bluuebunny/crossref_metadata_2025 huggingface dataset:
Temperament, childhood environment and psychopathology as risk factors for avoidant and borderline personality disorders
Authors: Joyce Peter R. , Mckenzie Janice M. , Luty Suzanne E. , Mulder Roger T. , Carter Janet D. , Sullivan Patrick F. , Robert Cloninger C.
Published: December 2009

Objective: To evaluate childhood experiences (neglect and abuse), temperament and childhood and adolescent psychopathology as risk factors for avoidant and borderline personality disorders in depressed outpatients.

Method: One hundred and eighty depressed outpatients were evaluated for personality disorders. Risk factors of childhood abuse, parental care, temperament, conduct disorder symptoms, childhood and adolescent anxiety disorders, depressive episodes, hypomania and alcohol and drug dependence were obtained by questionnaires and interviews.

Results: Avoidant personality disorder can be conceptualized as arising from a combination of high harm avoidance (shy, anxious), childhood and adolescent anxiety disorders and parental neglect. Borderline personality disorder can be formulated as arising from a combination of childhood abuse and/or neglect, a borderline temperament (high novelty seeking and high harm avoidance), and childhood and adolescent depression, hypomania, conduct disorder and alcohol and drug dependence.

Conclusions: Combinations of risk factors from the three domains of temperament, childhood experiences and childhood and adolescent psychopathology make major contributions to the development of avoidant and borderline personality disorders.
Case Managers' Attitudes to the Physical Health of Their Patients
Authors: Hyland Brendan , Judd Fiona , Davidson Sandra , Jolley Damien , Hocking Barbara
Published: December 2009

Objective: To examine the attitudes and practices of case managers working in Area Mental Health Services (AMHS) towards the physical health of people with chronic mental illness.

Method: Case managers at four AMHS in Melbourne participated in focus groups and completed a survey questionnaire.

Results: Case managers generally believed that mental illness, psychotropic medication and lifestyle factors contributed to the poor physical health status of their patients. Although many case managers attempted interventions aimed at improving physical health, there was inconsistency regarding the areas targeted. Preventive health measures were often neglected. Overall, there was a sense of pessimism around whether improved physical health was possible for people with chronic mental illness.

Conclusions: Lack of coordination among health professionals and the health system may contribute to the poor general health of people with mental illness. Patients often have difficulty accessing general practitioners and the culture within the AMHS can exclude considerations of physical health. Case management should include aspects addressing the physical health issues of AMHS clients.
Chronic Posttraumatic Stress Disorder and Family Functioning of Vietnam Veterans and Their Partners
Authors: Evans Lynette , Mchugh Tony , Hopwood Malcolm , Watt Carol
Published: December 2009

Objective: This study examines the association between posttraumatic stress disorder (PTSD), in terms of the three main symptom clusters (intrusion, avoidance and arousal), and the self-report of family functioning of Vietnam veterans and the self-report of family functioning of their partners. A second objective was to determine if depression, anger and alcohol abuse mediated between PTSD symptoms and family functioning.

Method: Vietnam veterans and their partners completed a series of questionnaires as part of their participation in the inpatient and outpatient PTSD treatment program, in the Veterans Psychiatry Unit, at the Austin and Repatriation Hospital.

Results: Data from 270 veterans and partners were used in the final analyses. The PTSD subscales were initially correlated with family functioning for veterans and family functioning for partners. Then two path diagrams were constructed and analyzed using the statistical program AMOS to test for mediating effects between PTSD symptoms and family functioning. For veterans there were significant initial correlations with all three subscales of the PTSD measure. In the path analysis when the mediating variables were included only the avoidance subscale of the PTSD measure remained directly associated with family functioning. The arousal PTSD subscale was mediated by anger. The measures of depression and anger were significantly associated with poor family functioning and the anger and the avoidance subscales were significantly associated with depression. In the second set of analyses conducted on data from partners, the PTSD symptoms of avoidance and arousal were initially correlated with family functioning. When the test for mediation was conducted none of the PTSD subscales remained associated with partners' self-report of family functioning. Posttraumatic stress disorder arousal and alcohol abuse were mediated by anger for partners' self-report of family functioning.

Conclusions: Posttraumatic stress disorder symptoms of avoidance for veterans, and comorbid symptoms of anger and depression for veterans, and anger on its own for partners appear to be important in the self-report of family functioning. These findings suggest that veterans and their partners have similar difficulties as couples with distressed relationships in the community.
A Mother's Attitude Towards her Infant and Child Behaviour Five Years Later
Authors: Bor William , Brennan Patricia A. , Williams Gail M. , Najman Jake M. , O'callaghan Michael
Published: December 2009

Objective: The relationship between maternal attitude to the infant at 6 months of age and behavioural outcomes at 5 years is explored, controlling for numerous demographic, child and psychosocial family factors.

Method: Data was used from the Mater-University Study of Pregnancy, an Australian longitudinal study of over 7000 mothers and children followed from pregnancy to when the children were 5 years. Measures ranging from the key variables of maternal attitude and child behaviour as well as numerous confounders were dichotomised. Logistic regression analyses were performed to examine the relationship between maternal negative attitude toward the infant and clinically significant levels of child behaviour problems and other infant risks, early social risks, and concurrent social risks.

Results: The results suggest that maternal negative attitude towards the infant at 6 months is an independent predictor of child behaviour problems at 5 years. This association remained significant for boys’ externalizing behaviours and girls’ internalizing behaviours.

Conclusions: The findings lend support to the concept of a sensitive period in early infancy; the need for a broad perspective in the assessment of the mother-infant relationship and the need for early intervention with dysfunctional mother-infant dyads.
Researching Psychiatry in Western Australia
Authors: Jablensky Assen
Published: December 2009

Objective: To provide an overview of the development, approaches and main research projects of the Centre for Clinical Research in Neuropsychiatry (CCRN) in Perth, Western Australia.

Method: Discursive.

Results: Underlying concepts, methods and selected findings of recent research into the neurobiology and epidemiology of schizophrenia, autism and other psychotic disorders are presented.

Conclusion: CCRN, one of Australia's youngest centres of psychiatric research, has invested fruitfully in research areas such as molecular genetics, neuropsychology, neurophysiology, behavioural pharmacology, diagnostic assessment procedures and record linkage epidemiology.
Australian Psychiatrists Today: Proud of their Profession but Stressed and Apprehensive about the Future
Authors: Rey Joseph M , Walter Garry , Giuffrida Michael
Published: December 2009

Objective: To examine the levels of satisfaction and stress of Australian psychiatrists.

Method: A survey was mailed in December 2002 to all Fellows of the Royal Australian and New Zealand College of Psychiatrists residing in Australia; 1039 out of 2059 (50%) returned the questionnaire.

Results: The large majority of respondents (79%) were proud of being a psychiatrist. Most (88%) reported being satisfied with their work. Reasons for dissatisfaction varied between public and private psychiatrists. Private psychiatrists nominated litigation/indemnity issues as the most frequent (69%) while the most common for public psychiatrists was lack of beds (47%). The main reason for satisfaction was helping patients get better (72%). Sixty-two percent found their work in the previous 12 months to be stressful. Dissatisfied psychiatrists were 11 times as likely to report being stressed as those satisfied. In the previous 12 months, 34% reported having had a threat of legal action, 39% had to answer a formal complaint, 67% had been verbally or physically abused by patients or relatives and 29% had patients who had suicided. Overall, psychiatrists were more pessimistic about the future than optimistic and 15% said they would not do psychiatry again. There were few differences according to state of origin or type of practice. However, females differed from males in several areas.

Conclusion: Helping patients was reported as the main source of satisfaction for Australian psychiatrists while not being able to provide the best care for patients was described as one of the main reasons for dissatisfaction. Although most Australian psychiatrists are satisfied and proud of their profession, they are stressed and often experience verbal or physical abuse and threats of legal action and complaints. They are apprehensive about the future. The increasing number of females in the profession, their higher levels of stress and dissatisfaction, and other differences from males must be taken into account as the profession reshapes its future. There is a need for regular surveys of this kind.
Some Recommendations to Assess Depression in Chinese People in Australasia
Authors: Chan Bibiana , Parker Gordon , Chan Bibiana , Parker Gordon
Published: December 2009

Objective: To provide some general recommendations for psychiatric assessment of depression among Chinese patients within a predominately Western society.

Method: A literature review is provided with interpretive comments.

Results: The prevalence of depression reported in community studies undertaken in Chinese communities is very low. To what extent Chinese people experience and seek help for depression, and how they report depressive symptoms have long been topics of some importance. The impact of acculturation as well as concepts and interpretations of illness in traditional Chinese medicine are discussed. Awareness of sensitive issues and practices within the Chinese culture will facilitate communication between medical professionals and patients, resulting in more accurate identification and diagnosis of depressive disorders.

Conclusion: Direct but culturally sensitive and empathic questioning of psychological symptoms is needed to unveil patients' explanatory models, as most Chinese initially nominate only somatic symptoms to health practitioners. Successfully treated patients can promote earlier and wider utilization of mental health services to other Chinese people.
Knowledge and Attitudes about Suicide in 25-Year-Olds
Authors: Beautrais Annette L. , John Horwood L. , Fergusson David M.
Published: December 2009

Objective: To examine knowledge and attitudes about suicide in a New Zealand sample of young people aged 25 years.

Method: The sample was a birth cohort of 1265 young people born in New Zealand in 1977 who have been followed in a longitudinal study for 25 years. At age 25, participants were asked a series of questions designed to assess their knowledge and attitudes about suicide.

Results: Young people had poor knowledge about youth suicide. They overestimated the number of youth suicide deaths, with a quarter believing that the number of deaths was at least 10× higher than the actual number. They overestimated the fraction of all suicides accounted for by youth suicides with two-thirds believing that 50% or more of all suicides occurred among young people. The most common source of information about suicide was the media. Young people tended to hold mixed attitudes toward suicide, having both liberal and conservative views. Those with lifetime histories of suicidal ideation or suicide attempt and those with family histories of suicide or suicide attempt tended to hold more liberal attitudes. Attitudes toward suicide were unrelated to gender and to knowledge about suicide.

Conclusions: Young people over-estimate the prevalence of youth suicide and the fraction of suicides accounted for by youth deaths, and hold both conservative and liberal attitudes toward suicide. Their primary source of information about suicide is the media. These findings raise concerns about the potential for media coverage of youth suicide issues to normalize suicide as a common, and thereby acceptable, response among young people, and suggest the need for careful dissemination of accurate information about suicide by knowledgeable, respected and reputable sources.
Single and Combined Psychotropic Medication Use in a Child and Adolescent Mental Health Service
Authors: Reed Elizabeth , Vance Alasdair , Luk Ernest , Nunn Kenneth
Published: December 2009

Objective: An audit of the extent and effectiveness of medication prescribing in a metropolitan child and adolescent mental health service (CAMHS) is presented, given the lack of data about medication effectiveness in CAMHS.

Method: The audit involved: (i) determining the rates of prescription of different medications, the symptoms, syndromes and diagnoses for which they were used, and the profession of the medication prescriber; and (ii) a semistructured interview of clinicians using combination pharmacotherapy enquiring about the rationale for its use and the outcomes obtained.

Results: Two hundred and thirty-five patients using medication were included in the study. A range of medications were prescribed, both alone and in combination. Indications for combination therapy were a single medication being ineffective or associated with adverse effects. They were targeted at symptoms and were associated with no increase in adverse effects. Trainees did relatively little prescribing.

Conclusions: This study confirms earlier findings that medical practitioners are prescribing combination pharmacotherapy despite a lack of research to support this practice. Trainees working in CAMHS may be receiving inadequate experience in prescribing psychotropic medication.
A Comparative Evaluation of Community Treatments for Post-Partum Depression: Implications for Treatment and Management Practices
Authors: Highet Nicole , Drummond Peter
Published: December 2009

Objective: To compare existing community treatments for post-partum depression (PPD), treatment efficacy was evaluated for 146 women seeking treatment for PPD in the local community.

Method: Self-report questionnaires were designed to assess clinical depression and anxiety (psychological and physiological), risk factors, treatment satisfaction and the impact of social supports.

Results: Comparison of treated subjects with those on a wait-list demonstrated that depression and the psychological component of anxiety decreased significantly after treatment. Psychological and pharmacological interventions produced similar clinical benefit in the treatment of psychological symptoms, and receiving both treatments in combination was of no added clinical benefit in the immediate or longer term. Individual treatment was associated with more rapid treatment gains initially than group treatment. However, the benefits of group treatment emerged during the 6 months following treatment, leading both interventions to be equally effective in the longer term. Cognitive behavioural therapy was not superior to the combination of non-specific counselling or behavioural strategies, either immediately following treatment or 6 months later.

Conclusions: Clinical efficacy together with other clinical and financial benefits strongly advocate the application of psychological treatment for PPD. Clear parallels between PPD and general depression support the application of knowledge about general depression to extend understanding of PPD and refine clinical management practices.
Longitudinal Designs, Methods and Analysis in Psychiatric Research
Authors: Anstey Kaarin J. , Hofer Scott M.
Published: December 2009

Objective: To outline the strengths and limitations of longitudinal research designs in psychiatry, and to describe different types of longitudinal designs and methods for analyzing longitudinal data.

Method: Key references on longitudinal methods were reviewed and examples drawn from literature in psychiatry and psychology.

Results: Longitudinal studies provide important information regarding the incidence and developmental trajectories of mental disorders. They allow for identification of risk factors and developmental concomitants. Recent developments in statistical methods for analyzing longitudinal data provide efficient estimates of change and predictors of change over time, identification and characteristics of distinct subgroups defined by change pattern, and improved methods for obtaining unbiased population estimates when data are incomplete.

Conclusion: Longitudinal designs, methods and analysis can contribute to psychiatric studies on risk factors for common mental disorders, studies of early intervention and prevention and treatment outcomes.
Australian and New Zealand Clinical Practice Guidelines for the Treatment of Bipolar Disorder
Authors:   Royal Australian And New Zealand College Of Psychiatrists Clinical Practice Guidelines Team For Bipolar Disorder
Published: December 2009

Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority

Method: For these guidelines, the CPG team reviewed the treatment outcome literature (including meta-analyses) and consulted with practitioners and consumers.

Treatment recommendations: This guideline provides evidence-based recommendations for the management of bipolar disorder by phase of illness, that is acute mania, mixed episodes and bipolar depression, and the prophylaxis of such episodes. It specifies the roles of various mood-stabilizing medications and of psychological treatments such as cognitive therapy and psycho-education.
Psychiatric Disorder in Women with Early Stage and Advanced Breast Cancer: a Comparative Analysis
Authors: Kissane David W. , Grabsch Brenda , Love Anthony , Clarke David M. , Bloch Sidney , Smith Graeme C.
Published: December 2009

Objective: To assess psychosocial morbidity in women with breast cancer and to compare the differential rates between women with early stage and advanced disease.

Method: In this report, 303 women with early stage breast cancer, psychiatrically assessed at baseline (as part of a study of cognitive-existential group therapy during adjuvant chemotherapy), are compared with 200 women with advanced breast cancer (similarly assessed in a trial of supportive-expressive group therapy). A structured psychiatric interview plus self-report measures were used to assess psychiatric morbidity, quality of life and cognitive attitude to cancer.

Results: The early stage patients, whose mean age was 46 years, were on average 3 months post-surgery and had an overall prevalence of DSM-IV psychiatric diagnosis of 45%. The metastatic patients, whose mean age was 51 years, were on average 63 months post-primary diagnosis and had an overall prevalence of DSM-IV diagnosis of 42%; the difference between the two rates was not statistically significant. Of women with early stage breast cancer, 36.7% had mood disorders, 9.6% suffering from major depression and 27.1% from minor depression. In the metastatic sample 31% had mood disorders, 6.5% having major depression and 24.5% with minor depression. Anxiety disorders were present in 8.6% of the early stage group and 6% of women with advanced disease. Fatigue, a past history of depression, and cognitive attitudes of helplessness, hopelessness or resignation were significantly associated with depression in both groups. The women from the metastatic sample were significantly less distressed by hair loss but more dissatisfied with body image, and had higher rates of lymphoedema and hot flushes than the early stage women.

Conclusions: The rates of psychosocial distress are high, and similar, across patients with both early and advanced stage breast cancer, although the illness related causes of distress are different. These data present a challenge to clinical services to provide a comprehensive range of support services to ameliorate this distress.
Self-Esteem in Patients who have Recovered from Psychosis: Profile and Relationship to Quality of Life
Authors: Gureje Oye , Harvey Carol , Herrman Helen
Published: December 2009

Background: New developments in pharmacotherapy are likely to improve substantially the symptomatic recovery from psychosis but low self-esteem may compromise quality of life.

Aims: To investigate the profile and correlates of self-esteem in individuals who have achieved symptomatic recovery from psychosis and determine its relationship with quality of life.

Method: Sixty-one individuals who had been free of psychotic symptoms for 6 months were selected during a community-based epidemiological survey of psychoses. Participants were evaluated for subjective assessment of self-esteem using a self-report questionnaire, for clinical and antecedent features of illness, and for quality of life.

Results: Forty-three percent had scores in the range indicative of low self-esteem on the questionnaire. Level of self-esteem was unrelated to gender, employment status, the type of psychotic disorder, course of disorder or premorbid social adjustment. Depression was associated with reduced levels of self-esteem. However, independent of depression and other confounding variables, a low level of self-esteem was a risk factor for impaired quality of life.

Conclusions: Self-esteem is often low among persons who have achieved symptomatic recovery from psychosis, is associated with depression and is a predictor of quality of life.
Duration of Untreated Psychosis and Treatment Outcome in Schizophrenia Patients Untreated for Many Years
Authors: Srinivasan Tirupati N. , Rangaswamy Thara , Raman Padmavati
Published: December 2009

Objective: The duration of untreated psychosis (DUP) influences treatment outcome in schizophrenia but its relevance in untreated patients, ill for a very long duration, is not known. This study examined outcome and factors related to it after one year of treatment of schizophrenia patients who were ill for many years and not previously treated.

Method: Among 75 never-treated patients with schizophrenia detected in a community survey in Chennai, India, 49 took treatment and were followed up prospectively for one year. Evaluation at intake and outcome was carried out using standardized methods.

Results: A good clinical outcome in 29%, social outcome in 35%, occupational outcome in 51% and global outcome in 31% was observed at the end of one year. Patients with poor global outcome did not significantly differ from those with good outcome on demographic and clinical variables at intake but for the presence of delusions and formal thought disorder. The proportion with good outcome in clinical, work and global measures fell steadily with increasing DUP. This difference was significant for clinical and global outcomes after a DUP of 5 years.

Conclusions: The relationship between DUP and response to treatment held good even in chronic stages of schizophrenia with longer DUP associated with poorer outcome.
Psychological Trauma: Psychiatry and the Law in Conflict
Authors: Tennant Chris
Published: December 2009

Objective: To contrast the psychiatric and legal construct of psychological trauma, with posttraumatic stress disorder (PTSD) as the reference disorder.

Method: Literature relevant to DSM-IV PTSD definition of a traumatic event (Criterion A) was assessed. This construct was compared with the current legal status for psychological trauma arising from recent judgements of the Australian High Court.

Conclusions: The current legal construct of psychological trauma is not only practical and sensible, but is far more evidence-based than the DSM-IV construct of trauma.
‘Kindling Theory’ in Arson: How Dangerous are Firesetters?
Authors: Brett Adam
Published: December 2009

Objective: This article aims to review the literature on firesetters particularly looking at recidivism rates. The early literature described firesetters as dangerous individuals. This article reviews the more recent empirical data to examine if it supports the early literature.

Method: A literature review was performed examining papers which described firesetters with any reference to recidivism. These were divided into three broad categories based on where studies have been performed, namely in forensic psychiatric settings, the criminal justice system and general and psychiatric hospitals.

Results: The literature has been poorly focused and provides little help when assessing an individual firesetter. Risk factors associated with general criminology have been cited.

Conclusions: The empirical literature cannot support the hypothesis that firesetters are inherently dangerous. More research should target different groups of firesetters and examining individual risk within that group with an aim of researching treatment for the different groups.
Bipolar II Disorder: Personality and Outcome in two Clinical Samples
Authors: Joyce Peter R. , Joyce Peter R. , Luty Suzanne E. , McKenzie Janice M. , Mulder Roger T. , McIntosh Virginia V. , Carter Frances A. , Bulik Cynthia M. , Sullivan Patrick F.
Published: December 2009

Objective: To compare the personality traits and disorders of patients with bipolar II disorder and major depression and to examine the impact on treatment outcome of a bipolar II diagnosis.

Method: Patients from two clinical trials, a depressive sample (n = 195, 10% bipolar II) and a bulimic sample (n = 135, 16% bipolar II), were assessed for personality traits using DSM-IV criteria. Patients were randomised to treatments (fluoxetine or nortriptyline for depressive sample; cognitive behaviour therapy for bulimic sample) and followed for 3 years (depressive sample) or 5 years (bulimic sample) to assess the impact on outcome of a bipolar II diagnosis.

Results: Bipolar II patients were assessed as having more borderline, histrionic and schizotypal personality traits than patients with major depression. A baseline bipolar II diagnosis did not impact negatively on treatment outcome, and less than 5% of bipolar II patients developed bipolar I disorder during follow up.

Conclusions: The low rate of conversion of bipolar II to bipolar I disorder and the lack of adverse impact of the diagnosis on outcome, questions the need for antimanic or mood stabliser medication in most bipolar II patients.
Length of Therapy with Selective Serotonin Reuptake Inhibitors and Tricyclic Antidepressants in Australia
Authors: Mcmanus Peter , Mcmanus Peter , Mant Andrea , Mitchell Philip , Dudley John
Published: December 2009

Objective: To investigate the proportion of patients starting on either selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) who continued treatment for a period consistent with recommended guidelines for major depression, that is at least 6 months.

Method: Cohort study using a national dispensing claims database involving patients eligible for social security entitlements in Australia. Two ‘new user’ cohorts were established of patients who were supplied a prescription for either an SSRI (6026) or a TCA (4158) in the first week of April 2000 and who had not received a prescription for any antidepressant in the preceding three months. The main outcome measure was the proportion of patients who were still having any SSRI or TCA prescription, respectively, dispensed between 6 and 8 months after initiation. Additionally, for patients starting on either a leading SSRI (sertraline) or TCA (dothiepin), the proportions of those that remained on these drugs or had changed to other antidepressants were determined. The dispensing data are not linked to reason for prescribing in the national dataset.

Results: 2267 SSRI ‘new users’ (38%) were still receiving SSRIs 6–8 months later, compared with 1269 (31%) of the 4158 TCA ‘new users’ (p < 0.001). The difference between the groups occurred early, by the 2–4 month time interval. 1038 (41%) of patients starting on the individual SSRI and 385 (38%) of patients starting on the individual TCA were receiving some type of antidepressant therapy at 6–8 months, with no significant difference (p = 0.6) in the proportions that had changed to another antidepressant.

Conclusions: In 2000, only 40% of patients started on an antidepressant continued to be prescribed some antidepressant therapy 6–8 months later. Patients were more likely to continue on SSRIs as a class than on TCAs and the difference in continuation between these two classes occurred within the first 2 months of therapy. However, patients starting on an individual SSRI or TCA were equally likely to change to another antidepressant.
Screening for Depression in Women with Metastatic Breast Cancer: A Comparison of the Beck Depression Inventory Short form and the Hospital Anxiety and Depression Scale
Authors: Love Anthony W. , Grabsch Brenda , Clarke David M. , Bloch Sidney , Kissane David W.
Published: December 2009

Objective: To compare two self-report questionnaires for identifying possible depression in women with metastatic breast cancer.

Method: We conducted structured psychiatric interviews and administered the Beck Depression Inventory Short Form (BDI-SF) and Hospital Anxiety and Depression Scale (HADS) to 227 women with stage IV breast cancer. The accuracy for identifying DSM-IVdefined major and minor depression was examined. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated and receiver operating characteristic curves plotted.

Results: Seventy-four (32.6%) patients satisfied DSM-IV criteria for a depressive disorder. With a cut-off of 4, the BDI-SF had a sensitivity of 0.84, specificity of 0.63, and PPV of 0.52. A cut-off of 11 on the HADS-Depression scale (HADS-D) resulted in sensitivity, specificity, and PPV of 0.16, 0.97, and 0.75, respectively. For major depression alone, the BDI-SF with a cut-off of 5 had excellent sensitivity but poor PPV; the HADS, with a cut-off of 7, had weak sensitivity and PPV.

Conclusions: Overall, the two scales perform similarly in identifying major depression, while the BDI-SF is the more useful in screening for DSM-IV major or minor depression categories in this clinical group.
Women Psychiatrists and Research: So Far, no Further? An Australasian Perspective on Factors that Encourage and Hinder Women Psychiatrists' Involvement in Research
Authors: Favilla Amanda , Bloch Sidney
Published: December 2009

Objective: Relatively few women psychiatrists conduct research during their careers. Little is known as to what accounts for this consistent finding. We sought to ascertain factors that might be pertinent among women Fellows of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Our long-term goal is to identify measures that could boost the proportion of women who become involved in research.

Method: We submitted a questionnaire to the 670 women Fellows of the RANZCP in which we asked them whether they participated in research and what factors they considered helpful or detrimental to the pursuit of an interest in research.

Results: Of the 375 (56%) respondents, 116 (31%) could be assigned to a researcher group (RG). Members of the RG more often identified features in their professional environment and access to mentors as facilitating research involvement compared to the non-researcher group (NRG). The RG had dedicated more time to research as well as to teaching, and less to clinical practice, compared to the NRG. Although family obligations affected both groups, the RG cited these as exerting less of an impact on their career than their non-researching colleagues.

Conclusions: Given the factors that distinguish researching from non-researching Fellows, attention needs to be paid to the ethos of the professional environment, mentoring, and training opportunities in research in order to increase the recruitment of women investigators.
Cognitive Functioning in Young People with First Episode Psychosis: Relationship to Diagnosis and Clinical Characteristics
Authors: Fitzgerald Dianne , Fitzgerald Dianne , Lucas Sara , Redoblado Marie Antoinette , Winter Virginia , Brennan John , Anderson Josephine , Harris Anthony
Published: December 2009

Objective: To examine the extent and nature of neuropsychological deficits in adolescents and young people with first episode psychosis (FEP), and to determine whether the pattern and extent of neuropsychological deficits varied according to diagnosis.

Method: A total of 83 FEP subjects aged 13–25 years, and 31 healthy controls completed a comprehensive battery of neuropsychological tests, grouped into 10 cognitive domains. First episode psychosis subjects were stratified into three diagnostic groups (schizophrenia, affective disorders, substance-induced psychosis) and differences in cognitive profiles were examined. The contribution of demographic and clinical characteristics to cognitive performance was also explored.

Results: The schizophrenia group demonstrated significantly worse performance on tasks of verbal learning and memory than the affective disorders group. Compared to healthy controls, the schizophrenia group also demonstrated global impairment across the majority of cognitive domains. The substance-induced group's performance lay between that of the schizophrenia and affective disorders groups. Analyses of differential deficits revealed that verbal learning, verbal memory and current intellectual functioning were selectively impaired in the schizophrenia group, whereas the affective disorders group demonstrated a selective deficit in speeded processing. Premorbid intellectual functioning, negative symptomatology and medication levels were the strongest predictors of cognitive performance in FEP subjects.

Conclusions: Verbal memory deficits differentiate individuals with schizophrenia from those with psychotic affective disorders. Although significant cognitive deficits are evident across all diagnostic FEP groups, individuals with schizophrenia appear to have more generalized impairment across a broad array of cognitive functions than other psychotic diagnoses. Lower premorbid intellectual functioning does not appear to contribute to greater cognitive deterioration following onset of psychosis, but severity of illness may be a more important factor than levels of mood disturbance.
Normative Verbal and Non-Verbal Memory Test Scores for Australian Women Aged 56–67
Authors: Clark Margaret S. , Dennerstein Lorraine , Elkadi Shaymaa , Guthrie Janet R. , Bowden Stephen C. , Henderson Victor W.
Published: December 2009

Objective: To establish normative data for tests of verbal and non-verbal memory for midlife Australian-born women, and in so doing investigate factors which contribute to variation in test performance.

Method: Two hundred and fifty-seven healthy women aged 56–67 years (mean age 60), who are participating in the Melbourne Women's Midlife Longitudinal Health Project, were administered two word list learning tasks, a story recall task (the East Boston Memory Test) and the Faces subtest from the Wechsler Memory Scale III as part of a larger neuropsychological battery. Word list learning tasks consisted of either 16 semantically related words, derived from the California Verbal Learning Test II, or a list of 10 unrelated words. Mood was assessed by the Center for Epidemiological Studies Depression questionnaire.

Results: Education was significantly related to memory performance and there was a nonsignificant trend for test scores to decline with age. Mood was unrelated to test performance. A confirmatory factor analysis indicated a clear distinction between verbal and non-verbal memory performances. Mean scores were stratified by education (less than 12 years vs. 12 or more years) and age (56–59 vs. 60–67 years), and scaled normative data were constructed for all the tests.

Conclusion: This study provides education-based normative data for tests of verbal and non-verbal memory for midlife Australian women. The establishment of population-based normative data will facilitate future investigations of ageing and dementia in Australian women.
The Portrayal of Mental Health and Illness in Australian Non-Fiction Media
Authors: Francis Catherine , Pirkis Jane , Francis Catherine , Pirkis Jane , Blood R. Warwick , Dunt David , Burgess Philip , Morley Belinda , Stewart Andrew , Putnis Peter
Published: December 2009

Objective: To provide a detailed picture of the extent, nature and quality of portrayal of mental health/illness in Australian non-fiction media.

Method: Media items were retrieved from Australian newspaper, television and radio sources over a 1-year period, and identifying/descriptive data extracted from all items. Quality ratings were made on a randomly selected 10% of items, using an instrument based on criteria in Achieving the Balance (a resource designed to promote responsible reporting of mental health/illness).

Results: Reporting of mental health/illness was common, with 4351 newspaper, 1237 television and 7801 radio items collected during the study period. Media items most frequently focused on policy/program initiatives in mental health (29.0%), or on causes/ symptoms/treatment of mental illnesses (23.9%). Stories about mental health issues in the context of crime were relatively uncommon, accounting for only 5.6% of items. Most media items were of good quality on eight of the nine dimensions; the exception was that details of appropriate help services were only included in 6.4% of items.

Conclusions: In contrast to previous research, the current study found that media reporting of mental health/illness was extensive, generally of good quality and focused less on themes of crime and violence than may have been expected. This is encouraging, since there is evidence that negative media portrayal of mental health/illness can detrimentally affect community attitudes. However, there are still opportunities for improving media reporting of mental health/illness, which should be taken up in future media strategies.
Assessing Cost-Effectiveness – Mental Health: Introduction to the Study and Methods
Authors: Haby Michelle M. , Haby Michelle M. , Carter Rob , Mihalopoulos Cathrine , Magnus Anne , Sanderson Kristy , Andrews Gavin , Vos Theo
Published: December 2009

Objective: The Assessing Cost-Effectiveness – Mental Health (ACE–MH) study aims to assess from a health sector perspective, whether there are options for change that could improve the effectiveness and efficiency of Australia's current mental health services by directing available resources toward ‘best practice’ cost-effective services.

Method: The use of standardized evaluation methods addresses the reservations expressed by many economists about the simplistic use of League Tables based on economic studies confounded by differences in methods, context and setting. The costeffectiveness ratio for each intervention is calculated using economic and epidemiological data. This includes systematic reviews and randomised controlled trials for efficacy, the Australian Surveys of Mental Health and Wellbeing for current practice and a combination of trials and longitudinal studies for adherence. The cost-effectiveness ratios are presented as cost (A$) per disability-adjusted life year (DALY) saved with a 95% uncertainty interval based on Monte Carlo simulation modelling. An assessment of interventions on ‘second filter’ criteria (‘equity’, ‘strength of evidence’, ‘feasibility’ and ‘acceptability to stakeholders’) allows broader concepts of ‘benefit’ to be taken into account, as well as factors that might influence policy judgements in addition to cost-effectiveness ratios.

Conclusions: The main limitation of the study is in the translation of the effect size from trials into a change in the DALY disability weight, which required the use of newly developed methods. While comparisons within disorders are valid, comparisons across disorders should be made with caution. A series of articles is planned to present the results.
Cost-Effectiveness of Psychological and Pharmacological Interventions for Generalized Anxiety Disorder and Panic Disorder
Authors: Heuzenroeder Louise , Donnelly Marie , Haby Michelle M. , Mihalopoulos Cathrine , Rossell Ruth , Carter Rob , Andrews Gavin , Vos Theo
Published: December 2009

Objective: To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]).

Method: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filters (‘equity’, ‘strength of evidence’, ‘feasibility’ and ‘acceptability to stakeholders’) is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs).

Results: Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater.

Conclusions: Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.
Comparing Psychiatric Diagnoses Generated by the Strengths and Difficulties Questionnaire with Diagnoses Made by Clinicians
Authors: Mathai John , Anderson Peter , Bourne Angela
Published: December 2009

Objective: To examine the level of agreement between clinical diagnoses by a community child and adolescent mental health service (CAMHS) and diagnoses generated by the Strengths and Difficulties Questionnaire (SDQ).

Method: A computerized algorithm developed by Goodman et al. was used at a community CAMHS in Australia to predict child psychiatric diagnoses on the basis of the symptom and impact scores derived from the SDQ completed by parents (n = 130), teachers (n = 101) and young people (n = 38). These diagnoses were compared with the diagnoses made by clinicians in a multidisciplinary community outpatient team and an independent clinician that examined the case notes and was blind to the SDQ scores.

Results: The level of agreement between SDQ generated diagnoses and clinical team diagnoses was moderate to high, ranging from 0.39 to 0.56. Correlations between the SDQ and an independent clinician ranged from 0.26 to 0.43. All were statistically significant.

Conclusion: The SDQ is a useful instrument to aid clinicians in diagnosis and could be used as part of the initial assessment process.
A Transdisciplinary Approach to Adolescent Forensic Mental Health
Authors: Stathis Stephen , Martin Graham
Published: December 2009

Objective: To examine new strategies which may be implemented to address the significant mental health and substance abuse problems of young people within the juvenile justice system.

Method: Wide-ranging literature review of mental health problems within the juvenile justice population is given, illustrating the high prevalence of mental health problems within this cohort of young people. Reference is made to the differing demographics and agendas of the American justice system compared to that found in Australia.

Results: It is suggested that new initiatives stemming from quality Australian studies are required in order to facilitate reform within adolescent forensic mental health. Psychiatrists need to be at the forefront of innovative policy delivery within the juvenile justice system.

Conclusions: A transdisciplinary approach is required to meet the changing needs of young people within the juvenile justice system. Such a system of care recognizes that these young people and their families have multiple needs that cross traditional boundaries and a collaborative approach across agencies is essential at both the policy and practical level. Psychiatrists have an important role to play in the development of these services. A systemic process to address such needs is offered.
Australian and New Zealand Clinical Practice Guidelines for the Treatment of Anorexia Nervosa
Authors:   Royal Australian And New Zealand College Of Psychiatrists Clinical Practice Guidelines Team For Anorexia Nervosa
Published: December 2009

Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Ministry of Health. This CPG covers anorexia nervosa (AN).

Method: The CGP team consulted with scientists, clinicians, carers and consumer groups in meetings of over 200 participants and conducted a systematic review of meta-analyses, randomized controlled trials and other studies.

Treatment recommendations: It is extremely difficult to draw general conclusions about the efficacy of specific treatment options for AN. There are few controlled clinical trials and their quality is generally poor. These guidelines necessarily rely largely upon expert opinion and uncontrolled trials. A multidimensional approach is recommended. Medical manifestations of the illness need to be addressed and any physical harm halted and reversed. Weight restoration is essential in treatment, but insufficient evidence is available for any single approach. A lenient approach is likely to be more acceptable to patients than a punitive one and less likely to impair self-esteem. Dealing with the psychiatric problems is not simple and much controversy remains. For patients with less severe AN who do not require in-patient treatment, out-patient or day-patient treatment may be suitable, but this decision will depend on availability of such services. Family therapy is a valuable part of treatment, particularly for children and adolescents, but no particular approach emerges as superior to any other. Dietary advice should be included in all treatment programs. Cognitive behaviour therapy or other psychotherapies are likely to be helpful. Antidepressants have a role in patients with depressive symptoms and olanzapine may be useful in attenuating hyperactivity.