bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Need for Mental Health Promotion
Authors: Herrman Helen 
Published: March 2003

Objective: To examine the concept and evidence for mental health promotion, within an understanding of mental health and mental illness and their determinants. Method: Aselective review of literature and opinion in the fields of public health and mental health. Results: Mental health and mental illness are often given a low priority, despite growing evidence of the burden of disease and costs to the economy. Improving mental health and reducing mental illness will improve quality of life, public health and productivity. The needs for mental health promotion are complementary to the needs for prevention and treatment of mental illness. The required activities are different. Mental health professionals have a necessary but not sufficient role in mental health promotion. Conclusions: An understanding that mental illnesses are treatable can encourage early entry to care, improve outcomes and lessen the stigma and discrimination related to mental illness. In primary health care there is some evidence that preventive interventions with groups at high risk of depression can prevent episodes of ill health. However, mental health promotion involves another dimension. Better understanding of the nature of mental health and mental illness is the key to changing the priorities, policies and practices in education, law, social services, housing and health critical in turn to the conditions conducive to mental health.
Characteristics of Adolescents with School Refusal
Authors: Mcshane Gerard , Walter Garry , Rey Joseph M. 
Published: March 2003

Objective: To describe the characteristics of young people presenting with school refusal to a child and adolescent psychiatric unit and examine differences between those admitted for inpatient treatment and the rest. Method: One hundred and ninety-two adolescents who had been assessed or treated for school refusal between 1994 and 1998 at the Rivendell Unit, Sydney, Australia were identified. An instrument was developed and used to gather data from files. Diagnoses were made by the consensus of two of the investigators using DSM IV criteria from all sources of information. Results: The commencement of school refusal generally occurred in the first 2 years of high school. School refusers had a high prevalence not only of anxiety, but also of mood and disruptive behaviour disorders. A family history of psychiatric illness was present in over half the sample. There were no differences between those subsequently admitted as inpatients and the rest in terms of symptom scores, family composition, family conflict, family separation or history of abuse. Those admitted for inpatient treatment were more likely to have a diagnosis of mood disorders and comorbid diagnoses and to have a maternal history of psychiatric illness. Conclusions: School refusal in adolescence can be a symptom of a variety of disorders, particularly anxiety and mood disorder. Treatment programs need to be geared to the range of diagnoses which occur in this patient group and to the various circumstances associated with the onset of the problem.
Whose Evidence? Lessons from the Philosophy of Science and the Epistemology of Medicine
Authors: Harari Edwin 
Published: March 2003

Objective: To demonstrate the inadequacies of empiricism as a scientific foundation for evidence-based approaches to psychiatry. Method: The principles of empiricism are reviewed in the light of developments in the philosophy of science and phenomenology. Case studies are selected from the history of physical sciences, biological science and clinical sciences (pathology, neuroscience, psychosocial science and psychopathology), paying particular attention to the role of observation in theory construction. Results: The principles of empiricism, particularly its view of the nature of observation as the basis of evidence do not reflect the historical reality of scientific theorizing and practice. Science has constructed alternative models of its own activity that do justice to the complexities of its subject matter, including the world of human experience and mental illness. Conclusions: A failure to recognize both the limitations of empiricism in science and the conceptual richness of alternative formulations that accord more closely with the complexity of psychiatry's domain will result in a naïve model of science and inadequate understanding of the limitations of ‘evidence’ that guide the training, clinical practice and research in our profession. The consequences will be the intellectual, clinical and ethical impoverishment of psychiatry.
The Role of Early Warning Symptoms in the Detection and Prevention of Relapse in Schizophrenia
Authors: Fitzgerald Paul B. 
Published: March 2003

Objective: The capacity of most clinical programs to detect early signs of relapse in schizophrenia and to implement strategies to prevent clinical progression remains unevaluated. The aim of this paper is to review the literature on the detection of relapse in schizophrenia and to draw conclusions that may be of use in the implementation of clinical programs. Method: The relevant literature identified by standard search methods is explored and analysed. Results: Few studies have the capacity to directly address the question as to whether it is possible to predict relapse with a high degree of predictive power. Recently, the implementation of a multifactorial approach to relapse prediction appears to have offered substantial benefits. Conclusions: The prediction of episodes of psychotic relapse is a realistic goal. Evidence indicates that interventions based upon programs of early detection can reduce rates of illness relapse. Prediction of relapse is most successful when implemented in a multifactorial way that involves specific and non-specific symptoms, structured ratings, clinical judgement, families, patients and clinicians.
Is Depression More Prevalent in Old Age?
Authors: Snowdon John 
Published: March 2003

Objective: To examine the prevalence of depression in old age and to review cross-age studies that reported age-related differences in prevalence. Method: Reports of studies that included data on the prevalence of depression in old age were reviewed, and conclusions from review articles were considered. Results: Findings have been inconsistent, but majority opinion holds that depression (especially ‘subsyndromal’) is common in old age. There may be two peaks in the prevalence rate of major depression, one in late old age and the other in middle age or earlier. Conclusions: The allocation of health care resources should not be determined by survey findings concerning the prevalence of major depression and dysthymia.
George L. Engel 1913–1999: Remembering his Life and Work: Strengthening a Father-Son Bond in a New Time of Grief
Authors: Engel Peter A , Engel Anna G 
Published: March 2003

Objective: This essay reviews George Engel's clinical and scientific contributions within the context of a personal and professional biography. An examination of the response to the abrupt loss of human bonds resulting from the attack on the World Trade Center is used to verify Dr Engel's belief that relationship and communication are central to scientific study in the clinical setting and in the practice of medicine. Methods: Engel's published autobiographical reports, personal reminiscences, and key scientific publications are reviewed in the light of published or broadcast personal responses to the World Trade Center disaster. Results and Conclusion: Dr Engel recognized the singular importance of human bonds to the work of the physician. He described the unity of complex human experiences and basic biological processes. Public and personal grief evoked by destruction of those bonds on September 11 reflects an implicit, universal understanding of the essential human connections between us all. In the work of the physician, Dr Engel proposed disciplined study of those bonds to enrich personal connections, to promote understanding of patient and illness and to sustain the physician through emotionally and intellectually meaningful work. Herein lies the connection between Engel's contributions and the grief evoked by these events.
A Review of the Validity of the General Health Questionnaire in Adolescent Populations
Authors: Tait Robert J , Hulse Gary K , Robertson Suzanne I 
Published: March 2003

Objective: To comprehensively review the validity of the General Health Questionnaire (GHQ) [ 1 ] with adolescents (aged 12–19). Although the GHQ has been extensively used and validated with adults and has been frequently used with adolescents, the validity data for this group are sporadic. Method: Systematic review of the English language peer-reviewed literature. Results: Eight studies were identified validating the GHQ with young people of which four included only adolescents and four studies involved young adults and adolescents. Of these eight studies, four used an English language version of the GHQ and four used a translated version. Conclusions: The GHQ has demonstrated validity with older adolescents (17 + years) from the UK and Hong Kong (Chinese translation) and with girls aged 15 in the UK, but there are few data for either gender, aged less than 15 years. Studies in Australia and Italy reported a high proportion of misclassified cases while the studies in Spain and Yugoslavia included some older subjects (20 + years). Therefore, the validity of the GHQ for adolescents in populations other than the UK and Hong Kong remains to be demonstrated. Implications: Psychiatrists and other mental health professionals need to be aware of the above limitations when using the GHQ as a screening instrument with adolescents. Further studies are required to: (i) determine the minimum age at which it can be employed, (ii) compare the use of adult versus adolescent criterion interviews, (iii) assemble relevant normative data, and (iv) establish the validity of translated versions.
Psychiatric Aspects of Self-Induced Epileptic Seizures
Authors: Ng Beng-Yeong 
Published: March 2003

Objective: To review the literature on self-induced epileptic seizures and apply psychiatric knowledge to define possible causes and treatment recommendations. Methods: A review of MEDLINE literature on self-induced epileptic seizures was conducted, followed by cross-referencing with the relevant neurologic, psychiatric and paediatric books and journals. Results: The reported prevalence of self-induction varies depending on the setting. In most instances, self-inducers are people affected by photosensitive primary generalized epilepsy, in whom self-induction is by intermittent photic stimulation or, more rarely, pattern stimulation or eye closure. Self-induced seizures are most commonly absences with spike-wave, though eyelid myoclonia and generalized myoclonic jerks occur. Earlier studies indicate that the majority of self-inducers were of subnormal intelligence but more recent ones indicate that as a group they could not be considered mentally retarded. Monitoring in a well-lit environment is indicated in any therapy-resistant photosensitive patient to determine whether or not selfinduction occurs. Self-induced epilepsy is notoriously resistant to therapy and reasons for this resistance are discussed. An explanatory model for the initiation and maintenance of selfinduction behaviour is also included. Conclusions: It is difficult to determine from published papers just what level of clinical difficulty self-induction of seizures actually posed to the patients and clinicians. In some cases there is contradictory evidence as to the degree of willfulness or self-induction. Self-induced epileptic seizures may be an important aspect of poor seizure control in a subgroup of epilepsy sufferers. These seizures might be modifiable by psychiatric intervention or behavioural modification.
Pro Re Nata Medication for Psychoses: The Knowledge and Beliefs of Doctors and Nurses
Authors: Geffen Josh , Cameron Allison , Sorensen Lene , Stokes Julie , Roberts Michael S. , Geffen Laurence 
Published: March 2003

Objective: To examine the knowledge and beliefs of doctors and nurses in inpatient psychiatric units about pro re nata (PRN) (as needed) medications for psychotic disorders. Methods: Medical (n = 44) and nursing (n = 80) staff in two metropolitan public hospital units completed a structured questionnaire about their use of PRN psychotropic medications on one occasion during the four months from March–June 1999. Results: Nurses selected more indications for PRN antipsychotics than doctors (3.49 vs 2.72, p < 0.05), whereas doctors selected more indications for PRN benzodiazepines (3.77 vs 3.19, p < 0.05). The groups did not differ in the number of selected indications for using anticholinergics. For agitation, the majority of nurses viewed both benzodiazepines (56%) and antipsychotics (86%) as effective, with 60% preferring an antipsychotic. For the acute control of psychotic symptoms, 99% of nurses believed antipsychotics were effective and 58% benzodiazepines, with 87% preferring an antipsychotic. A large majority of doctors viewed both PRN benzodiazepines, 94%, and antipsychotics, 81%, as effective for agitation, and 55% preferred to use a benzodiazepine. For psychotic symptoms, 80% believed PRN antipsychotics were effective, but only 32% viewed benzodiazepines as effective, and 64% preferred to use an antipsychotic. Nursing staff identified more non-pharmacological techniques for managing both agitation and psychotic symptoms and reported using these more often than doctors. Junior staff, both nursing and medical, had less knowledge of nonpharmacological alternatives to PRN medication than senior staff. Conclusions: Disparities existed between doctors and nurses views on the indications for PRN medication in the acute management of psychoses, thus it is important for doctors to specify indications when writing PRN prescriptions. Despite evidence for the safety and effectiveness of benzodiazepines, there was widespread reluctance to use them as PRN medication in acute psychoses. Beliefs of some staff about PRN medications were at odds with the known properties of these medicines. Educational interventions for both nurses and doctors are required to achieve best practice in PRN medication.
Australian and US Responses to Electroconvulsive Therapy Dosage Selection
Authors: Little John D , Mcfarlane Jo , Barton David , Varma Shashjit L 
Published: March 2003

Objective: The practice of electroconvulsive therapy (ECT) varies considerably across sites with a lack of certainty as to what constitutes seizure adequacy. The aim of this study was to trial a method to explore decision making and to describe any differences between Australian and US practitioners. Method: Two hundred and thirty-six consultant psychiatrists from Australia and US were asked what dosage of electrical energy they would prescribe after reading a standardized clinical vignette in which an unremarked upon change in seizure tracings followed the first two treatments. Results: Considerable variability in the dosage was found with 17.3% decreasing, 46.8% maintaining and 30% increasing charge. Involvement in administration of ECT was unrelated to this decision. Conclusion: Standardized vignettes may be a useful method to assess clinicians’ responses in dosage selection.
Cannabis Use is Not Associated With the Development of Psychosis in an ‘Ultra’ High-Risk Group
Authors: Phillips Lisa J , Curry Christina , Yung Alison R , Pan Yuen Hok , Adlard Steven , Mcgorry Patrick D 
Published: March 2003

Background: The association between cannabis use and the development of a first psychotic episode was studied in a group of 100 young people identified as being at very high risk for the onset of psychosis. Method: The ‘ultra’ high risk cohort was identified by the presence of subthreshold psychotic symptoms, or a combination of first-degree relative with a psychotic disorder and recent functional decline. Thirty-two per cent of the cohort developed an acute psychotic episode over the 12-month period after recruitment. As a component of a larger research study, the level of cannabis use by participants in the year prior to enrolment in the study was assessed at intake. Results: Cannabis use or dependence in the year prior to recruitment to this study was not associated with a heightened risk of developing psychosis over the following 12-month period and therefore did not appear to contribute to the onset of a psychotic disorder. Conclusion: The results of this study suggest that cannabis use may not play an integral role in the development of psychosis in a high-risk group. While this study does not support a role for cannabis in the development of first-episode psychosis, we cannot conclude that cannabis use should be completely ignored as a candidate risk factor for onset of psychosis. A number of weaknesses of the study (the low level of cannabis use in the current sample, the lack of monitoring of cannabis use after intake) suggest that it may be premature to dismiss cannabis use as a risk factor for the development of psychosis and further research is urged in this area.
A Five Year Follow-Up Study of the Use of Clozapine in Community Practice
Authors: Drew Leslie R.H. , Griffiths Kathleen M. , Hodgson Donna M. 
Published: March 2003

Objective: To present information about the value of clozapine in treatment-resistant schizophrenia. Data is reported on the use of clozapine in an entire cohort of (42) patients in a community, the Australian Capital Territory. It extends a 3-year study of clinical and financial outcomes to 5 years. Method: Experiences during the 2 years before clozapine was prescribed and those of the 5 years following prescription were compared by a records review, including hospital and hostel bed use and estimated treatment costs. Changes in dose levels, living circumstances and employment status were assessed, and treating psychiatrists reported on side-effects and their impression of clinical change since clozapine was prescribed. Results: Ten subjects were excluded. The remaining cohort (32 subjects) demonstrated continuing clinical improvement and cost savings during follow-up. Those (22) remaining on clozapine after the five year period showed continuing clinical improvement, reduced hospital admissions and hospital bed usage and significantly large cost savings, and were moderately to markedly improved after 3 years. Only one patient (of 22) showed a slight deterioration in the next two years while 14 showed further improvement. After 5 years, the clinical status of four of the 10 subjects who discontinued clozapine was unchanged or deteriorated compared with their preclozapine status. There were no suicides. Conclusion: The findings of continuing clinical improvement and decreased costs after longterm (5 years) use of clozapine supports the selective use of clozapine in community practice.
Neuropsychological Functioning in Children With DSM-IV Combined Type Attention Deficit Hyperactivity Disorder
Authors: Tripp Gail , Ryan Junita , Peace Kathryn 
Published: March 2003

Objective: To compare the global cognitive functioning and frontal lobe functioning of children with and without DSM-IV combined type Attention Deficit Hyperactivity Disorder (ADHD). Method: Participants were 6 to 10 year old, clinic-referred children diagnosed with combined type ADHD, who were medication naïve; and an age (± 3 months) and sex matched group of children without behaviour problems. The performance of the two groups were compared on measures of intellectual functioning and tests designed to assess the functions of the frontal lobes (verbal and-non-verbal fluency, reasoning, problem solving, spatial working memory, attention). Results: The children with ADHD obtained significantly lower Wechsler Intelligence Scale for Children-third edition IQ scores than controls and performed more poorly across the range of frontal lobe tests. Group differences on these tests were attenuated when IQ scores were included in the analyses as a covariate. Conclusions: Children with combined type ADHD have mild to moderate global cognitive impairment together with some impairment of functions subserved by the frontal lobes. Longitudinal studies are required to determine if the deficit in global cognitive functioning is a primary deficit or secondary to the deficit in frontal lobe functioning. The importance of neuropsychological assessment and follow-up for children with ADHD is stressed. Study limitations relate to the generalizability of the findings and the absence of a psychiatric control group.
Is it Time to Introduce Repetitive Transcranial Magnetic Stimulation into Standard Clinical Practice for the Treatment of Depressive Disorders?
Authors: Fitzgerald Paul 
Published: March 2003

Objective: To examine issues relating to the potential introduction of repetitive transcranial magnetic stimulation (rTMS) into clinical practice as a treatment for depression. Method: A review of the outcomes literature accompanied by an analysis of issues relating to the potential advantages and pitfalls of the introduction of rTMS as a treatment strategy. Results: Evidence is progressively accumulating that rTMS has antidepressant properties that are clinically relevant. These effects are biologically plausible and supported by basic research. Patients with therapy-resistant depression have few treatment alternatives and experience significant suffering, thus justifying the early introduction of a new treatment such as rTMS for this patient group. However, this must be balanced by a need to foster considerable further research and not to raise expectations unreasonably. Conclusions: It is timely for rTMS to be made more available to patients with treatment-resistant mood disorders. This need not be limited to clinical research trials but should only occur in medical settings where continual evaluation and research is conducted.
APPLICATION OF PROGNOSTIC SCORING SYSTEMS IN DIFFERENTIATED THYROID CARCINOMA
Authors: Chaplin JOHN M. , O’Brien CHRISTOPHER J. , Mcneil EDWARD B. , Haghighi Kourosh 
Published: March 2003

Background: Total thyroidectomy is widely practised in Australasia for papillary and follicular thyroid carcinoma. Data from large overseas series have demonstrated that patients with these cancers may be separated into risk groups based on clinicopathological prognostic factors. Furthermore, evidence suggests that low‐risk patients may be safely treated with less than total thyroidectomy. The aim of the present paper was to determine what proportion of our patients with papillary and follicular thyroid cancer were in the low‐risk group in order to select candidates for less aggressive treatment. Methods: A prospectively documented series of 175 previously untreated patients with papillary and follicular thyroid carcinoma, treated principally by total thyroidectomy over a 10‐year period, was divided into risk groups using the Mayo Clinic, Lahey Clinic and Memorial Hospital prognostic scoring systems. Complication rates for 103 patients treated by total thyroidectomy were also studied and reported. Results: Women outnumbered men by 2.3:1. There were 128 papillary carcinomas (73%) and 47 follicular cancers (27%). These tumours were < 4 cm in diameter in 81% of patients, and 41% of patients were 40 years of age or younger. Low‐risk patients accounted for 75, 81 and 45% of the study group, respectively, when the three prognostic scoring systems were applied to our patient population. The rates for recurrent laryngeal nerve palsy and permanent hypoparathyroidism for patients having total thyroidectomy were 1 and 1.9%, respectively. In the low‐risk group there were no permanent complications. Conclusion: Most patients treated at Royal Prince Alfred Hospital during the past 10 years were low‐risk patients who may have been eligible for less aggressive surgical treatment.