bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relative Misery and Youth Suicide
Authors: Barber James G. 
Published: March 2003

Objective: To test the ‘absolute misery hypothesis’ that suicide rates are a proxy measure of psychological maladjustment within the general population of young people. Method: Study I regressed World Health Organization statistics on youth suicide rates on measures of adolescent adjustment across seven countries. Study II analysed the results of a Canadian survey involving 2111 children from 31 schools in grades seven to 12 (ages 11–20 years, mean = 15.5, SD = 1.7). The survey contained measures of suicidality, depressed affect and social comparison. Results: Study I found that male suicide was much more likely in psychologically welladjusted countries than in less well-adjusted countries. Although not statistically significant in a sample of this size (n = 7), correlation analysis suggested that the relationship between suicide and adjustment was in the opposite direction for females. Study II found that suicidality in boys was not associated with depressed affect on its own, or with social comparison on its own, but was associated with the combination of depressed affect and negative social comparison. By contrast, suicidality in girls was significantly associated both with absolute and comparative levels of unhappiness. Conclusions: A new, ‘relative misery hypothesis’ is proposed to account for these results. Under this hypothesis, the disposition of vulnerable young men towards suicide is influenced by their affective state relative to others. When those around them are perceived to be better off than they are, the predisposition of young men to suicide is increased. By contrast, female suicide is predicted to be less influenced by young women's relative state, and more by their absolute level of unhappiness. The primary implication of the relative misery hypothesis is that the prevention of young male suicide in particular is likely to require methods that discourage vulnerable individuals from making negative social comparisons.
Evolutionary Approaches to Psychopathology: The Role of Natural Defences
Authors: Gilbert Paul 
Published: March 2003

Objective: Psychoanalytic theories of the mind emerged in the immediate post-Darwinian era of the 1880s and 1890s. Since that time much has changed in both psychoanalytic and evolutionary theorizing. This paper explores recent evolutionary thinking on psychopathology. Method: Relevant literature was reviewed. Results: This paper outlines some of the common behavioural defence mechanisms and then explores ways in which they are represented in various disorders, with a focus on depression. This paper suggests that ‘symptoms’ can be related to the activation of evolved defence mechanisms to respond to losses and threats. Such will involve, for example, anxious arousal and heightened vigilance and attention to the threat, with the type of defence (e.g. fight, flight, submit, help seeking) being mirrored in particular symptom presentations. Conclusion: Defences can become pathological when they are too easily aroused or prolonged, are arrested (aroused but not expressed) and/or ineffective.
Better Mental Health Services for Young People: Responsibility, Partnerships and Projects
Authors: Birleson Peter , Luk Ernest S.L. , Mileshkin Cristea 
Published: March 2003

Objective: This paper argues that adolescent psychiatry is best linked with child psychiatry and opposes separate youth mental health programmes for 12–25-year-olds. It reports on the current status of services and considers how adult mental health services (AMHS) can improve services for young adults (18–25-year-olds). Method: Factors in development, psychopathology, prevention, training and service systems are reviewed to suggest that current child and adolescent mental health service systems (CAMHS) are appropriate for 0–17-year-olds. Improvements in CAMHS are described from a Victorian perspective, including the model of specialist clinical programmes or teams for specific patient populations. Mechanisms are outlined for AMHS to better assist young adults from 18 to 25 years of age. Results: The model of clinical projects or clinical programme teams, developed in partnership with primary health and others, is a suitable vehicle to help AMHS to improve clinical services to their young adult populations. These may be funded from a variety of sources, including re-engineering existing service resources. Conclusions: Such developments complement the work of specialist research units and build local competencies. More programme development and evaluation is needed, which will require the support of the College and State and Commonwealth Mental Health Branches.
A Comparison of the Composite International Diagnostic Interview (CIDI-Auto) with Clinical Assessment in Diagnosing Mood and Anxiety Disorders
Authors: Komiti Angela A. , Jackson Henry J. , Judd Fiona K. , Cockram Alexandra M. , Kyrios Michael , Yeatman Richard , Murray Gregory , Hordern Celia , Wainwright Kylie , Allen Nicholas , Singh Bruce 
Published: March 2003

Objective: Increasingly, epidemiological studies are employing computerized and highly standardized interviews, such as the Composite International Diagnostic Interview (CIDIAuto), to assess the prevalence of psychiatric illness. Recent studies conducted in specialist units have reported poor agreement between experienced clinicians’ and CIDI-Auto diagnoses. In this study we investigated the concordance rate between clinicians and the CIDI-Auto for the diagnosis of six anxiety disorders and two mood disorders, whereby the CIDI-Auto was treated as the ‘gold standard’. Method: Subjects were 262 patients who were assessed by a clinical psychologist or psychiatrist and completed the CIDI-Auto at a tertiary referral unit for anxiety and mood disorders. Agreement between the clinicians’ diagnoses and the diagnoses generated by the CIDI-Auto according to both DSM-IV and ICD-10 codes, were examined by kappa statistics. Sensitivity and specificity values were also calculated. Results: Agreement between clinicians and the CIDI-Auto (DSM-IV) ranged from poor for social phobia and posttraumatic stress disorder (κ < 0.30) to moderate for obsessive– compulsive disorder (OCD; κ = 0.52). Agreement between clinicians and the CIDI-Auto (ICD-10) ranged from poor for major depressive episode (κ = 0.25) to moderate for OCD (κ = 0.57). With the CIDI diagnosis treated as the gold standard, clinicians’ diagnoses showed low sensitivity (κ < 0.70) for all the disorders except for OCD (for ICD-10), but high specificity (κ < 0.70) for all the disorders. Conclusion: Poor agreements between experienced clinicians and the CIDI-Auto were reported for anxiety and mood disorders in the current study. A major implication is that if diagnosis alone directed treatment, then patients could receive different treatments, depending on whether the computer, or a clinician, made the diagnosis.
The Humble Case Report
Authors: Walter Garry , Rey Joseph M. , Dekker Floor 
Published: March 2003

Objective: There is negligible systematic information about case reports in the psychiatric literature. We aimed to describe case report articles published in the Australian and New Zealand Journal of Psychiatry (ANZJP), to provide data about the quality of evidence they offer, to ascertain changes over time and to make recommendations, based on our findings, about these articles. Method: All articles describing cases which appeared in the ANZJP between 1967 and 1999 were identified and examined. Results: 256 articles describing a total of 479 cases were published over the study period. Fifty-five per cent of articles reported an unusual presentation. Thirty-eight per cent of cases had a mood disorder and 24% had a psychosis. Seventy-six per cent of patients had a positive outcome. Cases published in 1989–1999 were more likely to describe pharmacological treatments than cases published earlier. Conclusions: Clinical descriptions that lead to progress are undervalued. Case reports should retain a place in the ANZJP, provided they convey information that is new and useful (e.g. suggesting or refuting hypotheses) rather than simply document current practice or describe the unusual. Issues of patient consent and anonymity also warrant consideration.
Anorexia Nervosa in an Elderly Woman
Authors: Hill Rosalie , Haslett Christopher , Kumar Shailesh 
Published: March 2003

Objective: To demonstrate a case of anorexia nervosa in the elderly and to highlight the need for broadening of current diagnostic criteria. Clinical picture: First onset of anorexia nervosa in a 72-year-old woman following bereavement of her husband. Treatment: Nine treatments of electroconvulsive therapy. Outcome: Treatment resulted in remission of the depressive symptoms and improvement of eating behaviour. Conclusions: Anorexia nervosa does occur in the elderly and can be difficult to detect. Where comorbid depression exists it requires aggressive treatment.
Uses of Community Treatment Orders in New Zealand: Early Findings
Authors: Dawson John , Romans Sarah 
Published: March 2003

Objective: To assess the uses of Community Treatment Orders (CommTOs) in New Zealand. Method: A retrospective study of patients' records held by the regional administrator of mental health legislation and a survey of psychiatrists attending a conference in Dunedin. Results: Males under Community Treatment Orders (CommTOs) outnumbered females 6:4; a high proportion were considered to have a major psychotic disorder; and one fifth remained under a CommTO for more than a year without inpatient care. Among the psychiatrists, there was a high level of agreement that, when used appropriately, the benefits of CommTOs outweigh their coercive impact on the patients; the most strongly supported indicator for use was the promotion of compliance with medication. The rate of use of CommTOs in Otago is remarkably similar to the rate in Victoria, Australia. Conclusions: Records suggest that a significant proportion of patients under CommTOs are not soon readmitted; and many clinicians in New Zealand consider CommTOs to be a useful strategy for managing the community care of long-term patients with schizophrenia and major affective disorders.
Predictors of Types of Help Provided to People Using Services for Mental Health Problems: An Analysis of the Australian National Survey of Mental Health and Wellbeing
Authors: Parslow Ruth A. , Parslow Ruth A. , Jorm Anthony F. 
Published: March 2003

Objective: Using the 1997 National Survey of Mental Health and Wellbeing, this study examined the types of mental health help provided to those Australians who use mental health services. We also sought to identify the extent to which sociodemographic factors, patterns of psychiatric morbidity and type of health practitioner seen were associated with receiving different types of mental health help. Method: Multiple logistic regressions were undertaken to identify predictor variables associated with receiving information, medication, psychological therapy, practical help and help looking after oneself or one's home. A total of 25 predictor variables provided in the National Survey were considered including age, sex, marital status, labour force status, geographical location, education, psychological symptoms, neuroticism, diagnoses of affective, anxiety and substance-abuse disorders and self-identified depression, anxiety and substance abuse. The type of practitioner seen for mental health reasons was also considered. Results: Of the sociodemographic factors, age was the most consistently associated with receiving particular types of help. Younger respondents were more likely to have received information whereas older patients reported receiving more medication. As might be expected, the type and severity of psychiatric morbidity and the category of health professional seen were also associated with receiving particular types of mental health help. Conclusions: There are relatively few predictor variables that suggest possible bias in the types of help provided. Age group of recipient is an important exception. Our findings suggest that older recipients of mental health care are not provided the range of mental health treatments offered younger people who present with similar problems.
Access to Australian Mental Health Care by People from Non-English-Speaking Backgrounds
Authors: Pirkis Jane , Pirkis Jane , Burgess Philip , Meadows Graham , Dunt David 
Published: March 2003

Objective: This study aimed to examine access to mental health care for people from non-English-speaking backgrounds relative to that of people from English-speaking backgrounds, in the context of the mental health status of both groups; and to consider whether, if they perceive that they have needs for care, these needs are met. Method: The study used data from the population-based Australian National Survey of Mental Health and Wellbeing, conducted in 1997. Results: People from non-English-speaking backgrounds and English-speaking backgrounds were equally likely to experience anxiety disorders and affective disorders, but the former were less likely to experience substance-use disorders and any mental disorder. When those with each disorder type were considered alone, people from non-Englishspeaking backgrounds and English-speaking backgrounds were equally likely to use services for mental health problems. When those with perceived needs for care were considered in isolation, there was no difference between birthplace groups in terms of their likelihood of reporting that their needs were fully met. Conclusions: The study had several limitations (i.e. lack of detail on specific ethnic groups and exclusion of potential respondents who could not speak English), which mean that these findings should be interpreted with caution. There is a need to build on this populationbased work, by oversampling people from particular non-English speaking communities and ensuring that those who do not speak English are included in population samples. Such work will further clarify the relative ability of people from non-English-speaking backgrounds to access services, and the extent to which their needs are met.
Prevalence of Psychiatric Disorders in New Zealand Prisons: A National Study
Authors: Brinded Philip M.J. , Simpson Alexander I.F. , Laidlaw Tannis M. , Fairley Nigel , Malcolm Fiona 
Published: March 2003

Objective: The paper describes the methodologies and results obtained on a large cohort of prison inmates in New Zealand who were screened for psychiatric disorder. Method: All women and remanded male inmates in New Zealand prisons, and a randomly selected cohort of 18% of sentenced male inmates were interviewed. Interviewers used the Composite International Diagnostic Interview –Automated to establish DSM-IV diagnoses, and the Personality Disorders Questionnaire to identify personality disorder. All prisons in New Zealand were visited. Results: The results indicate markedly elevated prevalence rates for major mental disorder in the prison population when compared with community samples. This is especially the case for substance misuse, psychotic disorders, major depression, bipolar disorder, obsessive–compulsive disorder and posttraumatic stress disorder. Of particular concern is not only the increased prevalence rates for schizophrenia and related disorders but also the high level of comorbidity with substance misuse disorders demonstrated by this group. While 80.8% of inmates diagnosed with bipolar disorder were receiving psychiatric treatment in the prison, only 46.4% of depressed inmates and 37% of those suffering from psychosis were receiving treatment. Maori inmates were grossly overrepresented in the remand, female and male sentenced inmate population compared with the general population. Conclusions: A significant increase in provision of mental health services is required to cope with the high number of mentally ill inmates. The level of need demonstrated by this study requires a level of service provision that is quite beyond the capacity of current forensic psychiatry services, Department of Corrections Psychological Services or the prison nursing and medical officers. The elevated rates of common mental disorders argues for the use of improved psychiatric screening instruments, improved assessment and treatment capacities in the prison and an increased number of forensic psychiatric inpatient facilities to care for those psychotic inmates who are too unwell to be treated in the prison.
Routine Outcome Measurement in a Child and Adolescent Mental Health Service: An Evaluation of HoNOSCA
Authors: Brann Peter , Coleman Grahame , Luk Ernest 
Published: March 2003

Objective: This paper evaluates a range of properties for a clinician-based instrument designed for routine use in a child and adolescent mental health service (CAMHS). Method: The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is a new outcome measure with great promise. Case vignettes were used to examine interrater reliability. HoNOSCA was implemented for routine outpatient use by multidisciplinary staff with a return rate of 84%. The 305 ratings obtained at assessment were analysed by age, gender and diagnosis. Asample of 145 paired ratings with a 3-month interval were examined for the measurement of change over time. Results: Interrater reliability of the total score indicates moderate reliability if absolute scores are used and good reliability if the total score is used for relative comparisons. Most scales have good to very good reliability. The scales discriminated between age and gender in the expected way. HoNOSCA correlated with clinicians’ views of change and was sensitive to change over a 3-month period. The total score seemed a proxy for severity. Conclusion: Routine outcome instruments must be explored in settings where they will be used and with realistic training. HoNOSCA appears to be of value in routine outcome measurement and although questions remain about reliability and validity, the results strongly support further investigation.
Asystole During Electroconvulsive Therapy: A Case Report
Authors: Tang Wai-Kwong , Ungvari Gabor S. 
Published: March 2003

Objective: The objective of the report is to describe a case of asystole lasting for 18 s, which developed after a subconvulsive stimulus during electroconvulsive therapy (ECT) in a patient without pre-existing cardiovascular abnormality. A brief review of the relevant literature is also provided. Clinical picture: The patient was a 65-year-old Chinese man with a 2-year history of depression and good past medical health. Earlier he had responded well to a course of ECT without adverse effects. This time he presented with low mood, anhedonia, poor appetite and constipation. He did not respond to adequate trials with several antidepressant medications. When a subconvulsive stimulus was administered to determine the seizure threshold, no seizure activity was detected. However, immediately after the stimulus the patient developed an 18-s asystole, followed by bradycardia of 40 beats per minute for 10 s. The bradycardia resolved spontaneously before therapeutic intervention was effected. Treatment: Intravenous atropine was employed as premedication and suprathreshold stimulus was used in further ECT sessions. Outcome: Asystole did not recur in the subsequent six ECT sessions. Conclusion: When proper precautions are taken, asystole does not necessitate the suspension of further ECT sessions but intravenous atropine should be considered as premedication in such cases. Inducing anaesthesia with methohexital, avoiding excessive amounts of succinylcholine and employing suprathreshold stimulus and unilateral electrode placement may further lessen the likelihood of asystole in susceptible cases.
Imaging Normal and Abnormal Brain Development: New Perspectives for Child Psychiatry
Authors: Rapoport Judith L. , Castellanos Xavier F. , Gogate Nitin , Janson Kristin , Kohler Shawn , Nelson Phillip 
Published: March 2003

Objective: The availability of non-invasive brain imaging permits the study of normal and abnormal brain development in childhood and adolescence. This paper summarizes current knowledge of brain abnormalities of two conditions, attention deficit hyperactivity disorder (ADHD) and childhood onset schizophrenia (COS), and illustrates how such findings are bringing clinical and preclinical perspectives closer together. Method: A selected review is presented of the pattern and temporal characteristics of anatomic brain magnetic resonance imaging (MRI) studies in ADHD and COS. These results are discussed in terms of candidate mechanisms suggested by studies in developmental neuroscience. Results: There are consistent, diagnostically specific patterns of brain abnormality for ADHD and COS. Attention deficit hyperactivity disorder is characterized by a slightly smaller (4%) total brain volume (both white and grey matter), less-consistent abnormalities of the basal ganglia and a striking (15%) decrease in posterior inferior cerebellar vermal volume. These changes do not progress with age. In contrast, patients with COS have smaller brain volume due to a 10% decrease in cortical grey volume. Moreover, in COS there is a progressive loss of regional grey volume particularly in frontal and temporal regions during adolescence. Conclusions: In ADHD, the developmental pattern suggests an early non-progressive ‘lesion’ involving neurotrophic factors controlling overall brain growth and selected dopamine circuits. In contrast, in COS, which shows progressive grey matter loss, various candidate processes influencing later synaptic and dendritic pruning are suggested by human post-mortem and developmental animal studies.
Child and Adolescent Psychiatry in General Practice
Authors: Garralda Elena 
Published: March 2003

Objective: This review discusses the role of general practitioners and primary care health staff in the assessment, treatment and prevention of child and adolescent psychiatric disorders and to consider implications for service delivery. Method: Literature review. Papers were selected as having an empirical evidence base or as describing and documenting new initiatives in general practice. Results: A small proportion of about 3% of children present to general practice with behavioural or emotional problems, but psychiatric disorders in the context of somatic presentations are considerably more common. They are probably higher than in the general population reflecting an increased tendency by children with disorders to consult. Recognition by general practitioners is limited and few children with disorders are referred to specialist clinics. However, referrals are mostly appropriate: the more severely affected children in difficult psychosocial circumstances. A number of pilot studies have shown the feasibility and potential usefulness of setting up shifted specialist clinics in primary care and of training primary care doctors and other staff in the recognition or management of child mental heath problems. Conclusion: Primary care is an appropriate resource to help increase attention to child and adolescent mental health problems. Its potential requires further development and rigorous evaluation. Areas lending themselves to development include: improved medical undergraduate teaching and postgraduate training; suitable information and advice-giving on child mental health problems by the primary care team; the development of specific child and adolescent psychiatric interventions for use in the primary care setting; careful and discriminating development of shifted outpatient clinics for selected child psychiatric disorders; the development of focused protocols for referral to specialist services; further development of mental health promotion clinics in primary care.