bluuebunny/crossref_metadata_2025 huggingface dataset:
Reasons for Cannabis Use: Patients with Schizophrenia Versus Matched Healthy Controls
Authors: Schaub Michael , Fanghaenel Kyra , Stohler Rudolf
Published: December 2009

Objective: The aim of the present study was to compare self-reported reasons for cannabis use in patients with schizophrenia with those of matched healthy controls.

Methods: Thirty-six stable outpatients with schizophrenia treated with atypical antipsychotics and 36 matched controls were included. They completed a questionnaire exploring 15 common reasons for use, established in other studies.

Results: Overall, patients more frequently agreed with the proposed reasons for use than controls. More specifically, patients with schizophrenia more often stated that they consumed cannabis to fight boredom and to ease social contacts.

Conclusions: Stable schizophrenia outpatients treated with atypicals do not use cannabis in order to reduce side-effects of medication or symptoms of their disorder. Rather, they used cannabis to overcome a feeling of social exclusion. Therefore, enhancing social participation of cannabis-using patients might be an effective strategy for reducing consumption.
Evaluation of a Resilience-Based Intervention for Children of Parents With Mental Illness
Authors: Fraser Eliza , Pakenham Kenneth I.
Published: December 2009

Objective: The purpose of the present study was to evaluate the effectiveness of a group psychosocial intervention for children (aged 12–18) of a parent with mental illness (copmi).

Method: A treatment and waitlist-control design study with pre- and post-treatment, and 8 week follow up, was carried out. The treatment (n = 27) and control (n=17) groups were compared on three groups of dependent variables: intervention targets (mental health literacy, connectedness, coping strategies), adjustment (depression, life satisfaction, prosocial behaviour, emotional/behavioural difficulties), and caregiving experiences.

Results: Group comparisons failed to show statistically significant intervention effects, but reliable clinical change analyses suggested that compared to the control group, more intervention participants had clinically significant improvements in mental health literacy, depression, and life satisfaction. These treatment gains were maintained 8 weeks after treatment. Participant satisfaction data supported these treatment gains.

Conclusions: Given study limitations and the modest support for intervention effectiveness it is important that this and other similar interventions should continue to be revised and undergo rigorous evaluation.
Psychological Distress and Its Demographic Associations in an Immigrant Population: Findings from the Israeli National Health Survey
Authors: Ponizovsky Alexander M. , Radomislensky Ira , Grinshpoon Alexander
Published: December 2009

Objective: This study compared psychological distress and its sociodemographic correlates in immigrant and veteran Israeli populations using data from the Israel National Mental Health Survey, the first nationwide study designed to estimate the prevalence rates of psychological distress and mental disorders in the Israeli adult population, which was carried out in 2003–2004, in conjunction with the World Mental Health survey initiative.

Method: Personal interviews were held with 3906 veteran Israelis, 845 immigrants from the former Soviet Union (FSU) and 107 immigrants from other countries (all the immigrants immigrated after 1989). Psychological distress was measured on the General Health Questionnaire-12.

Results: Psychological distress among FSU immigrants was significantly higher than among veteran Israelis and immigrants from elsewhere. FSU immigrants were almost twice as likely to report severe psychological distress. Factors associated with psychological distress were female gender, age above 50, being divorced/widowed, being secular, having higher education and being either unemployed or ‘not in workforce’.

Conclusion: The results support the acculturation stress hypothesis as an explanation for psychological distress in immigrants only in immigrants from the FSU, indicating that policymakers should plan services and prevention programmes differentially for different immigrant populations.
Growth in Young Adults Who Screen Positive for Non-Affective Psychosis: Birth Cohort Study
Authors: Welham Joy , Scott James , Williams Gail , Najman Jake , O'Callaghan Michael , McGrath John
Published: December 2009

Objective: While birth cohort studies have shown that individuals who develop non-affective psychosis show subtle deviations in cognitive and behavioural developmental trajectories, there is less evidence about deviations in physical growth in these individuals. The purpose of the present study was to examine the association between behaviour and growth and maturation from infancy, through childhood and adolescence to early adulthood and the development of non-affective psychosis in young adults.

Method: Based on a birth cohort of 3801 young adults, weight and length/height were examined at birth and at years 5, 14 and 21, together with pubertal maturation at year 14. Behavioural measures taken at years 5 and 14 were also examined. Screen-positive non-affective psychosis (SP-NAP) was assessed at year 21 using Composite International Diagnostic Interview, or a self-report checklist. The association between the behavioural and growth measures at birth and at years 5, 14 and 21, and SP-NAP at year 21 was examined using logistic regression.

Results: There were 60 subjects in the cohort who were classified as having SP-NAP. In female subjects SP-NAP was significantly associated with being longer with a larger head circumference at birth, and less likely to be associated with being shorter at 21 years, with consistent trend associations for height between. There were no differences for weight. There was no significant association between the variables of interest in male subjects or for the total group. There was also no significant association between pubertal development at age 14 and risk of SP-NAP in either sex.

Conclusions: Unlike developmental behavioural problems, which showed continuity from childhood through adolescence, SP-NAP was not associated with marked deviations in growth trajectory for male subjects, but the present data suggests that female subjects with SP-NAP had an altered skeletal growth trajectory.
From Consultation–Liaison Psychiatry to Integrated Care for Multiple and Complex Needs
Authors: Smith Graeme C.
Published: December 2009

The aim of the present study was to review the ways in which contemporary medicine addresses physical/psychiatric multimorbidity, to review the underlying concepts and methodologies used, and to propose a novel approach that may help consultation–liaison psychiatry (CLP) position itself better in the health-care field. A Medline search of the terms ‘consultation-liaison psychiatry’, ‘integrated care’, ‘quality assurance’ and ‘qualitative methodology’, was complemented by study of the literature on complexity theory and by discussions with colleagues in both the health science and sociology fields. There is a growing realization that presentation with multimorbidity of both physical and psychiatric disorders is the norm. Other health-care disciplines have responded quickly to meeting the multiple and complex needs of such patients, attracting funding to an extent that CLP has been unable to achieve. Uncritical application, however, of integrated care technology based on evidence from randomized controlled trials has produced disappointing results. There is a growing realization that such quantitative methods need to be complemented by in-depth exploration using non-traditional methods including qualitative ones, and drawing on complexity theory. The Cochrane Collaboration is exploring this. As CLP and other medical and health-care disciplines face the challenge of patients with multimorbidity, they need to find acceptable answers to the question of what works for whom in what context for patients with multiple and complex needs. CLP can contribute its rich experience in the qualitative approaches that will be needed in research addressing this question, but needs help from other disciplines to refine its techniques so that its contributions are considered valid. The context for implementing effective interventions derived from such studies will in future be that of transdisciplinary teams whose mode of working is empirically based and transparent. CLP is well placed by dint of its psychodynamic and systems theory roots to provide leadership in this transformation in health-care delivery.
Complex Post-Traumatic Stress Disorder in Patients with Somatization Disorder
Authors: Spitzer Carsten , Barnow Sven , Wingenfeld Katja , Rose Matthias , Löwe Bernd , Grabe Hans Joergen
Published: December 2009

Objective: Given the association between severe childhood trauma, adult somatization and complex post-traumatic stress disorder (cPTSD), the purpose of the present paper was to assess this syndrome and its clinical correlates in patients with somatization disorder (SD).

Methods: A total of 28 patients (82% women, mean age = 41.7±10.1 years) meeting DSM-IV criteria for SD as confirmed by the Structured Clinical Interview for DSM-IV, Axis I were compared to 28 age- and gender-matched patients with major depression, but without a lifetime diagnosis of SD. They completed the Structured Interview for Disorders of Extreme Stress, the Brief Symptom Inventory, the Inventory of Interpersonal Problems–Circumplex Scales, and the SF-36 Health Survey.

Results: Compared to the control group, SD patients had higher risks for current and lifetime diagnoses of cPTSD (odds ratio (OR) = 15.0, 95% confidence interval (CI) = 1.76–127.54; and OR = 8.33, 95%CI = 2.04–34.07, respectively). SD subjects with cPTSD had more psychological distress, more interpersonal problems and worse psychosocial functioning than those without the syndrome.

Conclusion: The concept of complex PTSD may hold clinical utility when applied to SD patients because it identifies a distinct subgroup characterized by severe psychosocial impairment. The diagnostic and therapeutic implications of the present findings are discussed.
Preliminary Data on the Efficacy of the Incredible Years Basic Parent Programme in New Zealand
Authors: Fergusson David , Stanley Lesley , Horwood L. John
Published: December 2009

Objective: The aim of the present study was to conduct a preliminary examination of the efficacy and cultural acceptability of the Incredible Years Basic Parent Programme (IYBPP Au: (abstract objective) please confirm change of IYBPP definition to ‘Incredible Years Basic) using data provided by the New Zealand Ministry of Education.

Methods: Data were gathered on a series of 214 parents attending IYBPP for at least nine sessions. These data included (i) pre-test and post-test T scores on the Eyberg intensity and problem scales; (ii) pre-test and post-test scores on the parent version of the child Social Competence Scale; and (iii) parent satisfaction ratings.

Results: Pre-test–post-test comparisons indicated significant improvements in behaviour and social competence scores (p<0.001). Effect sizes ranged from 0.50 to 0.77. Effects were similar for Maori and non-Maori subjects. Parental satisfaction with the programme was high, with Maori and non-Maori parents reporting similar levels of satisfaction.

Conclusions: These preliminary data are consistent with the view that IYBPP is an effective and culturally appropriate programme. There is a need for a more comprehensive evaluation using pilot research to assess the fidelity of programme delivery and randomized trials to assess programme efficacy.
Association Between Magnesium Intake and Depression and Anxiety in Community-Dwelling Adults: The Hordaland Health Study
Authors: Jacka Felice N. , Overland Simon , Stewart Robert , Tell Grethe S. , Bjelland Ingvar , Mykletun Arnstein
Published: December 2009

Objective: Systemic inflammation is associated with both the dietary intake of magnesium, and depression. Limited experimental and clinical data suggest an association between magnesium and depression. Thus, there are reasons to consider dietary magnesium as a variable of interest in depressive disorders. The aim of the present study was to examine the association between magnesium intake and depression and anxiety in a large sample of community-dwelling men and women. This sample consisted of 5708 individuals aged 46–49 or 70–74 years who participated in the Hordaland Health Study in Western Norway.

Methods: Symptoms of depression and anxiety were self-reported using the Hospital Anxiety and Depression Scale, and magnesium intake was assessed using a comprehensive food frequency questionnaire.

Results: There was an inverse association between standardized energy-adjusted magnesium intake and standardized depression scores that was not confounded by age, gender, body habitus or blood pressure (β=−0.16, 95% confidence interval (CI)=−0.22 to −0.11). The association was attenuated after adjustment for socioeconomic and lifestyle variables, but remained statistically significant (β=−0.11, 95%CI=−0.16 to −0.05). Standardized magnesium intake was also related to case-level depression (odds ratio (OR)=0.70, 95%CI=0.56–0.88), although the association was attenuated when adjusted for socioeconomic and lifestyle factors (OR=0.86, 95%CI=0.69–1.08). The inverse relationship between magnesium intake and score and case-level anxiety was weaker and not statistically significant in the fully adjusted models.

Conclusion: The hypothesis that magnesium intake is related to depression in the community is supported by the present findings. These findings may have public health and treatment implications.
Are Chronic Fatigue and Chronic Fatigue Syndrome Valid Clinical Entities Across Countries and Health-Care Settings?
Authors: Hickie Ian , Davenport Tracey , Vernon Suzanne D. , Nisenbaum Rosane , Reeves William C. , Hadzi-Pavlovic Dusan , Lloyd Andrew ,   the International Chronic Fatigue Syndrome Study Group
Published: December 2009

Objective: The validity of the diagnosis of chronic fatigue syndrome and related chronic fatigue states remains controversial, particularly in psychiatry. This project utilized international epidemiological and clinical research data to test construct validity across diagnostic categories, health-care settings and countries. Relevant demographic, symptom and diagnostic data were obtained from 33 studies in 21 countries. The subjects had fatigue lasting 1–6 months (prolonged fatigue), or >6 months (chronic fatigue), or met diagnostic criteria for chronic fatigue syndrome.

Method: Common symptom domains were derived by factor analytic techniques. Mean scores on each symptom factor were compared across diagnostic categories, health-care settings and countries.

Results: Data were obtained on 37 724 subjects (n = 20 845 female, 57%), including from population-based studies (n = 15 749, 42%), studies in primary care (n = 19 472, 52%), and secondary or specialist tertiary referral clinics (n = 2503, 7%). The sample included 2013 subjects with chronic fatigue, and 1958 with chronic fatigue syndrome. A five-factor model of the key symptom domains was preferred (‘musculoskeletal pain/fatigue’, ‘neurocognitive difficulties’, ‘inflammation’, ‘sleep disturbance/fatigue’ and ‘mood disturbance’) and was comparable across subject groups and settings. Although the core symptom profiles were similar, some differences in symptoms were observed across diagnostic categories, health-care settings and between countries.

Conclusions: The construct validity of chronic fatigue and chronic fatigue syndrome is supported by an empirically derived factor structure from existing international datasets.
Adult Attachment Styles in Panic Disorder with and Without Comorbid Adult Separation Anxiety Disorder
Authors: Manicavasagar Vijaya , Silove Derrick , Marnane Claire , Wagner Renate
Published: December 2009

Objective: Attachment theory suggests that anxious attachment styles are associated with risk to psychiatric disorder, especially anxiety disorders. Separation anxiety would appear to be a core form of anxiety that is associated with anxious attachment. Nevertheless, as yet no research has examined the relationship of attachment styles to adult separation anxiety disorder, a condition that has only recently been fully recognized.

Method: The Attachment Style Questionnaire was used to examine attachment styles among 83 consecutive anxiety clinic patients diagnosed with panic disorder with agoraphobia and those re-assigned from that category to adult separation anxiety disorder.

Results: Dimensional associations showed strong correlations with scales measuring anxious attachment and separation anxiety. Patients assigned to the separation anxiety group scored significantly higher than those in the panic disorder group on the scales of Need for Approval and Preoccupation with Relationships.

Conclusions: The findings finally dispel the notion that separation anxiety and anxious attachment are relevant to panic disorder with agoraphobia, suggesting instead that that constellation is confined to a separate group, namely that of adult separation anxiety disorder. Possible implications for treatment are considered.
Coronary Heart Disease Risk Reduction Intervention Among Overweight Smokers with a Psychotic Disorder: Pilot Trial
Authors: Baker Amanda , Richmond Robyn , Castle David , Kulkarni Jayashri , Kay-Lambkin Frances , Sakrouge Rebecca , Filia Sacha , Lewin Terry J.
Published: December 2009

Objective: The aim of the present pilot study was to test the feasibility and short-term impact of a multi-component risk factor intervention for reducing (i) coronary heart disease (CHD) risk; (ii) smoking; and (iii) weight among smokers with psychosis. Secondary dependent variables included physical activity, unhealthy eating, substance use, psychiatric symptomatology, treatment retention, general functioning, and quality of life.

Method: This was a feasibility study utilizing a pre–post-treatment design with no control group (n=43). All participants provided written informed consent and were assessed before treatment and again a mean of 19.6weeks later. The treatment consisted of nine individual 1h sessions of motivational interviewing and cognitive behaviour therapy plus nicotine replacement therapy, in addition to treatment as usual. Research assistants who had not been involved in the delivery of the treatment programme conducted post-treatment assessments.

Results: The intervention was associated with significant reductions in CHD risk scores, smoking and weight. A significant improvement was also reported in level of moderate physical activity, and a small change in the unhealthy eating index was reported. No improvement in biological measures (cholesterol and blood pressure) was evident.

Conclusions: A multi-component CHD risk factor intervention among smokers with psychosis appears to be feasible and effective in the short-term. A randomized controlled trial replicating and extending these findings is warranted.
Prevalence and Predictors of Suicide Attempt in an Incidence Cohort of 661 Young People with First-Episode Psychosis
Authors: Robinson Jo , Cotton Sue , Conus Philippe , Graf Schimmelmann Benno , McGorry Patrick , Lambert Martin
Published: December 2009

Objectives: Studies investigating suicidal behaviour in psychosis rarely focus on incidence cohorts of first-episode patients. This is important, because patients who refuse study participation have higher rates of comorbid substance use disorders and longer duration of untreated psychosis as well as worse course illness, variables potentially linked to higher prevalence of suicidal behaviour. The aims of the present study were therefore to examine the prevalence and predictors of suicide and suicide attempt before and during the first 18–24months of treatment.

Method: A retrospective file audit of 661 patients was carried out.

Results: Six patients (0.9%) died by suicide, 93 (14.3%) attempted suicide prior to entry, and 57 (8.7%) did so during treatment. Predictors of suicide attempt were: previous attempt (odds ratio (OR)=45.54, 95% confidence interval (CI)=9.46–219.15), sexual abuse (OR=8.46, 95%CI=1.88–38.03), comorbid polysubstance (OR=13.63, 95%CI=2.58–71.99), greater insight (OR=0.17, 95%CI=0.06–0.49), lower baseline Global Assessment of Functioning Scale and Scale of Occupational and Functional Assessment score (OR=0.96, 95%CI=0.62–0.91; OR=0.98, 95%CI=0.95–0.99), and longer time in treatment (OR=1.05, 95%CI=1.03–1.08).

Conclusions: The prevalence of suicidal behaviour was high, indicating that suicidal behaviour in incidence populations is higher than in non-epidemiological cohorts of first-episode patients. The rate of repetition of suicide attempt among the sample, however, was lower than expected, suggesting that specialist services can play a role in reducing suicide risk.
Risk Factors for Deliberate Self-Harm and Completed Suicide in Young Chinese People with Schizophrenia
Authors: Lui Sai-Yu
Published: December 2009

Objectives: Suicide is best conceptualized as a risk rather than all-or-none behaviour. In the literature the majority of suicide studies have adopted a cross-sectional case–control design. Longitudinal design should be used in order to account for the time dimension of variables. The aim of the present study was therefore to identify risk factors and calculate hazard ratios for suicidal behaviour in young Chinese people suffering from schizophrenia.

Methods: Using a retrospective cohort design, 234 subjects with schizophrenia in the Early Assessment Service for Young People with Psychosis service were recruited and data retrieved from case notes and discharge summaries. Cox proportional hazard modelling was used to analyse potential risk factors.

Results: Traditional risk factors were confirmed to be applicable to the present subjects. Continuing medication was a protective factor while hallucination was a risk factor for suicide.

Conclusion: The limitations of the present study were due to its retrospective design, reliance on past records, and the large Type II error. A prospective cohort study design is recommended for future research in this area.
Effect of Augmentatory Repetitive Transcranial Magnetic Stimulation on Auditory Hallucinations in Schizophrenia: Randomized Controlled Study
Authors: Bagati Dhruv , Nizamie Shamshul Haque , Prakash Ravi
Published: December 2009

Objective: Auditory hallucinations are a characteristic symptom of schizophrenia and are usually resistant to treatment. The present study was conducted to further support the findings that repetitive transcranial magnetic stimulation (rTMS) reduces auditory hallucinations, and to evaluate the effect of low-frequency rTMS on auditory hallucinations in schizophrenia.

Methods: Forty schizophrenia patients were included in the study. Patients were randomized to control or experimental group. Low-frequency rTMS (1 Hz, 90% motor threshold) was applied to the left temporoparietal cortex of patients in the experimental group for 10 days following the standard guidelines as an addition to antipsychotic treatment. The control group received only antipsychotics. The changes in the psychopathology scores for the auditory hallucinations were recorded using auditory hallucination recording scale. The rater was blind to the intervention procedure.

Results: A significant improvement was found in auditory hallucinations in the experimental group as compared to the control group.

Conclusion: Left temporoparietal rTMS warrants further study as an intervention for auditory hallucinations. Data suggest that this intervention selectively alters neurobiological factors determining frequency of these hallucinations.
Is Suicidality Distinguishable from Depression? Evidence from a Community-Based Sample
Authors: Fairweather-Schmidt A. Kate , Anstey Kaarin J. , Mackinnon Andrew J.
Published: December 2009

Objective: Suicidal behaviour is often considered in the context of depression. Taking an empirical, dimensional and population-based approach, this investigation examines two issues: first, whether it is justifiable to regard suicidality as a symptom of depression or an independent construct. Second, although suicidal behaviour has been shown to decline with increasing age and differ across gender, little is known about the stability of the underlying construct across the lifespan and between genders.

Method: Data were derived from a community-based sample consisting of 7485 people aged 20–24, 40–44 or 60–64 years. Confirmatory factor analysis was used to assess the adequacy of model fit and measurement invariance across gender and then age groups.

Results: The data fitted a two-factor model of depression and suicidality better than a single-factor model. Multi-group analysis indicated strict measurement invariance for both gender and age groups, indicating no significant differences between groups in measurement model fit.

Conclusions: These analyses establish that suicidality is distinguishable from depression, although the factors are substantially correlated. Results suggest that the underlying factorial relationship between suicidality and depression appears not to vary considerably between genders or across cohorts aged 20–24, 40–44 and 60–64 years. Finally, the analyses also highlight the necessity of inventories with scales identifying symptoms of suicidality independent of depression symptoms.
Citation Bias in Reported Smoking Prevalence in People with Schizophrenia
Authors: Chapman Simon , Ragg Mark , McGeechan Kevin
Published: December 2009

Objective: A meta-analysis of 42 studies on tobacco smoking among schizophrenia subjects found an average smoking prevalence of 62% (range=14–88%). Statements are common, however, in the research literature and the media that between 80% and 90% of people with schizophrenia smoke. The purpose of the present paper was therefore to determine if citation bias exists in the over-citation and reportage of studies finding high rates of smoking prevalence in schizophrenia subjects.

Methods: Two hypotheses were tested: (i) that studies on the prevalence of smoking in people with schizophrenia reporting high smoking rates would be cited more often than studies reporting lower rates; and (ii) that statements about smoking rates among schizophrenic people on the Internet would report very high rates more often than more realistic, less dramatic rates.

Results: A 10% increase in reported prevalence of smoking was associated with a 61% (95% confidence interval (CI)=30–98%) increase in citation rate. Journal impact factor (IF) was significantly associated with citation rate (p=0.001) but the country in which a study was carried out did not have an effect (p=0.90). After adjusting for IF, a 10% increase in prevalence of smoking was associated with a 28% increase (95%CI=1–62%) in citation rate. This bias is mirrored on the Internet, where statements abound about uncommonly highly rates of smoking by people with schizophrenia.

Conclusions: Studies reporting very high prevalence of smoking among people with schizophrenia are cited more often than those studies reporting a low prevalence, a result consistent with citation bias. This citation bias probably contributes to the misinformation available on the Internet, and may have adverse policy and clinical implications.
Vicarious Trauma, Secondary Traumatic Stress or Simply Burnout? Effect of Trauma Therapy on Mental Health Professionals
Authors: Devilly Grant J. , Wright Renee , Varker Tracey
Published: December 2009

Objectives: The aim of the present study was to perform an assessment for secondary traumatic stress (STS), vicarious trauma (VT) and workplace burnout for Australian mental health professionals involved in clinical practice.

Methods: Recruited directly by mail, randomly selected participants were invited to submit a questionnaire by post or online. Of the 480 participants contacted, 152 mental health professionals completed the questionnaire, which contained measures of STS, VT and burnout.

Results: Exposure to patients’ traumatic material did not affect STS, VT or burnout, contradicting the theory of the originators of STS and VT. Rather, it was found that work-related stressors best predicted therapist distress.

Conclusions: These findings have significant implications for the direction of research and theory development in traumatic stress studies, calling into question the existence of secondary trauma-related phenomena and enterprises aimed at treating the consultants.
Short-Term Outcomes of Mothers and Newborn Infants with Comorbid Psychiatric Disorders and Drug Dependency
Authors: Oei Ju Lee , Abdel-Latif Mohamed E , Craig Fiona , Kee Aivy , Austin Marie-Paule , Lui Kei ,   on behalf of the NSW and ACT NAS Epidemiology Group
Published: December 2009

Objectives: The aim of the present study was to determine the characteristics and short-term outcomes of mother–infant pairs with comorbid drug dependency and psychiatric disorders.

Methods: A population-based retrospective chart review was carried out of 879 drug-dependent mother and infant pairs in New South Wales (NSW) and the Australian Capital Territory (ACT) who delivered between 1 January and 31 December 2004.

Results: Psychiatric comorbidity (dual diagnosis, DD) was identified in 396 (45%) of the 879 drug-dependent women. DSM-IV depression (79%), followed by anxiety (20%), was most prevalent. DD women were more likely to use amphetamines (29% vs 18%, p < 0.05), less likely to use opiates (42% vs 51%, p < 0.05) and to have had no antenatal care (24% vs 8%, p < 0.05). They also had more previous pregnancies (4, range = 2–5 vs 3, range = 2–5, p < 0.05) and domestic violence (29% vs 14%, p < 0.05) was more common. DD infants were less likely to be admitted to a nursery (47% vs 55%, p < 0.05). Withdrawal scores were similar (maximum median Finnegan scores = 4 (interquartile range = 3–8) vs 10 (interquartile range = 7–12, p = 0.30) but fewer needed withdrawal medication (19% vs 27%, p < 0.05). Maternal psychotropic agents did not worsen the severity of neonatal withdrawal.

Conclusions: Psychiatric comorbidity, especially depression, is common and affects almost half of drug-using mothers. Antenatal care, drug use and social outcomes are worse for DD mothers and their infants. It is recommended that all drug-using women be assessed antenatally for psychosocial disorders so that timely mental health intervention can be offered, if required.
Changes in Use of Psychostimulant Medication for ADHD in South Australia (1990–2006)
Authors: Prosser Brenton , Reid Robert
Published: December 2009

Objective: The aim of the present study was to undertake a retrospective analysis of archival data on psychostimulant prescriptions from South Australia for the periods 1990–2000 and 2001–2006 for 7849 youths aged from birth to 18 years.

Method: A person-based data set was used to assess: (i) rate of new prescriptions by age group; (ii) demographic characteristics (age of psychostimulant start, male: female ratio); (iii) duration of psychostimulant use; and (iv) geographic variation in psychostimulant prescription.

Results: Four major findings were observed: (i) the rate of new prescriptions was highly variable both for 1990–2000 and 2000–2006; (ii) demographic characteristics such as start age and male:female ratio declined over both periods; (iii) the duration of psychostimulant use was approximately 2.5 years for 1990–2000 and 2.0 years for 2000–2006; and (iv) there was geographic variation in both periods with a significant correlation between socioeconomic status and prescription rate per region.

Conclusions: The patterns of psychostimulant use in Australia closely parallel the USA. Physicians’ prescribing practice may be extremely volatile. Duration of psychostimulant treatment should receive increased attention. There is pronounced geographic variability in prescription rates, which may be related to socioeconomic status.
Criminal Law as it Pertains to ‘Mentally Incompetent Defendants’: A McNaughton Rule in the Light of Cognitive Neuroscience
Authors: Bennett Maxwell
Published: December 2009

The McNaughton rules for determining whether a person can be successfully defended on the grounds of mental incompetence were determined by a committee of the House of Lords in 1843. They arose as a consequence of the trial of Daniel McNaughton for the killing of Prime Minister Sir Robert Peel's secretary. In retrospect it is clear that McNaughton suffered from schizophrenia. The successful defence of McNaughton on the grounds of mental incompetence by his advocate Sir Alexander Cockburn involved a profound shift in the criteria for such a defence, and was largely based on the then recently published ‘scientific’ thesis of the great US psychiatrist Isaac Ray, entitled ‘A treatise on the medical jurisprudence of insanity’. Subsequent discussion of this defence in the House of Lords led to the McNaughton rules, still the basis of the defence of mental incompetence in the courts of much of the English-speaking world. This essay argues that the rules need to be reconsidered in the light of the discoveries of cognitive neuroscience made during the 160 years since Ray's treatise. It is shown, for instance, how the conflation of ‘the power of self-control’ with ‘irresistible impulse’ by Cockburn is not supported by cognitive neuroscience because these are separate capacities requiring normal activity in distinct brain structures for their expression. In this way cognitive neuroscience assists in distinguishing between different capacities. It is further shown that failure of appropriate restraint in the expression of a capacity can be related to failure of synapses in particular parts of the brain. This raises the question as to what level of synaptic loss will the legislature and the courts rule as sufficient for a subject to be no longer held responsible for their lack of restraint.
Internet-Based Course for the Management of Stress for Junior High Schools
Authors: Vliet Helen Van , Andrews Gavin
Published: December 2009

Objective: To determine the feasibility and efficacy of a Web-based stress management programme for schools.

Method: A six-lesson Web-based programme was constructed in collaboration with the schools. It was implemented across Year 8 in six schools (464 students). Students completed measures of knowledge, perceived competence, and coping behaviours, prior to the programme; at the conclusion of the last lesson; and 3 months later. Well-being and distress were measured prior to each lesson.

Results: Input from schools into the development of the programme was very valuable. Knowledge about stress improved after the six lessons and students reported that support seeking coping had increased and avoidance behaviour decreased. Scores on measures of distress went down and well-being scores rose. Seventy-nine per cent of the students completed five or more lessons.

Conclusions: Web-based curriculum-consistent education in mental health is feasible and efficacious at the level expected from a brief universal intervention.
Early Intervention for Adolescents with Borderline Personality Disorder: Quasi-Experimental Comparison with Treatment as Usual
Authors: Chanen Andrew M. , Jackson Henry J. , McCutcheon Louise K. , Jovev Martina , Dudgeon Paul , Yuen Hok Pan , Germano Dominic , Nistico Helen , McDougall Emma , Weinstein Caroline , Clarkson Verity , McGorry Patrick D.
Published: December 2009

Objective: The aim of the present study was to compare the effectiveness of specialized team-based early intervention for borderline personality disorder (BPD) with treatment as usual.

Method: In a quasi-experimental design, 32 outpatients who received historical treatment as usual (H-TAU) were compared with 78 participants from a recently published randomized controlled trial of cognitive analytic therapy (CAT; n = 41) versus manualized good clinical care (GCC; n = 37), conducted in a specialized early intervention service for BPD (the Helping Young People Early (HYPE) programme). All participants were 15–18-year-old outpatients who fulfilled 2–9 DSM-IV BPD criteria. It was predicted that, compared with H-TAU, HYPE + GCC and HYPE + CAT would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24months.

Results: At 24month follow up: (i) HYPE + CAT had lower standardized levels of, and a significantly faster standardized rate of improvement in, internalizing and externalizing psychopathology, compared with H-TAU; and (ii) HYPE + GCC had lower standardized levels of internalizing psychopathology and a faster rate of improvement in global functioning than H-TAU. HYPE + CAT yielded the greatest median improvement on the four continuous outcome measures over 24months. No adverse effects were shown with any of the treatments.

Conclusions: Specialized early intervention for subsyndromal or full-syndrome BPD is more effective than TAU, with HYPE + CAT being the most effective intervention. Reform of existing services using the HYPE model might yield substantial improvements in patient outcomes.
Tracking Depression-Related Mental Health Literacy Across South Australia: A Decade of Change
Authors: Goldney Robert D. , Dunn Kirsten I. , Grande Eleonora Dal , Crabb Shona , Taylor Anne
Published: December 2009

Objective: The aim of the present study was to measure and compare levels of depression-related mental health literacy in South Australia across three points in time: 1998, 2004, and 2008.

Method: Participants were those recruited for the 1998, 2004, and 2008 South Australian Health Omnibus Surveys. Comparisons were made across overall levels of depression-related mental health literacy as well as between responses to independent questionnaire items.

Results: A significant improvement was found in the overall measure of depression-related mental health literacy between 1998 and 2004 and this was consolidated in 2008. Some discrete changes in literacy were found between 2004 and 2008, with improvements recorded across some demographic groups and in participants’ ability to accurately classify symptoms. Participants in 2008, however, were significantly less likely to endorse providers or treatments as ‘helpful’ than in 2004.

Conclusions: Although knowledge and understanding of depression have improved significantly and stabilized since 1998, patient confidence in both mental health therapists and treatment options fell between 2004 and 2008, although it is still greater than in 1998.
Crime Victimization of Persons with Severe Mental Illness in Taiwan
Authors: Hsu Chien-Chi , Sheu Chuen-Jim , Liu Shen-Ing , Sun Yi-Wen , Wu Shu-I , Lin Ying
Published: December 2009

Objective: Research in the West has shown that persons with severe mental illness are easy targets of criminals. The aim of the present study was to investigate the types, incidence, and prevalence of crime victimization and its demographic and clinical correlates among persons with severe mental illness in Taiwan.

Methods: Participants diagnosed with schizophrenia or major affective disorders were selected from the psychiatric service of a general hospital. They were asked about any crime perpetrated against them within the preceding year. Only crimes occurring after a psychiatric diagnosis had been made were included. The results of this survey were compared with crimes among the general population in 2000 as reported by the Taiwan Crime Victimization Survey of the Ministry of Justice.

Results: The 1 year prevalence of victimization in the study population was 16.8%, compared with 11.3% in the general population. After controlling for demographic and clinical variables it was found that those with affective disorders or a history of alcohol abuse were more likely to be victimized.

Conclusion: In Taiwan, persons with severe mental illness are more vulnerable to crime victimization than the general population.
Design and Clinical Characteristics of a Homogeneous Schizophrenia Pedigree Sample from Tamil Nadu, India
Authors: Thara Rangaswamy , Srinivasan Tirupati , John Sujit , Nancarrow Derek , Chant David , Holliday Elizabeth , Mowry Bryan
Published: December 2009

Objective: The genetic complexity of schizophrenia may be compounded by the diagnostic imprecision inherent in distinguishing schizophrenia from closely related mood and substance use disorders. Further complexity may arise from studying genetically and/or environmentally diverse ethnic groups. Reported here are the ascertainment, demographic features and clinical characteristics, of a diagnostically and ethnically homogeneous schizophrenia pedigree sample from Tamil Nadu, India. Also reported is the theoretical power to detect genetic linkage in the subset of affected sibling pairs.

Method: Affected sibling pair and trio pedigrees were identified by caste/ethnicity. Affected probands and siblings fulfilled DSM-IV criteria for schizophrenia or schizoaffective disorder.

Results: The present sample consisted of 159 affected sibling pairs and 187 parent–offspring trios originating primarily from the Tamil Brahmin caste, but also incorporating pedigrees from genetically similar, geographically proximal caste groups. Consistent with previous studies in Tamil Nadu, a very low prevalence of affective psychoses such as schizoaffective disorder, was observed, with most affected individuals having schizophrenia (499/504). Also observed were extremely low rates of nicotine (12.4%), alcohol (1.1%) and illicit drug use (0%). Most affected individuals exhibited negative symptoms (>90%) and a severe, chronic course. All participants lived in the same geographic and climatic region and most affected individuals resided with close family members, increasing uniformity of the sociocultural environment. In affected sibling pairs, power to detect linkage to small-effect risk loci was modest, but this homogeneous sample may be enriched for loci of larger effect.

Conclusions: This Indian schizophrenia sample exhibits diagnostic and ethnic homogeneity with high consistency of sociocultural environmental features. These characteristics should assist efforts to identify risk genes for schizophrenia.
Liaison Psychiatry with Aboriginal and Torres Strait Islander Peoples
Authors: Wand Anne P. F. , Corr Melissa Jane , Eades Sandra J.
Published: December 2009

Objective: The aim of the present study was to describe the referral patterns, assessment and suggested management of Aboriginal and Torres Strait Islander peoples referred to an inner-city general hospital psychiatry service. The overarching goal was quality improvement.

Method: Participants were identified from the consultation–liaison psychiatry database of all referrals to the service from the general hospital and Emergency Department. All people over 18 identifying as Aboriginal and/or Torres Strait Islander seen during the period 1 July 2004–30 June 2007 were included. Information regarding referral and liaison patterns, suggested psychiatric management, disposition and follow up were gathered retrospectively from the medical records, with a particular focus on cultural references.

Results: There were 162 referrals to the consultation–liaison psychiatry team of people identifying as Aboriginal and/or Torres Strait Islander. The rate of referral to consultation–liaison psychiatry was 3%. The Emergency Department had the highest rate of referral followed by Obstetrics and Gynaecology. The most common reason for referral was assessment of risk. The patient's Aboriginal ethnicity was mentioned in 52.5% of consultation–liaison assessments. An Aboriginal health worker was consulted in 48.1% of cases. The most common management approach involved pharmacotherapy. The consultation–liaison service instigated legal interventions in 25% of cases. Forty-five patients were referred for psychiatric admission following their assessment. Mental health follow up was arranged in 43.8% of cases.

Conclusions: The range of mental health problems referred and types of diagnoses made in Aboriginal and Torres Strait Islander peoples reflect what has been previously reported, particularly in relation to comorbidity. Aboriginal ethnicity was variably identified and Aboriginal health workers, general practitioners and families were not routinely involved in consultation–liaison psychiatry assessments, highlighting an opportunity to improve communication and the quality of patient care.
Modelling Candidate Effectiveness Indicators for Mental Health Services
Authors: Burgess Philip , Pirkis Jane , Coombs Tim
Published: December 2009

Objective: Although Australia and the UK have both made efforts to systematize outcome measurement in mental health services, surprisingly little attention has been paid to how best to analyse routine outcome data in order to determine how services are performing.

Methods: Outcome data collected in acute inpatient and ambulatory mental health services across Australia during the 2006–2007 financial year were used. three approaches to measuring effectiveness were explored: effect size (ES); the reliable change index (RCI); and standard error of measurement (SEM).

Results: The most conservative results were produced by the RCI and the least conservative by the medium ES statistic and the SEM. By way of example, only 38.0% of inpatient admission–discharge periods of care showed significant improvement for adults when the RCI was used, whereas 67.4% and 72.9% did so when the medium ES and the SEM statistics were used, respectively.

Conclusions: In any routine outcome measurement exercise, the degree of effectiveness demonstrated by services will depend on the specific statistical indicator used to judge effectiveness. Routine outcome measurement has the potential to answer a range of crucial performance-related questions, but only if the same metric is used. Discussion of the appropriate statistical approach to take to facilitate cross-service, cross-area and even cross-national comparisons warrants attention.
Cost-Effectiveness of Combination Therapy Versus Antidepressant Therapy for Management of Depression in Japan
Authors: Sado Mitsuhiro , Knapp Martin , Yamauchi Keita , Fujisawa Daisuke , So Mirai , Nakagawa Atsuo , Kikuchi Toshiaki , Ono Yutaka
Published: December 2009

Objective: Major depression is expected to become the second leading contributor to disease burden worldwide by 2020. Only a few studies, however, have compared the cost-effectiveness of a combination of cognitive behavioural therapy and antidepressant therapy versus antidepressant therapy alone. The purpose of the present study was therefore to analyse cost-effectiveness, from the perspective of the health-care system and also from a social perspective, comparing combined cognitive behavioural therapy + antidepressant therapy and antidepressant therapy alone in the Japanese setting.

Method: A formal decision analytical model was constructed. The analyses were performed from both the perspective of the health-care system and the societal perspective. The clinical outcomes were determined from published articles and reports of expert panels. Because no patient-level data were available, deterministic costing of the different treatment strategies was carried out. Cost-effectiveness was assessed first by determining the incremental cost-effectiveness ratio (ICER) per successfully treated patient, and then by the ICER per quality-adjusted life years (QALYs).

Results: The combined therapy increased the rate of successfully treated patients, QALY of severe depression and QALY of moderate depression by 0.15, 0.08 and 0.04, respectively. The combined therapy proved to be more expensive from the health-care system perspective, but the incremental costs were completely offset by the considerable reduction of productivity loss from the social perspective. From the health-care perspective, the ICER per successfully treated patient, ICER per QALY of severe depression and ICER per QALY of moderate depression were JPY 140 418, JPY 268 550 and JPY 537 100, respectively. All the ICERs appeared to be negative from the social perspective.

Conclusion: The combined therapy appeared to be cost-effective from the health-care system perspective and the dominant strategy from the social perspective.