bluuebunny/crossref_metadata_2025 huggingface dataset:
The Efficacy of Psychosocial Approaches to Behaviour Disorders in Dementia: A Systematic Literature Review
Authors: Opie Janet , Rosewarne Richard , O'Connor Daniel W.
Published: March 2003

Objective: This paper provides a systematic review of research findings published between 1989 and 1998 concerning non-pharmacological strategies to alleviate behavioural disturbances in elderly persons with dementia.

Method: Data collection strategies included computer literature searches, manual searches of selected journals and checks of references listed in previous reviews. To warrant inclusion, studies were required to include some measure of behaviour before and after the introduction of an intervention. Papers were appraised in the following domains: design, sampling technique, setting, behaviours studied, measurement tools, data collection methods, type of interventions and feasibility. An overall validity rating was assigned to each article using predetermined rules.

Results: Forty-three studies met criteria for inclusion including five randomised controlled trials. Validity ratings were as follows: one strong, 15 moderate, and 27 weak. Areas of scientific weakness included small numbers of subjects, inadequate descriptions of study participants, imprecise data collection methods, high attrition rates and insufficient statistical analysis. Despite this, there is evidence to support the efficacy of activity programs, music, behaviour therapy, light therapy, carer education and changes to the physical environment. The evidence in favour of multidis-ciplinary teams, massage and aromatherapy is inconclusive.

Conclusions: It was easier to interpret the results of rigorously designed studies that focused on a single behaviour or single intervention tailored to the needs of individuals and carers. Future studies should seek to replicate the findings outlined here, improving methodologies where necessary and including outcome measures that encompass the interests of people with dementia, family caregivers and health professionals.
Alcohol Problems Among Residents in Old Age Homes in the City of Mannheim, Germany
Authors: Weyerer Siegfried , Schäufele Martina , Zimber Andreas
Published: March 2003

Objective: This study aims to determine the prevalence of alcohol problems among residents in old age homes, its demographic and clinical features, and its association with the risk of falling.

Method: All residents (n = 1922) living in 20 randomly selected residential and nursing homes in the city of Mannheim, Germany, were included. Based on routine documentation, details of their sociodemographic features, medical diagnoses made upon admission, and current medication were compiled. The home staff filled out for each resident a standardised assessment sheet on activities of daily living-impairment (Barthel Index), behaviour problems, alcohol consumption, and frequency of falls.

Results: According to the diagnoses of the primary care physicians, 7.4% of the residents had mental and behavioural disorders due to alcohol (ICD-10: F10). Rates were particularly high among men, and younger and single or divorced residents. A high percentage of those with a diagnosis of alcohol abuse/dependence (41.1%) were transferred from mental hospitals. Home staff reported current alcohol abuse/dependence among 3.4% of all residents. The risk of falling was significantly elevated (Odds ratio: 2.65; p < 0.01) among those with current alcohol problems.

Conclusion: The results corroborate the findings from other studies wherein residents of old age homes constitute a group at risk of alcohol abuse and dependence. Alcohol problems were more the cause for, rather than the consequence of, home admission.
Psychiatry of Old Age: From Section to Faculty
Authors: Draper Brian , Snowdon John
Published: March 2003

Objective: To describe the processes that led to formation of the RANZCP Faculty of Psychiatry of Old Age (FPOA).

Method and Results: Two criteria needed to be fulfilled before Faculty status could be approved. One was to demonstrate a recognised body of knowledge concerning psychiatry of old age, and the other was to be able to offer a comprehensive training program in this subspecialty.

Conclusions: On 1 January 1999, FPOA came into existence.
Vascular Risk Factors and Alzheimer's Disease
Authors: Stewart R. , Prince M. , Mann Anthony
Published: March 2003

Objective: We aim to summarise the recent and accumulating epidemiological research which suggests that cardiovascular disease and vascular risk factors play an important role as risk factors for Alzheimer's disease (AD) in later life.

Method: The epidemiological literature is summarised in considering the evidence for such an association, focusing on optimally designed population-based studies. Potential mechanisms of association are considered, drawing on relevant findings from neuroscience.

Results: Cardiovascular disease and vascular risk disorders appear to be important factors in the aetiology of AD. However, there is a paucity of prospective studies with an adequate duration of follow-up to investigate the apparent age- and time-dependent nature of these associations.

Conclusions: Vascular disorders represent potentially preventable risk factors with an important population impact due to their high prevalence in developed countries. The concept of AD and vascular dementia as clearly distinguishable disorders clinically or aetiologically is becoming increasingly tenuous. A better understanding of the relationship between AD and vascular disorders will depend on a more flexible diagnostic and conceptual framework.
Psychostimulants, Adult Attention Deficit Hyperactivity Disorder and Morbid Jealousy
Authors: Pillai Krishna , Kraya Niazi
Published: March 2003

Objective: This paper aims to discuss the relationship between morbid jealousy, stalking behaviour, and psychodynamic issues. Comment will be made on the risk associated with diagnosis of adult attention deficit hyperactivity disorder (ADHD) and use of psychostimulants.

Clinical picture: A man born in the former Yugoslavia charged with stalking was referred for assessment. He presented with a history of treatment for ADHD with dexamphetamine and delusions regarding his wife's fidelity.

Treatment: The patient was treated with neuroleptics and counselling for himself and his family.

Outcome: The patient was returned to the community. He separated from his wife but retains the abnormal belief.

Conclusions: The diagnosis of adult ADHD appears to be increasing in Western Australia. Treatment with stimulants is common. The misdiagnosis of ADHD and consequent misuse of stimulants, can lead to the development of morbid jealousy, stalking behaviour and arrest.
An Analysis of Consumer Perspectives Following Contact with an Eating-Disorders Service
Authors: Swain-Campbell Nicola R. , Surgenor Lois J. , Snell Deborah L.
Published: March 2003

Objective: The views of consumers following contact with treatment for eating disorders represent an underresearched aspect of service provision. The aim of this paper is to examine patterns of consumer satisfaction following contact with a specialist eatingdisorders service.

Method: Using both a structured and an open-ended questionnaire format, consumer perspectives were sought routinely through postal survey 3 months after the point of first contact. Responses were analysed from 120 patients who returned their questionnaires during the 2-year period ending in December 1998.

Results: Although the structured response format indicated high rates of satisfaction, the open-ended format revealed five categories describing the perceived best and worst aspects following consultation with the service. The category of therapeutic alliance drew the majority of positive comments, while the most frequently cited worst aspect of consultation was the category of treatment type.

Conclusions: People with eating disorders form a unique group of mental health consumers to survey for satisfaction. While approval ratings prompted by both structured and open-ended questions were high, and centred around the theme of therapeutic alliance, the most frequent source of negative commentary was activities and structures considered essential by traditional treatment modalities. This provides important insights into the predicaments of people with eating disorders presenting for treatment, and the importance of developing satisfaction surveys to accommodate such predicaments and concerns.
The Mental and Physical Health of Female Sex Workers: A Comparative Study
Authors: Romans Sarah E. , Potter Kathleen , Martin Judy , Herbison Peter
Published: March 2003

Objectives: The objective of this study was to compare the mental and physical health, adult abuse experiences and social networks of female sex workers with data previously collected from two large community samples of age-matched women.

Method: A convenience sample of sex workers were interviewed and completed two wellestablished questionnaires, the General Health Questionnaire (GHQ-28) and the Intimate Bond Measure (IBM). Sex workers were invited to reflect on their experiences of their work.

Results: There were no differences in mental health on the GHQ-28 or in self-esteem (measured by an item on the Present State Examination) between the two groups. Neither were there any differences in their assessment of their physical health or the quality of their social networks. Sex workers were less likely to be married and had been exposed to more adult physical and sexual abuse than the comparison group. They were more likely to smoke and to drink heavily when they drank. One-third said that their general practitioner was not aware of their work. A subgroup not working with regular clients or in a massage parlour had higher GHQ-28 scores and may be an at-risk group. Narrative information about the work, particularly its intermittent nature, is presented.

Conclusions: No evidence was found that sex work and increased adult psychiatric morbidity are inevitably associated, although there may be subgroups of workers with particular problems. The illegal and stigmatized nature of sex work are likely to make usual public health strategies more difficult to apply, considerations which should give concern from a preventive health standpoint.
A Clinical Validation of the Dysmorphic Concern Questionnaire
Authors: Jorgensen Lisa , Castle David , Roberts Clare , Groth-Marnat Gary
Published: March 2003

Objective: The current study addressed the concept of dysmorphic concern as a symptom that may exist in a number of disorders. The aims of the study were to: (i) validate a recently developed questionnaire that measures dysmorphic concern, the Dysmorphic Concern Questionnaire (DCQ); and (ii) evaluate the relationship of dysmorphic concern to depressed mood, social phobia, and obsessive–compulsive symptomatology.

Method: Sixty-five psychiatric inpatients were diagnosed using the computerized version of the Composite International Diagnostic Interview (CIDI-A). They then completed the DCQ, and questionnaires measuring body dysmorphic disorder (the Body Dysmorphic Disorder Examination, or BDDE), depression, social phobia, and obsessive–compulsive disorder (OCD). The factor structure and convergent validity of the DCQ were determined, and associations with mood and anxiety symptoms explored.

Results: The DCQ was found to be a reliable and valid instrument that is sensitive to dysmorphic concern. Furthermore, although dysmorphic concern was associated with body dysmorphic disorder (BDD), depression, social phobia and OCD, only the score from the BDDE predicted DCQ score in a multiple regression analysis. Finally, BDD symptomatology was best defined by the presence of negative body beliefs as measured by the DCQ.

Conclusions: Negative body beliefs are the hallmark of BDD. However, the existence of dysmorphic concern does not necessarily imply a diagnosis of BDD. The DCQ is a quick and efficient means of identifying dysmorphic concern in those who present with depression, OCD, social phobia or BDD.
The Human Costs to Staff from Closure of a General Hospital: An Example of the Effects of the Threat of Unemployment and Fragmentation of a Valued Work Structure
Authors: Valent Paul
Published: March 2003

Objectives: To describe the stressors and stress responses in medical (and to some extent other) staff as a result of the process of closure of a major general hospital. This is the first such clinical description in the literature.

Method: Semistructured individual interviews were conducted with 50 senior medical staff and with administrators at a time of imminent closure of the hospital. Information was also pooled from medical unit and other hospital meetings. Impressions regarding the effects on other staff were also noted.

Results: The perceived threat of loss of work, meaninglessness of the closure and erosion of medical values caused manifestations of demoralization and stress, as well as overt medical symptoms and illnesses. Methods of coping included denial and other defences. Treatment included stress counselling at individual and group levels, which provided staff relief through being able to verbalize, label and connect their feelings and distress to valid stressors. However, the overall impact of counselling was limited.

Conclusions: There must be an understanding of the human costs on staff and patients when hospital closures are contemplated.
Depressogenic Cognitive Schemas: Enduring Beliefs or Mood State Artefacts?
Authors: Gladstone Gemma , Gladstone Gemma , Parker Gordon
Published: March 2003

Objective: The objective of this study was to review findings from a previously posited ‘lock and key’ hypothesis which challenge a number of assumptions about cognitive theories of depression.

Method: A review of existing cognitive vulnerability theories is presented. Two recent studies employed to test the lock and key hypothesis are summarized. The hypothesis is reviewed in light of other diathesis-stress models of cognitive vulnerability.

Results: The identification of a depressed individual's core beliefs or cognitive schemas is a difficult task, with perhaps unresolvable difficulties in disentangling any mood state determinant. Longitudinal assessment of originally euthymic subjects appears the best method to investigate any cognitive risk to depression and the significance of diathesis-stress models.

Conclusions: Empirical evidence for or against the validity of cognitive vulnerability theories is largely dependent upon the methodologies used to detect cognitive styles, as well as the nature of the subject groups studied.
First-Episode Psychosis in the Military: A Comparative Study of Prodromal Symptoms
Authors: Tan Hao-Yang , Ang Yong-Guan , Tan Hao-Yang , Ang Yong-Guan
Published: March 2003

Objective: The objective of this study is to provide a retrospective description of prodromal symptoms of young military servicemen with first-episode psychosis, and a comparison with first-episode non-psychotic disorders.

Method: Thirty consecutive servicemen presenting with first-episode psychosis were studied. Thirty-four randomly selected servicemen from 123 with non-psychotic disorders served as comparison. A combination of unstructured and semistructured interviews with the patient and other informants was used to describe the prodromal symptoms.

Results: The most common prodromal psychotic symptoms were social withdrawal (83%); anxiety (77%); sleep disturbance (77%); disturbance in attention, concentration or memory (73%); deterioration in studies in school (70%); depressed mood (63%); odd behaviour (53%); and anger or irritability (53%). Common symptoms found in first-episode psychosis and non-psychotic patients included sleep disturbance, anxiety, depressed mood and anger or irritability. Common symptoms that were associated with the psychotic prodrome were social withdrawal (p < 0.001), deterioration in school results (p < 0.001) and disturbance in attention, concentration or memory (p < 0.001). The psychotic prodrome was also associated with apathy (p < 0.001), odd behaviour (p < 0.001), doing nothing (p = 0.004) and thought blocking (p = 0.04).

Conclusion: Cognitive disturbances and attenuated negative symptoms appear to be more specific to the psychotic prodrome in young patients with first-episode psychosis.
Restraint Practices in Australasian Emergency Departments
Authors: Cannon Marianne E. , Cannon Marianne E. , Sprivulis Peter , Mccarthy James
Published: March 2003

Objective: The objective of this study was to estimate the use of restraint techniques and evaluate restraint policies and training in Australasian emergency departments Method: A survey of 116 Australasian emergency departments was conducted to determine the type, indications/contraindications, training, policies, documentation and audit requirements for restraint.

Results: The overall estimated rate of patient restraint is 3.3 episodes per 1000 presentations. The commonest indications for restraint are violence or threatened violence (52%), psychosis (32%) and acute brain syndrome (10%). Major contraindications are medical instability, risk of harm to staff in applying restraint and the availability of alternatives to restraint. Chemical restraint is used in all emergency departments surveyed. The commonest agents used are haloperidol (93%), midazolam (82%) and diazepam (59%). At least one benzodiazepine and one major tranquilliser are used in 97% of emergency departments. Manual restraint (87%) is frequently used as a prelude to chemical or, less frequently, mechanical restraint (69%). Seclusion restraint is used in 23% of Australasian emergency departments. Formal training is most commonly undertaken for chemical restraint, being used in 33% of departments surveyed. Less than half of the departments have written policies guiding the use of restraint, and only 11% audit their use of restraint. A specific form for restraint documentation is used in only one emergency department.

Conclusions: Patient restraint is a common procedure in Australasian emergency departments. There is little formal training in, or documentation or audit of, restraint practices in Australasian emergency departments, despite the important clinical, occupational health and medical legal issues associated with the use of restraint.
Screening for Depression in the Medically Ill: The Suggested Utility of a Cognitive-Based Approach
Authors: Parker Gordon , Parker Gordon , Hilton Therese , Hadzi-Pavlovic Dusan , Bains Jatinder
Published: March 2003

Objective: There is a need for a valid measure of depression in the medically ill, and one that is independent of medical illness characteristics. As yet, there is no such widely accepted measure. We thus report on the early development of such a measure using cognitive constructs that define depressive mood state nuances.

Method: We studied 67 patients with a significant medical illness, verbally administering a set of 81 provisional items. Sample members also alternatively completed one of two comparison measures: the Hospital Anxiety and Depression Scale (HADS) or the Beck Depression Inventory for Primary Care (BDI-PC). A psychiatrist interviewed a subset to determine severity of any depression and whether subjects met formalized caseness criteria for depression. The Composite International Diagnostic Interview (CIDI) was also administered during interviews to assess agreement with psychiatrist judgements about caseness.

Results: A 16-item measure with high internal consistency was derived, with validation analyses suggesting it was distinctly superior to the HADS and somewhat superior to the BDI-PC measure.

Conclusions: A cognitive-based approach (as used by both our measure and the BDI-PC) to screen for depression in medically ill groups appears to have distinct utility in identifying depressed patients, and in avoiding confounding influences of physical symptoms.
Gender Differences in the Relationship Between Depression and Suicidal Ideation in Young Adolescents
Authors: Allison Stephen , Allison Stephen , Roeger Leigh , Martin Graham , Keeves John
Published: March 2003

Objective: This study examined the risk relationship between depressive symptomatology and suicidal ideation for young adolescent males and females.

Method: A large cohort of students in their first year of high school completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Adolescent Suicide Questionnaire. The risk relationship between depressive symptomatology and suicidal ideation was modelled using non-parametric kernel-smoothing techniques.

Results: Suicidal ideation was more frequently reported by females compared with males which was partly explained by females having higher mean depression scores. At moderate levels of depression females also had a significantly higher risk of suicidal ideation compared with males and this increased risk contributed to the overall higher levels of female ideation.

Conclusions: The risk relationship between depressive symptomatology and suicidal ideation is different for young adolescent males and females. The results indicate that moderate levels of depressive symptomatology can be associated with suicidal ideation (especially among young females) and that for these young people a suicide risk assessment is required.
How Reliable are Reported Plasma Clozapine Levels?
Authors: Bell Ron , Bell Ron , Mclaren Andrew , Copolov David
Published: March 2003

Objective: Many practitioners use plasma levels to determine the optimum dosage of clozapine. The aim of this study was to determine the intra- and interlaboratory accuracy in assaying samples of clozapine dissolved in human plasma.

Method: Three samples were sent to one laboratory to obtain an initial determination of accuracy (phase I). Then samples of clozapine dissolved in human plasma were prepared at concentrations of 140, 310 and 580 ng/mL and despatched on dry ice to 10 assaying centres in Australia and New Zealand. The results of the survey were analysed and posted to each centre (phase II). The programme was repeated using concentrations of 160, 380 and 640 ng/mL (phase III). Samples prepared in purified water and freeze-dried samples were also despatched.

Results: In phase II there were two centres with results significantly different from the mean. In phase III all the centres returned concordant results. There was a high level of consistency in the measurement of samples with a maximum coefficient of variation of 0.16. The concentrations determined by the centres, however, were significantly lower than the nominal concentrations of the prepared solutions.

Conclusions: Clinicians in Australia and New Zealand who wish to know their patients' plasma-clozapine levels can be confident that the result of the assay is unlikely to vary with the choice of centre or the operator who performs the assay.
Does Case Management Work? The Evidence and the Abuse of Evidence-Based Medicine
Authors: Rosen Alan , Teesson Maree
Published: March 2003

Objectives: This study reviews typologies of psychiatric case management and then discusses the efficacy, effectiveness and cost effectiveness of psychiatric case management, with particular focus on evidence from Australia and the UK. Subsequently, it aims to examine the way such evidence has been interpreted in the context of UK psychiatric research and services. Finally it examines the ways in which, by the selective reviewing or editorializing of evidence, case management has been brought into disrepute in the UK.

Method: This study reviews literature of the recent evidence for case management, and asks three questions of case management: has it been shown to be efficacious in controlled research, is it effective in applied settings, and is it cost effective? An examination is then made of the concurrent representations of the UK evidence in both the academic literature and the media.

Results: There is strong evidence for the efficacy effectiveness and cost-effectiveness of case management in psychiatry, the closer it conforms to active and assertive community treatment models. It appears, however, that studies and evidence-based reviews of case management have possibly been misused and misrepresented in a highly charged atmosphere of professional media debate. The potential for this abuse is not limited to psychiatry and remains a challenge for all evidence-based practice.

Conclusion: On the evidence, assertive community treatment case management is one of the most effective interventions in psychiatry today. Despite improving the evidence base for practice (e.g. as has occurred for case-management in psychiatry), evidence-based medicine (EBM) is still susceptible to compromise and misrepresentation, due to unexamined or undeclared bias. Unless this potential for abuse is recognized and checked, EBM in psychiatry is in danger of being discredited at the hand of some of its own proponents. There is a need for more rigorous pursuit of evidence-based psychiatry, including more systematic declaration of bias in all research, whether quantitative or qualitative in design.
The Mental Health of Young People in Australia: Key Findings from the Child and Adolescent Component of the National Survey of Mental Health and Well-Being
Authors: Sawyer M.G , Arney F. M. , Baghurst P. A. , Clark J. J. , Graetz B. W. , Kosky R. J. , Nurcombe B , Patton G. C. , Prior M. R. , Raphael B , Rey J. M. , Whaites L.C , Zubrick S.R
Published: March 2003

Objective: To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4–17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems.

Method: The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess healthrelated quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours.

Results: Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25%% of those with mental health problems had attended a professional service during the six months prior to the survey.

Conclusion: Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders.
‘Best Intentions’ Lives on: Untoward Health Outcomes of Some Contemporary Initiatives in Indigenous Affairs
Authors: Hunter Ernest
Published: March 2003

Objective: A shortened version of a presentation to the Australian Institute of Aboriginal and Torres Strait Islander Studies, this paper raises questions regarding policy and program directions in Indigenous affairs with consequences for Indigenous health.

Method: The author notes the inadequate Indigenous mental health database, and describes contemporary conflicts in the arena of Indigenous mental health, drawing on personal experience in clinical service delivery, policy and programme development.

Results: Medicalized responses to the Stolen Generations report and constructions of suicide that accompanied the Royal Commission into Aboriginal Deaths in Custody are presented to demonstrate unforeseen health outcomes. Examples are also given of wellintentioned social interventions that, in the context of contemporary Indigenous society appear to be contributing to, rather than alleviating, harm. Problems of setting priorities that confront mental health service planners are considered in the light of past and continuing social disadvantage that informs the burden of mental disorder in Indigenous communities.

Conclusions: The importance of acknowledging untoward outcomes of initiatives, even when motivated by concerns for social justice, is emphasized. The tension within mental health services of responding to the underpinning social issues versus providing equity in access to proven mental health services for Indigenous populations is considered.
An Analysis of Systems of Classifying Mild Cognitive Impairment in Older People
Authors: Collie Alexander , Maruff Paul
Published: March 2003

Objective: Over the past two decades, a number of systems have been developed for the classification of cognitive and behavioural abnormalities in older people, in order that individuals at high risk of developing neurodegenerative disease, particularly Alzheimer's disease, may be identified well before the disease manifests clinically. This article critically examines the inclusion and exclusion criteria of a number of such classification systems, to determine the effect that variations in criterion may have on clinical, behavioural and neuroimaging outcomes reported from older people with mild cognitive impairment.

Method: Qualitative review of the literature describing systems of classifying mild cognitive impairment, and outcomes from clinical, behavioural, neuroimaging and genetic studies of older people with mild cognitive impairment.

Results: The exclusion and inclusion criteria for these classification systems vary markedly, as do the design of studies upon which the validity of these systems has been assessed. Minor changes to individual exclusion/inclusion criterion may result in substantial changes to estimates of the prevalence and clinical outcome of mild cognitive impairment, while inadequate experimental design may act to confound the interpretation of results.

Conclusions: As a result of these factors, accurate and consistent estimates of the outcome of mild cognitive impairments in otherwise healthy older people are yet to be obtained. On the basis of this analysis of the literature, optimal criteria via which accurate classifications of mild cognitive impairment can be made in future are proposed.
Suicide in Australian Farming, 1988–1997
Authors: Page Andrew N. , Fragar Lyn J.
Published: March 2003

Objectives: To identify and describe suicide data for occupational classifications relating to farm managers and agricultural labourers for Australia for the period 1988 to 1997, and to relate resultant suicide rates to farmers’ terms of trade.

Method: Descriptive and linear regression analysis of aggregated mortality data.

Results: In the period 1988 to 1997, 921 suicides were identified. The majority of these suicides were farm managers (67.4%). Farm manager suicides occurred predominantly in older age groups (55 + years). In comparison agricultural labourer suicides were younger, with the majority of suicides occurring in the 15–39 years age group. The most common methods for both groups were firearms (particularly hunting rifles and shot guns), hanging and motor vehicle exhaust gas. These methods accounted for approximately 81% of all male farm suicides. Firearms accounted for 51% of male farm suicide, in comparison to 23% for the wider Australian male population for the same period. Estimated age standardized rates per 100 000 for male farm managers for the 10-year period ranged from 24.8 to 51.4. For male agricultural labourers these rates ranged from 23.5 to 41.9. Analyses also revealed a negative correlation (r = −0.75, p < 0.01) between farm manager suicide rates and farmers’ terms of trade.

Conclusion: Male farm manager and agricultural labourer suicide rates are higher than male national rates and rates in the wider rural population, particularly in the later years of the period investigated. Firearms prefigure as the most common method of suicide, despite decreases in this method in the wider rural population. Establishing more accurate denominator data for the farming community is a priority, as is preventative action that accounts for unique aspects of farm life.
Factors Associated With Dysmorphic Concern and Psychiatric Morbidity in Plastic Surgery Outpatients
Authors: Kisely Stephen , Morkell Daniel , Allbrook Bruce , Briggs Patrick , Jovanovic Jasmina
Published: March 2003

Objectives: To compare new referrals to a plastic surgery clinic for cosmetic (non-medically explained) reasons with a control group of equal size with medically explained symptoms.

Method: Patients attending for cosmetic (non-medically explained) reasons were compared with the controls using the general health questionnaire (GHQ), and dysmorphic concern questionnaire (DCQ). Patients were divided into high and low DCQ scores on the basis of their median scores.

Results: Ninety subjects were approached of whom 84 (93%) participated giving 42 patients each in the cosmetic (non-medically explained) and control groups. Forty-four per cent were referred for mammoplasty (n = 37) and 8% for rhinoplasty (n = 7). The other 40 cases (48%) were for other procedures including excision, abdominoplasty and blepharoplasty. Thirty-two per cent of the sample were GHQ cases (n = 27). Patients presenting for cosmetic (non-medically explained) reasons were 13 times more likely to be female (95% CI = 4.3–41), nine times more likely to have high DCQ scores (95% CI = 3.3–24), six times more likely to be GHQ cases (95% CI = 2.1–17), and seven times more likely to present for mammoplasty. The same factors were associated with high DCQ scores. Patients with high DCQ scores were 32 times as likely to be GHQ cases (95% CI = 6.8–151). On multivariate analysis, dysmorphic concern emerged as the only independent predictor of GHQ caseness rather than sex, surgical diagnosis or procedure (adjusted OR = 32.0, 95 % CI = 6.5–156). Similarly, only GHQ caseness and presentation for cosmetic (non-medically explained) surgery independently predicted DCQ score.

Conclusions: Patients presenting for cosmetic (non-medically explained) surgery have high rates of dysmorphic concern and psychiatric morbidity
Deinstitutionalization for Long-Term Mental Illness: A 6-Year Evaluation
Authors: Hobbs Coletta , Newton Lesley , Tennant Christopher , Rosen Alan , Tribe Kate
Published: March 2003

Objective: Forty-seven patients with long-term mental illness were transferred to the community following the closure of a psychiatric hospital in Sydney. This 6-year evaluation is an extension of a detailed clinical, ethnographic and economic study of the initial 2-years of community transition.

Method: Quantitative evaluation was conducted using the Brief Psychiatric Rating Scale, Life Skills Profile, Social Behaviour Scale, Montgomery Asberg Depression Rating Scale and Quality Of Life measures. Assessments were completed prior to discharge and at two- and 6-year intervals following community transfer. Repeated measures analysis was utilized to determine changes in outcome variables over time. The residents' perception of 6-years of community living was explored in qualitative semistructured interviews. Details of accommodation, level of care, readmissions, incidents and medication were also documented.

Results: During the 6 years following community relocation a total of seven residents returned to hospital for long-term care, three residents died from medical causes and one resident required detention in a corrective services facility. The 36 residents who remained in the community at the 6-year follow-up no longer required intensive 24-h supervision. Living semi-independently, 23 residents resided in two to three person accommodation with either daily or weekly case manager visits. Clinically, community residents remained stable over the 6 years without significant changes in psychiatric symptoms, depression, living skills or social behaviour problems. Clinical stability was achieved with significant reduction in medication levels over the 6 years. Community-based residents continued to experience improved quality of life and reported their marked preference for living in the community.

Conclusion: The residents maintained community tenure with significant improvement in quality of life and a reduction in medication, supported by a mental health system with adequate community resources. Issues regarding continuing rehabilitation and social integration need to be addressed. Further deinstitutionalization will require 24-h supervision for most initially and for some on a continuing basis. An ageing population will require specific age related medical and psychiatric services.
The Prevalence and Nature of Stalking in the Australian Community
Authors: Purcell Rosemary , Pathé Michele , Mullen Paul E.
Published: March 2003

Objective: This study examines the extent and nature of stalking victimisation in a random community sample.

Method: A postal survey was distributed to 3700 adult men and women selected from the electoral roll in the State of Victoria. Outcome measures included the lifetime and annual cumulative incidence of stalking, the duration and methods of harassment, rates of associated violence and responses to victimisation.

Results: Almost one in four respondents (23.4%;432) had been stalked, the unwanted behaviour they were subjected to being both repeated and fear-provoking. One in 10 (197) had experienced a protracted course of stalking involving multiple intrusions spanning a period of at least one month. Women were twice as likely as men to report having been stalked at some time in their lives, though the rates of victimisation in the 12 months prior to the study did not differ significantly according to gender. Younger people were significantly more likely than older respondents to report having been stalked. Victims were pursued by strangers in 42% of cases. The most common methods of harassment involved unwanted telephone calls, intrusive approaches and following. Associated threats (29%) and physical assaults (18%) frequently arose out of the stalking. Significant social and economic disruption was created by the stalking for 63% of victims. Most sought assistance to manage their predicament (69%).

Conclusions: The experience of being stalked is common and appears to be increasing. Ten percent of people have been subjected at some time to an episode of protracted harassment. Assaults by stalkers are disturblingly frequent. Most victims report significant disruption to their daily functioning irrespective of exposure to associated violence.
Life Events, Stress and Depression: A Review of Recent Findings
Authors: Tennant Christopher
Published: March 2003

Objective: To review recent empirical prospective studies on the relation between life event stressors and depression.

Method: A systematic literature search focusing on predictive studies was carried out from 1980 to early 2001 using Medline, Embase and PsychInfo.

Results: The empirical findings for the most part support clinical impressions of the relation of stressors to depression but at the same time provide some clearer understanding in relation to differences of stressor impact on depression type and on index episode, relapse or recurrence. Twin studies now provide the strongest evidence of the relative magnitude of effect of environmental stressors and genetic factors: the former explains at least as much of the variance in depression as our genes.

Conclusions: Continuing research into life events and depression have been fruitful especially those studies assessing the effect of stressors in combination with other aetiological variables such as genetic factors.
Treatments for Chronic Fatigue Syndrome and the Internet: A Systematic Survey of what Your Patients are Reading
Authors: Kisely Stephen R
Published: March 2003

Objective: To evaluate the type, quality, and focus of patient information on the treatment of chronic fatigue syndrome on the Internet using simple search techniques.

Design: The search phrase ‘chronic fatigue syndrome’ was entered into nine common Internet search engines. The 25 most highly ranked pages identified by each of the nine search engines were analysed using a standardized pro forma. The following outcome measures were used: balance of content, consistency of content with evidence-based practice, declared authorship with credentials, information sources including the presence of references, the declaration of any potential conflict of interest, and the need to clarify information with an appropriate health professional.

Results: Two hundred and twenty-five websites were reviewed during a 2-week period in September 2000. A further 15 sites (6.3%) were inaccessible. Agreement between websites and systematic reviews of treatment for chronic fatigue syndrome ranged from 4 to 68%, the greatest agreement being for recommendations for graded exercise and the avoidance of prolonged rest. Most sites (64%) had a named author. Only a quarter to a third contained a declaration of interest, advised readers to clarify information with an appropriate health professional, or avoided inaccurate statements.

Conclusions: The Internet contains a great deal of information on chronic fatigue syndrome that is neither balanced nor consistent with evidence-based practice. Doctors individually, and as a profession, should provide guidance on which Internet sites to trust.
Cardiotoxicity and Prescription of Thioridazine in New Zealand
Authors: Menkes David B , Knight James C
Published: March 2003

Objective: To review the production of cardiac arrhythmia by thioridazine, and consider the role of government regulation in light of antipsychotic prescribing trends in New Zealand.

Methods: We conducted a focused literature review on psychotropic-induced cardiotoxicity, including mechanisms and incidence. In addition, we considered trends in antipsychotic prescription in New Zealand and decisions made by regulatory bodies in Australia, North America and the United Kingdom regarding restrictions on the prescription of thioridazine.

Results: In general, the cardiotoxicity of antipsychotics, including thioridazine, relates to the ability of these drugs to antagonize voltage-sensitive potassium channels, and thereby prolong the QT interval. This action can lead to malignant arrhythmias in a very small proportion (< < 1%) of patients; the risk may be increased by other drugs or factors which prolong QT or inhibit the metabolism of thioridazine. A review of prescription doses and volumes in New Zealand indicates that thioridazine is prescribed mainly in low doses by nonspecialists, and its use has been waning significantly over the past 2 years. These trends predate recent publicity regarding cardiotoxicity.

Conclusions: Recommendations regarding thioridazine use are presented. Although new patients should not receive this drug, existing patients benefiting from modest doses should not be denied access unless clear-cut risk factors for cardiotoxicity are evident.
Project for a Scientific Psychiatry in the 21st Century
Authors: Levy Florence , Levy Florence
Published: March 2003

Objective: To discuss potential advances in neuroscientific knowledge in the 21st century, enabling the realization of Freud's original vision of a basic biological science and an associated metapsychology.

Results: The Australian Twin Study of Attention Deficit Hyperactivity Disorder (ADHD) has demonstrated the high heritability of the core symptoms of ADHD, as well as showing important genetic and environmental influences on comorbid conditions. Brain mapping techniques suggest that working memory, as measured by an A–X Continuous Performance Task, is important in ADHD.

Methods: To outline the development of our own clinical research into ADHD, and the potential for future behaviour and molecular genetic approaches.

Conclusions: The 21st century promises new and exciting developments in phenomenology, genetics, and neuroscientific understandings in Child Psychiatry.
Pro Re Nata Medication for Psychoses: An Audit of Practice in Two Metropolitan Hospitals
Authors: Geffen Josh , Sorensen Lene , Stokes Julie , Cameron Allison , Roberts Michael S. , Geffen Laurence
Published: March 2003

Objective: To examine the use of pro re nata (PRN) (as needed) medication in hospitalized patients with psychotic disorders.

Methods: Retrospective chart reviews were conducted at two large public psychiatry units situated in inner city general hospitals. Pro re nata medication prescription, administration and outcomes were examined during inpatient episodes of care for 184 consecutive admissions of patients diagnosed with a psychotic disorder. Patient demographics, diagnoses, and regularly prescribed medication were also recorded. All admissions were drawn from a threemonth period from December 1998–February 1999.

Results: The most prevalent diagnoses were schizophrenia related disorders (n = 111) and mania (n = 34). Substance use disorders (n = 49) were the most common comorbid disorders. Pro re nata medication was administered during the acute phase of 82% of admissions. Drugs prescribed Pro re nata were mostly typical antipsychotics, benzodiazepines and/or anticholinergics. Coprescription of typical antipsychotics PRN with regularly scheduled atypical antipsychotics was common (64%). Pro re nata medications accounted for 31% of the total antipsychotic dose and 28% of the total anxiolytic dose administered during acute treatment. Higher daily doses of PRN medication were given to manic patients, males, younger patients and those with substance use disorders. Pro re nata prescriptions usually specified a maximum daily dose (87%) but rarely gave indications for use (6%). Administration records frequently lacked a specified reason for use (48%) or a notation of outcome (64%). Unit staff noted medication-related morbidity in 37% of patients receiving PRN medication, compared to 3% of patients receiving only regularly scheduled medication. Extrapyramidal symptoms (EPS) were most frequently associated with administration of PRN haloperidol (Relative Risk vs other PRN medications = 5.61, 95% CI = 2.36–13.73).

Conclusions: Pro re nata medications comprised a significant part of the treatment which psychotic patients received. The common practice of coprescribing PRN typical antipsychotics with scheduled atypical antipsychotics is potentially problematical since administration of PRN medication is associated with significant medication related morbidity. Preferential use of benzodiazepines as PRN agents may minimize this morbidity and foster subsequent compliance with regularly prescribed antipsychotics.