bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cutaneous Wegener's granulomatosis: A variant or atypical localized form?
Authors: Kuchel Johanna , Lee Stephen 
Published: December 2004

SummaryA 74‐year‐old woman presented with an antineutrophil cytoplasmic antibody titre‐negative, treatment‐responsive Wegener's granulomatosis confined to the integument. She initially presented with a painful left postauricular nodulo‐ulcerative lesion with chronically discharging sinuses. This lesion was effectively treated with a short, 3‐month course of cyclophosphamide and 24 months of oral prednisone. After 5 months in remission, she developed further similar ulcers, in addition to painless nodules on her ankles and feet bilaterally. These lesions resolved with an extra 32 months of high‐dose oral prednisone therapy before complete remission. At most recent review, there was no evidence of disease recurrence 21 months after ceasing all active treatment. Histology demonstrated a granulomatous inflammation. No systemic disease progression to the upper respiratory tract, lung or kidney was detected. This case highlights the importance of being aware of atypical or partial presentations of Wegener's granulomatosis. This diagnosis needs to be considered with patients presenting with a culture‐negative chronic ulcer, where malignancy and trauma have been excluded. This will avoid unnecessary surgery and ensure early diagnosis and effective treatment of a disease that is disfiguring and usually fatal if inappropriately treated.
Multiple squamous cell carcinomas complicating linear porokeratosis
Authors: Curnow Paul , Foley Peter , Baker Christopher 
Published: December 2004

SummaryLinear porokeratosis is a distinctive variant of porokeratosis with malignant transformation, a known but infrequently reported complication. We report a case of linear porokeratosis on the right leg of a 57‐year‐old man present since infancy that, over a 2‐year period, developed two squamous cell carcinomas within the lesion. Concurrent right inguinal lymphadenopathy was demonstrated on biopsy to be reactive in nature.
Pachydermodactyly: A forme fruste of knuckle pads?
Authors: Chamberlain Alexander J , Venning Vanessa A , Wojnarowska Fenella 
Published: December 2004

SummaryA 16‐year‐old boy presented with painless swellings localized to the radial and ulnar aspects of his second through to the fifth fingers on the left hand, with more subtle changes affecting two fingers on the opposite hand. This had developed in the absence of mechanical trauma. Investigations for an arthropathy were negative, while a biopsy showed marked epidermal hyperplasia and an expanded dermis. These features are typical of pachydermodactyly, a benign dermatosis of uncertain aetiology. The interesting feature of this case is the presence of knuckle pads in the father of the patient, which raises the possibility that these two similar entities are related.
Pedigree of multiple benign adnexal tumours of Brooke–Spiegler type
Authors: Saunders Helen , Tucker Paul , Saurine Tricia , Watkins Frances 
Published: December 2004

SummaryA pedigree of autosomal dominant expression of multiple benign adnexal tumours is presented. Seven cases spanning three generations are discussed. The clinical manifestations of these tumours are quite variable, including multiple papules concentrated on the face, scalp nodules and a large turban tumour. One member of the family had a linear papular eruption involving one half of his body. Histopathology of all lesions demonstrated benign adnexal characteristics, including well‐characterized eccrine spiradenomas, trichoepitheliomas and an eccrine cylindroma. The cutaneous tumours occurring in these patients have continued to develop during their lifetimes. The authors propose that this pedigree has phenotypic characteristics consistent with Brooke–Spiegler syndrome.
Pigmented fungiform papillae on the tongue in an Asian man
Authors: Scarff Catherine E , Marks Robin 
Published: December 2004

SummaryFungiform papillae of the tongue vary in their appearance. It is not rare for them to be pigmented in black subjects, but this is less common in Asians. We report a case of pigmented fungiform papillae in a 65‐year‐old Vietnamese man. The patient also had recurrent aphthous ulceration and hepatitis C. Pigmentation affected all fungiform papillae and was asymptomatic. Macrocytosis was noted on full blood examination, while liver function tests were normal. The pigmentation of the fungiform papillae remained stable.
Contact dermatitis to Shiitake mushroom
Authors: Curnow Paul , Tam Mei 
Published: December 2004

SummaryA 44‐year‐old woman with occupational allergic contact dermatitis to Shiitake mushroom (Lentinus edodes), sawdust and thiuram. She presented with an 8‐month history of hand and face dermatitis that developed after working for 2.5 years in a mushroom farm. Within 3 months of ceasing work at the farm, her symptoms resolved completely.
Reactive angioendotheliomatosis in the setting of antiphospholipid syndrome
Authors: Thai Keng‐Ee , Barrett Wade , Kossard Steven 
Published: December 2004

SummaryA 31‐year‐old man with systemic lupus erythematosus and antiphospholipid syndrome developed erythematous purpuric plaques distributed over the lower chest, abdomen and upper thighs. Biopsy of lesional skin revealed intravascular proliferation of endothelial cells with associated microthrombi formation. The histological pattern was consistent with reactive angioendotheliomatosis, a rare reactive pattern seen associated with disparate medical conditions. The pathogenesis of the reactive angioendotheliomatosis in our patient was suspected to be related to his procoagulant state; thrombi formed despite a therapeutic international normalized ratio while on warfarin. His lesions began to resolve with the cessation of warfarin and commencement of subcutaneous enoxaparin, oral clopidogrel and oral aspirin. The skin biopsy findings were pivotal in influencing the change of therapy in this patient and decreasing his immunosuppression.
An Examination of the Efficiency of the 12-Item SPHERE Questionnaire as a Screening Instrument for Common Mental Disorders in Primary Care
Authors: Clarke David M. , Mckenzie Dean P. 
Published: December 2004

Objective: To further examine the screening capabilities (sensitivity, specificity, etc.) of the 12-item Somatic and Psychological Health Report (SPHERE) questionnaire. Method: A more extensive examination was carried out on data presented in a recent report. Results: The sensitivities of the questionnaire, scored in three different ways, ranged from 100% to 47%. Specificities ranged from 18% to 72%. As a global screen for mental disorder it had a very high false-positive rate, with, in one sample, 83% of patients screening positive while only 27% had a current psychiatric diagnosis, and in the other sample 55% screened positive with only 13% having a current psychiatric diagnosis. The PSYCH-6 scale used by itself had similar properties to the 30-item General Health Questionnaire from which it was derived. The addition of the scale measuring fatigue (SOMA-6) increased or decreased specificity depending on how it was combined with the PSYCH-6 scale. Conclusion: The evidence is insufficient to recommend the 12-item SPHERE, in its current form, as a screening instrument for DSM-IV mental disorders in general practice, as the specificity is inadequate. Ways of raising the threshold for caseness need to be explored. The argument for adding a measure of fatigue to a general screening measure is not supported.
Ethically Sensitive Mental Health Care: Is there a Need for a Unique Ethics for Psychiatry?
Authors: Crowden Andrew 
Published: December 2004

Objective: This article takes up the challenge to comment and extend on Jennifer Radden's claims for a ‘unique ethics for psychiatry’ articulated in ‘Notes towards a professional ethics for psychiatry’, Australian and New Zealand Journal of Psychiatry 2002; 36:52–59. Method: The author is analytically trained in bioethics and employs the method of conceptual analysis. Results: Psychiatry is a unique mental health care practice which calls for unique ethical responses. However, it doesn't necessarily follow that a unique ethics for psychiatry is required. Conclusions: A more plausible explanation for how philosophical ethics informs the unique nature of psychiatric practice is better articulated within claims about the role-related nature of particular health care practices and the influence that the virtue of phronesis (practical wisdom) has on a clinician's decision-making and judgement.
Repetition Risk for Adolescent Self-Poisoning: A Multiple Event Survival Analysis
Authors: Martin Reith David , Whyte Ian , Carter Greg 
Published: December 2004

Objectives: To examine risk factors associated with re-presentation (event rates) following an initial episode of hospital treated self-poisoning. Method: A longitudinal cohort study using the Hunter Area Toxicology Service (HATS) database of all presentations to hospital of self-poisoned patients aged 10–19 in Newcastle and Lake Macquarie Regions of New South Wales from January 1991 to December 1995. The study factors were: age, gender, employment status, ‘substance abuse’ and psychiatric diagnosis at index (first documented episode during the study time-period) admission. The main outcome measure was re-presentations per unit time. Time-event analysis (multivariate) was used to compare re-presentation rates per person-year exposure to the study factors. Results: There were 450 patients who presented on a total of 551 occasions. The median and modal age at initial presentation was 17. Three hundred and nine (69%) were female and 141 (31%) were male. The probability (95% CI) of a patient re-presenting within one year of an index admission with self poisoning was 0.09 (0.07–0.12) and within 5 years was 0.16 (0.12–0.21). The adjusted rate ratios for episodes of re-presentation were: any ‘substance abuse (ever)’ 3.87 (2.08–7.21), ‘alcohol abuse’ 2.32 (1.15–4.68),‘benzodiazepine abuse’ 4.89 (1.63–14.62), schizophrenia and other psychotic disorders (DSM-IV) 2.85 (1.2–6.79), and any personality disorder (DSM-IV) 2.68 (1.73–4.16). Conclusions: Interventions to decrease recurrence rates for adolescent self poisoning should be directed towards substance (particularly alcohol or benzodiazepine) abuse, nonaffective psychoses and personality disorder.
Outcome Evaluation of a Statewide Child Inpatient Mental Health Unit
Authors: Gavidia-Payne Susana , Littlefield Lyn , Hallgren Mats , Jenkins Peter , Coventry Neil 
Published: December 2004

Objective: To assess the impact of inpatient intervention, provided by a child mental health unit in Victoria, Australia, on a number of key child and family variables. Method: Pre-post test design with a four-month follow up was applied to assess changes across time. Twenty-nine parents, 42 teachers, and 37 referrers provided reports on a series of child, parent, and family functioning measures. Results: Significant improvements in child behaviour and functioning, parenting competency and efficacy, parenting practices, and reduced parental depression were observed over time. Changes in family functioning scores were not significant; however, univariate analysis indicated improvements in two individual subscales. Conclusions: There is a lack of studies of the outcome of inpatient interventions of children in psychiatric settings. However, as shown in the present study, improvements in functioning can be detected and obtained with short-term interventions that focus on both children and families. Methodological shortcomings (i.e. absence of comparison groups) and lack of specificity in intervention variables, however, are difficulties yet to be overcome in evaluation research of inpatient treatment.
Incidence of Catatonia in Children and Adolescents in a Paediatric Psychiatric Clinic
Authors: Thakur Anupam , Jagadheesan K. , Dutta Siddartha , Sinha Vinod Kumar 
Published: December 2004

Objective: To investigate the incidence and phenomenology of catatonia in a child and adolescent population. Method: Children and adolescents who had attended a paediatric psychiatric outpatient clinic between April and July 2001 were examined for catatonic signs with a formal catatonia rating scale, and patients who had at least two catatonic signs were included. Results: Eleven patients met the criteria (5.5% of the entire sample and 17.7% of the patients with affective and nonaffective psychotic disorder); of them eight had an affective disorder and three a nonaffective disorder. The mean catatonic scores were significantly high for males and patients with mental retardation. Conclusion: This study shows that catatonia occurs in children and adolescents. Further studies are essential to clarify the distribution of catatonia across various diagnoses and the outcome of paediatric catatonia.
Predisposition to Depression: The Role of Attachment
Authors: Beatson Josephine , Taryan Suzanna 
Published: December 2004

Objective: To examine the hypothesis that adverse early relational experiences causing activation of the hypophysial-pituitary-adrenal (HPA) axis during critical early stages of development can predispose to depression. Patients thus affected are likely to manifest insecure patterns of attachment in close relationships and are vulnerable to depression after adverse life events. Method: The literature pertaining to sensitization of the HPA axis in early life and the neurobiology of attachment is examined. Results: Adverse early relational experiences can result in activation of the HPA axis, causing sensitization of depression pathways in the brain. Secure attachment acts as a buffer against HPA activation in response to stress. Infants with insecure attachment lack this buffering effect and may be predisposed to depression and other psychiatric disorders in response to psychosocial stressors. Conclusions: There is a patient group predisposed to depression on the basis of adverse early life experience. In these cases, the neurobiology of attachment offers a means of integrating findings concerning sensitization of the HPA axis in infancy, the effects of early life experience on brain development, and predisposition to depression and other psychiatric disorders. These findings have important implications for the development of interventions aimed at prevention and treatment for this patient group.
Relationship Between Mental Health Disorders and Unemployment Status in Australian Adults
Authors: Comino Elizabeth J. , Harris Elizabeth , Chey Tien , Manicavasagar Vijaya , Wall Jonine Penrose , Davies Gawaine Powell , Harris Mark F. 
Published: December 2004

Objectives: To compare the prevalence of anxiety and affective disorders among employed and unemployed patients and to compare the type of treatment received between the two groups for these disorders. Method: A secondary analysis of the 1997 National Survey of Mental Health and Wellbeing of Adults cross-sectional study was undertaken. Results: Unemployed adults were more likely to have symptoms of anxiety (OR = 3.09, 95% CI = 2.80–3.41) or an affective disorder (OR = 2.11, 95% CI = 1.95–2.27) or anxiety and/or affective disorders (OR = 2.53, 95% CI = 2.37–2.69). Unemployed participants with symptoms were less likely to have seen a general practitioner for treatment but when they did they received similar care to employed participants. Conclusions: These results confirm studies reported elsewhere that the prevalence of symptoms of anxiety and/or affective disorders is higher for unemployed people. The data provide further evidence that people with an anxiety and/or affective disorder who are unemployed are not seeking medical treatment. However, unlike previous research undertaken by our group, these results indicate that symptomatic adults who seek help receive comparable treatment in general practice irrespective of their employment status.
Perceptions of Outcome from Electroconvulsive Therapy by Depressed Patients and Psychiatrists
Authors: Brodaty Henry , Berle David , Hickie Ian , Mason Cathy 
Published: December 2004

Objective: To determine (i) patients' expectations before and attitudes after a course of electroconvulsive therapy (ECT); (ii) the concordance between the perceptions of patients and their psychiatrists; and (iii) whether patients and psychiatrists are accurate in predicting a positive outcome with ECT. Method: Eighty-one inpatients (mean 67.2 years, median 70 years) with major depression were assessed before and after receiving a course of ECT. On both occasions, patients were administered the Hamilton Rating Scale for Depression (HRSD) and the Global Assessment of Functioning Scale (GAF). Patients and two research psychiatrists rated their expectancy of treatment outcome before ECT and their impression of outcome after ECT was completed. Results: Both HRSD and GAF scores improved with treatment. Before treatment, 39.7% of patients believed ECT would improve their condition. Following treatment, 68.8% of patients thought their condition had improved as a result of ECT. There was only slight agreement between patients' and psychiatrists' expectations before and ratings of efficacy after treatment. The psychiatrists', but not the patients', pretreatment expectations of ECT efficacy were significantly associated with improvement in depression as measured by the effect size change in HRSD score from pre- to post-ECT. Conclusions: Patients were poor judges of ECT outcome and, in this sample, less positive than previous reports had suggested. Psychiatrists' expectations however, were generally accurate indicating good clinical selection.
Gender Differences in the Relationship Between Acute Stress Disorder and Posttraumatic Stress Disorder Following Motor Vehicle Accidents
Authors: Bryant Richard A. , Harvey Allison G. 
Published: December 2004

Objective: Acute stress disorder (ASD) describes initial posttraumatic stress reactions that purportedly predict subsequent posttraumatic stress disorder (PTSD). This study aimed to index the influence of gender on the relationship between ASD and PTSD.Method: Motor vehicle accident survivors were assessed for ASD within 1-month posttrauma (n = 171) and were subsequently assessed for PTSD 6-months later (n = 134).Results: Acute stress disorder was diagnosed in 8% of males and 23% of females, and PTSD was diagnosed in 15% of males and 38% of females. In terms of patients followed up at 6 months, 57% and 92% of males and females, respectively, who met criteria for ASD were diagnosed with PTSD. Females displayed significantly more peritraumatic dissociation than males.Conclusion: Peritraumatic dissociation and ASD is a more accurate predictor of PTSD in females than males. This gender difference may be explained in terms of response bias or biological differences in trauma response between males and females.
The Therapeutic Alliance: The Key to Effective Patient Outcome? A Descriptive Review of the Evidence in Community Mental Health Case Management
Authors: Howgego Irene M. , Yellowlees Peter , Owen Cathy , Meldrum Lenore , Dark Frances 
Published: December 2004

Objective: The aim of this review was to examine the level of evidence supporting the assumed link between a positive therapeutic alliance among patients and case managers and effective outcome for patients with a mental illness who are managed in community mental health services. Method: MedLine, PsychINFO and Social Sciences Index search of articles from 1986 to 2001 returned 84 articles and two texts. Inclusion criteria were the use of validated measures and relevance to psychiatry and community case management. Results: A definite correlation exists in the psychotherapy literature between the therapeutic relationship and improved outcomes, with its potential as a prognostic indicator acknowledged. Attempts to apply the concept to patients outside the field of psychotherapy have been slow, although expansion of the concept to other forms of change-inducing therapy was a current trend. Issues of definition, quantification and measurement of the relationship caused rigorous debate in the literature. Case management research demonstrating the importance of the therapeutic relationship and ‘goodness-of-fit’ between patients and case managers was sparse with no published Australian studies. Conclusions: The level of evidence supporting the link between the therapeutic alliance of patients with mental illness and improved outcomes although sparse is encouraging. It indicates the potential of the alliance as a predictor of outcome for patients engaged in case management services in community mental health. Research to determine the role and effectiveness of the alliance in the patient/case manager dyad is needed to define this potential. Effectiveness of clinical practice in the case management field could be enhanced if research findings confirmed the genesis and value of the alliance in case management. Focus on relationship strategies as a clinical tool gives the clinician and service provider a potential vehicle for promoting partnerships with the seriously mentally ill person in managing their illness and optimizing their strengths in the community.
Use of Antidepressants by General Practitioners and Psychiatrists in Australia
Authors: Mcmanus Peter , Mant Andrea , Mitchell Philip , Britt Helena , Dudley John 
Published: December 2004

Objective: To examine the antidepressant prescribing patterns of psychiatrists and general practitioners (GPs) in Australia, focusing specifically on: the prescribed daily dose, the relative proportions (from subsidized dispensing data) of prescriptions written, and how these proportions change over time for a newly listed antidepressant drug (using paroxetine as an example). Method: Retrospective analyses of subsidized claims data (comprising nearly 90% of the community supply of antidepressants) and prescriber surveys. Results: General practitioners prescribe 86% of subsidized antidepressants in Australia. Almost three-quarters of the antidepressant prescriptions prescribed in primary care management are also initiated by a GP. Psychiatrists prescribed higher doses than general practitioners for all the antidepressants examined. For paroxetine, a higher than average proportion of scripts were written by psychiatrists when the drug was initially available and it only reached the GP/psychiatrist split seen with an established drug in the same therapeutic class (fluoxetine) four years after marketing. The most prominent type of depression that GPs believed they were treating was ‘chronic mild depression’, which contrasts with the subsidized indication for all newer antidepressant classes of ‘major depressive disorders’. Conclusions: General practitioners are the major providers of treatment for depression in Australia. When writing prescriptions for tricyclic antidepressants GPs use doses lower than those recommended for major depression, however, most management in primary care is not for conditions regarded by the GP as major depression. A significant number of prescriptions for the newer antidepressants may not accord with the Pharmaceutical Benefits Scheme (PBS) restrictions for use.