bluuebunny/crossref_metadata_2025 huggingface dataset:
Do Specific Anxiety Disorders Show Specific Drug Problems?
Authors: Page Andrew C. , Andrews Gavin
Published: November 2007

Objective: Comorbidity between anxiety and substance use disorders was examined. The hypothesis was tested that social phobics may report greater problem alcohol use (if alcohol is used to manage social anxiety) while problem use of sedative-hypnotics may be greater in people with panic (who may be over-prescribed anxiolytics because they repeatedly seek medical assistance).

Method: Self-reported lifetime rates of drug and alcohol problems were assessed with the computerised Diagnostic Interview Schedule — Revised. Subjects were 146 consecutive patients treated for panic disorder (with and without agoraphobia) and social phobia at the Clinical Research Unit for Anxiety Disorders.

Results: High prevalences of alcohol problems (three times that expected) and problem use of sedative hypnotics (eight times that expected) were found in all diagnoses. Social phobics exhibited comparatively high rates of problem alcohol use, but no diagnostic specific differences in problem sedative-hypnotic use were found.

Conclusion: Routine screening for drug and alcohol problems is necessary for patients with anxiety disorders.
Neuroleptic Malignant Syndrome: Two Cases without Muscle Rigidity
Authors: Wong Michael M.C.
Published: November 2007

Objective: Two patients with neuroleptic malignant syndrome without muscle rigidity are described.

Clinical picture: Both patients developed fever and altered consciousness while taking neuroleptic but did not develop muscle rigidity; the symptoms subsided when the neuroleptic was stopped but recurred when it was given again.

Treatment: The neuroleptic was stopped; one patient received supportive treatment and the other received bromocriptine. Outcome: One patient died while the other survived.

Conclusion: The pathophysiology is proposed as a combination of involvement of the central thermoregulatory, neuroregulatory and autonomic nervous systems, and the peripheral skeletal muscle. It supports the concept of a spectrum of clinical severity of neuroleptic malignant syndrome.
Neuroleptic Malignant Syndrome and Risperidone: A Case Report
Authors: Bonwick Richard J. , Hopwood Malcolm J. , Morris Philip L.R
Published: November 2007

Objective: To describe a case of neuroleptic malignant syndrome associated with risperidone.

Clinical picture: An elderly patient with bipolar affective disorder presented with neuroleptic malignant syndrome and relapse of hypomania after commencing risperidone.

Treatment: Risperidone was ceased and the patient monitored closely. Outcome: The symptoms of neuroleptic malignant syndrome were resolved. Conclusion: To our knowledge this is the first such case reported, and suggests that risperidone, like other neuroleptics, is associated with neuroleptic malignant syndrome.
The Successful Treatment of a Gender Dysphoric Patient with Pimozide
Authors: Puri B. K. , Singh I.
Published: November 2007

Objective: The case is reported of a gender dysphoric patient who responded successfully to pharmacotherapy with pimozide.

Clinical picture: An adult male patient with a borderline learning disability presented with cross-dressing and a strong wish to undergo a sex change. Treatment: Supportive psychotherapy and pharmacotherapy with pimozide was tried.

Outcome: There was an excellent response to pimozide 2 mg daily, with a cessation of both cross-dressing and the wish for sex reassignment. When, after 1 year, the dose was reduced to 1 mg daily, there was a rapid return of the cross-dressing and the wish for sex reassignment. An increase in the dose again led to a remission which has been maintained since then. Conclusion: Pharmacotherapy with pimozide should be considered in cases of doubtful gender dysphoria.
A Casemix for Mental Health Services: The Development of the Mental Health and Substance abuse Components of the Australian National Diagnosis-Related Groups
Authors: Ben-Tovim David , Elzinga Robert , Pilla John , McAllister Stuart , Wilhelm Kay , Lipton George , Pols Rene , Franklin John , Waters Marlene M.
Published: November 2007

Objective: To describe the development of the mental health and substance abuse sections of the version of the Australian casemix system, Australian national diagnosis-related groups 3 (AN-DRG 3), released in July 1995.

Method: The guiding principles and data sources used to construct the mental health and substance abuse components of AN-DRG 3 are described by the group who undertook that task. The group used data sets of patients separating from hospitals throughout Australia, and from hospitals in South Australia, to examine the capacity of existing and revised diagnosis-related groups (DRGs) to predict patients' lengths of hospital stay. They also reviewed the lists of conditions allowed as complicating and comorbid conditions within the AN-DRG system.

Results: A variety of recommendations were made including: moving organic mental disorder DRGs to a neuroscience area of the AN-DRG; completely reorganising the mental health section of the casemix; creating a number of narrowly defined DRGs covering areas such as schizophrenia, major affective disorders, anxiety disorders and eating disorders, while allowing for a limited number of more heterogenous DRGs; and simplifying substance abuse DRGs into groups covering alcohol and other substances, and differentiating intoxication and withdrawal from abuse and dependency.

Conclusions: A casemix dialect based on clinical diagnosis, which describes mental health and substance abuse problems in terms which should be familiar to clinicians, has been developed. Its applications and limitations are briefly discussed.
An XXYY Male with Schizophrenia
Authors: Lee Joseph W.Y.
Published: November 2007

Objective: A case of XXYY associated with schizophrenia is presented. Clinical picture: A European male with tall stature, hypogonadism, and mild grade intellectual handicap with significantly lower verbal than performance Intelligence Quotient (IQ) exhibited features of chronic paranoid schizophrenia, along with impulsive aggression.

Treatment and outcome: A trial of testosterone replacement exacerbated aggression. Psychotic symptoms persisted despite antipsychotic therapy. Conclusions: This is perhaps the first report of the XXYY syndrome associated with schizophrenia. The psychosis occurs more often in XXY and XXX than normal subjects, providing a clue to locating a gene predisposing to schizophrenia.
Religion, Spirituality and Psychiatry: Conceptual, Cultural and Personal Challenges
Authors: Turbott John
Published: November 2007

Objective: Recent psychiatric literature and contemporary sociopolitical developments suggest a need to reconsider the place of religion and spirituality in psychiatry. This paper was written with the aim of encouraging dialogue between the often antithetical realms of religion and science.

Method: Material from psychiatric, sociological and religious studies literature was reviewed, with particular emphasis on New Zealand sources. Results: Despite the secularising effects of science, the presence and influence of ‘religiosity’ remains substantial in Western culture. The literature emphasises the central importance of religion and spirituality for mental health, and the difficulty of integrating these concepts with scientific medicine. Psychiatric tradition and training may exaggerate the ‘religiosity gap’ between doctors and patients. In New Zealand, the politically mandated bicultural approach to mental health demands an understanding of Maori spirituality.

Conclusions: Intellectual, moral and pragmatic arguments all suggest that psychiatry should reconsider its attitude to religion and spirituality. There are many opportunities for research in the field. Psychiatry would benefit if the vocabulary and concepts of religion and spirituality were more familiar to trainees and practitioners. Patients would find better understanding from psychiatrists, and fruitful interdisciplinary dialogue about mutual issues of ‘ultimate concern’ might ensue.
Tourette's Syndrome in the Year 2000
Authors: Robertson Mary M. , Boardman James
Published: November 2007

Objective: To examine the current status of knowledge of Tourette's syndrome (TS) and to highlight those areas of research that are most likely to have the most significant advances in the next few years into the 21st century.

Method: Index Medicus was consulted from its beginning in 1885 until 1964 (inclusive), looking initially under the title ‘tics’ and subsequently under Tourette's Disorder'. From 1965 and the advent of MEDLINE, a search was performed looking for Tourette‘s’. A chronological examination of TS in the medical literature is presented. Some issues surrounding Huntington's Disease (HD) research are pertinent to TS and may serve as a guide in the future direction of TS research; these issues have been identified and illustrated in the context of TS. Where relevant, other medical disorders are also commented on.

Results: There has been a steady increase in the volume of TS literature since 1885, with a marked increase since 1980, changing in focus from a psychological to a neurobiological viewpoint. Current areas of interest include genetics, comorbid psychopathologies, neuroimaging, treatments, epidemiology and educational considerations. Issues raised by HD and other movement disorders such as Parkinson's Disease (PD) are predictive testing, gene therapy and neural transplants.

Conclusions: The year 2000 is likely to herald a significant increase in our knowledge of the genetics and neuroimaging of TS, with new developments in therapy. A broadening of awareness of TS among health workers and teachers in particular is likely to increase the number of diagnosed patients and, hence, new challenges will be posed to existing resources for health and educational provision.
Legal Rights and Responsibilities of Adolescents and Staff in Victorian Child and Adolescent Mental Health Services
Authors: Birleson Peter
Published: November 2007

Objectives: The aim of the paper is to clarify the legal rights of adolescent patients, guardians and staff in Victorian Child and Adolescent Mental Health Services (CAMHS). Victorian CAMHS have now been ‘gazetted’ and can admit patients on an involuntary basis under the amended Mental Health Act 1986 (MHA). The MHA applies equally to young people under the age of 18 years, which has raised some confusion about who has the right to consent to treatment.

Method: Staff of CAMHS inpatient units have recently posed questions to the Victorian chief psychiatrist. These have included clarification of when the MHA may be appropriately used for adolescents, what is the clinician's duty of care, how to assess young people's capacity to consent to treatment, how to manage some patient groups, and what is the role of the courts in treatment decisions. The author provides a view on each of these matters, based on recent literature and confirmed by legal opinion.

Results: Some matters of fact are presented and advice is provided.

Conclusions: Services must seek the informed consent of guardians and adolescents and, for those young people with major psychiatric disorders who require treatment and are unable to consent, the amended MHA provides clearer direction for the use of involuntary treatment. Where units offer admission to provide assessment and stabilisation, a clear explanation about the treatment goals, and the role of restraint and medication in managing behaviour is essential at the outset of the admission process.
Defining the Personality Disorders: Description of an Australian Database
Authors: Parker Gordon , Hadzi-Pavlovic Dusan , Wilhelm Kay , Austin Marie-Paule , Mason Catherine , Samuels Anthony , Mitchell Philip , Eyers Kerrie
Published: November 2007

Objective: We seek to improve the definition and classification of the personality disorders (PDs) and derive a large database for addressing this objective.

Method: The paper describes the rationale for the development of a large set of descriptors of the PDs (including all DSM-IV and ICD-10 descriptors, but enriched by an additional 109 items), the design of parallel self-report (SR) and corroborative witness (CW) measures, sample recruitment (of 863 patients with a priori evidence of personality disorder or disturbance) and preliminary descriptive data.

Results: Analyses (particularly those comparing ratings on molar PD descriptions with putative PD dimensions) argue for acceptable reliability of the data set, while both the size of the sample and the representation of all PD dimensions of interest argue for the adequacy of the database.

Conclusions: We consider in some detail current limitations to the definition and classification of the PDs, and foreshadow the analytic techniques that will be used to address the key objectives of allowing the PDs to be modelled more clearly and, ideally, measured with greater precision and validity.
Chronic Fatigue Syndrome and Dieting Disorders: Diagnosis and Management Problems
Authors: Griffiths Rosalyn A. , Beumont P. J. V. , Moore Gemma M. , Touyz Stephen W.
Published: November 2007

Objective: This paper illustrates the importance of conducting an initial and ongoing psychiatric assessment of patients with chronic fatigue syndrome in order to diagnose dieting disorders. The diagnostic issues and management problems of three case vignettes, two with anorexia nervosa and one with bulimia nervosa, are described.

Method: The treatment response of dieting disordered patients is generally prolonged after a previous diagnosis of chronic fatigue syndrome has been made and the patient and family favour a disease diagnosis.

Results: Several management problems arise and family members may also be reluctant to accept a dieting disorder diagnosis.

Conclusions: Early detection of dieting disorders by adequate screening and assessment is necessary so that a significant reduction in morbidity may occur.
Group Treatment for Postpartum Depression: A Pilot Study
Authors: Meager Ingrid , Milgrom Jeannette
Published: November 2007

Objective: There are few reports on the efficacy of treatment programs for women with postpartum depression, despite the long-term nature of this disorder. This study describes a pilot evaluation of a treatment program with educational, social support and cognitive-behavioural components.

Method: Ten women with persistent depression originating in the postpartum period were offered a 10-week group treatment program and compared to a wait-list control group.

Results: Following treatment, a significant improvement in depression was demonstrated on the Edinburgh Post-Natal Depression Scale, Beck Depression Inventory, and Profile of Mood States. Several common factors in women suffering from postpartum depression were also identified, as were drop-out characteristics.

Conclusion: These results are encouraging and suggest that a cognitive-behavioural group program might be effective as a treatment for depression in the postpartum period. However, further detailed studies are required to confirm this pilot study.
Denied Pregnancy
Authors: Kaplan Robert , Grotowski Therese
Published: November 2007

Objective: To review the literature on the topic of denied pregnancy and present a case study that illustrates some salient points.

Clinical picture: A 21-year-old woman was unaware of her pregnancy until she went into labour, at which time she went into a state of panic. She delivered a dead baby.

Treatment: She was interviewed over the 5 days following delivery and referred for psychiatric assessment. She was discharged when cleared of serious psychiatric illness.

Outcome: At follow-up she was well but haunted by recollections of the delivery. She was referred for further counselling.

Conclusions: Denial of pregnancy is more common than realised. It is a heterogeneous condition associated with different coping styles and psychiatric diagnoses. Early testing for pregnancy is recommended in young women with nausea, weight gain and menstruation-like bleeding.
A Patient with Mania and Photoconvulsive Epilepsy
Authors: Roxanas Miltiadis G. , Corbett Alastair J. , Reid Wayne G.J.
Published: November 2007

Objective: To describe a young patient who had a comorbidity of mania and photoconvulsive epilepsy.

Clinical picture: This patient presented with a clinical picture of mania which proved difficult to treat until an EEG revealed the presence of photoconvulsive epilepsy.

Treatment: Treatment with haloperidol and lithium was unsuccessful but the addition of carbamazepine produced a dramatic response. Haloperidol was stopped and the patient maintained on lithium and carbamazepine.

Outcome: A successful outcome was achieved with carbamazepine and the patient has remained well on this treatment for 2 years.

Conclusions: The authors postulate that there may be an association between photoconvulsive epilepsy and mania, perhaps on a kindling basis. The literature pertaining to the psychiatric aspects of photoconvulsive epilepsy is reviewed.
Assisted Suicide and Euthanasia: What about the Clinical Issues?
Authors: Kelly Brian J. , Varghese Francis T.
Published: November 2007

This paper aims to address the clinical issues involved in a patient's request for assisted suicide. The psychiatric and broader psychosocial issues for the dying patient, their family and their treating doctor have been largely unaddressed in the debate concerning euthanasia to date. A range of the clinical issues that need to be incorporated in the ethical and legal considerations are reviewed. The reasons for a patient seeking suicide as a treatment are complex and go beyond questions of a patient's right to die. The request for euthanasia needs to be seen in the context of the patient's circumstances, including relationships with and attitudes of carers and health professionals, along with patterns of psychiatric disorder and psychiatric symptoms in the medically ill. The clinical issues involve not only the diagnosis or management of psychiatric disorder but also the acknowledgment of the factors influencing an individual's adjustment to the threat of illness and death. The dynamics of family interactions and doctor–patient relationships in this setting are factors that may impinge upon a request for assistance to die. These factors may be more important than the severity of a person's illness or their quality of life, and are less likely to be recognised and addressed in situations of professional isolation. There are critical issues facing psychiatry in new legislative developments.
The Present State of Psychiatric Epidemiology
Authors: Henderson A. S.
Published: November 2007

The seven uses of epidemiology identified by Morris all have direct relevance for mental disorders. But psychiatric epidemiology has a number of distinguishing features: it has to depend on a nosology that may lack validity; it depends largely on subjective symptoms for its data; the morbidity it deals with is really a continuum, and not a dichotomy of cases and unaffected persons; the measurement of morbidity using scales or standardised interviews is open to considerable error; and the unbiased assessment of environmental exposures proves to be technically challenging. Some of these features have been the basis of interesting research developments. The main milestones in the progress of psychiatric epidemiology are reviewed, together with some of the current issues of general interest, including activities in Australasia.
Restlessness: The Anatomy of a Neuropsychiatric Symptom
Authors: Sachdev Perminder , Kruk Jane
Published: November 2007

Objective: The aim of the paper is to review the literature on restlessness and related syndromes in order to examine the different causes and clinical descriptions, and to present a pathogenetic model that would incorporate its diverse aetiology.

Method: A literature search was undertaken with restlessness, agitation, akathisia, hyperactivity, fidgetiness and jitteriness as key words.

Results: Causes of restlessness are diverse, and its distinction from other descriptions, such as agitation and hyperactivity, is poorly defined in the literature. Detailed descriptions of the syndromes are therefore lacking. The neuroanatomical basis of restlessness may consist of abnormalities in the corticc-subcortical neuronal circuits, the complex regulation of which may explain why different causes often lead to a common end result.

Conclusions: The terms used to describe restlessness and related disorders should be standardised, and the clinical manifestations investigated pedanti- cally. Human and animal studies should investigate the pathophysiology so that intervention can be based on the underlying mechanisms.
Sexual Abuse in Therapy: Gender Issues
Authors: Quadrio Carolyn
Published: November 2007

Objective: That sexual abuse in therapy occurs predominantly with male per- petrators and female patients is a phenomenon that requires analysis in terms of gender relations. Such an analysis is undertaken here from the perspective of feminist psychoanalytic and psychosocial theories.

Method: Data informing the analysis are derived from assessments of 40 women who experienced sexual abuse in therapy. These women had mostly presented with depression, 68% had a history of childhood abuse, and one half were themselves helping professionals.

Results: The majority were seriously damaged by the abusive therapy. Offenders were chiefly male (90%) and most were senior, well-qualified therapists of high status: some were charismatic leaders or teachers. Such a group cannot be dismissed as marginal, deviant, or Ill-informed; a more systemic analysis is necessary to understand how the professions spawn and some- times protect offenders.

Conclusion: It is concluded that the professional culture mirrors fundamental problems of gender relations that inhere in the larger socio-cultural context where they are expressed in various forms of sexual abuse and violence. A cultural change requires better education on issues of power and sexual politics.
Crime, Psychiatry and the Insanity Defence: A Report on Some Recent Reforms in the United States
Authors: Brakel Samuel Jan , Cavanaugh James L.
Published: November 2007

There have been substantial developments in mental health law in the United States over the last 10–15 years. One focal point has been the insanity defence, discussed here. The operational consequences of the legal changes remain to be assessed empirically, but informed speculation is possible. Both a description of the reforms and the assessment of their potential effect are relevant to members of the psychiatric profession in Australia, whether they be forensic specialists or traditional practitioners or researchers. Selective consideration of the American experience, as opposed to contemplating wholesale transposition, is the appropriate posture for Australian policymakers.
A Case of Unrelenting Pursuit of Castration
Authors: Leung C. M. , Lee T. S. , Chan Ho M. W. , Cheung B.
Published: November 2007

Objective: Explore the limitations of the classification of body dysmorphic disorder.

Clinical picture: A Chinese male relentlessly pursued castration to relieve painful erections which were never substantiated. The testes and corpora spongiosum had been removed. No psychotic symptom was prominent.

Treatment: Cognitive therapy and psychotropics were tried.

Outcome: The remaining corpora cavernosa was removed subsequently.

Conclusion: The distorted somatic perception and secondary cognitive amplification (painful erections) could represent a variant of body dysmorphic disorder involving internal body image; diagnostic classifications should accommodate such a category.
Antidepressant Deaths by Overdose
Authors: Battersby Malcolm W. , O'mahoney John J. , Beckwith Andrew R. , Hunt Justin L.
Published: November 2007

Objective: To determine the prevalence of antidepressant deaths in South Australia, the relative frequency of each antidepressant used and demographic data of those who died.

Method: This was a retrospective, case note study of all cases where death was caused by lethal levels of antidepressants in South Australia for the period from 1986 to 1990. The study occurred at the South Australian coroner's office. Subjects were selected from toxicology data, where serum or liver levels of one or more antidepressant were in the lethal range.

Results: Seventy-one cases were identified and information was obtained on 68 of these cases from the coroner's files. Amitriptyline, Doxepin and Dothiepin accounted for the majority of antidepressant deaths. Women were 2.5 times more likely to use antidepressants to suicide than men. At least 63% had a known psychiatric illness and 45% had previously attempted suicide. Conclusions: The older tricyclic antidepressants are a significant cause of suicide. It is recommended that the newer antidepressants, which are as efficacious yet safer in overdose, be prescribed in preference to the older tricyclic antidepressants, as the first line of treatment in newly diagnosed depressed outpatients.
Clinical and Subclinical Hypothyroidism in Patients with Chronic and Treatment-Resistant Depression
Authors: Hickie Ian , Bennett Barbara , Mitchell Philip , Wilhelm Kay , Orlay Wendy
Published: November 2007

Objective: To investigate the relationship between hypothyroidism and treatment-resistant depression (TRD).

Method: A retrospective case audit of 93 inpatients of a specialist Mood Disorders Unit. Patients referred with TRD were sub-classified into ‘adequate’ or ‘inadequate’ prior treatment groups on the basis of pre-established criteria, and compared with a ‘non-TRD’ control sample. Grades I (clinical) and II (subclinical) hypothyroidism were determined by review of relevant thyroid indices.

Results: Patients had chronic depressive disorders (sub-group means of 57.5-82.2 weeks of illness). Of those patients referred with TRD, 22% (10/46) had evidence of clinical or subclinical hypothyroidism compared with 2% (1/47) of the non-TRD patients (p < 0.01). A gradient in the rates of grade I hypothyroidism was observed with the adequately-treated TRD patients having the highest rate (13%), the inadequately-treated TRD patients having an intermediate rate (7%), and the non-TRD patients having the lowest rate (2%). Consistent with this view, the inadequately-treated TRD group had the highest rate of grade II hypothyroidism (p = 0.01) and tended to have higher thyroid stimulating hormone (TSH) values (p = 0.06). Differences in the rates of hypothyroidism could not be accounted for by differences in age or prior exposure to lithium and/or carbamazepine. Duration of the depressive episode was negatively correlated with both the free thyroxine indices (r = −0.25, P < 0.05) and TSH levels (r = −0.32, p < 0.01).

Conclusions: This study suggests that relative hypothyroidism may play a role in the development of some treatment-resistant depressive disorders.
Prevalence of Posttraumatic Stress Disorder, Depression and Anxiety in a Community Sample of New Zealand Vietnam War Veterans
Authors: Long Nigel , MacDonald Carol , Chamberlain Kerry
Published: November 2007

Objective: The aim of the paper is to investigate the prevalence of posttraumatic stress disorder (PTSD), depression and anxiety in a community sample of New Zealand Vietnam War veterans.

Method: Data were collected as part of a national survey on the health and mental health of New Zealand Vietnam veterans. Five hundred and seventy-three randomly selected male Vietnam veterans participated in a postal survey. The questionnaire contained a number of demographic, biographical and psychological measures.

Results: The results revealed that 10% of the veterans could be classified as PTSD cases and that these veterans exhibited high levels of depression and anxiety. In PTSD cases, 15% were also classified with anxiety, 6% with depression, and 73% were classified with both anxiety and depression. In PTSD cases 94% were classified with more than one additional disorder. In non-PTSD cases 27% were classified with anxiety, and 1% with depression, while 12% experienced both anxiety and depression.

Conclusions: The consequences of comorbidity for research and treatment are discussed and it is suggested that health professionals should be attentive to military experience as a predictor of these disorders.
A Prospective Study of Aggression among Psychiatric Patients in Rehabilitation Wards
Authors: Cheung P. , Schweitzer I. , Tuckwell V. , Crowley K. C.
Published: November 2007

Objective: The aim of the study was to determine, among patients in rehabilitation wards, the prevalence and nature of aggressive behaviour and the relationship between aggressive behaviour and patient characteristics and ward factors. Method: The aggressive behaviour of all 220 inpatients within the rehabilitation program of a large psychiatric hospital in Victoria was assessed using the Staff Observation Aggression Scale.

Results: Physical assaults occurred at a rate of 97.6 per 100 patients per year. About 40% of all incidents appeared to be unprovoked. Most physical incidents involved use of body parts and use of a weapon was uncommon. Aggression was most often directed at a staff member. Serious injury was rare. Aggressive behaviour was correlated with gender and duration of admission for the whole sample; however, there were different correlates of aggressive behaviour for different ward populations and different types of aggression. As for ward variables, time of day but not patient/staffing level was associated with aggressive behaviour.

Conclusions: There was a high rate of aggressive behaviour among patients in rehabilitation wards; this should be taken into consideration in the planning of their community placement. The findings also caution against aggregating different ward populations and types of aggressive behaviour for research.
English Language Ability and Mental Health Service Utilisation: A Census
Authors: Stuart Geoffrey W. , Minas I. Harry , Klimidis Steven , O'connell Siobhan
Published: November 2007

Objective: To explore the relationship between English language proficiency and mental health service utilisation.

Methods: In September 1993, a sample census was conducted of all mental health services in the State of Victoria, including public and private hospital wards, outpatient consultations provided by psychiatrists and clinical psychologists, and primary mental health care provided by general practitioners. Response rates ranged from 37% for monolingual general practitioners (GPs) to 96% for inpatient units. Particular emphasis was placed on patients' English language proficiency and the role played by bilingual clinicians.

Results: Over 80% of inpatients received a diagnosis of either dementia or psychosis. This proportion was even greater in the case of patients with English language difficulties. The latter group of patients underutilised specialist outpatient services, and those using these services were less likely to receive psychotherapy than fluent English speakers. They utilised GPs for mental disorder at at least the same rate as other patients. There was a marked preference for bilingual GPs, with 80% of patients with poor English language skills consulting GPs who spoke their native language.

Conclusion: There appears to be considerable underutilisation of specialist mental health services by patients who are not fluent in English. The liaison-consultation model of psychiatric care may be an effective way of addressing this problem, given the important role already played by bilingual GPs in the psychiatric care of those whose native language is not English.
Psychiatrists Working in Primary Care: A Survey of General Practitioners' Attitudes
Authors: Barber R. , Williams A. Sved
Published: November 2007

Objectives: To collect information on current working arrangements between general practitioners (GPs) and mental health professionals and to assess GPs' attitudes towards developing closer working practices with psychiatrists in the primary care setting.

Method: Six hundred and three GPs from South Australia were surveyed with questionnaires. Main outcome measures included information about existing primary care links between GPs and mental health professionals, GPs' preferred working arrangements with psychiatrists in the primary care setting and their attitude towards developing these practices, including perceived obstacles, advantages and disadvantages.

Results: One hundred and eighty-one completed questionnaires were returned. One in 11 GPs returning the questionnaire (RGPs) had established primary care links with a psychiatrist, 1 in 6 with clinical psychologists and 1 in 17 with psychiatric nurses and social workers. RGPs held positive attitudes towards developing closer links at their work settings with psychiatrists when it leads to improved collaboration and access to psychiatrists. Reservations were expressed about the public weakening of the GPs' primary care role.

Conclusions: The joint needs of clinical care and GPs' further training in psychiatry could be addressed by further development of schemes to attract psychiatrists to work in primary care settings. This is mostly viewed very positively by GPs, although the percentage of GPs responding make these conclusions tentative. It is more likely to occur with changes to current funding of both private psychiatric care and GP remuneration, with a recognition of time spent in liaison.
Neuropsychiatry
Authors: Sachdev Perminder
Published: November 2007

The relative emphasis on “biological” or “psychological” formulations in our understanding of “mental” disorders has varied at different periods in history. The early traditions of Western medicine, as represented by ancient Greek and Roman physicians, recognised that mental disturbance could be produced by physical disorders. The famous 17th century neurologist Thomas Willis, who coined the term “neurology”, believed in a neurological basis of psychiatric disorder. This opinion was explicitly stated in the mid-19th century text on mental disorders by Griesinger [1]. In fact, in die latter half of the 19th century, neuropsychiatry was synonymous with general psychiatry. A number of developments led to this situation. The study of aphasia had resulted in a burgeoning interest in brain structure-function relationships. The recognition of general paresis as an acquired disease with an identifiable aetiology had resulted in therapeutic optimism. Further, neurologists of this period were interested in retaining the territory of mental disorder as a source of patients.
A Mother and Baby Unit for Psychiatric Disorders in an Obstetric Hospital
Authors: Buist Anne
Published: November 2007

In February 1988 an outpatient service began at the Mercy Hospital for women with psychiatric disorders in the postpartum period. A year later an inpatient service, now eight beds, was opened.
‘One Word before, or Two After’ the Place of the Patient Information Leaflet in Psychiatric Practice
Authors: le Bas James
Published: November 2007

Words and magic were in the beginning one and the same thing, and even today words retain much of their magical power. By words one of us can give to another the greatest happiness or bring about utter despair; by words the teacher imparts his knowledge to the student; by words the orator sweeps his audience with him and determines its judgments and decisions. Words call forth emotions and are universally the means by which we influence our fellow creatures. Therefore let us not despise the use of words in psychotherapy. Freud General Introduction to Psycho-Analysis 1
The Social Context of Aboriginal Mental Health
Authors: Hunter Ernest
Published: November 2007

‘Collective despair, or collective lack of hope, will lead us to collective suicide. This type of suicide can take many forms, foreshadowed by many possible signs: identity crisis, loss of pride, every kind of dependence, denial of our customs and traditions, degradation of our environment, weakening of our language, abandonment of our struggle for our Aboriginal rights, our autonomy and our culture, uncaring acceptance of violence, passive acknowledgment of lack of work and unemployment, corruption of our morals, tolerance of drugs and idleness, parental surrendering of responsibilities, lack of respect for elders, envy of those who try to keep their heads up and who might succeed, and so on.’ (Royal Commission on Aboriginal Peoples, 1995:38)
Telemedicine in the Top End
Authors: Nagel Tricia , Yellowlees Peter
Published: November 2007

What Do Aboriginal Prisoners, an obstetrician, and a psychiatry trainee have in common? They all used the same video conference room in Darwin, to make contact with other parts of the country—each for rather different purposes. For the prisoners, a chance to talk to their home communities; the obstetrician participated in an Australia-wide link-up for quality assurance purposes; and we held our weekly supervision session.
Use of Interpreters in Psychiatry
Authors: Degotardi Vicki
Published: November 2007

There Is A Surprising Lack of discussion in the psychiatric literature on the problems of conducting a psychiatric interview through an interpreter. This is an increasingly important area of concern, given the multicultural mix of our society.
Medical Language: Necessary Doublespeak?
Authors: Menkes David B. , Jackson Timothy L.
Published: November 2007

During Our Medical School years we roughly double our vocabulary and by graduation have learnt a new language. While we may try to revert to our mother tongue with patients, communication problems abound [1–3] often because patients do not understand the technical language of medicine. Australian writers have n called attention to the serious misunderstandings produced by the use of medical lingo across the Tasman [4,5]. Such problems of comprehension are likely to be aggravated, for patients j and doctors alike, by the current proliferation of medical acronyms [6] and euphemisms [7,8].
Psycho Cyber Surfing
Authors: Epstein Michael
Published: November 2007

The Horrors Of Co-Dependency, the turmoil in Scientology, or direct access to Medline, the database of the US National Library of Medicine, these are just a taste of the myriad offerings available at your fingertips on the Internet. There are, of course, far, far more offerings for every taste. It's like browsing through the most comprehensive magazine you could ever imagine.
Workforce Issues in Psychiatry
Authors: Lipton George L.
Published: November 2007

In The Almost Thirty Years that I have been involved in College activities the subject of workforce, its mass, density and distribution have appeared as major problems in the field of psychiatric health care. I intend to suggest today that the problem is essentially insoluble and then, paradoxically, to offer some suggestions towards finding solutions to the grossest and most obvious difficulties. Before proceeding it is probably desirable that I spend a few minutes talking about psychiatry itself, the need for these services and the current demography of the services which attempt to meet this need.
The Essence of Casemix Management in Australasian Psychiatry
Authors: Mellsop Graham , Fjeldsoe Kevin
Published: November 2007

Arguments For And Against casemix and suggestions about alternatives have been put in previous issues of Australasian Psychiatry [1,2]. This brief paper is an attempt to update and clarify the issues for Australasian psychiatrists.
The Pace Clinic: Development of a Clinical Service for Young People at High Risk of Psychosis
Authors: Yung Alison R. , McGorry Patrick D. , McFarlane Colleen A. , Patton George C.
Published: November 2007

The Pace Clinic (Personal Assessment And Crisis Evaluation) is a newly established clinic which focuses on adolescents and young adults who are at risk of developing a psychotic disorder in the near future. It aims to assess, manage and prospectively study individuals who may be in the prodromal phase of psychosis. Until now it has not been possible to gain access to large numbers of patients in this pre-psychotic state. This paper describes developments that have allowed this to occur. This Clinic has a potentially important role in research into the aetiology of psychotic disorders, the process of transition from prodromal state to psychosis, and in the development of preventative strategies in psychosis.
A Death at Darwin
Authors: Ellard John
Published: November 2007

Each of us is marching inexorably towards his or her own death. Fortunately for us for most of our lives we do not know when it will happen and how it will happen. If we are particularly fortunate it will come suddenly, painlessly and unheralded; there are less happy alternatives.

Doctors do not save lives; when it is within our skill we postpone death and diminish suffering. We can do no more.
The Psychiatry of Consent: Assessing Why People Want Euthanasia
Authors: Glaser Bill
Published: November 2007

Psychiatrists have a special interest in the issue of euthanasia which goes beyond their membership of the medical profession. At a practical level, at the very least, we may be asked to make important and literally life-threatening judgements about a patient's mental state. Whether or not we agree with the AMA's opposition to recent legislation in the Northern Territory we must be aware that we are being once more asked by society to intervene in important decisions about life, death and the health of our patients.
The National Mental Health Strategy: Is it Making Any Difference?
Authors: Whiteford Harvey
Published: November 2007

In April 1992, the Health Ministers of all Australian states, territories and the Commonwealth endorsed, for the first time, a National Mental Health Policy.
Psychiatric Service Delivery in the Darwin Rural Region
Authors: Stanlon Malcolm W.
Published: November 2007

During my elective year of training I worked in the Darwin region. As part of my work I provided psychiatric services to the isolated communities living in the Darwin rural region. A description and analysis of this work led me to develop a theoretical model of how psychiatric services could most appropriately and effectively be provided to such a unique region. This work formed the basis of my dissertation for the Section II examinations for FRANZCP.
Towards the Best Public Health Response to Horrendous Events
Authors: Mackenzie M. C.
Published: November 2007

The recent shootings at Port Arthur have highlighted trends throughout the Western World to extend debriefing and post-event counselling to the local community and secondary victims of such tragedies as well as the primary victims and emergency personnel involved. The cost of providing this extended service is not inconsiderable. There is little research that confirms effectiveness of such debriefing [1–4] and even some that points to possible long-term harm [5]. It is important to reconsider the most effective, post-event response from public health authorities.
A snowdrift index based on SNOWPACK model calculations
Authors: Lehning Michael , Doorschot Judith , Bartelt Perry
Published: November 2007

The SNOWPACK model developed at the Swiss Federal Institute for Snow and Avalanche Research is a one-dimensional momentum, mass- and energy-balance model. Its current version includes important features such as a numerical solution of the instationary heat-transfer and creep/settlement equations, a complete surface-energy balance, phase changes, water transport and snow microstructure development (metamorphism). The microstructural parameters are linked to the thermal conductivity and the snow viscosity. The new snowdrift routine uses the modelled snow to determine a threshold friction velocity The drift model describes the local mass flux of snow, distinguishing between a saltation and suspension contribution. The snow-cover model adapts to erosion (or deposition) due to drifting and blowing snow. The drift formulation improves the seasonal snow-cover simulation considerably for stations that show a significant influence of snow transport. From the mass-flux calculation, a snowdrift index results that provides valuable information on local snowdrift for avalanche warning.
Evidence for recent climate change from ice cores in the central Himalaya
Authors: Dahe Qin , Mayewski Paul A. , Wake Cameron P. , Shichang Kang , Jiawen Ren , Shugui Hou , Tandong Yao , Qinzhao Yang , Zhefan Jin , Desheng Mi
Published: November 2007

Comparison of the terminus locations of Rongbuk Glacier, Mount Everest, measured in 1966 and 1997 shows that in the past 30 years the glacier has retreated 170–270 m equivalent to a retreat speed of 5.5–8.7 m a–1 . During summer 1997, a 15 m firn core was recovered from Dasuopu glacier (28°23’ N, 85°44’ E; 7000 m a.s.D on the northwest margin of Xixabangma Feng, Xizang (Tibet). The seasonal variations of δ18O values in the core indicate that monsoon signals are clearly recorded in the glacier. δ18O values are controlled by the amount effect in the monsoon season; more negative δ18O is representative of the monsoon season in snow layers. Analysis of the relationship between ice-core δ18O, sampled from 6500 m a.s.l. on the north side of Mount Everest, and instrumental series representing regional-scale precipitation, atmospheric circulation and temperature suggests a change in the relative influence of these parameters on δ18O since the 1940s. The results of the comparison add to and lengthen the sparse array of instrument data available for the Tibetan (Qinghai-Xizang) Plateau and demonstrate a recent decline in moisture flux for at least the southern part of the plateau. Glacier retreat, associated with a recent increase in temperature in the region, is coincident with this period of decreased moisture flux.
The response of a glacier to a surface disturbance: a case study on Vatnajökull ice cap, Iceland
Authors: Aðalgeirsdóttir G. , Gudmundsson G. H. , Björnsson H.
Published: November 2007

In the course of a tremendous outburst flood (jökulhlaup) following the subglacial eruption in Vatnajökull, Iceland, in October 1996, a depression in the surface of the ice cap was created as a result of ice melting from the walls of a subglacial tunnel. The surface depression was initially approximately 6 km long, 800 m wide and 100 m deep. This ˚canyon" represents a significant perturbation in the geometry of the ice cap in this area where the total ice thickness is about 200–400 m. We present results of repeated measurements of flow velocities and elevation changes in the vicinity of the canyon made over a period of about 2 years. The measurements show a reduction in the depth of the canyon and a concomitant decrease in surface flow towards it over time. By calculating the transient evolution of idealized surface depressions using both analytical zeroth- and first-order theories, as well as the shallow-ice approximation (SIA) and a finite-element model incorporating all the terms of the momentum equations we demonstrate the importance of horizontal stress gradients at the spatial scale of this canyon. The transient evolution of the canyon is calculated with a two-dimensional time-dependent finite-element model with flow parameters (the parameters A and n of Glen’s flow law) that are tuned towards an optimal agreement with measured flow velocities. Although differences between measured and calculated velocities are comparable to measurement errors, the differences are not randomly distributed. The model is therefore not verified in detail. Nevertheless the model reproduces observed changes in the geometry over a 15 month time period reasonably well The model also reproduces changes in both velocities and geometry considerably better than an alternative model based on the SIA.