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Objective: Our purpose was to determine the frequency of psychiatric morbidity and to assess the quality of life of women with advanced breast cancer.Methods: The 227 women in the sample were recruited in Melbourne, Australia, and were interviewed (prior to intervention) for a randomized controlled trial of supportive-expressive group therapy. The main outcome measures were DSM-IV psychiatric diagnoses plus quality of life data based on the EORTC QLQ-C30 (core) and QLQ-BR23 (breast module) instruments.Results: Forty-two percent of the women (97/227) had a psychiatric disorder; 35.7% (81) of these had depression or anxiety or both. Specific diagnoses were minor depression in 58 women (25.6%), major depression in 16 (7%), anxiety disorder in 14 (6.2%), and phobic disorder in 9 (4%). Seventeen (7.5%) women had more than one disorder. In terms of quality of life, one-third felt less attractive, one-quarter were dissatisfied with their body image, and, in most, sexual interest had waned. Menopausal symptoms such as hot flashes affected less than one-third, whereas symptoms of lymphedema were experienced by 26 (11.5%).Significance: Women with advanced breast cancer have high rates of psychiatric and psychological disturbance. Quality of life is substantially affected. Clinicians need to be vigilant in monitoring psychological adjustment as part of a comprehensive biopsychosocial approach. [ABSTRACT FROM AUTHOR]

Background: There is ample scope to devise forms of psychotherapy in consultation-liaison psychiatry, including the newly evolving area of psycho-oncology.Aims: To highlight the development of psychotherapy in psycho-oncology, providing two illustrations.Method: We report on conceptual and clinical research in the context of oncology and palliative care, focusing on (a) an approach for families at risk of maladaptive bereavement; and (b) a group programme for women newly diagnosed with early-stage breast cancer.Results: We were able to introduce new forms of psychological treatment for specific clinical groups, and anecdotal evidence points to useful benefits for participants.Conclusions: Psychotherapists should grasp the opportunity to bring their skills to the medical arena, but need to subject newly devised interventions to well-designed and methodologically rigorous research. [ABSTRACT FROM AUTHOR]

As grief is both an individual and shared experience, adopting a systemic perspective is most appropriate for health-care professionals seeking to assist the bereaved. Within this framework, the family virtually always constitutes the most significant social group in which grief is experienced. In this paper we review the literature on family grief, covering clinical case reports, the observations of family therapists, systematic family bereavement research and family intervention studies. An understanding of patterns of family grief and vulnerability factors for morbid grief is pivotal to both preventive intervention and treatment of an established disorder. [ABSTRACT FROM AUTHOR]

The place of family therapy in adult clinical psychiatry remains unclear, despite considerable theoretical developments in the subject. In order to delineate the potential role of a family therapeutic approach, a study was conducted of the first 50 families treated in a newly established family-therapy clinical located in an adult psychiatric hospital. [ABSTRACT FROM AUTHOR]

The treatment of patients with dysmorphophobia remains a confused matter, probably because of clinical heterogeneity. Our experience with the case reported in this paper suggests that psychodynamic psychotherapy is indicated for certain carefully selected patients. [ABSTRACT FROM AUTHOR]

The comparative value of possible therapeutic factors in group psychotherapy was studied by submitting questionnaires regularly to patients and therapists of six long-term out-patient groups. Both patients and therapists attached most importance to self-understanding, self-disclosure and learning from interpersonal actions. They diverged, however, in their overall perception of which factors were important in therapy. [ABSTRACT FROM AUTHOR]

Factors in the patient which have been commonly cited by therapists as relevant in assessment for psychotherapy are examined as well as the research done on them. These factors are discussed under four categories: (a) factors related to the illness, (b) personal factors related to the treatment, (c) personal factors not directly associated with the illness and (d) current life circumstances. Research on methods of assessing patient suitability is discussed together with an account of the reasons for the rather disappointing contribution of systematic research. [ABSTRACT FROM AUTHOR]

The types of problems of 49 patients referred to a psychiatrist in a terminal care unit are reported and their management reviewed. The findings suggest that a psychiatrist can play a useful role in such a unit, particularly in supervising medical and nursing staff in the psychological care of patients and in helping more directly in the management of psychiatrically complicated cases. [ABSTRACT FROM AUTHOR]

A method is described for the study of therapeutic factors in group therapy in which patients and their therapists prepare brief reports at regular intervals about those events in treatment which they regard as important; these reports are then assigned by independent judges to a classification of therapeutic factors which has been specifically devised for this purpose. The feasibility, validity and reliability of the method are discussed and its potential application to group therapy research and training briefly mentioned. [ABSTRACT FROM AUTHOR]

To overcome common limitations in assessing the outcome of psychotherapy, the following method was used: independent assessment by teams of experienced psychotherapists; individualized measures of outcome; and videotaped clinical interviews to allow the judges to rate, at one sitting, a patient's clinical state before and after eight months of therapy. Agreement between the judges' ratings was low both for the severity of the clinical state and for its outcome. Possible reasons for this low agreement are discussed. [ABSTRACT FROM AUTHOR]

The article replies to criticisms made by Professor Michael Shepherd against psychotherapy. According to the author, the type of criticism of psychotherapy leveled by Shepherd is regarded as tantamount to a regression to the Eysenckian period of the 1950s. The author claims that little purpose can be served by a pessimistic and rather destructive critical approach. He adds that psychotherapy demands a commitment to its intelligent study, as well as the exploration of paradigms for research.

The article offers information about the educational program in psychiatric ethics offered by the Department of Psychiatry of Oxford University in Oxford, England. The program was created for the university's postgraduate trainees in psychiatry and other related disciplines. The two main objectives of the program is to sensitize students to ethical issues in mental health and to introduce the students to terms and concepts in moral philosophy which have effects on their everyday professional practice.

Background: Codes of ethics in medicine have an ancient tradition, extending back to the Oath of Hippocrates. Yet it was only in the early 1970s that the speciality of psychiatry developed a specific code to address the unique ethical dilemmas and complexities arising in psychiatric practice. As the 50th anniversary of the publication of psychiatry's first code of ethics approaches, it is timely to reflect on the progress, role, and impact of such codes.Our aim is to provide a historically informed review of codes of ethics in psychiatry - their origins and evolution, the current picture, and the possibilities for future development., Methods: We conducted a selective review of relevant literature (including all codes of ethics accessible on the websites of World Psychiatric Association members states), analysis of the form and content of codes and related documents in psychiatry, and interviews of psychiatrists who have played central roles in their evolution., Results: Of the 143 WPA member states, only 15 codes of ethics for psychiatrists were identified, and few of these were associated with professional disciplinary processes. We found that these codes are rarely revised and sometimes supplemented with other statements and guidelines., Conclusions: While there are difficulties in measuring the direct effectiveness of codes of ethics on the practice of psychiatrists, we conclude that these codes help to (1) promote professional solidarity and autonomy, (2) enhance moral sensitivity, and (3) aid in psychiatric education and training.

Psychiatry has not reached a consensus hitherto concerning an optimal theoretical framework for ethical decision-making and corresponding action. Various theories have been considered, but found wanting. Moreover, classic theories may contradict one another, contribute to confusion and immobilise the clinician. We have examined major theories commonly applied in bioethics, conferred with moral philosophers and psychiatrists and striven to apply more recent insights drawn from moral philosophy. We report that instead of pursuing a single theoretical framework, we should garner the strengths of compatible approaches in a synergistic way. We propose a particular complementarity of principlism--with its pragmatic focus on respect for autonomy, beneficence, non-maleficence and justice--and care ethics, a variant of virtue theory, which highlights character traits pertinent to caring for vulnerable psychiatric patients.

Background: Past research and instrument development in caregiving have focused on specific aspects of caregiving or specific disability groups. This paper reports the scale characteristics of a new generic instrument developed to assess the experience of caregiving, and the social and emotional well-being of caregivers and a comparison group of 'non-caregivers'., Methods: Using computer-assisted telephone technology, a random survey of 26000 households was conducted in Victoria, Australia to identify and interview 976 caregivers of people who were aged or had a long-term illness or disability of any kind, and 219 non-caregivers. Both groups were re-interviewed after 15 months. Scales administered on each occasion to caregivers and non-caregivers included life satisfaction, positive and negative affect, social support and overload; and to caregivers, caring role satisfaction, resentment and anger, and, in relation to the care recipient, measures of help provided and needed, severity of disability and behaviour problems., Results: On each occasion and with each sample all scales demonstrated a satisfactory reliability. With a subsample of caregiver-care-recipient dyads (N = 67), caregiver reports of severity of disability, level of helped needed and provided were validated externally by clinician assessments., Conclusions: A comprehensive instrument to assess the experience of caregiving was developed. It is relevant to a broad range of ages, levels and types of disability and care provided; and, in assessing health and well-being, to both caregivers and non-caregivers. Scales, including both positive and negative dimensions, have demonstrated good internal consistency on two occasions. The instrument is potentially useful in a range of research and practical settings.