bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of State Anxiety on the Jumping to Conclusions Delusion Bias
Authors: Ho-wai So Suzanne , Freeman Daniel , Garety Philippa
Published: December 2009

Objective: This is the first study to investigate the relationship between the level of state anxiety and the jumping to conclusions (JTC) reasoning bias in patients with first-episode psychosis using an experimental manipulation procedure.

Method: Thirty patients with psychotic delusions and 30 non-clinical controls, from Hong Kong, were randomized into an anxiety induction or an anxiety reduction imagery condition. Questionnaires were used to measure trait emotions, psychotic symptoms and delusional thinking at baseline. After the anxiety manipulation, participants completed two versions of an assessment of the JTC reasoning bias, the beads task.

Results: Both the patients and the non-clinical controls were responsive to the anxiety reduction imagery, but only the non-clinical controls responded to the anxiety induction imagery. The JTC reasoning bias was, as hypothesized, more common in patients than in controls, but was not significantly different between the anxiety manipulation conditions. Both patients and controls had higher rates of JTC than in previous studies.

Conclusions: Patients with psychotic delusions have a marked JTC cognitive bias. This is the first JTC study in a Chinese sample, and the results suggest that the bias applies cross-culturally. The results indicate that state anxiety does not influence JTC. Limitations of the study include an inadequate anxiety state manipulation effect in psychotic patients using brief imagery, and unusually high rates of JTC in both patients and controls.
Ethnic Comparisons of Antipsychotic Use in Schizophrenia
Authors: Wheeler Amanda , Humberstone Verity , Robinson Elizabeth
Published: December 2009

Objective: The aim of the present study was to compare ethnic groups for antipsychotic prescribing in schizophrenia over 4.5 years.

Methods: All clinical files in three mental health services caring for outpatients in Auckland, New Zealand were reviewed at two time points (T1 =31 March 2000, T2 =31 October 2004). Data were collected (patient characteristics, diagnosis, antipsychotic treatment) and analysed at each time point. Adjustments were made for age and sex in the comparisons. After the first audit, feedback was provided to all three services.

Results: Differences in baseline prescribing were found between ethnic groups; rates of antipsychotic polypharmacy, second-generation antipsychotic (SGA) use, depot antipsychotic use, clozapine use and total antipsychotic dose. Overall five of the six prescribing outcome variables changed over the 4.5 years; only mean antipsychotic daily dose remained the same. Monotherapy rates increased in all ethnic groups with no difference found between them at T2 (85–86%). Similarly the prescribing variables of oral SGA use increased (83–87%), depots decreased (T2 =14–19%) and oral first-generation antipsychotics (FGAs) decreased (T2 =5–8%), all with no difference found between ethnic groups at T2. While clozapine use increased in all ethnic groups, a significant difference remained at T2; European, NZ Māori and Pacific all increased to 33–39%, but rates for Asian subjects increased only to 20%. The difference in mean daily antipsychotic dose between ethnic groups (122 mg day−1 chlorpromazine equivalent (CPZe) at T1; 86 mg day−1 CPZe at T2) reached statistical significance at both time points but overall the average dose (total mg day−1) for each group was within the usual clinical range. Adjustment for age and sex did not change the significance of any of the comparisons between ethnic groups.

Conclusions: Most baseline differences in antipsychotic prescribing between ethnic groups resolved over time, with equal access for patients to recommended best practice with antipsychotic treatment in schizophrenia. Further work is required to look at differences in access to clozapine for Asian people.
Impact of Substance-Induced and General Medical Condition Exclusion Criteria on the Prevalence of Common Mental Disorders as Defined by the CIDI
Authors: Sunderland Matthew , Slade Tim , Anderson Tracy M. , Peters Lorna
Published: December 2009

Objectives: It has been previously argued that the methodology used by the Composite International Diagnostic Interview version 2.1 to assess the substance-induced and general medical condition exclusion criteria are inadequate. As a result prevalence estimates generated from epidemiological studies using this interview may be underestimated. The purpose of the current study was to examine the substance-induced and general medical condition exclusion criteria in the Australian National Survey for Mental Health and Well-being and determine the impact that they have on prevalence estimates of the common mental disorders.

Method: Data from the 1997 Australian National Survey of Mental Health and Well-being were analysed. Frequencies were generated as an indication of how many respondents believed that their psychiatric symptoms were always due to a substance or general medical condition. New DSM-IV prevalence estimates were calculated ignoring the application of the substance-induced and general medical condition exclusion criteria and compared to standard DSM-IV prevalence estimates.

Results: The effect of the substance-induced and general medical condition exclusion criteria on final prevalence rates were minimal, with approximately a 0.1% increase when the exclusions were ignored. This equates to a relative difference ranging from no difference for generalized anxiety disorder to an increase of 12% of the base prevalence estimate for agoraphobia.

Conclusions: In surveys that use the Composite International Diagnostic Interview version 2.1 the substance-induced and general medical condition exclusion criteria have a minor impact on determining final case definition in the majority of mental disorders.
Is this D Vitamin to Worry About? Vitamin D Insufficiency in an Inpatient Sample
Authors: Berk Michael , Jacka Felice N. , Williams Lana J. , Ng Felicity , Dodd Seetal , Pasco Julie A.
Published: December 2009

Objective: The aim of the present study was to investigate the relationship between reduced serum vitamin D levels and psychiatric illness.

Method: This study was an audit of serum 25-hydroxyvitamin D (25-OHD) levels measured routinely in a sample of 53 inpatients in a private psychiatric clinic. These levels were compared with those of controls without psychiatric illness.

Results: The median levels of serum 25-OHD were 43.0 nmol L−1 (range 20–102 nmol L−1) in the patient population, 46.0 nmol L−1 (range 20–102 nmol L−1) in female patients (n =33) and 41.5 nmol L−1 (range 22–97 nmol L−1) in male patients (n =20). The proportion of vitamin D insufficiency (serum 25-OHD ≤50 nmol L−1) in this patient population was 58%. Furthermore, 11% had moderate deficiency (serum 25-OHD ≤25 nmol L−1). There was a 29% difference between mean levels in the patient population and control sample (geometric mean age- and season-adjusted levels: 46.4 nmol L−1 (95% confidence interval (CI) =38.6–54.9 nmol L−1) vs 65.3 nmol L−1 (95%CI =63.2–67.4 nmol L−1), p <0.001).

Conclusion: Low levels of serum 25-OHD were found in this patient population. These data add to the literature suggesting an association between vitamin D insufficiency and psychiatric illness, and suggest that routine monitoring of vitamin D levels may be of benefit given the high yield of clinically relevant findings.
Profile of Young People Attending Alcohol and Other Drug Treatment Services in Aotearoa, New Zealand: Clinical File Search
Authors: Schroder Ria , Sellman Doug , Frampton Chris , Deering Daryle
Published: December 2009

Objective: The aim of the present study was to provide a profile of young people attending alcohol and other drug (AOD) treatment services in Aotearoa, New Zealand.

Method: Data were gathered from a clinical file search of 184 randomly selected young people aged 13–19 years who had attended one of eight youth AOD treatment services in New Zealand during 2003 or 2004. These services represented eight of the 11 youth-specific AOD services available to youth in New Zealand.

Results: Young people who attend youth-specific AOD services in New Zealand present with a range of complex needs including substance use and mental health issues, criminality, family conflict and disengagement from school. A total of 62.0% were male, 56.4% had criminal convictions, 40.6% had spent some time in Child, Youth and Family Services care and 53.8% were reported to have a coexisting substance use and mental health disorder. Low rates of reporting of substance use and mental health diagnoses in treatment files suggest that substance use and mental health disorders among this population are likely to be higher than those reported.

Conclusions: This paper provides a unique profile of young people attending youth-specific AOD treatments in New Zealand. Such information is useful in informing treatment planning and funding and ensuring that service development occurs to specifically meet the complex needs of this patient group.
Estimating the Prevalence of Schizophrenia Among New Zealand Māori: A Capture–Recapture Approach
Authors: Kake Tai R. , Arnold Richard , Ellis Pete
Published: December 2009

Objective: The aim of the present study was to estimate the 12 month prevalence of schizophrenia in the Māori population of New Zealand.

Method: Mental health data from two national sources were obtained for the period 2000–2003. A simple count of unique individuals with schizophrenia was used to estimate contact prevalence and a four-list capture–recapture procedure to estimate population prevalence.

Results: Contact prevalence was significantly lower than the estimated population prevalence for both groups. The estimated 12 month prevalence of schizophrenia for Māori (0.97%) was significantly higher than for non-Māori (0.32%), even after adjustment for age, case under-ascertainment, and socioeconomic deprivation.

Conclusions: The prevalence of schizophrenia among Māori appears to be elevated, although limitations in diagnostic reliability and recording of ethnicity must be considered. This adds further evidence of worldwide variation in the prevalence of schizophrenia. Capture–recapture provides a reliable cost-effective alternative to epidemiological surveys for estimating the prevalence of low-prevalence disorders such as schizophrenia.
Prevalence and correlates of suicidality among Indian women with post-partum psychosis in an inpatient setting
Authors: Babu Girish N. , Subbakrishna Dodbalapur K. , Chandra Prabha S.
Published: December 2009

Objective: The aims of the present study were twofold: first, to determine the prevalence of suicidal ideation and suicide attempts among women inpatients with post-partum-onset psychosis; and second, to describe the clinical, childbirth-related and demographic correlates of suicidal ideation in this group.

Method: A total of 82 post-partum women consecutively admitted to the psychiatric unit of the National Institute of Mental Health and Neurosciences, India during 18 months were assessed using the Comprehensive Psychopathology Rating Scale (CPRS) for psychopathology and suicidality.

Results: Thirty-one women (38%) reported suicidal ideation, of whom 15 (18%) had attempted suicide in the current episode. Suicidal ideation and suicide attempts were more frequent in women with depression, an insidious onset of the current illness and those with higher scores on the depressive dimension. On logistic regression analysis, however, only higher scores on the depressive symptom dimension of CPRS, irrespective of diagnosis, emerged as significant (p<0.001). Suicidal ideation was also significantly associated with ideas of harm to the infant (p<0.05).

Conclusions: There is a high prevalence of suicidal ideation and suicide attempts in this group of patients. Depressive symptoms in post-partum psychosis appear to be the most important risk factor predicting suicidal ideation and attempts.
Targeted Clinical Education for Staff Attitudes Towards Deliberate Self-Harm in Borderline Personality Disorder: Randomized Controlled Trial
Authors: Commons Treloar Amanda J. , Lewis Andrew J.
Published: December 2009

Objective: The aim of the present study was to assess the impact of attending targeted clinical education on borderline personality disorder on the attitudes of health clinicians towards working with deliberate self-harm behaviours commonly exhibited by patients diagnosed with this complex disorder. Comparisons of clinicians across service settings, occupational fields, and other demographic areas were also made.

Method: A purpose-designed demographic questionnaire and the Attitudes Towards Deliberate Self-Harm Questionnaire were used to collect the demographic information and assess the attitudes of 99 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service, both before and after education attendance.

Results: Statistically significant improvements in attitude ratings were found for both emergency medicine clinicians and mental health clinicians in working with deliberate self-harm behaviours in borderline personality disorder, following attendance at the education program with a medium affect size (t(32)=−3.45, p=0.002, d=0.43 and t(65)=−5.12, p=0.000, d=0.42, respectively). Clinicians across occupational areas of nursing, allied health, and medical fields demonstrated equivocal levels of improvement in their attitude ratings.

Conclusions: Results are discussed in terms of the necessity of providing regular access to targeted clinical education for health professionals working with patients diagnosed with borderline personality disorder.
Mood Stabilizer Loading Versus Titration in Acute Mania: Audit of Clinical Practice
Authors: Wheeler Amanda , Robinson Gail , Fraser Allen
Published: December 2009

Objective: The aim of the present study was to investigate whether the use of a loading strategy with lithium or valproate followed recommended practice and second, whether this had any impact on indicators of outcome in acutely manic inpatients.

Method: A 12 month retrospective review of admissions to two adult psychiatric units in Auckland, New Zealand, was conducted. Demographic, legal status, psychiatric admissions, outcome indicators (length of stay, intensive care and seclusion use) and medication data were collected for all patients with a diagnosis of acute bipolar mania who started mood stabilizer treatment within 3 days of admission (n=93). Serum levels and adverse effects were also recorded.

Results: In 46.2% of admissions a loading strategy was prescribed, and lithium was the treatment choice in two-thirds of admissions. Serum levels were taken inconsistently, particularly for valproate. No difference was found between loading and titrating for the assessed outcomes in routine practice; average length of stay was 30.2 days; most patients (71.0%) spent time in intensive care (average 8.4 days) and 33.3% spent time in seclusion. More adverse effects occurred with loading (51.2%) compared to titrating (36.0%), particularly with lithium.

Conclusion: The literature supports a strong link between rapidly attained high serum levels and positive outcomes. The present study found inconsistent and infrequent measurement of levels, which was not in accord with recommended practice. Frequent monitoring of serum levels to support dosing decisions is important to inform better clinical decision making, especially when a loading strategy is used. This may explain the less than optimal outcomes (with respect to rapid resolution of mania and hospital discharge) that were found, irrespective of dosing strategy.
Naturalistic Comparison of Models of Programmatic Interventions for Combat-Related Post-Traumatic Stress Disorder
Authors: Forbes David , Lewis Virginia , Parslow Ruth , Hawthorne Graeme , Creamer Mark
Published: December 2009

Objectives: Post-traumatic stress disorder (PTSD) is a difficult-to-treat sequel of combat. Data on effectiveness of alternate treatment structures are important for planning veterans’ psychiatric services. The present study compared clinical presentations and treatment outcomes for Australian veterans with PTSD who participated in a range of models of group-based treatment.

Method: Participants consisted of 4339 veterans with combat-related PTSD who participated in one of five types of group-based cognitive behavioural programmes of different intensities and settings. Data were gathered at baseline (intake), as well as at 3 and 9 month follow up, on measures of PTSD, anxiety, depression and alcohol misuse. Analyses of variance and effect size analyses were used to investigate differences at intake and over time by programme type.

Results: Small baseline differences by programme intensity were identified. Although significant improvements in symptoms were evident over time for each programme type, no significant differences in outcome were evident between programmes. When PTSD severity was considered, veterans with severe PTSD performed less well in the low-intensity programmes than in the moderate- or high-intensity programmes. Veterans with mild PTSD improved less in high-intensity programmes than in moderate- or low-intensity programmes.

Conclusion: Comparable outcomes are evident across programme types. Outcomes may be maximized when veterans participate in programme intensity types that match their level of PTSD severity. When such matching is not feasible, moderate-intensity programmes appear to offer the most consistent outcomes. For regionally based veterans, delivering treatment in their local environment does not detract from, and may even enhance, outcomes. These findings have implications for the planning and purchasing of mental health services for sufferers of PTSD, particularly for veterans of more recent combat or peacekeeping deployments.
Programma 2000: Celebrating 10 Years of Activity of an Italian Pilot Programme on Early Intervention in Psychosis
Authors: Cocchi Angelo , Meneghelli Anna , Preti Antonio
Published: December 2009

Objective: This paper describes the structure and the organization of the single Italian programme specifically targeted at the early detection of and interventions for subjects at onset of or at high risk of psychosis, Programma 2000.

Methods: Programma 2000 is a comprehensive multi-modal protocol of early intervention in psychosis, set up in Milan in 1999. The service has been very active since its opening, and at the time of writing (spring (April) 2008), more than 300 young patients have been evaluated through a detailed protocol that embraces Health of the Nation Outcome Scale (HoNOS), Brief Psychiatric Rating Scale (BPRS), Cognitive Behavioural Assessment 2.0, Disability Assessment Schedule, Camberwell Family Interview, Wechsler Adult Intelligence Scale and the Early Recognition Inventory Retrospective Assessment of Symptoms. The treatment includes psychoeducation, cognitive behavioural therapy (CBT), both structured and unstructured psychosocial interventions and pharmacotherapy, when necessary.

Results: The programme focuses on young people aged 17–30 years: to date, a total of 132 subjects with definite psychosis or within the high-risk category have been enrolled in treatment after assessment. Patients with first-episode psychosis were, on average and expectedly, more severe than those in the at-risk group, and were more likely to be prescribed antipsychotic drugs. A large majority of patients in both groups received tailored CBT; individual sessions of skills training were provided to two-thirds of patients. In both groups, improvement was found in both the BPRS and HoNOS, and in the level of global functioning as assessed on Global Assessment of Functioning at 6 month and 1 year follow up. Global functioning was more sensitive to change than symptom severity, reflecting the intensive and personalized efforts to improve social and role functioning in patients.

Conclusions: Programma 2000 is still in development but it has already gained the support of therapists and other relevant people involved in the life of subjects at onset, or at high risk of psychosis.
Impact of Borderline Personality Disorder on Bulimia Nervosa
Authors: Rowe Sarah L. , Jordan Jennifer , McIntosh Virginia V. W. , Carter Frances A. , Bulik Cynthia M. , Joyce Peter R.
Published: December 2009

Objective: The primary aim of the present study was to examine whether the presence of borderline personality disorder (BPD) adversely impacted on outcome 3 years after treatment among women with bulimia nervosa (BN), in comparison to those women with either other personality disorders (other PD) or no personality disorder (no PD).

Method: Participants were 134 women who received cognitive behaviour therapy for BN. The sample was divided into three groups: BPD (n=38), other PD (n=37), and no PD (n=59). Eating disorder (ED) symptoms and attitudes, and personality traits were examined at pretreatment assessment, 1 year and 3 year follow up.

Results: At pretreatment assessment the BPD group had higher purging frequency, more comorbidity and poorer general functioning than the other PD and no PD groups. By 3 year follow up, however, no significant differences were found in ED symptomatology and general functioning among the groups. Pretreatment differences between the BPD and no PD groups on the personality measures of harm avoidance, self-directedness and cooperativeness disappeared over the course of 3 years.

Conclusion: Although women with BN and comorbid BPD appear more impaired at pretreatment assessment, they do not have poorer outcome than the other PD and no PD groups. The rate and level of improvement across the groups is not affected by the presence of BPD.
Enhancing Treatment Fidelity in Psychotherapy Research: Novel Approach to Measure the Components of Cognitive Behavioural Therapy for Relapse Prevention in First-Episode Psychosis
Authors: Alvarez-Jimenez Mario , Wade Darryl , Cotton Sue , Gee Donna , Pearce Tracey , Crisp Kingsley , McGorry Patrick D. , Gleeson John F.
Published: December 2009

Objectives: Establishing treatment fidelity is one of the most important aspects of psychotherapy research. Treatment fidelity refers to the methodological strategies used to examine and enhance the reliability and validity of psychotherapy. This study sought to develop and evaluate a measure specifically designed to assess fidelity to the different therapeutic components (i.e. therapy phases) of the individual intervention of a psychotherapy clinical trial (the EPISODE II trial).

Method: A representative sample of sessions stratified by therapy phase was assessed using a specifically developed fidelity measure (Relapse Prevention Therapy–Fidelity Scale, RPT-FS). Each RPT-FS subscale was designed to include a different component/phase of therapy and its major therapeutic ingredients.

Results: The measure was found to be reliable and had good internal consistency. The RPT-FS discriminated, almost perfectly, between therapy phases. The analysis of the therapeutic strategies implemented during the intervention indicated that treatment fidelity was good throughout therapy phases. While therapists primarily engaged in interventions from the appropriate therapeutic phase, flexibility in therapy was evident.

Conclusions: This study described the development of a brief, reliable and internally consistent measure to determine both treatment fidelity and the therapy components implemented throughout the intervention. This methodology can be potentially useful to determine those components related to therapeutic change.
Stress and Anxiety in Schizophrenia and Depression: Glucocorticoids, Corticotropin-Releasing Hormone and Synapse Regression
Authors: Bennett Ao Maxwell R.
Published: December 2009

Stress during childhood and adolescence has implications for the extent of depression and psychotic disorders in maturity. Stressful events lead to the regression of synapses with the loss of synaptic spines and in some cases whole dendrites of pyramidal neurons in the prefrontal cortex, a process that leads to the malfunctioning of neural networks in the neocortex. Such stress often shows concomitant increases in the activity of the hypothalamic–pituitary–adrenal system, with a consequent elevated release of glucocorticoids such as cortisol as well as of corticotropin-releasing hormone (CRH) from neurons. It is very likely that it is these hormones, acting on neuronal and astrocyte glucocorticoid receptors (GRs) and CRH receptors, respectively, that are responsible for the regression of synapses. The mechanism of such regression involves the loss of synaptic spines, the stability of which is under the direct control of the activity of N-methyl-d-aspartate (NMDA) receptors on the spines. Glutamate activates NMDA receptors, which then, through parallel pathways, control the extent in the spine of the cytoskeletal protein F-actin and so spine stability and growth. Both GR and CRH receptors in the spines can modulate NMDA receptors, reducing their activation by glutamate and hence spine stability. In contrast, glucocorticoids, probably acting on nerve terminal and astrocyte GRs, can release glutamate, so promoting NMDA receptor activation. It is suggested that spine stability is under dual control by glucocorticoids and CRH, released during stress to change the stability of synaptic spines, leading to the malfunctioning of cortical neural networks that are involved in depression and psychoses.
Shyness 3: Randomized Controlled Trial of Guided Versus Unguided Internet-Based CBT for Social Phobia
Authors: Titov Nickolai , Andrews Gavin , Choi Isabella , Schwencke Genevieve , Mahoney Alison
Published: December 2009

Objective: In two previous randomized controlled trials Titov et al. demonstrated significant benefit from an Internet- and email-based treatment programme for social phobia. The present study (Shyness 3) explores whether participants are able to complete this programme independently.

Method: A total of 98 individuals with social phobia were randomly assigned to a clinician-assisted computerized cognitive behavioural treatment (CaCCBT) group, a self-guided computerized CBT (CCBT) group, or to a waitlist control group. CaCCBT group participants completed the usual Shyness programme consisting of six online lessons, cognitive behavioural homework assignments, email contact with a therapist, and participation in an online discussion forum. CCBT group participants accessed the same resources except for therapist emails. An intention-to-treat model was used for data analyses.

Results: A total of 77% of CaCCBT and 33% of CCBT group participants completed all lessons. Significant differences were found after treatment between CaCCBT and control groups (mean between-groups effect size (ES) for the social phobia measures = 1.04), and between the CaCCBT and CCBT groups (mean between-groups ES for the social phobia measures = 0.66). No significant differences were found after treatment between the CCBT and control groups (mean between-groups ES for the social phobia measures = 0.38). CCBT participants, however, who completed the six lessons made good progress (mean within-group ES for the social phobia measures = 0.62). Quantitative and qualitative data indicate that both the CaCCBT and CCBT procedures were acceptable to participants.

Conclusions: The reliability of this Internet-based treatment programme for social phobia has been confirmed. The therapist-guided condition was superior to the self-guided condition, but a subgroup of participants still benefited considerably from the latter. These data confirm that self-guided education or treatment programmes for common anxiety disorders can result in significant improvements.
Is Schizophrenia the Price of Human Central Nervous System Complexity?
Authors: Dean Brian
Published: December 2009

The purpose of the present study was to determine if there is evidence to support the hypothesis that schizophrenia is a human-specific disorder associated with the need for highly complex central nervous system (CNS) development. A review was therefore undertaken of published literature relevant to the identification of human-specific CNS development. There was no clear evidence found at the macroscopic, microscopic or molecular level that suggests unique changes have occurred in the evolution of the human CNS. Rather, highly significant changes in the size of the frontal lobe, increases in numbers of specific cell types, changes in gene expression and changes in genome sequence all seem to be involved in the evolution of the human CNS. Human-specific changes in CNS development are wide ranging. The modification in CNS structure and function that has resulted from these changes affects many pathways and behaviours that appear to be also affected in subjects with schizophrenia. Therefore there is evidence to support the hypothesis that schizophrenia is a disease that develops because of derangements to human-specific CNS functions that have emerged since our species diverged from non-human primates.
Lifetime Prevalence of Suicidal Ideation, Suicide Plans and Attempts in Rural and Urban Regions of Beijing, China
Authors: Ma Xin , Xiang Yu-Tao , Cai Zhuo-Ji , Li Shu-Ran , Xiang Ying-Qiang , Guo Hong-Li , Hou Ye-Zhi , Li Zhen-Bo , Li Zhan-Jiang , Tao Yu-Fen , Dang Wei-Min , Wu Xiao-Mei , Deng Jing , Chan Sandra S. M. , Ungvari Gabor S. , Chiu Helen F. K.
Published: December 2009

Objective: There has been no large-scale survey of suicide-related behaviours including suicidal ideations, plans and attempts in China involving both rural and urban areas and using standardized assessment tools. The aim of the present study was to determine the lifetime prevalence of suicide-related behaviour and its relationship with sociodemographic factors and psychiatric disorders in the rural and urban regions of Beijing, China.

Methods: A total of 5926 subjects were randomly selected in Beijing and interviewed using the Composite International Diagnostic Interview. Basic sociodemographic and clinical data and data on suicide-related behaviour were also collected.

Results: The overall lifetime prevalence estimates of suicidal ideation, plans and attempts were 2.3%, 1.4%, and 1.0%, respectively; the corresponding figures were 2.8%, 1.6%, and 1.3% in the rural sample, and 1.8%, 1.3%, and 0.9% in the urban sample. Age (>25years), female sex, unmarried status, lower education level, lower (RMB2000month−1) monthly income and presence of major medical disorders were significantly associated with increased risk of suicide-related behaviour. 36.2% of subjects with suicide-related behavior consulted a medical practitioner and 20.7% consulted a psychiatrist.

Conclusions: The prevalence of lifetime suicide-related behaviour in Beijing is lower than in Western countries, but the low percentage of subjects treated for suicide-related behaviour indicates a major public health problem that should be addressed. National surveys are needed to further explore the prevalence of suicide-related behaviour in China.
Psychiatric Illness Among a Nationally Representative Sample of Sole and Partnered Parents in New Zealand
Authors: Tobias Martin , Gerritsen Sarah , Kokaua Jesse , Templeton Robert
Published: December 2009

Objective: To quantify the excess risk of specific, diagnosable mental illnesses experienced by sole parents in New Zealand, and to estimate the contribution of socioeconomic position (SEP), co-residence with other adults (as a proxy for social and practical support) and physical health status to this excess risk.

Methods: Data used in the present study were from the New Zealand Mental Health Survey, a nationally representative population-based household survey of 12992 adults (16+years) fielded in 2004. The sample included 1216 sole and 3681 partnered parents living with one or more dependent children, with an overall response rate of 73%. Mental illness (12month prevalence of anxiety, mood, and substance use disorders, and suicidality) was measured with version 3.0 of the Composite International Diagnostic Interview. Illness severity was measured with the Sheehan Disability Scale and the Global Assessment of Functioning Scale. Covariates included household income from all sources, labour market attachment, co-residence with other adults and doctor-diagnosed chronic physical illness. Multiple logistic regression was then carried out on the weighted cross-sectional survey dataset.

Results: Adjusting for demographic variables, sole parents had significantly higher 12month prevalences of mental illnesses than their partnered counterparts, with odds ratios (ORs) of 2.6 (95% confidence interval (CI)=2.0–3.3) for any mental illness, 2.9 (95%CI=2.1–4.0) for any serious mental illness, 2.2 (95%CI=1.7–2.8) for anxiety disorder, 2.6 (95%CI=2.0–3.4) for mood disorder, 3.6 (95%CI=2.2–6.0) for substance use disorder and 2.5 (95%CI=1.5–4.0) for suicidal ideation. Chronic physical illness accounted for only a small proportion of these excess risks. SEP and co-residence of another adult each explained approximately one-quarter of the excess risks and jointly explained approximately half (except for substance use disorders). Almost all of the effect of SEP was mediated by income, with employment status making only a very small independent contribution.

Conclusions: The present results confirm the higher prevalence of mental illness experienced by sole parents, underlining the importance of improving access to primary mental health care, including alcohol and drug rehabilitation services, for sole parents. But they also caution against a solely clinical response and highlight a need to better understand and respond to the social and economic processes that lie behind the associations between mental health, socioeconomic position and sole parenthood in New Zealand.
Personality Differences Between Depressed Melancholic and Non-Melancholic Inpatients
Authors: Alex Rubino I. , Zanasi Marco , Robone Camilla , Siracusano Alberto
Published: December 2009

Objective: The aim of the present study was to confirm that non-melancholic depression corresponds to a higher degree of personality dysfunction compared to melancholia.

Method: A total of 188 inpatients, with a main DSM-IV diagnosis of major depressive disorder, were classified as melancholic and non-melancholic according to CORE system, DSM-IV, Research Diagnostic Criteria (RDC) Retarded Depression, and RDC Agitated Depression. Personality was assessed by means of the Temperament and Personality Questionnaire (T&P). Only patients at the nadir of their episode were included.

Results: Compared to non-melancholic depressives, patients with CORE melancholia scored lower on social avoidance and higher on effectiveness and cooperativeness; patients with RDC Retarded Depression scored lower on Anxious–Worrying and Cooperativeness; patients with RDC Agitated Depression scored lower on Social Avoidance, Rejection Sensitivity and Anxious–Worrying, and higher on Effectiveness; while patients with DSM-IV melancholia scored higher on Irritability and lower on Cooperativeness. Both CORE and RDC Agitated Depression were associated with higher scores of Perfectionism.

Conclusions: The hypothesis of an association of melancholic depression with less marked personality dysfunction was confirmed for CORE melancholia and RDC Agitated Depression, and not supported for DSM-IV melancholia. Mixed evidence was obtained for RDC Retarded Depression. Personality of melancholic depressives seems to be characterized not only by less dysfunction but also by perfectionism, akin to the features of Tellenbach's typus melancholicus.
Characteristics of Bipolar Disorder in an Australian Specialist Outpatient Clinic: Comparison Across Large Datasets
Authors: Mitchell Philip B. , Johnston Amy K. , Corry Justine , Ball Jillian R. , Malhi Gin S.
Published: December 2009

Objectives: There have been relatively few detailed reports on the sociodemographic and clinical characteristics of bipolar disorder in large outpatient clinical samples. This paper reports on findings from the Black Dog Institute Bipolar Disorders Clinic (BDI-BDC) and compares this dataset with the predominantly outpatient Stanley Foundation Bipolar Disorders Network (SFBN) and Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) samples.

Methods: A total of 217 patients with DSM-IV bipolar disorder were assessed in detail in the BDI-BDC using a series of standardized and non-standardized structured interviews. Ninety per cent had bipolar I disorder, and 10% bipolar II disorder. This sample was compared with the SFBN and STEP-BD datasets.

Results: The sociodemographic characteristics of the three samples were remarkably similar. Female gender and younger age were overrepresented compared to the general population. Functional impairment, indicated by marital status and labour force participation, was clearly more common among the study subjects than in the general population. In all three samples, prior educational attainment was higher than the general population. With respect to clinical features, approximately half of each sample was euthymic and approximately one-third was in a DSM-IV episode of depression at study entry. One-half reported depression as their first episode of mood disturbance. Similar proportions identified positive family histories of bipolar disorder (40%) and unipolar depression (55%). Other clinical characteristics demonstrated more variation between the samples. The STEP-BD population reported an earlier age of onset. The SFBN subjects reported higher numbers of overall episodes, but psychotic features and suicide attempts were less common than in the BDI-BDC sample.

Conclusions: This report highlights the marked commonalities of the sociodemographic and clinical characteristics of patients with bipolar disorder recruited predominantly in the outpatient setting in three different continents, that is, Australia, North America and Europe. It also demonstrates some critical distinctions between such samples, emphasizing the need to be aware of these differences when interpreting findings, such as treatment outcome, from different bipolar disorder datasets.
Can the Highly Cited Psychiatric Paper be Predicted Early?
Authors: Hyett Matthew , Parker Gordon
Published: December 2009

Objective: Predicting the impact of any research article on its scientific discipline is often viewed as requiring the passage of time. A recent BMJ article, however, reported that an article's citation rate at 2years could be predicted by data available 3weeks following publication. The question remains as to whether establishing a citation trajectory at an early stage holds for psychiatric publications, given the low percentage of psychiatric articles in their analysis. The aim of the current article was to critically examine this area of the scientific literature.

Method: Data were collected from the Institute for Scientific Information on scientific papers published in January/February 2006, in the top 30 psychiatric journals. Analyses examined the comparative impact of early citation numbers and several predictors identified in the BMJ article.

Results: Only two BMJ variables (a larger number of references per article and larger number of authors) predicted higher citations at 2years in the principal analysis. Citation counts at 1, 3, 6 and 12months predicted citations at 2years, with increasing success over time, and such citation counts were distinctly superior to the quantified variables in the previous study.

Conclusions: It appears doubtful that data available at 3weeks after publication for psychiatric articles are useful in predicting citation counts at 2years. The trajectory of citation counts for a psychiatric article becomes more apparent with time.
Parent Problem Checklist: Measure of Parent Conflict
Authors: Morawska Alina , Thompson Emma
Published: December 2009

Objective: The purpose of the present study was to validate the psychometric properties of the Parent Problem Checklist (PPC), and to examine the contribution of conflict specific to child-rearing to the prediction of child problems.

Method: The study examined the relationship between marital conflict, parenting conflict and emotional and behavioural problems in children aged 2–16 years, in evaluating the psychometric properties of the PPC in a sample of 200 parents.

Results: Analysis of the PPC indicated good reliability and validity. Findings support the hypothesis that parenting conflict influences children's outcomes more than either general marital conflict or marital satisfaction.

Conclusions: There are a number of implications for clinical practice and understanding the role of parenting conflict in the development of child difficulty.
Stabilization of the Internal Structure of Persistent Auditory Verbal Hallucinations in Schizophrenia
Authors: Chang Jae Seung , Yi Jung Seo , Ahn Yong Min , Kim Jong Hoon , Kim Yong Sik
Published: December 2009

Objective: Numerous studies have been conducted to investigate the phenomenological characteristics of auditory verbal hallucinations in schizophrenia. Difficulties in understanding the clinical significance of auditory verbal hallucinations may be attributed to the changes in symptom structure over the long-term course of the illness. The purpose of the present study was therefore to investigate the longitudinal changes in the phenomenological dimensions of auditory verbal hallucinations in patients with schizophrenia.

Methods: Using the Psychotic Symptom Rating Scales–Auditory Hallucination Subscale, 40 patients meeting DSM-IV criteria for schizophrenia (drug-naïve first-episode schizophrenia, n=21; and drug-free chronic schizophrenia, n=19) who reported persistent auditory verbal hallucinations were assessed before the initiation of antipsychotic treatment and after 6 months of treatment. To detect the changes in underlying clusters of phenomenological variables, hierarchical clustering and multidimensional analysis were performed.

Results: The phenomenological variables of auditory verbal hallucinations formed two main clusters with 6 month treatment: emotional and cognitive. Physical characteristics failed to indicate a stable cluster. Psychosocial disruption, which initially formed a cluster with cognitive variables, congregated with emotional variables at 6 months. Subgroup analysis indicated that the cluster structure of the first-episode group showed more dynamic changes than did that of the chronic schizophrenia group.

Conclusions: Phenomenological variables characterizing persistent auditory verbal hallucinations can be differentiated into emotional and cognitive clusters with achievement of symptom stabilization, and the changes in physical characteristics may not be the sole sign of clinical improvement.
Motivational Change in an Inpatient Anorexia Nervosa Population and Implications for Treatment
Authors: Wade Tracey D. , Frayne Anna , Edwards Sally-Anne , Robertson Therese , Gilchrist Peter
Published: December 2009

Objective: The relationship between motivation and recovery in anorexia nervosa has received increased attention in the research literature although few controlled investigations of increasing motivation in this population exist. Three questions were therefore examined in an inpatient anorexia nervosa population: (i) does baseline motivation predict change in eating pathology; (ii) does change in motivation predict change in eating pathology; and (iii) can we increase motivation to recover in this group?

Method: Inpatients (n=47) in a specialist weight disorder unit with a mean age of 21.85 years (SD=5.37) were randomly allocated to receive four sessions of motivational interviewing with a novice therapist in addition to treatment as usual (n=22) or treatment as usual alone (n=25). Assessment of eating pathology and motivation to recover was conducted on three occasions: at admission (baseline), and at 2- and 6 week follow up. Eating pathology was assessed using the Eating Disorder Examination and self-reported motivation was assessed using the Anorexia Nervosa Stages of Change Questionnaire and six Likert scales.

Results: Higher baseline motivation across five of the seven measures predicted significant decreases in eating pathology, and increased Anorexia Nervosa Stages of Change Questionnaire scores between baseline and 2 week follow up predicted significant improvement in eating pathology between baseline and 6 week follow up. Significantly more patients were lost to follow up from the treatment as usual compared to the motivational interviewing group. More patients in the motivational interviewing condition moved from low readiness to change at baseline to high readiness to change at 2 and 6 week follow up.

Conclusions: Motivation is an important predictor of change in anorexia nervosa and preliminary evidence is provided that motivation can be improved in this population. Further investigations, however, of ways of improving motivation in this population need to be conducted, along with the impact of motivational changes on treatment outcome.
Climate Schools: Alcohol Module: Cross-Validation of a School-Based Prevention Programme for Alcohol Misuse
Authors: Newton Nicola C. , Vogl Laura E. , Teesson Maree , Andrews Gavin
Published: December 2009

Objective: The aim of the present study was to conduct a cross-validation trial of the efficacy of a computerized school-based intervention for alcohol misuse in adolescents.

Method: A cluster randomized control trial was carried out. Intervention and control groups were assessed at baseline, immediately after and 6 months after the intervention. A total of 764 Year 8 students from 10 independent secondary schools in Sydney, Australia participated in the study. Half of the schools were randomly allocated to the computerized prevention programme (n=397), and half to their usual classes (n=367). The six-lesson computerized intervention was evidence and curriculum based while having a focus on harm-minimization. Knowledge, expectancies, alcohol consumption (frequency, quantity and binging), patterns of use, and harms associated with one's own use of alcohol were assessed.

Results: There were significant improvements in knowledge regarding alcohol use at immediate and 6 month follow up. Average weekly alcohol consumption was reduced immediately after the intervention. No differences between groups were found on alcohol expectancies, frequency of drinking to excess and harms related to alcohol use over time.

Conclusions: The present results support the Climate Management and Treatment Education (CLIMATE) Schools: alcohol module as an effective intervention in increasing alcohol knowledge and reducing alcohol use in the short term.
Confirmatory Factor Analysis of the Parental Bonding Instrument in a Brazilian Female Population
Authors: Terra Luciana , Hauck Simone , Fillipon Ana Paula , Sanchez Patricia , Hirakata Vania , Schestatsky Sidnei , Ceitlin Lucia H.
Published: December 2009

Objective: The Parental Bonding Instrument (PBI) is a widely used measure of parenting. Recent studies have proposed different factor structures. There is a disagreement in the literature about whether the PBI is best used as a two-factor or a three-factor measure.

Method: Two hundred and fifty-seven female adults were recruited from a clinical population (139 psychiatric patients and 118 controls) and were requested to complete the PBI. Maximum likelihood confirmatory factor analyses were performed to compare the five different factor structures in terms of model fit.

Results: The poorest fit to the data was obtained by the Parker et al. model. The Kendler model was the only model that had an adjusted goodness-of-fit index >0.8 regarding both paternal and maternal PBI. When considering invariance of factor structure across age subgroups, the Kendler model was also the only acceptable model.

Conclusion: Three-factor structures are preferable to two-factor structures. The Kendler model was the only one to provide an acceptable fit, but it must be considered that it was a female sample, and when considering gender subgroups other studies have found the same results. Despite the gender limitation, the present study contributes to a better understanding and use of the PBI in Brazilian samples.