Search

A study involving 64 Australian sex offenders and 33 non-sex offenders found childhood emotional abuse and family dysfunction, childhood behavior problems, and childhood sexual abuse were developmental risk factors for paraphilia. Emotional abuse and family dysfunction was found to be a risk factor for pedophilia, exhibitionism, rape, or multiple paraphilia. (Contains references.) (CR)

Objective: Clinical psychologists are practitioners with expertise in mental health, who apply advanced psychological theory and knowledge to their practice in order to assess and treat complex psychological disorders. Given their robust specialised mental health training, clinical psychology is an integral component of the Australian mental health workforce, but is under-utilised. Recent reviews have identified significant problems with Australia's mental health system, including unequal access to clinical psychology services and fragmentation of service delivery, including convoluted pathways to care.Conclusions: Clinical psychology is well placed to contribute meaningfully to public mental health services (PMHS). We describe what clinical psychologists currently contribute to team-based care in PMHS, how we could further contribute and the barriers to making more extensive contributions. We identify significant historical and organisational factors that have limited the contribution made by clinical psychologists and provide suggestions for cultural change to PMHS. [ABSTRACT FROM AUTHOR]

Objective: We aimed to describe the prevalence and age distribution of personality disorders and their comorbidity with other psychiatric disorders in an age-stratified sample of Australian women aged ⩾25 years. Methods: Individual personality disorders (paranoid, schizoid, schizotypal, histrionic, narcissistic, borderline, antisocial, avoidant, dependent, obsessive-compulsive), lifetime mood, anxiety, eating and substance misuse disorders were diagnosed utilising validated semi-structured clinical interviews (Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition and Structured Clinical Interview for DSM-IV Axis II Personality Disorders). The prevalence of personality disorders and Clusters were determined from the study population (n = 768), and standardised to the Australian population using the 2011 Australian Bureau of Statistics census data. Prevalence by age and the association with mood, anxiety, eating and substance misuse disorders was also examined. Results: The overall prevalence of personality disorders in women was 21.8% (95% confidence interval [CI]: 18.7, 24.9). Cluster C personality disorders (17.5%, 95% CI: 16.0, 18.9) were more common than Cluster A (5.3%, 95% CI: 3.5, 7.0) and Cluster B personality disorders (3.2%, 95% CI: 1.8, 4.6). Of the individual personality disorders, obsessive-compulsive (10.3%, 95% CI: 8.0, 12.6), avoidant (9.3%, 95% CI: 7.1, 11.5), paranoid (3.9%, 95% CI: 3.1, 4.7) and borderline (2.7%, 95% CI: 1.4, 4.0) were among the most prevalent. The prevalence of other personality disorders was low (⩽1.7%). Being younger (25–34 years) was predictive of having any personality disorder (odds ratio: 2.36, 95% CI: 1.18, 4.74), as was being middle-aged (odds ratio: 2.41, 95% CI: 1.23, 4.72). Among the strongest predictors of having any personality disorder was having a lifetime history of psychiatric disorders (odds ratio: 4.29, 95% CI: 2.90, 6.33). Mood and anxiety disorders were the most common comorbid lifetime psychiatric disorders. Conclusions: Approximately one in five women was identified with a personality disorder, emphasising that personality disorders are relatively common in the population. A more thorough understanding of the distribution of personality disorders and psychiatric comorbidity in the general population is crucial to assist allocation of health care resources to individuals living with these disorders. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Little research has examined factors that contribute to the formation of attitudes toward one’s own aging. The current study aimed to examine personality as defined by the Five-Factor model of personality as an antecedent of attitudes, while taking into account demographic and health factors known to be relevant to such attitudes. Design and Methods: Participants aged 60 years or older (N = 421) were part of a longitudinal study of health and wellbeing in Australia, and completed a postal survey comprising measures of personality, the Attitudes to Ageing Questionnaire, the SF-12 health survey, and the Satisfaction with Life Scale. Results: Higher levels of neuroticism were associated with less positive attitudes toward old age as a time of psychological growth, and higher extraversion and agreeableness were significant predictors of less negative attitudes toward psychosocial loss. Baseline measures of self-reported mental and physical health, as well as change in those scores, also made significant contributions to attitudes toward aging. Implications: Personality was a significant antecedent of attitudes towards aging, as were mental and physical health. The data highlight the role of potentially modifiable factors, such as mental and physical health. If these factors act as resources that shape an individual's attitudes during the aging process, then one potential foundation for holding positive attitudes to aging is to maintain physical and mental health. This requires interventions and policies that are effective in encouraging health-promoting behaviors. [ABSTRACT FROM AUTHOR]

Objectives:With a longitudinal prospective design, we examined the impact of floods on the mental and physical health of older adults and explored risk and protective factors. Method:Two hundred and seventy four older adults (age ≥60) completed surveys before and after a flood event. Both the surveys included measures of anxiety, depression, self-reported health, and satisfaction with life; the post-flood survey also included questionnaires on flood experience, symptoms of post-traumatic stress disorder (PTSD), stoicism, and psychological coping with floods. Results:Compared to those not personally affected (78.8%), personally affected individuals (21.2%) reported significantly higher PTSD symptoms, with about one in six reporting PTSD symptoms that might require clinical attention. Personally affected individuals also reported a greater increase in anxiety post-flood, but changes in their depressive symptoms and self-reported health were not significantly different from those not personally affected. Greater flood exposure and the lack of social support were the risk factors for poorer mental and physical health. Higher stoicism was associated with higher post-flood depression and poorer self-reported mental health. The use of maladaptive coping, such as venting and distraction, was associated with greater deterioration in mental health after floods, whilst emotion-focused coping such as acceptance, positive reframing, and humour, was protective against such deterioration. Conclusion:Floods had adverse psychological impacts on some older adults who were personally affected. Despite the evidence of resilience, a small proportion of older adults experienced significant difficulties after the floods. The findings in this study help understand older adults’ psychological responses to disasters and have practical implications for service planning and delivery. [ABSTRACT FROM PUBLISHER]

This study investigated social perspective coordination (SPC) in youth (15-24-year-olds) with first-presentation borderline personality disorder (BPD). SPC is defined as the capacity to differentiate and integrate the perspective of the self with the perspectives of others (Selman, Beardslee, Schultz, Krupa, & Podorefsky, 1986). Two groups: patients with full or sub-syndromal BPD ( n == 30) and patients with major depressive disorder (MDD; n == 30) completed measures of SPC derived from the interpersonal negotiation strategies (INS) model (Selman et al., 1986). Compared with the MDD group, the BPD group responded to all vignettes with significantly lower SPC scores and SPC was a significant predictor of BPD status over and above self-reported, personality factors (Neuroticism and Agreeableness), attachment disturbance and functional impairment. These findings suggest that disturbances in social cognition are an important characteristic of individuals with BPD pathology. These difficulties extended beyond attachment contexts and were not limited to situations involving BPD-related themes of abandonment, deprivations or mistrust/abuse. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between childhood trauma, post-traumatic stress symptoms due to the experience of childhood trauma, and post-traumatic stress symptoms due to the experience of psychosis.Method: The current study assessed childhood trauma and post-traumatic stress disorder (PTSD) symptoms as a result of both childhood trauma and psychosis using the Impact of Events Scale - Revised, in a group of 36 people with first-episode psychosis.Results: Reported rates of clinical level post-psychotic PTSD symptoms, childhood trauma and childhood trauma-related clinical level PTSD symptoms were 47% (95% CI 31–64%), 64% (95% CI 48–80%) and 39% (95% CI 23–55%), respectively. Reporting childhood trauma increased the risk of developing post-psychosis PTSD 27-fold (95% CI 2.96–253.80, p = 0.01). Having childhood trauma-related PTSD increased the risk of developing post-psychosis PTSD 20-fold (95% CI 3.38–123.25, p = 0.01). These risks were not explained by illness factors such as duration of untreated psychosis, age of onset or severity of psychotic symptoms. Those without post-psychotic PTSD symptoms at clinical levels were unlikely to report childhood trauma (6%; 95% CI 3–8%).Conclusions: These results suggest the cognitive, social and biological consequences of childhood trauma can prevent effective recovery from the trauma of acute first-episode psychosis resulting in post-psychotic PTSD. Treatment strategies for post-psychotic PTSD must address childhood trauma and related PTSD. [ABSTRACT FROM PUBLISHER]

The authors reflect on the assessment of the Better Access scheme, which was sponsored by the Commonwealth Department of Health and Aging. The authors remark that because of poor methodology, there are numerous questions which were not answered by Better Access's evaluation. Meanwhile, the authors mention the editorial of Tony Jorm which points out that the scheme has been more expensive compared to what was expected.

Objective: In Australia the prevalence of mental health problems does not vary by gender, but help-seeking and service utilization do. The aim of the present study was to examine a number of attitudinal factors that may influence help-seeking for mental health problems. Method: A cross-sectional community survey was conducted with a sample of 579 rural residents (57.9% female), who completed self-report measures assessing stoicism, alexithymia, perceived and personal stigma and the various facets of the personality trait of openness to experience. Results: Men scored higher on measures of stoicism and personal stigma associated with mental health problems than women, and compared to women had lower scores on the facets of openness to experience. Conclusions: Higher rates of help-seeking for mental health problems by women may be due to lower levels of stoicism and personal stigma related to mental health problems in women compared to men. [ABSTRACT FROM AUTHOR]

Objective: Male farmers in Australia have an elevated risk of suicide. The aims of this study were to investigate the rate of mental health problems amongst farmers compared with non-farmer rural residents and to investigate what additional factors might contribute to an increased risk of suicide amongst farmers.Method: This study used a combination of quantitative and qualitative approaches. First, using self-report questionnaire data, we compared rates of mental health problems (a common correlate of suicide) and a number of personality measures between farmers (n=371) and non-farming rural residents (n=380). In addition, semi-structured interviews with farmers (n=32) were used to gain a richer understanding of how the context of farming and mental health interact.Results: Five key findings emerged from the study. First, in the quantitative study, we found no support for the proposition that farmers experience higher rates of mental health problems than do non-farmer rural residents, but we identified potentially important personality differences between farmers and non-farmers, with levels of conscientiousness being significantly higher amongst farmers and levels of neuroticism being significantly lower. A strong association between maleness and farming was also found. In the qualitative study, participants indicated that farming is an environment in which individuals experienced a range of stressors but have limited capacity to acknowledge or express these. In addition, there appeared to be significant attitudinal barriers to seeking help for those who may have mental health problems, particularly male farmers.Conclusion: The elevated rate of suicide amongst farmers does not seem to be simply explained by an elevated rate of mental health problems. Individual personality, gender and community attitudes that limit a person's ability to acknowledge or express mental health problems and seek help for these may be significant risk factors for suicide in farmers. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to examine in a national survey sample the risks of having a specific personality disorder (PD) and associations with gender, of having one or more physical conditions, of having one or more Axis 1 conditions, and of the severity (or degree) of disability. We also examined the association of specific PDs with having sought a consultation for health or mental health problems with a general practitioner (GP), a psychologist, or psychiatrist over the past 12 months.Method: Data were derived from the Australian National Mental Health and Well-Being Survey, conducted between May and August 1997. A stratified random sample of households was generated, from which all persons aged 18 or over were considered potential interviewees. There were 10,641 survey respondents, this representing a response rate of 78%. Each interviewee was asked 59 questions indexing specific ICD-10 PD criteria.Results: Logistic regressions identified that some specific PDs, especially borderline PD, were more strongly associated with having one or more Axis I conditions, greater mental disability and lost days of total and partial role functioning than having No PD, and that others, notably anankastic PD, were less likely to be associated with the same variables. Some specific PDs, again most notably borderline PD, were more associated than others, again most notably anankastic PD, with having sought mental health consultations from GPs, psychiatrists, and psychologists. By contrast, PD associations with gender, physical conditions, physical disability and health consultations with the three professional groups were weaker as reflected in the comparatively smaller odds ratios and were also less consistent than the pattern with the previously mentioned variables.Conclusion: The study reports findings from a nationwide survey and, as such, the data are less influenced by the selection and setting bias found in most other studies investigating these variables. The findings of the study do point to some specific PDs, such as borderline PD, being associated with greater Axis 1 psychopathology, disability and mental health consultations than others, such as anankastic PD. It appears that although anankastic PD in itself is associated with more disability than having No PD, it becomes significantly more disabling when it is associated with other comorbid PDs. [ABSTRACT FROM AUTHOR]

The absence of an agreed definition of ‘rural’ limits the utility of existing research into a possible relationship between rurality of residence and mental health. The present study investigates the bipolar dimension accessibility/remoteness as a possible correlate of mental health. A continuous area of non-metropolitan Australia was selected to provide a range of scores on the Accessibility/Remoteness Index of Australia (ARIA). A questionnaire measuring demographics, the five-factor model of personality and three aspects of mental health (distress, disability and wellbeing) was mailed to 20 000 adults selected randomly from electoral rolls. Responses were received from 7615 individuals (response rate = 40.5%; 57.1% female). ARIA was not associated with either distress or disability measures, but a small negative association was found between accessibility and two measures of wellbeing. Individuals residing in locales with better access to services and opportunities for interaction reported higher levels of satisfaction with life (SWL) and positive affect (PA). Adjusting statistically for a range of demographic and personality correlates did not alter the effect of ARIA on SWL. The effect on PA remained significant after adjusting for demographics, but not once personality correlates entered the model. By sampling across a single proposed parameter of rurality, a novel profile of correlations was identified. In accord with existing data, accessibility was not associated with distress or disability. In contrast, accessibility was positively associated with the wellbeing aspect of mental health. Further attention to the measurement of rural place and the exploration of accessibility as a parameter with mental health relevance, is warranted. [ABSTRACT FROM AUTHOR]

This paper argues that lack of adequate research is a barrier to the long-term improvement of the mental health and well-being of rural Australians. Following from national mental health policy, potential research avenues in four broad domains (prevention and early intervention, pathways to care, outcome of illness and aetiology) are defined. These four broad domains are interdependent and research into them can be brought together into a simple framework or model. This model could be used to guide research into rurality and mental health. The proposed model uses the inclusive concept of place to capture the potential complexities of the rural locale as a variable in mental health and disorder. The model's predictor variables include both risk and resilience factors, and the outcome variables extend beyond morbidity to positive psychological wellness. It is proposed that this provisional model, and the strategic research that it directs, will act as a useful counterpoint to the more immediate evaluation and resourcing needs that confront rural mental health. [ABSTRACT FROM AUTHOR]

In this paper the need for further investigation into the mental health of rural Australians will be discussed. It will be argued that while research to date has yielded valuable information, the volume and scope of existing studies has been inadequate to address the needs of the diverse and dynamic communities in non-metropolitan Australia. The diversity that exists within rural Australia is examined and the potential effects of this diversity on mental health status are highlighted. Then a number of issues that are relevant to people living in non-metropolitan areas that underscores the need for further study into rural mental health are identified. Finally, some specific areas that require further examination are outlined and some guiding principles for future mental health research are proposed. [ABSTRACT FROM AUTHOR]

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 review studies measuring prevalence in rural as opposed to urban location, and (ii) to argue the need to look beyond the ‘quantity’ question to the quality question: how does urban or rural place influence mental health? Method: A literature review (Medline and PsychLIT) was carried out using the words ‘rural, urban, mental/psychiatric, illness/disorders and prevalence’, as well as a review of relevant papers and publications known to the authors. Results: Many studies examining urban/rural differences in the rate of high prevalence disorders have been reported. Most use a ‘one size fits all’ definition of urban and rural, which assumes location is the key issue. The majority fail to show the purported difference in prevalence between the two settings. In general, studies have not examined interaction effects, but have simply treated the independent variables as main effects. Available data suggest that a variety of socio-demographic factors are more powerful predictors of difference in prevalence than is the location of residence. Conclusion: Further studies are required to understand if and how rural or urban place contributes to the development of psychiatric morbidity. These studies should mirror the clinical situation by taking into account a variety of individual and community-based (including urban/rural place) risk factors which may be important determinants of mental health and mental illness, and examining the interaction between them. This may then identify the nature of any differences or what issues are specific to, or especially important, in the rural setting. [ABSTRACT FROM AUTHOR]

Abstract: Rural Australians have limited access to care for mental health problems. We describe a collaboration between the University of Melbourne Departments of Psychology and Psychiatry and a rural Area Mental Health Service to provide a specialist anxiety and depression treatment service in rural Victoria. The clinical service and the education and training approach are described. [ABSTRACT FROM AUTHOR]

Abstract: The Accessibility/Remoteness Index of Australia (ARIA) is a validated index of the availability of services and opportunities for social interaction afforded by every location in Australia. ARIA therefore measures a feature of the social environment, and provides a unique foundation for investigating the relationship between persons and environments. The present study used ARIA alongside a measure of the Five-Factor Model of personality to test predictions about person–environment interactions deduced from the seminal work of Emmons and colleagues. Survey responses were received from N =7615 adults residing across a range of non-metropolitan locales ranging from very accessible (ARIA=0.0) to very remote (ARIA=11.1). Respondents were categorised into High, Moderate and Low Accessibility based on the ARIA value of their location of residence. Consistent with the choice of situations model, average levels of the traits openness to experience (O) and extraversion (E) tended to be higher amongst respondents living in High Accessibility locations. As predicted under the affect congruence model, analyses of extreme subgroups found that for both O and E, those respondents high on the trait who resided in more accessible locales reported higher Positive Affect than similar respondents who resided in less accessible locales. Avenues for future research are discussed in light of the findings and the present study’s limitations. [Copyright &y& Elsevier]

Abstract: This study evaluated the additional effectiveness of a 12-week manualized group counseling program over a structured naltrexone treatment program. The randomized controlled trial, the first of its kind in Australia, was conducted at Turning Point Alcohol and Drug Centre, Melbourne, Australia. Ninety-seven participants received a 50 mg dose of naltrexone daily and were randomized to either the experimental (n = 52) or control (n = 45) conditions. The experimental group received a structured group counseling program, which used a cognitive-behavioral relapse prevention approach. Using intention-to-treat analyses, there was only one statistically significant difference between the groups, with the control group reporting a significantly higher level of physical functioning at Week 6. All participants improved significantly in their level of heroin use and in psychosocial functioning between Baseline and Weeks 6, 12, and 24. It is not possible to conclude from these results whether or not group counseling provides additional benefit to naltrexone treatment. [Copyright &y& Elsevier]

Recent years have seen escalating media, public and scientific interest in psychedelic medicine. Australia and New Zealand have been late to this research; however, in the past 2 years, rapid developments suggest that this is changing. Here, we argue for the need to critically review existing evidence in this field to guide future directions. We focus on (±)3,4-methylenedioxymethamphetamine-assisted psychotherapy for post-traumatic stress disorder, currently the most advanced area of clinical psychedelic research. Food and Drug Administration approval of this approach is likely in 2023, based on a series of promising findings. We provide a detailed overview of Phase 2 and 3 studies published to date. We identify several concerns related to this body of evidence, including methodological/design limitations and broader factors - such as robust involvement of advocacy groups in research and reliance on non-government financing leading to simplistic public messaging - that compound the methodological issues identified. We propose steps for future improvement, including the need for large, high-quality, independent efficacy trials with design enhancements, effectiveness trials and for researchers to consider their own engagement with media and public messaging around these modalities. We argue that, notwithstanding promising findings to date, rigorous and dispassionate science is needed to move the field forward and safeguard the welfare of participants.

Background: The clinical onset of borderline personality disorder (BPD) usually occurs in young people (aged 12-25 years) and commonly leads to difficulty achieving and maintaining vocational (education and/or employment) engagement. While current psychosocial interventions lead to improvements in psychopathology, they have little effect upon functioning. Individual Placement and Support (IPS) is a client-driven model that assists individuals with severe mental illness to engage with education and/or employment appropriate to their personal goals, and that provides ongoing support to maintain this engagement. The objective of the INdividual Vocational and Educational Support Trial (INVEST) is to evaluate the effectiveness of adding IPS to an evidence-based early intervention programme for BPD, with the aim of improving vocational outcomes., Methods/design: INVEST is a single-blind, parallel-groups, randomised controlled trial (RCT). The randomisation is stratified by gender and age and uses random permuted blocks. The interventions are 39 weeks of either IPS, or 'usual vocational services' (UVS). Participants will comprise 108 help-seeking young people (aged 15-25 years) with three or more DSM-5 BPD features and a desire to study or work, recruited from the Helping Young People Early (HYPE) early intervention programme for BPD at Orygen, in Melbourne, Australia. All participants will receive the HYPE intervention. After baseline assessment, staff who are blind to the intervention group allocation will conduct assessments at 13, 26, 39 and 52 weeks. At the 52-week primary endpoint, the primary outcome is the number of days in mainstream education/employment since baseline. Secondary outcomes include the cost-effectiveness of the intervention, quality of life, and BPD severity., Discussion: Current treatments for BPD have little impact on vocational outcomes and enduring functional impairment is prevalent among this patient group. IPS is a targeted functional intervention, which has proven effective in improving vocational outcomes for adults and young people with psychotic disorders. This trial will investigate whether IPS is effective for improving vocational (employment and educational) outcomes among young people with subthreshold or full-syndrome BPD., Trial Registration: Australian New Zealand Clinical Trials Registry, ID: ACTRN12619001220156 . 13 September 2019.

Aim: Up to half of patients with borderline personality disorder report auditory verbal hallucinations that are phenomenologically indistinguishable from those in schizophrenia, occur early in the course of the disorder, and are enduring, distressing and disabling. In clinical practice, this symptom is widely assumed to be unresponsive to treatment with antipsychotic medication and early intervention is rarely offered. The Verbal Experiences Response in Borderline personality disorder to Aripiprazole TrIal Medication (VERBATIM) study aims to be the first controlled trial to investigate the effectiveness of conventional pharmacotherapy for this symptom in this patient group., Method: VERBATIM is a 12-week, triple-blind, single-centre, parallel groups randomised controlled trial, with a 27-week follow-up period. Participants between the ages of 15 and 25 years receive either aripiprazole or placebo daily, commencing at 2 mg and increasing to 10 mg by day 15. Further dose escalations (up to 30 mg) may occur, as clinically indicated. This trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry ACTRN12616001192471 on 30/08/2016., Results: The primary outcome is severity of auditory verbal hallucinations assessed using the Psychotic Symptom Rating Scale. Secondary outcomes include the severity of general psychopathology, borderline personality pathology, social and occupational functioning and change in brain resting state connectivity. The primary endpoint is week 12 and secondary endpoint is week 39., Conclusion: The results will inform treatment decisions for individuals with borderline personality disorder who present with auditory verbal hallucinations., (© 2019 John Wiley & Sons Australia, Ltd.)

Background: Attitudes are known to exert a powerful influence on a range of behaviors. The objective of this study was to investigate the contribution of attitudes toward one's own aging to satisfaction with life and physical and mental health measured in a sample of community-dwelling older adults., Methods: Adults who were part of a larger study of health and well-being in rural and regional Australia aged ≥60 years (N = 421) completed a cross-sectional postal survey comprising the Attitudes to Aging Questionnaire, the 12-Item Short Form Health Survey (SF-12), the Satisfaction with Life Scale, the Geriatric Anxiety Inventory, and the Center for Epidemiological Studies Depression Scale., Results: Overall, attitudes to aging were positive in this sample. More positive attitudes to aging were associated with higher levels of satisfaction with life, better self-report physical and mental health on the SF-12, and lower levels of anxiety and depression, after controlling for confounding variables. Better financial status and being employed were both associated with more positive attitudes to aging and better self-reported physical health. Relationship status was also significantly associated with mental health and satisfaction with life, but not physical health., Conclusion: The promotion of successful aging is increasingly becoming important in aging societies. Having positive attitudes to aging may contribute to healthier mental and physical outcomes in older adults. Overcoming negative stereotypes of aging through change at the societal and individual level may help to promote more successful aging.

Purpose: The aims of this study were to: (1) examine the role of psychosocial factors, physical and mental health in suicide; (2) to examine gender differences on those variables; and (3) determine whether there was a group who died by suicide who did not have a history of mental illness., Method: Data were obtained from The Australian National Coroners Information System (NCIS) for all deaths classified as suicides from 2000 to 2004 in all Australian states. The NCIS is an internet-based system for storing and retrieving data on coronial cases., Results: The overall results from the total sample reinforces many previous findings but also found some differences; importantly, psychiatric morbidity was less than generally reported, and comparable proportions of males and females used violent means to suicide. Using latent class analysis the study identified four clusters of people who had suicided. In two of those clusters mental illness appeared to be a significant factor; in one of those two clusters the mental illness was compounded by additional drug and alcohol and relationship problems whilst the other was without such levels of comorbidity. The third group was predominantly male, older and physical illness seemed to be a significant factor. The final group was characterised by low rates of mental illness and treatment for the same, but marked by relationship and financial difficulties., Conclusions: These data may suggest that the profile of suicide is changing or changeable. Certainly there has been a shift in the gender profile with comparable proportions of women and men. Whilst mental illness remains a major risk factor, perhaps greater emphasis needs to be placed on the broader psychosocial issues which may initiate or hasten the pathway to suicide. In addition, it may be that the relative contribution of mental illness and other factors is fluid in relation to both life stage and life circumstances. Suicide prevention programmes might usefully define a range of discrete areas of work.

Objective: To describe the longer-term clinical and functional outcome of a large, epidemiologic representative cohort of individuals experiencing a first episode of psychosis., Method: A naturalistic, prospective follow-up of an epidemiologic sample of 723 consecutive first-episode psychosis patients, followed between January 1998 and April 2005, at a median of 7.4 years after initial presentation to the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia. EPPIC is a frontline public mental health early psychosis program, servicing a geographically defined catchment area with a population of about 800,000 people. The main outcome measures included the Brief Psychiatric Rating Scale, the Schedule for the Assessment of Negative Symptoms, the Beck Depression Inventory, the Global Assessment of Functioning Scale, the Social and Occupational Functioning Assessment Scale, the Quality of Life Scale, and the remission criteria developed by the Remission in Schizophrenia Working Group., Results: Follow-up information was collected on up to 90.0% (n = 651) of the baseline cohort of 723 participants, with 66.9% (n = 484) interviewed. In the last 2 years, 57% of individuals with schizophrenia/schizophreniform, 54% with schizoaffective disorder, 62% with affective psychosis, and 68% with other psychotic disorders reported some paid employment. Depending upon the criteria applied, symptomatic remission at follow-up was observed in 37%-59% of the cohort. Social/vocational recovery was observed in 31% of the cohort. Approximately a quarter achieved both symptomatic remission and social/vocational recovery., Conclusion: The relatively positive outcomes are consistent with a beneficial effect of specialized early intervention programs; however it is premature to draw firm conclusions. There was no control group and there are many differences between the relevant comparison studies and the present one. Although difficult to conduct, large scale controlled health services research trials are required to definitively determine the impact and optimal duration of specialized early psychosis programs., (2010 Physicians Postgraduate Press, Inc.)

Objective: We investigated illness beliefs of recently hospitalized patients with coronary artery disease (CAD) and the prospective association between these beliefs and adherence to secondary prevention behaviors. Causal attributions of CAD and their concordance with actual patient risk profiles were also examined., Method: A prospective study of 193 patients was conducted. Data were collected by self-report and from medical records at 3, 6, and 9 months after discharge. Baseline depression was assessed by structured clinical interview. The association between illness beliefs and adherence was tested with hierarchical linear regression controlling for clinical and demographic confounders., Results: Most participants perceived high personal and treatment control and believed CAD to be chronic in duration with severe consequences. A relatively low number of symptoms were endorsed as being part of CAD. Heredity was considered the single most important and most commonly perceived cause of CAD. Smoking, alcohol, emotional state, and heredity were significantly more likely to be endorsed as causal factors by respondents with these risk profiles. In multivariate analysis, illness beliefs contributed an additional 6% of the total variance explained by the model (p = .02). Perceptions of more serious consequences predicted better adherence (p = .03). Social desirability was the best single predictor of adherence., Conclusion: Patient perceptions of risk factors were largely consistent with actual risk factors. Despite modest effect sizes, illness beliefs do contribute to our understanding of adherence to secondary prevention behavior. Interventions aimed at modifying these beliefs, particularly those related to the consequences of CAD, may improve patient outcomes.

Unlabelled: Young people with borderline personality disorder (BPD) commonly seek help but often go unrecognized. Screening offers a means of identifying individuals for more detailed assessment for early intervention and for research., Aims: This study compared the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Borderline Personality Questionnaire (BPQ), the BPD items from the International Personality Disorder Examination Screening Questionnaire and the BPD items from the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II) Personality Questionnaire., Method: 101 outpatient youth (aged 15-25 years) completed the screening measures and were interviewed, blind to screening status, with the SCID-II BPD module. The screening measures were readministered two weeks later to assess test-retest reliability., Results: All four instruments performed similarly but the BPQ had the best mix of characteristics, with moderate sensitivity (0.68), the highest specificity (0.90), high negative predictive value (0.91) and moderate positive predictive value (0.65). Compared to the other three instruments, the BPQ had the highest overall diagnostic accuracy (0.85), a substantially higher kappa (0.57) with the criterion diagnosis, the highest test-retest reliability (ICC = 0.92) and the highest internal consistency (alpha = 0.92). The only clear difference to emerge in the Receiver Operator Curve (ROC) analysis was that the BPQ significantly outperformed the MSI (p = 0.05)., Conclusion: Screening for BPD in out-patient youth is feasible but is not a replacement for clinical diagnosis.

Studies have documented poor functioning and higher rates of negative life events in association with personality disorders (PDs), in particular with borderline personality disorder (BPD). The current study investigated the impact of recent life events, daily hassles and uplifts on psychosocial functioning in patients with PDs, while extending previous research by examining the role of perceived coping effectiveness and perceived stress of recent life events. Ninety-seven participants (Axis I group, N = 30; BPD group, N = 23; Other PD group, N = 44) completed measures of functioning, recent life events, daily hassles and uplifts. Results indicated that the BPD group reported the poorest levels of functioning, especially interpersonal functioning. The BPD group also reported more negative life events, particularly in the interpersonal relationships, personal health, crime, and financial domains. The BPD group experienced less uplifts, more hassles and found employment circumstances particularly stressful and difficult to cope with. Intensity of hassles was a predictor of functioning independent of a BPD diagnosis. A greater frequency of life events was closely associated with a non-BPD diagnosis in predicting a decrease in psychosocial functioning.

Background: Most disability produced by psychotic illnesses, especially schizophrenia, develops during the prepsychotic period, creating a case for intervention during this period. However, only recently has it been possible to engage people in treatment during this phase., Methods: A randomized controlled trial compared 2 interventions in 59 patients at incipient risk of progression to first-episode psychosis. We termed this group ultra-high risk to emphasize the enhanced risk vs conventional genetic high-risk studies. Needs-based intervention was compared with specific preventive intervention comprising low-dose risperidone therapy (mean dosage, 1.3 mg/d) and cognitive behavior therapy. Treatment was provided for 6 months, after which all patients were offered ongoing needs-based intervention. Assessments were performed at baseline, 6 months, and 12 months., Results: By the end of treatment, 10 of 28 people who received needs-based intervention progressed to first-episode psychosis vs 3 of 31 from the specific preventive intervention group (P=.03). After 6-month follow-up, another 3 people in the specific preventive intervention group became psychotic, and with intention-to-treat analysis, the difference was no longer significant (P=.24). However, for risperidone therapy-adherent patients in the specific preventive intervention group, protection against progression extended for 6 months after cessation of risperidone use., Conclusions: More specific pharmacotherapy and psychotherapy reduces the risk of early transition to psychosis in young people at ultra-high risk, although their relative contributions could not be determined. This represents at least delay in onset (prevalence reduction), and possibly some reduction in incidence.

Background: The aims of this study were threefold. First, to ascertain whether personality disorder (PD) was a significant predictor of disability (as measured in a variety of ways) over and above that contributed by Axis I mental disorders and physical conditions. Second, whether the number of PD diagnoses given to an individual resulted in increasing severity of disability, and third, whether PD was a significant predictor of health and mental health consultations with GPs, psychiatrists, and psychologists, respectively, over the last 12 months., Method: Data were obtained from the National Survey of Mental Health and Wellbeing, conducted between May and August 1997. A stratified random sample of households was generated, from which all those aged 18 and over were considered potential interviewees. There were 10,641 respondents to the survey, and this represented a response rate of 78 %. Each interviewee was asked questions indexing specific ICD-10 PD criteria., Results: Five measures of disability were examined. It was found that PD was a significant predictor of disability once Axis I and physical conditions were taken into account for four of the five disability measures. For three of the dichotomously-scored disability measures, odds ratios ranged from 1.88 to 6.32 for PD, whilst for the dimensionally-scored Mental Summary Subscale of the SF-12, a beta weight of -0.17 was recorded for PD. As regards number of PDs having a quasi-linear relationship to disability, there was some indication of this on the SF-12 Mental Summary Subscale and the two role functioning measures, and less so on the other two measures. As regards mental consultations, PD was a predictor of visits to GPs, psychiatrists and psychologists, over and above Axis I disorders and physical conditions., Conclusion: The study reports findings from a nationwide survey conducted within Australia and as such the data are less influenced by the selection and setting bias inherent in other germane studies. However, it does support previous findings that PD is a significant predictor of disability and mental health consultations independent of Axis I disorders and physical conditions.