bluuebunny/crossref_metadata_2025 huggingface dataset:
The Development of the Separation Anxiety Symptom Inventory (SASI)
Authors: Silove Derrick , Manicavasagar Vijaya , O'connell Dianne , Blaszczynski Alex , Wagner Renate , Henry Jane
Published: November 2007

Separation anxiety continues to be implicated as an early risk factor to adult emotional disorder but recent research findings are somewhat contradictory. Inconsistencies in approaches to measuring memories of early separation anxiety may have contributed to this lack of clarity. We report the development of a brief self-report instrument, the Separation Anxiety Symptom Inventory (SASI), which was designed to overcome some of these deficiencies in measurement. The SASI was shown to have a coherent factorial structure, high internal consistency (Cronbach's Alpha>.80) and test-retest reliability over an average of 24 months (Intraclass Correlation Coefficient =. 89), with serial scores not being affected by changes in contemporaneous anxiety levels. Some index of the validity of the measure was achieved by (a) comparing SASI scores of index twins with descriptors of their “insecure’ behaviours in early life provided by corresponding co-twins; (b) comparing SASI scores with retrospective DSM III-R diagnoses of early anxiety disorders obtained by structured interviews; and (c) examining SASI scores in subjects with histories of school refusal. The SASI provides a useful standardised measure which will aid in the further testing of the separation anxiety hypothesis of adult emotional disorder.
Reported Early Separation Anxiety Symptoms in Patients with Panic and Generalised Anxiety Disorders
Authors: Silove Derrick , Manicavasagar Vijaya , O'connell Dianne , Blaszczynski Alex
Published: November 2007

Attachment theory has proposed that early separation anxiety is a risk factor for adult anxiety disorder, with the recent focus being particularly on panic disorder. The results of empirical studies examining this link are, however, contradictory, possibly because of inconsistencies across studies in measuring memories of early separation anxiety. In the present study, a psychometrically sound measure, the Separation Anxiety Symptom Inventory (SASI) was used to compare memories of such early symptoms in panic disorder (including those with mild phobic-avoidance), generalised anxiety disorder and control subjects. Anxiety patients as a group returned higher SASI scores (p<0.001) with a non-significant trend for panic disorder patients to score higher than those with generalised anxiety. These results suggest that early separation anxiety may be a harbinger of adult anxiety and that risk of panic disorder may be higher in the most severely affected youngsters. As a risk factor, early separation anxiety does not however appear to be uniquely related to adult panic disorder.
Physiological Principles in the Treatment of Difficulty Waking from Sleep
Authors: Little J. D.
Published: November 2007

The case report of a young man with profound difficulty waking from sleep is presented. Successful management was predicted and instituted from an understanding of the physiological principles of circadian rhythmicity.
Assessment of Contributions to Disability in People with Schizophrenia during Rehabilitation
Authors: O'connor Russ , Herrman Helen
Published: November 2007

The aim of this study was to assess a number of the components of disability in patients diagnosed with DSM-IIIR residual schizophrenia. Forty-one patients undergoing hospital and community rehabilitation programs were tested. A range of disability levels was defined with a measure of global assessment of function. A large proportion of the patients also had poor results on frontal lobe testing, persistent positive symptoms, and high levels of emotional distress. There was a trend for higher levels of positive symptoms to be associated with increases in global levels of disability, frontal lobe impairment and emotional distress. The work suggests that rehabilitation programs could be more focused if patients were assessed not only for their overall level of functional disability but also for the level of treatment resistant positive symptoms, frontal lobe impairment and the amount and type of emotional distress and insight.
Risk of Retraumatisation of Asylum-Seekers in Australia
Authors: Silove Derrick , McIntosh Philippa , Becker Rise
Published: November 2007

Australia has a long legacy of providing asylum to refugees who, it is now well established, suffer high rates of psychological and psychiatric problems requiring specialised treatment. In this paper we outline the special stressors faced by asylum-seekers who have not obtained formal refugee status and who are at risk of being forcibly repatriated. We suggest that the experiences they undergo in Australia, particularly that of prolonged detention, risk zretraumatising an already vulnerable group. The implications for policy formulation are considered.
Inequalities in the Regional Distribution of Private Psychiatric Services Provided under Medicare
Authors: Jorm Anthony F. , Rosenman Stephen J. , Jacomb Patricia A.
Published: November 2007

An analysis was carried out on Medicare data to find out if there are inequalities in the geographical distribution of private psychiatric services in Australia. The number of psychiatric services and persons becoming patients per 100,000 population was calculated for each federal electorate for the year 1985/86 and related to social indicators derived from the 1986 census. As a comparison, services provided by consultant physicians were analyzed as well. The data were based on the electorate of the patient rather than the electorate of the practitioner. Consultant psychiatrist services were found to be received more often in high socio-economic status electorates and those with older populations, and less often in rural areas. A similar pattern was found for consultant physician services, although the relationship with socio-economic status was not as strong. Frequent psychiatric consultations of longer duration, which are an indicator of insight psychotherapy, were more common in higher socioeconomic status electorates. A limitation of the Medicare data is that they cover only private services. To overcome this limitation, a supplementary analysis was carried out on the distribution of consultations for mental disorders using data from the National Health Survey. These data confirmed that individuals of high socio-economic status with a mental disorder are more likely to receive specialist treatment.
Conduct Problems and Attention Deficit Behaviour in Middle Childhood and Cannabis Use by Age 15
Authors: Fergusson D. M. , Lynskey M. T. , Horwood L. J.
Published: November 2007

The relationship between conduct problems and attention deficit behaviours at ages 6,8,10 and 12 years and the early onset of cannabis usage by the age of 15 years was studied in a birth cohort of New Zealand children. The analysis showed that while conduct problems during middle childhood were significantly associated with later cannabis use (p<0.05) there was no association between early attention deficit behaviours and cannabis use (p>0.40) when the associations between conduct problems and attention deficit behaviours were taken into account. It was estimated that children who showed tendencies to conduct disorder behaviour in middle childhood were between 2.1 to 2.7 times more likely to engage in early cannabis use than children not prone to conduct problems even when a range of factors including family social background, parental separation and parental conflict were taken into account. It is concluded that early conduct disorder behaviours are a risk factor for later cannabis use when due allowance is made for social and contextual factors associated with both early conduct problems and later cannabis use.
Professional Misconduct in Psychiatry: Sexual Behaviour with Patients. A Report of Recent New South Wales Findings
Authors: Dawson Eleanor M.
Published: November 2007

In the period 1989–1991 the Medical Tribunal in the state of New South Wales conducted enquiries into seven complaints about professional misconduct of a sexual nature incidental to psychiatric treatment. This study is submitted in the interests of patients, profession and public in accordance with the ethos of the Medical Practitioners Act (NSW). It is based on personal observations and published legal documents and refers to the legal context and procedures. It addresses the substance and style of complaints and complainants and of defences and respondents. The names of six psychiatrists and one trainee psychiatrist were removed from the Medical Register. In three instances decisions or orders were unsuccessfully appealed in the Supreme Court. In two instances associated complaints (of illicitly prescribing drugs of addiction and of divulging confidential information) were also found to be professional misconduct. Courtroom pitfalls are illustrated and practical principles explicit in judgements are reiterated.
Patient Satisfaction with a Mood Disorders Unit: Elements and Components
Authors: Eyers Kerrie , Brodaty Henry , Roy Kay , Parker Gordon , Boyce Philip , Wilhelm Kay , Hickie Ian , Mitchell Philip
Published: November 2007

Patient satisfaction is an indicator of effective service provision and may influence compliance with treatment. Of 265 patients attending a specialised mood disorders unit and surveyed at least two years after their initial contact, 221 (83%) replied. Characteristics of responders and non-responders were compared on demographic and clinical information from index assessment and follow-up. Sixty-four percent of responders were very satisfied and 21% partly satisfied with their management. Components of satisfaction included perceived competence of clinical management; the unit's administrative and after-treatment accessibility; and the support of staff and other patients. Those with a more adequate personality and melancholic depression at baseline assessment were more satisfied. A low current mood state at time of survey was associated with lower satisfaction in non-melancholies only. There were interactions between improvement in condition, diagnosis, personality and satisfaction. The survey provided a framework for formulating treatment programmes and was a useful quality assurance tool.
The Association between Spouse-Reported Type a Behaviour Pattern and Coronary Heart Disease
Authors: Atchison Michelle , Condon John
Published: November 2007

This paper describes further validation of the Spouse-Report Type A Behaviour Pattern Questionnaire. In a case controlled study of 61 cardiac patients versus 61 community controls, the questionnaire was found to discriminate statistically between a group of patients with proven coronary heart disease and a group of matched healthy controls on the anger/hostility subscale and total Type A score. No relationship between Type A score and coronary heart disease severity was found. Possible explanations for these findings are examined.
A Drive to Play: Evolution and Psychotherapeutic Theory
Authors: Meares Russell , Coombes Trish
Published: November 2007

Freud's thinking was influenced by evolutionary ideas. He built his theory about the instincts of sexuality and aggression. A third phylogenetically given propensity for behaviour, that of attachment, has been added to traditional theory following the work of Bowlby. We propose that the origins of certain psychiatric disturbances, most notably cluster B personality disorders, are to be found not in those drives which are ancient in evolutionary terms but through a disruption of that which has been most recently evolved, and which involves symbolization. It is manifest developmentally as symbolic play. A case report illustrates the hypothesis.
Teachers' Perceptions of Maladaptive Behaviour in Lebanese Refugee Children
Authors: Habir Elwathig El , Marriage Keith , Littlefield Lyn , Pratt Kelly
Published: November 2007

Research on the psychological status of children who are refugees from war has led to varying results. Children from war conditions or who have been subject to evacuation have been shown to have relatively low levels of disturbed behaviour, have internalising symptoms of anxiety or depression, display behaviour with aggressive features, and suffer slight psychological disturbance, depending on their caretakers' response to the stressful experience. Based on the contrasting evidence and observations within an inner Melbourne Muslim school, this study aimed to determine whether more behaviour problems existed in Muslim children from Lebanese families. Compared with other war refugee Muslim immigrant children, Lebanese children were not found to be more aggressive, but were more anxious. Lebanese males displayed more inattentive behaviour at school than non-Lebanese males. Sex differences were found in adaptive functioning within Lebanese and non-Lebanese groups. Differences in school performance and adaptive functioning were found between Lebanese and normative samples when males and females were analysed separately. These results are discussed in the context of teacher expectations and perceptions of culturally acceptable behaviour.
Women in Medicine — Socialization, Stereotypes and Self Perceptions
Authors: Turner Jane , Tippett Vivienne , Raphael Beverley
Published: November 2007

Eleven women in various specialities, including the academic and administrative spheres, were interviewed with regard to their experiences throughout their career. These women all held senior positions in Medicine and represent a broad age range (35–69 years). Information gathered during the interviews was analysed thematically in an attempt to develop a basis for further research examining predictors of success for women in medicine.
Homicide and Attempted Homicide by Patients Suffering from Dementia: Two Case Reports
Authors: Ticehurst Stephen B. , Gale Ian G. , Rosenberg Stewart J.
Published: November 2007

Two elderly patients suffering from a dementing illness are described. The patients manifested homicidal behaviour in association with dementia. Possible risk factors for such behaviour are explored. Implications arising from the cases are discussed.
The Concentration Camp Syndrome
Authors: Bower Herbert
Published: November 2007

A psychiatric syndrome following overwhelming stress after an interval of more than thirty years is described in holocaust survivors who had claimed compensation for persecution between 1939 and 1945.

Five nuclear symptom complexes emerge: depressive reactions; anxiety states; somatic complaints; subjective intellectual impairment; and contact abnormalities.

Subjects who had experienced persecution during their childhood exhibited contact abnormalities of an aggressive type three times as often as survivors who had suffered an identical trauma as adults.
Parental Bonding in Men with Alcohol Disorders: A Relationship with Conduct Disorder
Authors: Joyce Peter R. , Sellman Douglas , Oakley-Browne Mark , Wells Elisabeth , Frampton Chris M. , Hornblow Andrew R. , Bushnell John A.
Published: November 2007

Men from a clinical treatment setting suffering from alcohol dependence, and randomly selected men from the community diagnosed as having alcohol abuse and/or dependence, completed the Parental Bonding Instrument. The men from the alcohol treatment setting perceived both parents as having been uncaring and overprotective. In the general population sample, an uncaring and overprotective parental style was strongly associated with childhood conduct disorder, but not with alcohol disorder symptoms. This discrepancy in perceived parenting highlights the difficulties in extrapolating findings about aetiological factors for alcohol disorders from clinical samples. It also suggests that childhood conduct disorder and adult antisocial behaviour could influence which men with alcohol disorders receive inpatient treatment.
Patterns of Referral to Child Psychiatry in Hong Kong
Authors: Lai Kelly Y. C. , Wong C. K.
Published: November 2007

The referral pattern by three major sources to the Child and Adolescent Psychiatric Unit of a university teaching hospital in Hong Kong is reviewed. In a health care system where primary health care is not properly developed, referral of children with psychiatric problems relies heavily on secondary health care professionals. Over a three year period, 37.8% of the new cases were referred by the other departments of the same hospital, while the Education Department and general practitioners each referred 17.4%. Overall, up to 80% of these children had definite psychiatric problems. Because the morbidities of these children often traverse physical, psychological, social, and educational dimensions, a close liaison with all the different professionals involved is vital.
Suicide Litigation: An Australian Survey
Authors: Cantor Christopher H. , McDermott Peter M.
Published: November 2007

Social and legal attitudes towards suicide through history are described. General medical malpractice trends internationally are portrayed before describing the survey. The survey involved nineteen organisations — insurers and solicitors in the six Australian states — and obtained a 100% response rate. Twenty cases of litigation regarding failure to prevent suicidal behaviour were described since 1972, suggesting that it is uncommon. All but one case involved inpatients and in most instances hospitals were the defendants. Failure to supervise was the leading basis of claims. Most cases concerned non-fatal suicide attempts, usually with extensive injuries. Most claims were settled in favour of claimants — half of these actually in court.
Woman-Centred Perspectives on Female Psychosexuality
Authors: Quadrio Carolyn
Published: November 2007

Numerous contemporary analyses have challenged traditional models of female psychosexual development, identifying their norms as implicitly androcentric Femaleness has been regarded as derivative or deviant, as less and “other” than maleness. Alternative, woman-centred, models emphasise three major aspects of female psychosexual development: affiliation (women and others), maternity (women as mothers), and alterity (women and otherness). For some theorists the affiliative/maternal emphasis constructs a model of healthy and desirable femaleness. For others it represents not only the outcome of millennia of female subordination but also provides a justification for perpetuation of that subordination. Whatever the resolution of these dilemmas, a woman-centred perspective of female psychosexual development is relevant to contemporary psychiatric thinking. This review will present such a perspective and raise some of those dilemmas.
A Survey of Australian Psychiatrist's Attitudes and Practices regarding Physical Contact with Patients
Authors: Leggett Andrew
Published: November 2007

A brief review of the ethics of psychiatrist's and psychotherapist's physical contact with patients is followed by a more detailed review of the major North American studies using self report surveys to measure attitudes and behaviour regarding physical contact with patients The methodology and results of a recent sample survey of Australian psychiatrist's attitudes and behaviour regarding such physical contact are presented and discussed by comparison with the North American literature. Issues pertaining to both “erotic” and “non-erotic” contact are explored.
“Freedom's Just Another Word”: Aboriginal Youth and Mental Health
Authors: Hunter Ernest
Published: November 2007

Objective: The aim of the study was to review the available material on Aboriginal youth mental health, exploring certain contemporary issues.

Method: The review covers the psychiatric and social science literature, focusing on the recent period of major social change.

Results: The available material is severely limited, particular deficiencies being normal child development, the impact of social change and its consequences for the construction of Aboriginal identity.

Conclusion: There is a need for more work in this area and for psychiatric engagement at a political level.
Seasonality of Mania: A Tasmanian Study
Authors: Jones Ivor , Hornsby Helen , Hay David
Published: November 2007

Objective: The aim of the study was to examine the seasonal incidence of mania in a new Southern Hemisphere location.

Method: Using the Tasmanian psychiatric database, monthly admission rates were compared with expected admission rates for mania for the period 1983 to 1989. ICD-9 criteria for mania single episode (296.0) and mania recurrent episodes (296.1) were used, excluding individuals with a bipolar disorder (296.4 to 296.89).

Results: One thousand three hundred and twenty-eight persons were admitted during this period. There was a significant monthly variation with admissions occurring most commonly in the summer, but this was not consistent during the seven year period.

Conclusions: There was a statistically significant but inconstant summer excess. The inconstancy of the finding suggests that the phenomenon is not a simple consequence of light duration, and closer examination of these inconsistencies may lead to further elucidation of the phenomenon.
Suicidal Ideation and Behaviours among University Students in Australia
Authors: Schweitzer Robert , McLean John , Klayich Michael
Published: November 2007

Objective: The aim of the study was to investigate the prevalence and demographic correlates of suicidal ideation and behaviours among university students in Australia and the utilisation of mental health services by this population.

Method: Suicidal ideation and behaviours and demographic variables were assessed in a population of 1,678 undergraduate students by use of a modified Suicide Ideation Scale (SIS) and questionnaire.

Results: Sixty two percent of students surveyed showed some suicidal ideation and 6.6% reported one or more suicide attempts. Over half of the group who reported suicide attempts did not use any type of mental health services. Suicidal ideation was found to be highly correlated with previous use of mental health services. In examining the relationship between suicidal ideation (SI) and demographic variables, SI was not significantly different for gender or parental marital status but was related to living arrangements, racial groups, religious affiliation and father's education.

Conclusions: The results suggest that a higher proportion of students reported suicidal ideation and behaviours than that documented in related studies undertaken in the USA. While these findings draw attention to a higher level of suicidal ideation in students who utilise mental health assistance, more than half of those who reported suicide attempts did not use any kind of mental health service. The study has particular implications for detecting and assisting young people with a high suicide risk within the university environment.
Effects of Newspaper Stories on the Incidence of Suicide in Australia: A research Note
Authors: Hassan Riaz
Published: November 2007

This study investigates the impact of newspaper stories on the incidence of suicide in Australia. The effects of suicide stories appearing in two major metropolitan newspapers between 1.1.1981 and 31.12.1990 were examined. The findings show that the daily average suicide rate in Australia increases significantly after the publication and publicity of suicide stories in the Australian media; the rise tends to be primarily due to the increase in male suicide and not female suicide. Some plausible explanations of this finding are advanced.
Self-Amputation of the Ear: Three Men Amputate Four Ears within Five Months
Authors: Alroe Christopher John , Gunda Venkat
Published: November 2007

Four instances are presented of self-amputation of the pinna of the external ear carried out by three right-handed, white males between January 1993 and May 1993. The common characteristics of these subjects — two men with personality disorder and one with schizophrenia — are discussed and compared with other examples of self-mutilation involving the face and ears, including that of van Gogh. A survey of Australian and New Zealand prisons was conducted to determine the frequency of this form of self-mutilation within the last five years, and yielded only one other case. Connections exist between the amputees supporting the notion that self-mutilation is “contagious”; the relevance of this to issues of management is considered.
Velcro on the Slippery Slope: The Role of Psychiatry in Active Voluntary Euthanasia
Authors: Ryan Christopher James
Published: November 2007

Objective: The aim of the paper is to determine the role that psychiatrists should play in legislation that establishes a right to active voluntary euthanasia (AVE).

Method: One version of the “slippery slope” argument, usually invoked against the legalisation of AVE, is recast as an argument for the introduction of strong safeguards in any future AVE legislation. The literature surrounding the prevalence of psychiatric illnesses in the terminally ill, physicians' ability to identify such illnesses and the aetiology of suicide in the terminally ill is examined.

Results: The strength of the slippery slope argument, combined with the poor ability of general physicians to diagnose psychiatric illness in the terminally ill, demands that any legislation allowing AVE should require a mandatory psychiatric review of the patient requesting euthanasia.

Conclusions: Any legislation adopted that establishes a right to active voluntary euthanasia should include a mandatory psychiatric review of the person requesting euthanasia and a cooling off period before the request is acceded to. In addition, the discovery of a serious mental illness ought to disqualify the affected person from the right to AVE until that illness resolves.
Post-Stroke Depression: Outcome following Rehabilitation
Authors: Loong Chan Keen , Kenneth NG Kwan Chung , Paulin Straughan T.
Published: November 2007

Objective: This prospective study looks at the outcome of rehabilitation on mood and physical recovery in patients with post-stroke depression.

Methods: Fifty-two patients in a rehabilitation centre were assessed for depression, modified Barthel's score and Hamilton Rating Scale for depression on admission to and discharge from the rehabilitation centre. Aphasic, demented and delirious patients were excluded.

Results: Fifty-five percent of the patients were assessed to have depression on admission and 98% had physical impairment. At the time of discharge, only 28.6% were depressed and two-thirds had improved in physical function. Patients with ail degrees of functional impairment showed equal improvement and there was no difference between Barthel's scores for patients whose mood improved and those who remained depressed. There were very strong associations between functional assessment and depression, functional assessment on discharge with depression on admission, and patients' mood on admission and discharge. Depressed patients did not stay longer in the rehabilitation centre than non-depressed patients. Low doses of anti-depressants did not have an impact on mood or functional improvement.

Conclusion: We have found that depression might not have a clear negative impact on rehabilitation, that mood improved at the end of rehabilitation and that the degree of depression on admission was a good predictor of the outcome of final physical impairment.
A One Year Analysis of Appeals Made to Mental Health Review Tribunals in New Zealand
Authors: O'Brien T. A. , Mellsop G. W. , McDonald K. P. , Ruthe C. B.
Published: November 2007

Objectives: The aim of the paper is to present data on the first year of all appeals lodged with a Mental Health Review Tribunal against compulsory treatment orders of psychiatric inpatients.

Method: Two tribunals have been in operation in New Zealand since the introduction of a new Mental Health (Compulsory Assessment and Treatment) Act in 1992. The case records of all patients who had appeals heard by either the Northern or Southern regional tribunal from 16/12/92 to 7/12/93 inclusive were examined.

Results: 145 appeals were heard by the tribunals: 14.5% of appeal hearings resulted in the discharge of a patient from their compulsory treatment status. Discharge rates for the Southern Tribunal were found to be significantly higher at 22%, compared with 10% for the Northern Tribunal (p<0.05). Application for appeal was initiated by the patient in 72% of cases; District Inspectors initiated the remaining cases. District Inspectors were found to initiate significantly more female review applications (47%) than male applications (22%) (p<0.05). Of the appeals heard, 126 were lodged under s.79 of the Mental Health Act. The remaining cases were s.80 (special) cases: in no case was discharge from compulsory treatment recommended. Overall, 69% of appellants were represented by a lawyer. It was found however that engaging legal representation did not significantly increase patients' chances of successful discharge but did delay the hearings. Also considered in the study were the presence or absence of witnesses at hearings and the relationship this had to the outcome of the tribunal hearing.

Conclusions: Ambiguities within the Act need to be addressed in order that criteria used to judge a patient's fitness for discharge may be standardised. In addition, the Act stipulates a maximum delay of 14 days in reviewing a patient's case; however in practice a mean of 22 days elapses, indicating that this stipulation requires review.
The Mental Health of Australians: Can Informative Data be Found?
Authors: Henderson A. S.
Published: November 2007

The National Mental Health Policy has brought about a realisation that data on the mental health of Australians are sparse. This applies to the three levels of morbidity in the general population, the mental health component in general practice and the use of specialist services. This paper considers what epidemiological information is now needed to guide policy. There has probably never been a more opportune time to make a useful contribution to the nation's mental health services through well-planned epidemiological research.
Family Impacts on the Development of the Child
Authors: Edgar Don
Published: November 2007

I argue in this paper for a “cultural” view of child development rather than a psychological one: for a broader but more carefully specified approach to the measurement of “child outcomes” than is often apparent in the early childhood literature.
Does Influenza Cause Schizophrenia? A Five Year Review
Authors: McGrath John , Castle David
Published: November 2007

Over the last five years a body of literature has been generated concerning whether or not prenatal exposure to influenza results in an increased risk of developing schizophrenia in the exposed offspring. The studies are reviewed with respect to the traditional epidemiological criteria that help to define causality. There is a modest degree of consistency in support of an association between the 1957 influenza epidemic — and less so, for influenza epidemics in general — and later schizophrenia. Two cohort studies examining the 1957 epidemic do not support an association. The strength and specificity of the association remain weak. The proposed association draws coherence from the neurodevelopmental hypothesis of schizophrenia. Suggestions are made for future research that could add to our understanding of the putative association between influenza and schizophrenia.
Rapid Audit of Clinical Outcome and Cost by Computer
Authors: Marks Isaac
Published: November 2007

A method to audit clinical outcome and cost was reliable over 17 years and 2000 patients. Data gathered concerning 60 clinicians and 600 patients by a pilot computer system showed that inpatients with obsessive-compulsive disorder were more severely disabled than outpatients with the same disorder, and took twice the therapist time to treat. It was also found that some clinicians obtained three times the improvement per hour than did other clinicians with similar patients in the same unit. Outcome norms are accumulated for particular types of patient and treatment. A new computerised clinical audit system robust enough for general release will be available soon.
A Clinical Perspective on SPECT
Authors: Parker Gordon , Austin Marie-Paule
Published: November 2007

The potential clinical utility of SPECT (Single Photon Emission Computed Tomography) brain imaging to clarifying certain diagnostic dilemmas faced by clinical psychiatrists is considered generally and is illustrated by several case vignettes. Three case histories consider dementia vs depressive pseudo-dementia, two the possibility of a cerebral vasculitis in patients with auto-immune conditions, and two whether the patient had a “type” of depression likely to benefit from a course of ECT. Published studies reviewing the utility of SPECT in dementia, depression, depressive “pseudodementia” and cerebral lupus are considered. It is suggested that SPECT is an important investigatory technique providing additional information that may assist some diagnostic decisions, while its utility in assisting other clinical decisions awaits clarification.
Misidentification Syndromes in Schizophrenia: Case Reviews with Implications for Classification and Prevalence
Authors: Odom-White Aruby , de Leon Jose , Stanilla Joseph , Simpson George M , Cloud Blaine S.
Published: November 2007

Misidentification syndromes represent false, delusionally-based identification of self and/or others. These are variants of the Capgras Syndrome. Although the frequency of misidentification syndromes in schizophrenic populations has not yet been established, the authors believe this syndrome is more prevalent than previously described. Seven of twenty-five (28%) consecutive patients admitted to a chronic clozapine unit with a variant of misidentification syndrome will be described. Their symptoms are categorised according to traditional classification, and Silva's proposed nomenclature. Problems inherent in these classifications are discussed. The need for a more systematic classification of misidentification syndromes is emphasised. Longitudinal studies of misidentification syndrome, and the development of a standardised assessment tool for clinicians who treat chronically psychotic patients, are encouraged.
Respiratory Training Prior to Exposure in vivo in the Treatment of Panic Disorder with Agoraphobia: Efficacy and Predictors of Outcome
Authors: de Beurs Edwin , Lange Alfred , Koele Pieter , van Dyck Richard
Published: November 2007

Thirty-two patients suffering from panic disorder with agoraphobia were treated with repeated hyperventilation provocations and respiratory training, followed by exposure in vivo. The treatment was evaluated with a comprehensive set of outcome measures, including self-report questionnaires, a multitask behavioural avoidance test and continuous monitoring of panic. The treatment was found effective for the majority of patients in diminishing the frequency of panic attacks and agoraphobic avoidance. The clinical relevance of the treatment effect was evidenced by the considerable number of patients that recovered. The effect of the treatment was sustained over a three and six month follow-up period. The prognostic value of a number of variables for treatment outcome was also investigated. Three variables accounted for the majority of the variance in treatment outcome: a higher pretreatment level of agoraphobic complaints, use of psychotropic medication and a longer duration of the disorder were associated with poorer outcome. Other variables, such as the therapeutic relationship and the quality of the marital bond, had no prognostic value.
Psychosocial Stressors, Physical Illness and the Spectrum of Depression in Elderly Inpatients
Authors: Draper Brian , Anstey Kaarin
Published: November 2007

Objectives: To describe all elderly patients hospitalised with principal and secondary diagnoses of depression, and to determine whether a relationship can be demonstrated between psychosocial stressors, physical illness and type of depression.

Method: A retrospective chart review of elderly patients admitted to a general hospital psychiatry ward over a 7-year period with principal or secondary diagnoses of depression was undertaken. Four broad diagnostic categories of depression were used: major depression, psychotic depression, minor depression, and organic depression. Chief outcome measures were: number of medical diagnostic categories, presence of psychosocial stressors, global clinical improvement, and length of stay.

Results: Of 228 patients admitted with depression (194 principal diagnoses and 34 secondary diagnoses), 100 had major depression, 47 psychotic depression, 48 minor depression and 33 organic depression. Psychiatric comorbidi-ty occurred in 70%, about half of which was due to organic brain syndrome. Patients with psychotic depression had the fewest medical problems and those with organic depression the most, while patients with minor depression had the highest rate of family and marital problems, comorbid personality dysfunction and suicide attempts. Patients with psychotic depression had the longest admissions, while those with minor depression had the shortest. Overall, 89% showed significant clinical improvement. Conclusions: Elderly inpatients have a wide spectrum of depressive disorders with different psychosocial, medical and treatment profiles. Future studies of depression in old age should include all patients with clinical depression.
Does Depression Predict Relapse in the 6 Months following Treatment for Men with Alcohol Dependence?
Authors: Sellman John Douglas , Joyce Peter R.
Published: November 2007

Objective: To investigate whether depression measured at the time of treatment predicts relapse of alcohol dependence in the 6 months following treatment of alcohol-dependent men.

Method: Ninety-three subjects with moderate-severe alcohol dependence (DSM-Ill-R), recruited from a 3-week, abstinence-focused therapeutic program, were assessed for current and lifetime major depression using the SCID-P and baseline depressive symptoms using the SCL-90, and then followed up for 6 months. Drinking outcomes were based on multiple sources of data. Results: Relapse was not associated with either lifetime major depression, or baseline depressive symptoms; inadequate numbers of subjects with a current major depression precluded statistical analysis of this variable. Conclusions: Neither lifetime major depression, nor the degree of depressive symptoms in alcohol-dependent men at the time of treatment, compromise drinking outcomes in the 6 months following treatment.
Seasonal Affective Disorder: Some Epidemiological Findings from a Tropical Climate
Authors: Morrissey Shirley A. , Raggatt Peter T.F. , James Basil , Rogers John
Published: November 2007

Objective: To determine whether a predominantly summer-focussed pattern of seasonal affective disorder (SAD) exists in tropical northern Australia. Method: A mail survey containing a modified form of the Seasonal Pattern Assessment Questionnaire (SPAQ) was administered to 176 households in the city of Townsville (latitude: 19° south).

Results: Using previously reported screening criteria, 9% of respondents reported a degree of summer impairment indicative of SAD, while the incidence rate for winter SAD was 1.7%. This summer-winter ratio is typically reversed in more temperate latitudes.

Conclusions: Excessive heat and humidity were reported to be the two most influential environmental factors affecting mood and behaviour. It is likely that respondents meeting criteria for summer SAD represent the extreme end of a spectrum of summer-related mood and behaviour change that affects many individuals in northern Australia. Strategies for further clinical and epidemiological research on SAD in tropical climates are proposed.
Reconciling the Patient's Right to Confidentiality and the Family's Need to Know
Authors: Furlong Mark , Leggatt Margaret
Published: November 2007

Objective: Persistent difficulties have been identified in relation to confidentiality in mental health settings. The objective of the current investigation was to develop practical options enabling clinicians to negotiate this issue in a manner that is sensitive to families.

Method: A review of the international literature, the current legal and policy settings, and the needs of clients and their families was undertaken. Additional material was drawn from the authors' own practice and advocacy experience. Results: The literature and policies reviewed emphasised the importance of meaningful collaboration between clinicians and families. A close reading of the relevant legislation revealed possibilities for an interpretation of confidentiality that facilitates such collaboration. Options for negotiating the engagement phase which are consistent with meaningful collaboration were then developed.

Conclusion: Rather than assuming that confidentiality is an intransient problem, the authors conclude that dealing with the question of confidentiality sensitively presents clinicians with an opportunity to develop quality relationships with both clients and their families.
The Psychology of Self: An Update
Authors: Meares Russell
Published: November 2007

The psychology of self is gaining increasing influence, particularly in the treatment of personality disorder. Kohut's work has revived interest in an intellectual tradition that was made peripheral during the positivist-behaviourist era. Kohut's concepts, the most important of which is the selfobject, are the core of an evolving body of theory that is open to findings in such fields as child development and neurophysiology. Kohut saw severe personality disorder as the manifestation of a disruption in the development of self. Recent contributions to the theory include: (i) attempts to make an adequate definition of self, which Kohut was unable to do, using the work of William James; (ii) an approach to the development of self which follows this definition; and (iii) the use of current memory research in understanding the traumata which have impeded this development and which leave their imprint on the psychic system.
To Whom do You Refer? A Referrer Satisfaction Study
Authors: Parker Gordon , Sengoz Ayse , Wright Murray , Robertson Sadie
Published: November 2007

Objective: To report the development of a referrer satisfaction measure. Method: Urban and rural general practitioners, physicians, neurologists, as well as obstetricians and gynaecologists rated 36 items in terms of their judged importance to the respondent's satisfaction with a psychiatric service. Responses of the whole sample and component practitioner sub-groups were ranked.

Results: We established a high level of agreement across the several subgroups suggesting that we had identified general rather than idiosyncratic variables contributing to referrer satisfaction. Referrers prioritised as most important the immediacy of initial appointment, the psychiatrist reporting at the beginning and end of any treatment course, and ready verbal communication between the referrer and the psychiatrist. Items accorded low priority were the psychiatrist's billing arrangements, the psychiatrist being ‘perfect’ (in either having a high ‘cure’ rate or making a definitive diagnosis initially), or the psychiatrist taking complete responsibility for difficult patients. A principal components analysis identified four factors underpinning the item set, and we again established that scores on these factors were not influenced by the particular referrer sub-group.

Conclusions: Such findings suggest that only minor modifications would need to be made to the item set in developing a referrer satisfaction measure for quality assurance activities.
Smoking among Chinese Patients with Schizophrenia
Authors: Chong Siow Ann , Choo Hock Lai
Published: November 2007

Objectives: This study aimed to determine the prevalence of smoking among Chinese with schizophrenia, and to determine if smokers and nonsmokers differ in their age of onset of illness and neuroleptic requirement. Method: One hundred and ninety-five patients were assessed by a single rater using the Brief Psychiatric Rating Scale (BPRS) and the Simpson-Angus Scale. Other historical, demographic and treatment variables were recorded from case records and interviews with patients and family members. Results: A higher rate of smoking was found in patients with schizophrenia than in the general population. There was no significant difference between the smokers and non-smokers in their respective neuroleptic dosages and extrapyramidal side-effects but the smokers had a significantly higher BPRS score.

Conclusions: Racial difference is proposed to account for this discrepancy from other Western studies. The contribution of nicotine towards aggravating schizophrenic symptoms is also considered.
Unity and diversity in Psychiatry: Some Philosophical Issues
Authors: Dewhurst David , Watson Burges I. Patrick
Published: November 2007

Objective: The aim of this paper is to provide a defence of diversity in psychiatry and, correspondingly, to show that strict ‘biologism’ (or any other ‘total’ approach to psychiatry) is inappropriate.

Method: Arguments are developed using as a basis the writings of well known philosophers such as Stephen Toulmin, Joel Feinberg and Charles Taylor. The authors examine the concepts of explanation and causation and consider the consequences for psychiatry which might follow the acceptance of mind-brain identity. There is also a discussion of the concept of a person. Result: If the same phenomenon is subject to explanation from diverse psychiatric perspectives, it does not follow that these modes of explanation must exclude or be in competition with each other. They may in fact be necessary to each other if psychiatry is to provide a full picture of mental functioning and human conduct. The thesis of mind-brain identity does not eliminate the variety of discourses within psychiatry, and hence it does not provide a rationale for ‘biologism’.

Conclusion: There is a need for a co-operative multidimensional approach in psychiatry.
Consultation-Liaison Psychiatry in an Australian Oncology Unit
Authors: Kissane David W. , Smith Graeme C.
Published: November 2007

Objective: To provide an overview of the work of a consultation-liaison (C-L) psychiatry service to an oncology unit in a university affiliated teaching hospital, with the aid of a comprehensive clinical database.

Method: The MICROCARES prospective clinical database system was used to record data on all oncology inpatients referred to C-L psychiatry, and the hospital clinical database was used to compare referred inpatients with all oncology inpatients.

Results: Two hundred and seventy-one referrals were made in the 3 years from 1991 to 1993, a referral rate of 10.4%. The referred patients were younger but there was no bias in sex and marital status. The mean length of stay was twice that for all other oncology admissions, day cases excluded. The most frequent reasons for referral were coping problems, depression, terminal illness issues and anxiety. The most common psychiatric diagnoses were Systemic Family Problems (V codes, 24%), Mood Disorders (23%), Adjustment Disorders (16%) and Organic Mental Disorders (10%). Management involved family conferences in half of the patients and antidepressant medication in one-quarter. Concordance with pharmacological recommendations was 98%. Existential issues and family-centred care are discussed.

Conclusions: Both individual and family-centred care is required in an oncology service; a dedicated liaison attachment offers considerable staff support. Psycho-oncology is underdeveloped in Australia compared to many overseas services; there is scope for substantial growth in preventive and supportive work.