay , Menkes David , Snowdon John , Schweitzer Isaac , Grounds David , Skerritt Paul , Roy Kay , Hadzi-Pavlovic Dusan
Published: March 2003

Objective: The aim of this study was to determine, in a clinical panel sample, the extent to which patients with depression (and melancholic and non-melancholic subtypes) judged the effectiveness of previously received antidepressant treatments, particularly the comparative effectiveness of the older and newer antidepressant drugs.

Method: Twenty-seven Australasian psychiatrists assessed 341 non-psychotic depressed patients and rated the extent to which previous antidepressant treatments had been effective. Patients were assigned to ‘melancholic’ and residual ‘non-melancholic’ categories by two processes (DSM-IV decision rules, and a cluster analysis-derived allocation) and treatment effectiveness examined within each category.

Results: Electroconvulsive therapy (both bilateral and unilateral) was judged as highly effective by both melancholic and non-melancholic patients. Antipsychotic medication similarly rated highly (but was judged as more effective by the non-melancholic than melancholic patients). The tricyclics and irreversible monoamine oxidase inhibitors (MAOIs) were rated as more effective by the whole sample than several newer antidepressant classes (including the selective serotonin re-uptake inhibitors [SSRIs], venlafaxine, mianserin and moclobemide), whether effectiveness was examined dimensionally or categorically. Comparison of the overall tricyclic and SSRI classes indicated that any superior tricyclic effectiveness was specific to the melancholic subjects.

Conclusions: Despite methodological limitations intrinsic to such clinical panel data, the judged greater effectiveness of the older antidepressants (tricyclics and irreversible MAOIs) for melancholic depression is of importance. If valid, such data are of intrinsic clinical relevance but also have the potential to inform us about the neurobiological determinants of ‘melancholia’ and pharmacological actions which contribute to its effective treatment.
Child Sexual Abuse II: Treatment
Authors: Nurcombe Barry , Wooding Sally , Marrington Peter , Bickman Leonard , Roberts Gwenneth
Published: March 2003

Objective: To evaluate the scientific literature concerning the treatment of child sexual abuse.

Method: A critical review of the scientific literature.

Results: There are only nine published research studies in which subjects were randomly assigned to an index treatment or treatments and a comparison treatment or no-treatment control group. In seven of the studies, the index treatment exceeded the control or comparison group in regard to treatment outcome; in two studies it did not. The successful treatments involved group therapy, combined individual and group play therapy and cognitive behaviour therapy.

Conclusions: Treatment should be based on an explicit conceptual model of the psychopathology of sexual abuse. The University of Queensland Sexual Abuse Treatment Project, which is based on a transactional model, is described.
Maori and Alcohol: A Reconsidered History
Authors: Mancall Peter C. , Robertson Paul , Huriwai Terry
Published: March 2003

Objective: To document aspects of the history of alcohol use among Maori, with a particular focus on the period from 1840 to 1872 and to identify potential use of this knowledge in the development of strategies for the prevention and treatment of alcohol-related harm among Maori in contemporary New Zealand.

Method: A survey of the surviving documentation about alcohol in nineteenth-century New Zealand; materials were predominantly drawn from the writings of pakeha (non-Maori) missionaries, officials and travellers, as well as available statistical records.

Results: Analysis of early written historical records suggests significant variation in the response of Maori to the introduction of alcohol in different parts of New Zealand during the period following European contact.

Conclusions: One stereotype that has arisen suggests Maori have been incapable of and/or unable to manage the production and use of alcohol. On the other hand, another commonly held belief has been that Maori supported abstinence or ‘resisted alcohol’ because they recognised its ‘ruinous nature’ and because it was contrary to traditional custom and practices. Historical information indicates that the Maori response to the introduction of alcohol was in fact diverse and for much of the nineteenth century alcohol was non-problematic for many Maori. This reinterpretation of the historical record can potentially empower contemporary Maori to take greater responsibility for the use of alcohol. It also challenges the negativity of the stereotypes generated by historical misinformation.
The Role of Economic Evaluation in Mental Health Care
Authors: Singh Bruce , Hawthorne Graeme , Vos Theo
Published: March 2003

Objective: A consequence of the integration of psychiatry into acute and public health medicine is that psychiatrists are being asked to evaluate their services. There is pressure on mental health-care systems because it is recognized that funds should be directed where they can provide the best health outcomes, and also because there are resource constraints which limit our capacity to meet all demands for health care. This pressure can be responded to by evaluation which demonstrates the effectiveness and efficiency of psychiatric treatment. This paper seeks to remind psychiatrists of the fundamental principles of economic evaluation in the hope that these will enable psychiatrists to understand the methods used in evaluation and to work comfortably with evaluators.

Method: The paper reviews the basic principles behind economic evaluation, illustrating these with reference to case studies. It describes: (i) the cost of the burden of illness and treatment, and how these costs are measured; (ii) the measurement of treatment outcomes, both as changes in health status and as resources saved; and (iii) the various types of economic evaluation, including cost-minimization, cost-effectiveness, cost-utility and cost–benefit analysis.

Results: The advice in the paper provides psychiatrists with the necessary background to work closely with evaluators. A checklist of the critical questions to be addressed is provided as a guide for those undertaking economic evaluations. Conclusions: If psychiatrists are willing to learn the basic principles of economic evaluation and to apply these, they can respond to the challenges of evaluation.
Implications for Australia of the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder
Authors: Levy Florence
Published: March 2003

Objectives: This paper reviews the implications of the large-scale USA Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA) by the MTA Cooperative group for planning of clinical services for children with attention deficit hyperactivity disorder in Australia.

Method: The MTA study findings of no significant difference between active medication treatment alone, and combined medication combined with behaviour therapy treatments, on core symptom outcomes, are examined. Service traditions, workforce issues, diagnostic and ethical and philosophical considerations are discussed in relation to their impact on service planning in Australia. Implications of pharmacogenomic research are examined. Ethical and philosophical questions are raised in relation to the use of stimulant medications for subthreshold symptoms and for socialization of children.

Results: A critical evaluation of results reveals that combined treatments allow the use of lower medication doses, and that multimodal treatments are effective for comorbid symptoms. Completion of the Human Genome Project promises increasing technological advances. Arguments for and against a technological approach to child rearing are posited.

Conclusions: The MTA study raises not just service planning questions, but also important ethical and philosophical considerations about optimal degree of medicalization of services in an increasingly technological society. Child psychiatrists will be required to have an understanding of technological developments if they wish to contribute to future debates.
Cardiovascular Risk Factors for People with Mental Illness
Authors: Davidson Sandra , Judd Fiona , Jolley Damien , Hocking Barbara , Thompson Sandra , Hyland Brendan
Published: March 2003

Objective: The objective of this study was to document the prevalence of risk factors for cardiovascular disease among people with chronic mental illness.

Method: A cross-sectional survey was conducted of 234 outpatients attending a community mental health clinic in the North-western Health Care Network in Melbourne, Australia. Prevalence of smoking, alcohol consumption, body mass index, hypertension, salt intake, exercise and history of hypercholesterolemia was assessed.

Results: Compared with a community sample, the mentally ill had a higher prevalence of smoking, overweight and obesity, lack of moderate exercise, harmful levels of alcohol consumption and salt intake. No differences were found on hypertension. Men, but not women, with mental illness were less likely to undertake cholesterol screening.

Conclusions: Psychiatric outpatients have a high prevalence of cardiovascular risk factors which may account for the higher rate of cardiovascular mortality among the mentally ill. Further research is needed to trial and evaluate interventions to effectively modify risk factors in this vulnerable population.
Can We Manage Without the Mental Hospital?
Authors: Leff Julian
Published: March 2003

Objectives: Many developed countries, having invested massively in psychiatric hospitals in the past 150 years, are in the process of dismantling them. The central question is whether this change in the location of care from the psychiatric hospital to district-based services has benefited the patients. The objectives of this review are to examine the evidence on which an answer to the above question might be based.

Method: Much of the relevant research comes from the 13-year programme of the Team for the Assessment of Psychiatric Services conducted in London, but other research will be reviewed as appropriate.

Results and conclusions: Long-stay, non-demented patients, including the elderly, enjoy a better quality of life in the community homes compared with the psychiatric hospitals. Public attitudes constitute an obstacle to social integration into the healthy community, but can be ameliorated with local educational programmes. The provision of work has been unsatisfactory, but the development of social firms holds some promise. Patients with dementia receive better care in community nursing homes compared with hospital wards, according to their relatives' opinions, backed up by observational studies. The part of the service which is most unsatisfactory is the admission facilities. This is due to a variety of causes, including a failure to plan for the admission needs of discharged long-stay patients, the virtual absence of rehabilitation units in the community and an inadequate provision of a range of sheltered accommodation. However, these problems could be resolved with adequate investment in innovative facilities.
‘Why Getting Fat, Doc?’ Weight Gain and Psychotropic Medications
Authors: Malhi Gin S. , Mitchell Philip B. , Caterson Ian
Published: March 2003

Objectives: Weight gain associated with the use of psychotropic medications is a common clinical problem that is of particular importance because of its effects on the general health of psychiatric patients and their compliance with treatment. This paper aims to explore this issue and discuss the mechanisms of weight gain and methods of prevention.

Method: A literature review ( Index Medicus/Medline) was carried out as well as a review of other relevant papers and data known to the authors.

Results: Significant weight gain may result in considerable morbidity. The majority of psychotropic medications are associated with weight gain, however, the mechanisms of weight gain are often complex and poorly understood.

Conclusion: Clinically, weight gain can be anticipated and often managed with some success in the majority of psychiatric patients with simple but relatively effective measures. It is important for clinicians to be aware of this common clinical problem and educate patients from the outset, monitoring them regularly and intervening when necessary.
The Adjustment of Children of Australian Vietnam Veterans: Is There Evidence for the Transgenerational Transmission of the Effects of War-Related Trauma?
Authors: Davidson Ann C. , Mellor David J.
Published: March 2003

Objective: The presence of posttraumatic stress disorder (PTSD) in trauma survivors has been linked with family dysfunction and symptoms in their children, including lower selfesteem, higher disorder rates and symptoms resembling those of the traumatized parent. This study aims to examine the phenomenon of intergenerational transfer of PTSD in an Australian context.

Method: 50 children (aged 16–30) of 50 male Vietnam veterans, subgrouped according to their fathers’ PTSD status, were compared with an age-matched group of 33 civilian peers. Participants completed questionnaires with measures of self-esteem, PTSD symptomatology and family functioning.

Results: Contrary to expectations, no significant differences were found between the selfesteem and PTSD symptomatology scores for any offspring groups. Unhealthy family functioning is the area in which the effect of the veteran's PTSD appears to manifest itself, particularly the inability of the family both to experience appropriate emotional responses and to solve problems effectively within and outside the family unit.

Conclusion: Methodological refinements and further focus on the role of wives/mothers in buffering the impact of veterans’ PTSD symptomatology on their children are indicated. Further effort to support families of Veterans with PTSD is also indicated.
The Christchurch Health and Development Study: Review of Findings on Child and Adolescent Mental Health
Authors: Fergusson David M. , Horwood John L.
Published: March 2003

Objective: This paper provides an overview of the Christchurch Health and Development Study (CHDS) and a summary of findings relating to child and adolescent mental health.

Method: The CHDS is a longitudinal study of a birth cohort of 1265 children born in the Christchurch (New Zealand) urban region during mid 1977. This cohort has now been studied from birth to age 21.

Results: The paper examines the ways in which the study has been able to examine a wide range of issues. Key issues examined include: (i) measurement of disorder (respondent effects; dimensionality; scales vs categories); (ii) prevalence and treatment of disorder; (iii) stability and continuity of disorders; (iv) the contribution of risk and aetiological factors (e.g. lead exposure, parental divorce, child abuse, family adversity, sexual orientation) to psychosocial adjustment; and (v) the psychosocial consequences of mental health problems in adolescence.

Conclusions: The study findings illustrate the many advantages of a longitudinal study, such as the CHDS, in providing methodologically sound, theoretically relevant and cost effective research that caters for the interests of multiple end-users including the scientific community, clinicians and applied policy makers.
The Need for Mental Health Promotion
Authors: Herrman Helen
Published: March 2003

Objective: To examine the concept and evidence for mental health promotion, within an understanding of mental health and mental illness and their determinants.

Method: Aselective review of literature and opinion in the fields of public health and mental health.

Results: Mental health and mental illness are often given a low priority, despite growing evidence of the burden of disease and costs to the economy. Improving mental health and reducing mental illness will improve quality of life, public health and productivity. The needs for mental health promotion are complementary to the needs for prevention and treatment of mental illness. The required activities are different. Mental health professionals have a necessary but not sufficient role in mental health promotion.

Conclusions: An understanding that mental illnesses are treatable can encourage early entry to care, improve outcomes and lessen the stigma and discrimination related to mental illness. In primary health care there is some evidence that preventive interventions with groups at high risk of depression can prevent episodes of ill health. However, mental health promotion involves another dimension. Better understanding of the nature of mental health and mental illness is the key to changing the priorities, policies and practices in education, law, social services, housing and health critical in turn to the conditions conducive to mental health.
Characteristics of Adolescents with School Refusal
Authors: Mcshane Gerard , Walter Garry , Rey Joseph M.
Published: March 2003

Objective: To describe the characteristics of young people presenting with school refusal to a child and adolescent psychiatric unit and examine differences between those admitted for inpatient treatment and the rest.

Method: One hundred and ninety-two adolescents who had been assessed or treated for school refusal between 1994 and 1998 at the Rivendell Unit, Sydney, Australia were identified. An instrument was developed and used to gather data from files. Diagnoses were made by the consensus of two of the investigators using DSM IV criteria from all sources of information.

Results: The commencement of school refusal generally occurred in the first 2 years of high school. School refusers had a high prevalence not only of anxiety, but also of mood and disruptive behaviour disorders. A family history of psychiatric illness was present in over half the sample. There were no differences between those subsequently admitted as inpatients and the rest in terms of symptom scores, family composition, family conflict, family separation or history of abuse. Those admitted for inpatient treatment were more likely to have a diagnosis of mood disorders and comorbid diagnoses and to have a maternal history of psychiatric illness.

Conclusions: School refusal in adolescence can be a symptom of a variety of disorders, particularly anxiety and mood disorder. Treatment programs need to be geared to the range of diagnoses which occur in this patient group and to the various circumstances associated with the onset of the problem.
Whose Evidence? Lessons from the Philosophy of Science and the Epistemology of Medicine
Authors: Harari Edwin
Published: March 2003

Objective: To demonstrate the inadequacies of empiricism as a scientific foundation for evidence-based approaches to psychiatry.

Method: The principles of empiricism are reviewed in the light of developments in the philosophy of science and phenomenology. Case studies are selected from the history of physical sciences, biological science and clinical sciences (pathology, neuroscience, psychosocial science and psychopathology), paying particular attention to the role of observation in theory construction.

Results: The principles of empiricism, particularly its view of the nature of observation as the basis of evidence do not reflect the historical reality of scientific theorizing and practice. Science has constructed alternative models of its own activity that do justice to the complexities of its subject matter, including the world of human experience and mental illness.

Conclusions: A failure to recognize both the limitations of empiricism in science and the conceptual richness of alternative formulations that accord more closely with the complexity of psychiatry's domain will result in a naïve model of science and inadequate understanding of the limitations of ‘evidence’ that guide the training, clinical practice and research in our profession. The consequences will be the intellectual, clinical and ethical impoverishment of psychiatry.
The Role of Early Warning Symptoms in the Detection and Prevention of Relapse in Schizophrenia
Authors: Fitzgerald Paul B.
Published: March 2003

Objective: The capacity of most clinical programs to detect early signs of relapse in schizophrenia and to implement strategies to prevent clinical progression remains unevaluated. The aim of this paper is to review the literature on the detection of relapse in schizophrenia and to draw conclusions that may be of use in the implementation of clinical programs.

Method: The relevant literature identified by standard search methods is explored and analysed.

Results: Few studies have the capacity to directly address the question as to whether it is possible to predict relapse with a high degree of predictive power. Recently, the implementation of a multifactorial approach to relapse prediction appears to have offered substantial benefits.

Conclusions: The prediction of episodes of psychotic relapse is a realistic goal. Evidence indicates that interventions based upon programs of early detection can reduce rates of illness relapse. Prediction of relapse is most successful when implemented in a multifactorial way that involves specific and non-specific symptoms, structured ratings, clinical judgement, families, patients and clinicians.
Is Depression More Prevalent in Old Age?
Authors: Snowdon John
Published: March 2003

Objective: To examine the prevalence of depression in old age and to review cross-age studies that reported age-related differences in prevalence.

Method: Reports of studies that included data on the prevalence of depression in old age were reviewed, and conclusions from review articles were considered.

Results: Findings have been inconsistent, but majority opinion holds that depression (especially ‘subsyndromal’) is common in old age. There may be two peaks in the prevalence rate of major depression, one in late old age and the other in middle age or earlier.

Conclusions: The allocation of health care resources should not be determined by survey findings concerning the prevalence of major depression and dysthymia.
George L. Engel 1913–1999: Remembering his Life and Work: Strengthening a Father-Son Bond in a New Time of Grief
Authors: Engel Peter A , Engel Anna G
Published: March 2003

Objective: This essay reviews George Engel's clinical and scientific contributions within the context of a personal and professional biography. An examination of the response to the abrupt loss of human bonds resulting from the attack on the World Trade Center is used to verify Dr Engel's belief that relationship and communication are central to scientific study in the clinical setting and in the practice of medicine.

Methods: Engel's published autobiographical reports, personal reminiscences, and key scientific publications are reviewed in the light of published or broadcast personal responses to the World Trade Center disaster.

Results and Conclusion: Dr Engel recognized the singular importance of human bonds to the work of the physician. He described the unity of complex human experiences and basic biological processes. Public and personal grief evoked by destruction of those bonds on September 11 reflects an implicit, universal understanding of the essential human connections between us all. In the work of the physician, Dr Engel proposed disciplined study of those bonds to enrich personal connections, to promote understanding of patient and illness and to sustain the physician through emotionally and intellectually meaningful work. Herein lies the connection between Engel's contributions and the grief evoked by these events.
A Review of the Validity of the General Health Questionnaire in Adolescent Populations
Authors: Tait Robert J , Hulse Gary K , Robertson Suzanne I
Published: March 2003

Objective: To comprehensively review the validity of the General Health Questionnaire (GHQ) [ 1 ] with adolescents (aged 12–19). Although the GHQ has been extensively used and validated with adults and has been frequently used with adolescents, the validity data for this group are sporadic.

Method: Systematic review of the English language peer-reviewed literature.

Results: Eight studies were identified validating the GHQ with young people of which four included only adolescents and four studies involved young adults and adolescents. Of these eight studies, four used an English language version of the GHQ and four used a translated version.

Conclusions: The GHQ has demonstrated validity with older adolescents (17 + years) from the UK and Hong Kong (Chinese translation) and with girls aged 15 in the UK, but there are few data for either gender, aged less than 15 years. Studies in Australia and Italy reported a high proportion of misclassified cases while the studies in Spain and Yugoslavia included some older subjects (20 + years). Therefore, the validity of the GHQ for adolescents in populations other than the UK and Hong Kong remains to be demonstrated.

Implications: Psychiatrists and other mental health professionals need to be aware of the above limitations when using the GHQ as a screening instrument with adolescents. Further studies are required to: (i) determine the minimum age at which it can be employed, (ii) compare the use of adult versus adolescent criterion interviews, (iii) assemble relevant normative data, and (iv) establish the validity of translated versions.
Psychiatric Aspects of Self-Induced Epileptic Seizures
Authors: Ng Beng-Yeong
Published: March 2003

Objective: To review the literature on self-induced epileptic seizures and apply psychiatric knowledge to define possible causes and treatment recommendations.

Methods: A review of MEDLINE literature on self-induced epileptic seizures was conducted, followed by cross-referencing with the relevant neurologic, psychiatric and paediatric books and journals.

Results: The reported prevalence of self-induction varies depending on the setting. In most instances, self-inducers are people affected by photosensitive primary generalized epilepsy, in whom self-induction is by intermittent photic stimulation or, more rarely, pattern stimulation or eye closure. Self-induced seizures are most commonly absences with spike-wave, though eyelid myoclonia and generalized myoclonic jerks occur. Earlier studies indicate that the majority of self-inducers were of subnormal intelligence but more recent ones indicate that as a group they could not be considered mentally retarded. Monitoring in a well-lit environment is indicated in any therapy-resistant photosensitive patient to determine whether or not selfinduction occurs. Self-induced epilepsy is notoriously resistant to therapy and reasons for this resistance are discussed. An explanatory model for the initiation and maintenance of selfinduction behaviour is also included.

Conclusions: It is difficult to determine from published papers just what level of clinical difficulty self-induction of seizures actually posed to the patients and clinicians. In some cases there is contradictory evidence as to the degree of willfulness or self-induction. Self-induced epileptic seizures may be an important aspect of poor seizure control in a subgroup of epilepsy sufferers. These seizures might be modifiable by psychiatric intervention or behavioural modification.
Pro Re Nata Medication for Psychoses: The Knowledge and Beliefs of Doctors and Nurses
Authors: Geffen Josh , Cameron Allison , Sorensen Lene , Stokes Julie , Roberts Michael S. , Geffen Laurence
Published: March 2003

Objective: To examine the knowledge and beliefs of doctors and nurses in inpatient psychiatric units about pro re nata (PRN) (as needed) medications for psychotic disorders.

Methods: Medical (n = 44) and nursing (n = 80) staff in two metropolitan public hospital units completed a structured questionnaire about their use of PRN psychotropic medications on one occasion during the four months from March–June 1999.

Results: Nurses selected more indications for PRN antipsychotics than doctors (3.49 vs 2.72, p < 0.05), whereas doctors selected more indications for PRN benzodiazepines (3.77 vs 3.19, p < 0.05). The groups did not differ in the number of selected indications for using anticholinergics. For agitation, the majority of nurses viewed both benzodiazepines (56%) and antipsychotics (86%) as effective, with 60% preferring an antipsychotic. For the acute control of psychotic symptoms, 99% of nurses believed antipsychotics were effective and 58% benzodiazepines, with 87% preferring an antipsychotic. A large majority of doctors viewed both PRN benzodiazepines, 94%, and antipsychotics, 81%, as effective for agitation, and 55% preferred to use a benzodiazepine. For psychotic symptoms, 80% believed PRN antipsychotics were effective, but only 32% viewed benzodiazepines as effective, and 64% preferred to use an antipsychotic. Nursing staff identified more non-pharmacological techniques for managing both agitation and psychotic symptoms and reported using these more often than doctors. Junior staff, both nursing and medical, had less knowledge of nonpharmacological alternatives to PRN medication than senior staff.

Conclusions: Disparities existed between doctors and nurses views on the indications for PRN medication in the acute management of psychoses, thus it is important for doctors to specify indications when writing PRN prescriptions. Despite evidence for the safety and effectiveness of benzodiazepines, there was widespread reluctance to use them as PRN medication in acute psychoses. Beliefs of some staff about PRN medications were at odds with the known properties of these medicines. Educational interventions for both nurses and doctors are required to achieve best practice in PRN medication.
Australian and US Responses to Electroconvulsive Therapy Dosage Selection
Authors: Little John D , Mcfarlane Jo , Barton David , Varma Shashjit L
Published: March 2003

Objective: The practice of electroconvulsive therapy (ECT) varies considerably across sites with a lack of certainty as to what constitutes seizure adequacy. The aim of this study was to trial a method to explore decision making and to describe any differences between Australian and US practitioners.

Method: Two hundred and thirty-six consultant psychiatrists from Australia and US were asked what dosage of electrical energy they would prescribe after reading a standardized clinical vignette in which an unremarked upon change in seizure tracings followed the first two treatments.

Results: Considerable variability in the dosage was found with 17.3% decreasing, 46.8% maintaining and 30% increasing charge. Involvement in administration of ECT was unrelated to this decision.

Conclusion: Standardized vignettes may be a useful method to assess clinicians’ responses in dosage selection.