bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Freedom's Just Another Word”: Aboriginal Youth and Mental Health
Authors: Hunter Ernest 
Published: November 2007

Objective: The aim of the study was to review the available material on Aboriginal youth mental health, exploring certain contemporary issues. Method: The review covers the psychiatric and social science literature, focusing on the recent period of major social change. Results: The available material is severely limited, particular deficiencies being normal child development, the impact of social change and its consequences for the construction of Aboriginal identity. Conclusion: There is a need for more work in this area and for psychiatric engagement at a political level.
Seasonality of Mania: A Tasmanian Study
Authors: Jones Ivor , Hornsby Helen , Hay David 
Published: November 2007

Objective: The aim of the study was to examine the seasonal incidence of mania in a new Southern Hemisphere location. Method: Using the Tasmanian psychiatric database, monthly admission rates were compared with expected admission rates for mania for the period 1983 to 1989. ICD-9 criteria for mania single episode (296.0) and mania recurrent episodes (296.1) were used, excluding individuals with a bipolar disorder (296.4 to 296.89). Results: One thousand three hundred and twenty-eight persons were admitted during this period. There was a significant monthly variation with admissions occurring most commonly in the summer, but this was not consistent during the seven year period. Conclusions: There was a statistically significant but inconstant summer excess. The inconstancy of the finding suggests that the phenomenon is not a simple consequence of light duration, and closer examination of these inconsistencies may lead to further elucidation of the phenomenon.
Suicidal Ideation and Behaviours among University Students in Australia
Authors: Schweitzer Robert , McLean John , Klayich Michael 
Published: November 2007

Objective: The aim of the study was to investigate the prevalence and demographic correlates of suicidal ideation and behaviours among university students in Australia and the utilisation of mental health services by this population. Method: Suicidal ideation and behaviours and demographic variables were assessed in a population of 1,678 undergraduate students by use of a modified Suicide Ideation Scale (SIS) and questionnaire. Results: Sixty two percent of students surveyed showed some suicidal ideation and 6.6% reported one or more suicide attempts. Over half of the group who reported suicide attempts did not use any type of mental health services. Suicidal ideation was found to be highly correlated with previous use of mental health services. In examining the relationship between suicidal ideation (SI) and demographic variables, SI was not significantly different for gender or parental marital status but was related to living arrangements, racial groups, religious affiliation and father's education. Conclusions: The results suggest that a higher proportion of students reported suicidal ideation and behaviours than that documented in related studies undertaken in the USA. While these findings draw attention to a higher level of suicidal ideation in students who utilise mental health assistance, more than half of those who reported suicide attempts did not use any kind of mental health service. The study has particular implications for detecting and assisting young people with a high suicide risk within the university environment.
Velcro on the Slippery Slope: The Role of Psychiatry in Active Voluntary Euthanasia
Authors: Ryan Christopher James 
Published: November 2007

Objective: The aim of the paper is to determine the role that psychiatrists should play in legislation that establishes a right to active voluntary euthanasia (AVE). Method: One version of the “slippery slope” argument, usually invoked against the legalisation of AVE, is recast as an argument for the introduction of strong safeguards in any future AVE legislation. The literature surrounding the prevalence of psychiatric illnesses in the terminally ill, physicians' ability to identify such illnesses and the aetiology of suicide in the terminally ill is examined. Results: The strength of the slippery slope argument, combined with the poor ability of general physicians to diagnose psychiatric illness in the terminally ill, demands that any legislation allowing AVE should require a mandatory psychiatric review of the patient requesting euthanasia. Conclusions: Any legislation adopted that establishes a right to active voluntary euthanasia should include a mandatory psychiatric review of the person requesting euthanasia and a cooling off period before the request is acceded to. In addition, the discovery of a serious mental illness ought to disqualify the affected person from the right to AVE until that illness resolves.
Post-Stroke Depression: Outcome following Rehabilitation
Authors: Loong Chan Keen , Kenneth NG Kwan Chung , Paulin Straughan T. 
Published: November 2007

Objective: This prospective study looks at the outcome of rehabilitation on mood and physical recovery in patients with post-stroke depression. Methods: Fifty-two patients in a rehabilitation centre were assessed for depression, modified Barthel's score and Hamilton Rating Scale for depression on admission to and discharge from the rehabilitation centre. Aphasic, demented and delirious patients were excluded. Results: Fifty-five percent of the patients were assessed to have depression on admission and 98% had physical impairment. At the time of discharge, only 28.6% were depressed and two-thirds had improved in physical function. Patients with ail degrees of functional impairment showed equal improvement and there was no difference between Barthel's scores for patients whose mood improved and those who remained depressed. There were very strong associations between functional assessment and depression, functional assessment on discharge with depression on admission, and patients' mood on admission and discharge. Depressed patients did not stay longer in the rehabilitation centre than non-depressed patients. Low doses of anti-depressants did not have an impact on mood or functional improvement. Conclusion: We have found that depression might not have a clear negative impact on rehabilitation, that mood improved at the end of rehabilitation and that the degree of depression on admission was a good predictor of the outcome of final physical impairment.
A One Year Analysis of Appeals Made to Mental Health Review Tribunals in New Zealand
Authors: O'Brien T. A. , Mellsop G. W. , McDonald K. P. , Ruthe C. B. 
Published: November 2007

Objectives: The aim of the paper is to present data on the first year of all appeals lodged with a Mental Health Review Tribunal against compulsory treatment orders of psychiatric inpatients. Method: Two tribunals have been in operation in New Zealand since the introduction of a new Mental Health (Compulsory Assessment and Treatment) Act in 1992. The case records of all patients who had appeals heard by either the Northern or Southern regional tribunal from 16/12/92 to 7/12/93 inclusive were examined. Results: 145 appeals were heard by the tribunals: 14.5% of appeal hearings resulted in the discharge of a patient from their compulsory treatment status. Discharge rates for the Southern Tribunal were found to be significantly higher at 22%, compared with 10% for the Northern Tribunal (p<0.05). Application for appeal was initiated by the patient in 72% of cases; District Inspectors initiated the remaining cases. District Inspectors were found to initiate significantly more female review applications (47%) than male applications (22%) (p<0.05). Of the appeals heard, 126 were lodged under s.79 of the Mental Health Act. The remaining cases were s.80 (special) cases: in no case was discharge from compulsory treatment recommended. Overall, 69% of appellants were represented by a lawyer. It was found however that engaging legal representation did not significantly increase patients' chances of successful discharge but did delay the hearings. Also considered in the study were the presence or absence of witnesses at hearings and the relationship this had to the outcome of the tribunal hearing. Conclusions: Ambiguities within the Act need to be addressed in order that criteria used to judge a patient's fitness for discharge may be standardised. In addition, the Act stipulates a maximum delay of 14 days in reviewing a patient's case; however in practice a mean of 22 days elapses, indicating that this stipulation requires review.
Psychosocial Stressors, Physical Illness and the Spectrum of Depression in Elderly Inpatients
Authors: Draper Brian , Anstey Kaarin 
Published: November 2007

Objectives: To describe all elderly patients hospitalised with principal and secondary diagnoses of depression, and to determine whether a relationship can be demonstrated between psychosocial stressors, physical illness and type of depression. Method: A retrospective chart review of elderly patients admitted to a general hospital psychiatry ward over a 7-year period with principal or secondary diagnoses of depression was undertaken. Four broad diagnostic categories of depression were used: major depression, psychotic depression, minor depression, and organic depression. Chief outcome measures were: number of medical diagnostic categories, presence of psychosocial stressors, global clinical improvement, and length of stay. Results: Of 228 patients admitted with depression (194 principal diagnoses and 34 secondary diagnoses), 100 had major depression, 47 psychotic depression, 48 minor depression and 33 organic depression. Psychiatric comorbidi-ty occurred in 70%, about half of which was due to organic brain syndrome. Patients with psychotic depression had the fewest medical problems and those with organic depression the most, while patients with minor depression had the highest rate of family and marital problems, comorbid personality dysfunction and suicide attempts. Patients with psychotic depression had the longest admissions, while those with minor depression had the shortest. Overall, 89% showed significant clinical improvement. Conclusions: Elderly inpatients have a wide spectrum of depressive disorders with different psychosocial, medical and treatment profiles. Future studies of depression in old age should include all patients with clinical depression.
Does Depression Predict Relapse in the 6 Months following Treatment for Men with Alcohol Dependence?
Authors: Sellman John Douglas , Joyce Peter R. 
Published: November 2007

Objective: To investigate whether depression measured at the time of treatment predicts relapse of alcohol dependence in the 6 months following treatment of alcohol-dependent men. Method: Ninety-three subjects with moderate-severe alcohol dependence (DSM-Ill-R), recruited from a 3-week, abstinence-focused therapeutic program, were assessed for current and lifetime major depression using the SCID-P and baseline depressive symptoms using the SCL-90, and then followed up for 6 months. Drinking outcomes were based on multiple sources of data. Results: Relapse was not associated with either lifetime major depression, or baseline depressive symptoms; inadequate numbers of subjects with a current major depression precluded statistical analysis of this variable. Conclusions: Neither lifetime major depression, nor the degree of depressive symptoms in alcohol-dependent men at the time of treatment, compromise drinking outcomes in the 6 months following treatment.
Seasonal Affective Disorder: Some Epidemiological Findings from a Tropical Climate
Authors: Morrissey Shirley A. , Raggatt Peter T.F. , James Basil , Rogers John 
Published: November 2007

Objective: To determine whether a predominantly summer-focussed pattern of seasonal affective disorder (SAD) exists in tropical northern Australia. Method: A mail survey containing a modified form of the Seasonal Pattern Assessment Questionnaire (SPAQ) was administered to 176 households in the city of Townsville (latitude: 19° south). Results: Using previously reported screening criteria, 9% of respondents reported a degree of summer impairment indicative of SAD, while the incidence rate for winter SAD was 1.7%. This summer-winter ratio is typically reversed in more temperate latitudes. Conclusions: Excessive heat and humidity were reported to be the two most influential environmental factors affecting mood and behaviour. It is likely that respondents meeting criteria for summer SAD represent the extreme end of a spectrum of summer-related mood and behaviour change that affects many individuals in northern Australia. Strategies for further clinical and epidemiological research on SAD in tropical climates are proposed.
Reconciling the Patient's Right to Confidentiality and the Family's Need to Know
Authors: Furlong Mark , Leggatt Margaret 
Published: November 2007

Objective: Persistent difficulties have been identified in relation to confidentiality in mental health settings. The objective of the current investigation was to develop practical options enabling clinicians to negotiate this issue in a manner that is sensitive to families. Method: A review of the international literature, the current legal and policy settings, and the needs of clients and their families was undertaken. Additional material was drawn from the authors' own practice and advocacy experience. Results: The literature and policies reviewed emphasised the importance of meaningful collaboration between clinicians and families. A close reading of the relevant legislation revealed possibilities for an interpretation of confidentiality that facilitates such collaboration. Options for negotiating the engagement phase which are consistent with meaningful collaboration were then developed. Conclusion: Rather than assuming that confidentiality is an intransient problem, the authors conclude that dealing with the question of confidentiality sensitively presents clinicians with an opportunity to develop quality relationships with both clients and their families.
To Whom do You Refer? A Referrer Satisfaction Study
Authors: Parker Gordon , Sengoz Ayse , Wright Murray , Robertson Sadie 
Published: November 2007

Objective: To report the development of a referrer satisfaction measure. Method: Urban and rural general practitioners, physicians, neurologists, as well as obstetricians and gynaecologists rated 36 items in terms of their judged importance to the respondent's satisfaction with a psychiatric service. Responses of the whole sample and component practitioner sub-groups were ranked. Results: We established a high level of agreement across the several subgroups suggesting that we had identified general rather than idiosyncratic variables contributing to referrer satisfaction. Referrers prioritised as most important the immediacy of initial appointment, the psychiatrist reporting at the beginning and end of any treatment course, and ready verbal communication between the referrer and the psychiatrist. Items accorded low priority were the psychiatrist's billing arrangements, the psychiatrist being ‘perfect’ (in either having a high ‘cure’ rate or making a definitive diagnosis initially), or the psychiatrist taking complete responsibility for difficult patients. A principal components analysis identified four factors underpinning the item set, and we again established that scores on these factors were not influenced by the particular referrer sub-group. Conclusions: Such findings suggest that only minor modifications would need to be made to the item set in developing a referrer satisfaction measure for quality assurance activities.
Smoking among Chinese Patients with Schizophrenia
Authors: Chong Siow Ann , Choo Hock Lai 
Published: November 2007

Objectives: This study aimed to determine the prevalence of smoking among Chinese with schizophrenia, and to determine if smokers and nonsmokers differ in their age of onset of illness and neuroleptic requirement. Method: One hundred and ninety-five patients were assessed by a single rater using the Brief Psychiatric Rating Scale (BPRS) and the Simpson-Angus Scale. Other historical, demographic and treatment variables were recorded from case records and interviews with patients and family members. Results: A higher rate of smoking was found in patients with schizophrenia than in the general population. There was no significant difference between the smokers and non-smokers in their respective neuroleptic dosages and extrapyramidal side-effects but the smokers had a significantly higher BPRS score. Conclusions: Racial difference is proposed to account for this discrepancy from other Western studies. The contribution of nicotine towards aggravating schizophrenic symptoms is also considered.
Unity and diversity in Psychiatry: Some Philosophical Issues
Authors: Dewhurst David , Watson Burges I. Patrick 
Published: November 2007

Objective: The aim of this paper is to provide a defence of diversity in psychiatry and, correspondingly, to show that strict ‘biologism’ (or any other ‘total’ approach to psychiatry) is inappropriate. Method: Arguments are developed using as a basis the writings of well known philosophers such as Stephen Toulmin, Joel Feinberg and Charles Taylor. The authors examine the concepts of explanation and causation and consider the consequences for psychiatry which might follow the acceptance of mind-brain identity. There is also a discussion of the concept of a person. Result: If the same phenomenon is subject to explanation from diverse psychiatric perspectives, it does not follow that these modes of explanation must exclude or be in competition with each other. They may in fact be necessary to each other if psychiatry is to provide a full picture of mental functioning and human conduct. The thesis of mind-brain identity does not eliminate the variety of discourses within psychiatry, and hence it does not provide a rationale for ‘biologism’. Conclusion: There is a need for a co-operative multidimensional approach in psychiatry.
Consultation-Liaison Psychiatry in an Australian Oncology Unit
Authors: Kissane David W. , Smith Graeme C. 
Published: November 2007

Objective: To provide an overview of the work of a consultation-liaison (C-L) psychiatry service to an oncology unit in a university affiliated teaching hospital, with the aid of a comprehensive clinical database. Method: The MICROCARES prospective clinical database system was used to record data on all oncology inpatients referred to C-L psychiatry, and the hospital clinical database was used to compare referred inpatients with all oncology inpatients. Results: Two hundred and seventy-one referrals were made in the 3 years from 1991 to 1993, a referral rate of 10.4%. The referred patients were younger but there was no bias in sex and marital status. The mean length of stay was twice that for all other oncology admissions, day cases excluded. The most frequent reasons for referral were coping problems, depression, terminal illness issues and anxiety. The most common psychiatric diagnoses were Systemic Family Problems (V codes, 24%), Mood Disorders (23%), Adjustment Disorders (16%) and Organic Mental Disorders (10%). Management involved family conferences in half of the patients and antidepressant medication in one-quarter. Concordance with pharmacological recommendations was 98%. Existential issues and family-centred care are discussed. Conclusions: Both individual and family-centred care is required in an oncology service; a dedicated liaison attachment offers considerable staff support. Psycho-oncology is underdeveloped in Australia compared to many overseas services; there is scope for substantial growth in preventive and supportive work.
Do Specific Anxiety Disorders Show Specific Drug Problems?
Authors: Page Andrew C. , Andrews Gavin 
Published: November 2007

Objective: Comorbidity between anxiety and substance use disorders was examined. The hypothesis was tested that social phobics may report greater problem alcohol use (if alcohol is used to manage social anxiety) while problem use of sedative-hypnotics may be greater in people with panic (who may be over-prescribed anxiolytics because they repeatedly seek medical assistance). Method: Self-reported lifetime rates of drug and alcohol problems were assessed with the computerised Diagnostic Interview Schedule — Revised. Subjects were 146 consecutive patients treated for panic disorder (with and without agoraphobia) and social phobia at the Clinical Research Unit for Anxiety Disorders. Results: High prevalences of alcohol problems (three times that expected) and problem use of sedative hypnotics (eight times that expected) were found in all diagnoses. Social phobics exhibited comparatively high rates of problem alcohol use, but no diagnostic specific differences in problem sedative-hypnotic use were found. Conclusion: Routine screening for drug and alcohol problems is necessary for patients with anxiety disorders.
Neuroleptic Malignant Syndrome: Two Cases without Muscle Rigidity
Authors: Wong Michael M.C. 
Published: November 2007

Objective: Two patients with neuroleptic malignant syndrome without muscle rigidity are described. Clinical picture: Both patients developed fever and altered consciousness while taking neuroleptic but did not develop muscle rigidity; the symptoms subsided when the neuroleptic was stopped but recurred when it was given again. Treatment: The neuroleptic was stopped; one patient received supportive treatment and the other received bromocriptine. Outcome: One patient died while the other survived. Conclusion: The pathophysiology is proposed as a combination of involvement of the central thermoregulatory, neuroregulatory and autonomic nervous systems, and the peripheral skeletal muscle. It supports the concept of a spectrum of clinical severity of neuroleptic malignant syndrome.
Neuroleptic Malignant Syndrome and Risperidone: A Case Report
Authors: Bonwick Richard J. , Hopwood Malcolm J. , Morris Philip L.R 
Published: November 2007

Objective: To describe a case of neuroleptic malignant syndrome associated with risperidone. Clinical picture: An elderly patient with bipolar affective disorder presented with neuroleptic malignant syndrome and relapse of hypomania after commencing risperidone. Treatment: Risperidone was ceased and the patient monitored closely. Outcome: The symptoms of neuroleptic malignant syndrome were resolved. Conclusion: To our knowledge this is the first such case reported, and suggests that risperidone, like other neuroleptics, is associated with neuroleptic malignant syndrome.
The Successful Treatment of a Gender Dysphoric Patient with Pimozide
Authors: Puri B. K. , Singh I. 
Published: November 2007

Objective: The case is reported of a gender dysphoric patient who responded successfully to pharmacotherapy with pimozide. Clinical picture: An adult male patient with a borderline learning disability presented with cross-dressing and a strong wish to undergo a sex change. Treatment: Supportive psychotherapy and pharmacotherapy with pimozide was tried. Outcome: There was an excellent response to pimozide 2 mg daily, with a cessation of both cross-dressing and the wish for sex reassignment. When, after 1 year, the dose was reduced to 1 mg daily, there was a rapid return of the cross-dressing and the wish for sex reassignment. An increase in the dose again led to a remission which has been maintained since then. Conclusion: Pharmacotherapy with pimozide should be considered in cases of doubtful gender dysphoria.