bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcranial Magnetic Stimulation: Experience, Knowledge and Attitudes of Recipients
Authors: Walter Garry , Martin Janine , Kirkby Kenneth , Pridmore Saxby
Published: March 2003

Objective: To examine the experience, knowledge and attitudes of recipients of transcranial magnetic stimulation (TMS) regarding the treatment. There have been no studies of patient views about TMS.

Method: A 60-item survey was administered by telephone to persons with depressive illness who received TMS at Royal Hobart Hospital, Tasmania.

Results: Forty-eight patients were interviewed. About two-thirds also had a history of treatment with electroconvulsive therapy (ECT). Experience and opinions about TMS were generally very positive. Almost three-quarters of interviewees believed TMS had been helpful. The vast majority rated TMS as more acceptable than having, or the prospect of having, ECT. The majority would have TMS again and would recommend it to others.

Conclusions: The mostly favourable experiences and attitudes reported by interviewees will be reassuring to patients, their families and treating health professionals when TMS is being considered.
Relative Misery and Youth Suicide
Authors: Barber James G.
Published: March 2003

Objective: To test the ‘absolute misery hypothesis’ that suicide rates are a proxy measure of psychological maladjustment within the general population of young people.

Method: Study I regressed World Health Organization statistics on youth suicide rates on measures of adolescent adjustment across seven countries. Study II analysed the results of a Canadian survey involving 2111 children from 31 schools in grades seven to 12 (ages 11–20 years, mean = 15.5, SD = 1.7). The survey contained measures of suicidality, depressed affect and social comparison.

Results: Study I found that male suicide was much more likely in psychologically welladjusted countries than in less well-adjusted countries. Although not statistically significant in a sample of this size (n = 7), correlation analysis suggested that the relationship between suicide and adjustment was in the opposite direction for females. Study II found that suicidality in boys was not associated with depressed affect on its own, or with social comparison on its own, but was associated with the combination of depressed affect and negative social comparison. By contrast, suicidality in girls was significantly associated both with absolute and comparative levels of unhappiness.

Conclusions: A new, ‘relative misery hypothesis’ is proposed to account for these results. Under this hypothesis, the disposition of vulnerable young men towards suicide is influenced by their affective state relative to others. When those around them are perceived to be better off than they are, the predisposition of young men to suicide is increased. By contrast, female suicide is predicted to be less influenced by young women's relative state, and more by their absolute level of unhappiness. The primary implication of the relative misery hypothesis is that the prevention of young male suicide in particular is likely to require methods that discourage vulnerable individuals from making negative social comparisons.
Evolutionary Approaches to Psychopathology: The Role of Natural Defences
Authors: Gilbert Paul
Published: March 2003

Objective: Psychoanalytic theories of the mind emerged in the immediate post-Darwinian era of the 1880s and 1890s. Since that time much has changed in both psychoanalytic and evolutionary theorizing. This paper explores recent evolutionary thinking on psychopathology.

Method: Relevant literature was reviewed.

Results: This paper outlines some of the common behavioural defence mechanisms and then explores ways in which they are represented in various disorders, with a focus on depression. This paper suggests that ‘symptoms’ can be related to the activation of evolved defence mechanisms to respond to losses and threats. Such will involve, for example, anxious arousal and heightened vigilance and attention to the threat, with the type of defence (e.g. fight, flight, submit, help seeking) being mirrored in particular symptom presentations.

Conclusion: Defences can become pathological when they are too easily aroused or prolonged, are arrested (aroused but not expressed) and/or ineffective.
Better Mental Health Services for Young People: Responsibility, Partnerships and Projects
Authors: Birleson Peter , Luk Ernest S.L. , Mileshkin Cristea
Published: March 2003

Objective: This paper argues that adolescent psychiatry is best linked with child psychiatry and opposes separate youth mental health programmes for 12–25-year-olds. It reports on the current status of services and considers how adult mental health services (AMHS) can improve services for young adults (18–25-year-olds).

Method: Factors in development, psychopathology, prevention, training and service systems are reviewed to suggest that current child and adolescent mental health service systems (CAMHS) are appropriate for 0–17-year-olds. Improvements in CAMHS are described from a Victorian perspective, including the model of specialist clinical programmes or teams for specific patient populations. Mechanisms are outlined for AMHS to better assist young adults from 18 to 25 years of age.

Results: The model of clinical projects or clinical programme teams, developed in partnership with primary health and others, is a suitable vehicle to help AMHS to improve clinical services to their young adult populations. These may be funded from a variety of sources, including re-engineering existing service resources.

Conclusions: Such developments complement the work of specialist research units and build local competencies. More programme development and evaluation is needed, which will require the support of the College and State and Commonwealth Mental Health Branches.
A Comparison of the Composite International Diagnostic Interview (CIDI-Auto) with Clinical Assessment in Diagnosing Mood and Anxiety Disorders
Authors: Komiti Angela A. , Jackson Henry J. , Judd Fiona K. , Cockram Alexandra M. , Kyrios Michael , Yeatman Richard , Murray Gregory , Hordern Celia , Wainwright Kylie , Allen Nicholas , Singh Bruce
Published: March 2003

Objective: Increasingly, epidemiological studies are employing computerized and highly standardized interviews, such as the Composite International Diagnostic Interview (CIDIAuto), to assess the prevalence of psychiatric illness. Recent studies conducted in specialist units have reported poor agreement between experienced clinicians’ and CIDI-Auto diagnoses. In this study we investigated the concordance rate between clinicians and the CIDI-Auto for the diagnosis of six anxiety disorders and two mood disorders, whereby the CIDI-Auto was treated as the ‘gold standard’.

Method: Subjects were 262 patients who were assessed by a clinical psychologist or psychiatrist and completed the CIDI-Auto at a tertiary referral unit for anxiety and mood disorders. Agreement between the clinicians’ diagnoses and the diagnoses generated by the CIDI-Auto according to both DSM-IV and ICD-10 codes, were examined by kappa statistics. Sensitivity and specificity values were also calculated.

Results: Agreement between clinicians and the CIDI-Auto (DSM-IV) ranged from poor for social phobia and posttraumatic stress disorder (κ < 0.30) to moderate for obsessive– compulsive disorder (OCD; κ = 0.52). Agreement between clinicians and the CIDI-Auto (ICD-10) ranged from poor for major depressive episode (κ = 0.25) to moderate for OCD (κ = 0.57). With the CIDI diagnosis treated as the gold standard, clinicians’ diagnoses showed low sensitivity (κ < 0.70) for all the disorders except for OCD (for ICD-10), but high specificity (κ < 0.70) for all the disorders.

Conclusion: Poor agreements between experienced clinicians and the CIDI-Auto were reported for anxiety and mood disorders in the current study. A major implication is that if diagnosis alone directed treatment, then patients could receive different treatments, depending on whether the computer, or a clinician, made the diagnosis.
The Humble Case Report
Authors: Walter Garry , Rey Joseph M. , Dekker Floor
Published: March 2003

Objective: There is negligible systematic information about case reports in the psychiatric literature. We aimed to describe case report articles published in the Australian and New Zealand Journal of Psychiatry (ANZJP), to provide data about the quality of evidence they offer, to ascertain changes over time and to make recommendations, based on our findings, about these articles.

Method: All articles describing cases which appeared in the ANZJP between 1967 and 1999 were identified and examined.

Results: 256 articles describing a total of 479 cases were published over the study period. Fifty-five per cent of articles reported an unusual presentation. Thirty-eight per cent of cases had a mood disorder and 24% had a psychosis. Seventy-six per cent of patients had a positive outcome. Cases published in 1989–1999 were more likely to describe pharmacological treatments than cases published earlier.

Conclusions: Clinical descriptions that lead to progress are undervalued. Case reports should retain a place in the ANZJP, provided they convey information that is new and useful (e.g. suggesting or refuting hypotheses) rather than simply document current practice or describe the unusual. Issues of patient consent and anonymity also warrant consideration.
Anorexia Nervosa in an Elderly Woman
Authors: Hill Rosalie , Haslett Christopher , Kumar Shailesh
Published: March 2003

Objective: To demonstrate a case of anorexia nervosa in the elderly and to highlight the need for broadening of current diagnostic criteria.

Clinical picture: First onset of anorexia nervosa in a 72-year-old woman following bereavement of her husband.

Treatment: Nine treatments of electroconvulsive therapy.

Outcome: Treatment resulted in remission of the depressive symptoms and improvement of eating behaviour.

Conclusions: Anorexia nervosa does occur in the elderly and can be difficult to detect. Where comorbid depression exists it requires aggressive treatment.
Uses of Community Treatment Orders in New Zealand: Early Findings
Authors: Dawson John , Romans Sarah
Published: March 2003

Objective: To assess the uses of Community Treatment Orders (CommTOs) in New Zealand.

Method: A retrospective study of patients' records held by the regional administrator of mental health legislation and a survey of psychiatrists attending a conference in Dunedin.

Results: Males under Community Treatment Orders (CommTOs) outnumbered females 6:4; a high proportion were considered to have a major psychotic disorder; and one fifth remained under a CommTO for more than a year without inpatient care. Among the psychiatrists, there was a high level of agreement that, when used appropriately, the benefits of CommTOs outweigh their coercive impact on the patients; the most strongly supported indicator for use was the promotion of compliance with medication. The rate of use of CommTOs in Otago is remarkably similar to the rate in Victoria, Australia.

Conclusions: Records suggest that a significant proportion of patients under CommTOs are not soon readmitted; and many clinicians in New Zealand consider CommTOs to be a useful strategy for managing the community care of long-term patients with schizophrenia and major affective disorders.
Predictors of Types of Help Provided to People Using Services for Mental Health Problems: An Analysis of the Australian National Survey of Mental Health and Wellbeing
Authors: Parslow Ruth A. , Parslow Ruth A. , Jorm Anthony F.
Published: March 2003

Objective: Using the 1997 National Survey of Mental Health and Wellbeing, this study examined the types of mental health help provided to those Australians who use mental health services. We also sought to identify the extent to which sociodemographic factors, patterns of psychiatric morbidity and type of health practitioner seen were associated with receiving different types of mental health help.

Method: Multiple logistic regressions were undertaken to identify predictor variables associated with receiving information, medication, psychological therapy, practical help and help looking after oneself or one's home. A total of 25 predictor variables provided in the National Survey were considered including age, sex, marital status, labour force status, geographical location, education, psychological symptoms, neuroticism, diagnoses of affective, anxiety and substance-abuse disorders and self-identified depression, anxiety and substance abuse. The type of practitioner seen for mental health reasons was also considered.

Results: Of the sociodemographic factors, age was the most consistently associated with receiving particular types of help. Younger respondents were more likely to have received information whereas older patients reported receiving more medication. As might be expected, the type and severity of psychiatric morbidity and the category of health professional seen were also associated with receiving particular types of mental health help.

Conclusions: There are relatively few predictor variables that suggest possible bias in the types of help provided. Age group of recipient is an important exception. Our findings suggest that older recipients of mental health care are not provided the range of mental health treatments offered younger people who present with similar problems.
Access to Australian Mental Health Care by People from Non-English-Speaking Backgrounds
Authors: Pirkis Jane , Pirkis Jane , Burgess Philip , Meadows Graham , Dunt David
Published: March 2003

Objective: This study aimed to examine access to mental health care for people from non-English-speaking backgrounds relative to that of people from English-speaking backgrounds, in the context of the mental health status of both groups; and to consider whether, if they perceive that they have needs for care, these needs are met.

Method: The study used data from the population-based Australian National Survey of Mental Health and Wellbeing, conducted in 1997.

Results: People from non-English-speaking backgrounds and English-speaking backgrounds were equally likely to experience anxiety disorders and affective disorders, but the former were less likely to experience substance-use disorders and any mental disorder. When those with each disorder type were considered alone, people from non-Englishspeaking backgrounds and English-speaking backgrounds were equally likely to use services for mental health problems. When those with perceived needs for care were considered in isolation, there was no difference between birthplace groups in terms of their likelihood of reporting that their needs were fully met.

Conclusions: The study had several limitations (i.e. lack of detail on specific ethnic groups and exclusion of potential respondents who could not speak English), which mean that these findings should be interpreted with caution. There is a need to build on this populationbased work, by oversampling people from particular non-English speaking communities and ensuring that those who do not speak English are included in population samples. Such work will further clarify the relative ability of people from non-English-speaking backgrounds to access services, and the extent to which their needs are met.
Prevalence of Psychiatric Disorders in New Zealand Prisons: A National Study
Authors: Brinded Philip M.J. , Simpson Alexander I.F. , Laidlaw Tannis M. , Fairley Nigel , Malcolm Fiona
Published: March 2003

Objective: The paper describes the methodologies and results obtained on a large cohort of prison inmates in New Zealand who were screened for psychiatric disorder.

Method: All women and remanded male inmates in New Zealand prisons, and a randomly selected cohort of 18% of sentenced male inmates were interviewed. Interviewers used the Composite International Diagnostic Interview –Automated to establish DSM-IV diagnoses, and the Personality Disorders Questionnaire to identify personality disorder. All prisons in New Zealand were visited.

Results: The results indicate markedly elevated prevalence rates for major mental disorder in the prison population when compared with community samples. This is especially the case for substance misuse, psychotic disorders, major depression, bipolar disorder, obsessive–compulsive disorder and posttraumatic stress disorder. Of particular concern is not only the increased prevalence rates for schizophrenia and related disorders but also the high level of comorbidity with substance misuse disorders demonstrated by this group. While 80.8% of inmates diagnosed with bipolar disorder were receiving psychiatric treatment in the prison, only 46.4% of depressed inmates and 37% of those suffering from psychosis were receiving treatment. Maori inmates were grossly overrepresented in the remand, female and male sentenced inmate population compared with the general population.

Conclusions: A significant increase in provision of mental health services is required to cope with the high number of mentally ill inmates. The level of need demonstrated by this study requires a level of service provision that is quite beyond the capacity of current forensic psychiatry services, Department of Corrections Psychological Services or the prison nursing and medical officers. The elevated rates of common mental disorders argues for the use of improved psychiatric screening instruments, improved assessment and treatment capacities in the prison and an increased number of forensic psychiatric inpatient facilities to care for those psychotic inmates who are too unwell to be treated in the prison.
Routine Outcome Measurement in a Child and Adolescent Mental Health Service: An Evaluation of HoNOSCA
Authors: Brann Peter , Coleman Grahame , Luk Ernest
Published: March 2003

Objective: This paper evaluates a range of properties for a clinician-based instrument designed for routine use in a child and adolescent mental health service (CAMHS).

Method: The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is a new outcome measure with great promise. Case vignettes were used to examine interrater reliability. HoNOSCA was implemented for routine outpatient use by multidisciplinary staff with a return rate of 84%. The 305 ratings obtained at assessment were analysed by age, gender and diagnosis. Asample of 145 paired ratings with a 3-month interval were examined for the measurement of change over time.

Results: Interrater reliability of the total score indicates moderate reliability if absolute scores are used and good reliability if the total score is used for relative comparisons. Most scales have good to very good reliability. The scales discriminated between age and gender in the expected way. HoNOSCA correlated with clinicians’ views of change and was sensitive to change over a 3-month period. The total score seemed a proxy for severity.

Conclusion: Routine outcome instruments must be explored in settings where they will be used and with realistic training. HoNOSCA appears to be of value in routine outcome measurement and although questions remain about reliability and validity, the results strongly support further investigation.
Asystole During Electroconvulsive Therapy: A Case Report
Authors: Tang Wai-Kwong , Ungvari Gabor S.
Published: March 2003

Objective: The objective of the report is to describe a case of asystole lasting for 18 s, which developed after a subconvulsive stimulus during electroconvulsive therapy (ECT) in a patient without pre-existing cardiovascular abnormality. A brief review of the relevant literature is also provided.

Clinical picture: The patient was a 65-year-old Chinese man with a 2-year history of depression and good past medical health. Earlier he had responded well to a course of ECT without adverse effects. This time he presented with low mood, anhedonia, poor appetite and constipation. He did not respond to adequate trials with several antidepressant medications. When a subconvulsive stimulus was administered to determine the seizure threshold, no seizure activity was detected. However, immediately after the stimulus the patient developed an 18-s asystole, followed by bradycardia of 40 beats per minute for 10 s. The bradycardia resolved spontaneously before therapeutic intervention was effected.

Treatment: Intravenous atropine was employed as premedication and suprathreshold stimulus was used in further ECT sessions.

Outcome: Asystole did not recur in the subsequent six ECT sessions.

Conclusion: When proper precautions are taken, asystole does not necessitate the suspension of further ECT sessions but intravenous atropine should be considered as premedication in such cases. Inducing anaesthesia with methohexital, avoiding excessive amounts of succinylcholine and employing suprathreshold stimulus and unilateral electrode placement may further lessen the likelihood of asystole in susceptible cases.
Imaging Normal and Abnormal Brain Development: New Perspectives for Child Psychiatry
Authors: Rapoport Judith L. , Castellanos Xavier F. , Gogate Nitin , Janson Kristin , Kohler Shawn , Nelson Phillip
Published: March 2003

Objective: The availability of non-invasive brain imaging permits the study of normal and abnormal brain development in childhood and adolescence. This paper summarizes current knowledge of brain abnormalities of two conditions, attention deficit hyperactivity disorder (ADHD) and childhood onset schizophrenia (COS), and illustrates how such findings are bringing clinical and preclinical perspectives closer together.

Method: A selected review is presented of the pattern and temporal characteristics of anatomic brain magnetic resonance imaging (MRI) studies in ADHD and COS. These results are discussed in terms of candidate mechanisms suggested by studies in developmental neuroscience.

Results: There are consistent, diagnostically specific patterns of brain abnormality for ADHD and COS. Attention deficit hyperactivity disorder is characterized by a slightly smaller (4%) total brain volume (both white and grey matter), less-consistent abnormalities of the basal ganglia and a striking (15%) decrease in posterior inferior cerebellar vermal volume. These changes do not progress with age. In contrast, patients with COS have smaller brain volume due to a 10% decrease in cortical grey volume. Moreover, in COS there is a progressive loss of regional grey volume particularly in frontal and temporal regions during adolescence.

Conclusions: In ADHD, the developmental pattern suggests an early non-progressive ‘lesion’ involving neurotrophic factors controlling overall brain growth and selected dopamine circuits. In contrast, in COS, which shows progressive grey matter loss, various candidate processes influencing later synaptic and dendritic pruning are suggested by human post-mortem and developmental animal studies.
Child and Adolescent Psychiatry in General Practice
Authors: Garralda Elena
Published: March 2003

Objective: This review discusses the role of general practitioners and primary care health staff in the assessment, treatment and prevention of child and adolescent psychiatric disorders and to consider implications for service delivery.

Method: Literature review. Papers were selected as having an empirical evidence base or as describing and documenting new initiatives in general practice.

Results: A small proportion of about 3% of children present to general practice with behavioural or emotional problems, but psychiatric disorders in the context of somatic presentations are considerably more common. They are probably higher than in the general population reflecting an increased tendency by children with disorders to consult. Recognition by general practitioners is limited and few children with disorders are referred to specialist clinics. However, referrals are mostly appropriate: the more severely affected children in difficult psychosocial circumstances. A number of pilot studies have shown the feasibility and potential usefulness of setting up shifted specialist clinics in primary care and of training primary care doctors and other staff in the recognition or management of child mental heath problems.

Conclusion: Primary care is an appropriate resource to help increase attention to child and adolescent mental health problems. Its potential requires further development and rigorous evaluation. Areas lending themselves to development include: improved medical undergraduate teaching and postgraduate training; suitable information and advice-giving on child mental health problems by the primary care team; the development of specific child and adolescent psychiatric interventions for use in the primary care setting; careful and discriminating development of shifted outpatient clinics for selected child psychiatric disorders; the development of focused protocols for referral to specialist services; further development of mental health promotion clinics in primary care.
Mind Over Matter? I: Philosophical Aspects of the Mind–Brain Problem
Authors: Schimmel Paul
Published: March 2003

Objective: To conceptualize the essence of the mind–body or mind–brain problem as one of metaphysics rather than science, and to propose a formulation of the problem in the context of current scientific knowledge and its limitations.

Method and results: The background and conceptual parameters of the mind–body problem are delineated, and the limitations of brain research in formulating a solution identified. The problem is reformulated and stated in terms of two propositions. These constitute a ‘double aspect theory’.

Conclusions: The problem appears to arise as a consequence of the conceptual limitations of the human mind, and hence remains essentially a metaphysical one. A ‘double aspect theory’ recognizes the essential unity of mind and brain, while remaining consistent with the dualism inherent in human experience.
Traumatic Stress and Ways of Coping of Community Residents Exposed to a Train Disaster
Authors: Chung Man Cheung , Chung Man Cheung , Farmer Steven , Werrett Julie , Easthope Yvette , Chung Catherine
Published: March 2003

Objectives: The aims of this study were to examine the degree of traumatic stress and the coping strategies employed by community residents who lived on both sides of a rail track where a train collision occurred in 1996 in Stafford, UK. The hypothesis was that there would be a high level of traumatic stress and that emotion-focused coping would be the predictor to distress.

Method: This was a cross-sectional survey with a retrospective design in which 66 community residents, who lived between 30 and 100 feet away from the crash site, were interviewed. The study began approximately 7 months after the disaster. The Impact of Event Scale (IES), the General Health Questionnaire (GHQ-28) and the Ways of Coping Checklists (WOC) were administered to the residents.

Results: On the whole, the results did not entirely support the hypothesis. The residents were found to have experienced some intrusive thoughts and avoidance behaviour but their mean scores were significantly lower than those of standardized samples. Thirty-five per cent scored at 4 or above on the GHQ-28. Traumatic stress was predicted by both emotionfocused and problem-focused coping strategies.

Conclusion: Although community residents were not on the train or related to the dead or injured in any way, they could, after being exposed to a train disaster, manifest traumatic stress symptoms which had long-lasting effects. Such traumatic stress was found to be associated with coping strategies of community residents characterized by their efforts to manage or alter the source of stress, and by their efforts to regulate stressful emotions.
Defining Disability in Psychosis: Performance of the Diagnostic Interview for Psychosis-Disability Module (DIP-DIS) in the Australian National Survey of Psychotic Disorders
Authors: Gureje Oye , Herrman Helen , Harvey Carol , Trauer Tom , Jablensky Assen
Published: March 2003

Objective: We aimed to use data from the Australian Survey of Mental Health and Wellbeing to examine the psychometric properties of the Diagnostic Interview for Psychosis-Disability Module (DIP-DIS). The DIP-DIS is a semi-structured questionnaire specially designed to assess disability associated with psychotic disorders.

Method: The psychometric properties of the instrument were determined by examining its inter-rater reliability, internal structure, as well as its criterion and discriminant validities.

Results: Analysis shows: (1) that it can be rated reliably by trained interviewers, (2) that the items are complementary but tap a number of different domains, (3) that four factors account for over 66%% of the variance, and (4) that it is sensitive to differing clinical populations with expected differences in level of disability. Ratings on the DIP-DIS bore significant relationships with a criterion measure of quality of life.

Conclusions: The DIP-DIS has encouraging psychometric properties for cross-sectional assessment of disability and may be useful in future studies of disablement associated with psychosis. Future work should examine its sensitivity to change.
What Cognitive Changes can be Expected with Normal Ageing?
Authors: Christensen Helen
Published: March 2003

Background: This paper briefly summarizes recent evidence on the nature of cognitive decline, the variability in individual responses to ageing, and risk factors known to affect the rate of cognitive decline.

Method: Data from the Canberra Longitudinal Study were used to examine the course and diversity of cognitive decline. The sample consisted of 887 participants aged 70–93 years, who were examined in 1991 and followed up in 1994 and 1998. Data summarizing significant risk factors for cognitive decline were based on a review of 34 studies that examined the following predictors: education, the APOE ∊4 allele, health, activity and blood pressure.

Results: Using data from participants living in the community, there is evidence that cognitive speed and memory performance decline with age, but that crystallized abilities remain largely intact in those who survive for long-term follow-up. Variability in test scores for memory and speed increases with age. There is evidence that poor health, fewer years of education, lower activity, the presence of the APOE ∊4 allele, and blood pressure predict faster cognitive decline.

Conclusions: The diversity in cognitive ageing suggests that more than one process may be operating to produce the observed cognitive outcomes. Education, good health, absence of the APOE ∊4 allele, and activity may be protective of cognitive decline. Preventative strategies for sustaining high intellectual performance in later life may therefore be possible. These findings also speak to the need to extend analysis beyond examining mean changes in cognitive performance to an analysis based on individual differences in change.
Brain Ageing in the New Millennium
Authors: Trollor Julian N , Valenzuela Michael J
Published: March 2003

Objective: This paper examines the current literature pertaining to brain ageing. The objective of this review is to provide an overview of the effects of ageing on brain structure and function and to examine possible mediators of these changes.

Methods: A MEDLINE search was conducted for each area of interest. A selective review was undertaken of relevant articles.

Results: Although fundamental changes in fluid intellectual abilities occur with age, global cognitive decline is not a hallmark of the ageing process. Decline in fluid intellectual ability is paralleled by regionally specific age related changes apparent from both structural and functional neuroimaging studies. The histopathological mediators of these changes do not appear to be reduction in neuronal number, which, with the exception of selected hippocampal regions, remain relatively stable across age. At the molecular level, several mechanisms of age related change have been postulated. Such theoretical models await refinement and may eventually provide a basis for therapy designed to reduce effects of the ageing process. The role of possible protective factors such as ‘brain reserve’, neuroprotective agents and hormonal factors in modifying individual vulnerability to the ageing process has been the focus of a limited number of studies.

Conclusion: Our understanding of the functional and structural changes associated with both healthy and pathological ageing is rapidly gaining in sophistication and complexity. An awareness of the fundamental biological substrates underpinning the ageing process will allow improved insights into vulnerability to neuropsychiatric disease associated with advancing age.
Is Dementia a Mental Illness?
Authors: Ticehurst Stephen
Published: March 2003

Objective: To examine whether dementia is a mental illness.

Method: An analysis of decisions in the Supreme Court of New South Wales that dementia per se was not a mental illness in terms of the 1958 Mental Health Act. A brief review of the extrusion of other diseases from psychiatry.

Results: Concepts in legislation are based on a dichotomy between mental infirmity and mental illness that has changed over time. This change is the result of shifting perceptions about the basis of illness and disease and the causation of mental symptoms. Mental health legislation is aimed as much at social control of feared behaviour as protecting the ill/incompetent. Guardianship legislation offers a more holistic response that better meets the patient's needs and could be extended to supplant mental health legislation.

Conclusions: Dementia's departure from mental illness reflects psychiatry's continuing marginalization within medicine on an outdated mind/body or illness/disease split. This underlines one of the psychiatrist's roles as the vehicle to ‘medically’ explain abnormal behaviour. This model means that behaviour, once explained in terms of disease as opposed to illness, can be moved from the direct responsibility of psychiatry into other areas of medicine. Paradoxically, this suggests that the future of psychiatry will be in a completely different direction from its current biological focus.
Clinical Supervision: A Review of Underlying Concepts and Developments
Authors: Macdonald Joanna
Published: March 2003

Objective: This review examines how psychiatric clinical supervision is represented in the psychiatric literature and its relevance for Australasian psychiatry.

Method: The literature was first identified then reviewed using Medline and Psychlit, manual searches of relevant journals and personal contact with some key workers in Australia and New Zealand.

Results: The predominantly American literature written two to three decades ago reflected the conditions in which psychiatry was practised at that time, largely based in asylums or private offices and informed by the dominant psychoanalytic discourse of that era. These articles, frequently anecdotal and with little empirical support, conceptualized supervision as a developmental process, a syndrome, or a process of identification. They focused substantially on the nature of the relationship between the trainee and supervisor. More recent writers have included trainees’ perspectives. They have identified a number of problems with supervision, including role conflicts, uncertainty about boundaries, lack of supervisory training and lack of effective feedback, and have introduced the concepts of adult learning as highly relevant. These concerns, however, have led to little change to date.

Conclusion: The implementation by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) of new training by-laws provides an opportunity to define the meaning of supervision in the current clinical context, to undertake research to clarify the key elements in the process, and to evaluate different techniques of supervision.
The Assessment of Disability in Patients With Psychotic Disorders: An Application of the ICIDH-2
Authors: Chopra Prem , Couper Jeremy , Herrman Helen
Published: March 2003

Objectives: To describe the application of the International Classification of Functioning and Disability (ICIDH-2) in the assessment of disability in patients with psychotic disorders.

Method: The study was conducted at the inpatient unit of St Vincent's Mental Health Service, Melbourne. Twenty inpatients with psychotic disorders were concurrently assessed by two raters. An evaluation of the feasibility of the instrument was made during this process. Inter-rater agreement was determined using raw agreement percentages and weighted kappas.

Results: The ICIDH-2 provides a comprehensive framework for the description and measurement of disability, including the dimensions of impairments in body structures and functions, activity limitations, participation restrictions and environmental factors. Certain codes are difficult for clinicians to rate because of the subjective manner in which they are defined. Our inter-rater reliability assessment varied across the dimensions from poor to almost perfect agreement.

Conclusions: The ICIDH-2 is potentially useful in the clinical assessment of disability in patients with psychotic disorders although modifications are needed. These could include the use of anchor points defined for each dimension or code to assist the rating process and an alternative rating scale in which categories for rating are more broadly defined. Formal training may also be necessary to enable standardization of the rating process. There is also a need to augment measurements by clinicians with the assessment of the subjective experience of patients using self-rated disability and assessment of quality of life.
Are Psychiatrists Equipped for Management Roles in Mental Health Services?
Authors: Tobin Margaret , Edwards Julie L.
Published: March 2003

Objective: To promote the discussion of leadership and management skills development among psychiatrists in Australia and New Zealand.

Method: A key informant survey of fellows of the Royal Australian and New Zealand College of Psychiatrists was conducted via a semi-structured interview. This canvassed views about leadership and management issues including levels of confidence and needs for additional skills.

Results: There was widespread support for psychiatrists to be in management roles in mental health services; however, on entering management positions, psychiatrists often felt inadequately trained and prepared for their new role. Furthermore, many who had made the transition to management perceived a lack of support from their clinical colleagues. Clinicians appeared to believe that management was not difficult to learn and could be done by any experienced clinician. The provision of short courses and mentoring programmes is the preferred option for most psychiatrists seeking to acquire leadership and management skills.

Conclusions: For psychiatrists to maximize their potential as leaders in Australian and New Zealand mental health services, greater attention to promoting the acquisition of relevant skills throughout training and in the post-fellowship years is required. Psychiatrists need to be supported and encouraged to pursue further education, training and research in this area. Failure to address this issue risks psychiatrists continuing to feel disadvantaged in management roles and hence reluctant to undertake the challenge.
High Prevalence Disorders in Urban and Rural Communities
Authors: Judd Fiona K , Jackson Henry J , Komiti Angela , Murray Greg , Hodgins Gene , Fraser Caitlin
Published: March 2003

Objective: High prevalence disorders (anxiety, depressive and substance use) are generally assumed to be more common in urban than rural dwellers. The aims of this paper are (i) to critically review studies measuring prevalence in rural as opposed to urban location, and (ii) to argue the need to look beyond the ‘quantity’ question to the quality question: how does urban or rural place influence mental health?

Method: A literature review (Medline and PsychLIT) was carried out using the words ‘rural, urban, mental/psychiatric, illness/disorders and prevalence’, as well as a review of relevant papers and publications known to the authors.

Results: Many studies examining urban/rural differences in the rate of high prevalence disorders have been reported. Most use a ‘one size fits all’ definition of urban and rural, which assumes location is the key issue. The majority fail to show the purported difference in prevalence between the two settings. In general, studies have not examined interaction effects, but have simply treated the independent variables as main effects. Available data suggest that a variety of socio-demographic factors are more powerful predictors of difference in prevalence than is the location of residence.

Conclusion: Further studies are required to understand if and how rural or urban place contributes to the development of psychiatric morbidity. These studies should mirror the clinical situation by taking into account a variety of individual and community-based (including urban/rural place) risk factors which may be important determinants of mental health and mental illness, and examining the interaction between them. This may then identify the nature of any differences or what issues are specific to, or especially important, in the rural setting.
Notes Towards a Professional Ethics for Psychiatry
Authors: Radden Jennifer
Published: March 2003

Objective: The uniqueness of psychiatry calls for a unique ethics. By identifying the features distinguishing psychiatry as medical and social practice, this article seeks to illustrate the methodology by which that ethics can be derived and to determine what kind of a framework and focus such an ethics requires.

Method: The author is an analytically trained philosopher and employs the method of conceptual analysis.

Results: At least three characteristics are suggested by the features which taken together constitute psychiatry's uniqueness: an ethical framework accommodating character, a rubric for acknowledging boundary violations, and an emphasis on gender.

Conclusions: The larger task of formulating the substance and details of that unique ethics is the next step.
Mind – Body – Environment: George Engel's Psychoanalytic Approach to Psychosomatic Medicine
Authors: Taylor Graeme J
Published: March 2003

Objective: To provide an overview of George Engel's psychoanalytic approach and contributions to psychosomatic medicine.

Methods: Engel's publications were reviewed to identify his use of psychoanalytic methods and concepts to explore and conceptualize the interrelationships among mind, body and environment in health and disease.

Results: Engel's contributions include an interviewing method for accessing psychological data; insights into the psychobiology of anaclitic depression; a psychosomatic theory concerning the influence of relationships and loss on susceptibility to disease; an elucidation of psychodynamic factors in the pathogenesis of chronic pain; and a longitudinal self-analytic study of anniversary reactions.

Conclusions: Engel successfully bridged the disciplines of medicine, psychiatry, and psychoanalysis, and broadened the scope of psychosomatic research and clinical practice by identifying the role of interpersonal relationships throughout life in regulating mental and bodily processes.
The Neurobehavioural Effects of Kava
Authors: Cairney Sheree , Maruff Paul , Clough Alan R.
Published: March 2003

Objective: This review considers the context in which kava is used, together with its underlying psychopharmacological mechanisms, to investigate the neurobehavioural effects associated with kava use.

Method: We conducted a systematic search using the computerized databases MEDLINE, OVID and PsychLIT for all articles containing any of the following words: kava, kavain, kawa and Piper methysticum. In the opinion of the authors, all articles from this collection containing data that could inform the neurological and cognitive sequelae of kava use were included for the purpose of this review.

Results: The use of kava occurs among indigenous populations in the South Pacific and in northern Australia, while also being used throughout the western world as a herbal medicine. Animal studies show that kava lactones alter neuronal excitation through direct interactions with voltage-dependent ion channels, giving rise to kava's muscle relaxant, anaesthetic, anxiolytic and anticonvulsive properties. Several isolated cases of psychotic and severe dystonic reactions following kava use suggest that kava also has psychoactive properties, yet there is no conclusive evidence that kava interferes with normal cognitive processes.

Conclusions: Kava is effective in the treatment of tension and anxiety. There may be riskfactors for severe motor and psychiatric responses to kava use, although these are not wellunderstood. Given the increasingly widespread use of kava, further investigation is necessary to gain an understanding of its immediate neuropsychiatric effects and long-term cognitive effects.
Screening of Mental Disorders in Asylum-Seekers from Kosovo
Authors: Eytan Ariel , Bischoff Alexandre , Rrustemi Issah , Durieux Sophie , Loutan Louis , Gilbert Muriel , Bovier Patrick A
Published: March 2003

Objective: To determine how the use of trained and ad hoc interpreters during a medical screening interview affects referral to medical and psychiatric care.

Methods: We reviewed 319 structured interviews conducted by nurses with asylum-seekers from Kosovo during a systematic medical screening at time of entry, consisting of questions about health conditions, past exposure to traumatic events, and posttraumatic symptoms.

Results: The majority (72%) of asylum-seekers were male and the median age was 24 years. Forty-eight per cent were single and 55% declared having relatives already living in Switzerland. Screening interviews resulted in 36% of asylum-seekers being referred to a general practitioner and 6% to a psychiatrist. Relatives served as ad hoc interpreters in 18% of interviews and trained interpreters in 16%. The detection of traumatic events and psychological symptoms significantly improved when trained interpreters were present (traumatic events: no interpreters 55%, ad hoc interpreters 46%, trained interpreters 77%, P = 003; psychological symptoms: 12%, 14%, 33%, respectively, P = 0.001). Adjusted for traumatic events and posttraumatic symptoms, referral to medical care was more frequent when relatives served as ad hoc interpreter (OR: 1.9, 95% CI 1.0–3.6), while interviews conducted with trained interpreters were not significantly associated with increased referral to medical (OR: 1.3, 95% CI 0.6–2.6) and psychiatric care (OR: 2.3, 95% CI 0.7–7.0).

Conclusion: The use of trained interpreters improved the quality of communication, the detection of severe symptoms and traumatic situations, and facilitated therapeutic orientation of traumatized asylum-seekers.
Are Tryptophan and 5-Hydroxytryptophan Effective Treatments for Depression? A Meta-Analysis
Authors: Shaw Kelly , Turner Jane , Del Mar Christopher
Published: March 2003

Objective: To review the literature regarding the effectiveness of 5-hydroxytryptophan (5-HT) and L-tryptophan in the treatment of unipolar depression.

Methods: A systematic review of the literature from 1966 to 2000 using the search terms ‘tryptophan’, 5-hydroxytryptophan ′, ‘5-HTP’, ‘5-HT’ and ‘depression’. We extracted and grouped data for meta-analysis by pooling odds ratios (OR) and relative risks where possible.

Results: One hundred and eight studies were located of which only two studies, one of 5-HT and one of L-tryptophan, with a total of 64 patients met sufficient quality criteria to be included. These studies suggest 5-HT and L-tryptophan are better than placebo at alleviating depression (Peto OR = 4.1, 95% CI = 1.3–13.2). However, the small size of the studies, and the large number of inadmissible, poorly executed studies, casts doubt on the result from potential publication bias, and suggests that they are insufficiently evaluated to assess their effectiveness.

Conclusions: A large body of evidence was subjected to very basic criteria for assessing reliability and validity, and was found to largely be of insufficient quality to inform clinical practice. More well-designed studies are urgently required to enable an assessment of what may be an effective class of agents.