bluuebunny/crossref_metadata_2025 huggingface dataset:
From Mate Retention to Murder: Evolutionary Psychological Perspectives on Men's Partner-Directed Violence
Authors: Kaighobadi Farnaz , Shackelford Todd K. , Goetz Aaron T.
Published: December 2009

In response to the tragically high incidence and negative consequences of female-directed violence in intimate relationships, a large literature has been dedicated to the investigation of the proximate and the ultimate or evolutionary predictors of men's partner-directed violence. Evolutionary psychology offers a framework for investigating the design of evolved information-processing mechanisms that motivate costly behaviors such as men's partner-directed violence. We review several forms of men's partner-directed violence, including insults, sexual coercion, physical violence, and homicide, from an evolutionary psychological perspective and with a particular focus on the adaptive problem of paternity uncertainty. The problem of paternity uncertainty is hypothesized to have selected for the emotion of male sexual jealousy, which in turn motivates men's nonviolent and violent mate retention behaviors. We review empirical evidence for the relationships among paternity uncertainty, male sexual jealousy, and men's partner-directed violence. We propose that a comprehensive understanding of men's partner-directed violence will be achieved only by careful consideration of both proximate and ultimate causes.
Adverse Incidents in Acute Psychiatric Inpatient Units: Rates, Correlates and Pressures
Authors: Carr Vaughan J. , Lewin Terry J. , Sly Ketrina A. , Conrad Agatha M. , Tirupati Srinivasan , Cohen Martin , Ward Philip B. , Coombs Tim
Published: December 2009

Objective: This paper reports findings from a multicentre service evaluation project conducted in acute psychiatric inpatient units in NSW, Australia. Overall rates of aggression, absconding and early readmission are reported, as well as length-of-stay profiles and associations between these outcomes and selected sociodemographic and clinical characteristics routinely collected by health services.

Method: Data from the 11 participating units were collected for a 12month period from multiple sources, including electronic medical records, routine clinical modules, incident forms, and shift based project-specific logs. For the current analyses, two admission-level datasets were used, comprising aggregated patient-level events (n=3242 admissions) and basic sociodemographic, clinical, admission and discharge information (n=5546 admissions by 3877 patients).

Results: The participating units were under considerable strain: 23.3% of admissions were high acuity; 60.4% had previous hospital stays; 47.6% were involuntary; 25–30% involved adverse incidents; bed occupancy averaged 88.4%; median length of stay was 8days (mean=14.59days); and 17.4% had a subsequent early readmission. Reportable aggressive incidents (11.2% of admissions) were intermittent (averaging 0.55 incidents per month per occupied bed) and associated with younger age, personality disorder, less serious aggression, longer periods of hospitalization, and subsequent early readmission. Less serious aggressive incidents (15.0% of admissions) were maximal in the first 24h (averaging 3.73 incidents per month per occupied bed) and associated with younger age, involuntary status, bipolar and personality disorders, the absence of depression, and longer hospital stays. Absconding (15.7% of admissions) peaked in the second week following admission and was associated with drug and alcohol disorder, younger age, and longer periods of hospitalization.

Conclusions: By examining relationships between a core set of risk factors and multiple short-term outcomes, we were able to identify several important patterns, which were suggestive of the need for a multi-level approach to intervention, shifting from a risk management focus during the early phase of hospitalization to a more targeted, therapeutic approach during the later phase. But the latter approach may not be achievable under current circumstances with existing resources.
Use of Pro Re Nata Medications in Acute Inpatient Care
Authors: Stein-Parbury Jane , Reid Kim , Smith Narelle , Mouhanna Diane , Lamont Fiona
Published: December 2009

Objectives: Available evidence suggests that the use of ‘as needed’ (PRN; from the Latin pro re nata: for an occasion that has arisen) medications has remained a standard aspect of treatment in acute inpatient mental health units over a number of years despite lack of evidence from controlled clinical trials. The practice is one in which doctors and nurses are interdependent; that is, while doctors prescribe the medications, professional nurses are the ones who make the clinical decisions to administer them. The aim of the present study was to provide a detailed description of the circumstances surrounding the use of PRN medications across four inpatient units in Sydney.

Methods: The medical records of all patients admitted for >24h during a 2month period were retrospectively audited for details regarding prescriptions and administrations of PRN medications.

Results: A total of 420 records were reviewed, producing a total of 3868 PRN medication administrations. Ninety-seven per cent of all patients were prescribed PRN medications and 93.8% were prescribed regular medications. The most frequently prescribed medications were second-generation antipsychotics for regular use along with benzodiazepine for PRN use. Nearly 84% of patients received at least one PRN medication during their admission, while patients diagnosed with personality disorder received more PRNs per day. The most common reason for PRN administration was patient agitation. The results indicated poor documentation in the prescription and documentation of PRN administrations. Also, the findings show that a small subset of the patients (5%) received >30% of all PRN medications.

Conclusion: PRN medication use has endured as standard practice and the results of the present study are consistent with the reported frequency of use increasing slightly over the years. The combination of second-generation antipsychotics as regular medications and benzodiazepines for PRN medication is consistent with recommended treatment guidelines. The small subset of patients who were overrepresented in the PRN administrations is noteworthy.
Consequences of Using SF-12 and RAND-12 when Examining Levels of Well-Being and Psychological Distress
Authors: Lee Adeline , Browne Mark Oakley , Villanueva Elmer
Published: December 2009

Objective: To explore the consequences of using the Short-Form Health Survey (SF-12) and the RAND-12 Health Status Inventory (RAND-12) for estimation of associations between its component scores and the levels of well-being and psychological distress.

Methods: Data from a rural community mental health survey of 5641 participants were analysed. Physical and mental health component scores of the SF-12 and RAND-12 were compared between participants with different rating on the Satisfaction with Life Scale and the Kessler-10. Descriptive graphical methods were utilized to explore the relationship between SF-12 and RAND-12 components scores against well-being and psychological distress. Proportional odds model was utilized to estimate the quantitative relationship between component scores of the SF-12 and RAND-12 against categories of well-being and psychological distress.

Results: Both SF-12 and RAND-12 component scores were generally positively associated with well-being and negatively associated with psychological distress. Median scores were similar despite scoring techniques used. However, distribution of scores differed whereby the RAND-12 yielded wider spread of scores in measures of well-being and psychological distressed when compared to the SF-12. A larger proportion of participants was classified as having moderate and severe disability under the RAND-12 compared to the SF-12.

Conclusion: It is recommended that users of the SF-12 and the RAND-12 are aware of the implications of utilizing either of the scoring techniques. Scoring techniques used should ideally be based on the theoretical basis of the study with consideration of the target population. Researchers may wish to use the SF-12 if distinct uncorrelated physical and mental constructs are required and for studies on clinical populations. In contrast, RAND-12 should be used if correlated physical and mental constructs are required and if the study is on community or general populations.
Ethnic Neutropenia and Clozapine
Authors: Bray Amanda
Published: December 2009

Objectives: The aim of the present paper was to examine the concept of benign ethnic neutropenia and to consider the implications of ethnicity in the current clozapine regulatory system.

Method: The case of a young Palestinian man who lost access to clozapine due to a fall in his neutrophil count, is presented herein, and a brief review of ethnic variations in neutrophil levels is given.

Results: This patient's clozapine was ceased, with unfortunate consequences, despite his having normal immune function.

Conclusion: By using normative haematological data established in white populations, the Australian clozapine regulatory system places some non-white patients at a considerable disadvantage.
Spinal Cord Injury and Mental Health
Authors: Migliorini Christine , Tonge Bruce , Taleporos George
Published: December 2009

Objectives: The aim of the study was to examine the mental health of adults with spinal cord injury living in the community

Methods: The study was a representative community cross-sectional cohort self-report survey, carried out in adults with traumatic spinal cord injury registered on the Victorian Spinal Cord Injury Register and adults with non-traumatic spinal cord injury attending a specialist non-traumatic spinal cord injury rehabilitation clinic. Participants (n=443) completed a self-report survey by internet, telephone or hard copy, which used reliable and valid measures of depression, anxiety and stress (Depression, Anxiety and Stress Scale) and post-traumatic stress disorder (Impact of Events Scale–Revised).

Results: Nearly half (48.5%) of the population with spinal cord injury suffered mental health problems of depression (37%), anxiety (30%), clinical-level stress (25%) or post-traumatic stress disorder (8.4%). Overall, there was a twofold or more increase in the probability of emotional disorders compared to the general population. Of those with one mental health disorder, 60% also had at least one other emotional disorder, representing a substantial 56% increase over the general population in the probability of comorbidity of psychopathology. Better health and time since injury were associated with decreasing the risk of psychopathology.

Conclusion: The results of the present study underscore the vulnerability of the population with spinal cord injury to emotional disorders. This study highlights the complexity of mental health problems experienced by many individuals with spinal cord injury living in the community. The delivery of mental health services to this vulnerable population requires recognition of comorbidity and problems of mobility, access and stigma.
Psychosocial Adjustment in Newly Diagnosed Prostate Cancer
Authors: Love Anthony W. , Scealy Marita , Bloch Sidney , Duchesne Gill , Couper Jeremy , Macvean Michelle , Costello Anthony , Kissane David W.
Published: December 2009

Objective: To examine the psychological and social adjustment of men with early or advanced stage prostate cancer and to compare them with a matched group of cancer-free community volunteers.

Methods: A longitudinal observational study in which 367 men recently diagnosed with early (n=211) or advanced stage (n=156) prostate cancer were compared to 169 cancer-free men from the community, of similar age and residential area, using self-report measures of psychosocial adjustment.

Results: On the mental health subscales of the Short-Form 36-item Health Survey, men with advanced disease had lower vitality and social functioning than the other two groups, and lower mental health scores than the comparison group. Both patient groups had lower role-emotional scores than the comparison group. With regard to the Brief Symptom Inventory, the advanced disease group had higher somatization scores, and lower interpersonal sensitivity and paranoid ideation scores than the early stage group and the community comparison group. In terms of psychiatric morbidity, there were higher rates of anxiety disorders but not depressive disorders in both patient groups although overall diagnosis rates were low. No differences were found in terms of couple or family functioning.

Conclusions: There is impairment in psychosocial function in men with prostate cancer, particularly those with advanced disease, but no increase in the rate of formal psychiatric disorder or adverse effects on the couples and families. This suggests directions for psychosocial interventions with these patient groups.
Effects of Diagnostic Comorbidity and Dimensional Symptoms of Attention-Deficit–Hyperactivity Disorder in Men with Antisocial Personality Disorder
Authors: Semiz Umit B. , Basoglu Cengiz , Oner Ozgur , Munir Kerim M. , Ates Alpay , Algul Ayhan , Ebrinc Servet , Cetin Mesut
Published: December 2009

Objective: Although children with attention deficit hyperactivity disorder (ADHD) are at increased risk for later onset of antisocial personality disorder (APD) as adults, the utility of ADHD as either a comorbid diagnosis (ADHDc) or dimensional symptoms (ADHDd) in predicting behaviour and substance use problems in APD subjects has not been examined.

Method: A total of 105 adult male offenders with Structured Clinical Interview for Axis II Disorders (SCID-II)-based DSM-III-R APD were studied in terms of: (i) psychopathy scores on the Hare Psychopathy Checklist–Revised (PCL-R); (ii) ADHDc diagnostic comorbidity on clinically administered DSM-IV questionnaire; and (iii) ADHDd dimensional symptoms by means of Wender Utah Rating Scale (WURS) and Conners Adult ADHD Rating Scale (CAARS) during a 12 month study period (May 2005–May 2006).

Results: Sixty five per cent of APD subjects met criteria for ADHDc diagnostic comorbidity with significantly increased rates of childhood neglect, parental divorce and suicide attempt, but not of psychopathy. APD subjects with ADHDd symptoms were noted to have earlier onset and increased rate of self-injurious behaviour (SIB), suicide attempt, and psychopathy. The psychopathy scores, in turn, were predictive of earlier onset of SIB and behavioural problems.

Conclusion: Both ADHDc diagnostic comorbidity and ADHDd symptoms need to be assessed in APD subjects and the dimensional measures may be better in detecting earlier onset SIB, suicide attempt and other behavioural problems.
Antipsychotic Induced Weight Gain in Schizophrenia: Mechanisms and Management
Authors: Rege Sanil
Published: December 2009

The aim of the present paper was to describe the mechanisms and management of antipsychotic-induced weight gain in schizophrenia patients. A comprehensive literature review of all available articles on the mechanisms and management of antipsychotic-induced weight gain was done by searching databases PsychINFO and PubMed. A summary of the available guidelines for monitoring of antipsychotic-induced weight gain and metabolic syndrome is also provided. There has been a substantial increase in the number of studies investigating the mechanisms and management of antipsychotic-induced weight gain after 2002. These include advances in the understanding of pharmacogenomics of weight gain and several randomized controlled trials (RCTs) evaluating pharmacological and psychological treatments to promote weight loss. The most effective strategy for prevention of weight gain is the choice of antipsychotic medication with low weight gain potential. In individuals with established weight gain and metabolic issues, switching to an antipsychotic agent with lower weight gain potential and/or lifestyle modifications with physical activity are most effective in promoting weight loss. Pharmacological agents such as orlistat and sibutramine are effective in general obesity but have not been sufficiently evaluated in antipsychotic-induced weight gain. The case to prescribe routine pharmacological treatment to promote weight loss is weak. Long-term, pragmatic studies are required to inform clinical practice. Weight gain in schizophrenia is associated with significant physical and psychological morbidity. Achieving an optimal trade-off between effectiveness and side-effects of antipsychotic agents, although difficult, is achievable. This should be based on three main principles: (i) a shared decision-making model between the patient, clinician and carer(s) when choosing an antipsychotic; (ii) a commitment to baseline and follow-up monitoring with explicit identification of the responsible individual or team; and (iii) the adoption of clear structured protocols for clinicians to follow in case of clinically significant weight gain and metabolic issues, which should incorporate greater collaboration between various health professionals from psychiatric and medical specialist services.
Pilot Study Evaluating the Effect of Massage Therapy on Stress, Anxiety and Aggression in a Young Adult Psychiatric Inpatient Unit
Authors: Garner Belinda , Phillips Lisa J. , Schmidt Hans-Martin , Markulev Connie , O'Connor Jenny , Wood Stephen J. , Berger Gregor E. , Burnett Peter , McGorry Patrick D.
Published: December 2009

Objective: The aim of the present pilot study was to examine the effectiveness of a relaxation massage therapy programme in reducing stress, anxiety and aggression on a young adult psychiatric inpatient unit.

Method: This was a prospective, non-randomized intervention study comparing treatment as usual (TAU) with TAU plus massage therapy intervention (MT) over consecutive 7 week blocks (May–August 2006). MT consisted of a 20 min massage therapy session offered daily to patients during their period of hospitalization. The Kennedy Nurses’ Observational Scale for Inpatient Evaluation (NOSIE), the Symptom Checklist-90–Revised (SCL-90-R), the State–Trait Anxiety Inventory (STAI) and stress hormone (saliva cortisol) levels were used to measure patient outcomes at admission and discharge from the unit. The Staff Observation Aggression Scale–Revised (SOAS-R) was used to monitor the frequency and severity of aggressive incidents on the unit.

Results: There was a significant reduction in self-reported anxiety (p < 0.001), resting heart rate (p < 0.05) and cortisol levels (p < 0.05) immediately following the initial and final massage therapy sessions. Significant improvements in hostility (p = 0.007) and depression scores (p < 0.001) on the SCL-90-R were observed in both treatment groups. There was no group×time interaction on any of the measures. Poor reliability of staff-reported incidents on the SOAS-R limited the validity of results in this domain.

Conclusions: Massage therapy had immediate beneficial effects on anxiety-related measures and may be a useful de-escalating tool for reducing stress and anxiety in acutely hospitalized psychiatric patients. Study limitations preclude any definite conclusions on the effect of massage therapy on aggressive incidents in an acute psychiatric setting. Randomized controlled trials are warranted.
Anterior Cingulate Glutamate–Glutamine Levels Predict Symptom Severity in Women With Obsessive–Compulsive Disorder
Authors: Yücel Murat , Wood Stephen J. , Wellard R. Mark , Harrison Ben J. , Fornito Alex , Pujol Jesus , Velakoulis Dennis , Pantelis Christos
Published: December 2009

Objective: Abnormalities of the anterior cingulate cortex (ACC) have consistently been identified in obsessive–compulsive disorder (OCD), but very few studies have examined the biochemical basis of such changes. The purpose of the present study was to investigate how ACC biochemistry in OCD varies as a function of gender, hemisphere, subregion, and symptomatology.

Method: 3 T proton-magnetic resonance spectroscopy (MRS) was used to probe ACC biochemistry in 20 OCD patients (10 male, 10 female) and a comparable group of 26 healthy comparison subjects. Data were acquired from the left and right dorsal and rostral subregions of the ACC. Metabolites assessed included N-acetylaspartate (NAA), glutamate–glutamine (Glx), choline-containing compounds (Cho), creatine/phosphocreatine (Cr), and myoinositol-containing compounds (mI).

Results: Female OCD patients had significantly reduced levels of Glx in all but one subregion of the ACC when compared to matched controls. Levels of Glx were correlated with clinical measures of symptom severity in female but not male patients. State levels of anxiety and depression did not explain this association. In addition, both male and female OCD patients had relatively higher concentrations of mI in their right ACC (rostral and dorsal) compared with healthy controls. No other compounds had any statistically significant group differences, nor were the concentrations of any other compounds correlated with symptom measures.

Conclusions: To the authors’ knowledge this is the first study to demonstrate gender-specific neurochemical changes in OCD. Although these findings are tentative and require replication, they raise the possibility that MRS techniques may be of use in objectively monitoring patient progress and assessing the effectiveness of various treatments.
Physical Aggression During Admission to a Child and Adolescent Inpatient Unit: Predictors and Impact on Clinical Outcomes
Authors: Dean Angela J. , Duke Suzanne G. , Scott James , Bor William , George Michelle , McDermott Brett M.
Published: December 2009

Objective: Aggressive behaviour is common in young people admitted to child and adolescent inpatient services. Little is known about how physical aggression during admission influences patient outcomes. The aim of the present study was to identify predictors of aggression in a child and adolescent inpatient unit and examine differences in clinical outcomes between aggressive and non-aggressive patients.

Method: Episodes of aggression occurring within a child and adolescent inpatient unit were prospectively documented between October 2004 and December 2005. Patient factors (demographics, diagnoses, clinical history) were examined as predictors of aggression. Outcomes for admissions in which more than one episode of physical aggression occurred were compared to those in which no aggression occurred. Outcomes assessed were changes in symptom severity (as rated by the Health of the Nation Outcome Scales for Children and Adolescents) length of stay, and initiation of medications.

Results: A total of 134 patients were admitted during the study period (61.9% female, mean age=13.8years, SD=2.9); 31 patients (23.1%) exhibited physical aggression during admission and 20 of these exhibited more than one episode of physical aggression. Factors that predicted persistent physical aggression included history of aggression, use of medications at presentation and absence of self-harm. Persistent aggression was also associated with increased length of stay, but did not compromise improvements in clinical symptom ratings between admission and discharge or lead to increased medication prescribing

Conclusion: Contrary to hypotheses and existing research, aggression during admission does not appear to be a barrier to clinical improvement. Further research is necessary to clarify how aggressive children can receive the most benefit from inpatient admission while minimizing the risks to the patient and those around them.
Validation of Attention-Deficit–Hyperactivity Disorder Subtypes Among Taiwanese Children Using Neuropsychological Functioning
Authors: Chiang Mengchun , Gau Susan S. F.
Published: December 2009

Objective: The findings regarding the validity of attention-deficit–hyperactivity disorder (ADHD) subtypes using neuropsychological functioning have been inconsistent; and no such study has been conducted in an ethnic Chinese population. The aim of the present paper was therefore to examine the validity of attention tasks in distinguishing the ADHD-combined type (ADHD-C) from the ADHD-inattention type (ADHD-I), as compared to children without ADHD in Taiwan.

Methods: Participants included 52 children with ADHD-C, 17 with ADHD-I, and 52 controls, aged 7–10years. The clinical diagnosis of DSM-IV ADHD was further confirmed by a standardized psychiatric interview. Four attention components were examined: sensory selection, response selection, capacity/focus, and sustained attention, using the Cancellation Test, Digit Span, Trail-Making Test (TMT), Continuous Performance Test (CPT), and Circle-Tracing Test. Behaviour symptoms were rated by the parents, teachers, and investigators.

Results: Compared to children without ADHD, children with ADHD scored significantly higher in parent-reported and investigator-rated behavioural symptoms, and performed worse in the four domains of attention. Multiple comparisons indicated that children with ADHD-C had a worse performance on most tests than children with ADHD-I, except that children with ADHD-I had more off-target errors on the TMT with alphanumeric sequencing than children with ADHD-C.

Conclusions: Attention tests can distinguish Taiwanese children with ADHD from those without ADHD, and these tests also demonstrate different profiles between the ADHD-C and ADHD-I groups. Further investigation on this topic should include the ADHD-hyperactivity–impulsivity subtype (ADHD-HI) and increase sample sizes of the children with ADHD-I and ADHD-HI. (ClinicalTrials.gov number, NCT00494819.)
Factor Structure of the Greek Translation of the Scale for the Assessment of Thought, Language and Communication
Authors: Andreou Christina , Bozikas Vasilis P. , Papouliakos Ioannis , Kosmidis Mary H. , Garyfallos George , Karavatos Athanasios , Nimatoudis Ioannis
Published: December 2009

Objective: The Scale for the Assessment of Thought, Language and Communication (TLC) is a widely used instrument for the assessment of formal thought disorder. TLC disorders were initially conceptualized as having only two underlying dimensions, a negative and a positive one. But studies of the factorial structure of the TLC have not provided confirmation for the positive-versus-negative distinction. The aim of the present study was to assess the factorial structure of the Greek translation of the TLC.

Method: Subjects were 103 patients (69 male, 34 female) with psychotic disorders randomly recruited from both inpatient and outpatient facilities. The TLC was assessed by two raters based on a 20 min clinical interview.

Results: Principal component analysis with varimax rotation yielded a three-factor structure; the three factors consisted off items reflecting (i) disorganization of speech; (ii) peculiarities of speech; and (iii) verbosity. The disorganization factor could be further divided into two dimensions reflecting disturbances in the flow of ideas and in the structure of speech.

Conclusion: The investigation of the factorial structure of the Greek translation of the TLC scale found no support for the positive-versus-negative distinction of TLC disorders. Three factors (disorganization, speech peculiarities, and verbal productivity) were found to underlie the variance of the scale.
Echopraxia in Schizophrenia: Possible Mechanisms
Authors: Pridmore Saxby , Brüne Martin , Ahmadi Jamshid , Dale Jack
Published: December 2009

The aim of the current study was to present a possible mechanism underpinning echopraxia in schizophrenia. It is proposed that echopraxia occurs in schizophrenia when the mirror neuron system provides a representation to the inferior frontal gyrus (IFG) and the motor cortex (and via the IFG, to the anterior cingulate cortex) and that this potential becomes executed movement, when the disorder is associated with decreased inhibition and increased arousal.
Familial Psychopathology in the First Episode Psychosis Outcome Study
Authors: Morley Katherine I. , Cotton Susan M. , Conus Philippe , Lambert Martin , Schimmelmann Benno G. , McGorry Patrick D. , Foley Debra L.
Published: December 2009

Objective: The aim of the present study was to characterize the utility of family history data for predicting psychiatric and functional status in first-episode psychosis (FEP) during the pre-treatment phase of illness, at first presentation, and at 18 months follow up.

Method: An epidemiological study based upon a consecutive file audit of 661 patients admitted to the Early Psychosis Prevention and Intervention Centre between January 1998 and December 2000 using a standardized questionnaire.

Results: In the total sample of FEP patients family history was not significantly associated with psychiatric or functional status pre-treatment, at first presentation, or at 18 months. Male patients with a family history of psychotic illness had a longer duration of prodrome compared to those with no family history of psychiatric illness (mean=481.4 days, SD=678.0 vs mean=383.5 days, SD=524.7; p=0.03). Family history of non-psychotic illness was associated with comorbidity at first presentation in female patients, both for substance-use related comorbidity (p=0.02) and non-substance-use related comorbidity (p=0.03). There was substantial agreement between clinician reports of family history of psychosis and those obtained using a structured interview instrument (κ=0.69, 95% confidence interval (CI)=0.41–0.86), but agreement for non-psychotic family history was comparatively low (κ=0.28, 95%CI:=−0.03 to 0.52).

Conclusions: There are gender differences in the association between substance use disorder, duration of prodrome and family history. This supports the hypothesis that psychotic illness manifests differently in men and women. In the present sample, reports of family history of non-psychotic illness had lower convergent validity than reports of psychotic illness. The present reported associations with non-psychotic family history should therefore be interpreted with caution. Information on gender and family history of psychiatric illness may assist clinical diagnosis and determination of treatment in FEP patients, especially if specific familial risk factors can be identified.
Shyness 1: Distance Treatment of Social Phobia Over the Internet
Authors: Titov Nickolai , Andrews Gavin , Schwencke Genevieve , Drobny Juliette , Einstein Danielle
Published: December 2009

Objective: The purpose of the present study was to examine the effectiveness of an Internet-based clinician-assisted computerized cognitive behavioural therapy programme for social phobia.

Method: A total of 105 individuals with social phobia were randomly assigned to a six-lesson cognitive behavioural treatment programme or to a waitlist control group. Treatment consisted of four components: six online lessons; homework assignments; participation in an online discussion forum; and regular email contact with a therapist. An intention-to-treat model was used for data analyses.

Results: A total of 78% of treatment group participants completed all lessons, and post-treatment data were obtained from 93/105 participants. Significant post-treatment differences between treatment and waitlist participants were found on two measures of symptoms of social phobia. Mean within- and between-group effect sizes (Cohen's d) for the primary social phobia outcome measures were 1.15, and 0.95, respectively.

Conclusions: These results were comparable with those obtained in exemplary face-to-face treatment programmes. They provide further positive data about the utility of Internet-based guided self-help programmes for people with common mental disorders.
Pro Re Nata Medication for Psychiatric Inpatients: Time to Act
Authors: Hilton Michael F. , Whiteford Harvey A.
Published: December 2009

Pro re nata (PRN; ‘as needed’) medication is an archetypal mainstay for managing acute psychiatric inpatient symptoms and behaviours. Psychiatric and mental health nursing practices have circumnavigated the development of a uniform medical–ethical standard for the administration of PRN psychotropic medication. This paper examines the evidence for administration of PRN psychotropic medications and, in the context of evidence-based best practice, current mental health policy and professional ethics, proposes a standardized Australian PRN administration protocol. The procedures and circumstances leading to a nurse administering psychotropic PRN medication are divided into five simple steps, namely (i) medical prescription; (ii) nurse evaluation of patient indications for an intervention; (iii) nurse consideration of therapeutic options; (iv) obtaining patient informed consent; and (v) documentation of outcomes of PRN administration. The literature associated with each step is reviewed, along with national and international professional ethics, guidelines and patient rights documents pertaining to the care of mental health patients. Recommendations for best-practise care are discussed for each step. There is a lacuna of published evidence supporting the use of PRN medications in psychiatric inpatients. Yet there is published evidence that PRN medications are associated with increased risks of morbidity, inappropriate use, may result in above-recommended dosages or polypharmacy, and complicate the assessment of efficacy of regular scheduled medicines. Alternative non-pharmacological treatment options to PRN medication are effective and associated with fewer side-effects. There are no national explicit standards, operational criteria or quality assurance for the use of PRN medication in inpatient psychiatric units. Contemporary PRN practices are largely unregulated and driven by essentially anecdotal evidence, leaving the clinicians and the service open to claims of poor accountability and misuse (intentional and unintentional) of psychotropic medications. Development of best practice guidelines for the use of PRN administration is essential.
Shyness 2: Treating Social Phobia Online: Replication and Extension
Authors: Titov Nickolai , Andrews Gavin , Schwencke Genevieve
Published: December 2009

Objective: In a randomized controlled trial Titov et al. (2008) demonstrated significant benefit from an Internet- and email-based treatment programme for social phobia. The present study (Shyness 2) seeks to replicate that finding and compares results with benchmark data.

Method: Eighty-eight individuals with social phobia were randomly assigned to a clinician-assisted computerized cognitive behavioural treatment programme or to a waitlist control group. Participants completed the same treatment programme used in Shyness 1, consisting of six online lessons, cognitive behavioural homework assignments, email contact with a therapist, and participation in an online discussion forum. An intention-to-treat model was used for data analyses.

Results: A total of 80% of treatment group participants completed all lessons, and post-treatment data were obtained from 78/81 participants. Treatment group participants each had an average of 127 min of therapist contact over the 10 week programme, including an average of 22 email contacts plus therapist responses to forum postings. Pre- to post-treatment differences were seen between treatment and waitlist participants across two measures of symptoms of social phobia, and across a measure of disability. Mean within- and between-group effect sizes (Cohen's d) across the two primary outcome measures were 1.18, and 1.20, respectively. Quantitative and qualitative data indicate that the procedure is very acceptable to participants.

Conclusions: These results closely replicate those obtained in Shyness 1, indicating that the treatment procedure is reliable. These results compare favourably with outcomes reported in benchmarking studies from high-quality face-to-face treatment programmes for social phobia. These results provide further positive data about the utility of Internet-based guided self-help programmes for people with social phobia.
Dual Constraints on Synapse Formation and Regression in Schizophrenia: Neuregulin, Neuroligin, Dysbindin, DISC1, MuSK and Agrin
Authors: Bennett Ao Maxwell R.
Published: December 2009

During adolescence there is a loss of approximately 30% of the synapses formed in the cortex during childhood. Comprehensive studies of the visual cortex show that this loss of synapses does not occur as a consequence of less appropriate projections being eliminated in favour of more appropriate ones. Rather it seems that synapses with low efficacy for transmission are eliminated in favour of those with higher efficacy. The loss of low-efficacy synapses is known, on theoretical grounds, to enhance the function of neural networks, but large synapse losses lead to failure of network function. In the dorsolateral prefrontal cortex (DLPC) of those suffering from schizophrenia the number of synapses is relatively very low, approximately 60% lower than that observed in normal childhood. It is not known if this is due to an additional loss over that during normal adolescence or whether it results from a failure to form a normal complement of synapses during childhood. The first study of synapse loss in the mammalian nervous system was made on the neuromuscular junction at Sydney University in 1974. Since then this junction has provided principal insights into the molecular basis of synapse formation and regression, so providing a paradigm for investigations of these phenomena in the DLPC. For example the molecules muscle-specific receptor tyrosine kinase (MuSK), agrin and neuregulin have been identified and their critical roles in the formation and maintenance of synapses elucidated. Loss of function of MuSK or agrin leads to failure of neuromuscular synapse formation as well as a loss of approximately 30% of excitatory synapses in the cortex. Similar synapse loss occurs on failure of neuregulin in vitro and of neuroligin in vivo. It is suggested that three important questions need to be answered: first, over what development period are the synapse numbers in DLPC of subjects with schizophrenia lower than normal; second, what are the relative importance of MuSK/agrin, neuregulin/ErB and neurexin/neuroligin in synapse formation and regression in the DLPC; and third, to what extent have these molecules gone awry in schizophrenia.
Regulator of G-Protein Signalling 4 Expression is Not Altered in the Prefrontal Cortex in Schizophrenia
Authors: Stuart Gibbons Andrew , Scarr Elizabeth , McOmish Caitlin E. , Hannan Anthony J. , Thomas Elizabeth A. , Dean Brian
Published: December 2009

Objectives: Regulator of G-protein signalling 4 (RGS4) modulates signal transduction through several neurotransmitter receptor systems associated with the pathology of schizophrenia. A reported decrease in RGS4 expression in the prefrontal cortex of schizophrenia patients followed by supporting evidence from association studies implicated RGS4 as a susceptibility gene for schizophrenia. Subsequent efforts to extend these findings in post-mortem brain tissue have produced conflicting results. The aim of the present study was to reconcile these discrepancies by examining RGS4 expression in the dorsolateral prefrontal and parietal cortices from subjects with schizophrenia.

Methods: RGS4 mRNA and protein levels were measured in post-mortem Brodmann area (BA)9 and BA40 tissue from 19 schizophrenia patients subjects and 19 pair-matched controls using in situ hybridization and western blotting.

Results: Levels of RGS4 mRNA (F1,73=1.845; p >0.05) or protein (F1,72=3.336×10−4, p >0.05) did not vary significantly with diagnosis in BA9 or BA40 from subjects with schizophrenia.

Conclusions: Altered RGS4 expression is not universally present throughout the cortex of people with schizophrenia.
Early Childhood Predictors of Early Substance use and Substance use Disorders: Prospective Study
Authors: Hayatbakhsh Mohammad R. , Mamun Abdullah A. , Najman Jake M. , O'Callaghan Michael J. , Bor William , Alati Rosa
Published: December 2009

Objectives: The purpose of the present study was to examine the longitudinal association between early childhood factors and early initiation of use of substances and substance use disorders in a large prospective study.

Method: Data were from the Mater Hospital University of Queensland Study of Pregnancy, a prospective birth cohort study in Brisbane, Australia. Use of nicotine, alcohol and cannabis and age of initiation of such use were reported at the 21 year follow up. DSM-IV diagnosis of nicotine, alcohol and cannabis use disorders was assessed at 21 years using a computerized version of the Composite International Diagnostic Interview (CIDI-Auto). Early childhood factors were measured between mother's pregnancy and child age 5 years.

Results: Of the 3647 respondents with complete data, 15.4% had started to smoke cigarettes before 15 years. Another 17.4% and 12.2% reported having started to consume alcohol or use cannabis in early adolescence, respectively. Some 16.2%, 27.8% and 21.9% had ever had nicotine, alcohol or cannabis abuse or dependence (disorder) by 21 years, respectively. In multivariate models early initiation of use of substances, and substance use disorders were associated with disrupted families or drug-using parents, childhood problem behaviours, and poor parental monitoring and supervision in childhood.

Conclusions: There are four independent factors in early or middle childhood that predict early initiation of use of substances and subsequent substance use disorders by early adulthood. There is a need to consider whether what is known about the risk factors that predict young age of substance use, and substance use disorders, may be incorporated into treatment and/or prevention initiatives.
Estimating Premorbid Intelligence in Schizophrenia Patients: Demographically Based Approach
Authors: Dragovic Milan , Waters Flavie A.V. , Jablensky Assen
Published: December 2009

Objective: The aim of the present study was to provide a useful and quick estimate of premorbid intelligence that can be used in the population of schizophrenia patients.

Method: Regression analysis (stepwise procedure) was used to identify which of five demographic variables significantly predicted National Adult Reading Test (NART) scores in schizophrenia patients. The new regression equation was subsequently assessed in an independent patient sample. The results were compared with scores obtained for an equation developed in healthy populations.

Results: Age, occupation, and education contributed significantly to the equation, which accurately predicted NART scores in the patient sample. The equation developed in healthy people, however, consistently underestimated NART scores.

Conclusions: Equations developed in healthy people are not accurate predictors of NART scores. By contrast, the new equation acknowledges the educational and occupational characteristics typical of individuals with schizophrenia. The equation should be used cautiously, but can be used as a rapid estimate when it is not possible to conduct a cognitive assessment using more traditional approaches.
Harm Associated With Stalking Victimization
Authors: Thomas Stuart D. M. , Purcell Rosemary , Pathé Michele , Mullen Paul E.
Published: December 2009

Objective: The purpose of the present study was to determine the frequency at which assault and attempted assault occur as outcomes among stalking victims, and to explore the common characteristics of those cases in which the victims report these harmful outcomes as a result of the stalking behaviour.

Method: A sample of 3700 men and women randomly selected from the electoral roll were sent a postal questionnaire to determine the prevalence and nature of their experiences of stalking behaviours. Those who self-reported that they had been stalked were divided according to whether their pursuer had, or had not, attacked them.

Results: Of the 432 who reported having been stalked, 75 (17.4%) had been attacked. A number of victim and perpetrator factors differentiated those who reported attacks. A combination of the victim being threatened, being an ex-intimate, and being younger at the time of the stalking incident were predictive of attack. A multivariate model containing these factors correctly classified 82% of the sample and achieved an AUC of 0.87.

Conclusions: Stalking is an all too common problem behaviour that can result in a range of harmful outcomes for victims. Threats made by ex-intimates are a particular cause for concern. The generalizability of these findings should be tested using robust prospective methodologies in diverse populations.
Impact of Psychosocial Interventions on Children With Disruptive and Emotional Disorders Treated in a Health Camp
Authors: Gibbs Allen , Moor Stephanie , Frampton Christopher , Watkins William
Published: December 2009

Objective: The aim of the present study was to evaluate the impact of a health camp psychosocial intervention on children with behavioural and emotional problems and the impact of a parenting programme for their parents. The practical utility of introducing two outcome measures was also evaluated.

Method: A total of 157 consecutively referred children, with a range of emotional and behavioural problems, were rated by parents and teachers, before and after their residential stay, using the Strengths and Difficulties Questionnaire (SDQ). Concurrent change in parenting attitudes was assessed using the Adult Adolescent Parenting Inventory-2. One hundred parents participated in a parenting programme. Both child and parent outcomes for these parents were contrasted with those of the 57 non-participating parents.

Results: The whole group showed significant improvements in SDQ rated Emotional, Conduct, Hyperactive and Total problems. These were of moderate effect size. The parenting programme had minimal impact on parenting attitudes and no adjunctive value was demonstrated.

Conclusions: The Health Camp intervention appeared moderately beneficial for a range of common childhood emotional and behavioural problems. In contrast, there was no demonstrable effect from the parenting programme on either parenting attitudes or child outcomes. The SDQ appeared to have clinical utility as an outcome measure.
Links Between Ethnic Identification, Cannabis Use and Dependence, and Life Outcomes in a New Zealand Birth Cohort
Authors: Marie Dannette , Fergusson David M. , Boden Joseph M.
Published: December 2009

Objective: To examine the role of ethnic identity in cannabis use, and links between ethnic identity, cannabis use and life outcomes, in a birth cohort of >1000 young people studied to age 25.

Methods: Data were gathered on cultural identification, cannabis use, socioeconomic factors, childhood adversity, and a range of life outcomes as part of a longitudinal study of a New Zealand birth cohort (Christchurch Health and Development Study).

Results: Those reporting Māori identity had rates of cannabis use and dependence that were significantly higher (p<0.05) than rates for non-Māori. Regression analysis suggested that the elevated rates of cannabis use among Māori were largely explained by their higher exposure to socioeconomic disadvantage and childhood adversity. Further analyses examined the role of cannabis use in the links between ethnicity and a range of life outcomes, including education, income and employment, mental health, criminal offending, and intimate partner violence. These analyses showed that cannabis use made a small but detectable contribution to rates of Māori disadvantage in life outcomes, with this contribution being most evident in the areas of crime, education, and unemployment.

Conclusions: Māori ethnic identification was associated with increased risks of cannabis use and dependence. The higher rate of cannabis use by Māori could be largely attributed to a combination of socioeconomic factors and greater exposure to environmental factors known to influence risk of cannabis use. The higher rates of cannabis use by Māori made a small contribution to higher rates of early school leaving, crime, and unemployment among Māori.