Showing papers in "Australian and New Zealand Journal of Psychiatry in 1989"
TL;DR: Compared with results from the Epidemiologic Catchment Area Program, Puerto Rico and Edmonton, Christchurch has the highest rates for major depression and is among the highest for alcohol abuse/dependence.
Abstract: In 1986 the Christchurch Psychiatric Epidemiology Study obtained interviews with a probability sample of 1498 adults aged 18 to 64 years. The Diagnostic Interview Schedule (DIS) was used to enable DSM-III diagnoses to be made. This paper describes the methodology of the study and reports the lifetime prevalence of specific psychiatric disorders. The highest lifetime prevalences found were for generalised anxiety (31%), alcohol abuseldependence (19%) and major depressive episode (13%). Men had higher rates of substance abuse whereas women had higher rates of affective disorders and most anxiety disorders. Compared with results from the Epidemiologic Catchment Area Program, Puerto Rico and Edmonton, Christchurch has the highest rates for major depression and is among the highest for alcohol abuse/dependence.
358 citations
TL;DR: The IPSM appears related to measures of neuroticism and to low self-esteem but not to a modified concept of neurotism, emotional arousability, when the constructs contributing to interpersonal sensitivity and their relevance to depression are considered.
Abstract: Six patients with a history of Seasonal Affective Disorder (SAD) were treated with bright artificial light. Patients presented with at least two consecutive years of loss of energy, difficulty in working, loss of interest in activities, difficulty in concentrating, increased somnolence, over-eating (carbohydrate craving) and depressed mood. All received seven consecutive days of full-spectrum bright light with an intensity greater than 2,500 lux at a distance of three feet. Evening exposure for two hours resulted in significant clinical improvement. The main improvements were a return to normal sleeping patterns, a reduction in eating habits, improved energy level, a desire to continue with interests and activities and an improvement in mood. Possible mechanisms for the clinical effects of bright light treatment are discussed.
334 citations
TL;DR: Christchurch is shown to have higher six month prevalence rates for major depression and alcohol abuse/dependence than other sites which have utilised the Diagnostic interview Schedule in community surveys.
Abstract: The Christchurch Psychiatric Epidemiology Study determined the occurrence (over 2 weeks, 1 month, 6 months, 12 months and life-time) of a number of specific DWDSM-III psychiatric diagnoses in the Christchurch urban area. Data were collected on 1498 randomly selected adults, aged between 18 and 64 years. The Diagnostic interview Schedule (DIS) was used to collect information to make a DSM-III diagnosis. The six month prevalence rates of disorder are presented and compared with available results from the NlMH Epidemiological Catchment Area Program, Puerto Rico and Edmonton. Other period prevalences for the total sample are also presented. Christchurch is shown to have higher six month prevalence rates for major depression and alcohol abuse/dependence than other sites which have utilised the DIS in community surveys.
176 citations
TL;DR: Overall, adolescents perceived mothers as more caring but more personally intrusive than fathers, and adolescents who saw their father as uncaring and their mother as controlling tended to have the least positive psychosocial profiles.
Abstract: We examined the characteristics of a self-report measure for assessing perceptions of parents, the Parental Bonding Instrument (PBI), in an adolescent community sample (N = 2,147; mean age = 15.4 y...
131 citations
TL;DR: The case-prevalence rate using the binary scoring method was comparable with other studies, but misclassification rates were unacceptably high when DSM-Ill Axis I diagnosis was used as the criterion for the presence of any psychiatric disorder.
Abstract: General Health Questionnaire (GHQ) results are given for a large (N = 1013) sample of South Australian young people (average age 19.6 years), to compare the usefulness of the 12-, 28-, and 30-item forms of the GHQ. Internal reliabilities are generally adequate and the Likert scoring method produces significant correlations with psychological measures such as self-esteem. the case-prevalence rate using the binary scoring method was comparable with other studies, but misclassification rates were unacceptably high when DSM-Ill Axis I diagnosis was used as the criterion for the presence of any psychiatric disorder.
113 citations
TL;DR: It is shown that all psychological therapies are to some extent effective, however, rational-emotive and related therapies produced particularly large reductions in trait anxiety/neuroticism (around 1.25 standard deviations).
Abstract: It is argued that personality scales of neuroticism and anxiety are tapping the same personality trait and that this is a risk factor for neurotic disorders. To see whether this trait is modifiable, a meta-analysis was carried out of therapy outcome studies which included a measure of trait anxiety or neuroticism as a dependent measure. This meta-analysis showed that all psychological therapies are to some extent effective. However, rational-emotive and related therapies produced particularly large reductions in trait anxiety/neuroticism (around 1.25 standard deviations). The possibility that rational-emotive education programmes could be used to lower trait anxiety/neuroticism as a preventive measure is discussed.
83 citations
TL;DR: The data suggest that plasma P-endorphin may be a marker for PTSD and that chronic endogenous opioid depletion may play a role in the pathogenesis and perpetuation of this disorder.
Abstract: We compared serum cortisol, ACTH and plasma beta-endorphin in 21 Post-Traumatic Stress Disorder patients and 20 controls. Although we found no important disturbance in diurnal rhythms, the PTSD patients had significantly higher A.M. serum cortisols compared with controls. Both A.M. and P.M. plasma beta-endorphins in PTSD patients were significantly lower compared with controls. These data suggest that plasma beta-endorphin may be a marker for PTSD and that chronic endogenous opioid depletion may play a role in the pathogenesis and perpetuation of this disorder.
56 citations
TL;DR: The results from this study confirm the GHQ-28 to be a valid and practical screen for presence or absence of psychiatric disorder in New Zealand women.
Abstract: The GHQ-28 was validated against the short PSE in a New Zealand community study of female psychiatric morbidity. The GHQ-28 total scores were significantly correlated with the PSE scores. Higher coefficients were obtained using the scoring method of Good child and Duncan-Jones than with the standard scoring method. In this data set, the 3/4 cutoff had the best sensitivity and specificity. The correlations of the GHQ-28 subscales with ICD diagnostic classes and ad hoc PSE sub-scores were also statistically significant. Because the distribution of the GHQ-28 scores is positively skewed, non-parametric statistics may be preferable to the traditional Pearson's correlation coefficient. Overall, the results from this study confirm the GHQ-28 to be a valid and practical screen for presence or absence of psychiatric disorder in New Zealand women.
50 citations
TL;DR: This paper examines the suicide trends in Australia from a sociological perspective and provides a profile of some of the possible sociological factors which appear to have influenced the suicide rates of men and women in Australian society between 1880 and 1985.
Abstract: This paper examines the suicide trends in Australia from a sociological perspective using a selected number of sociological variables. Our aim is not to minimize the importance of psychogenic factors in suicide but to highlight its sociological aspects. The analysis of suicide trends shows that the overall suicide rate in Australia has remained fairly stable over the past one hundred years. This outward stability, however, camouflages some important internal changes in the suicide trends in Australian society. The paper examines some of these trends and provides a profile of some of the possible sociological factors which appear to have influenced the suicide rates of men and women in Australian society between 1880 and 1985.
45 citations
43 citations
TL;DR: The media could assist by publicising alternative coping mechanisms, rather than “normalizing” suicidal behaviour by reporting it, as studies demonstrate a statistically significant association between the amount of such reporting and ensuing increases in suicide.
Abstract: Studies addressing the issue of media reporting of suicide and subsequent suicide are reviewed. the majority demonstrate a statistically significant association between the amount of such reporting and ensuing increases in suicide. Restraint is clearly indicated. the media could assist by publicising alternative coping mechanisms, rather than “normalizing” suicidal behaviour by reporting it.
TL;DR: Bone density was significantly positively correlated with body mass index, and negatively correlated with illness duration and duration of amenorrhoea, and exercise levels, dietary calcium intake and taking an oestrogen pill did not correlate significantly with bone density.
Abstract: Sixty-nine female patients, mean age 27.5 years (range 20-40), with a past or current history of anorexia nervosa (DSM Ill-R) had spinal trabecular bone density assessed by single energy quantitative CT scan. Current exercise and dietary calcium levels were assessed by detailed questionnaires and categorized. A semi-structured interview was used to record weight, menstruation, exercise and dietary calcium intake histories from early adolescence. Serum sex hormones and total calcium assays were measured. Bone density was significantly lower in the patients compared to 31 controls. Bone density was significantly positively correlated with body mass index, and negatively correlated with illness duration and duration of amenorrhoea. Exercise levels, dietary calcium intake and taking an oestrogen pill did not correlate significantly with bone density. Recovered patients did not have osteopaenia but they had shorter illness histories than non-recovered patients. Management to minimise bone loss should focus on ...
TL;DR: Little research has been conducted on the effectiveness of the behavioural management of school refusal, as well as psychological adjustment to school.
Abstract: School refusal is a complex phenomenon that has been subject to definitional and diagnostic confusion. The aetiology of school refusal remains incompletely understood; heterogeneity rather than homogeneity prevails. In the behaviour management of school refusal, the clinician may plan either a gradual or rapid school return. Although a graduated return to school may be necessary in certain cases, secondary complications are minimized by an immediate return to school. Both graduated and rapid treatment require a flexible and integrative approach drawing on classical, operant and vicarious conditioning principles. Little research has been conducted on the effectiveness of the behavioural management of school refusal, as well as psychological adjustment to school.
TL;DR: Although seclusion offered no clear advantages in terms of duration of admission, levels of medication or relapse rates, it appeared to reduce the level of dangerousness in the unit, thereby enhancing staff morale.
Abstract: The use of seclusion within a psychiatric intensive care unit in a South Australian metropolitan mental hospital was documented over a ten week period. The seclusion rate within the unit was 32% of all admissions and 34% of new admissions. The overall seclusion rate for the hospital was 5.4% of all admissions and 6.3% of new admissions, somewhat higher than in the United Kingdom but considerably lower than in the Eastern United States. A comparison was then made between consecutive new admissions (30 secluded and 30 non-secluded) to this unit and to a similar unit without a seclusion room in the other mental hospital in the State. Although seclusion offered no clear advantages in terms of duration of admission, levels of medication or relapse rates, it appeared to reduce the level of dangerousness in the unit, thereby enhancing staff morale. The overall mean daily total of neuroleptic medication was about 1,200 mg chlorpromazine equivalent, somewhat less than in comparable units in the United States and E...
TL;DR: This article reviews the scientific literature on the psychological sequelae of induced abortion and concludes that abortion does not cause deleterious psychological effects and legislation which restricts abortion causes problems for women with unwanted pregnancies and their doctors.
Abstract: This article reviews the scientific literature on the psychological sequelae of induced abortion. The methodology and results of studies carried out over the last twenty-two years are examined critically. The unanimous consensus is that abortion does not cause deleterious psychological effects. Women most likely to show subsequent problems are those who were pressured into the operation against their own wishes, either by relatives or because their pregnancy had medical or foetal contraindications. Legislation which restricts abortion causes problems for women with unwanted pregnancies and their doctors. It is also unjust, as it adversely most affects lower socio-economic class women.
TL;DR: Key clinical features isolated were severity, retardation, delusions and paranoid features, non-reactivity and non-variability in mood, while vegetative features appeared to lack relevance.
Abstract: We review the concept of endogenous depression historically and undertake quantitative analyses of representative factor analytic studies. We also report an empirical study, isolating symptoms and signs associated with a clinical diagnosis of psychotic/endogenous depression, made by a large number of clinical raters assessing 300 depressives. The quantitative analyses and the study of practising psychiatrists agreed in delineating depressive type and together suggest a more restricted construct of endogenous and psychotic depression than has been held historically. Key clinical features isolated were severity, retardation, delusions and paranoid features, non-reactivity and non-variability in mood, while vegetative features appeared to lack relevance.
TL;DR: Those criteria did not adequately define the behaviour of patients in treatment for bulimia in a Weight Disorders Unit, 85% of whom not only binged, but induced vomiting afterwards, and prevalence rates using them fell within the 1–2% range.
Abstract: The widely used DSM-Ill criteria for the diagnosis of bulimia essentially define bulimia as a syndrome of guilty, secretive and subjectively hard to control binge over-eating. A self-report questionnaire for bulimic behavior was administered to three community and two hospital populations in South Australia. 13% of females in the community samples could be categorized as bulimic according to the DSM-Ill criteria. Those criteria did not adequately define the behaviour of patients in treatment for bulimia in a Weight Disorders Unit, 85% of whom not only binged, but induced vomiting afterwards. When diagnostic criteria were more closely aligned to clinical experience, the prevalence of bulimia in the community appeared closer to 1–2%. New DSM criteria (DSM-Ill-R) have been proposed and prevalence rates using them fell within the 1–2% range.
TL;DR: This paper reviews recent progress in the assessment of the psychopathology of psychosis and focuses upon a number of persistent limitations, in particular the over-emphasis upon reliability at the expense of validity.
Abstract: This paper reviews recent progress in the assessment of the psychopathology of psychosis and focuses upon a number of persistent limitations. In particular the over-emphasis upon reliability at the expense of validity is highlighted and the relationship between reliability and validity is reconsidered. A number of strategies aimed at improving the validity of psychopathological measures are outlined. Proposals to deploy such variables differently in research strategies and analyses are endorsed.
TL;DR: The Maori have shown an increase in first psychiatric admission rates since the 1950s, with rapid increases in the early 60s and the 80s, and the most significant changes have been for alcohol abuse, alcohol dependence and personality disorders.
Abstract: This paper compares psychiatric illness in the contemporary Maori with that in the non-Maori New Zealander. The ethnic data available are all from secondary sources. The limitations of this and the problems of achieving a satisfactory definition of “a Maori” are discussed. The data suggest that the Maori have a slightly greater risk of psychiatric hospitalization than the non-Maori. First admission rates for schizophrenia are higher for the Maori, as are the readmission rates. First admission rates for major affective illness are roughly comparable in the two groups, and those for neuroses and neurotic depression are lower in the Maori. Rates of admission for alcohol abuse, alcohol dependence and personality disorders are much higher for the Maori male aged 20–40 years and this group is at greatest risk of psychiatric hospitalization. A larger proportion of Maori are admitted involuntarily, especially under the Criminal Justice Act. The median stay in hospital is not longer for the Maori but their re-admi...
TL;DR: A body of knowledge with regard to renal transplantation has developed as discussed by the authors, and an update of psychiatric aspects of renal transplant can be found in the article "An Update of Psychiatric aspects of Renal Transplantation".
Abstract: Despite the growth of heart, liver and bone marrow transplantation, the kidney continues to be the organ most frequently transplanted. Over the years psychiatrists have been active in attempting to understand the adaptational tasks of organ donors and recipients and in evaluating and treating transplant patients. A body of knowledge with regard to renal transplantation has developed. What follows is an update of psychiatric aspects of renal transplantation.
TL;DR: The stereotype of the mad psychiatrist is examined and it emerges that members of “the first generation” of psychiatrists were labelled as mad, and it is inferred that the stereotype may not be about to change.
Abstract: The stereotype of the mad psychiatrist is examined. There is initial consideration of the “popular” model of madness. It is suggested that there is no firm evidence that psychiatrists suffer more f...
TL;DR: This essay has dealt exclusively with the positive (productive) symptoms of psychosis, and their treatment, and briefly traced the origin of the idea that hyperactive associations of thought (i.e. of inductive inference) play an important part in the psychology of acute psychosis.
Abstract: Disordered associative processes have long been regarded as central to the psychological description of psychotic states such as acute schizophrenia. Previous work is briefly summarised concerning the idea that hyperactive associative processes of thought underlie many of the symptoms of psychosis. The idea is developed further, with respect to several features of the psychotic state. Schneiderian symptoms are seenas a consequence of hyperactive associations of thought, combined with perceptual hypersensitivity characteristic of many psychotic individuals. Anxiety in psychotic states is seen as arising from the great ambiguity of mental images when associations are loosened. A vicious circle between high anxiety and hyperactive associations is postulated. The slow and variable response to neuroleptic treatment is seen as being determined in part by the dynamics of change of the memories acquired during a period of hyperactive associations.This essay has dealt exclusively with the positive (productive) sym...
TL;DR: While the AIMHS standards and a companion quality assurance manual are still undergoing refinement, they offer a guide for mental health professionals to the provision of services, and a checklist to service-users of services that should be available at every stage of care in a mental health system.
Abstract: A provisional set of standards of care was derived from a quality assurance strand of a wider research project, which reported the development of evaluation strategies for area integrated mental health services (AIMHS). In contrast to most published standards, they apply to all facets of care in a comprehensive catchment area mental health service, whether clinical or functional, community or hospital based, urban or rural, or managed by the public, private or voluntary sectors. We review briefly existing sets of standards of mental health services and report the process of development of standards of care, each with sub-sets of performance indicators and examples. While the AIMHS standards and a companion quality assurance manual are still undergoing refinement, they offer a guide for mental health professionals to the provision of services, and a checklist to service-users of services that should be available to them at every stage of care in a mental health system.
TL;DR: A 30-year-old man presenting with intellectual impairment and recurrent psychotic episodes was subsequently found to have suffered from a chronically untreated obstructive sleep apnoea syndrome, which led to complete resolution of sleep apNoea and remission of psychosis at 2 years' follow-up.
Abstract: A 30-year-old man presenting with intellectual impairment and recurrent psychotic episodes was subsequently found to have suffered from a chronically untreated obstructive sleep apnoea syndrome. Polysomnography revealed sleep fragmentation, slow wave sleep deprivation and abnormal arterial oxygen desaturation. Tonsillectomy led to complete resolution of sleep apnoea and remission of psychosis at 2 years' follow-up, but his apparent intellectual impairment persisted. The limited literature on psychosis associated with sleep apnoea is briefly reviewed.
TL;DR: An analysis of Medicare data for the 1985–86 financial year showed that the distribution of private psychiatric services varied greatly by age and sex, and females were greater users than males, except in childhood where the opposite was true.
Abstract: An analysis of Medicare data for the 1985–86 financial year showed that the distribution of private psychiatric services varied greatly by age and sex. Females were greater users than males, except in childhood where the opposite was true. Service use was lowest for children and for the elderly and highest for the 35–44 year old group. Amongst patients receiving psychiatric services, elderly people were more likely to receive short consultations and ECT. These findings carry considerable implications for health service policy and for medical education.
TL;DR: The development of post-traumatic stress disorder (PTSD) in a group of 42 individuals exposed to a multiple homicide was examined and it was suggested that the new criteria may not cluster with the core syndrome of PTSD.
Abstract: The development of post-traumatic stress disorder (PTSD) in a group of 42 individuals exposed to a multiple homicide was examined. A comparison of DSM-III and DSM-III-R indicated that 74% qualified for a diagnosis of PTSD using DSM-Ill, but only 33% met the criteria outlined in DSM-III-R. The most commonly reported symptoms were found to be intrusive recollections of the event and exaggerated startle response. In general, those symptoms that are new additions in the revised version were the least frequently reported, whilst guilt, which has been excluded from DSM-III-R, was experienced by 38% of the sample. It is suggested that the new criteria may not cluster with the core syndrome of PTSD.
TL;DR: An intuitive check list of ten items from 173 risk factors drawn from the literature was useful in predicting who would relinquish care or have majorparenting difficulty in two different samples drawn four years apart and before and after some major sociocultural changes in New Zealand.
Abstract: We describe the three stages of our attempt to predict parenting problems and child abuse antenatally. In the first stage, we made an intuitive check list of ten items from 173 risk factors drawn from the literature. The check list was useful in predicting who would relinquish care or have majorparenting difficulty in two different samples drawn four years apart and before and after some major sociocultural changes in New Zealand. In the second stage we used statistical techniques rather than intuition to maximise the predictive ability of the checklist and produced a new one of 9 items. In the third stage we validated the new list in a random sample of pregnant mothers. It was effective in predicting parenting difficulty In the 2 years after childbirth. We recommend it for routine use in a New Zealand setting. We do not know how useful the checklist will be in other cultural settings.
TL;DR: It is argued that while randomised controlled trials are desirable they are not always informative, and other, less robust, research designs can be acceptable when they provide independent evidence that their results are not invalidated by remission, regression to the mean, or placebo effect.
Abstract: When deciding which treatments are of benefit, results from placebo-controlled trials are conventionally preferred above all others, and treatments not supported by such trials are viewed sceptically. In this paper it is argued that while randomised controlled trials are desirable they are not always informative. Other, less robust, research designs can be acceptable when they provide independent evidence that their results are not invalidated by remission, regression to the mean, or placebo effect, particularly if they provide post-treatment follow-up assessments. Even when there are difficulties with a research design one can reasonably conclude that the treatment was responsible for the improvement provided a standard treatment was delivered, patient compliance was good, and a dose-response relationship was identified.
TL;DR: A model of intervention based on one of three models identified in the US studies involves a collaborative/consultative relationship between the psychiatric nurse and the psychiatrist, therefore maximising opportunities for successful intervention and cross-referral.
Abstract: The role of nursing staff in a liaison consultative unit is by no means established in this country although precedents exist in the United States. Nevertheless, there are clear theoretical reasons for including psychiatric nurses in the liaison team. This report concerns a model of intervention based on one of three models identified in the US studies. the model involves a collaborative/consultative relationship between the psychiatric nurse and the psychiatrist, therefore maximising opportunities for successful intervention and cross-referral. Two clinical vignettes illustrate this. the clinical presentations of 200 patients presenting primarily to the nurse specialist are compared with 200 presenting to the psychiatric department. the patterns of referrals and also the agencies referring differed. the differences in those profiles, together with the management implications, are discussed. High stress areas of nursing, such as cardiology, neurosurgery and haematology, provided a fertile area for referra...
TL;DR: Patients with alcohol-related problems made up 17.6% of the case load of psychiatric emergencies in an Indian general hospital, but only 10% were referred for outpatient treatment, and 80% were not given any follow-up advice because the patients said they needed no help.
Abstract: Alcohol-related problems made up 17.6% of the case load of psychiatric emergencies in an Indian general hospital. The police brought three-quarters of them, 45% for quarrels, street-fights and under influence of alcohol and 20% for minor offences like abusing in public. A psychiatric illness was definitely present in 40% of the cases. Only 10% of the patients with alcohol-related problems were referred for outpatient treatment, Eighty-five percent were not given any follow-up advice because the patients said they needed no help.