bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of Response to Antidepressant Medication by a Sign-Based Index of Melancholia
Authors: Parker Gordon , Hadzi-Pavlovic Dusan
Published: November 2007

We examine the capacity of a new melancholia index (focussing on CORE signs indicative of psychomotor change) to predict response to antidepressant medication. In a naturalistic study, depressed patients were assessed and rated by their treating psychiatrist, and we focus on those who received antidepressants for three weeks or more. Those subjects who returned high CORE scores (putative melancholia) at baseline improved more over the initial six weeks, but analyses suggested that the differential improvement outcome was independent of medication. Thus, CORE scores predicted outcome for those receiving antidepressant medication, but possible mechanisms remain unresolved.
The Essentials of Psychoanalysis
Authors: Blomfield O. H. D.
Published: November 2007

Psychoanalysis, as procedure, theory and therapy, is a unique activity centred around a special approach to a formalised intersubjective relationship. The phenomena of transference and counter-transference between analyst and analysand allow the emergence of a generative interplay between creative impulses struggling for expression and a persistent search for clarity by appropriate analytic interpretations and synthetic constructions of what takes place.
Adolescent Identity Disorder: A Case Presenting with Cultural Identification Problem
Authors: Luk Siu-Luen
Published: November 2007

A computer search of the psychiatric literature starting from 1983 showed no studies or clinical reports of Identity Disorder. A case history of a 15 year old Chinese boy with Identity Disorder presenting with cultural identification problems is described. Cultural identification among second generation immigrants is discussed in detail. Cultural factors can be very important in the consideration of Identity Crisis and Identity Disorder in adolescents.
Structural Characteristics of Australasian Psychiatric Practice
Authors: Wright Murray , Parker Gordon , Harris Meredith
Published: November 2007

A questionnaire examining structural and basic process characteristics of psychiatric practice was prepared by the RANZCP Quality Assurance Committee and circulated to all Fellows of the College in 1991. There were 830 replies (48%). A one in two sample of the replies was analysed and forms the basis of the descriptive report presented in this paper.
Prevalence of Schizophrenia among Women in Refuges for the Homeless
Authors: Virgona Angelo , Buhrich Neil , Teesson Maree
Published: November 2007

There are considerably more homeless mentally ill men than women. However the rate of mental illness among homeless women appears to be relatively greater than for men. We found the lifetime prevalence of schizophrenia among a cohort of 54 women residing in refuges for the homeless in inner Sydney to be approximately 30%. Only three of the women had a history of prolonged stay in a psychiatric institution. Schizophrenic women had resided at the refuges for longer than non-schizophrenic women.
Has Social Psychiatry Met its Waterloo? Methodological and Ethical Issues in a Community Study
Authors: Morgan Ann , Harris Meredith , Boyce Philip , Wilhelm Kay
Published: November 2007

The first wave of a longitudinal and prospective community study of minor psychiatric disorder among a cohort of socially disadvantaged women has been completed. The study hopes to extend the social model of depression, as initially proposed by Brown and Harris [1], by examining the mediating effects of personality factors and social support. Findings from previous studies have been largely restricted to associations between variables which may be at least partly attributable to methodological limitations in design and measurement techniques: specifically, the use of inherently biased sampling methods, single interview, retrospective data collection and less standardized diagnostic criteria to determine caseness. This paper discusses design strategies which were adopted to reduce the confounding between variables resulting from these limitations. The effectiveness of these strategies is evaluated in light of some methodological and ethical issues which have arisen during the recruitment of participants and the first wave of data collection.
Urinary Neopterin Quantification Indicates Altered Cell-Mediated Immunity in Healthy Subjects under Psychological Stress
Authors: Dunbar P. R. , Hill J. , Neale T. J.
Published: November 2007

In an effort to quantify changes in cell-mediated immunity (CMI) in healthy subjects under stress, we measured levels of neopterin, a well-validated marker of CMI activation, in the urine of medical students undergoing academic examinations. Neopterin/creatinine ratios measured on the first day of examinations (mean 46 μmol/mol) were significantly lower than those measured two weeks before (mean 78 μmol/mol, p =. 004). Minimum neopterin production coincided with maximum subjective stress, as measured by a visual analogue scale. After examinations, neopterin/creatinine ratios rose (means 62 μmol/mol immediately after, and 65 μmol/mol two weeks after examinations), and these levels were not statistically different from those two weeks before examinations. Over this post-examination period, subjective distress was significantly lower than at either time point before examinations. We conclude that urinary neopterin/creatinine ratios may change significantly during periods of psychological stress, indicating concomitant alterations in CMI activation.
Measuring the Specific Psychopathology of Eating Disorder Patients
Authors: Beumont P. J. V. , Kopec-Schrader E. M. , Talbot P. , Touyz S. W.
Published: November 2007

Cooper and Fairburn's Eating Disorder Examination (EDE) is a semi-structured interview designed to assess the specific psychopathology of eating disorder subjects. It was employed in a study of 116 Sydney patients for 2 purposes: first, to determine its usefulness in an Australian context; and second, to compare patients with anorexia nervosa, bulimia and atypical eating disorder. The instrument appears to be quite appropriate for studies in Australia. With respect to the second aim, the results emphasize the essential similarity in psychopathology between the three diagnostic groups. The relevance of this latter finding to the categorisation of eating disorders in the DSM-IV proposals is discussed.
Anorexia Nervosa in Males: A Report of 12 Cases
Authors: Touyz S. W. , Kopec-Schrader E. M. , Beumont P. J. V.
Published: November 2007

The demographic and clinical features of 12 male patients with anorexia nervosa were investigated by means of a retrospective analysis of their medical records. The clinical characteristics of the male patients were found to be remarkably similar to those reported for female patients and our findings concur with previously published literature. There appears however to be a greater tendency to exercise excessively. The importance of recognising anorexia nervosa in males is emphasized.
The Rise and Fall of Phrenology in Australia
Authors: Thearle M. John
Published: November 2007

In the first half of the nineteenth century phrenology, which was claimed to be the first science of the mind, experienced enormous popularity in the western world. It gave rise to a widespread movement attracting the attention of the professional and lay members of society. In Australia, as elsewhere, it had influence in penology and criminology, psychiatry, notions of racial inferiority, education, anthropology and popular application. By the second half of the nineteenth century, following advances in the knowledge of neuro-anatomy, it became relegated to the status of a pseudo-science. As such, it remained popular with charlatans and the public well into the twentieth century.
Non-Sexist Sexual Experiences Survey and Scale of Attraction to Sexual Aggression
Authors: McConaghy Nathaniel , Zamir Ruth , Manicavasagar Vijaya
Published: November 2007

Sixty-six male and 51 female second year medical students anonymously completed the Sexual Experiences Survey (SES) and the Attraction to Sexual Aggression (ASA) Scale, both modified so that women could report behaviours in which they were aggressors, and men, behaviours in which they were victims. Men's aggression scores on the two scales were significantly correlated. As expected, more men than women reported both the likelihood and the experience of being sexual aggressors, although 6% of women reported being so aroused they couldn't stop when their partner didn't want intercourse and 13% of men reported having intercourse against their will. In men sexually coercive behaviours correlated positively with the masculinity scale of the Bern Sex Role Inventory. Fewer female medical students reported experiencing sexually aggressive behaviours compared to US or New Zealand university students; however, the percentage of male students who reported using or threatening to use physical force was in the same range as that of US students. Significant attention to the issue of sexual coercion would appear necessary in the education of medical students.
Conversion Disorder Revisited: Severe Parasomnia Discovered
Authors: Bokey Kathleen
Published: November 2007

In light of recently described and reviewed disorders of movement and behaviour during sleep, the long standing diagnosis of conversion disorder in a forty-nine year old Vietnam veteran was reappraised. Polysomnographic studies showed that the nocturnal component of his “pseudoseizures’ was due to physical disorder, a severe mixed parasomnia comprising the recently described REM behaviour disorder and a non-REM parasomnia. His sleep architecture was also deranged, featuring reduced REM latency and increased REM density. An association between these abnormalities and psychological trauma is recognised in the literature. Treatment with clonazepam has abolished the nocturnal behavioural disturbance. His daytime pseudo-seizures occur less frequently and his general well being is improved. The case is a reminder that physical disorder may underlie and act as prototype to the psychologically-driven symptom. Before attributing behavioural disturbance at night to psychological causes alone, polysomnographic studies should be done to exclude a treatable parasomnia.
Generalised Dissociative Amnesia
Authors: Sengupta S. N. , Jena S. , Saxena Shekhar
Published: November 2007

A case of generalised dissociative amnesia is presented, which illustrates several characteristic features of this uncommon condition. The case showed poor response to thiopentone interviews and in vivo cueing. Amnesia had persisted at six months follow up.
Natural History of Khat Psychosis
Authors: Jager Alan D. , Sireling Lester
Published: November 2007

A paranoid psychosis, resembling amphetamine psychosis, caused by chewing Khat (stems and leaves from the plant Catha edulis) has been well described. Our case demonstrates the natural history of Khat psychosis which, in previous case reports, has been vigorously treated with major tranquillisers.
Parental Representation in Suicidal Adolescents: A Controlled Study
Authors: Adam Kenneth S. , Keller Adrienne , West Malcolm , Larose Simon , Goszer Leona B.
Published: November 2007

One hundred and eighty-seven adolescents referred to outpatient and residential services in three Canadian cities were assessed for lifetime suicidal ideation and attempt, and administered the Parental Bonding Instrument (PBI). Suicidal adolescents of both genders reported lower care and higher overprotection in relation to their mothers than non-suicidal subjects, and female subjects reported this pattern for their fathers as well. Male subjects did not show clear differentiation between groups on PBI ratings for their fathers. Mean PBI scores for female subjects indicated subjects with no suicidal ideation, those with suicidal ideation only, and those having made suicide attempts to be on a continuum, but findings for males did not. The findings extend previous reports of higher “affectionless control” in suicidal adults, but suggest that this pattern may be stronger in females than males, and that maternal Influences may be stronger than paternal influences.
Mental Representations of Attachment among Prospective Australian Fathers
Authors: Radojevic Marija
Published: November 2007

Research into security or otherwise of infant attachment and its correlates is well established. Research into adult internal representations of attachment is still in its infancy. This emergent area of investigation is facilitated by a new measurement instrument, the Adult Attachment Interview (AAI). This paper presents the first Australian report of the distribution of adult attachment classifications in a group of 62 men, prior to the transition to parenthood. Using the AAI, 35.4% of these men were classified as secure. This proportion is congruent with those reported by other investigators. Validity of the AAI is discussed and some theoretical questions related to the findings are raised.
Unilateral Musical Hallucinations and All that Jazz
Authors: Couper Jeremy
Published: November 2007

A 78-year-old hearing-impaired woman who presented to hospital with a stroke and a subsequent epileptic seizure later developed unilateral musical hallucinations in her better hearing (right) ear dShe was found to have a left-sided temporal epileptic focus and the music ceased after a second anti-convulsant was introduced. Comments are made on unusual features of the hallucination and its probable causation.
To See or Not to See: The Debate over Pornography and its Relationship to Sexual Aggression
Authors: Fukui Atsumi , Westmore Bruce
Published: November 2007

The role played by pornography in the generation of thoughts, feelings, impulses and behaviours in its viewers has long been a topic of debate and controversy. The uncertainty about its potential effects on human behaviour, especially its relationship to sexual aggression, has stimulated the recent debate with the possibility of tighter censorship laws being implemented throughout this country. A review of the topic from a number of different perspectives fails to establish that pornography in its purely erotic form has any significant detrimental effect on human behaviour. More difficult to determine are its effects on psychological development. If behavioural disturbances do occur following exposure to such material, they occur in the context of an individual who shows more global disturbances of personality. The current debate regarding pornography provides an opportunity to address in a broader social context issues perhaps more significant for our society: the relationships between men and women, and the roles and recognition provided to each of the sexes.
Borderline Personality Disorder: A Challenge for Mental Health Services
Authors: Clarke Michael , Hafner R. Julian , Holme Gwili
Published: November 2007

Objective: This study had two main aims: to determine the stability over time of the diagnosis borderline personality disorder (BPD) in a psychiatric hospital population; and to assess the quality and effectiveness of treatment offerred within a state mental health service.

Method: The case notes of 47 psychiatric hospital patients followed up for 3 years after the index admission were analysed.

Results: The mean number of previous psychiatric hospital admissions was 9.0, and at least 74% of the sample had further admissions (mean 3.7) during the 3 year follow-up. Comorbidity with schizophrenia and schizoaffective disorder was rare, and was only 13% with major depression. Longitudinal stability of diagnosis was very high.

Conclusions: The study firmly supported BPD as a valid diagnosis. Its treatment within the state mental health system was generally haphazard and ineffective. Post-discharge plans were implemented for only 3 subjects. Current moves toward community psychiatric treatment represent a unique opportunity for improving treatment of BPD by using existing resources more effectively.
Fluoxetine Treatment of Depressed Patients with HIV Infection
Authors: Judd Fiona K. , Mijch Anne M. , Cockram Alex
Published: November 2007

Objective: The aim of this paper is to describe the outcome of fluoxetine treatment of depressed patients with HIV infection.

Method: An open study was made of 20 patients with varying stages of HIV infection treated for depression with fluoxetine.

Results: 15 of 20 patients improved with fluoxetine treatment; the drug was generally well tolerated, with no significant drug-drug interactions. Conclusions: Fluoxetine appears to be effective for the treatment of depression in patients with HIV infection.
Working with Survivors of Torture and Trauma: The Victorian Foundation for Survivors of Torture in Perspective
Authors: McGorry Patrick
Published: November 2007

The health and welfare needs of refugee survivors of torture and trauma have in recent years belatedly found a prominent place on the policy agendas of Federal and State Governments. The development of a statewide service to meet these needs provides an opportunity to illustrate some of the general issues in developing a model specialist community health service, as well as the specific and complex elements involved in the care and resettlement of refugee survivors of torture and trauma. The early experience of the Victorian Foundation for Survivors of Torture is described and some descriptive data presented. Unresolved issues are highlighted, particularly the difficulty in providing skilled psychotherapeutic assistance to relatively large numbers of traumatised refugees.
Origins and Development of the Injunction Prohibiting Sexual Relationships with Patients
Authors: Leggett Andrew
Published: November 2007

This paper addresses the historical context, both ancient and modern, of the injunction prohibiting sexual relationships with patients. Reference is made to the increasing knowledge of factors predisposing to such breaches of ethical conduct and to the common dangers and consequences of sexual relationships with patients. Such research findings demonstrate adequate cause for the application of the injunction in all of the health care professions. The modern social context of liberal humanism and feminism, along with the recognised analogy with child sexual abuse, are considered as influences in the current resurgence of interest in the injunction itself.
Long-Term Psychotherapy in Borderline and Narcissistic Disorders: When is it Necessary?
Authors: Beatson Josephine A.
Published: November 2007

Objectives: This paper explores the barriers and impediments to psychological change in those patients with borderline and narcissistic character pathology requiring long-term psychotherapeutic treatment.

Method: Examination of the relevant literature was made and the author's clinical experience included.

Results: Those patients with borderline and narcissistic character pathology requiring long-term psychotherapeutic treatment to achieve lasting psychological change are characterised by their experience of severe early developmental trauma. This has resulted in the formation of entrenched adverse relational patterns which are unconscious, difficult to bring into consciousness and slow to change. These patients have failed to establish security of attachment patterns in the course of a depriving and/or traumatic childhood, often in the care of parents with similar character pathology. Such patients will often require a therapeutic relationship with an emotionally responsive therapist sustained over time within a secure therapy frame to achieve lasting psychological change.

Conclusions: Patients with borderline and narcissistic pathology who have sustained severe early developmental trauma will often require long-term psychotherapeutic treatment to achieve lasting psychological change. Such treatment is necessary for the relief of suffering in the patients, and may contribute to the alleviation or prevention of the intergenerational transmission of these disorders.
The Psychiatric Care of People with Intellectual Disabilities: The Perceptions of Trainee Psychiatrists and Psychiatric Medical Officers
Authors: Lennox Nicholas , Chaplin Robert
Published: November 2007

Objective: The main aim of this study was to document the perceptions of trainee psychiatrists and psychiatric medical officers regarding the psychiatric care of people with intellectual disabilities.

Method: A 28-item self-administered questionnaire was developed by the investigators and pretested on eight psychiatrists and psychiatric trainees. A revised version of the questionnaire was then sent to 128 psychiatric trainees and 27 medical officers working in the public psychiatric services in Victoria. 116 questionnaires were returned, and the responses analysed.

Results: The results indicate a high degree of interest in the psychiatry of intellectual disability, however this was tempered by a feeling that the respondents and their senior colleagues are inadequately trained. The respondents expressed major concerns regarding the care of people with dual disabilities in the hospital and community setting, and significant support for the development of specialised units and subspecialisation within psychiatry. The major concerns which were identified would in part explain why 30% of the respondents felt that they would prefer not to treat people with an intellectual disability and a psychiatric disorder.

Conclusion: We can only support the assertion made by the Burdekin Report [12] that “there is an urgent need for academic research, increased clinical expertise and substantial increased resources in the much neglected area of dual disability.”
Continuing Medical Education in Marital and Family Therapy: A Survey of South Australian Psychiatrists
Authors: Allison Stephen , Powrie Ros , Pearce Colby , Martin Graham
Published: November 2007

Objective: South Australian psychiatrists were surveyed to determine their impressions of the usefulness of marital and family therapy (MFT) in the management of serious psychiatric conditions and to ascertain their previous experience with Continuing Medical Education (CME) about family therapy. It was expected that psychiatrists' preferences regarding CME would be related to their clinical experience of the usefulness of MFT.

Method: One hundred and twenty psychiatrists returned a questionnaire about their training, clinical and research interests, with ratings of the usefulness of MFT and CME preferences. This represented 65% of those eligible for the CME programme.

Results: Thirteen percent of the respondents found MFT to be extremely useful and a further 47% found it moderately useful in their current practice. There was evidence of a possible training effect: respondents who had previous CME rated MFT as more useful, especially for mood disorders. Furthermore, the treatment of mood disorders seemed to have a particular relevance in family psychiatry, making a statistically unique contribution to ratings of MFT usefulness in the respondents' total practice. Sixty-nine percent of the respondents requested further CME in family therapy. This represented 45% of all South Australian psychiatrists. Respondents who rated MFT as more useful in practice were significantly more likely to be interested in CME.

Conclusions: There seems to be sufficient interest and clinical experience among psychiatrists for MFT to be included in CME courses. It is recommended that further training focus on major mental disorders, especially mood disorders and schizophrenia.
Substance Abuse Disorders: Psychiatric Trainees' Knowledge, Diagnostic Skills and Attitudes
Authors: Roche Ann M. , Parle Michael D. , Campbell Jane , Saunders John B.
Published: November 2007

Objective: The drug and alcohol related knowledge and attitudes of trainee psychiatrists were examined to obtain a baseline measure of these factors in order to determine whether current training is appropriate and adequate.

Method: A questionnaire was distributed to trainees enrolled in the training program of the Royal Australian and New Zealand College of Psychiatrists in New South Wales, Victoria, Queensland and South Australia (N=425). Questions were asked relating to theoretical knowledge, diagnostic and problem solving skills for a number of drug groups; further questions concerned the respondents' attitudes and opinions on aspects of management.

Results: Sixty per cent of recipients returned the questionnaire. Theoretical and applied knowledge levels were of an adequate standard overall, but highly variable. Notable areas of weakness included knowledge of opiates, barbiturates and stimulants. Trainees' views regarding treatment options were also variable. Alcoholics Anonymous was considered the best supported form of treatment from evidence from controlled trials. Low levels of self efficacy and little support were recognised for early intervention strategies.

Conclusions: While positive views were generally expressed towards involvement with patients with alcohol and drug problems, specific strategies to enhance training and performance are needed. Findings are discussed in terms of continuing education. It is recommended that if sufficient training in this area is not provided then psychiatrists will have little confidence in appropriate therapeutic approaches in treating substance misusers.
Psychopathology of Catatonic Speech Disorders and the Dilemma of Catatonia: A Selective Review
Authors: Ungvari Gabor S. , White Erica , Pang Alfred H.T.
Published: November 2007

Objective: Over the past decade there has been an upsurge of interest in the prevalence, nosological position, treatment response and pathophysiology of catatonia. However, the psychopathology of catatonia has received only scant attention. Once the hallmark of catatonia, speech disorders — particularly logorrhoea, verbigeration and echolalia — seem to have been neglected in modern literature. The aims of the present paper are to outline the conceptual history of catatonic speech disorders and to follow their development in contemporary clinical research.

Method: The English-language psychiatric literature for the last 60 years on logorrhoea, verbigeration and echolalia was searched through Medline and cross-referencing. Kahlbaum, Wernicke, Jaspers, Kraepelin, Bleuler, Kleist and Leonhard's oft cited classical texts supplemented the search.

Results: In contrast to classical psychopathological sources, very few recent papers were found on catatonic speech disorders. Current clinical research failed to incorporate the observations of traditional descriptive psychopathology.

Conclusions: Modern catatonia research operates with simplified versions of psychopathological terms devised and refined by generations of classical writers.
Psychiatric Characteristics of Female Prisoners in Tasmania
Authors: Jones Ivor H. , Marris Ben , Hornsby Helen
Published: November 2007

Objective: The aim of the paper is to describe some of the psychiatric, social and criminological features of female prisoners in Tasmania between 1981 and 1990 inclusive.

Method: Data were collated from prison records for all 210 women prisoners incarcerated between the above dates. Using the Mental Health Services database it was determined which prisoners had prior contact with State Psychiatric Services, their clinical state, various demographic data and ICD-9 diagnoses. Forensic data obtained from prison records were compared for those with and those without a psychiatric history of attendance at Mental Health Services; appropriate privacy safeguards were used in handling the material.

Results: Thirty-five per cent of prisoners had prior contact with the Mental Health Services before imprisonment. They were predominantly persons with an abnormal personality. Non-addictive drug abuse was the next most common psychiatric category (19%). Only 3% suffered from schizophrenia or affective disorder. Those with prior psychiatric presentation had greater social maladjustment, longer sentences for similar offences and a higher recidivism rate. There was an increase in the number of prisoners with and without a psychiatric diagnosis during the decade.

Conclusions: Thirty-five per cent of the female prison population had previously attended psychiatric services in the State. This is fewer than reported in Britain and the US, probably because of the different social structure of this community. These persons differ from other prisoners by showing greater impairment in social adjustments and relationships. They appear to be treated differently with respect to sentencing. There was no evidence of a simple reciprocal relationship between deinstitutionalisation and imprisonment.
Hyponatremia, Convulsions and Neuroleptic Malignant Syndrome in a Male with Schizoaffective Disorder
Authors: Looi Jeffrey C.L. , Cubis Jeffrey C. , Saboisky John
Published: November 2007

Objective: The aim of the study was to highlight the diagnostic difficulties occurring when hyponatremia presents concurrently with neuroleptic malignant syndrome (NMS). Diagnostic issues in the differentiation between hyponatremia and NMS are discussed.

Clinical picture: A case of dilutional hyponatremia (DH) secondary to psychogenic polydipsia (PP) associated with NMS occurring in a male with schizoaffective disorder is described. The clinical picture was complicated by convulsions, perhaps due to clonazepam withdrawal and possible lithium toxicity.

Treatment: The patient was treated with supportive medical measures. Outcome: The patient made a full recovery.

Conclusions: Hyponatremia and NMS have been found to be associated. This association may be due to an undefined common pathogenesis, or may be coincidental. Hyponatremia may also hinder the diagnosis of NMS.
Eating Disorder Patients at a NSW Teaching Hospital: A Comparison with State-Wide Data
Authors: Beumont P. J. V. , Kopec-Schrader E. M. , Lennerts W.
Published: November 2007

The aim of the study was to present data which may be useful in deciding the type of services needed for eating disorder (ED) patients in New South Wales (NSW). The demographic and clinical characteristics of 155 patients consecutively admitted to a special ED unit at a major Sydney teaching hospital during the triennium 1989–1991 were documented and compared with relevant data from the State as a whole (709 admissions for ED to public facilities and 938 admissions for ED to private facilities during the same period). The findings are discussed in the light of information from overseas studies.

Although a relatively large number of ED patients are admitted to hospitals in NSW, their short duration of stay suggests that many may receive inadequate treatment. The unit in the Department of Psychiatry at the Royal Prince Alfred Hospital (RPA), the largest public ED service in NSW, provides a special service for these patients. It is effective in bringing about nutritional restoration, with a duration of stay similar to those reported from centres overseas. Most referrals are tertiary, and there is a high prevalence of physical morbidity indicating a need for access to general medical facilities. Most serious physical complications occur in patients who can be identified by their chronicity and by the pattern of their behavioural disturbance. These various factors are considered in the formulation of recommendations for rationalising the service.
On Silence: A Language for Emotional Experience
Authors: Martyres Gita
Published: November 2007

Silence is an important aspect of human interaction, but is often experienced with discomfort and quickly filled with words. While quantitative parameters of silence such as timing and duration are easily recognised, qualitative experiential aspects are much more difficult to identify and describe. Emotions are experiential and complex, having antecedents in personal history, but words used to describe emotions are generally inadequate and simplistic. Silence is a useful experiential medium in which to identify and work with emotions. It is necessary to recognise what is being communicated by silence in each silence. This paper explores types of silences encountered in clinical work, and techniques to deal with them, avoiding symbolised language and technical terms of individual schools of psychotherapy.
Tertiary Prevention in Mental Health Care: Effects of Group Meetings for Family Caregivers
Authors: Winefield Helen R. , Harvey Eileen J.
Published: November 2007

Several series of discussion groups were conducted for people caring for relatives who suffer from chronic schizophrenia. Groups aimed to provide information from both experts and fellow caregivers about the illness and about coping techniques, and to foster emotional support within the peer group. Owing to the small number of subjects, statistical power was inadequate to test effects quantitatively; however the responses of the family caregivers to structured follow-up questions indicated many gains from group attendance. Attendance and participation rates were high once subjects were engaged; positive outcomes were reported by the carers, and they actively sought feedback of their dissatisfactions with mental health services to the relevant decision-makers. The results are relevant both in the area of preventive mental health care for carers, and in promoting collaboration between carers and professionals.
Multiple Personality Disorder in an Intellectually Disabled Man: A Case Report
Authors: Fairley Michael , Jones Roderick C. , McGuire Brian E. , Stevenson Janine
Published: November 2007

The case of a young man with the dual diagnoses of severe intellectual handicap (IQ 30 and mental age 4 years) and Multiple Personality Disorder is presented. The intellectual handicap is probably due to hypoxia in infancy and the Multiple Personality Disorder follows prolonged physical and sexual abuse. The patient frequently switches between any of nine discrete but incompletely formed identities. Although some personalities seem more capable than others, all have similar levels of disability on testing. The diagnosis of psychiatric disorders coexistent with the intellectual handicap is hindered by the difficulty in separating psychiatric phenomena from the behavioural disturbances associated with the disability. Differential diagnosis and management are discussed.
Group Peer Review in Psychiatry: The Relationship to Quality Improvement and Quality Care
Authors: Balla Margaret , Knothe Barbara , Lancaster Jeanette , Prager Shirley , Beatson Josephine
Published: November 2007

Objective: This study sought to elucidate the contribution of peer review groups involving psychiatrists to quality improvement and quality care. Method: Audio-taped interviews of groups engaged in peer review were analysed using a qualitative methodology. Participants' views of the ways in which they experienced and conceptualised peer review were explored. Results: The views of participants in peer review groups were analysed, and categories evolved which identified differences in how they perceived the structure and function of group peer review.

Conclusions: Participants in the groups studied perceived peer review as a professional growth forum within a quality improvement framework providing critical review of treatment, continuing education, and a sense of collegiality. Boundaries of acceptable practice were tested and defined. At its best, participation in peer review groups enhanced reflective practice which achieved new understandings of clinical work. In this regard, peer review is seen as a highly desirable method for the maintenance of professional standards.
Intervention and Social Breakdown in the Elderly
Authors: Little John D.
Published: November 2007

Objective: To discuss the ethical and clinical issues associated with the management of social breakdown in the elderly (SBE) in relation to the case of a 76-year-old recluse who was referred following community concerns about her living conditions and behaviour.

Method: Longitudinal assessment and management of the patient resulted in a diagnosis of schizophrenia and treatment with fluphenazine decanoate. Results: The patient responded to treatment and was returned home, after which a relationship was maintained by community services. Conclusions: A coherent and defensible position on both clinical and ethical grounds may be made in favour of intervention with SBE. Practical aspects of the process are suggested.
Diagnosis and Serious Mental Illness
Authors: Grant Donald C. , Harari Edwin
Published: November 2007

We examine some limitations of the psychiatric diagnosis, particularly in the assessment of the seriousness of a patient';;s mental illness. The bureaucratic or technocratic use of the concept ‘serious mental illness’ is contrasted with the perspective of the clinician who provides ongoing patient care. A decline in the clinical skills of psychiatrists is likely if proposed mental health reforms regulate psychiatric practice according to bureaucratic and technocratic definitions of serious mental illness rather than the realities of the clinical encounter between patient and doctor.
Querulous Paranoia in Chinese Patients: A Cultural Paradox
Authors: Pang Alfred H.T. , Ungvari Gabor S. , Lum Francis , Lai Kelly , Leung C. M.
Published: November 2007

Objective: There has been no reported case of querulous paranoia from the Asian population. A prospective study was undertaken to identify patients with querulous paranoia in an outpatient clinic.

Method: One thousand, five hundred and fifty-one new referrals to a university-affiliated psychiatric outpatient clinic in Hong Kong were screened for querulous paranoia during routine clinical work.

Results: Three patients with querulous paranoia (0.19%) were identified during 1 year. The case histories of these three patients are reported. Conclusion: Possible reasons for the low reporting rate are discussed and the importance of sociocultural traditions in the development and recognition of querulous paranoia is emphasised.
The Delusion of Infection with HIV
Authors: Nash Louise
Published: November 2007

Objective: This article briefly describes the consultation-liaison service of the HIV/AIDS service of the Royal North Shore Hospital, and reviews three men who had the delusional belief of being infected with HIV. Method: Twenty-three consecutive referrals from the HIV/AIDS unit to consultation-liaison psychiatry were reviewed. Three of these patients persistently believed that they were infected with HIV despite low risk factors and negative blood tests.

Results: These three men had a major depression. Two of the three patients were offered treatment with psychotherapy and antidepressant medication. The third declined psychiatric follow-up.

Conclusion: The presentation of a patient for HIV testing, with an atypical history, should raise the interviewer's concern that there may be an underlying mental illness, in particular a depressive disorder.
Computerised Psychoeducation for Patients with Eating Disorders
Authors: Andrewes David G. , Mulder Claudia , O'connor Peter , McLennan Jim , Say Stephen , Derham Harry , Weigall Sue
Published: November 2007

Objective: To assess a new computer-based method of health education for patients with bulimia and anorexia nervosa.

Method: Fifty-four patients with DSM-III-R diagnosed eating disorders were allocated randomly to one of two groups, one receiving a computer-presented health education package called DIET, the other experiencing a placebo computer-based program. Each group contained 14 anorexia nervosa patients, four anorexic patients with bulimia and nine bulimic patients. Groups were equivalent in terms of the severity of their eating disorder as measured on the Eating Disorders Inventory and their estimated premorbid intelligence according to the National Adult Reading Test. Both groups were assessed before and after intervention on a questionnaire measuring knowledge of eating disorders and a questionnaire measuring attitudes to eating-disordered behaviour. Results: The DIET group members were significantly improved when compared to the placebo group in terms of both their knowledge and attitudes towards their disorder. The patients rated the DIET program as being both easy to use and helpful.

Conclusion: The DIET program has been found to be a resource-efficient means of health education for patients with eating disorders. Further research is required to assess whether the program has therapeutic effects in terms of behavioural improvement.
A Malay Crosscultural Worldview and Forensic Review of Amok
Authors: Hatta S. Mohamed
Published: November 2007

Objective: This article attempts to review the criteria for the amok phenomenon since the late 15th century and how its meaning has evolved into its present day usage.

Method: A literature search was conducted examining and quoting Western sources vis-a-vis amok in the Malay context, ancient and modern. Results: This crosscultural approach overlaps with the forensic aspects of the phenomenon. This is inevitable as the word ‘amok’ itself brings to mind the phenomenon of violence which most often results in the breaching of the law. The changing face of amok as defined by Western authors is highlighted and compared to amuk as understood by modern Malays.

Conclusions: It is inferred that amok as understood and classified in modern psychiatry has a different criteria set when compared and contrasted with the Malay understanding of amuk. With the broadening of the definition of amok, it is finally portrayed as being a syndrome that belongs to the East as well as the West.
Delivery of Medication to Psychiatric Patients in Community Health Services in New South Wales
Authors: Buhrich Neil , Butchart Anne , Johnston Susan , Lauchlan Roberta
Published: November 2007

Objective: We investigated the supply and monitoring of medication to patients who attend community mental health services in NSW. Method: The staff at four metropolitan and one rural community centre health service were interviewed. Information sought included policies and procedures concerning medication, the delivery of medication to patients, and staff reports concerning their knowledge and practice related to the legal requirements of the New South Wales Poisons Act 1966.

Results: Sixty-five (62%) of 104 coordinators, medical officers and staff who were responsible for case managing patients were interviewed. The centres all differed in their existing policies and practices and the extent to which they were supported by their local hospital and retail pharmacies. Only one centre had a designated pharmacist and this was a part-time position. Conclusions: The delivery of medication at most centres is a fairly ad hoc arrangement with staff organising medication as best as they can. At times the supply of medication to patients fails to comply with legal and New South Wales Department of Health requirements.
Alprazolam-Induced Hypomania
Authors: Reddy Janardhan Y.C. , Khanna Sumant , Anand Uday , Banerjee Amiya
Published: November 2007

Objective: There are reports of alprazolam-induced hypomania/mania. Here is a case report of a patient who developed hypomania during treatment with alprazolam, but not with diazepam, another benzodiazepine derivative. Clinical picture: The illness was of 2 months' duration and the patient received a diagnosis of anxious depression. Following treatment with alprazolam, the patient developed hypomania characterised by euphoria, overactivity, overtalkativity, racing thoughts, oversocialisation, enhanced self-confidence and disturbed sleep.

Treatment: Hypomania subsided when alprazolam was withdrawn. There was no recurrence with fluoxetine or diazepam that ameliorated the primary condition.

Outcome: The patient was symptom-free on follow-up.

Conclusions: Alprazolam can induce hypomania/mania and, perhaps, it differs from other benzodiazepines in its mode of action. Clinicians have to be alert to the possibility of their patients developing hypomania/mania while on alprazolam.
Postpartum Psychiatric Disorder: Who Should be Admitted and to Which Hospital?
Authors: Barnett Bryanne , Morgan Mary
Published: November 2007

Objective: To review the question of whether an infant should be admitted to psychiatric services when a severe psychiatric disorder necessitates admission of the mother.

Method: All available literature on mother-infant joint admission was reviewed and arguments for and against are summarised.

Results: Early reports favoured joint admission, then opinions changed, possibly for economic reasons. Recent thinking encompasses research data on (i) longer-term adverse effects of postnatal depression on the children, and (ii) the finding of psychological and psychiatric morbidity in many of the fathers. Joint admission to designated special units is valuable, but such facilities are only cost-efficient and effective if established as part of an appropriate broader plan for managing postpartum psychiatric disorder. Conclusions: (1) Further research is needed to answer this question definitively. (2) Services at primary and secondary level require expansion. (3) All services should target the whole family.
Approaches to Measuring Quality of Life and their Relevance to Mental Health
Authors: Stedman Terry
Published: November 2007

Objectives: This paper describes the ‘sociological’ and ‘health-related’ approaches to the measurement of quality of life and aims to describe their major findings, shortcomings and potential uses with mental health problems. Method: The literature is selectively reviewed to illustrate the major developments and conclusions.

Results: Despite the lack of an accepted definition of quality of life, sociological approaches have repeatedly shown in general populations, the mentally ill and the elderly that subjective assessments are more influential in determining expressions of happiness, wellbeing and life satisfaction than are the objective circumstances of a person's life. This supports the use of subjective judgements as the basis for quality-of-life determinations. Conclusions: The quality-of-life approaches can help to answer a broad range of questions of interest to psychiatry. Health-related quality-of-life approaches are potentially useful methods of demonstrating the impact of mental illness and the benefit of interventions. Further work is required to determine whether the commonly used measures are sensitive to change.
Rehabilitation of Frontal/Executive Impairments in Schizophrenia
Authors: Delahunty Ann , Morice Rodney
Published: November 2007

Objective: A relatively high prevalence of deficits in cognitive flexibility, working memory and planning ability has been reported in schizophrenia patients. The objective was to develop a rehabilitation training program in an attempt to improve these specific cognitive functions.

Method: The deficits in cognitive flexibility, working memory and planning ability were interpreted as reflecting executive cognitive processing impairments secondary to prefrontal neural system dysfunction. Following the ‘process specific’ approach, it was considered important to develop tasks that hypothesised the exercise of these cognitive abilities and the more molecular information processes thought to be fundamental to these abilities. Care was taken to ensure that all tasks involved the practice of processes thought to activate frontal/prefrontal neural systems. Attentional, visual, verbal, conceptual, motor and fine motor tasks were considered important for each process area in order to involve as many functional modalities as possible. Results: A program comprising cognitive shift, working memory and planning modules was developed. Conducted over 11 weeks, four modules were of 2 weeks' duration, and the fifth of 3 weeks' duration. Four individual 1 hour training sessions were conducted each week. Core elements of the modules are described.

Conclusion: Consisting predominantly of pencil and paper information processing exercises, all of the training exercises are presented in the volumes of the Frontal/Executive Program. The program appears to be user-friendly with therapists now successfully delivering the program, in its entirety, to schizophrenia patients. Should future studies replicate preliminary findings of improved neurocognitive performance following training with the program, such findings would have important implications for the treatment of schizophrenia.