bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterising Psychosis in the Australian National Survey of Mental Health and Wellbeing Study on Low Prevalence (Psychotic) Disorders
Authors: Rosenman Stephen , Korten Ailsa , Medway Jo , Evans Mandy 
Published: December 2009

Objective: This study examines the factorial structure of symptoms and signs in psychosis in data from the Study on Low Prevalence (psychotic) Disorders which is part of the National Survey of Mental Health and Wellbeing, Australia 1997–1998. Method: The present study examined a wide variety of symptoms taken from the Schedules for Clinical Assessment in Neuropsychiatry items and the substance use items in the Diagnostic Interview for Psychosis, an instrument specially constructed for the national study. The instrument was applied to 980 community and hospital subjects with a wide range of psychotic illness diagnoses. The data were factor analysed and scales of ‘domains of psychopathology’ derived. Results: The data were best fitted by five principal factors (‘domains’) which can be approximately labelled dysphoria, positive symptoms, substance use, mania and negative symptoms/incoherence. These factors together explained 55.4% of variance in symptoms. Solutions with more numerous factors did not improve the representation. Conclusion: The five domains successfully characterise a large part of the variance in psychopathology found in the present study of low prevalence (psychotic) disorders. The approach allows sufferer's symptom range and severity to be well expressed without multiple comorbid diagnoses or the limits imposed by categorical diagnosis. Knowledge of alternative dimensional representations of psychopathology may usefully complement our use of categories, enhance awareness of symptoms and ensure that important psychopathology is heeded in practice and research.
Adolescent Depressive Disorder: A Population-Based Study of ICD-10 Symptoms
Authors: Patton G. C. , Coffey C. , Posterino M. , Carlin J. B. , Wolfe R. 
Published: December 2009

Objective: Earlier studies have suggested that symptoms of depressive disorder in adolescents may differ from those found in adults. Even so, diagnostic criteria developed in adults have come to be widely applied to younger subjects. This study examines the frequency of ICD-10 symptoms in depressive disorder and their association with severity in a large community sample of adolescents aged 15 to 18 years. Method: A six-wave prospective study of adolescent health and emotional wellbeing in 2032 Australian secondary school students provided an opportunity to conduct a two-phase study of adolescent onset depression. A self-administered computerised form of the revised Clinical Interview Schedule (CIS-R) was used as a first phase diagnostic measure. Second phase assessment using the Composite International Diagnostic Interview (CIDI) allowed the delineation of a group fulfilling criteria on both instruments. The ICD-10 symptoms and severity profiles for depression were generated with standard algorithms. Results: 1947 (95.8%) out of 2032 subjects in the designated sample completed phase 1 assessment at least once. Participation rates at phase 2 interviews were 93%. Over the 30-month study period 69 subjects (10 male, 59 female) fulfilled criteria for ICD-10 depressive episodes on both the CIS-R and CIDI. Thirty-one per cent (n = 21) had experienced a severe episode, 46% (n = 32) moderate and 23% (n = 16) mild episodes. Loss of interest and pleasure, decreased energy and fatigue, sleep disturbance, suicidal ideation and diminished concentration most clearly distinguished adolescents with depressive disorder from controls. Self-reproach and guilt, psycho-motor agitation and/or retardation and appetite disturbance with weight change showed the clearest increase in frequency with increasing severity of episode. The somatic syndrome was reported by close to one in three of those with a severe depressive episode, but was uncommon in those with mild and moderate episodes. Conclusions: The ICD-10 diagnostic criteria are applicable to depressive disorder in older adolescents. With the exception of depressed mood, found in one in five non-cases, all other symptoms were common in cases and uncommon in non-cases. Practitioner awareness of symptoms indicating the presence and severity of disorder should enhance early identification and choice of treatment in adolescent depression.
Towards a Psyche for Psychiatry
Authors: Meares Russell 
Published: December 2009

Objective: To draw attention to the absence of a concept of personal existence in standard psychiatric approaches to mental illness. Method: To sketch a shift in Western consciousness which occurred suddenly before World War I, involving a banishment of such notions as self and the awareness of inner life from the discourse of psychiatry, psychology and philosophy, leaving a fundamental vacancy at the heart of these disciplines. Results and Conclusion: The positivist–behaviourist hegemony of the twentieth century involved an implicit devaluation of that which is essentially human. The influence of this tradition brings with it the risk of an understanding and treatment of mental illness which leaves out issues at the core of humanity. I suggest we need to recover something of the manner of thinking of the great figures in psychological thought who were writing before the rise of behaviourism and who were contributing to the origins of dynamic psychiatry. A study of the phenomena of human consciousness was central to their work. Main figures mentioned include: Hughlings Jackson, the great neurologist who considered a career in philosophy; Pierre Janet, a philosopher turned psychiatrist; and William James, a physiologist who became a psychologist and philosopher.
An International Collaborative Database: Its Use in Predicting Length of Stay for Inpatient Treatment of Anorexia Nervosa
Authors: Maguire Sarah , Surgenor Lois J. , Abraham Suzanne , Beumont Peter 
Published: December 2009

Objective: We describe the establishment of an Australasian multisite research database for inpatient treatment of anorexia nervosa (AN). Using this database, the second aim of this study is to investigate the extent to which length of stay (LOS) in participating facilities could be predicted at admission from patient, clinical, and site variables. Method: Standardized demographic and clinical data were collated for 213 admission episodes involving 154 participants over a 20 month period from five Australian and one New Zealand specialist treatment centres. Results: While nine variables significantly predicted LOS on univariate analysis, linear regression determined that only body mass index, and having had 2–3 previous admissions made significant independent contributions to LOS. Discussion: Multisite databases offer a viable means by which to conduct clinical research, particularly in regard to low prevalence disorders such as AN. Their additional advantage is that of involving front-line practitioners recruiting participants more likely to be representative of cases seen across treatment centres. At just under a fifth of the total variance predicted by the best-fit model, LOS in hospital remains an aspect of AN treatment difficult to predict, and future studies need to explore variables other than the obvious demographic or clinical issues at admission. The clinical and planning implications are discussed
Right Unilateral Electroconvulsive Therapy at Six Times Seizure Threshold
Authors: Little John D. , Munday Jo , Lyall Gordon , Greene Dennis , Chubb Graeme , Orr Michelle 
Published: December 2009

Objective: To examine the clinical practice of right unilateral electroconvulsive therapy (ECT) administered at six times seizure threshold (6 × RUL ECT). Method: A retrospective review of all patients who received 6 × RUL ECT between July 2000 and June 2002. Results: Twenty-one patients across a range of ages and diagnostic groups received D'Elia unilateral ECT at a seizure dosage at or above 388.8 milliCoumbs (mC). In order to sustain predetermined criteria for seizure adequacy, energy was increased in 71% of patients. Final seizure lengths of 45 s electroencephalographic (EEG) activity, 28 s motor activity (cuffed) and a post-ictal suppression index (PSI) of 83% were recorded. Eighty percent of patients responded after a mean of 7.0 treatments. Cognitive side-effects were noted in 21% of patients. Fifty-two percent relapsed on average 6.3 months after the last treatment despite continuation pharmacotherapy. Conclusions: 6 × RUL ECT was found to be clinically effective, associated with cognitive side-effects and relapse. The debate over electrode placement is likely to continue.
Fifty Years of the Double Helix and its Impact on Psychiatry
Authors: Mcguffin Peter , Mcguffin Peter , Southwick Linda 
Published: December 2009

Objective: To discuss the impact of Watson and Crick's double helix discovery on the field of psychiatry. Method: Psychiatric research studies using molecular genetic techniques are summarized. The implications of these findings in terms of our understanding and treatment of mental illness are discussed. Results: There now exists growing evidence of candidate gene sites for a variety of psychiatric disorders ranging from schizophrenia to reading disability. Conclusions: The field of psychiatric genetics has become one of the most vital and productive areas of psychiatric research. New findings are continually coming to light, bringing us ever closer to understanding these complex disorders at a molecular level. Such knowledge could lead to improved drug treatments, screening of at-risk individuals and even a reduction in the stigma attached to psychiatric disorders.
Atypical Antipsychotic Weight Gain: A Major Clinical Challenge
Authors: Sharpe Jenny-Kay , Hills Andrew P. 
Published: December 2009

Objective: The major aim of this paper is to review findings from weight management intervention studies to consider clozapine and/or olanzapine induced weight gain. A parallel aim is to summarize the challenges facing future research and provide an overview of best practice in the management of weight in mental health patients. Method: A systematic literature search was conducted using Medline, Cinahl and PsychINFO data bases and reference lists from relevant published articles. Five studies which reported weight control practices in patients taking atypical antipsychotic medications were located and reviewed. Results: The studies reviewed provide some important descriptive clinical insights; however, common shortcomings include small subject numbers and methodological drawbacks such as lack of a control group. Conclusions: There is some evidence that weight gain associated with atypical antipsychotic medication can be ameliorated by lifestyle changes such as improved nutritional practices and increased physical activity. Lifestyle interventions for individuals with psychotic disorders may need to be adapted to be most effective; for example, using strategies to counter increased appetite and to enhance physical activity. Clinicians need to be vigilant and persistent in monitoring and intervening if weight gain occurs. A standardized screening tool and clinical pathway would help clinicians to target appropriate interventions for each person prescribed atypical antipsychotic medication.
Generic Versus Specialist Clinical Work Roles of Occupational Therapists and Social Workers in Mental Health
Authors: Lloyd Chris , King Robert , Mckenna Kryss 
Published: December 2009

Objective: There has been limited research in Australia examining the extent of generic and specialist work activities carried out by occupational therapists and social workers since the introduction of mental health reform. The aim of the project was to: (i) identify specific clinical work activities of occupational therapists and social workers; and (ii) identify whether they are performing a greater proportion of generic than specialist clinical or discipline specific core skills. Method: A cross-sectional survey of 304 (response rate 76.6%) occupational therapists and social workers working in mental health was conducted. For the purposes of the study a new instrument was developed to cover broad categories of clinical work activities. Results: The majority of the respondents were female, under the age of 30 years, who had worked in their current position less than 5 years. Generic work activities were the primary activities of the two professional groups, with nine of the 10 activities undertaken most frequently being generic in nature. Social work respondents performed more work activities while occupational therapists undertook more specialist clinical activities. Conclusions: Occupational therapists and social workers are required to have common competencies in addition to discipline-specific competencies in order to undertake broadspectrum mental health service activities. This has implications for the skill mix, education and training and recruitment of staff.
Understanding the Relationships Between Wellbeing, Goal-Setting and Depression in Children
Authors: Street Helen , Nathan Paula , Durkin Kevin , Morling Jonathan , Dzahari Mohamed Azahar , Carson Joel , Durkin Evelyn 
Published: December 2009

Objectives: This study investigates children's conceptions of happiness and wellbeing in relation to goal choice. It examines the prevalence and impact of Conditional goal setting (CGS) on levels of wellbeing and depression. Conditional goal setting describes commitment toward an important goal resulting from a conception that happiness is an end-point achieved through the attainment of this goal. Conditional goal setting has been identified as a significant factor in the development and maintenance of depression in adults. This study examines these same concepts among children. Method: Combined interpretative and quantitative methodology is used. Thirty-six children aged 10–12 years participated in six focus groups discussing their understandings of happiness, important goals and beliefs concerning CGS. Children each attended one of three primary schools in the Perth metropolitan district. They also completed CGS and depression questionnaires. Results: Responses were categorized into a number of common themes. Response content and the number of responses in each theoretical area were identified and discussed. The majority of participants conceptualized happiness as a goal dependant upon something extrinsic to themselves (such as an achievement or event). Statistical analyses suggested a significant relationship between goal setting styles, conceptualizations of happiness and depression. Depressed children were more likely than non-depressed children to be conditional goal setters. Conclusions: Findings suggest that some children conceptualize happiness as an outcome that is dependent on their important achievements and acquisitions. This conceptualization is related to depression. Alternatively, non-depressed children tended to conceptualize happiness as a process independent of goal achievement or failure.
Psychiatric Disorders in Homeless Men and Women in Inner Sydney
Authors: Teesson Maree , Hodder Tracey , Buhrich Neil 
Published: December 2009

Objective: To determine the 12-month prevalence of mental disorders among homeless people in inner Sydney and compare this data with data collected on homeless populations in other Western cities. Method: Representative sample of 210 homeless men and women in Sydney were interviewed using the Composite International Diagnostic Interview (2.0). Results: Seventy-three percent of men and 81% of women met criteria for at least one mental disorder in the past year and 40% of the men and 50% of the women had at least two mental disorders. The prevalence rate of schizophrenia among men and women was 23% and 46%, respectively. There was considerable comorbidity between mental disorders with one in five men (20%) and 29% of women meeting criteria for two mental disorders. The prevalence of any mental disorder is four times higher among homeless men and women in inner Sydney than within the Australian general population. International comparisons demonstrated significant cross-cultural differences in the prevalence of mental disorders among the homeless. Conclusions: This paper highlights the need for comparable epidemiological data when examining an international problem such as homelessness.
Medication Options in the Treatment of Treatment-Resistant Depression
Authors: Pridmore Saxby , Turnier-Shea Yvonne 
Published: December 2009

Aim: Less than half of those suffering major depressive episodes achieve remission with the first antidepressant provided and one-third of all patients suffering depression have a chronic condition. Clinical experience indicates that a substantial proportion of patients suffer treatment-resistant depression (TRD). Our aim is to explore the literature reporting the drug treatment of TRD, and to present such information as would be of interest to clinical psychiatrists. Method: Literature searches were conducted using PubMed and entering the words antidepressant, augmentation, combined antidepressants, treatment resistant depression and the names of individual antidepressant medications. Results: Most authors recommended that TRD should be first approached by reassessing the diagnosis, adding psychotherapy and attending to psychosocial factors. Details of the following pharmacological options were identified: (i) augmentation of the currently employed antidepressant with a medication which is not an antidepressant; (ii) change of antidepressant; and (iii) addition of a second antidepressant to the current antidepressant, or commencement of a combination of two antidepressants. Conclusions: When monotherapy provided at the maximum manufacturer-recommended doses for 3–4 weeks has failed to provide remission in depression, the diagnosis should be confirmed, psychotherapy added and psychosocial factors should receive attention. In the sustained absence of remission, a better outcome may be obtained by augmenting the antidepressant, changing from a single-action to a double- or multiple-action drug, or by combining antidepressants.
Impact of Demographic Factors, Early Family Relationships and Depressive Symptomatology in Teenage Pregnancy
Authors: Quinlivan Julie A. , Tan Louisa H. , Steele Angela , Black Kirsten 
Published: December 2009

Aim: Teenage pregnancy has been well studied from a demographic risk perspective, but less data examining the early interpersonal family experiences of teenage mothers are available. We aimed to explore the relative impact of demographic, early interpersonal family relationships and depressive symptomatology as associations for teenage, as compared to non-teenage, childbearing. Method: A prospective cross-sectional cohort study was undertaken. Institutional ethics committee approval and informed consent were obtained. Data from consecutive teenage (teenage) and non-teenage (control) subgroups of antenatal women were compared. Subjects were interviewed and completed the following questionnaires: demographic, drug use and lifestyle; early life experiences; Hospital Anxiety and Depression Scale (HADS); and General Health Questionnaire-28. Results: In multivariate analysis, the following factors had a significant independent association with younger age of motherhood in order of magnitude: a history of parental separation/divorce in early childhood; exposure to family violence in early childhood; illicit drug use (ever or in pregnancy); idealization of the pregnancy; low family income; a positive HADS-A or HADS-D subscale score; and a low level of education. Conclusion: Interventions to reduce the rate of teenage births need to be multifocal and should include strategies to address early childhood exposure to parental separation and violence, reduce idealization of pregnancy, diagnose psychological symptomatology and offer alternative career choices to children defaulting in the education system.
Academic Consumer Researchers: A Bridge Between Consumers and Researchers
Authors: Griffiths Kathleen M. , Jorm Anthony F. , Christensen Helen 
Published: December 2009

Objective: To describe the contributions that consumers, and academic consumer researchers in particular, can make to mental health research. Method: A literature survey and a systematic consideration of the potential advantages of consumer and academic consumer researcher involvement in health research. Results: Consumer researchers may contribute to better health outcomes, but there are significant barriers to their participation in the research process. To date, discussion has focused on the role of nonacademic consumers in the health research process. There has been little recognition of the particular contributions that consumers with formal academic qualifications and research experience can offer. Academic consumer researchers (ACRs) offer many of the advantages associated with lay consumer participation, as well as some unique advantages. These advantages include acceptance by other researchers as equal partners in the research process; skills in research; access to research funding; training in disseminating research findings within the scientific community; potential to influence research funding and research policy; capacity to influence the research culture; and potential to facilitate the involvement of lay consumers in the research process. In recognition of the value of a critical mass of ACRs in mental health, a new ACR unit (the Depression and Anxiety Consumer Research Unit [CRU]) has been established at the Centre for Mental Health Research at the Australian National University. Conclusions: Academic consumer researchers have the potential to increase the relevance of mental health research to consumers, to bridge the gap between the academic and consumer communities and to contribute to the process of destigmatizing mental disorders.
Violence in Male Patients with Schizophrenia: Risk Markers in a South African Population
Authors: Koen L. , Kinnear C. J. , Corfield V. A. , Emsley R. A. , Jordaan E. , Keyter N. , Moolman-Smook J. C. , Stein D. J. , Niehaus D. J. H. 
Published: December 2009

Objective: We investigate the role of functional variants in the catecholamine-O-methyl transferase gene ( COMT) and the monoamine oxidase-A gene ( MOA-A), as well as previously identified non-genetic risk factors in the manifestation of violent behaviour in South African male schizophrenia patients. Method: A cohort of 70 acutely relapsed male schizophrenia patients was stratified into violent and non-violent subsets, based on the presence or absence of previous or current violent behaviour. Standardized violence rating scales were also applied and the COMT/NlaIII and MAO-A promoter region variable number of tandem repeats (VNTR) polymorphisms were genotyped. Results: A multiple logistic regression model based on the clinical, genetic and sociodemographic variables indicated that delusions of control (OR = 3.7, 95% CI = 1.21–11.61) and the combined use of cannabis and alcohol (OR = 6.89, 95% CI = 1.28–37.05) were two significant predictors of violent behaviour in this schizophrenia population. No association was found between the tested polymorphisms and violent behaviour. Conclusions: Although the sample size may have limited power to exclude a minor role for these specific gene variants, such a small contribution would have limited clinical relevance given the strong significance of the non-genetic markers. These findings suggest that currently proactive management of violent behaviour in this schizophrenia population should continue to be based on clinical predictors of violence.