bluuebunny/crossref_metadata_2025 huggingface dataset:
Fregoli Syndrome
Authors: Mojtabai Ramin
Published: November 2007

Fregoli syndrome is the delusional belief that one or more familiar persons, usually persecutors following the patient, repeatedly change their appearance. This syndrome has often been discussed as a variant of the Capgras syndrome in the literature, but these two syndromes have different phenomenological structures and age and sex distributions. The author presents a review of 34 cases of Fregoli syndrome in the English and French language literature, discussing the syndrome's definition, aetiology and course. It is suggested that although an organic substrate may be found in some cases, it is the dominant psychotic theme which determines the content of the syndrome.
Stalking and the Pathologies of Love
Authors: Mullen Paul E. , Pathé Michele
Published: November 2007

Fourteen patients with pathologies of love (erotomania) are presented; all stalked the object of their disordered affections These cases were encountered in forensic practice and were personally assessed, and in most cases managed, by the authors. Victim impact reports or depositions made by the objects of these patient's unwanted attentions were available.

All patients indulged in stalking behaviours which included following, loitering in the victim's vicinity, approaching, telephoning, and sending letters. The objects of the patient's affections were threatened in five cases, violently assaulted in five – one fatally – and sexually attacked in seven cases. Those believed to stand in the way of their delusional love were also on occasion the victims of violence.

This series is unusual in the degree of intrusiveness and overt violence, which probably reflects the forensic context in which the cases were encountered. The cases comprise a particular group of erotomanics who exhibit stalking and violent behaviour. The erotomanic syndromes often went unrecognised and the threat to the peace and safety of the objects of their affections was not always given proper weight. The clinical importance of this sub-group of stalkers is emphasised, as is their relevance in the legislative, and judicial, responses to stalking.
The Clinical Manifestations of Senile Dementia of Lewy Body Type: A Case Report
Authors: Yeatman Richard , McLean Catriona Ann , Ames David
Published: November 2007

A case of senile dementia of Lewy body type is presented. The clinical and neuropathological characteristics of the illness are discussed in the context of recent advances in the understanding of this condition.
High Prevalence of Thyroid Function Test Abnormalities in Chronic Schizophrenia
Authors: Othman Sakinah S. , Kadir Khalid Abdul , Hassan Jamaliah , Hong Goh K. , Singh Baldev B. , Raman N.
Published: November 2007

The thyroid status of 249 patients with chronic schizophrenia (males = 136, females = 113) with a median age of 36 years (range: 16 to 58 years) and a median duration of hospitalisation of 10 years (range: 1 to 30 years) was assessed. Thyroid antibodies (TAb) were found in 51 patients (20%). In female patients, 32 (28%) were TAb positive compared to 13% (n=152, p=0.01) in healthy female blood donors. In male patients, the prevalence of TAb was 14% compared to 7% (n=449, p=0.01) in healthy male blood donors. Of the 183 patients who had thyroid hormone measurements, 60% had normal test, 5% had elevated TSH and 17% had low TSH. The T4, FT4I and FT3I were significantly lower in those with low or high TSH (p<0.001) compared to those with normal TSH. Of the 143 patients with normal TSH, 33 (23%) had low T3. In conclusion, there is a spectrum of thyroid function test abnormalities in chronic schizophrenia; this may be related to an abnormality in the central regulation of the hypothalamo-pituitary thyroid axis as well as at the peripheral level. However the association between chronic schizophrenia and the presence of thyroid antibodies, and the clinical relevance of these biochemical abnormalities, are still not clear.
The Clinical Boundaries of Posttraumatic Stress Disorder
Authors: McGorry Patrick D.
Published: November 2007

Three sets of clinical boundaries exist for posttraumatic stress disorder (PTSD), as for all concepts of psychiatric disorder. The first involves the border with normal psychology in general, and with the normal psychology of stress response in particular. This boundary can be surveyed from a number of vantage points and the maps which result will not necessarily correspond. The second boundary issue involves internal boundaries between psychiatric disorders, specifically between PTSD and other concepts of disorder. The high level of comorbidity documented in PTSD has ensured that this aspect of boundary setting is particularly contentious. The third set of boundaries is concerned with subtyping within the global construct of PTSD. The validity and extent of subtyping would be based on the degree to which phenomenological differences exist in relation to PTSD syndromes occurring in the wake of certain types of traumatic events. Such clinical subtyping might however need to be buttressed by external validity indicators such as differential treatment responses or outcome. A final boundary issue of major significance to therapists involves the need to place oneself unambiguously on the side of the trauma survivor in the struggle to resolve the traumatic experiences. The pivotal position of PTSD in the psychopathological arena is discussed.
The Loss of the Sense of Reality in Incest and Child Sexual Abuse: A Psychoanalytic Perspective
Authors: Whelan Maurice
Published: November 2007

This article takes a psychoanalytic perspective on incest and child sexual abuse. It concentrates on what could be called “the loss of the sense of reality” that is experienced by the victim of incest. The position in which a child of five is placed when she is sexually abused by her father is considered; this is followed by detailed material from the analysis of a woman who had an incestuous relationship with her brother. Transference and counter-transference difficulties that arise in work with abused patients are explored. A theoretical explanation of the damaging effects of an incestuous relationship is outlined.
Disruptions in Childhood Parental Care as Risk Factors for Major Depression in Adult Women
Authors: Browne Oakley M. A. , Joyce P. R. , Wells J. E. , Bushnell J. A. , Hornblow A. R.
Published: November 2007

Objective: The aim of this study was to examine the influence of different types of disruptions in childhood parental care before the age of 15 years as risk factors for major depression in women aged 18 to 44 years. The types of disruptions studied were parental death, parental separation or divorce, other types of loss (i.e. adoption, foster-care, etc.), and prolonged separation from both parents. Potential confounding factors were also examined. Method: The data were obtained from a community probability sample. Case-ness was determined by the use of the Diagnostic Interview Schedule (DIS) and both the current (one month) and lifetime prevalence periods were considered. Logistic regression was used to model the influence of each factor, singly and adjusted for the influence of other factors, on the risk for major depression.

Results: It was found that in this population 17% had experienced some type of parental loss (parental death 4%, separations/divorce 10% and other types of loss 3%) and 11% had experienced prolonged separation from both parents. Parental loss was significantly associated with lifetime depression, but this effect was no longer significant when adjusted for other factors. However, prolonged separation from both parents was associated with an increased risk of current and lifetime depressive episodes of approximately three to fourfold, even when the risk was adjusted for other factors.

Conclusions: The results of this study suggest that prolonged separation from both parents has a stronger association with current or lifetime depression in women than do parental death, separation/divorce and other types of loss. Prolonged separation may be a marker for other risk factors and may not be a risk factor on its own.
Fitting the Treatment to the Patient: Recent Advances in the Practice of Electroconvulsive Therapy
Authors: Frukacz Andrew , Mitchell Philip
Published: November 2007

Traditionally it has been thought that a grand mal seizure is both necessary and sufficient for the maximum efficacy of ECT. Recent important research, however, has demonstrated that both the electrical dosage above the seizure threshold, i.e. the suprathreshold dosage, and the electrode placement (unilateral or bilateral) determine the efficacy of this treatment, as well as the degree of cognitive impairment. This article reviews the development of these significant concepts and suggests specific practical recommendations for incorporating these into contemporary ECT practice.
How Do Research Psychiatrists Rate? Views of Neuroscientists
Authors: Parker Gordon
Published: November 2007

Objective: The aim of the paper is to define views of neuroscientists about research psychiatrists that might be restricting collaborative research. Method: A questionnaire was distributed to all members of the Australian Neuroscience Society. Forty-nine questionnaires were returned, and both quantitative and qualitative analyses undertaken.

Results: Neuroscientists rated research psychiatrists as “poor scientists” in having limited scientific training, being loose methodologists and in tending to cut corners, but also viewed research psychiatrists as addressing domains that generate harder research questions. Several factors inhibiting and promoting collaboration between neuroscientists and research psychiatrists were elicited.

Conclusions: If collaborative links involving neuroscientists and research psychiatrists are to be enhanced, research psychiatrists will need to address and redress views about perceived limitations of their scientific competence.
The Concept of Resilience
Authors: Wolff Sula
Published: November 2007

Objective: The concept of resilience highlights the complexity of psychopathology, helps to clarify possibilities for prevention and keeps hope alive in clinical practice. This paper reviews definitions of resilience, the nature of risk factors and of moderating processes.

Method: The place of single case studies is described, the components of resilience are outlined and consideration is given to how resilience can be fostered in the face of adversities and stresses: socio-economic deprivation, family discord and divorce, and maternal depression.

Conclusion: A plea is made for increased efforts to make knowledge more widely available: public and politicians need to know how decisions about housing, employment, welfare, education and criminal justice impinge on the development of children, and what changes in the macro-environment will preserve and enhance childhood resilience.
Practice Visits: A Pilot Study
Authors: Parker Gordon , Wright Murray , Robertson Sadie
Published: November 2007

Objective: The aim of the paper is to report a pilot study of practice visits.

Method: The study involved 35 psychiatrists as hosts and/or visitors, as well as four non-psychiatrist visitors, with the model and subsequent design changes described.

Results: The Quality Assurance Committee's rationale for practice visits is detailed, together with several focal concerns raised by committee members and other Fellows of the College.

Conclusions: Feedback was highly positive, with visitors being generally more positive and enthusiastic than hosts. A follow-up questionnaire indicated ongoing enthusiasm for such an activity and provided evidence of participants making changes to their practices. Identified concerns and some suggested modifications to the pilot study design are noted.
Hereditary Spastic Paraplegia with Dementia
Authors: Pridmore Saxby , Rao Gyaneshwar , Abusah Prosper
Published: November 2007

Objective: Hereditary spastic paraplegia (HSP) with dementia is a very rare condition. The aim of the paper is to present the first report of HSP in a Fijian Indian family.

Method: A psychiatrist and a general physician examined the affected members of the family on five occasions over three years. Results: There are three affected individuals In a sibship of seven. The parents are without symptoms and the marriage is non-consanguineous. The course of the disease has been remarkably similar. All subjects were healthy and performing well in the early years of school. In two, symptoms of cognitive loss preceded difficulty with ambulation and in the third, these symptoms appeared concurrently. All subjects had both symptoms by 13 years of age; they were unable to ambulate independently by the mid to late teens, at which time there was dysarthria spastic paraplegia and dementia. One subject suffered a three month episode of hypomanic behaviour. Over the three-year study period deterioration was slight but noticeable.

Conclusions: It is possible that HSP is more commonly associated with pre-senile dementia than is currently recognised. HSP with dementia is a very rare cause of failing school performance. Physical examination of the patient and other family members is indicated if this diagnosis is being considered.
The Western Australian Child Health Survey: A Pilot Study
Authors: Garton Alison F. , Zubrick Stephen R. , Silburn Sven R.
Published: November 2007

A pilot survey of 200 households was undertaken to field test the survey instruments and trial the validation and calibration procedures for the Western Australian Child Health Survey (WACHS) conducted in 1992. This paper describes the background to the WACHS, the development of the instrumentation and the conduct of the pilot study. This survey aims to replicate and extend previous epidemiological surveys conducted in other countries, and to provide Australian norms for mental health morbidity in 4 to 16 year old children.

The measurement of mental health was undertaken through the use of the Child Behaviour Checklist (CBCL). This screening instrument provided data on the prevalence of mental health morbidity and of specific mental disorders in 4 to 16 year olds. Its reliability and validity as a diagnostic indicator were checked through a clinical calibration technique. The pilot survey also permitted an examination of the sampling strategy adopted to ensure that the sample selected reflected “normality” in terms of expected trends and results. Modifications to the content of the questionnaires are described in light of both psychometric qualities of the data and comments from field interviewers and professionals who have examined the instrument. Finally, changes to data collection strategies are discussed.
Psychological Sequelae of Torture and Trauma in Chilean and Salvadorean Migrants: A Pilot Study
Authors: Thompson Maritza , McGorry Patrick
Published: November 2007

Torture has existed since the earliest times, usually as public punishment prior to death. Today it is predominantly used in secret with the aim of destroying the individual's personality. The effects of torture include severe physical and psychological sequelae which have only recently come under scrutiny. In recent years many Chilean and El Salvadorean migrants have left their countries after being tortured and severely traumatised as a result of organised violence.

The aim of this study was to pilot an investigation into the psychological sequelae of torture. Subjects were 30 Chileans and El Salvadoreans classified into three groups: torture, trauma and non-torture/trauma migrants. It was found to be feasible to access and interview survivors from a clinical research perspective without causing additional psychological morbidity. The subjects were interviewed and administered three scales: the Post-Traumatic Stress Disorder Scale, SCL-90-R, and the Impact of Event Scale. The results from the scales and the descriptive data presented indicate some support for the hypothesis that torture survivors show higher levels of PTSD, psychosomatic impairment and stress response disturbance than the trauma and non-torture/trauma groups. Methodological issues are discussed. The strengths and limitations of this preliminary study are considered in relation to future research.
Training to Administer Electroconvulsive Therapy: A Survey of Attitudes and Experiences
Authors: Halliday Graeme , Johnson Gordon
Published: November 2007

Recent Royal Australian and New Zealand College of Psychiatrists guidelines regarding Electroconvulsive Therapy (ECT) call for “specific training in both the practical and theoretical aspects of ECT”, involving provision of an “educational programme” by centres where ECT is administered, and “supervised administration of ECT prior to administering this treatment alone”. This survey was undertaken to elicit the attitudes and experiences of current trainees in relation to training to administer ECT. It was found that ECT is given entirely by the registrars, that consultants are rarely or never present, and in most centres, training typically consists of registrars being supervised once or twice by another registrar, and thereafter administering ECT alone. Twenty percent of those who had given ECT, however, reported not being supervised the first time they administered it. Most trainees indicated limited theoretical teaching in this area, and almost none were aware of a formal training scheme at their respective hospitals. The College guidelines, as stated, address these issues, and priority should be given to their implementation.
Australian Vietnam Veterans: Factors Contributing to Psychosocial Problems
Authors: Grayson David A. , Marshall Richard P. , Dobson Matthew , O'toole Brian I. , Schureck Ralph J. , Ffrench Margot , Pulvertaft Belinda , Meldrum Lenore
Published: November 2007

Objective: The objective of the present paper is to present comprehensive models of the current psychosocial morbidity of Australian Vietnam veterans. Seldom has research in this area attempted to ‘untangle’ direct and indirect influences on current functioning via possible pre-army, Vietnam and homecoming pathways.

Method: The Australian Vietnam Veterans' Health Study gathered data on a sample of 641 veterans throughout Australia drawn randomly from army Vietnam tour lists of the era. The data arose from interview and army records of the era, and fall into four temporal categories: pre-army, Vietnam service, homecoming after Vietnam, and current state. Path analysis models of the veterans' current psychological morbidities and social wellbeing are used to identify direct aetiological influences of earlier era constructs on current state, free of confounding by indirect (often selection) effects.

Results: Our results indicate that psychological morbidity (particularly post-traumatic stress disorder) is largely influenced by combat and poor homecoming experiences, although pre-military characteristics do play some direct roles in symptomatology. Social dysfunction measures show smaller effects of the Vietnam War, which may be accounted for by an indirect association with Vietnam-related psychological morbidity. Some social measures show evidence of compensatory influences of combat, high combat leading to social dysfunction because of morbidity, but simultaneously being associated with healthier social disposition (possibly because of increased ex-service activity).

Conclusions: For Australian Vietnam veterans, combat-related and homecoming effects persist on a range of psychosocial endpoints 20–30 years after exposure. These effects are not explicable in terms of veterans' pre-Vietnam characteristics.
Informed Consent by Children and Adolescents to Psychiatric Treatment
Authors: Batten Donald A.
Published: November 2007

The concept of competency to consent to psychiatric treatment is discussed as a multi-faceted complex interaction involving: the developmental stage of the child and its effect on cognitive ability and rationality; their social environment and previous experience; their relationship with the professional as well as with their own family; the information presented to them about treatment as well as their understanding of that information; and their mental state at the time of deciding. All of these factors exist on a continuum or spectrum (i.e. in shades of grey and not in black and white) and therefore the application of rigid arbitrary limits is inappropriate. What is not in doubt is that the child deserves to be considered as an individual and its rights protected. The doctor's main duty is to the child, as the patient, and every opportunity to allow them to give proper informed consent must be provided. In the event of the child being found to be incompetent to consent, then the issue of proxy consent is also discussed, including the dangers of assuming that the parents will act in the child's best interests.
An Exploration of the Quality of Peer Review Group Activities within Australasia
Authors: Robertson Sadie , Parker Gordon , Byrne Simon , Wright Murray
Published: November 2007

Objective: To describe a two-phase study of the structure of Australasian psychiatrist peer review groups.

Method (Phase one): Initially, information was sought from chairskoordinators of psychiatrist peer review groups regarding the nature and organisation of their group.

Results (Phase one): One hundred and three questionnaires were returned describing a number of models of peer review. Three principal models were identified: a teaching hospital model, a private practice model, and a private institution model.

Method (Phase two): The second-phase questionnaire sought information on the quality of the review, using six proposed standards developed by the Quality Assurance Committee of the Royal Australian and New Zealand College of Psychiatrists.

Results (Phase two): Many groups indicated that four of the proposed standards (those relating to documentation, having clear goals, reviewing actual clinical cases, and rigorous protection of confidentiality) were either already being followed or would be relatively easy to implement. The remaining two proposed standards (including structure, process and outcome dimensions of health care in the case discussion, and the use of explicit criteria) presented more difficulty.

Conclusion: The application of such standards to peer review group meetings should assist groups to provide a forum for presentation and evaluation of clinical work where participants know they will be challenged in an environment which is both supportive and educational.
The Cassel Hospital, London
Authors: Coombe Paul
Published: November 2007

This paper is an account of the principles and practices of treatment offered at the Cassel Hospital, London, with a particular focus on the Inpatient Families Unit. The Cassel Hospital is an internationally renowned therapeutic community, the operation of which is based on psychoanalytic principles and which has operated within the British National Health Service for nearly 50 years. An account of the historical development of the hospital is given as well as a description of its structure and function. The following three innovative structures are elaborated: a complex network within which patients can develop, Cassel-style nursing care, and nurse-therapist supervision. Theoretical underpinnings are outlined, which together with two case studies facilitate an appreciation of the capacity of the therapeutic network to foster the successful treatment of a range of severely disordered individuals and families. Such treatment may approach a level perhaps otherwise unattainable and which is widely applicable in the public hospital and clinic settings in Australia.
Neuroleptic Malignant Syndrome and Clozapine Monotherapy
Authors: Chatterton Ray , Cardy Susette , Schramm T. Mark
Published: November 2007

Objective: This report identifies neuroleptic malignant syndrome (NMS) occurring on a steady state dosage of clozapine monotherapy. Clinical picture: An outpatient presented with a recent history of stiffness and soreness of his legs, dizziness, polydipsia, polyuria, abdominal and chest pains. After admission to a general hospital, further symptomatology was identified including: pallor, diaphoresis, nausea, confusion, agitation, decrease in normal reflexes, minimally reactive pupils and rigid limbs. Treatment: Intravenous (I/V) diazepam was administered but failed to decrease the agitation and confusion. He was sedated with the administered of IN drop-eradol, intubated and placed on a ventilator with circulatory supports for 4 days.

Outcome: On day five he was extubated and transfered to a medical ward. All laboratory values had returned to normal values by this time. The patient was subsequently discharged.

Conclusions: Neuroleptic malignant syndrome can occur at any stage of clozapine treatment, and the patient can be rechallenged after such an episode. This person was rechallenged and after 6 months of treatment has suffered no further recurrence of NMS.
Homeless, Helpless and Hospitalised: The Travails of a Chinese Refugee
Authors: Looi Jeffrey C.L. , Drew Leslie R.H.
Published: November 2007

Objective: To report the case of a Chinese refugee who presented with a brief reactive psychosis in the presence of significant stressors. Clinical picture: A 30-year-old Chinese refugee, who fled alleged torture and persecution in China, presented with an acute, severe, paranoid psychosis. Treatment and outcome: This patient's psychosis was exacerbated by involuntary hospitalisation and treatment. The withdrawal of restrictive measures, cessation of medications and attention to his social needs led to an improvement in his condition.

Conclusions: Involuntary treatment of a brief reactive psychosis in those who have been previously tortured may exacerbate the psychosis. Withdrawal of restrictions and advocacy for the patient may generate a therapeutic alliance with a positive outcome.
Depression in Schizophrenia: A Descriptive Study
Authors: Markou Petros
Published: November 2007

Objective: To assess the level of depressive symptomatology among a group of patients with schizophrenia, both inpatients and outpatients, and speculate as to the reasons why differences among the groups may be occurring.

Method: Fifty inpatients of Baillie Henderson Hospital, a chronic stay psychiatric hospital in Queensland, and 44 outpatients of this hospital were assessed on a number of measures including the Positive and Negative Syndrome Scale for Schizophrenia, Abnormal Involuntary Movements Scale, Hamilton Rating Scale for Depression and Beck Depression Inventory. All patients were assessed in a structured interview for 35–40 minutes by the same clinician. A chart review also occurred. The chief outcome variable was a Hamilton Depression Rating Scale of 17 or greater.

Results: Clinically significant depression, as defined by a Hamilton Depression score of 17 or greater, was found in 10% (n = 5) of the inpatient sample. Of the outpatient sample, 4.5% (n = 2) showed a clinically significant depression, which was not significantly different to the inpatient group. The prevalence of mild to moderate depression, as defined by a Hamilton Depression score of between 10 and 17, was 42% in the inpatient group and 47.7% in the outpatient group. There was no significant difference between the two groups on the mean Hamilton Depression scores.

Conclusions: The results suggest a high level of depressive symptomatology in patients with schizophrenia. As suicide is common in this group, this finding is important. Self-reporting of this problem by patients with schizophrenia, by means of questionnaire, is feasible and provides comparable results to objective clinician ratings.
Pathological Gambling: Forensic Issues
Authors: Blaszczynski Alex , Silove Derrick
Published: November 2007

Objective: The aim of this paper is to review the literature describing the hypothesised link between crime and pathological gambling and its relevance to arguments of diminished responsibility.

Method: An attempt was made to include all publications in the psychiatry and psychology literature which made reference to pathological gambling and criminal behaviours. Given the limited research in this field, specific unpublished conference papers were also included in the review. Results: Evidence supports the contention that pathological gamblers are at high risk for committing criminal offences in order to maintain their habitual gambling behaviours. An antisocial personality disorder while acting to increase the risk factor is in itself an insufficient explanation for the observed link. As a result of the acceptance of pathological gambling as a psychiatric disorder, the judicial system is being increasingly confronted with an argument of diminished responsibility for gambling-related offences committed by pathological gamblers.

Conclusion: A diagnosis of pathological gambling does not diminish legal responsibility but is a factor that should be considered in sentencing. Referral to psychiatric services reduces the risk of recidivism.
Tics Status
Authors: Sachdev Perminder , Chee Kit-Yun , Wilson Andrew
Published: November 2007

Objectives: To describe two patients with tics status, propose a definition of this syndrome and draw attention to its clinical significance.

Method: Two patients suffering from Tourette's Syndrome who had developed episodes of continual motor tics that lasted from minutes to hours, were non-suppressible and intruded into normal functioning, were treated with an increase in the dose of haloperidol, in one case with the addition of clonazepam.

Results: The offset of the episodes was gradual and the tic disorder was worse after the episodes. One patient had further spontaneous episodes of tics status.

Conclusions: The recognition of tics status has implications for the management as well as our understanding of the pathobiology of tics and Tourette's Syndrome. The definition of tics status should be standardised.
The Fishing News
Authors: Wilton Noel M.
Published: November 2007

The delivery of healthcare throughout the world is rapidly changing due to economic and other factors, both national and international. Psychiatry, a marginal and poorly understood profession in the community, is particularly vulnerable to these changes. Psychiatrists and their representing organisations, such as the Royal Australian and New Zealand College of Psychiatrists, have a key role in advocating for equitable, high standard care for their patients. They need to engage with other professionals involved in psychiatric care, patients and the community to ensure continuing development of services. By recognising the factors influencing psychiatric services, strategies to address them can be developed. Actions taken by the Royal Australian and New Zealand College are described.
Janet and Freud: Revealing the Roots of Dynamic Psychiatry
Authors: Brown Paul , MacMillan Malcolm B. , Meares Russel , van der Hart Onno
Published: November 2007

Objectives: Interest in the work of Pierre Janet is presently undergoing a scholarly revival and, in the process, his contribution to dynamic psychiatry is increasingly being recognised. This article compares and contrasts Pierre Janet's early studies on hysteria and the neuroses with those of Freud. Method: The study surveys original works by Janet and Freud and contemporary scholarly exegeses. It particularly focuses on ideation and memory, consciousness and dissociation, psychological trauma, the self, therapeutic influence, and treatment by integration versus abreaction. Results: Grounds are presented for either preferring Janet's notions to Freud's, or for integrating them.

Conclusion: It is concluded that a number of Janet's contributions to psychopathology and psychotherapy, particularly in the field of dissociative disorders, deserve further exploration and application.
Outcome of Schizophrenia: The Madras Longitudinal Study
Authors: Thara Rangaswamy , Eaton William W.
Published: November 2007

Objective: The aim of the study was to determine the clinical outcome in a group of first-episode schizophrenic patients on a 10-year follow-up. The social, demographic and clinical variables associated with poor outcome and gender differences in outcome were other issues addressed.

Method: Ninety patients fulfilling Feighner's and ICD-9 criteria for schizophrenia, at Madras, India, were included for a 10-year follow-up. The Present State Examination and the Psychiatric and Personal schedule were administered at intake and at the end of every year. Clinical outcome was considered as a combination of the pattern of course and the presence of positive symptoms during year 10.

Results: After 10 years, 76 of the 90 patients included were followed up, giving a follow-up rate of 84%. The clinical outcome was good in nearly 75% of the patients with almost all symptoms showing a steep decline at the end of 10 years. Fifty-nine subjects were asymptomatic at the end of the follow-up period and 12 were ill during the entire 10th year. Sexual, religious and grandiose delusions and flat affect at inclusion predicted a poor clinical outcome. More males had a poor outcome and spent a longer time in a psychotic state. Conclusions: There is evidence of a good outcome in the majority of first-episode schizophrenic patients after 10 years in keeping with other reports from developing countries. Certain variables at inclusion predicted a poor clinical outcome and males had a poorer outcome than females.
Emotional Health of Indonesian Adoptees Living in Australian Families
Authors: Goldney Robert D. , Donald Maxine , Sawyer Michael G. , Kosky Robert J. , Priest Susan
Published: November 2007

Objective: To compare the prevalence of emotional and behavioural problems in adolescent adoptees from Indonesia living in South Australian families with that of adolescents living in the community and those referred to mental health clinics in South Australia.

Method: Thirty-four Indonesian adoptees completed the Youth Self-Report and their adoptive mothers completed the Child Behaviour Checklist. The results on these instruments were compared with the scores of a community sample and a mental health clinic population.

Results: There was a striking similarity between scores on the Youth Self-Report and the Child Behaviour Checklist instruments for the adoption and community groups. Both these groups had significantly fewer problems than adolescents referred to mental health clinics.

Conclusions: These results indicate that the outcome in terms of emotional and behavioural health for intercountry adoptions between Indonesia and Australia is favourable.
What is the Psychiatrist's Role in Drugs and Alcohol?
Authors: Pols René G. , Sellman Douglas , Jurd Steven , Baigent Michael , Waddy Nanette , Sacks Tobie , Tucker Peter , Fowler John , White Allan
Published: November 2007

Objective: This article describes a consensus view of the role of psychiatrists in respect of alcohol and other drug (AOD) problems, in response to the view expressed by Wodak [1].

Method: The data were selected on the basis of the knowledge and experience of the authors.

Results: Psychiatrists have made major contributions in the primary, secondary and tertiary prevention of AOD problems over many years in Australia and New Zealand. In recent years there has been an explosion of new knowledge in the AOD area and a shift from mental health to primary and public health care for these patients. Substance use disorders (SUD) are highly prevalent in all areas of psychiatric practice, requiring treatment in their own right as well as complicating the treatment of coexisting psychiatric illness. Conclusion: It is argued that psychiatrists have important roles in harm reduction, prevention and policy development; brief and early intervention in SUD in liaison and child psychiatry; and systematic treatment for those with dependence and other psychiatric comorbidity. A research and collaborative approach to AOD services and patients should be encouraged, rather than engaging in divisive debate over ‘ownership’ of this area of clinical practice.
The Role of Lithium in the Affective Disorders
Authors: Johnson Gordon
Published: November 2007

The current status of lithium in the treatment of mania and recurrent affective disorder is considered. The potential usefulness of lithium in clinical practice is not being realised. There is a need for information on clinical monitoring practices in the community. Long-term effects of lithium on renal function are reviewed and guidelines for monitoring are presented.
Mandatory Reporting of Child Abuse: Is it in the Best Interests of the Child?
Authors: Budai Pamela
Published: November 2007

Objective: To set out correctly the law on mandatory reporting of child abuse in each Australian jurisdiction and New Zealand to argue that all patients should be forewarned of the limits of confidentiality in respect of this and to discuss the question of whether mandatory reporting is in the best interests of the child.

Method: Discussion of statutes mandating reporting of child abuse, duty of confidentiality, the experience of mandatory reporting and failure to comply, forewarning of limits of confidentiality, arguments for and against mandatory reporting, and alternatives.

Results: Not all mental health providers comply with the law, for reasons both altruistic and non-altruistic. Although ethical codes for Australian mental health providers do not require forewarning, ethical practice would seem to do so.

Conclusions: Mandatory reporting statutes now in force are not necessarily in the best interests of the child. An important clinical implication of the law is that consideration should be given to forewarning patients.
The Dangers of Dextropropoxyphene
Authors: Dore Glenys Marie
Published: November 2007

Objective: Dextropropoxyphene is a commonly used analgesic despite its high toxicity in overdose and potential for abuse and dependence. This case report highlights these dangers.

Clinical picture: The case of a female who was addicted to dextropropoxyphene as an alternative to other opioids is described. Its use in high doses with other psychotropic agents resulted in adverse health effects. Treatment: The patient was treated with methadone and psychosocial interventions.

Outcome: The patient reduced her drug use and experienced improved physical health and psychosocial functioning.

Conclusions: Caution is needed when prescribing dextropropoxyphene because of its adverse effects compared with equally efficacious analgesics.
The Psychological Sequelae of Miscarriage: A Critical Review of the Literature
Authors: Frost Mary , Condon John T.
Published: November 2007

Miscarriage, although a common event in pregnancy, has been frequently overlooked in psychological research. This paper reviews the literature on the psychological sequelae of miscarriage, including the shortcomings of that literature. Best understood against the background of psychological changes in early pregnancy, the literature reveals aspects of grief specific to miscarriage. Important components of this grief comprise high levels of guilt, the loss of part of the self and a large impact upon personal identity. The psychological sequelae impact upon other family members, including partners and surviving children. Psychiatric consequences include depression, anxiety and posttraumatic stress disorder. Given the potentially serious nature of these sequelae, it behoves the psychiatrist to enquire routinely about pregnancy loss in all female patients.
Consultation-Liaison Psychiatry in an Obstetric Service
Authors: Dunsis Astrid , Smith Graeme C.
Published: November 2007

Objective: The aim of this paper is to provide an overview of the work of a consultation-liaison (C-L) psychiatry service to an obstetric inpatient unit in a university affiliated teaching hospital, with the aid of a comprehensive clinical database.

Method: The MICRO-CARES clinical database system was used for prospective recording of data on all obstetric inpatients referred to the C-L psychiatry service and the hospital clinical database was used to compare referred inpatients with all obstetric inpatients.

Results: Ninety patients were referred in 3 years, a referral rate of 1.2% of obstetric admissions. There was no bias in referral on age, but there were significantly more unmarried patients in the referred group (p<0.001). Referred patients had a significantly prolonged length of stay: a mean of 9 days for referred patients, with 6 days for all obstetric patients (p<0.001). The most frequent reasons for referral were: coping problems, depression, anxiety/fear and past history of major psychiatric illness. The most common DSM-III-R psychiatric diagnoses were: Personality Disorders (19%), Mood Disorders (17%), Schizophrenic Disorders (15%) and Adjustment Disorders (13%). At least one confirmed diagnosis was made in 77% of patients, but 42% of diagnoses remained differential. There were significantly more patients with diseases of the nervous system, endocrine and circulatory disorders in the referred group (p<0.001). Recommendations of psychosocial interventions predominated over psychopharmacological interventions, and concordance with these was 97% and 98%, respectively. Issues in the relationship of obstetrics and psychiatric C-L services are discussed and future directions indicated.

Conclusions: The referral rate was low compared with other specialty units. This is probably due to factors inherent in obstetric practice. A wide spectrum of psychiatric disorders was referred, including a higher than expected number of women with postpartum psychotic disorders, the majority of whom were managed successfully in the obstetric ward. There is a need for increased liaison with obstetric and community services and for collaborative research, with a particular emphasis on the prevention of psychiatric morbidity associated with pregnancy.
An Overview of Depression-Prone Personality Traits and the Role of Interpersonal Sensitivity
Authors: Boyce Philip , Mason Catherine
Published: November 2007

A number of personality styles have been proposed as vulnerability traits to depression. In this paper methodological problems associated with identifying such traits are discussed. These include state effects contaminating personality scales and the issue of depressive heterogeneity. Potential depression- prone personality traits are then discussed, including obsessionality, neuroticism, dependency and cognitive dysfunction. High interpersonal sensitivity as a risk factor to depression is then discussed.
Depressive Symptoms in Patients with HIV Infection
Authors: Judd Fiona K. , Mijch Anne M.
Published: November 2007

Objective: The aim of the paper was to assess the frequency and severity of depressive symptoms amongst HIV positive patients attending an out-patient treatment clinic.

Method: One hundred HIV positive patients attending the out-patient clinic at Fairfield Hospital, Melbourne, completed the Beck Depression Inventory (BDI).

Results: Forty-four patients scored 14 or more on the BDI. No significant relationship was demonstrated between BDI score and living situation, relationship status, duration of known seropositivity, current CD4 count, or Centres for Disease Control (CDC) category of illness. Significantly more patients scoring in the depressed range were unable to work because of illness. Forty patients reported suicidal ideation.

Conclusions: Depressive symptoms and suicidal ideation are common amongst HIV positive patients, occurring at comparable or greater rates than those found in a variety of other medically ill populations.
Rural Psychiatric Services
Authors: Tobin Margaret J.
Published: November 2007

Objective: The objective was to describe and evaluate a community mental health service developed during 1991–1992 in an attempt to meet the mental illness needs of an isolated rural community. The setting was the Grampians health region in Western Victoria: this region has an area of 45,000 square kilo-metres and a population of 182,000.

Method: The method involved firstly describing the evolution of the service delivery model. This comprised a team of travelling psychiatrists and community psychiatric nurses which succeeded in providing a combined inpatient and outpatient service which was integrated with general practitioners. Secondly, diagnostic and case load descriptions of patients receiving service were compared for both the inpatient and outpatient settings.

Results: The results were that reduced reliance on inpatient beds and increased consumer satisfaction were achieved.

Conclusion: It was concluded that on initial evaluation of the service it was seen to be meeting its objective of treating the seriously mentally ill in an isolated rural community based setting.
HIV in the Mentally Ill
Authors: Checkley Gill E. , Thompson Sandra C. , Crofts Nick , Mijch Anne M. , Judd Fiona K.
Published: November 2007

Objective: To review the published literature in relation to prevalence of HIV infection and risk behaviours for HIV among the mentally ill to assist in the development of appropriate strategies for public health policy, surveillance and clinical management of HIV and HIV risk in these groups.

Method: A search of published literature was carried out using ‘Medline’, in association with following up appropriate papers cited in the References of journals identified.

Results: The North American literature shows an increased risk of HIV infection in psychiatric patients receiving treatment in both inpatient or community settings. HIV infection is associated with a number of risk behaviours, particularly male homosexual sex and injecting drug use, and being the sexual partner of a person with a history of these. Impulsivity, high levels of sexual activity during acute exacerbations of psychiatric illness, poor skills at negotiating safe sex, homelessness and drug abuse are all risk behaviours common among those affected by some mental illnesses. The mentally ill also have a comparatively poorer knowledge of HIV/AIDS. There is a dearth of published Australian data addressing the question of HIV seroprevalence or risk in the mentally ill. Although there has been development and implementation of HIV risk-reduction programs overseas, the development and evaluation of any programs in Australia has not been published.

Conclusions: Arguably, Australia has developed a comprehensive program of national surveillance for HIV infection and has been relatively successful in its response to the HIV epidemic, with the high rates of infection in the early to mid-1980s substantially reduced to around 600 new diagnoses per year. However, while risk behaviours which exposed those infected with the virus are recorded, underlying conditions which predispose them to these behaviours are not. Nevertheless, there is HIV infection amongst mentally ill and intellectually disabled people in Australia. Examination of the North American experience reveals opportunities to prevent a high rate of HIV infection in those with mental illness in Australia. Such a program would require adequate risk behaviour assessment, appropriate diagnostic testing and management, and development of specific educational interventions which are properly evaluated to ensure their effectiveness.