bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Current Status of Tardive Dyskinesia
Authors: Sachdev Perminder S. 
Published: December 2009

Objective: This paper aims to provide an overview of the current knowledge on neuroleptic-induced tardive dyskinesia (TD) in relation to its clinical features, risk factors, pathophysiology and management.Method: The published literature was selectively reviewed and assessed.Results: Tardive diskinesia is a common neurological side-effect of neuroleptic medication, the cumulative incidence of which increases with increasing duration of treatment. Its clinical manifestations are diverse and subsyndromes have been described. Many risk factors for TD are now recognised, but increasing age remains pre-eminent as a risk factor. The pathophysiology of TD is not completely understood. Of the neurotransmitter hypotheses, the dopamine receptor supersensitivity hypothesis and the γ-aminobutyric acid insufficiency hypothesis are the main contenders. There is increasing recognition that TD may in fact be caused by neuroleptic-induced neuronal toxicity through free radical and excitotoxic mechanisms. The occurrence of spontaneous dyskinesias in schizophrenic patients and even healthy subjects suggests that neuroleptics act on a substratum of vulnerability to dyskinesia. As no effective treatment for TD is available, the primary emphasis is on prevention. Many drugs can be tried to reduce symptoms in established cases. The increasing use of atypical neuroleptics has raised the possibility of a lower incidence of TD in the future.Conclusions: After four decades of clinical recognition, the pathophysiology of TD is still not understood and no effective treatment is available. Its prevention with the optimal usage of currently available drugs and regular monitoring of patients on long-term neuroleptic treatment remain the best strategies to reduce its impact.
Preventive Interventions for Youth Suicide: A Risk Factor-Based Approach
Authors: Burns Jane M. , Patton George C. 
Published: December 2009

Objective: This review draws on current knowledge of risk for youth suicide to categorise strategies for intervention. Its goal is to identify areas of ‘research need’ and to provide an evidence base to identify ‘best buy’ preventive interventions for youth suicide. Method: The design, development, implementation and evaluation of prevention strategies ranging from clinical interventions to population-based universal approaches are considered within five risk factor domains: individual, family, community, school and peer. Results: There is a paucity of evidence on the effects of interventions targeting depression and suicidal behaviour. Nevertheless, there are effective indicated, selective and universal interventions for important risk factors for depression and suicidal behaviour. Little evidence has emerged to support the efficacy of some traditional approaches to suicide prevention, such as school based suicide education programs and telephone hotlines. Conclusions: Youth suicide prevention strategies in Australia have generally employed traditional approaches that focus on clinical interventions for self-harmers, restricting access to lethal means, providing services to high risk groups and enhancing general practitioner responses. Both program development and research evaluation of interventions for many important risk and protective factors for suicide have been neglected.
Attitudes Towards People with Depression: Effects on the Public's Help-Seeking and Outcome When Experiencing Common Psychiatric Symptoms
Authors: Jorm Anthony F. , Medway Jo , Christensen Helen , Korten Ailsa E. , Jacomb Patricia A. , Rodgers Bryan 
Published: December 2009

Objective: To determine whether people's attitudes towards a person who has experienced depression influence them in (i) the types of actions they take to help themselves if they experience common psychiatric symptoms, and (ii) the degree to which their symptoms improve. Method: A postal survey was carried out with 3109 adults to assess attitudes and symptoms of anxiety and depression. Attitudes were assessed by questions on a depressed person's likely long-term outcome in various areas of life and whether the respondents thought the depressed person was likely to experience discrimination. A follow-up survey was carried out 6 months later with 422 persons who had a high level of symptoms at baseline. These individuals were asked about whether they had taken various actions to relieve their symptoms. Results: The attitude measures did not predict use of actions which involved someone else having to know that the person had psychiatric symptoms, nor use of actions which did not. The attitude measures also did not predict change in anxiety and depression symptoms. Conclusions: The attitude measures did not predict patterns of help-seeking or outcome for people with common psychiatric symptoms. However, attitudes towards depression were quite benign and the situation could be different for people with severe mental disorders.
Mental Health Nurses' Beliefs About Interventions for Schizophrenia and Depression: A Comparison with Psychiatrists and the Public
Authors: Caldwell Tanya M. , Jorm Anthony F. 
Published: December 2009

Objective: The main objective of this paper was to investigate and compare mental health nurses' beliefs about interventions for schizophrenia and depression with those of psychiatrists and the public. Factors affecting nurses' beliefs were also investigated. Method: This research used methods employed in previous surveys of professional and public beliefs. A postal survey of 673 Australian mental health nurses was carried out. The survey was comprised of a vignette describing a person with either depression or schizophrenia. Participants rated whether particular medical, psychological and lifestyle interventions were helpful, harmful or neither. Factors examined included: nurses' age, sex, degree of contact with similar problems, work setting, level of highest qualification and whether their education was hospital-based or completed within the tertiary sector. Results: The nurses agreed with psychiatrists (but not the public) about the interventions most likely to be helpful, such as antidepressants for depression and antipsychotic medication for schizophrenia. However, there were many differences between nurses, psychiatrists and the public. Nurses were more likely than psychiatrists to believe that certain non-standard interventions such as vitamins, minerals and visiting a naturopath would be helpful. Nurses' beliefs tended to form a bridge between the attitudes of psychiatrists and the public for some of these non-standard interventions. Age, work setting and qualifications were related to nurses' intervention beliefs. Conclusions: Mental health practitioners need to be aware of a range of beliefs within mental health services. The acknowledgement of differing belief systems is important for high quality, integrated care.
The Epidemiology of Suicide and Attempted Suicide among Young Australians
Authors: Cantor Chris , Neulinger Kerryn 
Published: December 2009

Objective: This paper summarises a report to the NHMRC the objectives of which were to review research into the epidemiology of youth suicide in Australia and identify gaps in research. Method: Literature searches were conducted. A limited amount of new data analysis was included to shed light on reliability issues of official Australian suicide data. Results: The review examined suicide data systems, including issues to do with coroners, the Australian Bureau of Statistics and alternative systems. The epidemiological areas reviewed included: all ages, youth, age and gender, geographical, socioeconomic, marital, indigenous, migrants, suicides in custody and gay and lesbian suicides. Conclusion: While much is known about the epidemiology of youth suicide, much remains to be clarified. Study of indigenous issues is perhaps the most neglected area; study of family issues may be potentially be the most productive.
The Measurement of a Case Manager's Workload Burden
Authors: Meldrum Lenore , Yellowlees Peter 
Published: December 2009

Objective: The aim of this activity was to develop an appropriate scale to accurately assess the level of clinical load carried by each case manager at the Royal Brisbane Hospital Integrated Mental Health Service. Method: A survey of, and consultation with, case managers over a period of 15 months was used to gather data and modify the monitoring tool for future use in the service. Results and Conclusion: Analysis of the data gathered revealed the level of case managers' work load burden and the depth of need required by clients. Professionally the Clinical Load Monitoring scores have been used in the allocation of additional cases for case management and in the supervision by discipline seniors. Service management has used the Clinical Load Monitoring Scale by dividing individual caseloads into low, medium and heavy service users – with low service users being further investigated for discharge from the service. Heavy service users were assessed for entry into more intensive treatment areas.
The Perceived Utility of Six Selected Measures of Consumer Outcomes Proposed for Routine Use in Australian Mental Health Services
Authors: Stedman Terry , Yellowlees Peter , Drake Suzanne , Chant David , Clarke Robert , Chapple Ben 
Published: December 2009

Objective: This paper aims to assess the utility of six measures of consumer outcomes: the Behaviour and Symptom Identification Scale, the Mental Health Inventory (MHI), the Medical Outcomes Study 36-Item Short-Form Survey, the Health of the Nation Outcome Scales, the Life Skills Profile (LSP) and the Role Functioning Scale previously recommended for the routine assessment in Australian mental health services. Method: Consumers and service providers were invited through focus group discussions and surveys to describe the perceived utility of these selected measures. Results: All six measures were rated favourably. The qualitative and quantitative findings suggest that the MHI elicited the most positive results of the consumer measures. No observer-rated scale was clearly preferred. Conclusion: The qualitative feedback obtained indicated that process and context issues may be as important to the successful use of routine instruments for the measurement of consumer outcomes in clinical practice as the choice of instrument.
The Impact of the Organisation of Mental Health Services on the Quality of Assessment Provided to Older Patients with Depression
Authors: Hickie Ian , Burke David , Tobin Margaret , Mutch Carolyn 
Published: December 2009

Objective: The objective of this study was to examine the impact of the organisation of mental health services on the quality of medical and psychiatric assessment provided to patients with depression over 50 years of age. Method: A retrospective clinical audit of 99 patients with primary depressive disorders who were over 50 years of age was used. These patients were assessed initially by specialised psychogeriatric outpatient and community services (44%), community-based adult mental health services (35%) or an inpatient service (21%). At 2–3 years follow up, clinical outcomes were rated by treating physicians and included current depression status, cognitive and medical status, course of illness since initial assessment and current living circumstances. Results: Patients who were assessed by the community-based adult mental health service received the least comprehensive assessment. Although these patients were more likely to be living independently, they tended to have the poorest depression outcome. Patients who were assessed by the specialised or inpatient services received more comprehensive initial assessment and better coordinated long-term care. Although these patients had more medical and cognitive comorbidity they had better overall depression outcomes. Conclusions: Within a service system that determines access according to an arbitrary age of onset, patients with depression receive the best assessment from specialised psychogeriatric services. However, patients with an early age of onset, more chronic disorders and poor outcomes are treated largely within community-based adult services. Psychiatric services need to ensure that all older patients with depression receive appropriate biomedical and psychosocial assessment, as well as continuity of medical and psychological treatment.
Death by Hanging: Implications for Prevention of an Important Method of Youth Suicide
Authors: Kosky Robert J. , Dundas Pauline 
Published: December 2009

Aim: The aim of this study was to identify factors associated with deaths by hanging among young people in Queensland, Australia. Method: An examination of coroner's reports for all deaths by hanging of people under 25 years of age that occurred in Queensland in the years 1995 and 1996. Results: All cases were recorded as suicides. Most were males and a quarter were indigenous persons. Half the deaths occurred in regional or rural areas. Unemployment, the experience of personal loss, psychiatric illness and alcohol use were possible precipitating agents. Early warning signs were the onset of uncharacteristic behaviours and threats of suicide. Conclusions: The private nature of hanging means that there are rarely opportunities to prevent it in the period immediately before the fatal event. Earlier interventions will have to be considered. To prevent hanging as a means of suicide, we need to understand more about the difficulties experienced by some young men who are living in rural areas. We need more information about the cultural problems experienced by indigenous youths in their teenage years. Young people in the justice system may need personal support. There is a pressing need to determine if young people, especially in rural areas, have adequate access to the professional expertise needed to diagnose and treat mental disorders.
Prevalence of Psychological Distress and Use of Support Services by Cancer Patients at Sydney Hospitals
Authors: Pascoe Shane , Edelman Sarah , Kidman Antony 
Published: December 2009

Objective: The study aimed to estimate the prevalence of anxiety and depression within a cross section of cancer patients in the Sydney region, and to assess the use of and degree of satisfaction with available support services. Method: A survey was conducted at oncology outpatient departments of four Sydney hospitals. Participants completed the Hospital Anxiety and Depression Scale (HADS) and a questionnaire seeking information on their use of patient support services, as well as demographic and clinical information. Results: A total of 504 valid questionnaires were returned. Using a cut-off score of 11 on the HADS, the prevalence of clinically significant anxiety and depression was 11.5% and 7.1% respectively; 17% of patients had received individual counselling while 6.5% had attended support groups. The majority of patients who had attended counselling or support groups reported them to have been ‘extremely’ or ‘reasonably’ helpful (86% and 83% respectively). Of the patients who were experiencing clinically significant anxiety or depression, 75% had not received any counselling or psychological treatment. The main factors which predicted clinically significant anxiety or depression were: restricted activity levels, advanced disease, a non-English-speaking background and being female. Conclusions: While the prevalence of clinically significant anxiety or depression detected by the HADS was reasonably low, a substantial number of possible cases were identified. The majority of affected patients were not accessing counselling or psychological treatment. Systematic screening of oncology patients at hospital entry might enable more immediate identification of clinically affected patients, who could then be referred for further testing or psychological treatment.
Categorical Versus Dimensional Models of Mental Disorder: The Taxometric Evidence
Authors: Haslam Nick 
Published: December 2009

Objective: To review studies of the categorical versus dimensional status of mental disorders that employ taxometric methodology. Method: A comprehensive qualitative review of all published taxometric studies of psychopathology. Results: Categorical and dimensional models each receive well-replicated support for some groups of mental disorders. Studies favour categorical models for melancholia, eating disorders, pathological dissociation, and schizotypal and antisocial personality disorders. Dimensional models tend to be favoured for the broad neurotic spectrum – general depression, generalized anxiety, posttraumatic stress disorder – and for borderline personality disorder. Conclusions: Taxometric research clarifies the latent structure of psychopathology in ways that have implications for the classification, assessment, explanation and conceptualization of mental disorder
Mental Health Service Delivery to Older People in New South Wales: Perceptions of Aged Care, Adult Mental Health and Mental Health Services for Older People
Authors: Draper Brian , Jochelson Tanya , Kitching David , Snowdon John , Brodaty Henry , Russell Bob 
Published: December 2009

Objective: To compare the perceptions of aged care services, adult mental health services and mental health services for older people regarding aspects of mental health service delivery for older people in New South Wales, Australia. Method: The NSW Branch of the Faculty of Psychiatry of Old Age in association with the NSW Centre for Mental Health, sent a postal survey to all aged care services, adult mental health services and mental health services for older people in NSW. The survey canvassed issues ranging across service profiles, regional variations, availability of resources, processes of care, views on working relationships between services, difficulties and gaps experienced, and ways to improve co-ordination and service delivery. Clinical issues such as the management and practice of psychiatric disorders of old age, educational/training requirements and skill and experience in working with older people were explored. Results: An overall response rate of 86% was achieved, including 95% from aged care services (n = 58), 74% from adult mental health services (n = 62) and 90% from mental health services for older people (n = 20). Only 59% of aged care services and adult mental health services considered that their local mental health services for older people provided an adequate service; resource and budget limitations were portrayed as the main constraint. Mental health services for older people varied widely in structure, settings and activities undertaken. Access to mental health beds for older people was also variable, and alongside staffing levels was considered problematic. Lack of staff training and/or inexperience in psychogeriatrics posed a challenge for aged care services and adult mental health services. Conclusion: Relationships between aged care services, adult mental health services and mental health services for older people are affected by lack of access to psychogeriatric staff, resource limitations of mental health services for older people, and inadequate liaison and support between the service types. Joint case conferences, education, increased funding of mental health services for older people, and cross referrals were considered ways to address these issues.
Bridging the Chasm: A Professional College's Role in Quality
Authors: Miles Wayne 
Published: December 2009

Objective: To review the role of the Royal Australian and New Zealand College of Psychiatry (RANZCP) in ensuring quality and to suggest ways to enhance that role. Methods: Literature relating to medical error and quality of health care was reviewed and the performance of the RANZCP assessed against that literature. Results: Considerable evidence exists regarding the risk of medical practice to health. The ‘Quality Chasm’ report is a useful analytic framework for planning quality improvement. Conclusion: The RANZCP is on target with a number of quality initiatives. We need to strengthen the partnership with patients and their families in the design of initiatives.
Improving Collaboration Between Private Psychiatrists, the Public Mental Health Sector and General Practitioners: Evaluation of the Partnership Project
Authors: Pirkis Jane , Livingston Jenni , Herrman Helen , Schweitzer Isaac , Gill Lisa , Morley Belinda , Grigg Margaret , Tanaghow Amgad , Yung Alison , Trauer Tom , Burgess Philip 
Published: December 2009

Objectives: We describe the evaluation of the Partnership Project, which was designed to improve linkages between public and private sector mental health services. We consider the Project's key elements: a Linkage Unit, designed to improve collaborative arrangements for consumers and promote systems-level and cultural change; and the expansion of private psychiatrists' roles to include supervision and training, case conferencing and secondary consultation. The evaluation aimed to describe the impacts and outcomes of these elements. Method: The evaluation used de-identified data from the Linkage Unit database, the Project's billing system, and the Health Insurance Commission (HIC). It drew on consultations with key stakeholders (semistructured interviews with 36 key informants, and information from a forum attended by over 40 carers and a meeting of five public sector and three private sector psychiatrists) and a series of case studies. Results: The Linkage Unit facilitated 224 episodes of collaborative care, many of which had positive outcomes for providers, consumers and carers. It had a significant impact at a systems level, raising consciousness about collaboration and influencing procedural changes. Thirty-two private psychiatrists consented to undertaking expanded roles, and the Project was billed $78 032 accordingly. Supervision and training were most common, involving 16 psychiatrists and accounting for approximately 80% of the total hours and cost. Commonwealth expenditure on private psychiatrists' participation in the expanded roles was not associated with a reduction in benefits paid by the HIC. Key informants were generally positive about the expanded roles. Conclusions: The Project represented a considered, innovative approach to dealing with poor collaboration between the public mental health sector, private psychiatrists and GPs. The Linkage Unit achieved significant systems-level and cultural change, which has the potential to be sustained. Expanded roles for private psychiatrists, particularly supervision and training, may improve collaboration, and warrant further exploration in terms of costs and benefits.