bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adolescent Pregnancy: Psychopathology Missed
Authors: Quinlivan Julie A. , Petersen Rodney W. , Gurrin Lyle C. 
Published: March 2003

Objectives: Few data exist that explore the level of psychosocial problems and drug abuse in an Australian, adolescent, antenatal population. We set out to audit these data from a population of pregnant Western Australian adolescents. We also set out to examine whether social issues and the use of non-prescription drugs are routinely addressed in general public antenatal clinics. Methods: One hundred and sixty patients were involved in the prospective cohort study. In the assessed group, 100 consecutive patients from the King Edward Memorial Hospital Adolescent Antenatal Clinic were interviewed during the antenatal period to determine if any major psychosocial issues or a history of non-prescription drug abuse was present. The control group consisted of 60 adolescent patients who delivered in general antenatal clinics at three Perth metropolitan hospitals. Results: Sixty percent of the assessed group were identified as having a major psychosocial problem that interfered with their ability to carry out acts of daily living. Consumption of cigarettes, alcohol, marijuana, heroin and solvents were higher than that reported for the general Australian adolescent population. Of note, in the control group, many patients did not have a social, psychological, or drug use history taken by their caregivers. Conclusion: Failure to identify psychosocial problems and drug abuse during the antenatal period will result in missed opportunities for positive intervention. These problems are common in this population and interventions are required to offer these women alternative foundations upon which to base their mothercraft skills.
An Open Study of Sertraline in Patients with Major Depression who Failed to Respond to Moclobemide
Authors: George Tom , Theodoros Michael T. , Chiu Edmond , Krapivensky Natalie , Hokin Arthur , Tiller John W. G. 
Published: March 2003

Objectives: The aim of this study is to evaluate the efficacy and tolerability of sertraline in patients with major depression who have failed to respond to an adequate trial of moclobemide. Method: Sixty-three patients with major depression who had discontinued moclobemide within the last 6 weeks due to lack of efficacy were recruited from multiple psychiatric services in Victoria and Queensland. After a wash-out period, patients were treated with sertraline 50 mg once daily for 4 weeks. If there was an insufficient response, the dose was titrated upwards to a maximum of 200 mg/day, with 2 weeks at each dosage level. By the end of the study, patients had received a fixed dose of sertraline for 8 weeks. The main outcome measures were the 17-item Hamilton Rating Scale for Depression (HAMD) and Clinical Global Impression (CGI) scales. Secondary outcome measures included the Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI). Results: Of the 62 intention-to-treat patients enrolled, 48 (77%) responded to sertraline (i.e. experienced ≥ 50% reduction in HAMD total score from baseline and had a final HAMD score of ≤ 17). Fifty-four (87%) patients were at least ‘minimally improved’ on the CGI scale. There were also significant improvements in mean total MADRS and BDI scores. Sertraline was well tolerated. Adverse events were reported by 84% of patients, but only 5% withdrew due to adverse events. Conclusions: This study shows that patients with major depression who have failed to respond to moclobemide can generally be treated successfully with sertraline.
An Intensive Treatment Program for Chronic Posttraumatic Stress Disorder: 2-Year Outcome Data
Authors: Humphreys Leanne , Westerink John , Giarratano Leah , Brooks Robert 
Published: March 2003

Objective: The present study evaluates the efficacy of a closed-cohort treatment program for chronic posttraumatic stress disorder (PTSD). Method: The treatment orientation was a combined approach involving cognitive behaviour therapy and pharmacotherapy. Treatment involved an inpatient phase of 4 weeks, with group and individual follow-up sessions of at least 6-month duration. The treatment population consisted largely of Australian Vietnam veterans. Standardised psychometric measures were obtained pre-treatment, on completion of the residential phase; and at 6, 12 and 24 months post discharge from the residential program. Results: The results obtained from 64 patients demonstrate significant reductions in depression, anxiety and PTSD symptoms, maintained at 2 years post discharge from the residential phase of the treatment program. Conclusions: This paper presents encouraging findings for treatment with this troubled population.
Prevalence, Detection and Management of Anxiety and Depressive Symptoms in Unemployed Patients Attending General Practitioners
Authors: Comino Elizabeth J. , Harris Elizabeth , Silove Derrick , Manicavasagar Vijaya , Harris Mark F. 
Published: March 2003

Introduction: This study examined the detection and management of anxiety and depressive symptoms among unemployed patients attending general practitioners (GPs). Method: A cross-sectional study was undertaken of anxiety and depressive symptoms in general practice using measures completed by patients and GPs. Eligible patients were adults aged 18 to 64 years either working (n = 2273) or unemployed (n = 392). Results: Eighty per cent of patients were attending their regular GP at the time of the study. Unemployed patients were found to have a higher mean general health questionnaire (GHQ-12) score than employed patients (3.8 compared with 2.4, p < 0.001); were more likely to report symptoms of anxiety and depression which required medical treatment during the previous 4 weeks (30.9% compared with 14.6%, p < 0.001); and were more likely to have been treated for anxiety and depression by the GP (27.8% compared with 15.7%, p < 0.001). Among patients who the GPs reported treating for anxiety and depression, unemployed patients were 3.3 times (95% CI: 2.0–5.4) more likely to be prescribed medication than employed patients when severity was controlled but were no more likely to be referred to other health services. Unemployed patients identified increased use of services and were less satisfied with the care that they had received. Conclusions: Unemployed patients attending GPs have an increased risk of anxiety and depressive symptoms. Increased prescription of medication as opposed to referral suggests that GPs may treat their unemployed patients differently to employed patients. GPs need to be aware of the higher risk and severity of anxiety and depressive symptoms among unemployed patients and their desire to be more actively involved in their treatment. General practice is an important setting for addressing the health needs of unemployed people.
The Procedural Validity of Retrospective Case Note Diagnosis
Authors: Mihalopoulos Cathrine , McGorry Patrick , Roberts Susan , McFarlane Colleen 
Published: March 2003

Objective: Deriving diagnoses from retrospective case note examination is a common practice in psychiatric research. The Operational Criteria (OPCRIT) diagnostic checklist is essentially a checklist built up of operational criteria defined by a comprehensive glossary and is designed to assign reliable diagnoses from case notes. However, the validity of such a procedure compared with procedures involving prospective assessment has never been tested. We examined the procedural validity of the OPCRIT diagnostic system in relation to four other diagnostic procedures mostly employing prospectively gathered information. Method: Three experienced psychopathology raters rated the case notes and clinical abstracts, using the OPCRIT method of diagnostic assignment, of 50 subjects who had participated in an early procedural validity study as an adjunct to the DSM-IV Field Trial for psychotic disorders. The setting was the Early Psychosis Prevention and Intervention Centre (EPPIC), which focuses on first episode psychosis. Results: The pairwise concordance with the other procedures for DSM-III-R diagnoses assigned by OPCRIT using ratings derived from either the clinical abstracts or the case notes was found to be only poor to moderate when compared with the pairwise concordance of the four other procedures. The per cent agreement between OPCRIT clinical abstracts diagnoses and the other procedures ranged from 49% to 60% with kappa values between 0.30 and 0.45, and for OPCRIT case note diagnoses and the other procedures the per cent agreement range was between 44% and 57% and the kappa values were between 0.35 and 0.49. Conclusions: The procedural validity of diagnoses assigned via the application of checklists of operational criteria to case notes and clinical abstracts alone is unacceptably poor. Such sources need to be buttressed by other data, particularly direct patient interview and informant material.
Predicting Community Survival in Early Psychosis and Schizophrenia Populations after Receiving Intensive Case Management
Authors: Preston Neil Joseph 
Published: March 2003

Objective: The study was undertaken to assess whether social and living skills functioning predicted community survival between subjects with chronic schizophrenia and early episode psychosis after receiving assertive community-based case management. Method: Forty-two chronic schizophrenia patients and 49 early psychosis subjects were measured on hospitalisation for up to 3 years after receiving equivalent community-based assertive case management. A Kaplan–Meier survival analysis was performed to compare community survival between the two groups. A Cox-regression analysis was used to investigate whether sex, age, social and occupational functioning measured by the social and occupational functional assessment score (SOFAS), living skills measured by the life skills profile score (LSP), and overall role functioning measured by the role functioning scale (RFS) predicted community survival. Subscales of the LSP were also analysed in a subsequent Cox-regression using the forward selection method. Results: Differences in rate of community survival were not statistically significant (using the log-rank Chi-squared test) between subjects with early psychosis and chronic schizophrenia; however, half of the early psychosis subjects survived past the 12-month period while only a third of the chronic schizophrenia subjects did so within the same time period. The life skill profile was a significant predictor of community survival with low scores on the subscale of non-turbulence (i.e. antisocial behaviour) contributing to poorer community survival. Conclusion: The amount of antisocial behaviour displayed while receiving assertive community-based case management may be an important predictor of community survival among subjects with early psychosis and chronic schizophrenia. Treatment of such behaviour may improve community survival among these populations.
Publishing Ethics in Psychiatry
Authors: Walter Garry , Bloch Sidney 
Published: March 2003

Objective: The ethics of publishing in psychiatry has gained only limited attention. We examine, in a historical context, pertinent ethical problems and offer a series of recommendations for dealing with them. Method: The study was conducted by exploration of medical databases and websites, and systematic discussion with ethicists, legal experts, publishers and researchers. Results: Serious ‘publishing misconduct’ appears to have been rare in the psychiatric literature, but any occurrence of redundant publication, plagiarism and publication of fraudulent or inhumane research is disturbing and should be prevented. Difficulties around authorship, sensitive use of language, conflict of interest and bias in the publishing process are additional issues claiming our attention. Conclusions: A clearly articulated publishing ethos is desirable. Potential strategies to achieve this include devising guidelines on publishing ethics, teaching the subject to new writers, journals committing themselves to the ethical dimension of their operations, and penalising colleagues who violate agreed principles of good conduct.
What is Chronic Fatigue Syndrome? Heterogeneity Within an International Multicentre Study
Authors: Wilson Andrew , Hickie Ian , Wilson Andrew , Hickie Ian , Hadzi-Pavlovic Dusan , Wakefield Denis , Parker Gordon , Straus Stephen E. , Dale Janet , Mccluskey David , Hinds Gwynneth , Brickman Andrew , Goldenberg Don , Demitrack Mark , Blakely Tony , Wessely Simon , Sharpe Michael , Lloyd Andrew 
Published: March 2003

Objective: We sought to compare the characteristics of patients presenting with chronic fatigue (CF) and related syndromes in eight international centres and to subclassify these subjects based on symptom profiles. The validity of the subclasses was then tested against clinical data. Method: Subjects with a clinical diagnosis of CF completed a 119-item self-report questionnaire to provide clinical symptom data and other information such as illness course and functional impairment. Subclasses were generated using a principal components-like analysis followed by latent profile analysis (LPA). Results: 744 subjects returned complete data sets (mean age 40.8 years, mean length of illness 7.9 years, female to male ratio 3:1). Overall, the subjects had a high rate of reporting typical CF symptoms (fatigue, neuropsychological dysfunction, sleep disturbance). Using LPA, two subclasses were generated. Class one (68% sample) was characterized by: younger age, lower female to male ratio; shorter episode duration; less premorbid, current and familial psychiatric morbidity; and, less functional disability. Class two subjects (32%) had features more consistent with a somatoform illness. There was substantial variation in subclass prevalences between the study centres (Class two range 6–48%). Conclusions: Criteria-based approaches to the diagnosis of CF and related syndromes do not select a homogeneous patient group. While substratification of patients is essential for further aetiological and treatment research, the basis for allocating such subcategories remains controversial.
Depressive Disorders in Elderly Chinese Patients in Macau: A Comparison of General Practitioners' Consultations with a Depression Screening Scale
Authors: Da Canhota Carlos Manuel Nogueira , Piterman Leon 
Published: March 2003

Objective: The objectives of this study were to identify the prevalence of depressive symptomatology in an elderly population using a screening scale; to assess general practitioner (GP) recognition of depression; to determine patient reasons for consultation; and to relate depression to social and demographic factors. Method: An analytical cross-sectional study was carried out on a systematic sample of elderly Chinese patients currently resident in Macau, who presented to general practices in December 1997. Data collected included patient demographics, economic and social supports, patient depressive status assessed using the Hospital Anxiety and Depression scale (HAD), reason for attendance, and the reason for the consultation. Clinical records were analysed in order to collect GP-registered morbidity and recent relevant management. Results: Data were collected from 386 elderly Chinese patients of 31 GPs (97% patient response rate). Patients presented with somatic symptoms rather than psychological issues. Using HAD cut-off score of <8, 47% of the population studied were depressed; with a HAD subscale score <11, 26.2% were depressed. Depression was detected more often in women (59%) and being female was associated with depressive status (p = 0.010). Age (greater than 75 years) was also associated with being depressed, as was not having someone to talk to (p = 0.037), and being from low social class (p = 0.050). Not having someone willing to listen to their problems, difficulties and worries, was significantly related to depression (p = 0.041). There were no referrals or antidepressive medications detected in the clinical charts. Conclusion: Participants’ characteristics such as being over 75 years of age, being female and socially isolated were related to depression. General practitioners can play an important role in the early detection and management of psychological disorders. Although studies on a sample of Chinese patients in Macau cannot be generalized to Chinese populations elsewhere, awareness of somatic presentation of psychological illness is crucial in detecting depression in this and possibly other Chinese populations.
Inquiries Into Homicides and Serious Violence Perpetrated by Psychiatric Patients in New Zealand: Need for Consistency of Method and Result Analysis
Authors: Simpson Alexander I.F. , Allnutt Stephen , Chaplow David 
Published: March 2003

Background: The violent action of mentally ill people is a source of considerable public and professional concern. At times such incidents are subject to inquiry. In England and Wales, homicides by people suffering from mental illness are subject to mandatory external inquiry. Further, the Royal College of Psychiatrists coordinates a confidential research study into homicide and suicide by people in contact with mental health services. Inquiries have raised concern regarding widespread problems in mental health service delivery. Within New Zealand, similar concerns have been raised, but inquiries have been irregular and not of consistent methodology. The paper aims to review 10 years of inquiries into violent incidents to describe their methods, structure and findings. Method: All inquiries into violent actions perpetrated by patients in contact with mental health services between 1988 and 1998 and held by the Ministry of Health were reviewed. The nature of the inquiry, the incident, findings and recommendations were summarized. For each inquiry, an assessment was made as to whether the incident was predictable or preventable. Results: There were 11 incidents leading to 13 inquiries, six of homicide, two of rape, one of the release of a dangerous patient and two in which a patient was shot by police. Two internal inquiries were followed by external inquiries. All inquiries found deficiencies of varying severity, the degree of deficiency being greater with external inquiries. Consistent criticisms related to skill, resource, coordination and communication failures. Two of the 11 inquiries found the incident to be ‘predictable’, and eight to have been ‘preventable’. Conclusions: The problems in New Zealand are similar to those noted in England and Wales. Small numbers of inquiries make firm conclusions difficult, but the authors feel that a mandatory process of independent review of serious incidents is wise.
Global Measures of Impairment in Children and Adolescents: Results from a Swiss Community Survey
Authors: Steinhausen Hans-Christoph , Winkler Metzke Christa 
Published: March 2003

Objective: Based on data from a Swiss epidemiological survey, both the parent and the child versions of two global measures of impairment, the Columbia Impairment Scale (CIS) and the Children's Global Assessment Scale (CGAS) were analysed with regard to validity and the effects of gender. Method: Concurrent and discriminant validity were evaluated by examining the associations with other indicators of impairment. Gender effects on impairment were considered in each type of analysis. Results: Based on the total sample and on the girls' data, concurrent validity of the various impairment scores as computed by correlations with other indicators of psychological dysfunction was good. When based on the boys' data it was less convincing. Discriminant validity was estimated by comparing impairment scores between those using and not using services and was proven for all impairment scores. There were significant gender effects for almost all scores, indicating that girls in contrast to boys were more impaired and functioned less well when professional contacts and psychiatric diagnosis were considered. Conclusions: The two impairment measures are well suited to community studies. Gender and informant differences have to be considered when defining thresholds for caseness. The two scales could also be used clinically, for example for training and evaluation purposes and for the decision whether or not a child or adolescent requires treatment.
Longitudinal Predictors of Behavioural Adjustment in Pre-Adolescent Children
Authors: Prior Margot , Smart Diana , Sanson Ann , Oberklaid Frank 
Published: March 2003

Objectives: Longitudinal data from infancy onwards, from the Australian Temperament Project, a prospective study of the temperament and development of a large and representative sample of Victorian children, were examined to identify predictors of psychological disorder at 11–12 years of age. Method: Those children scoring in the at-risk range for psychological disorder according to parents, teachers and self-reports using the Child Behaviour Questionnaire were selected at 11–12 years of age for in-depth assessment and comparison with a group of children with no history of adjustment problems. Analyses of group differences using longitudinal data gathered from infancy to 12 years focused on parent and teacher reports on child temperament and behaviour, and various facets of home and school adjustment. Results: The strongest predictors of adjustment at 12 years were previous behaviour problems, along with some specific temperament factors involving self-regulation capacities and mother's overall rating of child difficulty. Results based on parallel teacher data including peer adjustment, and social and academic competence measures were consistent with parent data. Conclusions: Our research confirms the persistence of early appearing behaviour problems in a community sample and the longitudinal influence of temperament factors in childhood. The study supports the need for a focus on early intervention and prevention strategies in the child mental health field.
Can Research Influence Mental Health Policy?
Authors: Whiteford Harvey 
Published: March 2003

Objective: This paper describes the processes involved in policy development and implementation with examples of how this can be influenced by the outcomes of research. Method: The author draws on his experience in the development and implementation of Australia's National Mental Health Policy and on the literature describing public policy analysis. Results: A five-step process of problem identification, policy development, political decision, policy implementation and evaluation is described. This process identifies how issues are considered, adopted and implemented by governments. Conclusion: An understanding of this process can inform mechanisms by which scientific research can impact on the issues considered and the decisions made in each step of policy analysis and development.