bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reflections on Facilitated Discharge from a Mental Health Service
Authors: Jespersen Sean , Chong Terence , Donegan Tony , Gray Kelly , Kudinoff Teresa , McGain Leanne , Gant Deborah 
Published: December 2009

Objective: The aim of this paper is to review research evidence and describe our experience of facilitated discharge from mental health services to primary care. Method: A literature review of facilitated discharge was conducted. In addition, the clinical characteristics of 21 discharged and 21 non-discharged patients from one shared care service were compared in a retrospective file review. Thirty-one patients in another facilitated discharge program were surveyed. Results: Discharged patients had a higher level of function. There was a trend towards discharged patients being female and employed with less chronic illness, involuntary treatment, behavioural symptoms, depot medication, triage contact, service contact with family, and more mood disorder. Of the 10 survey respondents, 60% reported feeling better compared with their last service contact, 70% felt not having contact was a good thing and most saw their doctors regularly and reported a good relationship. Conclusions: There was a trend towards more stable patients being discharged and it appeared that they responded positively to this, without a clear indication of which factors best determine suitability for discharge. Consequently, we elected to incorporate discharge planning processes as a core function of case management and increase shared care with the primary care sector.
Implementation of the Strengths Model at an Area Mental Health Service
Authors: Chopra Prem , Hamilton Bridget , Castle David , Smith Jenny , Mileshkin Cris , Deans Michael , Wynne Brad , Prigg Glenn , Toomey Nigel , Wilson Michael 
Published: December 2009

Objective: The objectives of this paper are to provide an overview of recovery-focused models of care and discuss the implementation of the Strengths Model at St. Vincent's Mental Health Melbourne (SVMH), Victoria, Australia. Conclusions: The implementation of the Strengths Model at SVMH is discussed with particular emphasis on the process of implementation, service implications, practical challenges and dilemmas that have arisen, and proposed evaluation. Recovery-focused care is feasible and can enhance current practice of mental health services.
A Comparison of Patient and Staff Satisfaction with Services After Relocating to a New Purpose-Built Mental Health Facility
Authors: Cleary Michelle , Hunt Glenn , Walter Garry 
Published: December 2009

Objective: This study measured patient satisfaction levels and staff views regarding their expectations and workplace and other opinions after relocation to a new purpose-built mental health facility within the grounds of a general repatriation hospital. Method: Patients were interviewed face-to-face using a standardized satisfaction survey at least 2 months after the move to the new facility. In addition, surveys were sent by mail to all clinical staff rostered to work the same period that the patient interviews were conducted. Results: One hundred patients were interviewed and 123 staff returned the survey (56% response rate). Patients and staff rated the new ward environment and food services most highly and were least satisfied with patient information and medical services. Less satisfaction was expressed about resource issues such as information technology and dedicated staff facilities. Most staff (70–80%) rated services provided to patients to be the same or better than their original expectations. Conclusions: The results indicate that the hospital move did not have any measurable negative impact on overall service provision or patient satisfaction. In fact, expectations were met or improved for several clinically relevant areas after relocating the mental health facility. Another survey is planned in 12 months to assess if patient and staff ratings change.
A Brief, Descriptive Typology of Depressed Mood
Authors: Restifo Sam 
Published: December 2009

Objective: The purpose of this paper is to consider the potential clinical utility of a descriptive typology of negative mood states that can present as, and tend to get loosely subsumed under, the broad ranging term, ‘depression’. Method: Information and ideas from clinical practice and the existing literature have been brought together with a view to compiling a provisional, brief, descriptive typology of depressed mood. Conclusion: A qualitative typology of various kinds of depressed mood has heuristic value in engaging, formulating and planning treatment for people presenting with ‘depression’.
Hallucinations Arising in the Context of Torn Attachment, Traumatic Childhood and Tapeworms
Authors: Power Brian , Goossens Carolyn 
Published: December 2009

Objective: The aim of this paper is to describe the processes underlying psychotic symptoms in an adolescent who presented to our service at the age of 15 years. Conclusion: sA teenage female presented having experienced her early childhood in a war-torn third-world country, during which time her mother died, and she suffered worm infestation, neglect and trauma, before being adopted by a family in a developed country, where she lived for several years prior to relocating to Australia. The presenting complaints included longstanding anxiety, depressive and dissociative symptoms, with subsequent behavioural problems and learning difficulties. More recently, she had developed auditory hallucinations, and the antipsychotic she had been taking was beneficial. An MRI of the brain demonstrated lesions in keeping with healed parasitic disease (neurocysticercosis). The patient's hallucinations are discussed in the context of the relationship between a traumatic childhood and psychosis, and neurocysticercosis. Within months of her presentation, the hallucinations resolved as her step-mother became more available. Her antipsychotic medication is being carefully decreased, and the patient is engaging in psychological therapies to deal with her past trauma and disrupted attachment.
A Mental Health and Substance Abuse Service for a Youth Detention Centre
Authors: Letters Paul , Stathis Stephen 
Published: December 2009

Objectives: To describe a new programme, the Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) at the Brisbane Youth Detention Centre, which aims to provide young people in detention with the same quality of mental health and substance dependency services that would normally be available to them in the community. Conclusions: Young people in detention suffer from considerable mental health and substance abuse problems. MHATODS seeks to address the specific needs of this group of young people. Its innovative structure recognizes the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has created an integrated treatment service for young people in detention.
Why do Doctors Dislike Treating People with Somatoform Disorder?
Authors: Pridmore Saxby , Skerritt Paul , Ahmadi Jamshid 
Published: December 2009

Objective: To consider the question of why doctors dislike treating people with somatoform disorder, with a view to assisting debate and improving services. Methods: The literature was examined, and compared with clinical experience. Results: Psychological, sociological and evolutionary theory make relevant contributions. Important factors include that these conditions are problematic and positive outcomes may not be possible given current knowledge and clinical skills and techniques. Patients may not accept that their problem is a form of psychiatric or brain disorder. Most importantly, the doctor may not accept that somatoform disorders are beyond the control of patients, setting the scene for irritation and unsatisfactory interactions. Conclusions: There are many factors that underlie the dislike of some doctors for treating people with somatoform disorder. There is a pressing need for educational efforts to help students and doctors accept that the symptoms of somatoform disorder are beyond the control of those who suffer them.
Commitment and Collaboration for Excellence in Older Persons' Mental Health: The ACT Experience
Authors: Raymond Judy , Kirkwood Helen , Looi Jeffrey 
Published: December 2009

Objective: To describe the development of the older persons' mental health service in the Australian Capital Territory (ACT), a region with both urban and rural characteristics. Methods: Elements include: (i) collaboration with health-care and non-governmental organizations; (ii) provision of consultation-liaison service to patients, family and professional care-providers via collaboration with general practitioners; (iii) partnerships built through consultation, regular communication, education and training of primary health-care providers; and (iv) development of a multidisciplinary academic centre in partnership with the local universities designed to enhance roles in education, training and research. The disciplines of general practice, nursing, psychology, social work and psychiatry collaborate in service provision, education and an active research centre. Conclusions: An expanded, multidisciplinary comprehensive service has been developed from an initial consultation-liaison model, illustrating that commitment and collaboration with existing services and carer groups can advance care.
The Medical Specialist Outreach Assistance Programme in South Australia at 2 Years
Authors: Cord-Udy Nigel 
Published: December 2009

Objective: To describe the progress and achievements of the psychiatric services developed by the Medical Specialist Outreach Assistance Programme in South Australia over the last 2 years. There is a particular focus on services provided to the remote areas of the far northern region of South Australia. Conclusion: During this period there has been an expansion of visiting psychiatric services to South Australia's rural and remote communities. In particular, child and Indigenous services have improved considerably. These have been important developments and it is hoped that funding and services will continue after the June 2004 conclusion of the Medical Specialist Outreach Assistance Programme.
Use of a Routine Outcome Measure in a Consultation-Liaison Mental Health Service
Authors: Trauer Tom 
Published: December 2009

Objective: The problem severity of patients seen by a psychiatric consultationliaison service was studied through the use of a routine outcome measure. Methods: Ratings on the Health of the Nation Outcome Scales (HoNOS) over nearly 3 years in the emergency department, general hospital, and on admission to the acute psychiatric unit were compared. Results: Mean HoNOS total scores in the emergency department were not significantly different from those at admission to the acute psychiatric unit, but were significantly higher than those in the general hospital. Mean scores in all three settings were higher than those obtained at case review of psychiatric patients in the community. Despite differences in age, sex, and psychiatric diagnosis between the three hospital settings, differences in mean HoNOS total scores remained substantially unchanged after adjustment for these factors. Most HoNOS assessments were performed by medical staff. Conclusions: The suspected high levels of problem severity and comorbidity of patients seen by a psychiatric consultation-liaison service were confirmed through the use of a routine outcome measure.
Treatment Guidelinesfor Depression in the Asia Pacific Region: A Review of Current Developments
Authors: Hickie Ian 
Published: December 2009

Objective: This paper examines the development of treatment guidelines, medication algorithms and clinical pathway guides for depression in countries participating in the SEBoD Initiative. Methods: A systematic review of the extent of development of treatment guidelines, medication algorithms or clinical pathway guides for depression in participating countries. Results: Most countries in the Asia Pacific region have commenced the development of treatment guidelines, medication algorithms or clinical pathway guides. The promoters of such efforts have included a range of professional and government bodies. Most efforts have borrowed heavily on existing international guidelines. There is a significant emphasis on medication practices in most countries, with less emphasis on the role of psychological or other non-pharmacological approaches. There has been insufficient emphasis on integrating local classification, assessment and cultural practices into the provision of high quality care. Important additional measures, including practice surveys and consensus judgements, have been undertaken in some countries. Conclusions: The development of a genuine quality improvement movement for depression treatments is in its infancy in the Asia Pacific region. However, there is now the capacity to bring together such efforts at a regional level and, in doing so, promote standards for best care, more community and professional involvement and the uptake of a wider variety of treatment approaches.
Clinical Decision Support Systems in Psychiatry in the Information Age
Authors: Kotze Beth , Brdaroska Bilyana 
Published: December 2009

Objective: Clinical decision support systems (CDSSs) are active knowledge systems that use two or more items of patient data to generate case-specific advice. They were developed to improve health-care quality. There is evidence that they can be a valuable tool in fostering the process of dissemination and uptake of clinical guidelines that, in turn, can improve clinical decision-making and outcomes. The present paper will explore why, despite this potential, CDSSs have not been extensively used in psychiatry. Conclusions: There is an abundant literature that explores the barriers to the development and implementation of information technology in health. This can be understood as related to clinician, organizational, cultural and technological factors. Certain characteristics of the clinical discipline of psychiatry present an additional barrier, although diagnostic systems appear to have gained a level of acceptance.
Psychostimulant Treatment of Adults With Mental Retardation and Attention-Deficit Hyperactivity Disorder
Authors: Jou Roger , Handen Benjamin , Hardan Antonio 
Published: December 2009

Objective: To examine the potential effectiveness and tolerability of psychostimulants in adults with mental retardation (MR) and attention-deficit hyperactivity disorder (ADHD). Methods: A retrospective chart review was conducted in a clinic specialized in treating individuals with developmental disabilities. Improvement was assessed using the Aberrant Behaviour Checklist-Community Version (ABC-C) and the global improvement item of the Clinical Global Impression scale. Results: Ten consecutive adult outpatients were identified. Five were judged to be responders, based on impressions from chart review and the ABC-C. Significant improvements were observed in the hyperactivity and irritability subscales of the ABC-C. Adverse events were minimal and no patients required treatment termination. Conclusions: Psychostimulants might be effective and well-tolerated in the treatment of ADHD in adults with MR. However, larger prospective open-label studies, and, eventually, double-blind placebo-controlled studies are needed to confirm these findings.
Leadership for Change in Complex Systems
Authors: Minas Harry 
Published: December 2009

Objectives: To examine clinician leadership for change from the perspective of complexity. Methods: The core features of complex adaptive systems are described and examples of these characteristics are identified in Australia's mental health system. The implications of conceiving of themental health system as a complex adaptive system are explored. Conclusions: It is concluded that there is value in conceiving of Australia's mental health system as a complex adaptive system and that such a conception provides useful guidance for leadership for change and for management.
A New Model of Triage in an Aged Persons Mental Health Service
Authors: George Kuruvilla , Macdonald Gail 
Published: December 2009

Objective: To describe a new model of triage in an aged persons mental health service. Methods: The process of developing the new model is described and compared with the previous system. Results: The outcomes reveal an increase in the contacts and accepted referrals. However, the increase in contacts (54.8%) is proportionately much higher than the increase in accepted referrals (16%). Conclusions: The outcomes suggest that the new model is working with improved accessibility (increased contacts) and effective triage (proportionately smaller increase in accepted referrals). Triage should not be a static model but needs ongoing development to be effective and responsive.
Randomized Controlled Trial of Olanzapine in the Treatment of Cognitions in Anorexia Nervosa
Authors: Mondraty Naresh , Laird Birmingham C. , Touyz Stephen , Sundakov Viktoria , Chapman Lucy , Beumont Pierre 
Published: December 2009

Objective: Recovery from anorexia nervosa is confounded by intrusive anorec-tic cognitions and rituals. It has been observed that olanzapine, an atypical antipsychotic, can reduce this anorexic rumination. A pilot study was designed to test the effectiveness of olanzapine in this role. Methods: A randomized trial of olanzapine versus chlorpromazine, with anorexic rumination as the primary outcome, was conducted. Of the 26 patients who presented, 15 were randomized in a balanced block design, eight to olanzapine and seven to chlorpromazine. Results: Only the olanzapine group had a significant reduction in the degree of rumination. Conclusion: Olanzapine may be of benefit in anorexia nervosa by causing a reduction in anorexic rumination.
Severe Tachycardia Following Low-Dose Clozapine Treatment
Authors: Stampfer Hans , Swanepoel Peter 
Published: December 2009

Objective: To reporta case of severe and sustained tachycardia that developed asymptomatically on a low dose of clozapine (ISO mg daily). Method: Case report. Results: Serially monitored 24 h heart rate after the introduction of clozapine showed an increase in the 24 h mean from 87 to 126 bpm, a reduction of pulse variability and anomalies in sleep-wake regulation. Cessation of clozapine was followed by a rapid return to preclozapine activity. Application of the Naranjo Adverse Drug Reaction Probability Scale indicated a probable relationship between clozapine and the sustained tachycardia. Conclusions: Severe and sustained tachycardia can develop asymptomatically with a relatively low dose of clozapine and a slow titration rate. The severity of the tachycardia may not be revealed in isolated pulse measurements and may escape clinical detection without closer monitoring of heart rate.
Development of Clinical Guidelines for the Pharmacological Management of Behavioural Disturbance and Aggression in People with Psychosis
Authors: Castle David , Daniel Jeffrey , Knott Jonathan , Fielding John , Goh Joyce , Singh Bruce 
Published: December 2009

Objective: To describe the process underpinning the development of clinical guidelines for the management of behavioural disturbance in psychosis. Method: A structured process was followed, encompassing a literature review, focus groups with key staff, and pilot testing and monitoring of the guidelines in an acute psychiatric setting. Results: The process was well accepted by staff and was found useful in monitoring outcomes in a naturalistic setting. The final guidelines proved safe and effective in the acute setting. Conclusions: The incorporation of a monitoring system for interventions for the management of behavioural disturbance in acute psychiatric settings is beneficial for staff and patients alike.
Preventing Episode II: Relapse Prevention in First-Episode Psychosis
Authors: Gleeson John ,   On Behalf of the Episode II Research Team
Published: December 2009

Objective: This paper outlines a rationale for expanding research and clinical innovations focused upon relapse prevention following a first episode of psychosis. Some general principles for further progress are extracted from an overview of the first-episode psychosis (FEP) relapse literature. A cognitive behaviour therapy intervention for relapse prevention for FEP, that has been developed at the Early Psychosis Prevention and Intervention Centre, is described to illustrate these principles. Conclusions: Further progress is needed in refining interventions specific to the prevention of relapse following FEP. Future progress is dependent upon improved understanding of the interaction of biological, interpersonal and psychological processes underpinning relapse.
Diagnostic Stability in Patients with First-Episode Psychosis
Authors: Amini Homayoun , Alaghband-Rad Javad , Omid Abbas , Sharifi Vandad , Davari-Ashtiani Rozita , Momeni Farzad , Aminipour Zahra 
Published: December 2009

Objective: To examine the short-term stability of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) and International Classification of Diseases (10th revision; ICD-10) diagnoses in a group of patients with first-episode psychosis. Method: Sixty patients with first-episode psychosis admitted consecutively to Roozbeh Hospital, Tehran, were sampled; their illnesses could not be attributed to any medical or substance-induced conditions. Patients were assessed at the time of discharge from the hospital, and at 3, 6and 12 month intervals following admission. Ateach visit, two psychiatrists made consensusDSM-IV and ICD10 diagnoses, based on all available information. Stability was discerned as the consistency between diagnoses at the time of discharge and at 12 month follow up. Results: Forty-eight patients completed follow up. Affective psychotic disorders and schizophrenia in both classification systems were highly stable. In addition, all patients with DSM-IV brief psychotic disorder and ICD-10 acute and transient psychotic disorders remained the same at follow up. Conclusions: Affective psychoses and schizophrenia, in line with previous findings, remained stable. Diagnoses of brief psychoses were highly stable as well; this could reflect a non-relapsing course ofacute brief psychoses, especially in developing countries.
Development of Australia's First Psychiatric Emergency Centre
Authors: Frank Rowena , Fawcett Lisa , Emmerson Brett 
Published: December 2009

Objectives: To describe the development of the first Australian psychiatric emergency centre co-located with the Emergency Department at the Royal Brisbane and Women's Hospital. This paper covers the current operational model, significant partnerships and benefits of this service, which assesses and treats over 7200 presentations per year. Conclusions: The co-location of the Psychiatric Emergency Centre and Emergency Department has created a unique model of service delivery and effective working relationships between the two services. The model improves clinical care providing multiple benefits for patients and the Emergency Department by means of direct access to specialized mental health staff, early mental health responsibility for patients and reduced access block.