bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differential Effects of GdCl3‐ or MDP Treatment on Rat Liver Microcirculation and Gene Expression in the Hepatic Non‐Parenchymal Cell Fraction in LPS Shock
Authors: Henrich Dirk , Lehnert Mark , Herzog Carsten , Niederlaender Stephan , Relja Borna , Conzelmann Lars , Marzi Ingo 
Published: December 2009

ABSTRACTBackground:Dichloromethylenebisphosphonate (MDP) and gadolinium chloride (GdCl3) are substances frequently used for experimental depletion of Kupffer Cells (KC) in models of endotoxin shock. The aim was to determine whether depletion of KC through pretreatment with GdCl3or MDP alters the hepatic microcirculation during lipopolysaccharide (LPS)‐induced shock in rats and to test if there are substance‐specific differences.Methods:Rats received either MDP or GdCl3or saline prior to induction of LPS shock. Hepatic microcirculation was evaluated by intravital microscopy (sinusoidal diameter, sinusoidal bloodflow, leukocyte adhesion), and the gene expression in the hepatic non‐parenchymal cell fraction was determined by RT‐PCR.Results:GdCl3pretreatment prevented sinusoidal narrowing but did not restore sinusoidal blood flow and did not normalize leukocyte‐endothelial interaction time after LPS. In contrast, MDP pretreatment improved hepatic microcirculation consistently for all parameters measured compared to GdCl3pretreated animals. In the non‐parenchymal cell fraction, eNOS gene expression was preserved and gene expression of TNF‐α was blocked after MDP but not after GdCl3application prior to LPS shock.Conclusions:The results show that GdCl3and MDP cannot be used equivalently for experimental KC depletion in the condition of LPS‐induced shock. These findings should be taken into consideration in studies that evaluate the role of Kupffer cells in models of endotoxin‐induced shock.
Responding to Serious and Complex Mental Health Problems in Youth: The Role of an Interagency Forum
Authors: Lee Erica , Dillon Alana , Dorries Valda , Beech Michael , McDermott Brett 
Published: December 2009

Objective: To review the origins, processes, clientele and outcomes of a child and youth interagency forum, a collaborative response to children and youth with severe and complex presentations. Methods: After a description of the Forum origins, membership and processes, both qualitative and quantitative information is provided on the Forum clientele. The Forum's effectiveness is considered in terms of changes in services provided to this group, as well as changes in agency and interagency work practices. Results: Forum clients were predominantly boys aged 12 years, with an overrepresentation of indigenous and intellectually disabled children. Few lived with biological parents, and on average had experienced five schools, 11 or more residential placements and were involved with six agencies. Disruptive behaviour symptoms were common, as were suicidal thoughts or actions (43%), history of physical (50%) or sexual abuse (21%), alcohol (29%) and drug use (14%). On average Forum clients were taking three psychotropic medications. Forum client impairment ranged from major impairment to gross impairment across several domains. Conclusions: While this is not a formal outcome study, evidence suggesting Forum usefulness included qualitative feedback from agencies, altered clinical and interagency practices, and decreased client impairment. Practical interventions for clients with chronic, complex multidomain impairments are discussed in the context of current Australian child and adolescent mental health services.
Policy, Structural Change and Quality of Psychiatric Services in Australia: The Views of Psychiatrists
Authors: Rey Joseph , Walter Garry , Giuffrida Michael 
Published: December 2009

Objective: Given that 10 years have elapsed since the implementation of Australia's National Mental Health Strategy, the aim of the paper was to ascertain the views of the country's psychiatrists about changes in mental health services. Methods: A survey was mailed to all Fellows of the Royal Australian and New Zealand College of Psychiatrists living in Australia; 1039 out of 2059 (50%) returned the questionnaire. Results: Private care has not changed much in the last 5 years, but the quality in public psychiatric services has deteriorated. While 67% of private practitioners, 46% of psychiatrists with mixed practice, 39% of exclusively public psychiatrists and 27% of academics believed public practice had deteriorated, only 18% of psychiatrist administrators believed that to be the case. Daily or weekly problems admitting patients to hospital was reported by 40% of psychiatrists working in the public system. Public psychiatrists believed that they now treat more patients who are more disturbed, more acute and more demanding. However, they see their patients less often, provide less psychotherapy and use more medication. Administrative demands have increased. Conclusions: According to psychiatrists, implementation of the National Mental Health Strategy has not yet resulted in better psychiatric care in the public health system.
The Psychological Impact of Complaints and Negligence Suits on Doctors
Authors: Nash Louise , Tennant Christopher , Walton Merrilyn 
Published: December 2009

Objective: To describe the psychological impact of complaints and negligence litigation on doctors. Methods: A review of the literature from 1966 to 2003 was conducted. Additional sources were obtained from targeted experts and organizations. Results: Doctors who have been sued or who have had formal complaints made against them describe the process as an extremely stressful experience. Depression and adjustment disorder were relatively common, while drug and alcohol abuse, physical illness and suicidal ideation were reported less frequently. The majority of doctors who have been the subject of a complaint or law suit practice more ‘defensively’. Conclusions: A complaint or law suit is uncommon in the daily practice of doctors, yet in today's medicolegal environment they pose a constant potential threat. The threat of, or actual, legal process can cause psychological, physical and behavioural practice changes. The obsessional personality of many doctors may make them particularly vulnerable to seeing the process as a challenge to their professional and personal identity.
Antwone Fisher: How Dangerous is ‘Dr Wonderful’?
Authors: Macfarlane Stephen 
Published: December 2009

Objective: To describe the style of psychotherapy portrayed in the film Antwone Fisher. The rationale for this examination is that prospective patients often have little idea about what the process of psychotherapy may involve; depictions of therapy in popular films and on television serve to ‘prime’ our patients' expectations in this regard. Conclusions: The film in question shows a psychiatrist who might be readily perceived as unambiguously good by a lay audience, despite a number of clear therapeutic boundary violations occurring throughout the film. Although such positive depictions might enhance the public image of psychiatry, they have the potential to create unreal expectations within patients and to promote the acceptability of boundary violations.
‘Like Minds, Like Mine’: A New Zealand Project to Counter the Stigma and Discrimination Associated with Mental Illness
Authors: Vaughan Gerard , Hansen Chris 
Published: December 2009

Objective: To demonstrate how mass media advertising and community education has been successfully used in New Zealand as part of a comprehensive public health project to reduce stigma and discrimination associated with mental illness. Conclusions: The involvement of people with experience of mental illness in the campaign has been critical to its success. Advertising involving the stories of well-known and famous people who have experienced mental illness has created significant interest, awareness and improved attitudes among the general public. Local community education and other follow-up activities have also contributed to this success.
Bloomsday 100: The Making of a Literary Legend
Authors: Kaplan Robert M. 
Published: December 2009

Objective: As a background to the centenary of Bloomsday, to explore the circumstances in which James Joyce wrote Ulysses, noting the autobiographical elements and unique style, including the stream-of-consciousness technique that depicted the inner life of the characters. Selected quotations are used to illustrate these points. Joyce wanted to show that the epic and the heroic is in our lives every day. Conclusions: Ulysses defined the literary consciousness of the 20th century. By basing the novel about a day in the life of three ordinary characters on Homer's epic account of an 18 year voyage, Joyce re-established the link between 20th century consciousness and classical times.
Religion, Spirituality and Psychiatry: Steps Towards Rapprochement
Authors: Turbott John 
Published: December 2009

Objectives: To consider the claim that there is a fundamental epistemological conflict between religion and psychiatry over what constitutes rational explanation, and what impediment this might be to rapprochement between the two. Conclusions: An epistemological gap most certainly exists, but there is a growing acceptance of the importance of religion and spirituality to psychiatry. Rapprochement may best be achieved by increasing psychiatric awareness and knowledge of the issues, and by a willingness to embrace intellectual, cultural and religious pluralism.
Spiritually Augmented Cognitive Behavioural Therapy
Authors: D'Souza Russell F , Rodrigo Angelo 
Published: December 2009

Objective: To describe spiritually augmented cognitive behaviour therapy (SACBT) and its applications. Methods: The background for the need to incorporate spirituality into therapy is considered, and SACBT as a therapy for sustaining mental health and functional recovery is described. Cognitive and behavioural components are considered, including the use of existential techniques in discovering meaning. The use of meditation and the validation and incorporation of the appropriate belief system of patients into their treatment are described. Results: Controlled studies have demonstrated 16-session SACBT to be beneficial in extinguishing hopelessness and despair, improving treatment collaboration, reducing relapse rates and enhancing functional recovery. Conclusion: SACBT can aid therapists in providing ‘whole person’ care and achieving better global outcomes for patients with psychological illness.
The Psychological Impact of September 11 Terrorism on Australian Inpatients
Authors: Taylor Mark , Jenkins Kym 
Published: December 2009

Objective: To investigate the psychological impact on Australian hospital patients of the media coverage of the September 11 (9/11) terrorist attack. Methods: Thirty psychiatry and 26 matched medical and surgical inpatients were assessed. Results: Both reported and observed distress was common. Women reported significantly more distress than men. Individuals with psychiatric illness were significantly more varied in their attribution of cause for 9/11. Seven patients (29%) with pre-existing psychosis became delusional surrounding the events, but there were no significant differences between the psychiatry and the medical and surgical inpatients. Conclusions: Clinical impressions were confirmed, namely, that a large proportion of hospital inpatients were adversely affected by TV footage of the 9/11 terrorist attack. Most vulnerable were those already with a mental disorder, particularly those with a pre-existing psychotic illness.
Audit of Antipsychotic Prescribing in a Private Psychiatric Hospital
Authors: Botvinik Lev , Ng Chee , Schweitzer Isaac 
Published: December 2009

Objectives: There exists a substantial and growing body of evidence suggesting that antipsychotic medications are efficacious in the treatment of many non-psychotic psychiatric disorders. Although indications for the use of antipsychotics (particularly the atypicals) remain relatively narrow in Australia, psychiatrists seem to be using them for an expanding range of disorders in a variety of clinical settings. This has raised issues of costeffectiveness and methods of funding of these medications. The present study aimed to quantify and describe the patterns of prescribing of antipsychotic medications in a large private psychiatric hospital. Another aim was to compare the findings with other published evidence, and consider the implications of antipsychotic use for current clinical practice in Australia. Methods: A retrospective review of the medical records of 100 consecutive patients admitted to a private psychiatric hospital was conducted. The data collected included demographic details, major psychiatric diagnoses, all medications prescribed during the admission and their doses and, in the case of antipsychotics, the target symptoms/conditions for which they were prescribed. Results: Fifty-nine per cent of inpatients received at least one dose of an antipsychotic during their admission. While all patients with psychotic illnesses were treated with antipsychotics, 57% of patients with primary mood disorders and 40% of patients with a primary anxiety disorder also received an antipsychotic. The most common indications for use of antipsychotics included the treatment of psychotic symptoms, augmentation of antidepressants, relief of anxiety symptoms and lessening of agitation, and control of difficult behaviours (including self-harm and aggression) associated with personality disorders. The most frequently used antipsychotic was olanzapine (22%), followed by chlorpromazine (20%), and quetiapine (14%). Eleven per cent of patients received a combination of two antipsychotics. Conclusions: Antipsychotic medications were widely used in a private psychiatric inpatient setting for the treatment of non-psychotic disorders. This finding parallels those from other Australian studies of psychotropic prescribing patterns. The issues of clinical utility, cost-effectiveness and benefits of funding of these medications for such wider indications require further study and evaluation.
Epidemiology of Depression in the Asia Pacific Region
Authors: Chiu Edmond 
Published: December 2009

Objective: To summarise studies reporting rates of depression (for the general population and older samples) and suicide in the Asia Pacific region. Methods: Information on local data was collected from the members of the SEBoD International Advisory Board on known epidemiological studies. Additionally, online searches were conducted using Medline and PsycInfo for the period 1994–2004. Results: Across the Asia Pacific region, rates of current or 1-month major depression ranged from 1.3% to 5.5%, rates of major depression in the previous year ranged from 1.7% to 6.7%, and lifetime rates ranged from 1.1% to 19.9%, with a median of 3.7%. Rates of suicide in the Asia Pacific region are now similar to those in Europe and the Americas. The exceptions include China and South Korea. Conclusions: Epidemiological studies in Asian populations are rare and use various diagnostic criteria. However, studies indicate that rates of depression in Asia Pacific, whilst lower, are comparable to other western countries. As such, depression as a health issue in Asia Pacific demands greater recognition. It is important that Asian countries should have the human and financial resources to conduct large scale epidemiological surveys not only in the area of depression, but also in the broader field of mental disorders.
The Economic Burden of Depression and Reimbursement Policy in the Asia Pacific Region
Authors: Hu Teh-wei 
Published: December 2009

Objective: To determine the economic burden of depression in the Asia Pacific region, review the negative economic consequences attributable to depression, and describe the reimbursement policies for health-care services throughout the Asia Pacific region. Methods: Both direct and indirect costs were obtained via a literature review of international mental health journals. Disability adjusted life year (DALYs) estimates were obtained from the World Health Organization. Reimbursement policy data were obtained from personal communication with the SEBoD International Advisory Board. Results: There are only two studies of the economic costs of depression in the Asia Pacific region. From these, the total cost of depression in Australia for 1997–98 was estimated as US$1.8 billion (22% direct costs), and in Taiwan for 1994 as US$1.4 billion (25% direct costs). In the year 2000, it was estimated that unipolar major depression accounted for 14.2 million DALYs in China and 22.7 million DALYs for all other Asia Pacific countries. The majority of Asia Pacific health-care systems have extensive insurance coverage, but not specific provisions for depression. However, relatively low overall fee schedules diminish financial barriers for outpatient treatment of depression. Conclusions: Untreated depression is a very costly disorder across the Asia Pacific region, with indirect costs constituting a substantial proportion. Consequently, treatment of depression should be the focus of policy makers to avoid major negative cost repercussions. It is encouraging that most Asia Pacific health service reimbursement policies enable the treatment of depression (especially outpatient treatment) to be relatively affordable. To advance this issue, the paucity of specific information on the epidemiology of depression, as well as service use and cost, needs to be addressed.
A Guide to the Internet for Psychiatrists
Authors: Straton David 
Published: December 2009

Objective: To provide psychiatrists with a guide to using the Internet. Conclusions: The key to using the Internet is to have the skills to keep the signal-to-noise ratio high. This requires knowledge and practice. The paper contains tips on searching and information about surfing skills, noticeboards, portals and email lists, and lists a range of very useful websites.
A Tale of Three Pathways: The Experience of RBWH Mental Health
Authors: Emmerson Brett , Fawcett Lisa , Frost Aaron , Lacey Maree , Todd Cathy , Powell Jacinta 
Published: December 2009

Objectives: Australian research has identified that there are significant variations between service providers in terms of clinical management of patients with comparable presenting problems. Internal audits within the facility at Royal Brisbane and Women's Hospital revealed that these variations occurred between wards, treating teams and psychiatric consultants. Given the increasing emphasis on evidence-based practice, it was decided that the literature should be reviewed to determine what the standard of care should be. The paper then examines how clinical pathways for psychosis and for depression were developed and how they eventually evolved into an acute inpatient pathway. It identifies the framework used and examines important aspects relating to the adaptation of these frameworks to mental health issues. The process for the development and implementation of the clinical pathway is discussed. Recommendations for their future use in a mental health setting are also presented. Conclusions: Mental Health care is complex. For this reason, mental health clinical pathways have to remain flexible and innovative. With the present project, it was found that the pathways were not suited for specific diagnoses so that they evolved into a single acute inpatient pathway.
Description and Evaluation of an Up-Skilling Workshop for Rural and Remote Mental Health Practitioners in South Australia
Authors: Chur-Hansen Anna , Todd Elizabeth , Koopowitz Leslie 
Published: December 2009

Objective: In response to the identified need for up-skilling in psychiatry for rural and remote general practitioners, a series of workshops has been designed and delivered to medical and nursing staff in South Australia. In this paper one such workshop is described, dealing with acute psychiatric care. Quantitative and qualitative evaluations of the workshop are reported on, and recommendations are made for future training programmes. Conclusions: The workshop was well received and increased participants’ knowledge about the management of acute psychiatric presentations. Qualitative data indicate that the pharmacological management and neurobiology of psychiatric illness was interesting but difficult for some participants, and further training in these areas may be appropriate in future workshops. Inclusion of all professional stakeholders in future training is recommended, including students, to promote interest in working in rural and remote health. Participants considered networking with colleagues as an important benefit of the workshop. Targeted training in psychiatry may be needed for overseas-trained doctors. Further, rigorous research is needed to evaluate the long-term benefits of up-skilling workshops, and to inform funding bodies as to where resources might be most effectively channelled.
Establishing and Running a Trauma and Dissociation Unit: A Contemporary Experience
Authors: Middleton Warwick , Higson David 
Published: December 2009

Objective: To evaluate the functioning of a trauma and dissociation unit that has run for the past 8 years in a private hospital, with particular regard to operating philosophy, operating parameters, challenges encountered, research and educational initiatives, and the applicability of the treatment model to other settings. Conclusions: Despite the challenges associated with significant difficulties in the corporate management of a private health-care system, it has been possible to operate an inpatient and day hospital programme tailored to the needs of patients in the dissociative spectrum, and the lessons learnt from this experience are valid considerations in the future planning of mental health services overall
Changeability, Confidence, Common Sense and Corroboration: Comprehensive Suicide Risk Assessment
Authors: O'Connor Nick , Warby Monica , Raphael Beverley , Vassallo Tony 
Published: December 2009

Objective: The authors, in collaboration with NSW Health, have recently developed a comprehensive suicide risk assessment framework. The present paper describes key concepts in the assessment of suicide risk by mental health professionals. Methods: A framework for conducting a comprehensive suicide risk assessment was derived from the literature, incident analysis and clinical experience. The framework underwent a consultation process involving clinicians in NSW area mental health services. The aim was to provide clinicians with a standardized conceptual map for the assessment of suicide risk. A MEDLINE search was conducted for publications dealing with ‘suicide’ and ‘suicide risk assessment’ from 1980 to 2002. The recommendations from sentinel event reviews conducted in a NSW area mental health service in the period 1999-2002 were reviewed. The lessons from a visit to a coroner's relatives support group for people who had been bereaved by suicide also informed the development of the guidelines. Results: A framework is proposed for the assessment of suicide risk. The framework promotes a reflective style of practice, encouraging clinicians to evaluate their assessment and its limitations. Risk assessment is always undertaken as part of a full clinical assessment and an evaluation of the person's current predicament and psychosocio-cultural context. The concepts of changeability, assessment confidence, common sense and the importance of corroboration are incorporated in the framework. Conclusions: Mental health clinicians can be guided by a framework in suicide risk assessment and documentation. The assessment of suicide risk can generate a suicide risk rating for which minimum standards of care can be mandated.