bluuebunny/crossref_metadata_2025_split huggingface dataset:
Admissions of Elderly Patients from English-Speaking and Non-English-Speaking Backgrounds to an Inpatient Psychogeriatric Unit
Authors: Hassett Anne , George Kuruvilla , Harrigan Susan 
Published: December 2009

Objective: The aim of this study was to compare differences between elderly patients from non-English-speaking backgrounds (NESB) and English-speaking backgrounds (ESB) admitted to an acute psychogeriatric unit. Method: Sociodemographic and clinical variables were collated from inpatient files for a 12-month period and analysed according to NESB and ESB status. The 1996 Australian Census data were used for comparison of catchment area representation of different ethnic groups. Results: With a few exceptions, admission rates for elderly patients from NESB reflected the representation of that ethnic group in the catchment area population figures. No significant differences were found between the two groups for mean age, length of stay and previous admissions to the unit. Patients from NESB were less likely to be admitted voluntarily and less likely to be diagnosed with affective disorder. These differences were more marked for males, who were more likely to be diagnosed with dementia. Conclusions: These findings suggest that further investigation is required into the accessibility of psychiatric hospitalisation for elderly patients from NESB. Under recognition of disorders such as depression and reluctance to accept necessary inpatient management are two possible factors that should concern mental health service providers for the ethnic elderly. A subsequent analysis will examine if differences also exist between elderly patients from NESB and ESB who receive community-based psychiatric treatment. Implications for mental health service provision for the elderly from NESB are discussed.
Post-Stroke Mania Late in Life Involving the Left Hemisphere
Authors: Fenn David , George Kuruvilla 
Published: December 2009

Objective: Although post-stroke depression is well recognised, post-stroke mania has rarely been reported and researched. Most reported cases have involved lesions of the non-dominant hemisphere. We report a case of late-onset mania following stroke with a lesion in the dominant hemisphere. Clinical picture: A 78-year-old, right-handed man developed sudden cognitive deficits and manic symptoms. Investigations revealed lesions in the dominant hemisphere. Treatment: Pharmacological intervention was complicated by side effects. Outcome: His symptoms resolved gradually over 2 months and he was back to normal in 4 months. Conclusions: We would encourage further study in the area of post-stroke mania and especially in relation to the site of the lesion in the brain.
Actigraphic Predictors of Depressed Mood in a Cohort of Non-Psychiatric Adults
Authors: Mendlowicz Mauro V. , Jean-Louis Girardin , von Gizycki Hans , Zizi Ferdinand , Nunes João 
Published: December 2009

Objective: Depressed mood is one of the essential features for the diagnosis of major depression. Evidence from the three-site Epidemiologic Catchment Area study (EcA, Baltimore, Durham and Los Angeles) suggests a prevalence of 4.4% of depressive symptoms in the community. In this study, we examined whether depressed mood, as coded in the Alzheimer's Disease Assessment Scale, would be correlated with actigraphic-derived daytime activity and sleep/wake parameters in a non-psychiatric sample. Method: Consenting volunteers were monitored at home for 5 days with a wrist actigraph. On the last day of the recording, they were given a neuropsychological battery including the Alzheimer's Disease Assessment Scale. Results: Daytime activity level was the best predictor of depressed mood as indicated by a logistic regression analysis. The regression model further suggested that sleep onset latency, total time asleep, and time in bed were also significant predictors of depressed mood. Conclusion: This investigation demonstrates that daytime activity level could be used as an index of depressed mood even in a non-psychiatric sample. Further, the results support the notion that depression should be considered more as a continuum rather than as a set of rigid categories.
Cannabis Use in Psychotic Patients
Authors: Sembhi Sati , Lee Joseph W.Y. 
Published: December 2009

Objective: The purpose of this study was to examine the level of cannabis use in psychotic patients admitted to two acute admission wards in New Zealand. Symptomatology was investigated using the Brief Psychiatric Rating Scale (BPRS). Method: During a 1-month period, all acute admissions to Tokanui Hospital with psychosis were interviewed and symptoms rated on the BPRS (n = 35). Cannabis use was recorded with a questionnaire and urine test. Those positive for cannabis were compared to those negative. Results: Thirty patients (86%) had tried cannabis at least once and 11 (31%) were positive on urine screen. Those with positive urine tests were significantly more likely to use cannabis most days (p < 0.001). This positive urine test group was less likely to be thought disordered, suspicious or deluded (as measured by the BPRS). Conclusions: Cannabis use was widespread in this sample of patients with psychosis and may affect their symptomatology. Larger studies are needed to examine these associations in more detail.
Dissociation, Abuse and the Eating Disorders: Evidence from an Australian Population
Authors: Brown Lisa , Russell Janice , Thornton Christopher , Dunn Stewart 
Published: December 2009

Objective: Anumber of European and Northern American studies have investigated a possible association between dissociative phenomena, eating disorders, child sexual abuse and self-mutilation. However, there has been little confirmation from other countries and cultures, and the Australian experience of these interrelationships has not previously been studied. Method: Dissociative symptomatology and self-reported history of abusive experiences, physical and sexual, were retrospectively studied in a sample of Australian eating disordered patients using a self-report measure, the Dissociation Questionnaire (DIS-Q). Results: As hypothesised, dissociative symptoms were particularly frequent in those who reported child and adult sexual abuse and in those who self-mutilated. A correlation between multiple forms of abuse and higher dissociation scores was only partially upheld. Conclusions: Interrelationships between victimisation and dissociation are discussed within the context of current knowledge in the field, and brief suggestions for therapeutic strategies are offered.
A Randomised, Double-Blind, Placebo-Controlled Trial of Dexamphetamine in Adults with Attention Deficit Hyperactivity Disorder
Authors: Paterson Roger , Douglas Charles , Hallmayer Joachim , Hagan Michael , Krupenia Zyron 
Published: December 2009

Objective: The aim of this paper is to determine the efficacy of dexamphetamine in adult attention deficit hyperactivity disorder (ADHD) in a naturalistic setting. Method: A randomised, double-blind, placebo-controlled study of dexamphetamine was conducted by two psychiatrists in private practice who saw a total of 68 consecutive referrals of patients thought to have ADHD by their referring general practitioners. Patients were admitted to the study if their current level of ADHD symptoms satisfied DSM-IV criteria (modified for use in adults), and were not currently comorbid for major mood disturbance or substance abuse. Response to medication was assessed by repeated administration of these modified DSM-IV criteria, self- and relatives' rating, as well as clinician rating using the Clinical Global Impressions Scale. More general outcome measures included the Brief Symptom Inventory and a patient satisfaction questionnaire. Medication side effects were recorded, including monitoring blood pressure and weight change. Urinalysis monitored concurrent substance usage and compliance. Results: Dexamphetamine had a significant therapeutic response exceeding the placebo response (p = 0.045). The response was similar in both genders and across the age range. It was detected by patients, their relatives and the two clinicians. The only significant side effect was weight loss. One patient on dexamphetamine discontinued the trial because of an event possibly related to the medication. Conclusions: In the short term, dexamphetamine appears to be efficacious in treating adult ADHD. As this is the first study in the literature, the result requires replication. Given that stimulant medication use in adult ADHD appears to be long-term, studies of long-term efficacy need to be carried out.
Psychological Factors in Severe Chronic Asthma
Authors: Vamos Marina , Kolbe John 
Published: December 2009

Objective: Levels of psychological distress, social support factors, and emotional adjustment to illness were measured in a sample of patients with severe asthma. These were then examined in terms of their interrelationships and their ability to predict self-management knowledge. Method: A sample of 80 patients was recruited from a hospital-based asthma clinic designed for patients with severe asthma. Thirty-four percent of consecutive attenders approached took part. Morbidity and asthma management were recorded from case records. Anxiety, depression, social support, emotional adjustment to asthma and asthma knowledge were measured using self-report instruments selected for their acceptability and ease of administration. Results: Twenty-five percent of the sample had possible or definite caseness for anxiety; 10.3% had possible or definite caseness for depression. Twenty-five percent had inadequate social support in some way. Three independent attitudinal factors were found: emotional maladjustment to asthma, the doctor-patient relationship, and asthma-related stigma. Level of asthma knowledge was very low. None of the measures of psychosocial function chosen were predictive of asthma knowledge. Conclusions: Levels of asthma knowledge were dangerously low, despite apparently adequate educational intiatives. In addition, patients with severe asthma have high levels of distress, particularly of anxiety, even between attacks. Their attitudes to their illness are multifactorial, and are significantly correlated with emotional distress, morbidity indices and some demographic factors. While this may point the way to interventions designed to relieve patients' distress, the hypothesis that this might in turn relate to practical asthma knowledge was not confirmed.
Psychotherapy with Borderline Patients: II. A Preliminary Cost Benefit Study
Authors: Stevenson Janine , Meares Russell 
Published: December 2009

Objective: The aim of this study was to conduct a preliminary cost benefit study of the effect of outpatient psychotherapy, twice a week for 1 year, in 30 borderline patients. Method: Costs to the health system in terms of inpatient care for the year before treatment were compared with the costs for the year following treatment. Results: The cost of hospital admissions for the 30 patients for the year before treatment was $684 346 (range = $0–$143 756/patient). The cost of hospital admissions for the year after treatment was $41 424 (range = $0–$12 333/patient). These figures represent an average decrease in costs per patient of $21 431. By using the schedule fee as the basis, the estimated cost of therapy per patient was approximately $13 000, representing a saving/patient of $8431 or approximately $250 000 over the total cohort in the first year after treatment. Conclusion: This study suggests that there is a significant cost benefit in the appropriate treatment of borderline patients.
Measurement of Need for Care: A Trial of the Camberwell Assessment of Need and the Health of the Nation Outcome Scales
Authors: Issakidis Cathy , Teesson Maree 
Published: December 2009

Objective: The accurate assessment of the individual needs of clients has been the focus of increasing discussion in mental health service delivery and evaluation. There is evidence to suggest that clinicians and clients differ in their perceptions of need and that staff assessments alone may not be sufficient for determining need for care. This study addresses these discrepancies in an Australian setting. Method: The Camberwell Assessment of Need (short version) and the Health of the Nation Outcome Scales (HoNOS) were completed on a sample of 78 clients of a mental health service in inner Sydney. Results: Clinicians identified a mean number of 7.3 needs per client (SD = 5.0) compared with 6.0 (SD = 2.4) identified by clients. The mean kappa coefficient for agreement between clinicians and clients in identification of the 22 need areas was 0.18 (range = 0–0.45), indicating poor to moderate agreement. Similarly, client ratings of need were only moderately correlated with clinician ratings of disability on the HoNOS (Pearson's r = 0.35). Clinician ratings of disability and unmet need were highly correlated (Pearson's r = 0.80), whereas ratings of disability and met need were moderately correlated (Pearson's r = 0.52). Conclusions: Individual needs assessments using the CAN are applicable in this Australian setting. Staff and clients differ in their assessment of need. It is important to consider both the role of the rater and the context in which they are making the ratings when applying need and disability assessments in clinical practice.
Australia's Mental Health: An Overview of the General Population Survey
Authors: Henderson Scott , Andrews Gavin , Hall Wayne 
Published: December 2009

Objectives: The objectives of this study were to estimate the 1-month and 1-year prevalence of mental disorders in the Australian adult population; to determine the amount of disablement associated with this; and to determine the use of health and other services by persons with common mental disorders. Method: For the Adult Survey, a household sample of 10 600 persons aged 18 years and over were interviewed across Australia by experienced field staff of the Australian Bureau of Statistics. This was 78%% of the target sample. The interview consisted of the composite international diagnostic interview in its automated presentation (CIDI-A) and other components to determine disablement, use of services and satisfaction with services received. The diagnostic classifications used in the analyses were both ICD-10 and DSM-IV. Only the results from ICD-10 are reported here. Results: A total of 17.7%% of the sample had one or more common mental disorders, anxiety, depression, alcohol or substance abuse and neurasthenia. This morbidity was associated with considerable disablement in daily life: 3 days of impaired social role performance in the previous 4 weeks, compared with 1 day for the general population. Of all cases, 64.6%% had had no contact with health services in the previous year; 29.4%% had seen GPs and 7.5%% had seen psychiatrists. Conclusion: Australia now has its own national estimates of psychiatric morbidity. The morbidity is associated with considerable disablement, but most of it is untreated. General practitioners encounter by far the largest proportion of those reaching services.
Risk Factors for Suicide and Attempted Suicide among Young People
Authors: Beautrais Annette L. 
Published: December 2009

Objective: Suicide rates in young people have increased during the past three decades, particularly among young males, and there is increasing public and policy concern about the issue of youth suicide in Australia and New Zealand. This paper summarises current knowledge about risk factors for suicide and suicide attempts in young people. Method: Evidence about risk factors for suicidal behaviour in young people was gathered by review of relevant English language articles and other papers, published since the mid-1980s. Results: The international literature yields a generally consistent account of the risk factors and life processes that lead to youth suicide and suicide attempts. Risk factor domains which may contribute to suicidal behaviour include: social and educational disadvantage; childhood and family adversity; psychopathology; individual and personal vulnerabilities; exposure to stressful life events and circumstances; and social, cultural and contextual factors. Frequently, suicidal behaviours in young people appear to be a consequence of adverse life sequences in which multiple risk factors from these domains combine to increase risk of suicidal behaviour. Conclusions: Current research evidence suggests that the strongest risk factors for youth suicide are mental disorders (in particular, affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology, indicating that priorities for intervening to reduce youth suicidal behaviours lie with interventions focused upon the improved recognition, treatment and management of young people with mental disorders.
Demoralisation, Depression and Desire for Death: Problems with the Dutch Guidelines for Euthanasia of the Mentally Ill
Authors: Kissane David W. , Kelly Brian J. 
Published: December 2009

Objective: Given the recent publication of Dutch guidelines for euthanasia of the mentally ill, our aim in this paper is to review the clinical role of the psychiatrist in assessing patients who seek euthanasia or physician-assisted suicide. Method: Three areas are examined that are informative of the role of the psychiatrist in assessing patients who desire death: recent surveys of psychiatrists' attitudes, empirical and clinical studies, and treatment issues. Results: Demoralisation and depression emerge as pertinent clinical issues worthy of psychiatric intervention. The role of the psychiatrist is complex and includes issues of assessment, systems, countertransference and treatment. Conclusions: Dutch guidelines for physician-assisted suicide in the mentally ill generate serious concern given the uncertainty of prognosis, potential range and variability of outcome of treatments of suicidality and the boundary violations that are involved for the psychiatrist. The guidelines have the potential to dangerously alter the practice of psychiatry and should be condemned.
Medicine, Psychiatry and Euthanasia: An Argument Against Mandatory Psychiatric Review
Authors: Parker Malcolm 
Published: December 2009

Objective: The paper critically appraises the argument that requests for active assistance to die should be subject to mandatory psychiatric assessment. Method: The argument for mandatory psychiatric assessment is usually supported by an appeal to the need for safeguards against errors and omissions in both the diagnosis of psychiatric conditions affecting the terminally ill and the exploration of the meanings of their requests. This intuitively appealing view is challenged through a broader analysis which examines connections between medicine's traditional adherence to the moral distinction between acts and omissions and the following issues: the historical relationship between medical practice and dying, the recent development of research into treatment-withdrawal decisions, the scientific status of psychiatry, the logic of rationality and decision-making competence. Results: The analysis reveals a number of hitherto unexamined and unacknowledged influences which would make psychiatric review of requests for assisted death a much less objective and impartial process than is assumed. Conclusion: Mandatory psychiatric review is an instance of the medicalisation of death and dying which could abridge the freedom of certain individuals to make decisions about their deaths.
Psychotic Disorders in Urban Areas: An Overview of the Study on Low Prevalence Disorders
Authors: Jablensky Assen , McGrath John , Herrman Helen , Castle David , Gureje Oye , Evans Mandy , Carr Vaughan , Morgan Vera , Korten Ailsa , Harvey Carol 
Published: December 2009

Objective: This paper reports on a study designed within the framework of the National Survey of Mental Health and Wellbeing to: estimate the prevalence of psychoses in urban areas of Australia; identify profiles of symptomatology, impairments and disabilities; collect information on services received and needed; and explore quality of life issues in a broadly representative sample of people with psychotic illnesses. Method: The study was conducted over four areas in the Australian Capital Territory, Queensland, Victoria and Western Australia, as a two-phase survey: (i) a census and screening for psychosis of all individuals who made contacts with mental health services during a period of 1 month in 1997; and (ii) interviews with a stratified random sample (n = 980) of the screen-positive individuals (n = 3800) using a standardised instrument. Results: The point prevalence (1 month) of psychotic disorders in the urban population aged 18–64 is in the range of 4–7 per 1000 with a weighted mean of 4.7 per 1000. People with psychotic disorders experience high rates of functional impairments and disability, decreased quality of life, persistent symptoms, substance-use comorbidity and frequent side effects of medication. Although the utilisation of hospital-based and community mental health services, as well as of public and non-governmental helping agencies, is high, the majority live in extreme social isolation and adverse socioeconomic circumstances. Among the many unmet needs, the limited availability of community-based rehabilitation, supported accommodation and employment opportunities is particularly prominent. Conclusions: The so-called ‘low-prevalence’ psychotic disorders represent a major and complex public health problem, associated with heavy personal and social costs. There is a need for a broad programmatic approach, involving various sectors of the community, to tackle the multiple dimensions of clinical disorder, personal functioning and socioeconomic environment that influence the course and outcome of psychosis and ultimately determine the effectiveness of service-based intervention.
How High a Dose of Stimulant Medication in Adult Attention Deficit Hyperactivity Disorder?
Authors: Sachdev Perminder S. , Trollor Julian N. 
Published: December 2009

Objective: This paper examines clinical and neuroscientific evidence to address the question whether high doses of stimulant drugs offer additional advantages in the treatment of adult attention deficit hyperactivity disorder (ADHD) and at what cost. It attempts to arrive at a reasonable upper limit of dosage for clinical purposes.Method: The study involves a selective review of the treatment studies of ADHD in children and adults and an examination of the pharmacokinetic and pharmaco-dynamic data on psychostimulants in humans and animals.Results and Conclusions: The clinical and experimental data justify the use of chronic low-dose stimulant treatment of ADHD in adults, with the recommended upper limit of dose being 1 mg/kg for methylphenidate and 0.5 mg/kg for dexamphetamine. There is no empirical evidence of greater improvement with higher doses and any beneficial effect is likely to be compromised by the adverse effects, some of which can be very serious. The recommended doses should be exceeded only after careful consideration and objective documentation of beneficial and adverse consequences. Monitoring of drug levels in blood may be of some value for compliance or pharmacokinetic considerations, as there is a direct relationship between blood and brain levels as well as dopamine transporter occupancy. These recommendations are tentative and further clinical research is warranted.