bluuebunny/crossref_metadata_2025 huggingface dataset:
Warm tub bath during labor. A study of 1385 women with prelabor rupture of the membranes after 34 weeks of gestation
Authors: Eriksson Margareta , Ladfors Lars , Mattsson Lars‐Åke , Fall Ole
Published: November 2007

Background. To evaluate the influence of a bath on infectious morbidity in mothers and neonates in women with prelabor rupture of the membranes after 34 weeks of gestation.

Methods. A nonrandomized study of 1385 healthy women. During the first stage of labor 538 women wanted a bath while 847 did not. The women awaited spontaneous contractions up to 24 or 72 hours after the membranes had ruptured before labor was induced with oxytocin. Digital examinations of the cervix were avoided until onset of active labor or until the time induction was planned. For statistical analysis Fisher's exact test was used.

Results. Chorioamnionitis during labor occured in 1.1% of the women in the bath group and in 0.2% in the reference group (p=0.06). Postpartum endometritis was found in three cases both in the bath group (0.6%) and in the reference group (0.4%) (p=0.68). The frequency of neonates receiving antibiotics was 3.7% and 4.8% respectively (p=0.43).

Conclusion. A tub bath did not increase the risk of maternal or neonatal infection after premature rupture of the membranes and prolonged latency.
Treatment of severe ovarian hyperstimulation syndrome by a conservative medical approach
Authors: Balasch Juan , Fábregues Francisco , Arroyo Vicente , Jiménez Wladimiro , Creus Montserrat , Vanrell Juan A.
Published: November 2007

Objective. To assess the value of a conservative medical therapeutic approach in the management of severe ovarian hyperstimulation syndrome (OHSS).

Design. Prospective longitudinal study.

Setting. Assisted Reproduction Unit of the Hospital Clinic i Provincial de Barcelona, a tertiary care setting.

Patients. Twenty‐five women with ascites because of OHSS.

Interventions. Patients were treated by strict bed rest, low‐sodium diet (60 mEq/day), plasma volume expansion with albumin (50 g/day of salt‐poor albumin) and diuretics (20 mg of furosemide given intravenously every 8‐12 hours).

Main outcome measures. Measurement at admission and 48 hours after commencement of treatment of the following: body weight, mean arterial pressure, heart rate, hematocrit, hemoglobin concentration, leukocyte and platelet counts, urine volume, sodium excretion, serum sodium, serum creatinine, plasma renin activity, and plasma aldosterone, norepinephrine, antidiuretic hormone, and atrial natriuretic peptide concentrations.

Results. After 2 days of therapy there was marked improvement in clinical symptoms, standard laboratory parameters, diuresis and urinary sodium excretion in all patients. There was also a significant decrease in the plasma levels of volume‐dependent endogenous vasoactive substances in the five patients in whom these measurements were repeated during treatment. The length of treatment with albumin plus furosemide ranged between 2 and 6 days with an average of 3.3 and it correlated directly with the severity of the syndrome. The hospital stay ranged from 4 to 10 days (mean 6.5 days). All patients recovered without any complication.

Conclusions. Severe ovarian hyperstimulation syndrome can be managed using the proposed conservative medical approach.
Potentiating effect of hydrogen peroxide on the serotonin‐induced vasocontraction in human umbilical artery
Authors: Watanabe Kazushi , Okatani Yuji , Sagara Yusuke
Published: November 2007

Background. Our objective was to investigate the role of hydrogen peroxide in the vasocontraction induced in the human umbilical artery by serotonin.

Methods. Umbilical arteries collected from healthy women at term were cut helically and suspended in an organ bath to record isometric mechanical activity. In Study I, we measured the concentration‐contraction response to serotonin with or without pretreatment with hydrogen peroxide (0.01 ˜ 10 μM). In Study 2, vessels were pre‐incubated with L‐arginine (0.1 ˜ 10 mM), or with hydrogen peroxide (10 mM) and L‐arginine (1 mM), then serotonin was added cumulatively. In Study 3, vessels were suspended in a calciuim‐free solution containing potassium chloride 20 mM, and a cumulative concentration‐response curve to calcium chloride (10−5˜ 10−3 M) was constructed for vessels pretreated with hydrogen peroxide (10 μM). In Study 4, vessels were pre‐treated with M1, an inhibitor of 5‐HT2 serotoninergic receptors, and hydrogen peroxide (10 μM), and then prostaglandin F2α (9.0±10−7 M). Finally, we measured the 5‐HT1 receptor‐mediated relaxation induced by serotonin.

Results. Hydrogen peroxide (1 or 10 μM) significantly potentiated the contractile response to serotonin (p<0.04, p<0.005). L‐arginine (1 or 10 mM) significantly reduced the contractile response to serotonin (p<0.02, p<0.0002). Pretreatment with L‐arginine significantly suppressed the potentiating effect of hydrogen peroxide on the serotonin‐induced contraction. The sensitivity of the arteries to calcium chloride in the presence of hydrogen peroxide did not differ from that in the control group. Pretreatment with hydrogen peroxide significantly reduced the 5‐HT, serotoninergic receptor‐mediated relaxation at higher concentrations of serotonin (1.23±10−4 M, 2.47±10−4 M, 2.47±10−4 M).

Conclusion. Hydrogen peroxide potentiated the umbilical artery contraction induced by serotonin. This action may be mediated by suppression of endogenous nitric oxide activity.
Potentially avoidable perinatal deaths in Denmark and Sweden 1991
Authors: Langhoff‐roos Jens , Borch‐christensen Hanne , Larsen Steen , Lindberg Bo , Wennergren Margaretha
Published: November 2007

Background. Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths.

Material and methods. Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing on potential avoidability from a health services perspective was elaborated at a Nordic‐Baltic workshop, using the variables: time of death in relation to admission and delivery, fetal malformation, gestational age, growth‐retardation and Apgar score at 5 min.

Results. Rates of perinatal deaths of malformed infants (0.00195 and 0.00145) and intrapartum deaths of non‐malformed infants (0.00042 and 0.00019) was significantly higher in Denmark than in Sweden.

Conclusion. Application of the Nordic‐Baltic Perinatal Death Classification on perinatal deaths in Denmark and Sweden in 1991 raises the questions as to why the rate of perinatal death of malformed infants is higher in Denmark than in Sweden and whether intrapartum care in Denmark could be improved.
Reproductive characteristics of a population of urban Swiss women
Authors: Morabia Alfredo , Khatchatrian Naira , Bernstein Martine , Walker Dilys M. , Campana Aldo
Published: November 2007

Objective. To describe the variability of reproductive life, from menarche to menopause, in the Geneva female population.

Design. Women's Health Survey, 1992‐1993.

Setting. Mobile epidemiology unit of a University Hospital.

Subjects. One thousand and thirty‐two women aged 30 to 74 years, resident in Geneva, Switzerland.

Main outcome measure. Menstrual and reproductive history.

Results. A ‘typical’ woman of Geneva has her menarche at 13 years, regular 28 day cycles with 5 days of menstrual flow. She is 26 years old when she first gives birth and has her last baby (which is typically the second) at age 31. She has 37 years of potential fecundity and a natural menopause at age 50. In addition, 11% of the women have tried to be pregnant during two years without success, 67% have ever used oral contraceptives, 20% had a first birth at age 30 or more and 23% were nulliparous. Younger women reported earlier ages at menarche. Women with lower education tended to be a younger age at the birth of her first child.

Conclusions. In this first study of the reproductive characteristics of women in Geneva, nulliparity and a late first birth appeared unusually frequent, especially when compared with American or Chinese women. The observed distributions of reproductive history are compatible with the very high incidence rate of breast cancer in the Geneva population.
Immunohistochemical assessment of steroid hormone receptors in tissues of the anal canal
Authors: Franz Heiko B. G. , Wendler Diether , Oettling GÜNter
Published: November 2007

Background. A prerequisite for a hormonal influence on anal continence in women is the presence of hormone receptors in the tissues of the anal canal. Using immunohistochemical techniques, we demonstrated and localized estrogen and progesterone receptors (ER, PR) in tissue sections of the anal canal.

Methods. Thirty‐five specimens of the anorectal region from 21 patients (14 women, seven men) were examined histologically for smooth muscle (present in specimens from ten females and in seven males), striated muscle (present in three females and five males), and perimuscular connective tissue (present in 12 females and seven males). Immunostaining for ER and PR was then performed by incubating with primary anti‐ER and anti‐PR antibody and visualization of specific antibody binding by the ABC technique with DAB as chromogen.

Results. Positive staining for ER and PR was seen exclusively over cell nuclei. Estrogen receptors were found in the smooth muscle cells of the internal sphincter of all females (10/10) and in four of the seven males. Staining for ER was detected in the perimuscular connective tissue of all females (12/12) and in four of the seven males. No specific staining for ER or PR was found in the nuclei of striated muscle cells of the external sphincter in males or females (n=8). In females, about 50% of the ER‐positive tissues were also found to be positive for PR. Amongst the male patients, only one exhibited staining for PR, and this was confined to the smooth muscle.

Conclusions. Expression of ER is a constitutional feature of the connective tissue and smooth muscle cells of the anal continence organ. Estrogen receptors and PR are not detectable in the striated muscle fibers of the external anal sphincter in either sex. The presence of ER in the stroma and smooth muscles of the anal canal suggests that these tissues are targets for estrogen. This constitutes a theoretical basis for the beneficial effects of estrogen and progestin replacement on anal continence in postmenopausal women.
The number of follicles and ovarian volume in the assessment of response to clomiphene citrate treatment in polycystic ovarian syndrome
Authors: Fiçiciolu Gem , Api Murat , Özden Selçuk
Published: November 2007

Objective. To evaluate whether the number of follicles and ovarian volume have any significance in evaluating the response to clomiphene citrate treatment in polycystic ovarian syndrome (PCOS).

Design. A prospective study of 70 infertile women, 44 of which were diagnosed with polycystic ovarian syndrome.

Main outcome measures. Follicle numbers and volumes in both ovaries, hormonal profile, response to Clomiphene Citrate(CC).

Results. Ovarian volume was significantly greater in cases with polycystic ovarian syndrome than controls. However, ovarian volume in the Clomiphene Citrate nonresponders was significantly greater than in Clomiphene Citrate responders in the polycystic ovarian syndrome group. The number of small follicles was significantly higher in cases with polycystic ovarian syndrome than controls, and in the Clomiphene Citrate nonresponder group this number was also significantly higher than in Clomiphene Citrate responders. Endocrine features of patients with polycystic ovarian syndrome revealed that Dehydroepiandrostenedione sulfate, Androstenedione, follicle stimulating and luteninizing hormone do not discriminate between patients who respond to Clomiphene Citrate and those who do not respond. However, Testosterone and luteinizing hormone levels differ significantly in responders and nonresponders.

Conclusions. Small multiple follicles (>9) and enlarged ovarian volume (>6.8 ml) were the most prominent transvaginal ultrasonographic features of ovaries in Clomiphene Citrate non‐responsive patients with polycystic ovarian syndrome. Higher levels of Testosterone, luteinizing hormone and significantly higher number of small follicles were associated with lack of Clomiphene Citrate response. These ultrasonographic features and laboratory assays could be clinically useful for distinguishing better the Clomiphene Citrate nonresponders from responders.
Recurrent first trimester spontaneous abortion associated with antiphospholipid antibodies:
Authors: Marzusch Klaus , Dietl Johannes , Klein Reinhild , Hornung Daniela , Neuer Andreas , Berg Peter A.
Published: November 2007

Background. Antiphospholipid antibodies, unassociated with an underlying connective tissue disease, have repeatedly been detected in women suffering from recurrent spontaneous abortions. Several therapeutic regimens have been advocated for pregnant women with recurrent fetal loss and antiphospholipid antibodies. However, most of these approaches were empirical, using several drugs simultaneously, and most reports describe single cases or limited series.

Patients and interventions. In a pilot study, thirty‐eight women with a history of three or more consecutive first trimester spontaneous abortions and antiphospholipid antibodies were treated with intravenous immunoglobulin. As soon as pregnancy had been confirmed, intravenous immunoglobulin was administered at a dose of 300 mg/kg bodyweight, and infusions were repeated at three‐weekly intervals until the 16th–17th week of pregnancy.

Results. Pregnancy proceeded beyond the first trimester in 34 of the patients (89.4%), and 31 patients (81.4%) gave birth to healthy infants at 37 to 42 weeks' gestation.

Conclusions. Although the results are promising, randomized placebo‐controlled trials are necessary to exclude the influence of other factors (e.g. intense obstetric supervision and psychological factors) on pregnancy outcome and confirm the effectiveness of intravenous immunoglobulin in patients with recurrent spontaneous abortions and antiphospholipid antibodies.
Morphological action of tamoxifen in the endometrium of persistent estrous rats
Authors: Patriarca Marisa Teresinha , Simotes Rosana Durães , Smaniotto Salete , de Teves Danilo Carreiro , Simães Manuel De Jesus , Evěncio‐neto Joaquim , De Freitas Vilmon , De Lima Geraldo Rodrigues
Published: November 2007

Background. The aim of this study was to evaluate the action of tamoxifen on the endometrium in states of chronic anovulation.

Methods. Thirty‐eight rats inducted to persistent estrous (testosterone propionate) confirmed by hormonal colpocytology were divided into a control and an experimental group; the latter received tamoxifen and had fragments of the uterine horns processed for morphological and morphometrical analysis. Data were analysed statistically by the Mann‐Whitney and Student's t tests.

Results. Our findings revealed minor uterine weight, epithelial thickness; number of endometrial glands and low eosinophil counts in the group that received tamoxifen. These results were statistically significant. We often observed areas of metaplasic stratified squamous epithelium between cylindrical epithelial cells in both groups.

Conclusions. Our results indicate that antiestrogenic effect of tamoxifen was only partial in persistent estrous, since there was no blocking against the squamous metaplasia of the endometrium.
Cost‐effectiveness of intracytoplasmic sperm injection in comparison with donor insemination
Authors: Granberg Maria , Wikland Matts , Hamberger Lars
Published: November 2007

Background. Due to the need for cost containment in the national health services in many countries, there is a demand for analysis of both medical and cost benefits of new technologies. Intracytoplasmic sperm injection has in recent years been proved to be the method of choice for treating severe infertility. It also needs to be shown that intracytoplasmic sperm injection is a cost‐effective treatment.

Aim and methods. The aim of this study was to evaluate the cost‐effectiveness of intracytoplasmic sperm injection over a two‐year period and to compare it with the cost‐effectiveness of donor insemination. The mean direct and indirect costs of the two modes of treatment were compared with the outcome of the subsequent pregnancies and the cost per delivery in the two groups were calculated.

Results and conclusions. The cost analysis showed a direct and indirect cost per delivery after intracytoplasmic sperm injection of 264.300 SEK in 1993, decreasing to 174.900 SEK in 1994. The corresponding cost of donor insemination was 88.900 SEK during the two‐year period. The cost analysis showed a 34% increase in cost‐effectiveness of intracytoplasmic sperm injection from the first to the second year, an increase that will most probably continue. In the near future intracytoplasmic sperm injection will be a cost‐effective treatment and, in addition, intracytoplasmic sperm injection will have the advantage of resulting in genetic children in a majority of the treated couples suffering from severe male subfertility.
Tubal artery blood flow in evaluation of tubal pregnancy
Authors: Stefanovic Vedran , Cacciatore Bruno , Ylöstalo Pekka
Published: November 2007

Objective. To evaluate whether the assessment of tubal blood flow can indicate the side of the tubal pregnancy.

Methods. Using transvaginal color Doppler ultrasonography, we measured blood flow in the tubal arteries on both sides in 46 women with early ectopic pregnancy. We compared the resistance index (RI) and pulsatility index (PI) values of the tubal artery flow on the tubal pregnancy side to the contralateral side.

Results. The Resistance index (RI) and Pulsatility index (PI) values were lower at the tubal pregnancy side in 70% and 61%, respectively, when compared with the contralateral side. However, in the mean values of RI and PI the difference between the sides was not statistically significant. During the follow up in cases with spontaneous resolution between‐side difference was often subjected to changes.

Conclusion. Assessment of tubal blood flow by using transvaginal color Doppler sonography in the evaluation of the side of tubal pregnancy has limited clinical value.
Immunohistochemistry in the diagnosis of the gestational trophoblastic disease
Authors: Lösch Alexander , Kainz Christian
Published: November 2007

Objective. The gestational trophoblastic disease summarizes all types of hydatidiform moles, placental site trophoblastic tumor and choriocarcinoma. It is of clinical relevance to distinguish between complete hydatidiform mole and partial hydatidiform mole to predict prognosis of re‐currency of molar pregnancy and the risk of the devolopment of malign and metastatic gestational trophoblastic disease. Differential diagnosis of choriocarcinoma versus placental site trophoblastic tumor, carcinoma or sarcoma with low differentiation can cause problems in borderline‐cases. The present study investigates the value of immunohistochemistry in the diagnosis of gestational trophoblastic disease.

Method. Nine cases of patients with complete hydatidiform mole, 20 cases of partial hydatidiform mole and seven cases of choriocarcinoma were analyzed for the immunohistochemical reaction with antibodies against human choriogonadotropin (hCG), human placental lactogen (hPL), placental alkaline phosphatase (PLAP), cytokeratine and vimentin.

Results. Complete hydatidiform mole shows strong expression of hCG and weak expression of PLAP. Weak hCG and strong PLAP expression is found in partial hydatidiform mole. Choriocarcinoma presents strong expression of hCG and weak expression of hPL and PLAP. All tissues show positive reaction with anticytokeratine and negative reaction with anti‐vimentin.

Conclusion. Our study proves immunohistochemistry as useful tool for differential diagnosis in borderline cases of gestational trophoblastic disease.
Breast‐conserving surgery and adjuvant chemotherapy in pregnancy
Authors: Inbar Moshe J. , Ron Ilan G.
Published: November 2007

While cancer is a leading cause of death in women of childbearing age, its simultaneous occurrence with pregnancy is uncommon, with a reported incidence of 0.07%‐0.1% (1). The malignant neoplasms complicating pregnancy are those most frequently seen in young women: lymphoma, leukemia, melanoma and cancers of the breast, cervix, ovary, thyroid and colon (2, 3). Breast cancer, the most common of them all and, in many areas of the world, the most frequent cause of cancer deaths in women, is also the type of cancer most likely to be seen in pregnancy or lactation (4). This cancer, in association with pregnancy, occurs in three of every 10,000 pregnancies and in 3% of all breast cancer patients (1, 5). Except for delay in diagnosis, no convincing data exist that pregnancy per se adversely influences the prognosis or biology of maternal cancer, and this includes breast cancer as well. There are no firm data which show that there is a greater likelihood of reactivation of cancer during pregnancy. Conversely, there are only a few reports in the literature which indicate that cancer adversely affects pregnancy (6). It is well known, however, that a delay in diagnostic and therapeutic interventions are potentially deleterious to both mother and fetus.
Book Review
Authors: Lange Aksel P.
Published: November 2007

Steegers EAP, Eskes TKAB and Symonds EM (guest editors). Preventive cave in Obstetrics. Baillière's Clinical Obstetrics and Gynaecology 1995; vol 9(3): 403‐637. Price GBP: 30.
Validity of the GHQ-28 in New Zealand Women
Authors: Romans-Clarkson Sarah E. , Walton Valerie A. , Mullen Paul E. , Herbison G. Peter
Published: November 2007

The GHQ-28 was validated against the short PSE in a New Zealand community study of female psychiatric morbidity. The GHQ-28 total scores were significantly correlated with the PSE scores. Higher coefficients were obtained using the scoring method of Good child and Duncan-Jones than with the standard scoring method. In this data set, the 3/4 cutoff had the best sensitivity and specificity. The correlations of the GHQ-28 subscales with ICD diagnostic classes and ad hoc PSE sub-scores were also statistically significant. Because the distribution of the GHQ-28 scores is positively skewed, non-parametric statistics may be preferable to the traditional Pearson's correlation coefficient. Overall, the results from this study confirm the GHQ-28 to be a valid and practical screen for presence or absence of psychiatric disorder in New Zealand women.
Hyperactivity of Associations in Psychosis
Authors: Miller Robert
Published: November 2007

Disordered associative processes have long been regarded as central to the psychological description of psychotic states such as acute schizophrenia. Previous work is briefly summarised concerning the idea that hyperactive associative processes of thought underlie many of the symptoms of psychosis. The idea is developed further, with respect to several features of the psychotic state. Schneiderian symptoms are seenas a consequence of hyperactive associations of thought, combined with perceptual hypersensitivity characteristic of many psychotic individuals. Anxiety in psychotic states is seen as arising from the great ambiguity of mental images when associations are loosened. A vicious circle between high anxiety and hyperactive associations is postulated. The slow and variable response to neuroleptic treatment is seen as being determined in part by the dynamics of change of the memories acquired during a period of hyperactive associations.

This essay has dealt exclusively with the positive (productive) symptoms of psychosis, and their treatment. It has briefly traced the origin of the idea that hyperactive associations of thought (i.e. of inductive inference) play an important part in the psychology of acute psychosis. Further it has attempted to show that this idea can be extended to give an account of Schneiderian symptoms, the high anxiety levels commonly found in acute psychosis, as well as the great variability in the rate and extent of response to drug treatment. The negative symptoms of schizophrenia are not included in the discussion. Some of these symptoms are not responsive to neuroleptic drugs. This leads one to suspect that other pathological processes in addition to those discussed above may be involved in the genesis of the negative symptoms.
Schizophrenia and Biological Determinism
Authors: Herrman Helen
Published: November 2007

Conceptual developments in mid-twentieth century medicine, the many factors known to influence course and outcome in schizophrenia, and recent systemic models of brain function all suggest the value of re-assessing the view of schizophrenia as biologically determined. Although the current view of schizophrenia as a brain disease, invoking the natural history model of disease, has mobilised research and public interest, it encourages a new biological determinism in thinking about schizophrenia which current evidence does not warrant and which restricts research and clinical advances.
Grasping the Nettle: Forensic Child Psychiatry
Authors: Connell Helen M.
Published: November 2007

Child psychiatry is becoming increasingly involved with the law. Other professionals have expertise in interpreting children's needs and behaviours to the courts, but child psychiatrists have unique skills and lawyers should be helped to understand what they have to offer. Difficulties in the dialogue between child psychiatry and the law are discussed. Training child psychiatrists to function efficiently in the legal system must be given priority by the newly established Faculty of Child Psychiatry.
The Stereotype of the Mad Psychiatrist
Authors: Walter Garry
Published: November 2007

The stereotype of the mad psychiatrist is examined. There is initial consideration of the “popular” model of madness. It is suggested that there is no firm evidence that psychiatrists suffer more frequently from “popular madness” than other medical practitioners. The paper subsequently explores the stereotype's functions, origins, means of propagation and range of effects. It emerges that members of “the first generation” of psychiatrists were labelled as mad. It is inferred that the stereotype may not be about to change. The paper invokes the conceptually closely-related literatures and attendant terminologies of stereotyping, mythology, labelling, deviance, prejudice and stigma.
Tardive Dystonia
Authors: Chiu Helen F.K. , Lee Sing
Published: November 2007

Unlike tardive dyskinesia (TD) which is much better known by clinicians, tardivedystonia is a more recently recognised complication of neuroleptic use. It refers to chronic dystonia related to the use of neuroleptic drugs and may be an even more disabling condition than TD. This article reviews its epidemiology, clinical features and treatment aspects, and suggests that it should be separated from TD as a distinct entity.
Psychotropic Drug Prescribing in a General Hospital Inpatient Psychiatric Unit
Authors: Brayley John , Rafalowicz Elias , Yellowlees Peter
Published: November 2007

The drugs prescribed to 241 general hospital psychiatric unit inpatients were surveyed at the time of admission and discharge. Sixty-three per cent of patients were prescribed psychotropic drugs on admission, compared to 68% on discharge. There was a significant reduction in patients prescribed minor tranquillisers from 23% to 8%, and an increase in those prescribed tricyclic antidepressants from 26% to 42%. Compared to previous surveys of psychiatric hospital populations, fewer general hospital psychiatric patients were prescribed medications overall, less neuroleptics and less anti-parkinsonian agents were used, but more patients were treated with antidepressant medication. This reflects a different patient population. An analysis such as this allows prescriptions of psychotropic drugs to be compared with the recommended regimes suggested in the literature, as well as comparisons of drug usage between different units and hospitals.
Standards of Care for Area Mental Health Services
Authors: Rosen Alan , Miller Vivienne , Parker Gordon
Published: November 2007

A provisional set of standards of care was derived from a quality assurance strand of a wider research project, which reported the development of evaluation strategies for area integrated mental health services (AIMHS). In contrast to most published standards, they apply to all facets of care in a comprehensive catchment area mental health service, whether clinical or functional, community or hospital based, urban or rural, or managed by the public, private or voluntary sectors. We review briefly existing sets of standards of mental health services and report the process of development of standards of care, each with sub-sets of performance indicators and examples. While the AIMHS standards and a companion quality assurance manual are still undergoing refinement, they offer a guide for mental health professionals to the provision of services, and a checklist to service-users of services that should be available to them at every stage of care in a mental health system.
Prior Neurologic Illness and the Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (Silent)
Authors: Adityanjee  , Balaraju K. B. , Ahuja G. K.
Published: November 2007

Prior neurologic illness or CNS insult of any kind is known to increase the vulnerability to neurotoxicity of lithium. In this event the occurrence of neurotoxicity does not correlate with serum lithium levels. The authors describe a patient with hemiparesis who developed the syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) while being treated with lithium for a manic episode. The authors review the literature on this aspect and highlight the dangers of starting lithium treatment in patients with neurologic impairment.
Psychiatry as a Career Choice
Authors: Mowbray R. M. , Davies B. M. , Biddle N.
Published: November 2007

The paper reviews articles in the field of research in medical education specifically dealing with the factors involved in the choice of Psychiatry as a medical specialty and describes three studies conducted in Melbourne. These studies focus on the relevance of personality factors in the psychiatrist's choice of a career. While they confirm other work in this field, it is felt that the emphasis should no longer be placed on single factors. Future investigations should be multifactorial in design and analysis to highlight the combination of factors underlying such choices.
Factors that Determine Medical Student Interest in Psychiatry
Authors: Ney Philip G. , Tam William W. K. , Maurice William L.
Published: November 2007

Our study of pre-medical and medical students attending the Universities of British Columbia, Hong Kong and Otago, together with house surgeons, general practitioners, surgeons and psychiatrists in New Zealand, demonstrated many agreements regarding both positive and negative factors affecting their interest in psychiatry. Positive factors included: interest in human behaviour, personal aptitude, and quality of patient care. Negative factors included: the stress of practising psychiatry, faculty attitude and the quality of the science. Differences were determined by age of the students and cultural and personal experiences. We concluded that if more students are to be interested in psychiatry then psychiatrists will need to show that they enjoy their work and give effective treatment.
Review of a Mother-Baby Unit in a Psychiatric Hospital
Authors: Buist Anne E. , Dennerstein Lorraine , Burrows Graham D.
Published: November 2007

Admissions to a mother-baby unit in a psychiatric hospital were reviewed over a 51 month period. Forty-four mothers (3 admitted twice) and 44 babies were admitted. Eighteen women were diagnosed as having major depression (1 admitted twice), 14 with schizophreniform psychosis, 8 with schizophrenia (2 admitted twice), 4 with bipolar disorder, 2 with anxiety disorders and in 1 diagnosis was deferred. Data are presented from these women's background and that related to pregnancy, as well as duration of stay and treatment in the unit. A description of the unit is also included.
Psychiatry and the Frontal Lobes
Authors: Russell Janice D. , Roxanas Milton G.
Published: November 2007

The frontal lobes of the brain have long been regarded as enigmatic in their function and perhaps should be considered even more so in states of dysfunction. Observed associations between structural lesions and psychiatric symptoms and the demonstration of disturbed function and morphology in the frontal lobes of individuals suffering from major psychiatric disorders have led to increased interest in this brain area. Psychiatrists have been particularly concerned with seeking the aetiogenesis of common diagnostic entities and this article attempts to synthesize the available facts. A brief overview of relevant biological data precedes a description of methods of neuropsychological testing and the clinical features arising from frontal lobe damage. A discussion of the role of the frontal lobes in some aspects of personality function follows. Neuropsychiatric features associated with known frontal lobe pathology are described, prefacing a discussion of those psychiatric conditions where an aetiological role for frontal lobe dysfunction has been proposed.
Neuropsychological Assessment and Brain Imaging Technologies in Evaluation of the Sequelae of Blunt Head Injury
Authors: Shores Arthur , Kraiuhin Claudia , Zurynski Yvonne , Singer Andrew , Gordon Evian , Marosszeky Jeno , Fearnside Michael R.
Published: November 2007

A 43 year old man with a traumatic amnesic syndrome experienced only a brief, if any, loss of consciousness following an injury to the head. Four years after this injury, his results on standard psychometric assessment were normal. Long-latency evoked response potentials results were normal, and the neurological examination and computed tomography scans were unhelpful in explaining his amnesic symptoms. He had no history of alcohol abuse, yet his neuropsychological profile was that of a Korsakoff-like amnesia with frontal lobe features. Magnetic-resonance images demonstrated evidence of extensive frontal lobe damage, while cerebral blood flow studies provided additional evidence of bilateral frontal lobe dysfunction. The case highlights the need for those giving opinions in medico-legal head trauma cases to go beyond a reliance on routine indicators, such as duration of coma, results of standard psychometric assessment and computed tomography scans, to more specialised neuropsychological evaluations and magnetic-resonance imaging scans.
Biologism in Psychiatry
Authors: Silove Derrick
Published: November 2007

A recent study visit to North America impressed on me the seriousness with which Australian psychiatry should consider the recent ideological shift in the USA to an extreme biological model of mental disorders [1]. There is increasing evidence that proponents of this model are not simply promoting the value of biological research (with which few psychiatrists would quibble), but that the field is at risk of being overwhelmed by a reductionistic “biologism” which assumes an organic causation for all abnormal human behaviour.

Australian and New Zealand Journal of Psychiatry 1190; 24: 461–463
A Double Blind Trial of Moclobemide versus Amltrlptyllne in the Treatment of Depressive Disorders
Authors: Newburn Gil M. , Fraser Allen R. , Menkes David B. , Mullen Paul E.
Published: November 2007

The antidepressant efficacy and side-effect profile of amitriptyline were compared to those of moclobemide, a reversible monoamine oxidase inhibitor with selectivity for the type A isozyme. Forty nine patients with DSM-Ill major depression were randomly assigned to receive either amitriptyline or moclobemide. Thirty seven patients (amitriptyline n=l6, moclobemide n=21) completed the six week protocol, which was conducted under double blind conditions. The results indicated a comparable antidepressant time course and efficacy for the two treatments. Amitriptyline produced significantly more sedation and antimuscarinic side-eff ects. Moclobemide appears to be a well tolerated antidepressant without the liability to produce significant postural hypotension and without the need for a tyramine-poor diet.
Obsessive-Compulsive Disorder: An Exploration of Some Unresolved Clinical Issues
Authors: Hafner R. Julian , Miller Robyn J.
Published: November 2007

The study data were obtained from a questionnaire survey of a South Australian community support group for obsessive-compulsive disorder (OCD). The response rate was 47%, yielding 81 questionnaire sets completed by members who, on the basis of their questionnaire responses, were judged to meet DSM-Ill-R criteria for OCD. The clinical and demographic characteristics of the respondents were very similar to those of previously reported clinical populations. Mean age at onset of OCD was 18 years and mean duration 17 years; 55% of respondents rated their current OCD as extremely or very severe. Seventy-seven percent had received psychiatric treatment (mean 55 occasions) and 47% had attended clinical psychologists or professional counsellors (mean 20 occasions). Those who reported prominent fears of losing control of motor behaviours had received a significant excess of outpatient and inpatient psychiatric treatment. Most respondents reported the presence of all 4 identified components of OCD, of which the obsession/rumination component was central. Levels of OCD correlated strongly with levels of overall psychopathology, and fertility rates were significantly reduced in those patients who reported the most symptoms.
“Negative Symptoms”: A Cu Mu Latlve Trauma Stress Disorder?
Authors: Stampfer Hans G.
Published: November 2007

A theory is proposed that “negative symptoms”, which are usually associated with schizophrenia, are manifestations of a traumatic stress disorder that is fundamentally similar in terms of the clinical phenomena and pathophysiological disturbance to chronic post-traumatic stress disorder (PTSD) as defined in DSM-Ill-R. Wider theoretical implications are explored briefly.
Reliability of the Parental Bonding Instrument and Intimate Bond Measure Scales
Authors: Wilhelm Kay , Parker Gordon
Published: November 2007

The long-term reliability of the Parental Bonding Instrument (PBI) and of the Intimate Bond Measure (IBM) are examined in a non-clinical group, with data being examined over eleven and five years for the two respective measures. Such reliability data are compared with reliability data on a number of personality measures within the same cohort. Results demonstrate considerable stability in the PBI over an extended period and moderate stability in IBM scores.
The Effectiveness of Services and Treatment in Psychogeriatrics
Authors: Draper Brian
Published: November 2007

The future development of new psychogeriatric services in Australia may well depend upon the demonstration of their potential effectiveness and efficiency. Descriptive accounts of effective services provide ample guidelines, although formal evaluation is lacking. Examining the major psychiatric disorders of the elderly shows that most are functional. Effective acute psychiatric treatment is available for these. In dementia cases, effective therapies exist for the reduction of secondary behavioural disabilities in the sufferer and the stress on carers. Adequately resourced comprehensive psychogeriatric services would be best equipped to deliver such treatments.
Alcohol and the Elderly
Authors: Ticehurst Stephen
Published: November 2007

Alcohol abuse and dependence are the third most common psychiatric diagnoses in elderly men in the community, occurring in 3% over the age of 65. Elderly patients may present in a number of atypical guises to medical, social, psychiatric and forensic services. When they do, their alcohol problem is often missed. They have high rates of physical morbidity and are most often found in the general hospital setting. While there is a steady decline in consumption and alcohol-related problems with age, up to a third of elderly abusers take up drinking in late life, possibly in response to psychosocial stressors. Recognition has been a major barrier to effective management. Intervention studies point to difficulties in attracting patients to treatment, with little consensus on treatment regimes or goals. Given these problems, a regionally based service responsible for identifying and managing alcohol abuse in the elderly is proposed. Such a service could improve liaison with community and hospital-based programmes and allow practical research to be undertaken into this enigmatic problem.
On Letting go: The Patient, Haemodialysis and Opting Out
Authors: Cramond William , Fraenkel Margaret , Barratt Lindsay
Published: November 2007

The title of this article refers not only to the patient who decides to let go of life, the quality of which on dialysis is such that death is preferable, but also to the family and the renal unit staff who have to let go of the patient who makes this decision. One such case is described in detail since the problem is not one restricted to the treatment of end-stage renal failure alone, but occurs more and more frequently in other branches of medicine and surgery.
Australasian Field Trials of the Mental and Behavioural Disorders Section of the Draft ICD-10
Authors: Ellis Peter M. , Welch Garry , Purdie Gordon L. , Mellsop Graham W.
Published: November 2007

Field trials of the “Mental and Behavioural Disorders” section of the 1987 draft of the ICD-10 have been co-ordinated for the World Health Organisation by a number of regional centres. The design of the field trials and the major features of ICD-10 are briefly discussed. The results of the field trials in the Western Pacific region are described, and compared with the results of the original DSM-Ill field trials. ICD-10 appears to be an acceptably reliable diagnostic system, and the ratings of its feasibility and utility by participating clinicians suggest that it will be seen as a distinct advance over ICD-9.
Child Psychiatry in Hong Kong: An Overview
Authors: Wong C. K.
Published: November 2007

Hong Kong has a population of 5.5 million with 1.3 million below the age of 15. Child psychiatry has been very under-developed until recently. The brief history and development of child psychiatry in Hong Kong, and specifically that of the Child and Adolescent Psychiatric Unit at the Prince of Wales Hospital, the teaching hospital of The Chinese University of Hong Kong, are described. Traditionally psychiatric services for children in Hong Kong were heavily skewed towards neuropsychiatric and developmental conditions but in this Unit a full spectrum of child psychiatric conditions are seen. Relevant clinical statistics are used to illustrate these differences as well as to further highlight the philosophy and practice of the Unit. Other aspects, such as undergraduate and postgraduate teaching, and research are also mentioned. The magnitude of child psychiatric morbidity in Hong Kong is briefly illustrated with a three-stage epidemiological study done in a primary school in a lower middle social class area. It was found that 16.3% of the children were psychiatrically disturbed. Emotional disorder, with a prevalence of 8.8%, was the commonest condition. Finally, the future development of child psychiatry in Hong Kong is discussed, addressing the disconcerting facts of a huge population and very limited resources.
Australian Suicide Data and the use of “Undetermined” Death Category (1968–1985)
Authors: Cantor Christopher H. , Dunne Michael P.
Published: November 2007

There has been considerable recent debate about the impact that changes in the use of the “undetermined” death classification may have upon trends in national suicide statistics. This study focused on changes over time within each state in Australia in an attempt to determine the source of apparent patterns in national data. Considerable intra- and inter-state variability was revealed, and it was concluded that, apart from a general trend for decreasing use of the undetermined category, the data are not of sufficient quantity to warrant further interpretation. The suggestion that changes in classification practices by coroners may have contributed to the rise in young male suicides was not supported.
The Role of Liaison Psychiatry in an AIDS Unit
Authors: Wright J. Murray , Perkins Richard J.
Published: November 2007

The experience of a liaison psychiatry team working in the setting of an AIDS unit is described. Several clinical themes are identified which highlight crucial issues with regard to both diagnosis and management. These issues are illustrated by case histories. Discussion draws attention to the value of using a biopsychosocial model in order to understand aetiology and to formulate appropriate management. Issues related to staff involvement provide a further theme for discussion.
The Ranzcp Membership Examination: A Review of the Relevant Literature
Authors: Condon John
Published: November 2007

The design of any assessment system, as well as the way it is scored, must be intimately linked to the purpose it is to serve. Previous literature on the RANZCP membership examination has tended to focus exclusively on issues of reliability and validity at the expense of broader concerns. The present paper selectively reviews the literature on assessment in education highlighting the differences between normative and criterion referencing and their implications for the profession. Published studies of the reliability of post-graduate written and oral examinations are reviewed focussing particularly on those conducted in psychiatric settings. Finally, the arguments for and against continuous assessment are summarised. Greater familiarity with the literature may result in more informed and constructive debate about the assessment process than has hitherto been evident.
Ranitidine and Depression
Authors: Stocky Andrew
Published: November 2007

Three cases are described in which the cessation of the H2-antagonist ranitidine was followed by a rapid improvement in severe depressive symptoms. The literature concerning H2-receptor antagonists and depression is reviewed, and an alternative drug (omeprazole) for severe peptic ulceration is discussed.
An Unusual Case of Munchausen Syndrome by Proxy
Authors: Single Toni , Henry Richard Leigh
Published: November 2007

An 11-year-old boy was presented by his father with a long and plausible history of cystic fibrosis. The diagnostic test for cystic fibrosis, the sweat test, was normal and excluded the diagnosis. The medical history was later found to be false, and the child to be well. By definition, the case met the criteria for Munchausen Syndrome by Proxy with fabrication of symptoms on behalf of another in order to deceive medical personnel. Unusual features included the illness chosen, the father as the parent falsifying illness, his failure to pursue unnecessary investigations and treatment, and the ease with which he relinquished the diagnosis of cystic fibrosis.
Potentially Reversible Dementia: A Review
Authors: Draper Brian
Published: November 2007

Potentially reversible dementia is reviewed with reference to diagnosis, causes and outcome. Many disorders which cause cognitive impairment, such as drug toxicity and depression, fail to meet diagnostic criteria for dementia. These tend to have the best prognosis. Studies of the neuropsychiatric syndromes associated with disorders causing potentially reversible dementias suggest that dementia is an infrequent outcome and when it does occur, few cases recover. Factors predictive of improvement are short duration of symptoms and mild degree of cognitive impairment, usually subcortical in type. It is suggested that potentially reversible cognitive impairment would be a more accurate term as many cases are due to delirium and depression. While cases of well established dementia do not require extensive investigation, all cases should have a thorough clinical assessment as in many instances dual pathology exists and all require psychosocial management.