Showing papers in "Australian and New Zealand Journal of Psychiatry in 1983"
TL;DR: Community treatment did not increase the burden upon the community, was considered to be significantly more satisfactory and helpful by patients and their relatives, achieved a clinically superior outcome, and cost less than standard care and after-care.
Abstract: One hundred and twenty patients presenting for admission were randomly allocated into two groups. Controls received standard hospital care and after-care. Projects were not admitted if this could be avoided; instead they and their relatives were provided with comprehensive community treatment and a 24-hour crisis service. Patients with a primary diagnosis of alcohol or drug dependence, organic brain disorder or mental retardation were excluded. During the 12 months study period, 96% of controls were admitted, 51% more than once. Of the projects, 60% were not admitted at all and only 8% were admitted more than once. Controls spent an average of 53.5 days in psychiatric hospitals; projects spent an average of 8.4 days. Community treatment did not increase the burden upon the community, was considered to be significantly more satisfactory and helpful by patients and their relatives, achieved a clinically superior outcome, and cost less than standard care and after-care.
246 citations
TL;DR: Electroconvulsive therapy was recommended in patients with endogenous depression who were severely ill, troubled by hallucinations and delusions or for whom the antidepressant drugs had not proven effective.
Abstract: With College and Government support the Quality Assurance Project is developing a series of explicit and detailed treatment outlines of major psychiatric disorders for use in peer review. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists and the views of a panel of nominated experts. The present outline concerns the treatment of depressive disorders. The three sources of information were in agreement that tricyclic and allied antidepressants were the treatments of choice for endogenous depression and were also to be considered in persistent neurotic depressions. Electroconvulsive therapy was recommended in patients with endogenous depression who were severely ill, troubled by hallucinations and delusions or for whom the antidepressant drugs had not proven effective. The psychotherapies, both dynamic and behavioural, were regarded as the treatments of choice in neurotic depression.
93 citations
TL;DR: It is argued that the 60-item GHQ is probably the best as it gives the lowest misclassification rates, the smallest standard error of estimated prevalence rates and allows measurement of certain subscales not contained within the shorter versions.
Abstract: Literature pertinent to the use of the various versions of the General Health Questionnaire (GHQ) is briefly surveyed. The literature indicates that the 60-item version has the highest reliability and validity coefficients, the lowest misclassification rate, and the highest sensitivity and specificity. Using data from a previously published community survey in Perth using the 60-item GHQ, comparisons are made between use of the 60-, 30-, 20- and 12-item versions, including community prevalence rates, simultaneous identification of cases, disagreement rates and patterns of community rates with age. The 60-item version gives the lowest prevalence rates. It is argued that the 60-item GHQ is probably the best as it gives the lowest misclassification rates, the smallest standard error of estimated prevalence rates and allows measurement of certain subscales not contained within the shorter versions.
74 citations
TL;DR: The literature on the psychopathology of children of alcoholic parents is reviewed and the relevance of the last two issues explored.
Abstract: The familial nature of alcoholism is well established, but the interaction of nature and nurture remains unresolved. Other effects of alcoholic parents on the psychopathology of their children are poorly documented, with studies variably claiming that there is no discernible impact or that there is a significantly higher incidence of problems, particularly in the area of antisocial and aggressive behaviour. The relative importance of family disharmony and disruption which so often accompanies alcohol abuse, as against the impact of the alcohol abuse itself, is rarely considered. The literature on the psychopathology of children of alcoholic parents is reviewed and the relevance of the last two issues explored.
32 citations
TL;DR: It is time to examine the present state of knowledge about dementia, to consider where further progress in understanding is likely to take place, and to hope that some contribution may come from Australasia and the College to a global problem.
Abstract: The problem of senile dementia is a welcome challenge to psychiatric science. It provides an outstanding opportunity to make a useful contribution to medicine and to public health. While it is a common disorder, its aetiology is unknown; its natural history is largely uncharted; its treatment is as yet only palliative, and its social impact is gruesome. But now there has come a notable increase in the scientific interest accorded to dementia, after many decades of its being seen as a particularly unexciting group of diseases occurring in an unexciting age group. Quite suddenly, the causes and treatment of brain failure are being vigorously pursued. The reasons are easy to see. On the one hand, the Alzheimer type of dementia is a disease of wholly unknown aetiology, yet clues to its biological causes have been fast accumulating. At the same time, the developed, and indeed the developing world, are becoming gravely concerned at the demographic shift which is taking place, whereby at least a doubling in the proportion of the very old in the population is taking place within one generation. This is the very age-group in which the prevalence of dementia is at its height. The social impact of dementia is already substantial, but it will increase further. Accordingly, governments, medical research councils and the World Health Organisation have begun to accord high priority to research in this area. It is time to examine the present state of knowledge about dementia, to consider where further progress in understanding is likely to take place, and to hope that some contribution may come from Australasia and our College to a global problem. In its excellent report on dementia, the Royal College of Physicians (1980) states: ‘The high prevalence of organic mental impairment in the
31 citations
TL;DR: A log-linear analysis revealed that the adverse effects of unemployment on mental health were not attributable to poor quality of upbringing, and the unemployed were older on average, less well educated and had experienced a poorer quality of parental upbringing than the apprentices.
Abstract: A cross-sectional study was carried out to compare psychiatric impairment in young unemployed men and apprentices from Sydney's western suburbs. The unemployed men were found to have a psychiatric case rate (as defined by the GHQ) of 48% as against a rate of 28% for the apprentices. Comparisons of the unemployed men and apprentices on other measures indicated that they did not differ in physical health nor in the value they attached to work. The unemployed, however, were older on average, less well educated and had experienced a poorer quality of parental upbringing than the apprentices. A log-linear analysis revealed that the adverse effects of unemployment on mental health were not attributable to poor quality of upbringing.
30 citations
TL;DR: Although ‘depression’ is regularly mentioned as a possible consequence of propranolol therapy, actual reports of a clinical depressive syndrome have been remarkably infrequent considering the widespread use of the drug and the serious morbidity of depressive illness.
Abstract: The non-selective beta adrenoreceptor blocking agent propranolol is in widespread usage in clinical medicine, particularly in the management of ca rd iac disease a n d hyper tens ion . Neuropsychiatric side-effects of propranolol include lassitude, insomnia, vivid nightmares, hypnagogic hallucinations, confusional states and toxic schizophreniform psychosis. Although ‘depression’ is regularly mentioned as a possible consequence of propranolol therapy, actual reports of a clinical depressive syndrome have been remarkably infrequent considering the widespread use of the drug and the serious morbidity of depressive illness.
21 citations
TL;DR: This study attempted to replicate the factor structure of the RBPC, originally developed for U.S.A. children, and to establish norms for its use with New Zealand children, using ratings from the community sample.
Abstract: The Revised Behavior Problem Checklist (RBPC) is a recent expansion of the widely used Behavior Problem Checklist. This study attempted to replicate the factor structure of the RBPC, originally developed for U.S.A. children, and to establish norms for its use with New Zealand children. Two groups of children, aged five to 13 years, were rated on the scale by their parents. One was a clinic sample and comprised 266 patients attending two psychiatric clinics. The second was a random community sample of 267 children, from four census tracts in Auckland, selected to cover a range of socioeconomic strata representative of New Zealand. Factor analysis of the clinic data resulted in a factor structure similar to that found in American children. Only two of the six factors (Socialised Aggression and Psychotic Behaviour) differed to any degree. Using ratings from the community sample, norms were developed for screening and diagnostic purposes.
21 citations
TL;DR: An Index of Definition cut-off point of 5 or more on the PSE for a neurotic depressive ‘case’ is supported by the finding that only 2% of the patients, compared with 26% ofThe SVs, did not rate as ‘cases’.
Abstract: A comparative study of neurotic depression in 66 symptomatic community volunteers (SVs) and 43 formal psychiatric patients is reported. Compared to the psychiatric patients the SVs were older and there was a less marked female preponderance. Their depression was of a longer duration and vegetative symptoms (e.g. appetite and weight loss) were less marked. They were less likely to have made a suicide attempt in the past, less likely to be single or divorced, and much less likely to have experienced a disruption in an intimate relationship in the preceding year. On personality measures the SVs rated as having a more internal locus of control and a higher self-esteem. An Index of Definition cut-off point of 5 or more on the PSE for a neurotic depressive ‘case’ is supported by the finding that only 2% of the patients, compared with 26% of the SVs, did not rate as ‘cases’.
20 citations
TL;DR: It is suggested that depressive symptoms may be less severe in general practice ‘ cases’ than in ‘cases’ of depression referred to a psychiatrist, or that differences reflect demographic differences of the samples.
Abstract: The Zung Self-Rating Depression Scale was used to study depressive symptoms in 251 people routinely attending their general practitioners. Lower social class and female sex were weak predictors of higher Zung scores. Sociodemographic influences on responses to particular Zung scale items are reported. Using a cut-off score of 40, 53 subjects (21%) were found to be significantly depressed (24% of females and 15% of males) with the point prevalence data for males and females being strikingly similar to data obtained in another Sydney general practice study using a differing methodology. Zung scale scores of our subjects were compared with those of 43 neurotic depressive patients assessed at initial psychiatric referral. While the total Zung scores of the two groups were very similar, depressives in the general practice sample scored as having a less marked mood disturbance, were less irritable, were less likely to cry and less likely to report weight loss. We suggest that either these symptoms may be less s...
20 citations
TL;DR: A syndrome is described which consists of three symptoms: a mood disturbance of fear and sadness, an inability to do anything useful, and an insensitivity to pain and pleasure.
Abstract: A syndrome is described which consists of three symptoms: a mood disturbance of fear and sadness, an inability to do anything useful, and an insensitivity to pain and pleasure Since the fourth century this condition has been known as acedia The arguments are reviewed for its distinction from mild depression It is suggested that the condition may be due to a lack of satisfying work
TL;DR: Dream material is influenced by the race of the therapist who may be less easy to disguise in dreams, and the therapist may avoid certain dream interpretations because of unacknowledged discomfort about race.
Abstract: The race of the therapist can play a significant role in the manifestation of transference and counter-transference phenomena in inter-racial psychotherapy. References to the race of therapist may be the first sign of a developing transference relationship. Failure to appreciate the impact of racial difference can impede therapeutic progress while sensitive confrontation may be a valuable tool in the recognition and communication of emotionally charged feelings in therapy. Dream material is influenced by the race of the therapist who may be less easy to disguise in dreams, and the therapist may avoid certain dream interpretations because of unacknowledged discomfort about race. These observations have implications for the supervisory process in training and for the general issue of the influence of the person of the therapist on the process of psychotherapy.
TL;DR: Persistence of suicidal ideation and repeat attempts were correlated with the diagnosis of psychosis and personality disorder and predictions about the likelihood of further suicidal activity were accurate.
Abstract: Ninety-eight subjects who had attempted suicide and 102 general practice controls previously interviewed were followed-up at 18-24 months. The former continued to show greater social and psychiatric disability than controls and more than one-third made repeat suicide attempts. Nevertheless, as a group, the attempted suicides showed significant improvement in mental state, and familial and interpersonal relationships, whereas controls reported little change in most measures. Persistence of suicidal ideation and repeat attempts were correlated with the diagnosis of psychosis and personality disorder and predictions about the likelihood of further suicidal activity were accurate. Although 92% of patients were referred for further treatment, 38% of these were judged to have dropped out prematurely. Completion of treatment and being in ongoing treatment were positively correlated with patients' self reports of improvement. The findings are compared to experience elsewhere and to a previous Christchurch follow-...
TL;DR: The national age-standardised suicide rate for all age groups combined decreased between the 1969–73 period and 1976–80 both for males and (more so) for females, however, there was a 24% Increase for 20–29-year-old males.
Abstract: Australian suicide rates were compared for the 1969–73 and 1976–80 periods by age, sex and State. Rates for males were generally at least twice those for females. The sex difference was marked, irrespective of age, State and time period. Middle-aged and older Australians generally had higher rates than 20–29-year-olds, although this finding was not consistent by State for males. The national age-standardised suicide rate for all age groups combined decreased between the 1969–73 period and 1976–80 both for males and (more so) for females. However, there was a 24% Increase for 20–29-year-old males. While the suicide rate for 20–29-year-old females decreased between the 1969–73 period and 1976–80, an analysis of yearly trends within the 1976–80 period revealed an upward trend for individuals aged 20–29 years, for both females and males.
TL;DR: It is concluded with the hope that the combination of modern humanism, modern communication technology and therapeutic advances may lead to an improvement in the lives of ‘hard core’ chronically ill psychiatric patients.
Abstract: A brief reference to history suggests that there is a recurrent alternation of providing service to the indigent disturbed through asylum, general hospital and community. Despite modern knowledge about mental health, public attitudes remain seriously prejudiced against this group of mentally ill, and political decisions reflect these attitudes. Many developments for the emotionally disturbed deny the needs of the most disturbed. This paper considers the alienation of the severely mentally ill, the fear about the mentally ill, the guilt about their care, community education about the mentally ill, the development of advocacy on their own behalf by the mentally ill, and therapeutic advances in their care. The paper, although pessimistic about the future, concludes with the hope that the combination of modern humanism, modern communication technology and therapeutic advances may lead to an improvement in the lives of ‘hard core’ chronically ill psychiatric patients.
TL;DR: Likelihood of problem drinking increased substantially with the number of adverse factors reported and it was concluded that knowledge of these factors would help the general practitioner in the identification of women with alcohol problems.
Abstract: A sample of 655 women was contacted whilst attending general practitioners' surgeries and questioned on numerous health and social matters. Follow-up interviews were held a year later in the women's homes and information on drinking behaviour and problems with drinking obtained. Almost 15% of the sample could be classified as problem drinkers on the basis of their responses to a ‘problems with drinking’ scale. Seven major variables were identified as being associated with problem drinking amongst these women. These included familial history of heavy drinking, depression, stress level, major life changes, reported alcohol consumption, usual type of leisure activities and abuse of substances such as coffee and tobacco which can result in dependency. Likelihood of problem drinking increased substantially with the number of adverse factors reported. It was concluded that knowledge of these factors would help the general practitioner in the identification of women with alcohol problems.
TL;DR: The application of strategic family therapy is described as the core treatment model in a teaching hospital child and family psychiatry service providing outpatient, daypatient and residential care.
Abstract: This paper describes the application of strategic family therapy as the core treatment model in a teaching hospital child and family psychiatry service providing outpatient and residential care. The admission of the whole family is seen as a desirable innovation in that it may prevent the process by which admission of the troubled child acts as reinforcement to, and a continuation of, family dysfunction.
TL;DR: Australian students generally presented more favourable attitudes to mental illness, in that they were more willing to work with or marry the mentally ill and possibly held a much narrower view of the types of persons labelled mentally ill.
Abstract: One hundred and thirty-three (76 male, 57 female) Papua New Guinean (PNG) and 144 (93 male, 51 female) Australian high school students completed a series of structured and open-ended measures on attitudes to the mentally ill, especially opinions about the nature of mental illness, characteristics of the mentally ill, and treatment. Both groups of students suggested hereditary and environmental causes, with PNG students citing more often witchcraft and sorcery. Australian students generally presented more favourable attitudes to mental illness, in that they were more willing to work with or marry the mentally ill. PNG students, however, were more likely to highlight the disruptive, violent behaviour of the long long and possibly held a much narrower view of the types of persons labelled mentally ill.
TL;DR: A primary lymphoma involving the limbic system was eventually detected on repeat CAT scan and was confirmed at autopsy, which indicates this tumour may be radiosensitive if detected early enough.
Abstract: A 65-year-old man was referred from a medical unit for psychiatric assessment of a depressive illness associated with intermittent vomiting. No organic disorder was identifiable after the initial clinical examination and extensive investigations. A primary lymphoma involving the limbic system was eventually detected on repeat CAT scan and was confirmed at autopsy. This tumour, which is increasing in incidence, is notoriously difficult to diagnose and frequently presents with combined psychological and organic symptoms. It may be radiosensitive if detected early enough.
TL;DR: This case report of a patient with musical hallucinations has many of the features already described but in this patient the hallucinations were associated with a worsening dementia as well as the occurrence of visual and tactile hallucinations not associated with delirium.
Abstract: (1983). Musical Hallucinations in the Elderly. Australian and New Zealand Journal of Psychiatry: Vol. 17, No. 3, pp. 286-287.
TL;DR: Evidence is reviewed which indicates desensitization has a lasting effect in agoraphobia but not in specific phobias, and suggests it should be able to replace aversive therapy in the treatment of compulsive behaviours.
Abstract: Anxiety is identified with a state of high arousal. Agoraphobia is differentiated from specific phobias which are inherent responses to situations which threatened primitive man. In agoraphobia, attacks of high arousal are produced by situations which delay ongoing activity. It is hypothesised that such delays produce arousal by activating behaviour completion mechanisms. Evidence is reviewed which indicates desensitization has a lasting effect in agoraphobia but not in specific phobias. It is suggested that desensitization reduces the arousal produced by behaviour completion mechanisms. Aversive therapy in homosexuality reduces the subjects' drive to carry out compulsive sexual behaviours but does not alter sexual orientation. It is suggested that compulsive sexual behaviours are not activated by primary sexual drives but by behaviour completion mechanisms which are also responsible for other compulsive behaviours. Aversive therapy acts by reducing the arousal produced by the behaviour completion mechani...
TL;DR: With the exception of Malan's (1963, 1976a) finding of the efficacy of therapist-parent interpretations there are no replicated data available to support the use of any particular technique.
Abstract: There is a need for clear definitions of psychotherapeutic techniques in order to allow for proper evaluation and application of the process of brief psychotherapy. The literature is reviewed on five technical factors germane to brief dynamic psychotherapy: time, activity, focus, transference and termination. With the exception of Malan's (1963, 1976a) finding of the efficacy of therapist-parent interpretations there are no replicated data available to support the use of any particular technique. This lack of supporting evidence may reflect insufficient specificity and definition in the use of brief psychotherapy, and an excessively generalised approach to research.
TL;DR: If the frequency of seizures by police of hallucinogenic seizures reflects the frequency with which various hallucinogens are ingested in Australasia, most toxic states resulting from hallucinogen abuse are due to Bromo-DMA and not to LSD as is commonly reported by the subjects.
Abstract: If the frequency of seizures by police of hallucinogens reflects the frequency with which various hallucinogens are ingested in Australasia, most toxic states resulting from hallucinogen abuse are due to Bromo-DMA and not to LSD as is commonly reported by the subjects. Two cases of intoxication with the new hallucinogen, Bromo-DMA, are reported. Both recovered within 24 hours following treatment with haloperidol.
TL;DR: Since the early ’seventies, the disciplines of surgery, gastroenterology, rheumatology, rehabilitation medicine and psychiatry and special interest areas have been represented to the National Health and Medical Research Council as being underfunded, relative to their social and clinical relevance.
Abstract: The psychiatric research community is concerned about the financial support available for its endeavours. This is true of clinical research workers in general. Since the early ’seventies, the disciplines of surgery, gastroenterology, rheumatology, rehabilitation medicine and psychiatry and special interest areas, such as allergic disorders, alcohol and drug abuse and road traffic accidents, have been represented to the National Health and Medical Research Council (NH & MRC) as being underfunded, relative to their social and clinical relevance. Clinicians have frequently noted that the basic biomedical sciences are over-represented within the funding profiles of the NH & MRC. Partly for this reason and partly because of a general public questioning of their value, basic scientists have had to lead the way in mounting vigorous defences concerning the relevance of medical research to the Australian community. The NH & MRC has responded to this debate by: 1 defending the position of basic science as a natural and productive means of inducing substantial and significant change in the health of Australians. Council has acknowledged that this involves a long time scale; and 2 by advocating increased funding for medical research. This has resulted in rises in total endowment funds over and above inflation each year for the past six years; and 3 by acknowledging that there is a growing public demand for obvious and specific support for work that is goal directed, mission oriented and applied. This last is perhaps the least understood component of the NH & MRC’s endeavours. Since the NH & MRC is totally committed to scientific merit as the basis for support of projects, solutions such as earmarked funds for areas requiring development, are not viable options. Council has thus turned to the development of scientific expertise as its method of meeting its responsibilities. Units in epidemiology, social psychiatry, road accident research and health economics have been established. The Applied Health Fellowships scheme has aimed at increasing scientific expertise in areas such as clinical pharmacology, geriatrics and psychiatry. Funds to aid in the upgrading of the quality of projects within areas such as alcohol abuse and rehabilitation medicine have been advanced. These initiatives have done little to quiet psychiatrists’ concerns for their own endeavours.
TL;DR: On 29 March 1948, at Bundoora Repatriation Hospital in Melbourne, a 54-year-old male patient, W.B., started to take lithium as a treatment for his chronic manic symptoms.
Abstract: On 29 March 1948, at Bundoora Repatriation Hospital in Melbourne, a 54-year-old male patient, W.B., started to take lithium as a treatment for his chronic manic symptoms. On 1 May his treating doct...
TL;DR: It is concluded that there is emerging an objective body of data which can buttress psychiatric opinion in these matters, but that a number of the principles which have guided the Courts to date have not been thoroughly researched.
Abstract: With the high rate of marriage breakdown, increasing numbers of children are becoming the subjects of custody and access disputes. The Courts are looking to the services of psychiatrists in these matters. They value our expert opinion on the least detrimental available alternative for the child. This paper reviews available research data which are relevant to psychiatric testimony on the determination of exclusive custody, joint custody and access. It is concluded that there is emerging an objective body of data which can buttress psychiatric opinion in these matters, but that a number of the principles which have guided the Courts to date, have not been thoroughly researched.
TL;DR: Proposals for a peer review process for long term psychotherapy are mooted in the expectation that agreement between the health insurance industry and psychiatry would benefit those patients in need of psychotherapy.
Abstract: The Australian health insurance industry has been critical of psychiatry. The data on patterns of claims which have been the focus for some of their concerns are reviewed. The evidence on the efficacy of psychotherapy is also reviewed. Psychotherapy has been shown to be an effective treatment for persons with incapacitating neurotic and personality disorders, a treatment too important to be endangered by dissent over health insurance payments. Proposals for a peer review process for long term psychotherapy are mooted in the expectation that agreement between the health insurance industry and psychiatry would benefit those patients in need of psychotherapy.
TL;DR: The results of two recent surveys are described, one of 216 women less than 45 years old who had a hysterectomy for non-malignant conditions at a major Sydney hospital and another carried out at a hospital on the outskirts of Sydney, about one year after their operations.
Abstract: Hysterectomy, its indications and its consequences for later health, have been prominent topics in recent psychiatric, gynaecological and lay literature. This study describes the results of two recent surveys, one of 216 women less than 45 years old who had a hysterectomy for non-malignant conditions at a major Sydney hospital. These women were interviewed on the seventh to tenth postoperative day. One hundred and ninety-four were then followed up by questionnaire 13 months later. In a later study carried out at a hospital on the outskirts of Sydney, 100 out of 146 women responded to a follow-up questionnaire approximately one year after their operations. These studies and their relevance to recent similar studies are discussed in terms of post-hysterectomy adaptation and prognostic factors associated with poor psychiatric outcome.
TL;DR: Genetics has been reinstated, for its opponents have been unable to find any answer to the studies of adoptees that have not only re-emphasised the importance of heredity in schi-ophrenia and manic-depressive illness but also in a1coholism6.
Abstract: The comparative effects of psychosocial and biological factors in the causation of mental illness have provided a source of argument, sometimes heated, at least since the 17th century. In recent times the psychosocial approach has enjoyed a long period of eminence. Genetics was decried and those with biological leanings were derisively referred to as ‘organic psychiatrists’. In the last few years we have seen the psychosocial approach diminished by such observations as those of Andrews’ who has shown that the stresses of life events are very much less important when judged prospectively than retrospectively; and of Henderson et al.’ who, following their detailed and well-designed research studies, concluded that ‘the causes of neurosis lie much more within the person than within the social environment’ - adding that ‘the findings . . . are for the most part unexpected . . . and they call for a reconsideration of some basic issues in the principles and practice of psychiatry’. Genetics has been reinstated, for its opponents have been unable to find any answer to the studies of adoptees that have not only re-emphasised the importance of heredity in schi~ophrenia~,~ and manic-depressive illne~s,~ but also in a1coholism6~’ and