bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-Ictal Psychosis: an Unusual Clinical Entity
Authors: Prendergast Joanna , Spira Paul , Schnieden Vivienne
Published: March 2003

Objective: The aim of this paper is to describe a case of post-ictal psychosis (PIP) and to discuss the literature surrounding this interesting disorder.

Clinical picture: A 32-year-old woman with epilepsy presented on three occasions with psychosis following tonic-clonic seizures.

Treatment and outcome: The psychosis resolved within 14 days on haloperidol 7 mg daily.

Conclusions: Post-ictal psychosis is an unusual clinical entity that is frequently recurrent and may be misdiagnosed and treated inappropriately. Prophylaxis of PIP is an area for important future research.
A Double-Blind, Multicentre Study to Assess the Tolerability and Efficacy of Paroxetine Compared with Amitriptyline in the Treatment of Depressed Patients in Australian General Practice
Authors: Freed Edgar , Goldney Robert , Lambert Timothy , Tiller John , Johnston Robyn
Published: March 2003

Objective: This study compared the tolerability and efficacy of paroxetine and amitriptyline in the treatment of depression in general practice.

Methods: In this double-blind, multicentre study conducted in the general practice, patients with depression (Montgomery Asberg Depression Rating Scale [MADRS] score ≥ 20) who were regarded as requiring antidepressant therapy were randomly assigned to receive paroxetine (20 mg, n=184) or amitriptyline (50–100 mg, n=191) once daily for 9 weeks.

Results: More patients completed treatment with paroxetine than with amitriptyline (71.1% vs 56.1%, p=0.009). Depression rating scores (MADRS and Clinical Global Impression [CGI]) were improved with both agents, but at week 9, paroxetine achieved more favourable scores compared with amitriptyline on MADRS (p=0.019), CGI severity of depression (p=0.044), and CGI efficacy index (p=0.038).

Conclusions: Depressed patients treated in general practice respond more quickly and are more likely to complete the treatment regimen with paroxetine than with amitriptyline.
A Model for Clinical and Educational Psychiatric Service Delivery in Remote Communities
Authors: Owen Cathy , Tennant Christopher , Jessie Deslee , Jones Michael , Rutherford Valerie
Published: March 2003

Objective: A model of intermittent psychiatric service provision to rural and remote New South Wales communities by metropolitan psychiatrists and mental health professionals has been evaluated. The services provided included peer support to lone mental health and generic health workers, direct psychiatric care to clients in their own environment and skills development education sessions to general health staff and other professionals affiliated with health care (e.g. police and ambulance officers).

Method: There were 10 visits of teams made up of a psychiatrist and another mental health professional to six rural and remote locations. Outcomes of the services delivered were examined including clinical services and teaching skills training sessions. Indirect outcome measures included changes to Pharmaceutical Benefits Scheme prescription patterns in areas serviced and data regarding transfer of clients for psychiatric care in regional centres. Difficulties in evaluation are discussed.

Results: The feasibility of intermittent service provision was demonstrated. Education packages were well received and a positive change in workers' attitudes toward mental health practice was found.

Conclusion: Intermittent psychiatric services in remote settings add value to health care delivery particularly when dovetailed with skills-based education sessions.
Adolescent Pregnancy: Psychopathology Missed
Authors: Quinlivan Julie A. , Petersen Rodney W. , Gurrin Lyle C.
Published: March 2003

Objectives: Few data exist that explore the level of psychosocial problems and drug abuse in an Australian, adolescent, antenatal population. We set out to audit these data from a population of pregnant Western Australian adolescents. We also set out to examine whether social issues and the use of non-prescription drugs are routinely addressed in general public antenatal clinics.

Methods: One hundred and sixty patients were involved in the prospective cohort study. In the assessed group, 100 consecutive patients from the King Edward Memorial Hospital Adolescent Antenatal Clinic were interviewed during the antenatal period to determine if any major psychosocial issues or a history of non-prescription drug abuse was present. The control group consisted of 60 adolescent patients who delivered in general antenatal clinics at three Perth metropolitan hospitals.

Results: Sixty percent of the assessed group were identified as having a major psychosocial problem that interfered with their ability to carry out acts of daily living. Consumption of cigarettes, alcohol, marijuana, heroin and solvents were higher than that reported for the general Australian adolescent population. Of note, in the control group, many patients did not have a social, psychological, or drug use history taken by their caregivers.

Conclusion: Failure to identify psychosocial problems and drug abuse during the antenatal period will result in missed opportunities for positive intervention. These problems are common in this population and interventions are required to offer these women alternative foundations upon which to base their mothercraft skills.
An Open Study of Sertraline in Patients with Major Depression who Failed to Respond to Moclobemide
Authors: George Tom , Theodoros Michael T. , Chiu Edmond , Krapivensky Natalie , Hokin Arthur , Tiller John W. G.
Published: March 2003

Objectives: The aim of this study is to evaluate the efficacy and tolerability of sertraline in patients with major depression who have failed to respond to an adequate trial of moclobemide.

Method: Sixty-three patients with major depression who had discontinued moclobemide within the last 6 weeks due to lack of efficacy were recruited from multiple psychiatric services in Victoria and Queensland. After a wash-out period, patients were treated with sertraline 50 mg once daily for 4 weeks. If there was an insufficient response, the dose was titrated upwards to a maximum of 200 mg/day, with 2 weeks at each dosage level. By the end of the study, patients had received a fixed dose of sertraline for 8 weeks. The main outcome measures were the 17-item Hamilton Rating Scale for Depression (HAMD) and Clinical Global Impression (CGI) scales. Secondary outcome measures included the Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI).

Results: Of the 62 intention-to-treat patients enrolled, 48 (77%) responded to sertraline (i.e. experienced ≥ 50% reduction in HAMD total score from baseline and had a final HAMD score of ≤ 17). Fifty-four (87%) patients were at least ‘minimally improved’ on the CGI scale. There were also significant improvements in mean total MADRS and BDI scores. Sertraline was well tolerated. Adverse events were reported by 84% of patients, but only 5% withdrew due to adverse events.

Conclusions: This study shows that patients with major depression who have failed to respond to moclobemide can generally be treated successfully with sertraline.
An Intensive Treatment Program for Chronic Posttraumatic Stress Disorder: 2-Year Outcome Data
Authors: Humphreys Leanne , Westerink John , Giarratano Leah , Brooks Robert
Published: March 2003

Objective: The present study evaluates the efficacy of a closed-cohort treatment program for chronic posttraumatic stress disorder (PTSD).

Method: The treatment orientation was a combined approach involving cognitive behaviour therapy and pharmacotherapy. Treatment involved an inpatient phase of 4 weeks, with group and individual follow-up sessions of at least 6-month duration. The treatment population consisted largely of Australian Vietnam veterans. Standardised psychometric measures were obtained pre-treatment, on completion of the residential phase; and at 6, 12 and 24 months post discharge from the residential program.

Results: The results obtained from 64 patients demonstrate significant reductions in depression, anxiety and PTSD symptoms, maintained at 2 years post discharge from the residential phase of the treatment program.

Conclusions: This paper presents encouraging findings for treatment with this troubled population.
Prevalence, Detection and Management of Anxiety and Depressive Symptoms in Unemployed Patients Attending General Practitioners
Authors: Comino Elizabeth J. , Harris Elizabeth , Silove Derrick , Manicavasagar Vijaya , Harris Mark F.
Published: March 2003

Introduction: This study examined the detection and management of anxiety and depressive symptoms among unemployed patients attending general practitioners (GPs).

Method: A cross-sectional study was undertaken of anxiety and depressive symptoms in general practice using measures completed by patients and GPs. Eligible patients were adults aged 18 to 64 years either working (n = 2273) or unemployed (n = 392).

Results: Eighty per cent of patients were attending their regular GP at the time of the study. Unemployed patients were found to have a higher mean general health questionnaire (GHQ-12) score than employed patients (3.8 compared with 2.4, p < 0.001); were more likely to report symptoms of anxiety and depression which required medical treatment during the previous 4 weeks (30.9% compared with 14.6%, p < 0.001); and were more likely to have been treated for anxiety and depression by the GP (27.8% compared with 15.7%, p < 0.001). Among patients who the GPs reported treating for anxiety and depression, unemployed patients were 3.3 times (95% CI: 2.0–5.4) more likely to be prescribed medication than employed patients when severity was controlled but were no more likely to be referred to other health services. Unemployed patients identified increased use of services and were less satisfied with the care that they had received.

Conclusions: Unemployed patients attending GPs have an increased risk of anxiety and depressive symptoms. Increased prescription of medication as opposed to referral suggests that GPs may treat their unemployed patients differently to employed patients. GPs need to be aware of the higher risk and severity of anxiety and depressive symptoms among unemployed patients and their desire to be more actively involved in their treatment. General practice is an important setting for addressing the health needs of unemployed people.
The Procedural Validity of Retrospective Case Note Diagnosis
Authors: Mihalopoulos Cathrine , McGorry Patrick , Roberts Susan , McFarlane Colleen
Published: March 2003

Objective: Deriving diagnoses from retrospective case note examination is a common practice in psychiatric research. The Operational Criteria (OPCRIT) diagnostic checklist is essentially a checklist built up of operational criteria defined by a comprehensive glossary and is designed to assign reliable diagnoses from case notes. However, the validity of such a procedure compared with procedures involving prospective assessment has never been tested. We examined the procedural validity of the OPCRIT diagnostic system in relation to four other diagnostic procedures mostly employing prospectively gathered information.

Method: Three experienced psychopathology raters rated the case notes and clinical abstracts, using the OPCRIT method of diagnostic assignment, of 50 subjects who had participated in an early procedural validity study as an adjunct to the DSM-IV Field Trial for psychotic disorders. The setting was the Early Psychosis Prevention and Intervention Centre (EPPIC), which focuses on first episode psychosis.

Results: The pairwise concordance with the other procedures for DSM-III-R diagnoses assigned by OPCRIT using ratings derived from either the clinical abstracts or the case notes was found to be only poor to moderate when compared with the pairwise concordance of the four other procedures. The per cent agreement between OPCRIT clinical abstracts diagnoses and the other procedures ranged from 49% to 60% with kappa values between 0.30 and 0.45, and for OPCRIT case note diagnoses and the other procedures the per cent agreement range was between 44% and 57% and the kappa values were between 0.35 and 0.49.

Conclusions: The procedural validity of diagnoses assigned via the application of checklists of operational criteria to case notes and clinical abstracts alone is unacceptably poor. Such sources need to be buttressed by other data, particularly direct patient interview and informant material.
Predicting Community Survival in Early Psychosis and Schizophrenia Populations after Receiving Intensive Case Management
Authors: Preston Neil Joseph
Published: March 2003

Objective: The study was undertaken to assess whether social and living skills functioning predicted community survival between subjects with chronic schizophrenia and early episode psychosis after receiving assertive community-based case management.

Method: Forty-two chronic schizophrenia patients and 49 early psychosis subjects were measured on hospitalisation for up to 3 years after receiving equivalent community-based assertive case management. A Kaplan–Meier survival analysis was performed to compare community survival between the two groups. A Cox-regression analysis was used to investigate whether sex, age, social and occupational functioning measured by the social and occupational functional assessment score (SOFAS), living skills measured by the life skills profile score (LSP), and overall role functioning measured by the role functioning scale (RFS) predicted community survival. Subscales of the LSP were also analysed in a subsequent Cox-regression using the forward selection method.

Results: Differences in rate of community survival were not statistically significant (using the log-rank Chi-squared test) between subjects with early psychosis and chronic schizophrenia; however, half of the early psychosis subjects survived past the 12-month period while only a third of the chronic schizophrenia subjects did so within the same time period. The life skill profile was a significant predictor of community survival with low scores on the subscale of non-turbulence (i.e. antisocial behaviour) contributing to poorer community survival.

Conclusion: The amount of antisocial behaviour displayed while receiving assertive community-based case management may be an important predictor of community survival among subjects with early psychosis and chronic schizophrenia. Treatment of such behaviour may improve community survival among these populations.
Publishing Ethics in Psychiatry
Authors: Walter Garry , Bloch Sidney
Published: March 2003

Objective: The ethics of publishing in psychiatry has gained only limited attention. We examine, in a historical context, pertinent ethical problems and offer a series of recommendations for dealing with them.

Method: The study was conducted by exploration of medical databases and websites, and systematic discussion with ethicists, legal experts, publishers and researchers.

Results: Serious ‘publishing misconduct’ appears to have been rare in the psychiatric literature, but any occurrence of redundant publication, plagiarism and publication of fraudulent or inhumane research is disturbing and should be prevented. Difficulties around authorship, sensitive use of language, conflict of interest and bias in the publishing process are additional issues claiming our attention.

Conclusions: A clearly articulated publishing ethos is desirable. Potential strategies to achieve this include devising guidelines on publishing ethics, teaching the subject to new writers, journals committing themselves to the ethical dimension of their operations, and penalising colleagues who violate agreed principles of good conduct.
What is Chronic Fatigue Syndrome? Heterogeneity Within an International Multicentre Study
Authors: Wilson Andrew , Hickie Ian , Wilson Andrew , Hickie Ian , Hadzi-Pavlovic Dusan , Wakefield Denis , Parker Gordon , Straus Stephen E. , Dale Janet , Mccluskey David , Hinds Gwynneth , Brickman Andrew , Goldenberg Don , Demitrack Mark , Blakely Tony , Wessely Simon , Sharpe Michael , Lloyd Andrew
Published: March 2003

Objective: We sought to compare the characteristics of patients presenting with chronic fatigue (CF) and related syndromes in eight international centres and to subclassify these subjects based on symptom profiles. The validity of the subclasses was then tested against clinical data.

Method: Subjects with a clinical diagnosis of CF completed a 119-item self-report questionnaire to provide clinical symptom data and other information such as illness course and functional impairment. Subclasses were generated using a principal components-like analysis followed by latent profile analysis (LPA).

Results: 744 subjects returned complete data sets (mean age 40.8 years, mean length of illness 7.9 years, female to male ratio 3:1). Overall, the subjects had a high rate of reporting typical CF symptoms (fatigue, neuropsychological dysfunction, sleep disturbance). Using LPA, two subclasses were generated. Class one (68% sample) was characterized by: younger age, lower female to male ratio; shorter episode duration; less premorbid, current and familial psychiatric morbidity; and, less functional disability. Class two subjects (32%) had features more consistent with a somatoform illness. There was substantial variation in subclass prevalences between the study centres (Class two range 6–48%).

Conclusions: Criteria-based approaches to the diagnosis of CF and related syndromes do not select a homogeneous patient group. While substratification of patients is essential for further aetiological and treatment research, the basis for allocating such subcategories remains controversial.
Depressive Disorders in Elderly Chinese Patients in Macau: A Comparison of General Practitioners' Consultations with a Depression Screening Scale
Authors: Da Canhota Carlos Manuel Nogueira , Piterman Leon
Published: March 2003

Objective: The objectives of this study were to identify the prevalence of depressive symptomatology in an elderly population using a screening scale; to assess general practitioner (GP) recognition of depression; to determine patient reasons for consultation; and to relate depression to social and demographic factors.

Method: An analytical cross-sectional study was carried out on a systematic sample of elderly Chinese patients currently resident in Macau, who presented to general practices in December 1997. Data collected included patient demographics, economic and social supports, patient depressive status assessed using the Hospital Anxiety and Depression scale (HAD), reason for attendance, and the reason for the consultation. Clinical records were analysed in order to collect GP-registered morbidity and recent relevant management.

Results: Data were collected from 386 elderly Chinese patients of 31 GPs (97% patient response rate). Patients presented with somatic symptoms rather than psychological issues. Using HAD cut-off score of <8, 47% of the population studied were depressed; with a HAD subscale score <11, 26.2% were depressed. Depression was detected more often in women (59%) and being female was associated with depressive status (p = 0.010). Age (greater than 75 years) was also associated with being depressed, as was not having someone to talk to (p = 0.037), and being from low social class (p = 0.050). Not having someone willing to listen to their problems, difficulties and worries, was significantly related to depression (p = 0.041). There were no referrals or antidepressive medications detected in the clinical charts.

Conclusion: Participants’ characteristics such as being over 75 years of age, being female and socially isolated were related to depression. General practitioners can play an important role in the early detection and management of psychological disorders. Although studies on a sample of Chinese patients in Macau cannot be generalized to Chinese populations elsewhere, awareness of somatic presentation of psychological illness is crucial in detecting depression in this and possibly other Chinese populations.
Inquiries Into Homicides and Serious Violence Perpetrated by Psychiatric Patients in New Zealand: Need for Consistency of Method and Result Analysis
Authors: Simpson Alexander I.F. , Allnutt Stephen , Chaplow David
Published: March 2003

Background: The violent action of mentally ill people is a source of considerable public and professional concern. At times such incidents are subject to inquiry. In England and Wales, homicides by people suffering from mental illness are subject to mandatory external inquiry. Further, the Royal College of Psychiatrists coordinates a confidential research study into homicide and suicide by people in contact with mental health services. Inquiries have raised concern regarding widespread problems in mental health service delivery. Within New Zealand, similar concerns have been raised, but inquiries have been irregular and not of consistent methodology. The paper aims to review 10 years of inquiries into violent incidents to describe their methods, structure and findings.

Method: All inquiries into violent actions perpetrated by patients in contact with mental health services between 1988 and 1998 and held by the Ministry of Health were reviewed. The nature of the inquiry, the incident, findings and recommendations were summarized. For each inquiry, an assessment was made as to whether the incident was predictable or preventable.

Results: There were 11 incidents leading to 13 inquiries, six of homicide, two of rape, one of the release of a dangerous patient and two in which a patient was shot by police. Two internal inquiries were followed by external inquiries. All inquiries found deficiencies of varying severity, the degree of deficiency being greater with external inquiries. Consistent criticisms related to skill, resource, coordination and communication failures. Two of the 11 inquiries found the incident to be ‘predictable’, and eight to have been ‘preventable’.

Conclusions: The problems in New Zealand are similar to those noted in England and Wales. Small numbers of inquiries make firm conclusions difficult, but the authors feel that a mandatory process of independent review of serious incidents is wise.
Global Measures of Impairment in Children and Adolescents: Results from a Swiss Community Survey
Authors: Steinhausen Hans-Christoph , Winkler Metzke Christa
Published: March 2003

Objective: Based on data from a Swiss epidemiological survey, both the parent and the child versions of two global measures of impairment, the Columbia Impairment Scale (CIS) and the Children's Global Assessment Scale (CGAS) were analysed with regard to validity and the effects of gender.

Method: Concurrent and discriminant validity were evaluated by examining the associations with other indicators of impairment. Gender effects on impairment were considered in each type of analysis.

Results: Based on the total sample and on the girls' data, concurrent validity of the various impairment scores as computed by correlations with other indicators of psychological dysfunction was good. When based on the boys' data it was less convincing. Discriminant validity was estimated by comparing impairment scores between those using and not using services and was proven for all impairment scores. There were significant gender effects for almost all scores, indicating that girls in contrast to boys were more impaired and functioned less well when professional contacts and psychiatric diagnosis were considered.

Conclusions: The two impairment measures are well suited to community studies. Gender and informant differences have to be considered when defining thresholds for caseness. The two scales could also be used clinically, for example for training and evaluation purposes and for the decision whether or not a child or adolescent requires treatment.
Longitudinal Predictors of Behavioural Adjustment in Pre-Adolescent Children
Authors: Prior Margot , Smart Diana , Sanson Ann , Oberklaid Frank
Published: March 2003

Objectives: Longitudinal data from infancy onwards, from the Australian Temperament Project, a prospective study of the temperament and development of a large and representative sample of Victorian children, were examined to identify predictors of psychological disorder at 11–12 years of age.

Method: Those children scoring in the at-risk range for psychological disorder according to parents, teachers and self-reports using the Child Behaviour Questionnaire were selected at 11–12 years of age for in-depth assessment and comparison with a group of children with no history of adjustment problems. Analyses of group differences using longitudinal data gathered from infancy to 12 years focused on parent and teacher reports on child temperament and behaviour, and various facets of home and school adjustment.

Results: The strongest predictors of adjustment at 12 years were previous behaviour problems, along with some specific temperament factors involving self-regulation capacities and mother's overall rating of child difficulty. Results based on parallel teacher data including peer adjustment, and social and academic competence measures were consistent with parent data.

Conclusions: Our research confirms the persistence of early appearing behaviour problems in a community sample and the longitudinal influence of temperament factors in childhood. The study supports the need for a focus on early intervention and prevention strategies in the child mental health field.
Can Research Influence Mental Health Policy?
Authors: Whiteford Harvey
Published: March 2003

Objective: This paper describes the processes involved in policy development and implementation with examples of how this can be influenced by the outcomes of research.

Method: The author draws on his experience in the development and implementation of Australia's National Mental Health Policy and on the literature describing public policy analysis.

Results: A five-step process of problem identification, policy development, political decision, policy implementation and evaluation is described. This process identifies how issues are considered, adopted and implemented by governments.

Conclusion: An understanding of this process can inform mechanisms by which scientific research can impact on the issues considered and the decisions made in each step of policy analysis and development.
Improving Community-Based Services for Older Patients with Depression: The Benefits of an Educational and Service Initiative
Authors: Mutch Carolyn , Tobin Margaret , Hickie Ian , Mutch Carolyn , Tobin Margaret , Hickie Ian , Davenport Tracey , Burke David
Published: March 2003

Objective: The objective of this study was to report a quality improvement project for older patients with depression. The initiative focused on both clinical practice changes (improvement of medical, neurocognitive and behavioural assessment) and service development (greater continuity of care).

Method: After initial identification of key deficits, implementation of a service and educational initiative took place within a district mental health service. The service consisted of an inpatient unit, a specialized psychogeriatric service and two adult community mental health services. Mental health staff received education regarding the specific needs of older patients with depression and were provided with assessment materials, patient education and treatment aids. General practitioners participated in shared long-term management.

Results: Following graded implementation, the management of 44 subjects (mean age = 65.4 years, 91% female) recruited over an 8-month period was reviewed. Compared with 99 subjects (mean age = 68.9 years, 69% female) from the earlier 12-month assessment phase, there were significant improvements in medical (43% to 92%), neurocognitive (37% to 84%) and behavioural (e.g. suicidal ideation: 78% to 100%) assessments. Similarly, relevant laboratory investigations (neuroimaging: 21% to 67%) and communication with general practitioners (73% to 97%) improved. The most change occurred in the adult community-based treatment services.

Conclusions: A coordinated management and educational initiative resulted in marked improvement in basic medical and psychiatric assessment and more integrated care. These changes did not require expansion of specialist services.
Outpatient Cognitive Behavioural Therapy Programme for Alcohol Dependence: Impact of Naltrexone Use on Outcome
Authors: Feeney Gerald F.X. , Feeney Gerald F.X. , Young Ross McD. , Connor Jason P. , Tucker Jane , Mcpherson Annie
Published: March 2003

Objective: Cognitive–behavioural therapy (CBT) has been effectively used in the treatment of alcohol dependence. Clinical studies report that the anticraving drug naltrexone, is a useful adjunct to treatment. Currently, few data are available on the impact of adding this medication to programmes in more typical, outpatient, and rehabilitation settings. The objective of this study was to examine the impact on outcome of adding naltrexone to an established outpatient alcohol rehabilitation program which employed CBT.

Method: Fifty patients participated in an established 12-week, outpatient, ‘contract’-based alcohol abstinence programme which employed CBT. They also received naltrexone 50 mg orally daily (CBT + naltrexone). Outcomes were compared with 50 historical, matched controls, all of whom participated in the same programme without an anticraving medication (CBT alone). All patients met DSM-IV criteria for alcohol dependence.

Results: Programme attendance across the eight treatment sessions was lower in the CBT alone group (p < 0.001). Relapse to alcohol use occurred sooner and more frequently in the CBT alone group (p < 0.001). Rehabilitation programme completion at 12 weeks was 88% (CBT + naltrexone) compared with 36% for (CBT alone) (p < 0.001). Alcohol abstinence at 12 weeks was 76% (CBT + naltrexone) compared with 18% (CBT alone) (p < 0.001).

Conclusion: When employing the same outpatient rehabilitation programme and comparing outcomes using matched historical controls, the addition of naltrexone substantially improves programme attendance, programme completion and reported alcohol abstinence. In a typical outpatient programme, naltrexone addition was associated with significantly improved programme participation, better outcomes and was well tolerated.
An Audit of Medico-Legal Reports Prepared for Claims of Psychiatric Injury Following Motor Vehicle Accidents
Authors: Large Matthew , Nielssen Olav
Published: March 2003

Objective: The objective of this audit was to examine whether the content of medico-legal reports regarding psychiatric injury following motor vehicle accidents was influenced by the role of the report writers.

Method: The audit consisted of a retrospective review, using a novel rating scale, of archived documents from 559 consecutively examined insurance claims following motor vehicle accidents in New South Wales.

Results: Treating practitioners wrote less complete reports than experts representing the plaintiff or defendant. Treating practitioners and plaintiffs' experts were more likely to diagnose posttraumatic stress disorder (PTSD) and depression, while defendants' experts were more likely to find no psychiatric disorder. Limitations of the study were that it was retrospective and examined report writing between 1989 and 1994. The completeness, rather than quality, of the medico-legal reports was measured.

Conclusion: Further training and quality assurance procedures may improve medico-legal report writing. Reform of the rules regulating the content of experts' reports may reduce the extent to which the role of the report writer influences their opinion.
History of Depression as a Risk Factor for Dementia: An Updated Review
Authors: Jorm Anthony F.
Published: March 2003

Objective: This review updates an earlier meta-analysis of the data on history of depression as a risk factor for dementia. It also considers the available evidence on the hypotheses proposed to explain the association between history of depression and dementia.

Method: A meta-analysis was carried out on results from seven case-control and six prospective studies. A qualitative review was carried out on the evidence related to the hypotheses to explain the association.

Results: The meta-analysis found evidence to support an association from both casecontrol studies (estimated relative risk 2.01; 95%% CI 1.16–3.50) and prospective studies (estimated relative risk 1.87; 95%% CI 1.09–3.20). However, the evidence did not clearly support any one hypothesis explaining the association. The most likely contenders are: (i) depression can be an early prodrome of dementia, (ii) depression brings forward the clinical manifestation of dementing diseases, and (iii) depression leads to damage to the hippocampus through a glucocorticoid cascade.

Conclusions: The possibility that history of depression is a risk factor for dementia needs to be taken seriously and explanations of the association need to be further researched.
Informing Patients About Tardive Dyskinesia: Four-Year Follow Up of a Trial of Patient Education
Authors: Chaplin Robert , Timehin Clive
Published: March 2003

Objective: This paper evaluates the effects of an educational intervention about tardive dyskinesia on knowledge and clinical stability at long-term follow up.

Method: Fifty-six patients receiving antipsychotic maintenance completed a questionnaire assessing their knowledge about tardive dyskinesia. After random allocation to either educational intervention or control group, their knowledge, clinical stability and rates of tardive dyskinesia were reassessed after four years. Results: Seventy per cent of patients completed the study. The patients in the educational group retained significantly more knowledge at follow up than at baseline but this knowledge was not significantly greater than that of the control group. There were no significant differences in the clinical outcomes between the groups.

Conclusion: Patients can retain a small but significant amount of information with a low risk of noncompliance. Discussion about tardive dyskinesia is necessary in the process of obtaining informed consent to treatment.
The Roles and Relationships of Psychiatrists and Other Service Providers in Mental Health Services
Authors: Herrman Helen , Trauer Tom , Warnock Julie ,   Professional Liaison Committee (Australia) Project Team
Published: March 2003

Objective: A number of the problems facing psychiatry are identified as having common origins in unresolved issues about teamwork. The aim is to identify the issues and to formulate recommendations for dealing with these obstacles.

Method: The Royal Australian and New Zealand College of Psychiatrists Professional Liaison Committee (Australia) of the Board of Professional and Community Relations convened a number of meetings and discussions, with external assistance from JW and TT.

Results: Much of contemporary mental health care is delivered either directly or indirectly by several persons, often working in teams. Teamwork and collaboration are central to good working relationships and service delivery. Effective teamwork and collaboration is supported by key elements including agreed goals, an agreed approach, effective communication styles, established ground rules, clear team roles, and competent leadership. The obstacles to effective teamwork and collaboration are discussed in terms of the following: ambiguity and conflict over roles; conflict and confusion over leadership; differing understandings of clinical responsibility and accountability; interprofessional misperceptions; and differing rewards between the professions.

Conclusions: Developing an understanding of these issues opens the way to a series of recommendations in relation to education, professional organizations, and workplaces and government, which can be considered by a number of sectors and groups.
Magnetic Resonance Spectroscopy and its Applications in Psychiatry
Authors: Malhi Gin S. , Valenzuela Michael , Wen Wei , Sachdev Perminder
Published: March 2003

Objective: This paper briefly describes neuroimaging using magnetic resonance spectroscopy (MRS) and provides a systematic review of its application to psychiatric disorders.

Method: A literature review ( Index Medicus/ Medline) was carried out, as well as a review of other relevant papers and data known to the authors.

Results: Magnetic resonance spectroscopy is a complex and sophisticated neuroimaging technique that allows reliable and reproducible quantification of brain neurochemistry provided its limitations are respected. In some branches of medicine it is already used clinically, for instance, to diagnose tumours and in psychiatry its applications are gradually extending beyond research. Neurochemical changes have been found in a variety of brain regions in dementia, schizophrenia and affective disorders and promising discoveries have also been made in anxiety disorders.

Conclusions: Magnetic resonance spectroscopy is a non-invasive investigative technique that has provided useful insights into the biochemical basis of many neuropsychiatric disorders. It allows direct measurement, in vivo, of medication levels within the brain and has made it possible to track the neurochemical changes that occur as a consequence of disease and ageing or in response to treatment. It is an extremely useful advance in neuroimaging technology and one that will undoubtedly have many clinical uses in the near future.
Suicide Among Psychiatric Patients: A Case-Control Study
Authors: Pirkis Jane , Burgess Philip , Jolley Damien
Published: March 2003

Objective: To examine patient- and treatment-based differences between psychiatric patients who do and do not die by suicide.

Method: By linking databases of deaths and psychiatric service use in Victoria, we compared 597 cases who suicided over 5 years with individually matched controls.

Results: Cases and controls could not be distinguished on the majority of patient- or treatment-based characteristics. The exceptions were that cases were more likely to be male, less likely to be outside the labour force, more likely to have recent contact with inpatient and community services, and more likely to have a registration as their last contact.

Conclusions: Patients who suicide ‘look’ similar to those who do not, suggesting prevention approaches should ensure that all psychiatric patients receive optimal care, including appropriate detection, diagnosis, assessment and treatment of mental health problems, and careful, individualised assessment of suicide risk.
Reporting of Suicide in the Australian Media
Authors: Pirkis Jane , Francis Catherine , Pirkis Jane , Francis Catherine , Warwick Blood Richard , Burgess Philip , Morley Belinda , Stewart Andrew , Putnis Peter
Published: March 2003

Objective: The media monitoring project aimed to establish a baseline picture of the extent, nature and quality of reporting of suicide by the Australian media, with a view to informing future strategies intended to optimize reporting of suicide.

Method: Newspaper, television and radio items on suicide were retrieved over 12 months. Identifying and descriptive information were extracted for each item. Approximately 10% of items were rated for quality, using a rating scale based on criteria from Achieving the Balance, a kit designed to promote awareness among media professionals of issues relating to suicide. The scale ranged from 0 (poor quality) to 100 (good quality).

Results: Reporting of suicide was extensive (with 4813 items retrieved). The nature of reporting was variable. Items tended to be about completed suicide (rather than attempted suicide or suicidal ideation), and most commonly involved content related to an individual's experiences, policy/programme initiatives and/or suicide statistics, although there were differences across media types. Items showed variability across dimensions of quality. The majority of suicide items did not have examples of inappropriate language, were not inappropriately located, did not use the word ‘suicide’ in the headline, and did not use explicit photographs/diagrams or footage. However, around half of the suicide items provided a detailed discussion of the method of self-harm and portrayed suicide as merely a social phenomenon. Where items concerned the suicide of a celebrity, reference was commonly made to that person's celebrity status. Most items failed to provide information on help services. The median total quality score was 57.1%.

Conclusions: The reporting of suicide is extensive across all media types, and varies in nature and quality. In general, good items outnumber poorer items. However, there are still opportunities for improving media reporting of suicide.
Emotional Numbing in Posttraumatic Stress Disorder: Current and Future Research Directions
Authors: Litz Brett T , Litz Brett T , Gray Matt J
Published: March 2003

Objective: Despite being understudied and poorly understood relative to the chronic fear, anxiety and other aversive emotional states that occur in the immediate aftermath of trauma, emotional numbing has become a core defining feature of posttraumatic stress disorder (PTSD).

Method: This paper seeks to briefly review the literature bearing on these seemingly disparate emotional responses to trauma as well as theoretical accounts of emotional numbing that have been proffered to date. We then offer an alternative theory of posttraumatic emotional functioning and review empirical support for this model.

Result: The experience of trauma produces very intense emotions such as overwhelming fear, horror, and anxiety, and these reactions can linger for a lifetime. Many trauma survivors also report restrictions in their emotional experience – a phenomenon most commonly referred to as emotional numbing. In contrast to previous accounts of posttraumatic emotional functioning our model posits that individuals with PTSD have difficulty expressing positive emotions as a result of re-experiencing states. We further argue that patients with PTSD are capable of experiencing and expressing the full range of emotions that were available pretraumatically.

Conclusion: Our model holds that individuals with PTSD are not, in fact, ‘emotionally numb’ as a result of traumatic experience. Rather, PTSD is associated with hyperresponsivity to negatively valenced emotional stimuli. Consequently, patients with PTSD require more intense positive stimulation to access the full complement of appetitive or pleasant emotional behaviour.
Antipsychotic Use in Australia: The Patients' Perspective
Authors: Castle David , Castle David , Morgan Vera , Jablensky Assen
Published: March 2003

Objective: To describe patterns of self-reported medication use in a population-based sample of people with psychotic disorders; to establish correlates with clinical variables; to determine perceived side-effect burden; and investigate patient perception of efficacy for different classes of antipsychotic agent.

Methods: Using the Australian Low Prevalence (Psychosis) Study database we analysed patterns of psychotropic medication and examined their clinical correlates. We also determined rates of reported side-effects and perceived benefit or otherwise associated with the different antipsychotic drugs.

Results: Of the 1126 persons interviewed, 88.6% were on psychotropic medication; 54.3% were using ‘typical’ antipsychotics (24.8% in depot form), while 8.3% were on clozapine, 13.3% on risperidone, and 8.8% on olanzapine. Around 30% of women, and 20% of men, were on mood stabilizers or antidepressants. Over half of respondents were on more than one agent. Of those on only one agent, nearly 80% reported at least one side-effect; the mean number of side-effects was 3.9 for typical antipsychotics, and 3.3 for atypicals. Atypicals, notably clozapine, tended to be rated by patients as more efficacious than typicals; depot preparations, in particular, tended to be seen as unhelpful, and were associated with a higher side-effect burden.

Conclusions: This study presents an insight into patients’ perception of efficacy and sideeffects of antipsychotic medications. The findings have implications for clinicians, and can inform treatment options in people with psychotic disorders.
Maternal Bonding Behaviour in Schizophrenia and Schizoaffective Disorder, Considering Premorbid Personality Traits
Authors: Willinger Ulrike , Heiden Angela M. , Meszaros Kurt , Formann Anton K. , Aschauer Harald N.
Published: March 2003

Objective: Bonding between mother and child is described as a complex two-way process ensuring the needs of the child for nurture and protection. As such, it is dependent on the contribution of mother and child [ 1 – 3 ] whereby characteristics of personality of the child may have consequences on maternal bonding behaviour. In the current study the perception of maternal behaviour, premorbid personality traits and relationships between maternal behaviour and personality traits were investigated in schizophrenic and schizoaffective patients and their same-sex, healthy siblings.

Methods: We recruited 36 schizophrenic and schizoaffective patients and their same-sex healthy siblings. Information about maternal bonding behaviour was assessed by the Parental Bonding Instrument, information about premorbid personality traits was obtained from their mothers using the ‘Gießen-Test’.

Results: Compared to their siblings, patients showed less social resonance, more permeability, less social competence and a more depressed and anxious mood. Furthermore, patients described their mothers to be less caring and to be more overprotective than their siblings described them. But there were strong associations between maternal bonding behaviour and premorbid personality traits. These findings were supported by missing significant differences in maternal care behaviour between patients and siblings when using premorbid characteristics as covariates. Significant high maternal overprotection perceived by patients with schizophrenia and schizaffective disorders still remained after correcting for the influence of premorbid personality traits.

Conclusion: The results suggest that premorbid personality traits should be considered not only in analyses of maternal care behaviour in schizophrenic and schizoaffective patients but also when studying other psychiatric patient groups.
Psychiatric Morbidity in First Time Stroke Patients in Hong Kong: A Pilot Study in a Rehabilitation Unit
Authors: Tang Wai-Kwong , Ungvari Gabor S , Chiu Helen F. K. , Sze Kai-Hoi , Woo Jean , Kay Richard
Published: March 2003

Objective: There is a paucity of data on post-stroke psychiatric morbidity in Chinese populations. We examined the frequency of post-stroke psychiatric morbidity in Chinese first time stroke patients, including depressive and anxiety disorders, mania, and psychosis.

Methods: One hundred and fifty-seven patients following their first stroke, who were consecutively admitted to a rehabilitation unit, participated in this prospective, cross-sectional study. All subjects were interviewed by a qualified psychiatrist using the SCID-DSM-III-R. Subjects’ cognitive function, neurological status, and level of functioning were also measured. Twenty-five (92.6%) of the subjects with the diagnosis of depression were followed up 6.0 ± 3.9 months after the initial assessment.

Results: The frequency of all depressive disorders was 17.2%. Major depressive episodes, adjustment disorder with depressed mood, dysthymia, and generalized anxiety disorder were diagnosed in 7.6%, 8.2%, 1.3% and 0.6% of the subjects, respectively. No cases of other anxiety disorders, mania or psychosis were found. The majority of depressed subjects were in remission at the follow-up assessment.

Conclusions: The low morbidity of affective disorders and their relatively favourable shortterm outcome in Chinese first time stroke patients warrants further investigation.