bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disability, Employment and Work Performance Among People with ICD-10 Anxiety Disorders
Authors: Waghorn Geoff , Chant David , White Paul , Whiteford Harvey 
Published: December 2009

Objective: To ascertain at a population level, patterns of disability, labour force participation, employment and work performance among people with ICD-10 anxiety disorders in compar ison to people without disability or long-term health conditions. Method: A secondary analysis was conducted of a probability sample of 42 664 individuals collected in an Australian Bureau of Statistics (ABS) national survey in 1998. Trained lay interviewers using ICD-10 computer-assisted interviews identified household residents with anxiety disorders. Results: Anxiety disorders were associated with: reduced labour force participation, degraded employment trajectories and impaired work performance compared to people without disabilities or long-term health conditions. Conclusion: People with anxiety disorders may need more effective treatments and assistance with completing education and training, joining and rejoining the workforce, developing career pathways, remaining in the workforce and sustaining work performance. A whole-of-government approach appears needed to reduce the burden of disease and increase community labour resources. Implications for clinicians, vocational professionals and policy makers are discussed.
Public and Private Psychiatry: Can They Work Together and is it Worth the Effort?
Authors: Yung Alison , Gill Lisa , Sommerville Elizabeth , Dowling Bernie , Simon Kim , Pirkis Jane , Livingston Jenni , Schweitzer Isaac , Tanaghow Amgad , Herrman Helen , Trauer Tom , Grigg Margaret , Burgess Philip 
Published: December 2009

Objective: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative ‘shared care’ arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems. Method: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area. Results: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: ‘Difficulty communicating’ endorsed by 71.4% of public clinicians and 72% of private psychiatrists, ‘Confusion of roles and responsibilities’ endorsed by 62.9% and 66%, respectively, and ‘Different treatment approach’ by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors. Conclusions: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.
Psychosocial Support for War-Traumatized Child and Adolescent Refugees: Evaluation of a Short-Term Treatment Program
Authors: Möhlen Heike , Parzer Peter , Resch Franz , Brunner Romuald 
Published: December 2009

Objective: The purpose of this study was to evaluate a newly designed psychosocial treatment program for war traumatized child and adolescent refugees. The program was designed to reduce emotional distress and improve psychosocial functioning. Method: Ten young Kosovan refugees (mean age 13.3 years) residing in Germany participated in the manual based intervention program. This multimodal program consists of individual, family and group sessions using a psychoeducational approach beside trauma and grief focusing activities, creative techniques and relaxation. Kind and severity of traumatic experiences were gathered by interviewing the child and their caretakers using the Harvard Trauma Questionnaire (HTQ). Psychiatric diagnoses (Schedule for Affective Disorders and Schizophrenia for School-Age Children, K-SADS) were assessed prior to the intervention. Post-traumatic symptomatology (HTQ), emotional problems (Diagnostic System for Psychological Disorders, DYSIPS) and the overall psychosocial functioning (Child Global Assessment Scale, CGAS) were assessed before and after the 12-week intervention. Results: Following the intervention the degree of overall psychosocial functioning increased substantially in 9 of 10 participants. Furthermore, post-traumatic, anxiety and depressive symptoms were reduced significantly. The rate of post-traumatic stress disorder (PTSD) diagnoses fell from 60% to 30%. The number of patients with PTSD and a high rate of comorbid symptoms (depression and anxiety) as well as a history of severe traumatization remained at 30%. Conclusions: This study suggests that the psychosocial treatment program specified for war traumatized adolescents may be useful for the relief of psychiatric sequelae and for an improvement in overall psychosocial functions, but not for the subgroup of severely traumatized patients with complex psychiatric disturbances.
Clinical Profiles, Scope and General Findings of the Western Sydney First Episode Psychosis Project
Authors: Harris Anthony , Brennan John , Anderson Josephine , Taylor Anne , Sanbrook Mark , Fitzgerald Dianne , Lucas Sara , Redoblado-Hodge Antoinette , Gomes Lavier , Gordon Evian 
Published: December 2009

Objective: To examine the clinical profile, treatment and social functioning of a communitybased sample of young people presenting with their first episode of psychosis. Methods: Over a 2-year period, young people with their first episode of psychosis referred to early intervention services in two area mental health services in western Sydney were assessed with a battery of clinical, neuropsychological, psychophysiological and neuroanatomical measures. This paper reports the clinical results of the baseline section of the study. Results: Of the 224 referrals to the project, 94 subjects meet inclusion criteria and agreed to take part. Subjects were divided into three diagnostic groups – ‘Schizophrenia’, ‘Mood Disorders’ and ‘Mixed Psychosis’, the latter principally comprised of substance induced psychotic disorders. Subjects from the ‘Schizophrenia’ group differed significantly from the other two groups in that they had higher levels of negative symptoms and general psychopathology, and were less likely to be employed or engaged in study. They had poorer overall social functioning. Subjects with ‘Mixed Psychosis’ were similar to those from the ‘Schizophrenia’ group in that they were older and male, but they did not have the same burden of negative symptoms as the ‘Schizophrenia’ group. The ‘Mood Disorders’ group was younger, female and had overall a higher level of psychosocial functioning than the other two groups. Subjects from the ‘Mood Disorders’ group were more likely to be managed with mood stabilisers and multiple drug therapies. The use of atypical antipsychotic medication was almost universal. Conclusions: Even shortly after the time of presentation to mental health services young people with a schizophrenia spectrum diagnosis have a heavier burden of symptoms and are significantly more impaired by them than young people with other psychotic illnesses. This and their symptom profile differentiated them from young people with other psychotic disorders.
Clinical Management of Deliberate Self-Harm in Young People: The Need for Evidence-Based Approaches to Reduce Repetition
Authors: Burns Jane , Dudley Michael , Hazell Philip , Patton George 
Published: December 2009

Objective: To examine the evidence for the effectiveness of clinical interventions designed to reduce the repetition of deliberate self-harm (DSH) in adolescents and young adults. Methods: Electronic databases were searched for papers describing randomised and clinical control trials (RCTs) and quasi-experimental studies of interventions targeting adolescents and young adults presenting to clinical services following DSH or suicidal ideation. Results: Three RCTs, four clinical control trials and three quasi-experimental studies were identified. Group therapy, trialled in a RCT, was the only specific programme which led to a significant reduction in rates of repetition of self-harm. Attendance at follow-up did not improve significantly regardless of the intervention, while one clinically controlled trial of intensive intervention resulted in poorer attendance at follow-up. One quasi-experimental study of family therapy resulted in a significant reduction in suicidal ideation. Conclusions: The evidence base for treatments designed to reduce the repetition of self-harm in adolescents and young adults is very limited. Expensive interventions such as intensive aftercare offer no clear benefit over routine aftercare. Given that deliberate selfharm among young people is a common clinical problem further good quality treatment studies are warranted. Careful consideration should be given to process evaluation to determine which individual components of any given intervention are effective.
Relationship Between Control and the Intermediate Term Outcome of Anorexia Nervosa in Hong Kong
Authors: Lee Sing , Lydia Chan Y.Y. , Kwok Kathleen , George Hsu L.K. 
Published: December 2009

Objective: To examine the relationship between control and the intermediate term outcome of Chinese patients with anorexia nervosa. Method: 88 patients who fulfilled the DSM-III-R criteria for typical (fat phobic, n = 63) and atypical (non-fat phobic, n = 25) anorexia nervosa were contacted 9 years after the onset of illness. They completed the Morgan-Russell Outcome Assessment Schedule, Shapiro Control Inventory, and Eating Disorder Inventory-I. Results: 62.2%, 32.4% and 5.4% of patients had good, intermediate, and poor outcome. Outcome was positively correlated with the overall general and specific sense of control, positive sense of control, and negatively with negative sense of control. Patients with good outcome exhibited the least negative modes of control and had the least desire for control. Typical and atypical patients showed similar but not identical control profiles. Conclusion: Healthier control was associated with better outcome of anorexia nervosa but their causal relationship was far from clear because of the cross-sectional nature of the present study. The Shapiro Control Inventory is a potentially useful instrument for studying control in eating disorders.
Accommodation History and Continuity of Care in Patients with Psychosis
Authors: Holmes Alex C.N. , Hodge Mark A. , Bradley Gail , Bluhm Alan , Hodges Jane , Didio Louisa , Markulev Natasha 
Published: December 2009

Objectives: The objective of this study was to determine the relationship between accommodation history and management outcome in patients with psychosis. Method: Demographic information, diagnosis and an accommodation history were taken from patients with psychosis accepted for case management by the Inner West Area Mental Health Service over a 12-month period. The patients were followed up 2 years later to determine their continuity of care and discharge outcome. Results: One hundred 42 patients completed the assessments. Forty-eight percent of patients had spent at least 1 day in a homeless setting in the previous 12 months. Twentytwo percent of patients had long-term (between 2 and 12 months) and six percent chronic (more than 12 months) homelessness. The duration of previous homelessness was significantly inversely correlated with the length of engagement with the service, continuity of psychiatric care at discharge or likelihood of transfer to primary care. Previous interstate mobility was significantly associated with discontinuity of care at discharge. Conclusions: A history of homelessness is common in patients with psychosis using inner urban mental health services and is associated with poorer engagement with psychiatric services.
Explaining Transitions Over the Hypothesized Psychosis Continuum
Authors: Krabbendam Lydia , Myin-Germeys Inez , Bak Maarten , Van Os Jim 
Published: December 2009

Objectives: It is crucial to understand the psychological mechanisms that mediate transition from having one or two psychotic symptoms to becoming a patient with a psychotic disorder. This study investigated whether: (i) a delusional interpretation and/or a depressed response to hallucinatory experiences predicts the later onset of clinical psychotic disorder; and (ii) the presence of need for care in relation to psychotic disorder was associated with the use of particular coping strategies. Method: A general population sample of 4672 individuals with no lifetime evidence of any psychotic disorder were interviewed with the Composite International Diagnostic Interview Schedule (CIDI) at baseline and 1 and 3 years later. At year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify onset of psychotic disorder with need for care. Coping, subjective distress with and perceived control over the psychotic experience were assessed using the Maastricht Assessment of Coping Strategies (MACS). Results: Given the presence of hallucinatory experiences at baseline, the increase in risk on the additive scale of having the psychosis outcome at T2 was higher in the group with delusional ideation at T1 than in those without delusional ideation at T1. Similarly, presence of depressed mood at T1 increased the risk of having the psychosis outcome at T2, but this effect overlapped partly with the risk-increasing effect of delusional ideation. Individuals with a need for care were much more likely to display symptomatic coping, whereas the presence of the other coping types was not different across the groups with and without need for care. Conclusion: Transitions over the psychosis continuum are, at least in part, driven by the emotional, cognitive and behavioural responses to the initial psychotic or psychosis-like experiences. Individuals who react with a delusional interpretation, negative emotional states and/or a symptomatic coping style have an increased risk for developing clinical psychosis.
Mortality and Mental Illness
Authors: Drew Leslie R.H. 
Published: December 2009

Background: The finding by Lawrence, Holman and Jablensky (Duty to Care) that mortality among the mentally ill in Western Australia was 2.5 times that of the general population, seemingly, has great significance for public policy concerning the mentally ill. ‘Mortality’ could be a useful outcome measure for mental health services. Objectives: To replicate that study in the Australian Capital territory (ACT), comparing mortality rates in the mentally ill with those of the total population. Method: A list of all people who contacted the ACT mental health services between 1985 and 2000 was compiled. Using the national register of deaths (Australian Institute of Health and Welfare), persons known to the mental health services who died between 1990 and 2000 were identified and sex, date of birth, date of death, cause of death and place of death were noted. Using Australian Bureau of Statistics data for all deaths in the ACT, deaths in the total population and in the mentally ill population were tabulated for the period 1996–2000. With 1996 data as the base, using total population data from the ABS and mental health population data derived by amending ‘the list’ to remove duplications, pre1996 deaths and post1996 additions, mortality rates for the period 1996–2000 were compared. Results: The gender and age distribution of the mentally ill population and the total population, and of deaths in those populations, were very different. One third of all deaths in the mentally ill occurred outside of the ACT. Compared with the general population, mortality in the mentally ill (including deaths outside of the ACT) was only slightly excessive for ‘all causes’ and ischaemic heart disease but grossly excessive for ‘suicide’. Conclusions: This study did not confirm the excessive mortality rate in the mentally ill reported by Lawrence et al. except for suicide. Many methodological issues in using population studies to attempt to measure the size of the increase were identified. Differences in method between the ACT and WA studies probably explain the differences in results. Caution is urged in using the results of mortality studies as determinants of public policy or to evaluate services.
A Methodology for Timing Reviews of Inpatient Hospital Stay
Authors: Page Andrew C. , Hooke Geoff R. , Rampono Jonathan 
Published: December 2009

Objective: This paper aims to describe a methodology to inform decisions about the optimal time to schedule reviews of a patient's hospital stay and to provide an example of its implementation. Method: Length of hospital stay was assessed in 1227 consecutive inpatient admissions. Data were transformed to reflect the probability of discharge from hospital in the following 7 days. Results: The resulting data reflected the points at which the conditional probability of being discharged were declining, revealing the potentially efficient times to conduct reviews of inpatient admissions. Conclusions: The methodology outlined appears useful in assisting psychiatrists responsible for inpatient care to decide upon optimal times to review a patient's stay in hospital.
Mania in the Swedish Twin Registry: Criterion Validity and Prevalence
Authors: Soldani Federico , Sullivan Patrick F. , Pedersen Nancy L. 
Published: December 2009

Background: In population surveys, the assessment of mania is commonly done by trained lay interviewers using structured diagnostic instruments: the validity of this approach has been questioned. We examined the criterion validity and prevalence of lifetime mania in a survey of Swedish twins conducted with interview methodology usually applied in psychiatric epidemiology. Methods: 41 838 individuals in the Swedish Twin Registry were evaluated via a telephone interview that included the eight DSM-IV mania items, and these data were merged with inpatient hospitalization discharge diagnoses from two comprehensive national registries (the criterion). An algorithm with eight cut-points was used to diagnose lifetime mania, and compared by a receiver operator characteristic curve to the criterion. The algorithm requiring at least four positive items resembling a DSM-IV diagnosis. Results: History of hospitalization for a psychiatric condition that included a manic episode was present for 0.7% of all living twins, and predicted non-response to the survey (OR = 0.5; 95% CI = 0.4–0.6). The incidence rate for first hospitalization was 2.1/10 000 year –1. For ≥1 symptom (first cut-point), the prevalence, sensitivity and specificity were 3.6%, 39.0% and 96.6%; for ≥ 4 symptoms (DSM-IV-like cut-point) 2.6%, 36.5% and 97.6%; and for eight symptoms 0.3%, 18.0% and 99.8%. Positive predictive values were, respectively, 5.5%, 7.0% and 29.8%. Conclusions: The performance of the telephone screening for mania by lay interviewers in terms of positive predictive power was not satisfactory; despite a high specificity, the false positive rate was high. The low population prevalence of mania, non-response bias, criterion choice and inherent limitations of the interviewing method are among the explanations. Assessment of a lifetime manic episode based on lay interviewer screening may yield misleading data.
Temporal Stability of the dex/CRH Test in Patients with Rapid-Cycling Bipolar I Disorder: A Pilot Study
Authors: Watson Stuart , Thompson Jill M. , Malik Navdeep , Nicol Ferrier I. , Young Allan H. 
Published: December 2009

Objective: To examine the hypothesis that hypothalamic-pituitary-adrenal (HPA) axis function is a trait abnormality in bipolar disorder. Method: We examined HPA axis function in a pilot study of five patients with rapid-cycling bipolar disorder in both relapse and remission using the dexamethasone/corticotropin releasing hormone (dex/CRH) test. Results: The cortisol response to the dex/CRH test correlated significantly between the 2 tests (r = 0.997; p < 0.0005). Conclusion: The data suggests that the cortisol response to the dex/CRH test is stable over time and independent of mood state.
A Cross-Sectional Analysis of Factors that Influence the Detection of Depression in Older Primary Care Patients
Authors: Pfaff Jon J , Pfaff Jon J , Almeida Osvaldo P 
Published: December 2009

Objective: To determine the characteristics of depressed older patients whose mental health status is detected by their general practitioner (GP). Method: Cross-sectional analytical design of 218 patients scoring above the cut-off (≥ 16) of the Center for Epidemiological Studies – Depression Scale (CES-D), from a sample of 916 consecutive patients aged 60 years or over attending one of 54 randomly selected GPs in Western Australia. Prior to their medical consultation, patients completed a self-report questionnaire, which included questions about depressive symptomatology (CES-D). Following the consultation, general practitioners recorded the patient's presenting complaint(s), medication information, and mental health details on a patient summary sheet. Results: Among these 218 patients, 39.9% (87/218) were correctly classified as depressed by their GP. Detection of depressive symptomatology was associated with patients who acknowledged taking sleeping tablets (OR = 2.6, 95% CI = 1.3–5.4), had CES-D scores indicative of major depression (≥ 22) (OR = 2.8, 95% CI = 1.4–5.6) and were thought to be at risk for suicide (OR = 35.1, 95% CI = 4.5–274.2). Conclusions: While GPs are most apt to detect depression among older patients with prominent mental health symptoms, many patients in this age group silently experience significant depressive symptomatology and miss the opportunity for effective treatment. The routine use of screening tools in primary care is recommended to enhance the detection rate of depression in older adults.