bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Community-Based Services for Older Patients with Depression: The Benefits of an Educational and Service Initiative
Authors: Mutch Carolyn , Tobin Margaret , Hickie Ian , Mutch Carolyn , Tobin Margaret , Hickie Ian , Davenport Tracey , Burke David 
Published: March 2003

Objective: The objective of this study was to report a quality improvement project for older patients with depression. The initiative focused on both clinical practice changes (improvement of medical, neurocognitive and behavioural assessment) and service development (greater continuity of care). Method: After initial identification of key deficits, implementation of a service and educational initiative took place within a district mental health service. The service consisted of an inpatient unit, a specialized psychogeriatric service and two adult community mental health services. Mental health staff received education regarding the specific needs of older patients with depression and were provided with assessment materials, patient education and treatment aids. General practitioners participated in shared long-term management. Results: Following graded implementation, the management of 44 subjects (mean age = 65.4 years, 91% female) recruited over an 8-month period was reviewed. Compared with 99 subjects (mean age = 68.9 years, 69% female) from the earlier 12-month assessment phase, there were significant improvements in medical (43% to 92%), neurocognitive (37% to 84%) and behavioural (e.g. suicidal ideation: 78% to 100%) assessments. Similarly, relevant laboratory investigations (neuroimaging: 21% to 67%) and communication with general practitioners (73% to 97%) improved. The most change occurred in the adult community-based treatment services. Conclusions: A coordinated management and educational initiative resulted in marked improvement in basic medical and psychiatric assessment and more integrated care. These changes did not require expansion of specialist services.
Outpatient Cognitive Behavioural Therapy Programme for Alcohol Dependence: Impact of Naltrexone Use on Outcome
Authors: Feeney Gerald F.X. , Feeney Gerald F.X. , Young Ross McD. , Connor Jason P. , Tucker Jane , Mcpherson Annie 
Published: March 2003

Objective: Cognitive–behavioural therapy (CBT) has been effectively used in the treatment of alcohol dependence. Clinical studies report that the anticraving drug naltrexone, is a useful adjunct to treatment. Currently, few data are available on the impact of adding this medication to programmes in more typical, outpatient, and rehabilitation settings. The objective of this study was to examine the impact on outcome of adding naltrexone to an established outpatient alcohol rehabilitation program which employed CBT. Method: Fifty patients participated in an established 12-week, outpatient, ‘contract’-based alcohol abstinence programme which employed CBT. They also received naltrexone 50 mg orally daily (CBT + naltrexone). Outcomes were compared with 50 historical, matched controls, all of whom participated in the same programme without an anticraving medication (CBT alone). All patients met DSM-IV criteria for alcohol dependence. Results: Programme attendance across the eight treatment sessions was lower in the CBT alone group (p < 0.001). Relapse to alcohol use occurred sooner and more frequently in the CBT alone group (p < 0.001). Rehabilitation programme completion at 12 weeks was 88% (CBT + naltrexone) compared with 36% for (CBT alone) (p < 0.001). Alcohol abstinence at 12 weeks was 76% (CBT + naltrexone) compared with 18% (CBT alone) (p < 0.001). Conclusion: When employing the same outpatient rehabilitation programme and comparing outcomes using matched historical controls, the addition of naltrexone substantially improves programme attendance, programme completion and reported alcohol abstinence. In a typical outpatient programme, naltrexone addition was associated with significantly improved programme participation, better outcomes and was well tolerated.
An Audit of Medico-Legal Reports Prepared for Claims of Psychiatric Injury Following Motor Vehicle Accidents
Authors: Large Matthew , Nielssen Olav 
Published: March 2003

Objective: The objective of this audit was to examine whether the content of medico-legal reports regarding psychiatric injury following motor vehicle accidents was influenced by the role of the report writers. Method: The audit consisted of a retrospective review, using a novel rating scale, of archived documents from 559 consecutively examined insurance claims following motor vehicle accidents in New South Wales. Results: Treating practitioners wrote less complete reports than experts representing the plaintiff or defendant. Treating practitioners and plaintiffs' experts were more likely to diagnose posttraumatic stress disorder (PTSD) and depression, while defendants' experts were more likely to find no psychiatric disorder. Limitations of the study were that it was retrospective and examined report writing between 1989 and 1994. The completeness, rather than quality, of the medico-legal reports was measured. Conclusion: Further training and quality assurance procedures may improve medico-legal report writing. Reform of the rules regulating the content of experts' reports may reduce the extent to which the role of the report writer influences their opinion.
History of Depression as a Risk Factor for Dementia: An Updated Review
Authors: Jorm Anthony F. 
Published: March 2003

Objective: This review updates an earlier meta-analysis of the data on history of depression as a risk factor for dementia. It also considers the available evidence on the hypotheses proposed to explain the association between history of depression and dementia. Method: A meta-analysis was carried out on results from seven case-control and six prospective studies. A qualitative review was carried out on the evidence related to the hypotheses to explain the association. Results: The meta-analysis found evidence to support an association from both casecontrol studies (estimated relative risk 2.01; 95%% CI 1.16–3.50) and prospective studies (estimated relative risk 1.87; 95%% CI 1.09–3.20). However, the evidence did not clearly support any one hypothesis explaining the association. The most likely contenders are: (i) depression can be an early prodrome of dementia, (ii) depression brings forward the clinical manifestation of dementing diseases, and (iii) depression leads to damage to the hippocampus through a glucocorticoid cascade. Conclusions: The possibility that history of depression is a risk factor for dementia needs to be taken seriously and explanations of the association need to be further researched.
Informing Patients About Tardive Dyskinesia: Four-Year Follow Up of a Trial of Patient Education
Authors: Chaplin Robert , Timehin Clive 
Published: March 2003

Objective: This paper evaluates the effects of an educational intervention about tardive dyskinesia on knowledge and clinical stability at long-term follow up. Method: Fifty-six patients receiving antipsychotic maintenance completed a questionnaire assessing their knowledge about tardive dyskinesia. After random allocation to either educational intervention or control group, their knowledge, clinical stability and rates of tardive dyskinesia were reassessed after four years. Results: Seventy per cent of patients completed the study. The patients in the educational group retained significantly more knowledge at follow up than at baseline but this knowledge was not significantly greater than that of the control group. There were no significant differences in the clinical outcomes between the groups. Conclusion: Patients can retain a small but significant amount of information with a low risk of noncompliance. Discussion about tardive dyskinesia is necessary in the process of obtaining informed consent to treatment.
The Roles and Relationships of Psychiatrists and Other Service Providers in Mental Health Services
Authors: Herrman Helen , Trauer Tom , Warnock Julie ,   Professional Liaison Committee (Australia) Project Team
Published: March 2003

Objective: A number of the problems facing psychiatry are identified as having common origins in unresolved issues about teamwork. The aim is to identify the issues and to formulate recommendations for dealing with these obstacles. Method: The Royal Australian and New Zealand College of Psychiatrists Professional Liaison Committee (Australia) of the Board of Professional and Community Relations convened a number of meetings and discussions, with external assistance from JW and TT. Results: Much of contemporary mental health care is delivered either directly or indirectly by several persons, often working in teams. Teamwork and collaboration are central to good working relationships and service delivery. Effective teamwork and collaboration is supported by key elements including agreed goals, an agreed approach, effective communication styles, established ground rules, clear team roles, and competent leadership. The obstacles to effective teamwork and collaboration are discussed in terms of the following: ambiguity and conflict over roles; conflict and confusion over leadership; differing understandings of clinical responsibility and accountability; interprofessional misperceptions; and differing rewards between the professions. Conclusions: Developing an understanding of these issues opens the way to a series of recommendations in relation to education, professional organizations, and workplaces and government, which can be considered by a number of sectors and groups.
Magnetic Resonance Spectroscopy and its Applications in Psychiatry
Authors: Malhi Gin S. , Valenzuela Michael , Wen Wei , Sachdev Perminder 
Published: March 2003

Objective: This paper briefly describes neuroimaging using magnetic resonance spectroscopy (MRS) and provides a systematic review of its application to psychiatric disorders. 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: Magnetic resonance spectroscopy is a complex and sophisticated neuroimaging technique that allows reliable and reproducible quantification of brain neurochemistry provided its limitations are respected. In some branches of medicine it is already used clinically, for instance, to diagnose tumours and in psychiatry its applications are gradually extending beyond research. Neurochemical changes have been found in a variety of brain regions in dementia, schizophrenia and affective disorders and promising discoveries have also been made in anxiety disorders. Conclusions: Magnetic resonance spectroscopy is a non-invasive investigative technique that has provided useful insights into the biochemical basis of many neuropsychiatric disorders. It allows direct measurement, in vivo, of medication levels within the brain and has made it possible to track the neurochemical changes that occur as a consequence of disease and ageing or in response to treatment. It is an extremely useful advance in neuroimaging technology and one that will undoubtedly have many clinical uses in the near future.
Suicide Among Psychiatric Patients: A Case-Control Study
Authors: Pirkis Jane , Burgess Philip , Jolley Damien 
Published: March 2003

Objective: To examine patient- and treatment-based differences between psychiatric patients who do and do not die by suicide. Method: By linking databases of deaths and psychiatric service use in Victoria, we compared 597 cases who suicided over 5 years with individually matched controls. Results: Cases and controls could not be distinguished on the majority of patient- or treatment-based characteristics. The exceptions were that cases were more likely to be male, less likely to be outside the labour force, more likely to have recent contact with inpatient and community services, and more likely to have a registration as their last contact. Conclusions: Patients who suicide ‘look’ similar to those who do not, suggesting prevention approaches should ensure that all psychiatric patients receive optimal care, including appropriate detection, diagnosis, assessment and treatment of mental health problems, and careful, individualised assessment of suicide risk.
Reporting of Suicide in the Australian Media
Authors: Pirkis Jane , Francis Catherine , Pirkis Jane , Francis Catherine , Warwick Blood Richard , Burgess Philip , Morley Belinda , Stewart Andrew , Putnis Peter 
Published: March 2003

Objective: The media monitoring project aimed to establish a baseline picture of the extent, nature and quality of reporting of suicide by the Australian media, with a view to informing future strategies intended to optimize reporting of suicide. Method: Newspaper, television and radio items on suicide were retrieved over 12 months. Identifying and descriptive information were extracted for each item. Approximately 10% of items were rated for quality, using a rating scale based on criteria from Achieving the Balance, a kit designed to promote awareness among media professionals of issues relating to suicide. The scale ranged from 0 (poor quality) to 100 (good quality). Results: Reporting of suicide was extensive (with 4813 items retrieved). The nature of reporting was variable. Items tended to be about completed suicide (rather than attempted suicide or suicidal ideation), and most commonly involved content related to an individual's experiences, policy/programme initiatives and/or suicide statistics, although there were differences across media types. Items showed variability across dimensions of quality. The majority of suicide items did not have examples of inappropriate language, were not inappropriately located, did not use the word ‘suicide’ in the headline, and did not use explicit photographs/diagrams or footage. However, around half of the suicide items provided a detailed discussion of the method of self-harm and portrayed suicide as merely a social phenomenon. Where items concerned the suicide of a celebrity, reference was commonly made to that person's celebrity status. Most items failed to provide information on help services. The median total quality score was 57.1%. Conclusions: The reporting of suicide is extensive across all media types, and varies in nature and quality. In general, good items outnumber poorer items. However, there are still opportunities for improving media reporting of suicide.
Emotional Numbing in Posttraumatic Stress Disorder: Current and Future Research Directions
Authors: Litz Brett T , Litz Brett T , Gray Matt J 
Published: March 2003

Objective: Despite being understudied and poorly understood relative to the chronic fear, anxiety and other aversive emotional states that occur in the immediate aftermath of trauma, emotional numbing has become a core defining feature of posttraumatic stress disorder (PTSD). Method: This paper seeks to briefly review the literature bearing on these seemingly disparate emotional responses to trauma as well as theoretical accounts of emotional numbing that have been proffered to date. We then offer an alternative theory of posttraumatic emotional functioning and review empirical support for this model. Result: The experience of trauma produces very intense emotions such as overwhelming fear, horror, and anxiety, and these reactions can linger for a lifetime. Many trauma survivors also report restrictions in their emotional experience – a phenomenon most commonly referred to as emotional numbing. In contrast to previous accounts of posttraumatic emotional functioning our model posits that individuals with PTSD have difficulty expressing positive emotions as a result of re-experiencing states. We further argue that patients with PTSD are capable of experiencing and expressing the full range of emotions that were available pretraumatically. Conclusion: Our model holds that individuals with PTSD are not, in fact, ‘emotionally numb’ as a result of traumatic experience. Rather, PTSD is associated with hyperresponsivity to negatively valenced emotional stimuli. Consequently, patients with PTSD require more intense positive stimulation to access the full complement of appetitive or pleasant emotional behaviour.
Antipsychotic Use in Australia: The Patients' Perspective
Authors: Castle David , Castle David , Morgan Vera , Jablensky Assen 
Published: March 2003

Objective: To describe patterns of self-reported medication use in a population-based sample of people with psychotic disorders; to establish correlates with clinical variables; to determine perceived side-effect burden; and investigate patient perception of efficacy for different classes of antipsychotic agent. Methods: Using the Australian Low Prevalence (Psychosis) Study database we analysed patterns of psychotropic medication and examined their clinical correlates. We also determined rates of reported side-effects and perceived benefit or otherwise associated with the different antipsychotic drugs. Results: Of the 1126 persons interviewed, 88.6% were on psychotropic medication; 54.3% were using ‘typical’ antipsychotics (24.8% in depot form), while 8.3% were on clozapine, 13.3% on risperidone, and 8.8% on olanzapine. Around 30% of women, and 20% of men, were on mood stabilizers or antidepressants. Over half of respondents were on more than one agent. Of those on only one agent, nearly 80% reported at least one side-effect; the mean number of side-effects was 3.9 for typical antipsychotics, and 3.3 for atypicals. Atypicals, notably clozapine, tended to be rated by patients as more efficacious than typicals; depot preparations, in particular, tended to be seen as unhelpful, and were associated with a higher side-effect burden. Conclusions: This study presents an insight into patients’ perception of efficacy and sideeffects of antipsychotic medications. The findings have implications for clinicians, and can inform treatment options in people with psychotic disorders.
Maternal Bonding Behaviour in Schizophrenia and Schizoaffective Disorder, Considering Premorbid Personality Traits
Authors: Willinger Ulrike , Heiden Angela M. , Meszaros Kurt , Formann Anton K. , Aschauer Harald N. 
Published: March 2003

Objective: Bonding between mother and child is described as a complex two-way process ensuring the needs of the child for nurture and protection. As such, it is dependent on the contribution of mother and child [ 1 – 3 ] whereby characteristics of personality of the child may have consequences on maternal bonding behaviour. In the current study the perception of maternal behaviour, premorbid personality traits and relationships between maternal behaviour and personality traits were investigated in schizophrenic and schizoaffective patients and their same-sex, healthy siblings. Methods: We recruited 36 schizophrenic and schizoaffective patients and their same-sex healthy siblings. Information about maternal bonding behaviour was assessed by the Parental Bonding Instrument, information about premorbid personality traits was obtained from their mothers using the ‘Gießen-Test’. Results: Compared to their siblings, patients showed less social resonance, more permeability, less social competence and a more depressed and anxious mood. Furthermore, patients described their mothers to be less caring and to be more overprotective than their siblings described them. But there were strong associations between maternal bonding behaviour and premorbid personality traits. These findings were supported by missing significant differences in maternal care behaviour between patients and siblings when using premorbid characteristics as covariates. Significant high maternal overprotection perceived by patients with schizophrenia and schizaffective disorders still remained after correcting for the influence of premorbid personality traits. Conclusion: The results suggest that premorbid personality traits should be considered not only in analyses of maternal care behaviour in schizophrenic and schizoaffective patients but also when studying other psychiatric patient groups.
Psychiatric Morbidity in First Time Stroke Patients in Hong Kong: A Pilot Study in a Rehabilitation Unit
Authors: Tang Wai-Kwong , Ungvari Gabor S , Chiu Helen F. K. , Sze Kai-Hoi , Woo Jean , Kay Richard 
Published: March 2003

Objective: There is a paucity of data on post-stroke psychiatric morbidity in Chinese populations. We examined the frequency of post-stroke psychiatric morbidity in Chinese first time stroke patients, including depressive and anxiety disorders, mania, and psychosis. Methods: One hundred and fifty-seven patients following their first stroke, who were consecutively admitted to a rehabilitation unit, participated in this prospective, cross-sectional study. All subjects were interviewed by a qualified psychiatrist using the SCID-DSM-III-R. Subjects’ cognitive function, neurological status, and level of functioning were also measured. Twenty-five (92.6%) of the subjects with the diagnosis of depression were followed up 6.0 ± 3.9 months after the initial assessment. Results: The frequency of all depressive disorders was 17.2%. Major depressive episodes, adjustment disorder with depressed mood, dysthymia, and generalized anxiety disorder were diagnosed in 7.6%, 8.2%, 1.3% and 0.6% of the subjects, respectively. No cases of other anxiety disorders, mania or psychosis were found. The majority of depressed subjects were in remission at the follow-up assessment. Conclusions: The low morbidity of affective disorders and their relatively favourable shortterm outcome in Chinese first time stroke patients warrants further investigation.
A Comparison in Hospitalization Rates Between a Community-Based Mobile Emergency Service and a Hospital-Based Emergency Service
Authors: Hugo Malcolm , Smout Matthew , Bannister John 
Published: March 2003

Objectives: The aims of this study were to compare the rates of inpatient admission between a mobile community-based psychiatric emergency service and a hospital-based psychiatric emergency service, and to identify the clinical characteristics of consumers more likely to be admitted to hospital. Methods: A retrospective, quasi-experimental design was used with a 3-month cohort of all face-to-face emergency service contacts presenting at the mobile and hospital-based sites. The Health of the Nation Outcome Scales and details of the outcome following initial assessment were completed for all contacts, and each group was compared for differences in clinical characteristics and outcome. Results: Hospital-based emergency service contacts were found to be more than three times as likely to be admitted to a psychiatric inpatient unit when compared with those using a mobile community-based emergency service, regardless of their clinical characteristics. Those with severe mental health disorders such as schizophrenia and major affective disorder, and experiencing problems with aggression, non-accidental self-injury, hallucinations and delusions, problems with occupation, activities of daily living, and living conditions were more likely to be admitted to hospital. Nevertheless, after controlling for clinical characteristics, site of initial assessment accounted for a substantial proportion of the variance in decisions to admit to hospital. Conclusions: Emergency psychiatric services which include a mobile component and provide a specialized multidisciplinary team approach appear to be most effective in providing services in the least restrictive environment and avoiding hospitalization.