bluuebunny/crossref_metadata_2025 huggingface dataset:
Alcohol Dependence: The Impact of Cognitive Behaviour Therapy with or Without Naltrexone on Subjective Health Status
Authors: Feeney Gerald F. X. , Feeney Gerald F. X. , Connor Jason P , Young Ross Mc.D , Tucker Jane , Mcpherson Annie
Published: December 2009

Objectives: To examine the health-related quality of life of alcohol-dependent patients across a 12-week cognitive behaviour treatment (CBT) program and identify whether the patient selection of the anticraving medication naltrexone further enhanced these outcomes.

Method: One hundred and thirty-six consecutive alcohol-dependent subjects voluntarily participated and were offered naltrexone, of which 73 (54%) participants declined medication. A matched design was used. Of the 136 subjects, 86 (43 naltrexone and CBT; 43 CBT only) could be individually matched (blind to outcome measures) for gender, age, prior alcohol detoxification and dependence severity. Measures of health status and mental health wellbeing included the Rand Corporation Medical Outcomes Short Form 36 Health Survey (SF-36) and the General Health Questionnaire (GHQ-28).

Results: Pre-treatment, all had SF-36 and GHQ-28 scores markedly below national norms. Post-treatment, significant improvement in seven of the eight SF-36 subscales and all of the GHQ-28 subscales occurred, approximating national normative levels. Patients in the CBT ++ naltrexone group were significantly more likely to have increased days abstinent (p = 0.002) and to complete the program abstinent (p = 0.051). The adjunctive use of naltrexone did not provide additional benefit as reflected in SF-36 and GHQ-28 scores, beyond CBT alone.

Conclusions: Patients who completed the CBT-based treatment program reported significant improvements in self-reported health status (SF-36) and wellbeing (GHQ-28). The adjunctive use of naltrexone demonstrated no additional improvement in these measures.
How Mental Health Clinicians View Community Treatment Orders: A National New Zealand Survey
Authors: Romans Sarah , Dawson John , Mullen Richard , Gibbs Anita
Published: December 2009

Objective: To determine New Zealand mental health clinicians' views about community treatment orders, indications for their use, their benefits, problems and impact on patients and therapeutic relationships.

Method: A national survey of New Zealand psychiatrists and a regional survey of nonpsychiatric community mental health professionals for comparison.

Results: The great majority of NZ psychiatrists prefer to work with community treatment orders as an option. They consider they are used properly in most cases, can enhance patients' priority for care, provide a structure for treatment, support continuing contact and produce a period of stability for patients during which other therapeutic changes can occur. They consider these orders can harm therapeutic relationships, especially in the short term, but when used appropriately their overall benefits outweigh their coercive impact. The other mental health professionals surveyed have similar views. A minority of clinicians do not support their use.

Conclusions: The precise impact of community treatment orders on patients' quality of life remains an open question. Until that matter is more clearly resolved, New Zealand law should continue to authorise compulsory outpatient care, provided it is carefully targeted and adequate community services are available.
Critique of the Guidelines for the Treatment of Depression: Flaws in the Construction
Authors: Parker Gordon
Published: December 2009

Objective: To examine the likely utility of the recently published Australian and New Zealand clinical practice guidelines for the treatment of depression.

Method: The guidelines are critiqued for their intrinsic logic and their success in extracting potentially valid and useful management templates.

Results: This paper provides examples of key limitations to many specific interpretations and conclusions.

Conclusions: It is argued that these guidelines are far less precise and informative for clinical practice than they appear and with a disturbing lack of rigour for a document promulgated by a professional college.
Trauma-Related Dissociation: Conceptual Clarity Lost and Found
Authors: Van Der Hart Onno , Nijenhuis Ellert , Steele Kathy , Brown Daniel
Published: December 2009

Objective: Imprecise conceptualizations of dissociation hinder understanding of traumarelated dissociation. An heuristic resolution for research and clinical practice is proposed.

Method: Current conceptualizations of dissociation are critically examined. They are compared with a new theory that incorporates classical views on dissociation with other contemporary theories related to traumatization, viewing dissociation as a lack of integration among psychobiological systems that constitute personality, that is, as a structural dissociation of the personality.

Results: Most current views of dissociation are overinclusive and underinclusive. They embrace non-dissociative phenomena – rigid alterations in the level and field of consciousness – prevalent in non-traumatized populations, and which do not require structural dissociation. These views also largely disregard somatoform and positive symptoms of dissociation and underestimate integrative deficiencies, while emphasizing the psychological defensive function of dissociation. They do not offer a common psychobiological pathway for the spectrum of trauma-related disorders. Structural dissociation of the personality likely involves divisions among at least two psychobiological systems, each including a more or less distinct apperceptive centre, that is, a dissociative part of the personality. Three prototypical levels of structural dissociation are postulated to correlate with particular traumarelated disorders.

Conclusions: Limitation of the concept of dissociation to structural dividedness of the personality sets it apart from related but non-dissociative phenomena and provides a taxonomy of dissociative symptoms. It postulates a common psychobiological pathway for all trauma-related disorders. Trauma-related dissociation is maintained by integrative deficits and phobic avoidance. This conceptualization advances diagnosis, classification, treatment and research of trauma-related disorders.
Clozapine-Related Myocarditis and Cardiomyopathy in an Australian Metropolitan Psychiatric Service
Authors: Reinders Jonathan , Parsonage William , Lange Diana , Potter Julia M , Plever Sally
Published: December 2009

Objectives: Myocarditis and cardiomyopathy are rarely reported complications of clozapine treatment. The incidence of clozapine-related myocarditis has been variably reported at between 0.03% and 0.19% of initiations and cardiomyopathy has been reported even less commonly. In our Brisbane-based service, nine of 94 patients initiated on clozapine over the previous 3 years appeared to have experienced myocarditis or cardiomyopathy. The unique co-location of our service with a major cardiothoracic hospital facilitated a review of identified cases to inform decisions regarding clozapine treatment and rechallenge in this service.

Method: Cases were identified by survey of psychiatric and cardiac medical staff at The Prince Charles Hospital and subjected to re-evaluation by a multidiscipline consensus panel. The panel compared cases to international reports and identified the clinical features that supported a diagnosis of clozapine-related myocarditis or cardiomyopathy.

Results: This process resulted in the stratification of the nine cases into the following categories of diagnostic likelihood: three highly probable, three probable, and two possible cases of clozapine-related myocarditis, and one possible case of clozapine-related cardiomyopathy. Successful clozapine rechallenge/continuation was undertaken in two patients and the panel agreed that this was a viable future option for several other patients.

Conclusions: Findings of the panel review supported the initial clinical diagnoses. This confirmed that there was an apparent high incidence of clozapine-related myocarditis within this service, for which there was no clear reason. Mechanisms underlying clozapine-related myocarditis and cardiomyopathy, as well as successful clozapine continuation and rechallenge were considered, but definitive explanations remain unknown. This review highlighted the clinician's role in post-marketing drug surveillance to guide rational management of suspected adverse drug effects.
Parenting Programs for Women with Mental Illness who have Young Children: A Review
Authors: Craig Elizabeth A
Published: December 2009

Objective: To provide an overview of the literature relevant to, and describing, parenting programs for women with mental illness who have young children.

Method: A literature search was undertaken, including MEDLINE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews and EMBASE: Psychiatry. Searches were limited to English journals and books and to the last five years in the first instance, with earlier literature considered where appropriate.

Results: Maternal mental illness can impact negatively on a child's life, especially where an insecure attachment is formed between mother and baby during the important early developmental years. The potential sequelae of maternal mental illness for children include impaired cognitive development, behavioural difficulties and increased risk of psychiatric disorder. Effective parenting skills are suggested to be a protective factor against these sequelae. However, the effects of parenting programs for women with mental illness have not been empirically tested, so that the potential long-term benefits of such interventions are not known.

Conclusions: Parenting skills training for women with mental illness may be a useful selective preventive intervention. It is unlikely generic programs will be suitable. Rather, interventions for women with a mental illness will need to address the commonly experienced parenting problems as well as the more specific needs of women with mental illness.
Do Nations' Mental Health Policies, Programs and Legislation Influence their Suicide Rates? An Ecological Study of 100 Countries
Authors: Burgess Philip , Pirkis Jane , Jolley Damien , Whiteford Harvey , Saxena Shekhar
Published: December 2009

Objective: To test the hypothesis that the presence of national mental health policies, programs and legislation would be associated with lower national suicide rates.

Method: Suicide rates from 100 countries were regressed on mental health policy, program and legislation indicators.

Results: Contrary to the hypothesized relationship, the study found that after introducing mental health initiatives (with the exception of substance abuse policies), countries' suicide rates rose.

Conclusion: It is of concern that most mental health initiatives are associated with an increase in suicide rates. However, there may be acceptable reasons for the observed findings, for example initiatives may have been introduced in areas of increasing need, or a case-finding effect may be operating. Data limitations must also be considered.
Association Between Lifestyle Factors and Mental Health Measures Among Community-Dwelling Older Women
Authors: Cassidy Kellie , Kotynia-English Ria , Acres John , Flicker Leon , Lautenschlager Nicola T. , Almeida Osvaldo P. , Cassidy Kellie , Kotynia-English Ria , Acres John , Flicker Leon , Lautenschlager Nicola T. , Almeida Osvaldo P.
Published: December 2009

Objective: To investigate the association between potentially modifiable lifestyle factors and cognitive abilities/depressive symptoms in community-dwelling women aged 70 years and over.

Method: Cross-sectional study of community-dwelling women aged 70 years and over (n = 278; mean age = 74.6 years). Lifestyle variables assessed included smoking, alcohol consumption, physical activity, nutrition and education. The mental health measures of interest were depression, anxiety, quality of life and cognitive function, as assessed by the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), SF-36, and the Cambridge Cognitive Examination for Mental Disorders of the Elderly (CAMCOG), respectively.

Results: Physically active women were half as likely to be depressed (BDI score ≥ 10) and anxious (BAI score ≥ 8) when compared to their physically inactive counterparts (OR = 0.5, 95% CI = 0.3–0.8 for both, adjusted for marital status and smoking in the case of depression). Having ever smoked more than 20 cigarettes per day was associated with increased risk of depression (OR = 2.8, 95% CI = 1.4–5.5, adjusted for marital status and physical activity). Moderate alcohol use was associated with increased likelihood of having a CAMCOG score within the highest 50 percentile (OR = 2.0, 95% CI = 1.1–3.5, adjusted for age and education), as was more than minimum statutory education (OR = 2.0, 95% CI = 1.1–3.5, adjusted for age and alcohol consumption). There was no obvious association between vitamin B12/folate deficiency or obesity with any of the measures of interest.

Conclusions: The results of this study are consistent with the hypothesis that depression is directly associated with heavy smoking and inversely associated with physical activity. They also support the idea that non-harmful alcohol consumption is associated with better cognitive performance. Randomised clinical trials should be now designed to clarify whether management of lifestyle factors reduces the incidence of mood disorders and cognitive impairment in later life.
Negative Beliefs about Self and Illness: A Comparison of Individuals with Psychosis with or Without Comorbid Social Anxiety Disorder
Authors: Gumley Andrew , O'grady Margaret , Power Kevin , Schwannauer Matthias
Published: December 2009

Objective: This study set out to investigate whether socially anxious individuals with psychosis will perceive more loss, entrapment, shame and humiliation, will blame themselves more for their illness and have lower self-esteem than non-socially anxious individuals with psychosis.

Method: Two groups of participants with psychosis with (n = 19) and without (n = 19) social anxiety disorder were matched on the basis of gender and diagnosis.

Results: There were no differences between the two groups in terms of positive and negative symptoms. Participants with social anxiety had significantly higher levels of selfblame, entrapment, shame and lower self-esteem. Differences in entrapment, shame and self-esteem remained significant after controlling for depression.

Conclusions: Negative beliefs about self and psychosis may be associated with the development of concurrent social anxiety disorder. The clinical and research implications of the findings are discussed.
Evidence-Based Guidelines: Response to Professor Gordon Parker's Critique
Authors: Ellis Pete M. , Hickie Ian B. , Smith Don A. R.
Published: December 2009

Objective: To clarify the development of the ‘Australian and New Zealand clinical practice guidelines for the treatment of depression’ and to discuss the critique of these guidelines.

Method: Consideration of international practice in evidence-based medicine and rebuttal of criticisms.

Results: We agree with Professor Gordon Parker on fundamental issues in the treatment of depression. His main criticisms reflect his concerns about the classification of depression. We consider that many of his detailed criticisms reflect a difference of opinion on how data should be evaluated or interpreted.

Conclusions: The guideline for the treatment of depression makes sound recommendations, in agreement with comparable guidelines from the US and the UK.
‘Bipolar Missed States’: The Diagnosis and Clinical Salience of Bipolar Mixed States
Authors: Berk Michael , Dodd Seetal , Malhi Gin S.
Published: December 2009

Objective: To explore diagnostic and treatment issues concerning bipolar mixed states.

Method: Bipolar mixed states are described and concerns about diagnostic and treatment difficulties are summarized and discussed.

Result: Mixed states can present with equal admixtures of depressive or manic symptoms, or more commonly one component predominates. There is fair consensus, although little data, regarding the management of manic mixed states. However depressive mixed states are far more complex both in terms of recognition and management. People suffering from mixed states characteristically present with complaints of depression.

Conclusions: The boundaries between depressive mixed states and agitated depression are vague, yet carry substantial therapeutic implications. Bipolar mixed states are often difficult to treat, and tend to take much longer to settle than either pure mania or depression. Furthermore there is data that treatment with antidepressants can worsen the course of mixed states. Hence missed diagnoses can potentially have negative clinical implications. Therefore in this paper the clinical presentation, diagnosis and therapy of mixed states is reviewed with a view to improving management.
Mental Health Research and Philanthropy: Possible Partnerships?
Authors: Scott Dorothy
Published: December 2009

Mental health research has received relatively little philanthropic support in Australia compared with other areas of health research. Philanthropic trusts do not generally provide recurrent funding or make grants for that perceived to be the responsibility of the state or the market. The emergence of ‘strategic philanthropy’ however, provides potential for mental health researchers to form partnerships with philanthropic foundations, particularly on initiatives that are focused on prevention and innovative and sustainable models with the capacity to ‘go to scale’ across the service system.
Disability, Employment and Work Performance Among People with ICD-10 Anxiety Disorders
Authors: Waghorn Geoff , Chant David , White Paul , Whiteford Harvey
Published: December 2009

Objective: To ascertain at a population level, patterns of disability, labour force participation, employment and work performance among people with ICD-10 anxiety disorders in compar ison to people without disability or long-term health conditions.

Method: A secondary analysis was conducted of a probability sample of 42 664 individuals collected in an Australian Bureau of Statistics (ABS) national survey in 1998. Trained lay interviewers using ICD-10 computer-assisted interviews identified household residents with anxiety disorders.

Results: Anxiety disorders were associated with: reduced labour force participation, degraded employment trajectories and impaired work performance compared to people without disabilities or long-term health conditions.

Conclusion: People with anxiety disorders may need more effective treatments and assistance with completing education and training, joining and rejoining the workforce, developing career pathways, remaining in the workforce and sustaining work performance. A whole-of-government approach appears needed to reduce the burden of disease and increase community labour resources. Implications for clinicians, vocational professionals and policy makers are discussed.
Public and Private Psychiatry: Can They Work Together and is it Worth the Effort?
Authors: Yung Alison , Gill Lisa , Sommerville Elizabeth , Dowling Bernie , Simon Kim , Pirkis Jane , Livingston Jenni , Schweitzer Isaac , Tanaghow Amgad , Herrman Helen , Trauer Tom , Grigg Margaret , Burgess Philip
Published: December 2009

Objective: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative ‘shared care’ arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems.

Method: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area.

Results: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: ‘Difficulty communicating’ endorsed by 71.4% of public clinicians and 72% of private psychiatrists, ‘Confusion of roles and responsibilities’ endorsed by 62.9% and 66%, respectively, and ‘Different treatment approach’ by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors.

Conclusions: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.
Psychosocial Support for War-Traumatized Child and Adolescent Refugees: Evaluation of a Short-Term Treatment Program
Authors: Möhlen Heike , Parzer Peter , Resch Franz , Brunner Romuald
Published: December 2009

Objective: The purpose of this study was to evaluate a newly designed psychosocial treatment program for war traumatized child and adolescent refugees. The program was designed to reduce emotional distress and improve psychosocial functioning.

Method: Ten young Kosovan refugees (mean age 13.3 years) residing in Germany participated in the manual based intervention program. This multimodal program consists of individual, family and group sessions using a psychoeducational approach beside trauma and grief focusing activities, creative techniques and relaxation. Kind and severity of traumatic experiences were gathered by interviewing the child and their caretakers using the Harvard Trauma Questionnaire (HTQ). Psychiatric diagnoses (Schedule for Affective Disorders and Schizophrenia for School-Age Children, K-SADS) were assessed prior to the intervention. Post-traumatic symptomatology (HTQ), emotional problems (Diagnostic System for Psychological Disorders, DYSIPS) and the overall psychosocial functioning (Child Global Assessment Scale, CGAS) were assessed before and after the 12-week intervention.

Results: Following the intervention the degree of overall psychosocial functioning increased substantially in 9 of 10 participants. Furthermore, post-traumatic, anxiety and depressive symptoms were reduced significantly. The rate of post-traumatic stress disorder (PTSD) diagnoses fell from 60% to 30%. The number of patients with PTSD and a high rate of comorbid symptoms (depression and anxiety) as well as a history of severe traumatization remained at 30%.

Conclusions: This study suggests that the psychosocial treatment program specified for war traumatized adolescents may be useful for the relief of psychiatric sequelae and for an improvement in overall psychosocial functions, but not for the subgroup of severely traumatized patients with complex psychiatric disturbances.
Clinical Profiles, Scope and General Findings of the Western Sydney First Episode Psychosis Project
Authors: Harris Anthony , Brennan John , Anderson Josephine , Taylor Anne , Sanbrook Mark , Fitzgerald Dianne , Lucas Sara , Redoblado-Hodge Antoinette , Gomes Lavier , Gordon Evian
Published: December 2009

Objective: To examine the clinical profile, treatment and social functioning of a communitybased sample of young people presenting with their first episode of psychosis.

Methods: Over a 2-year period, young people with their first episode of psychosis referred to early intervention services in two area mental health services in western Sydney were assessed with a battery of clinical, neuropsychological, psychophysiological and neuroanatomical measures. This paper reports the clinical results of the baseline section of the study.

Results: Of the 224 referrals to the project, 94 subjects meet inclusion criteria and agreed to take part. Subjects were divided into three diagnostic groups – ‘Schizophrenia’, ‘Mood Disorders’ and ‘Mixed Psychosis’, the latter principally comprised of substance induced psychotic disorders. Subjects from the ‘Schizophrenia’ group differed significantly from the other two groups in that they had higher levels of negative symptoms and general psychopathology, and were less likely to be employed or engaged in study. They had poorer overall social functioning. Subjects with ‘Mixed Psychosis’ were similar to those from the ‘Schizophrenia’ group in that they were older and male, but they did not have the same burden of negative symptoms as the ‘Schizophrenia’ group. The ‘Mood Disorders’ group was younger, female and had overall a higher level of psychosocial functioning than the other two groups. Subjects from the ‘Mood Disorders’ group were more likely to be managed with mood stabilisers and multiple drug therapies. The use of atypical antipsychotic medication was almost universal.

Conclusions: Even shortly after the time of presentation to mental health services young people with a schizophrenia spectrum diagnosis have a heavier burden of symptoms and are significantly more impaired by them than young people with other psychotic illnesses. This and their symptom profile differentiated them from young people with other psychotic disorders.
Clinical Management of Deliberate Self-Harm in Young People: The Need for Evidence-Based Approaches to Reduce Repetition
Authors: Burns Jane , Dudley Michael , Hazell Philip , Patton George
Published: December 2009

Objective: To examine the evidence for the effectiveness of clinical interventions designed to reduce the repetition of deliberate self-harm (DSH) in adolescents and young adults.

Methods: Electronic databases were searched for papers describing randomised and clinical control trials (RCTs) and quasi-experimental studies of interventions targeting adolescents and young adults presenting to clinical services following DSH or suicidal ideation.

Results: Three RCTs, four clinical control trials and three quasi-experimental studies were identified. Group therapy, trialled in a RCT, was the only specific programme which led to a significant reduction in rates of repetition of self-harm. Attendance at follow-up did not improve significantly regardless of the intervention, while one clinically controlled trial of intensive intervention resulted in poorer attendance at follow-up. One quasi-experimental study of family therapy resulted in a significant reduction in suicidal ideation.

Conclusions: The evidence base for treatments designed to reduce the repetition of self-harm in adolescents and young adults is very limited. Expensive interventions such as intensive aftercare offer no clear benefit over routine aftercare. Given that deliberate selfharm among young people is a common clinical problem further good quality treatment studies are warranted. Careful consideration should be given to process evaluation to determine which individual components of any given intervention are effective.
Relationship Between Control and the Intermediate Term Outcome of Anorexia Nervosa in Hong Kong
Authors: Lee Sing , Lydia Chan Y.Y. , Kwok Kathleen , George Hsu L.K.
Published: December 2009

Objective: To examine the relationship between control and the intermediate term outcome of Chinese patients with anorexia nervosa.

Method: 88 patients who fulfilled the DSM-III-R criteria for typical (fat phobic, n = 63) and atypical (non-fat phobic, n = 25) anorexia nervosa were contacted 9 years after the onset of illness. They completed the Morgan-Russell Outcome Assessment Schedule, Shapiro Control Inventory, and Eating Disorder Inventory-I.

Results: 62.2%, 32.4% and 5.4% of patients had good, intermediate, and poor outcome. Outcome was positively correlated with the overall general and specific sense of control, positive sense of control, and negatively with negative sense of control. Patients with good outcome exhibited the least negative modes of control and had the least desire for control. Typical and atypical patients showed similar but not identical control profiles.

Conclusion: Healthier control was associated with better outcome of anorexia nervosa but their causal relationship was far from clear because of the cross-sectional nature of the present study. The Shapiro Control Inventory is a potentially useful instrument for studying control in eating disorders.
Accommodation History and Continuity of Care in Patients with Psychosis
Authors: Holmes Alex C.N. , Hodge Mark A. , Bradley Gail , Bluhm Alan , Hodges Jane , Didio Louisa , Markulev Natasha
Published: December 2009

Objectives: The objective of this study was to determine the relationship between accommodation history and management outcome in patients with psychosis.

Method: Demographic information, diagnosis and an accommodation history were taken from patients with psychosis accepted for case management by the Inner West Area Mental Health Service over a 12-month period. The patients were followed up 2 years later to determine their continuity of care and discharge outcome.

Results: One hundred 42 patients completed the assessments. Forty-eight percent of patients had spent at least 1 day in a homeless setting in the previous 12 months. Twentytwo percent of patients had long-term (between 2 and 12 months) and six percent chronic (more than 12 months) homelessness. The duration of previous homelessness was significantly inversely correlated with the length of engagement with the service, continuity of psychiatric care at discharge or likelihood of transfer to primary care. Previous interstate mobility was significantly associated with discontinuity of care at discharge.

Conclusions: A history of homelessness is common in patients with psychosis using inner urban mental health services and is associated with poorer engagement with psychiatric services.
Explaining Transitions Over the Hypothesized Psychosis Continuum
Authors: Krabbendam Lydia , Myin-Germeys Inez , Bak Maarten , Van Os Jim
Published: December 2009

Objectives: It is crucial to understand the psychological mechanisms that mediate transition from having one or two psychotic symptoms to becoming a patient with a psychotic disorder. This study investigated whether: (i) a delusional interpretation and/or a depressed response to hallucinatory experiences predicts the later onset of clinical psychotic disorder; and (ii) the presence of need for care in relation to psychotic disorder was associated with the use of particular coping strategies.

Method: A general population sample of 4672 individuals with no lifetime evidence of any psychotic disorder were interviewed with the Composite International Diagnostic Interview Schedule (CIDI) at baseline and 1 and 3 years later. At year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify onset of psychotic disorder with need for care. Coping, subjective distress with and perceived control over the psychotic experience were assessed using the Maastricht Assessment of Coping Strategies (MACS).

Results: Given the presence of hallucinatory experiences at baseline, the increase in risk on the additive scale of having the psychosis outcome at T2 was higher in the group with delusional ideation at T1 than in those without delusional ideation at T1. Similarly, presence of depressed mood at T1 increased the risk of having the psychosis outcome at T2, but this effect overlapped partly with the risk-increasing effect of delusional ideation. Individuals with a need for care were much more likely to display symptomatic coping, whereas the presence of the other coping types was not different across the groups with and without need for care.

Conclusion: Transitions over the psychosis continuum are, at least in part, driven by the emotional, cognitive and behavioural responses to the initial psychotic or psychosis-like experiences. Individuals who react with a delusional interpretation, negative emotional states and/or a symptomatic coping style have an increased risk for developing clinical psychosis.
Mortality and Mental Illness
Authors: Drew Leslie R.H.
Published: December 2009

Background: The finding by Lawrence, Holman and Jablensky (Duty to Care) that mortality among the mentally ill in Western Australia was 2.5 times that of the general population, seemingly, has great significance for public policy concerning the mentally ill. ‘Mortality’ could be a useful outcome measure for mental health services.

Objectives: To replicate that study in the Australian Capital territory (ACT), comparing mortality rates in the mentally ill with those of the total population.

Method: A list of all people who contacted the ACT mental health services between 1985 and 2000 was compiled. Using the national register of deaths (Australian Institute of Health and Welfare), persons known to the mental health services who died between 1990 and 2000 were identified and sex, date of birth, date of death, cause of death and place of death were noted. Using Australian Bureau of Statistics data for all deaths in the ACT, deaths in the total population and in the mentally ill population were tabulated for the period 1996–2000. With 1996 data as the base, using total population data from the ABS and mental health population data derived by amending ‘the list’ to remove duplications, pre1996 deaths and post1996 additions, mortality rates for the period 1996–2000 were compared.

Results: The gender and age distribution of the mentally ill population and the total population, and of deaths in those populations, were very different. One third of all deaths in the mentally ill occurred outside of the ACT. Compared with the general population, mortality in the mentally ill (including deaths outside of the ACT) was only slightly excessive for ‘all causes’ and ischaemic heart disease but grossly excessive for ‘suicide’.

Conclusions: This study did not confirm the excessive mortality rate in the mentally ill reported by Lawrence et al. except for suicide. Many methodological issues in using population studies to attempt to measure the size of the increase were identified. Differences in method between the ACT and WA studies probably explain the differences in results. Caution is urged in using the results of mortality studies as determinants of public policy or to evaluate services.
A Methodology for Timing Reviews of Inpatient Hospital Stay
Authors: Page Andrew C. , Hooke Geoff R. , Rampono Jonathan
Published: December 2009

Objective: This paper aims to describe a methodology to inform decisions about the optimal time to schedule reviews of a patient's hospital stay and to provide an example of its implementation.

Method: Length of hospital stay was assessed in 1227 consecutive inpatient admissions. Data were transformed to reflect the probability of discharge from hospital in the following 7 days.

Results: The resulting data reflected the points at which the conditional probability of being discharged were declining, revealing the potentially efficient times to conduct reviews of inpatient admissions.

Conclusions: The methodology outlined appears useful in assisting psychiatrists responsible for inpatient care to decide upon optimal times to review a patient's stay in hospital.
Mania in the Swedish Twin Registry: Criterion Validity and Prevalence
Authors: Soldani Federico , Sullivan Patrick F. , Pedersen Nancy L.
Published: December 2009

Background: In population surveys, the assessment of mania is commonly done by trained lay interviewers using structured diagnostic instruments: the validity of this approach has been questioned. We examined the criterion validity and prevalence of lifetime mania in a survey of Swedish twins conducted with interview methodology usually applied in psychiatric epidemiology.

Methods: 41 838 individuals in the Swedish Twin Registry were evaluated via a telephone interview that included the eight DSM-IV mania items, and these data were merged with inpatient hospitalization discharge diagnoses from two comprehensive national registries (the criterion). An algorithm with eight cut-points was used to diagnose lifetime mania, and compared by a receiver operator characteristic curve to the criterion. The algorithm requiring at least four positive items resembling a DSM-IV diagnosis.

Results: History of hospitalization for a psychiatric condition that included a manic episode was present for 0.7% of all living twins, and predicted non-response to the survey (OR = 0.5; 95% CI = 0.4–0.6). The incidence rate for first hospitalization was 2.1/10 000 year –1. For ≥1 symptom (first cut-point), the prevalence, sensitivity and specificity were 3.6%, 39.0% and 96.6%; for ≥ 4 symptoms (DSM-IV-like cut-point) 2.6%, 36.5% and 97.6%; and for eight symptoms 0.3%, 18.0% and 99.8%. Positive predictive values were, respectively, 5.5%, 7.0% and 29.8%.

Conclusions: The performance of the telephone screening for mania by lay interviewers in terms of positive predictive power was not satisfactory; despite a high specificity, the false positive rate was high. The low population prevalence of mania, non-response bias, criterion choice and inherent limitations of the interviewing method are among the explanations. Assessment of a lifetime manic episode based on lay interviewer screening may yield misleading data.
Temporal Stability of the dex/CRH Test in Patients with Rapid-Cycling Bipolar I Disorder: A Pilot Study
Authors: Watson Stuart , Thompson Jill M. , Malik Navdeep , Nicol Ferrier I. , Young Allan H.
Published: December 2009

Objective: To examine the hypothesis that hypothalamic-pituitary-adrenal (HPA) axis function is a trait abnormality in bipolar disorder.

Method: We examined HPA axis function in a pilot study of five patients with rapid-cycling bipolar disorder in both relapse and remission using the dexamethasone/corticotropin releasing hormone (dex/CRH) test.

Results: The cortisol response to the dex/CRH test correlated significantly between the 2 tests (r = 0.997; p < 0.0005).

Conclusion: The data suggests that the cortisol response to the dex/CRH test is stable over time and independent of mood state.
A Cross-Sectional Analysis of Factors that Influence the Detection of Depression in Older Primary Care Patients
Authors: Pfaff Jon J , Pfaff Jon J , Almeida Osvaldo P
Published: December 2009

Objective: To determine the characteristics of depressed older patients whose mental health status is detected by their general practitioner (GP).

Method: Cross-sectional analytical design of 218 patients scoring above the cut-off (≥ 16) of the Center for Epidemiological Studies – Depression Scale (CES-D), from a sample of 916 consecutive patients aged 60 years or over attending one of 54 randomly selected GPs in Western Australia. Prior to their medical consultation, patients completed a self-report questionnaire, which included questions about depressive symptomatology (CES-D). Following the consultation, general practitioners recorded the patient's presenting complaint(s), medication information, and mental health details on a patient summary sheet.

Results: Among these 218 patients, 39.9% (87/218) were correctly classified as depressed by their GP. Detection of depressive symptomatology was associated with patients who acknowledged taking sleeping tablets (OR = 2.6, 95% CI = 1.3–5.4), had CES-D scores indicative of major depression (≥ 22) (OR = 2.8, 95% CI = 1.4–5.6) and were thought to be at risk for suicide (OR = 35.1, 95% CI = 4.5–274.2).

Conclusions: While GPs are most apt to detect depression among older patients with prominent mental health symptoms, many patients in this age group silently experience significant depressive symptomatology and miss the opportunity for effective treatment. The routine use of screening tools in primary care is recommended to enhance the detection rate of depression in older adults.
People Never See Us Living Well: An Appraisal of the Personal Stories About Mental Illness in a Prospective Print Media Sample
Authors: Nairn R. G. , Coverdale J. H.
Published: December 2009

Objective: Having found no discussions of self-depictions offered by psychiatric patients in the mass media we sought such items in a prospective national sample of print media and analysed how those speakers portrayed themselves.

Method: As part of a larger study of media depictions of mental illnesses in print media all items with any mental health or illness aspect that appeared in a New Zealand publication over a four-week period were collected. The resulting collection of 600 items ranged from news briefs to full-page newspaper articles. From that set we selected and analysed items in which a person identified as having been a psychiatric patient or as having a mental disorder was either quoted by the reporter who had interviewed them, or personally described their experiences. Employing both propositional analyses and discourse analysis we explored how the speakers were positioned and identified patterns or themes in their construction of living with a mental illness.

Results: Only five articles (0.8%) met our criteria for a person with a mental disorder being reported directly. In those items the journalists had positioned the speakers as credible, expert sources who, in representing their lives and experiences, drew on five clusters of resources, that we titled: Ordinariness/Living Well; Vulnerability; Stigma; Crisis; and Disorder/ Treatment. Ordinariness/Living Well foregrounded the role of personal strengths in living well and in overcoming adversity, particularly that associated with being stigmatized. We identified that theme as central to the ways in which these speakers depicted themselves as recognizably human and understandable.

Conclusion: The findings are preliminary but these depictions are different from those reported by most researchers. Unlike those depictions, these speakers provided accessible and recognizably human self-portrayals. That finding intensifies our concern that most researchers appear to be unaware that these consumer voices are largely absent from mass media depictions of mental illnesses.
Anatomical MRI Abnormalities in Bipolar Disorder: Do They Exist and Do They Progress?
Authors: Serap Monkul E. , Malhi Gin S. , Soares Jair C.
Published: December 2009

Aim: Morphometric brain imaging studies have revealed regional brain abnormalities in patients with bipolar disorder, which may play a role in illness pathophysiology. It is not known whether such changes are of neurodevelopmental, neurodegenerative, or combined origin. We reviewed the anatomical brain imaging literature in bipolar disorder, in an attempt to determine whether there is evidence to suggest that such abnormalities are progressive.

Method: Literature searches were conducted using MEDLINE for the period from 1966 to June 2004, using specific key words; bipolar disorder and the names of the individual brain structures. Papers were selected according to their salience in relation to whether reported changes are progressive.

Results: Available findings suggest reduced grey matter in prefrontal brain regions such as anterior cingulate and subgenual prefrontal cortex, and abnormalities in amygdala size in adult and paediatric bipolar patients. White matter hyperintensities, which are non-specific abnormalities, are also common in bipolar patients. Bipolar patients may lose more brain grey matter by ageing. There is also evidence for impaired myelination of the corpus callosum in bipolar disorder. Lithium may reverse or prevent grey matter prefrontal cortex abnormalities in bipolar patients by its neuroprotective effects.

Conclusions: Both early developmental and later neurodegenerative processes may play a role in the pathophysiology of bipolar disorder. Findings from anatomical brain imaging studies implicate key regions involved in mood regulation. The evidence for the progressive nature of this illness is tentative, as no follow-up study with bipolar patients has been reported to this date.
Screening for Autism in Infants and Preschool Children with Developmental Delay
Authors: Gray Kylie M. , Tonge Bruce J.
Published: December 2009

Objective: This study aimed to identify emotional and behavioural problems specific to young children with autism using the Developmental Behaviour Checklist (DBC-P) and thus evaluate the efficacy of this checklist as a screening tool for autism in children with developmental delay aged 18–48 months.

Method: Subjects were 60 children with autism and developmental delay and 60 children with developmental delay without autism.

Results: Features were identified which differentiated the children with autism from those with developmental delay without autism. Analyses revealed that a 17-item version of the DBC-P performed well as a screening tool for autism, with an ‘area under the curve’ of 0.874, sensitivity of 0.8750, and specificity of 0.6909.

Conclusions: The DBC-P offers a potential simple and inexpensive method of screening at risk populations of preschool children with developmental delay for autism, thus facilitating timely referral to scarce specialist autism diagnostic services.
Antipsychotic Treatment in Obsessive Compulsive Disorder: A Literature Review
Authors: Keuneman Richard J. , Pokos Vanda , Weerasundera Rajiv , Castle David J.
Published: December 2009

Objective: To review the role of antipsychotic medications in the treatment of obsessivecompulsive disorder (OCD); to explore current hypothesized conceptualizations of their mechanism of action; to highlight evolving interest in the validation of meaningful OCD subtypes within a heterogeneous spectrum of OCD, based on treatment response and other psychobiological variables.

Method: A computerized literature search ( MEDLINE: 1966 to December 2003, EMBASE: 1982 to December 2003) was used to locate relevant literature, using the terms obsessivecompulsive, antipsychotic and subtypes, with no restrictions imposed on searches.

Results: Earlier studies of augmentation of serotonergic antidepressants (SRIs) with typical antipsychotics including haloperidol and pimozide in OCD demonstrated favourable responses, also highlighting patient subgroups with robust treatment response. Studies examining augmentation with atypical agents are emerging. SRI-resistant OCD patients are likely to benefit from augmentation with atypical antipsychotics in around 50% of cases.

Conclusions: While there is little role for antipsychotic monotherapy in OCD, there is growing evidence in support of adjunctive antipsychotics in OCD refractory to serotoninreuptake inhibitors (SRIs). Further controlled trials are warranted. Particular subgroups of OCD patients, notably those with comorbid tic disorder and those with schizotypal personality disorder, have been shown to respond more robustly to augmentation strategies in some trials of both typical and atypical antipsychotics. Dopaminergic mediation with or without a moderating effect on serotonergic systems is likely to be important in the pharmacodynamic mechanisms of action of antipsychotic-SRI combinations in OCD.