bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sub-Grouping Non-Melancholic Major Depression Using Both Clinical and Aetiological Features
Authors: Parker Gordon , Roy Kay , Wilhelm Kay , Mitchell Phillip , Austin Marie-Paule , Hadzi-Pavlovic Dusan 
Published: March 2003

Objective: In previous papers we have considered the extent to which two contrasting analytic approaches, examining reported clinical symptom variables alone and aetiological variables alone, assist definition of subgroups of non-melancholic major depression. Here, we address the same objective but combine both sets of variables, and contrast the combined solution with each of the contributing ones. Method: We study a sample of 185 subjects with a putative non-melancholic major depressive disorder, with analyses involving 13 aetiological and 38 symptom variables. Results: A four-class subgrouping was derived by use of a cluster analytic technique, with ‘neurotic depression’, non-anxious ‘depressed’, ‘situational’ and ‘residual’ groups. The largest group comprised ‘neurotic depression’ subjects, with characteristics compatible with a spectrum disorder encompassing both clinical features as well as an underlying temperament and personality style marked by anxiety. Conclusions: Comparative advantages and properties of the three differing analytic approaches to defining ‘meaningful’ non-melancholic major depressive subgroupings are considered. As a ‘neurotic depressive’ class has been consistently identified across those three approaches, but with quite varying numbers of subjects circumscribed, it is clearly a ‘fuzzy’ entity which may benefit from a dimensional approach to its measurement. As many of the non-melancholic groupings appear secondary to a substantive predisposing factor such as anxiety or disordered personality functioning, the clinical importance and treatment utility in identifying and circumscribing such classes are clearly supported.
Experience, Knowledge and Attitudes of Mental Health Staff Regarding Patients' Problematic Drug and Alcohol Use
Authors: Siegfried Nandi , Ferguson Joanne , Cleary Michelle , Walter Garry , Rey Joseph M. 
Published: March 2003

Objective: The aim of this study was to assess the experience, knowledge and attitudes of mental health staff regarding patients' problematic drug and alcohol use in order to provide direction for planned drug and alcohol education. Method: A 47-item questionnaire was developed and individually posted to all mental health staff employed by Central Sydney Area Health Service (n == 536). Results: Three hundred and thirty-eight (63%) staff members completed the questionnaire. Thirty-six percent of respondents had received drug and alcohol training and 41% had drug and alcohol work experience. Drug and alcohol training and work experience were associated with increased drug and alcohol knowledge. Respondents' perception of their knowledge and competence was positively correlated with their actual knowledge. Most staff reported having regular contact with patients with psychotic illnesses and drug and alcohol problems. The majority considered the management of this patient group difficult and currently inadequate. Seventy percent believed that as mental health professionals they had a role to play in the management of their patients' drug and alcohol problems. Almost all (95%) were willing to participate in further education and training in this area. Conclusions: Mental health staff are often confronted with drug and alcohol problems in patients with psychotic illnesses. They perceive a need for drug and alcohol education and training specific to the management of these patients. Future research will need to evaluate outcomes of education and training programs for both staff and patients.
Parental Representations Associated with Adult Separation Anxiety and Panic Disorder-Agoraphobia
Authors: Manicavasagar Vijaya , Silove Derrick , Wagner Renate , Hadzi-Pavlovic Dusan 
Published: March 2003

Objective: Early bonding abnormalities have been associated with a range of anxiety and depressive disorders in adulthood, but no specific parental patterns have emerged for particular disorders. The present study investigated the possibility that parental overprotectiveness may be linked to a risk of separation anxiety (SA) in adulthood. Method: Two samples were recruited: volunteers (n=34) whose major anxieties focused on separation concerns, and adult anxiety clinic patients (n=37) who were diagnosed with panic disorder. Parental characteristics and early SA were assessed by dichotomising the combined sample first according to adult SAcategorisation and then by panic disorder status. Results: Subjects assigned to the adult SAcategory reported high levels of juvenile SA and exposure to maternal overprotectiveness, whereas patients diagnosed with panic disorder reported few differences in their bonding histories compared to residual anxious patients. Conclusions: The findings of this study suggest that early SA and parental overprotectiveness may not be associated with panic disorder per se, but rather with persisting SA symptoms in adulthood. The overlapping samples and retrospectivity of some measures are important limitations of the study.
Secondary Mania in Patients with HIV Infection
Authors: Ellen Steven R. , Judd Fiona K. , Mijch Anne M. , Cockram Alex 
Published: March 2003

Objective: The aim of this study was to identify a cohort of patients with mania secondary to HIV infection, to describe the clinical and radiological features of HIV-related mania, and to describe the treatment outcome of the patients. Method: All patients referred to the HIV consultation-liaison psychiatry service over the 29-month period from January 1993 to June 1995 were screened for the presence of manic symptoms. Diagnosis of mania was made according to DSM-III-R. Cases were defined as secondary mania if there was no clear history of mood disorder, and no family history of mood disorder. Cases were interviewed by the treating psychiatry registrar and psychiatrist to obtain information regarding present and past psychiatric history and family history of psychiatric disorder. The psychiatry registrar and consultant determined treatment. Results: Twenty-three patients with mania were identified; 19 were considered to have secondary mania. The prevalence of secondary mania over the 29 months was 1.2% for HIV-positive patients, and 4.3% for those with AIDS. The clinical characteristics and response to treatment appeared to be similar to mania associated with bipolar affective disorder (primary mania). Neuroradiological abnormalities were common, occurring in 10 of the 19 patients, but did not appear to be clinically relevant. Cognitive impairment developed in five of the 15 patients where follow-up was possible. Conclusions: Mania occurring in advanced HIV disease appears to be more common than expected from epidemiological data regarding bipolar affective disorder. Differentiating secondary from primary mania has implications for the management and prognosis of mania.
An Evaluation of a Surveillance System for Patients Discharged from the Acute Psychiatry Unit in Southern Tasmania
Authors: Sladden Michael J. , Thomson Alexander N. 
Published: March 2003

Objectives: The aim is to evaluate the current community follow-up, or health surveillance, system for patients discharged from the acute psychiatry unit into the community in southern Tasmania. Method: We developed a conceptual model which considered community mental health follow-up as analogous to an epidemiological surveillance system. The surveillance system was evaluated by prospectively following recorded contacts between the system and a cohort of 100 patients consecutively discharged from the acute psychiatry unit. Main outcome measures were attendance at follow-up appointments, patient re-engagement and hospital readmission. Results: There is no formal system of follow-up and no policy relating to non-attenders of follow-up appointments after psychiatric hospitalisation. There is no defined role for private medical practitioners and agencies in the community. Of the 97 patients considered to need community follow-up, 11 patients were lost to follow-up after 3 months, while another 15 remained in the system because of hospital readmission. Afurther seven patients returned to the system during the following 2 years (six in year 1 and one in year 2) due to readmission. There is appropriate policy about the content and timing of discharge summaries; most summaries were sent promptly. Conclusions: After discharge from the acute psychiatric unit, there was inadequate community follow-up of those patients for whom follow-up was considered necessary. Research is needed to determine whether increased patient follow-up is beneficial. Stakeholders should decide whether formal follow-up or health surveillance is necessary.
The Place for the Tricyclic Antidepressants in the Treatment of Depression
Authors: Boyce Philip , Judd Fiona 
Published: March 2003

Objective: The new generation antidepressants have been an important advance in the treatment of depression. Since their introduction, their use has become widespread and the role of the older tricyclic antidepressants (TCAs) has been suggested only as a second-line choice. This assumption is questioned and the role of the TCAs as a first-line treatment for severe depression is discussed. Method: The relevant literature concerning the efficacy, tolerability and safety of the antidepressant drugs is reviewed, particularly those studies which compare the newer antidepressant agents with the TCAs. Results: The newer agents are equally as efficient as the tricyclics in the treatment of mild to moderate depression. There are indications that the TCAs are more efficacious for severe depression. The tolerability of the drugs appear about equivalent in terms of discontinuation rates; however, the side effects are different and clinicians need to be mindful of drug interactions and the potential of the serotonin syndrome with the selective serotonin re-uptake inhibitors (SSRIs), problems not found with the TCAs. The TCAs are potentially lethal in overdose; however, appropriate clinical management appears to be a more important issue than the toxicity of the medication. Conclusions: The newer antidepressant agents are important advances in the treatment of depression. However, the TCAs still have an important place as the first-line treatment for patients with severe (melancholic/endogenous) depression.
The Measurement of Improvement During Hospitalisation for Acute Psychiatric Illness
Authors: Trauer Tom , Callaly Tom , Hantz Paul 
Published: March 2003

Objective: The aim of this paper is to compare clinical changes and lengths of stay of patients with schizophrenic and affective disorders in public and private hospital settings. Method: Recently published Australian work using the Health of the Nation Outcome Scales (HoNOS) was compared with new data collected in a public setting. Changes in HoNOS scores between admission and discharge were analysed against length of stay. Individual HoNOS items were also examined. Results: Public facilities tended to show greater improvements, owing to higher admission severities, and their lengths of stay tended to be shorter. Certain HoNOS items, notably the self-harm item, were significantly more severe in both diagnostic groups on admission in the public facilities. Conclusions: The findings are discussed in terms of the fact that self-harm is a criterion for involuntary hospitalisation, and private facilities do not treat involuntary patients. Certain problems assessed by the HoNOS are more amenable to rapid reduction than others, and this may contribute to differences in length of stay. Implications for outcome measurement are discussed.
An Early Settler in Sickness and in Health
Authors: Sheehan Garry 
Published: March 2003

Objective: This paper is an examination of an early Australian settler's states of mind in episodes of psychosis and some issues from her life which may have contributed to the psychoses. Method: Hospital records of her psychoses and her diary entries in the months surrounding the onset of illness were investigated from a psychoanalytic perspective, and inferences about her underlying personality are drawn from a recent publication about her diaries. Results: An historical interpretation of her life and states of mind based on the documents is presented. Conclusions: Failure to resolve psychic conflict led to restrictions in how she and her family lived, and left her susceptible to decompensation.
Use of Antipsychosis and Adjunctive Medications by an Inner Urban Community Psychiatric Service
Authors: Keks Nicholas A. , Altson Kylie , Hope Judy , Krapivensky Natalie , Culhane Christine , Tanaghow Amgad , Doherty Peter , Bootle Anne 
Published: March 2003

Objective: The aim of this paper is to survey patterns of use of new generation and conventional antipsychosis and adjunctive drugs by an inner urban community psychiatric service. Method: All prescriptions for antipsychosis medications and all patients receiving these drugs in May 1998 were identified. Case record review yielded demographic and diagnostic data. Information was also obtained directly from prescribers. Results: Of 859 patients, 77% received antipsychosis medication; 53% of prescriptions for antipsychotics were for new generation drugs: risperidone (42%), olanzapine (37%) and clozapine (21%). Mean doses were 4.1 ± 2.5 mg (risperidone), 14.7 ± 8.2 mg (olanzapine) and 377.4 ± 178.9 mg (clozapine). Doses for men tended to be higher than those for women, but the differences were not significant. DSM-IV diagnosis was schizophrenia for 74% of patients on atypicals, but patients with other diagnoses were also being treated with these drugs. Risperidone was more commonly used in combination with benzodiazepines and anticholinergics than olanzapine and clozapine, while clozapine was less likely to be combined with antidepressants and mood stabilisers. Of the conventionals, 66% were in depot form, mostly because of non-compliance. Combinations of antipsychotics were prescribed to 13% of patients. Conclusion: New generation antipsychosis medications were prescribed more commonly than conventional drugs in this service for a wide range of diagnoses. Adjunctive medications were commonly utilised. These findings underline the clinical complexity of antipsychotic treatment in a changing environment.
Dementia with Lewy Bodies
Authors: McKeith Ian , O'Brien John 
Published: March 2003

Objective: The aim of this paper is to summarise recent clinical and research findings with regard to dementia with Lewy bodies (DLB). Method: A literature review (Medline) was carried out, as well as a review of reports of recent DLB symposia of international meetings and of other relevant papers and data known to the authors. Results: Dementia with Lewy bodies, as the disorder should be known, is the second commonest form of degenerative dementia, accounting for up to 20% cases in the elderly. It is characterised by fluctuating cognitive impairment, spontaneous parkinsonism and recurrent visual hallucinations. Consensus clinical and neuro-pathological criteria have been published. The clinical criteria have been shown to have high specificity, but may still lack sensitivity. Recognition of DLB is clinically important in view of the high incidence (60%) of adverse and life-threatening reaction to antipsychotics, the difference in prognosis and, possibly, the differential treatment response to cholinergic therapy. Neuroimaging changes have not been well described in DLB but some show promise as potential markers to differentiate DLB from AD. These include relative preservation of temporal lobe structures on magnetic resonance imaging and loss of pre- and postsynaptic dopaminergic markers on single photon emission tomography. Conclusions: Dementia with Lewy bodies is a common cause of cognitive impairment in late life which appears to be clinically and neuropathologically distinct from AD. All clinicians should be aware of the typical triad of clinical features (fluctuating cognitive impairment, visual hallucinations and parkinsonism) which characterise the disorder and either avoid antipsychotics or prescribe them with extreme caution in such patients. Further research is likely to result in advances in diagnostic methods and therapeutics in the near future.
Treatment of Psychogenic Polydipsia: Comparison of Risperidone and Olanzapine, and the Effects of an Adjunctive Angiotensin-II Receptor Blocking Drug (Irbesartan)
Authors: Kruse David , Pantelis Christos , Rudd Ray , Quek Joy , Herbert Penny , McKinley Michael 
Published: March 2003

Objective: Our objective was to determine the outcome of novel strategies in managing a case of severe polydipsia. Clinical picture: The patient was a 39-year-old male with a 20-year history of paranoid schizophrenia who, despite only mild residual psychotic symptoms, had been hospitalized for the previous 10 years because of severe polydipsic behaviour complicated by water intoxication. Treatment: Novel antipsychotic agents, risperidone and olanzapine, as well as the specific angiotensin-II receptor blocking drug, irbesartan were employed at selected intervals in a study lasting nearly 3 years. A strict behavioural management programme was ongoing, in which diurnal weight change and the number of breaches of weight limits, requiring management in a low-stimulus environment, were documented on a daily basis. Summary measures of diurnal weight change and behavioural intervention were charted against changes in treatment. Outcome: Polydipsic behaviour improved on risperidone up to 4 mg daily, but was not sustained. Olanzapine was similarly successful in stabilizing polydipsia, and improvement was achieved with the addition of irbesartan. Conclusion: We suggest that the D2-sparing profiles of receptor binding achieved with low-dose risperidone and olanzapine may account for this beneficial effect. The benefit derived with irbesartan implicates the involvement of brain angiotensin systems centrally in helping to regulate drinking behaviour.
Improving Services for People with a Psychotic Disorder and Problematic Substance Use: A Multifaceted Approach to Project Evaluation
Authors: Siegfried Nandi , Sainsbury Peter 
Published: March 2003

Objective: The objective of this study was to conduct a multifaceted formative evaluation of the Central Sydney Area Health Service (CSAHS) Psychosis and Substance Use Project. Method: Four evaluative methods were used: (i) description and interpretation of the Project's documented processes and outcomes; (ii) a benchmark comparison of the Project processes and outcomes against three of the 11 National Standards for Mental Health Services; (iii) a survey of the Project's key stakeholders; and (iv) interviews with 12 purposefully sampled key informants. Results: The Project achieved its aim to develop a strategy to improve services for people with comorbid psychosis and problematic substance use. Three of the five Project objectives were fully achieved: examination of current clinical services, development of a clinical services plan, and development of a staff education programme. The Project partially achieved two objectives: development of an information system, and a research agenda. The Project and CSAHS performed well when measured against three of the National Mental Health Standards. Project participants perceived the Project to have been successful and worth continuing, identified some shortcomings and made recommendations for the second phase. Conclusions: The participatory approach to the Project and the evaluation was successful. With some improvements the Project is worth continuing into a second phase. A multifaceted approach and qualitative research methods are useful for formative evaluation of health service programmes.
The Gender Identity Disorder in the DSM-IV Classification: A Critical Evaluation
Authors: Bower Herbert 
Published: March 2003

Objective: The DSM-IV classification in its definition and description of the gender identity disorder omits a number of diagnostically significant features. This paper attempts to correct the deficiencies. Method: The text under the headings: ‘Diagnostic features’, ‘Specifiers’, ‘Associated disorders’, ‘Laboratory findings’, ‘Prevalence’, ‘Course’ and ‘Differential diagnosis’ is subjected to a detailed scrutiny, using the author's experience as consultant psychiatrist to the Monash University Gender Dysphoria Clinic over a period of 25 years as source and background. Results of two studies of male-to-female and female-to-male transsexuals are given in the Table. Results: DSM-IV criteria are augmented and the symptomatology focused. The existing gaps in the delineation of specifiers and associated features are closed by providing additional clinical material. The description of the course and the differential diagnosis are enriched. Conclusions: Although the critical analysis of the DSM-IV classification of the gender identity disorder has shown the manual to be adequate, it nevertheless has shortcomings which may impede exact diagnosis.
A Pessimistic Attitude Towards the Future and Low Psychosocial Functioning Predict Psychiatric Diagnosis Among Treatment-Seeking Adolescents
Authors: Laukkanen Eila , Korhonen Veijo , Peiponen Sirkka , Nuutinen Marjatta , Viinamäki Heimo 
Published: March 2003

Objective: The objective was to study factors associated with psychiatric diagnosis among adolescents (n = 164) seeking psychiatric care for mental symptoms. Method: Psychiatric diagnosis was confirmed by a structured diagnostic interview. Psychosocial functioning was assessed with the Global Assessment of Functioning Scale, and the Beck Depression Inventory and Offer Self-Image Questionnaire were also used. Background data were gathered. Results: A majority (76%) of the adolescents met DSM-III-R criteria for psychiatric diagnosis. The self-image was more negative and the Beck score was higher among these adolescents than the others. All who had attempted suicide had a psychiatric disorder. Those diagnosed as having a psychiatric disorder consumed alcohol in order to get drunk more often than others. Continual conflicts with parents and smoking were not associated with the existence of a psychiatric disorder. In logistic regression analysis, low psychosocial functioning (OR = 3.9) and an uncertain or pessimistic attitude towards the future (OR = 9.1) proved to be independent risk factors for psychiatric disorders. Conclusions: Health service staff should be aware of factors associated with psychiatric disorders in adolescents so that they can identify those at high risk.
Measuring Mental Health Outcomes in a Private Psychiatric Clinic: Health of the Nation Outcome Scales and Medical Outcomes Short Form SF-36
Authors: Page Andrew C. , Hooke Geoffrey R. , Rutherford Elizabeth M. 
Published: March 2003

Objective: This study reports on data collected from the routine use of the Health of the Nation Outcome Scales (HoNOS) and the Medical Outcomes Short Form (SF-36). Three main aims were addressed in using these measures: (i) to establish patient disability levels; (ii) to determine the level of treatment effectiveness; and (iii) to explore the ability of these instruments to predict length of stay and mood change. Method: The clinician-rate HoNOS and the patient-rated SF-36 were included in the assessment battery, at admission and discharge, of consecutive inpatients (n = 754) at one private psychiatric facility over a 2-year period. Results: The sample, on admission, was comparable in illness severity to levels reported at other Australian private psychiatric facilities. Treatment was shown to be effective, and the degree of changes in HoNOS ratings compared favourably with other private psychiatric facilities. Certain factors underlying the structure of the HoNOS and the SF-36 only weakly predicted length of stay and changes in depression and anxiety levels. Conclusion: The HoNOS and the SF-36 provided valid and reliable data on patient function, with the HoNOS being most sensitive to treatment change. However, neither instrument proved useful in predicting length of stay or levels of depression and anxiety at discharge.