bluuebunny/crossref_metadata_2025 huggingface dataset:
Collagens in the human ovary and their changes in the perifollicular stroma during ovulation
Authors: LIND A.‐K. , WEIJDEGÅRD B. , DAHM‐KÄHLER P. , Mölne J. , SUNDFELDT K. , BRÄNNSTRÖM M.
Published: December 2009

Background. Remodeling of the collagens around the follicle is a major event in ovulation. The aim of the present study was to investigate the distribution of collagen I, III, and IV in the human ovary. Methods. Biopsies of the perifollicular stroma were obtained at sterilization during the preovulatory phase (follicle size >14 mm) or at any of three intervals (12–18 h after human chorionic gonadotrophin: early ovulatory phase; >18–24 h: late ovulatory phase; 44–77 h: postovulatory phase) after human chorionic gonadotrophin. Excised dominant follicles and whole ovarian sections were also obtained. Immunohistochemistry using antibodies against collagen I, III, IV, vimentin, and CD 45 was performed. Results and conclusions. Collagens I and III were distributed in concentric layers in the capsular stroma with bundles of collagens connecting these layers to form a mesh. Collagen I was present in larger quantities in the outer layers and collagen III showed the inverse distribution. In the theca, collagen I was present in the externa and collagen III in the entire layer. The staining intensity of collagens I and III in the perifollicular stroma decreased from the preovulatory stage. Collagen IV was present in the basal lamina separating granulosa and theca cells. This study shows that collagen I and III are abundant in and around the ovulating human follicle with typical patterns of distribution. Collagen IV is present in the basal membrane that separates the granulosa from the theca cells. Taking into account the abundance of collagens in the follicular wall and their specific localization, major site‐directed degradation of collagens seems to be necessary for follicular rupture to occur.
The Effect on Hospital Admissions of Psychiatric Case Management Involving General Practitioners: Preliminary Results
Authors: Wood Kate , Anderson Jeremy
Published: December 2009

A two year follow-up of two matched groups of subjects with chronic severe mental illness was performed in order to evaluate a new psychiatric case management system. One group (n=59) received care through psychiatric case management, using an assertive community treatment model that directly involved general practitioners. The other group, matched for age, sex, diagnostic group and number of hospital admissions, received standard outpatient care. Comparing the two years before and after case management, the experimental group showed a dramatic fall in inpatient admission days while the control group admission days remained the same (median difference in admission days across matched subject pairs = 64.5, 95% C.I. from 134.5 to 16). The experimental group remained out of hospital longer before first readmission (Kaplan-Meier survival analysis, P=0.002). This type of case management programme can shorten or prevent admissions to psychiatric hospitals of patients with chronic mental illness, and increase their time before readmission.
Does Nursing Theory Adequately Prepare Psychiatric Nurses to Work with Delusional Patients?
Authors: Hawthorne Dianne , McKenzie Andrew
Published: December 2009

The theory and practice of psychiatric nursing has been subjected to little serious research; consequently some nursing interventions recommended by nursing texts lack formal evaluation. This study examined one aspect of practice: the way in which nurses work with delusional patients. Registered psychiatric nurses were asked to describe the way in which they deal with patients whose delusions are a major clinical problem. The findings highlight a disparity between practice and theory.
Investigating Discharge Destinations for Schizophrenic Patients
Authors: Bland Robert , Harrison Christine A.
Published: December 2009

An audit of hospital records of 542 patients diagnosed as having schizophrenia discharged in the years 1986–88 from the Princess Alexandra Hospital, Brisbane, showed that 46% of patients left hospital to live with other family members, usually parents or spouses. Analysis of destination suggested that the extent of patient-family connectedness increases when the patient is younger, has had fewer admissions, or has had the illness for a shorter period of time.
Neuropsychological Outcome from Psychosurgery for Obsessive-Compulsive Disorder
Authors: Cumming Steven , Hay Phillipa , Lee Teresa , Sachdev Perminder
Published: December 2009

Seventeen obsessive-compulsive disorder patients treated with psychosurgery were administered a comprehensive neuropsychological test battery. Their performance on neuropsychological testing was compared with that of an age and severity matched sample of 17 OCD sufferers who had not received psychosurgery. The psychosurgery and control groups did not differ in intellectual or memory functioning, consistent with earlier findings that psychosurgery does not reduce global ability estimates. The psychosurgery group performed more poorly than the control group on an adaptation of the Wisconsin Card Sorting Test, demonstrating the possible impact of frontal lobe lesions on the abilities underpinning the formation and shifting of response sets.
Glimpses of a Cassel Hospital Outpatient Group
Authors: Coombe Paul
Published: December 2009

The following is a selective account of the experience of conducting a weekly out-patient analytic group at the Cassel Hospital, London. Certain features of this experience are highlighted: in particular, the significance and value of a male and female co-therapy pair as conductors. Attention is drawn to the fundamentally reparative potential for damaged individuals in group psychotherapy. Such an experience may be valuable, especially in terms of it facilitating a greater degree of personality integration. Certain suggestions are made as to the prerequisites for such a psychotherapeutic approach. The observations may be useful in the provision of psychotherapy services in the Australian health care system.
A Mass Killing in New Zealand
Authors: Brinded Philip M.J. , Taylor Antony J.
Published: December 2009

The circumstances surrounding a mass killing in New Zealand are described in conjunction with a review of a number of other similar multiple victim homicides. Due to the rare and extreme nature of such events, it is argued that they should be managed as human disasters by the professionals involved and that stress debriefing should be available for all potential primary, secondary and tertiary victims.
Catatonia LSD Induced?
Authors: Perera K. M. H. , Ferraro A. , Pinto M. R. M.
Published: December 2009

The case of a patient who developed catatonia one week following Lysergic Acid Diethylamide (LSD) ingestion is presented. The psychosis developed two days after the intake. The catatonic syndrome resolved dramatically following one treatment of electroconvulsive therapy (ECT). This is perhaps the first case report of catatonia following the use of LSD. The need for a diagnostic category of organic catatonia is highlighted.
The Use of the Health of the Nation Outcome Scale in an Outreach Rehabilitation Program
Authors: Prabhu Radha , Oakley Browne Mark
Published: December 2009

Objective: The aim of this paper is to describe the use of the Health of the Nation Outcome Scale (HoNOS) in an outreach-based rehabilitation program in regional Victoria, Australia.

Method: Routine outcome measures (ROM), including the HoNOS, were introduced in the Stepping Stones Recovery Program (SSRP) in 2002. HoNOS data routinely collected for 122 patients between 2003 and 2006 was examined for sensitivity in capturing clinical changes by using paired t-tests.

Results: There was a statistically significant decrease in total HoNOS scores as well as scores on subsets of ‘impairment’ and ‘symptomatic problems’. HoNOS scores reflected positive changes in patients and were useful as a global overview, but did not tap into process issues that are more clinically meaningful.

Conclusions: The SSRP provided a wide range of interventions and promoted a structured collaborative approach which could be the main reason for the uptake of ROM in this service. There are significant hurdles in integrating ROM in routine clinical practice, such as feasibility issues and clinician attitudes, along with larger systemic issues that need to be addressed. The introduction of ROM in Australia has resulted in strongly polarized viewpoints. Suggestions for facilitating the administration and use of ROM in routine clinical practice are discussed.
Continuing Professional Development for Australian Rural Psychiatrists by Videoconference
Authors: Greenwood James , Williams Rachael
Published: December 2009

Objective: The Rural Special Interest Group (RSIG) of the Royal Australian and New Zealand College of Psychiatrists provided a program of educational meetings for psychiatrists and trainees in rural locations to decrease professional isolation and facilitate opportunities to obtain credit for continuing professional development (CPD) purposes in ongoing professional registration. A pilot peer review group by videoconference was also implemented in Western Australia, to provide peer review for psychiatrists working in isolation.

Method: Six national interactive videoconferenced education seminars were provided. The membership was polled prior to the program for topic preferences and requested speakers, who were subsequently approached to present the seminars. A West Australian peer review group was formed, involving psychiatrists from five different rural locations and one psychiatrist from the metropolitan area.

Results: National seminars were attended by 106 individuals (67% consultant psychiatrists, 17% trainees and 16% allied health professionals). Evaluation demonstrates favourable views of the content and quality of the presentations and impact on practice patterns.

Conclusions: Attendance at seminars via videoconferencing provided rural psychiatrists with opportunities to obtain CPD credit without the need to travel, providing a cost-effective alternative for accessing education. Involvement enabled interaction among peers throughout Australia, alleviating professional isolation and generating networking opportunities. The West Australian peer review group demonstrated sustainability with a commitment to continuation and positive impact on practice.
Reflections of a Retiring Examiner
Authors: Handrinos Dennis
Published: December 2009

Objective: This article is a transcript of an invited talk given to the Victorian Branch of the Australian and New Zealand Association of Psychiatrists in Training in February 2008, as part of an annual function designed to assist trainee psychiatrists as they prepare for the Royal Australian and New Zealand College of Psychiatrists’ clinical examination. Six points of reflection are discussed from the perspective of the examiner. The talk focuses on the Observed Clinical Interview component of the clinical examination as this is where many candidates seem to struggle to meet the required standard.

Conclusion: While specific examination preparation is essential, breadth of clinical experience, supervision and an opportunity to think and reflect on one's learning seem to be essential elements in success at these high stakes examinations.
Prescribing and Monitoring Clozapine in Christchurch
Authors: McKean Andrew , Vella-Brincat Jane , Begg Evan
Published: December 2009

Objective: The aim of the study was to identify the pattern of usage of clozapine in Christchurch, New Zealand, including daily dose, indication and use of drug concentration monitoring.

Method: Patients (n=353) were identified retrospectively from the pharmacy computer system. Data gathered included patient demographics, the daily clozapine dose and the number of occasions that clozapine drug concentration monitoring occurred. In addition, each psychiatrist who had prescribed clozapine was surveyed, regarding their indications for the use of clozapine and their use of clozapine drug concentration monitoring.

Results: The majority (63%) of patients on clozapine were male. The mean age of the patients was 43 years (range 15–88 years). The mean daily dose of clozapine was 325 mg (range 12.5–900 mg). Patients over the age of 65 years were on a significantly lower dose (mean=143 mg, 95% CI=103–183 mg) compared with those under 65 years of age (mean=350 mg, 95% CI=330–370 mg). The median duration of treatment on clozapine was 4 years. Fifty-one percent of patients had undergone drug concentration monitoring, the majority on multiple occasions. In females, increasing age correlated with an increase in dose-corrected plasma clozapine concentrations (r2=0.29, p<0.001). This was not demonstrated in the male population. Of the psychiatrists surveyed, 44% prescribed clozapine for unlicensed indications and 79% used clozapine drug concentration monitoring in their patients. This was most commonly performed to assess compliance or confirm toxicity.

Conclusions: The mean daily dose of clozapine of 325 mg was similar to that found in other studies. An age-related decline in dose was observed, probably due to different indications, with many of the elderly patients receiving clozapine for Parkinsonian related symptoms. There was also an age-related decline apparent in clearance in females. Clozapine was often used for unlicensed indications, and a clear majority of psychiatrists use drug concentration monitoring.
Forensic Mental Health Orders: Orders Without Borders
Authors: Carroll Andrew , Scott Russ , Green Bob , Dalton Tom , Brett Adam , McVie Ness
Published: December 2009

Objective: Persons subject to forensic mental health orders imposed by the courts form a small but politically salient group. Their management provides a number of challenges for mental health services and for governments throughout Australia. Although their overall management has been enhanced by recent developments in forensic services, there is a lack of consistent cross-border agreements between states and territories. This paper will discuss how this situation is not conducive to effective risk management and is a denial of patients’ legitimate demands for freedom of movement. A proposal for the adoption of appropriate principles to improve the current state of affairs is outlined.

Conclusion: Legislative reform is required to ensure the safe and ethical management of mentally disordered offenders subject to forensic mental health orders in Australia.
Integration Through Relatedness in the Conversational Model: A Case Study
Authors: Haliburn Joan
Published: December 2009

Objective: The aim of this paper is to demonstrate the principles of the conversational model in two therapies with a patient, at 16 years of age and again 20 years later.

Method: Described is the first therapy of L, which commenced in hospital and continued twice weekly after discharge. L was an acutely disturbed 16-year-old female admitted for 4 months to the psychiatry ward, a dynamically oriented milieu of a University teaching hospital where I was training. This is followed by a brief description of L's second therapy. Supervision was through audiotape of sessions.

Results: At the conclusion of the first therapy, L was functioning well. Five years later, she married and had a child. She was referred to me again after she attempted suicide following an acute stressful event which resulted in hospitalization. She is more aware and reflective at present but continues to be vulnerable.

Conclusions: Attention to certain aspects of the psychotherapeutic relationship is important as demonstrated in the conversational model.
A University Psychotherapy Training Program in a Psychiatric Hospital: 25 Years of the Conversational Model in the Treatment of Patients with Borderline Personality Disorder
Authors: Haliburn Joan , Stevenson Janine , Gerull Friederike
Published: December 2009

Objective: The aim of this paper is to describe the development, delivery and experience of a university psychotherapy training program for psychiatry trainees in a public psychiatric hospital, demonstrating that patients with severe borderline personality disorder can be treated successfully with psychodynamic psychotherapy and stressing the need for structured psychodynamic psychotherapy training in psychiatry.

Method: Two of the authors (JH and JS) were part of the first group of eight trainees supervised by Professor Russell Meares and several other experienced psychiatrists.

Results: Ninety trainees have successfully completed the course. Two hundred and forty patients have been treated by trainees in this program to date; 49 patients have dropped out.

Conclusions: The training program provided a sound psychodynamic base and an improved capacity to relate with our patients, not only in the program but also in our routine work as psychiatrists. An important public health issue and community need was addressed, which also proved to make sound economic sense as the number of patients who were treated might not have otherwise received long-term psychotherapy. An integrated process model of psychoanalytic psychotherapy – the conversational model – has evolved and continues to be offered as a 3-year part-time clinically oriented course leading to a Masters in Medicine, Psychotherapy at the University of Sydney. Several outcome studies and papers have been published and workshops have been presented both in Australia and overseas. The patients improved considerably – their self harming behaviour stopped within 6 months and they were no longer clinically depressed at the end of 1 year.
Glenside Hospital's Role in the Introduction of Electroconvulsive Therapy and Psychosurgery to Australian Psychiatry
Authors: Goldney Robert , Adams Rob
Published: December 2009

Objective: This paper records the introduction of electroconvulsive therapy (ECT) and psychosurgery to Australia at Parkside Mental Hospital (present day Glenside Hospital) in South Australia.

Method: A review of treatment provided at Glenside Hospital since its inception in 1870.

Results: The desperate plight of patients and the limited array of interventions leading up to the introduction of ECT and psychosurgery are noted. Their introduction and the early results from the treatments are described.

Conclusion: Glenside Hospital, as Parkside Mental Hospital, pioneered the use of ECT and psychosurgery in Australia.
Implementation of Indigenous Mental Health Training in Victoria
Authors: Duke Michael , Ewen Shaun
Published: December 2009

Objective: This article aims to describe the process of implementation of the 2004 Indigenous Mental Health Royal Australian and New Zealand College of Psychiatrists (RANZCP) Training By-Laws within Victoria.

Conclusions: It is likely that the challenges of ensuring access to this training experience, within the Victorian RANZCP Training Program, have been experienced to varying degrees within other Australian training programs. The vertical integration of an Indigenous health curriculum extends work being done in all undergraduate medical schools in Australia and New Zealand, and which the Australian Medical Council has incorporated into the accreditation of medical schools.
What Does ‘Clinical Significance’ Mean in the Context of the Health of the Nation Outcome Scales?
Authors: Burgess Philip , Trauer Tom , Coombs Tim , McKay Rod , Pirkis Jane
Published: December 2009

Objective: The aim of this paper was to improve understanding of what ‘clinical significance’ means in relation to the Health of the Nation Outcome Scales (HoNOS) and its older persons and child/adolescent equivalents (the HoNOS65+ and HoNOSCA).

Method: An anonymous, web-based survey was completed by 94 outcome measurement experts, most of whom had clinical responsibilities. Respondents were asked to indicate for acute inpatient and ambulatory settings: the rating on each item which represented a clinically significant problem; the relative importance of each item in determining overall clinical severity; and the items which would not be expected to improve between admission and review, admission and discharge, review and review, and review and discharge.

Results: A score of 2 (‘mild problem but definitely present’) on each HoNOS/HoNOS65+/HoNOSCA item resonates with experts as being evidence of a clinically significant problem that requires active monitoring or intervention. In the main, all items on these instruments are viewed as equally important in making an overall judgement of clinical severity. The items making up the impairment and, to a lesser extent, social subscales are least likely to demonstrate change during the course of an episode of care, according to expert opinion. Generally, these findings apply across instruments and service settings.

Conclusions: Overall, the findings provide support for the content validity and clinical utility of the HoNOS/HoNOS65+/HoNOSCA. Further exploration of the question of clinical significance as reflected in these instruments could take a number of forms.
The Doctrine of Integration in Psychiatry and the Pre-Socratics
Authors: Plastow Michael
Published: December 2009

Objective: The notion of the integration of the mental and the physical, and of a number of other divisions, is widely promoted in psychiatry. René Descartes is often held responsible for divisions that appear in our profession and in our practice. The wish for integration, though, fails to recognize the way in which such divisions might be fundamental and necessary in our profession. This paper describes the endeavour in psychiatry and in Western thought more generally to cover up such divisions. It traces the drive towards integration to the origins of contemporary thought in Plato and Aristotle, in order to examine what preceded such thought.

Conclusions: The pre-Socratic thinkers were able to articulate fundamental and radical divisions, an ability which has been lost since the writings of Plato and Aristotle. A reappraisal of the pre-Socratics can lead to a reconsideration of the ongoing attempt to cover over the necessary divisions which mark our clinical practice, in order to be able to value what is most fundamental in our profession.
The PTSD Supremacy: Criterion F in Three Voyager Cases
Authors: Gaughwin Peter
Published: December 2009

Objective: The aim is to consider whether the courts and experts in their application of Criterion F for posttraumatic stress disorder (PTSD) have applied it consistently in civil claims brought years after the event.

Method: Three cases for compensation relating to the Voyager disaster are considered.

Results: It appears, from the cases considered in this paper, that while courts consider that Criterion F is crucial in making a diagnosis of PTSD, there are some inconsistencies in terms of understanding and applying this criterion, both by the courts and experts. This may be because of a lack of guidance in psychiatric texts as to how to apply Criterion F.

Conclusions: Criterion F is, after the satisfaction of Criterion A(1), arguably the most important of the criteria for PTSD for, while the symptoms referred to in Criteria B–D have been shown to be fairly easy to simulate, it is arguably harder to do this with Criterion F, particularly in cases that arise a long time after the event. It is important therefore that psychiatrists assessing persons so long after an event adhere rigorously to Criterion F, because it is based on facts open to objective corroboration, while criteria B, C and D tend to rely on subjective experiences which are the most sensitive to distortion. Thus, it is to be hoped that if DSM-V is to maintain a criterion of clinically significant distress or impairment in the majority of the disorders described therein, it will provide some assistance as to how this criteria should be applied.
Gender-Sensitive Mental Health Care
Authors: Judd Fiona , Armstrong Sue , Kulkarni Jayashri
Published: December 2009

Objective: The aim of this paper is to examine aspects of mental health and mental health care through a gender lens.

Conclusion: Gender differences have an impact on mental health and the experience and course of women's mental illness. Comprehensive gender-sensitive mental health care requires the planning, delivery, monitoring and quality improvement initiatives of mental health care to be informed by a knowledge and understanding of gender differences in women and men and their inter-relationship with respect to childhood and adult life experiences (e.g. violence and abuse); day-to-day social, cultural, and family realities; expression and experience of mental ill health and treatment needs and responses.
Accountability or Responsibility? The Challenge of Policies in Clinical Psychiatry
Authors: Dignam Paul
Published: December 2009

Objective: The aim of this paper is to describe some of the differences between personal and administrative approaches to clinical risk management by reflecting on some recent experiences in policy development.

Conclusions: Administrative preoccupation with policy development and political accountability may detract from professional development and personal responsibility.
Reflections on Facilitated Discharge from a Mental Health Service
Authors: Jespersen Sean , Chong Terence , Donegan Tony , Gray Kelly , Kudinoff Teresa , McGain Leanne , Gant Deborah
Published: December 2009

Objective: The aim of this paper is to review research evidence and describe our experience of facilitated discharge from mental health services to primary care.

Method: A literature review of facilitated discharge was conducted. In addition, the clinical characteristics of 21 discharged and 21 non-discharged patients from one shared care service were compared in a retrospective file review. Thirty-one patients in another facilitated discharge program were surveyed.

Results: Discharged patients had a higher level of function. There was a trend towards discharged patients being female and employed with less chronic illness, involuntary treatment, behavioural symptoms, depot medication, triage contact, service contact with family, and more mood disorder. Of the 10 survey respondents, 60% reported feeling better compared with their last service contact, 70% felt not having contact was a good thing and most saw their doctors regularly and reported a good relationship.

Conclusions: There was a trend towards more stable patients being discharged and it appeared that they responded positively to this, without a clear indication of which factors best determine suitability for discharge. Consequently, we elected to incorporate discharge planning processes as a core function of case management and increase shared care with the primary care sector.
Implementation of the Strengths Model at an Area Mental Health Service
Authors: Chopra Prem , Hamilton Bridget , Castle David , Smith Jenny , Mileshkin Cris , Deans Michael , Wynne Brad , Prigg Glenn , Toomey Nigel , Wilson Michael
Published: December 2009

Objective: The objectives of this paper are to provide an overview of recovery-focused models of care and discuss the implementation of the Strengths Model at St. Vincent's Mental Health Melbourne (SVMH), Victoria, Australia.

Conclusions: The implementation of the Strengths Model at SVMH is discussed with particular emphasis on the process of implementation, service implications, practical challenges and dilemmas that have arisen, and proposed evaluation. Recovery-focused care is feasible and can enhance current practice of mental health services.
A Comparison of Patient and Staff Satisfaction with Services After Relocating to a New Purpose-Built Mental Health Facility
Authors: Cleary Michelle , Hunt Glenn , Walter Garry
Published: December 2009

Objective: This study measured patient satisfaction levels and staff views regarding their expectations and workplace and other opinions after relocation to a new purpose-built mental health facility within the grounds of a general repatriation hospital.

Method: Patients were interviewed face-to-face using a standardized satisfaction survey at least 2 months after the move to the new facility. In addition, surveys were sent by mail to all clinical staff rostered to work the same period that the patient interviews were conducted.

Results: One hundred patients were interviewed and 123 staff returned the survey (56% response rate). Patients and staff rated the new ward environment and food services most highly and were least satisfied with patient information and medical services. Less satisfaction was expressed about resource issues such as information technology and dedicated staff facilities. Most staff (70–80%) rated services provided to patients to be the same or better than their original expectations.

Conclusions: The results indicate that the hospital move did not have any measurable negative impact on overall service provision or patient satisfaction. In fact, expectations were met or improved for several clinically relevant areas after relocating the mental health facility. Another survey is planned in 12 months to assess if patient and staff ratings change.
A Brief, Descriptive Typology of Depressed Mood
Authors: Restifo Sam
Published: December 2009

Objective: The purpose of this paper is to consider the potential clinical utility of a descriptive typology of negative mood states that can present as, and tend to get loosely subsumed under, the broad ranging term, ‘depression’.

Method: Information and ideas from clinical practice and the existing literature have been brought together with a view to compiling a provisional, brief, descriptive typology of depressed mood.

Conclusion: A qualitative typology of various kinds of depressed mood has heuristic value in engaging, formulating and planning treatment for people presenting with ‘depression’.
Hallucinations Arising in the Context of Torn Attachment, Traumatic Childhood and Tapeworms
Authors: Power Brian , Goossens Carolyn
Published: December 2009

Objective: The aim of this paper is to describe the processes underlying psychotic symptoms in an adolescent who presented to our service at the age of 15 years.

Conclusion: sA teenage female presented having experienced her early childhood in a war-torn third-world country, during which time her mother died, and she suffered worm infestation, neglect and trauma, before being adopted by a family in a developed country, where she lived for several years prior to relocating to Australia. The presenting complaints included longstanding anxiety, depressive and dissociative symptoms, with subsequent behavioural problems and learning difficulties. More recently, she had developed auditory hallucinations, and the antipsychotic she had been taking was beneficial. An MRI of the brain demonstrated lesions in keeping with healed parasitic disease (neurocysticercosis). The patient's hallucinations are discussed in the context of the relationship between a traumatic childhood and psychosis, and neurocysticercosis. Within months of her presentation, the hallucinations resolved as her step-mother became more available. Her antipsychotic medication is being carefully decreased, and the patient is engaging in psychological therapies to deal with her past trauma and disrupted attachment.
A Mental Health and Substance Abuse Service for a Youth Detention Centre
Authors: Letters Paul , Stathis Stephen
Published: December 2009

Objectives: To describe a new programme, the Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) at the Brisbane Youth Detention Centre, which aims to provide young people in detention with the same quality of mental health and substance dependency services that would normally be available to them in the community.

Conclusions: Young people in detention suffer from considerable mental health and substance abuse problems. MHATODS seeks to address the specific needs of this group of young people. Its innovative structure recognizes the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has created an integrated treatment service for young people in detention.
Why do Doctors Dislike Treating People with Somatoform Disorder?
Authors: Pridmore Saxby , Skerritt Paul , Ahmadi Jamshid
Published: December 2009

Objective: To consider the question of why doctors dislike treating people with somatoform disorder, with a view to assisting debate and improving services.

Methods: The literature was examined, and compared with clinical experience.

Results: Psychological, sociological and evolutionary theory make relevant contributions. Important factors include that these conditions are problematic and positive outcomes may not be possible given current knowledge and clinical skills and techniques. Patients may not accept that their problem is a form of psychiatric or brain disorder. Most importantly, the doctor may not accept that somatoform disorders are beyond the control of patients, setting the scene for irritation and unsatisfactory interactions.

Conclusions: There are many factors that underlie the dislike of some doctors for treating people with somatoform disorder. There is a pressing need for educational efforts to help students and doctors accept that the symptoms of somatoform disorder are beyond the control of those who suffer them.
Commitment and Collaboration for Excellence in Older Persons' Mental Health: The ACT Experience
Authors: Raymond Judy , Kirkwood Helen , Looi Jeffrey
Published: December 2009

Objective: To describe the development of the older persons' mental health service in the Australian Capital Territory (ACT), a region with both urban and rural characteristics.

Methods: Elements include: (i) collaboration with health-care and non-governmental organizations; (ii) provision of consultation-liaison service to patients, family and professional care-providers via collaboration with general practitioners; (iii) partnerships built through consultation, regular communication, education and training of primary health-care providers; and (iv) development of a multidisciplinary academic centre in partnership with the local universities designed to enhance roles in education, training and research. The disciplines of general practice, nursing, psychology, social work and psychiatry collaborate in service provision, education and an active research centre.

Conclusions: An expanded, multidisciplinary comprehensive service has been developed from an initial consultation-liaison model, illustrating that commitment and collaboration with existing services and carer groups can advance care.
The Medical Specialist Outreach Assistance Programme in South Australia at 2 Years
Authors: Cord-Udy Nigel
Published: December 2009

Objective: To describe the progress and achievements of the psychiatric services developed by the Medical Specialist Outreach Assistance Programme in South Australia over the last 2 years. There is a particular focus on services provided to the remote areas of the far northern region of South Australia.

Conclusion: During this period there has been an expansion of visiting psychiatric services to South Australia's rural and remote communities. In particular, child and Indigenous services have improved considerably. These have been important developments and it is hoped that funding and services will continue after the June 2004 conclusion of the Medical Specialist Outreach Assistance Programme.
Use of a Routine Outcome Measure in a Consultation-Liaison Mental Health Service
Authors: Trauer Tom
Published: December 2009

Objective: The problem severity of patients seen by a psychiatric consultationliaison service was studied through the use of a routine outcome measure.

Methods: Ratings on the Health of the Nation Outcome Scales (HoNOS) over nearly 3 years in the emergency department, general hospital, and on admission to the acute psychiatric unit were compared.

Results: Mean HoNOS total scores in the emergency department were not significantly different from those at admission to the acute psychiatric unit, but were significantly higher than those in the general hospital. Mean scores in all three settings were higher than those obtained at case review of psychiatric patients in the community. Despite differences in age, sex, and psychiatric diagnosis between the three hospital settings, differences in mean HoNOS total scores remained substantially unchanged after adjustment for these factors. Most HoNOS assessments were performed by medical staff.

Conclusions: The suspected high levels of problem severity and comorbidity of patients seen by a psychiatric consultation-liaison service were confirmed through the use of a routine outcome measure.
Treatment Guidelinesfor Depression in the Asia Pacific Region: A Review of Current Developments
Authors: Hickie Ian
Published: December 2009

Objective: This paper examines the development of treatment guidelines, medication algorithms and clinical pathway guides for depression in countries participating in the SEBoD Initiative.

Methods: A systematic review of the extent of development of treatment guidelines, medication algorithms or clinical pathway guides for depression in participating countries.

Results: Most countries in the Asia Pacific region have commenced the development of treatment guidelines, medication algorithms or clinical pathway guides. The promoters of such efforts have included a range of professional and government bodies. Most efforts have borrowed heavily on existing international guidelines. There is a significant emphasis on medication practices in most countries, with less emphasis on the role of psychological or other non-pharmacological approaches. There has been insufficient emphasis on integrating local classification, assessment and cultural practices into the provision of high quality care. Important additional measures, including practice surveys and consensus judgements, have been undertaken in some countries.

Conclusions: The development of a genuine quality improvement movement for depression treatments is in its infancy in the Asia Pacific region. However, there is now the capacity to bring together such efforts at a regional level and, in doing so, promote standards for best care, more community and professional involvement and the uptake of a wider variety of treatment approaches.
Clinical Decision Support Systems in Psychiatry in the Information Age
Authors: Kotze Beth , Brdaroska Bilyana
Published: December 2009

Objective: Clinical decision support systems (CDSSs) are active knowledge systems that use two or more items of patient data to generate case-specific advice. They were developed to improve health-care quality. There is evidence that they can be a valuable tool in fostering the process of dissemination and uptake of clinical guidelines that, in turn, can improve clinical decision-making and outcomes. The present paper will explore why, despite this potential, CDSSs have not been extensively used in psychiatry.

Conclusions: There is an abundant literature that explores the barriers to the development and implementation of information technology in health. This can be understood as related to clinician, organizational, cultural and technological factors. Certain characteristics of the clinical discipline of psychiatry present an additional barrier, although diagnostic systems appear to have gained a level of acceptance.
Psychostimulant Treatment of Adults With Mental Retardation and Attention-Deficit Hyperactivity Disorder
Authors: Jou Roger , Handen Benjamin , Hardan Antonio
Published: December 2009

Objective: To examine the potential effectiveness and tolerability of psychostimulants in adults with mental retardation (MR) and attention-deficit hyperactivity disorder (ADHD).

Methods: A retrospective chart review was conducted in a clinic specialized in treating individuals with developmental disabilities. Improvement was assessed using the Aberrant Behaviour Checklist-Community Version (ABC-C) and the global improvement item of the Clinical Global Impression scale.

Results: Ten consecutive adult outpatients were identified. Five were judged to be responders, based on impressions from chart review and the ABC-C. Significant improvements were observed in the hyperactivity and irritability subscales of the ABC-C. Adverse events were minimal and no patients required treatment termination.

Conclusions: Psychostimulants might be effective and well-tolerated in the treatment of ADHD in adults with MR. However, larger prospective open-label studies, and, eventually, double-blind placebo-controlled studies are needed to confirm these findings.
Leadership for Change in Complex Systems
Authors: Minas Harry
Published: December 2009

Objectives: To examine clinician leadership for change from the perspective of complexity.

Methods: The core features of complex adaptive systems are described and examples of these characteristics are identified in Australia's mental health system. The implications of conceiving of themental health system as a complex adaptive system are explored.

Conclusions: It is concluded that there is value in conceiving of Australia's mental health system as a complex adaptive system and that such a conception provides useful guidance for leadership for change and for management.
A New Model of Triage in an Aged Persons Mental Health Service
Authors: George Kuruvilla , Macdonald Gail
Published: December 2009

Objective: To describe a new model of triage in an aged persons mental health service.

Methods: The process of developing the new model is described and compared with the previous system.

Results: The outcomes reveal an increase in the contacts and accepted referrals. However, the increase in contacts (54.8%) is proportionately much higher than the increase in accepted referrals (16%).

Conclusions: The outcomes suggest that the new model is working with improved accessibility (increased contacts) and effective triage (proportionately smaller increase in accepted referrals). Triage should not be a static model but needs ongoing development to be effective and responsive.
Randomized Controlled Trial of Olanzapine in the Treatment of Cognitions in Anorexia Nervosa
Authors: Mondraty Naresh , Laird Birmingham C. , Touyz Stephen , Sundakov Viktoria , Chapman Lucy , Beumont Pierre
Published: December 2009

Objective: Recovery from anorexia nervosa is confounded by intrusive anorec-tic cognitions and rituals. It has been observed that olanzapine, an atypical antipsychotic, can reduce this anorexic rumination. A pilot study was designed to test the effectiveness of olanzapine in this role.

Methods: A randomized trial of olanzapine versus chlorpromazine, with anorexic rumination as the primary outcome, was conducted. Of the 26 patients who presented, 15 were randomized in a balanced block design, eight to olanzapine and seven to chlorpromazine.

Results: Only the olanzapine group had a significant reduction in the degree of rumination.

Conclusion: Olanzapine may be of benefit in anorexia nervosa by causing a reduction in anorexic rumination.
Severe Tachycardia Following Low-Dose Clozapine Treatment
Authors: Stampfer Hans , Swanepoel Peter
Published: December 2009

Objective: To reporta case of severe and sustained tachycardia that developed asymptomatically on a low dose of clozapine (ISO mg daily).

Method: Case report.

Results: Serially monitored 24 h heart rate after the introduction of clozapine showed an increase in the 24 h mean from 87 to 126 bpm, a reduction of pulse variability and anomalies in sleep-wake regulation. Cessation of clozapine was followed by a rapid return to preclozapine activity. Application of the Naranjo Adverse Drug Reaction Probability Scale indicated a probable relationship between clozapine and the sustained tachycardia.

Conclusions: Severe and sustained tachycardia can develop asymptomatically with a relatively low dose of clozapine and a slow titration rate. The severity of the tachycardia may not be revealed in isolated pulse measurements and may escape clinical detection without closer monitoring of heart rate.
Development of Clinical Guidelines for the Pharmacological Management of Behavioural Disturbance and Aggression in People with Psychosis
Authors: Castle David , Daniel Jeffrey , Knott Jonathan , Fielding John , Goh Joyce , Singh Bruce
Published: December 2009

Objective: To describe the process underpinning the development of clinical guidelines for the management of behavioural disturbance in psychosis.

Method: A structured process was followed, encompassing a literature review, focus groups with key staff, and pilot testing and monitoring of the guidelines in an acute psychiatric setting.

Results: The process was well accepted by staff and was found useful in monitoring outcomes in a naturalistic setting. The final guidelines proved safe and effective in the acute setting.

Conclusions: The incorporation of a monitoring system for interventions for the management of behavioural disturbance in acute psychiatric settings is beneficial for staff and patients alike.
Preventing Episode II: Relapse Prevention in First-Episode Psychosis
Authors: Gleeson John ,   On Behalf of the Episode II Research Team
Published: December 2009

Objective: This paper outlines a rationale for expanding research and clinical innovations focused upon relapse prevention following a first episode of psychosis. Some general principles for further progress are extracted from an overview of the first-episode psychosis (FEP) relapse literature. A cognitive behaviour therapy intervention for relapse prevention for FEP, that has been developed at the Early Psychosis Prevention and Intervention Centre, is described to illustrate these principles.

Conclusions: Further progress is needed in refining interventions specific to the prevention of relapse following FEP. Future progress is dependent upon improved understanding of the interaction of biological, interpersonal and psychological processes underpinning relapse.
Diagnostic Stability in Patients with First-Episode Psychosis
Authors: Amini Homayoun , Alaghband-Rad Javad , Omid Abbas , Sharifi Vandad , Davari-Ashtiani Rozita , Momeni Farzad , Aminipour Zahra
Published: December 2009

Objective: To examine the short-term stability of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) and International Classification of Diseases (10th revision; ICD-10) diagnoses in a group of patients with first-episode psychosis.

Method: Sixty patients with first-episode psychosis admitted consecutively to Roozbeh Hospital, Tehran, were sampled; their illnesses could not be attributed to any medical or substance-induced conditions. Patients were assessed at the time of discharge from the hospital, and at 3, 6and 12 month intervals following admission. Ateach visit, two psychiatrists made consensusDSM-IV and ICD10 diagnoses, based on all available information. Stability was discerned as the consistency between diagnoses at the time of discharge and at 12 month follow up.

Results: Forty-eight patients completed follow up. Affective psychotic disorders and schizophrenia in both classification systems were highly stable. In addition, all patients with DSM-IV brief psychotic disorder and ICD-10 acute and transient psychotic disorders remained the same at follow up.

Conclusions: Affective psychoses and schizophrenia, in line with previous findings, remained stable. Diagnoses of brief psychoses were highly stable as well; this could reflect a non-relapsing course ofacute brief psychoses, especially in developing countries.
Development of Australia's First Psychiatric Emergency Centre
Authors: Frank Rowena , Fawcett Lisa , Emmerson Brett
Published: December 2009

Objectives: To describe the development of the first Australian psychiatric emergency centre co-located with the Emergency Department at the Royal Brisbane and Women's Hospital. This paper covers the current operational model, significant partnerships and benefits of this service, which assesses and treats over 7200 presentations per year.

Conclusions: The co-location of the Psychiatric Emergency Centre and Emergency Department has created a unique model of service delivery and effective working relationships between the two services. The model improves clinical care providing multiple benefits for patients and the Emergency Department by means of direct access to specialized mental health staff, early mental health responsibility for patients and reduced access block.