bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Health of the Nation Outcome Scales: Validating Factorial Structure and Invariance Across Two Health Services
Authors: Preston Neil Joseph 
Published: December 2009

Objective: The Health of the Nation Outcome Scale (HoNOS) was developed in the mid-1990s as an inclusive and comprehensive instrument to measure patient outcomes in four main factors: behaviour, impairment, symptoms and social problems. This paper attempts to investigate whether similar health services rate the HoNOS with equivalent psychometric calibration. Method: The purpose of this study was to test for invariant construct interpretation of the instrument across two equivalent health services, using simultaneous confirmatory factor analysis. Results: Although the four-factor model of the HoNOS was confirmed, structural non-invariance occurred, casting doubt on the equivalent interpretability and generalisability of the instrument across similar heath services. Conclusions: Over-inclusiveness, lack of specificity and questionable independence of observations may have contributed to the non-invariant factor structure between the two health services. Such results shed some doubt on the ability of the HoNOS and like observational instruments to provide equivalent comparisons between health services.
The Internal and External Boundaries of Obsessive–Compulsive Disorder
Authors: Castle David J. , Groves Aaron 
Published: December 2009

Objective: This study aims to explore the internal and external boundaries of obsessive–compulsive disorder (OCD). Method: Selected literature is reviewed. Results: Prevalence and incidence estimates for OCD vary markedly according to diagnostic criteria applied. External boundaries of the disorder are permeable, with a large degree of overlap with other psychiatric disorders, and an association with certain neurological disorders. Some cases of OCD appear to have a neurodevelopmental origin. Conclusions: Further delineation of disorders characterised by obsessional and compulsive symptoms can inform models of aetiology, pathophysiology and treatment.
Cannabis, Vulnerability, and the Onset of Schizophrenia: An Epidemiological Perspective
Authors: Hambrecht Martin , Häfner Heinz 
Published: December 2009

Objective: Second to alcohol, cannabis is the most frequently misused substance among patients with schizophrenia. The aim of this paper is to examine at early onset of psychosis whether the high comorbidity of schizophrenia and cannabis abuse is due to a causal relationship between the two disorders. Previous studies have mostly included chronic patients or samples with mixed stages of the psychotic illness. Method: In a German catchment area with a population of 1 500 000, a representative first-episode sample of 232 patients with schizophrenia was included in the Age, Beginning and Course of Schizophrenia Study. By means of a structured interview, the Retrospective Assessment of the Onset of Schizophrenia, the onset and course of schizophrenic symptoms and of substance abuse was systematically assessed retrospectively. Information given by relatives validated the patients' reports. Results: Thirteen per cent of the sample had a history of cannabis abuse, which was twice the rate of matched normal controls. Male sex and early symptom onset were major risk factors. While cannabis abuse almost always preceded the first positive symptoms of schizophrenia, the comparison of the onset of cannabis abuse and of the first (prodromal) symptoms of schizophrenia differentiated three approximately equal groups of patients: group 1 had been abusing cannabis for several years before the first signs of schizophrenia emerged, group 2 experienced the onset of both disorders within the same month, and group 3 had started to abuse cannabis after the onset of symptoms of schizophrenia. Conclusions: The vulnerability-stress-coping model of schizophrenia suggests possible interpretations of these findings. Group 1 might suffer from the chronic deteriorating influence of cannabis reducing the vulnerability threshold and/or coping resources. Group 2 consists of individuals which are already vulnerable to schizophrenia. Cannabis misuse then is the (dopaminergic) stress factor precipitating the onset of psychosis. Group 3 uses cannabis for self-medication against (or for coping with) symptoms of schizophrenia, particularly negative and depressive symptoms. These patients probably learn to counterbalance a hypodopaminergic prefrontal state by the dopaminergic effects of cannabis. The implications of these very preliminary results include issues of treatment and prognosis, but replication studies are needed.
A Comparative Mental Health Literacy Survey of Psychiatrists and Other Mental Health Professionals in Singapore
Authors: Parker Gordon , Chen Helen , Kua Joshua , Loh Jennifer , Jorm Anthony F. 
Published: December 2009

Objective: The objectives of this study are, first, to replicate and extend an Australian approach to assessing mental health literacy by studying a sample of Singapore mental health professionals, and to focus on differences between judgements made by the psychiatrists in comparison with the other mental health professionals. Second, to compare the psychiatrists' judgements with those of Australian psychiatrists. Method: The Australian questionnaire, assessing responses in relation to vignettes of major depression and to schizophrenia was extended by adding a third vignette of mania, and by the addition of several region-specific response options. Nearly 500 questionnaires were distributed to representative staff (psychiatrists, nurses and allied health) of a large psychiatric institution in Singapore, with a response rate of 81%. Psychiatrists' judgements were compared with all other hospital staff, and with Australian psychiatrists' judgements. Results: The two principal contrast groups (Singapore psychiatrists and other Singapore mental health professionals) differed slightly in terms of diagnostic accuracy. The psychiatrists differed in favouring a more professionally focused model of intervention, while both professional groups viewed traditional healers and their practices as distinctly unhelpful. Direct comparison of psychiatrist ratings generated in Singapore and in Australia revealed quite similar response profiles. Conclusions: In addition to generating data of some intrinsic importance, comparison with Australian survey data allows the potential impact of regional and cultural differences, as well as of varying psychiatric practices, to be identified. Responses identified more similarities than differences in the judgements of the psychiatrists from the two countries.
Comparative Efficiency Ratings Between Public and Private Acute Inpatient Facilities
Authors: Hugo Malcolm 
Published: December 2009

Objectives: The aims of this study are to compare clinical outcomes and efficiency ratings in an acute psychiatric inpatient facility with findings from other studies, and to examine relationships between symptom severity, admission medico-legal status and length of stay. Method: The Health of the Nation Outcome Scales was administered at admission and discharge and analysed against admission medico-legal status and length of stay. Efficiency ratings were calculated and compared with those from other acute psychiatric inpatient settings. Results: Clinical outcomes and efficiency ratings were similar to those from other public acute inpatient facilities, with greater admission severities and higher efficiency ratings than those found in private facilities. Involuntary hospitalisation was found to be associated with higher admission severities and longer lengths of stay. Conclusions: Outcome or effect size is enhanced by higher admission severities, however, mean outcome per 10 days of stay is decreased by involuntary admission legal status. Factors unrelated to admission legal status effect differences in efficiency ratings found between public and private acute psychiatric inpatient facilities.
What is the Role of Procedural Justice in Civil Commitment?
Authors: McKenna Brian G. , Simpson Alexander I.F. , Coverdale John H. 
Published: December 2009

Objective: To determine best practice management strategies in the clinical application of civil commitment. Method: All relevant literature on the topics of ‘civil commitment', ‘coercion’ and ‘procedural justice’ were located on MEDLINE and PsychUT databases and reviewed. Literature on the use of Ulysses contracts and advance directives in mental health treatment was integrated into the findings. Results: Best practice evidence that guides management strategies is limited to the time of enactment of civil commitment. Management strategies involve enhancing the principles of procedural justice as a means of limiting negative patient perception of commitment. In the absence of evidence-based research beyond this point of enactment, grounds for the application of the principles of procedural justice are supported by reference to ethical considerations. Ulysses contracts provide an additional method for strengthening procedural justice. Conclusions: Procedural justice principles should be routinely applied throughout the processes of civil commitment in order to enhance longer term therapeutic outcomes and to blunt paternalism.
Defining Effective Community Support for Long-Term Psychiatric Patients According to Behavioural Principles
Authors: Evans Ian M. , Moltzen Natasha L. 
Published: December 2009

Objective: The purpose of this article is to define the characteristics of effective support in community mental health settings for patients with serious and persistent mental illness. Method: A broad literature providing empirical evidence on competent caregiver behaviours and styles is selectively reviewed. Relevant findings from family caregiver research and studies of social environments that enhance skill development in people with intellectual disabilities are incorporated, within a cognitive-behavioural framework. Results: Six important domains are identified which represent positive caregiver styles: acceptance, creating a positive atmosphere, expectations of change, responsiveness, normalisation and educativeness. Conclusion: The characteristics hypothesised to be critical for caregivers and support workers are defined in a general way that can allow for individualisation according to the goals of the programs and the cultural priorities of staff and patients. Further empirical validation of these characteristics would enable community mental health services to provide more specialised clinical treatments.
MindMatters, a Whole-School Approach Promoting Mental Health and Wellbeing
Authors: Wyn Johanna , Cahill Helen , Holdsworth Roger , Rowling Louise , Carson Shirley 
Published: December 2009

Objective: MindMatters is an innovative, national mental health promotion program which provides a framework for mental health promotion in Australian schools. Its objectives are to facilitate exemplary practice in the promotion of whole-school approaches to mental health promotion; develop mental health education resources, curriculum and professional development programs which are appropriate to a wide range of schools, students and learning areas; trial guidelines on mental health and suicide prevention and to encourage the development of partnerships between schools, parents, and community support agencies to promote the mental wellbeing of young people. Method: A team of academics and health education professionals, supported by a reference group of mental health experts, developed MindMatters. The program was piloted in 24 secondary schools, drawn from all educational systems and each State and Territory in Australia. The pilot program was amended and prepared for dissemination nationally. Results: The program provides a framework for mental health promotion in widely differing school settings. The teacher professional development dimension of the program is central to enhancing the role of schools in broad population mental health promotion. Conclusions: Promoting the mental health and wellbeing of all young people is a vital part of the core business of teachers by creating a supportive school environment that is conducive to learning. Teachers need to be comfortable and confident in promoting and teaching for mental health. Specific, targeted interventions, provided within a whole-school framework, address the needs of the minority of students who require additional support.
The Reliability and Validity of the Health of the Nation Outcome Scales: Validation in Relation to Patient Derived Measures
Authors: Brooks Robert 
Published: December 2009

Objective: The Health of Nation Outcome Scales (HoNOS) was developed to assess mental health outcomes. The aim of the studies is to examine the psychometric properties, reliability and validity of the HoNOS. Method: Three studies were conducted within St John of God Hospitals in New South Wales, Australia. They examined the reliability and the validity of the HoNOS. The first study examined the interrater reliability of the HoNOS, before and after staff training in the use of the HoNOS. The second study examined the validity of the HoNOS with the Symptom Checklist 90 Revised (SCL90-R) and the third study examined the validity of the HoNOS with the Short-Form 36 (SF-36). Results: The first study showed an improvement in the interrater reliability (IRR) of the HoNOS due to training. However, a generally unsatisfactory IRR (range 0.50–0.65) was achieved. The second study found no correlation between the SCL90-R and the HoNOS on admission (r = 0.04) and discharge (r = 0.06). The third study found no significant correlation between the Mental Component Score of the SF-36 and the HoNOS on admission (r = −0.033) nor on discharge (r = −0.104). Conclusions: The HoNOS has at best moderate interrater reliabilities. Further, the validity of the HoNOS is under question, that is, it does not correlate with a major measure of mental health symptoms, nor with a major measure of health status. As such, it is concluded that the psychometric properties of the HoNOS do not warrant its use as a routine measure.
Cognitive-Behavioural Assessment and Treatment of Maladaptive Help-Seeking Behaviour in a Patient with Schizophrenia
Authors: Norris Gus , Laube Roy 
Published: December 2009

Objective: Maladaptive help-seeking behaviour in psychiatric patients is a significant problem for public mental health services, yet it is not addressed in the mainstream literature. We present a report on the successful treatment of a person with schizophrenia who displayed this common dilemma for patients and clinicians. Clinical picture: A 31-year-old man with borderline intellectual functioning had a 10-year history of schizophrenia marked by negative features. He frequently presented in crisis to public mental health services, the local hospital, and his general practitioner; this resulted in excessive use of services, including admissions. Treatment: The patient was reassessed from a cognitive-behavioural perspective rather than a syndromal perspective. Specific behaviours were modified, cognitions were identified, challenged and restructured, and other service providers were provided with an alternative to admission or acute community care. Outcome: At 24 months the maladaptive behaviour remains in remission. Conclusions: Behavioural problems in persons with chronic schizophrenia may be effectively treated by reconceptualising the behaviour as distinct from the major diagnosis.
The Future of Australasian Psychiatrists: Online or Out of Touch?
Authors: Yellowlees Peter M. 
Published: December 2009

Objective: The aim of this paper is to examine the delivery of mental health care which will be enabled by the various communications technologies over the next 5 to 10 years. Method: A literature review, reviews of multiple Internet websites and the author's personal experience and opinions are combined to provide a commentary on the group of new technologies for communication available within health, and how they will affect the practice of psychiatry and psychiatrists over the next decade. The driving forces for these changes are the rise of consumerism, technological change and financial necessity, and it is evident that patients will have in future much greater choice of access to their therapists than at present. The health-care environment of the future will be different to today, as will the roles of psychiatrists, who will increasingly have to work as members of teams in an expert capacity rather than in traditional one-to-one practice. Conclusions: It is concluded that it is essential for psychiatrists to become involved in online health care, and in particular to join their patients on the Internet, and that there are major opportunities for Australasian psychiatrists to provide high quality psychiatric care across national boundaries, particularly into the Asia-Pacific region.
Youth Mental Health Promotion in the Hunter Region
Authors: Waring Trevor , Hazell Trevor , Hazell Philip , Adams Jane 
Published: December 2009

Objective: To describe the work of the Hunter Institute of Mental Health, with special emphasis on its role in mental health promotion and prevention with adolescents. Method and Results: The Ottawa Charter for Health Promotion is used as a framework to describe the varied functions of this organisation. Four youth mental health promotion programs are given as examples of the Institute's work. Results of preliminary evaluation of the Youth Suicide Prevention — National University Curriculum Project are provided. Conclusion: The Hunter Institute of Mental Health, a self-funding unit of the Hunter Area Health Service, provides innovative health promotion programs as part of its role as a provider of mental health education and training. The model may be particularly applicable to mental health services in regional Australia.
Chronic Fatigue Syndrome and Australian Psychiatry: Lessons from the UK Experience
Authors: Couper Jeremy 
Published: December 2009

Objective: The aim of this paper is to outline the opportunities and dangers the chronic fatigue syndrome (CFS) issue presents to Australian psychiatry. Method: The scientific literature of the last 50 years on CFS in adults was reviewed and samples of recent media portrayals of CFS in the UK and Australia were collected. The author has worked in both the UK and Australia managing adult CFS patients in specialist outpatient consultation–liaison (C–L) psychiatry settings. Results: Chronic fatigue syndrome has been at the heart of an acrimonious debate in the UK, both within the medical profession and in the wider community. UK psychiatry has been drawn into the debate, at times being the target of strong and potentially damaging criticism, yet UK psychiatry, especially the C–L subspecialty, has played a crucial role in clarifying appropriate research questions and in devising management strategies. The issue has served to enhance and broaden psychiatry's perceived research and clinical role at the important medicine–psychiatry interface in that country. Conclusions: Handled properly, the CFS issue offers Australian psychiatry, especially C–L psychiatry, an opportunity to make a useful contribution to patient care in a clinically difficult and contentious area, while at the same time serving to help broaden psychiatry's scope in the Australian medical landscape.
Youth Suicide Trends in Australian Metropolitan and Non-Metropolitan Areas, 1988–1997
Authors: Wilkinson David , Gunnell David 
Published: December 2009

Objective: The objective of this study was to examine trends in suicide among 15–34-year-olds living in Australian metropolitan and non-metropolitan areas between 1988 and 1997. Method: Suicide and population data were obtained from the Australian Bureau of Statistics. We calculated overall and method-specific suicide rates for 15–24 and 25–34-year-old males and females separately, according to area of residence defined as non-metropolitan (≤ 20 000 people) or metropolitan. Results: Between 1988 and 1997 suicide rates in 15–24-year-old non-metropolitan males were consistently 50% higher than metropolitan 15–24-year-olds. In 1995–1997, for example, the rates were: 38.2 versus 25.1 per 100 000 respectively (p < 0.0001). The reverse pattern was seen in 25–34-year-old females with higher rates in metropolitan areas (7.5 per 100 000) compared with non-metropolitan areas (6.1 per 100000, p = 0.21) in 1995–1997. There were no significant differences according to area of residence in 25–34-year-old males or 15–24-year-old females. Over the years studied we found no clear evidence that suicide rates increased to a greater extent in rural than urban areas. Rates of hanging suicide have approximately doubled in both sexes and age groups in both settings over this time. Despite an approximate halving in firearm suicide, rates remain 3-fold higher among non-metropolitan residents. Conclusion: Non-metropolitan males aged 15–24 years have disproportionately higher rates of suicide than their metropolitan counterparts. Reasons for this require further investigation. Hanging is now the most favoured method of non-metropolitan suicide replacing firearms from 10 years ago. Although legislation may reduce method-specific suicide the potential for method-substitution means that overall rates may not fall. More comprehensive interventions are therefore required.
A Cognitive-Behavioural, Group-Based Intervention for Social Anxiety in Schizophrenia
Authors: Halperin Stephen , Nathan Paula , Drummond Peter , Castle David 
Published: December 2009

Objective: The objective of this study was to investigate the efficacy of group-based cognitive-behavioural therapy (CBT) for social anxiety in schizophrenia. Method: Patients with schizophrenia (20) with comorbid social anxiety were randomly assigned to the group-based CBT or wait-list control condition. Pre-, post- and 6-week follow-up ratings included measures of social anxiety and avoidance, mood and quality of life. Results: The intervention group improved on all outcome measures and the control group showed no change in symptomatology. Conclusions: Group-based CBT is effective in treating social anxiety in schizophrenia.
Enhancing Case Managers' Skills in the Assessment and Management of Antipsychotic Medication Side-Effects
Authors: Morrison Paul , Meehan Tom , Gaskill Deanne , Lunney Paul , Collings Paul 
Published: December 2009

Objective: Our goal was to reduce the prevalence of antipsychotic medication side-effects by providing a short-term training program on the assessment and management of side-effects to case managers. Method: Forty-four patients in receipt of community-based mental health services were allocated to comparison (n = 20) and intervention (n = 24) groups based on the health service district in which they resided. While case managers working with the intervention group attended a short-term training program to improve their assessment and management of neuroleptic side-effects, case managers providing services to the comparison group received no additional training. Side-effects were assessed pre- and postintervention using the Liverpool University Neuroleptic Side-effect Rating Scale (LUNSERS). Results: A reduction in the overall prevalence of side-effects in both groups was observed, however, only those patients in the intervention group reported a statistically significant reduction in mean side-effect scores between the pre- and post-measures (Wilcoxon Matched Pairs Signed-ranks Test, z = −2.8411, two-tailed, p < 0.01). In addition, qualitative data collected during the second survey revealed that patients in the intervention group had acquired some positive management strategies for dealing with unwanted side-effects. The strategies were elicited from eight different patients distributed across six of the 12 case managers who took part in the training program. Conclusions: Training cases managers in the assessment and management of side-effects may help to reduce their impact on the lives of people prescribed neuroleptic medication.