bluuebunny/crossref_metadata_2025_split huggingface dataset:
Collaborative Recovery: An Integrativemodel for Working with Individuals Who Experience Chronic and Recurring Mental Illness
Authors: Oades Lindsay , Deane Frank , Crowe Trevor , Gordon Lambert W , Kavanagh David , Lloyd Chris 
Published: December 2009

Objectives: Recovery is an emerging movement in mental health. Evidence for recovery-based approaches is not well developed and approaches to implement recovery-oriented services are not well articulated. The collaborative recovery model (CRM) is presented as a model that assists clinicians to use evidencebased skills with consumers, in a manner consistent with the recovery movement. A current 5 year multisite Australian study to evaluate the effectiveness of CRM is briefly described. Conclusion: The collaborative recovery model puts into practice several aspects of policy regarding recovery-oriented services, using evidence-based practices to assist individuals who have chronic or recurring mental disorders (CRMD). It is argued that thismodel provides an integrative framework combining (i) evidence-based practice; (ii) manageable and modularized competencies relevant to case management and psychosocial rehabilitation contexts; and (iii) recognition of the subjective experiences of consumers.
Psychiatric Comorbidity: Concepts, Controversies and Alternatives
Authors: Starcevic Vladan 
Published: December 2009

Objective: To review various concepts of psychiatric comorbidity, their implications, surrounding controversies and underlying issues. A further aim is to propose an alternative term that might be more clinically useful and meaningful for describing the coexistence of mental disorders. Conclusions: There is wide dissatisfaction with the concepts of psychiatric comorbidity because ofdifferent meanings, speculations on which they are often based and consequent confusion. Although the coexistence of mental disorders should be studied further so that any patterns in the corresponding relationships can be elucidated, there is a need for conceptual clarity and making the concept more meaningful for clinical practice and treatment. With that in mind, this present paper proposes avoidance of the term comorbidity and introduction of the term ‘co-occurrence’. The latter is defined in this article, and the distinction made between diagnostic co-occurrence and clinically significant co-occurrence.
Consultation–liaison Psychiatry Services to Nursing Homes
Authors: Craig Elizabeth , Pham Hieu 
Published: December 2009

Objective: The aim of the present paper is to review current opinion relating to the provision of mental health consultation to nursing homes, and to provide recommendations for future research. Method: The current literature pertaining to consultation–liaison psychi atry within nursing homes was reviewed. Results: There is a paucity of well-designed empirical studies of mental health service provision to Australian nursing homes. This is of particular concern given the ageing Australian population and the prevalence of psychiatric symptoms in nursing home residents. Psychiatric consultation and liaison to nursing homes may result in reduced need for crisis inter vention, improved use of behavioural management strategies for the symp toms associated with dementia, and reduced nursing home staff stress and burnout. Conclusions: Further research is required to evaluate the costs and benefits of providing regular mental health services to nursing homes in Australia, particularly in rural areas. Future service development should be complemented by methodologically sound evaluation.
Restoring Wisdom to the Practice of Psychiatry
Authors: Boyce Philip 
Published: December 2009

Objective: While psychiatry is an exciting and rewarding discipline of medicine, the practice of psychiatry has become increasingly simplistic. This address seeks to identify some of the influences that underlie this phenomenon. Conclusions: The influences include an increased demand for services and pressure on beds, the sway of the pharmaceutical industry with a biological approach being promulgated, excessive managerial constraints with an emphasis on efficiency versus effectiveness, and the acceptance of DSM diagnostic categories of uncertain validity. I argue that we need to rediscover a more wise approach to psychiatric practice. We have to insist upon changes to our training such that trainees are encouraged to get to know their patients and understand them from a biopsychosocial perspective. As a profession, we have to insist on proper care for our patients and work with managers and bureaucrats to ensure that the management of our patients is centred on quality of care and effectiveness over and above efficiency.
Social Engineers and Bystanders: The Limits of ‘Responsibility’ in Indigenous Affairs
Authors: Hunter Ernest 
Published: December 2009

Objective: A significant shift is occurring in Australian Indigenous affairs. Contentiously, key Aboriginal and Torres Strait Islander leaders have challenged governments and organizations, both mainstream and Indigenous, to confront ‘passive welfare dependence’. This paper explores some of the social justice implications and considers the roles of non-Indigenous professionals. Methods: A publication by Pat Dodson and Noel Pearson is used to frame the discussion. Results: Ambiguity surrounding a number of key concepts and the shifting territory of Indigenous rights has contributed to bureaucratic inertia in Indigenous affairs. A range of ‘new’ concepts is being introduced into the current debate, such as expectancy, reciprocity and mutual obligation, challenging ideas of responsibility, agency and the roles played by non-Indigenous bureaucrats and practitioners. Conclusions: Regardless of good intentions or social justice motivations, non-Indigenous interventions must be informed by an awareness of the potential to undermine Indigenous agency and, consequently, cause harm.
Developing New Services for Eating Disorders: An Evaluation Study
Authors: Endacott Ruth , Kidd Susan , Deacon-Crouch Melissa , Judd Fiona , Menzel Michelle , Cornett Marian 
Published: December 2009

Objective: This paper aims to evaluate the structures and processes of eating disorders services in two regional cities in Australia. Method: Stakeholder evaluation undertaken between 2002 and 2005 uses interviews, questionnaires and service delivery data to examine: structure and patient profile of the two services, barriers and success factors and local factors influencing development of the services. Results: The Bendigo service provided secondary consultation and specialist management with upskilling of primary care workers as a key goal. Patients were referred to the service via mental health triage. The Geelong service initially offered assessment only, with direct access for the general public. Treatment was offered from early 2004. The Bendigo service assessed 41 patients, 63% were diagnosed with anorexia nervosa or bulimia nervosa. Most patients had a moderate or severe eating disorder. The Geelong service assessed 186 patients, 55% were diagnosed with anorexia nervosa or bulimia nervosa and 80% of this subset had not previously been treated for an eating disorder. General practitioners identified barriers to development of the services as: problems with capacity building and unrealistic expectations. The success factors were providing a locally based service with credible clinicians and effective communication. Conclusions: Activity analysis demonstrates that the goals for both services were met. There is a need to measure both short- and long-term patient outcomes in order to fully assess effectiveness and applicability to other settings. Local factors, such as availability of specialist providers, would need to be taken into account.
Extended Matching Questions and the Royal Australian and New Zealand College of Psychiatrists Written Examination: An Overview
Authors: Samuels Anthony 
Published: December 2009

Objective: To provide an overview, for trainees and fellows, of the Extended Matching Question, a new question type recently introduced in the Royal Australian and New Zealand College of Psychiatrists written examination. The characteristics, technical aspects and construction of these question types are discussed. Some pointers for candidates and those setting questions are outlined. Conclusions: Extended Matching Questions are now commonly used to test medical knowledge in many areas of medicine, including psychiatry. They represent a transparent, evidence-based approach to the assessment of medical knowledge, which lends itself to electronic marking and statistical analysis. These questions facilitate the development of question banks and provide an easily accessible oversight of what areas of the curriculum have been examined.
From Golden Beaches to the Heartland: Reflections of NSW Rural Trainees
Authors: De Moore Gregory , Smith Kathleen , Earle Maree 
Published: December 2009

Objective: To describe the training experiences of rural-based psychiatry trainees in New South Wales. Method: Semistructured interviews were conducted with psychiatry trainees, rural psychiatrists and rural mental health administrators. The interviews were, for the most part, conducted face to face. Results: Three factors that make this programme work are the opportunity to start training in a rural centre, a local psychiatrist who can act as guide and mentor and the initiative of this group of registrars. Three obstacles are a perceived lack of flexibility in College guidelines, isolation from peers and insufficient support when relocating to the city for specialty terms. Conclusions: The NSW rural psychiatry training project is an exciting development. Three years on, it represents the best avenue for creating a locally based rural psychiatrist network. It stands as a model for the rest of the country.
Drug-Induced Psychosis Associated with Crystalline Methamphetamine
Authors: Dore Glenys , Sweeting Melinda 
Published: December 2009

Objective: A case of drug-induced psychosis related to crystalline meth amphetamine is described, highlighting the phenomenology and relevant treatment. Results: A 44-year-old woman with borderline personality traits and severe drug dependence developed a protracted drug-induced psychosis related to chronic high-dose crystalline methamphetamine use. Complete resolution of symptoms occurred with antipsychotic medication and abstinence from methamphetamine. Rapid recurrence of symptoms occurred at a time of high stress associated with minimal methamphetamine use and cessation of low-dose quetiapine. Symptoms rapidly resolved with abstinence, quetiapine and reduction of stressors. Conclusions: A drug-induced psychosis resembling paranoid schizophrenia can occur with repeated or high-dose use of methamphetamine. While this generally resolves rapidly with cessation of stimulant use, some cases of protracted drug-induced psychosis in vulnerable individuals have been documented. Behavioural sensitization can also occur, and neuroleptics may prevent the recurrence of further psychosis triggered by ongoing low-dose methamphetamine use.
The ‘Mentally Disordered’ Provisions of the New South Wales Mental Health Act 1990: Their Ethical Standing and Effect on Services
Authors: Patfield Martyn 
Published: December 2009

Objective: To consider whether the mentally disordered provisions of the NSW Mental Health Act 1990 can be ethically justified and whether any departure from the usual justification for compulsory care comes at a cost. Conclusions: The shaky ethical standing of these provisions has encouraged mental health services in NSW to play a role in controlling unacceptable behaviour, even in the absence of mental illness. This places the Act in an exceptional position in comparison to other Western Mental Health Acts. It is causing increasing strain on services as well as having unforseen consequences on those detained.
Chronic Mental Illness and Community Treatment Resistance
Authors: Holmes Alex , Hodge Mark , Lenten Simon , Fielding John , Castle David , Velakoulis Dennis , Bradley Gail 
Published: December 2009

Objectives: The movement from institutional to community care has been a key component of national mental health reform in Australia. In Victoria, where a model of community care has been fully implemented, a specialized forensic hospital is the sole remaining stand-alone psychiatric inpatient facility and access to long-term inpatient beds is severely limited. Clinical experience suggests that some high-needs patients are not well serviced by this structure. These patients are placing an increasing burden on a wide range of community services outside mental health. This paper aims to define more clearly this patient group, explore the limitations of their management and outline potential pathways for service development. Conclusions: A population of complex patients with chronic mental illness are not effectively contained within a ‘good enough’ communitybased mental health system. Active debate is required regarding the com-munity's willingness to tolerate the risks and challenges that arise from the current approach. A collaborative care model involving case-based and incentive funding in combination with community-integrated complex care units may improve the care of these patients.
Australasian Dialectical Behaviour Therapy Pilot Outcome Study: Effectiveness, Utility and Feasibility
Authors: Brassington Jan , Krawitz Roy 
Published: December 2009

Objectives: This paper aims to describe the outcome of 10 patients treated in a New Zealand pilot study of dialectical behaviour therapy (DBT) for people with borderline personality disorder (BPD), and to ascertain the clinical utility and feasibility of implementing DBT into a standard New Zealand public mental health service. Method: Patients had a clinical and an International Personality Disorder Examination diagnosis of BPD and received 6 months of standard DBT treatment. Rating scales used were the Millon Clinical Muliaxial Inventory, 3rd edition (MCMI-III) and the Symptom Checklist 90-Revised (SCL-90-R), which were completed pre treatment and post treatment. Pre–post treatment data were completed on inpatient resource usage. Qualitative patient interviews were conducted post treatment. Results: There were statistically significant improvements in functioning on 10 of the 24 MCMI-III subscales (p < 0.03 to p < 0.0008), including notably the borderline personality subscale (p < 0.01) and the anxiety (p < 0.05) and depression (p < 0.001) subscales. There was a statistically significant improvement on the Global Severity Index of the SCL-90-R (p < 0.001) and on 10 of the 12 SCL-90-R scales (p < 0.05 to p < 0.001). The hospital bed days used decreased from 0.57 days per patient per month to 0.2 days per patient per month. Conclusions: These preliminary results document the clinical effectiveness of DBT. Dialectical behaviour therapy has practical and clinical utility of relevance to Australasian public mental health services. A DBT service can be successfully implemented within existing public mental health services.
The Quest to Fund Research: Playing Research Lotto
Authors: Cleary Michelle , Walter Garry , Hunt Glenn 
Published: December 2009

Objective: To provide some direction for those interested in obtaining funding with the purpose of highlighting opportunities for beginner researchers in the health-care field. Method: Features of a good grant application are described and an audit of seven mental health professional journals was undertaken, the latter to determine, inter alia, whether the paper reported research findings and whether the authors received formal research funding. Result: The audit revealed that many types of papers that are published do not receive formal research funding and describe, for example, services, training issues, clinical practice and education programmes. Conclusion: Innovative and enterprising efforts are required to secure clinical research funding. Submissions must be detailed, comprehensive and relevant, but the onus is also on the researcher to ensure a feasible study, where funding obligations can be fulfilled and findings readily disseminated. Many research studies are conducted without achieving competitive funding, and getting published –and getting started in writing –does not hinge on conducting formal research or receiving research funding.
A Framework for Mental Health Consumers to Evaluate Service Provision
Authors: Malins Gillian , Morland Kim , Strang Jon , Dowson Trevor , Hunt Sandra , Williamson David , Mason Michael , Eman Yvonne , Oades Lindsay 
Published: December 2009

Objectives: This paper outlines a proposed framework including values, principles and steps, developed by consumers, to evaluate mental health services from a consumer's perspective. Method: A research team consisting of consumer researchers, established academics and students developed the framework. The team had already conducted qualitative research with consumers of mental health services. Using these experiences and the evaluation literature, the proposed framework was developed over a series of 13 meetings. Results: An evaluation framework, which describes the values underpinning consumer-directed evaluation of mental health services and the principles and steps to follow in conducting this type of evaluation, is presented. Conclusions: The evaluation framework will guide consumers and services in conducting consumer-directed evaluation of mental health services, and assist in developing more genuine consumer participation in services.
Assessment of Distress and Burden in Australian Private Psychiatric Inpatients
Authors: Page Andrew , Hooke Geoff , O'brien Natalie , Defelice Nick 
Published: December 2009

Objectives: The study aimed to examine (i) the extent of the objective and subjective burden of care experienced by carers of individuals attending Australian private psychiatric hospitals, (ii) the degree to which a carer's distress was influenced by the patient's symptoms and the burden of care experienced. Methods: A group of 135 inpatient-carer dyads, for inpatients who attended three Australian private psychiatric clinics, completed measures of distress (Depression Anxiety Stress Scales) and caregiver burden (Burden Assessment Scale; BAS) during an inpatient admission to a private psychiatric hospital. Results: The level of burden reported by carers was comparable with overseas data. Factor analysis was used to identify the key dimensions of the BAS. The chief concerns of carers related to worries about the patient and disruption to activities. Conclusion: The burden experienced by carers needs to be recognized and addressed to ensure that they are able to continue to provide the care and support required by psychiatric inpatients. Present data are discussed in terms of the best way to support the carers of psychiatric inpatients.
Aboriginal Mental Health Workers and the Improving Indigenous Mental Health Service Delivery Model in the ‘Top End’
Authors: Nagel Tricia , Thompson Carolyn 
Published: December 2009

Objectives: This article reviews the changing Aboriginal mental health service delivery model of Top End Mental Health Services, and highlights the importance of Aboriginal mental health workers in improving communication with Aboriginal patients. The Australian Integrated Mental Health Initiative Northern Territory Indigenous stream (AIMHI NT) is introduced. Method: Baseline measures of AIMHI NT in 2003, and findings from two clinical file audits (1996 and 2001) at Royal Darwin Hospital inpatient unit are presented. The files were audited for a range of assessment and treatment interventions. Results: The audits reveal significant improvements in Aboriginal inpatient care between 1995 and 2001. Conclusion: Aboriginal mental health workers provide essential services as cross-cultural brokers in the setting of Aboriginal mental illness. The improvements in care found in this file audit coincide with the commencement of employment of Aboriginal mental health workers in the inpatient unit. The AIMHI consultation reveals broad support for employment of more Aboriginal mental health workers in the Top End.
Borderline Personality Disorder: A Pilot Survey about Clinician Views on Defensive Practice
Authors: Krawitz Roy , Batcheler Mike 
Published: December 2009

Objective: To conduct a pilot survey about clinician views on defensive practice when working with adults with borderline personality disorder. Method: All mental health clinicians from adult community, crisis and inpatient services of a district public mental health service who attended a routine team meeting completed a survey questionnaire (n = 29). Results: Defensive practice was common, with 85% of clinicians having practised in the previous year in a manner that they believed was not in the best interests of their patients. Conclusions: The findings support clinical impressions of a significant gap between clinician views on best practice and actual practice. The potential importance of the findings warrants a comprehensive multicentred study.
A Case of Schizophrenia with Complete Agenesis of the Corpus Callosum
Authors: Chinnasamy Dhamodharan , Rudd Rebecca , Velakoulis Dennis 
Published: December 2009

Objective: To describe the case of a person with schizophrenia and agenesis of the corpus callosum. Conclusion: A 24-year-old Caucasian woman with schizophrenia was incidentally found to have complete agenesis of the corpus callosum. A comprehensive neuropsychiatric assessment allowed management to be specifically tailored to the patient's unique clinical profile.
The Role of Child and Adolescent Mental Health Services in Suicide Prevention in New Zealand
Authors: Fortune Sarah , Clarkson Hugh 
Published: December 2009

Objective: We consider the role of child and adolescent mental health services (CAMHS) in the prevention of suicide by young people in New Zealand by examining the conflicting demands placed on CAMHS as a result of public expectation, health-care policy and structures, the current focus in the health sector on risk assessment and the inability of CAMHS to see all the young people who may consider suicide in any given year. Conclusions: We suggest that CAMHS are currently under significant pressures which are inadvertently leading to distortions of clinical practice away from the clinical needs of suicidal children, adolescents and their families towards risk assessment and risk management strategies. The inability of CAMHS to offer comprehensive services to all young people considering suicide may be addressed by greater provision of consult–liaison activities, better understanding between clinicians and health managers, and improvements in clinical skills.
Prevalence of Psychotropic Use in a South Australian Population
Authors: Goldney Robert , Bain Marcus 
Published: December 2009

Objective: To determine the prevalence of psychotropic medication use in a South Australian population. Methods: Face-to-face interviews with a random and representative sample of the South Australian population (at least 15 years of age) living in metropolitan and rural areas between March and June 2004. Results: From 4700 households selected, 3015 participants were interviewed (65.9% response rate). Of the respondents, 10.6% were taking psychotropic medications; psychotropic drug use was higher in females (14.4%) than in males (6.8%), and increased with age. Antidepressants were the most common category of psychotropics reported by respondents (6.8%), followed by anxiolytics (1.8%), hypnotics and sedatives (1.5%) and antipsychotics (0.6%). The majority (64.8%) of those respondents who were taking a tricyclic antidepressant were on a dose of 50 mg or less. Only 0.07% of respondents were taking lithium. Conclusions: The use of psychotropic medications was higher than recently reported studies conducted in the UK, the USA, Europe and Canada. More detailed enquiry about the indication for such use appears desirable in order to ascertain whether higher use in this Australian population is clinically appropriate.