bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insight and Hopelessness in Forensic Patients with Schizophrenia
Authors: Carroll Andrew , Pantelis Christos , Harvey Carol 
Published: December 2009

Objective: To quantitatively explore the level of insight in forensic patients with schizophrenia, and its relationship to symptoms and to a history of violence. In addition, to test the hypothesis that scores in the insight domains of ‘compliance’ and ‘awareness of illness’ are positively correlated with scores on a self-report scale measuring ‘hopelessness’. Method: The study consisted of a cross-sectional survey. Subjects were inpatients and outpatients in the rehabilitation service of the Victorian Institute of Forensic Mental Health. Twenty-eight patients with a diagnosis of schizophrenia and a history of serious offending consented to take part. Twenty-two of these had committed homicide. Measures were obtained for each on the Schedule for Assessment of Insight, the Positive and Negative Syndrome Scale for Schizophrenia and the Beck Hopelessness Scale. Results: The mean insight score for forensic patients was 8.39 (SD 4.88). Insight scores did not differ significantly between those subjects who had a history of violence prior to their index offence and those who did not. Awareness of illness, but not compliance, was positively correlated with level of hopelessness. A higher level of awareness of having a mental illness was thus related to feeling more hopeless about the future. Conclusions: Mean insight scores in patients with schizophrenia with a forensic history do not differ significantly from those in non-forensic populations. Being more aware of being mentally ill may be a risk factor for hopelessness about the future. The limitations of the study are the small sample size, and the fact that it is confined to a relatively clinically stable population.
The Neurobiology of Bipolar Disorder: Findings Using Human Postmortem Central Nervous System Tissue
Authors: Dean Brian 
Published: December 2009

Objective: Postmortem brain studies have been undertaken to understand changes in the molecular architecture of the central nervous system (CNS) of subjects with bipolar disorder. These studies, along with a limited number of functional neuroimaging studies, have been reviewed to provide information on the neurobiology underlying the disorder.Method: Findings from the study of postmortem brain tissue and neuroimaging were reviewed if their focus was on the molecular architecture of the human CNS to identify future lines of research required to understand the underlying pathology of bipolar disorder.Results: There is considerable evidence to implicate the serotonergic system of the CNS and abnormalities in signal transduction pathways in the pathology of bipolar disorder. In addition, preliminary findings suggest that changes in the benzodiazepine binding site on the γ aminobutyric acid A receptor may be affected in bipolar disorder.Conclusions: Further systematic studies on the serotonergic systems of the CNS, as well as the interaction between neurotransmitter receptors, G-proteins and signal transduction pathways are required to better understand the pathology of bipolar disorder. In addition, findings on the serotonin transporter indicate that changes in presynaptic function may be a critical component of the pathology of bipolar disorder.
An Audit of Outpatient Antipsychotic Usage in the Three Health Sectors of Auckland, New Zealand
Authors: Humberstone Verity , Wheeler Amanda , Lambert Tim 
Published: December 2009

Objective: To examine antipsychotic usage in outpatients in three community mental health centres. Method: A retrospective chart review was conducted for all outpatient files that were active in March 2000 at all community mental health services in Auckland (population 1.3 million). All patients prescribed an antipsychotic had information entered into a specifically designed computer software program. The antipsychotic, dose and route of administration were recorded. The diagnosis, number of hospitalizations, ethnicity and gender were also collected. Results: 6558 community files were audited and 3254 people were prescribed antipsychotics; 3178 (97.6%) files had adequate information for study inclusion. The mean antipsychotic daily dose in chlorpromazine equivalents (CPZe) was 360 mg. Most of the population (76.6%) was prescribed an oral antipsychotic alone, 14.9% were prescribed depot antipsychotic only and 8.4% were on a depot and oral antipsychotic. The average daily dose prescribed for people on antipsychotic polypharmacy was 601 mg CPZe compared with 312 mg CPZe for those on a single antipsychotic. There were 2300 patients with schizophrenia (72.5% of cohort) and 585 patients with bipolar affective disorder (18.5%). The mean total daily dose in CPZe was significantly higher for schizophrenia than any other psychotic diagnoses. Regional analysis showed differences in the doses and type of antipsychotics prescribed; one health sector had significantly higher daily doses while another was significantly more likely to prescribe atypical antipsychotics and correspondingly fewer depot antipsychotics. Conclusions: There is a significant variation in the prescribing of antipsychotics across the three Auckland health sectors. The variation relates to dosage used, type of antipsychotics prescribed and effect of multiple antipsychotic prescribing. Combination therapy of more than one oral antipsychotic or a combination of oral and depot antipsychotics leads to a significant trend of higher doses in excess of best practice guidelines.
Benign Brain Tumours and Psychiatric Morbidity: A 5-Years Retrospective Data Analysis
Authors: Gupta Ramesh K. , Kumar Rajeev 
Published: December 2009

Objective: To examine the psychiatric comorbidity in benign brain tumours. Method: A retrospective (5 years) data analysis at our 500 bed teaching hospital. The diagnoses of benign brain tumours were based on the record of final diagnoses in the case records confirmed by either CT or MRI scans. Case records of patients with clearly documented history of psychiatric symptoms of several weeks to several months duration were identified only if such symptoms had antedated a diagnosis of the brain tumour. Using a specially designed proforma, two psychiatrists rated the symptoms together. We also collected data on age, gender and CT/MRI findings. Consensus was reached on all cases in regard to the psychiatric phenomenology. The symptoms were divided according to their presentation into purely neurological or psychiatric symptoms. Results: A total of 79 patients were identified as having a primary diagnosis of benign brain tumour. There were 56 female patients and 23 male patients. Seventy-two of these had meningiomas. Fifteen (21%) of 72 meningioma cases, eight men and seven women, presented with psychiatric symptoms in the absence of neurological symptoms. Affective disorders were a common presentation. There was no correlation between brain laterality and the psychiatric comorbidity. Conclusions: Psychiatric symptoms may be the only initial manifestations of meningiomas of the brain in a significant number of cases occurring in the fifth decade of life. Such patients must be investigated by brain imaging studies even if there are no neurological signs or symptoms.
The Trauma of First Episode Psychosis: The Role of Cognitive Mediation
Authors: Jackson Chris , Knott Claire , Skeate Amanda , Birchwood Max 
Published: December 2009

Objective: First episode psychosis can be a distressing and traumatic event which has been linked to comorbid symptomatology, including anxiety, depression and PTSD symptoms (intrusions, avoidance, etc.). However, the link between events surrounding a first episode psychosis (i.e. police involvement, admission, use of Mental Health Act, etc.) and PTSD symptoms remains unproven. In the PTSD literature, attention has now turned to the patient's appraisal of the traumatic event as a key mediator. In this study we aim to evaluate the diagnostic status of first episode psychosis as a PTSD-triggering event and to determine the extent to which cognitive factors such as appraisals and coping mechanisms can mediate the expression of PTSD (traumatic) symptomatology. Method: Approximately 1.5 years after their first episode of psychosis, patients were assessed for traumatic symptoms, conformity to DSM-IV criteria for posttraumatic stress disorder (PTSD), and their appraisals of the traumatic events and coping strategies. Psychotic symptomatology was also measured. Results: 31% of the sample of 35 patients who agreed to participate reported symptoms consistent with a diagnosis of PTSD. Although no relationship was found between PTSD (traumatic) symptoms and potentially traumatic aspects of the first episode (including place of treatment, detention under the MHA etc.), intrusions and avoidance were positively related to retrospective appraisals of stressfulness of the ward (i.e. the more stressful they rated it the greater the number of PTSD symptoms) and the patient's coping style (sealers were less likely to report intrusive re-experiencing but more likely to report avoidance). Conclusions: The results call into question whether it is possible to make claims for a simple causal link between psychosis and PTSD. Instead patients' appraisals of potentially traumatic events and their coping styles may mediate the traumatic impact of a first episode of psychosis.
Australian and New Zealand Clinical Practice Guidelines for the Treatment of Depression
Authors:   Royal Australian And New Zealand College Of Psychiatrists Clinical Practice Guidelines Team For Depression
Published: December 2009

Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Ministry of Health. Method: The CPG team reviewed the treatment outcome literature, consulted with practitioners and patients and conducted meta-analyses of outcome research. Treatment recommendations: Establish an effective therapeutic relationship; provide the patient with information about the condition, the rationale for treatment, the likelihood of a positive response and the expected timeframe; consider the patient's strengths, life stresses and supports. Treatment choice depends on the clinician's skills and the patient's circumstances and preferences, and should be guided but not determined by these guidelines. In moderately severe depression, all recognized antidepressants, cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) are equally effective; clinicians should consider treatment burdens as well as benefits, including side-effects and toxicity. In severe depression, antidepressant treatment should precede psychological therapy. For depression with psychosis, electroconvulsive therapy (ECT) or a tricyclic combined with an antipsychotic are equally helpful. Treatments for other subtypes are discussed. Caution is necessary in people on other medication or with medical conditions. If response to an adequate trial of a first-line treatment is poor, another evidence-based treatment should be used. Second opinions are useful. Depression has a high rate of recurrence and efforts to reduce this are crucial.
Psychosocial Stressors that Precipitate Dissociative Trance Disorder in Singapore
Authors: Ng Beng-Yeong , Chan Yiong-Huak 
Published: December 2009

Objective: To study the psychosocial stressors that precipitate dissociative trance disorder (DTD) and to identify predictors of DTD. Method: We conducted semistructured interviews in which detailed information was obtained for 58 cases diagnosed with DTD at a psychiatric hospital in Singapore. A comparison group of 58 patients who received treatment at the same hospital for major depression (MD) were also interviewed, using the same instrument. Results: While 100% of the DTD group described at least one psychosocial stressor, only 80% of the MD group did so. Common stressors for the DTD group include problems with military life (38%), conflicts over religious and cultural issues (38%), and domestic disharmony and marital woes (24%). Conflicts over religious and cultural issues seemed to be important in the precipitation of DTD but not in the precipitation of MD (p < 0.001). Logistic regression reveals that the following are positive predictors for DTD: conflicts over religious and cultural issues; prior exposure to trance states; and being a spiritual healer or his/her assistant. Conclusions: An understanding of the precipitating psychosocial stressors that overwhelmed the patient's coping abilities would have implications for treatment and enable the clinician to devise strategies for intervention and prevention.
Early Extrapyramidal Side-Effects as Risk Factors for Later Tardive Dyskinesia: A Prospective Study
Authors: Sachdev Perminder 
Published: December 2009

Objective: To determine whether acute neuroleptic-induced parkinsonism and akathisia were risk factors for the later development of tardive dyskinesia (TD) in patients on typical neuroleptics. Method: Of 100 subjects examined for parkinsonism and akathisia after the initiation of typical neuroleptic medication, 78 were followed up for TD after a mean 41.2 months. Results: Nine (11.5%) subjects were diagnosed with TD, predominantly manifesting as oro-facial dyskinesia. They had greater severity of parkinsonism and akathisia at baseline, and a larger neuroleptic load, than those who did not develop TD. On regression analyses, parkinsonism at baseline was a significant predictor of later TD. Examined independently of parkinsonism, akathisia severity at 2 weeks was also a significant predictor of later TD. Conclusions: Acute drug-induced parkinsonism and akathisia are both predictors of TD, with parkinsonism having greater predictive value. Acute and tardive extrapyramidal syndromes may share vulnerability factors.
Compiling a Caseload Index for Mental Health Case Management
Authors: King Robert , Meadows Graham , Le Bas James 
Published: December 2009

Objective: The purpose of this study was to explore methods of determining an appropriate caseload for mental health case managers. Method: Seven factors that may impinge on case manager performance and impact on caseload were identified, having reference to published literature and service practice in Victoria and Queensland. The advantages and disadvantages of including these factors in a caseload index were evaluated. Results: Three caseload index methodologies are presented. Each method makes use of different data and has advantages and disadvantages. There is a trade-off between simplicity and ease of application and the comprehensive use of relevant information. Methods vary in their implications for service efficiency and equity in workload distribution. Conclusions: Caseload is a key issue in service planning and staff management. Factors that have the potential to contribute to caseload can be readily identified. However, there is likely to be disagreement as to the weight assigned to any factor and the approach taken may depend on the purpose and context of the caseload calculation. A great deal more research is required to provide an empirical basis for algorithms used in caseload calculation.
Vocational Rehabilitation in Psychiatry: A Re-Evaluation
Authors: Morris Philip , Lloyd Chris 
Published: December 2009

Objective: To highlight the vocational gap in the provision of psychiatric rehabilitation, to outline the goals and conceptual framework of psychiatric rehabilitation, and to discuss rehabilitation interventions with specific reference to vocational rehabilitation and the evidence base for supported employment.Conclusions and service implications: Vocational psychiatric rehabilitation has been a neglected area of practice in Australian psychiatry. Psychiatric treatment needs to adopt a more balanced approach in the provision of a range of services, including vocational rehabilitation, in order to improve long-term outcomes for people suffering from psychiatric disability. A vocational focus should be included in psychiatric rehabilitation and better integration between mental health services and vocational services needs to take place. Supported employment is an evidence-based practice that is designed to help people with psychiatric disabilities participate as much as possible in the competitive job market.
Psychiatric Aspects of Detention: Illustrative Case Studies
Authors: Koopowitz Leslie F. , Abhary Sotoodeh 
Published: December 2009

Objective: Although the two political systems cannot be equated, the psychiatric and psychosocial issues raised by people detained under the migration regulations of the present Australian government, and those detained under the security legislation of the last apartheid government in South Africa, are similar in many aspects. Method: We present two case scenarios representative of the cumulative clinical experience of the authors in their work (as part of their routine clinical practice and medical school experience) with asylum seekers and political detainees in acute psychiatric units in both South Africa and Australia. Results: Similar issues raised included the validity of a psychiatric diagnosis in these patients and the debate this conundrum provoked among the multidisciplinary teams. The pressures placed on clinicians by politicians in terms of clinical management of hospitalized detainees raised similar ethical questions across both countries. The clinical syndromes of depression and posttraumatic stress disorder were similar. The effect of the ‘non-person’ status conferred upon refugees by the ‘temporary protection visa’ could be equated with the effect of ‘banning orders’ imposed on opponents of the Apartheid regime. Conclusions: In South Africa, political detainees entered into the struggle expecting to face hardship and torture at the hands of the government of the time. Asylum seekers flee to Australia expecting support from a democratic system and generally had not prepared themselves for further incarceration and yet another political struggle. Despite this seemingly fundamental difference, the experiences of detainees across two very different political systems are remarkably similar.
Cost-Effectiveness of Cognitive Behavioural Therapy and Selective Serotonin Reuptake Inhibitors for Major Depression in Children and Adolescents
Authors: Haby Michelle M. , Tonge Bruce , Littlefield Lyn , Carter Rob , Vos Theo 
Published: December 2009

Objective: To assess from a health sector perspective the incremental cost-effectiveness of cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of major depressive disorder (MDD) in children and adolescents, compared to ‘current practice’. Method: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analysis of randomised controlled trials. An assessment on second stage filter criteria (‘equity’; ‘strength of evidence’, ‘feasibility’ and ‘acceptability to stakeholders’) is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are tracked for the duration of a new episode of MDD arising in eligible children (age 6–17 years) in the Australian population in the year 2000. Simulation-modelling techniques are used to present a 95% uncertainty interval (UI) around the cost-effectiveness ratios. Results: Compared to current practice, CBT by public psychologists is the most costeffective intervention for MDD in children and adolescents at A$9000 per DALY saved (95% UI A$3900 to A$24 000). SSRIs and CBT by other providers are less cost-effective but likely to be less than A$50 000 per DALY saved (< 80% chance). CBT is more effective than SSRIs in children and adolescents, resulting in a greater total health benefit (DALYs saved) than could be achieved with SSRIs. Issues that require attention for the CBT intervention include equity concerns, ensuring an adequate workforce, funding arrangements and acceptability to various stakeholders. Conclusions: Cognitive behavioural therapy provided by a public psychologist is the most effective and cost-effective option for the first-line treatment of MDD in children and adolescents. However, this option is not currently accessible by all patients and will require change in policy to allow more widespread uptake. It will also require ‘start-up’ costs and attention to ensuring an adequate workforce.
Australian Data and Psychometric Properties of the Strengths and Difficulties Questionnaire
Authors: Hawes David J. , Dadds Mark R. 
Published: December 2009

Objective: We examine the Australian psychometric properties of the Strengths and Difficulties Questionnaire (SQD), a brief screening measure of behavioural and emotional problems in children and adolescents. Method: Using a large community sample (n = 1359) of young Australian children (4–9 years), we assessed the internal consistency, stability, and external validity of the parent-report SDQ. Normative data and cut-offs were also produced. Results: Moderate to strong internal reliability was exhibited across all SDQ subscales, and support was found for the original five-factor structure of the measure. Adequate validity was evidenced in the relationship of these scales to one another, while correlations between the SDQ subscales, teacher ratings, and diagnostic interviews demonstrated sound external validity. SDQ total difficulties scores were associated with concurrent treatment status and scores over a 12-month period were stable. Conclusions: The current study of the SDQ with Australian children presents evidence of sound psychometric properties. Being the first study to empirically support the use of the SDQ in Australia, it is recommended that the youth and teacher-report forms of the measure receive similar attention in the future.
Life Events and Survival in Dementia: A 5-Year Follow-Up Study
Authors: Butler Rob , Orrell Martin , Ukoumunne Obioha C. , Bebbington Paul 
Published: December 2009

Objectives: To examine the relationship between life events and survival for people with dementia. To investigate whether this relationship differs from that for people without dementia. To identify which psychiatric and social factors are associated with survival in people with dementia. Method: A prospective cohort study with external controls. One hundred and sixteen people with dementia and 50 fit, elderly controls were assessed for life events over a 6-month period. They were followed-up at 5 years and data collected on length of survival. Results: There was an association between two or more severe life events and reduced survival. This association appeared stronger for controls than people with dementia although the interaction was not significant (p = 0.052). The only psychiatric or social factor associated with poor survival in dementia was depression. Other factors associated with reduced survival in the dementia group were male sex, older age, poor physical health, later age of onset and a poorer level of functioning. Conclusions: This study provides some evidence that having two or more stressful and negative life events may reduce survival in older people with and without dementia. If replicated, this finding will have implications for our understanding of the clinical course of dementia.