bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinician-Assisted Internet-Based Treatment is Effective for Depression: Randomized Controlled Trial
Authors: Perini Sarah , Titov Nickolai , Andrews Gavin 
Published: December 2009

Objective: The aim of the present study was to determine the efficacy of an Internet-based clinician-assisted computerized cognitive behavioural treatment (CaCCBT) programme for depression. Method: Forty-five individuals meeting diagnostic criteria for depression were randomly assigned to the Sadness programme or to a waitlist control group. In the clinician-assisted Sadness programme, participants complete six online lessons, weekly homework assignments, receive weekly email contact from a clinical psychologist, and contribute to a moderated online discussion forum with other participants. An intention-to-treat model was used for data analyses. Results: A total of 20 (74%) treatment group participants completed all lessons within the 8 week programme, and post-treatment data were collected from 18/27 treatment group and 17/18 waitlist group participants. Treatment group participants reported significantly reduced symptoms of depression as measured by the Beck Depression Inventory–second edition and the Patient Health Questionnaire–Nine Item. Treatment group participants each received an average of eight email contacts (111 min of therapist time]. Mean within- and between-group effect sizes (Cohen's d) across the two measures of depressive symptoms were 0.98 and 0.75, respectively. Participants found the treatment programme acceptable and satisfactory. Conclusions: These results replicate those from the pilot trial reported by Perini et al. and are consistent with literature indicating that Internet-based programmes for depression and other mental disorders combined with clinical guidance can result in clinically significant improvements. These data provide further support for the development of Internet-based treatment for common mental disorders.
Is the Australian National Survey of Mental Health and Wellbeing a Reliable Guide for Health Planners? A Methodological Note on the Prevalence of Depression
Authors: Goldney Robert , Hawthorne Graeme , Fisher Laura 
Published: December 2009

Objective: To consider whether the prevalence of depression reported in the Australian National Survey of Mental Health and Wellbeing is a reliable guide for mental health planners. Method: A comparison of methodologies for the detection of depression in the Australian National Survey and a South Australian survey. Results: The Australian National Survey using the Composite International Diagnostic Interview (CIDI) reported considerably less depression than a South Australian survey, which used the mood module of the PRIME-MD 1000 study. Although the PRIME-MD may over-diagnose depression, it is probable that the preclusion criteria of the CIDI result in an under-reporting of depression. Conclusions: It is probable that the Australian National Survey under-estimates the prevalence of depression in the community. This has implications not only in assessing the morbidity and economic burden of depression, but also for the planning of future mental health services.
Assessing Attachment: Convergent Validity of the Adult Attachment Interview and the Parental Bonding Instrument
Authors: Manassis Katharina , Owens Mary , Adam Kenneth S. , West Malcolm , Sheldon-Keller Adrienne E. 
Published: December 2009

Objective: The aim of this study was to determine whether or not the Parental Bonding Instrument (PBI) can provide information about parent-child attachment that is comparable to information obtained from the Adult Attachment Interview (AAI), a more complex measure of attachment. Method: One hundred and thirty emotionally and/or behaviourally disturbed adolescents (73 male, 57 female; ages 13–19 years, × = 15.3 ± 1.47 years) participating in a study of attachment and suicidality completed the PBI and the AAI. Data from these measures were compared within participants. Results: Maternal care and overprotection on the PBI differed significantly by AAI attachment classification (F3,122 = 2.79, p = 0.012), with autonomous participants showing the most optimal and unresolved participants the least optimal PBI results. Maternal love and maternal involvement/role reversal on the AAI were significant predictors of maternal care and maternal overprotection, respectively, on the PBI (R2 = 0.15; R2 = 0.16). These predictions improved when AAI scales measuring idealisation and involving anger towards the mother were included in the regression analyses (R2 = 0.35; R2 = 0.20). Autonomous participants on AAI showed the highest scale correlations across instruments. Conclusions: Attachment information obtained from the PBI and the AAI is comparable in participants with optimal attachment histories, but not in participants showing idealisation or anger towards their mothers. Caution is, therefore, advisable when using the PBI to obtain attachment information in clinical samples where suboptimal attachment histories are likely.
Training for the Mental Health Workforce: A Review of Developments in the United Kingdom
Authors: Lambert Gordon , Gournay Kevin 
Published: December 2009

Objective: Implementation of the National Mental Health Strategy has important implications for education and training of the Australian mental health workforce. This paper discusses relevant developments in the United Kingdom that may provide some lessons for Australia. Method: A review was undertaken of a number of specific clinical education and training programs for mental health workers in the United Kingdom which have been subjected to published evaluation. Results and conclusions: A finite mental health resource base dictates that education and training activity should: (i) be evaluated; (ii) target those clients most in need; (iii) include evidence-based approaches such as assertive community treatment, medication management, cognitive—behaviour therapy and family interventions; and (iv) prepare mental health workers in the core competencies needed to implement these approaches. Two programs, developed in the United Kingdom, which meet these criteria are presented as examples of best practice: the nurse therapy model established by Isaac Marks; and the Thorn initiative established in association with the Institute of Psychiatry, London and the University of Manchester.
Schizophrenia and Hypocalcaemia: Variable Phenotype of Deletion at Chromosome 22q11
Authors: Chow L. Y. , Garcia-Barcelo Merce , Wing Y. K. , Waye Mary M. Y. 
Published: December 2009

Objective: The aim of this paper is to report the diagnosis of velo-cardio-facial syndrome (VCFS) in a patient presenting with schizophrenia and hypocalcaemia. Screening of deletion 22q11 in patients with schizophrenia is discussed. Clinical picture: We report a schizophrenic patient presenting with hypocalcaemia as the only feature of VCFS. Deletion 22q11 was confirmed by fluorescent in situ hybridisation (FISH). Treatment: The patient was treated with haloperidol 3 mg/day with resolution of psychotic symptoms. Outcome: The patient harboured some residual psychotic symptoms probably related to her irregular compliance. Conclusions: The wide range of phenotypic variability of VCFS makes screening of 22q11 deletion in schizophrenia difficult. It is proposed that screening of 22q11 deletion in schizophrenia should be selectively targeted only at patients with specific features of VCFS highly predictive of the presence of 22q11 deletion.
Integrated Drug and Alcohol Intervention: Development of an Opportunistic Intervention Program to Reduce Alcohol and other Substance use among Psychiatric Patients
Authors: Sitharthan Thiagarajan , Singh Subba , Kranitis Paul , Currie Jon , Freeman Pauline , Murugesan Ganapathi , Ludowici Joan 
Published: December 2009

Objective: This paper describes the rationale, aims and processes involved in developing and implementing an opportunistic intervention program to reduce substance misuse detected among psychiatric patients. Method: In this randomised, opportunistic intervention program, eligible patients recruited from a large psychiatric hospital and its associated community mental health centres are assigned to receive an integrated drug and alcohol intervention (IDAI) or alternatively allocated to a minimal intervention condition (MI). The IDAI is based on motivational enhancement and cognitive-behavioural principles, and incorporates harm-reduction approaches. This clinical program is based on the research findings and recommendations of the mental health and the drug and alcohol literature. Results: A collaborative partnership between the Mental Health Services and the Drug and Alcohol Services was formed. Following a relatively short training period, mental health staff were trained to opportunistically detect drug and alcohol problems among psychiatric patients and offer appropriate integrated clinical care. Conclusion: The process of implementing an integrated opportunistic intervention program is achievable and can be readily incorporated in psychiatric hospitals and community mental health clinics.
The Senior Psychiatrist Survey I: Age and Psychiatric Practice
Authors: Draper Brian , Winfield Stephanie , Luscombe Georgina 
Published: December 2009

Objective: The aim of this study is to determine the effects of age on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Method: A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: age; location and type of psychiatric practice; hours of work; attitudes towards re-accreditation; changes in work practices over the career; and the perceived benefits and drawbacks of age to psychiatric practice and case selection. Results: Of 1086 eligible subjects, 629 participated. The mean age of the sample was 52.7 years (SD = 13.5). Those psychiatrists favouring re-accreditation were younger. Psychiatrists practising psychotherapy, forensic psychiatry or general psychiatry; working in psychiatric hospitals and private practice were more likely to be older. Older psychiatrists worked shorter hours. There was largely no association between case selection and age. Psychiatrists reporting increased credibility and respect as a benefit of their current age upon their psychiatric practice were older, as were those identifying fatigue and an inability to keep up to date as a drawback of age. Psychiatrists reporting a lack of credibility and respect were younger, as were those who reported increased enthusiasm and optimism. Conclusions: Age is associated with benefits and drawbacks to the practice of psychiatry and this may be reflected in the different practice profiles of older and younger psychiatrists.
The Senior Psychiatrist Survey II: Experience and Psychiatric Practice
Authors: Draper Brian , Luscombe Georgina , Winfield Stephanie 
Published: December 2009

Objective: The aim of this study is to determine the effects of experience on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Method: A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: years of psychiatric experience; higher medical qualifications; location and type of psychiatric practice; attitudes about senior psychiatrists and mentorship; changes in work practices over the career; and the perceived benefits and drawbacks of experience on psychiatric practice and case selection. Results: Of 1086 eligible subjects, 629 participated. Over 96% of respondents, particularly the younger and less experienced, believed that senior psychiatrists have wisdom to offer to junior colleagues. This wisdom principally related to mentor-ship/supervision. Increased ‘respect and tolerance’ of patients as a benefit of experience was more likely to be reported by respondents who were more experienced. Respondents more confident about treating younger patients and treating functional psychoses were more likely to be less experienced, as were those reluctant to take on psychotherapy cases. Those respondents reluctant to take on ‘dangerous or acting-out patients’ were more experienced. The field of psychiatric practice significantly influenced case selection. Conclusions: Senior psychiatrists have accumulated wisdom through experience that is sought by junior colleagues via mentorship. It is recommended that the RANZCP should specifically address the needs of early career and senior psychiatrists.
Criteria for Involuntary Hospitalisation
Authors: McLachlan A. J. , Mulder R. T. 
Published: December 2009

Objective: The aim of this paper is to provide an overview of the ethical bases of compulsory commitment legislation. Method: The ethical principles of beneficence and autonomy are examined and used to identify criteria for the commitment of mentally ill patients. Results: Two aspects of beneficence, medical paternalism and social paternalism, are discussed. It is argued that social paternalism is insufficient ethically to warrant involuntary admission, and that the basis for compulsory hospitalisation is medical paternalism. Conclusion: The central role of autonomy in medical ethics suggests a patient should have a diminished capacity for autonomous decision-making and a potential to benefit from hospitalisation, as well as a risk of harm to self (including self-neglect) to warrant committal. In specific circumstances, the risk of harm to others may also justify committal. These ethical principles may be at odds with public attitudes.
Way Out of Tune: Lessons from Shine and Its Exposé
Authors: Rosen Alan , Walter Garry 
Published: December 2009

Objective: The depiction of David Helfgott's life presented in the movie Shine is at odds with other public accounts, notably one by his sister, Margaret. These significant discrepancies have sparked a prolonged media debate and provide the opportunity to examine cinema's apparent ground rules governing depictions of psychiatry in film, the media values and pressures which are claimed to limit the scope of these portrayals, and the implications for psychiatry. Method: Information was obtained from a number of sources, including Shine, books about the movie and Shine film paraphernalia, other films about mental illness, the psychiatric papers on cinema, media images of mental illness and media values, and through discussions with fellow mental health professionals, consumers, carers and media specialists. Results: David Helfgott emerges as an undoubtedly remarkable and resilient individual, who, together with his family, was vulnerable to, and may have experienced, exploitation and violation through the cinema. Conclusions: Filmmakers should reconcile media values and constraints with considerations of ethics and public accountability. Marrying these considerations is both possible and compatible with good filmmaking and audience appeal. There is the potential for a story about those who have mental illness to be told from multiple points of view without compromising dramatic power.
Methods of Youth Suicide in New Zealand: Trends and Implications for Prevention
Authors: Beautrais Annette L. 
Published: December 2009

Objective: One commonly suggested approach to reducing suicide is to restrict access to potentially lethal means of suicide. This paper summarises recent trends in methods of suicide among young people in New Zealand and examines the feasibility of suicide prevention through restricting access to methods of suicide. Method: Data derived from official mortality statistics were used to examine trends, from 1977 to 1996, in methods of suicide among young people aged 15–24 years. Results: During the last two decades, male youth suicide rates in New Zealand doubled, from 20.3 per 100 000 in 1977 to 39.5 per 100 000 in 1996. This increase was accounted for, almost entirely, by increased use of hanging (71% of total increase) and vehicle exhaust gas (26% of total increase). Suicide rates among young females also increased, from 4 per 100 000 in 1977 to 14.3 per 100 000 in 1996. As for males, the increased female suicide rate was largely accounted for by increased rates of hanging and vehicle exhaust gas. Conclusions: The marked increases in rates of youth suicide in New Zealand during the past two decades are accounted for, almost wholly, by increases in rates of suicide by hanging and, to a lesser extent, vehicle exhaust gas. In 1996 the majority (79.7%) of youth suicides were accounted for by these two methods: hanging (61.5%) and vehicle exhaust gas (18.2%). Both methods are widely available and difficult to restrict, implying that limiting access to means of suicide is a strategy which is unlikely to play a major role in reducing suicidal behaviour among young people in New Zealand.
Antidepressants Versus Placebo for the Treatment of Bulimia Nervosa: A Systematic Review
Authors: Bacaltchuk Josue , Hay Phillipa , Mari Jair Jesus 
Published: December 2009

Objective: The objective of this study was to valuate the effectiveness, tolerability and acceptability of various classes of antidepressants compared with placebo in the treatment of bulimia nervosa. Method: A meta-analysis including 16 randomised controlled trials and 1300 bulimic patients was performed. Dichotomous outcomes were analysed by calculating relative risks, and continuous outcomes by calculating effect sizes. Methodological quality, heterogeneity in the results and selective publication were assessed. Results: Short-term remission in bulimic symptoms was statistically more likely on antidepressants than placebo (Relative Risk = 0.88, 95%% Cl = 0.83–0.94, p < 0.0001). Drop-out rates were high but no statistical difference was found between treatment groups (34.6%% and 31.4%% for drug and placebo; RR = 1.03, 95%% CI = 0.80–1.32, p = 0.8). No difference in efficacy could be demonstrated among different classes of antidepressants. Conclusions: The use of a single antidepressant agent was clinically effective for the treatment of bulimia nervosa when compared with placebo, with an overall greater remission rate and a higher rate of drop-outs. No differential effect regarding efficacy and tolerability among the various classes of antidepressants could be demonstrated.
Alcohol- and Drug-Use Disorders in Australia: Implications of the National Survey of Mental Health and Wellbeing
Authors: Teesson Maree , Hall Wayne , Lynskey Michael , Degenhardt Louisa 
Published: December 2009

Objective: This study reports the prevalence and correlates of ICD-10 alcohol- and drug-use disorders in the National Survey of Mental Health and Wellbeing (NSMHWB) and discusses their implications for treatment. Method: The NSMHWB was a nationally representative household survey of 10 641 Australian adults that assessed participants for symptoms of the most prevalent ICD-10 and DSM-IV mental disorders, including alcohol- and drug-use disorders. Results: In the past 12 months 6.5%% of Australian adults met criteria for an ICD-10 alcohol-use disorder and 2.2%% had another ICD-10 drug-use disorder. Men were at higher risk than women of developing alcohol- and drug-use disorders and the prevalence of both disorders decreased with increasing age. There were high rates of comorbidity between alcohol- and other drug-use disorders and mental disorders and low rates of treatment seeking. Conclusions: Alcohol-use disorders are a major mental health and public health issue in Australia. Drug-use disorders are less common than alcohol-use disorders, but still affect a substantial minority of Australian adults. Treatment seeking among persons with alcohol- and other drug-use disorders is low. A range of public health strategies (including improved specialist treatment services) are needed to reduce the prevalence of these disorders.
Obstacles to a Randomised Controlled Trial of Intensive Dynamic Psychotherapy: An Account of the New South Wales Section of Psychotherapy Outcomes Project
Authors: White Richard T. , Walden Maxine A. 
Published: December 2009

Objective: This paper examines the obstacles to a randomised controlled trial (RCT) of intensive dynamic psychotherapy (IDP) by reference to the fate of the New South Wales Section of Psychotherapy outcomes project. Method: Planning was complete and the final research protocol was about to be implemented when funding difficulties led to suspension of the project. The opinions of the research subcommittee regarding the main obstacles to the ultimate success of the project are now analysed in the expectation that better research strategies will follow. Results: With hindsight, six of the eight members of the research subcommittee reported that the project was not feasible. By choice of questionnaire items they identified the greatest threats to a successful trial as: standardisation of the procedures, termination at 24 months, the availability of funding and the choice of treatment procedures. The most frequently volunteered concerns related to the enlistment and cooperation of the trial therapists (5), standardisation of the experimental therapy (3), probable shortfall in trial subjects (3) and the availability of funding (2). Conclusions: The most powerful general obstacles to success of the project related to the standardisation of procedures and the failure to maintain sufficient cooperation of trial therapists. The protocol required IDP therapists to terminate procedures at 24 months, which contradicted their usual practices and led to some alienation from the project. Amendments to the protocol might improve the possibility of a successful trial. However, one might also conclude that it is premature to attempt a naturalistic RCT of IDP.
Nosological Implications of Psychotic Symptoms in Patients with Established Posttraumatic Stress Disorder
Authors: Chan Angelina Oi Mei , Silove Derrick 
Published: December 2009

Objective: We describe three patients with chronic posttraumatic stress disorder (PTSD) who later developed psychotic symptoms. The nosological implications are discussed. Clinical picture: All three patients had no prior history of psychotic illness. The content of the psychotic symptoms was restricted to core features of the traumatic experiences which initially led to PTSD. Treatment: The patients received low-dose antipsychotic medications in addition to other treatments for PTSD and/or depression. Outcome: All three patients developed severe extrapyramidal side effects, particularly akathisia, and discontinued drug treatment. Conclusion: Psychotic symptoms occasionally can complicate chronic PTSD, but uncertainty remains about their aetiology and nosological status.
The Development of Clinical Indicators for a Consultation–Liaison Service
Authors: Holmes Alex C.N. , Judd Fiona K. , Lloyd John H. , Dakis Jennifer , Crampin Emma F. , Katsenos Spiri 
Published: December 2009

Objective: The aim of this paper is to describe the development and implementation of clinical indicators in the consultation–liaison service at Royal Melbourne Hospital (RMH). Method: A working party lead by the University of Melbourne was established in 1998 to develop clinical indicators and a database for the RMH consultation–liaison service. Core parameters for measuring service functioning and six clinical indicators were developed. The system was implemented using a data collection form and computerised database operating within a system of regular clinical reviews. Results: The clinical indicators, database and review system were found to be a feasible, useful and efficient addition to a consultation–liaison service at a major general hospital. Conclusions: Clinical indicators may be used within specialist psychiatry services to enhance clinical care and aid in service development and teaching.