bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-Effectiveness of Dexamphetamine and Methylphenidate for the Treatment of Childhood Attention Deficit Hyperactivity Disorder
Authors: Donnelly Marie , Haby Michelle M. , Donnelly Marie , Haby Michelle M. , Carter Rob , Andrews Gavin , Vos Theo 
Published: December 2009

Objective: To analyze from a health sector perspective the cost-effectiveness of dexamphetamine (DEX) and methylphenidate (MPH) interventions to treat childhood attention deficit hyperactivity disorder (ADHD), compared to current practice. Method: Children eligible for the interventions are those aged between 4 and 17 years in 2000, who had ADHD and were seeking care for emotional or behavioural problems, but were not receiving stimulant medication. To determine health benefit, a meta-analysis of randomized controlled trials was performed for DEX and MPH, and the effect sizes were translated into utility values. An assessment on second stage filter criteria (‘equity’, ‘strength of evidence’, ‘feasibility’ and ‘acceptability to stakeholders’) is also undertaken to incorporate additional factors that impact on resource allocation decisions. Simulation modelling techniques are used to present a 95% uncertainty interval (UI) around the incremental costeffectiveness ratio (ICER), which is calculated in cost (in A$) per DALY averted. Results: The ICER for DEX is A$4100/DALY saved (95% UI: negative to A$14 000) and for MPH is A$15 000/DALY saved (95% UI: A$9100–22 000). DEX is more costly than MPH for the government, but much less costly for the patient. Conclusions: MPH and DEX are cost-effective interventions for childhood ADHD. DEX is more cost-effective than MPH, although if MPH were listed at a lower price on the Pharmaceutical Benefits Scheme it would become more cost-effective. Increased uptake of stimulants for ADHD would require policy change. However, the medication of children and wider availability of stimulants may concern parents and the community.
Factors Predicting Discharge of Patients from Community Residential Facilities: A Longitudinal Study from Italy
Authors: D'avanzo Barbara , Nadia Battino R. , Gallus Silvano , Barbato Angelo 
Published: December 2009

Objective: Community residential facilities for psychiatric patients have increased in Italy in the last years, but little information is available on their use, the patients they host, the interventions they deliver and the rate at which they discharge patients. To investigate these issues, we conducted a longitudinal study in 2000–2001 on all the community residential facilities in Lombardy, a large region in North Italy. Method: The study base comprised all the patients residing in the community residential facilities identified in Lombardy in 2000. Out of the 196 community residential facilities identified, 91% agreed to participate. The study sample consisted of all the patients living in the residential facilities on 15 November, 2000. A total of 1792 patients were recruited and described. Results: In the study period, a total of 316 patients were discharged. Among these, 191 (11%) went to lower-protection settings or home and 49 (3%) to higher-protection settings. The probability of discharge to lower-protection settings and home was higher for people in residential care centres, not coming from a psychiatric hospital, having shorter duration of the current admission, having work at the time of admission and with a low HoNOS score. Associations were found between discharge to higher-protection settings and old age, inadequate accommodation in staff opinion, and the public sector managing the facility. Conclusions: Turn-over of patients in the community residential facilities was limited. Discharges to higher-protection settings were related to need for specific care for older patients. Type of facility and duration of stay predicted discharge to lower-protection facilities and home independently from other patient characteristics. If a higher turn-over and a more extensive use of this resource must be achieved, roles of other psychiatric and social community-based services should be taken into account.
Rurality and Mental Health: The Role of Accessibility
Authors: Murray Greg , Judd Fiona , Jackson Henry , Fraser Caitlin , Komiti Angela , Hodgins Gene , Pattison Pip , Humphreys John , Robins Garry 
Published: December 2009

Objective: The absence of an agreed definition of ‘rural’ limits the utility of existing research into a possible relationship between rurality of residence and mental health. The present study investigates the bipolar dimension accessibility/remoteness as a possible correlate of mental health. Method: A continuous area of non-metropolitan Australia was selected to provide a range of scores on the Accessibility/Remoteness Index of Australia (ARIA). A questionnaire measuring demographics, the five-factor model of personality and three aspects of mental health (distress, disability and wellbeing) was mailed to 20 000 adults selected randomly from electoral rolls. Results: Responses were received from 7615 individuals (response rate = 40.5%; 57.1% female). ARIA was not associated with either distress or disability measures, but a small negative association was found between accessibility and two measures of wellbeing. Individuals residing in locales with better access to services and opportunities for interaction reported higher levels of satisfaction with life (SWL) and positive affect (PA). Adjusting statistically for a range of demographic and personality correlates did not alter the effect of ARIA on SWL. The effect on PA remained significant after adjusting for demographics, but not once personality correlates entered the model. Conclusions: By sampling across a single proposed parameter of rurality, a novel profile of correlations was identified. In accord with existing data, accessibility was not associated with distress or disability. In contrast, accessibility was positively associated with the wellbeing aspect of mental health. Further attention to the measurement of rural place and the exploration of accessibility as a parameter with mental health relevance, is warranted.
What Determines Compulsory Community Treatment? A Logistic Regression Analysis Using Linked Mental Health and Offender Databases
Authors: Xiao Jianguo , Preston Neil J. , Kisely Steve 
Published: December 2009

Objective: Western Australia has one of the highest published rates of the use of compulsory treatment orders in the English-speaking world. Differences in patient characteristics, legislation and service setting may explain variations in the reported efficacy of compulsory community treatment. Our objective is to investigate predictors of Community Treatment Orders (CTO) placement in the first year of implementation in Western Australia and see if there were any differences in the type of patients placed on these orders compared to other studies. Method: A population–based record linkage study of Mental Health and Offender Databases comparing 265 patients on CTOs with a consecutive control group (CCG) of equal number matched on date of discharge from inpatient care or CTO placement. Results: Previous health service use, after-care placement, mental disorder history including schizophrenic history, a positive forensic history of violence to others as well as patient's marital status were the significant predictors of CTO placement. Conclusions: Studies of compulsory community treatment appear to be of similar populations. In spite of the comparatively high rate of use, psychiatrists in Western Australia do not appear to be applying community treatment orders to different types of patient compared to elsewhere. We need further research to establish the relative contribution of patient characteristics, legislation and service setting toward the use and outcome of compulsory community treatment.
Somatoform Dissociation, Reported Abuse and Animal Defence-Like Reactions
Authors: Nijenhuis Ellert R. S. , van der Hart Onno , Kruger Karlien , Steele Kathy 
Published: December 2009

Objective: To test the hypotheses that among general psychiatric outpatients, somatoform dissociation is associated with posttraumatic stress symptoms and with reported potentially traumatizing events, especially with events that involve bodily threat from a person, also when reported age at onset, duration and subjectively rated impact of potentially traumatizing events are considered. Method: Administration of self-report questionnaires evaluating the severity of somatoform and psychoform dissociation, posttraumatic stress-symptoms, and reported traumatizing events, using samples of consecutive and unselected psychiatric outpatients (n = 153). Results: Somatoform dissociation was strongly correlated with posttraumatic stress symptoms and with reported cumulative traumatization as assessed with two different self-report trauma questionnaires. Among a wide range of trauma types, bodily threat from a person best predicted somatoform dissociation. Emotional neglect and age further improved the prediction, but emotional neglect and abuse did not predict somatoform dissociation when interpersonal threat to the body was not reported. Somatoform dissociation was also best predicted by bodily threat when reported age at onset, duration and subjective impact of reported traumatization were included in the analyses. Conclusion: This retrospective study suggests that recurrent interpersonal bodily threat may evoke animal defence-like psychobiological systems manifesting as somatoform dissociation and that this type of threat is often accompanied by emotional neglect. These hypotheses should now be tested in prospective studies.
Clinical Outcome of an Early Psychosis Intervention Program: Evaluation in a Real-World Context
Authors: Nash Louise , Gorrell Joanne , Cornish Alison , Rosen Alan , Miller Vivienne , Tennant Chris 
Published: December 2009

Objective: To examine whether staff training and service restructuring to provide specialized early psychosis services results in improved clinical outcomes for young people with first-episode psychosis. Method: Staff attended workshops on the treatment of early psychosis throughout 1997–2000 and specialized early psychosis teams began operating between 1998 and 2000 following service restructure. There was no additional funding provided for clinical services, but through the restructure, there was a shift in resources. During this period a comprehensive package including the Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms and the Health of the Nation Outcome Scale was introduced for clinicians to assess patients at intake, 3 months and 12 months into treatment. Symptom scores of patients treated earlier in the project are compared with those patients treated later, after more training and service developments had occurred. Results: Ninety-four of 215 potential first-episode patients consented to take part in the project. They provided data variously at intake, 3 months and 12 months into treatment. Regardless of the year of treatment, significant improvement in psychiatric symptomatology was found over the three assessment periods. Individuals who entered the service in the latter phase of the project experienced fewer negative symptoms (after 12 months of treatment) compared with patients who entered the service in the early phase of the project. Conclusions: Improvements in both pharmacological and possibly psychosocial treatment may have led to a greater improvement in negative symptoms. Benefits and limitations of conducting research in a ‘real-world’ context are discussed.
Prevalence and Risk Factors of Insomnia in Community-Dwelling Chinese Elderly: A Taiwanese Urban Area Survey
Authors: Su Tung-Ping , Huang Shuang-Ruang , Chou Pesus 
Published: December 2009

Objective: To determine the prevalence of and risk factors for self-reported sleep complaints in the elderly. Method: A cross-sectional interview study was conducted in a total of 2045 noninstitutionalized older individuals aged 65 years or above of an urban community of Taiwan. Results: The prevalence of one-month insomnia was 6% overall with a higher rate in elderly women (8%) than men (4.5%). Frequent use of hypnotics over the past month was 8.4%. Among specific sleep complaints, poor sleep quality was the most commonly reported symptom, followed by difficulty falling asleep and difficulty maintaining sleep or early morning awakenings. Increasing age did not correlate with an increased rate of insomnia and female gender was not an independent risk factor. Factors associated with insomnia for both genders were nocturnal micturation (OR = 20.6) and regular use of hypnotics (OR = 3.2). Pulmonary disease (OR = 2.7), not married (OR = 2.3), excessive daytime sleepiness (OR = 2.4), and mental illness (OR = 8.6) were risk factors for men while lack of education (OR = 1.8) and body pain (OR = 2.6) were risk factors for women. Depression (OR = 2.2) was strongly associated with insomnia in the elderly women as well. Conclusions: There was a low insomnia prevalence rate in the urban elderly community. Identified insomniacs required treatment of physical and mental problems, particularly in gender-specific risk factors. For those who complained of putative poor sleep quality symptom, early intervention may halt their progress of sleep disturbance and avoid unnecessary benzodiazepine use. Future longitudinal studies to investigate causes of insomnia, as well as its detrimental effects on mood and health, are warranted.
Depressive Symptoms and Suicidal Behaviour: Changes with Time in an Adolescent Clinic Cohort
Authors: Starling Jean , Rey Joseph M. , Simpson Judy M. 
Published: December 2009

Objective: There are suggestions of a secular increase in the prevalence of depression, self-harm and suicidal behaviour in young people. This study aims to examine changes in prevalence of psychological disturbance over time in adolescents referred for treatment. Method: Data on the type and severity of emotional and behavioural problems was measured using the Youth Self-Report and Child Behaviour Checklist in 4495 clinic-referred adolescents aged 12–17 years, born in a 21-year period (1966–1986). Results: After taking into account the confounding effects of age and gender, there were significant increases in reports of self-harm and suicidal ideation (5% and 4% increase in odds per year, respectively) according to parents, but there was no change in parental ratings of depression (anxious/depressed scale). There were no changes in ratings of self-harm, suicidal ideation or anxiety/depression when adolescent reports were considered. The mean age at the time of referral decreased with increasing year of birth, from 14.6 years in those born in 1966–1971, to 13.1 years in those born in 1981–1986. Conclusions: Parents of referred adolescents reported increasing self-harm and suicidal behaviour with increasing year of birth. In contrast, there were no changes over time in the adolescents' reports. Neither parents nor children reported an increase in depressive symptoms. Perceptions of a secular increase may reflect increasing parental awareness of some behaviours, particularly self-harm and suicidal ideation. Interpretation of these results needs to be cautious given the clinical origin of the sample.
The Assessment of Patients with Long-Term Psychotic Disorders: Application of the who Disability Assessment Schedule II
Authors: Chopra P. K. , Chopra P. K. , Couper J. W. , Herrman H. 
Published: December 2009

Objectives: To evaluate the use of the World Health Organization Disability Assessment Schedule II (WHODAS II), a patient questionnaire measuring disability, in patients treated for long-term psychotic disorders. Method: The study was conducted at St. Vincent's Mental Health Service, Melbourne, Australia. Twenty patients with long-term psychotic disorders under the care of either the residential Community Care Unit or the outpatient Mobile Support and Treatment Service were selected. For all 20 patients a clinician assessment of disability and functional status was recorded using the International Classification of Impairments, Disabilities and Handicaps-2 (ICIDH-2), Life Skills Profile (LSP) and Health of the Nation Outcome Scale (HoNOS). The WHODAS II survey was then administered to each patient. The WHODAS II was re-administered by a second rater within 5 days of the initial assessment for the purpose of test-retest reliability analysis. Each patient also completed the WHO Quality of Life instrument (brief version) (WHQOL-BREF), a self-report questionnaire on quality of life. Results: The WHODAS II was experienced as relatively complex and at times difficult to administer with full co-operation in this clinical context. Overall, test-retest reliability was fair. The information it yielded gave valuable insights into patients' experiences. Most of the participants reported fewer impairments in mental functions and fewer activity limitations than reported by clinicians. However, patients reported significant restrictions in participation in social activities and limitations due to environmental barriers. The WHOQOL-BREF highlighted difficulties experienced by patients in their participation in society, through exploring difficulties and satisfaction with various aspects of life experience and this instrument was well accepted. Conclusions: The self-reported experience of patients is needed alongside clinician-rated measures to assess outcomes in people with long-term psychotic disorders. The WHODAS II records and measures patients' own experiences of disability. It may be used together with the WHOQOL–BREF, a distinct and complementary self-report assessment of quality of life.
Changes in Early Psychosis Service Provision: A File Audit
Authors: Gorrell Joanne , Cornish Alison , Tennant Chris , Rosen Alan , Nash Louise , McKay Diana , Moss Beverley 
Published: December 2009

Objective: To measure change in services provided to young people with first-episode psychosis following the introduction of specialized early psychosis teams and staff training. Method: A standardized tool was developed to audit services provided to young people with first-episode psychosis. The tool initially comprised 27 clinical indicators measuring aspects of optimal care derived from the Australian clinical guidelines for early psychosis. The first 12 months of treatment, as documented in the case records, were audited for all young people receiving their first treatment for psychosis during a 6-month period prior to the introduction of these service developments (n = 47). These subjects were compared with those who received treatment after the implementation of service development strategies (n = 70). A comparison was also made within the second group, between those receiving some treatment from a specialized early psychosis team and those being exclusively treated by other services. Results: Inter-rater reliability was achieved for 24 of the 27 indicators. Improvements were found on 10 indicators which measured psychosocial interventions, prescribing practices, family interventions and continuity of care. There was no significant deterioration on any of the indicators. Clients who attended early psychosis teams were significantly more likely to receive psychoeducation. Conclusions: The services increased their provision of ‘guideline concordant’ care for early psychosis. The audit proved useful to monitor performance, to demonstrate improvements in care and to identify those areas of service provision and documentation in need of improvement.
Medicalizing Meaning: Demoralization Syndrome and the Desire to Die
Authors: Parker Malcolm 
Published: December 2009

Objective: To critically analyse the proposed new psychiatric condition, demoralization syndrome, and the implications drawn by its proponents for the clinical–ethical status of requests by terminally ill patients for assistance to die. Method: The diagnostic features of demoralization syndrome, a proposed new psychiatric disorder, recognizable particularly in palliative care settings, are summarized. The consequences of proposed therapeutic interventions are described, one of which is relief of the desperation which motivates some demoralized patients to consider ending their lives and to seek assistance in dying. The connections between the proposed condition and the desire to die are analysed in the context of the continuing tensions surrounding the ontological status and sociopolitical implications of psychiatric categories and the pervasive medicalization of modern life. Results: The analysis suggests that by medicalizing existential cognitions at the end of life, the proposed diagnostic category also normalizes a particular moral view concerning assistance in dying. Conclusions: While further research into the issues described in this provisional syndrome may benefit some patients, the categorization of demoralization as a medical diagnosis is a questionable extension of psychiatry's influence, which could serve particular social, political and cultural views concerning the end of life.
General Practice Encounters for Psychological Problems in Rural, Remote and Metropolitan Areas in Australia
Authors: Caldwell T.M. , Caldwell T.M. , Jorm A.F. , Knox S. , Braddock D. , Dear K.B.G. , Britt H. 
Published: December 2009

Objective: Previous Australian research suggests there is very little difference in the prevalence of mental health disorders across rural, remote and metropolitan areas. However, mental health specialists are particularly scarce in rural and remote areas and some researchers have argued that non-metropolitan residents rely heavily on general practitioners (GPs) for mental health care. This article investigated rates of GP services for psychological problems across rural, remote and metropolitan areas. Method: The Bettering the Evaluation and Care of Health (BEACH) program, Medicare and Pharmaceutical Benefits Scheme data were used in this report. Data included all psychological, depression and anxiety problems reported as managed by GPs and prescriptions for mental health medications (written and filled). Problem and medication rates are given per 100 patient encounters and per 1000 population. Results: Only a few regional differences were evident in the rate of psychological problems and prescriptions for mental health medications per 100 GP-patient encounters. However, rural and remote residents visited GPs less frequently than their metropolitan counterparts. Lower rates of GP encounters for psychological problems were evident for residents of most non-metropolitan areas (per 1000 population). Additionally, GPs prescribed mental health medications at half the rate for residents of remote areas than capital cities. Conclusions: General practitioners provide fewer mental health services per capita in nonmetropolitan areas. This difference could represent completely untreated psychological problems or fewer follow-up consultations. While non-metropolitan residents have limited access to specialists, rates of GP encounters for psychological problems are also very low.