bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlates of Self-Reported Coercive Parenting of Preschool-Aged Children at High Risk for the Development of Conduct Problems
Authors: Bor William , Sanders Matthew R.
Published: December 2009

Objective: This study examines the correlates of coercive parenting in a high-risk sample of 305 three-year-old children likely to develop later conduct problems. As parental coercion has been identified as a significant risk factor for future psychopathology, the study sought to identify modifiable inter and intra-personal factors most closely associated with coercion.

Method: Key variables known to place young children at future risk, such as maternal mood states, current child behaviour problems, demographic characteristics such as low income, past mental health problems and parents' sense of competence, were analyzed based on parent-report measures and clinical interviews. Correlational and heirachical regression analysis identified key predictors of coercion.

Results: Three variables emerged as the strongest predictors of maternal coercion: selfefficacy, child behaviour and maternal depression. Demographic factors contributed little to the model.

Conclusions: Enhancing parental self-efficacy, especially specific parenting tasks with disruptive young children has the potential to make a significant contribution toward prevention of future conduct problems.
Can Psychiatric Terminology be Translated into Legal Regulation? The Anorexia Nervosa Example
Authors: Beumont Pierre , Beumont Pierre , Carney Terry , Beumont Pierre , Carney Terry
Published: December 2009

Objective: To explore the tension between the definition of mental illness in clinical psychiatry and its embodiment in legislation applied by tribunals reviewing decisions to treat.

Method: Severe anorexia nervosa is used as a case exemplar of the tension between the appropriate narrative to express the clinical imperative to treat and the law's focus on finer technical language which secures individual civil rights and liberties. Australian and international experience is reviewed.

Results: The paper finds that the clinical and the legal narratives about how to ‘define’ mental illness do differ at the formal level of expression where they necessarily intersect in the setting of tribunal review of involuntary treatment decisions. However, in practice mental health admissions and tribunal reviews generally endorse the clinical applications of that more capacious and fluid terminology of clinical psychiatry.

Conclusions: While tribunal reviews of clinical decisions may occasionally require clinicians to participate in an unfamiliar legal dialogue about narrowly construed definitions of mental illness, tribunals apply more complex tests which are sensitive to clinical practice and good therapeutic objectives.
Grey Lungs and Blue Moods: Smoking Cessation in the Context of Lifetime Depression History
Authors: Wilhelm Kay , Wilhelm Kay , Arnold Karen , Niven Heather , Richmond Robyn
Published: December 2009

Objective: To present an overview of the relationship between depression and cigarette smoking and to provide recommendations for clinicians who wish to help patients with a history of depression to stop smoking.

Method: English language journal articles published in the last 15 years on clinical material related to depression history, smoking cessation and related health issues were collected via MEDLINE, PsycINFO and Cochrane Library database searches.

Results: Nicotine dependence is associated with increased rates of depression prior to and after taking up smoking as well as increased rates of suicidal ideation. Depression history is associated with increased rates of nicotine dependence, problems with smoking cessation and depression after cessation. While nicotine replacement and counselling are effective for smoking cessation, standard smoking cessation strategies may not pay sufficient attention to the needs of smokers with a depression history. Some antidepressants (bupropion and nortriptyline) are particularly effective for those with a lifetime depression history as they appear to assist with dysphoria during withdrawal and prevent relapse. Psychological and lifestyle strategies, such as motivational interviewing, relaxation exercises and mood charts, assist in mood regulation over and above the standard smoking cessation treatments for smokers with a depression history, who require more attention to relapse of depression and smoking after quitting.

Conclusions: There is a complex and circular relationship between depression, smoking and medical illness that complicates smoking cessation in those who have a history of depression. Depression-history smokers require a multimodal approach to assist with mood regulation and nicotine withdrawal. Further research is required to identify effective strategies to reduce smoking in this context.
Mortality and Further Suicidal Behaviour After an Index Suicide Attempt: a 10-Year Study
Authors: Gibb Sheree J. , Beautrais Annette L. , Fergusson David M.
Published: December 2009

Objective: To examine further suicide attempts and mortality in the 10 years after a suicide attempt requiring hospital admission.

Method: Participants were a consecutive series of 3690 individuals admitted to Christchurch Hospital for attempted suicide during the 10-year period 1993–2002. Data were obtained on admissions to Christchurch Hospital for attempted suicide during the study period. Mortality subsequent to the index suicide attempt was established from the National Mortality Database. The influence of age, gender and method of index suicide attempt on mortality and further suicide attempts requiring hospitalization were examined.

Results: Within 10 years, 28.1% of those who had been admitted for an index suicide attempt were readmitted for a further non-fatal suicide attempt, and 4.6% died by suicide. Risks and rates of readmission were higher in: females; those under 55; and those whose index attempt involved a method of low lethality. Risks and rates of suicide were higher in: males; those aged 25 and over; and those using an index suicide attempt method of high lethality. Risks and rates of readmission and mortality from suicide were highest in the first 2 years after the index attempt, although deaths and readmissions occurred throughout the 10 years study period.

Conclusions: Those making suicide attempts requiring hospital admission are at high risk of further hospitalization for suicide attempt and of death from suicide. These findings suggest a need for ongoing support and monitoring, and for enhanced treatment and management of all those making suicide attempts which require hospital admission in an effort to reduce risks of further suicidal behaviour.
A Tale of Two Jurisdictions. Can Australia and Canada Learn from Each Other's Experience with Cannabis Control?
Authors: Kisely Steve
Published: December 2009

Objective: To compare public health and legal policies to reduce the harm associated with cannabis use in Canada and Australia, given similarities between both countries.

Method: A review of the epidemiological and health policy literature.

Results: Although both countries have adopted harm minimization, a continued heavy reliance on legislative and punitive approaches in both Canada and Australia has failed to arrest the increase in cannabis use, especially among young people. A Senate inquiry in Canada has recommended the liberalization of laws on the possession and use of cannabis, while tightening legislation against operating vehicles or machinery while intoxicated.

Conclusions: Existing policies are not evidence-based and lead to adverse outcomes such as criminalization of otherwise law-abiding citizens and diversion of resources from more effective policing or health service initiatives.
Victimization of Patients with Schizophrenia and Related Disorders
Authors: Fitzgerald Paul B. , De Castella A. R. , Filia K. M. , Filia S. L. , Benitez J. , Kulkarni J.
Published: December 2009

Background: Previous research has predominately focused on patients with mental illness as the instigators, rather than the victims, of violence and criminal activity. However, patients with schizophrenia appear to experience a higher degree of victimization compared to general community samples. We aimed to establish the 1-month prevalence of violent and non-violent victimization in a sample of patients with schizophrenia spectrum disorders and to investigate the determinants of victimization.

Method: Reports of violent and non-violent victimization were recorded in 348 patients in Dandenong, an outer metropolitan suburb of Melbourne, Australia along with the subjective perception of patients as to their degree of protection from being robbed or attacked. Patients reporting victimization were compared with those who did not, across a range of clinical and psychosocial variables.

Results: 11.2% of the sample reported being the victim of non-violent crime and 4.3% the victim of violent crime in the 1-month period. 23.2% reported dissatisfaction with their protection against being attacked or robbed. The major determinant of victimization was the lack of any meaningful daily activity.

Conclusions: Patients with schizophrenia spectrum disorders are at increased risk of victimization, both of the violent and non-violent type. Further research is required to understand the pathways through which victimization occurs and to understand whether psychosocial interventions can reduce victimization in this patient population.
The Impact of Beyondblue: The National Depression Initiative on the Australian Public's Recognition of Depression and Beliefs About Treatments
Authors: Jorm Anthony F. , Jorm Anthony F. , Christensen Helen , Griffiths Kathleen M. , Jorm Anthony F. , Christensen Helen , Griffiths Kathleen M.
Published: December 2009

Objective: To evaluate whether a campaign to increase public knowledge about depression ( beyondblue: the national depression initiative) has influenced the Australian public's ability to recognize depression and their beliefs about treatments.

Method: Data from national surveys of mental health literacy in 1995 and 2003–04 were analysed to see if states and territories which funded beyondblue (the high exposure states) had greater change than those that did not (the low exposure states). In both surveys, participants were asked what was wrong with a person in a depression case vignette and to give opinions about the likely helpfulness for this person of a range of treatments. In the 2003–04 survey participants were also asked questions to assess awareness of beyondblue.

Results: Awareness of beyondblue in the states that provided funding was found to be around twice the level of those that did not. Using the low-exposure states as a control, the high-exposure states had greater change in beliefs about some treatments, particularly counselling and medication, and about the benefits of help-seeking in general. Recognition of depression improved greatly at a national level, but slightly more so in the high-exposure states.

Conclusions: The data are consistent with beyondblue having had a positive effect on some beliefs about depression treatment.
Screening and Treatment for Depression During Pregnancy: A Cautionary Note
Authors: Carter Frances A , Carter Janet D , Luty Suzanne E , Wilson Deborah A , Frampton Christopher M. A. , Joyce Peter R
Published: December 2009

Objective: The aim of this study was to evaluate the recruitment and retention of depressed pregnant women, identified initially through screening, to a randomized controlled psychotherapy trial.

Method: Consecutive pregnant women presenting for routine ultrasound scan were asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Women who scored greater than 12 on the EPDS and who agreed to contact were invited to attend an initial assessment to determine eligibility for the trial. Consenting, eligible women were randomized to either cognitive behaviour therapy (CBT) or routine clinical care (RCC). Follow-up assessments were conducted at mid (6 weeks following initial assessment), end (approximately 36 weeks gestation), and postpartum (approximately 4 months postdelivery) for all participants.

Results: 400 women were offered the EPDS, and 93% completed the questionnaire (370/400). Thirteen percent (49/370) of these women scored greater than 12, although only a minority of these women agree to be contacted (15/49). Of those who agreed to be contacted, less than half attended initial interview (7/15 attended; 3/15 ineligible; 5/15 declined). Upon interview, all women except for one, were eligible and consenting (6/7). Three women were randomized to CBT and three to RCC. Only one woman randomized to CBT chose to commence treatment, and only one woman randomized to RCC was offered treatment for her low mood by her lead maternity provider.

Conclusions: While the vast majority of pregnant women were willing to complete a depression screening questionnaire, most did not agree to additional contact or assessment, and either were not offered treatment or did not accept treatment. This was not an effective recruitment strategy for a randomized controlled psychotherapy trial.
Work-Related Subjective Experiences Among Community Residents with Schizophrenia or Schizoaffective Disorder
Authors: Waghorn Geoff , Chant David , King Robert
Published: December 2009

Objective: To develop a self-report scale of subjective experiences of illness perceived to impact on employment functioning, as an alternative to a diagnostic perspective, for anticipating the vocational assistance needs of people with schizophrenia or schizoaffective disorders.

Method: A repeated measures pilot study (n1= 26, n2= 21) of community residents with schizophrenia identified a set of work-related subjective experiences perceived to impact on employment functioning. Items with the best psychometric properties were applied in a 12 month longitudinal survey of urban residents with schizophrenia or schizoaffective disorder (n1= 104; n2= 94; n3= 94).

Results: Construct validity, factor structure, responsiveness, internal consistency, stability, and criterion validity investigations produced favourable results. Work-related subjective experiences provide information about the intersection of the person, the disorder, and expectations of employment functioning, which suggest new opportunities for vocational professionals to explore and discuss individual assistance needs.

Conclusion: Further psychometric investigations of test-retest reliability, discriminant and predictive validity, and research applications in supported employment and vocational rehabilitation, are recommended. Subject to adequate psychometric properties, the new measure promises to facilitate exploring: individuals' specific subjective experiences; how each is perceived to contribute to employment restrictions; and the corresponding implications for specialized treatment, vocational interventions and workplace accommodations.
Application of Risk Assessment for Violence Methods to General Adult Psychiatry: A Selective Literature Review
Authors: Kumar Shailesh , Simpson Alexander I. F.
Published: December 2009

Objective: General adult psychiatrists are required to assess risk of violence as frequently as forensic psychiatrists. Yet most of the literature on risk assessment has originated from forensic settings, has been written by forensic psychiatrists, is applicable to forensic patients but may not apply to general psychiatric settings. Because the patient population and the nature of risk assessed may differ between the two settings, there is a need to consider the relevance of systems of assessment of risk of violence specific to the context of general adult psychiatry.

Methods: We searched the literature on the way risk has been conceptualized in different disciplines using Medline database from 1993 to 2003. Keywords used were violence and risk management and risk assessment. Additional papers were identified from cross-references and personal knowledge of authors.

Results: Seven hundred and nine key papers were identified. We identified three common key concepts that define risk: Uncertainty, weighing up the likelihood of different outcomes arising and, the possibility of benefits as well as harm due to risk assessment. The impact of safety culture – the collection of beliefs, norms, attitudes, roles and practices while making daily activities and management decisions – on psychiatric thinking is examined. We review the two main methods of risk assessment from forensic psychiatric literature (actuarial and clinical) with a view to examine their utility in general adult psychiatric context.

Conclusions: In order to develop a system of risk assessment relevant to general adult psychiatry, we note the benefits of shifting from risk prediction to assessment, management and reduction of risk, the need to merge actuarial and clinical approaches, communication of risk and finally the need to involve patients in the process of risk assessment.
The Validity of the DSM-IV Subtypes of Attention-Deficit/Hyperactivity Disorder
Authors: Woo Bernardine S. C. , Rey Joseph M.
Published: December 2009

Objective: To examine the validity of the three subtypes of ADHD defined by DSM-IV.

Method: Studies published in English were identified through searches of literature databases.

Results: Estimates of the prevalence of ADHD have increased as a result of the introduction of DSM-IV criteria. Factor analytical and genetic studies provide some support for the validity of the distinction between the three subtypes. However, diagnosis of the combined subtype seems more reliable than the other two subtypes, although reliability is largely unknown for the latter. The hyperactive-impulsive subtype, the least common, differs from the other two subtypes in age distribution, association with other factors and neuropsychological parameters. Almost all treatment trials are based on participants with the combined type.

Conclusion: Data supporting the validity of the inattentive and hyperactive-impulsive subtypes of ADHD a decade after the publication of DSM-IV are still scarce. Given that inattention is the hypothesized core ADHD symptom, it remains to be demonstrated that hyperactive-impulsive children who are not inattentive have the same condition. One of the main research deficits refers to data on treatment of the inattentive and hyperactive impulsive subtypes.
What is a Clinically Important Level of Improvement in Symptoms of Attention-Deficit/Hyperactivity Disorder?
Authors: Hazell Philip , Lewin Terry , Sly Ketrina
Published: December 2009

Objective: To compare the desired and actual reduction in scores on a parent reported behaviour rating scale in a naturalistic sample of children and adolescents who had been treated with psychostimulant medication, referenced to global ratings of treatment benefit.

Method: Forty-five parents reporting poor global response to psychostimulant treatment, 44 reporting moderate response, and 49 reporting a high response retrospectively completed Conners rating scales describing their child prior to treatment, the child currently, and how the parent hoped the child would be following treatment.

Results: Percentage actual improvement in behaviour rating scales from baseline ranged from around 25% for the poor responders to above 50% for the high responders. Desired improvement was above 50%, with no significant difference between the groups on level of expectation.

Conclusions: Percentage cut points used to indicate clinical improvement reported in previous controlled trials of psychostimulant medication are probably too low, and could lead to an overestimate of treatment effect. Expectation of treatment benefit is unlikely to contribute to variation in treatment response.
Dyssomnia in Children Diagnosed with Attention Deficit Hyperactivity Disorder: A Critical Review
Authors: Bullock Gabrielle L. , Schall Ulrich
Published: December 2009

Objective: Studies prior to 1999 reported prevalent sleep disturbances in children diagnosed with attention deficit hyperactivity disorder (ADHD). However, these reports were largely inconclusive and inconsistent in their findings, hence the current review based on studies published thereafter.

Method: An online research of the National Library of Medicine and the Cochrane Library was conducted using the terms ‘attention deficit hyperactivity disorder’, ‘sleep’, ‘human’, and ‘English language’.

Results: Sixteen articles met the search criteria with 10 reporting objective measures of sleep characteristics (i.e. polysomnography, actigraphy, and/or video recording). These studies confirm an increase of rapid eye movement (REM) sleep latency and a proportional decrease of REM sleep in children diagnosed with ADHD. Stimulant treatment appears to have little effect on sleep quality while parent's reports of poor sleep in their ADHD-diagnosed offspring was largely inconsistent with the objective measures.

Conclusions: The review demonstrated a link between disturbances in sleep architecture and ADHD. Whether this is of an intrinsic or extrinsic cause remains debateable, as both behavioural (parental reporting) and physiological (objective differences in sleep architecture) factors are indicated. The effect of stimulant medication on sleep also requires further research, as current evidence is limited by study design.
Mental Disorders Among Maori Attending Their General Practitioner
Authors:   The MaGPIe Research Group,   The MaGPIe Research Group, Bushnell John
Published: December 2009

Objective: This paper identifies rates of common mental disorders among Maori and non-Maori consulting a general practitioner (GP), and explores the association between ethnicity and social and material deprivation.

Method: Survey of GPs and their patients. Participants were randomly selected GPs (n = 70), and their patients (n = 3414, of whom a subset of 786 form the basis of this paper). The main comparison is between self-identified ethnicity, mental disorder assessed by the Composite International Diagnostic Interview, and social and material deprivation measured by NZDep2001 (an area based measure), and an individualized index of deprivation.

Results: Rates of mental disorder among Maori general practice attenders were higher than among non-Maori. Overall, Maori women attenders were twice as likely as non-Maori women attenders to have a diagnosable mental disorder. The rates of anxiety, depressive and substance use disorders were all higher for Maori than for others attending GPs. Treatment for psychological problems was offered by the GP at similar rates to both Maori and non-Maori. Although there were differences between Maori and non-Maori in terms of social and material deprivation, higher rates of mental disorder among Maori attending GPs compared to non-Maori cannot be accounted for by these differences alone.

Conclusions: These findings support the view that whilst social and material deprivation may play a role in the high rates of mental disorders among Maori general practice attenders, there are additional ethnicity-specific factors involved. Interventions to address Maori mental health (whether by reducing risk factors for mental disorder, by promoting disclosure, early recognition and intervention, or by ensuring access to acceptable and effective treatments) may need to explicitly take those factors into account.
Mental Disorder in the New South Wales Prisoner Population
Authors: Butler Tony , Allnutt Stephen , Cain David , Owens Dale , Muller Christine
Published: December 2009

Objectives: To determine the prevalence of mental illness among prisoners in New South Wales (NSW), Australia.

Method: Mental illness was examined in two NSW prisoner populations: (i) new receptions to the correctional system; and (ii) sentenced prisoners. Reception prisoners were screened at four male centres and one female centre in NSW. The sentenced population was randomly selected from 28 correctional centres across the state. Reception prisoners were screened consecutively whenever possible while the sentenced group was randomly selected as part of the 2001 Inmate Health Survey. We adopted the same instrument, Composite International Diagnostic Interview – Auto (CIDI-A), for diagnosing mental illness as used in the Australian National Survey of Mental Health and Wellbeing.

Results: Overall, 43% of those screened had at least one of the following diagnoses: psychosis, anxiety disorder, or affective disorder. Reception prisoners suffered from mental illness to a greater extent than sentenced prisoners (46% vs. 38%). Women had higher levels of psychiatric morbidity than men (61% vs. 39%). Nine percent (9%) of all prisoners had experienced psychotic symptoms (due to any cause) in the prior 12 months. Twenty percent (20%) of all prisoners had suffered from at least one type of mood disorder and 36% had experienced an anxiety disorder. Posttraumatic stress disorder was the most common disorder, diagnosed in 26% of receptions and 21% of sentenced prisoners.

Conclusions: These findings confirm that prisoners are a highly mentally disordered group compared with the general community. Given the high prevalence of mental illness identified by this study, it is essential that prison mental health services be adequately resourced to address the demand and, at minimum, ensure that mental health does not deteriorate during incarceration.
Psychoanalysis, Science and the Seductive Theory of Karl Popper
Authors: Grant Don C. , Harari Edwin
Published: December 2009

Objective: To present a critique of the ideas of Karl Popper, the philosopher of science, whose depiction of psychoanalysis as a pseudoscience is often used to justify attacks on psychoanalysis.

Method: Published sources are used to provide a brief intellectual biography of Popper, a summar yof his concept of science and a summar yof criticisms of Popper's view of science. His depiction of psychoanalysis and Freud's reply are presented. Clinical, experimental and neurobiological research which refutes Popper's view is summarized.

Results: There is a vast scholarly published work critical of Popper's falsifiability criterion of science. Less recognized is Popper's misunderstanding and misrepresentation of psychoanalysis; his argument against it is logically flawed and empirically false. Even if Popper's theory of science is accepted, there is considerable clinical, experimental and neurobiological research in psychoanalysis which meets Popper's criterion of science.

Conclusion: Attacks on psychoanalysis based on Popper's theory of science are illfounded and reflect inadequate scholarship. Keywords: evidence, falsifiability, philosophy of science, psychoanalysis, science.
Self-Administered Instrument to Measure the Patient's Experience of Recovery After First-Episode Psychosis: Development and Validation of the Psychosis Recovery Inventory
Authors: Chen Eric Y.H. , Tam Dennise K.P. , Wong Josephine W.S. , Law C.W , Chiu Cindy P.Y.
Published: December 2009

Objective: Patients who are recovering from a first-episode psychosis face specific and complex issues that are related to their illness and treatment experiences, such as the appraisal of the extent of their recoveryand the risk ofrelapse. Currently, no instrument provides a comprehensive assessment of these related attitudes. A novel self-administered rating scale for the measurement of key perceptions during the recovery stage after a firstepisode psychosis is presented. The Psychosis Recovery Inventory (PRI) is designed to specifically address a number of closely related issues that are faced by patients who are recovering from a first-episode psychosis.

Method: The process of development of the PRI involved the generation of items from qualitative interviews, the construction and refinement of these items and a validation study. The longitudinal stability of the PRI items was assessed in a test–retest reliability study in which 20 patients completed the retest within 4 weeks. The internal consistency and convergent validity of the PRI were evaluated by a comparison of the PRI subscale scores and the Scale to Assess Unawareness of Mental Disorder and Drug Attitude Inventory scores in a sample of 48 first-episode psychosis patients.

Results: The validation study shows that the PRI is an instrument with a good test–retest reliability, internal consistency and convergent validity.

Conclusions: This pragmatic, low burden, self-administered scale can be applied in clinical and research settings to obtain reliable information on the attitudes of patients on a range of interrelated issues in the recovery stage that follows a first-episode psychosis.
Imputing Missing Repeated Measures Data: How Should We Proceed?
Authors: Elliott Peter , Hawthorne Graeme
Published: December 2009

Objective: This paper compares six missing data methods that can be used for carrying out statistical tests on repeated measures data: listwise deletion, last value carried forward (LVCF), standardized score imputation, regression and two versions of a closest match method.

Method: The efficacy of each was investigated under a variety of sample sizes and with differing levels of missingness. Randomly selected samples from a dataset (n=804) were used to compare the methods using t-tests. Efficacy was defined as the closeness of the estimated t-values to the true t-values from the complete dataset.

Results: The results suggest a reliable and efficacious basis for imputation method for repeated measures data is to substitute a missing datum with a value from another individual who has the closest scores on the same variable measured at other timepoints, or the average value of four individuals who have the closest scores on the same variable at other timepoints. The LVCF and standardized score methods performed relatively poorly, which is of concern since these are often recommended. Listwise deletion was also an inefficient missing data method.

Conclusions: Researchers should consider using closest matchmissing data imputation. Since listwise deletion performed poorly, is widely reported and is the default method in many statistical software packages, the findings have broad implications.
Factors Associated with Readmission to Adolescent Psychiatric Care
Authors: Bobier Candace , Bobier Candace , Warwick Matt
Published: December 2009

Objective: The aim of this study is to identify factors associated with readmission to adolescent psychiatric inpatient care, in the context of a relapsing major mental illness.

Method: Data were obtained from 71 patients admitted to an adolescent psychiatric inpatient unit over a 2-year period. Patients who were rehospitalized within 12 months of discharge were compared with patients who had only one admission during the study period with respect to diagnosis, age of first admission, history of child sexual abuse (CSA) and the events precipitating admission.

Results: Medication non-adherence and a history of CSA were positively and independently associated with relapse readmission, while a trend emerged among readmitted patients toward younger age at first psychiatric hospitalization. A negative association was found between readmission and the experience of personal loss. Readmission was not related to DSM-IV axis I or axis II diagnosis, including substance abuse.

Conclusions: The association, in an adolescent sample, of medication non-adherence and relapse readmission is consistent with findings from numerous adult studies, as is the trend toward younger age of first admission. The relationship of a history of CSA to readmission has attracted little previous research and the finding of a positive association suggests that further investigation of a history of CSA in this context is warranted. The implications of these findings and suggestions for further research are discussed.
Anxiety and Social Worries in Children with Asperger Syndrome
Authors: Russell Emily , Sofronoff Kate , Russell Emily , Sofronoff Kate
Published: December 2009

Objective: The current study examined anxiety and social worries in a group of children with Asperger syndrome (AS).

Method: Sixty-five children with AS were compared with a clinically anxious sample and a normative sample using parent and child reports.

Results: Comparisons between clinically anxious children and children with AS showed similar scores on overall anxiety and on six anxiety subscales using child reports. Parent reports revealed higher ratings of overall anxiety and described children with AS experiencing more obsessive–compulsive symptoms and physical injury fears than clinically anxious children.

Conclusions: Children with AS without a diagnosis of anxiety, present with more anxiety symptoms than a normal population and with a different profile than a clinically anxious population. Study limitations are identified and considerations for future research presented.
Pharmacotherapy for Posttraumatic Stress Disorder: Empirical Review and Clinical Recommendations
Authors: Cooper John , Carty Jessica , Creamer Mark
Published: December 2009

Objective: Growing awareness of the psychological effects of trauma has emphasized the need for clinicians across a range of practice settings to be aware of evidence-based treatment options for posttraumatic stress disorder (PTSD). The purpose of this article is to review the available empirical data on pharmacological approaches to PTSD and to provide recommendations for clinical practice.

Method: Although a comprehensive search of PsychInfo and Medline databases revealed a multitude of case reports and open-label trials, this paper focuses primarily on evidence obtained from randomized controlled trials to determine the most effective pharmacological treatments for PTSD.

Results: The research data overwhelmingly supports antidepressant medication as the first-line pharmacotherapy for PTSD, with selective serotonin re-uptake inhibitors having the strongest body of empirical support. Other medications, and with care, combination pharmacotherapy, may also have a role in the management of certain presentations. Cautions for clinicians in treating this complex disorder are provided.

Conclusions: Despite a substantial increase in the amount and quality of research into pharmacological treatments for PTSD in recent years, there is still a pressing need for more data to guide routine clinical practice. In particular, future research regarding the psychobiological basis of PTSD may guide the development of a PTSD-specific drug, designed to treat the unique characteristics of this disorder.
Nature of Depression in Patients with HIV/AIDS
Authors: Judd Fiona , Komiti Angela , Chua Phyllis , Mijch Anne , Hoy Jennifer , Grech Paul , Street Alan , Lloyd John , Williams Ben
Published: December 2009

Objective: Existing research suggests that the rate of depressive illness and depressive symptoms are high in people living with HIV/AIDS, but investigations on the causes of depression provide conflicting results. Social, psychological and biological factors have all been suggested as possible causes of depression in people living with HIV/AIDS. The suggestion that depression may be the result of the neurotropic effects of the virus on the central nervous system leading to an ‘organic’ or secondary depression has major implications in the treatment of HIV/AIDS. The aim of the current study was to further investigate the nature and underlying aetiology of depression in people living with HIV/AIDS.

Method: One hundred and twenty-nine people living with HIV/AIDS recruited for the study from outpatients clinics and primary care settings completed a range of self-report symptom measures including the Beck Depression Inventory (BDI), SF-36, SPHERE and a personality measure, the NEO Personality Inventory (NEO-PI). They also completed a battery of neuropsychological tests (CANTAB) and a structured clinical interview (SCID-DSM-IV). Medical and sociodemographic data were also recorded.

Results: Approximately one-third scored ≥14 on the BDI and 27% met criteria for a current ‘mood disorder’ on the SCID. Depressive symptoms were strongly related to personality style, having a past psychiatric history and current stressful psychosocial situation. There was no association between depression and HIV disease status. There was no evidence in this study cohort of a distinct subtype of ‘organic’ or secondary depression.

Conclusions: These results suggest that at least for ‘well’ people living with HIV/AIDS, there is no distinct subtype of depression and early treatment approaches can be modelled on those used for other non-HIV groups. Further longitudinal studies will be required to dissect out the multiple factors underlying depression in HIV/AIDS.
Anxiety and Depression in Fathers in Teenage Pregnancy
Authors: Quinlivan Julie A. , Condon John
Published: December 2009

Objective: It is recognized that pregnant teenagers have higher levels of psychological symptomatology compared to older pregnant women. However, there are limited data on fathers in the setting of teenage pregnancy. The aim of this study was to compare levels of psychological symptomatology in fathers in the setting of teenage as compared to non-teenage pregnancy.

Method: A cross-sectional cohort study was undertaken. Data from interviews with consecutive fathers in the setting of teenage (Teenage) and non-teenage (Control) pregnancy were compared during the antenatal period. Subjects were interviewed to obtain information covering demographic and family information, the Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire-28 (GHQ-28).

Results: Significantly more fathers in the setting of teenage pregnancy met the case criteria for HADS-A and HADS-D subscales compared to older fathers. They had significantly higher GHQ-28 totals and all subscale scores and were more likely predictive of a young age of death compared to older fathers. However, formal contact with psychiatric services was similar between groups. Interestingly, 14% of fathers in the setting of teenage pregnancy reported losing their own father as a child. In multivariate analysis, a high HADS score was significantly associated with younger age of onset of fatherhood and exposure to domestic violence as a child, whereas having their own father alive was significantly protective against a high HADS score.

Conclusion: Fathers, in the setting of teenage pregnancy, have unrecognized psychological symptomatology and require services along with teenage mothers.
‘Big Build’: Hidden Depression in Men
Authors: Brownhill Suzanne , Wilhelm Kay , Barclay Lesley , Schmied Virginia
Published: December 2009

Objective: To investigate men's experience of depression.

Method: A sample ofmale and female teachers and students was recruited from four sites of a tertiary education institution to a series of focus groups. A grounded theory approach to qualitative data analysis was used to elucidate men's experience of depression. Content analysis was applied to the women's data to examine similarities and contrasts with the men. Standard measures of mood and dispositional optimism confirmed the non-clinical status of the group.

Results: The findings suggest that some men who are depressed can experience a trajectory of emotional distress manifest in avoidant, numbing and escape behaviours which can lead to aggression, violence and suicide. Gender differences appear not in the experience of depression per se, but in the expression of depression.

Conclusion: Emotional distress, constrained by traditional notions of masculinity, may explain why depression in men can often be hidden, overlooked, not discussed or ‘acted out’. There are implications for the types of questions asked of men to detect depressive symptoms.
Psychiatric Diagnostic Dilemmas in the Medical Setting
Authors: Strain James J.
Published: December 2009

Objective: To review the problems posed for doctors by the failure of existing taxonomies to provide a satisfactory method for deriving diagnoses in cases of physical/psychiatric comorbidity, and of relating diagnoses on multiple axes.

Method: Review of existing taxonomies and key criticisms. The author was guided in selection by his experience as a member of the working parties involved in the creation of the American Psychiatric Association's DSM-IV.

Results: The attempts of the two major taxonomies, the ICD-10 and the American Psychiatric Association's DSM-IV, to address the problem by use of glossaries and multiple axes are described, and found wanting. Novel approaches, including McHugh and Slavey's perspectives of disease, dimensions, behaviour and life story, are described and evaluated. The problem of developing valid and reliable measures of physical/psychiatric comorbidity is addressed, including a discussion of genetic factors, neurobiological variables, target markers and other pathophysiological indicators. Finally, the concept of depression as a systemic illness involving brain, mind and body is raised and the implications of this discussed.

Conclusions: Taxonomies require major revision in order to provide a useful basis for communication and research about one of the most frequent presentations in the community, physical/psychiatric comorbidity.
Blood-Borne Viral and Sexually Transmissible Infections Among Psychiatric Populations: What are we Doing About Them?
Authors: Hercus Matthew , Lubman Dan I. , Hellard Margaret
Published: December 2009

Objective: To discuss the prevalence of blood-borne viral and sexually transmissible infections among psychiatric populations, as well as current treatment approaches, both locally and internationally.

Method: In this paper, we outline available epidemiological data, as well as interventions designed to target infectious disease risk among those with serious mental illness.

Results: Within Australia, the prevalence of blood-borne viral and sexually transmissible infections among at-risk populations remains unacceptably high despite a number of successful harm reduction and prevention strategies. Although the highest rates of new infections occur among young people aged 15–29 years, recent research suggests that psychiatric populations are also at significant risk. However, despite increased rates, there is currently no coordinated strategy to educate, test and reduce disease risk among people suffering with mental illness within Australia.

Conclusions: Although further epidemiological research at a local level is needed, interventions specifically targeting psychiatric populations and younger cohorts in particular, are essential. This will require multidisciplinary, collaborative service development, incorporating mental health, substance use and infectious disease specialists.
Smoking Bans in Psychiatric Inpatient Settings? A Review of the Research
Authors: Lawn Sharon , Pols Rene
Published: December 2009

Objective: This paper reviews the findings from 26 international studies that report on the effectiveness of smoking bans in inpatient psychiatric settings. The main aim is to identify which processes contribute to successful implementation of smoking bans and which processes create problems for implementation in these settings.

Method: After performing an electronic search of the literature, the studies were compared for methods used, subjects involved, type of setting, type of ban, measures and processes used and overall results. Total bans were distinguished from partial bans. All known studies of smoking bans in psychiatric inpatient units from 1988 to the present were included.

Results: Staff generally anticipated more smoking-related problems than actually occurred. There was no increase in aggression, use of seclusion, discharge against medical advice or increased use of as-needed medication following the ban. Consistency, coordination and full administrative support for the ban were seen as essential to success, with problems occurring where this was not the case. Nicotine replacement therapy was widely used by patients as part of coping with bans. However, many patients continued to smoke post-admission indicating that bans were not necessarily effective in assisting people to quit in the longer term.

Conclusions: The introduction of smoking bans in psychiatric inpatient settings is possible but would need to be a clearly and carefully planned process involving all parties affected by the bans. Imposing bans in inpatient settings is seen as only part of a much larger strategy needed to overcome the high rates of smoking among mental health populations.
Cigarette Smoking in Psychiatric Settings: Occupational Health, Safety, Welfare and Legal Concerns
Authors: Lawn Sharon
Published: December 2009

Objective: In the current climate of growing concern for the harmful effects of cigarette smoking and passive smoking, the high prevalence of this activity within psychiatric settings can no longer be ignored. This paper reviews the findings of research in a public stand-alone psychiatric facility in South Australia where significant legal and occupational health, safety and welfare (OHSW) concerns were apparent for both patients and staff as a consequence of the strong culture of smoking in that setting. The aim of this paper is to raise awareness of this significant health and legal issue and to inform policy and practice change.

Method: This paper reviews legal issues associated with smoking in psychiatric settings and presents relevant findings from previous studies in which in-depth interviews and observations in community and inpatient psychiatric settings were conducted.

Results: Significant legal and OHSW concerns were apparent for both patients and staff in all settings. The potential for future litigation was high.

Conclusions: There are a number of legal and OHSW implications of continued smoking by staff and patients within mental health settings. Several administrative, clinical and cultural practices need to change within this system of care in order to improve overall patient wellbeing and to avoid the potential for litigation by patients and staff.
Dissociative Disorders: Pathways to Diagnosis, Clinician Attitudes and Their Impact
Authors: Leonard David , Brann Susan , Tiller John
Published: December 2009

Objectives: To study the attitudes and experiences of Australian clinicians with dissociative disorders and the paths to diagnosis and experiences of patients.

Method: The attitudes of Australian clinicians to dissociative disorders and the experiences of patients were assessed by questionnaires. The clinicians were mental health specialists and a small number of general medical practitioners. The patients had all been diagnosed with a dissociative disorder.

Results: Of the 250 clinicians, 21% reported experience with more than six cases on average of any one of the dissociative disorders, 38% with less than six, 42% with none; 55% regarded them as valid diagnoses, 35% dubiously valid and 10% invalid. Of the 55 patients, 76% reported delays in diagnosis (57%, <3 years and 25%, <10 years) with adverse consequences in 64%; 80% had experienced sceptical or antagonistic attitudes from clinicians, rated as destructive by 48%. They were disabled (60% rated as <50% impaired) and were heavy consumers of health services (48% hospitalized, 68% <5 times). There was considerable comorbidity including moderate or severe depression (96%), self-harm (68%), suicide attempts (69%), panic disorder (53%), eating disorders (75%), substance abuse (25%), poor physical health (44%), major interpersonal (70%) and sexual problems (90%). Patients rated individual psychotherapy as the most helpful treatment (90%) but medications, such as antidepressants, were also valued (60%).

Conclusions: Although over half of the responding Australian clinicians thought that dissociative disorders were valid, the rest were dubious about their validity with 10% believing them to be invalid. Only 21% had considerable experience with the disorders. These findings may relate to some of the difficulties perceived by patients, which included delays in diagnosis, suboptimal treatment and negative experiences with clinicians.