Showing papers in "Australian and New Zealand Journal of Psychiatry in 2002"
TL;DR: This paper aims to provide beginning researchers, and those unfamiliar with qualitative research, with an orientation to the principles that inform the evaluation of the design, conduct, findings and interpretation of qualitative research.
Abstract: Qualitative research aims to address questions concerned with developing an understanding of the meaning and experience dimensions of humans' lives and social worlds. Central to good qualitative research is whether the research participants' subjective meanings, actions and social contexts, as understood by them, are illuminated. This paper aims to provide beginning researchers, and those unfamiliar with qualitative research, with an orientation to the principles that inform the evaluation of the design, conduct, findings and interpretation of qualitative research. It orients the reader to two philosophical perspectives, the interpretive and critical research paradigms, which underpin both the qualitative research methodologies most often used in mental health research, and how qualitative research is evaluated. Criteria for evaluating quality are interconnected with standards for ethics in qualitative research. They include principles for good practice in the conduct of qualitative research, and for trustworthiness in the interpretation of qualitative data. The paper reviews these criteria, and discusses how they may be used to evaluate qualitative research presented in research reports. These principles also offer some guidance about the conduct of sound qualitative research for the beginner qualitative researcher.
2,098 citations
TL;DR: Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress, suggesting that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.
Abstract: Objective: This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precurso...
521 citations
TL;DR: Twin studies now provide the strongest evidence of the relative magnitude of effect of environmental stressors and genetic factors: the former explains at least as much of the variance in depression as the authors' genes.
Abstract: Objective: To review recent empirical prospective studies on the relation between life event stressors and depression.Method: A systematic literature search focusing on predictive studies was carri...
462 citations
TL;DR: The aim here is to review and summarize the literature pertaining to demoralization in order to examine the validity of the construct, and find a place for it in psychiatric nomenclature.
Abstract: Objective: Demoralization, as described by Jerome Frank, is experienced as a persistent inability to cope, together with associated feelings of helplessness, hopelessness, meaninglessness, subjective incompetence and diminished self-esteem. It is arguably the main reason people seek psychiatric treatment, yet is a concept largely ignored in psychiatry. The aim here is to review and summarize the literature pertaining to demoralization in order to examine the validity of the construct.Method: A narrative review of demoralization and the related concepts of hope, hopelessness, and meaning is presented, drawing on a range of empirical and observational studies in the medical and psychiatric literature.Results: An examination of the concepts of the ‘Giving Up–Given Up’ syndrome (George Engel), ‘suffering’ (Eric Cassell), and demoralization (Jerome Frank), demonstrate considerable convergence of ideas. Demoralization has been commonly observed in the medically and psychiatrically ill and is experienced as exis...
427 citations
TL;DR: It is suggested that the CRP provides a practical way of enhancing daily functioning for adults with ADHD and was designed to target problems commonly associated with adult ADHD.
Abstract: Objective: This is the first systematic examination of the efficacy of a cognitive remediation programme (CRP) for management of adult Attention Deficit Hyperactivity Disorder (ADHD). The CRP was designed to target problems commonly associated with adult ADHD, namely, attention problems, poor motivation, poor organizational skills, impulsivity, reduced anger control and low self-esteem.Method: In a randomized, controlled trial, a representative sample of adults with ADHD (some medicated, some not) were assigned to either a CRP (n = 22) or a waiting list control (n = 21). The CRP was delivered in an intensive format with eight two-hour, weekly sessions with support people who acted as coaches, and participant workbooks with homework exercises.Results: Participants who completed the CRP reported reduced ADHD symptomatology (effect size (d) = 1.4), improved organizational skills (d = 1.2) and reduced levels of anger (d = 0.5). Clinically significant improvements in ADHD symptomatology (d = 1.4) and organizat...
236 citations
TL;DR: Negative depictions that predominate confirm the stereotypic understanding of mental illness that is stigmatizing, and underscore the challenge facing mental health professionals attempting to change attitudes towards mental disorders when the stereotypes are so regularly reinforced.
Abstract: Objective: Because there are no published reports of depictions of mental illness in print media based on national samples, we set out to prospectively collect and analyse a near complete New Zealand sample of print media.Methods: A commercial clipping bureau was contracted to provide cuttings of all items with any mental health or illness aspect over a four week period. These items were analysed for potentially positive and negative depictions and how mental illness was represented within each item. An independent search for additional newspaper items concerning one prominently featured topic indicated that the rate of identification of relevant stories was at least 91%.Result: The collection consisted of six hundred print items which were most commonly news or editorial pieces (n = 562, 93.7%). Negative depictions predominated, with dangerousness to others (n = 368, 61.3%) and criminality (n = 284, 47.3%) being the most common. Positive depictions, including human rights themes, leadership and education...
229 citations
TL;DR: The experience of being stalked is common and appears to be increasing, with ten percent of people have been subjected at some time to an episode of protracted harassment.
Abstract: Objective: This study examines the extent and nature of stalking victimisation in a random community sample.Method: A postal survey was distributed to 3700 adult men and women selected from the electoral roll in the State of Victoria. Outcome measures included the lifetime and annual cumulative incidence of stalking, the duration and methods of harassment, rates of associated violence and responses to victimisation.Results: Almost one in four respondents (23.4%;432) had been stalked, the unwanted behaviour they were subjected to being both repeated and fear-provoking. One in 10 (197) had experienced a protracted course of stalking involving multiple intrusions spanning a period of at least one month. Women were twice as likely as men to report having been stalked at some time in their lives, though the rates of victimisation in the 12 months prior to the study did not differ significantly according to gender. Younger people were significantly more likely than older respondents to report having been stalke...
205 citations
TL;DR: There is a need to look beyond the ‘quantity’ question to the quality question: how does urban or rural place influence mental health, and to understand if and how rural or urban place contributes to the development of psychiatric morbidity.
Abstract: Objective: High prevalence disorders (anxiety, depressive and substance use) are generally assumed to be more common in urban than rural dwellers. The aims of this paper are (i) to critically revie...
191 citations
TL;DR: Male farm manager and agricultural labourer suicide rates are higher than male national rates and rates in the wider rural population, particularly in the later years of the period investigated.
Abstract: Objectives: To identify and describe suicide data for occupational classifications relating to farm managers and agricultural labourers for Australia for the period 1988 to 1997, and to relate resultant suicide rates to farmers’ terms of trade.Method: Descriptive and linear regression analysis of aggregated mortality data.Results: In the period 1988 to 1997, 921 suicides were identified. The majority of these suicides were farm managers (67.4%). Farm manager suicides occurred predominantly in older age groups (55 + years). In comparison agricultural labourer suicides were younger, with the majority of suicides occurring in the 15–39 years age group. The most common methods for both groups were firearms (particularly hunting rifles and shot guns), hanging and motor vehicle exhaust gas. These methods accounted for approximately 81% of all male farm suicides. Firearms accounted for 51% of male farm suicide, in comparison to 23% for the wider Australian male population for the same period. Estimated age stand...
147 citations
TL;DR: The model holds that individuals with PTSD are not, in fact, ‘emotionally numb’ as a result of traumatic experience, Rather, PTSD is associated with hyperresponsivity to negatively valenced emotional stimuli and patients with PTSD require more intense positive stimulation to access the full complement of appetitive or pleasant emotional behaviour.
Abstract: Objective: Despite being understudied and poorly understood relative to the chronic fear, anxiety and other aversive emotional states that occur in the immediate aftermath of trauma, emotional numbing has become a core defining feature of posttraumatic stress disorder (PTSD).Method: This paper seeks to briefly review the literature bearing on these seemingly disparate emotional responses to trauma as well as theoretical accounts of emotional numbing that have been proffered to date. We then offer an alternative theory of posttraumatic emotional functioning and review empirical support for this model.Result: The experience of trauma produces very intense emotions such as overwhelming fear, horror, and anxiety, and these reactions can linger for a lifetime. Many trauma survivors also report restrictions in their emotional experience – a phenomenon most commonly referred to as emotional numbing. In contrast to previous accounts of posttraumatic emotional functioning our model posits that individuals with PTS...
139 citations
TL;DR: Antisocial behaviour and hyperactivity are the most consistent behaviours associated with alcoholism, which is not specific for alcoholism and are associated with many other psychiatric conditions.
Abstract: Objective: The search for an alcoholic personality has been pursued with varying enthusiasm throughout the 20th century. This paper reviews the methodological issues, research designs and current theories relating alcoholism and personality.Method: A selected literature search using computerised databases was ordered via the four major research design strategies: cross sectional studies, high-risk studies, longitudinal studies and genetic epidemiology studies.Results: Cross sectional studies have suggested that two broad bands of personality, impulsivity/novelty seeking and neuroticism/negative emotionality, are associated with alcoholism. Although high-risk studies have repeatedly shown that sons of male alcoholics are at increased risk of alcoholism, whether this risk is related to personality variables is unclear. Many authors believe that the presence of antisocial personality disorder is a confounder and that this may explain some of the contradictory findings. Longitudinal studies have consistently ...
TL;DR: While female gender, youth, lower education and residence in poorer areas predicted posttraumatic stress disorder after trauma, multivariate analysis showed that the nature of trauma (especially sexual assault) predominated.
Abstract: Aim: To investigate the distribution and risk factors for trauma and posttraumatic stress disorder in the Australian population sample taken for the 1997 National Survey of Mental Health and Wellbeing.Methods: The confidentialised unit record file (CURF) was prepared by the Australian Bureau of Statistics from the survey sample of 10 641 adults. It was interrogated for the lifetime experience of specific trauma and the 12-month prevalence of posttraumatic stress disorder according to DSM-IV and ICD-10. Univariate and multivariate analyses were applied to quantify risks for traumatic experience and for DSM-IV posttraumatic stress disorder.Results: Fifty-seven per cent of the population reported lifetime experience of the specified trauma. Men were more likely to experience most traumas and multiple traumas except for sexual assaults. The twelve-month prevalence of DSM-IV posttraumatic stress disorder in the overall adult population was 1.5%. It occurred in 3.8% of women and 2.0% of men who had experienced ...
TL;DR: This study does not support a role for cannabis in the development of first-episode psychosis, but it cannot conclude that cannabis use should be completely ignored as a candidate risk factor for onset of psychosis.
Abstract: Background: The association between cannabis use and the development of a first psychotic episode was studied in a group of 100 young people identified as being at very high risk for the onset of psychosis.Method: The ‘ultra’ high risk cohort was identified by the presence of subthreshold psychotic symptoms, or a combination of first-degree relative with a psychotic disorder and recent functional decline. Thirty-two per cent of the cohort developed an acute psychotic episode over the 12-month period after recruitment. As a component of a larger research study, the level of cannabis use by participants in the year prior to enrolment in the study was assessed at intake.Results: Cannabis use or dependence in the year prior to recruitment to this study was not associated with a heightened risk of developing psychosis over the following 12-month period and therefore did not appear to contribute to the onset of a psychotic disorder.Conclusion: The results of this study suggest that cannabis use may not play an ...
TL;DR: Neurobehavioural studies, in particular, executive functioning, lateralization, visual-perceptual and motor processing, have provided an important source of information about the potential neurobiological dissociation that may exist between autism and Asperger's disorder.
Abstract: Objective: To compare, contrast and review clinical and neuropsychological studies of highfunctioning autism and Asperger's disorderMethod: This paper reviews past and contemporary conceptualizati
TL;DR: Important developmental differences in postdisaster psychological responses exist across a broad spectrum of developmental stages in children, and complex, non-linear relationships between depression, emotional distress and school grade were found.
Abstract: Objective: Developmental approaches have not been widely used in child and adolescent posttraumatic stress disorder research, and little is known about developmental differences in response to postdisaster trauma. Our objective was to investigate postdisaster depression and emotional distress psychopathology across a broad child and adolescent developmental range.Method: Six months following a bushfire disaster, 2379 grade 4–12 school students completed an extensive self-report battery, which included the Impact of Event Scale and the Birleson Depression Inventory. Generalized linear models were constructed to model the effects of multiple covariates on continuous outcome measures of depression and emotional distress.Results: Significant independent predictors of persisting depressive symptoms were increased symptoms of emotional distress; increased symptoms of anxiety; evacuation experience; and school grade. Significant independent predictors of emotional distress were persisting depressive symptoms; pe...
TL;DR: A systematic review of published and unpublished research was undertaken to identify principles that have been proposed for implementing routine outcome assessment and synthesize proposals for specific outcome domains into emergent categories, developing a four-step method for adult mental health services wishing to implement routine outcome Assessment.
Abstract: Objective: Routine outcome assessment in adult mental health services involves the ongoing assessment of patient-level outcomes. Use of outcomes to inform treatment is widely recommended, but seldom implemented. The goals of this review were (i) to identify principles that have been proposed for implementing routine outcome assessment, (ii) to identify the full range of outcome domains that have been proposed for assessment, and (iii) to synthesize proposals for specific outcome domains into emergent categories.Method: A systematic review of published and unpublished research was undertaken, using electronic databases, research registers, conference proceedings, expert informants and the World Wide Web. For goal (i) studies were included that proposed principles for implementing routine outcome assessment. For goal (ii) studies were included that identified at least two patient-level outcome domains for patients using adult mental health services and made some reference to a broader literature base.Result...
TL;DR: In this article, the diagnostic efficiency of the Hospital Anxiety and Depression Scale (HADS) in patients with breast cancer was investigated and the recommended cut-off scores for depression and anxiety scales identified probable caseness and the accuracy was compared with DSM-IV diagnoses.
Abstract: Objective: To investigate the diagnostic efficiency of the Hospital Anxiety and Depression Scale (HADS) in patients with breast cancer.Methods: Women (303) recently diagnosed with stage I or II breast cancer completed the HADS and were psychiatrically assessed. Recommended cut-off scores for Depression (D) and Anxiety (A) Scales identified probable caseness and the accuracy was compared with DSM-IV diagnoses. Cut-off scores were varied to establish optimal accuracy.Results: One hundred and eleven (36.6%) met criteria for depressive disorders and 25 (8.3%) met criteria for anxiety disorders. At the recommended cut-off score of 11 for the D scale, positive and negative predictive values were.75 and.64, respectively, while sensitivity and specificity were.05 and.99, respectively. For the A scale, positive predictive value (PPV) was.15; negative predictive value (NPV),.90; sensitivity,.08; and specificity,.87. Reducing the cut-off score to 5 produced PPV of.63, NPV of.74, sensitivity of.49 and specificity of....
TL;DR: This pattern justifies the development of early intervention strategies for FE manic patients and supports more exploratory research to identify prodromal symptoms, which might ultimately lead to even earlier focus on preventive interventions.
Abstract: Objective: While first-episode (FE) psychosis has become an important field of research, FE affective psychoses, and mania in particular, have been relatively neglected. This paper summarizes curre...
TL;DR: It is suggested that cases of delayed onset PTSD suffer subsyndromal levels of posttraumatic stress prior to the diagnosis of PTSD, challenging the notion of PTSD developing after a period without symptoms.
Abstract: Objective: Delayed onset posttraumatic stress disorder (PTSD) refers to PTSD that develops at least 6 months after the traumatic event. This study aimed to index the features of patients who develop delayed-onset PTSD.Method: This study investigated delayed onset PTSD by prospectively assessing 103 motor vehicle accident survivors within 1 month of the motor vehicle accident for acute stress disorder, and subsequently assessing them for PTSD 6 months post-accident, and 2 years post-accident. Patients were initially assessed for symptoms of traumatic stress, anxiety, depression, and resting heart rate.Results: Five patients displayed PTSD 2 years post-trauma without meeting PTSD criteria 6 months posttrauma. Delayed onset cases were characterized by elevated psychopathology scores and resting heart rate levels within the initial month and elevated psychopathology 6 months posttrauma.Conclusions: These findings suggest that cases of delayed onset PTSD suffer subsyndromal levels of posttraumatic stress prior...
TL;DR: Magnetic resonance spectroscopy is a non-invasive investigative technique that has provided useful insights into the biochemical basis of many neuropsychiatric disorders and will undoubtedly have many clinical uses in the near future.
Abstract: Objective: This paper briefly describes neuroimaging using magnetic resonance spectroscopy (MRS) and provides a systematic review of its application to psychiatric disorders.Method: A literature review (Index Medicus/Medline) was carried out, as well as a review of other relevant papers and data known to the authors.Results: Magnetic resonance spectroscopy is a complex and sophisticated neuroimaging technique that allows reliable and reproducible quantification of brain neurochemistry provided its limitations are respected. In some branches of medicine it is already used clinically, for instance, to diagnose tumours and in psychiatry its applications are gradually extending beyond research. Neurochemical changes have been found in a variety of brain regions in dementia, schizophrenia and affective disorders and promising discoveries have also been made in anxiety disorders.Conclusions: Magnetic resonance spectroscopy is a non-invasive investigative technique that has provided useful insights into the bioc...
TL;DR: Sex differences were found with more current alcohol-abuse problems reported among male than female participants and non-alcohol-related substance abuse was relatively lower than rates reported by other studies in the literature.
Abstract: Objective: The objective of this study was to determine the rates of substance use problems in a sample of diagnosed pathological gamblers seeking treatment in a university teaching hospital cognitive behavioural outpatient clinic.Methods: A semistructured interview schedule and the composite international diagnostic interview (CIDI-auto) were administered to assess substance dependence in a sample of 75 poker-machine gamblers meeting DSM-IV and South Oaks gambling screen (SOGS) criteria for pathological gambling. Both the self-reported rates and the proportion meeting criteria for a psychiatric disorder were determined.Results: The rates for substance use disorder within a sample of treatment-seeking pathological gamblers is higher as compared to general population figures. Gender differences were found with more current alcohol-abuse problems reported among male than female participants. Non-alcohol-related substance abuse was relatively lower than rates reported by other studies in the literature.Concl...
TL;DR: The attitudes of medical students can perhaps be modified and recruitment into psychiatry enhanced by presenting the reality of psychiatry today - namely the wide range of available therapeutic processes, the predominantly positive outcomes, the interesting and intellectually challenging nature of the subject and its nurturing and accommodating work environment.
Abstract: Objective: We sought to examine the attitudes of newly recruited medical students towards psychiatry and other specialties to determine what factors influence their career choice options.Method: We surveyed the attitudes of 655 medical students using a 31-item self-report questionnaire.Results: Australian medical students rated the ability to help patients as the most important aspect of a specialty in determining their choice. Attraction to psychiatry was based on the specialty being interesting and intellectually challenging, and providing a career that promised job satisfaction with good prospects and enjoyable work. Females expressed a greater interest in psychiatry and were more likely to consider pursuing it as a career, principally due to a greater interest in the subject matter and a stronger desire for interaction with patients. The least attractive aspects of psychiatry were its lack of prestige among the medical community and a perceived absence of a scientific foundation.Conclusion: The attitu...
TL;DR: A system of key principles and processes for organizing treatment in a way which helps overcome a wide variety of barriers that impede the delivery of optimal care are proposed.
Abstract: Objective: This paper describes qualitative research that was carried out as part of a project aimed at drawing up a series of guidelines for the assessment and management for people with coexistin...
TL;DR: Shonkoff and Phillips as mentioned in this paper presented the report of the Committee on Integrating the Science of Early Child Health and Development (CISHDH) for the first time.
Abstract: Jack P Shonkoff, Deborah A Phillips (eds)Washington, DC: National Academy PressISBN 0 30906 988 2 pp.588 $US40.00This text is the report of the Committee on Integrating the Science of Early Childho...
TL;DR: Clinicians need to carefully monitor depression in patients, and warn patients of the risks of reduced tolerance to opiates following naltrexone treatment, which appears to be equivalent to or greater than that for untreated heroin users.
Abstract: Objective: This article examines the use of naltrexone in the treatment of heroin dependence. The relationship between naltrexone and depression as well as risk of overdose is examined.Method: The existing literature is reviewed along with recent interim data from clinical trials underway in Victoria.Results: Naltrexone is a recent addition to treatment for heroin dependence in Australia. The relationship between depression and naltrexone has been examined in previous literature. Underlying rates of depression in heroin users are high and treatment may resolve or exacerbate depression. Research to date demonstrates that the addition of naltrexone does not necessarily increase depression in patients. The risk of non-fatal heroin overdose is significantly elevated after naltrexone treatment as a result of reduced tolerance. Data from clinical trials underway in Victoria demonstrate a significantly elevated rate of non-fatal overdose in naltrexone patients compared to those in substitution maintenance treatm...
TL;DR: This article critically examines the inclusion and exclusion criteria of a number of classification systems developed for the classification of cognitive and behavioural abnormalities in older people in order that individuals at high risk of developing neurodegenerative disease may be identified well before the disease manifests clinically.
Abstract: Objective: Over the past two decades, a number of systems have been developed for the classification of cognitive and behavioural abnormalities in older people, in order that individuals at high risk of developing neurodegenerative disease, particularly Alzheimer's disease, may be identified well before the disease manifests clinically. This article critically examines the inclusion and exclusion criteria of a number of such classification systems, to determine the effect that variations in criterion may have on clinical, behavioural and neuroimaging outcomes reported from older people with mild cognitive impairment.Method: Qualitative review of the literature describing systems of classifying mild cognitive impairment, and outcomes from clinical, behavioural, neuroimaging and genetic studies of older people with mild cognitive impairment.Results: The exclusion and inclusion criteria for these classification systems vary markedly, as do the design of studies upon which the validity of these systems has be...
TL;DR: Peripheral blood cell, brain necropsy and 31P-MRS analysis reveal a disturbed lipid biology, suggesting generalized membrane alterations in schizophrenia, including increased membrane turnover at illness onset and persisting membrane abnormalities in established schizophrenia.
Abstract: Objective: Preclinical and clinical data suggest that lipid biology is integral to brain development and neurodegeneration. Both aspects are proposed as being important in the pathogenesis of schizophrenia. The purpose of this paper is to examine the implications of lipid biology, in particular the role of essential fatty acids (EFA), for schizophrenia.Methods: Medline databases were searched from 1966 to 2001 followed by the crosschecking of references.Results: Most studies investigating lipids in schizophrenia described reduced EFA, altered glycerophospholipids and an increased activity of a calcium-independent phospholipase A2 in blood cells and in post-mortem brain tissue. Additionally, in vivo brain phosphorus-31 Magnetic Resonance Spectroscopy (31P-MRS) demonstrated lower phosphomonoesters (implying reduced membrane precursors) in first- and multi-episode patients. In contrast, phosphodiesters were elevated mainly in first-episode patients (implying increased membrane breakdown products), whereas in...
TL;DR: It is not known whether treatment of identified psychological morbidity leads to improved antiretroviral medication adherence and better medical outcome, but a longitudinal study could help answer this question.
Abstract: Objective: To determine whether psychological morbidity is associated with poor compliance with antiretroviral medication in HIV-positive subjects.Method: This is a cross-sectional survey of patients attending a public HIV clinic in Sydney. Volunteers completed a survey which gathered data on substance use, psychological distress, attitudes to illness and medication, and self-reported medication adherence. Psychological morbidity was assessed using the 28 question General Health Questionnaire, GHQ-28, and adherence was assessed using a combination of direct self-report and indirect questions.Results: Forty-four per cent of subjects were identified as suffering psychological disorder on the GHQ. They reported significantly poorer adherence to antiretroviral medication than subjects not identified as ‘cases’ (odds ratio 4.5). Expressed scepticism about medication and previous use of psychotropics was also associated with poor adherence.Conclusions: Psychological morbidity is associated with poor adherence t...
TL;DR: Children with combined type ADHD have mild to moderate global cognitive impairment together with some impairment of functions subserved by the frontal lobes.
Abstract: Objective: To compare the global cognitive functioning and frontal lobe functioning of children with and without DSM-IV combined type Attention Deficit Hyperactivity Disorder (ADHD).Method: Participants were 6 to 10 year old, clinic-referred children diagnosed with combined type ADHD, who were medication naive; and an age (± 3 months) and sex matched group of children without behaviour problems. The performance of the two groups were compared on measures of intellectual functioning and tests designed to assess the functions of the frontal lobes (verbal and-non-verbal fluency, reasoning, problem solving, spatial working memory, attention).Results: The children with ADHD obtained significantly lower Wechsler Intelligence Scale for Children-third edition IQ scores than controls and performed more poorly across the range of frontal lobe tests. Group differences on these tests were attenuated when IQ scores were included in the analyses as a covariate.Conclusions: Children with combined type ADHD have mild to ...