bluuebunny/crossref_metadata_2025 huggingface dataset:
Catharsis Reconsidered
Authors: Straton David
Published: November 2007

Mainstream psychiatry and psychotherapy have held for many years that cathartic psychotherapies involving powerful emotional expression have limited value. The conventional wisdom is that they are either dangerous, or ineffective, or that their effectiveness is short-lived. This paper reviews the origins of this conventional wisdom and makes two findings. Firstly, that there is remarkably little serious research into cathartic psychotherapies, but what there is tends to support catharsis. Secondly, that the periods in the last 200 years when cathartic methods have fallen into disrepute have often coincided with threatened or actual scandals involving prominent practitioners of cathartic psychotherapy. Four models of catharsis are described; the “Hydraulic”, the “Pavlovian”, the “Cathexis”, and the “Holographic”. The discussion suggests situations in which catharsis would be likely to prove useful, and indicates potential risks.
Psychosocial Effects on Carers of Living with Persons with Dementia
Authors: Brodaty Henry , Hadzi-Pavlovic Dusan
Published: November 2007

A survey of members of the Alzheimer's Disease and Related Disorders Society confirmed high rates of psychological morbidity, though not of depression, and social isolation in family carers of persons with dementia. Psychological morbidity in carers was associated with having an affected person at home, the carer being a spouse, demanding problem behaviours, poor physical health in the carer, social isolation, dissatisfaction with social supports, greater use of psychotropic medication, and a deteriorated marital relationship. Carers and patients had high rates of consultations with doctors and other health professionals. There was a vulnerable group of carers who were impaired psychologically, socially and physically. The identification of risk factors to carer morbidity may lead to useful interventions.
Suicide from River Bridges
Authors: Cantor Christopher H. , Hill Michael A.
Published: November 2007

The opening of a new high river bridge in Brisbane allowed a naturalistic experimental testing of whether the sample engaging in suicidal behaviour from the new bridge was similar to that from the adjoining older bridge. Substantial differences were found for the two samples. This suggests that persons prevented from jumping from one bridge, for example by a barrier, will not automatically jump from the alternative bridge although a minority may do so.
Psychological Consequences of Spinal Injury: A Review of the Literature
Authors: Craig A. R. , Hancock K. M. , Dickson H. , Martin J. , Chang E.
Published: November 2007

The traumatic nature of spinal cord injury necessitates adjustments for the individual physically, socially, vocationally and sexually, as well as placing great strain on the family. Although one would suspect a high prevalence of psychological disruption following spinal cord injury, there is still much debate concerning the extent of the psychological reaction to such a trauma. This situation can partly be attributed to the lack of systematic research characteristic of most studies in this area. This paper reviews more recent literature which has investigated psychological morbidity in persons with spinal cord injury. The inadequacies of this research are discussed and suggestions for future research and psychological treatment for the spinal injured are provided.
Long Term Follow-up of Agoraphobics Treated by Brief Intensive Group Cognitive Behavioural Therapy
Authors: Evans Larry , Holt Craig , Oei Tian P.S.
Published: November 2007

This study reports the long term efficacy of a brief intensive (2 days) group cognitive behavioural programme for the treatment of agoraphobia with panic attacks. A total of 97 patients was included in the study. Seventy-four patients were in the treated group and 23 were on the waiting list control group. The Fear Questionnaire (FQ), Fear Survey Schedule (FSS), Maudsley Personality Inventory (MPI), the Hostility and Direction of Hostility Questionnaire (HDHQ) and a clinical assessment based on structured interview to assess current levels of functioning were used as dependent measures. The results show that patients in the treated group show significant improvement on FSS and FQ when compared with the patients in the control group. Clinical rating shows that 85% of the patients were either symptom free or their symptoms had been reduced and these effects of treatment were shown to be maintained at follow-up which was on average 1 year after the treatment.
Altered Pharmacokinetics of Tricyclic Antidepressants in Burns
Authors: Crompton D. R. , Pegg S. P. , Jellett L. B. , Middleton W.
Published: November 2007

A case of self-inflicted burns which occurred in the setting of a major depression with psychotic features is described. The case emphasises the difficulties in utilising plasma (serum) tricyclic antidepressant levels to determine adequacy of treatment and risk of toxicity. The case discussion demonstrates the altered pharmacokinetics of tricyclic antidepressants that can occur during disorders such as burns, surgery and medical illness.
A Systems Approach to Loss
Authors: Bloch Sidney
Published: November 2007

Following the death of a family member, the mourners' experiences of grief are inevitably influenced by and, in turn, influence the experiences of their relatives. Therapy should apply a model which takes this interactive process into account. A systems approach can fulfil this requirement in certain cases. Three case histories are provided to illustrate the potential effectiveness of a systems-oriented intervention. The questions still remain as to when the model is optimally applied, and whether it has a role in preventive psychiatry.
The Role of Specialised Units in the Treatment of Affective Disorders
Authors: Lyndon R. William
Published: November 2007

Units which specialise in the treatment of affective (mood) disorders are gaining popularity in Australia and overseas. This paper examines the history, role and function of these units with particular reference to their benefits and disadvantages. Specialised units can offer advantages in the assessment and management of depression and bipolar illness, as well as being centres for research and education. Further research into their effectiveness is needed to enable their rational integration into existing psychiatric services.
The Relationship between Divorce, Unemployment and Female Participation in the Labour Force and Suicide Rates in Australia and America
Authors: Lester David , Yang Bijou
Published: November 2007

Identical data sets for Australia and the USA from 1946 to 1984 were analysed to explore the association of unemployment rates, female participation in the labour force and divorce with suicide rates. While female participation in the labour force was related to suicide rates in Australia, unemployment was not. For the USA, both female participation in the labour force and unemployment were related to suicide rates.
Chaos Theory: A New Paradigm for Psychotherapy?
Authors: Lonie Isla
Published: November 2007

Thomas Kuhn's concept of paradigm as central to the functioning of a mature science is linked with Johnson-Abercrombie's recognition that perception itself is shaped by the schemata available to the subject. The rapidly advancing field of non-linear mathematics, in offering conceptual forms to represent complex events, may provide a useful framework in which to place various psychodynamic formulations about the development of the personality, and suggests the possibility of a new approach to research concerning the efficacy of psychotherapy. Dan Stern's latest concept of “moments” as the basic unit in structuring the personality, leading to the complex representational patterns and feed-back loops he terms “RIGS” may be viewed in this context. The paradigm may be extended to include such concepts as Peterfreund's linkage of psychodynamic theorising with aspects of information theory generated by the study of computers, and with Sullivan's concepts of repetitive patterns of behaviour recognisable, and changing, throughout the course of a therapy.
Psychosis in a 15 Year Old Hypothyroid Girl: Myxoedematous Madness?
Authors: Chalk John N.
Published: November 2007

The case of a fifteen year old girl with sudden onset of a psychotic illness thought to be related to marked hypothyroidism is reported. Apart from the age several features of this case warrant discussion and the value of screening for thyroid disease in psychotic illnesses is highlighted.
Depression Sub-Typing: Unitary, Binary or Arbitrary?
Authors: Parker Gordon , Hall Wayne , Boyce Philip , Hadzi-Pavlovic Dusan , Mitchell Philip , Wilhelm Kay , Brodaty Henry , Hickie Ian , Eyers Kerrie
Published: November 2007

The strongest statistical support for the binary view of depression has been provided by factor (principal components) analytic studies which delineate a bipolar factor with features interpreted as reflecting “endogenous depression” and “neurotic depression” at opposing poles. We review the seminal studies to suggest instead that the bipolar factor has generally polarised depression and anxiety, and that no such entity or symptom complex of “neurotic depression” has been isolated. Instead, “neurotic depression” has been defined principally by features of anxiety and personality style. We argue that the suggested entity is, in fact, a pseudo-entity, being no more than a residual group of non-depressive features without any significant intrinsic depressive characteristics. We support our interpretation by showing comparable solutions in published studies of depressives alone, contrasted with separate analyses of anxious and depressed patients. We also report two studies in which the “neurotic depressive” pole is made to appear and disappear by the inclusion and exclusion of anxiety items. As factor analytic studies have defined the “residual” pole so variably, we argue that some features held to distinguish neurotic depression are of no utility and that such a diagnosis is meaningless. We suggest that the clinician should not proceed (after excluding endogenous depression) to conclude that the default option is necessarily an entity “neurotic depression” and that instead a heterogeneous group of options (e.g. anxiety, personality disorder) require review. If the “neurotic depressive” type of the multivariate analytic studies is a pseudo-entity, then a modified unitary view of depression may be valid.
The Naming of Our Species: Appellations for the Psychiatrist
Authors: Walter Gamy
Published: November 2007

A number of appellations for the psychiatrist are discussed from a historical, semantic and political perspective. Many are ambiguous, which may reflect an ambivalent attitude towards those who manage mental illness. The current designations, “headshrinker”, “shrink” and “trick-cyclist” have considerable scope for interpretation. The expression “psycho, the rapist” may signify a disturbing “postambivalent” linguistic stage. The profession's potential responses to this development are considered.
Clonazepam in Acute Mania: A Double Blind Trial
Authors: Edwards Rod , Stephenson Una , Flewett Tom
Published: November 2007

In a double-blind trial involving acutely manic patients, clonazepam was compared to placebo, both groups receiving chlorpromazine as needed. The group receiving clonazepam showed significantly more improvement in their manic but not their psychotic symptoms compared to the placebo group. This effect was not primarily related to the sedative effects of clonazepam. Clonazepam tended to reduce the need for phenothiazine medication. Side effects related to sedation were more common to the clonazepam group. These findings are the first to indicate that clonazepam may have a specific antimanic effect over and above that of phenothiazines alone.
The Concept of Recovery and Secondary Prevention in Psychotic Disorders
Authors: McGorry Patrick D.
Published: November 2007

The concept of recovery is embedded in the current classification of functional psychosis, an unfortunate fact which has obscured important therapeutic and preventive opportunities for patients and their relatives. A range of theoretical perspectives is reviewed which could be drawn upon to extend research, and develop and evaluate new forms of intervention in this area. The major tasks facing patients and their families at different stages of illness are described, and a series of principles is then proposed to guide the clinical care of recovering psychotic patients.
Childhood through the Eyes of Child Psychiatrists and Paediatricians
Authors: Lawrence Jenny , Adler Robert
Published: November 2007

Attitudes to childhood in general and towards one's own childhood in particular are compared in a survey of 152 Australian and New Zealand child psychiatric and paediatric trainees. Results confirm the findings of Enzer et al [1] that paediatricians view childhood more positively than do child psychiatrists. Although there is a significant difference between the two groups on measures of their perceptions of the parenting they received with child psychiatrists rating their own parents as less caring than do paediatricians, there is no relationship between attitudes to childhood and perceptions of the parenting they received. Implications of these findings are examined, both in terms of motivation for choosing one or other speciality and for the working relationship between the two professions.
Paternalistic Interventions with the Gravely Disabled
Authors: Spittle Bruce
Published: November 2007

Interfering in the affairs of the gravely disabled has received attention in areas such as philosophy, theology, law, politics, and sociology. For such persons to be declared incompetent and have guardians appointed to care for them, a balancing is required of the right to personal freedom against the right to care. When consideration is given to the underlying principles of autonomy and beneficence, a case can be made for weak paternalistic interventions with persons of diminished capacity who are clearly endangered and in whom the conduct involved is substantially nonvoluntary. Examples are given of beneficial results occurring in persons with alcohol dependence or alcohol-related brain damage on whom a paternalistic intervention involving financial management was imposed with the aim of seeing that basic needs were met and that spending on alcohol was not excessive.
Human Immunodeficiency Virus Infection, Dementia and the Older Patient
Authors: Kernutt Graeme J. , Price Amanda J. , Judd Fiona K. , Burrows Graham D.
Published: November 2007

Australian statistics have shown that 10.9% of AIDS cases have occurred in the 50 years and over age group. To date little attention has been given to the many issues surrounding HIV infection in the older population, for example, the failure to consider HIV as an aetiological factor in the older person presenting with neuropsychiatric disorder and the potential for misdiagnosis of AIDS dementia complex as dementia of the Alzheimer type. This paper includes a discussion of the clinical features of the AIDS dementia complex, its resemblance to the syndrome of “subcortical dementia”, and review of the literature reporting dementia as the presenting feature of HIV infection in older individuals.
Screening for Psychiatric Symptoms and Illness Behaviour in a Pain Clinic
Authors: Levit Pamela , Skerritt Paul W. , White Barry W. S. , Robinson A. R. , Anderson R. Duncan , Sedgley Grace
Published: November 2007

Evolution of a multidisciplinary pain clinic in a rehabilitation hospital is described. The assessment process was facilitated, particularly with respect to psychiatric and psychological evaluation, by the preliminary administration of two well established but simple self-administered questionnaire instruments, the Illness Behaviour Questionnaire (IBQ) and the Crown-Crisp Experiential Index (CCEI). The characteristics of our pain clinic population are described. They demonstrate questionnaire profiles which are typical of pain patients. Attention is drawn to the CCEI profile now shown in three studies of pain patients, predominance of the somatic anxiety (S) scale occurring in all. Correlations between the IBQ and CCEI showed, inter alia, that the S scale is a measure of somatisation in pain patients. This paper aims to describe the changes in the clinic since previously published descriptions, to note the characteristics of our patients on the questionnaire instruments and to comment on the value of these questionnaires in the assessment of psychiatric symptoms and somatisation in pain clinic patients.
How Many Bed-Days for an Area's Psychogeriatric Patients?
Authors: Snowdon John
Published: November 2007

Data were obtained concerning all admissions during a four-year period of persons aged 65 years and over, from a defined catchment area, to the general hospital psychiatric units in the area or to the nearest psychiatric hospital. The mean length of stay was 41.3 days. Of 449 admissions, 55% were diagnosed as having affective disorder or adjustment disorder with depressed mood, but this group accounted for 65% of the bed-days in the acute units with a mean length of stay of 49.2 days. Dementia cases accounted for 24% of admissions and 23% of bed-days. At present, the recommended number of acute psychogeriatric beds to serve this population of 34,000 elderly is 22; development of a comprehensive psychogeriatric service with appropriate community staffing may make it possible to reduce this number.
Psychosocial Interventions for Very Low Birthweight Infants: Their Scope and Efficacy
Authors: Dudley Michael , Gyler Louise , Blinkhorn Susan , Barnett Bryanne
Published: November 2007

With the burgeoning of infant psychiatry, and the increasing survival and development of cohorts of very low birthweight (VLBW) infants, psychiatrists are becoming increasingly involved with other professionals in designing and implementing early intervention programs. Psychosocial interventions for VLBW infants generally report positive results regardless of the orientation of the practitioners, or the stated goal of the intervention: however, they have often taken place independently of longitudinal research, and sometimes without grounding in theories of infant and family development. This paper first reviews the current state of research and findings related to infant-focussed, parent-directed, and interactional programs. Second, it addresses a number of basic questions to be considered by psychiatrists involved in consulting to neonatal intensive care units, who have to appraise, design or implement intervention programs with this group. Throughout this discussion, it is proposed that the notion of infants at developmental risk needs to be supplemented by that of caregivers at risk, and that the professional boundaries which these distinctions represent need to be overcome.
Psychiatrist-Patient Sexual Relationships: The Ethical Dilemmas
Authors: Galletly Cherrie A.
Published: November 2007

Sexual relationships between psychiatrists and their patients raise a number of important ethical issues. The power inequality, transference and dependence which often occur in a therapeutic relationship render patients vulnerable to exploitation. Psychiatrists informed by a patient of sexual contact with a previous psychiatrist face a complex ethical dilemma. Attempts at regulation by professional organisations, or by the legal system, may create conflicts between the rights of the persons involved. The role of the psychiatric profession in confronting the problem of sexual exploitation of patients is discussed.
Back to Bedlam? Chelmsford and the Press
Authors: Lupton Deborah
Published: November 2007

The Australian press played a vital part in bringing the events at Chelmsford Private Hospital to the attention of the general public, and in pressuring the New South Wales government to institute a Royal Commission into Deep Sleep Therapy. This paper describes the ways in which the press brought Chelmsford events onto the public agenda. It pays particular attention to aspects of the press coverage of the findings of the Royal Commission. The paper identifies the discourses concerning psychiatric care, the doctor-patient relationship and the role of the government in regulating the medical profession which were dominant in press accounts of Chelmsford. It is argued that while pre-existing stereotypes about mad psychiatrists and asylums were used to describe Chelmsford, more confronting ideas concerning the need for medical regulation and patient consumerism received press attention and therefore a public airing. The implications for psychiatric care in Australia are examined.
Peer Review of Psychotherapeutic Treatments in Psychiatry: A Review of the Literature
Authors: Beatson Josephine A. , Lancaster Jeanette E.
Published: November 2007

This paper reviews the literature concerning the current status of peer review of psychotherapeutic treatments in psychiatry. Accounts of the aims and mechanisms of peer review, administrative issues and the effects of peer review on patient care and professional practice are examined.
The Psychiatrist and Peer Review: A Psychodynamic Perspective
Authors: Beatson Josephine A.
Published: November 2007

Consideration of peer review is timely, given that formalisation of peer review processes is one of the responses the psychiatric profession could make to increasing calls for accountability from within and without the profession. The establishment of formal peer review evoked strong, often hostile, responses among psychiatrists in the United States, reflecting considerable underlying anxiety. This paper examines the responses to formal peer review in psychiatrists from a psychodynamic perspective.
Depressive Disorders among Elderly People in Long-Term Institutional Care
Authors: Ames David
Published: November 2007

Depressive disorders are common among old people in residential and nursing homes. Outside Australia the prevalence rate for depressive symptoms in homes ranges from 30–75% while that for depressive disorders defined by psychiatric diagnostic criteria is well over 20% in many nursing home studies. These rates are between two and twenty times higher than those found among the elderly living at home. Evidence from Australia indicates that a problem of similar magnitude exists here. While physical disability is strongly associated with depression in these populations, it is not the only factor likely to be responsible for the initiation and maintenance of depression among those in long-term care. There is an urgent need for studies which will better define likely aetiological and maintaining factors for depression in institutional populations, as well as controlled trials of both pharmacological treatments and environmental improvements. In addition, research is needed to establish whether depression is an independent risk factor for mortality among institutional residents.
Suicide among Psychiatric in-Patients in the Wellington Region
Authors: Read Deborah A. , Thomas Christopher S. , Mellsop Graham W.
Published: November 2007

To identify risk factors for in-patient suicide, a case-control study of in-patient suicide was conducted in the Wellington Area Health Board region between 1984 and 1989 on 27 cases and 86 controls. The risk of in-patient suicide was increased among individuals who had been compulsorily admitted, suffered from schizophrenia, had a past history of deliberate self harm, had been in hospital for more than a month, or were unmarried. Notably, there was no relationship with physical health, a history of substance abuse, number of psychiatric admissions and time since the last known episode of deliberate self harm. These characteristics can assist clinical assessment of individual suicidal risk. Further evaluation of the relation of compulsory admission to suicide is required.
Variations in Therapeutic Interventions for Cambodian and Chilean Refugee Survivors of Torture and Trauma: A Pilot Study
Authors: Morris Patrick , Silove Derrick , Manicavasagar Vijaya , Bowles Robin , Cunningham Margaret , Tarn Ruth
Published: November 2007

The treatment of refugee survivors of torture and trauma has attracted increasing clinical attention. The present study surveyed therapists concerning the emphasis that was placed on disclosure of previous traumatic experiences in therapy with refugees from Chile and Cambodia. Significant differences were found between the two groups with trauma story discussion being judged by therapists to be more important to treatment outcome in Chilean patients. The problem of potential therapist bias limits definitive conclusions, however we suggest that differences in cultural preparedness for psychotherapy aimed at uncovering previous traumatic experiences may be the main reason for variations in styles of therapy offered to these distinctive ethnic groups. Other possible explanations are differences in diagnostic profiles and types of previous traumatic experiences.
The Influence of Spinal Cord Injury on Coping Styles and Self-Perceptions: A Controlled Study
Authors: Hancock Karen , Craig Ashley , Tennant Chris , Chang Esther
Published: November 2007

Well-controlled research investigating psychological responses following Spinal Cord Injury (SCI) is lacking. In addition, much of the literature is based on depression following SCI and is dominated by data from the USA. The effects of SCI on perceptions of control, self-esteem and coping styles over the first year of SCI were investigated. Forty-one acute spinal injured patients and 41 able-bodied controls matched for age, sex and education completed a variety of standardised questionnaires on three occasions over one year. The instruments included the Locus of Control of Behaviour Scale, Rosenberg's Self-Esteem Scale, and an adapted Mental Adjustment to Cancer (MAC) Scale which measures coping styles, including fighting spirit, helplessness/hopelessness and fatalism. The SCI group were found to be more external in their perceptions of control, lower in self-esteem, and more helpless/hopeless and fatalistic in attitude than the controls. The majority of the SCI group had scores reflecting adaptive coping styles and intact levels of self-esteem but there were still a substantial proportion who displayed maladaptive coping styles (e.g. external locus of control, fatalism, helplessness). No differences in scores across time were found for either group. Implications for psychological rehabilitation are discussed.
The Psychiatrist in an Obstetric/Gynaecology Hospital: Establishing a Consultation-Liaison Service
Authors: Phillips Nicole , Dennerstein Lorraine
Published: November 2007

The establishment and first six months of a psychiatric consultation-liaison service to an Australian obstetric and gynaecology hospital is described. Referrals, diagnoses and follow-up of patients are discussed, with case reports used to illustrate the types of patients seen. Evaluation of the findings and Dossible future directions for the service are discussed.
Why Study the History of Psychiatry?
Authors: Mulder Roger T.
Published: November 2007

The history of psychiatry is being neglected. The major psychiatric textbooks no longer offer any overview of psychiatric history. Possible reasons for this indifference are discussed. It is suggested that a knowledge of our history is not only necessary in a general intellectual sense, but also specifically in enabling us to more easily tolerate the incompleteness and ambiguity of many of our concepts. Furthermore, it may help psychiatry to more convincingly explain the reality and consequences of mental illness to a sceptical public.
The Genetics of Bipolar Disorder
Authors: Mitchell Philip , Mackinnon Andrew , Waters Brent
Published: November 2007

Growing interest in the application of molecular biological techniques to psychiatric disorders has reinvigorated interest in the genetics of the psychoses. It is therefore timely to review the current state of knowledge of the genetics of bipolar disorder. Family, twin and adoption studies are all consistent in confirming the strongly heritable nature of this condition. As segregation analyses have been unable to determine the mode of transmission of bipolar disorder, ongoing linkage analyses using DNA markers will be crucial in determining whether this condition is due to a single major gene, a small number of genes, or multifactorial polygenic inheritance.
A Consensus Conference on Psychotic Depression
Authors: Finlay-Jones Robert , Parker Gordon
Published: November 2007

We report a consensus conference on psychotic depression that addressed historic, classification, phenomenologic, epidemiologic, aetiologic, management and outcome issues. We were able to detail the impact of the information offered by having audience members complete questionnaires before and after the conference. The respondents indicated that the status of psychotic depression (as a separate type or as a more severe expression of depression) remains unclear; that delusions, hallucinations and severe psychomotor disturbance have high cross-sectional diagnostic weighting (while longitudinal information is of importance); that determinants include both genetic and organic factors; that most patients with this condition require admission to hospital; and that bilateral ECT is the most effective treatment. The answers to the questionnaires established areas where the audience did not modify their responses because they were already well-informed, others where their views were considerably changed (e.g. “psychotic’ episodes in those with a borderline personality disorder) and others where they modified their clinical reasoning (e.g. “if a “psychotic’ feature is mood-congruent then the condition must be an affective disorder’ became “if the patient has an affective disorder, the psychotic feature must be mood-congruent’). Finally, we make some recommendations for future consensus conferences.
Psychiatric Disorder and Disability in New Zealand Long-Stay Psychiatric Patients
Authors: Fairley Nigel A. , Siegert Richard , Simpson Alexander , Wilson Janice , Roach Brendan
Published: November 2007

A study was undertaken of the prevalence of physical disease, psychiatric disorder and deviant behaviour in a sample of 137 long stay psychiatric patients at Porirua Hospital near Wellington, New Zealand. Patients were in the main male, single, middle-aged to elderly and of European descent. Schizophrenia was the most common diagnosis. Psychiatric symptoms were moderately severe, the most common being unusual mannerisms and posturing, anxiety, blunted affect, tension, unusual thought content and somatic concerns. Known physical disorders were present in 66 patients. Levels of neuroleptic medication were high and tardive dyskinesia was observed in almost 60% of patients. Frequency of deviant behaviour was low in absolute terms but nonetheless problematic. The frequency of deviant behaviour was similar to those reported for British patients.
Electroconvulsive Therapy: A Study of Attitudes and Attitude Change after Seeing an Educational Video
Authors: Battersby Malcolm , Ben-Tovim David , Eden Joylene
Published: November 2007

Despite the proven efficacy of Electroconvulsive Therapy [ECT], negative attitudes occur in some patients towards its use. However, research into attitudes of patients and public towards ECT, and the influence of the media on these attitudes, is limited and often contradictory. The aims of this study were: to develop a self-administered questionnaire to assess attitudes; to assess the effect of an educational video on attitudes; and to assess the effect of the media on attitudes. The questionnaire was administered to psychiatric and non-psychiatric patients of a Veterans’ hospital and to a group of general hospital patients. A video was shown to a randomly assigned group of the Veteran hospital psychiatric patients. Their attitudes were assessed before and after the video. An overall positive attitude towards ECT was demonstrated in all three groups. Showing a video to the Veteran psychiatric patients produced an improvement in some attitudes, but no reduction in fear. For the psychiatric patients, the effect of the media was negative.
The Historical Method in Psychiatric Research
Authors: Davies John
Published: November 2007

This paper describes the historical method of psychiatric research and compares it with the method of natural science. Examples are provided of methodological errors in the use of this method: errors in the gathering of clinical evidence and the drawing of inferences. The paper concludes that the historical method need be no less rigorous in its application than the method of natural science, and that both methods are necessary in the comprehensive formulation of a psychiatric case.
Wernicke's Encephalopathy Complicating Schizophrenia
Authors: Spittle Bruce , Parker Josie
Published: November 2007

Wernicke's encephalopathy producing an altered mental state may occur in malnourished psychiatric patients even in the absence of alcohol abuse. A case is reported of a woman, aged 61 years, with schizophrenia who refused her medication for four months, had the delusion she was dying from a tumour, and withdrew to her bed with a neglect of her nutrition. She was committed to hospital in a mute unresponsive state and after taking some food and fluids for four days lapsed into coma. She responded within three hours to the administration of thiamine. Clinicians need to remain vigilant to the possibility that an altered mental state in malnourished patients may be due to thiamine deficiency rather than to the primary psychiatric disorder. If doubt exists as to the presence of Wernicke's encephalopathy, then parenteral thiamine should be administered.
Clinical and Research Implications of the Co-Occurrence of Asperger's and Tourette Syndromes
Authors: Marriage K. , Miles T. , Stokes D. , Davey M.
Published: November 2007

Recent advances in the understanding of Tourette Syndrome and Asperger's Syndrome are reviewed. Reports of the co-occurrence of these two uncommon neuropsychological disorders pose a number of questions, the answers to which are likely to have implications for other conditions at the interface of psychiatry and neurology.
Communications between Medical Referrers and Child Psychiatry Staff
Authors: Jones Sarah , Jordan Brigid
Published: November 2007

Communicating in organisations is often seen as the key to good practice, good relationships and good service. A survey was conducted on what communication was wanted by medical referrers to a Department of Child and Family Psychiatry, the types of feedback preferred, and its timing and content. The main finding was that paediatricians received different and better information about referred patients than general practitioners.
Psychiatric Issues in the “Loin Pain and Haematuria Syndrome”
Authors: Kelly Brian
Published: November 2007

The Loin Pain and Haematuria Syndrome is a relatively new diagnosis applied to the problem of persistent loin pain, often with haematuria, in the absence of identifiable explanatory organic pathology. Case reports have suggested a range of salient psychopathological features associated with the complaints of pain and haematuria, although the psychological factors have been largely neglected in understanding the aetiology or in approaches to management. The roles of illness behaviour, patterns of somatisation, and psychiatric disorder associated with chronic pain syndromes, need to be addressed, as do the patterns of medical and surgical response to these patients. The use of the term “syndrome” to describe these symptoms implies a degree of uniformity in clinical features and outcome that has not yet been substantiated. New surgical techniques have been developed such as renal denervation and renal auto-transplantation to treat the pain, with limited success. A review of this condition illustrates the frequent failure of medicine to apply multi-factorial biopsychosocial models to understanding the aetiology and management of unexplained physical symptoms. It also illustrates the failure of our current nosology and understanding of somatoform disorders to achieve application outside psychiatry.
Editorial
Authors: Bloch Sidney
Published: November 2007

After two years in the editorial chair and eight published issues, it seems opportune to take stock of the Journal's current state and direction. In this editorial, I will highlight aspects of the Journal I regard as noteworthy and also point to new policy decisions taken by the Editorial Board.
Clinical Practice beyond Science: Debunking the Scientific Myth
Authors: Halasz George
Published: November 2007

The theme of the RANZCP 28th Conference questioned the science of clinical practice. This question is explored in the light of prevailing paradigms of 20th century psychiatry and recent claims by scientism, especially biologism, that assumes an organic causation for all abnormal behaviour. It is argued that a paradigm of objective science is necessary to understanding many aspects of mental illness, but not sufficient to explain certain essential phenomena, such as altered states of consciousness and empathy, encounted daily in clinical practice. Discarding these phenomena in the name of “science” runs the risk of clinical practice becoming “mindless”. The “reconquest of the subjective” is offered as a way to extend clinical practice beyond objective science.
Treatment Resistant Depression in an Australian Context II: Outcome of a Series of Patients
Authors: Wilhelm Kay , Mitchell Philip , Sengoz Ayse , Hickie Ian , Brodaty Henry , Boyce Philip
Published: November 2007

The clinical characteristics and treatment outcome of a series of 107 patients referred to a mood disorders unit with an episode of “treatment resistant” Major Depression are reviewed. Subjects were categorised by diagnosis (into melancholic and non-melancholic subtypes) and by adequacy of previous treatment. At subsequent review (mean period of 37.5 months) these patients were re-assessed both in terms of outcome and which treatments had been considered to be most effective. Forty one percent of the patient group were fully recovered and a further 43% were partially improved. Different treatments were considered effective for melancholic and non-melancholic sub-types.
Treatment-Resistant Depression: A Critique of Current Approaches
Authors: Dyck Murray J.
Published: November 2007

The clinical and research literature on “treatment-resistant depression” is sampled and reviewed. Major conceptual and methodological inadequacies are identified in this literature. The main conceptual problem consists of a confounding of syndrome description with clinicians' treatment-outcome expectations. Methodological problems include: (a) the failure to adequately conceptualise and/or specifically define treatments; (b) the extreme variety of treatments evaluated in the absence of methodological controls; (c) inadequate sampling procedures; (d) the heterogeneity of the patient samples; (e) the bias in favour of reporting positive results; (f) the misrepresentation of outcome in published reports; and (g) the neglect of considering spontaneous remission as a viable alternative explanation. It is recommended that research attention be refocussed on defining the characteristics of the depressed person who does not respond to standard anti-depressant therapies, as a precursor to identifying a specific therapy.
An Examination of the Associations between Life Problems and Psychiatric Disorders in a Rural Patient Population
Authors: Yellowlees Peter M. , Kaushik Anil V.
Published: November 2007

The objective of this clinical study was to examine the differential effects of adversity on pathology. Data obtained from a previously described consecutive series of 707 patients was re-analysed to this effect. A series of specific life events, as well as behaviours that were likely to be secondary to psychiatric disorder, were examined. High rates of life problems such as incest, sexual assault, domestic violence, suicide attempts, and alcohol, tranquilliser and substance abuse were found in the group of patients in general. There were no major differences in the prevalence of these problems in patients with major functional disorders, anxiety disorders, short-lived minor psychiatric disorders, or in “control” patients with no primary Axis I or Axis II diagnosis. Patients with personality disorders as their major psychiatric diagnosis did, however, experience higher levels of the majority of these problems. The clinical implications of the findings are discussed. It is concluded that patients who develop chronic psychiatric illnesses are probably more psychologically or biologically vulnerable than those patients who develop short-lived disorders and who do not achieve a major psychiatric diagnosis from the practising clinician.
Psychotherapy: The Search for Chaos and the Discovery of Determinism
Authors: Langs Robert , Badalamenti Anthony
Published: November 2007

The search for a science of psychoanalysis is introduced by defining three modes of psychoanalytic science: domain, statistical-stochastic, and formal. The paper outlines the domain science propositions of the communicative approach to psychoanalytic psychotherapy and indicates how this version of psychoanalytic theory led to the development of an extensive series of statistical-stochastic and formal science studies of the communications between patients and therapists. The formal science efforts which began as a mathematical search for chaotic attractors revealed instead a deep determinism within the psychotherapeutic dialogue. Three specific laws of the mind and human communication have been identified. The research is centred on how we communicate (the communicative vehicle) rather than what we express (the contents). After describing a wide range of unexpected and unprecedented results, the paper concludes with a discussion of some of the clinical implications of these findings and of the new formal science of psychoanalysis created by these investigations.
Rapid Eye Movement Sleep Behaviour Disorder in a Chinese Male
Authors: Chung K. F. , Wong Michael T. H.
Published: November 2007

A case of rapid eye movement (REM) sleep behaviour disorder (RBD) is reported. The features and treatment of RBD are discussed and the importance of sleep laboratory evaluation on injury during sleep is highlighted.
Staffing and Funding of Consultationliaison Psychiatry Services in Australia and New Zealand
Authors: Smith Graeme C. , Ellis Peter M. , Carr Vaughan J. , Ashley Warwick K. , Chesterman Helen M. , Kelly Brian , Skerritt Paul W. , Wright Murray
Published: November 2007

The aim of the study was to establish the current and desired levels of staffing and funding of the 52 consultation-liaison (C-L) psychiatry training units in Australian and New Zealand general hospitals. Administration of a questionnaire and follow-up verification provided data on referral rates, existing and preferred staffing levels, and staff workloads. The referral rates and staffing levels in most cases fall below those quoted for Europe and the USA, and those considered optimal by the respondents. This, together with the large variation in referral rates and workload, has implications for the type of clinical activity conducted and quality of the training experience in different units.
Suicide Litigation: From Legal to Clinical Wisdom
Authors: Cantor Christopher H. , McDermott Peter M.
Published: November 2007

Literature on legal aspects of suicide prevention is reviewed to focus on fundamental issues of care. The legal basis of liability is discussed in the context of risk assessment and risk management of suicidal patients. The “four Ds” — duty, dereliction of duty, damages and direct causation — are illustrated. Standards are described at three levels: of the profession, the court and the individual practitioner. Risk assessment is often confused with prediction; the latter is conceptually unsound, and while the former is more sound it is disappointingly imprecise. Despite reliability problems, risk assessment and appropriate management are important, as life itself is involved. Clinicians should be aware that informed consent requires responsibility for suicide prevention to be shared with patients. Such involvement of patients in self-destructive frames of mind raises complex issues. Management issues of both inpatients and outpatients at acute or chronic risk are discussed. Potential pitfalls for clinicians are outlined. Communications with, and the supervision of, other staff must be carefully considered. Families of vulnerable persons or those following bereavement also merit consideration. Patients are entitled to treatment with dignity and liberty — the latter should not be compromised any more than is essential — even when suicide is a possibility. Balancing these difficult issues may be easier if clinicians have a clear awareness of them.
Assertive Community Treatment for the Seriously Mentally Ill in Suburban Sydney: A Programme Description and Evaluation
Authors: Hambridge John A. , Rosen Alan
Published: November 2007

Assertive and intensive community treatment for the seriously mentally ill is becoming a widely accepted approach internationally. This type of service is, however, still relatively new in Australia and New Zealand, and it has rarely been fully integrated into a comprehensive catchment area community and hospital mental health service. This paper has two aims. Firstly, it describes an innovative assertive community mental health service in suburban Sydney. This service was initially provided to 64 clients with a serious mental illness, who had previously experienced repeated hospitalisations and were unable to benefit from existing high quality services. Secondly, it presents the results of the ongoing evaluation of this service. Following the implementation of the service, the number of psychiatric bed days occupied by these clients decreased by 62%; the number of clients admitted decreased, client functioning improved and symptom severity decreased, all to a significant degree.
Single Photon Emission Computed Tomography (SPECT) Measures of Brain Function in Schizophrenia
Authors: Gordon E. , Anderson J. , Meares R. A. , Yong C. , Barry R. J. , Fawdry R. , Grunewald S.
Published: November 2007

This study explores SPECT measured in schizophrenic patients at rest. Left temporal lobe activity was found to be decreased with increasing positive symptom's scores scores. Medicated patients showed a reversal of this pattern underlying this positive symptom effect. Patients with a recent history of auditory hallucinations showed an atypical right temporal lobe dominance, which occurred independently of medication status. These preliminary data are suggestive of the potential utility of SPECT to elucidate symptom/medication/brain activity interrelationships in schizophrenia.
The Clinical Significance of Serial Creatine Phosphokinase Estimations in Acute Ward Admissions
Authors: Wilhelm Kay , Curtis Jackie , Birkett Virginia , Kenney-Herbert Jeremy
Published: November 2007

The aim of the study was to assess the effects of a number of physical factors on serial total creatine phosphokinase (CK) levels within the first few days of admission to an acute psychiatric ward. Patients (n=17) who received parenteral injections within 48 hours of admission were compared with those (n=30) who did not, looking at factors such as method of admission, alcohol use, presence of restraint and serial CK estimations. Those receiving injections had significantly raised CK levels over the first few days post-admission; these levels tended to normalise over 72 hours of admission. A small number of the patients who were given intramuscular injections demonstrated CK levels of over 1000 U/L. It is suggested that where CK levels are elevated, NMS should be excluded on clinical grounds. CK levels should return to normal over the next 72 hours (in the absence of NMS) if there are no further intramuscular injections.