bluuebunny/crossref_metadata_2025 huggingface dataset:
The Public's Ability to Recognize Mental Disorders and their Beliefs about Treatment: Changes in Australia Over 8 Years
Authors: Jorm Anthony F. , Christensen Helen , Griffiths Kathleen M.
Published: December 2009

Objective: A national survey of Australian adults in 1995 showed a low level of recognition of mental disorders and beliefs about treatment that were often discordant with those of professionals. The present study aimed to find out whether recognition and treatment beliefs have changed over 8 years.

Method: A national survey of 2001 adults in 2003–2004 included the same questions as the 1995 survey. These interview questions were based on a vignette of a person with either depression or schizophrenia.

Results: Over the 8 years, the public showed better recognition of depression and schizophrenia and gave more positive ratings to a range of interventions, including help from mental health professionals, medications, psychotherapy and psychiatric ward admission.

Conclusions: The Australian public's beliefs have changed over 8 years to be more like those of mental health professionals. This change may have positive implications for helpseeking and treatment concordance.
Positive Relationships Between Public Awareness Activity and Recognition of the Impacts of Depression in Australia
Authors: Highet Nicole J. , Luscombe Georgina M. , Davenport Tracey A. , Burns Jane M. , Hickie Ian B.
Published: December 2009

Objective: This report records the level of exposure to depression-related information across the Australian community and explores associations with recognition of depression and relevant sociodemographic factors.

Method: A cross-sectional telephone survey was conducted with a representative community sample. Participants consisted of 3200 respondents (400 respondents across each Australian State/Territory).

Results: Sixty-five point four per cent (n=2089/3193) of respondents indicated that they or someone close to them had experienced depression, of whom 18.7% (n=391/2089) reported a personal experience of this illness. Various measures of recent exposure to depression-related information were high with 69.0% (n=2207/3200) reporting that they had seen, read or heard something in the media in the last 12 months. Recognition of beyondblue: the national depression initiativewas also surprisingly high (61.9%, 1982/3200). Those with greater understanding that depression is common and debilitating were more likely to recall recent media stories, spontaneously recall relevant organizations such as beyondblue, to have had direct or family experiences, to be younger and to have achieved higher levels of education. Depression, however, is rarely mentioned (1.3%, 47/3720) as a major general health as distinct from a mental health problem.

Conclusion: The active promotion of depression-related material to the community appears to have contributed to recognition of the commonality and impacts of this illness. Although depression is commonly recognized as a mental health problem, it is not yet considered a major general health problem. Further, like many public health campaigns, those initially reached appear more likely to be female, younger, better educated and residing in metropolitan areas.
Adolescents' Responses to Peers with Depression or Conduct Disorder
Authors: Kelly Claire M. , Jorm Anthony F. , Rodgers Bryan
Published: December 2009

Objective: To determine how young people are likely to respond to a peer with mental illness, or who has severe behavioural problems.

Method: A mental health literacy survey was conducted with 1137 adolescents in years 8, 9 and 10 in South Australia and the Australian Capital Territory. Respondents were presented with a vignette of either a 16-year-old boymeeting criteria for conduct disorder or a 16-year-old girl meeting criteria for major depression. As part of the survey, respondents were asked to write in words what they would do if the person in the vignette was a friend of theirs and they wished to help. Responses were coded into categories.

Results: Over half the sample (53%) described positive social support as the only action they would take to help. A further 23% said they would engage an adult such as a parent, teacher or school counsellor to help with the situation. Those responding to the conduct disorder vignette were more likely to describe engaging an adult to help and males were more likely to say they would do nothing. Female students tended to answer differently to the conduct disorder and depression vignettes, while male students responded similarly to the two vignettes.

Conclusions: Many adolescents do not respond to friends' distress in ways which are likely to facilitate appropriate help. Mental health education in schools should include skills for offering help and encouraging peers to seek help.
Risk and Protective Factors for Medically Serious Suicide Attempts: A Comparison of Hospital-Based with Population-Based Samples of Young Adults
Authors: Donald Maria , Dower Jo , Correa-Velez Ignacio , Jones Mark
Published: December 2009

Objective: To investigate risk and protective factors for medically serious suicide attempts among young Australian adults.

Method: The study used a case–control design. A clinical sample of 18–24 year olds was recruited via the emergency department of a large public hospital following a suicide attempt (n=95) and was compared to a sample of 18–24 year olds who participated in a population-based survey (n=380).

Results: Risk factors for medically serious suicide attempts included early school leaving, parental divorce (males only), distress due to problems with parents (females only), distress due to problems with friends, distress due to the break-up of a romantic relationship, tobacco use, high alcohol use, current depressive symptomatology and a previous diagnosis of depression. Protective factors included social connectedness, problem-solving confidence and locus of control. There was a trend for social connectedness to be more protective among those with high rather than low levels of depressive symptomatology, and among smokers rather than non-smokers.

Conclusions: Results are discussed in terms of designing evidence-based suicide prevention activities for young adults.
Correlates of the use of Purging and Non-Purging Methods of Weight Control in a Community Sample of Women
Authors: Mond Jonathan J. , Hay Phillipa J. , Rodgers Bryan , Owen Cathy , Mitchell James
Published: December 2009

Objective: To inform the classification of bulimic-type eating disorders, the correlates of purging and non-purging methods of weight control were examined in a large community sample of young adult women reporting recurrent episodes of binge eating.

Method: Scores on self-report measures of eating disorder psychopathology, functional impairment and health-service utilization were compared among individuals who reported (recurrent episodes of binge eating and) the use of either purging (self-induced vomiting, laxative or diuretic misuse; n = 41) or non-purging (extreme dietary restriction, excessive exercise, or use of diet pills; n = 62) methods of weight control. Individuals who reported recurrent binge eating in the absence of extreme weight control behaviours (n = 442) were also included in the analysis.

Results: Non-purgers tended to be younger and heavier and have higher levels of eating disorder psychopathology and functional impairment than purgers and non-compensating binge eaters, however these differences were not statistically significant. Purgers were more likely than non-purgers to have sought treatment specifically for a problem with eating, however this difference was no longer significant after age and body mass index were statistically controlled. In multivariate analysis, frequency of extreme dietary restriction was the best predictor of functional impairment.

Conclusions: These findings call into question the validity of subtyping of bulimia nervosa into purging and non-purging forms as outlined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.
Seizure Threshold Determination for Electroconvulsive Therapy: Stimulus dose Titration Versus Age-Based Estimations
Authors: Tiller John W.G. , Ingram Nicholas
Published: December 2009

Objective: This study compared electroconvulsive therapy (ECT) seizure threshold determined by stimulus dose titration with age-based estimations.

Method: Patients with major depressive disorder had their initial seizure thresholds determined by stimulus dose titration and the results compared with age-based estimations. There are no significant differences in thresholds determined by these methods.

Results: Two hundred and three psychiatric patients (149 females, 54 males) had their seizure thresholds determined by stimulus dose titration. There was a significant positive correlation between seizure thresholds and age for males and females with male thresholds greater than female thresholds. Age determinations of seizure threshold would have resulted in excessive initial treatment stimuli for 30% of females and 8% of males. Ineffective stimulus doses would have been given to 2% of females and 7% of males on a full age basis and 64% using a half age strategy.

Conclusions: For effective high-dose right unilateral ECT, initial seizure threshold should be determined by stimulus dose titration.
Firearms Legislation and Reductions in Firearm-Related Suicide Deaths in New Zealand
Authors: Beautrais A. L. , Fergusson D. M. , Horwood L. J.
Published: December 2009

Objective: To examine the impact of introducing more restrictive firearms legislation (Amendment to the Arms Act, 1992) in New Zealand on suicides involving firearms.

Method: National suicide data were examined for 8 years before, and 10 years following the introduction of the legislation.

Results: After legislation, the mean annual rate of firearm-related suicides decreased by 46% for the total population (p < 0.0001), 66% for youth (15–24 years; p < 0.0001) and 39% for adults (≥25 years; p < 0.01). The fraction of all suicides accounted for by firearm-related suicides also reduced for all three populations (p < 0.0001). However, the introduction of firearms legislation was not associated with reductions in overall rates of suicide for all three populations.

Conclusions: Following the introduction of legislation restricting ownership and access to firearms, firearm-related suicides significantly decreased, particularly among youth. Overall rates of youth suicide also decreased over this time but it is not possible to determine the extent to which this was accounted for by changes in firearms legislation or other causes.
Mental Disorders in Female Prisoners
Authors: Tye Christine S. , Mullen Paul E.
Published: December 2009

Objective: The objective of the study was to investigate the rates of mental disorder among women in prison in Victoria, and to compare with community rates.

Design: A midnight census of all women in prison in Victoria was undertaken. Respondents were interviewed with a version of the Composite International Diagnostic Interview (CIDI), an adapted version of the Personality Diagnostic Questionnaire (PDQ-4+) and a demographics questionnaire.

Main Outcome Measures: Twelve-month prevalence rates of ICD-10 mental disorders including depressive disorders, anxiety disorders and drug-related disorders were examined. Prevalence of personality disorders was also investigated.

Results: Eighty-four per cent of the female prisoners interviewed met the criteria for a mental disorder (including substance harmful use/dependence) in the year prior to interview. This rate was reduced to 66% when drug-related disorders were excluded. Fortythree per cent of subjects were identified as cases on a personality disorder screener. For all disorders, (except obsessive-compulsive disorder and alcohol harmful use) women in prison had a significantly greater likelihood of having met the 12-month diagnostic criteria when compared to women in the community. The most prevalent disorders among the female prisoners were: drug use disorder (57%), major depression (44%), Posttraumatic stress disorder (36%), and personality disorders. Almost a quarter (24%) of respondents were identified as a ‘case’ on the psychosis screen.

Conclusions: In the present study female prisoners had significantly higher rates of the mental disorders investigated (with the exceptions of OCD and alcohol harmful use) when compared with women in the community. The pattern of disorder found among female prisoners is consistent with the abuse literature, suggesting that histories of abuse among the prison population may account for part of the discrepancy. These results highlight the need for improved assessment and treatment resources to meet the demands of this population.
Using Participatory Action Research in a Community-Based Initiative Addressing Complex Mental Health Needs
Authors: Knightbridge Stephen M. , King Robert , Rolfe Timothy J.
Published: December 2009

Objective: This paper describes the first phase of a larger project that utilizes participatory action research to examine complex mental health needs across an extensive group of stakeholders in the community.

Method: Within an objective qualitative analysis of focus group discussions the social ecological model is utilized to explore how integrative activities can be informed, planned and implemented across multiple elements and levels of a system. Seventy-one primary care workers, managers, policy-makers, consumers and carers from across the southern metropolitan and Gippsland regions of Victoria, Australia took part in seven focus groups. All groups responded to an identical set of focusing questions.

Results: Participants produced an explanatory model describing the service system, as it relates to people with complex needs, across the levels of social ecological analysis. Qualitative themes analysis identified four priority areas to be addressed in order to improve the system's capacity for working with complexity. These included: (i) system fragmentation; (ii) integrative case management practices; (iii) community attitudes; and (iv) money and resources.

Conclusions: The emergent themes provide clues as to how complexity is constructed and interpreted across the system of involved agencies and interest groups. The implications these findings have for the development and evaluation of this community capacity-building project were examined from the perspective of constructing interventions that address both top-down and bottom-up processes.
Pathways to the First Contact with Specialist Mental Health Care
Authors: Steel Zachary , Mcdonald Robert , Silove Derrick , Bauman Adrian , Sandford Phil , Herron Jennifer , Harry Minas I.
Published: December 2009

Objective: To examine the pathways to mental health care followed by patients presenting for the first time to community- and hospital-based services and the degree to which individual characteristics, cultural background, illness type, severity and service-related variables influence the time and pathways taken to reach care.

Method: One hundred and forty-six consecutive Australian-born, Asian and Arabicspeaking patients making their first lifetime contact with mental health services in two area health regions were included. Symptom severity was assessed using the Health of the Nations Outcome Scales. Illness explanatory models, social support, English-language proficiency and acculturation were also assessed.

Results: An average of three professional consultations were made prior to first contact with public mental health services. Family physicians occupied a pivotal role in the helpseeking pathway with 53% of patients consulting a general practitioner. The median time taken to reach specialist mental health services was 6 months, with significantly shorter time for patients with psychotic disorders. Individual variables such as gender, social support, ethnicity and English flency were not associated with delays in receiving public mental health care. Ethnicity was associated with lower utilization of allied health professionals.

Conclusions: The data suggest that social and cultural factors influence the range of professionals consulted by those with a mental illness but do not delay their presentation to public mental health services.
Survey of Quality of Life and Related Risk Factors for a Taiwanese Village Population 3 Years Post-Earthquake
Authors: Wu Hung-Chi , Chou Pesus , Huang-Chih Chou Frank , Su Chao-Yueh , Tsai Kuan-Yi , Ou-Yang Wen-Chen , Tung-Ping Su Tom , Chao Shin-Shin , Sun Wen-Jung , Chen Ming-Chao
Published: December 2009

Objective: To investigate quality of life (QOL) and related risk factors in Taiwanese earthquake survivors diagnosed with different psychiatric disorders 3 years after the 1999 Chi-Chi earthquake.

Method: This study was a population survey. Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and questionnaires to interview 405 respondents (189 men and 216 women) aged 16 years or older, who had been exposed to the earthquake. Psychiatrists interviewed the same respondents using the Mini-International Neuropsychiatric Interview, with an adjusted response rate of 70.2%.

Results: The prevalence range for psychiatric disorders in the earthquake survivors was 0.2–7.2% 3 years after the Chi-Chi earthquake, with rates for major depression (MD) and posttraumatic stress disorder (PTSD) of 6.4% and 4.4%, respectively. The QOL scores for the PTSD/MD group were lower than for the other two diagnostic groups, as determined by assessment of physical and mental aspects of functional integrity from MOS SF-36 scores. The predictors for poor QOL were age, female gender, economic problems, physical illness, subjective assessment of memory and social-activity decline and diagnosis of PTSD or MD.

Conclusion: The QOL for earthquake survivors with psychiatric disorders, especially PTSD or MD, was inferior compared with the mentally healthy analogues, with contemporaneous decreases in mental and physical function scores across the QOL subscales. The persistence of long-term economic problems was one of many important factors affecting QOL.
Changes in Private Sector Electroconvulsive Treatment in Australia
Authors: Doessel Darrel P. , Scheurer Roman W. , Chant David C. , Whiteford Harvey A.
Published: December 2009

Objectives: This paper reports on changes, over time and between states, in the use of electroconvulsive therapy (ECT) in the private psychiatric sector in Australia between 1984 and 2004.

Method: Data for ECT services, and all specialist psychiatry services provided under the Medicare system, have been analysed in absolute numbers and as utilization rates.

Results: Changes in the use of ECT over time are different from other services provided by private psychiatrists. As in other countries, the use of ECT initially declined in period studied but has increased in recent years. In addition, there is a clear pattern of differential use of ECT between the states and territories.

Conclusions: This descriptive study cannot ‘explain’ the results obtained: other data, incorporated into an explanatory model using regression analysis, are needed to determine the factors underlying the utilization patterns obtained in this study. Thus, further work is needed. Furthermore, it is important to analyse data at a lower level of geographical aggregation than that of the state/territory: this (state/territory) aggregation conceals differences in utilization between metropolitan, minor city, rural and remote regions of the country.
A Survey of Publicly Funded aged Psychiatry Services in Australia and New Zealand
Authors: O'connor Daniel , Melding Pamela
Published: December 2009

Objective: To map the size and distribution of publicly funded aged psychiatry (psychogeriatric) services in Australia and New Zealand in 2003.

Method: Services were tracked exhaustively through personal, professional and academic contacts, electronic searches and word-of-mouth. Directors or managers of services were asked to complete a brief questionnaire concerning their locality, services, staff profile and patient contacts.

Results: Services varied widely with respect to their numbers, size and community outreach. Victoria was the only Australian state to provide specialist, multidisciplinary aged psychiatry teams with community, acute inpatient and residential arms in all its major cities. New South Wales, the state with the largest aged population, performed relatively poorly on most indicators. New Zealand performed relatively well despite its small size and widely dispersed population.

Conclusions: Publicly funded aged mental health services are effective and reach frail, multiply disabled old people who cannot access private psychiatrists and are often overlooked by services for younger adults. At the time of our survey, such services were distributed in Australia in a highly inequitable fashion.
Prospects for the Treatment of Depression
Authors: Norman Trevor R.
Published: December 2009

Antidepressant drugs represent the principal form of treatment for major depressive disorder. While there are a plethora of medications available for this task, current drugs have many shortcomings. In the face of these deficiencies there is an ongoing search for new agents. The search has been guided, in part, by drug design based on existing agents and their putative mechanism of action. This has been less than fruitful in addressing inadequacies of existing medications as it has not produced compounds which are novel in terms of pharmacological mechanisms. Recent insights from molecular biological approaches hold promise for the discovery of novel compounds, in particular the so-called neurogenesis hypothesis suggests novel therapeutic approaches. Although significantly modified over the years, the monoamine hypothesis of depression and antidepressant drug action still remains an important driving force behind the development of new compounds. Several recently marketed agents and some in early-phase development tend to conform to these existing mechanistic hypotheses. Clearly the place of these agents in the treatment of depression is dependent on issues such as short- and long-term safety and efficacy. Duloxetine has been developed as a dual monoamine re-uptake inhibitor. Agomelatine is a compound with major effects on the circadian system as well as effects on subtypes of the serotonin receptor system. While the mechanism of action of this compound is not certain, recent evidence would suggest that the drug exerts its effects through antagonist actions at serotonin receptors. Compounds based on the hypothalamic pituitary adrenal axis, substance P antagonism and other neuropeptides have potential application for the treatment of depression but require further development before that potential is realized.
What Violent Offenders Remember of their Crime: Empirical Explorations∗
Authors: Evans Ceri
Published: December 2009

Little systematic evidence is available about how violent offenders remember and think about their violent crimes. The general aim of this article is to selectively review a range of different ‘types’ of memory disturbance and their risk factors, in an attempt to draw together different strands of research concerning memories of offending that might usefully be considered together for clinical purposes. A selective review of psychiatric or psychological studies related to amnesia, intrusive memories, posttraumatic stress disorder (PTSD), ruminations, and pleasurable memories was performed. The body of research on amnesia in relation to violent crime is relatively small and is subject to significant limitations. The empirical base of studies identifying intrusive memories arising from violent crime is also very limited, with no previous published study primarily focusing on description of the form and content of intrusive memories related to acts of violence in a population of violent offenders. A small number of studies have investigated PTSD directly arising from the commission of a violent or sexual crime, in those with mental illness. No published studies that investigated the presence of ruminations related to violent offending were identified. No systematic comparative studies were identified that described the form and content that positive memories of non-sexual violence might take. Relevant phenomenological reports from extreme populations raise concerns about selection bias. A memory-based approach to eliciting descriptions of violent offending may elicit clinical information relevant to violence risk assessment and therapeutic interventions within forensic settings.
Smoking and Schizophrenia: Is Symptom Profile Related to Smoking and which Antipsychotic Medication is of Benefit in Reducing Cigarette use?
Authors: Barnes Mark , Lawford Bruce R. , Burton Simon C. , Heslop Karen R. , Noble Ernest P. , Hausdorf Karrin , Young Ross McD.
Published: December 2009

Objective: Smoking rate is disproportionately high among patients with schizophrenia, resulting in significant morbidity and mortality. However, cigarette smoking has been reported to have beneficial effects on negative symptoms, extrapyramidal symptoms, cognitive functioning and mood symptoms. Therefore, smoking cessation may worsen disability in schizophrenia. The association between smoking and these key clinical parameters was examined. Additionally, severity of smoking across four different antipsychotic treatment groups was explored.

Method: One hundred and forty-six patients with schizophrenia were assessed for smoking using expired carbon monoxide and smoking history. They were administered the Positive and Negative Symptom Scale, The Extrapyramidal Symptom Rating Scale, the Barnes Akathisia Rating Scale, Reitans Trail-making Test (A and B) and General Health Questionnaire-28.

Results: There was no difference in the chlorpromazine equivalent dose of any of the medications studied. Atypical agents were associated with significantly lower levels of smoking when compared with typical medications. There was no difference in smoking severity between the individual atypical medications examined. Similarly, there were no significant differences between smoking and non-smoking groups with regard to Positive and Negative Symptom Scale, Extrapyramidal Symptom Rating Scale, Trail-making Test and General Health Questionnaire-28. However, there was a significant difference between these groups with the smoking group demonstrating less akathisia.

Conclusions: Smoking is not associated with positive, negative cognitive and mood symptoms in schizophrenia. Smoking is associated with lower levels of antipsychotic induced akathisia. Clinicians should not be discouraged from helping patients stop smoking for fear of worsening symptoms. However, akathisia may emerge upon cessation of smoking. Switching patients from typical to atypical antipsychotics may assist patients with schizophrenia to give up smoking.
Clinical Staging of Psychiatric Disorders: A Heuristic Framework for Choosing Earlier, Safer and more Effective Interventions
Authors: McGorry Patrick D. , Hickie Ian B. , Yung Alison R. , Pantelis Christos , Jackson Henry J.
Published: December 2009

Diagnosis in psychiatry increasingly struggles to fulfil its key purposes, namely, to guide treatment and to predict outcome. The clinical staging model, widely used in clinical medicine yet virtually ignored in psychiatry, is proposed as a more refined form of diagnosis which could restore the utility of diagnosis, promote early intervention and also make more sense of the confusing array of biological research findings in psychiatry by organizing data into a coherent clinicopathological framework. A selective review of key papers in clinical medicine and psychiatry which describe clinical and clinicopathological staging, and a range of related issues. Clinical staging has immediate potential to improve the logic and timing of interventions in psychiatry just as it does in many complex and potentially serious medical disorders. Interventions could be evaluated in terms of their ability to prevent or delay progression from earlier to later stages of disorder, and they could be selected on clear-cut risk/benefit criteria. Biological variables and a range of candidate risk factors could be studied within and across stages, and their role, specificity and centrality in risk, onset and progression of disorder could be greatly clarified. A clinicopathological framework could be progressively constructed. Clinical staging with a restructure across and within diagnostic boundaries with the explicit operationalization of criteria for extent and progression of disorder should be actively explored in psychiatry as a heuristic strategy for the development and evaluation of earlier, safer, and more effective clinical interventions, and for clarifying the biological basis of psychiatric disorders.
The Latent Structure of Attention-Deficit/Hyperactivity Disorder: A Taxometric Analysis
Authors: Haslam Nick , Williams Ben , Prior Margot , Haslam Ric , Graetz Brian , Sawyer Michael
Published: December 2009

Objective: To test whether the latent structure of attention deficit/hyperactivity disorder (ADHD) is best understood as categorical or dimensional in samples of 1774 children (aged 6–12 years) and 1222 adolescents (aged 13–17 years) drawn from an Australian epidemiological study.

Method: Two taxometric procedures (MAXEIG and MAMBAC) examined ADHD symptom measures assessed by diagnostic interview and parental ratings.

Results: Consistent with behavioural genetic research, findings fail to support the view that a latent category underpins ADHD.

Conclusions: ADHD is best modelled as a continuum among both children and adolescents, and no discrete dysfunction can therefore be assumed to cause it. The placement of the diagnostic threshold should therefore be decided on pragmatic grounds (e.g. impairment or need for treatment).
Stress, the Hippocampus and the Hypothalamic-Pituitary-Adrenal Axis: Implications for the Development of Psychotic Disorders
Authors: Phillips Lisa J. , Mcgorry Patrick D. , Garner Belinda , Thompson Katherine N. , Pantelis Christos , Wood Stephen J. , Berger Gregor
Published: December 2009

Objective: The experience of stress is commonly implicated in models of the onset of psychotic disorders. However, prospective studies investigating associations between biological markers of stress and the emergence of psychotic disorders are limited and inconclusive. One biological system proposed as the link between the psychological experience of stress and the development of psychosis is the Hypothalamic-Pituitary-Adrenal (HPA) axis. This paper summarizes and discusses evidence supporting a role for HPA-axis dysfunction in the early phase of schizophrenia and related disorders.

Method: A selective review of psychiatric and psychological research on stress, coping, HPA-axis, the hippocampus and psychotic disorders was performed, with a particular focus on the relationship between HPA-axis dysfunction and the onset of psychotic disorders.

Results: Individual strands of past research have suggested that the HPA-axis is dysfunctional in at least some individuals with established psychotic disorders; that the hippocampus is an area of the brain that appears to be implicated in the onset and maintenance of psychotic disorders; and that an increase in the experience of stress precedes the onset of a psychotic episode in some individuals. Models of the onset and maintenance of psychotic disorders that link these individual strands of research and strategies for examining these models are proposed in this paper.

Conclusions: The current literature provides some evidence that the onset of psychotic disorders may be associated with a higher rate of stress and changes to the hippocampus. It is suggested that future research should investigate whether a relationship exists between psychological stress, HPA-axis functioning and the hippocampus in the onset of these disorders. Longitudinal assessment of these factors in young people at ‘ultra’ high risk of psychosis and first-episode psychosis cohorts may enhance understanding of the possible interaction between them in the early phases of illness.
Neuropsychiatry of Complex Visual Hallucinations
Authors: Mocellin Ramon , Walterfang Mark , Velakoulis Dennis
Published: December 2009

Objective: To describe the phenomenology and pathophysiology of complex visual hallucinations (CVH) in various organic states, in particular Charles Bonnet syndrome and peduncular hallucinosis.

Method: Three cases of CVH in the setting of pontine infarction, thalamic infarction and temporoparietal epileptiform activity are presented and the available psychiatric, neurological and biological literature on the structures of the central nervous system involved in producing hallucinatory states is reviewed.

Results: Complex visual hallucinations can arise from a variety of processes involving the retinogeniculocalcarine tract, or ascending brainstem modulatory structures. The cortical activity responsible for hallucinations results from altered or reduced input into these regions, or a loss of ascending inhibition of their afferent pathways.

Conclusions: A significant degree of overlaps exists between the concepts of Charles Bonnet syndrome and peduncular hallucinosis. The fluidity of these eponymous syndromes reduces their validity and meaning, and may result in an inappropriate attribution of the underlying pathology. An understanding of how differing pathologies may produce CVH allows for the appropriate tailoring of treatment, depending on the site and nature of the lesion and content of perceptual disturbance.
Naturalistic Study of the use of Transcranial Magnetic Stimulation in the Treatment of Depressive Relapse
Authors: Fitzgerald Paul B. , Benitez Jessica , De Castella Anthony R. , Brown Timothy L. , Jeff Daskalakis Z. , Kulkarni Jayashri
Published: December 2009

Background: The efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression has been assessed in a number of acute treatment trials during the last 10 years. Little is known about the long-term impact of the treatment on the disorder and its effectiveness when applied for repeated relapses of depression over time.

Method: Nineteen patients who had previously responded to rTMS in clinical trials received treatment with rTMS for a total of 30 episodes of depressive relapse.

Results: Approximately 10 months elapsed between treatment episodes. The majority of patients achieved a significant improvement in each treatment course with significant improvements achieved in patients treated with both low-frequency right-sided rTMS and high-frequency left-sided rTMS.

Conclusions: The study suggests that rTMS may have value in the treatment of episodes of depressive relapse with little reduction in efficacy over time.
Help-Seeking by Rural Residents for Mental Health Problems: The Importance of Agrarian Values
Authors: Judd Fiona , Jackson Henry , Komiti Angela , Murray Greg , Fraser Caitlin , Grieve Aaron , Gomez Rapson
Published: December 2009

Objective: To examine the role of stoicism, self-effficacy and perceived stigma in predicting help-seeking by rural residents, for mental health problems.

Method: A cross-sectional community survey was conducted with a sample of 467 rural residents (58% female), who completed self-report questionnaires assessing current levels of symptomatology, disability, perceived stigma, self-effficacy, stoicism, attitudes towards and experience of seeking help for psychological problems.

Results: Overall, 27.6% (n = 129) of respondents had sought help from a general practitioner and/or mental health professional for psychological problems or a mental health issue. More women than men reported having sought such help. Lifetime helpseeking for a psychological problem or mental health issue was positively associated with higher levels of distress and lower levels of stoicism and, to a lesser extent, lower levels of self-effficacy.

Conclusions: Efforts to improve help-seeking by rural residents for mental health problems should focus on understanding and addressing attitudes, such as stoicism which act as barriers to help-seeking.
Mental Health Literacy in Rural Queensland: Results of a Community Survey
Authors: Bartlett Helen , Travers Catherine , Cartwright Colleen , Smith Norman , Bartlett Helen , Travers Catherine , Cartwright Colleen , Smith Norman
Published: December 2009

Objectives: The aim of this study was to assess the awareness of, and attitudes to, mental health issues in rural dwelling Queensland residents. A secondary objective was to provide baseline data of mental health literacy prior to the implementation of Australian Integrated Mental Health Initiative - a health promotion strategy aimed at improving the health outcomes of people with chronic or recurring mental disorders.

Method: In 2004 a random sample of 2% (2132) of the estimated adult population in each of eight towns in rural Queensland was sent a postal survey and invited to participate in the project. A series of questions were asked based on a vignette describing a person suffering major depression. In addition, questions assessed respondents' awareness and perceptions of community mental health agencies.

Results: Approximately one-third (36%) of those surveyed completed and returned the questionnaire. While a higher proportion of respondents (81%) correctly identified and labelled the problem in the vignette as depression than previously reported in Australian community surveys, the majority of respondents (66%) underestimated the prevalence of mental health problems in the community. Furthermore, a substantial number of respondents (37%) were unaware of agencies in their community to assist people with mental health issues while a majority of respondents (57.6%) considered that the services offered by those agencies were poor.

Conclusion: While mental health literacy in rural Queensland appears to be comparable to other Australian regions, several gaps in knowledge were identified. This is in spite of recent widespread coverage of depression in the media and thus, there is a continuing need for mental health education in rural Queensland.
Influence of Gender on Mental Health Literacy in Young Australians
Authors: Cotton Sue M. , Wright Annemarie , Harris Meredith G. , Jorm Anthony F. , Mcgorry Patrick D.
Published: December 2009

Objectives: To determine the effects of gender on mental health literacy in young people between 12 and 25 years of age.

Design: Computer-Assisted Telephone Interviewing was employed to conduct a crosssectional structured interview focusing on young people's awareness of depression and psychosis.

Participants: The sample comprised 1207 young Australians (539 males and 668 females) between the ages of 12-25 recruited from two metropolitan and two regional areas within Victoria. Six hundred and six respondents were presented a depression vignette and 601 were presented a psychosis vignette.

Results: Female respondents (60.7%) were significantly more likely to correctly identify depression in the vignette as compared to male respondents (34.5%). No significant gender differences were noted for the psychosis vignette. Males were less significantly likely to endorse seeing a doctor or psychologist/counsellor for the treatment of psychosis. Males were also significantly more likely than females to endorse alcohol as a way of dealing with depression and antibiotics as useful for dealing with psychosis.

Conclusion: Gender differences in mental health literacy are striking. Males showed significantly lower recognition of symptoms associated with mental illness and were more likely endorse the use alcohol to deal with mental health problems. Such factors may contribute to the delays in help seeking seen in young males. Further research is needed to delineate how these gender differences in young people may obstruct help seeking, early intervention and other aspects of mental health service delivery.
Mental-Physical Comorbidity in Te Rau Hinengaro: The New Zealand Mental Health Survey
Authors: Scott Kate M. , Oakley Browne Mark A. , Mcgee Magnus A. , Elisabeth Wells J. ,   for the New Zealand Mental Health Survey Research Team
Published: December 2009

Objective: To estimate the prevalence of chronic physical conditions, and the risk factors for those conditions, among those with 12 month mental disorder; to estimate the prevalence of 12 month mental disorder among those with chronic physical conditions.

Method: A nationally representative face-to-face household survey was carried out in October 2003 to December 2004 with 12 992 participants aged 16 years and over, achieving a response rate of 73.3%. Mental disorders were measured with the World Mental Health version of the Composite International Diagnostic Interview (CIDI 3.0). Physical conditions were self-reported. All associations are reported adjusted for age and sex.

Results: People with (any) mental disorder, relative to those without mental disorder, had higher prevalences of several chronic physical conditions (chronic pain, cardiovascular disease, high blood pressure and respiratory conditions) and chronic condition risk factors (smoking, overweight/obesity, hazardous alcohol use). Around a quarter of people with chronic physical conditions had a comorbid mental disorder compared with 15% of the population without chronic conditions. Significant relationships occurred between some mental disorders and obesity, cardiovascular disease and diabetes for females, but not for males.

Conclusions: This paper provides evidence of substantial comorbidity between mental disorders and chronic physical conditions in New Zealand. This should be borne in mind by clinicians working in both mental health and medical services.
Disability in Te Rau Hinengaro: The New Zealand Mental Health Survey
Authors: Scott Kate M. , McGee Magnus A. , Wells J. Elisabeth , Oakley Browne Mark A.
Published: December 2009

Objective: To show the disability associated with 1 month mental disorders and chronic physical conditions for the New Zealand population, controlling for comorbidity, age and sex.

Method: A nationally representative face-to-face household survey was carried out from October 2003 to December 2004 with 12 992 participants aged 16 years and over, achieving a response rate of 73.3%. Mental disorders were measured with the World Mental Health (WMH) Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0). Disability was measured with the WMH Survey Initiative version of the World Health Organization Disability Assessment Schedule (WMH WHO-DAS) in the long-form subsample (n = 7435). Outcomes include five WMH WHO-DAS domain scores for those with 1 month mental disorders and with chronic physical conditions.

Results: Mood disorders were associated with more disability than anxiety or substance use disorders. Experiencing multiple mental disorders was associated with substantial role impairment. Mental disorders and chronic physical conditions were associated with similar degrees of disability on average. The combination of mental and physical disorders had additive effects on associated disability.

Conclusions: Mood disorders are disabling. The investigation of disability in relation to 1 month rather than 12 month disorders is likely to provide a clearer indication of the disability associated with mood disorders. Although some researchers have queried whether negative mood can lead to ‘over-reporting’ of disability, recent conceptualizations of disability provide a perspective which may ease such concerns. Comorbidity, of mental disorders or of mental and physical disorders, is disabling.
Prevalence of Mental Disorders Among Māori in Te Rau Hinengaro: The New Zealand Mental Health Survey
Authors: Baxter Joanne , Kani Kingi Te , Tapsell Rees , Durie Mason , Mcgee Magnus A. ,   For The New Zealand Mental Health Survey Research Team
Published: December 2009

Objective: To describe the prevalence of mental disorders (period prevalence across aggregated disorders, 12 month and lifetime prevalence) among Māori in Te Rau Hinengaro: The New Zealand Mental Health Survey.

Method: Te Rau Hinengaro: The New Zealand Mental Health Survey, undertaken between 2003 and 2004, was a nationally representative face-to-face household survey of 12 992 New Zealand adults aged 16 years and over, including 2595 Māori. Ethnicity was measured using the 2001 New Zealand census ethnicity question. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0), was used to measure disorder. The overall response rate was 73.3%. This paper presents selected findings for the level and pattern of mental disorder prevalence among Māori.

Results: Māori lifetime prevalence of any disorder was 50.7%, 12 month prevalence 29.5% and 1 month prevalence 18.3%. The most common 12 month disorders were anxiety (19.4%), mood (11.4%) and substance (8.6%) disorders and the most common lifetime disorders were anxiety (31.3%), substance (26.5%) and mood (24.3%) disorders. Levels of lifetime comorbidity were high with 12 month prevalence showing 16.4% of Māori with one disorder, 7.6% with two disorders and 5.5% with three or more disorders. Twelvemonth disorders were more common in Māori females than in males (33.6% vs 24.8%) and in younger age groups: 16–24 years, 33.2%; 25–44 years, 32.9%; 45–64 years, 23.7%; and 65 years and over, 7.9%. Disorder prevalence was greatest among Māori with the lowest equivalized household income and least education. However, differences by urbanicity and region were not significant. Of Māori with any 12 month disorder, 29.6% had serious, 42.6% had moderate and 27.8% had mild disorders.

Conclusion: Mental disorders overall and specific disorder groups (anxiety, mood and substance) are common among Māori and measures of severity indicate that disorders have considerable health impact. Findings provide a platform for informing public health policy and health sector responses to meeting mental health needs of Māori.
Twelve-Month and Lifetime Prevalences of Mental Disorders and Treatment Contact Among Pacific People in Te Rau Hinengaro: The New Zealand Mental Health Survey
Authors: Foliaki Siale A. , Kokaua Jesse , Schaaf David , Tukuitonga Colin ,   for the New Zealand Mental Health Survey Research Team
Published: December 2009

Objective: To show the 12 month and lifetime prevalences of mental disorders and 12 month treatment contact of Pacific people in Te Rau Hinengaro: The New Zealand Mental Health Survey.

Method: Te Rau Hinengaro: The New Zealand Mental Health Survey, undertaken in 2003 and 2004, was a nationally representative face-to-face household survey of 12 992 New Zealand adults aged 16 years and over including M ori (n = 2457), Pacific people (n = 2236), people of mixed Pacific and M ori ethnicity (n = 138), and ‘Others’ (a composite group of predominantly European descent) (n = 8161). Ethnicity was measured by self-identified ethnicity using the New Zealand 2001 Census of Population and Dwellings question. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0), was used to measure disorders. The overall response rate was 73.3%.

Results: Pacific people have high rates of mental illness: the unadjusted 12 month prevalence for Pacific people was 25.0% compared with 20.7% for the total New Zealand population. There were also higher 12 month prevalences of suicidal ideation (4.5%) and suicide attempts (1.2%). Only 25.0% of Pacific people who had experienced a serious mental disorder had visited any health service for their mental health reason compared with 58.0% of the total New Zealand population. The prevalence of mental disorder was lower among Pacific people born in the Islands than among New Zealand-born Pacific people.

Conclusion: Pacific people experience high prevalence of mental disorder and New Zealand-born Pacific people experience significantly higher prevalence than Island-born Pacific people.