bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers to the Effective Management of Depression in General Practice
Authors: Richards Jeffrey C. , Richards Jeffrey C. , Ryan Paul , Mccabe Marita P. , Groom Grace , Hickie Ian B. 
Published: December 2009

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice. Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients. Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent. Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.
A Statewide Survey of High-Support Services for People with Chronic Mental Illness: Assessment of Needs for Care, Level of Functioning and Satisfaction
Authors: Freeman Adele , Malone John , Hunt Glenn E 
Published: December 2009

Objective: The primary aim of this study was to describe high support accommodation services available for patients with chronic mental illness living in New South Wales (NSW). The second aim was to ask patients in these facilities about their needs and satisfaction with services and to assess their level of functioning. Method: Non-inpatient services matching NSW Health's definition for high support, very high support and residential rehabilitation were sent a survey regarding type of service, criteria for acceptance, choice of housing options, patient demographics, evaluation methods and staff details. The Camberwell Assessment of Need was used to assess needs and the Life Skills Profile–16 was used to assess level of functioning. Comparisons were made between services operated by NSW Health and non-government organizations (NGOs), rural and urban services and services providing 24-hour support and those with less intensive staffing. Results: Forty of the 42 identified services were included in the survey (95% response rate) of which 25 were operated by NGOs. There were 753 residential beds and 1132 patients lived in these facilities over the financial year 2001/2002. Interviews were completed at 25 locations across the state with 159 patients. Seventy-four percent were male and the mean age was 43 years. Patients had on average 7.6 needs of which 2.2 were unmet and their mean LSP-16 total score was 16.8. Almost half the patients responded that they were homeless at one time because they could not find appropriate housing. Conclusions: There were no significant differences in the number of needs expressed by patients residing in government or non-government operated services, those living in rural or urban areas and those in 24-hour services compared to patients in less intensively staffed services. Existing services are doing a good job of meeting patients' needs for practical assistance, but social and psychological needs remain unmet for a significant proportion.
Maori Experience of Community Treatment Orders in Otago, New Zealand
Authors: Gibbs Anita , Dawson John , Forsyth Hine , Mullen Richard ,   Te Oranga Tonu Tanga (Maori Mental Health Team)
Published: December 2009

Objective: To consider the impact of community treatment orders (CommTOs) on Maori patients and their whanau (extended family) and the associated views of mental health professionals. Method: As a distinct aspect of a larger study of CommTOs, eight Maori patients under compulsory community care were interviewed and, where possible, members of their whanau. Associated interviews were held with their psychiatrists, key workers and other carers: 39 interviews in total. Results: Both benefits and drawbacks of CommTOs for Maori were identified by patients and whanau. CommTOs were considered helpful in increasing patient safety and whanau security and in promoting access to services. They were favoured over hospital care, forensic care and homelessness. The drawbacks included the sense of external control imposed on both Maori patients and staff, particularly concerning medication and restrictions on choices. Conclusions: This was a small study of a limited number of Maori patients under CommTOs. Their views may not be fully representative. There was a general consensus among those interviewed that the timely use of CommTOs can enhance the mental wellbeing and social relationships of Maori patients. Continuing efforts are needed by health professionals to communicate effectively with whanau and to understand the conflicts experienced by Maori in reconciling their traditional beliefs with the medical model of mental illness.
Alcohol Dependence: The Impact of Cognitive Behaviour Therapy with or Without Naltrexone on Subjective Health Status
Authors: Feeney Gerald F. X. , Feeney Gerald F. X. , Connor Jason P , Young Ross Mc.D , Tucker Jane , Mcpherson Annie 
Published: December 2009

Objectives: To examine the health-related quality of life of alcohol-dependent patients across a 12-week cognitive behaviour treatment (CBT) program and identify whether the patient selection of the anticraving medication naltrexone further enhanced these outcomes. Method: One hundred and thirty-six consecutive alcohol-dependent subjects voluntarily participated and were offered naltrexone, of which 73 (54%) participants declined medication. A matched design was used. Of the 136 subjects, 86 (43 naltrexone and CBT; 43 CBT only) could be individually matched (blind to outcome measures) for gender, age, prior alcohol detoxification and dependence severity. Measures of health status and mental health wellbeing included the Rand Corporation Medical Outcomes Short Form 36 Health Survey (SF-36) and the General Health Questionnaire (GHQ-28). Results: Pre-treatment, all had SF-36 and GHQ-28 scores markedly below national norms. Post-treatment, significant improvement in seven of the eight SF-36 subscales and all of the GHQ-28 subscales occurred, approximating national normative levels. Patients in the CBT ++ naltrexone group were significantly more likely to have increased days abstinent (p = 0.002) and to complete the program abstinent (p = 0.051). The adjunctive use of naltrexone did not provide additional benefit as reflected in SF-36 and GHQ-28 scores, beyond CBT alone. Conclusions: Patients who completed the CBT-based treatment program reported significant improvements in self-reported health status (SF-36) and wellbeing (GHQ-28). The adjunctive use of naltrexone demonstrated no additional improvement in these measures.
How Mental Health Clinicians View Community Treatment Orders: A National New Zealand Survey
Authors: Romans Sarah , Dawson John , Mullen Richard , Gibbs Anita 
Published: December 2009

Objective: To determine New Zealand mental health clinicians' views about community treatment orders, indications for their use, their benefits, problems and impact on patients and therapeutic relationships. Method: A national survey of New Zealand psychiatrists and a regional survey of nonpsychiatric community mental health professionals for comparison. Results: The great majority of NZ psychiatrists prefer to work with community treatment orders as an option. They consider they are used properly in most cases, can enhance patients' priority for care, provide a structure for treatment, support continuing contact and produce a period of stability for patients during which other therapeutic changes can occur. They consider these orders can harm therapeutic relationships, especially in the short term, but when used appropriately their overall benefits outweigh their coercive impact. The other mental health professionals surveyed have similar views. A minority of clinicians do not support their use. Conclusions: The precise impact of community treatment orders on patients' quality of life remains an open question. Until that matter is more clearly resolved, New Zealand law should continue to authorise compulsory outpatient care, provided it is carefully targeted and adequate community services are available.
Critique of the Guidelines for the Treatment of Depression: Flaws in the Construction
Authors: Parker Gordon 
Published: December 2009

Objective: To examine the likely utility of the recently published Australian and New Zealand clinical practice guidelines for the treatment of depression. Method: The guidelines are critiqued for their intrinsic logic and their success in extracting potentially valid and useful management templates. Results: This paper provides examples of key limitations to many specific interpretations and conclusions. Conclusions: It is argued that these guidelines are far less precise and informative for clinical practice than they appear and with a disturbing lack of rigour for a document promulgated by a professional college.
Trauma-Related Dissociation: Conceptual Clarity Lost and Found
Authors: Van Der Hart Onno , Nijenhuis Ellert , Steele Kathy , Brown Daniel 
Published: December 2009

Objective: Imprecise conceptualizations of dissociation hinder understanding of traumarelated dissociation. An heuristic resolution for research and clinical practice is proposed.Method: Current conceptualizations of dissociation are critically examined. They are compared with a new theory that incorporates classical views on dissociation with other contemporary theories related to traumatization, viewing dissociation as a lack of integration among psychobiological systems that constitute personality, that is, as a structural dissociation of the personality.Results: Most current views of dissociation are overinclusive and underinclusive. They embrace non-dissociative phenomena – rigid alterations in the level and field of consciousness – prevalent in non-traumatized populations, and which do not require structural dissociation. These views also largely disregard somatoform and positive symptoms of dissociation and underestimate integrative deficiencies, while emphasizing the psychological defensive function of dissociation. They do not offer a common psychobiological pathway for the spectrum of trauma-related disorders. Structural dissociation of the personality likely involves divisions among at least two psychobiological systems, each including a more or less distinct apperceptive centre, that is, a dissociative part of the personality. Three prototypical levels of structural dissociation are postulated to correlate with particular traumarelated disorders.Conclusions: Limitation of the concept of dissociation to structural dividedness of the personality sets it apart from related but non-dissociative phenomena and provides a taxonomy of dissociative symptoms. It postulates a common psychobiological pathway for all trauma-related disorders. Trauma-related dissociation is maintained by integrative deficits and phobic avoidance. This conceptualization advances diagnosis, classification, treatment and research of trauma-related disorders.
Clozapine-Related Myocarditis and Cardiomyopathy in an Australian Metropolitan Psychiatric Service
Authors: Reinders Jonathan , Parsonage William , Lange Diana , Potter Julia M , Plever Sally 
Published: December 2009

Objectives: Myocarditis and cardiomyopathy are rarely reported complications of clozapine treatment. The incidence of clozapine-related myocarditis has been variably reported at between 0.03% and 0.19% of initiations and cardiomyopathy has been reported even less commonly. In our Brisbane-based service, nine of 94 patients initiated on clozapine over the previous 3 years appeared to have experienced myocarditis or cardiomyopathy. The unique co-location of our service with a major cardiothoracic hospital facilitated a review of identified cases to inform decisions regarding clozapine treatment and rechallenge in this service. Method: Cases were identified by survey of psychiatric and cardiac medical staff at The Prince Charles Hospital and subjected to re-evaluation by a multidiscipline consensus panel. The panel compared cases to international reports and identified the clinical features that supported a diagnosis of clozapine-related myocarditis or cardiomyopathy. Results: This process resulted in the stratification of the nine cases into the following categories of diagnostic likelihood: three highly probable, three probable, and two possible cases of clozapine-related myocarditis, and one possible case of clozapine-related cardiomyopathy. Successful clozapine rechallenge/continuation was undertaken in two patients and the panel agreed that this was a viable future option for several other patients. Conclusions: Findings of the panel review supported the initial clinical diagnoses. This confirmed that there was an apparent high incidence of clozapine-related myocarditis within this service, for which there was no clear reason. Mechanisms underlying clozapine-related myocarditis and cardiomyopathy, as well as successful clozapine continuation and rechallenge were considered, but definitive explanations remain unknown. This review highlighted the clinician's role in post-marketing drug surveillance to guide rational management of suspected adverse drug effects.
Parenting Programs for Women with Mental Illness who have Young Children: A Review
Authors: Craig Elizabeth A 
Published: December 2009

Objective: To provide an overview of the literature relevant to, and describing, parenting programs for women with mental illness who have young children. Method: A literature search was undertaken, including MEDLINE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews and EMBASE: Psychiatry. Searches were limited to English journals and books and to the last five years in the first instance, with earlier literature considered where appropriate. Results: Maternal mental illness can impact negatively on a child's life, especially where an insecure attachment is formed between mother and baby during the important early developmental years. The potential sequelae of maternal mental illness for children include impaired cognitive development, behavioural difficulties and increased risk of psychiatric disorder. Effective parenting skills are suggested to be a protective factor against these sequelae. However, the effects of parenting programs for women with mental illness have not been empirically tested, so that the potential long-term benefits of such interventions are not known. Conclusions: Parenting skills training for women with mental illness may be a useful selective preventive intervention. It is unlikely generic programs will be suitable. Rather, interventions for women with a mental illness will need to address the commonly experienced parenting problems as well as the more specific needs of women with mental illness.
Do Nations' Mental Health Policies, Programs and Legislation Influence their Suicide Rates? An Ecological Study of 100 Countries
Authors: Burgess Philip , Pirkis Jane , Jolley Damien , Whiteford Harvey , Saxena Shekhar 
Published: December 2009

Objective: To test the hypothesis that the presence of national mental health policies, programs and legislation would be associated with lower national suicide rates. Method: Suicide rates from 100 countries were regressed on mental health policy, program and legislation indicators. Results: Contrary to the hypothesized relationship, the study found that after introducing mental health initiatives (with the exception of substance abuse policies), countries' suicide rates rose. Conclusion: It is of concern that most mental health initiatives are associated with an increase in suicide rates. However, there may be acceptable reasons for the observed findings, for example initiatives may have been introduced in areas of increasing need, or a case-finding effect may be operating. Data limitations must also be considered.
Association Between Lifestyle Factors and Mental Health Measures Among Community-Dwelling Older Women
Authors: Cassidy Kellie , Kotynia-English Ria , Acres John , Flicker Leon , Lautenschlager Nicola T. , Almeida Osvaldo P. , Cassidy Kellie , Kotynia-English Ria , Acres John , Flicker Leon , Lautenschlager Nicola T. , Almeida Osvaldo P. 
Published: December 2009

Objective: To investigate the association between potentially modifiable lifestyle factors and cognitive abilities/depressive symptoms in community-dwelling women aged 70 years and over. Method: Cross-sectional study of community-dwelling women aged 70 years and over (n = 278; mean age = 74.6 years). Lifestyle variables assessed included smoking, alcohol consumption, physical activity, nutrition and education. The mental health measures of interest were depression, anxiety, quality of life and cognitive function, as assessed by the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), SF-36, and the Cambridge Cognitive Examination for Mental Disorders of the Elderly (CAMCOG), respectively. Results: Physically active women were half as likely to be depressed (BDI score ≥ 10) and anxious (BAI score ≥ 8) when compared to their physically inactive counterparts (OR = 0.5, 95% CI = 0.3–0.8 for both, adjusted for marital status and smoking in the case of depression). Having ever smoked more than 20 cigarettes per day was associated with increased risk of depression (OR = 2.8, 95% CI = 1.4–5.5, adjusted for marital status and physical activity). Moderate alcohol use was associated with increased likelihood of having a CAMCOG score within the highest 50 percentile (OR = 2.0, 95% CI = 1.1–3.5, adjusted for age and education), as was more than minimum statutory education (OR = 2.0, 95% CI = 1.1–3.5, adjusted for age and alcohol consumption). There was no obvious association between vitamin B12/folate deficiency or obesity with any of the measures of interest. Conclusions: The results of this study are consistent with the hypothesis that depression is directly associated with heavy smoking and inversely associated with physical activity. They also support the idea that non-harmful alcohol consumption is associated with better cognitive performance. Randomised clinical trials should be now designed to clarify whether management of lifestyle factors reduces the incidence of mood disorders and cognitive impairment in later life.
Negative Beliefs about Self and Illness: A Comparison of Individuals with Psychosis with or Without Comorbid Social Anxiety Disorder
Authors: Gumley Andrew , O'grady Margaret , Power Kevin , Schwannauer Matthias 
Published: December 2009

Objective: This study set out to investigate whether socially anxious individuals with psychosis will perceive more loss, entrapment, shame and humiliation, will blame themselves more for their illness and have lower self-esteem than non-socially anxious individuals with psychosis. Method: Two groups of participants with psychosis with (n = 19) and without (n = 19) social anxiety disorder were matched on the basis of gender and diagnosis. Results: There were no differences between the two groups in terms of positive and negative symptoms. Participants with social anxiety had significantly higher levels of selfblame, entrapment, shame and lower self-esteem. Differences in entrapment, shame and self-esteem remained significant after controlling for depression. Conclusions: Negative beliefs about self and psychosis may be associated with the development of concurrent social anxiety disorder. The clinical and research implications of the findings are discussed.
Evidence-Based Guidelines: Response to Professor Gordon Parker's Critique
Authors: Ellis Pete M. , Hickie Ian B. , Smith Don A. R. 
Published: December 2009

Objective: To clarify the development of the ‘Australian and New Zealand clinical practice guidelines for the treatment of depression’ and to discuss the critique of these guidelines. Method: Consideration of international practice in evidence-based medicine and rebuttal of criticisms. Results: We agree with Professor Gordon Parker on fundamental issues in the treatment of depression. His main criticisms reflect his concerns about the classification of depression. We consider that many of his detailed criticisms reflect a difference of opinion on how data should be evaluated or interpreted. Conclusions: The guideline for the treatment of depression makes sound recommendations, in agreement with comparable guidelines from the US and the UK.
‘Bipolar Missed States’: The Diagnosis and Clinical Salience of Bipolar Mixed States
Authors: Berk Michael , Dodd Seetal , Malhi Gin S. 
Published: December 2009

Objective: To explore diagnostic and treatment issues concerning bipolar mixed states. Method: Bipolar mixed states are described and concerns about diagnostic and treatment difficulties are summarized and discussed. Result: Mixed states can present with equal admixtures of depressive or manic symptoms, or more commonly one component predominates. There is fair consensus, although little data, regarding the management of manic mixed states. However depressive mixed states are far more complex both in terms of recognition and management. People suffering from mixed states characteristically present with complaints of depression. Conclusions: The boundaries between depressive mixed states and agitated depression are vague, yet carry substantial therapeutic implications. Bipolar mixed states are often difficult to treat, and tend to take much longer to settle than either pure mania or depression. Furthermore there is data that treatment with antidepressants can worsen the course of mixed states. Hence missed diagnoses can potentially have negative clinical implications. Therefore in this paper the clinical presentation, diagnosis and therapy of mixed states is reviewed with a view to improving management.