bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship between Psychiatric Illness and the Circadian Pattern of Heart Rate
Authors: Stampfer Hans G. 
Published: January 2008

Objective: The aim of this study was to investigate the relationship between psychiatric status and the circadian pattern of heart rate. Method: Serial 24–hour recordings of minute average heart rate were obtained from 30 normal volunteers and 200 patients representing a range of DSM-III-R diagnoses. Records were compared in terms of their circadian “morphology” and grouped into different pattern types. The distribution of patterns in different diagnoses was analysed statistically. Results: It was found that states such as generalised anxiety and depression are strongly associated with a distinctive circadian pattern, whereas others such as somatoform disorder show more variation in this regard. Serial recordings show that the relationship between psychiatric status and circadian pattern is state-dependent; a change in clinical status leads to a change in the circadian pattern. Conclusions: The presented findings together suggest that there is a systematic relationship between psychiatric status and heart rate in which core physiological differences between certain states are reflected in distinctively different circadian patterns of activity. The state-dependent nature of this relationship suggests obvious practical applications, and examples are given of how these adjunct data can provide objective indices of clinical status and change. At a theoretical level, the physiological dimension revealed by these data may help to define more reliable syndromal distinctions between various clinical manifestations and hence contribute to a more robust nosology.
Learning Organisations: A Suitable Model for Improving Mental Health Services?
Authors: Birleson Peter 
Published: January 2008

Objective: The aim of this paper was to describe an organisational model that has created interest in recent business management literature as supporting learning, adaptation and continuous improvement. Method: Some key features of the literature on learning organisations are outlined, including the values and processes involved, together with a structural and cultural template that has been applied to a community child and adolescent mental health service. Some blocks to learning and the leadership skills required to develop adaptive services are described. Results: The experience of applying the model has led to a change in mental health service organisational structure and culture towards greater support for research, quality improvement, experimentation and adaptation. Conclusions: The learning organisation model offers a more comprehensive framework for designing adaptive mental health services and supporting quality management practices than any other recent organisational form.
The Community Treatment Order: Clinical and Ethical Issues
Authors: McIvor Ronan 
Published: January 2008

Objective: In the light of recent legislation, this paper reviews the implementation of the Community Treatment Order (CTO) in terms of clinical efficacy and ethical issues involved in its use. The debate surrounding the introduction of CTOs in other countries is explored. Method: A Medline search was conducted and references of recent articles followed up, with attention to Australian, New Zealand and international trends. A review of relevant legislation and government reports was conducted. Results: There has been limited debate in the Australian and New Zealand literature concerning the operation of CTOs. Despite their increasing and widespread use, there is a paucity of research on the efficacy of CTOs. Concerns about their negative effects on civil liberties have been stressed in the United Kingdom and American literature. Conclusions: If the continued use of CTO is to be justified, both clinically and from the civil liberties perspective, controlled research needs to be carried out to identify whether CTOs are more effective than comprehensive assertive community outreach programs in reducing relapse rates and hospitalisation, and increasing compliance. Clinical guidelines concerning who is most likely to respond to such orders need to be developed. Alternatives to the CTO are explored, and future directions in research are outlined.
Obsessional Symptoms Associated with Risperidone Treatment
Authors: Mahendran Rathi 
Published: January 2008

Objective: The aim of this paper is to report the occurrence of obsessional symptoms with risperidone treatment in a patient with no past history of obsessive-compulsive symptoms. Clinical picture: A 26–year-old, single, Chinese lady with a chronic untreated schizophrenic illness was prescribed risperidone after she experienced side effects with other antipsychotic medication. After the second week on risperidone, she developed obsessional symptoms. Treatment and Outcome: The obsessional symptoms responded to treatment with low dose clomipramine. Conclusion: The potential for the newer antipsychotic medication to precipitate or exacerbate obsessive-compulsive symptoms during treatment for schizophrenia must be borne in mind.
Psychological Distress and Suicidal Ideation among 15–24–Year-Olds Presenting to General Practice: A Pilot Study
Authors: McKelvey Robert S. , Davies Lisa C. , Pfaff Jon J. , Acres John , Edwards Stephen 
Published: January 2008

Objectives: The study sought to determine: (i) the prevalence rates of psychological distress and suicidal ideation among 15–24–year-old patients presenting to general practice; and (ii) the relationship between patients' presenting complaints and their levels of psychological distress and suicidal ideation. Method: This was a pilot study designed to sample patients aged 15–24 years presenting consecutively to general practitioners during a 4–week period. The study was set among five general practices in the western suburbs of Perth, Western Australia. Participants included five general practitioners and 69 patients aged 15–24 years. Main outcome measures were the General Health Questionnaire (GHQ-12), the Centre for Epidemiological Studies Depression Scale (CES-D) and the Depressive Symptom Inventory-Suicidality Subscale (DSI-SS). Results: One-third of patients scored above the cut-off of the GHQ-12,31.9% above the cut-off of the CES-D and 20.3% above the cut-off of the DSI-SS. The majority of patients (87.5%) presented with medical complaints. Of these, 26.8%, 23.2% and 21.4% scored above the cut-offs of the GHQ-12, CES-D and DSI-SS, respectively. Patients presenting with psychological complaints (12.5%) were significantly more likely to score above the cut-off of the CES-D. Conclusions: In this pilot study, patients aged 15–24 presenting to five general practices had relatively high levels of psychological distress and suicidal ideation. Of most concern were those presenting with medical complaints and who also had high levels of unreported psychological distress.
Sex, Lies and Training Programs: The Ethics of Consensual Sexual Relationships between Psychiatrists and Trainee Psychiatrists
Authors: Ryan Christopher James 
Published: January 2008

Objective: The aim of this paper is to chart the ethical territory surrounding the issue of consensual sexual relationships between psychiatrists and doctors training in psychiatry.Method: The arguments for and against the prohibition of such relationships are critically examined both in general and in a number of specific circumstances. Results: There should not be a general prohibition against such relationships, but a prohibition should apply in certain special circumstances. Such circumstances include occasions when the psychiatrist is currently supervising the trainee, when a particular psychiatrist has repeated sexual relationships with trainees and when a group of psychiatrists voluntarily pledge to abstain from such relationships. Conclusions: Institutions involved in psychiatric training should develop guidelines for dealing with such relationships, adopting a generally permissive attitude toward them with clear exceptions in special cases.
Bilingual Professionals in Community Mental Health Services
Authors: Mitchell Penny , Malak Abd , Small David 
Published: January 2008

Objective: This paper presents results from research that explored the roles of bilingual professionals in community mental health services in the Sydney metropolitan area of New South Wales. There were two main objectives to the research: (i) to identify and describe the roles of bilingual professionals that are important in improving the quality of community mental health services for clients from non-English-speaking backgrounds (NESB); and (ii) to identify and describe the factors that facilitate and inhibit the conduct of these roles. Method: Data collection involved indepth interviews with bilingual professionals and team leaders in community mental health services and various other community health services; and various staff responsible for policy and service development with regard to cultural diversity. Results: Bilingual mental health workers were found to have at least four critical roles. These were (i) direct clinical service provision to NESB clients; (ii) mental health promotion and community development; (iii) cultural consultancy; and (iv) service development. Respondents reported that the latter three roles were seriously underdeveloped compared to the clinical service provision role. Conclusions: It is critical that service managers implement strategies to make better use of the linguistic and cultural skills of bilingual professionals. In addition to their role in clinical service provision ways must be found to facilitate the community-focused, cultural consultancy and service development roles of bilingual professionals employed in mental health services.
Childhood Abuse, Parenting and Postpartum Depression
Authors: Buist Anne 
Published: January 2008

Objective: While the potential negative effects on children of maternal depression has been documented, the influence of a maternal history of childhood abuse on child development is unclear. This study, the first stage of a 3–year follow-up study, looks at childhood abuse in women with depression in the postpartum period. Method: Fifty-six women admitted with postpartum depressive disorders were assessed with respect to their wellbeing, relationships and infant interaction. Twenty-eight women had a history of sexual abuse before the age of 16, nine physical/ emotional abuse and 19 had no history of abuse. Results: The mother-infant relationship was seen to be impaired in the sexually abused group (p = 0.007). The significance increased when all abused women were compared to controls (p = 0.001). In addition, abuse was associated with more severe depression on the Beck Depression Inventory (p = 0.046), and a trend to higher anxiety and longer lengths of stay (p = 0.05 for physical abuse). Partners rated themselves as being more skilled and confident parents. Conclusions: The effect of childhood abuse was indistinguishable between emotional and physical abuse in postpartum depressed women. The most significant effect was a deleterious one on the mother-infant relationship in those women with a history of abuse.
Chronic Fatigue Syndrome: An Immunological Perspective
Authors: Vollmer-Conna Uté , Lloyd Andrew , Hickie Ian , Wakefield Denis 
Published: January 2008

Objective: The aim of this study is to review research examining an immunological basis for chronic fatigue syndrome (CFS) and to discuss how a disturbance in immunity could produce central nervous system (CNS)-mediated symptoms. Method: Data relevant to the hypothesis that abnormal cytokine release plays a role in the pathogenesis of CFS are reviewed as well as recent evidence relating to potential mechanisms by which immune products may enter the brain and produce a disturbance in CNS processes. Results: Examinations of cytokine levels in patients with CFS have produced inconclusive results. Recent evidence suggests that abnormal release of cytokines within the CNS may cause neural dysfunction by a variety of complex mechanisms. Conclusion: Neuropsychiatric symptoms in patients with CFS may be more closely related to disordered cytokine production by glial cells within the CNS than to circulating cytokines. This possibility is discussed in the context of unresolved issues in the pathogenesis of CFS.
The Clinical Use of Plasma Clozapine Levels
Authors: Bell Ron , McLaren Andrew , Gaianos Jason , Copolov David 
Published: January 2008

Objective: This review examines the evidence supporting the proposition that a threshold clozapine plasma level can predict clinical response. In addition, it provides a brief overview of the pharmacokinetics, side effects, drug interactions and assay methodology of clozapine. Method: A comprehensive search of relevant literature was made with respect to the above criteria. The findings were collated and analysed to produce an overview of the usefulness of using clozapine levels in clinical practice. Results: Most researchers find that, although the correlation between dose of cloza pine and clinical effect is not high, a threshold plasma level of 350–420 ng mL of clozapine is associated with an increased probability of a good clinical response to the drug. Results vary, however, with the study design. Conclusions: The data reviewed present a case for increasing the dose of cloz apine in non-responsive patients to achieve a plasma level of at least 350–420 ng mL−1. Non-response at these levels, however, should not preclude a further upward titration of dose. This should occur unless (i) clinical response is obtained at a lower dose, (ii) intolerable side effects occur, or (iii) a daily dose of 900 mg is reached.
Early Intervention in Schizophrenia in the Elderly
Authors: Burke David , Shome Sushmita 
Published: January 2008

Objective: The aim of this paper is to briefly review the literature on early intervention in schizophrenia in the elderly, and to present six cases of schizophrenia in the elderly which highlight the need for assertive management of the type encouraged widely for early onset illness in younger patients. Method: Six case histories are presented. Results: All six patients were diagnosed with DSM-IV schizophrenia, all were single and all were socially isolated. They required involuntary admission, treatment with depot antipsychotics, extensive psychosocial intervention and community treatment orders. The use of these treatment strategies led to a positive outcome in each case. Conclusion: The authors argue that assertive treatment of elderly patients with schizophrenia should be pursued with the enthusiasm often reserved for younger, early onset patients, and that therapeutic optimism is required and warranted.
Deliberate Exposure to Motor Vehicle Exhaust Gas: The Psychosocial Profile of Attempted Suicide
Authors: Skopek Michaela A. , Perkins Richard 
Published: January 2008

Objective: Deliberate exposure to motor vehicle exhaust gas has become the second most commonly used method of suicide in Australia. In an attempt to understand the factors contributing to the rise in popularity of this method, the psychosocial profiles, factors influencing method choice and circumstances of the act of self-harm were examined in a group of survivors. Method: A cross-sectional cohort study of 30 patients presenting for hyperbaric oxygen treatment having survived deliberate exposure to car exhaust gas was undertaken. A structured clinical interview was administered together with scales measuring depression, hopelessness and suicidal intent. Daily assessment of mental state and cognitive function was performed. Results: Factors common to the majority of subjects included male gender, age group of 20–50 years, and alcohol abuse. Relationship discord was the most common precipitating factor. Reasons given for choice of this method included the availability and accessibility of motor vehicles, painlessness, awareness that the method was lethal, knowledge of another person's successful suicide by this method and awareness of the method through media portrayal. Most of the cars used did not have engines fitted with catalytic converters, substantially increasing the risk of toxicity. Regret of the attempt, denial of further suicidal ideation after the event, and the absence of a suicide note were common findings. Most denied excessive time spent planning. The most common diagnosis in this group was adjustment disorder with depressed mood. Suicide intent scores were not high, inconsistent with the majority of patients being aware of the lethality of the method. Conclusion: Sociodemographic findings resemble those of psychological autopsy studies of subjects completing suicide by this method. Survival in this group was due to failure of the method or unexpected discovery rather than patient factors. This population described the method as highly acceptable and accessible emphasising the urgent need for reduction of access to this means of suicide in Australia.
Length of Stay, Leave and Re-Offending by Patients from a Queensland Security Patients Hospital
Authors: Green Bob , Baglioni Anthony J. 
Published: January 2008

Objective: The release of patients from a security patients hospital has been the subject of public controversy. The present study uses empirical data to examine the length of stay, leave, and re-offending of patients from a security hospital. Methods: Survival analysis was used to examine factors that may be predictive of length of stay and time under restriction, as well as time to first overnight leave. Data on re-offending were obtained from a variety of sources and were compared with seriousness of index offences. Results: Consistent with international research, patients with more serious offences had longer hospitalisations. Patients with more serious offences were also hospitalised for longer periods before leave was granted. Compared with international studies, re-offending was in the lower range. Conclusions: Despite concerns raised in the media regarding patient ‘dangerousness’, time spent in hospital and the granting of leave, patients with serious offences were more likely to be hospitalised longer, which suggests decision makers do take into account public safety.
Relationship History and Relationship Attitudes in Gay Males and Lesbians: Attachment Style and Gender Differences
Authors: Ridge Stacy R. , Feeney Judith A. 
Published: January 2008

Objective: The objective of the present study was to assess the applicability of attachment theory to the relationships of gay males and lesbians, with particular emphasis on parental relationships, relationship satisfaction, sexual attitudes and ‘coming out’ as being homosexual. Methods: Gay males (n = 77) and lesbians (n = 100) completed questionnaires assessing attachment style, working models of attachment, early relationships with parents and relationship history, status and functioning. A comparison sample of heterosexual participants completed measures of attachment style and relationship history. Results: Relative frequencies of attachment styles were similar for homosexual and heterosexual samples. Contrary to previous research using largely heterosexual respondents, no link between early parenting and attachment style was found. However, homosexual males reported more positive early relationships with mothers than did females. Associations of attachment style with working models, relationship variables and sexual attitudes largely supported those based on heterosexual samples. Gender and attachment style differences were found in reported effects of ‘coming out’ on relationships with parents. Conclusions: Overall, the results suggest that insecure attachment may not be over-represented in gay and lesbian samples, but that insecurity is associated with less relationship satisfaction and with problems related to the disclosure of sexual orientation. The implications of these findings for research and clinical practice are addressed.
Religious—Sociocultural Psychotherapy in Patients with Anxiety and Depression
Authors: Razali S. M. , Hasanah C. I. , Aminah K. , Subramaniam M. 
Published: January 2008

Objective: To show the effectiveness of incorporating religious–sociocultural components in the management of patients with generalised anxiety disorders and major depression who have strong religious and cultural backgrounds as compared with a normal psychotherapeutic approach. Methods: One hundred and three cases of anxiety and 100 cases of depression with strong religious and cultural backgrounds were randomly assigned to the study or control groups. Both groups received standard treatment for their respective illnesses. The study group was given additional religious–sociocultural psychotherapy. They were followed for 6 months and were assessed in a double-blind fashion using the Hamilton Anxiety Rating Scale or the Hamilton Depression Rating Scale. Results: Patients receiving additional religious–sociocultural psychotherapy responded significantly faster than those who received standard treatment. However, the difference became non-significant at the end of 6 months. Conclusions: Incorporating a religious and sociocultural component in the treatment program rapidly improved anxiety and depressive symptoms in patients with strong religious and cultural backgrounds. The present study demonstrates a need for more sensitivity to religious–sociocultural issues in the field of mental health.
Mental Health Professionals' Attire
Authors: Rajagopalan Mani , Santilli Mario , Powell David , Murphy Megan , O'brien Marice , Murphy John 
Published: January 2008

Objective: Our aim was to obtain mental health patients' views on psychiatrists' and case managers' attire Methods: Eighty-six patients treated at a community mental health service were surveyed. Various types of commonly worn attire were listed. Respondents were asked to choose what they thought was most appropriate for their psychiatrist and case manager to wear. Results: Over 50% of respondents felt that psychiatrist or case manager dress was not an important issue. However, those who felt that it was preferred less formal attire. Conclusions: Psychiatrists and case managers in a community mental health team could consider adopting less formal attire. This conclusion is limited by the small sample and may be relevant to rural areas only. Further research is needed in urban centres. Implications of these findings are discussed.
Neuroleptic Malignant Syndrome Associated with Olanzapine
Authors: Johnson Vanessa , Bruxner George 
Published: January 2008

Objective: The aim of the present paper is to report a case of Neuroleptic Malignant Syndrome (NMS) occurring 2 days after olanzapine was added to the treatment regimen of an elderly patient with Schizoaffective Disorder. The patient had a previous history of NMS associated with risperidone. Clinical picture: Two days after commencement of olanzapine, the patient presented in a stuporous state with dysarthria and increased muscle tone with cogwheeling. His level of consciousness fluctuated over the following 24 h with worsening rigidity, the onset of a mild fever, tachycardia and elevated blood pressure. Biochemical screening revealed markedly elevated creatine kinase. Treatment: Olanzapine was ceased and intravenous fluid replacement commenced. Hourly physical observations were instigated, as was regular serum monitoring of creatine kinase level. Outcome: Over the subsequent 48 h, there was gradual clinical improvement with resolution of dysarthria, ataxia, rigidity and fever. The patient was returned to the psychiatric ward 3 days after his admission to the medical ward. Conclusions: Olanzapine therapy can be associated with NMS. To our knowledge, there are no previous reports of this in the literature.