bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Integrated Treatment Algorithm for Pharmacotherapy and Psychotherapy
Authors: Kisely Stephen R. , Jones Judy 
Published: March 2003

Objective: As in Australia, demand for psychotherapy is rising in Britain, and the wide variety of psychological treatments available within the National Health Service (NHS), the independent sector, and voluntary agencies leads to uncertainty about which patients are most suitable for which type of psychotherapy, as well as the appropriate balance between psychological and pharmacological interventions. This paper describes how Birmingham Health Authority (HA), the largest HA in England and Wales with a population of just under one million, developed and implemented an evidence-based strategy for the use of psychotherapy services. Method: A literature search and health needs assessment for psychotherapy in Birmingham was performed. Results: It was possible to estimate the need for evidence-based psychotherapy services using routinely available epidemiological data. By matching specific techniques to individual diagnosis and estimating the size of the population for whom this was appropriate, demand for psychotherapy exceeded service provision by a factor of four. Conclusions: The following steps were undertaken: (i) setting priorities for the commissioning of psychotherapy on the basis of the scientific literature including greater use of brief and focused forms of integrative therapy from a variety of psychotherapeutic schools; (ii) targeting interventions on the basis of objective criteria to ensure that patients were referred for the appropriate level and intensity of psychological intervention using the full range of available services within the NHS, the independent sector, and voluntary agencies; (iii) agreeing on an integrated treatment algorithm (ITA) for the use of the most cost-effective treatments while ensuring that a range of alternative interventions was available for patients for whom a first line therapy was not suitable. Such an ITA could be adapted to assist general practitioners in their management and referral decisions; (iv) sharing skills between specialist psychotherapy services and members of primary and mental health teams through training, supervision and consultation–liaison.
A Patient-Based Voucher System for Brief Hospitalisation
Authors: Little John , Stephens David 
Published: March 2003

Objective: The aim of this study was to demonstrate the clinical use of a patient-based voucher system for brief hospitalisation. Clinical picture: A 31-year-old male, chronically disabled, with schizophrenia, poly-substance, and borderline personality disorders presented concerns for the treating team. Treatment: Management was community based except for a single admission in which the patient chose the timing and duration via a predetermined set of vouchers. Outcome: In contrast to previous admissions, a patient-chosen, voucher-based admission was single, brief and uneventful. Conclusions: Novel approaches to chronically disabled patients with psychiatric illness enable change from therapeutic pessimism. A patient-based voucher system seemed to be of use in one patient.
Schizoaffective Disorder in a Fragile-X Carrier
Authors: Al-Semaan Yousef , Malla Ashok K. , Lazosky Andrea 
Published: March 2003

Objective: Here we report the case of a schizoaffective psychosis in a female carrier of fragile-X (CGG sequence > 200). Clinical picture: The patient presented with symptoms of psychosis (hallucinations, delusions and disorganised thinking) and mania, preceded by decline in intellectual and social functioning. Treatment and outcome: Initial treatment with antipsychotic drugs alone or in combination with sodium valproate was only partially effective, but the addition of lithium resulted in a complete remission. Conclusions: One year later the patient presented predominantly with deficit symptoms and profound deficits in memory and executive functions. It is likely that the intellectual deterioration around the time of puberty associated with fragile-X increased her vulnerability to a schizoaffective disorder and eventually to poor functioning.
Trauma-Induced Dissociative Amnesia in World War I Combat Soldiers. II. Treatment Dimensions
Authors: Brown Paul , Hart Onno van der , Graafland Mariétte 
Published: March 2003

Objective: This is the second part of a study of posttraumatic amnesia in World War I (WW I) soldiers. It moves beyond diagnostic validation of posttraumatic amnesia (PTA), to examine treatment findings, and relates these to contemporary treatment of dissociative amnesia, including treatment of victims of civilian trauma (e.g. childhood sexual abuse). Method: Key WW I studies are surveyed which focus on the treatment of PTA and traumatic memories. The dissociation-integration and repression-abreaction models are contrasted. Results: Descriptive evidence is cited in support of preferring Myers' and McDougalls' dissociation-integration treatment approach over Brown's repression-abreaction model. Conclusion: Therapeutic findings in this paper complement diagnostic data from the first report. Although effective treatment includes elements of both the dissociative-integrative and abreactive treatment approaches, cognitive integration of dissociated traumatic memories and personality functions is primary, while emotional release is secondary.
The Impact of Posttraumatic Stress Disorder on Partners and Children of Australian Vietnam Veterans
Authors: Westerink Jan , Giarratano Leah 
Published: March 2003

Objective: This study explored the emotional and physical health of a group of families of Australian Vietnam veterans suffering posttraumatic stress disorder (PTSD). The aim was to study the impact of PTSD upon the families of the sufferers. Method: The families of a random sample of Vietnam veterans receiving treatment at a specialist PTSD Unit were invited to participate in this study. Partners of the veterans and children over the age of 15 years were eligible to participate. Four selfreport psychometric inventories were administered assessing psychological distress, social climate within their families, self-esteem, and a range of lifestyle issues, including physical health. A control group, consisting of a sample of volunteers, was also surveyed. Results: The partners of the Vietnam veterans showed significantly higher levels of somatic symptoms, anxiety and insomnia, social dysfunction and depression than the control group. They reported significantly less cohesion and expressiveness in their families and significantly higher levels of conflict. The partners also had significantly lower levels of self-esteem. The children of the veterans reported significantly higher levels of conflict in their families. However, the children showed no significant differences on measures of psychological distress and self-esteem from their matched counterparts. Conclusions: These findings support overseas studies that indicate that the families of PTSD sufferers are also impacted by the disorder. In this study, the families of Australian Vietnam veterans experienced more conflict and their partners were significantly more psychologically distressed (i.e. somatic symptoms, anxiety, insomnia, social dysfunction, depression and low self-esteem) than a matched control group.
Are the Newer Antidepressant Drugs as Effective as Established Physical Treatments? Results from an Australasian Clinical Panel Review
Authors: Parker Gordon , Mitchell Philip , Wilhelm Kay , Menkes David , Snowdon John , Schweitzer Isaac , Grounds David , Skerritt Paul , Roy Kay , Hadzi-Pavlovic Dusan 
Published: March 2003

Objective: The aim of this study was to determine, in a clinical panel sample, the extent to which patients with depression (and melancholic and non-melancholic subtypes) judged the effectiveness of previously received antidepressant treatments, particularly the comparative effectiveness of the older and newer antidepressant drugs. Method: Twenty-seven Australasian psychiatrists assessed 341 non-psychotic depressed patients and rated the extent to which previous antidepressant treatments had been effective. Patients were assigned to ‘melancholic’ and residual ‘non-melancholic’ categories by two processes (DSM-IV decision rules, and a cluster analysis-derived allocation) and treatment effectiveness examined within each category. Results: Electroconvulsive therapy (both bilateral and unilateral) was judged as highly effective by both melancholic and non-melancholic patients. Antipsychotic medication similarly rated highly (but was judged as more effective by the non-melancholic than melancholic patients). The tricyclics and irreversible monoamine oxidase inhibitors (MAOIs) were rated as more effective by the whole sample than several newer antidepressant classes (including the selective serotonin re-uptake inhibitors [SSRIs], venlafaxine, mianserin and moclobemide), whether effectiveness was examined dimensionally or categorically. Comparison of the overall tricyclic and SSRI classes indicated that any superior tricyclic effectiveness was specific to the melancholic subjects. Conclusions: Despite methodological limitations intrinsic to such clinical panel data, the judged greater effectiveness of the older antidepressants (tricyclics and irreversible MAOIs) for melancholic depression is of importance. If valid, such data are of intrinsic clinical relevance but also have the potential to inform us about the neurobiological determinants of ‘melancholia’ and pharmacological actions which contribute to its effective treatment.
Child Sexual Abuse II: Treatment
Authors: Nurcombe Barry , Wooding Sally , Marrington Peter , Bickman Leonard , Roberts Gwenneth 
Published: March 2003

Objective: To evaluate the scientific literature concerning the treatment of child sexual abuse. Method: A critical review of the scientific literature. Results: There are only nine published research studies in which subjects were randomly assigned to an index treatment or treatments and a comparison treatment or no-treatment control group. In seven of the studies, the index treatment exceeded the control or comparison group in regard to treatment outcome; in two studies it did not. The successful treatments involved group therapy, combined individual and group play therapy and cognitive behaviour therapy. Conclusions: Treatment should be based on an explicit conceptual model of the psychopathology of sexual abuse. The University of Queensland Sexual Abuse Treatment Project, which is based on a transactional model, is described.
Maori and Alcohol: A Reconsidered History
Authors: Mancall Peter C. , Robertson Paul , Huriwai Terry 
Published: March 2003

Objective: To document aspects of the history of alcohol use among Maori, with a particular focus on the period from 1840 to 1872 and to identify potential use of this knowledge in the development of strategies for the prevention and treatment of alcohol-related harm among Maori in contemporary New Zealand. Method: A survey of the surviving documentation about alcohol in nineteenth-century New Zealand; materials were predominantly drawn from the writings of pakeha (non-Maori) missionaries, officials and travellers, as well as available statistical records. Results: Analysis of early written historical records suggests significant variation in the response of Maori to the introduction of alcohol in different parts of New Zealand during the period following European contact. Conclusions: One stereotype that has arisen suggests Maori have been incapable of and/or unable to manage the production and use of alcohol. On the other hand, another commonly held belief has been that Maori supported abstinence or ‘resisted alcohol’ because they recognised its ‘ruinous nature’ and because it was contrary to traditional custom and practices. Historical information indicates that the Maori response to the introduction of alcohol was in fact diverse and for much of the nineteenth century alcohol was non-problematic for many Maori. This reinterpretation of the historical record can potentially empower contemporary Maori to take greater responsibility for the use of alcohol. It also challenges the negativity of the stereotypes generated by historical misinformation.
The Role of Economic Evaluation in Mental Health Care
Authors: Singh Bruce , Hawthorne Graeme , Vos Theo 
Published: March 2003

Objective: A consequence of the integration of psychiatry into acute and public health medicine is that psychiatrists are being asked to evaluate their services. There is pressure on mental health-care systems because it is recognized that funds should be directed where they can provide the best health outcomes, and also because there are resource constraints which limit our capacity to meet all demands for health care. This pressure can be responded to by evaluation which demonstrates the effectiveness and efficiency of psychiatric treatment. This paper seeks to remind psychiatrists of the fundamental principles of economic evaluation in the hope that these will enable psychiatrists to understand the methods used in evaluation and to work comfortably with evaluators. Method: The paper reviews the basic principles behind economic evaluation, illustrating these with reference to case studies. It describes: (i) the cost of the burden of illness and treatment, and how these costs are measured; (ii) the measurement of treatment outcomes, both as changes in health status and as resources saved; and (iii) the various types of economic evaluation, including cost-minimization, cost-effectiveness, cost-utility and cost–benefit analysis. Results: The advice in the paper provides psychiatrists with the necessary background to work closely with evaluators. A checklist of the critical questions to be addressed is provided as a guide for those undertaking economic evaluations. Conclusions: If psychiatrists are willing to learn the basic principles of economic evaluation and to apply these, they can respond to the challenges of evaluation.
Implications for Australia of the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder
Authors: Levy Florence 
Published: March 2003

Objectives: This paper reviews the implications of the large-scale USA Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA) by the MTA Cooperative group for planning of clinical services for children with attention deficit hyperactivity disorder in Australia. Method: The MTA study findings of no significant difference between active medication treatment alone, and combined medication combined with behaviour therapy treatments, on core symptom outcomes, are examined. Service traditions, workforce issues, diagnostic and ethical and philosophical considerations are discussed in relation to their impact on service planning in Australia. Implications of pharmacogenomic research are examined. Ethical and philosophical questions are raised in relation to the use of stimulant medications for subthreshold symptoms and for socialization of children. Results: A critical evaluation of results reveals that combined treatments allow the use of lower medication doses, and that multimodal treatments are effective for comorbid symptoms. Completion of the Human Genome Project promises increasing technological advances. Arguments for and against a technological approach to child rearing are posited. Conclusions: The MTA study raises not just service planning questions, but also important ethical and philosophical considerations about optimal degree of medicalization of services in an increasingly technological society. Child psychiatrists will be required to have an understanding of technological developments if they wish to contribute to future debates.
Cardiovascular Risk Factors for People with Mental Illness
Authors: Davidson Sandra , Judd Fiona , Jolley Damien , Hocking Barbara , Thompson Sandra , Hyland Brendan 
Published: March 2003

Objective: The objective of this study was to document the prevalence of risk factors for cardiovascular disease among people with chronic mental illness. Method: A cross-sectional survey was conducted of 234 outpatients attending a community mental health clinic in the North-western Health Care Network in Melbourne, Australia. Prevalence of smoking, alcohol consumption, body mass index, hypertension, salt intake, exercise and history of hypercholesterolemia was assessed. Results: Compared with a community sample, the mentally ill had a higher prevalence of smoking, overweight and obesity, lack of moderate exercise, harmful levels of alcohol consumption and salt intake. No differences were found on hypertension. Men, but not women, with mental illness were less likely to undertake cholesterol screening. Conclusions: Psychiatric outpatients have a high prevalence of cardiovascular risk factors which may account for the higher rate of cardiovascular mortality among the mentally ill. Further research is needed to trial and evaluate interventions to effectively modify risk factors in this vulnerable population.
Can We Manage Without the Mental Hospital?
Authors: Leff Julian 
Published: March 2003

Objectives: Many developed countries, having invested massively in psychiatric hospitals in the past 150 years, are in the process of dismantling them. The central question is whether this change in the location of care from the psychiatric hospital to district-based services has benefited the patients. The objectives of this review are to examine the evidence on which an answer to the above question might be based. Method: Much of the relevant research comes from the 13-year programme of the Team for the Assessment of Psychiatric Services conducted in London, but other research will be reviewed as appropriate. Results and conclusions: Long-stay, non-demented patients, including the elderly, enjoy a better quality of life in the community homes compared with the psychiatric hospitals. Public attitudes constitute an obstacle to social integration into the healthy community, but can be ameliorated with local educational programmes. The provision of work has been unsatisfactory, but the development of social firms holds some promise. Patients with dementia receive better care in community nursing homes compared with hospital wards, according to their relatives' opinions, backed up by observational studies. The part of the service which is most unsatisfactory is the admission facilities. This is due to a variety of causes, including a failure to plan for the admission needs of discharged long-stay patients, the virtual absence of rehabilitation units in the community and an inadequate provision of a range of sheltered accommodation. However, these problems could be resolved with adequate investment in innovative facilities.
‘Why Getting Fat, Doc?’ Weight Gain and Psychotropic Medications
Authors: Malhi Gin S. , Mitchell Philip B. , Caterson Ian 
Published: March 2003

Objectives: Weight gain associated with the use of psychotropic medications is a common clinical problem that is of particular importance because of its effects on the general health of psychiatric patients and their compliance with treatment. This paper aims to explore this issue and discuss the mechanisms of weight gain and methods of prevention. Method: A literature review ( Index Medicus/Medline) was carried out as well as a review of other relevant papers and data known to the authors. Results: Significant weight gain may result in considerable morbidity. The majority of psychotropic medications are associated with weight gain, however, the mechanisms of weight gain are often complex and poorly understood. Conclusion: Clinically, weight gain can be anticipated and often managed with some success in the majority of psychiatric patients with simple but relatively effective measures. It is important for clinicians to be aware of this common clinical problem and educate patients from the outset, monitoring them regularly and intervening when necessary.
The Adjustment of Children of Australian Vietnam Veterans: Is There Evidence for the Transgenerational Transmission of the Effects of War-Related Trauma?
Authors: Davidson Ann C. , Mellor David J. 
Published: March 2003

Objective: The presence of posttraumatic stress disorder (PTSD) in trauma survivors has been linked with family dysfunction and symptoms in their children, including lower selfesteem, higher disorder rates and symptoms resembling those of the traumatized parent. This study aims to examine the phenomenon of intergenerational transfer of PTSD in an Australian context. Method: 50 children (aged 16–30) of 50 male Vietnam veterans, subgrouped according to their fathers’ PTSD status, were compared with an age-matched group of 33 civilian peers. Participants completed questionnaires with measures of self-esteem, PTSD symptomatology and family functioning. Results: Contrary to expectations, no significant differences were found between the selfesteem and PTSD symptomatology scores for any offspring groups. Unhealthy family functioning is the area in which the effect of the veteran's PTSD appears to manifest itself, particularly the inability of the family both to experience appropriate emotional responses and to solve problems effectively within and outside the family unit. Conclusion: Methodological refinements and further focus on the role of wives/mothers in buffering the impact of veterans’ PTSD symptomatology on their children are indicated. Further effort to support families of Veterans with PTSD is also indicated.
The Christchurch Health and Development Study: Review of Findings on Child and Adolescent Mental Health
Authors: Fergusson David M. , Horwood John L. 
Published: March 2003

Objective: This paper provides an overview of the Christchurch Health and Development Study (CHDS) and a summary of findings relating to child and adolescent mental health. Method: The CHDS is a longitudinal study of a birth cohort of 1265 children born in the Christchurch (New Zealand) urban region during mid 1977. This cohort has now been studied from birth to age 21. Results: The paper examines the ways in which the study has been able to examine a wide range of issues. Key issues examined include: (i) measurement of disorder (respondent effects; dimensionality; scales vs categories); (ii) prevalence and treatment of disorder; (iii) stability and continuity of disorders; (iv) the contribution of risk and aetiological factors (e.g. lead exposure, parental divorce, child abuse, family adversity, sexual orientation) to psychosocial adjustment; and (v) the psychosocial consequences of mental health problems in adolescence. Conclusions: The study findings illustrate the many advantages of a longitudinal study, such as the CHDS, in providing methodologically sound, theoretically relevant and cost effective research that caters for the interests of multiple end-users including the scientific community, clinicians and applied policy makers.