bluuebunny/crossref_metadata_2025 huggingface dataset:
Naming of Patients by Therapists
Authors: Rosenman S. J. , Goldney R. D.
Published: November 2007

A self-report questionnaire to elicit the patients' preferences for how they were to be addressed was given to 102 in-patients. Of 94 replies, 90 asked to be called by their first name.
Obtaining Outpatient Referrals for Clinical Research
Authors: Tiller John W. G. , Biddle Nola
Published: November 2007

Two methods of recruiting patients with generalised anxiety disorder (GAD) were compared. One hundred general practitioners in the immediate neighbourhood of a major urban hospital were approached for referrals, and an article on generalised anxiety asking for volunteers was placed in the evening newspaper. The former resulted in ten doctor-initiated referrals, two of whom fulfilled DSM-Ill criteria for GAD. The latter resulted in over 500 volunteers. In a random selection of 136 volunteers who secured their doctors' approval, 56 fulfilled GAD criteria. The majority of the remainder had a depressive illness. The newspaper article was more economical of researchers' time and more successful in finding suitable subjects than directly approaching general practitioners.
Propofol as an Anaesthetic Agent for Ect: Effect on Outcome and Length of Course
Authors: Mitchell Philip , Torda Thomas , Hickie Ian , Burke Christine
Published: November 2007

Recent reports of reduced seizure duration with ECT under propofol anaesthesia have led to concerns that propofol may diminish the efficacy of this treatment. To investigate the effect of propofol on the response to ECT, we reviewed records of 66 patients with primary depression treated with ECT, 37 of whom had been assessed prospectively with pre- and post-ECT Hamilton and Zung depression severity ratings. Despite demonstrating that the individual seizure duration was significantly reduced with propofol compared to thiopentone we found no evidence of reduced ECT efficacy with propofol. Courses under propofol anaesthesia were on an average two treatments longer than with thiopentone. Although this difference was not statistically significant this may have been due to a type II error. These results suggest that it is premature to abandon the use of this new anaesthetic agent in ECT without controlled prospective outcome studies.
Authoritarianism among Medicine and Law Students
Authors: Pestell Richard , Ball J. Richard B.
Published: November 2007

This study assessed the effects of gender, faculty, and year (level) on “authoritarianism” among university students within the faculties of law and medicine. A questionnaire, using the Ray Adapted F Scale to measure authoritarianism, was administered to 454 students at the University of Western Australia. The first, third and sixth year medical students were compared with first, third and final year law students. Gender alone was responsible for a significant source of variance, with males more authoritarian than females. Faculty alone showed a strong trend towards significance with medicine more authoritarian than law. Although no other 2– or 3– way interactions were significant a trend was apparent in which females became more and males less authoritarian with increasing level.
The Pattern of Psychiatric Morbidity in a Victorian Urban Aboriginal General Practice Population
Authors: McKendrick Jane , Cutter Trevor , Mackenzie Alan , Chiu Edmond
Published: November 2007

Victorian Aboriginal people, most of whom live an urban lifestyle, form a distinct cultural group within the wider Victorian community. This paper describes a unique psychosocial study of urban Aboriginal adults attending a general practitioner at the Victorian Aboriginal Health Service in Fitzroy. The frequency and nature of psychiatric disorders among survey respondents is reported, together with a discussion of the association between this morbidity and certain sociodemographic variables.
New Pharmacological Approaches to the Management of Depression: From Theory to Clinical Practice
Authors: Norman Trevor R. , Judd Fiona K. , Burrows Graham D.
Published: November 2007

A review of the clinical efficacy of four structurally distinct antidepressant drugs is presented. Their antidepressant activity can be rationalised within current pharmacological hypotheses of drug action, despite markedly different effects on “in vitro” testing. Fluoxetine, a specific serotonin re-uptake inhibitor, has proven safe, effective treatment for depressive illness and may have a role to play in the treatment of obsessive-compulsive disorder and panic attacks. While it has few of the anticholinergic side effects of the tricyclic antidepressants, nausea, tremor, headache, weight loss, nervousness and sweating are side effects most frequently reported. Minaprine, a compound with weak MAO inhibiting properties and effects on serotonergic receptors, has clinical efficacy in the treatment of depression based on several comparative studies. It is claimed that minaprine lacks anticholinergic and sedative properties. Moclobemide, a specific, reversible inhibitor of MAO-A, has been extensively evaluated in depressive illness. The major advantage of this agent over other irreversible, non-specific MAO inhibitors, is the significant attenuation of the so-called “cheese effect” with doses of tyramine likely to be encountered in foodstuffs. Rolipram, a phosphodiesterase inhibitor, represents a new approach to antidepressant treatment. Limited clinical data suggest that the drug may be an effective antidepressant with few side effects. The place of these agents in therapy is yet to be established.
Social Psychiatry and Sociology of Mental Health: A View on Their Past and Future Relevance
Authors: Krupinski Jerzy
Published: November 2007

The origins of social psychiatry can be traced to the age of enlightenment and to the effects of the industrial revolution. Social psychiatry deals with social factors associated with psychiatric morbidity, social effects of mental illness, psycho-social disorders and social approaches to psychiatric care. Since the end of World War II up to the early seventies it has been claimed that social psychiatry should concentrate on the fight against war, poverty, racial discrimination, urban decay and all other social ills affecting people's mental health, and that the psychiatrist should be responsible for the mental health of the society. In contrast, sociology of mental health questioned the expertise of the psychiatrist and the very existence of mental illness, claiming that it covers deviant behaviour rejected by the society. The paper refutes this approach indicating that not the existence but the perception and presentation of psychiatric illness are socially determined. Acknowledging the contribution of sociology and social sciences to psychiatry, it is suggested that the heroic period of social psychiatry and the iconoclastic approach of sociology of mental health are over. However, social psychiatry, enriched by the use of epidemiological methods, has still much to offer to the daily practice of psychiatry.
Psychoanalysis, Science and Clinical Practice
Authors: King Robert
Published: November 2007

The question of the relationship between psychoanalysis and science, and the place of psychoanalysis in clinical practice is reviewed. A commonly held view that the central question is whether or not psychoanalysis is scientific is challenged. It is argued instead that psychoanalysis, science and clinical practice are epistemologically independent fields and attempts to subsume one within the other are unproductive. Psychoanalysis may have as much to say concerning the epistemological basis of science as science has to say concerning the epistemological basis of psychoanalysis. Only a proper appreciation of this enables the question of the relationship between psychoanalysis and clinical practice to be adequately examined.
The Quantum of Meaning: An Approach to the Paradox of Self-Observation
Authors: Morstyn Ron
Published: November 2007

Self-observation contains a paradox largely unaddressed in current psychiatric theory. It is impossible to make “objective” observations of the meaning of our own thoughts and feelings because we use those very same thoughts and feelings to make our observations. Nevertheless most psychiatric theory assumes a clear separation between the internal part of ourselves which observes and that part which forms the object of our observations. Analogies from quantum physics can be used to elucidate this paradox. Once the complexities of self-observation are understood, so are many of the enigmas of psychotherapy.
Julius Wagner von Jauregg: A Reappraisal
Authors: Riebl L. , Sharp P.
Published: November 2007

A little more than half a century has passed since the death of Julius Wagner von Jauregg, a significant figure in the history of modern psychiatry. We believe that after this passage of time the life and work of Wagner von Jauregg deserve reappraisal.
The Biology of Personality
Authors: Mulder Roger
Published: November 2007

Historically, models of personality have generally postulated, or assumed, a link with biology. This century has witnessed a major revision of these ideas with both behavioural and psychoanalytic theorists emphasising life experiences as being largely responsible for behaviour as adults. Challenges to this assumption of the overwhelming importance of life experiences are reviewed. An extensive body of data now exists suggesting that biology contributes significantly to individual variability. This biological contribution occurs at a relatively low level in the central nervous system, best defined as temperament. Further research has suffered from the lack of a cohesive psychobiological model. Cloninger's tridimensional theory of personality is presented as a model which attempts to bridge the gap between theoretical temperamental traits, neurotransmitter function and clinical psychiatry. It is to be hoped that new theoretical models will be formulated which will focus on the importance of temperamental variables in psychiatric disorders.
Empathy — A Retrospective on its Development in Psychotherapy
Authors: Sharma Renuka M.
Published: November 2007

The paper situates the notion of empathy broadly within the historical context of its origins and subsequent conceptual development, particularly in psychotherapy. It shows how the term is related to its wider usage in popular culture and in studies outside of psychoanalytic psychotherapy. The paper surveys the contributions of several psychoanalytic writers, from Freud to Kohut. This is followed by a critique of more recent psychoanalytic inquiries into empathy. The discussion explores reasons for some of the difficulties resting with a psychoanalytic approach. It is suggested that these are due in large measure to inherent difficulties in defining the term, but that they are accentuated by the language and polemics of psychoanalysis. More specific contributions are considered with a view to understanding the notions of aetiology, description, function and epistemology in regard to empathy within the psychoanalytic framework.
Clarification of Values in Counselling and Psychotherapy
Authors: Mickleburgh W. E.
Published: November 2007

When an individual acts contrary to personal values, then there is dissonance, with consequences of guilt, anxiety, despair, or alienation. If unresolved and of sufficient strength these feelings may manifest in mental illness. Thus, clarification of values and resolution of value conflict are relevant to counselling and psychotherapy. A framework for the systematic examination of values in therapy is described. Values are classified as personal, social, environmental and sensate. In therapy, goals may be matched for congruence between personal values and overt behaviour. Processes which erode values and ways to maintain integrity of personal value systems are considered.
Symptomatic Response to Antipsychotics Differs between Recent Onset and Recurrent Chronic Schizophrenic Patients
Authors: Hill Christine , Keks Nicholas A. , Jackson Henry , Kulkarni Jayashri , Hannah Deborah , Copolov David , Singh Bruce
Published: November 2007

The symptomatic response to standard antipsychotic treatment was assessed over the first 4 weeks of hospitalisation in 39 patients with DSM-III schizophrenia, active phase, using the Brief Psychiatric Rating Scale (BPRS). While highly significant improvement was noted overall, 36% of patients either did not improve or worsened. Furthermore there was no diminution in the withdrawal-retardation factor of the BPRS. Patients experiencing their first admission to hospital, all with recent-onset illness, were then compared with patients who presented with a recurrence and had illness of at least 3 years duration. Despite similarities in overall response, withdrawal-retardation scores did not diminish in recent-onset patients, in contrast to multiple admissions who demonstrated significant improvement. These findings suggest greater responsiveness of negative symptoms to treatment in patients with longstanding illness, and possibly a poorer prognosis in first admission patients with deficit manifestations.
Knowledge and Compliance towards Lithium Therapy among Chinese Psychiatric Patients in Hong Kong
Authors: Lee Sing , Wing Y. K. , Wong K. C.
Published: November 2007

Although patient education is believed to promote medication compliance, the exact relationship between the acquisition of drug knowledge and compliance during lithium treatment is unclear. A survey of 50 Chinese patients on maintenance lithium therapy revealed that their medical knowledge about lithium treatment, as measured by a “Lithium Questionnaire,” was very limited. Nonetheless, 70% of these patients were found, by multiple criteria, to be good compliers, and lithium compliance was apparently not affected by the amount of drug knowledge that patients possessed. It is argued that in the process of conducting patient education to enhance lithium compliance, a sound therapeutic alliance is more important than sheer knowledge acquisition.
An Australian Multicentre Study of Moclobemide versus Amitriptyline in the Treatment of Depression
Authors: Evans Larry , George Tom , O'sullivan Brendan , Mitchell Philip , Johnson Gordon , Adena Michael
Published: November 2007

This paper reports the results of a multicentre study of the new monoamine oxidase inhibitor, moclobemide, in the treatment of major depression. Moclobemide is a specific monoamine oxidase-A inhibitor which does not bind irreversibly to the enzyme, unlike the currently available MAOIs. Recent studies would suggest that in subjects taking moclobemide blood pressure elevation caused by tyramine is significantly less than that induced by the irreversible MAOIs, particularly when tyramine is administered in an oral form. Forty-eight patients with major depression were randomly allocated to treatment with either moclobemide or amitriptyline for 4 weeks in a double-blind comparison. There were no statistically significant differences between the two groups on measures of efficacy. Patients taking amitriptyline reported a greater number of side-effects and more patients in the amitriptyline group dropped out because of these. There were no reports of interactions with tyramine-containing foods.
A Study of Referrals of Black Children to a General Hospital Psychiatric Outpatient Clinic
Authors: Lasich Angelo John , Nair Margaret Gemma
Published: November 2007

Five hundred and seventy-seven children who attended a child psychiatric out-patient clinic during 1987 were evaluated. Their clinical and demographic characteristics are described and management discussed. High on the list of presenting complaints were poor school performance and behavioural problems. Factors considered as influencing referrals are socio-economic, political, lack of school psychological services and facilities for the management of the intellectually handicapped. The most common diagnoses were mental retardation (39.5%) and epilepsy (16.2%).
Social Networks and Psychiatric Morbidity in New Zealand Women
Authors: Romans S. E. , Walton V. A. , Herbison G. P. , Mullen P. E.
Published: November 2007

A random community survey of urban and rural New Zealand women revealed higher rates of psychiatric morbidity in subjects who reported poorer social support. Substantial differences in social networks were found between demographic subgroups. Rural women described better than expected social relationships, giving some support to the pastoral ideal of well integrated rural communities. Women in part-time employment also described better social networks. Elderly, low socio-economic, and widowed, separated and divorced women had poorer social relationships. It is suggested that normative values for social network measures for each demographic subgroup will need to be established before the clinical significance of deviations from the norm can be meaningfully evaluated. Also, the mechanisms linking social networks to health may vary in different subgroups.
Quantity Frequency (Consumption Index) versus “Cage” in the Detection of Alcoholism
Authors: Indran Saroja Krishnaswamy
Published: November 2007

The aim of this study was to compare and validate two simple methods of detecting excessive alcohol drinkers in a Malaysian hospital population. All 621 patients in the Medical, Surgical and Orthopaedic units of the General Hospital Kuala Lumpur were screened with the “CAGE” Questionnaire (a four question screening test to discriminate excessive drinkers) and two questions on the frequency and quantity of drinking called the Consumption Index. All CAGE scores had poor agreement (K = 0.37 to K = 0.1) with a psychiatric diagnosis of alcohol abuse and dependence using DSM III diagnosis. Reasons why the Consumption Index is a better screening instrument than the CAGE are discussed.
Senior Trainees and New Consultants Group
Authors: Samuels Anthony , Mackay Murray
Published: November 2007

After four years of training and the completion of the FRANZCP part one examination, trainees commence their elective year. The acceptance of their dissertation approximately one year later represents the culmination of a relatively brief “practising subphase” [1]. In both Australia and New Zealand, new graduates are in the fortunate position of being virtually assured a Consultant post but the relatively rapid escalation to Consultant status creates considerable attendant role changes and responsibilities. Many new graduates enter this phase with residual “shame and doubt” [2]. Some feel that they could have done better in the examination process; others experience a degree of “survivor guilt” [3], feeling less deserving of their newly acquired status than colleagues unsuccessful in previous sections of the examination.
The Neglect of Prevention in Psychiatry
Authors: Sartorius N. , Henderson A. S.
Published: November 2007

The prevention of mental disorders has been neglected but the public health burden now is too high for this to continue. Nearly one half of all mental and neurological disorders are amenable to primary prevention. Effective measures could be applied even in countries with few resources. By and large these measures all rely on available knowledge and commonly involve sectors other than health. This paper calls attention to the opportunities that offer but that have been so far largely unheeded.
The Expert Witness in Forensic Psychiatry
Authors: Chaplow David G. , Peters Janet L. , Kydd Rob R.
Published: November 2007

Forensic psychiatry operates at the interface of the Justice and Health systems and has been defined as: “That branch of psychiatry which requires special knowledge and training in the law as it relates to the mental state of the offender, or alleged offender” [1]. As a consequence of working in this area, psychiatrists are often called into court to give evidence as “expert witnesses”. This article examines some of the professional and legal issues involved in providing expert testimony. Secondly, it aims to outline some practical guidelines for giving evidence in the court-room. The predominant focus is on criminal, rather than civil, proceedings in which the forensic psychiatrist gives expert testimony; however much of the information is also relevant to other psychiatrists and psychologists undertaking this role in the legal arena.
A Multicentre Double Blind Trial of Fluoxetine versus Amitriptyline in the Treatment of Depressive Illness
Authors: Judd Fiona K. , Moore Kate , Norman Trevor R. , Burrows Graham D. , Gupta Ramesh K. , Parker Gordon
Published: November 2007

The antidepressant efficacy and side effect profile of a fixed dose of 20 mg/day of fluoxetine, a specific serotonin reuptake inhibitor, were compared to those of amitriptyline. Fifty-eight patients with DSM-III-R depression were randomly assigned to receive either fluoxetine or amitriptyline. Fifty-six patients (fluoxetine N = 23, amitriptyline N = 23) completed the 6 week study. Comparable antidepressant efficacy was demonstrated for the two drugs. Patients taking fluoxetine reported less side-effects than those taking amitriptyline.
Making Conscious Identifications: A Means of Promoting Empathic Contact
Authors: Korner Tony
Published: November 2007

A rationale for encouraging the development of empathic skills is discussed, along with the current status of such training in medical education. The concept of empathy and previous approaches to empathy training are discussed briefly. A technique, which I have called “conscious identification”, is described. In essence it involves an attempt by the trainee to “put himself in the patient's position” and to write an account in the first person of what he perceives of the patient's experience. The technique is illustrated using three case studies. Possible applications are discussed as well as the limitations of the technique.
Psychotherapy Supervision in Hong Kong: A Meeting of Two Cultures
Authors: Cheng Louis Yang-Ching
Published: November 2007

The experience of psychotherapy supervision of a group of trainee psychiatrists, in a university setting in Hong Kong, is reported from the supervisor's perspective. The trainees showed difficulties in this exercise. The cultural difference between the supervisor and the trainees, and that between the Western psychotherapy culture and the Chinese culture, is discussed. It is then followed by a description of what is seen as the trainees' resistance in the acceptance of psychotherapy and of the supervisor. This is considered to be one of the problems in the transcultural application of psychotherapy, and has to be overcome if this importation is to be successful.
An International Perspective on Bereavement Related Concepts
Authors: Middleton Warwick , Moylan Ann , Raphael Beverley , Burnett Paul , Martinek Nada
Published: November 2007

This paper reports on part of a study which was aimed at assessing the views of leading researchers, theorists or clinicians working in the field of bereavement on key issues including, as reported here, concepts of different forms of grief as well as favoured theoretical orientations. Of a range of conceptual models the most favoured, by a large margin, were attachment theory and the psychodynamic model.

The views of the “experts’ were canvassed with respect to the use of seven selected terms used to denote some variant of the grieving process. There was, on the part of the respondents, reasonable support for the syndromes of “delayed’, “chronic’, “anticipatory’ and “absent’ grief. “Inhibited’ and “unresolved’ grief tended to be described using one of the four terms already supported, while the use of the term “distorted grief’ attracted little support.
The Edinburgh Postnatal Depression Scale: Validation for an Australian Sample
Authors: Boyce Philip , Stubbs Joanne , Todd Angela
Published: November 2007

One hundred and three post-partum women completed the Edinburgh Postnatal Depression Scale (EPDS) and were interviewed using the Diagnostic Interview Schedule. A cut-off score of 12.5 on the Edinburgh Postnatal Depression Scale identified all nine women who reached criteria for major depression. At this threshold the sensitivity (the percentage of true “cases’ identified) of the EPDS was 100%, its specificity (the percentage of true “non-cases’ identified as such) 95.7% and its positive predictive value (the percentage of all those tested as positive who were correctly identified as such) 69.2%. Although this study supported the validity of the EPDS, a replication of this study on a larger sample is suggested.
Emotional Lability after Stroke
Authors: Morris Philip L.P. , Robinson Robert G. , Raphael Beverley
Published: November 2007

The aims of this study were (i) to determine the frequency of emotional lability following first ever stroke, and (ii) to identify factors associated with this condition. Sixty-six consecutive inpatients with first ever stroke were surveyed two months post stroke for the presence of emotional lability. Demographic, clinical, psychiatric and stroke lesion characteristics were also assessed. Emotional lability was present in 12 of the 66 patients (prevalence: 18%). Emotional lability occurred independently of post stroke depression. Single lesions located in anterior regions of the cerebral hemispheres had four times the odds of emotional lability than lesions located anywhere else (p<0.05). Emotional lability is a common emotional-behavioural syndrome following stroke and is probably a separate condition from post stroke depression. The aetiology of this condition is possibly related to the consequences of injury to anterior regions of the cerebral hemispheres.
Adolescent Suicide Clusters: Evidence, Mechanisms and Prevention
Authors: Hazell Philip
Published: November 2007

Cluster suicides account for an estimated 5% of all teenage suicides in the USA. Not all hypothesised clusters are verified, however, when submitted to statistical analysis. This paper reviews possible mechanisms underlying adolescent cluster suicides using the “infectious disease model’, key concepts of which are host susceptibility, modes of transmission, degree of virulence, and dose dependency. Preventive measures against cluster suicides are reviewed, including primary prevention against youth suicide, tempered media reporting of suicide, and “postvention strategies’ directed to communities affected by suicide.
Panic Provocation in the Treatment of Agoraphobia: A Preliminary Investigation
Authors: Page Andrew C.
Published: November 2007

The efficacy of panic provocation exercises in the treatment of agoraphobia is examined. Twenty six patients with agoraphobia were allocated to a cognitive-behavioural program with and without panic provocation exercises. Both programs significantly reduced symptoms. Despite a trend in favour of panic provocation, differences between treatments failed to reach significance. Results are discussed in terms of a cognitive model of panic and the manner in which future research into panic provocation should be conducted.
DSM-III-R Disorders in New Zealand 18-Year-Olds
Authors: Feehan Michael , McGee Rob , Raja Shyamala Nada , Williams Sheila M.
Published: November 2007

The one-year prevalence and correlates of selected DSM-III-R disorders were determined in a sample of 93018-year-olds. Using both diagnostic and impairment criteria 340 individuals (36.6%) were considered to have disorder. The most prevalent disorders were major depressive episode (16.7%), alcohol dependence (10.4%) and social phobia (11.1%). There was a high degree of co-morbidity among disorders; 46% of those with disorder had two or more. The prevalence of disorders was greater for females, with the exception of conduct disorder and alcohol or marijuana dependence. A variety of characteristics were associated with disorder, including poor social competence, disadvantage and self-rated health status. A third of those with disorder had their problems recognised by a “significant-other”. The results are presented within the context of a perceived need for research in the area of adolescent and early adult mental health in order to minimise the toll of mental disorder in later life.
Comorbidity between Disruptive Disorders and Depression in Referred Adolescents
Authors: Rey Joseph M.
Published: November 2007

Parent questionnaires from large Australian (N=2093) and American (N=500) clinic cohorts of adolescents were used to diagnose depression, attention deficit disorder with hyperactivity, and oppositional and conduct disorders. Co-occurrence of diagnoses was very high. Comorbidity between depression and conduct disorder was not higher than that expected for any psychiatric disorder (odds ratios =1.20 and 1.45 respectively for each cohort) while comorbidity between attention deficit disorder with hyperactivity and oppositional disorder was higher than expected (odds ratios =7.03 and 9.02) but comparable to that between conduct and oppositional disorder (odds ratios =7.35 and 6.14). Co-occurrence of depression with other disorders did not increase the likelihood of comorbid conduct disorder.
DRGs and Australian Psychiatry
Authors: Hunter Christine E. , McFarlane Alexander C.
Published: November 2007

The introduction of diagnosis related groups (DRGs) as a basis for funding in the United States has revealed several shortcomings in current DRG systems. Overall, DRGs have proven to be poor predictors of cost, accounting for approximately one third of the variation in cost and length of stay for surgical DRGs and falling to less than 10% for medical DRGs. Their ability to contain costs also remains uncertain, with savings associated with reductions in length of stay being offset by increased readmission rates. Given the increasing commitment of government to casemix approaches to funding it is suggested that psychiatry should participate in the process of solving the problems so far identified with DRG systems. Participation would, it is hoped, create a focussed debate about the provision of a “gold standard” of care for all patients. The evaluation and refinement of existing DRGs is urgently needed and could utilise a number of comprehensive data bases which already exist across the country. Alternatives to diagnosis such as functional status and treatment needs should also be explored.
Combining Lithium and Sodium Valproate for Bipolar Disorder
Authors: Mitchell Philip , Withers Keri , Jacobs George , Hickie Ian
Published: November 2007

We report two cases of severe bipolar disorder in which there was a dramatic response to the combination of lithium and sodium valproate. Both patients had failed to respond to the respective monotherapies. These cases suggest that the combination of lithium and sodium valproate may be more effective than each of these drugs used alone. There is a clear need for controlled outcome studies of the common clinical practice of combining lithium and the anticonvulsants.
Whose Territory is it Anyway? Should Psychiatry own Alcohol and Drugs in Australia?
Authors: Wodak Alex
Published: November 2007

Surely alcohol and drug matters in Australia should be regarded as the province of psychiatry? Decades before any other branch of medicine displayed any interest in the subject and long before alcohol and drugs were considered even remotely respectable, numerous Australian psychiatrists provided inspiration and leadership in this Cinderella field. Drs Bartholomew, Bell, Buchanan, Chegwidden, Dalton, Drew, Ellard, Lennane, Milner, Milton, Waddy and Pols are some of the best known among the many Australian psychiatrists who pioneered efforts to improve treatment for patients with alcohol and drug problems. The NHMRC Committee on Alcohol and Drug Dependence, which has a considerable potential for influencing the field in Australia, has always been dominated by psychiatrists. In the United Kingdom and the United States, countries which often serve as models for much of Australian medical and other practice, alcohol and drug matters are determined almost exclusively by psychiatrists. Is there any evidence that they have been held back by a psychiatric hegemony on alcohol and drug's? For many decades (and until quite recently), alcohol and drug matters were handled for the World Health Organisation by its Mental Health Division. Did we suffer globally because WHO placed alcohol and drugs under the control of psychiatry?
The Psychogenic Factor in Infertility
Authors: Christie George L.
Published: November 2007

The influence of the psyche upon human fertility continues to be underestimated by many workers in the field. For certain individuals and couples there appears to be an unconscious link between a lowering of the level of fertility, and psychosocial, interpersonal or intrapsychic situation rendering it an unsuitable time to allow a baby to come. Such matters need to be explored in an unhurried way. We need time also for a gradual integration of findings from many related fields of knowledge. These issues are discussed and three case studies presented.
A Study of the Relation between Eating Disorder and Death Concern
Authors: Warren W. G. , Jackson C. C. , Thornton C. , Russell J. , Touyz S. W. , Beumont P. J. V.
Published: November 2007

The relationship between eating disorder and various components of death orientation (fear, anxiety, acceptance and concern) was examined, taking into account the level of depression in patient samples as well as elements of religiosity. The results were not able to support more than a very modest relationship between eating disorder and death orientation. Eating disorder patients could not be distinguished from other clinical controls, nor did anorexia nervosa patients differ from other eating disorder patients in this respect. Beck and Beck [20] depression scores were higher in the non eating disordered clinical sample than in the eating disorder group, and death concern was shown to be related to the severity of depression. Religiosity did not appear important when indices of religiosity were considered, but did emerge as an important factor in the “free information” provided by participants.
Workforce Deployment: Reconciling Demands and Resources
Authors: Andrews Gavin
Published: November 2007

Objective: The purpose of the study was to review the information in a Consultancy prepared for the National Mental Health Policy which suggested that half of the people with serious mental illnesses were untreated, while persons with “mental problems” were being overserviced by the specialist mental health services. The fate of the large group of persons with mental disorders of mid-range severity was not addressed.

Method: Epidemiological data was reconciled with the service patterns of the clinical workforce and the extent of the unmet need estimated. Results: It was estimated that 25–30% of the Australian population meet criteria for a mental disorder in any year, yet less than one third will receive treatment. Of those that are treated, three quarters will receive their treatment from general practitioners and the remaining quarter will be treated by either the public mental health services, the addiction services, or private psychiatrists. The problem is that less than one half of those with serious mental disorders and only two thirds of those with chronic and disabling disorders appear to be being treated by anyone. Even if there were no slippage of services away from these serious and chronic groups of patients, there would still be a workforce shortfall, especially in rural and remote areas.

Conclusions: Strategies to remedy this shortfall that involve psychiatrists, clinical psychologists and general practitioners are noted, and the need for a National Mental Health Survey to provide accurate data is stressed.
The Relationship between Social Factors and Frequent Use of Psychiatric Services
Authors: Kent Suzanne , Yellowlees Peter
Published: November 2007

The purpose of the study was to develop a comprehensive demographic, diagnostic and social profile of patients who are heavy service users of hospital and community based services within the South Australian Mental Health Services (SAMHS). This paper concentrates on the relationship of social issues to heavy service use.

The 50 heaviest users of public adult acute psychiatric services in a defined catchment area of Adelaide were identified. Data were obtained retrospectively from the case notes over a 3 year study period. All patients' primary therapists were interviewed, as were 35 of the patients. These structured interviews included a variety of psychosocial rating scales investigating disability and social networks.

The 50 patients studied were found to be seriously disabled by chronic psychiatric illness, with substance abuse often complicating their management and their ability to live successfully in the community. The study confirms the emergence in the literature of a valid global profile of the heavy service user patient, and indicates that social factors are strongly related to heavy service use.
A Community Study of Preschool Behaviour Disorder in New Zealand
Authors: Pavuluri Mani N. , Luk Siu-Luen , Clarkson John , McGee Rob
Published: November 2007

A two stage epidemiological study of 320 children aged between 2.5 and 5 years of age, from eight randomly selected preschool centres, was performed in order (1) to test the psychometrics of the Behaviour Check List (BCL), a parent report instrument for preschool children, (2) to estimate the prevalence, and (3) to describe the correlates of preschool behaviour disorder. After the initial screening using the BCL, the Hyperactivity Scale (HAS) and the Internalising Disorder Scale (IDS), parents were interviewed using the Behaviour Screening Questionnaire (BSQ); the children were examined using the Rutter and Graham's interview. Data was also collected on family functioning, maternal mental health, social adversity, development, physical health and perinatal history.

The BCL was found to be a reliable and valid screening measure. A cut off point of 8+ was established for New Zealand preschoolers; this is lower than that in the UK sample, illustrating the importance of retesting the instruments in a different culture. The prevalence rate of behaviour problems based on clinical diagnosis was 22.5%. Results of logistic regression analysis showed that poor family functioning, poor maternal mental health and parental separation were associated significantly with behaviour disorder.

This study emphasises the need to identify preschool behaviour disorder and associated risk factors to enable an early intervention.
The Life Skills Profile: A Study of Its Psychometric Properties
Authors: Trauer Thomas , Duckmanton Robert A. , Chiu Edmond
Published: November 2007

Two hundred patients with severe mental illness of mixed type were assessed by treating mental health professionals a total of 730 times with the Life Skills Profile (LSP). Confirmatory factor analyses broadly confirmed the existence of the Self-care and Non-turbulence subscales. Internal consistencies were generally good but inter-rater reliabilities were of only marginal acceptability. The fit of the data to the five subscales can be improved by reassigning two items. The Communication subscale had the poorest psychometric properties. Certain LSP scale scores were found to vary with how well and how long the rater had known the patient. Validity, which was assessed by relating LSP scores to locus of care (i.e. community or hospital), Brief Psychiatric Rating Scale (BPRS) ratings and Resource Associated Functional Level Scale (RAFLS) ratings, was good. An alternative scoring system yielded rather clearer meaning for some of the subscales.
Munchausen Syndrome by Proxy Abuse: A Foundation for Adult Munchausen Syndrome
Authors: Conway Steven Philip , Pond Michael Neil
Published: November 2007

Symptoms fabricated by the mother, and abnormal maternal pressurising of medical staff, resulted in misinterpretation of sweat test results and a diagnosis of cystic fibrosis in a two year old child. Her mother refused to accept later medical evidence which irrefutably showed this diagnosis to be wrong. The child was extensively investigated and for most of her childhood was treated for pancreatic malabsorption. She progressed from an innocent child victim of Munchausen Syndrome by Proxy abuse to an accomplice in her mother's deception, and finally to adult Munchausen Syndrome behaviour. Munchausen Syndrome by Proxy abuse may programme a child into developing adult Munchausen Syndrome.
The Concept of “Self”
Authors: Gilhotra J.
Published: November 2007

This paper discusses several different points of view in an effort to define the elusive and often confusing concept of “self”, and to differentiate it from “ego”, a term which has, at times, been used synonymously with it. The concept of self is then discussed in relation to its usefulness in normal, healthy individuals as well as those with psychological problems.
Childhood Sexual Abuse: A Risk Factor for Postpartum Depression?
Authors: Buist A. , Barnett B.
Published: November 2007

While the link between childhood sexual abuse and adult psychiatric disorder has been documented, such research has not looked at any association with postpartum depression. Admissions to the Mercy Mother-Baby Unit are reviewed with respect to a possible link, with case examples presented. An aetiological model is proposed and clinical implications are highlighted.
Ethnic Differences in the Utilisation of Public Psychiatric Services in An Area of Suburban Melbourne
Authors: Trauer Tom
Published: November 2007

Objective: The main aim of this study was to compare levels of service use by English and non-English speaking background people.

Method: A comparison of service use in 1991/1992 between clients of English speaking (ESB) and non English-speaking (NESB) background was undertaken using hospital inpatient statistics, community mental health centre contact data, interpreter usage figures, and the 1991 Australian census.

Results: The main findings indicated: (a) longer median lengths of stay of NESB than ESB inpatients; (b) roughly equal involuntary hospitalisation rates between ESB and NESB residents, but significantly lower rates of voluntary hospitalisation for NESB residents; (c) NESB face-to-face clinic contacts significantly shorter (by between five to ten minutes) than ESB; and (d) variable and generally low use of interpreters. No significant associations between ethnicity, legal status and gender were found. There were limitations in the available data and conclusions could be drawn only with caution.

Conclusions: Recommendations include better routine collection of ethnically relevant information, and measures designed to improve the acceptability and accessibility of inpatient services.
Victims of Violence in Fiji
Authors: Pridmore Saxby , Ryan Kim , Blizzard Leigh
Published: November 2007

Objective: The aim of the paper is to examine the statistics for violence performed by self or others in Fiji during the period 1969–1989 in the following sub-classifications: (1) fatal vs non-fatal; (2) Fijian vs Indian; and (3) male vs female.

Method: Crude rates per 100,000 were determined and the data sets were statistically examined.

Results: (1) Violence by self, which includes suicide and non-fatal injury by self, has significantly increased; (2) Indian violence by self has increased in both males and females; (3) suicide is 4 times more common than homicide, whereas non-fatal injury by others is 4 times more common than non-fatal injury by self; (4) non-fatal injury by self is 8 times more common than suicide, whereas non-fatal injury by others is over 100 times more common than homicide; (5) Indian violence by self is 6 times more common than Fijian violence by self, whereas Fijians experience violence by others 2.5 times more commonly than Indians; (6) female violence by self is 1.5 times more common than male violence by self, whereas male violence by others is 3 times more common than female violence by others; (7) the rates of suicide and homicide are low by international standards; and (8) Fijian violence by self is particularly low, but consistent with the low suicide rate of the indigenous populations in surrounding geographical regions.

Conclusion: Our findings suggest that racial differences in violence are likely to be due to cultural factors.
Posttraumatic Stress Disorder after a Bus Accident
Authors: Watts Rod
Published: November 2007

There is insufficient information on the prevalence of posttraumatic stress disorder (PTSD) and other psychological reactions caused by surviving serious road accidents. This paper presents the assessments of 29 people who narrowly escaped death in a coach accident that killed eleven people. Their high vulnerability is clearly established, with 41% having PTSD, and 52% severe intrusion or avoidance phenomena, which included 31 % who had both. The occurrence of psychological sequelae was associated with being currently distressed by another event, but not with the survivor's age, gender or acquaintance with people killed in the accident. Seeing bodies or witnessing the death of someone was the predominant cause of distress, both at the time of the accident and in a recurring way. Delayed reactions were evident, with the impact of several factors changing over time.
Gender Differences in Obsessive Compulsive Disorder
Authors: Castle David J. , Deale Alicia , Marks Isaac M.
Published: November 2007

We investigated gender differences in 219 patients with obsessive compulsive disorder consecutively referred to a centre specialising in the behavioural treatment of anxiety disorders. Females had a later mean onset-age, and were more likely to be married and to have children; they were also marginally more likely to have a past history of an eating disorder or depression, while males were more likely to have a history of anxious or meticulous personality traits. Family loading for psychiatric disorders did not differ significantly between the sexes. The results are discussed in the context of the epidemiological literature on gender differences in OCD.
A Comparison of Two Structured Diagnostic Interviews: CIDI and SCAN
Authors: Andrews Gavin , Peters Lorna , Guzman Ana-Maria , Bird Kevin
Published: November 2007

The relationship between and the inter-rater reliability of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) for anxiety and depressive disorders were explored. The CIDI and the SCAN were administered by trained interviewers in counterbalanced order. A subsample of interviews was observed to determine the inter-rater reliability of the instruments. Subjects were 101 patients accepted for treatment at an Anxiety Disorders Clinic; 29 of the 101 patients participated in the inter-rater reliability study. Concordance between the instruments as measured by canonical correlation analysis was moderate for current (r=0.69, p=0.05) and for lifetime (r=0.66, p=0.05) diagnoses. Inter-rater reliability of the CIDI was perfect (overall intraclass kappa = 1.00), and of the SCAN was good (overall intraclass kappa = 0.67). It is concluded that although the two instruments made similar diagnostic distinctions, the clinical judgement involved in administering the SCAN resulted in the more moderate levels of agreement between the interviewer and observer than those found for the CIDI.