bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychotherapy in the Medically Ill: A Commentary
Authors: Vamos Marina
Published: December 2009

Objective: To overview the field of psychotherapy in the medically ill. Rather than attempting a systematic review of this very extensive area, the article seeks to capture some of the main threads and issues of importance.

Method: The subject is looked at under four headings: (i) which illnesses have attracted research interest in psychotherapy; (ii) which outcome measures have been chosen; (iii) which modes of intervention have been used; and (iv) finally a review of the methodology and the results obtained.

Results: Some illnesses have attracted much more psychotherapeutic interest than others; the differences are haphazard. Outcome measures on the whole have focused on coping with illness and psychological distress, with a smaller number looking at disease outcome. Only short-term changes have been sought in the main. The most commonly used modalities of therapy have been cognitive-behavioural; additionally, supportive information-giving and group therapy have been trialled. Benefit in terms of all these have been reported, but the majority of studies are weakened by major methodological shortcomings.

Conclusion: There is an overall paucity of well-designed studies that clearly demonstrate psychotherapy as an efficacious treatment in the medically ill. The field is hampered by the lack of a clear conceptual thread recognizing the long-term and diverse experience of patients with medical illness and relating this to the question of the part psychotherapy should play. Future work needs to concentrate on appropriate selection of patients who might benefit, as well as including a wider range of more clinically relevant outcome measures and more stringent methodology.
Symbolism of Community I: The Boundary between Hospital and Community
Authors: Barrett Robert J. , Parker Damon B.
Published: December 2009

Objective: To study the symbolism of community as understood and practised in a mental health Crisis and Assessment Service in an Australian city.

Theoretical approaches: The paper draws on anthropological theories of symbolism and boundary work.

Method: Ethnographic fieldwork techniques were employed for data collection. Ethnographic analysis was then applied to these data.

Results: In mental health practice, community is primarily defined in contradistinction to hospital. Narratives about community, including an orthodox version and a sceptical counter-narrative, revolve around this community–hospital boundary.

Conclusions: This analysis identifies a key symbol, which we have designated community, and enumerates the social values that comprise it.
Symbolism of Community II: The Boundary between Community Mental Health Professional and Community
Authors: Parker Damon B. , Barrett Robert J.
Published: December 2009

Objective: To study the symbolism of community as understood and practised within a mental health Crisis and Assessment Service in an Australian city.

Theoretical approaches: The paper draws on anthropological theories of symbolism, boundary work and social networks.

Method: Ethnographic fieldwork techniques were employed for data collection. Ethnographic analysis was then applied to these data.

Results: In mental health practice, rules of professional behaviour established a boundary that prohibited mental health professionals from social engagement with members of the community they served. Ethical imperatives prevented them from forming interpersonal bonds with their clients. Rules of privacy and confidentiality meant that they could not relate to the client's social network as a whole.

Conclusions: The companion to this paper identified a summarizing symbol, which we designated community, and it specified the social values it represented when appropriated to the task of drawing a boundary between hospital and community. This paper specifies additional social values represented by community when it is appropriated to the task of drawing a boundary between community mental health professionals and the community.
Effect of Post-Migration Detention on Mental Health Among Afghan Asylum Seekers in Japan
Authors: Ichikawa Masao , Nakahara Shinji , Wakai Susumu
Published: December 2009

Objectives: Afghan asylum seekers in Japan were increasingly subject to detention following the terrorist attack in New York in September 2001, yet little is reported about the net impact of the detention on their mental health. We examined this by comparing asylum seekers who had once been detained in post-migration and their non-detained counterparts.

Method: We conducted a cross-sectional survey in 2002/03 among asylum seekers from Afghanistan who were in the process of refugee application in Japan. We contacted them through their lawyers or non-governmental organizations. Of 73 contacted, 55 agreed to participate. Anxiety and depression were measured using the Hopkins Symptom Checklist 25, and posttraumatic stress disorders (PTSD) and past traumatic experiences were studied with the Harvard Trauma Questionnaire. These mental disorders were scored on a 4-point scale; the average symptom score of 4 indicates the worst mental health status.

Results: Respondents reported a mean (SD) of 10 (4.0) pre-migration traumas. Since their arrival in Japan, 18 (33%) had once been detained. Trauma exposures and other characteristics of those detained were not significantly different from those not detained, whereas the symptom scores of anxiety (2.91), depression (2.75) and PTSD (2.90) among those detained were higher than among those not detained (2.30, 2.41, 2.34 respectively). Multiple regression analyses revealed independent adverse effects of post-migration detention, alongside exposure to greater trauma and living alone, and the effects were comparable between these variables.

Conclusion: The post-migration detention of Afghan asylum seekers in Japan was independently related to their worsened mental health.
Antiglucocoticoid Treatments for Depression
Authors: Young Allan H.
Published: December 2009

Objective: To selectively review the literature germane to antiglucocoticoid treatments for depression.

Method: Selective review of the relevant literature.

Results: Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis has been welldescribed in both bipolar and unipolar depression. Hypercortisolaemia, possibly secondary to breakdown in glucocorticoid-receptor-mediated negative feedback mechanisms within the HPA axis, may be central to the pathogenesis of both depressive symptoms and the neurocognitive deficits which characterize these disorders. Strategies to counteract the effects of elevated cortisol, which may potentially restore HPA axis integrity, have been the focus of recent research.

Conclusions: Both preclinical and clinical studies report encouraging results which suggest that lowering circulating cortisol levels or blocking the effects of elevated cortisol with antagonists, which may up-regulate glucocorticoid receptors, has therapeutic benefits in terms of improvements in depressive symptoms and some domains of neurocognitive function.
Anticonvulsants in Bipolar Disorder
Authors: Bowden Charles L. , Karren Nancy U.
Published: December 2009

Objective: To review the literature on the effectiveness of anticonvulsant drugs in the management of bipolar disorder.

Methods: A selective review of the literature.

Results: Valproate is an effective drug, alone or in combination, for mania, but has limited benefit in bipolar depression. Although valproate is widely used in maintenance therapy of bipolar disorder, and secondary analyses suggest benefit, in the largest randomised maintenance trial there was only a trend favouring valproate. Lamotrigine has benefit in bipolar depression and maintenance, but not in mania. Carbamazepine is effective in mania. Other anticonvulsant drugs have been tried in mania, but with mixed results.

Conclusions: Valproate, lamotrigine and carbamazepine have a valuable place in the management of bipolar disorder.
Transcranial Magnetic Stimulation for Depression
Authors: Mitchell Philip B. , Loo Colleen K.
Published: December 2009

Objective: To review the accumulated literature on the efficacy, safety and predictors of response for repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression.

Methods: A descriptive review of the more than 25 published sham-controlled rTMS studies in depression was undertaken, focusing on reported meta-analyses as well as individual trial reports. Potential determinants of efficacy were examined, including the form of shams employed, stimulation parameters and clinical features.

Results: There is now clear evidence for the statistical superiority of left-prefrontal high frequency rTMS compared with sham therapy. However, the clinical benefits are marginal in the majority of reports. There is also still considerable uncertainty concerning the optimal stimulation parameters. Those clinical features which appear to be associated with greater response include younger age, lack of refractoriness to antidepressants and no psychotic features.

Conclusions: Current studies confirm statistical efficacy, but insubstantive clinical benefit. Large multicentre studies currently underway should clarify if rTMS should be approved by regulatory agencies for widespread clinical availability. Furthermore, there is a need to clarify the preferred parameters for administering this treatment.
Pathways to Care in a New Zealand Firstepisode of Psychosis Cohort
Authors: Turner Mark , Turner Mark , Smith-Hamel Cecilia , Mulder Roger
Published: December 2009

Objectives: To present the clinical and sociodemographic characteristics of patients referred to a New Zealand early intervention for psychosis service and to describe the pathways to care for these patients.

Method: Clinical and sociodemographic characteristics were examined in 200 patients consecutively admitted to an early psychosis service over a 5-year period. Assessment measures included DSM-IV diagnosis, the Quality of Life Scale, Positive and Negative Syndrome Scale and information on pathways to care.

Results: The majority of patients were young (mean age = 22.35), single (90.1%), male (72.5%), of New Zealand European descent (63.7%), living in the parental home (60.2%) and on a government benefit (60.2%). Overall, 40.8% of patients were initially diagnosed with a schizophrenia spectrum disorder, 36.4% with a mood disorder and 22.8% were classified as ‘other psychoses’ (substance-induced psychosis, brief psychotic disorder, etc.). Those with a schizophrenia spectrum disorder had a median duration of untreated psychosis of 120 days compared with 29 days for other diagnoses. Overall, 64.1% of referrals came from the Inpatient Service, 36.3% of patients had a compulsory admission under the Mental Health Act, and 41.8% had contact with police in 6 months prior to referral to the service. No differences in inpatient admission rates, police involvement or compulsory admission were evident for ethnicity or diagnosis.

Conclusions: The pathways to care, clinical and sociodemographic descriptors of the present sample are somewhat different to those previously reported in international cohorts. This reflects the inclusion of patients with affective psychoses, the age range of 18–30 years and New Zealand's distinctive healthcare system. Examination of the sociodemographic characteristics and pathways to care in the present cohort suggests that service reconfigurations are required to optimize the experience of inpatient admission, given the substantial proportion of clients with non-schizophrenia spectrum disorders that present acutely for treatment.
Pattern and Correlates of Inpatient Admission During the Initial Acute Phase of First-Episode Psychosis
Authors: Wade Darryl , Harrigan Susy , Harris Meredith G. , Wade Darryl , Harrigan Susy , Harris Meredith G. , Edwards Jane , Mcgorry Patrick D. , Wade Darryl , Harrigan Susy , Harris Meredith G. , Edwards Jane , Mcgorry Patrick D.
Published: December 2009

Objectives: The first aim of this study was to examine the rate, pattern and correlates of inpatient admission during the first 3 months of treatment for first-episode psychosis (FEP). The second aim was to determine whether the pattern of inpatient admission during this period was associated with remission of psychotic symptoms or inpatient service use at 15-month follow-up.

Method: One hundred and four consecutive patients with FEP at a specialist treatment service were approached to participate in a follow-up study. Patients were grouped on the basis of the pattern of inpatient admission (none, one, or multiple) during the first 3 months of treatment. Clinical ratings at baseline and 3-month follow-up, and ratings of remission of psychotic symptoms at 3 and 15-month follow-up, were available for two-thirds of the patients. Inpatient data for the 15-month follow-up period were derived from an electronic database for most patients (n = 98).

Results: Eighty (76.9%) of the 104 patients were admitted to an inpatient unit during the first 3 months of treatment. Fifty-nine (56.7%) patients had a single admission and 21 (20.2%) had multiple admissions. At baseline, inpatient admission was associated with a diagnosis of affective psychosis and more severe behavioural and functional disturbance but not positive psychotic symptoms. Multiple admissions were associated with risks to self or others at baseline and 3-month follow-up, and lack of remission of positive symptoms at 3 and 15-month follow-up. There was no association between the pattern of inpatient admission during the initial 3-month period and inpatient service use during the following 12-month period.

Conclusions: The substantial proportion of young patients with FEP admitted to hospital emphasizes the need for youth-friendly treatment environments and practices. Although patients with multiple admissions during the initial treatment period are less likely to achieve remission, these patients are no more likely to establish a pattern of revolvingdoor hospitalizations compared with other patients.
Treatment with Olanzapine, Risperidone or Typical Antipsychotic Drugs in Asian Patients with Schizophrenia
Authors: Lee Chul , Wu Kuang-Hsien , Habil Hussain , Dyachkova Yulia , Lee Phil
Published: December 2009

Objective: To examine clinical outcomes in Asian patients with schizophrenia receiving monotherapy with olanzapine, risperidone or typical antipsychotics in naturalistic settings.

Method: In this report, data from the first 12 months of the prospective, observational, 3-year Intercontinental Schizophrenia Outpatient Health Outcomes study are presented for patients from participating Asian countries (Korea, Taiwan and Malaysia) who were started on, or switched to, monotherapy with olanzapine (n = 484), risperidone (n = 287) or a typical antipsychotic drug (n = 127) at baseline.

Results: At 12 months, overall reduction in the score of Clinical Global Impressions-Severity of Illness rating scale was greatest with olanzapine (p < 0.001 vs typical agents), followed by risperidone (p = 0.007 vs typical agents) treatment. Olanzapine treatment was found to have significantly better effects than typical agents on negative and depressive symptom scores, and significantly greater improvements than risperidone on negative and cognitive symptoms. The occurrence of extrapyramidal symptoms was least likely with olanzapine (p < 0.001 vs typical agents, and p = 0.012 vs risperidone), while the estimated odds of tardive dyskinesia were greatest in the typical treatment group (p = 0.046 vs olanzapine, and p = 0.082 vs risperidone). Mean weight increase was greater for olanzapine-treated patients compared with the other agents (p = 0.030 vs typical agents and p < 0.001 vs risperidone). The risk of menstrual disturbance was relatively high with risperidone when compared with olanzapine treatment (p < 0.001).

Conclusions: The results of this observational study indicate that, in Asian patients with schizophrenia, olanzapine may offer benefits when compared with typical agents or risperidone. However, the significantly greater odds of weight gain should be considered in the clinical management of olanzapine-treated patients.
Deinstitutionalization of Long-Stay Patients with Schizophrenia: The 2-Year Social and Clinical Outcome of a Comprehensive Intervention Program in Japan
Authors: Ryu Yonosuke , Mizuno Masafumi , Sakuma Kei , Munakata Shunichi , Takebayashi Toru , Murakami Masaaki , Falloon Ian R.H. , Kashima Haruo
Published: December 2009

Objectives: The Sasagawa Project aimed to investigate the effects of deinstitutionalization and evidence-based strategies for the treatment of mental disorders among long-stay patients after their discharge from a mental hospital using a quasi-experimental longitudinal study design and to assess the patients' social and clinical outcomes over a 2-year post-discharge period.

Method: Seventy-eight patients with schizophrenia were transferred to a community facility (Sasagawa Village) following the closure of Sasagawa Hospital in Koriyama in March 2002. The patients had undergone psychosocial training following the protocol outlined by the Optimal Treatment Project. All evaluations were performed prior to the patients' discharge and were repeated 12 and 24 months after discharge using the Positive and Negative Syndrome Scales, the Global Assessment for Functioning, the Schedule for Assessment of Insight, the Rehabilitation Evaluation Hall and Baker Scale, the Social Functioning Scale, the Drug Attitude Inventory, and the Mini-Mental State Examination.

Results: During the 24-month study period, 18 residents had incidents that made their continued stay at Sasagawa Village impossible. Only four (5.1%) of these residents were readmitted to psychiatric wards because of exacerbations of their conditions. Twelve residents were admitted to hospital because of serious physical illnesses. The 60 residents who remained in the community facility for 2 years demonstrated significant improvements in not only their psychiatric symptoms, but also their social functioning, as evidenced by their scores for Social Activity, Speech Skills, Disturbed Speech, Self-Care and General Behaviour on the Rehabilitation Evaluation Hall and Baker Scale and Withdrawal, Independence (Performance), Independence (Competence), and Employment on the Social Functioning Scale.

Conclusions: Careful planning that minimized social and clinical dislocation may have contributed to the successful transition from mental hospital to community facility assessed in this study. Patients with a long history of illness showed favourable outcomes with little clinical deterioration and various improvements in their psychiatric symptoms and social functioning.
Association between Childhood Trauma and Dissociation Among Patients with Borderline Personality Disorder
Authors: Watson Stuart , Chilton Roy , Fairchild Helen , Whewell Peter
Published: December 2009

Objective: To examine the relationship between childhood trauma and dissociative experience in adulthood in patients with borderline personality disorder.

Method: Dissociative experiences scale scores and subscale scores for the Childhood Trauma Questionnaire were correlated in 139 patients. Patients were dichotomized into high or low dissociators using the Median Dissociative Experiences Scale score as the cut-off.

Results: Childhood Trauma Questionnaire Subscale scores for emotional and physical abuse and emotional neglect but not sexual abuse correlated significantly with Dissociative Experiences Scale scores. High dissociators reported significantly greater levels of emotional abuse, physical abuse, emotional neglect and physical neglect but not sexual abuse than low dissociators.

Conclusion: Patients with borderline personality disorder therefore demonstrated levels of dissociation that increased with levels of childhood trauma, supporting the hypothesis that traumatic childhood experiences engender dissociative symptoms later in life. Emotional abuse and neglect may be at least as important as physical and sexual abuse in the development of dissociative symptoms.
Childhood Adversity and Adult Personality
Authors: Rosenman Stephen , Rodgers Bryan
Published: December 2009

Objectives: To explore how recalled childhood adversity affects trait measures of personality in three age cohorts of an Australian adult population and to examine the effects of particular adversities on adult personality traits.

Method: A total of 7485 randomly selected subjects in the age bands of 20–24, 40–44 and 60–64 years were interviewed at the outset of a longitudinal community study of psychological health in the Canberra region of Australia. In the initial interview, subjects answered 17 questions about domestic adversity and three questions on positive aspects of upbringing to age 16 years. Personality traits were measured by Eysenck Personality Questionnaire, Behavioural Activation and Inhibition Scales, Positive and Negative Affect Scales and a measure of dissocial behaviours.

Results: Higher levels of childhood adversity substantially increase the risk of high neuroticism (OR = 2.6) and negative affect (OR = 2.6), less for behavioural inhibition (OR = 1.7) and for dissocial behaviour (OR = 1.7). No significant effect is seen for extraversion, psychoticism or behavioural activation. Age and gender had little effect on the pattern of risk. Maternal depression has significant and substantial independent effects on measures of neuroticism and negative affect as well as most other measures of personality.

Conclusion: Childhood domestic adversity has substantial associations with clinically important aspects of personality: neuroticism and negative affect. Only small effects are seen on behavioural inhibition and dissocial behaviour, and no significant effect on extraversion and behavioural activation. These unexpected findings contradict clinical belief. Maternal psychological ill-health is pre-eminent among adversities predicting later disadvantageous traits, even for those traits that had only the slightest association with childhood adversity. Consequences of childhood adversity prevail throughout the lifespan in men and women equally. The study underlines the importance of childhood domestic adversity and especially maternal psychological ill-health as a target for preventive intervention for psychological difficulties at all ages.
Psychopathy/Antisocial Personality Disorder Conundrum
Authors: Ogloff James R.P.
Published: December 2009

Psychopathy has traditionally been characterised as a disorder primarily of personality (particularly affective deficits) and, to a lesser extent, behaviour. Although often used interchangeably, the diagnostic constructs of psychopathy, antisocial personality disorder, and dissocial personality disorder are distinct. In this article, the relevant historical and contemporary literature concerning psychopathy is briefly reviewed. The diagnostic criteria for psychopathy, antisocial personality disorder, and dissocial personality disorder are compared. Consideration is given to the assessment, prevalence, and implications of psychopathy for violence risk and treatment efficacy. The DSM-IV-TR criteria for antisocial personality disorder, in particular, are largely behaviourally based. The ICD criteria for dissocial personality disorder, while paying more attention to affective deficits, also do not represent the broad personality and behavioural components of psychopathy. Since 1980, a great deal of research on these disorders has been conducted, using the Hare Psychopathy Checklist, Revised (PCL-R). The PCL-R assesses both personality (interpersonal and affective) and behavioural (lifestyle and antisocial) deficits. As such, the research and clinical implications of psychopathy, as operationalised by the PCL-R, cannot be readily extrapolated to the diagnoses of antisocial personality disorder and dissocial personality disorder. As currently construed, the diagnosis of antisocial personality disorder grossly over-identifies people, particularly those with offence histories, as meeting the criteria for the diagnosis. For example, research shows that between 50% and 80% of prisoners meet the criteria for a diagnosis of antisocial personality disorder, yet only approximately 15% of prisoners would be expected to be psychopathic, as assessed by the PCL-R. As such, the characteristics and research findings drawn from the psychopathy research may not be relevant for those with antisocial or dissocial personality disorder.
Court Diversion in Perspective
Authors: James David V.
Published: December 2009

Court diversion schemes have been running for a decade in New Zealand and are increasing in number in Australia. This paper aims to give an international and historical context to these developments, by reference to psychiatric initiatives at courts in the US and in England and Wales. From a review of the specialist literature, an account is given of three forms of psychiatric intervention in courts over the last 90 years: court psychiatric clinics and mental health courts in the US, and court diversion schemes in England and Wales. High levels of psychiatric morbidity among prisoners, coupled with a continuing increase in prisoner numbers, demonstrate the need for systems for dealing with mentally ill people who come before the courts. Court diversion in England and Wales developed as part of a system where the mentally ill who are found guilty are sent to hospital in lieu of any other sentence. Its focus is on a form of psychiatric triage, and its ethos is the health of the patient. Court psychiatric clinics in the US grew up as an alternative to assessment in prison. Their focus has been on full psychiatric evaluation in an insanity and incompetence jurisdiction. The ethos has been that of serving the court. Mental health courts are heavily influenced by ideas of therapeutic jurisprudence, and their emphasis has been on a judge holding minor offenders in community care through the threat of judicial sanction. Experience in England and Wales has shown that court diversion can be a powerful and effective intervention. In order for it to function properly, those running court schemes need direct admission rights to psychiatric beds, both open and locked. Court diversion schemes are best as part of a spectrum of services to police stations, courts and prisons, which involved both general and forensic psychiatrists.
Fire Interest, Fire Setting and Psychopathology in Australian Children: a Normative Study
Authors: Dadds Mark R. , Fraser Jennifer A.
Published: December 2009

Objective: Child and adolescent fire setting is associated with a broad pattern of antisocial behaviour and is associated with huge costs to the Australian community. Assessment and treatment options have principally been tested in clinically referred or incarcerated children and adolescents. Little information is available about fire setting in normal populations and thus opportunities for screening and early intervention are not well developed.

Method: In this study, a large sample of 4- to 9-year-old children were assessed using a seven-item fire interest history screen with other measures of antisocial behaviour, children's mental health, parenting style and quality and parenting stress. These were followed-up with parent and teacher report measures and a diagnostic interview at 12 months.

Results: The fire history screening tool demonstrated utility in screening for early signs of fire setting. Prevalences of fire interest, and match- and fire-play were low overall but consistently higher for boys than for girls across ages. As expected, fire setting was associated with parental stress and a range of antisocial behaviours including conduct problems, hyperactivity, cruelty to animals and thrill-seeking temperament. In girls, it was also associated with anxiety/depression problems.

Conclusions: Fire behaviours in children are related to broader psychopathology and family stress, and can be effectively identified in young children using a brief screening measure.
Psychosocial Correlates of Problem Gambling in Australian Students
Authors: Delfabbro Paul , Lahn Julie , Grabosky Peter
Published: December 2009

Objective: This study examined the relationship between problem gambling and psychological and social adjustment in Australian adolescents.

Method: A sample of 926 adolescents (mean age=14.46 years) in the Australian Capital Territory were administered a standardized series of measures relating to gambling and psychosocial adjustment. Young people were asked to indicate how often they gambled, to report any difficulties that they might have been experiencing with gambling, and to complete a variety of measures of psychosocial health, including: the GHQ-12, Rosenberg's self-esteem scale and other measures of social functioning.

Results: The results were generally consistent with previous international studies. Those adolescents classified as problem gamblers were found to have poorer scores on all psychosocial measures. Although many in the problem gambling group reported being part of a socially active peer group, they also reported being more alienated and unpopular among their classmates.

Conclusions: The results suggest that problem gambling appears to be a significant risk factor for poorer mental health among Australia adolescents. Given previous adult research indicating a link between early gambling and long-term gambling problems and poorer life outcomes (e.g. Abbott, McKenna and Giles, 2000 in New Zealand), these findings suggest a need to enhance existing educational initiatives and services specifically designed to assist adolescents with gambling problems.
Do Older Australians Truly have Low Rates of Anxiety and Depression? A Critique of the 1997 National Survey of Mental Health and Wellbeing
Authors: O'Connor Daniel W.
Published: December 2009

This paper sets out to critically evaluate reports from the Australian-wide National Survey of Mental Health and Wellbeing of very low rates of ICD-10 anxiety and depressive disorders in community resident older Australians. Data from the National Survey, which relied on the Composite International Diagnostic Interview (CIDI) were re-computed and re-analysed to address concerns about population sampling, interview response patterns and alternate measures of mental health. Rates of anxiety and depressive disorders fell to low levels after 65 years and continued to fall thereafter. This is at odds with findings from gerontological surveys that used assessment tools better suited to frail older people. Scores on mental health scales, together with diagnostic algorithms that obviated CIDI skip patterns, showed much less change in mental wellbeing across generations. It is argued that sampling and case ascertainment bias combined to reduce rates of anxiety and depression in very old people, especially when adjustments are made for the high morbidity levels encountered in aged residential facilities. Functional mental disorders almost certainly rise in frequency in advanced old age, often in conjunction with dementia.
Workforce Capacity to Respond to Children Whose Parents have a Mental Illness
Authors: Maybery Darryl , Reupert Andrea
Published: December 2009

Objective: The first of the three objectives of this study was to identify the core barriers that impede adult mental health and other clinicians from working with patients about parenting and child-related issues. The second and third objectives were to rate the importance of these barriers and to compare barriers for adult mental health workers with other workers.

Method: There were two data collection phases; the first, qualitative phase involved collecting verbatim responses from 60 mental health and welfare workers, regarding barriers about working with mentally ill patients about their parenting role as well as with their children. The second involved 32 participants, including 20 adult mental health workers and 12 other workers, responding to the scaled questionnaire items based on the qualitative barriers identified at phase one.

Results: The most important barriers highlighted by workers were patients not identifying their illness as a problem for their children and patients denying that they had a mental health problem. All workers reported that it was part of their role to get involved with issues regarding their patient's children. In comparison to other workers, adult mental health workers reported time and resource limitations, as well as skill and knowledge deficits regarding parenting and working with children.

Conclusions: The findings are discussed in relation to adult mental health policy and ongoing professional development, particularly for adult mental health workers.
Season of Birth, Age and Negative Symptoms in a Xhosa Schizophrenia Sample from the Southern Hemisphere
Authors: Jordaan Esmè R. , Niehaus Dana J.H. , Koen Liezl , Seller Cathlene , Mbanga Irene , Emsley Robin A.
Published: December 2009

Objectives: Seasonality of birth, more specifically winter/spring births, has been implicated as a risk factor for the development of schizophrenia. The primary aim of this study was to determine whether schizophrenia patients of Xhosa ethnicity born in autumn/ winter have different symptom profiles to those born in spring/summer. The secondary aim was to determine whether the autumn/winter and spring/summer birth rates for schizophrenia patients of Xhosa ethnicity were similar to that of the general Xhosa population.

Method: Individuals with a diagnosis of schizophrenia, born in the Western and Eastern Cape Provinces of South Africa (n = 386), were categorized as autumn/winter-born (March to August) patients or summer/spring-born (September to February) patients. Negative global scores of the schedules for the assessment of negative symptoms were categorized as normal (rating of 0 and 1) or positive (rating of 2 to 5).

Results: Patients born in autumn/winter were more likely to have avolition/apathy than those born in summer/spring. The results also showed that the age of the patients played a significant role in modifying the effect of the season of birth on symptoms of schizophrenia. Especially older people (more than 30 years old) born in autumn/winter had a higher incidence of avolition/apathy than those born in summer/spring (p = 0.026). Furthermore, in the relationship of birth season and avolition/apathy, the marital status of the patient was a significant independent explanatory variable, while gender was not. The study also showed a spring excess of 4% in birth rate compared with the general Xhosa population.

Conclusion: The results from our study support the existence of a seasonal birth pattern in an African schizophrenia population and suggest that avolition/apathy may underpin this seasonal pattern.
Psychological Health of Men with Partners who have Post-Partum Depression
Authors: Roberts Sarah L. , Roberts Sarah L. , Bushnell John A. , Roberts Sarah L. , Bushnell John A. , Collings Sunny C. , Purdie Gordon L.
Published: December 2009

Objective: To compare the psychological health of men with partners who have postpartum depression (PPD; index group) with that of men with partners without PPD (comparison group).

Method: Using a cross-sectional survey, psychological symptoms and disturbances of index group men (n = 58) and comparison group men (n = 116) were compared. Validated self-report measures were used to assess five key areas of mental health: depression, anxiety, non-specific psychological impairment, aggression and alcohol use.

Results: Index group men had more symptoms of depression, aggression and nonspecific psychological impairment, and had higher rates of depressive disorder, nonspecific psychological problems and problem fatigue than comparison group men. Index group men were also more likely to have three or more comorbid psychological disturbances. There was no difference between the groups on measures of anxiety and alcohol use.

Conclusions: Although many men in the postnatal period experience a variety of mental health problems, those who have a partner with PPD are themselves at increased risk for experiencing psychological symptoms and disturbances. Differentiation of psychological syndromes is important; higher rates of depressive disorder, non-specific psychological problems and problem fatigue were found, but rates of anxiety disorder and hazardous alcohol use did not differ between the groups. More attention from health professionals to men's mental health in the postnatal period may be beneficial to the entire family system.
Anti-Heat Shock Protein 90 is Increased in Acute Mania
Authors: Shen Winston W. , Liu Hsing-Cheng , Yang Yi-Yuan , Lin Chia-Yi , Chen Kun-Po , Yeh Tien-Shun , Leu Sy-Jye
Published: December 2009

Objective: The aim of this work was to examine autoantibodies in patients with bipolar disorder.

Method: We enrolled 94 patients with acute bipolar mania, with 37 of them medicated and 57 unmedicated at the time of blood sampling. The samples also consisted of 44 patients in the remission state and another 48 normal controls. We first used human glioblastoma (U373 MG) cell lysate to screen the potential autoantibodies present in sera of bipolar mania patients, and anti-heat shock protein (anti-HSP) 60, 70 and 90 autoantibodies were identified. We then examined the serum levels of these autoantibodies by enzyme-linked immunosorbent assay.

Results: The findings of this study showed that serum anti-HSP90 level was significantly higher in bipolar patients in acute mania than those in remission (p = 0.002).

Conclusions: The data of this study suggest that increased anti-HSP90 might be a state marker for acute mania in patients with bipolar disorder.
Cortical-Subcortical Re-Entrant Circuits and Recurrent Behaviour∗
Authors: Levy Florence , Krebs Peter R.
Published: December 2009

Objective: To explore the application of Parallel Distributed Processing (PDP) models to biological cortical-subcortical re-entrant circuits, and their implications for recurrent psychiatric symptomatology.

Method: The literature on cortical-cortical and cortical-subcortical re-entrant circuits is reviewed and possible neural network (PDP) analogies are described. Examples from the attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) literature are explored and compared.

Results: A common circuit architecture for at least five circuits was found. Recurrent PDP models suggest that subcortical centres can exert significant influences on behaviour, but their effect will depend on gating processes at higher centres, governed by both feedback (phasic arousal/reinforcement) and synaptic activity at higher levels. The latter can vary around a ‘Golden Mean’ at cortical receptor levels, which degrades when it is either overaroused or under-aroused. The Continuous Performance Task, which models both working memory and inhibitory processing is a useful task for functional imaging of an attentional network.

Conclusion: Recurrent symptoms occur as a result of incoordination between phasic subcortical inputs and synaptic gating processes in cortical-subcortical circuits. Obsessive-compulsive disorder and ADHD represent opposite manifestations of recurrent cortical-subcortical processing deficits, with excess arousal in the former and insufficient maintenance of reinforcement and working memory in the latter. These processes may be subject to separate genetic influences at cortical versus subcortical levels.
Daily and Spaced Treatment with Transcranial Magnetic Stimulation in Major Depression: A Pilot Study
Authors: Turnier-Shea Yvonne , Bruno Raimondo , Pridmore Saxby
Published: December 2009

Objective: Transcranial magnetic stimulation is an emerging treatment of treatmentresistant depression. Current protocols rely on daily treatments. This study was designed to determine whether the time period over which treatment is delivered is an important factor in efficacy.

Method: Sixteen adult patients with treatment-resistant major depression were randomly assigned to one of the two treatment groups, both of which received 2 weeks of treatment. One group received daily treatment (10 treatments, on business days). The other group received three treatments in week one, and two treatments in week two (five treatments, on spaced business days). Mood was rated using the Hamilton Depression Rating Scale (HDRS) and a self-rated visual analogue scale. Response was defined as a 50% reduction in HDRS rating, and remission was defined as achieving an HDRS score of 8 or less. The groups were compared throughout the 2-week study period.

Results: At entry, there were no demographic differences between the groups. Multivariate tests showed a significant main effect for time (Pillai trace = 0.76, F(4,56) = 8.56, p < 0.001, power = 0.99) reflecting the improvement in both measures of depression during treatment. There was no significant difference between the groups overall (Pillai trace = 0.25, F(2,13) = 2.12, p = 0.16, power = 0.36). Additionally, there was no significant interaction between time and treatment group (Pillai trace = 0.18, F(4,56) = 1.35, p = 0.26, power = 0.39) indicating that the significant improvement in depression over time was similar for both treatment groups. There were no significant differences in response and remission rates between the groups.

Conclusion: The time period of treatment appeared to be an important outcome factor. This suggests that less than daily transcranial magnetic stimulation treatment may be a useful clinical alternative.
Mentally Abnormal Homicide in New Zealand as Defined by Legal and Clinical Criteria: A National Study
Authors: Simpson Alexander I.F. , Skipworth Jeremy , McKenna Brian , Moskowitz Andrew , Barry-Walsh Justin
Published: December 2009

Background: Homicides by people with mental illness have been studied using either clinical or legal categorization of the homicide as abnormal. No previous study has employed both definitions in the same population.

Method: A retrospective study of all homicides in New Zealand between 1988 and 2000 considered mentally abnormal homicide using a legal definition (when the courts deemed a contribution of mental illness was present) and a clinical definition (defined as the presence of a discharge diagnosis from inpatient mental health treatment) of ‘mentally abnormal’. Rates, characteristics and time trends were investigated.

Results: Of the 844 cases, 7.1% met legal criteria for being mentally abnormal, while 7.7% had ever received a diagnosis for a psychotic illness, and a further 14.5% had been admitted to a psychiatric hospital for any other reason. The majority (60%) of perpetrators with a psychotic diagnosis received a mental health disposition from the court. Of these, 60% were first diagnosed with their psychotic illness prior to the homicide, while 28% were first diagnosed at the time of the offence and a further 12% after imprisonment. Of all those who received a psychotic diagnosis, 89% had post-conviction admissions or a mental health disposition.

Conclusion: Legal and clinical definitions of mentally abnormal homicide detect similar rates of mentally abnormal homicide, but illustrate somewhat different dimensions of the relationship between mental illness and homicide.
Prevalence, Interference with Life and Severity of 12 Month DSM-IV Disorders in Te Rau Hinengaro: The New Zealand Mental Health Survey
Authors: Wells J. Elisabeth , Oakley Browne Mark A. , Scott Kate M. , McGee Magnus A. , Baxter Joanne , Kokaua Jesse
Published: December 2009

Objective: To estimate the 12 month prevalence of DSM-IV disorders in New Zealand, and associated interference with life and severity.

Method: A nationally representative face-to-face household survey carried out in 2003–2004. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0) was used. There were 12 992 completed interviews from participants aged 16 years and over. The overall response rate was 73.3%. In this paper the outcomes reported are 12 month prevalence, interference with life and severity for individual disorders.

Results: The prevalence of any disorder in the past 12 months was 20.7%. The prevalences for disorder groups were: anxiety disorders 14.8%, mood disorders 7.9%, substance use disorders 3.5%, eating disorders 0.5%. The highest prevalences for individual disorders were for specific phobia (7.3%), major depressive disorder (5.7%) and social phobia (5.1%). Interference with life was higher for mood disorders than for anxiety disorders. Drug dependence, bipolar disorder and dysthymia had the highest proportion of severe cases (over 50%), when severity was assessed over the disorder itself and all comorbid disorders. Overall, only 31.7% of cases were classified as mild with 45.6% moderate and 22.7% serious.

Conclusions: Compared with other World Mental Health survey sites New Zealand has relatively high prevalences, although almost always a little lower than for the US. For all disorders, except specific phobia, interference with life was reported to be moderate, on average, which has lead to less than a third of cases being classified as mild. Most people who have ever met full DSM-IV criteria, including the impairment criterion, and who experience symptoms or an episode in the past 12 months find that their disorders impact on their lives to a non-trivial extent.
Twelve-Month and Lifetime Health Service use in Te Rau Hinengaro: The New Zealand Mental Health Survey
Authors: Oakley Browne Mark A. , Elisabeth Wells J , Mcgee Magnus A. ,   For The New Zealand Mental Health Survey Research Team
Published: December 2009

Objective: To estimate the 12 month and lifetime use of health services for mental health problems.

Method: A nationwide face-to-face household survey carried out in 2003–2004. A fully structured diagnostic interview, the World Health Organization Composite International Diagnostic Interview (CIDI 3.0) was used. There were 12 992 completed interviews from participants aged 16 years and over. The overall response rate was 73.3%. In this paper, the outcomes reported are 12 month and lifetime health service use for mental health and substance use problems.

Results: Of the population, 13.4% had a visit for a mental health reason in the 12 months before interview. Of all 12 month cases of mental disorder, 38.9% had a mental health visit to a health or non-health-care provider in the past 12 months. Of these 12 month cases, 16.4% had contact with a mental health specialist, 28.3% with a general medical provider, 4.8% within the human services sector and 6.9% with a complementary or alternative medicine practitioner. Most people with lifetime disorders eventually made contact if their disorder continued. However, the percentages seeking help at the age of onset were small for most disorders and several disorders had large percentages who never sought help. The median duration of delay until contact varies from 1 year for major depressive disorder to 38 years for specific phobias.

Conclusions: A significant unmet need for treatment for people with mental disorder exists in the New Zealand community, as in other comparable countries.