bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case of Capgras' Phenomenon
Authors: Wilcox James A.
Published: October 2008

It has been suggested that neurological abnormalities may act in the pathogenesis of Capgras' phenomena. In this case, a schizophrenic male with Capgras' symptoms exhibited evidence of organic dysfunction suggested by the presence of abnormal neurological soft signs, an abnormal EEG, and an atypical computerised tomographic (CT) head scan. These findings suggest that organic factors may play a role in the development of Capgras' syndrome.
Parasuicide and Depression: A Comparison of Clinical and Questionnaire Diagnoses
Authors: Reeves Jan C. , Large Robert G. , Honeyman Margaret
Published: October 2008

The frequency with which depressive disorder is diagnosed in parasuicide varies. It has been suggested that when observer bias is removed and a depression questionnaire employed, a greater number of young women who attempt suicide will be designated as depressed than would be expected on the basis of previous clinical reports. Our study compared clinical diagnoses made according to Feighner's research diagnostic criteria or DSM III with the categorisations obtained by the Levine-Pilowsky Depression questionnaire (LPD). Fifty-one patients, 34 female and 17 male, were studied, 31.4% having a primary Major Depressive Disorder and 23.5%% secondary depression as clinical diagnoses. The LPD categorised 72.5%% as depressed. Comparison of the clinical diagnoses with questionnaire data suggests that the LPD is overinclusive and not as specific as clinical diagnosis. Alcohol and substance abuse disorders accounted for almost one-third of the diagnoses and are therefore an important concomitant of parasuicide.
Admissions to a Prison Psychiatric Unit
Authors: Glaser William F.
Published: October 2008

Fifty consecutive admissions to the psychiatric division in a central metropolitan gaol were given DSM III diagnoses and their psychiatric, social and criminal histories analysed. Seventy-two per cent suffered from schizophrenic, affective or organic mental illness, 56% had chronic physical disabilities and 84% had had previous in-patient treatment in either hospital or prison or both. Fifty-four per cent exhibited psychopathology that most clinicians would have thought required urgent attention. Of the current offences committed by this group 54% were against the person (murder, assaults, sex offences and robbery). A significant proportion of these were committed by a distinct subgroup composed of socially isolated schizophrenics with no prior convictions, no physical illness, apparently normal premorbid personalities, and a greater current level of psychiatric disturbance. It is argued that the group as a whole, and this subgroup in particular exemplify the problems of the psychiatrically disturbed offender. Prison psychiatric facilities are inadequate for the range of functions they are being asked to serve and their token placement in the correctional services by-passes many important clinical, social and legal issues.
The Psychological Aspects of Artificial Nutritional Support
Authors: Gilchrist P. N. , Phillips P. J. , Odgers C. L. , Hoogendorp J.
Published: October 2008

Patients receiving artificial nutritional support are subject to ongoing psychological stress. They are often physically ill, are required to follow a rigid dietary regime and, by necessity, are involved in an ongoing relationship with members of the treating team. This paper presents examples of the clinical problems and discusses the role of the psychiatrist as a member of the multidisciplinary team.
Psychogenic Erectile Impotence — A Useful Or a Misleading Concept?
Authors: Williams Warwick
Published: October 2008

Psychological factors alone may not fully explain some cases of apparently purely psychogenic acute situational impotence. Chronic impotence is often due to a combination of aetiological factors. Erectile selectivity is not a reliable means of diagnosing purely psychogenic impotence. Nocturnal penile tumescence monitoring is not absolutely reliable in making a distinction between organic and psychogenic impotence. The either/or concept of impotence being organic or psychogenic should be abandoned as serious errors can be made by adhering to it.
Pimozide Treatment in Disruptive Severely Retarded Patients
Authors: White Tony J. R. , Aman Michael G.
Published: October 2008

Eight severely retarded residents took part in a double blind, placebo controlled trial of pimozide. The drug did not alter behavioural adjustment as assessed by behaviour observations. However, ratings on a standardised checklist of aberrant behaviour showed significant drug-induced improvements on two dimensions (Irritability and Hyperactivity/non-compliance). Learning performance, as assessed by a discrimination learning task, was not affected by the drug.
The Dexamethasone Suppression Test in Elderly, Non-Depressed Patients with Dementia
Authors: Galletly C. A. , Morris H. , Newcombe A.
Published: October 2008

Attempts have been made to use the dexamethasone suppression test (DST) to distinguish patients who have a primary depressive disorder from those suffering a degenerative cerebral disorder. It has been suggested however, that organic brain damage reduces neuroendocrine sensitivity and can be associated with failure to suppress on the DST. This study investigates the DST in 21 patients, over 65 years, with dementia but no evidence of depression on a variety of clinical criteria. Seven patients had abnormal DSTs.
Distinctions between Panic Disorder and Generalised Anxiety Disorder: Clinical Presentation
Authors: Rapee R. M.
Published: October 2008

Thirty-eight panic disorder and 48 generalised anxiety disorder subjects were asked to complete a number of questionnaires aimed at developing a general clinical picture of the two disorders. The results indicated that panic disorder is characterised by a sudden onset around the mid- to late-20s age group and is distinguished by symptoms which are chiefly hyperventilatory in nature and are accompanied by thoughts of serious physical or mental illness. Generalised anxiety disorder is characterised by a gradual onset of symptoms. Somatic symptoms associated with this disorder are generally accompanied by a realisation that the symptoms are the result of anxiety and are harmless. The two groups did not appear to differ greatly on a number of other scales except that the generalised anxiety disorder subjects scored higher on measures of manifest anxiety and social phobia.
The Prevalence of Schizophrenia in a Refuge for Homeless Men
Authors: Doutney C. P. , Buhrich N. , Virgona A. , Cohen A. , Daniels P.
Published: October 2008

The prevalence of schizophrenia in a large hostel for homeless men in an inner city area was found to be in the order of 15%. Concern is expressed that this figure represents a recent increase in the number of mentally ill among homeless men and may be related to changes in the management of chronic mental illness. Literature relating mental illness and homelessness is reviewed.
Treatment Outlines for the Management of Obsessive-Compulsive Disorders
Authors: Andrews Gavin
Published: October 2008

The Quality Assurance Project is developing explicit and detailed treatment outlines for each of the major psychiatric disorders. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists, and the views of a panel of nominated experts. The recommendations for the treatment of obsessive-compulsive disorder were as follows: for those patients who have no significant personality disorder, either short-term dynamic psychotherapy or cognitive behaviour therapy is indicated if the illness has lasted less than a year or if obsessions are the predominant symptoms. When compulsions predominate, particularly when they have been present for more than a year, response prevention is the treatment of choice. Tricyclic antidepressants and cingulo-tractomy are also worthy of consideration in patients with persisting symptoms. Psychotherapy or cognitive behaviour therapy are the approaches recommended for compulsive personality disorder.
Whose Hysteria: Briquet's, Janet's or Freud's?
Authors: Meares Russell , Hampshire Robert , Gordon Evian , Kraiuhin Claudia
Published: October 2008

Somatisation disorder (Briquet's syndrome) is a recent addition to psychiatric nosology. It represents an attempt to describe a syndrome of ‘hysteria’, the term initially applied to this polysymptomatic disorder by Guze and his colleagues. The manner of identification of this syndrome, however, has been the subject of criticism. This brief review suggests that the ideas of Janet, who worked at Salpetriere 30 to 40 years after Briquet, may provide a more precise approach to diagnosis. Furthermore, his hypotheses about predisposition to this disorder are seen to offer a preliminary way towards its understanding. Recent experimental evidence lends some support to Janet's hypotheses.
The Problem of Multiple Inference in Psychiatric Research
Authors: Hall Wayne , Bird Kevin
Published: October 2008

This paper deals with the problem of multiple inference in psychiatric research, an issue which arises whenever a researcher has to make more than one statistical inference in a single research study. It frequently arises in psychiatric research because of multivariate study designs, with subjects being measured on more than one dependent variable with the intention of studying differences between groups in mean scores. The disadvantages of the commonly adopted strategy of using multiple univariate tests (e.g. multiple t-tests) are outlined. Two broad strategies — Bonferroni-adjusted univariate tests and multivariate statistical analysis — are introduced. Their advantages and disadvantages are discussed in terms of their usefulness in confirmatory and exploratory research in psychiatry.
Suicide in Hong Kong
Authors: Lo W. H. , Leung T. M.
Published: October 2008

Coroners' statistics indicated there were 684 suicides for the whole of Hong Kong in 1981. This gave a crude suicide rate of 18.1 per 100,000 population aged 15 years and over and constituted 2.7% of all deaths reported in that year. Only a few data were recorded in all coroners' files but additional data were obtained from police records on 168 of these suicides. The age and sex distribution among the suicides as well as the effect of marital and employment status on suicide rates were found to be similar to western countries. Jumping from a height was the most common method of suicide (47.2%) followed by hanging (30.8%). Psychiatric illness and chronic physical disability were two most important precipitating causes of suicide (39.8% and 35.7% respectively). Twenty per cent had a history of previous attempts with one-third occurring within six months of their completed suicide. Over 40% had communicated their suicide intention to others, while 19% left a note. ‘Psychiatric’ cases as a group had special features: there were more in the younger age groups, more with records of previous suicide attempts and more chose readily available methods.
Community Attitudes toward Mental Illness: The Influence of Contact and Demographic Variables
Authors: Sellick Ken , Goodear Jo
Published: October 2008

Residents of three large rural cities were surveyed to investigate the influence of ‘psychiatric exposure’ and demographic variables on community attitudes toward mental illness. Samples drawn from the three communities, which differed according to the availability of mental health services, were administered the Opinions About Mental Illness Scale, with questionnaire items that elicited measures of the amount of contact with mental illness and standard demographic data. Multiple regression analyses showed that demographic but not ‘exposure’ variables had a significant influence on community attitudes. Contrary to previous findings, the older, less-educated members of the public were more positive in their opinions on mental health issues. Other variables to have an influence on attitudes were ethnic origin and occupational status.
Preparedness to Accept Psychiatric Referral
Authors: Parker Gordon , Tracy Mark , Hadzi-Pavlovic Dusan
Published: October 2008

A survey of 312 patients attending 13 Sydney general practices suggested that preparedness to accept psychiatric referral by a general practitioner related most clearly to preparedness to consult the general practitioner in the first instance and the perceived likelihood of the general practitioner suggesting a psychological problem, while the sociodemographic characteristics of the patient did not appear of relevance. Data on actual psychiatric referrals by the contributing general practitioners suggested a higher psychiatric referral by practices in lower social class regions of Sydney and a differential referral pattern, with referral to a community psychiatric facility being rare in other than low social class general practices.
Creativity and the Boundaries of the Self: Separation and Engulfment Anxiety in Keats and Poe
Authors: Powell Craig
Published: October 2008

Creativity is considered as a vicissitude of the cohesiveness or fragmentation of the self. The emergence of a self, separate from the mothering figure, requires the mother's empathic fuelling and the child's capacity to contain his gradual disillusionment with her. The process is never fully completed, allowing a potential for anxiety over threatened disintegration, along a continuum from separation anxiety (loss of the object), in a relatively cohesive self, to engulfment anxiety (loss of the self) in the less cohesive. The creative artist is uniquely sensitive to these anxieties, through his own difficulties in separating from the infantile union with the mother, or in mourning an object that dies during his childhood. The artist draws on his unconscious experience to speak to the unconscious of the audience. For the audience, it is having one's own deepest longings and deepest anxieties spoken to and spoken for that constitutes the power of creative art.
From Humpty-Dumpty to Rapunzel: Theoretical Formulations concerning Borderline Personality Disorder
Authors: Lonie Isla
Published: October 2008

A brief review of the development of the concept of Borderline Personality Disorder is given, together with a more detailed consideration of theorists who have made significant contributions to its psychodynamic understanding. Examples of the extreme limits of this diagnostic category are illustrated, using the symbolism of Humpty-Dumpty and Rapunzel. The theories of Winnicott and Kohut, which both elaborate on the concept of a developmental defect, are compared and contrasted. Some implications for therapy are considered.
Beyond Language — Speculations on the Prefrontal Cortex and Schizophrenia
Authors: Morice Rodney
Published: October 2008

Changes to the structural complexity of the spoken language of schizophrenic patients have been demonstrated in three recent studies. The speculation is offered that these changes could result from dorsolateral prefrontal cortical dysfunction. Impairment of the executive functions of this part of the brain could theoretically explain both the varied symptomatology of schizophrenia and its unique pattern of ages of onset.
Liaison Consultation Psychiatry with Patients who Have Replantation Surgery to the Upper Limb
Authors: Schweitzer Isaac , Rosenbaum Maj-Britt , Sharzer Leonard A. , Strauch Berish
Published: October 2008

Thirty-eight patients who had replantation surgery to the upper limb were studied and findings, case vignettes and specific liaison-consultation issues are presented. The assessment of the patient for pre-existing psychopathology, such as drug and alcohol abuse and personality abnormalities, is emphasised; the possibility of the amputation having been a deliberate, self-inflicted act is noted; and the roles of pre-accident stress and emotional conflict are discussed. Data concerning adverse post-operative emotional reactions are presented and body-image changes, including the disruption to body integrity and the reintegration of the bodily part, are described. The psychological aspects of replantation surgery are compared to other forms of surgery, in particular amputation and renal transplantation.
Parameters of Kava Used as a Challenge to Alcohol
Authors: Cawte John
Published: October 2008

The kava bowl, a traditional feature of Pacific Island societies, has been adopted and adapted by a number of Aboriginal (Yolngu) communities of northern Australia, where it was introduced in the hope that it would challenge alcohol. This paper reports a study of its usage at Elcho Island, Northern Territory. At the high level of intake in this community, medical effects hitherto unreported are being observed. Some, such as a condition of detachment, reminiscent of the archetypal ‘blissful indolence’ of the lotus-eaters of Greek tradition as limned by the poet Homer, are obvious to the lay observer. Other effects are apparently advantageous for the management of alcohol abuse and some forms of psychosis. A surprising effect is the occurrence of a pellagrinous reaction. These observations indicate that further studies of the clinical effects and the human metabolism of high dosage kava are needed. Looming over all are questions of pharmacology. Do the kava pyrones possess anxiolytic or antipsychotic properties? Do they indeed have the property for which Pacific missionaries introduced them to Australia, as an alternative to alcoholism?
Predicting Schizophrenic Relapse: A Comparison of Two Measures
Authors: Parker Gordon , Mater Richard
Published: October 2008

A parental environment placing schizophrenic patients at high risk to relapse has been defined by two measures. One assessing expressed emotion (EE) is ‘objective’, but takes a considerable time to administer and requires a highly trained rater. The other involves use of a self-report measure (the Parental Bonding Instrument or PBI) which is acceptable in clinical groups and requires only a brief period for completion. The degree to which the two measures predict the course of schizophrenia in patients discharged to their families is examined in representative studies. Each measure is assessed in terms of its sensitivity, specificity, odds ratio and overall diagnostic power, after calibrating modified PBI cut-off scores against rehospitalisation data. The PBI is a potentially useful clinical aid to predicting relapse in schizophrenic patients who return to the home environment.
Mental Health Law Reform: Advance towards Enlightenment or Denial of Reality?
Authors: Doutney Charles
Published: October 2008

In the field of human affairs, curiosity prompts us to seek a panoramic view in order to gain a vision of reality that will make it as intelligible as possible for a human mind … A panoramic view will at any rate be a less misleading reflection of reality than a partial view.

Toynbee (1972)
The Operation of the Mental Health Act, 1983 (NSW)
Authors: Errington Michael R.
Published: October 2008

The Mental Health Act, 1983, and its associated legislation, effects an extensive reorganisation of the law relating to mental health in New South Wales. This paper seeks to explain the operation of the Act from the point of view of medical practitioners, for the most part medical officers and psychiatrists employed in psychiatric hospitals. Reference is also made to the rights of patients, medical and surgical treatment of patients, the property of patients and the operation of the Mental Health Review Tribunal.
The Contest between Psychiatrists and Lawyers over Involuntary Detention: The Effects of Recent Changes in Mental Health Legislation in New South Wales
Authors: Silove Derrick , Doutney Charles , Pollock Christopher
Published: October 2008

New mental health legislation was enacted in New South Wales in 1983 and, although the reformed Act remains unproclaimed, some of the new procedures have already been introduced into psychiatric hospitals. The spirit of the Act is clearly aimed at protecting the rights of the mentally ill, who are often unable to act as their own advocates. To ensure this protection, it is now routine for solicitors to represent detained patients in their pleas for release. In this report we describe three recent cases that illustrate the difficulties that arise when solicitors and psychiatrists contest the legitimacy of detention orders. The atmosphere of judicial hearings is becoming increasingly adversarial and the public disclosure of sensitive information can provoke unnecessary distress in patients and their families. In the zeal to preserve civil rights, the special needs of psychiatric patients can be obscured, sacrificing the patients' rights to confidentiality, privacy and appropriate treatment. While the involuntary detention of patients is a matter of the utmost seriousness, current procedures, which seem to be modelled on those of the criminal legal system, are proving to be inappropriate to the needs of psychiatric patients.
Factors in the Teaching Environment Associated with Severe Psychological Distress among School Teachers
Authors: Finlay-Jones Robert
Published: October 2008

A survey of over 2,000 school teachers found that 17% had symptoms of severe psychological distress compared with an expected figure of 9% for the community generally. The excess was associated with the teachers' exposure to 16 factors in the teaching environment. The most important factor was the misbehaviour of pupils. Most of the factors can be changed.
Australian Prisoners of War of the Japanese: Post-War Psychiatric Hospitalisation and Psychological Morbidity
Authors: Tennant Christopher , Goulston Kerry , Dent Owen
Published: October 2008

Evidence of chronic psychiatric and psychosomatic morbidity was found in a randomly selected sample of Australian prisoners of war (POWs) of the Japanese over the 40-year period following the Second World War. A clinical interview revealed more contemporary depressive and anxiety disorders and more post-war psychiatric illness overall than in a comparison group of randomly selected combatant veterans of the Pacific and South East Asian campaign. The POWs were no more likely to have had psychiatric admissions than non-POWs and fewer of them had had multiple psychiatric admissions. POWs had more duodenal ulcers than controls but otherwise their physical health was similar, as was their age-adjusted mortality in the post-war years. Finally, POWs were more likely to have Totally and Permanently Incapacitated Service Pensions than controls.
Panic and Phobic Disorders—Are Psychological or Pharmacological Treatments Effective?
Authors: Judd Fiona K. , Burrows Graham D.
Published: October 2008

Panic disorder with or without phobic avoidance has recently been delineated as a distinct nosological entity. Several controlled studies have demonstrated the efficacy of various pharmacological agents in controlling panic attacks. Behaviour therapy, especially desensitisation, is of value in alleviating phobic avoidance but has not yet been shown to be effective in the alleviation of panic attacks. No systematic studies comparing pharmacological and psychological treatments in panic disorder are available.
Simultaneous Multiple Comparison Procedures for Categorical Data
Authors: Hall Wayne , Bird Kevin D.
Published: October 2008

Methods are outlined for performing simultaneous multiple comparisons between groups when the dependent variable is one in which subjects are assigned to one of two or more categories. These methods provide tests which are analogous to Scheffe- and Bonferroni-adjusted tests of contrasts in the analysis of variance. Examples are provided of each of these procedures.
Perceived Parental Characteristics and Reports of Early Parental Deprivation in Agoraphobic Patients
Authors: Silove Derrick
Published: October 2008

It is commonly believed that patients with agoraphobia have suffered more frequently from aberrant family experiences in childhood. Some authors have described an excess of parental deprivation and others have incriminated parental overprotectiveness. Recent studies have failed to confirm these impressions but, instead, find that agoraphobic patients recall deficits in parental warmth and care during their early years. This report of a Sydney case-control study adds support to the view that parental overprotectiveness in isolation is unlikely to place the child at greater risk of developing agoraphobia in the future. Only when the child experiences a sense of parental neglect and lack of care, either alone or in combination with overprotection, does the risk of agoraphobia in adulthood appear to be increased.
Psychiatrists and Drug Use: Implications of Alternatives to the ‘Disease’ Concept
Authors: Drew L. R. H.
Published: October 2008

The development of the disease concept of drug use and the application of the medical model of management of drug problems were an accompaniment of the growth of modern medicine. They have, however, been subject to considerable review and criticism. A positive response to such criticism is advocated. Consideration of the ‘way of life leading to predicaments’ model, based on the work of a number of authors, allows the identification of essential tasks in helping people out of predicaments and the clarification of roles that psychiatrists can and should play.
Plasma Melatonin Concentrations in Depression
Authors: McIntyre Iain M. , Judd Fiona K. , Norman Trevor R. , Burrows Graham D.
Published: October 2008

The pineal hormone melatonin was measured in midnight plasma samples from 11 depressed patients and 18 control subjects. Plasma melatonin concentrations were significantly lower in the depressed patients. The implication of these findings for beta-adrenoceptor subsensitivity in depression is discussed.
The Dissemination of Research Findings: Some Limitations Revealed When Attempting a Meta-Analysis
Authors: Jorm A. F.
Published: October 2008

A meta-analysis of the literature on drug treatments for Alzheimer's disease revealed the following limitations in the dissemination of research findings: multiple publication of findings, failure to report basic descriptive statistics and failure to respond to written requests for additional information on the research. The possible reasons for these problems and remedies for them are discussed.
The Burn Victim—A Review of Psychosocial Issues
Authors: Tucker Peter
Published: October 2008

Over recent decades, with the introduction of specialist units for the treatment of severely burnt patients, a volume of literature on psychological aspects of burns has accumulated, containing anecdote and opinion as well as research of varying quality. This literature is reviewed under three headings: epidemiology and prevention; reactions following acute hospitalisation; and long-term outcomes. Adverse personal, health, and social factors may predispose to burn injury. In hospital, the psychological course of the patient proceeds in stages that can be related to the well-recognised reactions to loss and overwhelming stress, modified by the major physiological insult. Reactions of family and staff are of great significance. In the longer term, rehabilitation prospects are generally good, although recovery may be complicated by a gradually subsiding level of neurotic symptoms and relationship difficulties.
Does Depressive Illness in the Elderly Have a Poor Prognosis?
Authors: Burvill P. W. , Stampfer H. , Hall W.
Published: October 2008

The few available longitudinal studies of depressive illness in the elderly indicate a poor prognosis. Various risk factors are discussed. Both severe and chronic physical illness, and severity of the depressive disorder are the two most important prognostic factors. The possibility of interactional effects between these risk factors should be studied. Most studies to date have been of severely depressed patients and this may give an unduly pessimistic picture. A case is made for the desirability of well-designed prognostic longitudinal studies with subjects being drawn from a wide spectrum of severity of illness.
Anxiety and Depression in the Immediate Post-Partum Period: A Controlled Investigation of a Primiparous Sample
Authors: Knight Robert G. , Thirkettle Jacqueline A.
Published: October 2008

In a preliminary investigation of the post-partum ‘blues’, a group of 98 primiparous women were assessed before and after birth, using a state depression scale, the state anxiety scale of the State-Trait Anxiety Inventory, and visual analogue scales for rating anxiety and depression. A matched sample of 96 non-pregnant women was given the same measures, at the same time intervals. Between-group differences were found on the visual analogue scales administered on the days immediately after birth, but not on the other state mood scales. The most sensitive measures of the post-partum blues proved to be the highest and average visual analogue scale of depression scores recorded over the period of hospitalisation.
Psychiatric Research Series Editor: Wayne Hall: Some Statistics for Analysing Change in Psychiatric Research
Authors: Hadzi-Pavlovic Dusan
Published: October 2008

Variations in psychological features, including the emergence of, or recovery from, psychiatric disorder, typically involve a long-term process. Consequently, most investigations of these processes will assess the individual or group on a number of occasions, creating complexities in any accompanying statistical analysis. In this paper an approach to analysing such data is introduced, including an extension of the t-test and the analysis of variance.
Pre-Menopausal and Post-Menopausal Depressed Women
Authors: Roy Alec , Linnoila Markku , Jimerson David C. , Gold Philip , Pickar David
Published: October 2008

In a consecutive series of 28 depressed women, pre-menopausal (n = 13) and post-menopausal (n = 15) patients were compared. Post-menopausal women had significantly higher levels of plasma norepinephrine, plasma 3-methoxy-4-hydroxyphenylglycol, post-dexamethasone plasma cortisol, cerebrospinal fluid 3-methoxy-4-hydroxyphenylglycol and corticotropin-releasing hormone. However, when biologic measures were adjusted for age by analyses of covariance there were no significant differences. Pre-menopausal women had had significantly more life events before the onset of depression than post-menopausal women. The implications of these findings are discussed.
Research by Regional Psychiatrists, 1978–84
Authors: Parker Gordon
Published: October 2008

An audit was undertaken of research by psychiatrists in Australia and New Zealand published in an accepted scientific journal during the seven-year period, 1978-84. The key analyses were limited to first authors only and identified 89 responsible for 372 scientific publications. Despite an increase in psychiatrists in the region there was no evidence of any increased research output during the seven years. While the distribution of researchers across the region was consistent with the overall distribution of psychiatrists, relatively strong and consistent differences in measures of quality and quantity of research output were demonstrated between geographical areas. The audit examined published research by topic, by publishing journal, and by the affiliation of the researcher. Several measures of research quality and productivity were internally and externally validated. Profiles are given of the average researcher and of those distinguished in terms of high productivity and high citation rates.
An Outpatient Survey of Antidepressant Prescription Habits
Authors: Schrader Geoffrey D. , Gibbs Andrew , Harcourt Robert G.
Published: October 2008

A review of case notes of patients attending a general hospital psychiatric outpatient clinic revealed that 75% of patients with depressive disorders and 38% of patients with neurotic disorders were prescribed antidepressants. Antidepressants were often prescribed for long periods in low doses and in combination with benzodiazepines. There was less polypharmacy, however, with more sedating antidepressants. The results indicate that clinical prescription habits for antidepressants may still be at some variance with recommendations from the literature.
The People Seen by Sydney Psychiatrists
Authors: Andrews Gavin , Hickie Catherine
Published: October 2008

A one-in-six sample of psychiatrists practising in Sydney was asked to provide details of patients seen in the previous five working days. The averaged workload of the 49 psychiatrists showed that they spent a third of their time with patients with psychotic illnesses, a third with patients with neurotic conditions and most of the remainder on patients troubled by personality disorders. Sixty-one per cent of the patients were female and the median age of the patients was 39 years. Psychotherapy was the most commonly used primary treatment for the neuroses and personality disorders, but drugs were used most frequently for the psychoses.
Coexistence of Capgras and its Related Syndromes in a Single Patient
Authors: Atwal Satnam , Khan Mujeeb H.
Published: October 2008

A very unusual case of Capgras syndrome is described. It is unique because of the coexistence of three related syndromes, namely the syndrome of Fregoli, the syndrome of intermetamorphosis, and the syndrome of subjective doubles, in the same patient during the course of his illness. A brief description of these colourful syndromes is given and we speculate upon the possible role of psychodynamic and organic factors in the patho-physiology of these intriguing syndromes.
Re-Evaluation of the Evidence on the Prognostic Importance of Schizophrenic and Affective Symptoms
Authors: Herrman Helen
Published: October 2008

An earlier literature noted consistently that depressive symptoms appear to bode well for outcome in schizophrenia and related disorders. Although this view is psychodynamically plausible, most of the studies suggesting it have substantial shortcomings. In particular, most studies have been confounded by the effects of variations in duration and history of disorder, which have a major influence on both affective expression and outcome. A contrary view is that depressive symptoms in patients with schizophrenia and related disorders suggest an increased risk of self-harm and social dysfunction, just as these symptoms do in individuals with other disorders. The substantial risks of mortality and morbidity from self-harm, the link between suicide and depression, and the high prevalence of depressive symptoms in the acute and chronic stages of the disorder have all been documented in people diagnosed as having schizophrenia. Social influences are well known to be crucial to the course and outcome of schizophrenia. The expectations of others and patients' own attitudes to their illness are also known to influence outcome. Despite this, there is no longitudinal study of first admission patients to allow us to examine the possible intervening or other role of depression in the development of chronic disability.
Incest: What do we Really Know about It?
Authors: Kosky R.
Published: October 2008

The literature on incest is reviewed. Current knowledge rests on a very insecure scientific basis and has been mainly derived from small, highly selected clinical series. Recently, some important epidemiological studies of general populations have been reported, but the results of prevalence are inconsistent. Overall, however, it appears that incest, when defined in terms of sexual intercourse, occurs in less than 1% of the population, but other forms of intrafamilial sexual activity may affect 10% of females before they are 16 years of age. Some children are more at risk than others. Because information has generally been derived from court or treatment samples, we are unclear about the long-term effects of incest experiences but, overall, the impression is that incest has markedly adverse effects, especially if it is accompanied by violence and threats and is directed, as it usually is, at the young pre-pubescent child.
The Pharmacological Treatment of Tricyclic-Resistant Depression: Review and Management Guidelines
Authors: Mitchell Philip
Published: October 2008

Despite the introduction of a wide range of antidepressant drugs since the late 1950s, approximately 30–50% of depressed subjects do not respond to these agents. Various treatment strategies, both pharmacological and non-pharmacological, have been proposed for treatment-resistant depression. This paper critically reviews the studies of single and combined pharmacological treatments for tricyclic-resistant patients, with a particular discussion of lithium augmentation. The major inadequacies of these studies have been the frequent lack of definitions of treatment resistance, the heterogeneity of the depressed samples, and the infrequent use of double-blind, placebo-controlled designs. Two central issues, definition of treatment resistance and clinical predictors of response to pharmacological treatments, are discussed in detail. Finally, a suggested guideline for the management of tricyclic-resistant depression is proposed.
Psychiatric Morbidity in Hobart's Dependent Aged
Authors: Kay D. W. K. , Holding T. A. , Jones Bonita , Littler Sue
Published: October 2008

Psychiatric morbidity in the dependent aged was studied in the elderly population of Hobart's nursing homes and long-stay hospitals. Only patients with home addresses in Hobart and who were admitted for the first time aged 70 years or over were included. Three hundred and twelve persons were interviewed with a standard interview, and an informant was interviewed when appropriate. The medical records were searched for diagnoses and drug treatments. Physical disability was rated on an ad hoc scale. Comparisons were made of the prevalence of dementia, depression and anxiety in different types of unit, and between these and two domiciliary samples, one of which received domiciliary nursing services (n = 100) and the other not (n = 100). The differential use of institutions by men and women, and a possible sex difference in the prevalence of dementia is discussed.
Diagnostic Reasoning and Treatment Planning: II. Treatment
Authors: Nurcombe Barry
Published: October 2008

The concepts of therapy-oriented and problem-oriented plans are discussed and their advantages and disadvantages considered. Goal-directed planning is proposed as an alternative to intuitive decision making. Goal-directed planning involves the abstraction of pivotal problems from a diagnostic formulation, the restatement of problems as goals, the selection of appropriate therapy, the designation of a target date, the stipulation of objectives, the selection of methods of evaluation and the monitoring of progress. Systematic goal-directed planning fosters teamwork, promotes accountability, obviates therapeutic drift and enhances outcome evaluation. Its chief disadvantage is its unfamiliarity.
Diagnostic Reasoning and Treatment Planning: III. A Case Example
Authors: Nurcombe Barry
Published: October 2008

A diagnostic formulation and treatment plan are derived from the case history of a psychiatrically disturbed adolescent admitted to hospital. This paper illustrates the goal-directed method of treatment planning outlined in the two previous papers.
Sex Differences in Neuroticism: A Quantitative Synthesis of Published Research
Authors: Jorm A. F.
Published: October 2008

The personality trait of neuroticism is thought to be an important risk factor for depression. To ascertain the possible role of neuroticism in producing sex differences in depression, a meta-analysis was carried out on published studies reporting sex- and age-specific norms for neuroticism inventories. A general sex difference was found, with females having higher scores. However, the sex difference was greater in young and middle-aged adults than in children or the very elderly. This age trend in sex differences for neuroticism is similar in form to that previously reported for depression, except that the sex difference for depression completely disappeared in the very young and very old, but the sex difference in neuroticism did not.
A Simplified Logic of Causal Inference
Authors: Hall Wayne
Published: October 2008

This paper provides a simplified method for evaluating the evidence in favour of a causal claim. It analyses the evidence bearing upon such a claim in terms of two questions: Do the putative cause and effect covary, and can alternative non-causal explanations of the relationship be ruled out? The different research designs for assessing covariation are outlined, as are the ways in which these designs permit a researcher to decide between alternative explanations of the relationship.
Pre-Admission Adaptive Functioning as a Measure of Prognosis in Psychiatric Inpatients
Authors: Mellsop Graham , Peace Kathryn , Fernando Thakshan
Published: October 2008

This prospective study examined the concept of pre-admission adaptive functioning and its relationship with outcome. Pre-admission adaptive functioning was assessed by the self-report Social Adjustment Scale and the therapist rated Axis V of DSM-III. In addition, an instrument designed to look separately at the areas of interpersonal relationships, occupational functioning and use of leisure time was given to a subgroup. These measures were compared with outcome at six months as assessed by the General Health Questionnaire. Adaptive functioning proved to be a significant predictor of outcome, with the Social Adjustment Scale being a better predictor than Axis V for the whole group. In contrast, for patients with schizophrenia, the initial Axis V rating was the best predictor of the outcome score. Statistically significant correlations were found between the three areas of adaptive functioning for the group as a whole but, when examined by diagnosis, they proved to be statistically significant only in the schizophrenia sub-group, suggesting that it would be invaluable to rate the three areas separately in non-psychotic patients.
The Secret and the Self: On a New Direction in Psychotherapy
Authors: Meares Russell
Published: October 2008

This paper briefly describes some principles of a self-psychology, this term being used in a broad sense. As a heuristic device, the theme of evolution of self is woven about the formation of its boundary. Boundary formation is seen to be fostered by therapeutic responses that ‘match’ inner states. This notion is linked to other means of enhancing a sense of ‘innerness’. They include a respect for the distinction between the realms of public and private, a potentiation of the ‘ownership’ of experience and the use of certain forms of language. Through a consideration of the concept of ‘the secret’, self-psychology is contrasted with the traditional or ego psychologies. What emerges is a therapeutic approach to personality disorder that resembles important aspects of the work of Kohut and Winnicott, the major contributors to this developing body of theory.
I and Thou: An Examination of Empathy
Authors: Bragan Ken
Published: October 2008

Empathy is introduced as an important current issue in psychoanalysis and in psychotherapy in general. Kohut's contribution to this is examined and placed in the context of the relationship world of Buber. Similarities between Kohut's empathic relatedness and Buber's I-Thou are demonstrated as well as some congruence in their clinical views. The significance of this apparent accord, both for psychoanalysis and psychotherapeutic practice, is considered.
Family Care and Schizophrenia: The Effects of a Supportive Educational Program on Relatives' Personal and Social Adjustment
Authors: Pakenham Kenneth I. , Dadds Mark R.
Published: October 2008

In the aftermath of deinstitutionalisation and the move to community management of schizophrenia, relatives play an increasing role in the management of the illness. Families often complain of being misinformed and ill equipped to aid in the treatment. A supportive/educational intervention for relatives is described and evaluated. Seven parents with a schizophrenic offspring participated in a descriptive pilot study employing a pre-post-treatment design. To test the hypotheses that treatment would impact on participants' distress, burden, family conflict, isolation and knowledge of schizophrenia, before and after measures were taken on self-report indices utilising these features. Generalisation effects on family coping were assessed via tri-weekly telephone interviews for the duration of the study. The intervention included information and sharing sessions. There was a substantial reduction in distress symptoms, anxiety, depression, burden and the amount of family conflict; there was an increase in the duration of home visits, out of home excursions and knowledge of schizophrenia. Most of the subjects' needs were met by the intervention. These gains were achieved with a high level of consumer acceptance. It was concluded that this kind of education has an important role in psychosocial intervention with relatives of the mentally ill.
Severe Threat in the Genesis of Panic Disorder
Authors: Silove Derrick
Published: October 2008

The hypothesis that panic disorder is a separate biological disease has attracted a great deal of controversy in recent years. One of the cornerstones of this theory is that panic attacks arise spontaneously, suggesting that the illness is generated by an autonomous physiological process. A number of cases are reported that illustrate Beck's theory that cognitive factors are central to the genesis of acute anxiety. Evidence for a developmental/cognitive theory of anxiety is discussed, and it is concluded that a purely biological model for panic disorder is inadequate.
Limitations on the Use of Scales in Psychiatric Research
Authors: Grayson D. A.
Published: October 2008

This paper discusses some issues involved in the construction and interpretation of scales in psychiatric research. The issues covered include scale construction, measures of scale homogeneity, the logic of factor analysis and the interpretation of effects manifesting in scale-data, especially interaction effects. The aim of the paper is to “de-mystify” some of the psychometric techniques commonly available, and to emphasize that their appropriate use depends on both a firm understanding of the content area to which they are applied and a rudimentary knowledge of what the methods purport to do.
The Work of Australian Psychatrists, Circa 1986
Authors: Andrews Gavin , Hadzi-Pavlovic Dusan
Published: October 2008

A random sample of psychiatrists was asked to supply details about their last 20 patients. Sixty percent responded. The median patient in treatment was aged 36 and saw a psychiatrist in office practice once a month over a three year period. Forty-one percent of the patient case load suffered from a psychotic disorder, 39% from a neurosis, and 6% from a personality disorder. Marital problems, problems in living and drug or alcohol dependence were infrequent reasons for consultation. Two positive conclusions were drawn: that the case load reflected the morbidity in the community, and that the prognosis for patients with personality disorders was better than usually expected. There were two areas of concern that may need attention: that insight and group psychotherapy require substantial numbers of treatment hours, and that behavioural psychotherapy is rarely used for patients whith neurotic conditions.
DSM-III-R: Too Much Too Soon?
Authors: Rey Joseph M.
Published: October 2008

Some of the more important changes carried out in the recently published revision of the DSM-III classification (DSM-III-R) are described, and an assessment is made on whether a revision of this nature was necessary and whether it achieved its aims. Since a large number of disorders have been modified in one way or another and since empirical evidence for many of the changes is lacking, the author concludes that DSM-III-R, rather than illuminating the field, is likely to cause confusion and frustration in the minds of clinicians, researchers and administrators, and that in fact DSM-III-R is a new classification, a DSM-IV in disguise.