Showing papers in "Australian and New Zealand Journal of Psychiatry in 1991"
TL;DR: The dopamine hypothesis of Attention Deficit Hyperactivity Disorder (ADHD) is examined from the point of view of differential dose effects of CNS stimulant medications, and theories of neural control.
Abstract: Clinical, animal and neuroanatomical studies of differential isomer and dosage effects of CNS stimulant medications on behaviour are reviewed. Wender's hypothesis that an underlying biochemical abnormality and a disorder of reinforcement was the primary deficit in "MBD" children is restated in terms of a disorder of polysynaptic dopaminergic circuits, between prefrontal and striate centres. Wender's notion of a disorder of reinforcement is broadened to include a disorder of planning and correction of behaviour, including capacity for cortical control of automatic instinctual motor programmes. The dopamine hypothesis of Attention Deficit Hyperactivity Disorder (ADHD) is examined from the point of view of differential dose effects of CNS stimulant medications, and theories of neural control. Clinical, animal and neuropharmacological studies are reviewed. Implications of the findings for understanding clinical and side effects in ADHD children of stimulants are discussed.
225 citations
TL;DR: Distress was correlated with recent stressful life events and was more severe in women awaiting trial, and the most frequent diagnoses were adjustment disorder with depressed mood and personality disorders.
Abstract: The population of a women's prison (n=92) was screened for psychological distress and psychiatric morbidity with the 12-item General Health Questionnaire, the Hamilton Depression Rating Scale, a Recent Stressful Life Events questionnaire and the Structured Clinical Interview for DSM-III-R. High levels of symptoms of psychological distress were recorded. Distress was correlated with recent stressful life events and was more severe in women awaiting trial. Fifty-three per cent of the prisoners were diagnosed as current cases of a psychiatric disorder and the most frequent diagnoses were adjustment disorder with depressed mood and personality disorders. Lifetime prevalence of psychoactive substance use disorders was 54 per cent. Aboriginal women were over-represented in this prison population. A follow-up survey after 4 months showed no fall in the prevalence of psychological distress and psychiatric morbidity.
110 citations
TL;DR: The aim of this study was to examine the prevalence of psychiatric morbidity in a sample of medical and surgical inpatients in an Australian general hospital, and the estimated prevalence was 30% using the 60-item General Health Questionnaire.
Abstract: The aim of this study was to examine the prevalence of psychiatric morbidity in a sample of medical and surgical inpatients in an Australian general hospital. Using the 60-item General Health Questionnaire, the estimated prevalence was 30% (previous studies have yielded estimates generally between 20 and 50%). The prevalence of morbidity was significantly higher in medical (45%) than in surgical (23%) inpatients. Twelve percent of patients (20% of medical patients and 8% of surgical patients) satisfied DSM-III criteria for a current Major Depressive Episode. Anxiety scores on the State-Trait Anxiety Inventory were higher than those reported in general population samples. There were no significant differences between males and females on any scores. The problems associated with the definition and identification of depressive and anxiety syndromes in medical and surgical inpatients are discussed, whilst the importance of this task is emphasized.
77 citations
TL;DR: The distinctive experiences of torture survivors who present for treatment in western countries are outlined and a broader therapeutic aim is proposed to ensure successful psychosocial rehabilitation.
Abstract: Growing recognition that the world faces a modern epidemic of torture has stimulated widespread interest amongst mental health professionals in strategies for the treatment of survivors. In this article we outline the distinctive experiences of torture survivors who present for treatment in western countries. These survivors are usually refugees who, in addition to torture, have suffered a sequence of traumatic experiences and face ongoing linguistic, occupational, financial, educational and cultural obstacles in their country of resettlement. Their multiple needs call into question whether "working through" their trauma stories in psychotherapy will on its own ensure successful psychosocial rehabilitation. Drawing on our experience at a recently established service, we propose a broader therapeutic aim.
74 citations
TL;DR: The PDs were distinctly older than the EDs at assessment and at initial onset of any affective disorder, and had delusions, one-fifth reported hallucinations and psychomotor disturbance was marked, while other differential clinical findings were sustained mood disturbance, constipation, and the absence of a diurnal variation in mood and energy.
Abstract: We review research literature on psychotic (delusional) depression, including demographic, illness pattern, clinical, biological marker and treatment issues. Secondly, we report a study of a consecutive sample of 137 patients meeting criteria for DSM-III melancholia, RDC definite endogenous depression and our "clinical" criteria for endogenous depression, of whom there were 35 "psychotic depressives" (PDs). The PDs were contrasted with the remaining 76 depressives (EDs) and with an age and sex-matched subset (MEDs). The PDs were distinctly older than the EDs at assessment and at initial onset of any affective disorder. Compared to the MEDs, they tended to have longer illnesses, were more likely to be hospitalised (and to have longer stays), to receive (in the past and for the current episode) combination antipsychotic/antidepressant medication and/or ECT, and to have a poorer course over the following year. They were no more likely to have a bipolar pattern, a family history of depressive disorder, schizophrenia or alcoholism, or vegetative depressive features. Developmental psychosocial stressors and antecedent life event stressors were not over-represented. Most of the PDs had delusions, one-fifth reported hallucinations and psychomotor disturbance was marked. Other differential clinical findings were sustained mood disturbance, constipation, and the absence of a diurnal variation in mood and energy.
55 citations
TL;DR: Findings are the first to indicate that clonazepam may have a specific antimanic effect over and above that of phenothiazines alone.
Abstract: In a double-blind trial involving acutely manic patients, clonazepam was compared to placebo, both groups receiving chlorpromazine as needed. The group receiving clonazepam showed significantly more improvement in their manic but not their psychotic symptoms compared to the placebo group. This effect was not primarily related to the sedative effects of clonazepam. Clonazepam tended to reduce the need for phenothiazine medication. Side effects related to sedation were more common to the clonazepam group. These findings are the first to indicate that clonazepam may have a specific antimanic effect over and above that of phenothiazines alone.
50 citations
TL;DR: It is premature to abandon the use of this new anaesthetic agent in ECT without controlled prospective outcome studies, despite demonstrating that the individual seizure duration was significantly reduced with propofol compared to thiopentone.
Abstract: Recent reports of reduced seizure duration with ECT under propofol anaesthesia have led to concerns that propofol may diminish the efficacy of this treatment To investigate the effect of propofol on the response to ECT, we reviewed records of 66 patients with primary depression treated with ECT, 37 of whom had been assessed prospectively with pre- and post-ECT Hamilton and Zung depression severity ratings Despite demonstrating that the individual seizure duration was significantly reduced with propofol compared to thiopentone we found no evidence of reduced ECT efficacy with propofol Courses under propofol anaesthesia were on an average two treatments longer than with thiopentone Although this difference was not statistically significant this may have been due to a type II error These results suggest that it is premature to abandon the use of this new anaesthetic agent in ECT without controlled prospective outcome studies
50 citations
TL;DR: It is suggested that many further studies in the area are warranted providing methodological difficulties are addressed adequately and reasons for and drawbacks of the emphasis on depression in studies to date.
Abstract: Attention is drawn to some shortcomings of previous findings with regard to the nature, prevalence and aetiology of psychiatric disorder after stroke, and in particular post-stroke depression. Reasons for and drawbacks of the emphasis on depression in studies to date are discussed. Inconsistencies amongst previous findings are examined and it is suggested that many further studies in the area are warranted providing methodological difficulties are addressed adequately.
46 citations
TL;DR: New Zealand suicide rates from 1957 to 1986 were analysed for age, period and cohort effects, and poisoning declined as a method of suicide, while hanging and carbon monoxide poisoning increased.
Abstract: New Zealand suicide rates from 1957 to 1986 were analysed for age, period and cohort effects. Cumulative suicide rates were relatively stable but more complex patterns were revealed by detailed analysis. There was a steadily increasing rate in young men and a recent increase in elderly men. Reduced mortality rates in equivalent categories of accidental and “undetermined” deaths could have accounted for only a proportion of these increases. A cohort effect was noted in men, with increasing risks of suicide in the young for successive birth-cohorts born from 1947 onwards. In women a period effect was likely, with increasing rates for all age-groups between 1957–61 and 1962–66, followed by a decline recently among all except the youngest age-groups. These trends in women may have been largely due to changes in barbiturate prescribing. In both sexes poisoning declined as a method of suicide, while hanging and carbon monoxide poisoning increased. Firearm suicides also increased in men. The implications of thes...
45 citations
TL;DR: In this article, a loose linkage model is proposed to represent more accurately the true state of affairs in psychotic disorder, with fewer historical preconceptions, and it is argued that the psychopathology of psychosis is more fluid than acknowledged by the dominant neo-Kraepelinian paradigm in particular.
Abstract: Increasing sophistication in the neurosciences has re-stimulated expectations that the underlying biological mechanisms involved in the psychoses might finally be clarified. These expectations however coexist with a sense of mounting frustration over the continuing failure of such progress to occur. One important factor in this failure is an enduring reliance upon obsolete nosological concepts and tools. The persistence of concepts such as schizophrenia and manic-depressive illness, which are substantially based upon unsustainable assumptions concerning the relationship between pathophysiology, symptoms and outcome, interferes with the appropriate deployment of new technologies and the interpretation of the resulting data. As many have suspected for some time, we are in a state of chronic paradigm failure, yet the lack of a superior alternative makes it difficult to dispense with traditional concepts. Following a review of the principal nosological paradigms, it is argued that the psychopathology of psychosis is more fluid than acknowledged by the dominant neo-Kraepelinian paradigm in particular. An alternative, which may be termed the loose linkage model, is proposed, which though it falls short of full paradigm status, does represent more accurately the true state of affairs in psychotic disorder, with fewer historical preconceptions. Its importance lies particularly in its significance for research strategy, and its capacity to minimise early iatrogenic sequelae of the diagnostic process and permit a more honest approach to clinical care.
33 citations
TL;DR: Patients in the treated group show significant improvement on FSS and FQ when compared with the patients in the control group, and these effects of treatment were shown to be maintained at follow-up which was on average 1 year after the treatment.
Abstract: This study reports the long term efficacy of a brief intensive (2 days) group cognitive behavioural programme for the treatment of agoraphobia with panic attacks. A total of 97 patients was included in the study. Seventy-four patients were in the treated group and 23 were on the waiting list control group. The Fear Questionnaire (FQ), Fear Survey Schedule (FSS), Maudsley Personality Inventory (MPI), the Hostility and Direction of Hostility Questionnaire (HDHQ) and a clinical assessment based on structured interview to assess current levels of functioning were used as dependent measures. The results show that patients in the treated group show significant improvement on FSS and FQ when compared with the patients in the control group. Clinical rating shows that 85% of the patients were either symptom free or their symptoms had been reduced and these effects of treatment were shown to be maintained at follow-up which was on average 1 year after the treatment.
TL;DR: Patients who believed that they were suffering from a mental illness were comparatively happy about being under Guardianship, and a belief that the patient was mentally ill was significantly associated with reduced ex-trapunitiveness in relatives.
Abstract: In 1979 a Guardianship Board assumed responsibility in South Australia for the welfare of those mentally ill or handicapped people unable to look after their own health or safety, or to manage their own affairs. This study examines the attitudes to guardianship and involuntary treatment of 79 patients referred to the Board from a psychiatric hospital, all of whom were under guardianship at the time of the study. Forty-seven of their relatives took part in the project, which included measures of patients' psychiatric symptoms and relatives' punitiveness. Although almost 70% of patients objected to Guardianship in principle, they made more positive than negative statements about it. Nearly 60% rated involuntary treatment, including medication, as helpful. Patients reported a level of psychiatric symptoms less than half of that of a psychiatric outpatient sample. Relatives were strongly in favour of Guardianship, stating frequently that it allowed an improved relationship between themselves and the patient. ...
TL;DR: The traditional role of psychiatrist as the central figure in the delivery of mental health services is changing; the advent of structured diagnostic interviews means that the diagnosis of mental disorders is no longer the exclusive preserve of psychiatrists and psychiatrists now treat a minority of the patients with mental disorders.
Abstract: The traditional role of psychiatrist as the central figure in the delivery of mental health services is changing. First, the advent of structured diagnostic interviews means that the diagnosis of mental disorders is no longer the exclusive preserve of psychiatrists; second, the growth of community mental health services staffed by non-psychiatrists means that psychiatrists now treat a minority of the patients with mental disorders; and third, the psychiatrists' continued endorsement of dynamic psychotherapy means they are becoming identified with an unproven and very expensive treatment. These changes should be seen against the broader background of a profession that is well-trained, active in evaluating performance, supported by a burgeoning research base in cognitive science and neuroscience, and delivering services efficiently and inexpensively.
TL;DR: Identical data sets for Australia and the USA from 1946 to 1984 were analysed to explore the association of unemployment rates, female participation in the labour force and divorce with suicide rates.
Abstract: Identical data sets for Australia and the USA from 1946 to 1984 were analysed to explore the association of unemployment rates, female participation in the labour force and divorce with suicide rates. While female participation in the labour force was related to suicide rates in Australia, unemployment was not. For the USA, both female participation in the labour force and unemployment were related to suicide rates.
TL;DR: Two psychologically vulnerable Chinese girls are reported, in whom traditional health concepts reinforced dieting behaviour, led to weight loss, regression of acne and eventually anorexia nervosa.
Abstract: Acne is a highly visible and common skin disorder which is potentially disfiguring and associated with adverse emotional responses in adolescents, who are markedly sensitive to body image changes. Two psychologically vulnerable Chinese girls are reported, in whom traditional health concepts reinforced dieting behaviour, led to weight loss, regression of acne and eventually anorexia nervosa. The intricate interactions of acne, health beliefs, dieting behaviour and eating disorders are discussed.
TL;DR: Data are reported which suggest that patients with a strong somatic focus are less likely to be referred for psychiatric assessment despite the presence of significant psychiatric morbidity.
Abstract: Recognition of psychiatric disturbance and rate of referral to psychiatric units in general hospitals falls far short of the prevalence of psychiatric morbidity in such hospitals. This study has sought to determine whether particular patterns of “illness behaviour” contribute to the decision to refer. A group of patients referred to a psychiatric service was compared to a group of non-referred patients using the General Health Questionnaire (GHQ) as a general measure of morbidity, the Inventory to Diagnose Depression (IDD), the State-Trait Anxiety Inventory (STAI) and the Illness Behaviour Questionnaire (IBQ). The rate of referral to the service was 2.9%. The estimated prevalence of psychiatric morbidity was 30%. Referred patients scored more highly on all measures of morbidity (GHQ, IDD, STAI) and on the IBQ scale Affective Disturbance, and scored lower on the Denial Scale. Data are reported which suggest that patients with a strong somatic focus are less likely to be referred for psychiatric assessment ...
TL;DR: Systemic problems are identified within the institutions of medicine and psychiatry which compromise the development of both female and male trainees and which must concern medical educators.
Abstract: Gender disadvantage within the professions significantly affects the development of women doctors, resulting in morbidity and less than optimal development. Paradoxically, for a profession primarily concerned with the study of the vicissitudes of human development, psychiatry in Australia and New Zealand has yet to articulate those issues which bear directly upon the development of its own members. Systemic problems are identified within the institutions of medicine and psychiatry which compromise the development of both female and male trainees and which must concern medical educators. Recommendations are made concerning the structure and content of training programmes, most particularly post-graduate psychiatry.
TL;DR: The prevalence of tardive dyskinesia in 514 psychiatric patients who were 60 years and above in Singapore was found to be 27.6%, which is low compared with other studies done on elderly psychiatric patients in the West.
Abstract: The prevalence of tardive dyskinesia (TD) in 514 psychiatric patients who were 60 years and above in Singapore was found to be 27.6%. This is low compared with other studies done on elderly psychiatric patients in the West. Among the different ethnic groups, the Eurasians have the highest prevalence of 53.8% compared to the Chinese, Malays or Indians. Inpatients have a higher prevalence (31.5%) than outpatients (10.5%). Higher prevalence was also found in women, who were 2.2 times more common than men. 50% of the mentally retarded patients were found to have TD.
TL;DR: Huntington's disease-affected individuals were found to be at least as fertile as members of the general population, which supports earlier studies.
Abstract: A study was conducted of the fertility (number of live births) of Huntington's disease (HD)-affected individuals compared to that of the general population using data from the 1986 Census of Population and Housing. HD-affected individuals were found to be at least as fertile as members of the general population. This finding supports earlier studies.
TL;DR: Two cases are described in which fenfluramine, a presynaptic 5 HT-releasing agent and 5HT-reuptake inhibitor was used to augment clomipramine treatment for OCD.
Abstract: Recently, much research interest has been directed to demonstrating a possible biological basis to obsessive compulsive disorder. In particular, dys-regulation in brain serotonin is suggested to be important. Two cases are described in which fenfluramine, a presynaptic 5 HT-releasing agent and 5HT-reuptake inhibitor was used to augment clomipramine treatment for OCD.
TL;DR: The questions still remain as to when the model is optimally applied, and whether it has a role in preventive psychiatry.
Abstract: Following the death of a family member, the mourners' experiences of grief are inevitably influenced by and, in turn, influence the experiences of their relatives. Therapy should apply a model which takes this interactive process into account. A systems approach can fulfil this requirement in certain cases. Three case histories are provided to illustrate the potential effectiveness of a systems-oriented intervention. The questions still remain as to when the model is optimally applied, and whether it has a role in preventive psychiatry.
TL;DR: Aboriginal suicide has emerged as an issue of public concern only within the recent past. as mentioned in this paper examines suicides that have occurred in the following two years, with comparisons both with the previous suicides, and with a group of age-matched Aborigines from the general Kimberley population drawn from a random sample survey.
Abstract: Aboriginal suicide has emerged as an issue of public concern only within the recent past. Within the last decade there has been a substantial increase from levels that were previously low. Under the shadow of the Royal Commission into Aboriginal Deaths in Custody these increases, involving primarily young adult males, raise serious questions. Two years ago the author examined a series of suicides that had occurred in one area of remote Aboriginal Australia, the Kimberley region of Western Australia. This paper examines suicides that have occurred in the following two years, with comparisons both with the previous suicides, and with a group of age-matched Aborigines from the general Kimberley population drawn from a random sample survey.
TL;DR: It is suggested that the clinician should not proceed to conclude that the default option is necessarily an entity “neurotic depression” and that instead a heterogeneous group of options (e.g. anxiety, personality disorder) require review.
Abstract: The strongest statistical support for the binary view of depression has been provided by factor (principal components) analytic studies which delineate a bipolar factor with features interpreted as reflecting “endogenous depression” and “neurotic depression” at opposing poles. We review the seminal studies to suggest instead that the bipolar factor has generally polarised depression and anxiety, and that no such entity or symptom complex of “neurotic depression” has been isolated. Instead, “neurotic depression” has been defined principally by features of anxiety and personality style. We argue that the suggested entity is, in fact, a pseudo-entity, being no more than a residual group of non-depressive features without any significant intrinsic depressive characteristics. We support our interpretation by showing comparable solutions in published studies of depressives alone, contrasted with separate analyses of anxious and depressed patients. We also report two studies in which the “neurotic depressive” po...
TL;DR: The concordance of physicians with the recommendations of psychiatric consultants in a sample of 270 consultations in a 400-bed general hospital found that 37% of patients about whom a consultation was sought had a past psychiatric history, and 67% were on psychotropic drugs.
Abstract: We studied the concordance of physicians with the recommendations of psychiatric consultants in a sample of 270 consultations in a 400-bed general hospital. Of the patients about whom a consultation was sought, 37% had a past psychiatric history, and 67% were on psychotropic drugs. Twelve percent had Organic Mental Disorder, 35% Affective Disorder, and for 24% no DSM-Ill diagnosis could be made. The psychiatrist made psychotropic drug recommendations in 62%, and the physicians' concordance with this recommendation was 86%. The physician's discharge summary included a diagnosis which concorded with the psychiatrist's diagnosis in 53% of files. The psychiatrist recommended further investigations in only 5.2% of files.
TL;DR: The rapidly advancing field of non-linear mathematics, in offering conceptual forms to represent complex events, may provide a useful framework in which to place various psychodynamic formulations about the development of the personality, and suggests the possibility of a new approach to research concerning the efficacy of psychotherapy.
Abstract: Thomas Kuhn's concept of paradigm as central to the functioning of a mature science is linked with Johnson-Abercrombie's recognition that perception itself is shaped by the schemata available to the subject. The rapidly advancing field of non-linear mathematics, in offering conceptual forms to represent complex events, may provide a useful framework in which to place various psychodynamic formulations about the development of the personality, and suggests the possibility of a new approach to research concerning the efficacy of psychotherapy. Dan Stern's latest concept of “moments” as the basic unit in structuring the personality, leading to the complex representational patterns and feed-back loops he terms “RIGS” may be viewed in this context. The paradigm may be extended to include such concepts as Peterfreund's linkage of psychodynamic theorising with aspects of information theory generated by the study of computers, and with Sullivan's concepts of repetitive patterns of behaviour recognisable, and chan...
TL;DR: The case met the criteria for Munchausen Syndrome by Proxy with fabrication of symptoms on behalf of another in order to deceive medical personnel.
Abstract: An 11-year-old boy was presented by his father with a long and plausible history of cystic fibrosis. The diagnostic test for cystic fibrosis, the sweat test, was normal and excluded the diagnosis. The medical history was later found to be false, and the child to be well. By definition, the case met the criteria for Munchausen Syndrome by Proxy with fabrication of symptoms on behalf of another in order to deceive medical personnel. Unusual features included the illness chosen, the father as the parent falsifying illness, his failure to pursue unnecessary investigations and treatment, and the ease with which he relinquished the diagnosis of cystic fibrosis.
TL;DR: It is suggested that potentially reversible cognitive impairment would be a more accurate term as many cases are due to delirium and depression, and all cases should have a thorough clinical assessment.
Abstract: Potentially reversible dementia is reviewed with reference to diagnosis, causes and outcome. Many disorders which cause cognitive impairment, such as drug toxicity and depression, fail to meet diagnostic criteria for dementia. These tend to have the best prognosis. Studies of the neuropsychiatric syndromes associated with disorders causing potentially reversible dementias suggest that dementia is an infrequent outcome and when it does occur, few cases recover. Factors predictive of improvement are short duration of symptoms and mild degree of cognitive impairment, usually subcortical in type. It is suggested that potentially reversible cognitive impairment would be a more accurate term as many cases are due to delirium and depression. While cases of well established dementia do not require extensive investigation, all cases should have a thorough clinical assessment as in many instances dual pathology exists and all require psychosocial management.
TL;DR: The all-round improvement included a decrease in psychiatric symptoms, improvement in self-assessment, better and more social activities and being more able to cope with problems.
Abstract: Ninety-one Chinese in the community, aged between 18 and 45, with mental health problems ranging from mild to moderate degree, were treated by cognitive behavioural group therapy (CBGT) for a period of 3 months. All subjects were assessed on multiple measures at 4 time points: screening, pre-treatment (after 3 months), post-treatment and at 3-month follow-up. Attendance was good. A standard practice manual was developed to ensure consistent treatment by 2 group workers. After controlling for the placebo effect in the waiting period, treatment effect was demonstrated which was sustained after a three month period. The all-round improvement included a decrease in psychiatric symptoms, improvement in self-assessment, better and more social activities and being more able to cope with problems. In terms of psychiatric diagnosis, depressed subjects gained the most benefit and personality disorder subjects the least. Parents seemed to benefit more than non-parents.
Journal Article•
TL;DR: The migrant patient-group was older, developed the illness later, and had a higher proportion of females, while patients born in U.K. and Ireland resembled the Australian-born.
Abstract: Comparison is made between migrant (n = 332) and Australian-born (n = 242) schizophrenic outpatients attending a regional psychiatric hospital. Age-corrected rates show that migrants are over-represented. The migrant patient-group was older, developed the illness later, and had a higher proportion of females. More female migrant patients had developed the illness before arrival and in the first five years after migration compared to males whose peak incidence was between 11 and 15 years after arrival. Migrant patients showed greater family cohesion. On broad socio-economic indices, illness characteristics and treatment received, no significant differences emerged. In many respects patients born in U.K. and Ireland resembled the Australian-born.