bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatric Out-Patients Seen Once Only in South Verona and Western Australia: A Comparative Case-Register Study
Authors: Rossi Alberto , Morgan Vera , Amaddeo Francesco , Sandri Marco , Tansella Michele , Jablensky Assen 
Published: December 2009

Objective: This study examined variables associated with having a once-only contact with the out-patient department of two community mental health services in Italy and Australia. Method: Two 8-year cohorts of patients, who had a new episode of care with out-patient psychiatric departments in South Verona and in Western Australia, were followed-up for 3 months after the first contact, to identify those patients who had no further contact with services. Potential determinants of once-only contact were analysed. Results: Thirty percent of new episodes of care for persons who met the inclusion criteria of the study were once-only contacts with the service in South Verona. In Western Australia, the figure was 24%. Moreover, the proportion of once-only contact patients has increased over time in South Verona whereas, in Western Australia, it has remained stable. In Western Australia, once-only contact patients were younger whereas in South Verona they tended to be older. At both research sites, patients who had a once-only contact were more likely to be male and to have a less severe mental illness. Conclusions: The results of this study suggest that only clinical characteristics were significant determinants of this pattern of contact with services consistently at both sites: the less severe the patient's diagnosis, the more likely the patient is to have a once-only contact. This may well indicate good screening at the initial point of contact by both sets of mental health service providers. Prospective studies are necessary to clarify the problem of ‘onceonly contact’ and to organize a proper psychiatric care.
Power Therapies and Possible Threats to the Science of Psychology and Psychiatry
Authors: Devilly Grant J. 
Published: December 2009

Objective: Advocates of new therapies frequently make bold claims regarding therapeutic effectiveness, particularly in response to disorders which have been traditionally treatmentrefractor y. This paper reviews a collection of new therapies collectively self-termed ‘The Power Therapies’, outlining their proposed procedures and the evidence for and against their use. These therapies are then put to the test for pseudoscientific practice. Method: Therapies were included which self-descr ibe themselves as ‘Power Therapies’. Published work searches were conducted on each therapy using Medline and PsychInfo databases for randomized controlled trials assessing their efficacy, except for the case of Eye Movement Desensitization and Reprocessing (EMDR). Eye Movement Desensitization and Reprocessing has more randomized controlled studies conducted on its efficacy than any other treatment for trauma and thus, previous meta-analyses were evaluated. Results and conclusions: It is concluded that these new therapies have offered no new scientifically valid theories of action, show only non-specific efficacy, show no evidence that they offer substantive improvements to extant psychiatric care, yet display many characteristics consistent with pseudoscience.
What Patients and Carers Want to Know: An Exploration of Information and Resource Needs in Adult Mental Health Services
Authors: Cleary Michelle , Freeman Adele , Hunt Glenn E. , Walter Garry 
Published: December 2009

Objective: The objectives of this study were to: (i) obtain baseline data on the extent of carer involvement across a representative sample of hospital and community patients within an integrated area health service; and (ii) examine perspectives on discharge planning and community care among patients and their carers to identify information and resources they consider important. Method: Over a 4-month period, inpatients before discharge and patients accessing community mental health services participated in face-to-face interviews. Information was collected about carer involvement and, with the patient's consent, the identified carer was sent a similar survey to determine demographics and information needs. This resulted in a representative sample of patients and carers accessing inpatient and community settings acrossa metropolitan mental health service. Support needs and carerburden were also assessed but are not reported here. Results: A total of 407 interviews were completed, 207 in inpatient settings and 200 in the community. An inpatient response rate of 70% and a community response rate of 75% was achieved. Across both settings, 67% of patients identified a carer and a carer response rate of 28% was then obtained. We found carers and patients have different priorities regarding the information they want and information is often not provided to carers. Furthermore, patients were more confident in their ability to manage their mental health in the community than carers. Conclusions: This study yielded important baseline data about the number of patients who have a carer. We were also able to determine that routine clinical information provided to patients and carers is inadequate from their perspective. It is anticipated that this initiative will assist ongoing service planning and improve partnerships with patients and their carers.
Role of Stigma and Attitudes Toward Help-Seeking from a General Practitioner for Mental Health Problems in a Rural Town
Authors: Wrigley Sarah , Jackson Henry , Judd Fiona , Komiti Angela 
Published: December 2009

Objective: To examine the role of perceived stigma and attitudes to seeking care in predicting help-seeking from a general practitioner (GP) for mental health problems. Method: Across-sectional surveyin 2002 with self-repor t questionnaires assessing current levels of symptomatology, disability, attitudes towards mental illness, knowledge of prevalence and causes of mental illness, contact with mental illness and help-seeking behaviour and preferences and attitudes toward seeking professional psychological help. Results: No significant relationship was found between symptom measures and measures of disability and help-seeking. Variables positively associated with general attitudes to seeking professional psychological help were: lower perceived stigma, and biological rather than person-based causal attributions for schizophrenia. Willingness to discuss mental health issues with a GP was predicted by the perceived helpfulness of the GP and by no other variable. Conclusions: Causal attributions and perceivedstigma rather than participants' levels of symptomatology and disability influence attitudes to help-seeking for mental health issues. Efforts to improve attitudes to help-seeking should focus on reducing stigma and improving mental health literacy regarding the causes of disorders.
Changes in the Pattern of Substance Abuse After the Onset of Psychosis
Authors: Kaiser Roland , Löhrer Frank , Morgan Vera , Hambrecht Martin 
Published: December 2009

Objective: The aim of this study was to examine early signs of psychosis in patients suffering from both drug dependence and schizophrenia, compared to a control group of drug-addicted patients without a comorbid psychotic disorder, and to assess whether the presence of these signs was related to changes in the pattern of substance abuse. Method: In a rehabilitation hospital for young addicts, 32 patients with a comorbid diagnosis of schizophrenia and 30 patients without the diagnosis of a psychotic disorder, were assessed using the Interview for the Retrospective Assessment of the Onset of Schizophrenia. Information relating to 64 signs of early psychosis was collected from every patient. From the 64 signs, five groups of symptoms were defined: non-specific and precursor symptoms; non-specific and depressive symptoms; negative symptoms; positive symptoms; and impaired social adjustment. The semiquantitative pattern of substance abuse for each 1-year interval over the previous 10 years was investigated using the categories of chapter F1 of ICD-10 and including an additional categor y ‘biological drugs’. The relationship between the pattern of substance abuse and the presence of early signs was assessed using ANOVA and non-parametric statistical methods. Results: The results indicate that the defined pathological symptomatology greatly influences the pattern of consumption of psychoactive substances in both the psychosis group and the control group. The group factor exerted the greatest influence within the categories ‘biological drugs’ and ‘other stimulants’, where the ‘psychosis and addiction group’ consumed significantly more than the control group. Conclusions: There is a subgroup of non-psychotic addicted patients whose pattern of psychoactive substance abuse is similar to that found in addicted patients suffering from schizophrenia. It may be helpful to systematically identify this subgroup with regard to possible therapeutic implications, particularly with regard to possible pharmacological treatment options.
Acute Tryptophan Depletion. Part II: Clinical Effects and Implications
Authors: Bell Caroline J. , Hood Sean D. , Nutt David J. 
Published: December 2009

Objective: This is the second of two articles reviewing the modern dietary technique of acute tryptophan depletion (ATD), a method of transiently reducing central serotonin levels in both healthy volunteers and clinical populations. This article details the clinical studies to date and discusses the implications of this research methodology. Method: The authors present a review of clinical ATD studies collated from a MEDLINE search, unpublished communications and the authors' considerable experience with this paradigm. Results: Following from the initial use of ATD in subjects with depressive illness, studies of anxiety disorders and other psychiatric illnesses have been reported. Sleep, aggressive and cognitive effects are also active areas of research and are reviewed here. Conclusions: Acute tryptophan depletion remains a useful psychiatric research tool. The findings from the clinical studies reviewed here are summarized and implications for future research detailed.
Maintenance Therapies in Bipolar Disorder: Focus on Randomized Controlled Trials
Authors: Muzina David J. , Calabrese Joseph R. 
Published: December 2009

Objective: Lithium remains the cornerstone of maintenance therapy for bipolar disorder despite growing use of other agents, including divalproex, lamotrigine, carbamazepine and the atypical antipsychotics. Lithium has the largest body of data to support its continued use as a prophylactic agent; however, most of this data comes from early studies that did not use contemporary analytic methods. Alternatives to lithium are needed because of the relatively high rate of non-response to lithium monotherapy and the drug's frequent side-effects. This article reviews available data with an emphasis on double-blind, placebo controlled studies that examine the efficacy of lithium and other putative mood stabilizers: carbamazepine, divalproex, lamotrigine and olanzapine. Method: The authors reviewed key literature using Medline searches using key words: bipolar disorder, controlled trials, mood stabilizer, lithium, lomotrigine, divalproex, olanzapine, carbamazepine. Results: Lithium remains the gold standard for overall preventative efficacy in bipolar disorder, especially to decrease manic or hypomanic relapse. Of the mood stabilizers that have marked prophylactic antimanic properties, lithium appears to possess the greatest antidepressant effect. Divalproexmay also prevent recurrent bipolar mood episodes but the relative lack of controlled maintenance studies makes this less certain. There now exists an extensive and well-designed research database supporting the use of lamotrigine in the acute and prophylactic management of bipolar I disorder. Lamotrigine offers a spectrum of clinical effectiveness that complements lithium, in that it appears to stabilize mood ‘from below baseline’ by preventing episodes of depression and has been shown to be effective in rapid-cycling bipolar II disorder. Carbamazepine may be a useful alternative to lithium, divalproex and lamotrigine, particularly for patients with a history of mood-incongruent delusions and other comorbidities, but controlled data is more equivocal and it may lose some of its prophylactic effect over time. Emerging data continue to support the growing use of atypical antipsychotics, particularly olanzapine. Conclusions: Any monotherapy for use as a maintenance therapy of bipolar disorder appears to be inadequate for long-term use in the management of the majority of patients with bipolar disorder. Combination therapy has become the standard of care in the treatment of bipolar disorder and particularly in patients with treatment-refractory variants such as those with rapid-cycling. The emerging consensus is that patients on monotherapy, if followed for sufficiently long periods, will eventually require concomitant treatment to maintain a full remission. There exists a need for controlled trials that use random assignment to parallel arms including combination therapy followed by data analyses that include both relapse rate and survival techniques.
Cost-Effectiveness of Cognitive–Behavioural Therapy and Drug Interventions for Major Depression
Authors: Vos Theo , Corry Justine , Haby Michelle M. , Carter Rob , Andrews Gavin 
Published: December 2009

Objective: Antidepressant drugs and cognitive–behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness – Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression. Method: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods. Results: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below $A10 000 per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from $A17 000 to $A20 000 per DALY) but still well below $A50 000, which is considered the affordable threshold. Conclusions: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.
Assessing Cost-Effectiveness in Mental Health: Vocational Rehabilitation for Schizophrenia and Related Conditions
Authors: Chalamat Maturot , Mihalopoulos Cathrine , Carter Rob , Vos Theo 
Published: December 2009

Objective: Existing evidence suggests that vocational rehabilitation services, in particular individual placement and support (IPS), are effective in assisting people with schizophrenia and related conditions gain open employment. Despite this, such services are not available to all unemployed people with schizophrenia who wish to work. Existing evidence suggests that while IPS confers no clinical advantages over routine care, it does improve the proportion of people returning to employment. The objective of the current study is to investigate the net benefit of introducing IPS services into current mental health services in Australia. Method: The net benefit of IPS is assessed from a health sector perspective using cost–benefit analysis. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis of the net benefit, defined as the benefits of IPS (comprising transfer payments averted, income tax accrued and individual income earned) minus the costs. The second stage involves application of ‘second-filter’ criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using the multivariate probabilistic sensitivity analysis. Results: The costs of IPS are $A10.3M (95% uncertainty interval $A7.4M–$A13.6M), the benefits are $A4.7M ($A3.1M–$A6.5M), resulting in a negative net benefit of $A5.6M ($A8.4M–$A3.4M). Conclusions: The current analysis suggests that IPS costs are greater than themonetary benefits. However, the evidence-base of the current analysis is weak. Structural conditions surrounding welfare payments in Australia create disincentives to full-time employment for people with disabilities.
Assessing Cost-Effectiveness in Mental Health: Helping Policy-Makers Prioritize and Plan Health Services
Authors: Vos Theo , Haby Michelle M. , Magnus Anne , Mihalopoulos Cathrine , Andrews Gavin , Carter Rob 
Published: December 2009

Objective: We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward ‘best practice’ cost-effective services. Method: We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account ‘second-filter criteria’ of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia. Results: There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive–behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost A$68 million less than current practice. These savings would more than cover the estimated A$36M annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost A$121M annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment. Conclusions: Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.
Performance of Routine Outcome Measures in Adult Mental Health Care
Authors: Eagar Kathy , Trauer Tom , Mellsop Graham 
Published: December 2009

Objective: To examine the performance of two widely used outcome measures in public adult mental health services. Method: As part of a larger study, clinical staff in eight New Zealand District Health Board areas collected consumer outcomes data for a period of 6 months. Among other measures, the Health of the Nation Outcome Scales (HoNOS) and Life Skills Profile (LSP-16) were completed at the start and end of episodes of care, as well as at 90-day reviews. Results: The performance of these twomeasures was examined in relation to compliance with the data collection protocol, item completion rates, certain psychometric properties, the relationship between them and the relationship of each instrument to the age, sex, principal psychiatric diagnosis and legal status of the consumer. Compliance with the HoNOS was superior to the LSP-16, but the reverse was true for completion. The two instruments were strongly correlated, but not enough to suggest that one may substitute for the other. A five-subscale structure for the HoNOS was supported. Certain HoNOS subscales were associated with age, but the total score was not, and differences between the sexes were small. Some large diagnostic differences were observed on both instruments. All LSP-16 summary scores and all HoNOS summary scores apart from Depression were higher (worse) in involuntary episodes. Only one LSP-16 item, relating to work potential, was related to age and men generally scored higher (worse) than women. Conclusion: From a technical perspective, the HoNOS and LSP-16 appear suitable for routine collection. New Zealand has adopted the HoNOS for routine use but not the LSP-16 because of local concerns about its appropriateness and acceptability. The clinician-rated measures reported here need to be complemented by both consumer-rated and family/carer measures.
Assessing Reliable and Clinically Significant Change on Health of the Nation Outcome Scales: Method for Displaying Longitudinal Data
Authors: Parabiaghi Alberto , Barbato Angelo , D'avanzo Barbara , Erlicher Arcadio , Lora Antonio 
Published: December 2009

Objective: Many authors recommended that reliable and clinically significant change (RCSC) should be calculated when reporting results of interventions. To test the reliability of the Health of the Nation Outcome Scales (HoNOS) in identifying RCSC, we applied the Jacobson and Truax model to two HoNOS assessments in a large group of people evaluated in 10 community mental health services in Lombardy, Italy, in 2000. Method: The HoNOS was administered to 9817 patients; of these, 4759 (48%) were re-assessed. Reliable change (RC) was calculated using Cronbach's alpha ( α), as a parameter of the reliability of the measure. Clinical significance cut-offs were calculated using a classification of severity based on HoNOS items. Results: In the whole sample, the clinical improvement cut-off was 11 and the remission cut-off was 5. Considering the severe patients, the clinical improvement cut-off was 12. The RC index calculated on the whole group and on the subgroup of severe patients indicated that eight-point and seven-point changes, respectively, were needed to be confident that a real change had occurred. Longitudinal changes were depicted on two-dimensional graphs as examples of reporting RCSC on HoNOS total scores in a routine data collection: 91.6% of the whole sample (4361) was stable, 5.6% (269) improved and 1.8% (129) worsened. Conclusion: Our study proposes a methodological framework for computing RCSC normative data on a widely used outcome scale and for identifying different degrees of clinical change.