bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Case for a Psychological Perspective on Late-Onset Psychosis
Authors: Hassett Anne 
Published: January 2008

Objective:A conceptual framework is proposed for studying late-onset psychotic disorders. This incorporates developmental and psychological perspectives to complement the biological focus of most recent studies in this area. Method:Studies of late-onset psychosis that focus on the specificity of neuroimaging abnormalities, family history and sensory deficits were reviewed. Aspects of the developmental and personality literature were then examined with the goal of ascertaining their relevance for the emergence of psychosis in late life. Possible future directions incorporating biological and psychological approaches are proposed. Results:The biological abnormalities identified in studies of late-onset psychosis lack the specificity to stand alone as aetiological factors. Neuroimaging changes and sensory impairment are commonly found in study subjects; however, they also occur in elderly persons without psychiatric illness as well as in those with other late-onset psychiatric disorders. Perhaps it is more appropriate to regard these changes as conferring a vulnerability to psychosis in old age, but symptoms do not develop unless other risk factors, either longstanding or ageing-related, are also present. Developmental studies of late life that have used Erikson's concept of a final lifestage crisis of achieving ‘ego-integrity’, suggest that personality style may be influential in determining the negotiation of this last maturational task. Failure to do so results in ‘despair’, fragmentation of self-image and paranoid fears. To date, there has been little investigation of the relevance of these developmental and personality factors for the emergence of psychosis in old age. Conclusions:If we are to advance our understanding of late-onset psychotic disorders, research in this area needs to move beyond the elusive search for specific biological markers. A model of causation that integrates the longitudinal perspective of lifestage tasks with personality and biological vulnerability factors provides a broad framework which protects against premature foreclosure on aetiological determinants.
The Ethics Committee of a Psychiatric College: Its Procedures and Themes
Authors: Pargiter Russell , Bloch Sidney 
Published: January 2008

Objective:Ethics committees (ECs) of medical colleges and other medical associations have become part of their professional experience only in recent years. This is probably attributable to such factors as greater professional accountability and informed consumerism. Relatively little is known about the procedures and agendas of such committees. The aim of the present study was to examine the EC of the Royal Australian and New Zealand College of Psychiatrists, with respect to its practices, in order to learn how a medical college grapples with ethical concerns.Methods:Two members of the College's EC, including its foundation chairman, assembled relevant documents, and subjected them to detailed scrutiny. Consensus was used, preceded by independent attempts at categorising these issues covering the period from the EC's inception in 1978 to June, 1995.Results:Three hundred and sixty-seven issues were dealt with by the EC over a 17 year period, covering clinical practice, financial aspects, forensic psychiatry, teaching and research, liaison with other organisations and preparation of guidelines and a code of ethics.Conclusions:An EC can play a vital role in advising its parent body and members in the ethics of day-to-day professional life as well as formulating (and revising) a code of ethics and supplementary ethical guidelines.
Psychiatric Morbidity in Australian Veterans of the United Nations Peacekeeping Force in Somalia
Authors: Ward Warren 
Published: January 2008

Objective: Since World War II, an increasing number of soldiers have been deployed in United Nations (UN) peacekeeping forces. However, little is known about the psychiatric impact of such deployments. The present study investigated the nature, prevalence, aetiology and natural history of psychiatric morbidity in Australian veterans of the United Nations peacekeeping force in Somalia. Method: Fifteen months after their return from Somalia, 117 Somalian veterans completed the 28-item version of the General Health Questionnaire (GHQ-28), the Impact of Events Scale (IES), the Combat Exposure Scale (CES), and a checklist of posttraumatic stress disorder symptoms, completed by veterans 12 months previously as part of an evaluation by the Department of Defence. Seventy-seven non-veteran controls also completed the GHQ-28. Results: Veterans scored significantly higher on the GHQ-28 than controls. Twenty-four-point-eight per cent (24.8%) of veterans were GHQ cases (using 4/5 as a cut-off point) compared to 13.0% of controls. Psychiatric morbidity in veterans was associated with combat exposure and a past psychiatric history. Levels of morbidity reduced over time, although they remained substantial at 15 months following soldiers' return to Australia, with posttraumatic stress disorder symptoms being reported by approximately 20% of veterans. Conclusions: At least one-fifth of Australian soldiers who served in Somalia had significant levels of psychiatric morbidity 15 months following their return. This was almost twice that of their non-veteran peers. Risk factors for the development of psychiatric morbidity included combat exposure and past psychiatric history. Levels of psychiatric morbidity were much higher than those reported in previous studies on UN soldiers.
Depression in Adults with Intellectual Disability. Part 1: A Review
Authors: Davis Julian P. , Judd Fiona K. , Herrman Helen 
Published: January 2008

Objective: To examine the available literature regarding prevalence, clinical features and treatment of depression in adults with intellectual disability (ID). Method: A review of standard texts of ID and available literature examining psychiatric problems of individuals with ID. Results: Few methodologically sound studies of prevalence have been reported. The clinical features of depression in adults with ID appear to vary with level of disability; in those with higher levels of disability in particular, irritability and anger, self-injurious and aggressive behaviour, psychomotor change and loss of activities of daily living skills may be observed rather than ‘classic’ depressive symptoms. No systematic treatment studies have been reported; case reports support the efficacy of cognitive and behavioural strategies, antidepressants and electroconvulsive therapy. Conclusions: Well designed studies to assess the prevalence and evaluate the treatment of depression in individuals with ID are urgently needed. Design of these studies will need to address the questions of reliability and validity of diagnosis in individuals with ID and examine the appropriateness of available diagnostic criteria.
Ocular Abnormalities in Chronic Schizophrenia: Clinical Implications
Authors: Smith Deidre , Pantelis Christos , McGrath John , Tangas Christine , Copolov David 
Published: January 2008

Objective: As part of a randomised double-blind study of a new atypical antipsychotic we sought to determine both the levels of visual acuity and the occurrence of toxic side-effects in a group of patients treated for many years on a variety of antipsychotics. Method: Twenty-three inpatients with a DSM-III-R diagnosis of chronic schizophrenia from two separate hospital locations who met the criteria for the double-blind trial were examined for ocular abnormalities at both baseline and at trial completion. Results: At baseline a high prevalence of abnormalities was identified: 19 patients (82.6%) were found to have one or more ocular abnormalities, including lens opacities/cataracts and corneal pigmentation; three patients, with delusions related to the sun, were noted to have solar burns; a high proportion (almost 70%) of patients had untreated visual acuity problems. No further changes were observed at the follow-up examinations. Conclusions: The possible causes of ocular disturbance in schizophrenia and the reasons for the relatively high ocular morbidity in this group are thought to result from both illness-related factors and the effects of antipsychotic medication. Causality is confounded by a number of issues such as the high prevalence of smoking, poor general health and the variety of antipsychotic medications used in the treatment of psychosis as well as substance abuse. The clinical implications are considered in this paper in relation to the move towards community-based psychiatric services.
The Assessment of Clinically Significant Change Using the Life Skills Profile
Authors: Trauer Tom , Duckmanton Robert A. , Chiu Edmond 
Published: January 2008

Objective: In the context of the need to develop practical outcome measures, the present study aimed to assess the sensitivity of the Life Skills Profile (LSP) in terms of differences between hospital-based and community-based clients, and to assess the sensitivity of the LSP to changes over time. In this way, criteria could be established whereby the LSP could be used to determine appropriate changes in locus of care, both in terms of the ‘cut-off’ for hospital-based and community-based tenure, and the level of ‘clinically significant change’ in functioning. Method: The LSP was administered at 3-monthly intervals to 200 clients of an area public mental health service with serious mental illness over a 21-month period. Locus of care (hospital or community) was noted at each administration. Results: Clients in the community scored significantly better than those in hospital, however there was a great deal of overlap. Using hospital or community tenure as the variable of interest, a measure of reliable and clinically significant change over a 3-month period based on the LSP was developed. A total LSP score of 116.5 or above best discriminated clients in the community from those in hospital, and a difference of 18 points or more in two LSP obtained 3 months apart was unlikely to have arisen by chance. A simple, two-part criterion of significant change based on these results showed 89% accuracy in matching transition (or lack of transition) between hospital and community with changes in LSP scores. Conclusions: The results need to be understood within the methodological limitations of the present study. The findings provide users of the LSP with guidelines for the interpretation of repeat assessments. This may encourage more services to use formal reassessment methods to monitor the progress of their clients.
Intravenous Sedation of Involuntary Psychiatric Patients in New South Wales
Authors: Nielssen Olav , Buhrich Neil , Finlay-Jones Robert 
Published: January 2008

Objective: Intravenous sedation of involuntary psychiatric patients is practised in almost all hospitals in New South Wales. Despite its widespread use, little has been published about the medications used or their safety and efficacy. The present study reports the frequency and reasons for intravenous sedation, the medications used, and the incidence of adverse effects. Method: Eighteen of 21 acute psychiatric admission units in the State were reviewed. The medical records of a random sample of 495 patients admitted involuntarily during 1990 were examined and information from the progress notes, drug charts and physical observations was recorded and subjected to statistical analysis. Results: Of the 495 patients, 132 (27%) were intravenously sedated. Eighty-six per cent (86%) of patients received a combination of haloperidol or diazepam, usually 20 mg of each drug. The threat of violence was the most significant patient characteristic predicting the use of intravenous sedation. Patients with mania or intoxication were relatively more likely to be intravenously sedated than other diagnostic categories. Patients admitted via accident and emergency departments and those admitted to teaching and metropolitan general hospitals compared to rural and large psychiatric hospitals were significantly more likely to receive intravenous sedation. The most common complications of intravenous sedation were dystonia (37%), hypotension (8%) and confusion (5%). The incidence of phlebitis and other extrapyramidal side-effects was probably under-reported. Conclusion: About one in four involuntary psychiatric patients receive intravenous sedation in NSW. Intravenous sedation is more likely when patients are admitted through accident and emergency departments to teaching or metropolitan hospitals, and pose a threat of violence. Intravenous sedation was shown to be a safe procedure given certain precautions.
Seasonal Affective Disorder in Australia: Is Photoperiod Critical?
Authors: Murray Gregory W. , Hay David A. 
Published: January 2008

Objectives: Seasonal affective disorder (SAD) is a variant of recurrent depression in which episodes are linked to a particular season, typically winter. SAD is understood as the extreme end of a continuum of seasonality in the general population. Photoperiod (the timing and duration of daylight) has been assumed to be aetiologically critical. The present research used a survey design to investigate the assumed centrality of photoperiod for SAD/seasonality in Australia. Two hypotheses were tested: that self-reported seasonality does not increase further from the equator and that seasonality does not stand alone from non-seasonal neurotic complaints. Method: The sampling frame used was adult females on the Australian Twin Registry roll. A sample of 526 women residing across the latitudes of Australia responded to a survey based around the Seasonal Pattern Assessment Questionnaire (SPAQ). The SPAQ asks respondents to retrospectively report on season-related changes in mood and behaviour. The survey also contained three questionnaire measures of neurotic symptoms of anxiety and depression: the General Health Questionnaire (GHQ), the Community Epidemiological Survey for Depression (CES-D) and the State-Trait Anxiety Inventory—Trait (STAI-T). Results: Self-reported seasonality did not correlate with latitude (r=0.01, NS). On the other hand, a substantial relationship was found between seasonality and each of the measures of non-seasonal complaints: GHQ (r=0.35, p<0.001); CES-D (r=0.35, p<0.001); and STAI-T (r=0.30, p<0.001). Conclusions: Within the limitations of a design based on retrospective self-report, the findings of the present study suggest that the diathesis for SAD/seasonality may not be photoperiod-specific. At least in Australia, there is provisional support for the proposal that human seasonality may have a broader psychological component. The findings are discussed in terms of established research into normal mood, trait personality and non-seasonal depression.
Sexually Transmitted Disease and Family Planning Counselling of Psychiatric Patients in New Zealand
Authors: Coverdale John , Falloon Ian , Turbott Sarah 
Published: January 2008

Objective: We aimed to determine the attitudes and behaviours of mental health professionals (MHPs) including psychiatrists towards identifying and reducing their own patients' risk for sexually transmitted diseases and unwanted pregnancies. Method: 102 of all of the 162 mental health professionals serving predominantly chronically psychiatrically ill adult outpatients and inpatients in Waitemata district responded to an anonymous questionnaire (response rate = 63%), concerning their own attitudes and behaviours towards identifying and counselling patients on their risk for sexually transmitted diseases and unwanted pregnancies. Results: Mental health professionals reported that, on average, they had counselled 14% of their own male patients and 21% of their own female patients on sexually transmitted diseases, including AIDS prevention, and that more of their own patients were at risk than were counselled. They also reported that they had counselled 5% of their own male patients and 17% of their own female patients about family planning. Forty-two per cent of mental health professionals indicated that they had insufficient knowledge about sexually transmitted diseases to educate patients, 72% indicated that when it came to risky sexual behaviours chronic psychiatric patients were much the same as other people, and 33% or more felt uncomfortable discussing topics of condom use and patients' sexual preferences. Conclusion: These results suggest that family planning and sexually transmitted diseases risk preventive interventions for psychiatric patients need to overcome mental health professionals' own barriers to risk prevention.
Inpatient Suicides in an Australian Mental Hospital
Authors: Shah Ajit K. , Ganesvaran Thirunavakarasu 
Published: January 2008

Objective: Suicide rates among psychiatric inpatients are higher than in the general population. Mental health professionals are poor at predicting suicide risk. Method: One hundred and three inpatient suicides, over a 21-year period, in a large psychiatric hospital in Melbourne were examined. The characteristics, including demographic and clinical data, for 60 of these suicides were compared with a matched comparison group stratified for the time of admission. Violent methods (including jumping in front of trains, trams and road traffic, jumping off buildings, hanging and drowning) were most frequently used. Results: Over one-third of the suicides occurred during periods of approved leave and a similar number occurred after absconding from the hospital. Suicide was associated with a diagnosis of schizophrenia, increased duration of admission, more frequent prescription of neuroleptics and antidepressants, previous deliberate self-harm, suicidal ideation at the time of admission and during the admission, suicide attempts during the admission, unstable (fluctuating) suicidal ideation during the admission and a greater number of ward transfers. Conclusions: Psychiatric units should be developed away from readily available methods of suicide. Patients with previous or intra-admission suicidal ideation or attempts, or unstable suicidal ideation, should be carefully observed to avoid absconding. Suicide risk should be carefully evaluated in such patients prior to approving periods of leave.
Is There an Adult form of Separation Anxiety Disorder? A Brief Clinical Report
Authors: Manicavasagar Vijaya , Silove Derrick 
Published: January 2008

Objective: The aim of this clinical report is to investigate whether symptoms of separation anxiety disorder can occur in adulthood. Clinical picture: Three cases are described to illustrate that adults may experience: wide-ranging separation anxiety symptoms, such as extreme anxiety and fear, when separated from major attachment figures; avoidance of being alone; and fears that harm will befall those close to them. Symptoms of panic appeared to be secondary to separation anxiety, and none of the patients fulfilled criteria for dependent personality disorder. Treatment: Group cognitive behavioural treatment focusing on preventing panic attacks and generalised anxiety did not appear to have an impact on core separation anxiety symptoms. Outcome: Exacerbations of separation anxiety appeared to be closely linked to actual or threatened ruptures to primary bonds. Conclusions: Separation anxiety disorder may be a neglected diagnosis in adulthood. Formal nosological systems such as the DSM may need to be revised to incorporate adult manifestations of the disorder.
Lessons to be Learned from the Study of Sexual Boundary Violations
Authors: Gabbard Glen O. 
Published: January 2008

Objective: This paper illustrates certain recurrent themes occurring in the evaluation of sexual boundary violations that provide valuable lessons for all psychotherapists. Method: By reviewing patterns found in nearly 80 cases of sexual misconduct by psychotherapists, I have been able to delineate common errors of clinical judgement that lead to serious boundary violations. Results: Several issues deserve attention by all therapists: (i) the therapist's conscious and unconscious intent may be at odds with one another; (ii) feelings of love for a patient may defend against hostility and aggression; (iii) supportive psychotherapy requires careful attention to boundary issues; and (iv) therapists who withhold secrets from supervisors or consultants are at high risk for enacting boundary violations. Conclusions: There is a confluence of clinical error and ethical misconduct in the development of sexual boundary violations during psychotherapy. The study of such cases reveals a number of important lessons to be learned by all psychotherapists. These lessons, as well as their implications for prevention in terms of training and supervision, are discussed.
The Assessment of Depression in the Postnatal Period: A Comparison of Four Self-Report Questionnaires
Authors: Condon John T. , Corkindale Carolyn J. 
Published: January 2008

Objective: The objective of this study was to ascertain the degree of agreement between four self-report depression scales, with particular emphasis on whether each scale would identify the same subgroup of women as being ‘most depressed’. Method: The questionnaires were administered to a sample of approximately 200 postnatal women at 4 weeks, 4 months and 8 months after delivery. The instruments were: the Edinburgh Postnatal Depression Scale; the depression subscale of the Hospital Anxiety Depression Scale; the Zung Self-Rating Depression Scale; and the depression subscale of the Profile of Mood States. Results: Agreement between pairs of instruments, in terms of identifying the most depressed subgroup of women in the cohort, only averaged approximately 40%. Agreement between the three instruments was only about 25%. Conclusions: This poor level of agreement most likely reflects the different emphasis in item content of the questionnaires, which in turn reflects different notions of ‘depression’ held by the designers of the instruments. The implications of the findings for research and clinical practice are discussed.
Vietnamese and Arabic Women's Responses to the Diagnostic Interview Schedule (Depression) and Self-Report Questionnaires: Cause for Concern
Authors: Matthey Stephen , Barnett Bryanne E. W. , Elliott Amanda 
Published: January 2008

Objective: The original study aimed to determine the best cut-off scores to screen for postnatal depression on translated versions of the Edinburgh Postnatal Depression Scale (EPDS) for Vietnamese and Arabic women. This research was conducted using the depression module of the Diagnostic Interview Schedule (DIS) to determine caseness. This paper reports on the suitability of this diagnostic interview as a criterion measure of depression in these women with a non-English speaking background. Method: Vietnamese and Arabic women in south-west Sydney completed the EPDS and a General Health Questionnaire (GHQ-30) antenatally. At 6–8 weeks postpartum they completed an EPDS, the GHQ-30 and a Faces Scale, and were interviewed using the depression module of the DIS. Members of a small convenience sample of women were asked about the cultural appropriateness of each of the instruments. Results: Vietnamese women admitted to few depressive symptoms on the DIS, whereas they appeared more open to reporting these on the EPDS and the GHQ-30. Arabic women responded more openly to the questionnaires and the interview, although they too were reluctant to report specific symptoms on the DIS. Conclusion: The usefulness of the DIS in determining rates of major depression in the Vietnamese and Arabic community in Australia is questionable. Further studies designed specifically to investigate this are needed.