bluuebunny/crossref_metadata_2025_split huggingface dataset:
Re‐awakenings?: A discourse analysis of the recovery from schizophrenia after medication change
Authors: Rudge Trudy , Morse Kristy 
Published: March 2003

ABSTRACT This paper explores the construction of recovery from schizophrenia after medication change through the analysis of people living with schizophrenia. The study is framed by a discourse analysis which assumes that the language used to discuss schizophrenia and its treatment by medication is imbued with the power relations of mental health. The analysis uses research literature, pharmaceutical literature and previous studies of schizophrenia as the discursive background that frames how recovery can be talked about. The discussion highlights how the discourses of medical science construct recovery as a linear event that silences the embodiment of schizophrenia. People with schizophrenia refuse this construction, through finding a ‘niche’ for themselves. In conclusion, the paper suggests how such analysis opens up for exploration of the silencing of ‘insanity’, and establishes a beginning dialogue with people who live with the continuing presence of schizophrenia.
Survey of stakeholders’ opinions of community psychiatric nursing services
Authors: Shanley Eamon , Watson George , Cole Alison 
Published: March 2003

ABSTRACT The paper describes a telephone survey of the views of representatives of users, purchasers and providers of community psychiatric nursing services on services in Scotland. The telephone interview protocol was based on seven themes derived from interviewing 63 users, purchasers and providers throughout the UK. Descriptive statistics were used to present the responses in the survey to the forced choice questions. Responses to the open ended questions were coded, categorized and computed. The paper describes the responses by the major stakeholders to each of the themes. Overall, the quality of the existing services was placed in the ‘good’ category. However, criticism was directed at the insufficient numbers of Community Psychiatric Nurses in the service, the inadequate amount of time spent with clients and their poorly organized method of working. Other findings and stakeholders’ recommendations are discussed.
Immigrants and Equitable Health‐Care Delivery in Rural Areas
Authors: Fuller Jeff , Ballantyne Alison 
Published: March 2003

ABSTRACTIn response to settlement patterns in Australia, most immigrant specialist services and programs have been developed in metropolitan locations and large provincial cities. However, immigrants have also settled in smaller numbers in country locations. It is of concern, therefore, to consider how responsive and equitable health‐care services can be delivered in country regions when immigrants do not reach the critical mass that would warrant the development of specialist services. This paper draws on a consultation conducted in South Australia to propose a way forward in linking country health services with local immigrant communities and immigrant specialist services in cities.
Variation in religious affiliations between different populations: metropolitan, rural, agricultural and elderly
Authors: Peach Hedley G. 
Published: March 2003

ABSTRACT: People with a religious affiliation are more likely to hold beliefs affecting health care choices. It is hypothesised that a religious affiliation, particularly to a Christian religion, is more common outside metropolitan areas, particularly in rural, very elderly and agricultural populations. The study's aim was to test this hypothesis. Rural, very elderly and agricultural populations within regional Victoria were compared with Melbourne on religious affiliations reported in the 1996 census. A religious affiliation was significantly more common in the very elderly (83.3%) and agricultural (86.1%) populations than in Melbourne (79.1%). A Christian affiliation was significantly more common in the rural (78.6%), very elderly (82.9%) and agricultural (85.8%) populations than in the metropolitan area (72.5%), while a non‐Christian affiliation was significantly less common (< 0.8
vs
. 6.6%). This study confirms that a Christian religious affiliation is more common outside metropolitan areas, particularly in rural, very elderly and agricultural populations. Beliefs affecting health‐care choices are also likely to be more common in very elderly and agricultural populations due to their higher level of religious affiliation overall.
Dexamethasone Suppression Test Reversal in Rapid Transcranial Magnetic Stimulation-Treated Depression
Authors: Reid Philip D. , Pridmore Saxby 
Published: March 2003

Objective: The aim of this paper is to report the effect of rapid transcranial magnetic stimulation (rTMS) on the mood and dexamethasone suppression test (DST) of a patient with major depressive disorder (DSM-IV). Clinical picture: A36-year-old woman with a past history of prolactinoma and recurrent major depressive disorder presented with major depression on three separate occasions over a 3-month period. DST was positive on each occasion. Treatment: During each episode, a course of rTMS was given. Courses varied from seven to 13 once-daily treatment sessions depending on clinical response. These treatment sessions were 20 trains of 10 Hz for 5 s at 100% of motor threshold. Outcome: Remission was achieved, psychiatric rating scales improved and the DST status converted from positive to negative. There were no side effects. Conclusion: DST status in major depressive disorder can be converted from positive to negative by rTMS. This so far unreported observation increases our knowledge of rTMS.
The Response of Healthcare Services to People at Risk of Suicide: a Qualitative Study
Authors: Nirui Meredith , Chenoweth Lynn 
Published: March 2003

Objective: This paper describes a small qualitative research study conducted in the area of suicide. Family and close friends of 15 young people who lived in Sydney, New South Wales, prior to their suicide, between 1990 and 1995, were interviewed to elicit their perceptions of the healthcare support given to the suicidees prior to their death. Method: Content analysis of in-depth interview transcripts identifying common themes in the description of the participants' experiences and impressions was carried out. A recurring theme was their call for more proactive management and support programs for people at risk of suicide, as well as education and support for close family and friends. Result: Participants claimed that they believed there were inadequate supports in place, that information and education were uncoordinated and sparse, and that healthcare workers were not effective in preventing suicide attempts because they lacked adequate diagnostic and management skills and displayed poor attitudes towards suicidees. Conclusion: Experiences of care received and suggestions for improving them by people closely associated with suicide, provide healthcare staff with important information about the types of information, education and support that those at risk of suicide and their loved ones require at a time of crisis.
Attention Deficit Hyperactivity Disorder: Anxiety Phenomena in Children Treated with Psychostimulant Medication for 6 Months or More
Authors: Vance Alasdair L.A. , Luk Ernest S.L. , Costin Jan , Tonge Bruce J. , Pantelis Christos 
Published: March 2003

Objective: The intermediate- to long-term use of psychostimulant medication has unclear benefits on the core symptoms of attention deficit hyperactivity disorder (ADHD) and delayed onset affective symptom side effects which can mimic these core ADHD symptoms. ‘ADHD and anxiety’ has also been associated with a poor response to short-term psychostimulant medication treatment. In addition, it is unclear whether ‘ADHD and anxiety’ should be defined from the child's and/or the parent's perspective. We propose that anxiety will be increased in children with ADHD who are treated with psychostimulant medication in the intermediate- to long-term who are identified by clinicians as poor responders. Method: Twenty children with ADHD who were medicated for 6 months or more and who had ongoing core symptoms of ADHD were compared to 20 age- and IQ-matched children with ADHD who were medication-naive. Chi-squared tests were performed on the categorical dependent variables and independent t-tests on the dependent continuous variables. Results: Anxiety is significantly increased in children with ADHD treated with psychostimulant medication in the intermediate- to long-term who are noted by clinicians to have ongoing core symptoms of ADHD. This statistically significant finding is evident with both categorical and dimensional measures of anxiety from the child's perspective. Conclusions: The recognition of anxiety and its management in children with ADHD is generally poorly understood. In this particular group of children with ADHD, anxiety may be a side effect of intermediate- to long-term psychostimulant medication and/or a potential marker for a poor response to intermediate- to long-term psychostimulant medication treatment.
The Evaluation of Depression in Inpatients with HIV Disease
Authors: Cockram Alexandra , Judd Fiona K. , Mijch Anne , Norman Trevor 
Published: March 2003

Objectives: The aim of this paper is: to compare the utility of four approaches to the diagnosis of depression in patients with human immunodeficiency virus (HIV) disease; to examine the utility of four rating scales to assess the presence and severity of depression; and to devise a set of substitutive criteria that would be appropriate in patients with HIV disease. Method: A group of inpatients was assessed using standard clinical interview. Patients found to have major depression using DSM-III-R (aetiological) criteria were assessed using inclusive, substitutive and exclusive criteria for the diagnosis of depression. Severity was assessed using the Hamilton Depression Rating Scale (HDRS), the Montgomery Asberg Depression Rating Scale (MADRS), the Beck Depression Inventory (BDI), and the Centre for Epidemiological Studies Depression Rating Scale (CES-D). Agroup of control patients were matched for age and severity of HIV illness. Results: Seventeen patients met DSM-III-R (aetiological criteria) for major depression. All were male; they had a mean age of 40.6 years and one-third had acquired immune deficiency syndrome (AIDS). Using alternative approaches to the diagnosis of depression, up to five additional ‘depressed’ patients were identified (‘false positives’). All 17 patients meeting the DSM-III-R criteria also met the substitutive and exclusive criteria but only 15 exclusive criteria. Of the 17 controls (not meeting DSM-III-R criteria), two met substitutive, five inclusive and one exclusive criteria for depression. The mean (±SD) scores for the patients and controls were significantly different on all four rating scales. Analysis of individual items on the rating scales revealed that a number did not show significant differences between the depressed and non-depressed groups: on the MADRS the items lassitude and inner tension; on the HDRS the three items depicting anxiety symptoms, loss of libido, hypochondriasis, loss of weight, and maintenance of insight; on the BDI a sense of being punished, disappointed in self, being self-critical, a feeling of looking unattractive, fatigue, weight loss, worried about health and loss of libido; on the CES-D I felt just as good as others, hopeful, talk less, people unfriendly and felt people dislike me. Conclusions: The aetiological approach used by clinicians familiar with the features of HIV disease, was found to be useful. All four rating scales differentiated equally well between depressed and non-depressed groups.
Post-Disaster Service Provision Following Proactive Identification of Children with Emotional Distress and Depression
Authors: McDermott Brett M. C. , Palmer Lyle J. 
Published: March 2003

Objective: Proactive, school-based psychological testing for emotional distress and depression was employed 6 months after a bushfire disaster. The service provision aim was to provide children with the greatest emotional distress the relatively limited therapeutic resources available in the post-disaster environment. Specific hypotheses were tested: that the prevalence of emotional distress and depression would be elevated 6 months post disaster; that emotional distress would be correlated with traumatic events; and that depression would be related to experiences of loss. Method: Six months after a bushfire disaster grade 4, 5, and 6 students (n = 601) participated in screening using a test battery measuring emotional distress, depressive symptoms and trait anxiety. Results: Twelve percent (n = 72) of children experienced severe emotional distress 6 months after the bushfire. Rates of depression were similar to rates in non-traumatised child community samples. Multivariate analysis suggested that emotional distress was significantly associated with trait anxiety, evacuation experience, the perception that parents may have died during the bushfire, and depressive symptoms. Depressive symptoms were associated with total distress score, trait anxiety and perception of threat to the parents. Conclusions: Substantial mental health morbidity was identified 6 months after a bushfire disaster. The usefulness of post-disaster service provision influenced by proactive screening is discussed and reasons for further research highlighted.
Preventative Mental Health Care: Accessing the Target Population
Authors: Phillips Lisa , Yung Alison R. , Hearn Narelle , McFarlane Colleen , Hallgren Mats , McGorry Patrick D. 
Published: March 2003

Objective: Preventative approaches to mental illness are becoming a focus of clinical and research settings. To date, however, few clinical programs have been established with this primary aim. This descriptive paper summarises patterns of referral to one service providing clinical care for young people known to be at high risk of developing a psychotic illness. Methods and results: A 20-month survey of referrals to the service revealed that most patients had a prolonged and circuitous route to assessment. Additionally, a lengthy time period elapsed between the onset of symptoms and initiation of help seeking. Conclusions: Information arising from this survey may influence the development of strategies to improve access to this service and others aimed at the prevention of psychosis. Further, this information may affect the development of generalised pre-ventative mental health services for young people.
The Psychotherapeutic Management of a Patient Presenting with Brief Psychotic Episodes
Authors: Schimmel Paul 
Published: March 2003

Objective: The aim of this article is to illustrate: (i) the advantages of a psycho-dynamically informed management of patients with a borderline personality organisation who require inpatient treatment; and (ii) the principles of a ‘therapeutic community’ approach in practice. Method: The 18-month residential therapeutic community treatment of a patient presenting with a history of brief psychotic episodes is described. An attempt is made to analyse the relationships between treatment variables and the patient's clinical progress over the treatment period. Results: By the end of treatment significant improvement in the patient's clinical state had occurred. Evidence is presented to support the conclusion that the treatment was an important factor in this outcome. Conclusions: Clinical management based upon a psychodynamic understanding of the borderline patient's presentation is likely to best fit the individual patient's needs. Such a treatment approach, as embodied in a well-functioning therapeutic community, may help create the possibility of a ‘new beginning’ for the patient.
A Jacksonian and Biopsychosocial Hypothesis Concerning Borderline and Related Phenomena
Authors: Meares Russell , Stevenson Janine , Gordon Evian 
Published: March 2003

Objective: The aim of this paper is to develop an aetiological model for borderline personality disorder. Method: The postulates of Hughlings Jackson are used to provide a preliminary explanatory framework for borderline phenomena. As a necessary background to this discussion, the findings concerning abuse in the early history of borderline personality disorder (BPD) and other conditions, notably somatisation disorder and dissociative states, are briefly reviewed. Other data, including family studies, which might have significance in the aetiology of BPD are also reviewed. Results: The hypothesis is put forward that the symptoms of BPD are due to the failure of ‘experience-dependent’ maturation of a cascade of neural networks, with prefrontal connections, which become active relatively late in development and which coordinate disparate elements of central nervous system function. These networks subserve higher psychological functions, including attentional focus and affect regulation. They also underpin the reflective function necessary to the emergence of self as the stream of consciousness, which appears at about the age of 4 years. Conclusion: Adverse developmental circumstances may produce an interrelated set of symptom clusters, with associated neural network disturbances that are amenable to investigation with psychometric and brain imaging techniques. Since these disturbances are seen as ‘experience-dependent’, they are considered reversible, at least in part.
The Efficacy of Psychosocial Approaches to Behaviour Disorders in Dementia: A Systematic Literature Review
Authors: Opie Janet , Rosewarne Richard , O'Connor Daniel W. 
Published: March 2003

Objective: This paper provides a systematic review of research findings published between 1989 and 1998 concerning non-pharmacological strategies to alleviate behavioural disturbances in elderly persons with dementia. Method: Data collection strategies included computer literature searches, manual searches of selected journals and checks of references listed in previous reviews. To warrant inclusion, studies were required to include some measure of behaviour before and after the introduction of an intervention. Papers were appraised in the following domains: design, sampling technique, setting, behaviours studied, measurement tools, data collection methods, type of interventions and feasibility. An overall validity rating was assigned to each article using predetermined rules. Results: Forty-three studies met criteria for inclusion including five randomised controlled trials. Validity ratings were as follows: one strong, 15 moderate, and 27 weak. Areas of scientific weakness included small numbers of subjects, inadequate descriptions of study participants, imprecise data collection methods, high attrition rates and insufficient statistical analysis. Despite this, there is evidence to support the efficacy of activity programs, music, behaviour therapy, light therapy, carer education and changes to the physical environment. The evidence in favour of multidis-ciplinary teams, massage and aromatherapy is inconclusive. Conclusions: It was easier to interpret the results of rigorously designed studies that focused on a single behaviour or single intervention tailored to the needs of individuals and carers. Future studies should seek to replicate the findings outlined here, improving methodologies where necessary and including outcome measures that encompass the interests of people with dementia, family caregivers and health professionals.
Alcohol Problems Among Residents in Old Age Homes in the City of Mannheim, Germany
Authors: Weyerer Siegfried , Schäufele Martina , Zimber Andreas 
Published: March 2003

Objective: This study aims to determine the prevalence of alcohol problems among residents in old age homes, its demographic and clinical features, and its association with the risk of falling. Method: All residents (n = 1922) living in 20 randomly selected residential and nursing homes in the city of Mannheim, Germany, were included. Based on routine documentation, details of their sociodemographic features, medical diagnoses made upon admission, and current medication were compiled. The home staff filled out for each resident a standardised assessment sheet on activities of daily living-impairment (Barthel Index), behaviour problems, alcohol consumption, and frequency of falls. Results: According to the diagnoses of the primary care physicians, 7.4% of the residents had mental and behavioural disorders due to alcohol (ICD-10: F10). Rates were particularly high among men, and younger and single or divorced residents. A high percentage of those with a diagnosis of alcohol abuse/dependence (41.1%) were transferred from mental hospitals. Home staff reported current alcohol abuse/dependence among 3.4% of all residents. The risk of falling was significantly elevated (Odds ratio: 2.65; p < 0.01) among those with current alcohol problems. Conclusion: The results corroborate the findings from other studies wherein residents of old age homes constitute a group at risk of alcohol abuse and dependence. Alcohol problems were more the cause for, rather than the consequence of, home admission.
Psychiatry of Old Age: From Section to Faculty
Authors: Draper Brian , Snowdon John 
Published: March 2003

Objective: To describe the processes that led to formation of the RANZCP Faculty of Psychiatry of Old Age (FPOA). Method and Results: Two criteria needed to be fulfilled before Faculty status could be approved. One was to demonstrate a recognised body of knowledge concerning psychiatry of old age, and the other was to be able to offer a comprehensive training program in this subspecialty. Conclusions: On 1 January 1999, FPOA came into existence.
Vascular Risk Factors and Alzheimer's Disease
Authors: Stewart R. , Prince M. , Mann Anthony 
Published: March 2003

Objective: We aim to summarise the recent and accumulating epidemiological research which suggests that cardiovascular disease and vascular risk factors play an important role as risk factors for Alzheimer's disease (AD) in later life. Method: The epidemiological literature is summarised in considering the evidence for such an association, focusing on optimally designed population-based studies. Potential mechanisms of association are considered, drawing on relevant findings from neuroscience. Results: Cardiovascular disease and vascular risk disorders appear to be important factors in the aetiology of AD. However, there is a paucity of prospective studies with an adequate duration of follow-up to investigate the apparent age- and time-dependent nature of these associations. Conclusions: Vascular disorders represent potentially preventable risk factors with an important population impact due to their high prevalence in developed countries. The concept of AD and vascular dementia as clearly distinguishable disorders clinically or aetiologically is becoming increasingly tenuous. A better understanding of the relationship between AD and vascular disorders will depend on a more flexible diagnostic and conceptual framework.
Psychostimulants, Adult Attention Deficit Hyperactivity Disorder and Morbid Jealousy
Authors: Pillai Krishna , Kraya Niazi 
Published: March 2003

Objective: This paper aims to discuss the relationship between morbid jealousy, stalking behaviour, and psychodynamic issues. Comment will be made on the risk associated with diagnosis of adult attention deficit hyperactivity disorder (ADHD) and use of psychostimulants. Clinical picture: A man born in the former Yugoslavia charged with stalking was referred for assessment. He presented with a history of treatment for ADHD with dexamphetamine and delusions regarding his wife's fidelity. Treatment: The patient was treated with neuroleptics and counselling for himself and his family. Outcome: The patient was returned to the community. He separated from his wife but retains the abnormal belief. Conclusions: The diagnosis of adult ADHD appears to be increasing in Western Australia. Treatment with stimulants is common. The misdiagnosis of ADHD and consequent misuse of stimulants, can lead to the development of morbid jealousy, stalking behaviour and arrest.