bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-Effectiveness of Psychological and Pharmacological Interventions for Generalized Anxiety Disorder and Panic Disorder
Authors: Heuzenroeder Louise , Donnelly Marie , Haby Michelle M. , Mihalopoulos Cathrine , Rossell Ruth , Carter Rob , Andrews Gavin , Vos Theo 
Published: December 2009

Objective: To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). Method: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filters (‘equity’, ‘strength of evidence’, ‘feasibility’ and ‘acceptability to stakeholders’) is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs). Results: Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater. Conclusions: Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.
Comparing Psychiatric Diagnoses Generated by the Strengths and Difficulties Questionnaire with Diagnoses Made by Clinicians
Authors: Mathai John , Anderson Peter , Bourne Angela 
Published: December 2009

Objective: To examine the level of agreement between clinical diagnoses by a community child and adolescent mental health service (CAMHS) and diagnoses generated by the Strengths and Difficulties Questionnaire (SDQ). Method: A computerized algorithm developed by Goodman et al. was used at a community CAMHS in Australia to predict child psychiatric diagnoses on the basis of the symptom and impact scores derived from the SDQ completed by parents (n = 130), teachers (n = 101) and young people (n = 38). These diagnoses were compared with the diagnoses made by clinicians in a multidisciplinary community outpatient team and an independent clinician that examined the case notes and was blind to the SDQ scores. Results: The level of agreement between SDQ generated diagnoses and clinical team diagnoses was moderate to high, ranging from 0.39 to 0.56. Correlations between the SDQ and an independent clinician ranged from 0.26 to 0.43. All were statistically significant. Conclusion: The SDQ is a useful instrument to aid clinicians in diagnosis and could be used as part of the initial assessment process.
A Transdisciplinary Approach to Adolescent Forensic Mental Health
Authors: Stathis Stephen , Martin Graham 
Published: December 2009

Objective: To examine new strategies which may be implemented to address the significant mental health and substance abuse problems of young people within the juvenile justice system. Method: Wide-ranging literature review of mental health problems within the juvenile justice population is given, illustrating the high prevalence of mental health problems within this cohort of young people. Reference is made to the differing demographics and agendas of the American justice system compared to that found in Australia. Results: It is suggested that new initiatives stemming from quality Australian studies are required in order to facilitate reform within adolescent forensic mental health. Psychiatrists need to be at the forefront of innovative policy delivery within the juvenile justice system. Conclusions: A transdisciplinary approach is required to meet the changing needs of young people within the juvenile justice system. Such a system of care recognizes that these young people and their families have multiple needs that cross traditional boundaries and a collaborative approach across agencies is essential at both the policy and practical level. Psychiatrists have an important role to play in the development of these services. A systemic process to address such needs is offered.
Australian and New Zealand Clinical Practice Guidelines for the Treatment of Anorexia Nervosa
Authors:   Royal Australian And New Zealand College Of Psychiatrists Clinical Practice Guidelines Team For Anorexia Nervosa
Published: December 2009

Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Ministry of Health. This CPG covers anorexia nervosa (AN). Method: The CGP team consulted with scientists, clinicians, carers and consumer groups in meetings of over 200 participants and conducted a systematic review of meta-analyses, randomized controlled trials and other studies. Treatment recommendations: It is extremely difficult to draw general conclusions about the efficacy of specific treatment options for AN. There are few controlled clinical trials and their quality is generally poor. These guidelines necessarily rely largely upon expert opinion and uncontrolled trials. A multidimensional approach is recommended. Medical manifestations of the illness need to be addressed and any physical harm halted and reversed. Weight restoration is essential in treatment, but insufficient evidence is available for any single approach. A lenient approach is likely to be more acceptable to patients than a punitive one and less likely to impair self-esteem. Dealing with the psychiatric problems is not simple and much controversy remains. For patients with less severe AN who do not require in-patient treatment, out-patient or day-patient treatment may be suitable, but this decision will depend on availability of such services. Family therapy is a valuable part of treatment, particularly for children and adolescents, but no particular approach emerges as superior to any other. Dietary advice should be included in all treatment programs. Cognitive behaviour therapy or other psychotherapies are likely to be helpful. Antidepressants have a role in patients with depressive symptoms and olanzapine may be useful in attenuating hyperactivity.
The Rates and Management of Psychological Problems in Australian General Practice
Authors: Harrison Christopher M. , Britt Helena , Harrison Christopher M. , Britt Helena 
Published: December 2009

Objective: General practitioners (GPs) provide the majority of care for people's mental health problems. The recently introduced Better Outcomes in Mental Health Care initiative aims to improve the quality of mental health care in general practice. This study examines current GP management of psychological problems and any changes in their management in the decade leading up to this initiative. Method: Current practice was examined through a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) (2000–02) data. We compared BEACH data with the Australian Morbidity and Treatment Survey (1990–1991) to investigate management changes over the past decade. Results: Between April 2000 and March 2002, psychological problems were managed at a rate of 11.5/100 encounters. Problems most commonly managed were mood disorders, stress-related disorders, behavioural syndromes and disorders due to psychoactive substances. Prescriptions occurred at a rate of 69.5/100 contacts and clinical treatments at a rate of 50.0/100 contacts with psychological problems from 1990 to 1991. The management rate of psychological problems increased from 9683/100 000 encounters (95% CI = 9129–10 237) in 1990–1991 to 11 557 (11 136–11 977) in 2000–2002. Prescription rates (from 63.3, 95% CI = 60.5–66.1 to 69.1, 95% CI = 67.1–71.1) and clinical treatments (from 36.0, 95% CI = 33.4–38.7 to 53.1, 95% CI = 51.3–54.9) increased. Conclusions: This study shows that prior to the introduction of the Better Outcomes in Mental Health initiative changes had already occurred in rates and management of psychological problems in general practice. It also provides a baseline from which future research can measure the impact of the recent reforms on mental health care.
General Practitioner Recognition of Mental Illness in the Absence of a ‘Gold Standard’
Authors:   The Mental Health and General Practice Investigation (MaGPIe) Research Group,   Wellington School Of Medicine And Health Sciences,   University of Otago, New Zealand
Published: December 2009

Objective: To compare general practitioner (GP) recognition of mental illness with cases identified by screening and diagnostic instruments. Method: Cross-sectional survey (part of the Mental Health and General Practice Investigation [MaGPIe] study) set in the lower North Island of New Zealand. The study sample consisted of consecutive patients from a random sample of GPs who were screened using the General Health Questionnaire (GHQ-12). Based on GHQ scores a stratified random sample of patients was selected and invited to participate in an in-depth interview to assess their psychological health and a subsequent longitudinal study. GPs assessed patients' psychological health using a 5-point scale of severity. Patients completed the GHQ-12, Composite International Diagnostic Interview (CIDI), Somatic and Psychological Health Report (SPHERE-12) and World Health Organization's Disability Assessment Schedule Version II (WHODAS). Results: Seventy GPs (90% response) and 775 patients (70% response) were included in analyses. Overall, GPs recognized symptoms of psychological disorders in the past 12 months in 56.4% (95% CI = 49.3–63.5) of patients. Agreement between GP rates of recognition of mental disorders and diagnostic or symptom rating instruments varied depending on the instruments used and was highest when there was concordance between several instruments and high levels of disability. Only 17.2% (95% CI = 14.5–19.9) of the patients identified by at least one of the GHQ-12, CIDI or SPHERE, were identified by all three instruments. Conclusions: In understanding rates of recognition of mental disorders by GPs, careful consideration needs to be given to the degree to which any single instrument can be utilized as a diagnostic ‘gold standard’.
Safer at Work: Development and Evaluation of an Aggression and Violence Minimization Program
Authors: Grenyer Brin F. S. , Grenyer Brin F. S. , Ilkiw-Lavalle Olga , Biro Philip , Middleby-Clements Jane , Comninos Andreas , Coleman Mark 
Published: December 2009

Objective: Aggression and violence are recognized as significant occupational risks for health care staff. A new aggression minimization program for all public health service staff at risk in New South Wales, Australia was developed and evaluated. Twenty-two hours of training was divided into specific modules addressing: general aggression and violence minimization competencies (modules 1 and 4, 10 h); the specific needs of staff working in high-risk environments (module 2, 8 h); and a module for workplace managers and supervisors (module 3, 4 h). Method: Two pilot samples were evaluated: (i) 15 experienced aggression trainers from across New South Wales completed and evaluated a two-day ‘train the trainer’ program; (ii) 48 experienced health staff completed the four training modules and assessed satisfaction, knowledge and skills acquired, attitudes toward managing aggression and confidence in dealing with aggressive incidents. Results: Program materials were judged to be highly suitable. Staff were satisfied and increased their knowledge and skills, and evidenced improved attitudes toward working with aggressive patients. A significant increase in staff confidence for dealing with aggressive incidents was also found, with the more modules staff completed the greater their confidence in dealing with aggressive incidents. Conclusions: The program may contribute to helping health service industry staff attain a safer workplace.
Indices of Social Risk Among First Attenders of an Emergency Mental Health Service in Post-Conflict East Timor: An Exploratory Investigation
Authors: Silove Derrick , Manicavasagar Vijaya , Baker Kim , Mausiri Manual , Soares Marce , De Carvalho Florentino , Soares Aristedes , Amiral Zulmira Fonseca 
Published: December 2009

Objective: Little is known about the profile of patients treated in mental health services in low-income, post-conflict countries, especially in the post-emergency phase. We postulated that patients attending the first community mental health service in East Timor would be characterized not only by mental disturbance but by high levels of social vulnerability. Method: Drawing on existing methods and on consultations with East Timorese mental health staff, five social indicators were identified: dangerousness; inability to undertake lifesustaining self-care; bizarre behaviour; incapacitating distress; and social unmanageability. Adequate levels of interrater reliability (65–91%) were achieved in identifying these indicators from case notes. Forty-eight randomly selected case notes were analyzed to ascertain the prevalence of social risk factors as well as the referral source and broad diagnostic groupings. Results: Major referral sources were the family, humanitarian agencies and the police. Twenty-nine percent met criteria for dangerousness; 42% for inability to undertake self-care; 58% for bizarre behaviour; 75% for distress; and 19% for unmanageability. Ninety-eight percent fulfilled at least one social indicator, with the modal score being 2. Conclusions: Although the approach to documentation and analysis was preliminary, the data suggest that a focus on social risk indicators may assist in determining those mentally disturbed persons in need of priority care in resource-poor post-conflict countries.
Dual Relationships in Mental Health Practice: Issues for Clinicians in Rural Settings
Authors: Scopelliti Joseph , Judd Fiona , Scopelliti Joseph , Judd Fiona , Grigg Margaret , Hodgins Gene , Fraser Cait , Hulbert Carol , Endacott Ruth , Wood Anita 
Published: December 2009

Objective: This paper aims to provide an overview of the literature on non-sexual dual relationships, and to discuss these in the context of rural mental health practice in Australia. Method: An internet-driven literature search was undertaken using OVID databases, which include MEDLINE, PsycINFO, CINAHL, and EMBASE: Psychiatry. Ethical codes of practice for the mental health professions of psychiatry, psychology, occupational therapy, social work and nursing were referred to. Searches were not limited by year of publication. Other unpublished material or information was included where relevant. Results: Dual relationships are common in rural mental health practice. However, research on non-sexual dual relationship boundary issues in rural mental health is limited. Ethical codes of practice of mental health professional bodies provide little guidance regarding nonsexual dual relationships. Decision-making models addressing the ethics of dual relationships are restricted to considerations of whether to enter a dual relationship rather than how to manage such a relationship. Conclusions: ‘Everyday’ dual relationships are a predictable part of rural mental health practice. Further research is required to identify the benefits and/or problems in clinical practice resulting from non-sexual dual relationships. Responsibility for identifying and implementing ways of appropriately managing such relationships should be shared by the patient, the clinician, mental health services and professional organizations.
Disability and Service use among Homeless People Living with Psychotic Disorders
Authors: Herrman Helen , Herrman Helen , Evert Helen , Harvey Carol , Gureje Oye , Pinzone Tony , Gordon Ian 
Published: December 2009

Background: The prevalence of psychosis and needs for care among homeless people were studied in inner Melbourne. Method: This was a two-stage nested study within the Australian National Survey of People Living with Psychotic Illness. A screen for psychosis was administered to a representative sample of men and women living in marginal housing in a mental health service catchment area. A selected subsample of 82 screen-positive respondents was interviewed using the Diagnostic Interview for Psychosis (DIP), a semistructured, standardized interview with three modules: (i) demography, functioning and quality of life; (ii) diagnosis; and (iii) service use. Results: An unexpectedly high prevalence of people living with psychotic disorders (estimated lifetime prevalence 42%, 95% CI = 37 − 47%) may reflect a concentration of vulnerable people in the shrinking marginal housing supply in the inner city areas. Disability in everyday, occupational and social functioning is greater for this subgroup than for other people living with psychosis in Australia. Most people were single and unemployed, and many reported social isolation and feeling unsafe. Substance use disorders were common. Most people were using health services, including specialist mental health services, but few were receiving rehabilitation, vocational or housing support. Conclusions: Despite high levels of contact with a well-organized, sectorized mental health service in an affluent country, this pocket of several hundred people had high levels of persisting disability and needs. The literature and local experience suggest that changing this situation is likely to require co-ordinated policy and practice between the health, welfare and housing sectors.
Outcomes for Elderly Patients with Mental Illness Following Relocation from a Stand-Alone Psychiatric Hospital to Community-Based Extended Care Units
Authors: Meehan Tom , Meehan Tom , Robertson Samantha , Stedman Terry , Byrne Gerard 
Published: December 2009

Objective: To assess the outcomes for a group of elderly patients with mental illness following their discharge from a stand-alone psychiatric facility to seven extended care units (ECUs). Method: All patients (n = 60) who were relocated to the ECUs were assessed using a number of standardized clinical and general functioning instruments at 6 months and 6 weeks pre-move, and again at 6 weeks, 6 months and 18 months post-move. Results: By 18 months post-discharge, 13 of the 60 patients (21.7%) had died and seven others had been transferred to nursing homes. Those who died were older and had significantly higher levels of physical ill health when compared to those who did not die. Changes on measures of clinical and behavioural functioning in those who remained in the study did not reach statistical significance by 18 months post-move. However, participants did demonstrate improvements in quality of life with significantly higher scores on measures of social contact and community access. Conclusions: The mortality observed in the follow-up period is likely to be related to physical ill health and old age rather than the trauma associated with relocation. While overall functioning did not improve following relocation, patients had more independence and greater access to community-based activities.
Neuropsychological Disturbances and Cerebral Blood Flow in Bipolar Disorder
Authors: Benabarre Antoni , Vieta Eduard , Martínez-Arán Anabel , Garcia-Garcia Margarida , Martín Francisco , Lomeña Francisco , Torrent Carla , Sánchez-Moreno José , Colom Francesc , Reinares María , Brugue Esteve , Valdés Manuel 
Published: December 2009

Objective: To determine and correlate alterations in neuropsychological function and cerebral blood flow in bipolar patients. Method: Assessments included the Positive and Negative Symptom Scale, Global Assessment Functioning, Wechsler Adult Intelligence Scale (WAIS), Wisconsin Card Sorting Test (WCST), Stroop test, Trail Making Test (TMT), California Verbal Learning Test (CVLT), Wechsler Memory Scale (WMS) and phonetic verbal fluency/controlled oral word association tests. Single photon emission computed tomography (SPECT) was carried out with the administration of 99mTc-HMPAO. Forty-three outpatients out of 85 fulfilling RDC diagnostic criteria for bipolar disorder and six healthy subjects were included in the study. SPECT and neuropsychological assessments were performed in 30 patients in manic (n = 7), hypomanic (n = 8), depressed (n = 12) or euthymic (n = 3) states. All assessments were carried out before starting treatment. Result: Several corrected correlations between neuropsychological function and cerebral blood flow (CBF) were identified: executive function (WCST) and striatal, frontal, temporal, cerebellum, parietal and cingulate CBF; memory (WMS, WAIS-Digits) and striatal, frontal, temporal and parietal CBF; attentional tasks (Stroop) and striatal, temporo-medial and parietal CBF; verbal learning (CVLT) and frontal, posterior temporal, cingulate and occipital CBF; psychomotor disturbances (TMT) and anterior temporal CBF; poorer intelligence performance scores (WAIS-Vocabulary) and cerebellum and parietal CBF. Conclusions: This study confirms the presence of functional disturbances in frontosubcortical structures, the cerebellum and limbic system in bipolar patients.