bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liaison Psychiatry with Aboriginal and Torres Strait Islander Peoples
Authors: Wand Anne P. F. , Corr Melissa Jane , Eades Sandra J. 
Published: December 2009

Objective: The aim of the present study was to describe the referral patterns, assessment and suggested management of Aboriginal and Torres Strait Islander peoples referred to an inner-city general hospital psychiatry service. The overarching goal was quality improvement. Method: Participants were identified from the consultation–liaison psychiatry database of all referrals to the service from the general hospital and Emergency Department. All people over 18 identifying as Aboriginal and/or Torres Strait Islander seen during the period 1 July 2004–30 June 2007 were included. Information regarding referral and liaison patterns, suggested psychiatric management, disposition and follow up were gathered retrospectively from the medical records, with a particular focus on cultural references. Results: There were 162 referrals to the consultation–liaison psychiatry team of people identifying as Aboriginal and/or Torres Strait Islander. The rate of referral to consultation–liaison psychiatry was 3%. The Emergency Department had the highest rate of referral followed by Obstetrics and Gynaecology. The most common reason for referral was assessment of risk. The patient's Aboriginal ethnicity was mentioned in 52.5% of consultation–liaison assessments. An Aboriginal health worker was consulted in 48.1% of cases. The most common management approach involved pharmacotherapy. The consultation–liaison service instigated legal interventions in 25% of cases. Forty-five patients were referred for psychiatric admission following their assessment. Mental health follow up was arranged in 43.8% of cases. Conclusions: The range of mental health problems referred and types of diagnoses made in Aboriginal and Torres Strait Islander peoples reflect what has been previously reported, particularly in relation to comorbidity. Aboriginal ethnicity was variably identified and Aboriginal health workers, general practitioners and families were not routinely involved in consultation–liaison psychiatry assessments, highlighting an opportunity to improve communication and the quality of patient care.
Modelling Candidate Effectiveness Indicators for Mental Health Services
Authors: Burgess Philip , Pirkis Jane , Coombs Tim 
Published: December 2009

Objective: Although Australia and the UK have both made efforts to systematize outcome measurement in mental health services, surprisingly little attention has been paid to how best to analyse routine outcome data in order to determine how services are performing. Methods: Outcome data collected in acute inpatient and ambulatory mental health services across Australia during the 2006–2007 financial year were used. three approaches to measuring effectiveness were explored: effect size (ES); the reliable change index (RCI); and standard error of measurement (SEM). Results: The most conservative results were produced by the RCI and the least conservative by the medium ES statistic and the SEM. By way of example, only 38.0% of inpatient admission–discharge periods of care showed significant improvement for adults when the RCI was used, whereas 67.4% and 72.9% did so when the medium ES and the SEM statistics were used, respectively. Conclusions: In any routine outcome measurement exercise, the degree of effectiveness demonstrated by services will depend on the specific statistical indicator used to judge effectiveness. Routine outcome measurement has the potential to answer a range of crucial performance-related questions, but only if the same metric is used. Discussion of the appropriate statistical approach to take to facilitate cross-service, cross-area and even cross-national comparisons warrants attention.
Cost-Effectiveness of Combination Therapy Versus Antidepressant Therapy for Management of Depression in Japan
Authors: Sado Mitsuhiro , Knapp Martin , Yamauchi Keita , Fujisawa Daisuke , So Mirai , Nakagawa Atsuo , Kikuchi Toshiaki , Ono Yutaka 
Published: December 2009

Objective: Major depression is expected to become the second leading contributor to disease burden worldwide by 2020. Only a few studies, however, have compared the cost-effectiveness of a combination of cognitive behavioural therapy and antidepressant therapy versus antidepressant therapy alone. The purpose of the present study was therefore to analyse cost-effectiveness, from the perspective of the health-care system and also from a social perspective, comparing combined cognitive behavioural therapy + antidepressant therapy and antidepressant therapy alone in the Japanese setting. Method: A formal decision analytical model was constructed. The analyses were performed from both the perspective of the health-care system and the societal perspective. The clinical outcomes were determined from published articles and reports of expert panels. Because no patient-level data were available, deterministic costing of the different treatment strategies was carried out. Cost-effectiveness was assessed first by determining the incremental cost-effectiveness ratio (ICER) per successfully treated patient, and then by the ICER per quality-adjusted life years (QALYs). Results: The combined therapy increased the rate of successfully treated patients, QALY of severe depression and QALY of moderate depression by 0.15, 0.08 and 0.04, respectively. The combined therapy proved to be more expensive from the health-care system perspective, but the incremental costs were completely offset by the considerable reduction of productivity loss from the social perspective. From the health-care perspective, the ICER per successfully treated patient, ICER per QALY of severe depression and ICER per QALY of moderate depression were JPY 140 418, JPY 268 550 and JPY 537 100, respectively. All the ICERs appeared to be negative from the social perspective. Conclusion: The combined therapy appeared to be cost-effective from the health-care system perspective and the dominant strategy from the social perspective.
Reliability and Validity of the Chinese Version of the Calgary Depression Scale for Schizophrenia
Authors: Xiao Weidong , Liu Hao , Zhang Hongyan , Liu Qi , Fu Peixin , Chen Jingxu , Wang Xiaoping , Wang Gaohua , Li Lingzhi , Shu Liang 
Published: December 2009

Objective: The aim of the present study was to determine the reliability and validity of the Chinese version of the Calgary Depression Scale for Schizophrenia (CDSS-C) in schizophrenia patients. Method: One hundred and one inpatients from four mental health units who met DSM-IV criteria for schizophrenia were enrolled. The Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS-24), Simpson–Augus Rating Scale (SAS), and Barnes Acathisia Rating Scale (BARS) were administered by the first rater, whereas the CDSS-C was assessed by a second independent rater. Results: The internal consistency (Cronbach's α = 0.80) and the inter-rater reliability (κ coefficient >0.79) were good. The test–retest reliability was high (r = 0.927). The scale had good construct validity, with statistically significant correlations with the HDRS-24, G6 item (depression) of PANSS, and significant weak correlations with the general psychopathology subscale of PANSS. The CDSS-C showed no correlation with the positive and negative subscale of PANSS, the SAS and the BARS. Conclusion: The Chinese version of CDSS is a valid and reliable instrument for the assessment of depression in schizophrenia.
Effect of Restricting Access to a Suicide Jumping Site
Authors: Skegg Keren , Herbison Peter 
Published: December 2009

Objective: The road to a headland that had become a suicide jumping hotspot was temporarily closed because of construction work. This created an opportunity to assess whether loss of vehicular access would lead to a reduction in suicides and emergency police callouts for threatened suicide at the site. Method: Deaths at the headland were ascertained for a 10 year period before road closure and for 2 years following closure using records from the local police inquest officer, the coroner's pathologist and Marine Search and Rescue. Police provided a list of police callouts for threatened suicide at the site for a 4 year period before closure and for 2 years following closure. Simple rates were compared and incident rate ratios were calculated where possible. Results: There were 13 deaths at the headland involving suicide or open verdicts in the 10 years before access was restricted, and none in the 2 years following road closure. This difference was statistically significant (incident rate difference = 1.3 deaths per year, 95% confidence interval (CI) = 0.6–2.0). No jumping suicides occurred elsewhere in the police district following the road closure. Police callouts for threatened suicide also fell significantly, from 19.3 per year in the 4 years prior to road closure to 9.5 per year for the following 2 years (incident rate ratio = 2.0, 95%CI = 1.2–3.5). Conclusions: Preventing vehicular access to a suicide jumping hotspot was an effective means of suicide prevention at the site. There was no evidence of substitution to other jumping sites.
Reliability of the Mood Disorder Questionnaire: Comparison with the Structured Clinical Interview for the DSM-IV-TR in a Population Sample
Authors: Dodd Seetal , Williams Lana J. , Jacka Felice N. , Pasco Julie A. , Bjerkeset Ottar , Berk Michael 
Published: December 2009

Objective: The Mood Disorder Questionnaire (MDQ) is a widely used self-report screening instrument for the detection of bipolar disorder in clinical populations. The aim of the present study was therefore to investigate the reliability of this instrument. Methods: Screening results using the MDQ were compared with results obtained using the Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition (SCID) in a community-based sample of 1066 women. Trained personnel, who were blind to the results of the MDQ screen, conducted clinical interviews. Results: Using the MDQ, 21 women screened positive for bipolar disorder, and using the SCID diagnoses, 24 women were confirmed with a diagnosis of bipolar disorder. Six women were detected on both instruments. Compared to the SCID, the sensitivity for the MDQ was 25%, specificity 99%, positive predictive value 28%, negative predictive value 98%, and a demonstrated kappa of 0.25. The MDQ failed to detect any of the 11 participants in the study with bipolar II disorder and missed seven of 13 participants with bipolar I disorder or bipolar not otherwise specified. Of the 21 women who screened positive using the MDQ, 19 had current or past psychopathologies other than bipolar disorder. Conclusion: The MDQ has substantial limitations for detection of bipolar disorder, in particular bipolar II disorder, in non-clinical populations.
Personality and Self-Reported Treatment Effectiveness in Depression
Authors: Parker Gordon , Crawford Joanna 
Published: December 2009

Objective: The aim of the present study was to examine the associations between eight personality styles and retrospective self-reported response to a wide range of treatments for depression, including pharmacological, psychological and alternative strategies. Method: An online survey posted on the Black Dog Institute website was completed by 3486 respondents reporting a history of treatment for depression. Inclusion criteria resulted in a sample of 2692 respondents. Participants completed the Temperament and Personality Questionnaire, which assesses eight personality dimensions: anxious worrying, perfectionism, personal reserve, irritability, social avoidance, rejection sensitivity, self-criticism and self-focus. Results: A series of linear regressions quantified that the personality dimensions – as well as age and gender – accounted for very little of the variance in self-reported treatment effectiveness (1–7%). Self-criticism was associated with a poorer response to most treatments, and social avoidance was associated with a poorer response to psychological treatments (e.g. cognitive behaviour therapy) and behavioural strategies (e.g. exercise). Several other weak associations are reported. Conclusion: The association between personality style and retrospective self-reported treatment response was overall weak at most. The association between a personality style of self-criticism and poor treatment response warrants clarification.
Discontinuation Symptoms with Nefazodone
Authors: Rajagopalan Mani , Little John 
Published: December 2009

Objective: We report a patient who developed discontinuation symptoms following nefazodone cessation. Clinical picture: The patient experienced nausea, vomiting, diarrhoea, ataxia, insomnia, marked agitation, headache and flu-like symptoms. Treatment: She was reluctant to recommence nefazodone and was symptomati-cally treated with oxazepam. Outcome: The patient recovered completely in 10 days. Conclusions: Nefazodone discontinuation can result in withdrawal symptoms and therefore needs to be tapered gradually. Those who have experienced discontinuation symptoms with other antidepressants in the past may be at increased risk.
The Relevance of Herbal Treatments for Psychiatric Practice
Authors: Walter Garry , Rey Joseph M. 
Published: December 2009

Objective: The aim of this paper is to inform psychiatrists about the basic priniciples, terminology, schools of thought, efficacy, safety and regulatory issues regarding herbal treatments for mental illness. Method: Information was obtained by computerised and manual searching of medical and botanical data bases, and by discussions with experts in herbal medicine and regulatory aspects of the pharmaceutical industry. Results: Herbal medicines are commonly used in developed and developing countries for psychiatric illness. The main schools of herbal medicine in Australia are Western herbal medicine, traditional Chinese medicine and ‘Ayurveda’ (Indian herbal medicine). Herbs used for psychiatric or neurological disorders are termed ‘nervines’. Three nervines which have attracted considerable attention recently are St John's Wort, Gingko biloba and Valeriana officinalis. In Australia, most herbal drugs are classed as ‘listed drugs’ which are required to satisfy less rigorous safety and efficacy criteria than ‘registered drugs’. The popularity of herbal remedies has a number of clinical and research implications for psychiatry. Conclusions: Psychiatrists should not endorse treatments that are unsupported by sound research, nor remain ignorant about alternative approaches to mental illness. The extent of use of herbal treatments for mental illness suggests that psychiatrists should become more knowledgeable about developments in this area.
Norms and the Effects of Demographic Variables on a Neuropsychological Battery for Use in Healthy Ageing Australian Populations
Authors: Collie Alexander , Shafiq-Antonacci Ruxsana , Maruff Paul , Tyler Peter , Currie Jon 
Published: December 2009

Objective: The current study examined the performance of a healthy ageing population on the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological test battery in order to determine norms for use in an Australian setting. The effects of age, education, gender and mood on cognitive performance in healthy older individuals were also explored. Method: The CERAD neuropsychological battery was administered to a sample of healthy elderly subjects (n = 243). Subjects also completed an anxiety inventory and a depression scale. Means and standard deviations of different age, gender and education groups are reported as normative data. A Principal Components Analysis (PCA) was also calculated. Linear regression was applied to the five factors extracted from the PCA using age, education, gender and mood as independent variables. Results: All recorded means were within 1 SD of those reported in the original CERAD normative study. Five factors that loaded on measures of memory and learning, language, praxis and executive function were extracted. The independent variables age, education and gender all had significant effects on cognitive performance. However, mood had no such effect. Conclusions: Risk factors for cognitive decline indicated by the CERAD battery include age, education and gender. Anxiety and depression are not associated with CERAD cognitive performance. The CERAD battery is a valid and reliable neuropsychological tool that may assist in the detection and diagnosis of Alzheimer's disease in Australian populations.
Inhibition of Hypervigilance in the Treatment of Traumatic Simple Phobias: Three Case Examples
Authors: Lee Anna , Vaughan Kevin , Armstrong Michael 
Published: December 2009

Objective: In traumatic simple phobia (TSP) fear of retraumatisation tends to be enduring and may show little reduction with time despite frequent and prolonged exposure. This paper describes how hypervigilant behaviour may account for this enduring response by interfering with exposure. Method: Three case histories illustrating the clinical features of TSP and its treatment using in vivo exposure coupled with direct inhibition of hypervigilance are presented. Result: In all three cases, reduction of anxiety occurred with spontaneous generalisation of improvement. Conclusions: The efficacy of in vivo therapeutic exposure for fear of retraumatisation may be enhanced by the use of strategies to inhibit hypervigilant behaviour.
Does the Use of Psychiatrists as Sources of Information Improve Media Depictions of Mental Illness? A Pilot Study
Authors: Nairn Raymond 
Published: December 2009

Objective: The aim of this study is to determine whether mental illnesses are depicted in less negative ways in print media when psychiatrists rather than lay persons are the source of information. Method: Seven items from a special report on mental health, four derived from lay sources and three from psychiatrists, were subjected to a discourse analysis informed by knowledge of media practices. Results: The psychiatrists were clearly distinguished and deployed as experts in contrast to lay sources. Two of the psychiatrists presented mental illnesses in less negative ways than in the other items. These more positive depictions were undermined by the devices that the journalists used to give authority to the portrayals of mental illness and by the need to create ‘newsworthy’ items. Conclusion: If psychiatrists and other mental health professionals are to have a positive effect on how media depict mental illness, they will have to develop closer relationships with journalists and a better appreciation of media priorities and practices.
Prolonged Fatigue, Anxiety and Depression: Exploring Relationships in a Primary Care Sample
Authors: Koschera Annette , Hickie Ian , Hadzi-Pavlovic Dusan , Wilson Andrew , Lloyd Andrew 
Published: December 2009

Objective: While prolonged fatigue states are frequently comorbid with other forms of distress, they are now the subject of independent aetiological and treatment research. The objective of this study was to use principal component analysis to clarify the relationships between proposed measures of prolonged fatigue and anxiety and depression in data obtained from patients attending primary care. Method: Self-report measures of prolonged fatigue and psychological distress (anxiety and depression) were administered to consecutive ambulatory care patients attending primary care. Results: Data from 1593 subjects were obtained. A two-factor principal component solution (varimax rotation) demonstrated a clear separation between fatigue-related items (Cronbach's α = 0.81) as compared with those items describing anxiety and/or depression (Cronbach's α = 0.95). A four-factor solution produced similar results with two factors describing general psychological distress (contrasting anxiety and depression), with two other factors describing the profiles of mental and physical fatigue. Conclusions: The results lend weight to the argument that prolonged fatigue states can be measured independently of conventional notions of anxiety and depression in patients attending primary care. Epidemiological, aetiological and treatment research in psychiatry may need to focus greater attention on such prolonged fatigue states.
Psychotherapy with Borderline Patients: I. A Comparison Between Treated and Untreated Cohorts
Authors: Meares Russell , Stevenson Janine , Comerford Anne 
Published: December 2009

Objective: The aim of this study is to compare the clinical outcome of patients with borderline personality disorder (BPD) who had received outpatient psychotherapy for 1 year with BPD patients who received no formal psychotherapy for the same period. Method: Thirty patients with BPD were treated by trainee psychotherapists working according to clearly described therapeutic principles. They received intensive audiotaped supervision. Patients were seen twice weekly for 1 year. They were compared with 30 patients subsequently referred to the clinic, for whom no therapist was available and who remained on a waiting list for 1 year, receiving their usual treatment. The outcome measure was a score derived from DSM criteria. It was taken at the beginning and end of the year's treatment, in the former case, and after at least 1 year on the waiting list in the latter. (The average waiting period was 17.1 months.) Results and Conclusions: Patients who received psychotherapy were significantly improved in terms of the DSM score. Thirty percent of treated patients no longer fulfilled DSM-III criteria for BPD. The untreated patients were unchanged.
Does Reducing Safety Behaviours Improve Treatment Response in Patients with Social Phobia?
Authors: Morgan Hugh , Raffle Catriona 
Published: December 2009

Objective: This study assessed the efficacy of instructions to drop ‘safety behaviours’ during exposure tasks in a cognitive-behaviour therapy (CBT) group treatment program for social phobia. Method: Fourteen subjects with social phobia received a standardised CBT treatment program and were compared to 16 subjects with social phobia who were given additional instructions to drop safety behaviours. Results: Repeated measures of ANOVA between groups on a specific social phobia measure (SPAI) demonstrated significant benefit when instructions to drop safety behaviours were added to the treatment program. Conclusions: The addition of instruction to drop safety behaviours in exposure tasks in the course of CBT treatment for social phobia may be useful. This result supports the cognitive model of social phobia developed by Clark and Wells (1995), which postulates that anxiety and negative beliefs about social situations are in part maintained by engaging in safety behaviours. Further replication with larger samples is required and warranted on the basis of the present study.
Absconding Behaviour: an Exploratory Investigation in an Acute Inpatient Unit
Authors: Meehan Tom , Morrison Paul , McDougall Sue 
Published: December 2009

Objective: The aim of this study is to identify patient and environmental characteristics associated with absconding behaviour, and to gain an understanding of the behaviour from the patients' perspective. Method: A prospective analysis of 77 consecutive incidents of absent-without-leave (AWOL) behaviour (n = 51 patients) was undertaken to develop a profile of patient and environmental characteristics associated with absconding behaviour. In addition, semi-structured interviews were carried out with a subsample of 14 patients within 24 h of returning to hospital from being AWOL. Results: Those who absconded were male (58%), under 40 years of age (74%), admitted involuntarily (78%), and had a diagnosis of schizophrenia (42%). One-third of all AWOL incidents resulted from repeated absconding by the same individuals. The first 7 days post admission was a high-risk period for absconding behaviour. Issues raised in the interviews with patients identified a number of situational and environmental factors which are likely to increase the risk of absconding. Conclusions: Situational and environmental factors are more likely than patient characteristics to be predictive of absconding behaviour.