bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Casemix for Mental Health Services: The Development of the Mental Health and Substance abuse Components of the Australian National Diagnosis-Related Groups
Authors: Ben-Tovim David , Elzinga Robert , Pilla John , McAllister Stuart , Wilhelm Kay , Lipton George , Pols Rene , Franklin John , Waters Marlene M. 
Published: November 2007

Objective: To describe the development of the mental health and substance abuse sections of the version of the Australian casemix system, Australian national diagnosis-related groups 3 (AN-DRG 3), released in July 1995. Method: The guiding principles and data sources used to construct the mental health and substance abuse components of AN-DRG 3 are described by the group who undertook that task. The group used data sets of patients separating from hospitals throughout Australia, and from hospitals in South Australia, to examine the capacity of existing and revised diagnosis-related groups (DRGs) to predict patients' lengths of hospital stay. They also reviewed the lists of conditions allowed as complicating and comorbid conditions within the AN-DRG system. Results: A variety of recommendations were made including: moving organic mental disorder DRGs to a neuroscience area of the AN-DRG; completely reorganising the mental health section of the casemix; creating a number of narrowly defined DRGs covering areas such as schizophrenia, major affective disorders, anxiety disorders and eating disorders, while allowing for a limited number of more heterogenous DRGs; and simplifying substance abuse DRGs into groups covering alcohol and other substances, and differentiating intoxication and withdrawal from abuse and dependency. Conclusions: A casemix dialect based on clinical diagnosis, which describes mental health and substance abuse problems in terms which should be familiar to clinicians, has been developed. Its applications and limitations are briefly discussed.
An XXYY Male with Schizophrenia
Authors: Lee Joseph W.Y. 
Published: November 2007

Objective: A case of XXYY associated with schizophrenia is presented. Clinical picture: A European male with tall stature, hypogonadism, and mild grade intellectual handicap with significantly lower verbal than performance Intelligence Quotient (IQ) exhibited features of chronic paranoid schizophrenia, along with impulsive aggression. Treatment and outcome: A trial of testosterone replacement exacerbated aggression. Psychotic symptoms persisted despite antipsychotic therapy. Conclusions: This is perhaps the first report of the XXYY syndrome associated with schizophrenia. The psychosis occurs more often in XXY and XXX than normal subjects, providing a clue to locating a gene predisposing to schizophrenia.
Religion, Spirituality and Psychiatry: Conceptual, Cultural and Personal Challenges
Authors: Turbott John 
Published: November 2007

Objective: Recent psychiatric literature and contemporary sociopolitical developments suggest a need to reconsider the place of religion and spirituality in psychiatry. This paper was written with the aim of encouraging dialogue between the often antithetical realms of religion and science. Method: Material from psychiatric, sociological and religious studies literature was reviewed, with particular emphasis on New Zealand sources. Results: Despite the secularising effects of science, the presence and influence of ‘religiosity’ remains substantial in Western culture. The literature emphasises the central importance of religion and spirituality for mental health, and the difficulty of integrating these concepts with scientific medicine. Psychiatric tradition and training may exaggerate the ‘religiosity gap’ between doctors and patients. In New Zealand, the politically mandated bicultural approach to mental health demands an understanding of Maori spirituality. Conclusions: Intellectual, moral and pragmatic arguments all suggest that psychiatry should reconsider its attitude to religion and spirituality. There are many opportunities for research in the field. Psychiatry would benefit if the vocabulary and concepts of religion and spirituality were more familiar to trainees and practitioners. Patients would find better understanding from psychiatrists, and fruitful interdisciplinary dialogue about mutual issues of ‘ultimate concern’ might ensue.
Tourette's Syndrome in the Year 2000
Authors: Robertson Mary M. , Boardman James 
Published: November 2007

Objective: To examine the current status of knowledge of Tourette's syndrome (TS) and to highlight those areas of research that are most likely to have the most significant advances in the next few years into the 21st century. Method: Index Medicus was consulted from its beginning in 1885 until 1964 (inclusive), looking initially under the title ‘tics’ and subsequently under Tourette's Disorder'. From 1965 and the advent of MEDLINE, a search was performed looking for Tourette‘s’. A chronological examination of TS in the medical literature is presented. Some issues surrounding Huntington's Disease (HD) research are pertinent to TS and may serve as a guide in the future direction of TS research; these issues have been identified and illustrated in the context of TS. Where relevant, other medical disorders are also commented on. Results: There has been a steady increase in the volume of TS literature since 1885, with a marked increase since 1980, changing in focus from a psychological to a neurobiological viewpoint. Current areas of interest include genetics, comorbid psychopathologies, neuroimaging, treatments, epidemiology and educational considerations. Issues raised by HD and other movement disorders such as Parkinson's Disease (PD) are predictive testing, gene therapy and neural transplants. Conclusions: The year 2000 is likely to herald a significant increase in our knowledge of the genetics and neuroimaging of TS, with new developments in therapy. A broadening of awareness of TS among health workers and teachers in particular is likely to increase the number of diagnosed patients and, hence, new challenges will be posed to existing resources for health and educational provision.
Legal Rights and Responsibilities of Adolescents and Staff in Victorian Child and Adolescent Mental Health Services
Authors: Birleson Peter 
Published: November 2007

Objectives: The aim of the paper is to clarify the legal rights of adolescent patients, guardians and staff in Victorian Child and Adolescent Mental Health Services (CAMHS). Victorian CAMHS have now been ‘gazetted’ and can admit patients on an involuntary basis under the amended Mental Health Act 1986 (MHA). The MHA applies equally to young people under the age of 18 years, which has raised some confusion about who has the right to consent to treatment. Method: Staff of CAMHS inpatient units have recently posed questions to the Victorian chief psychiatrist. These have included clarification of when the MHA may be appropriately used for adolescents, what is the clinician's duty of care, how to assess young people's capacity to consent to treatment, how to manage some patient groups, and what is the role of the courts in treatment decisions. The author provides a view on each of these matters, based on recent literature and confirmed by legal opinion. Results: Some matters of fact are presented and advice is provided. Conclusions: Services must seek the informed consent of guardians and adolescents and, for those young people with major psychiatric disorders who require treatment and are unable to consent, the amended MHA provides clearer direction for the use of involuntary treatment. Where units offer admission to provide assessment and stabilisation, a clear explanation about the treatment goals, and the role of restraint and medication in managing behaviour is essential at the outset of the admission process.
Defining the Personality Disorders: Description of an Australian Database
Authors: Parker Gordon , Hadzi-Pavlovic Dusan , Wilhelm Kay , Austin Marie-Paule , Mason Catherine , Samuels Anthony , Mitchell Philip , Eyers Kerrie 
Published: November 2007

Objective: We seek to improve the definition and classification of the personality disorders (PDs) and derive a large database for addressing this objective. Method: The paper describes the rationale for the development of a large set of descriptors of the PDs (including all DSM-IV and ICD-10 descriptors, but enriched by an additional 109 items), the design of parallel self-report (SR) and corroborative witness (CW) measures, sample recruitment (of 863 patients with a priori evidence of personality disorder or disturbance) and preliminary descriptive data. Results: Analyses (particularly those comparing ratings on molar PD descriptions with putative PD dimensions) argue for acceptable reliability of the data set, while both the size of the sample and the representation of all PD dimensions of interest argue for the adequacy of the database. Conclusions: We consider in some detail current limitations to the definition and classification of the PDs, and foreshadow the analytic techniques that will be used to address the key objectives of allowing the PDs to be modelled more clearly and, ideally, measured with greater precision and validity.
Chronic Fatigue Syndrome and Dieting Disorders: Diagnosis and Management Problems
Authors: Griffiths Rosalyn A. , Beumont P. J. V. , Moore Gemma M. , Touyz Stephen W. 
Published: November 2007

Objective: This paper illustrates the importance of conducting an initial and ongoing psychiatric assessment of patients with chronic fatigue syndrome in order to diagnose dieting disorders. The diagnostic issues and management problems of three case vignettes, two with anorexia nervosa and one with bulimia nervosa, are described. Method: The treatment response of dieting disordered patients is generally prolonged after a previous diagnosis of chronic fatigue syndrome has been made and the patient and family favour a disease diagnosis. Results: Several management problems arise and family members may also be reluctant to accept a dieting disorder diagnosis. Conclusions: Early detection of dieting disorders by adequate screening and assessment is necessary so that a significant reduction in morbidity may occur.
Group Treatment for Postpartum Depression: A Pilot Study
Authors: Meager Ingrid , Milgrom Jeannette 
Published: November 2007

Objective: There are few reports on the efficacy of treatment programs for women with postpartum depression, despite the long-term nature of this disorder. This study describes a pilot evaluation of a treatment program with educational, social support and cognitive-behavioural components. Method: Ten women with persistent depression originating in the postpartum period were offered a 10-week group treatment program and compared to a wait-list control group. Results: Following treatment, a significant improvement in depression was demonstrated on the Edinburgh Post-Natal Depression Scale, Beck Depression Inventory, and Profile of Mood States. Several common factors in women suffering from postpartum depression were also identified, as were drop-out characteristics. Conclusion: These results are encouraging and suggest that a cognitive-behavioural group program might be effective as a treatment for depression in the postpartum period. However, further detailed studies are required to confirm this pilot study.
Denied Pregnancy
Authors: Kaplan Robert , Grotowski Therese 
Published: November 2007

Objective: To review the literature on the topic of denied pregnancy and present a case study that illustrates some salient points. Clinical picture: A 21-year-old woman was unaware of her pregnancy until she went into labour, at which time she went into a state of panic. She delivered a dead baby. Treatment: She was interviewed over the 5 days following delivery and referred for psychiatric assessment. She was discharged when cleared of serious psychiatric illness. Outcome: At follow-up she was well but haunted by recollections of the delivery. She was referred for further counselling. Conclusions: Denial of pregnancy is more common than realised. It is a heterogeneous condition associated with different coping styles and psychiatric diagnoses. Early testing for pregnancy is recommended in young women with nausea, weight gain and menstruation-like bleeding.
A Patient with Mania and Photoconvulsive Epilepsy
Authors: Roxanas Miltiadis G. , Corbett Alastair J. , Reid Wayne G.J. 
Published: November 2007

Objective: To describe a young patient who had a comorbidity of mania and photoconvulsive epilepsy. Clinical picture: This patient presented with a clinical picture of mania which proved difficult to treat until an EEG revealed the presence of photoconvulsive epilepsy. Treatment: Treatment with haloperidol and lithium was unsuccessful but the addition of carbamazepine produced a dramatic response. Haloperidol was stopped and the patient maintained on lithium and carbamazepine. Outcome: A successful outcome was achieved with carbamazepine and the patient has remained well on this treatment for 2 years. Conclusions: The authors postulate that there may be an association between photoconvulsive epilepsy and mania, perhaps on a kindling basis. The literature pertaining to the psychiatric aspects of photoconvulsive epilepsy is reviewed.
Restlessness: The Anatomy of a Neuropsychiatric Symptom
Authors: Sachdev Perminder , Kruk Jane 
Published: November 2007

Objective: The aim of the paper is to review the literature on restlessness and related syndromes in order to examine the different causes and clinical descriptions, and to present a pathogenetic model that would incorporate its diverse aetiology. Method: A literature search was undertaken with restlessness, agitation, akathisia, hyperactivity, fidgetiness and jitteriness as key words. Results: Causes of restlessness are diverse, and its distinction from other descriptions, such as agitation and hyperactivity, is poorly defined in the literature. Detailed descriptions of the syndromes are therefore lacking. The neuroanatomical basis of restlessness may consist of abnormalities in the corticc-subcortical neuronal circuits, the complex regulation of which may explain why different causes often lead to a common end result. Conclusions: The terms used to describe restlessness and related disorders should be standardised, and the clinical manifestations investigated pedanti- cally. Human and animal studies should investigate the pathophysiology so that intervention can be based on the underlying mechanisms.
Sexual Abuse in Therapy: Gender Issues
Authors: Quadrio Carolyn 
Published: November 2007

Objective: That sexual abuse in therapy occurs predominantly with male per- petrators and female patients is a phenomenon that requires analysis in terms of gender relations. Such an analysis is undertaken here from the perspective of feminist psychoanalytic and psychosocial theories.Method: Data informing the analysis are derived from assessments of 40 women who experienced sexual abuse in therapy. These women had mostly presented with depression, 68% had a history of childhood abuse, and one half were themselves helping professionals.Results: The majority were seriously damaged by the abusive therapy. Offenders were chiefly male (90%) and most were senior, well-qualified therapists of high status: some were charismatic leaders or teachers. Such a group cannot be dismissed as marginal, deviant, or Ill-informed; a more systemic analysis is necessary to understand how the professions spawn and some- times protect offenders.Conclusion: It is concluded that the professional culture mirrors fundamental problems of gender relations that inhere in the larger socio-cultural context where they are expressed in various forms of sexual abuse and violence. A cultural change requires better education on issues of power and sexual politics.
A Case of Unrelenting Pursuit of Castration
Authors: Leung C. M. , Lee T. S. , Chan Ho M. W. , Cheung B. 
Published: November 2007

Objective: Explore the limitations of the classification of body dysmorphic disorder. Clinical picture: A Chinese male relentlessly pursued castration to relieve painful erections which were never substantiated. The testes and corpora spongiosum had been removed. No psychotic symptom was prominent. Treatment: Cognitive therapy and psychotropics were tried. Outcome: The remaining corpora cavernosa was removed subsequently. Conclusion: The distorted somatic perception and secondary cognitive amplification (painful erections) could represent a variant of body dysmorphic disorder involving internal body image; diagnostic classifications should accommodate such a category.
Antidepressant Deaths by Overdose
Authors: Battersby Malcolm W. , O'mahoney John J. , Beckwith Andrew R. , Hunt Justin L. 
Published: November 2007

Objective: To determine the prevalence of antidepressant deaths in South Australia, the relative frequency of each antidepressant used and demographic data of those who died. Method: This was a retrospective, case note study of all cases where death was caused by lethal levels of antidepressants in South Australia for the period from 1986 to 1990. The study occurred at the South Australian coroner's office. Subjects were selected from toxicology data, where serum or liver levels of one or more antidepressant were in the lethal range. Results: Seventy-one cases were identified and information was obtained on 68 of these cases from the coroner's files. Amitriptyline, Doxepin and Dothiepin accounted for the majority of antidepressant deaths. Women were 2.5 times more likely to use antidepressants to suicide than men. At least 63% had a known psychiatric illness and 45% had previously attempted suicide. Conclusions: The older tricyclic antidepressants are a significant cause of suicide. It is recommended that the newer antidepressants, which are as efficacious yet safer in overdose, be prescribed in preference to the older tricyclic antidepressants, as the first line of treatment in newly diagnosed depressed outpatients.
Clinical and Subclinical Hypothyroidism in Patients with Chronic and Treatment-Resistant Depression
Authors: Hickie Ian , Bennett Barbara , Mitchell Philip , Wilhelm Kay , Orlay Wendy 
Published: November 2007

Objective: To investigate the relationship between hypothyroidism and treatment-resistant depression (TRD). Method: A retrospective case audit of 93 inpatients of a specialist Mood Disorders Unit. Patients referred with TRD were sub-classified into ‘adequate’ or ‘inadequate’ prior treatment groups on the basis of pre-established criteria, and compared with a ‘non-TRD’ control sample. Grades I (clinical) and II (subclinical) hypothyroidism were determined by review of relevant thyroid indices. Results: Patients had chronic depressive disorders (sub-group means of 57.5-82.2 weeks of illness). Of those patients referred with TRD, 22% (10/46) had evidence of clinical or subclinical hypothyroidism compared with 2% (1/47) of the non-TRD patients (p < 0.01). A gradient in the rates of grade I hypothyroidism was observed with the adequately-treated TRD patients having the highest rate (13%), the inadequately-treated TRD patients having an intermediate rate (7%), and the non-TRD patients having the lowest rate (2%). Consistent with this view, the inadequately-treated TRD group had the highest rate of grade II hypothyroidism (p = 0.01) and tended to have higher thyroid stimulating hormone (TSH) values (p = 0.06). Differences in the rates of hypothyroidism could not be accounted for by differences in age or prior exposure to lithium and/or carbamazepine. Duration of the depressive episode was negatively correlated with both the free thyroxine indices (r = −0.25, P < 0.05) and TSH levels (r = −0.32, p < 0.01). Conclusions: This study suggests that relative hypothyroidism may play a role in the development of some treatment-resistant depressive disorders.
Prevalence of Posttraumatic Stress Disorder, Depression and Anxiety in a Community Sample of New Zealand Vietnam War Veterans
Authors: Long Nigel , MacDonald Carol , Chamberlain Kerry 
Published: November 2007

Objective: The aim of the paper is to investigate the prevalence of posttraumatic stress disorder (PTSD), depression and anxiety in a community sample of New Zealand Vietnam War veterans. Method: Data were collected as part of a national survey on the health and mental health of New Zealand Vietnam veterans. Five hundred and seventy-three randomly selected male Vietnam veterans participated in a postal survey. The questionnaire contained a number of demographic, biographical and psychological measures. Results: The results revealed that 10% of the veterans could be classified as PTSD cases and that these veterans exhibited high levels of depression and anxiety. In PTSD cases, 15% were also classified with anxiety, 6% with depression, and 73% were classified with both anxiety and depression. In PTSD cases 94% were classified with more than one additional disorder. In non-PTSD cases 27% were classified with anxiety, and 1% with depression, while 12% experienced both anxiety and depression. Conclusions: The consequences of comorbidity for research and treatment are discussed and it is suggested that health professionals should be attentive to military experience as a predictor of these disorders.
A Prospective Study of Aggression among Psychiatric Patients in Rehabilitation Wards
Authors: Cheung P. , Schweitzer I. , Tuckwell V. , Crowley K. C. 
Published: November 2007

Objective: The aim of the study was to determine, among patients in rehabilitation wards, the prevalence and nature of aggressive behaviour and the relationship between aggressive behaviour and patient characteristics and ward factors. Method: The aggressive behaviour of all 220 inpatients within the rehabilitation program of a large psychiatric hospital in Victoria was assessed using the Staff Observation Aggression Scale. Results: Physical assaults occurred at a rate of 97.6 per 100 patients per year. About 40% of all incidents appeared to be unprovoked. Most physical incidents involved use of body parts and use of a weapon was uncommon. Aggression was most often directed at a staff member. Serious injury was rare. Aggressive behaviour was correlated with gender and duration of admission for the whole sample; however, there were different correlates of aggressive behaviour for different ward populations and different types of aggression. As for ward variables, time of day but not patient/staffing level was associated with aggressive behaviour. Conclusions: There was a high rate of aggressive behaviour among patients in rehabilitation wards; this should be taken into consideration in the planning of their community placement. The findings also caution against aggregating different ward populations and types of aggressive behaviour for research.