bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing Cost-Effectiveness of Drug Interventions for Schizophrenia
Authors: Magnus Anne , Carr Vaughan , Mihalopoulos Cathrine , Carter Rob , Vos Theo 
Published: December 2009

Objective: To assess from a health sector perspective the incremental cost-effectiveness of eight drug treatment scenarios for established schizophrenia. Method: Using a standardized methodology, costs and outcomes are modelled over the lifetime of prevalent cases of schizophrenia in Australia in 2000. A two-stage approach to assessment of health benefit is used. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted, using best available evidence. The robustness of results is tested using probabilistic uncertainty analysis. The second stage involves application of ‘second filter’ criteria (equity, strength of evidence, feasibility and acceptability) to allow broader concepts of benefit to be considered. Results: Replacing oral typicals with risperidone or olanzapine has an incremental costeffectiveness ratio (ICER) of A$48 000 and A$92 000/DALY respectively. Switching from low-dose typicals to risperidone has an ICER of A$80 000. Giving risperidone to people experiencing side-effects on typicals is more cost-effective at A$20 000. Giving clozapine to people taking typicals, with the worst course of the disorder and either little or clear deterioration, is cost-effective at A$42 000 or A$23 000/DALY respectively. The least costeffective intervention is to replace risperidone with olanzapine at A$160 000/DALY. Conclusions: Based on an A$50 000/DALY threshold, low-dose typical neuroleptics are indicated as the treatment of choice for established schizophrenia, with risperidone being reserved for those experiencing moderate to severe side-effects on typicals. The more expensive olanzapine should only be prescribed when risperidone is not clinically indicated. The high cost of risperidone and olanzapine relative to modest health gains underlie this conclusion. Earlier introduction of clozapine however, would be cost-effective. This work is limited by weaknesses in trials (lack of long-term efficacy data, quality of life and consumer satisfaction evidence) and the translation of effect size into a DALY change. Some stakeholders, including SANE Australia, argue the modest health gains reported in the literature do not adequately reflect perceptions by patients, clinicians and carers, of improved quality of life with these atypicals.
Changing Demand for Mental Health Services in the Emergency Department of a Public Hospital
Authors: Kalucy Ross , Thomas Lyndall , King Diane 
Published: December 2009

Objective: Deinstitutionalization and mainstreaming may have contributed to increased attendance in public emergency departments by people with mental health problems. This study describes changing patterns of attendances by patients with mental health problems to the emergency department (ED) of a public teaching hospital in Adelaide, South Australia. Method: Records from a 10-year period from the ED were examined to identify changes in the number of, and diagnoses for, patients attending for primarily mental health concerns. Admission rates, detention and length of stay (LOS) were also examined in an attempt to identify trends. Results: A tenfold increase in the number of patients attending the ED with primarily mental health problems has occurred over the 10-year period. This is within the context of relatively stable total ED presentations. The increase has been observed in all diagnostic categories although the greatest increase, by percentage, has been for psychotic disorders. A lesser increase was observed for patients presenting with overdose. People presenting with psychotic disorders are also more likely to be detained and admitted. LOS in the ED has also increased along with increasing demand. Conclusions: Reasons for the increased demand are likely multifactorial. While deinstitutionalization and mainstreaming have contributed, the closure of the ED at the local psychiatric hospital does not account entirely for the change. Insufficient community-based mental health services may also contribute to the reasons why people present to the ED and lack of inpatient beds contributes to the increasing LOS experienced in the ED.
The Health of the Nation Outcome Scales for Children and Adolescents in an Adolescent In-Patient Sample
Authors: Harnett Paul H. , Loxton Natalie J. , Sadler Trevor , Hides Leanne , Baldwin Andrea 
Published: December 2009

Objective: The primary aims of the study were to examine the reliability and validity of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) in a sample of adolescents requiring medium to long-term in-patient psychiatric treatment and to examine the association between HoNOSCA scores and age, gender and length of treatment. Methods: A multidisciplinary team completed the HoNOSCA for 51 adolescent patients at intake and at 3- and 6-months following admission to the unit. Results: The study provided support for the test-retest reliability, concurrent and convergent validity, but not the internal reliability, of the HoNOSCA. Total HoNOSCA scores at intake were similar to those found in adolescent outpatient samples, although there were some differences at the level of individual items. Similarly, while the total HoNOSCA score showed some sensitivity to change, using the total HoNOSCA score obscured important changes in specific domains of functioning over the course of admission. Conclusion: The HoNOSCA was found to be a valid measure of global functioning at intake, thereby supporting its use in an adolescent psychiatric unit. However, focusing on individual items, rather than total score, appears more useful in evaluating the impact of inpatient psychiatric treatment on adolescents.
The Reynolds Adolescent Depression Scale in New Zealand Adolescents
Authors: Walker Lyndon , Merry Sally , Watson Peter D. , Robinson Elizabeth , Crengle Sue , Schaaf David 
Published: December 2009

Objective: To examine aspects of the reliability and validity of the Reynolds Adolescent Depression Scale (RADS) in measuring depression in New Zealand adolescents of all major ethnic groups. Method: A sample of 9699 randomly selected New Zealand secondary school students participated in the Youth2000 Health and Wellbeing Survey which included the RADS. Data from this survey have been used to assess some aspects of the reliability and validity of the RADS in the New Zealand context across different ethnic groups. Cronbach's alpha, itemtotal score correlations, correlation to other questions and a factor analysis were done in order to examine the internal reliability, content validity, convergent validity and construct validity of the data and compare to the original Reynolds validation study. Results: Tests of the scale resulted in scores over 0.90 on Cronbach's alpha and high itemtotal score correlations, with a median correlation of 0.62 and 25 of the 30 correlations measuring more than 0.5. The scores were found to have similar factor structure to the original scale and the correlations to other depression related questions indicate acceptable concurrent validity. Conclusions: On all of the tests conducted, the RADS was found to have acceptable reliability and validity for New Zealand adolescents across the major different ethnic groups, indicating that it is a valid and appropriate instrument to use with New Zealand adolescents.
Serotonergic and Dopaminergic Systems in Anorexia Nervosa: A Role for Atypical Antipsychotics?
Authors: Bosanac Peter , Norman Trevor , Burrows Graham , Beumont Peter 
Published: December 2009

Objective: To review serotonergic and dopaminergic system function in anorexia nervosa in terms of potential modulation by atypical antipsychotic medications. Method: A systematic review of clinical, neurobiological and functional neuroimaging findings of serotonergic and dopaminergic system activity in anorexia nervosa was conducted via MEDLINE, PsycINFO and EMBASE psychiatry databases, with a critical review of dysregulation of these systems as therapeutic targets for atypical antipsychotics, in context of evidence regarding the utility and efficacy of these medications in this syndrome. Results: There is evidence of persistently altered serotonergic and dopaminergic function in anorexia nervosa independent to weight-recovery. Case reports, open-label and singleblinded studies, albeit sparse, suggest that atypical antipsychotics may be beneficial in the management of anorexia nervosa psychopathology beyond weight gain. Conclusions: Double-blind placebo controlled studies of atypical antipsychotics in anorexia nervosa with well defined outcome measures are required.
Staying Well with Bipolar Disorder
Authors: Russell Sarah J. , Browne Jan L. 
Published: December 2009

Objective: The research aimed to investigate how people diagnosed with bipolar mood disorder avoided episodes of illness and managed to stay well. The research also examined the role that personal, social and environmental factors played in helping people with bipolar mood disorder to stay well. Method: This project used a combination of qualitative research methods. The design contained three (3) components: recruitment from general community, preliminary written questionnaire and semistructured interviews. To meet the criteria for inclusion, the participant must have stayed well for the past 2 years. The two main analytical categories were ‘stay well concept’ and ‘strategies to stay well’. The main category ‘strategies to stay well’ contained a number of subcategories. These subcategories were acceptance of diagnosis, mindfulness, education, identify triggers, recognize warning signals, manage sleep and stress, make lifestyle changes, treatment, access support, and stay well plans. Results: 100 people were eligible for inclusion in the study. The sample included 63 women and 37 men. The ages ranged from 18 to 83 years, with 86% over the age of 30. Duration of time since last episode of illness ranged from 2 years to < 50 years. In the sample, 76% of participants were in paid employment. In addition, 36% of participants were parents. Participants actively managed bipolar disorder by developing a range of strategies to stay well. These strategies were based on participants' individual needs and social contexts. The strategies included acceptance of the diagnosis, education about bipolar disorder, identifying both triggers and warning signals, adequate amounts of sleep, managing stress, medication and support networks. Conclusion: Staying well involved participants being mindful of their illness, which enabled them to develop an individual stay-well plan, including intervention strategies to prevent episodes of illness.
Clinical Management for Hospital-Treated Deliberate Self-Poisoning: Comparisons between Patients with Major Depression and Borderline Personality Disorder
Authors: Carter Gregory L. , Lewin Terry J. , Stoney Carolyn , Whyte Ian M. , Bryant Jennifer L. 
Published: December 2009

Objective: To compare the initial clinical management of hospital-treated deliberate selfpoisoning patients with major depressive disorder (MDD) or borderline personality disorder (BPD) after controlling for demographic factors and level of suicide ideation. Method: This study compared sequential hospital treated deliberate self-poisoning patients (n = 570) with either MDD or BPD (but no major comorbid psychopathology) on four outcomes modelled using logistic regression: (i) length of stay in the general hospital; (ii) discharge to a psychiatric hospital; (iii) psychiatric follow-up; and (iv) general practitioner (GP) follow-up. Results: BPD and MDD patients were discharged to psychiatric inpatient care at very similar rates (33%–35%) and almost all subjects with high levels of suicidal ideation were discharged to psychiatric hospital. However, for mild to moderate levels of suicidal ideation BPD patients were more likely to be discharged to psychiatric hospital than MDD patients. After controlling for demographics and suicidal ideation, BPD patients were more likely to be referred for psychiatric hospitalization on discharge (adjusted OR = 1.79, 95% CI = 1.01–3.18) and less likely to be referred to GPs if discharged to home (adjusted OR = 0.44, 95% CI = 0.24–0.81). There were no differences in general hospital length of stay or arrangements made for psychiatric follow-up for those discharged to home. Conclusions: This suggests that for mild to moderate suicidal ideation levels clinicians are more likely to choose to send BPD patients, after deliberate self-poisoning, to inpatient psychiatric care than MDD patients. Clinicians are also apparently more likely to choose to manage MDD patients in primary care settings, for those patients discharged to home. This has implications for service planning and clinical guidelines.
Role of Omega-3 Fatty Acids as a Treatment for Depression in the Perinatal Period
Authors: Rees Anne-Marie , Austin Marie-Paule , Parker Gordon 
Published: December 2009

Objectives: To consider the possible rationale and utility of omega-3 fatty acids as a treatment for depression in the perinatal period. Method: A review of published and unpublished research was undertaken, using electronic databases, conferences proceedings and expert informants. Results: Relevant bodies of evidence include an epidemiological link between low fish intake and depression. Laboratory studies show correlations between low omega-3 fatty acid levels and depression, as well as reduced levels of omega-3 in non-depressed women during the perinatal period. Treatment studies using omega-3 in patients with mood disorders further support an omega-3 contribution, as do neuroscientific theories. Research into omega-3 and infant development also highlights potential effects of depletion in the perinatal period and supports infant safety and benefits of supplementation. Conclusions: There is a relative lack of knowledge about the safety of standard antidepressants in the perinatal period. There is a clear need for more research into alternative treatments, such as omega-3 fatty acids, in the management of depression in the perinatal period.
Ole Taeao Afua, the New Morning: A Qualitative Investigation Into Samoan Perspectives on Mental Health and Culturally Appropriate Services
Authors: Tamasese Kiwi , Peteru Carmel , Waldegrave Charles , Bush Allister 
Published: December 2009

Objectives: The first objective was to develop a culturally appropriate research method to investigate Samoan perspectives on mental health issues. The second objective was to apply this to identify cultural values and understandings important in the care and treatment of Samoan people with mental health problems. Method: Gender-specific focus groups consisting of Samoan elders and service providers were facilitated by Samoan researchers in the Samoan language. Systematic analysis of the transcripts, adapted to the cultural context, were conducted in Samoan and later translated into English. Results: A culturally derived method, referred to as Fa'afaletui, reflecting Samoan communal values and familiar institutional structures within the community, allowed each focus group to come to a consensual view on issues discussed. The Samoan self was identified as an essential concept for understanding Samoan views of mental health. This self was described as a relational self and mental wellness as a state of relational harmony, where personal elements of spiritual, mental and physical are in balance. Mental ill health was sometimes linked to breaches of forbidden and sacred relationships, which could be addressed effectively only within protocols laid down in the culture. Additional stressors contributing to mental ill-health were identified as low income, unemployment, rising housing costs and the marginalization of Samoan cultural norms in New Zealand. Participants identified the need for a culturally based mental health service for Samoan people to address key cultural factors. Conclusions: The Fa'afaletui method is a new research method which is sensitive and responsive to Samoan cultural norms and is methodologically rigorous. Such an approach may be relevant for other Pacific Island cultures and other cultures, which have a strong emphasis on collectivity. The Samoan concept of self provides a theoretical foundation for understanding the mental health needs of Samoan people and a basis for developing appropriate services.
Cortical Release Signs in Psychiatry
Authors: Walterfang Mark , Velakoulis Dennis 
Published: December 2009

Objective: To review the role of cortical release signs (CRS) in neuropsychiatry. Method: A thorough literature review was conducted using Medline and Psychlit databases, and other relevant references available to the authors. Results: A number of neurological abnormalities are reported at elevated rates in neuropsychiatric conditions. CRS are a group of primitive reflexes that are present in the neonate but become inhibited as the infant central nervous system (CNS) develops, only to later re-emerge in the context of CNS disease. The clinical elicitation and interpretation of each CRS is described with reference to its neurobiology. The prevalence of CRS in schizophrenia, affective disorder, obsessive-compulsive disorder, Alzheimer's disease, vascular dementia, frontotemporal dementia and other neuropsychiatric illness allows for their use in the clinical management of these patients, including diagnostic assessment, treatment monitoring and prognosis. Conclusions: A number of issues complicate their interpretation in neuropsychiatric illness, including the apparent high base rate of some CRS in non-clinical populations, their increasing prevalence with age, lack of specificity and uncertainty over what constitutes an ‘abnormal’ response. In some circumstances, CRS may assist in diagnostic differentiation and illness staging.
Characteristics of Internalizing and Externalizing Disorders in Medication-Naïve, Clinically Referred Children with Attention Deficit Hyperactivity Disorder, Combined Type and Dysthymic Disorder
Authors: Sanders Michelle , Arduca Yolanda , Karamitsios Mary , Boots Marilyn , Vance Alasdair 
Published: December 2009

Objective: Internalizing and externalizing disorders are frequently comorbid with attention deficit hyperactivity disorder, combined type (ADHD-CT) and dysthymic disorder (DD) in referred primary school-age children, yet there has been relatively little systematic research of the nature of these comorbid disorders. We describe the characteristics of parent- and child-reported internalizing and externalizing disorders in primary school-age children with ADHD-CT and DD. Method: A cross-sectional study of 45 clinically referred medication naïve children with ADHD-CT and DD, examining parent and child reports of internalizing and externalizing disorders, defined categorically and dimensionally. Results: Generalized anxiety disorder and separation anxiety disorder were increased in the DD groups, whether ADHD-CT was present or not. Major depressive disorder was increased in the ADHD-CT and DD group compared to the ADHD-CT alone and the DD alone groups. Conduct disorder was increased in the ADHD-CT alone group compared to the DD with and without ADHD-CT groups. Verbal and fullscale IQ were increased in the DD groups, whether ADHD-CT was present or not, compared to the ADHD-CT alone group. Conclusions: There is emerging evidence that DD and anxiety may represent a different phenotypic expression of a common underlying aetiological process, while the co-occurrence of ADHD-CT and anxiety disorders remains unclear. Only the ADHD-CT and DD group is significantly associated with major depressive disorder, which suggests an additive effect. In contrast, conduct disorder and decreased verbal and fullscale IQ are only associated with the ADHD-CT group, which may suggest a protective effect of DD when comorbid with ADHDCT. From a research perspective, it is important to confirm these found associations in larger samples derived from epidemiological populations.
Similarities and Differences Between Aggressive and Delinquent Children and Adolescents in a National Sample
Authors: Rey Joseph M. , Sawyer Michael G. , Prior Margot R. 
Published: December 2009

Objective: To examine differences in the correlates, comorbidity and use of services between aggressive and delinquent children and adolescents. Method: An Australian representative sample (n = 4083) of parents of children and adolescents were administered a psychiatric diagnostic interview, the Child Behaviour Checklist, and other instruments to measure service use. The characteristics of children with high scores (top 5%) in the aggressive and delinquent syndromes or both were then examined. Results: The proportion of aggressive children decreased with increasing age while that of delinquents increased. The aggressive group was specifically associated with the impulsivehyperactive subtype of attention deficit hyperactivity disorder (ADHD) (OR = 12.63; 95% CI = 5.97–26.74). Comorbidity between ADHD, aggression and delinquency was less frequent among adolescents than in children, with the exception of the inattentive subtype in which comorbidity was higher. Both aggressive and delinquent groups had a considerable overlap with conduct disorder. Aggressive and delinquent youths used services more often, but parents perceived aggressive children as more in need of help than delinquent ones. Living in a sole parent family was specifically associated with the delinquent group (OR = 3.34; 95% CI = 2.25–4.96). Conclusions: The results suggest that these empirically derived syndromes while sharing many features also differ in important ways, highlighting the need for further convergence between categorical and dimensional classifications. Their differential association with the subtypes of ADHD requires further examination and may help to understand the relationship between ADHD and conduct problems. The importance of aggressive behaviour in children should not be underestimated since it is associated with significant psychopathology, parental distress and use of services.
Prevalence of Intellectual Disability and Comorbid Mental Illness in an Australian Community Sample
Authors: White Paul , Chant David , Edwards Niki , Townsend Clare , Waghorn Geoff 
Published: December 2009

Objective: The aim of this study was to bring to light the high prevalence of Australians affected by intellectual disability and comorbid serious mental illnesses. Results from a broad scale study are used to explore the reasons for this regularly overlooked phenomenon. Methods: This study was based on secondary analysis of data collected in the national ‘Disability, Ageing and Carers Survey, 1998’. The analysed data consisted of an Australian wide sample of 42 664 individuals living at home or in cared accommodation. Classification of intellectual disability and comorbid psychosis, anxiety and depressive disorder was based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Results: The prevalence of intellectual disability in the sampled population was 1.25%. Of these people 1.3% had a psychotic disorder, 8% had a depressive disorder and 14% had an anxiety disorder that had been present for at least 6 months and was of such severity that it too was disabling. Conclusions: Findings indicate that people with intellectual disability are at high risk of developing comorbid serious mental illness. Dual diagnosis is however, often overlooked due to difficulties associated with establishing a diagnosis of a mental disorder in people with an intellectual disability, a problem which is heightened when the individual's capacity to participate in a clinical assessment is limited.