Showing papers in "Australian and New Zealand Journal of Psychiatry in 1995"
TL;DR: This paper reviewed definitions of resilience, the nature of risk factors and of moderating processes and made a plea for increased efforts to make knowledge more widely available: public and politicians need to know how decisions about housing, employment, welfare, education and criminal justice impinge on the development of children, and what changes in the macro-environment will preserve and enhance childhood resilience.
Abstract: Objective: The concept of resilience highlights the complexity of psychopathology, helps to clarify possibilities for prevention and keeps hope alive in clinical practice. This paper reviews definitions of resilience, the nature of risk factors and of moderating processes.Method: The place of single case studies is described, the components of resilience are outlined and consideration is given to how resilience can be fostered in the face of adversities and stresses: socio-economic deprivation, family discord and divorce, and maternal depression.Conclusion: A plea is made for increased efforts to make knowledge more widely available: public and politicians need to know how decisions about housing, employment, welfare, education and criminal justice impinge on the development of children, and what changes in the macro-environment will preserve and enhance childhood resilience.
170 citations
TL;DR: Investigation of gender differences in 219 patients with obsessive compulsive disorder consecutively referred to a centre specialising in the behavioural treatment of anxiety disorders found females had a later mean onset-age, and were more likely to be married and to have children, while males were morelikely to have a history of anxious or meticulous personality traits.
Abstract: We investigated gender differences in 219 patients with obsessive compulsive disorder consecutively referred to a centre specialising in the behavioural treatment of anxiety disorders. Females had a later mean onset-age, and were more likely to be married and to have children; they were also marginally more likely to have a past history of an eating disorder or depression, while males were more likely to have a history of anxious or meticulous personality traits. Family loading for psychiatric disorders did not differ significantly between the sexes. The results are discussed in the context of the epidemiological literature on gender differences in OCD.
147 citations
TL;DR: Although the two instruments made similar diagnostic distinctions, the clinical judgement involved in administering the SCAN resulted in the more moderate levels of agreement between the interviewer and observer than those found for the CIDI.
Abstract: The relationship between and the inter-rater reliability of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) for anxiety and depressive disorders were explored. The CIDI and the SCAN were administered by trained interviewers in counterbalanced order. A subsample of interviews was observed to determine the inter-rater reliability of the instruments. Subjects were 101 patients accepted for treatment at an Anxiety Disorders Clinic; 29 of the 101 patients participated in the inter-rater reliability study. Concordance between the instruments as measured by canonical correlation analysis was moderate for current (r=0.69, p=0.05) and for lifetime (r=0.66, p=0.05) diagnoses. Inter-rater reliability of the CIDI was perfect (overall intraclass kappa = 1.00), and of the SCAN was good (overall intraclass kappa = 0.67). It is concluded that although the two instruments made similar diagnostic distinctions, the clinical judgement involved in adm...
112 citations
TL;DR: The planning for the group, the teaching techniques used, the actual group process and a subjective assessment of outcomes are discussed and possible directions for future interventions are presented.
Abstract: A social skills group was conducted for 8 boys aged 8 to 12 years on a weekly basis for 14 sessions. In this descriptive paper we discuss the planning for the group, the teaching techniques used, the actual group process and a subjective assessment of outcomes. Possible directions for future interventions are also presented.
102 citations
TL;DR: Most believed that drug abuse initiated or exacerbated their schizophrenia; 80% took drugs primarily to relieve dysphoria and anxiety; Amphetamines improved subjective well-being significantly more than alcohol, but choice of drugs was determined mainly by price and availability.
Abstract: Fifty-three psychiatric hospital inpatients with a dual diagnosis of substance abuse and schizophrenia were given the Brief Symptom Inventory and the Schizophrenia/Substance Abuse Interview Schedule. Mean age was 29; 49 were men. Only 11% were employed. Forty percent abused mainly alcohol, 40% cannabis and 8% amphetamines; 20% abused more than one substance. Mean onset age of drug abuse was 16 years; schizophrenia was diagnosed a mean of 5 years later, and subjects had been admitted to hospital an average of 7 times since then. Most believed that drug abuse initiated or exacerbated their schizophrenia; 80% took drugs primarily to relieve dysphoria and anxiety. Amphetamines improved subjective well-being significantly more than alcohol, but choice of drugs was determined mainly by price and availability. Only cannabis increased positive symptoms of schizophrenia and only amphetamines reduced negative ones. Effectively treating this population requires an integration of psychiatric and drug treatment servic...
101 citations
TL;DR: In this article, the authors investigated the prevalence and demographic correlates of suicidal ideation and behaviours among university students in Australia and the utilisation of mental health services for mental health care.
Abstract: Objective: The aim of the study was to investigate the prevalence and demographic correlates of suicidal ideation and behaviours among university students in Australia and the utilisation of mental...
96 citations
TL;DR: The findings show that the daily average suicide rate in Australia increases significantly after the publication and publicity of suicide stories in the Australian media; the rise tends to be primarily due to the increase in male suicide and not female suicide.
Abstract: This study investigates the impact of newspaper stories on the incidence of suicide in Australia. The effects of suicide stories appearing in two major metropolitan newspapers between 1.1.1981 and 31.12.1990 were examined. The findings show that the daily average suicide rate in Australia increases significantly after the publication and publicity of suicide stories in the Australian media; the rise tends to be primarily due to the increase in male suicide and not female suicide. Some plausible explanations of this finding are advanced.
80 citations
TL;DR: Female sex and an interaction between sexual abuse and binge drinking predicted suicide attempts and the need for a comprehensive approach to interventions for troubled youth gives greater recognition to mental health issues related to family circumstances, including abuse is pointed to.
Abstract: In order to assess the need for drug-related services for at-risk youth, a survey was conducted among young people aged 12-17 years who, owing to severe family discord, were currently living away from home (homeless) or had experienced periods away from home in the past 12 months (potentially homeless). Prevalence of use and of potentially harmful levels of use of alcohol and other licit and illicit drugs were higher than in a comparative population. Of the 155 people interviewed, 54% reported past physical abuse, 28% reported past sexual abuse, and 73% had a family alcohol or other drug history. Of the total, 62% had been in a youth refuge at some time in the past 12 months. Twenty four per cent had been to hospital as a result of alcohol or other drug use and 45% had attempted suicide. Female sex and an interaction between sexual abuse and binge drinking predicted suicide attempts. This study points to the need for a comprehensive approach to interventions for troubled youth which gives greater recognition to mental health issues related to family circumstances, including abuse.
64 citations
TL;DR: The activities of a consultation-liaison psychiatry service to general medical units in a university affiliated suburban teaching hospital are described, with a report from the MICRO-CARES clinical database on 165 consecutive referrals over a 12 month period.
Abstract: The activities of a consultation-liaison psychiatry service to general medical units in a university affiliated suburban teaching hospital are described, with a report from the MICRO-CARES clinical database on 165 consecutive referrals over a 12 month period. The referral rate was 4.2% of admissions. The data confirm the association of psychiatric referral and prolonged length of hospital stay (mean of 18 days for referred patients, 9 days for non-referred patients). The most common reasons for referral were depression, suicide risk evaluation, organic brain syndrome and suspected psychological component to illness. The most common psychiatric diagnoses were Mood Disorders (55%), Organic Mental Disorders (35%), Adjustment Disorders (19%), Somatoform and other Somatic Disorders (16%) and Personality Disorders (15%). Although 67% of patients received at least one confirmed diagnosis, 39% of all diagnoses remained “differential”, or unconfirmed, at discharge. Concordance with drug recommendations was 97% and...
59 citations
TL;DR: There is an urgent need for academic research, increased clinical expertise and substantial increased resources in the much neglected area of dual disability, and the results indicate a high degree of interest in the psychiatry of intellectual disability.
Abstract: Objective: The main aim of this study was to document the perceptions of trainee psychiatrists and psychiatric medical officers regarding the psychiatric care of people with intellectual disabilities.Method: A 28-item self-administered questionnaire was developed by the investigators and pretested on eight psychiatrists and psychiatric trainees. A revised version of the questionnaire was then sent to 128 psychiatric trainees and 27 medical officers working in the public psychiatric services in Victoria. 116 questionnaires were returned, and the responses analysed.Results: The results indicate a high degree of interest in the psychiatry of intellectual disability, however this was tempered by a feeling that the respondents and their senior colleagues are inadequately trained. The respondents expressed major concerns regarding the care of people with dual disabilities in the hospital and community setting, and significant support for the development of specialised units and subspecialisation within psychiat...
59 citations
TL;DR: It is suggested that prolonged separation from both parents has a stronger association with current or lifetime depression in women than do parental death, separation/divorce and other types of loss.
Abstract: Objective: The aim of this study was to examine the influence of different types of disruptions in childhood parental care before the age of 15 years as risk factors for major depression in women aged 18 to 44 years. The types of disruptions studied were parental death, parental separation or divorce, other types of loss (i.e. adoption, foster-care, etc.), and prolonged separation from both parents. Potential confounding factors were also examined. Method: The data were obtained from a community probability sample. Case-ness was determined by the use of the Diagnostic Interview Schedule (DIS) and both the current (one month) and lifetime prevalence periods were considered. Logistic regression was used to model the influence of each factor, singly and adjusted for the influence of other factors, on the risk for major depression.Results: It was found that in this population 17% had experienced some type of parental loss (parental death 4%, separations/divorce 10% and other types of loss 3%) and 11% had expe...
TL;DR: It is found that depression might not have a clear negative impact on rehabilitation, that mood improved at the end of rehabilitation and that the degree of depression on admission was a good predictor of the outcome of final physical impairment.
Abstract: Objective: This prospective study looks at the outcome of rehabilitation on mood and physical recovery in patients with post-stroke depression.Methods: Fifty-two patients in a rehabilitation centre...
TL;DR: Patients with severe mental illness of mixed type were assessed by treating mental health professionals a total of 730 times with the Life Skills Profile (LSP), and confirmatory factor analyses broadly confirmed the existence of the Self-care and Non-turbulence subscales.
Abstract: Two hundred patients with severe mental illness of mixed type were assessed by treating mental health professionals a total of 730 times with the Life Skills Profile (LSP). Confirmatory factor analyses broadly confirmed the existence of the Self-care and Non-turbulence subscales. Internal consistencies were generally good but inter-rater reliabilities were of only marginal acceptability. The fit of the data to the five subscales can be improved by reassigning two items. The Communication subscale had the poorest psychometric properties. Certain LSP scale scores were found to vary with how well and how long the rater had known the patient. Validity, which was assessed by relating LSP scores to locus of care (i.e. community or hospital), Brief Psychiatric Rating Scale (BPRS) ratings and Resource Associated Functional Level Scale (RAFLS) ratings, was good. An alternative scoring system yielded rather clearer meaning for some of the subscales.
TL;DR: There is a modest degree of consistency in support of an association between the 1957 influenza epidemic — and less so, for influenza epidemics in general — and later schizophrenia.
Abstract: Over the last five years a body of literature has been generated concerning whether or not prenatal exposure to influenza results in an increased risk of developing schizophrenia in the exposed offspring. The studies are reviewed with respect to the traditional epidemiological criteria that help to define causality. There is a modest degree of consistency in support of an association between the 1957 influenza epidemic - and less so, for influenza epidemics in general - and later schizophrenia. Two cohort studies examining the 1957 epidemic do not support an association. The strength and specificity of the association remain weak. The proposed association draws coherence from the neurodevelopmental hypothesis of schizophrenia. Suggestions are made for future research that could add to our understanding of the putative association between influenza and schizophrenia.
TL;DR: Some support for the hypothesis that torture survivors show higher levels of PTSD, psychosomatic impairment and stress response disturbance than the trauma and non-torture/trauma groups is indicated.
Abstract: Torture has existed since the earliest times, usually as public punishment prior to death. Today it is predominantly used in secret with the aim of destroying the individual's personality. The effects of torture include severe physical and psychological sequelae which have only recently come under scrutiny. In recent years many Chilean and El Salvadorean migrants have left their countries after being tortured and severely traumatised as a result of organised violence. The aim of this study was to pilot an investigation into the psychological sequelae of torture. Subjects were 30 Chileans and El Salvadoreans classified into three groups: torture, trauma and non-torture/trauma migrants. It was found to be feasible to access and interview survivors from a clinical research perspective without causing additional psychological morbidity. The subjects were interviewed and administered three scales: the Post-Traumatic Stress Disorder Scale, SCL-90-R, and the Impact of Event Scale. The results from the scales and the descriptive data presented indicate some support for the hypothesis that torture survivors show higher levels of PTSD, psychosomatic impairment and stress response disturbance than the trauma and non-torture/trauma groups. Methodological issues are discussed. The strengths and limitations of this preliminary study are considered in relation to future research.
TL;DR: The study confirms the emergence in the literature of a valid global profile of the heavy service user patient, and indicates that social factors are strongly related to heavy service use.
Abstract: The purpose of the study was to develop a comprehensive demographic, diagnostic and social profile of patients who are heavy service users of hospital and community based services within the South Australian Mental Health Services (SAMHS). This paper concentrates on the relationship of social issues to heavy service use. The 50 heaviest users of public adult acute psychiatric services in a defined catchment area of Adelaide were identified. Data were obtained retrospectively from the case notes over a 3 year study period. All patients' primary therapists were interviewed, as were 35 of the patients. These structured interviews included a variety of psychosocial rating scales investigating disability and social networks. The 50 patients studied were found to be seriously disabled by chronic psychiatric illness, with substance abuse often complicating their management and their ability to live successfully in the community. The study confirms the emergence in the literature of a valid global profile of the heavy service user patient, and indicates that social factors are strongly related to heavy service use.
TL;DR: This type of case management programme can shorten or prevent admissions to psychiatric hospitals of patients with chronic mental illness, and increase their time before readmission.
Abstract: A two year follow-up of two matched groups of subjects with chronic severe mental illness was performed in order to evaluate a new psychiatric case management system. One group (n=59) received care through psychiatric case management, using an assertive community treatment model that directly involved general practitioners. The other group, matched for age, sex, diagnostic group and number of hospital admissions, received standard outpatient care. Comparing the two years before and after case management, the experimental group showed a dramatic fall in inpatient admission days while the control group admission days remained the same (median difference in admission days across matched subject pairs = 64.5, 95% C.I. from 134.5 to 16). The experimental group remained out of hospital longer before first readmission (Kaplan-Meier survival analysis, P=0.002). This type of case management programme can shorten or prevent admissions to psychiatric hospitals of patients with chronic mental illness, and increase th...
TL;DR: Dementia praecox approaches its centenary with a strengthened identity and enshrined in the diagnostic manuals of psychiatry in slightly revised form, as “schizophrenia”, but despite burgeoning technological expertise the binary model has failed to contribute to any significant clarification of the underlying substrates of dementia.
Abstract: (1995). A treatment-relevant classification of psychotic disorders. Australian and New Zealand Journal of Psychiatry: Vol. 29, No. 4, pp. 555-558.
TL;DR: Recommendations include better routine collection of ethnically relevant information, and measures designed to improve the acceptability and accessibility of inpatient services.
Abstract: Objective: The main aim of this study was to compare levels of service use by English and non-English speaking background people.Method: A comparison of service use in 1991/1992 between clients of English speaking (ESB) and non English-speaking (NESB) background was undertaken using hospital inpatient statistics, community mental health centre contact data, interpreter usage figures, and the 1991 Australian census.Results: The main findings indicated: (a) longer median lengths of stay of NESB than ESB inpatients; (b) roughly equal involuntary hospitalisation rates between ESB and NESB residents, but significantly lower rates of voluntary hospitalisation for NESB residents; (c) NESB face-to-face clinic contacts significantly shorter (by between five to ten minutes) than ESB; and (d) variable and generally low use of interpreters. No significant associations between ethnicity, legal status and gender were found. There were limitations in the available data and conclusions could be drawn only with caution.Co...
TL;DR: The demographic and clinical characteristics of 155 patients consecutively admitted to a special ED unit at a major Sydney teaching hospital during the triennium 1989–1991 were documented and compared with relevant data from the State as a whole.
Abstract: The aim of the study was to present data which may be useful in deciding the type of services needed for eating disorder (ED) patients in New South Wales (NSW). The demographic and clinical characteristics of 155 patients consecutively admitted to a special ED unit at a major Sydney teaching hospital during the triennium 1989-1991 were documented and compared with relevant data from the State as a whole (709 admissions for ED to public facilities and 938 admissions for ED to private facilities during the same period). The findings are discussed in the light of information from overseas studies. Although a relatively large number of ED patients are admitted to hospitals in NSW, their short duration of stay suggests that many may receive inadequate treatment. The unit in the Department of Psychiatry at the Royal Prince Alfred Hospital (RPA), the largest public ED service in NSW, provides a special service for these patients. It is effective in bringing about nutritional restoration, with a duration of stay similar to those reported from centres overseas. Most referrals are tertiary, and there is a high prevalence of physical morbidity indicating a need for access to general medical facilities. Most serious physical complications occur in patients who can be identified by their chronicity and by the pattern of their behavioural disturbance. These various factors are considered in the formulation of recommendations for rationalizing the service.
Journal Article•
TL;DR: Professional Institutional Original Effective Date: November 1, 2011 Original Effective date: November1, 2011 Revision Date(s): December 7, 2012; May 7, 2013; October 15, 2014; March 18, 2015; February 17, 2016; August 15, 2017; November 7, 2018
Abstract: Professional Institutional Original Effective Date: November 1, 2011 Original Effective Date: November 1, 2011 Revision Date(s): December 7, 2012; May 7, 2013; October 15, 2014; March 18, 2015; February 17, 2016; August 15, 2017; November 7, 2018 Revision Date(s): December 7,2012; May 7, 2013; October 15, 2014; March 18, 2015; February 17, 2016; August 15, 2017; November 7, 2018 Current Effective Date: March 18, 2015 Current Effective Date: March 18, 2015
TL;DR: Admissions to the Mercy Mother-Baby Unit are reviewed with respect to a possible link with postpartum depression, and an aetiological model is proposed and clinical implications are highlighted.
Abstract: While the link between childhood sexual abuse and adult psychiatric disorder has been documented, such research has not looked at any association with postpartum depression Admissions to the Mercy Mother-Baby Unit are reviewed with respect to a possible link, with case examples presented An aetiological model is proposed and clinical implications are highlighted
TL;DR: The aims of the present paper are to outline the conceptual history of catatonic speech disorders and to follow their development in contemporary clinical research with simplified versions of psychopathological terms devised and refined by generations of classical writers.
Abstract: Objective: Over the past decade there has been an upsurge of interest in the prevalence, nosological position, treatment response and pathophysiology of catatonia. However, the psychopathology of c...
TL;DR: Some useful preliminary data on factors pertaining to use of and satisfaction with health services among Cambodians were collected, and future research should examine family characteristics and the decision-making processes that determine service use.
Abstract: Objective: The objectives of this study were to determine, among all adult Cambodians living in Dunedin: prevalence of illness aetiology beliefs; psychiatric and physical health status; pattern of ...
TL;DR: In this article, the effect of propofol and methohexitone on seizure duration and clinical outcome was assessed in a prospective, randomised, double blind study in 32 depressed patients receiving electroconvulsive therapy (ECT).
Abstract: The effect of the induction agents propofol and methohexitone on seizure duration and clinical outcome was assessed in a prospective, randomised, double blind study in 32 depressed patients receiving electroconvulsive therapy (ECT). Assessments comprised Hamilton rating scales pre-ECT, weekly during the course, and at one month follow-up. Patients showed a significant improvement in depression as measured by the Hamilton rating scale across the course of the ECT treatment. This improvement was not significantly different in the propofol and methohexitone groups. Nor was the amount of improvement related to either the total duration of seizure experienced by the patient during the ECT series or the use of tricyclic antidepressants by some patients.
TL;DR: A pilot survey of 200 households was undertaken to field test the survey instruments and trial the validation and calibration procedures for the Western Australian Child Health Survey (WACHS), which aims to replicate and extend previous epidemiological surveys conducted in other countries.
Abstract: A pilot survey of 200 households was undertaken to field test the survey instruments and trial the validation and calibration procedures for the Western Australian Child Health Survey (WACHS) conducted in 1992. This paper describes the background to the WACHS, the development of the instrumentation and the conduct of the pilot study. This survey aims to replicate and extend previous epidemiological surveys conducted in other countries, and to provide Australian norms for mental health morbidity in 4 to 16 year old children.The measurement of mental health was undertaken through the use of the Child Behaviour Checklist (CBCL). This screening instrument provided data on the prevalence of mental health morbidity and of specific mental disorders in 4 to 16 year olds. Its reliability and validity as a diagnostic indicator were checked through a clinical calibration technique. The pilot survey also permitted an examination of the sampling strategy adopted to ensure that the sample selected reflected “normality”...
TL;DR: Results of logistic regression analysis showed that poor family functioning, poor maternal mental health and parental separation were associated significantly with behaviour disorder.
Abstract: A two stage epidemiological study of 320 children aged between 2.5 and 5 years of age, from eight randomly selected preschool centres, was performed in order (1) to test the psychometrics of the Be...
TL;DR: The early experience of the Victorian Foundation for Survivors of Torture is described and some descriptive data presented and unresolved issues are highlighted, particularly the difficulty in providing skilled psychotherapeutic assistance to relatively large numbers of traumatised refugees.
Abstract: The health and welfare needs of refugee survivors of torture and trauma have in recent years belatedly found a prominent place on the policy agendas of Federal and State Governments. The development of a statewide service to meet these needs provides an opportunity to illustrate some of the general issues in developing a model specialist community health service, as well as the specific and complex elements involved in the care and resettlement of refugee survivors of torture and trauma. The early experience of the Victorian Foundation for Survivors of Torture is described and some descriptive data presented. Unresolved issues are highlighted, particularly the difficulty in providing skilled psychotherapeutic assistance to relatively large numbers of traumatised refugees.
TL;DR: The authors believe this syndrome is more prevalent than previously described, and the need for a more systematic classification of misidentification syndromes is emphasised.
Abstract: Misidentification syndromes represent false, delusionally-based identification of self and/or others. These are variants of the Capgras Syndrome. Although the frequency of misidentification syndromes in schizophrenic populations has not yet been established, the authors believe this syndrome is more prevalent than previously described. Seven of twenty-five (28%) consecutive patients admitted to a chronic clozapine unit with a variant of misidentification syndrome will be described. Their symptoms are categorised according to traditional classification, and Silva's proposed nomenclature. Problems inherent in these classifications are discussed. The need for a more systematic classification of misidentification syndromes is emphasised. Longitudinal studies of misidentification syndrome, and the development of a standardised assessment tool for clinicians who treat chronically psychotic patients, are encouraged.
TL;DR: The treatment was found effective for the majority of patients in diminishing the frequency of panic attacks and agoraphobic avoidance, and the clinical relevance of the treatment effect was evidenced by the considerable number of patients that recovered.
Abstract: Thirty-two patients suffering from panic disorder with agoraphobia were treated with repeated hyperventilation provocations and respiratory training, followed by exposure in vivo. The treatment was evaluated with a comprehensive set of outcome measures, including self-report questionnaires, a multitask behavioural avoidance test and continuous monitoring of panic. The treatment was found effective for the majority of patients in diminishing the frequency of panic attacks and agoraphobic avoidance. The clinical relevance of the treatment effect was evidenced by the considerable number of patients that recovered. The effect of the treatment was sustained over a three and six month follow-up period. The prognostic value of a number of variables for treatment outcome was also investigated. Three variables accounted for the majority of the variance in treatment outcome: a higher pretreatment level of agoraphobic complaints, use of psychotropic medication and a longer duration of the disorder were associated wi...