bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship Between Public Causal Beliefs and Social Distance Toward Mentally Ill People
Authors: Dietrich Sandra , Beck Michael , Bujantugs Bujana , Kenzine Denis , Matschinger Herbert , Angermeyer Matthias C.
Published: December 2009

Objective: The aim of this study is to investigate the nature of the relationship between public causal beliefs and social distance toward people with mental disorders, particularly schizophrenia and depression.

Method: In total, three representative surveys were carried out in Germany, Russia and Mongolia using personal, fully structured interviews.

Results: Despite the subjects' different cultural backgrounds, their responses show similar trends with regard to attributing depression and schizophrenia to psychosocial causes: ‘acute stress’ (life event) was most frequently endorsed as the cause for these two disorders. The biological causes (‘brain disease’ and ‘heredity’) were less frequently selected for depression than for schizophrenia. Irrespective of place and type of mental disorder, endorsing biological factors as the cause of schizophrenia was associated with a greater desire for social distance, the same relationship applies to depression in half the instances.

Conclusions: It would be premature to draw conclusions with regard to interventions aimed at reducing discrimination based on stigma. However, our study provides stimulus for re-considering the assumptions underlying antistigma interventions: that promulgating biological concepts among the public might not contribute to a desired reduction in social distance toward people with mental disorders.
Quality of Life and Related Risk Factors in a Taiwanese Village Population 21 Months after an Earthquake
Authors: Chou Frank Huang-Chih , Chou Pesus , Su Tom Tung-Ping , Ou-Yang Wen-Chen , Chien I-Chia , Lu Ming-Kun , Huang Ming-Wei
Published: December 2009

Objective: To investigate quality of life and related risk factors of Taiwanese earthquake survivors with different psychiatric disorders 21 months after the earthquake.

Method: This was a population survey. Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and questionnaires to interview 461 respondents (209 males and 252 females) 16 years or older who were equally exposed to the earthquake. Psychiatrists interviewed the same respondents using the Mini-International Neuropsychiatric Interview (MINI), with an adjusted response rate of 79.9%.

Results: The prevalence of varied psychiatric disorders in earthquake survivors ranged from 3.3% to 18%. However, there was almost a positive trend in quality of life in survivors among the following groups: posttraumatic stress disorder combined with major depressive episode; major depressive episode; posttraumatic stress disorder; other psychiatric diseases; and healthy mentality groups on the physical aspect or mental aspect of the MOS SF-36. When survivors were elderly or female and had experienced prominent financial loss immediately after the earthquake, social network change, and mental impairment, their quality of life tended to be worse.

Conclusion: The earthquake survivors had a higher percentage of psychiatric disorders. The risk factors that affected quality of life in survivors were age, female sex, financial loss, social network change, and mental impairment.
Prevention and Treatment of Childhood and Adolescent Aggression and Antisocial Behaviour: A Selective Review
Authors: Bor William
Published: December 2009

Objective: In this paper I examine the possible role of public sector child and youth mental health services in prevention and treatment of childhood and adolescent aggression. The problem of juvenile antisocial behaviour in Australian society is discussed.

Method: The review details the extent, concern and costs of juvenile antisocial behaviour. The most efficacious prevention and treatment programs for aggressive and antisocial behaviour are reviewed within the context of reforms to public sector mental health services. The place of evidence-based mental health programs within child and youth mental health services is discussed.

Results: Recommendations are made on the adoption of selective programs demonstrated to be efficacious in the prevention and treatment of aggression and antisocial behaviour.

Conclusion: Child and youth mental health services can make a specific contribution to crime prevention.
Correlates of Dysmorphic Concern in People Seeking Cosmetic Enhancement
Authors: Castle David J. , Molton Michael , Hoffman Keturah , Preston Neil J. , Phillips Katharine A.
Published: December 2009

Objective: To determine the clinical correlates of dysmorphic concern in persons seeking cosmetic enhancement from cosmetic physicians.

Method: A questionnaire survey of 137 patients attending the practices of two cosmetic physicians.

Results: Four subjects (2.9%; 95% CI = 0.8%–7.3%) had a diagnosis of body dysmorphic disorder (BDD), but many more expressed overconcern with physical appearance (‘dysmorphic concern’). Dysmorphic concern accounted for a substantial amount of the variance for mood, social anxiety, and impairment in work and social functioning, while concerns related to how self or others perceive the putative flaw in appearance, impacted significantly on work and leisure activities, but did not apparently influence mood and social anxiety to any significant degree.

Conclusions: Dysmorphic concern is a broad dimensional construct that is related to both inter- and intrapsychic distress and disablement associated with people seeking cosmetic enhancement
Beliefs of Women Concerning Causes and Risk Factors for Bulimia Nervosa
Authors: Mond Jonathan M. , Hay Phillipa J. , Rodgers Bryan , Owen Cathy , Beumont Pierre J. V.
Published: December 2009

Objective: To examine the beliefs of women concerning causes and risk factors for eatingdisordered behaviour.

Method: Face-to-face interviews were conducted with a community sample of 208 women aged 18–45 years. Respondents were presented with a vignette describing a fictional person meeting diagnostic criteria for bulimia nervosa (BN) and were asked to indicate whether each of several factors was ‘very likely’, ‘likely’ or ‘not likely’ to be a cause of the problem described, which factor was most likely to be a cause, and whether particular subgroups of people would be ‘more likely’, ‘less likely’ or ‘equally likely’ to have or develop the problem described.

Results: ‘Having low self-esteem’ was considered very likely to be a cause of BN by 75.0% of respondents, and the most likely cause by 40.5% of respondents. Other factors perceived as significant were ‘problems from childhood’, ‘portrayal of women in the media’, ‘being overweight as a child or adolescent’ and ‘day-to-day problems’, while genetic factors and preexisting psychological problems were perceived to be of minor significance. Most respondents believed that women aged under 25 years were at greatest risk of having or developing BN.

Conclusions: Women's beliefs concerning causes and risk factors for BN are generally consistent with empirical evidence. However, information concerning the increased risk associated with pre-existing anxiety and affective disorders might usefully be included in prevention programs. Systematic investigation of the benefits of addressing individuals' beliefs concerning risk factors for eating disorders – as opposed to risk factors per se – would be of interest.
Evaluating Treatments for the Mood Disorders: Time for the Evidence to Get Real
Authors: Parker Gordon
Published: December 2009

Objective: To detail limitations to level I evidence derived from randomised controlled trials of antidepressant treatments and which is held to be fundamental to the development and validity of treatment guidelines.

Method: Recent efficacy studies and meta-analyses of treatments of major depression are considered.

Results: The largest database in psychiatry – demonstrating that all principal treatments are of similar efficacy, and that antidepressant drugs are not distinctly superior to placebo treatment – is unlikely to be valid.

Conclusion: Excessive belief in and weighting of the evidence emerging from randomised controlled trials deserves to be criticized. An argument is put for adopting alternative approaches to evaluating the likely effectiveness of any antidepressant treatment.
Australian and New Zealand Clinical Practice Guidelines for the Management of Adult Deliberate Self-Harm
Authors:   Royal Australian And New Zealand College Of Psychiatrists Clinical Practice Guidelines Team For Deliberate Self-Harm
Published: December 2009

Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority.

Method: For these guidelines, the CPG Team for Deliberate Self-harm reviewed the treatment outcome literature (including meta-analyses) and consulted with practitioners and patients.

Treatment recommendations: (i) Organization of general hospital services to provide: emergency department admission; a safe environment; integrated medical and psychiatric management; risk assessment; identification of psychiatric morbidity, and adequate followup. (ii) Detection and treatment of any psychiatric disorder. (iii) Dialectical behaviour therapy, psychoanalytically orientated partial hospitalization or home-based interpersonal therapy (for certain patients) to reduce repetition of deliberate self-harm (DSH).

Conclusion: Deliberate self-harm is common and is costly in terms of both individual distress and service provision. General hospitals are often the first point of clinical contact, but may not be appropriately organized to care for these patients. Evidence for the effectiveness of psychological treatments is based on single RCTs without replication. The three recommended psychological treatments are not widely available in Australia and New Zealand, and the interventions that are, such as cognitive behaviour therapy, problem solving and ‘green cards’ (an agreement guaranteeing access to services), do not reduce repetition of DSH. The effect of follow-up in psychiatric hospitals or in the community is poorly understood. We need to develop and evaluate interventions that will reduce repetition of both fatal and non-fatal deliberate self-harm and improve the person's functioning and quality of life.
The Emerging Role of Pharmacogenetics: Implications for Clinical Psychiatry
Authors: Hong Ng Chee , Hong Ng Chee , Schweitzer Isaac , Norman Trevor , Easteal Simon
Published: December 2009

Objective: This article aims to review the implications of pharmacogenetics for clinical psychiatry; these are discussed in the context of environmental and sociocultural factors.

Method: A selective literature review was conducted using Medline search and other relevant references available to the authors.

Results: The individual differences in therapeutic and adverse effects of psychotropic drugs are largely determined by genetic factors. Recent advances in pharmacogenetics have highlighted the potential utility in predicting metabolic phenotypes, risks for side-effects and likelihood of drug response for the individual patient.

Conclusions: Genotyping, especially for drug metabolizing enzymes, could enable more rational, cost-effective and optimal prescribing in future psychopharmacotherapy. Although the advances of pharmacogenetics may have many benefits in clinical practice, the importance of non-genetic factors must also be considered as cultural and environmental factors significantly impinge on response to medications. To clarify the extent pharmacogenetics can be adopted in clinical practice to predict drug response in patients from diverse backgrounds, further studies in different ethnic groups and clinical settings are required.
Assessing Cost-Effectiveness in Mental Health: Family Interventions for Schizophrenia and Related Conditions
Authors: Mihalopoulos Cathrine , Mihalopoulos Cathrine , Magnus Anne , Carter Rob , Vos Theo
Published: December 2009

Objective: Existing evidence suggests that family interventions can be effective in reducing relapse rates in schizophrenia and related conditions. Despite this, such interventions are not routinely delivered in Australian mental health services. The objective of the current study is to investigate the incremental cost-effectiveness ratios (ICERs) of introducing three types of family interventions, namely: behavioural family management (BFM); behavioural intervention for families (BIF); and multiple family groups (MFG) into current mental health services in Australia.

Method: The ICER of each of the family interventions is assessed from a health sector perspective, including the government, persons with schizophrenia and their families/carers using a standardized methodology. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted. The second stage involves application of ‘second filter’ criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using multivariate probabilistic sensitivity analysis.

Results: The most cost-effective intervention, in order of magnitude, is BIF (A$8000 per DALY averted), followed by MFG (A$21 000 per DALY averted) and lastly BFM (A$28 000 per DALY averted). The inclusion of time costs makes BFM more cost-effective than MFG. Variation of discount rate has no effect on conclusions.

Conclusions: All three interventions are considered ‘value-for-money’ within an Australian context. This conclusion needs to be tempered against the methodological challenge of converting clinical outcomes into a generic economic outcome measure (DALY). Issues surrounding the feasibility of routinely implementing such interventions need to be addressed.
Risk Factors for Suicide and other Deaths Following Hospital Treated Self-Poisoning in Australia
Authors: Reith David M. , Whyte Ian , Carter Greg , McPherson Michelle , Carter Natalia
Published: December 2009

Objective: To analyze the risk factors for suicide, premature death and all-cause death in a representative population of hospital-treated deliberate self-poisoning patients.

Method: A prospective cohort study using data-linkage between the Hunter Area Toxicology Service Database and the National Death Index of the Australian Institute of Health and Welfare, from January 1991 to December 2000.

Results: There were 4105 subjects, of whom 228 (5.6%) died, 122 (2.9%) by premature death and 58 (1.4%) by suicide. The probability of suicide after 10 years follow-up was 2%. The adjusted hazard ratios (95% CI) for suicide were: ‘disorders usually diagnosed in infancy, childhood and adolescence’, 5.28 (95% CI = 2.04–13.65): male gender, 4.25 (95% CI = 2.21–8.14); discharge to involuntary psychiatric hospital admission, 3.20 (95% CI = 1.78–5.76); and increasing age, 1.02 (95% CI = 1.01–1.04). Men and women showed different patterns of multivariate risks, although increased risk with increasing age and discharge to an involuntary psychiatric admission was true for both. The standardized all-cause mortality ratio (95% CI) was: for men, 6.42 (95% CI = 5.44–7.57), and for women 4.39 (95% CI = 3.56–5.41). The standardized suicide mortality ratio (95% CI) was: for men, 20.55 (95% CI = 15.24–27.73), and for women 22.95 (95% CI = 13.82–38.11).

Conclusions: Men and women have different risk factors for subsequent suicide after selfpoisoning. Hospital-treated self-poisoning patients have increased risk of subsequent suicide, premature and all-cause death. Psychiatric assessment, leading to discharge decisions, is worthwhile in identifying patients at long-term risk of suicide, premature and all-cause death.
Borderline Personality Disorder: Attitudinal Change Following Training
Authors: Krawitz Roy
Published: December 2009

Objective: To assess the effect of a two-day training workshop on clinician attitudes to working with people with borderline personality disorder (BPD). The main goal of the workshop was to achieve positive change in the attitude of clinicians treating people with BPD in a public setting. The hypothesis underlying the intervention was that informing clinicians about current concepts of the diagnosis, aetiology, prognosis and treatment of BPD, combined with detailed discussion of the principles of treatment in the public setting, would result in positive attitude change.

Method: Changes in attitudes (optimism, enthusiasm, confidence and willingness to work with people with BPD) and self-perceptions of knowledge and skills among staff working with BPD patients were assessed for 418 participants from public mental health and substance abuse services who attended the workshops over an 18-month period. A survey questionnaire was administered pre- and post-workshop and at 6 month follow-up (time 1, time 2, time 3, respectively). One-way repeated measures analysis of variance (ANOVA) were carried out to compare scores on attitudes and perceptions of knowledge and skills at time 1, time 2 and time 3.

Results: The results from repeated measures ANOVA show that there was a statistically significant effect for time for all six items. Analyses of within-subject contrasts indicated that, for all six variables, the time 2 and the time 3 scores were statistically significantly different from time 1 scores (p < 0.01). These findings confirm that there were statistically significant changes at the post-workshop assessment, which were either maintained or showed a nonsignificant decrease at 6-month follow-up.

Conclusions: The brief training workshop described was effective in achieving positive attitude change in clinicians working with patients with BPD. This research shows that it is possible through brief training to assist clinician positivity and to effect clinician attitude change. Implications of this research could include the influencing of future training of clinicians in public mental health and substance abuse fields.
Cost-Effectiveness of Dexamphetamine and Methylphenidate for the Treatment of Childhood Attention Deficit Hyperactivity Disorder
Authors: Donnelly Marie , Haby Michelle M. , Donnelly Marie , Haby Michelle M. , Carter Rob , Andrews Gavin , Vos Theo
Published: December 2009

Objective: To analyze from a health sector perspective the cost-effectiveness of dexamphetamine (DEX) and methylphenidate (MPH) interventions to treat childhood attention deficit hyperactivity disorder (ADHD), compared to current practice.

Method: Children eligible for the interventions are those aged between 4 and 17 years in 2000, who had ADHD and were seeking care for emotional or behavioural problems, but were not receiving stimulant medication. To determine health benefit, a meta-analysis of randomized controlled trials was performed for DEX and MPH, and the effect sizes were translated into utility values. An assessment on second stage filter criteria (‘equity’, ‘strength of evidence’, ‘feasibility’ and ‘acceptability to stakeholders’) is also undertaken to incorporate additional factors that impact on resource allocation decisions. Simulation modelling techniques are used to present a 95% uncertainty interval (UI) around the incremental costeffectiveness ratio (ICER), which is calculated in cost (in A$) per DALY averted.

Results: The ICER for DEX is A$4100/DALY saved (95% UI: negative to A$14 000) and for MPH is A$15 000/DALY saved (95% UI: A$9100–22 000). DEX is more costly than MPH for the government, but much less costly for the patient.

Conclusions: MPH and DEX are cost-effective interventions for childhood ADHD. DEX is more cost-effective than MPH, although if MPH were listed at a lower price on the Pharmaceutical Benefits Scheme it would become more cost-effective. Increased uptake of stimulants for ADHD would require policy change. However, the medication of children and wider availability of stimulants may concern parents and the community.
Factors Predicting Discharge of Patients from Community Residential Facilities: A Longitudinal Study from Italy
Authors: D'avanzo Barbara , Nadia Battino R. , Gallus Silvano , Barbato Angelo
Published: December 2009

Objective: Community residential facilities for psychiatric patients have increased in Italy in the last years, but little information is available on their use, the patients they host, the interventions they deliver and the rate at which they discharge patients. To investigate these issues, we conducted a longitudinal study in 2000–2001 on all the community residential facilities in Lombardy, a large region in North Italy.

Method: The study base comprised all the patients residing in the community residential facilities identified in Lombardy in 2000. Out of the 196 community residential facilities identified, 91% agreed to participate. The study sample consisted of all the patients living in the residential facilities on 15 November, 2000. A total of 1792 patients were recruited and described.

Results: In the study period, a total of 316 patients were discharged. Among these, 191 (11%) went to lower-protection settings or home and 49 (3%) to higher-protection settings. The probability of discharge to lower-protection settings and home was higher for people in residential care centres, not coming from a psychiatric hospital, having shorter duration of the current admission, having work at the time of admission and with a low HoNOS score. Associations were found between discharge to higher-protection settings and old age, inadequate accommodation in staff opinion, and the public sector managing the facility.

Conclusions: Turn-over of patients in the community residential facilities was limited. Discharges to higher-protection settings were related to need for specific care for older patients. Type of facility and duration of stay predicted discharge to lower-protection facilities and home independently from other patient characteristics. If a higher turn-over and a more extensive use of this resource must be achieved, roles of other psychiatric and social community-based services should be taken into account.
Rurality and Mental Health: The Role of Accessibility
Authors: Murray Greg , Judd Fiona , Jackson Henry , Fraser Caitlin , Komiti Angela , Hodgins Gene , Pattison Pip , Humphreys John , Robins Garry
Published: December 2009

Objective: The absence of an agreed definition of ‘rural’ limits the utility of existing research into a possible relationship between rurality of residence and mental health. The present study investigates the bipolar dimension accessibility/remoteness as a possible correlate of mental health.

Method: A continuous area of non-metropolitan Australia was selected to provide a range of scores on the Accessibility/Remoteness Index of Australia (ARIA). A questionnaire measuring demographics, the five-factor model of personality and three aspects of mental health (distress, disability and wellbeing) was mailed to 20 000 adults selected randomly from electoral rolls.

Results: Responses were received from 7615 individuals (response rate = 40.5%; 57.1% female). ARIA was not associated with either distress or disability measures, but a small negative association was found between accessibility and two measures of wellbeing. Individuals residing in locales with better access to services and opportunities for interaction reported higher levels of satisfaction with life (SWL) and positive affect (PA). Adjusting statistically for a range of demographic and personality correlates did not alter the effect of ARIA on SWL. The effect on PA remained significant after adjusting for demographics, but not once personality correlates entered the model.

Conclusions: By sampling across a single proposed parameter of rurality, a novel profile of correlations was identified. In accord with existing data, accessibility was not associated with distress or disability. In contrast, accessibility was positively associated with the wellbeing aspect of mental health. Further attention to the measurement of rural place and the exploration of accessibility as a parameter with mental health relevance, is warranted.
What Determines Compulsory Community Treatment? A Logistic Regression Analysis Using Linked Mental Health and Offender Databases
Authors: Xiao Jianguo , Preston Neil J. , Kisely Steve
Published: December 2009

Objective: Western Australia has one of the highest published rates of the use of compulsory treatment orders in the English-speaking world. Differences in patient characteristics, legislation and service setting may explain variations in the reported efficacy of compulsory community treatment. Our objective is to investigate predictors of Community Treatment Orders (CTO) placement in the first year of implementation in Western Australia and see if there were any differences in the type of patients placed on these orders compared to other studies.

Method: A population–based record linkage study of Mental Health and Offender Databases comparing 265 patients on CTOs with a consecutive control group (CCG) of equal number matched on date of discharge from inpatient care or CTO placement.

Results: Previous health service use, after-care placement, mental disorder history including schizophrenic history, a positive forensic history of violence to others as well as patient's marital status were the significant predictors of CTO placement.

Conclusions: Studies of compulsory community treatment appear to be of similar populations. In spite of the comparatively high rate of use, psychiatrists in Western Australia do not appear to be applying community treatment orders to different types of patient compared to elsewhere. We need further research to establish the relative contribution of patient characteristics, legislation and service setting toward the use and outcome of compulsory community treatment.
Somatoform Dissociation, Reported Abuse and Animal Defence-Like Reactions
Authors: Nijenhuis Ellert R. S. , van der Hart Onno , Kruger Karlien , Steele Kathy
Published: December 2009

Objective: To test the hypotheses that among general psychiatric outpatients, somatoform dissociation is associated with posttraumatic stress symptoms and with reported potentially traumatizing events, especially with events that involve bodily threat from a person, also when reported age at onset, duration and subjectively rated impact of potentially traumatizing events are considered.

Method: Administration of self-report questionnaires evaluating the severity of somatoform and psychoform dissociation, posttraumatic stress-symptoms, and reported traumatizing events, using samples of consecutive and unselected psychiatric outpatients (n = 153).

Results: Somatoform dissociation was strongly correlated with posttraumatic stress symptoms and with reported cumulative traumatization as assessed with two different self-report trauma questionnaires. Among a wide range of trauma types, bodily threat from a person best predicted somatoform dissociation. Emotional neglect and age further improved the prediction, but emotional neglect and abuse did not predict somatoform dissociation when interpersonal threat to the body was not reported. Somatoform dissociation was also best predicted by bodily threat when reported age at onset, duration and subjective impact of reported traumatization were included in the analyses.

Conclusion: This retrospective study suggests that recurrent interpersonal bodily threat may evoke animal defence-like psychobiological systems manifesting as somatoform dissociation and that this type of threat is often accompanied by emotional neglect. These hypotheses should now be tested in prospective studies.
Clinical Outcome of an Early Psychosis Intervention Program: Evaluation in a Real-World Context
Authors: Nash Louise , Gorrell Joanne , Cornish Alison , Rosen Alan , Miller Vivienne , Tennant Chris
Published: December 2009

Objective: To examine whether staff training and service restructuring to provide specialized early psychosis services results in improved clinical outcomes for young people with first-episode psychosis.

Method: Staff attended workshops on the treatment of early psychosis throughout 1997–2000 and specialized early psychosis teams began operating between 1998 and 2000 following service restructure. There was no additional funding provided for clinical services, but through the restructure, there was a shift in resources. During this period a comprehensive package including the Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms and the Health of the Nation Outcome Scale was introduced for clinicians to assess patients at intake, 3 months and 12 months into treatment. Symptom scores of patients treated earlier in the project are compared with those patients treated later, after more training and service developments had occurred.

Results: Ninety-four of 215 potential first-episode patients consented to take part in the project. They provided data variously at intake, 3 months and 12 months into treatment. Regardless of the year of treatment, significant improvement in psychiatric symptomatology was found over the three assessment periods. Individuals who entered the service in the latter phase of the project experienced fewer negative symptoms (after 12 months of treatment) compared with patients who entered the service in the early phase of the project.

Conclusions: Improvements in both pharmacological and possibly psychosocial treatment may have led to a greater improvement in negative symptoms. Benefits and limitations of conducting research in a ‘real-world’ context are discussed.
Prevalence and Risk Factors of Insomnia in Community-Dwelling Chinese Elderly: A Taiwanese Urban Area Survey
Authors: Su Tung-Ping , Huang Shuang-Ruang , Chou Pesus
Published: December 2009

Objective: To determine the prevalence of and risk factors for self-reported sleep complaints in the elderly.

Method: A cross-sectional interview study was conducted in a total of 2045 noninstitutionalized older individuals aged 65 years or above of an urban community of Taiwan.

Results: The prevalence of one-month insomnia was 6% overall with a higher rate in elderly women (8%) than men (4.5%). Frequent use of hypnotics over the past month was 8.4%. Among specific sleep complaints, poor sleep quality was the most commonly reported symptom, followed by difficulty falling asleep and difficulty maintaining sleep or early morning awakenings. Increasing age did not correlate with an increased rate of insomnia and female gender was not an independent risk factor. Factors associated with insomnia for both genders were nocturnal micturation (OR = 20.6) and regular use of hypnotics (OR = 3.2). Pulmonary disease (OR = 2.7), not married (OR = 2.3), excessive daytime sleepiness (OR = 2.4), and mental illness (OR = 8.6) were risk factors for men while lack of education (OR = 1.8) and body pain (OR = 2.6) were risk factors for women. Depression (OR = 2.2) was strongly associated with insomnia in the elderly women as well.

Conclusions: There was a low insomnia prevalence rate in the urban elderly community. Identified insomniacs required treatment of physical and mental problems, particularly in gender-specific risk factors. For those who complained of putative poor sleep quality symptom, early intervention may halt their progress of sleep disturbance and avoid unnecessary benzodiazepine use. Future longitudinal studies to investigate causes of insomnia, as well as its detrimental effects on mood and health, are warranted.
Depressive Symptoms and Suicidal Behaviour: Changes with Time in an Adolescent Clinic Cohort
Authors: Starling Jean , Rey Joseph M. , Simpson Judy M.
Published: December 2009

Objective: There are suggestions of a secular increase in the prevalence of depression, self-harm and suicidal behaviour in young people. This study aims to examine changes in prevalence of psychological disturbance over time in adolescents referred for treatment.

Method: Data on the type and severity of emotional and behavioural problems was measured using the Youth Self-Report and Child Behaviour Checklist in 4495 clinic-referred adolescents aged 12–17 years, born in a 21-year period (1966–1986).

Results: After taking into account the confounding effects of age and gender, there were significant increases in reports of self-harm and suicidal ideation (5% and 4% increase in odds per year, respectively) according to parents, but there was no change in parental ratings of depression (anxious/depressed scale). There were no changes in ratings of self-harm, suicidal ideation or anxiety/depression when adolescent reports were considered. The mean age at the time of referral decreased with increasing year of birth, from 14.6 years in those born in 1966–1971, to 13.1 years in those born in 1981–1986.

Conclusions: Parents of referred adolescents reported increasing self-harm and suicidal behaviour with increasing year of birth. In contrast, there were no changes over time in the adolescents' reports. Neither parents nor children reported an increase in depressive symptoms. Perceptions of a secular increase may reflect increasing parental awareness of some behaviours, particularly self-harm and suicidal ideation. Interpretation of these results needs to be cautious given the clinical origin of the sample.
The Assessment of Patients with Long-Term Psychotic Disorders: Application of the who Disability Assessment Schedule II
Authors: Chopra P. K. , Chopra P. K. , Couper J. W. , Herrman H.
Published: December 2009

Objectives: To evaluate the use of the World Health Organization Disability Assessment Schedule II (WHODAS II), a patient questionnaire measuring disability, in patients treated for long-term psychotic disorders.

Method: The study was conducted at St. Vincent's Mental Health Service, Melbourne, Australia. Twenty patients with long-term psychotic disorders under the care of either the residential Community Care Unit or the outpatient Mobile Support and Treatment Service were selected. For all 20 patients a clinician assessment of disability and functional status was recorded using the International Classification of Impairments, Disabilities and Handicaps-2 (ICIDH-2), Life Skills Profile (LSP) and Health of the Nation Outcome Scale (HoNOS). The WHODAS II survey was then administered to each patient. The WHODAS II was re-administered by a second rater within 5 days of the initial assessment for the purpose of test-retest reliability analysis. Each patient also completed the WHO Quality of Life instrument (brief version) (WHQOL-BREF), a self-report questionnaire on quality of life.

Results: The WHODAS II was experienced as relatively complex and at times difficult to administer with full co-operation in this clinical context. Overall, test-retest reliability was fair. The information it yielded gave valuable insights into patients' experiences. Most of the participants reported fewer impairments in mental functions and fewer activity limitations than reported by clinicians. However, patients reported significant restrictions in participation in social activities and limitations due to environmental barriers. The WHOQOL-BREF highlighted difficulties experienced by patients in their participation in society, through exploring difficulties and satisfaction with various aspects of life experience and this instrument was well accepted.

Conclusions: The self-reported experience of patients is needed alongside clinician-rated measures to assess outcomes in people with long-term psychotic disorders. The WHODAS II records and measures patients' own experiences of disability. It may be used together with the WHOQOL–BREF, a distinct and complementary self-report assessment of quality of life.
Changes in Early Psychosis Service Provision: A File Audit
Authors: Gorrell Joanne , Cornish Alison , Tennant Chris , Rosen Alan , Nash Louise , McKay Diana , Moss Beverley
Published: December 2009

Objective: To measure change in services provided to young people with first-episode psychosis following the introduction of specialized early psychosis teams and staff training.

Method: A standardized tool was developed to audit services provided to young people with first-episode psychosis. The tool initially comprised 27 clinical indicators measuring aspects of optimal care derived from the Australian clinical guidelines for early psychosis. The first 12 months of treatment, as documented in the case records, were audited for all young people receiving their first treatment for psychosis during a 6-month period prior to the introduction of these service developments (n = 47). These subjects were compared with those who received treatment after the implementation of service development strategies (n = 70). A comparison was also made within the second group, between those receiving some treatment from a specialized early psychosis team and those being exclusively treated by other services.

Results: Inter-rater reliability was achieved for 24 of the 27 indicators. Improvements were found on 10 indicators which measured psychosocial interventions, prescribing practices, family interventions and continuity of care. There was no significant deterioration on any of the indicators. Clients who attended early psychosis teams were significantly more likely to receive psychoeducation.

Conclusions: The services increased their provision of ‘guideline concordant’ care for early psychosis. The audit proved useful to monitor performance, to demonstrate improvements in care and to identify those areas of service provision and documentation in need of improvement.
Medicalizing Meaning: Demoralization Syndrome and the Desire to Die
Authors: Parker Malcolm
Published: December 2009

Objective: To critically analyse the proposed new psychiatric condition, demoralization syndrome, and the implications drawn by its proponents for the clinical–ethical status of requests by terminally ill patients for assistance to die.

Method: The diagnostic features of demoralization syndrome, a proposed new psychiatric disorder, recognizable particularly in palliative care settings, are summarized. The consequences of proposed therapeutic interventions are described, one of which is relief of the desperation which motivates some demoralized patients to consider ending their lives and to seek assistance in dying. The connections between the proposed condition and the desire to die are analysed in the context of the continuing tensions surrounding the ontological status and sociopolitical implications of psychiatric categories and the pervasive medicalization of modern life.

Results: The analysis suggests that by medicalizing existential cognitions at the end of life, the proposed diagnostic category also normalizes a particular moral view concerning assistance in dying.

Conclusions: While further research into the issues described in this provisional syndrome may benefit some patients, the categorization of demoralization as a medical diagnosis is a questionable extension of psychiatry's influence, which could serve particular social, political and cultural views concerning the end of life.
General Practice Encounters for Psychological Problems in Rural, Remote and Metropolitan Areas in Australia
Authors: Caldwell T.M. , Caldwell T.M. , Jorm A.F. , Knox S. , Braddock D. , Dear K.B.G. , Britt H.
Published: December 2009

Objective: Previous Australian research suggests there is very little difference in the prevalence of mental health disorders across rural, remote and metropolitan areas. However, mental health specialists are particularly scarce in rural and remote areas and some researchers have argued that non-metropolitan residents rely heavily on general practitioners (GPs) for mental health care. This article investigated rates of GP services for psychological problems across rural, remote and metropolitan areas.

Method: The Bettering the Evaluation and Care of Health (BEACH) program, Medicare and Pharmaceutical Benefits Scheme data were used in this report. Data included all psychological, depression and anxiety problems reported as managed by GPs and prescriptions for mental health medications (written and filled). Problem and medication rates are given per 100 patient encounters and per 1000 population.

Results: Only a few regional differences were evident in the rate of psychological problems and prescriptions for mental health medications per 100 GP-patient encounters. However, rural and remote residents visited GPs less frequently than their metropolitan counterparts. Lower rates of GP encounters for psychological problems were evident for residents of most non-metropolitan areas (per 1000 population). Additionally, GPs prescribed mental health medications at half the rate for residents of remote areas than capital cities.

Conclusions: General practitioners provide fewer mental health services per capita in nonmetropolitan areas. This difference could represent completely untreated psychological problems or fewer follow-up consultations. While non-metropolitan residents have limited access to specialists, rates of GP encounters for psychological problems are also very low.
Barriers to the Effective Management of Depression in General Practice
Authors: Richards Jeffrey C. , Richards Jeffrey C. , Ryan Paul , Mccabe Marita P. , Groom Grace , Hickie Ian B.
Published: December 2009

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent.

Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.
A Statewide Survey of High-Support Services for People with Chronic Mental Illness: Assessment of Needs for Care, Level of Functioning and Satisfaction
Authors: Freeman Adele , Malone John , Hunt Glenn E
Published: December 2009

Objective: The primary aim of this study was to describe high support accommodation services available for patients with chronic mental illness living in New South Wales (NSW). The second aim was to ask patients in these facilities about their needs and satisfaction with services and to assess their level of functioning.

Method: Non-inpatient services matching NSW Health's definition for high support, very high support and residential rehabilitation were sent a survey regarding type of service, criteria for acceptance, choice of housing options, patient demographics, evaluation methods and staff details. The Camberwell Assessment of Need was used to assess needs and the Life Skills Profile–16 was used to assess level of functioning. Comparisons were made between services operated by NSW Health and non-government organizations (NGOs), rural and urban services and services providing 24-hour support and those with less intensive staffing.

Results: Forty of the 42 identified services were included in the survey (95% response rate) of which 25 were operated by NGOs. There were 753 residential beds and 1132 patients lived in these facilities over the financial year 2001/2002. Interviews were completed at 25 locations across the state with 159 patients. Seventy-four percent were male and the mean age was 43 years. Patients had on average 7.6 needs of which 2.2 were unmet and their mean LSP-16 total score was 16.8. Almost half the patients responded that they were homeless at one time because they could not find appropriate housing.

Conclusions: There were no significant differences in the number of needs expressed by patients residing in government or non-government operated services, those living in rural or urban areas and those in 24-hour services compared to patients in less intensively staffed services. Existing services are doing a good job of meeting patients' needs for practical assistance, but social and psychological needs remain unmet for a significant proportion.
Maori Experience of Community Treatment Orders in Otago, New Zealand
Authors: Gibbs Anita , Dawson John , Forsyth Hine , Mullen Richard ,   Te Oranga Tonu Tanga (Maori Mental Health Team)
Published: December 2009

Objective: To consider the impact of community treatment orders (CommTOs) on Maori patients and their whanau (extended family) and the associated views of mental health professionals.

Method: As a distinct aspect of a larger study of CommTOs, eight Maori patients under compulsory community care were interviewed and, where possible, members of their whanau. Associated interviews were held with their psychiatrists, key workers and other carers: 39 interviews in total.

Results: Both benefits and drawbacks of CommTOs for Maori were identified by patients and whanau. CommTOs were considered helpful in increasing patient safety and whanau security and in promoting access to services. They were favoured over hospital care, forensic care and homelessness. The drawbacks included the sense of external control imposed on both Maori patients and staff, particularly concerning medication and restrictions on choices.

Conclusions: This was a small study of a limited number of Maori patients under CommTOs. Their views may not be fully representative. There was a general consensus among those interviewed that the timely use of CommTOs can enhance the mental wellbeing and social relationships of Maori patients. Continuing efforts are needed by health professionals to communicate effectively with whanau and to understand the conflicts experienced by Maori in reconciling their traditional beliefs with the medical model of mental illness.