bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mind Over Matter? I: Philosophical Aspects of the Mind–Brain Problem
Authors: Schimmel Paul 
Published: March 2003

Objective: To conceptualize the essence of the mind–body or mind–brain problem as one of metaphysics rather than science, and to propose a formulation of the problem in the context of current scientific knowledge and its limitations. Method and results: The background and conceptual parameters of the mind–body problem are delineated, and the limitations of brain research in formulating a solution identified. The problem is reformulated and stated in terms of two propositions. These constitute a ‘double aspect theory’. Conclusions: The problem appears to arise as a consequence of the conceptual limitations of the human mind, and hence remains essentially a metaphysical one. A ‘double aspect theory’ recognizes the essential unity of mind and brain, while remaining consistent with the dualism inherent in human experience.
Traumatic Stress and Ways of Coping of Community Residents Exposed to a Train Disaster
Authors: Chung Man Cheung , Chung Man Cheung , Farmer Steven , Werrett Julie , Easthope Yvette , Chung Catherine 
Published: March 2003

Objectives: The aims of this study were to examine the degree of traumatic stress and the coping strategies employed by community residents who lived on both sides of a rail track where a train collision occurred in 1996 in Stafford, UK. The hypothesis was that there would be a high level of traumatic stress and that emotion-focused coping would be the predictor to distress. Method: This was a cross-sectional survey with a retrospective design in which 66 community residents, who lived between 30 and 100 feet away from the crash site, were interviewed. The study began approximately 7 months after the disaster. The Impact of Event Scale (IES), the General Health Questionnaire (GHQ-28) and the Ways of Coping Checklists (WOC) were administered to the residents. Results: On the whole, the results did not entirely support the hypothesis. The residents were found to have experienced some intrusive thoughts and avoidance behaviour but their mean scores were significantly lower than those of standardized samples. Thirty-five per cent scored at 4 or above on the GHQ-28. Traumatic stress was predicted by both emotionfocused and problem-focused coping strategies. Conclusion: Although community residents were not on the train or related to the dead or injured in any way, they could, after being exposed to a train disaster, manifest traumatic stress symptoms which had long-lasting effects. Such traumatic stress was found to be associated with coping strategies of community residents characterized by their efforts to manage or alter the source of stress, and by their efforts to regulate stressful emotions.
Defining Disability in Psychosis: Performance of the Diagnostic Interview for Psychosis-Disability Module (DIP-DIS) in the Australian National Survey of Psychotic Disorders
Authors: Gureje Oye , Herrman Helen , Harvey Carol , Trauer Tom , Jablensky Assen 
Published: March 2003

Objective: We aimed to use data from the Australian Survey of Mental Health and Wellbeing to examine the psychometric properties of the Diagnostic Interview for Psychosis-Disability Module (DIP-DIS). The DIP-DIS is a semi-structured questionnaire specially designed to assess disability associated with psychotic disorders. Method: The psychometric properties of the instrument were determined by examining its inter-rater reliability, internal structure, as well as its criterion and discriminant validities. Results: Analysis shows: (1) that it can be rated reliably by trained interviewers, (2) that the items are complementary but tap a number of different domains, (3) that four factors account for over 66%% of the variance, and (4) that it is sensitive to differing clinical populations with expected differences in level of disability. Ratings on the DIP-DIS bore significant relationships with a criterion measure of quality of life. Conclusions: The DIP-DIS has encouraging psychometric properties for cross-sectional assessment of disability and may be useful in future studies of disablement associated with psychosis. Future work should examine its sensitivity to change.
What Cognitive Changes can be Expected with Normal Ageing?
Authors: Christensen Helen 
Published: March 2003

Background: This paper briefly summarizes recent evidence on the nature of cognitive decline, the variability in individual responses to ageing, and risk factors known to affect the rate of cognitive decline. Method: Data from the Canberra Longitudinal Study were used to examine the course and diversity of cognitive decline. The sample consisted of 887 participants aged 70–93 years, who were examined in 1991 and followed up in 1994 and 1998. Data summarizing significant risk factors for cognitive decline were based on a review of 34 studies that examined the following predictors: education, the APOE ∊4 allele, health, activity and blood pressure. Results: Using data from participants living in the community, there is evidence that cognitive speed and memory performance decline with age, but that crystallized abilities remain largely intact in those who survive for long-term follow-up. Variability in test scores for memory and speed increases with age. There is evidence that poor health, fewer years of education, lower activity, the presence of the APOE ∊4 allele, and blood pressure predict faster cognitive decline. Conclusions: The diversity in cognitive ageing suggests that more than one process may be operating to produce the observed cognitive outcomes. Education, good health, absence of the APOE ∊4 allele, and activity may be protective of cognitive decline. Preventative strategies for sustaining high intellectual performance in later life may therefore be possible. These findings also speak to the need to extend analysis beyond examining mean changes in cognitive performance to an analysis based on individual differences in change.
Brain Ageing in the New Millennium
Authors: Trollor Julian N , Valenzuela Michael J 
Published: March 2003

Objective: This paper examines the current literature pertaining to brain ageing. The objective of this review is to provide an overview of the effects of ageing on brain structure and function and to examine possible mediators of these changes. Methods: A MEDLINE search was conducted for each area of interest. A selective review was undertaken of relevant articles. Results: Although fundamental changes in fluid intellectual abilities occur with age, global cognitive decline is not a hallmark of the ageing process. Decline in fluid intellectual ability is paralleled by regionally specific age related changes apparent from both structural and functional neuroimaging studies. The histopathological mediators of these changes do not appear to be reduction in neuronal number, which, with the exception of selected hippocampal regions, remain relatively stable across age. At the molecular level, several mechanisms of age related change have been postulated. Such theoretical models await refinement and may eventually provide a basis for therapy designed to reduce effects of the ageing process. The role of possible protective factors such as ‘brain reserve’, neuroprotective agents and hormonal factors in modifying individual vulnerability to the ageing process has been the focus of a limited number of studies. Conclusion: Our understanding of the functional and structural changes associated with both healthy and pathological ageing is rapidly gaining in sophistication and complexity. An awareness of the fundamental biological substrates underpinning the ageing process will allow improved insights into vulnerability to neuropsychiatric disease associated with advancing age.
Is Dementia a Mental Illness?
Authors: Ticehurst Stephen 
Published: March 2003

Objective: To examine whether dementia is a mental illness. Method: An analysis of decisions in the Supreme Court of New South Wales that dementia per se was not a mental illness in terms of the 1958 Mental Health Act. A brief review of the extrusion of other diseases from psychiatry. Results: Concepts in legislation are based on a dichotomy between mental infirmity and mental illness that has changed over time. This change is the result of shifting perceptions about the basis of illness and disease and the causation of mental symptoms. Mental health legislation is aimed as much at social control of feared behaviour as protecting the ill/incompetent. Guardianship legislation offers a more holistic response that better meets the patient's needs and could be extended to supplant mental health legislation. Conclusions: Dementia's departure from mental illness reflects psychiatry's continuing marginalization within medicine on an outdated mind/body or illness/disease split. This underlines one of the psychiatrist's roles as the vehicle to ‘medically’ explain abnormal behaviour. This model means that behaviour, once explained in terms of disease as opposed to illness, can be moved from the direct responsibility of psychiatry into other areas of medicine. Paradoxically, this suggests that the future of psychiatry will be in a completely different direction from its current biological focus.
Clinical Supervision: A Review of Underlying Concepts and Developments
Authors: Macdonald Joanna 
Published: March 2003

Objective: This review examines how psychiatric clinical supervision is represented in the psychiatric literature and its relevance for Australasian psychiatry. Method: The literature was first identified then reviewed using Medline and Psychlit, manual searches of relevant journals and personal contact with some key workers in Australia and New Zealand. Results: The predominantly American literature written two to three decades ago reflected the conditions in which psychiatry was practised at that time, largely based in asylums or private offices and informed by the dominant psychoanalytic discourse of that era. These articles, frequently anecdotal and with little empirical support, conceptualized supervision as a developmental process, a syndrome, or a process of identification. They focused substantially on the nature of the relationship between the trainee and supervisor. More recent writers have included trainees’ perspectives. They have identified a number of problems with supervision, including role conflicts, uncertainty about boundaries, lack of supervisory training and lack of effective feedback, and have introduced the concepts of adult learning as highly relevant. These concerns, however, have led to little change to date. Conclusion: The implementation by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) of new training by-laws provides an opportunity to define the meaning of supervision in the current clinical context, to undertake research to clarify the key elements in the process, and to evaluate different techniques of supervision.
The Assessment of Disability in Patients With Psychotic Disorders: An Application of the ICIDH-2
Authors: Chopra Prem , Couper Jeremy , Herrman Helen 
Published: March 2003

Objectives: To describe the application of the International Classification of Functioning and Disability (ICIDH-2) in the assessment of disability in patients with psychotic disorders. Method: The study was conducted at the inpatient unit of St Vincent's Mental Health Service, Melbourne. Twenty inpatients with psychotic disorders were concurrently assessed by two raters. An evaluation of the feasibility of the instrument was made during this process. Inter-rater agreement was determined using raw agreement percentages and weighted kappas. Results: The ICIDH-2 provides a comprehensive framework for the description and measurement of disability, including the dimensions of impairments in body structures and functions, activity limitations, participation restrictions and environmental factors. Certain codes are difficult for clinicians to rate because of the subjective manner in which they are defined. Our inter-rater reliability assessment varied across the dimensions from poor to almost perfect agreement. Conclusions: The ICIDH-2 is potentially useful in the clinical assessment of disability in patients with psychotic disorders although modifications are needed. These could include the use of anchor points defined for each dimension or code to assist the rating process and an alternative rating scale in which categories for rating are more broadly defined. Formal training may also be necessary to enable standardization of the rating process. There is also a need to augment measurements by clinicians with the assessment of the subjective experience of patients using self-rated disability and assessment of quality of life.
Are Psychiatrists Equipped for Management Roles in Mental Health Services?
Authors: Tobin Margaret , Edwards Julie L. 
Published: March 2003

Objective: To promote the discussion of leadership and management skills development among psychiatrists in Australia and New Zealand. Method: A key informant survey of fellows of the Royal Australian and New Zealand College of Psychiatrists was conducted via a semi-structured interview. This canvassed views about leadership and management issues including levels of confidence and needs for additional skills. Results: There was widespread support for psychiatrists to be in management roles in mental health services; however, on entering management positions, psychiatrists often felt inadequately trained and prepared for their new role. Furthermore, many who had made the transition to management perceived a lack of support from their clinical colleagues. Clinicians appeared to believe that management was not difficult to learn and could be done by any experienced clinician. The provision of short courses and mentoring programmes is the preferred option for most psychiatrists seeking to acquire leadership and management skills. Conclusions: For psychiatrists to maximize their potential as leaders in Australian and New Zealand mental health services, greater attention to promoting the acquisition of relevant skills throughout training and in the post-fellowship years is required. Psychiatrists need to be supported and encouraged to pursue further education, training and research in this area. Failure to address this issue risks psychiatrists continuing to feel disadvantaged in management roles and hence reluctant to undertake the challenge.
High Prevalence Disorders in Urban and Rural Communities
Authors: Judd Fiona K , Jackson Henry J , Komiti Angela , Murray Greg , Hodgins Gene , Fraser Caitlin 
Published: March 2003

Objective: High prevalence disorders (anxiety, depressive and substance use) are generally assumed to be more common in urban than rural dwellers. The aims of this paper are (i) to critically review studies measuring prevalence in rural as opposed to urban location, and (ii) to argue the need to look beyond the ‘quantity’ question to the quality question: how does urban or rural place influence mental health? Method: A literature review (Medline and PsychLIT) was carried out using the words ‘rural, urban, mental/psychiatric, illness/disorders and prevalence’, as well as a review of relevant papers and publications known to the authors. Results: Many studies examining urban/rural differences in the rate of high prevalence disorders have been reported. Most use a ‘one size fits all’ definition of urban and rural, which assumes location is the key issue. The majority fail to show the purported difference in prevalence between the two settings. In general, studies have not examined interaction effects, but have simply treated the independent variables as main effects. Available data suggest that a variety of socio-demographic factors are more powerful predictors of difference in prevalence than is the location of residence. Conclusion: Further studies are required to understand if and how rural or urban place contributes to the development of psychiatric morbidity. These studies should mirror the clinical situation by taking into account a variety of individual and community-based (including urban/rural place) risk factors which may be important determinants of mental health and mental illness, and examining the interaction between them. This may then identify the nature of any differences or what issues are specific to, or especially important, in the rural setting.
Notes Towards a Professional Ethics for Psychiatry
Authors: Radden Jennifer 
Published: March 2003

Objective: The uniqueness of psychiatry calls for a unique ethics. By identifying the features distinguishing psychiatry as medical and social practice, this article seeks to illustrate the methodology by which that ethics can be derived and to determine what kind of a framework and focus such an ethics requires. Method: The author is an analytically trained philosopher and employs the method of conceptual analysis. Results: At least three characteristics are suggested by the features which taken together constitute psychiatry's uniqueness: an ethical framework accommodating character, a rubric for acknowledging boundary violations, and an emphasis on gender. Conclusions: The larger task of formulating the substance and details of that unique ethics is the next step.
Mind – Body – Environment: George Engel's Psychoanalytic Approach to Psychosomatic Medicine
Authors: Taylor Graeme J 
Published: March 2003

Objective: To provide an overview of George Engel's psychoanalytic approach and contributions to psychosomatic medicine. Methods: Engel's publications were reviewed to identify his use of psychoanalytic methods and concepts to explore and conceptualize the interrelationships among mind, body and environment in health and disease. Results: Engel's contributions include an interviewing method for accessing psychological data; insights into the psychobiology of anaclitic depression; a psychosomatic theory concerning the influence of relationships and loss on susceptibility to disease; an elucidation of psychodynamic factors in the pathogenesis of chronic pain; and a longitudinal self-analytic study of anniversary reactions. Conclusions: Engel successfully bridged the disciplines of medicine, psychiatry, and psychoanalysis, and broadened the scope of psychosomatic research and clinical practice by identifying the role of interpersonal relationships throughout life in regulating mental and bodily processes.
The Neurobehavioural Effects of Kava
Authors: Cairney Sheree , Maruff Paul , Clough Alan R. 
Published: March 2003

Objective: This review considers the context in which kava is used, together with its underlying psychopharmacological mechanisms, to investigate the neurobehavioural effects associated with kava use. Method: We conducted a systematic search using the computerized databases MEDLINE, OVID and PsychLIT for all articles containing any of the following words: kava, kavain, kawa and Piper methysticum. In the opinion of the authors, all articles from this collection containing data that could inform the neurological and cognitive sequelae of kava use were included for the purpose of this review. Results: The use of kava occurs among indigenous populations in the South Pacific and in northern Australia, while also being used throughout the western world as a herbal medicine. Animal studies show that kava lactones alter neuronal excitation through direct interactions with voltage-dependent ion channels, giving rise to kava's muscle relaxant, anaesthetic, anxiolytic and anticonvulsive properties. Several isolated cases of psychotic and severe dystonic reactions following kava use suggest that kava also has psychoactive properties, yet there is no conclusive evidence that kava interferes with normal cognitive processes. Conclusions: Kava is effective in the treatment of tension and anxiety. There may be riskfactors for severe motor and psychiatric responses to kava use, although these are not wellunderstood. Given the increasingly widespread use of kava, further investigation is necessary to gain an understanding of its immediate neuropsychiatric effects and long-term cognitive effects.
Screening of Mental Disorders in Asylum-Seekers from Kosovo
Authors: Eytan Ariel , Bischoff Alexandre , Rrustemi Issah , Durieux Sophie , Loutan Louis , Gilbert Muriel , Bovier Patrick A 
Published: March 2003

Objective: To determine how the use of trained and ad hoc interpreters during a medical screening interview affects referral to medical and psychiatric care. Methods: We reviewed 319 structured interviews conducted by nurses with asylum-seekers from Kosovo during a systematic medical screening at time of entry, consisting of questions about health conditions, past exposure to traumatic events, and posttraumatic symptoms. Results: The majority (72%) of asylum-seekers were male and the median age was 24 years. Forty-eight per cent were single and 55% declared having relatives already living in Switzerland. Screening interviews resulted in 36% of asylum-seekers being referred to a general practitioner and 6% to a psychiatrist. Relatives served as ad hoc interpreters in 18% of interviews and trained interpreters in 16%. The detection of traumatic events and psychological symptoms significantly improved when trained interpreters were present (traumatic events: no interpreters 55%, ad hoc interpreters 46%, trained interpreters 77%, P = 003; psychological symptoms: 12%, 14%, 33%, respectively, P = 0.001). Adjusted for traumatic events and posttraumatic symptoms, referral to medical care was more frequent when relatives served as ad hoc interpreter (OR: 1.9, 95% CI 1.0–3.6), while interviews conducted with trained interpreters were not significantly associated with increased referral to medical (OR: 1.3, 95% CI 0.6–2.6) and psychiatric care (OR: 2.3, 95% CI 0.7–7.0). Conclusion: The use of trained interpreters improved the quality of communication, the detection of severe symptoms and traumatic situations, and facilitated therapeutic orientation of traumatized asylum-seekers.
Are Tryptophan and 5-Hydroxytryptophan Effective Treatments for Depression? A Meta-Analysis
Authors: Shaw Kelly , Turner Jane , Del Mar Christopher 
Published: March 2003

Objective: To review the literature regarding the effectiveness of 5-hydroxytryptophan (5-HT) and L-tryptophan in the treatment of unipolar depression. Methods: A systematic review of the literature from 1966 to 2000 using the search terms ‘tryptophan’, 5-hydroxytryptophan ′, ‘5-HTP’, ‘5-HT’ and ‘depression’. We extracted and grouped data for meta-analysis by pooling odds ratios (OR) and relative risks where possible. Results: One hundred and eight studies were located of which only two studies, one of 5-HT and one of L-tryptophan, with a total of 64 patients met sufficient quality criteria to be included. These studies suggest 5-HT and L-tryptophan are better than placebo at alleviating depression (Peto OR = 4.1, 95% CI = 1.3–13.2). However, the small size of the studies, and the large number of inadmissible, poorly executed studies, casts doubt on the result from potential publication bias, and suggests that they are insufficiently evaluated to assess their effectiveness. Conclusions: A large body of evidence was subjected to very basic criteria for assessing reliability and validity, and was found to largely be of insufficient quality to inform clinical practice. More well-designed studies are urgently required to enable an assessment of what may be an effective class of agents.