bluuebunny/crossref_metadata_2025 huggingface dataset:
Rural-Urban Differences in Reasons for Living
Authors: Mclaren Suzanne , Hopes Lisa M.
Published: March 2003

Objective: The suicide rate in Australia is cause for concern, especially the increase in attempted and completed suicides in rural and regional locations. The present study examined reasons for choosing not to commit suicide as a function of residential location.

Method: The study involved 655 Victorian residents from four population-based strata; urban, regional city, regional town, and rural.

Results: Results from the Reasons for Living Inventory revealed significant differences as a function of residential location. Overall, residents in rural locations reported having significantly more to live for than their urban counterparts. Further analysis of six reasons for living (child, family, moral, social, coping and death-related concerns) showed a pattern whereby residents in rural locations reported having the most to live for, followed by regional residents, and urban residents who reported having the least to live for.

Conclusions: These findings are in contrast to increase of suicide rates in rural areas, and highlight the need for a greater understanding of the mechanisms underlying suicidal behaviour.
Barriers to Optimal Care for Patients with Coexisting Substance Use and Mental Health Disorders
Authors: Todd Fraser C. , Douglas Sellman J. , Robertson Paul J.
Published: March 2003

Objective: This paper describes qualitative research that was carried out as part of a project aimed at drawing up a series of guidelines for the assessment and management for people with coexisting substance use and mental health disorders, or dual diagnosis [ 1 ].

Method: A core consultation team of 14 experts with experience in the areas of both substance use and mental health in New Zealand was established to advise on the development of eight clinical scenarios. The clinical scenarios were selected to highlight a range of real life issues in the treatment of people with coexisting substance use and mental health disorders and were presented at 12 focus groups around New Zealand. The 261 participants of the focus groups were asked to comment on what was optimal management for each of the scenarios and to identify barriers to optimal care in their region. Written notes were analysed for recurring and strongly stated themes and these comprise the results of the study.

Results: While there was marked regional variation in treatment approaches and service structures, many of the barriers to optimal care that were identified were common to all regions. The results are considered under the headings of systems issues, clinical issues and attitudes.

Conclusions: A wide variety of barriers that impede the delivery of optimal care have been identified. These range from the attitudes of individual clinicians to the structure of the systems within which they work. A system of key principles and processes for organizing treatment in a way which helps overcome these barriers is proposed.
Mental Health of Adolescents in Custody: The Use of the ‘Adolescent Psychopathology Scale’ in a Tasmanian Context
Authors: Bickel Rosie , Campbell Alistair
Published: March 2003

Objective: To investigate the incidence of mental health problems based on the DSM-IV [ 1 ] among adolescents in custody in Tasmania, using the Adolescent Psychopathology Scale (APS) [ 2 ].

Methods: The APS was administered to 50 adolescents admitted consecutively to a youth detention centre in Tasmania, Australia, using a structured interview format.

Results: In this sample 46% scored positively for a mood disorder, 36% for posttraumatic stress disorder (PTSD), and 32% for an anxiety disorder excluding PTSD.

Conclusions: Tasmania is no exception to the rule that adolescents in custody have a high proportion of mental health problems. This study confirmed findings of previous studies that detained adolescents had a roughly equivalent level of mental health problems as young people referred to mental health services and five times more than adolescents in the community. Therefore, all detained adolescents should be assessed for mental health problems as their risk is equivalent to that of young people referred to mental health services in the community. Youth detention centres are able to provide significant opportunities for individual therapy and group programmes for young people with mental health problems. However, to achieve a realization of this potential, detention facilities need to develop philosophies and procedures, which facilitate the development of therapeutic, as opposed to ‘punishing’, environments.
A Profile of Regional Psychiatry Publishing: Home and Away
Authors: Parker Gordon , Parker Kay
Published: March 2003

Objective: Previous reports have profiled Australian psychiatry publishing in high-ranking international journals over the last two decades. An audit of selected high ranking and regional psychiatric journals was therefore undertaken to obtain a current profile of Australasian publishing.

Methods: Journals were selected on the basis of impact factors for the year 2000, with the top five regional, generalist and specialist journals being selected, and with publication numbers over a two-year period (1999–2000) compared with numbers from other major geographical regions.

Results: Of the 4573 papers identified in the 15 journals, Australasian authors contributed 269 to the regional journals (with two-thirds in the Australian and New Zealand Journal of Psychiatry), 47 to the generalist journals (with two-thirds in Psychological Medicine) and very few (23) to the specialist journals. Representation in the so-called ‘dominant four’ international journals has increased since the 1986–1989 audit. When analysis was made of the ‘top nine’ international journals, the Australasian representation rate was a low 1.8% and lower than most regions examined.

Conclusions: If Australasian psychiatry is to advance its international presence, a greater representation rate in top-ranking international journals should be set as an objective.
Postdisaster Emotional Distress, Depression and Event-Related Variables: Findings Across Child and Adolescent Developmental Stages
Authors: Mcdermott Brett M. , Palmer Lyle J.
Published: March 2003

Objective: Developmental approaches have not been widely used in child and adolescent posttraumatic stress disorder research, and little is known about developmental differences in response to postdisaster trauma. Our objective was to investigate postdisaster depression and emotional distress psychopathology across a broad child and adolescent developmental range.

Method: Six months following a bushfire disaster, 2379 grade 4–12 school students completed an extensive self-report battery, which included the Impact of Event Scale and the Birleson Depression Inventory. Generalized linear models were constructed to model the effects of multiple covariates on continuous outcome measures of depression and emotional distress.

Results: Significant independent predictors of persisting depressive symptoms were increased symptoms of emotional distress; increased symptoms of anxiety; evacuation experience; and school grade. Significant independent predictors of emotional distress were persisting depressive symptoms; perception of threat to self or to parents; evacuation experience; and school grade. Gender was not a significant predictor in either the depression or emotional distress multivariate models. Complex, non-linear relationships between depression, emotional distress and school grade were found.

Conclusion: This study suggests that important developmental differences in postdisaster psychological responses exist across a broad spectrum of developmental stages in children.
Monitoring Consumer Satisfaction With Inpatient Service Delivery: The Inpatient Evaluation of Service Questionnaire
Authors: Meehan Thomas , Bergen Helen , Stedman Terry
Published: March 2003

Objective: To report on the development, testing and psychometric properties of a brief consumer satisfaction measure for use with psychiatric inpatients.

Method: Focus group discussions with inpatients were used to develop a pool of items related to satisfaction with hospital stay. A second cohort of 72 inpatients was invited to rate the 51 items that emerged for importance in contributing to satisfaction. Mean importance scores highlighted 20 items that were subsequently framed into neutrally worded statements. A draft questionnaire comprising these statements was introduced, on a trial basis, in a range of inpatient facilities.

Results: Factor analysis of 356 completed questionnaires yielded three factors comprising a staff-patient alliance; doctor/treatment issues; and an environmental component. Psychometric properties include good response variability and high internal consistency.

Conclusions: The Inpatient Evaluation of Service Questionnaire addresses many of the shortcomings of existing satisfaction measures. It was developed through extensive consumer involvement, it is simply worded, easy to score and appears to perform well with acute and rehabilitation inpatients.
Use of Antipsychotic Medications in Australia Between July 1995 and December 2001
Authors: Mond Jonathan , Morice Rodney , Owen Cathy , Korten Ailsa
Published: March 2003

Objective: To examine trends in the use of oral conventional, depot and atypical antipsychotic medications in Australia between July 1995 and December 2001.

Method: For each six-month interval between July 1995 and December 2001, prescription data obtained from the Health Insurance Commission of Australia were converted into a measure of drug utilization expressed as the number of defined daily doses per thousand population per day (DDDs/1000/day).

Results: Between July 1995 and December 2001, use of atypical medications increased from an estimated 0.27 to an estimated 3.83 DDDs/1000/day. Use of oral conventional medications decreased from 1.76 to 0.91 DDDs/1000/day, while use of depot medications decreased from 1.38 to 0.96 DDDs/1000/day. During the latter half of 2001, atypical medications accounted for 67.3%, oral conventional medications for 16.0%, and depot medications for 16.7% of total prescriptions for antipsychotic medications dispensed through community pharmacies in Australia. The increased use of atypical medications was accounted for largely by a dramatic increase in the use of olanzapine. Between July 2001 and December 2001, prescriptions for olanzapine accounted for 65.0% of total prescriptions for atypical antipsychotic medications.

Conclusions: The results of the present study confirm that atypical antipsychotic medications have replaced conventional medications as the first-line pharmacological treatment for psychotic illness in Australia. While this change in prescribing practice is gratifying, the overwhelming preference for the use of olanzapine among clinicians prescribing antipsychotic medication is surprising and is of some concern given the significant increases in body weight that can accompany long-term use of this medication.
The Association Between Depression and Isotretinoin Use in Acne
Authors: Hong Ng Chee , Schweitzer Isaac
Published: March 2003

Objective: The association between isotretinoin and depression has received little attention in the psychiatric literature despite an increasing number of reports in medical journals. The purpose of this paper is to highlight this association, examine the possible link and review the clinical implications.

Method: A critical review of the literature pertaining to depression in patients with acne who were treated with isotretinoin was conducted.

Results and Conclusions: The causal relationship between isotretinoin therapy and depression has not been clearly established and needs further study. Isotretinoin is likely to have a positive psychological impact for the majority of patients who benefit from such a highly efficacious anti-acne treatment. However, it is important to recognize that depression can occur as an idiosyncratic side-effect that requires urgent and appropriate treatment. Therefore, having a low threshold for detection of this uncommon complication and early psychiatric referral to address both the depression and its contributing factors may prevent serious consequences.
IMPROVED PERCUTANEOUS INSERTION OF LONG‐TERM CENTRAL VENOUS CATHETERS IN CHILDREN: THE ‘SHRUG’ MANOEUVRE
Authors: Holland A. J. A. , Ford W. D. A.
Published: March 2003

Background: Surgical central venous access in children usually requires open exposure of the internal jugular vein or one of its tributaries. The percutaneous route has the potential advantages of a reduced rate of wound infection, superior cosmesis and reduced operating time. We report our modifications to the percutaneous approach that facilitate the application of this technique to children over the age of 12 months.

Methods: The dilator and peel‐away sheath of the introducer set should be inserted into the subclavian vein under fluoroscopic control. Elevation of the ipsilateral shoulder assists passage of the peel‐away sheath and subsequently the catheter from the subclavian vein into the superior vena cava.

Results: This technique has been used successfully to establish surgical central venous access in the majority of children at the Women’s and Children’s Hospital, Adelaide, South Australia, over a 3‐year period.

Conclusions: With the modifications described this technique may be safely applied to the paediatric age group.
A REVIEW OF COMPLEX TRAUMA TO THE ELBOW
Authors: Bain GREGORY I.
Published: March 2003

This paper presents a review of common complex elbow traumatic disorders. It presents an algorithm to aid in the management of these cases and discusses indications for radial head replacement and dynamic external fixateurs.
ROLE OF SELECTIVE INTRA‐OPERATIVE CHOLANGIOGRAPHY DURING CHOLECYSTECTOMY
Authors: Singh G. , Gupta P. C. , Sridar G. , Katariya R. N.
Published: March 2003

Background: The use of routine intra‐operative cholangiography (IOC) remains controversial. This prospective study was carried out to determine whether to perform selective or routine IOC in patients undergoing cholecystectomy for gallstones.

Methods: All consecutive patients undergoing open cholecystectomy over a 16‐month period were included in the present study. They were divided into two groups based on the absence (n = 79) or presence (n = 55) of indicators of choledocholithiasis. All patients were subjected to cholangiography. Each indicator, subsets of indicators and all indicators combined were evaluated for their ability to predict choledocholithiasis.

Results: There would be only two missed stones (1.5%) if selective cholangiography was to be practised. Intra‐operative cholangiography had a positive predictive value of 100%. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of all the indicators combined were 93.5%, 84.6%, 74.5%, 97.5% and 88.0%, respectively. The best indicators in each subset were jaundice, common bile duct diameter as assessed by ultrasonography, and a palpable stone during surgery with NPV of 82.7%, 91.1% and 96.8%, respectively.

Conclusion: Routine IOC during cholecystectomy is not essential for the prevention of retained stones. A combination of the various indicators of choledocholithiasis can be used to select patients for cholangiography.
Ultrasound‐assisted lipoplasty
Authors: Cooter Rodney , Babidge Wendy , Mutimer Keith , Wickham Peter , Robinson David , Kiroff George , Chapman Andrew , Maddern Guy
Published: March 2003

Background: Ultrasound‐assisted lipoplasty (UAL) has been associated with particular types of complications and uncertain long‐term effects arising from interactions between ultrasonic energy and living tissue. The present review seeks to address these issues.

Methods: Search strategy Three search strategies were devised to retrieve literature from Medline, Current Contents, Embase and Cochrane Library databases up until April 2000. Study selection Inclusion of papers was largely determined using a predetermined protocol. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials, case series or case reports. Data collection and analysis Thirty‐six papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding and chance. Other papers were also included to provide background material.

Results: There was little high‐level evidence available comparing UAL and suction‐assisted lipoplasty (SAL), with no conclusive evidence that UAL has a safety benefit, although low‐quality evidence suggests that UAL is associated with reduced surgeon fatigue as well as increased operating times, slower aspiration rates and an increased learning curve. There is inadequate evidence to determine whether the theoretical potential for DNA damage from ultrasound is realized in the clinical setting.

Conclusions: The evidence base for UAL is inadequate to determine the procedure’s safety and efficacy. The potential for DNA damage must be investigated with appropriate in vivo animal models. Recommendations for the safe use of UAL are discussed.
Metabolic and immunologic consequences of laparoscopy with helium or carbon dioxide insufflation: A randomized clinical study
Authors: Neuhaus Susan J. , Watson David I. , Ellis Tanya , Lafullarde Thierry , Jamieson Glyn G. , Russell W. John
Published: March 2003

Background: Previous studies using animal models have demonstrated that carbon dioxide (CO2) pneumoperitoneum during laparoscopy is associated with adverse physiological, metabolic, immunological and oncological effects, and many of these problems can be avoided by the use of helium insufflation. The present study was performed in patients to compare the effect of helium and CO2 insufflation on intraperitoneal markers of immunological and metabolic function.

Methods: Eighteen patients undergoing elective upper gastrointestinal laparoscopic surgery were randomized to have insufflation achieved by using either helium (n = 8) or CO2 (n = 10) gas. Intraperitoneal pH was monitored continuously during surgery, and peritoneal macrophage function was determined by harvesting peritoneal macrophages at 5 min and 30 min after commencing laparoscopy, and then assessing their ability to produce tumour necrosis factor‐α (TNF‐α), and their phagocytic function.

Results: Carbon dioxide laparoscopy was associated with a lower intraperitoneal pH at the commencement of laparoscopy, although this difference disappeared as surgery progressed. The production of TNF‐α was better preserved by CO2 laparoscopy, but the insufflation gas used did not affect macrophage phagocytosis. Patients undergoing helium laparoscopy required less postoperative analgesia.

Conclusion: The choice of insufflation gas can affect intraperitoneal macrophage function in the clinical setting, and possibly acid–base balance. The present study suggested no immunological advantages for the clinical use of helium as an insufflation gas. The outcomes of the present study, however, are different to those obtained from previous laboratory studies and further research is needed to confirm this outcome.
Creating self and shaping the world
Authors: Wilcock Ann A
Published: March 2003

Every day, through their daily occupations, people create and recreate themselves and shape the world in some way. This ongoing process is an important factor in maintaining or enhancing health for individuals and communities, as well as professional associations. It can also be a major determinant of dysfunction, disease, disability or death should regular engagement in occupation not meet the needs of the people or sustain a healthy environment. In order to illustrate how occupational therapists can create themselves and shape the world in a positive way, this paper tells the stories of three women, Octavia Hill, Elizabeth Casson and Betty McIntyre, who in different ways, places and times, pioneered our profession. The paper includes brief discussion about some of the influences on, and the influence of, these women and about how knowing and reflecting on their stories can influence our future. In part, this includes the need for us to understand the depth and strength of our heritage and the power of taking a proactive stance towards increasing sociopolitical awareness of occupational therapists’ distinctive and often unappreciated view of the relationship between occupation and health.
Quality of life: An overview of issues for use in occupational therapy outcome measurement
Authors: Liddle Jacki , McKenna Kryss
Published: March 2003

The concept of quality of life (QOL) has been used as an outcome measure to indicate the global health, functioning and wellbeing of a person following illness, injury or disability, and to evaluate the effectiveness of therapeutic interventions. Whilst QOL has been widely used for these purposes by researchers and practitioners in the health and social sciences, it has had limited application by occupational therapists. This has occurred despite the obvious links to occupational therapy philosophy, with both having a multifaceted, holistic, and client‐centred approach to people’s lives, and a concern with the roles and functions that give life meaning and value. This paper reviews QOL literature in order to introduce occupational therapists to the issues involved with using this construct, from its conceptualization to its measurement. A guide to the decision‐making processes involved in selecting an appropriate QOL outcome measure for use in occupational therapy practice is provided.
Holidays and celebrations as a spiritual occupation
Authors: Luboshitzky Dvora , Bennett Gaber Lee
Published: March 2003

Holistic occupational therapists acknowledge their responsibility in addressing the spiritual dimension of their clients. However, due to the difficulties in applying spirituality to practice, the role of occupational therapists in regard to their clients’ spirituality remains unclear. This study suggests that the celebration of holidays may be used as a meaningful activity for fulfilling clients’ spiritual needs. Holidays, which commemorate religious, national, or personal events, are a special time set apart from ongoing day‐to‐day existence. While the meaning of holidays has been widely discussed from a historical, anthropological, sociocultural, and educational point of view, little can be found in the literature regarding the therapeutic aspects of holidays. The present paper discusses four dimensions in the meaningful celebration of holidays and their therapeutic implications: religious; sociocultural; time management; and leisure. These dimensions are explored as foci of intervention in occupational therapy. Finally, recommendations for clinical practice accompanied by a case illustration are presented.
Deaf and Mentally Ill: Are Their Needs Being Met?
Authors: Briffa Dianne
Published: March 2003

The plight of the deaf person who has been admitted to or assessed by a mental health service has been recognised for over 30 years [ 1 , 3 – 6 ]. Even though studies have been carried out, recommendations made, and in some areas of the world, units set up specifically for the deaf, Australia is still far behind other countries in assisting our members of the deaf community, having only one assessment unit for the deaf in Sydney.
Psychiatrists Managing Change: Lost Control or at a Loss
Authors: Tobin Margaret , Wells Jayne
Published: March 2003

The RANZCP, in its role as a vehicle of influence and change within the psychiatric profession specifically and the mental health system generally, has recently and publicly recognised the implications of health system reform in Australia and New Zealand. In its strategic planning process, it has identified training and development of the fellowship as a critical component of preparing psychiatrists for their changing role in the new health environment [ 1 ]. The College has instigated a review (Review of Education and Training. 26 February 1999), with the objective of enabling psychiatrists to gain the skills, knowledge and attitudes which will equip them to work competently in a variety of emergent systems of delivery of mental health service.
Mental Health Service Models Queensland Style
Authors: Emmerson Brett , Yellowlees Peter , Brown Peggy , Davies John
Published: March 2003

The aim of this article is to describe the three administrative and three clinical organisational models which have evolved in Queensland's acute Mental Health Services in the last five years. The strengths and weaknesses of each model are highlighted.
Psychotherapy Supervision for Pre-Section I Trainees: Access, Equity and Quality
Authors: Burke David , Moore Michael , Newman Louise , Orr Fran
Published: March 2003

Supervision is a cornerstone of psychiatric training in Australia and New Zealand [ 1 ], and the problems that have arisen in the psychiatrist-trainee relationship in New South Wales (NSW) in recent years have been clearly identified [ 2 , 3 ].
The Elective Year: It's Far Too Short!
Authors: Brett Adam
Published: March 2003

The elective year is far too short! From the relief of passing your exams you are plunged into a new world of research. I will outline my elective year and show that with all the unexpected glitches and delays, to produce significant research in the allocated time frame is very difficult.
The Pacific Rim College of Psychiatrists
Authors: Singh Bruce S. , Minas Harry
Published: March 2003

The Pacific Rim College of Psychiatrists (PRCP) is an association of psychiatrists from countries bordering the Pacific. The College was formed in 1980 by a group of 56 psychiatrists from 10 countries — Canada, Hong Kong, India, Japan, Korea, Philippines, Sri Lanka, Taiwan, Thailand and the United States — with a prominent role having been played in the establishment of the College by academic psychiatrists associated with the Department of Psychiatry at the University of California, Los Angeles. Though primarily formed by academic psychiatrists, it has membership open to psychiatrists in any area of practice. The membership of the College is mainly made up of psychiatrists from the USA, Canada, Japan, South Korea, China, Hong Kong, and Taiwan, with Malaysia, Thailand, the Philippines and Australia each having a small number of members.
The Victorian Dual Disability Service
Authors: Bennett Chad
Published: March 2003

This paper aims to provide the context and model of the development of a new, innovative state-wide service for people with a mental illness and intellectual disability (Dual Disability). Preliminary data on referral patterns and assessments are also discussed
The Safe Way to Early Intervention: An Account of the SAFE (Southern Area First Episode) Project
Authors: Welch Mark , Garland Graham
Published: March 2003

“Early intervention and prevention in psychotic disorders is increasingly seen as having the potential to produce better outcomes for people who have developed these disorders.”[ 1 ] However, the operationalisation of this hypothesis is less clear, and the emphasis to date has been on specialised services within large metropolitan areas.

This paper will describe an initiative in the provision of best possible care in early psychosis undertaken by Southern Area Health Service, NSW, a small predominantly rural service with few resources and a scattered and attenuated population. It will demonstrate how a mainstreamed early intervention program can be effective and efficient, providing it pays careful attention to partnerships in early identification, and the absorption into the health service culture of sound principles, practices and processes.
The Use of “Safe Cells” in The Management of Suicidal and Violent Prisoners
Authors: Corcos Christopher D. , Lewin Robert D.
Published: March 2003

Objective: To survey psychiatrists' practice in the use of prison safe cells.

Method: The experiences, views and working protocols of Australia and New Zealand forensic psychiatrists in relation to authorisation of placement of prison inmates in safe cells were sought via a postal questionnaire.

Results: Despite a low response rate, most psychiatrists with clinical involvement in the area replied. There was a wide diversity of clinical practice, ethical standpoints, knowledge of and reference to practices in other parts of the world, and sense of priorities.

Conclusion: There appears to be considerable ambivalence and some discomfort in the role that psychiatrists in Australia and New Zealand are asked to play in the placement of prisoners in safe cells.
Mental Health Literacy Study of General Practitioners: A Comparative Study in Singapore and Australia
Authors: Parker Gordon , Lee Cheng , Chen Helen , Kua Joshua , Loh Jennifer , Jorm Anthony F
Published: March 2003

Objective: To compare responses to a mental health literacy survey by general practitioners in Singapore and Australia.

Method: Cross-sectional surveys of general practitioners were undertaken in Australia in 1996 (n = 872) and in Singapore in 1999 (n = 264). Questionnaires provided vignettes of schizophrenia and depression, and sought responses to a range of information assessing mental health literacy.

Results: The two groups returned generally similar responses, with high diagnostic accuracy and distinctly high agreement in judging the likely helpfulness of a range of resource people, activities and therapies. In addition to a few minor differences, the Singaporean practitioners tended to view outcome for the disorders more optimistically and to differentiate less in estimating outcome for the two disorders.

Conclusions: Previous reports of the responses by the Australian general practitioners had generally shown their views to be consistent with mental health professionals and, on several important parameters, discordant with the views of the Australian general public. This report highlights distinct similarities in general practitioner responses across cultures.
Training Directors' and Registrars' Views on Research Training in Australasian Psychiatry
Authors: Andrews Leah , Coverdale John , Turbott Sarah
Published: March 2003

Objective: To determine to what extent research skills are taught and how they are taught to psychiatrists-in-training across Australasia.

Method: Anonymous mail-out survey of training directors and trainee representatives on local training committees.

Results: The questionnaire was completed by 20 of 23 directors (response rate = 87%) who reported on 522 trainee psychiatrists. Formal seminars or lectures and journal clubs were the most commonly adopted methods of teaching (90% and 70% of programs respectively) while only two programs formally required trainees' participation in research. Epidemiologi-cal research methods, critical appraisal skills, ethical issues, and research design were the topics most commonly taught formally, and these were taught in 80% of programs or less. Only 33 (6.3%) trainees were involved in a research project that involved data collection.

Conclusions: Research skills were rather uniformly taught. The results are discussed in relation to identified areas for improvement.
Preparing Psychiatrists for a Changing World: Review of Training, Examinations and Continuing Education (Final Report)
Authors: Ranzcp
Published: March 2003

In October 2000, General Council supported the recommendations in the following Report and requested the Fellowships Board to consider the process for implementation of the recommendations and development of appropriate documentation. An Implementation Working Party is currently being formed.
The Development of a Clinic to Manage Disruptive Behaviour Disorders not Responding to Conventional Psychological and Psychostimulant Treatments
Authors: Vance Alasdair LA , Costin Jan , Birleson Peter , Luk Ernest SL , Tonge Bruce J , Maruff Paul
Published: March 2003

Objective: The development of a specialised Disruptive Behaviour Disorders clinic to assess, treat and monitor clinically referred primary school-age children with Attention Deficit Hyperactivity Disorder-combined type (ADHD-CT), oppositional defiant disorder (ODD) and conduct disorder (CD) who are not responding to conventional psychological and psychostimulant medication treatments is described.

Conclusions: Systematic clinical research and ongoing evaluation of complex Disruptive Behaviour Disorder cases is achievable within a metropolitan Child and Adolescent Mental Health Service.
Views of Psychiatrists and Trainees on Drug Company Involvement in CME Activities
Authors: Sara Grant , Prior Nigel
Published: March 2003

Objective: To report the views of Australasian Psychiatry readers about pharmaceutical industry involvement in CME activities.

Method: A discussion paper and fax-back survey form in a previous issue of Australasian Psychiatry sought views on specific areas of possible risk and several different strategic approaches which may be taken.

Results: 182 responses were received from a wide cross section of College Fellows. Views on our current strategy (prohibition) were highly polarised and weakly associated with gender, years since fellowship and state. There was strong support for declaration, engagement and education strategies.

Conclusions: There is much concern about the issue. Declaration, engagement and education strategies should be further developed.
Obsessive–Compulsive Disorder: Treatment and Treatment Resistance
Authors: Hood Sean , Alderton Deirdre , Castle David
Published: March 2003

Objective: To review the treatment options for obsessive–compulsive disorder (OCD), with particular reference to treatment resistance, and provide a guideline for clinicians managing these patients, drawing upon evidence from clinical trials and expert consensus.

Conclusions: The behavioural technique of exposure and ritual prevention (EX/RP) and serotonergic medications have emerged as effective standard treatments of OCD, although full symptom remission is rare. Predictors of poor and partial response to these treatments may reflect substantial underlying heterogeneity in OCD. Clinicians can now begin to apply psychological and pharmacological augmenting strategies that specifically target these heterogenous subgroups in an attempt to improve response. We offer a treatment algorithm for OCD derived from this understanding.
Clinical Psychology and The Common Good
Authors: Farhall John
Published: March 2003

Objective: From the perspective of a clinical psychologist within public mental health services, this paper aims to discuss factors that affect interdisciplinary teamwork, and to draw upon both the literature and practical experience to suggest approaches that may enhance the relationships between disciplines.

Conclusions: Barriers to interdisciplinary teamwork may be intergroup phenomena, organisational impediments or interpersonal processes. Intergroup barriers may be addressed through improved mutual awareness, adoption of shared frameworks, and the valuing of intellectual pluralism. Current organisational impediments, such as poor use of psychologists and confusion over team leadership, could be addressed by re-thinking in a more rational and collaborative way issues of specialist versus generic roles, and leadership in mental health teams. Most importantly, professional isolation perpetuates ignorance and breeds mistrust. Thus, the common good is most likely to be advanced if psychologists debate overarching goals and effective strategies jointly with consumers, carers and colleagues from other disciplines.
Inquiries — High Costs, Unacceptable Side Effects and Low Effectiveness: Time for Revision
Authors: Hobbs Paul
Published: March 2003

Objective: To review recent literature about inquiries into serious adverse incidents in mental health in order to generate discussion and change.

Conclusion: Inquiries held into serious adverse incidents have a number of limitations and problems. They are liable to over determine causes and to ignore “near miss” events. There is an excessive reliance on the value of risk assessment and a poor understanding of limitations of prediction, prevention, responsibility and blame. The role of experts is discussed. Inquiries can have serious consequences for clinicians and for the provision of services. Suggestions for improvement are made. Psychiatrists are advised to be prepared, more involved and more assertive.
A New Model for Postgraduate and Continuing Education in Psychiatry
Authors: Burke David
Published: March 2003

Objectives: To summarise changes in education and medical education which have influenced the development of a new model for postgraduate and continuing education in psychiatry, and to describe that model.

Conclusions: The NSW Institute of Psychiatry Postgraduate Course in Psychiatry has incorporated developments in problem-based learning in medical education, the modern principles of adult learning, the principles and practices of distance education, and selected advances in computerbased learning. The course is unique in postgraduate and continuing medical education, and is at the forefront of learning in psychiatry.
Social Work and The Mental Health Team
Authors: Bland Robert , Renouf Noel
Published: March 2003

Objective: The contributions of social work to the interdisciplinary team are described, along with opportunities for, and barriers to, effective teamwork.

Conclusions: Social work is concerned with the social context and consequences of mental illness on the individual, family and community. Social work serves to connect the treatment team to the broader issues of family welfare, housing, income security, and community and sense of belonging. This broader focus and the social justice framework for social work can create tension between social work and other disciplines. Both undergraduate and postgraduate education for social workers remain a challenge, given the complexity and demands of the mental health workplace.
From Good Foundations: The Role of Treatment Guidelines for Psychiatrists - An Overview of The RANZCP CPG Project
Authors: Boyce Philip , Harris Meredith , Penrose-Wall Jonine
Published: March 2003

Objectives: To provide an overview on the role of evidence-based clinical guidelines in the context of the consultation, dissemination and implementation planning phases of the new RANZCP guidelines for psychiatrists and other specialist mental health care providers.

Conclusions: Despite a vast literature on guidelines and evidence-based practice in general medicine and allied health, little is published on these themes in mental health. Anxieties about the introduction of guidelines often surface during the consultation stage of developing new guidelines and provide clues to barriers for implementation. Facilitating discussion about the pros and cons of guidelines is prudent for informing dissemination planning and is a necessary precursor to any programs intended to achieve implementation. Guidelines must reflect a fit between clinician aspirations, the evidence, and consumer expectations if they are to be adopted into routine service delivery. The six RANZCP guidelines will be foundation documents to ensure that all practitioners have access to the basic tools to guide practice. In particular, they will contain the evidence status and rationale behind recommended treatments, so that this information can be at hand or committed to memory to justify and share clinical decision making with consumers.
The Greater Murray Accessline
Authors: Wilson Andrew , Cullen Matthew
Published: March 2003

Objective: To provide an overview of the service delivery model and operational data for a technology-enabled rural mental health triage and case management programme. Implications for other mental health services will be discussed.

Method: Naturalistic descriptive data collection and analysis using the service provider's telephony and clinical information systems. Service utilisation, sociodemographic and illness variables are reported as well as consumer and provider satisfaction data obtained via survey.

Results: Over 25,000 telephone contacts occurred during the eighteen-month period reported. Approximately 40% were triage calls with the remainder related to telephone-based case management. A wide variety of user groups were identified with utilisation by the indigenous population significantly higher than expected (12% of total contacts). Ninety five per cent of consumers rated the service as being satisfactory or higher. A trend was observed for reduced use of inpatient resources.

Conclusions: This paper confirms international data supporting the value of technology driven, protocol-based triage and case management. Delivery of telephone-based contacts within a mental health service can be successfully achieved from a geographically remote site and may provide significant benefits for the delivery of rural mental health services.
Psychotherapy in Hollywood Cinema
Authors: Gabbard Glen
Published: March 2003

Objective: To describe the portrayal of psychotherapy in Hollywood cinema. This may reveal popular myths and fantasies about this therapeutic modality.

Conclusions: The perceived omniscience of psychiatrists is both envied and feared, and psychiatrists are continually denigrated to neutralise these feelings. Movies reflect this process by seeking to show that psychiatrists have the same human frailties as everyone else.
Do Patients Expect Psychiatrists to be Interested in Spiritual Issues?
Authors: D'Souza Russell
Published: March 2003

Objective: To carry out a pilot study surveying the spiritual attitudes and needs of patients with a psychiatric illness at the Centre of Excellence in Remote and Rural Psychological Medicine, Broken Hill Base Hospital, NSW.

Method: A questionnaire consisting of 6 questions was completed by 79 patients.

Results: It was found that 79% of the patients rated spirituality as very important and 82% thought their therapists should be aware of their spiritual beliefs and needs. Sixty-nine per cent of the patients reported that patients's; spiritual needs should be considered by the therapist in treating their psychological illness and 67% said that their spirituality helped them cope with their psychological pain.

Conclusion: The majority of patients said spirituality was important to them and that they wanted their therapist to take their spiritual needs into consideration in the assessment and management of their illness.
A Muslim Suicide
Authors: Sarfraz M. Aamer , Castle David
Published: March 2003

Objective: To describe the case of a young Muslim male who completed suicide and discuss the implications in terms of his religion.

Method: Case Report.

Results: The patient's suicide occurred on the background of parental expectations regarding his career, criticism of his interests and lifestyle, and the development of a depressive illness. The aftermath was characterised by the family being rejected by their community because of the stigma associated with suicide in the religion.

Conclusions: It is a myth that suicide is rare among Muslims. Muslim communities need to be re-educated about suicide phenomena through their leaders at home and abroad.
Pain from Many Inputs
Authors: Pridmor Saxby , Oberoi Gajiende , Samilowitz Hazel
Published: March 2003

Objective: In keeping with the best scientific principles, modern medicine hankers after single aetiological agents. In our clinical observations, however, chronic pain is usually the result of many inputs. The objective was to review the etiological theories of pain, with a view to identifying potentially important inputs.

Conclusion: Many potential inputs were identified, including, 1) CNS sensitization following injury, 2) impoverished interpersonal skills, 3) fear of pain and avoidance of movement, 4) care eliciting behaviour, 5) concurrent mental disorder, 6) protracted litigation, and 7) anger toward a wide range of individuals, including doctors and lawyers. In none of the reviewed theories was it necessary that the factor they supported be the only active one. It is probable that chronic pain is often the result of many inputs.
The Development of Clinical Guidelines for the Use of Zuclopenthixol Acetate
Authors: Barnes Caryl W. , Alderton Deidre , Castle David
Published: March 2003

Objective: This paper illustrates the process that was undertaken in the development of guidelines for the use of Zuclopenthixol Acetate (ZA) and presents the guidelines that were developed at the end of this process.

Conclusions: A number of investigations were undertaken to inform the above process, including: (i) A questionnaire sent to College Fellows and psychiatric registrars, to assess their use of ZA in the management of acute arousal in psychosis. This highlighted the lack of confidence that clinicians had in using ZA and some deficits in knowledge that confirmed the local need for such guidelines; (ii) A retrospective audit of the use of ZA in two psychiatric intensive care units over a 6 month period. This revealed significant differences between the centres in the manner in which ZA was prescribed; (iii) A review of published studies on ZA.
Depression in Young People: A National School-Based Initiative for Prevention, Early Intervention and Pathways for Care
Authors: Burns Jane , Hickie Ian
Published: March 2003

Objective: To describe the national school-based initiative of ‘beyondblue’.

Conclusions: The goals of the initiative are: to reduce levels of depressive symptoms in young people, to promote emotional well-being in adolescence and to increase the capacity of organisations to design, implement and evaluate interventions relevant to the prevention of depression. The theoretical framework underpinning the program will build on expertise and evidence-based research from both the education and health sectors while the proposed initiative will draw on the existing capacity of school systems. The program will target not only the specific needs of individual students but will combine this targeted approach with a whole-school approach that addresses the quality of the social climate in which the individual is situated. The intervention strategy in partnership with the education sector will seek to make changes in the schools' social and learning environments, introduce relevant and important life skills through the curriculum, and strengthen structures that promote links between the school, families and communities.
When You're Smiling does the Whole World Smile for You?
Authors: Gladstone Gemma , Parker Gordon
Published: March 2003

Objective: To summarise and review findings from a longitudinal study examining the predictive significance of authentic smiling.

Conclusions: A smile captured at one point in time (i.e. in a college photograph) was modestly but significantly associated with less self-reported negative emotionality and more perceived self-competence in a sample of women followed up over several years. Smiling also had a favourable influence upon observer judgements, with subjects who smiled being judged as more likeable and approachable than non-smilers and non-authentic smilers. Authentic smiling in adults is probably a behavioural marker of various helpful or protective psychological qualities fuelled at least moderately by temperament. Variation exists in smiling behaviour like it does in any other individual difference, but the very act of smiling might even serve as a kind of self-fulfilling prophecy - so smile more, but don't fake it!
Choosing a Psychodynamic Psychotherapy Model for an Australian Public Sector Mental Health Service
Authors: Petchkovksy Leon , Morris Philip , Rushton Paul
Published: March 2003

Objective: To choose models of psychodynamic psychotherapy that will work within the characteristics and constraints of Public Sector mental health practice without compromising nuancing and depth.

Conclusions: The authors briefly describe the development of the Gold Coast Integrated Mental Health Services Psychotherapy Programme, and the processes which have informed their selection of suitable psycho-dynamic models. They recommend IPT (Interpersonal Therapy) and the Conversational Model.