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Objectives: Both antidepressant medications and psychological therapy are common treatments for depression in postpartum women. Antidepressant treatment may have a number of practical disadvantages, including a preference by women to avoid medication while breastfeeding. Consequently, more information about the relative benefits of the two modalities in the perinatal period is helpful. In the treatment of depressive disorders there is some evidence that combination therapies (pharmacological plus psychological treatment) may be more efficacious than either form of mono-therapy in isolation. However, in the treatment of postnatal depression, such evidence is limited. Method: Forty five postpartum women with a DSM-IV diagnosis of depression were randomised to receive either: 1) cognitive behavioural therapy (CBT); 2) sertraline, or 3) a combination of both treatment modalities. Psychometric measures were collected weekly for 12 weeks, with a follow-up at 24 weeks. Results: Symptoms of depression and anxiety were reduced to a significant degree following all three treatments. CBT mono-therapy was found to be superior to both sertraline mono-therapy and combination therapy after 12 weeks. The CBT mono-therapy group appeared to display the most rapid initial gains after treatment commencement. Conclusions: In this sample, a specialised CBT program for postnatal depression was found to be superior as a mono-therapy compared to sertraline, a commonly prescribed SSRI antidepressant. This is in contrast to previous studies which have found no detectable difference in the efficacies of drug and psychological treatment for postnatal depression. Unlike some previous work, this study allowed a statistically independent evaluation of CBT mono-therapy for postnatal depression compared to both antidepressant and combination therapy. In line with previous studies in postpartum women, there was no detectable advantage of combining pharmacological and psychological treatments in the short term.

Gamma-aminobutyric acid (GABA) is quantitatively the most important inhibitory neurotransmitter in the central nervous system, and benzodiazepines (BZs) act via a binding site on the GABA receptor complex. The neurobiology of the GABA-BZ receptor complex is being increasingly understood as imaging and pharmacological techniques to study the receptor complex both indirectly and directly improve. This paper outlines the evidence for BZ receptor abnormalities in panic disorder and post-traumatic stress disorder. Copyright © 2008 John Wiley & Sons, Ltd.

Objective: To compare executive, memory and visuospatial functioning of DSM-IV anorexia nervosa (AN), bulimia nervosa (BN), and normal controls (NC). Method: A comparison of women involving: (i) 16 AN with body mass indices (BMI) 17.5 kg/m2; (ii) 12 AN with BMI[18.5 kg/m2 for at least 3 months; (iii) 13 BN; and (iv) 16 NC participants was performed with groups of similar age and intelligence. Groups were assessed with EDE-12, MADRS, HAMA, Cognitive Drug Research (CDR) battery, and Bechara tasks. Results: Significant impairments in CDR Power of Attention were present in underweight AN and BN participants. CDR Morse Tapping was significantly impaired in all clinical groups. The BN and weight-recovered AN groups were significantly impaired on CDR immediate word recall. The BN group alone was significantly impaired on CDR delayed word recall. Conclusion: Attentional impairment is similar in AN and BN. Impaired motor tasks in AN persist after ‘‘weight-recovery’’ and are similar to impairments in BN. BN may be discriminated from AN on word recall.

Background Atypical antipsychotics may be beneficial in treating the core psychopathology of anorexia nervosa (AN). Methods An 8 week open-label study of quetiapine was conducted in eight severely ill DSM-IVAN patients consecutively admitted to a specialist eating disorders unit. Participants were assessed by EDE-12, MADRS, YBOCS, SAPS-delusions and CDR neuropsychological battery at baseline, 4 weeks and 8 weeks, and by weekly body mass index (BMI), CGI and extrapyramidal scores. Quetiapine doses ranged from 50 mg to 800 mg per day, according to efficacy and tolerability. Results Seven participants completed 4 weeks and five participants completed 8 weeks. All participants had clinically significant levels of specific eating disorders psychopathology, and mild to moderately severe depressive symptomatology. Apart from initial mild sedation, no subjects experienced any significant adverse events. Over 4 weeks there was no significant difference in BMI, but a significant difference in the EDE-12 restraint score. There were significant differences on BMI and EDE-12 restraint subscale scores over 8 weeks. Conclusions A double-blind placebo controlled study is required to further evaluate the therapeutic utility of quetiapine in severely ill AN patients beyond multidisciplinary specialist intervention.

The clinical and research literature suggests that cognitive and behavioural therapies are particularly helpful in assisting clients overcome problem gambling behaviour. Several articles have described the efficacy of a range of cognitive interventions, especially provision of information regarding rates of return and the odds of games and the exploration of irrational beliefs and myths and misconceptions regarding gambling activity. This paper describes in detail an innovative cognitive strategy which focuses on problem gambling clients’ financial status. The strategy incorporates the use of illustrations, generally using a whiteboard, to highlight how problem gambling behaviour negatively impacts on financial wealth over time. Step by step instructions are provided, together with illustrations, to allow clinicians to incorporate the strategy in treatment with their own clients.

A number of specialised counselling services are now available to assist individuals who experience difficulties as a result of problem gambling behaviour. Clinicians within these services may utilise one or a number of counselling approaches depending on their own preferences and their assessment of the counselling style suitable for use with particular clients. The purpose of this paper is twofold. The first is to describe the range of specialised gambling counselling services now available in Australia. The second aim is to provide clinicians in the field with a range of practical cognitive counselling strategies that may be used to good effect to assist clients to reassess their attitudes towards and thoughts about gambling.

Objective: To provide an overview of the current knowledge on the impact of motherhood on women with schizophrenia and schizoaffective disorder. Method: The published literature was selectively reviewed and assessed, based on a complete MEDLINE and PsychLIT (1971 to current) search, including English and non-English journals and books. Results: Research to date into motherhood and schizophrenic illnesses has been limited by a number of methodological constraints, limiting the ability to draw conclusions and the prevention of relapses and mother-infant difficulties. These constraints have included: a paucity of prospective studies with initial, antenatal recruitment; variable definitions of the length of the puerperium; significant changes in psychiatric classification; the heterogeneity of postpartum psychotic disorders, with the majority being mood or schizoaffective disorder rather than schizophrenia; selection biases inherent in studying mother-baby unit inpatients; difficulties in life events research in general, such as its retrospective nature and confounding, illness factors; and the specificity versus non-specificity of childbirth as a unique or discrete life event. Conclusions: Further study is required to explore: the impact of child care, parenting and having a partner on the course of women with schizophrenic and schizoaffective disorders during the first postpartum year; whether women with postpartum relapses of these mental illnesses are likely to have slower recoveries than those women with the same diagnoses but without young children; and protective factors against postpartum relapse.

Group counselling offers clients a number of therapeutic benefits and is used widely to provide general emotional support or assist participants to overcome specific personal difficulties in their lives. Group counselling has been used to assist individuals to overcome difficulties associated with problem gambling behaviour; however, there are few reports of this application in the clinical and research literature. This paper provides a brief review of group counselling, including the therapeutic benefits available to participants involved in this modality of counselling delivery. A description of counselling approaches and strategies commonly used in group counselling settings is also provided.The application of group counselling to assist individuals with gambling problems is then described. Both self-help and counsellor-led groups are discussed.

Paroxetine and pindolol have been used in combination to augment the antidepressant response of SSEIs. The rationale given involves the prevention of a negative feedback inhibition of serotonergic neurons but few studies have addressed potential pharmacokinetic interactions. This paper reports on elevated plasma paroxetine concentrations in a 37-year-old depressed woman following the introduction of pindolol. This case study supports the possibility of competitive drug-drug interactions in combinations of paroxetine and pindolol.

1. The effects of single oral doses of zopiclone and temazepam were investigated in eight healthy male volunteers using a single blind, placebo controlled cross over study. Doses of zopiclone were 7.5 and 15mg while the dose of temazepam was 20mg. 2. Each dose was separated by at least a one-week washout period. For each subject the dim light melatonin onset (DLMO) was determined on a screening night and the drugs were administered at the time of the DLMO. 3. Melatonin concentrations were determined by radioimmunoassay from plasma samples collected throughout the night. Both temazepam and zopiclone tended to reduce the amount of melatonin secreted, as determined by the area under the plasma concentration time curve. 4. The differences from placebo were not statistically significant (F 3.31 =1.07 P>0.1). Similarly a repeated measures analysis of variance on the plasma concentration-time curves did not show any statistically significant differences between drugs and placebo (F 3,28 =1.15, P>0.1). 5. There was no evidence from this study of a phase shifting effect of the drugs used. The reasons for the lack of effect on melatonin may be due to the differences in potency of the interaction of these drugs with the GABA-benzodiazepine-chloride ion channel.

This paper describes Australian counselling services which use the telephone as the medium for counselling delivery. It provides a background to telephone counselling and describes its uses as reported in the research and clinical literature. Special considerations in utilising the telephone to provide counselling are discussed. The paper also reviews the clinical and research literature to determine which counselling techniques are most applicable for use over the telephone.

The aim of this study was to evaluate the response to venlafaxine in patients with treatment-resistant depression during an extension phase of an open-label study of venlafaxine. After completing the initial 8 weeks of the study, patients could continue venlafaxine treatment for an additional period of up to 10 months. Efficacy results are given for 149 patients with treatment-resistant depression. Response was defined as a 50% reduction in scores on the Montgomery-Asberg Depression Rating Scale (MADRS); 69% were responders after 8 weeks of treatment in the initial study phase, and 73% were responders at their final extension-phase visit. The mean MADRS score was 32.8 before treatment, 12.9 by 8 weeks, and 10.8 at the final extension visit. There was a statistically significant reduction of 2.1 MADRS units from entry into the extension phase to the final extension visit. At extension entry, 36.7% patients were in remission, as defined by a MADRS score of less than 12, whereas at the final extension visit, this had increased to 49%. Improvement in Clinical Global Impressions Scale scores (both patient and physician ratings) was maintained throughout the extension period, with 88% of patients reporting some improvement (75% with "very much" or "much") and 92% of doctors noting some improvement in patients (79% with "very much" or "much") at the last extension visit. The safety profile during the extension phase of the study was similar to that found in the initial phase and in other studies. The most common study events were somnolence (21%), headache (18%), insomnia (16%), sweating (16%), constipation (14%), dry mouth (11%), nausea (10%), and dizziness (10%). Patients with resistant depression that was treated with venlafaxine maintained their response for up to 10 months after an 8-week phase of treatment and showed some evidence of further improvement.

The aim of this study was to replicate the findings of a 1994 study, in which a 30% response rate to venlafaxine was found in patients with treatment-refractory depression, as well as to examine for any predictors of such an outcome. The study was an 8-week, open-label, prospective investigation of venlafaxine in doses up to 300 mg in 312 patients fulfilling criteria for either "absolute" or "relative" treatment resistance. By week 8, 52.6% of the patients had responded, which was defined as a 50% reduction in scores on the Montgomery-Asberg Depression Rating Scale; 49% of those defined with "absolute resistance" demonstrated such an outcome. Forty-five percent of the patients with absolute resistance who had failed to respond to at least one tricyclic antidepressant responded to venlafaxine. Response rates were higher in those with an absence (57.5%) compared with the presence (31.0%) of any comorbid psychiatric disorder (p < 0.001), "marked" (60.3%) compared with "mild or moderate" (51.6%) or "severe" (43.4%) baseline ratings on the patient-rated Clinical Global Impressions Scale (p < 0.05), and "relative" (61%) compared with "absolute" resistance (49%) (p = 0.06). Furthermore, improvement in scores of 20% or 30% at weeks 1 or 2 was associated with higher rates of final response (p < 0.0005). After logistic regression, both comorbid psychiatric illness (p < 0.001) and early improvement (p < 0.0001) remained significant and independent predictors of final response.

Aims: A modified version of the Mental Adjustment to Cancer Scale (The Mental Adjustment to HIV Scale-MAHIVS) was used to evaluate patterns of psychological adjustment in response to HIV infection. Methods: A sample of 164 HIV positive homosexual/bisexual men were recruited across three Australian centers (79 asymptomatic (CDC II/III) and 85 symptomatic HIV infection (CDC IV)). Factor analysis of the MAHIVS was conducted and the predictive validity of the MAHIVS was investigated using the General Health Questionnaire, while The Diagnostic Interview Schedule was used to assess current and lifetime psychiatric disorder. Other measures of adjustment/coping were used to investigate the construct validity of the MAHIVS (neuroticism, locus of control, defense style). Results: Factor analysis of the MAHIVS detected four factors: Hopelessness, Fighting Spirit/Self Efficacy, Personal Control, and Minimization. Hopelessness and Fighting Spirit factors exhibited acceptable levels of internal consistency and validity, with significant correlations detected with psychological symptoms and significant association with other measures of psychological adjustment and personality. Fighting Spirit emerged as a potential indicator of psychological resilience, whereas Hopelessness was significantly associated with psychological symptoms and current major depression (but not past depression). Conclusions: The findings indicate the validity of the MAHIVS and support the presence of common themes in the psychological adaptation to life-threatening illness that can be detected across disease categories and groups.

Objective: To critically review the literature on clinical trials in which pindolol, a 5HT1A receptor antagonist, has been used to augment the effects of antidepressants in patients with depression and to examine the pharmacodynamics and pharmacokinetics that may underlie such augmentations. Method: The available literature from the previous 10 years relating to the clinical use of pindolol in combination with antidepressants was critically examined. This was placed in the context of its pharmacodynamic rationale, and evidence supporting its use was critically reviewed. Results: A number of open-label and placebo-controlled, double-blind trials on patients with depression showed conflicting results as to the value of adding pindolol to various antidepressant regimens in reducing latency or in augmenting the anti-depressant effect in treatment-resistant cases. While pre-clinical studies using electrophysiological and microdialysis techniques suggest utility in terms of increases in extracellular concentration of 5-hydroxy-tryptamine (5HT) in serotonergic projection areas, few studies have examined the possibility of drug–drug interactions and subsequent elevated plasma levels of antidepressant. Conclusions: Pre-clinical studies suggest possible advantages of pindolol augmentation of antidepressant regimens and the achievement of faster acting antidepressants. The results of investigations in patients with depression have so far been conflicting. There exists the possibility of drug–drug interaction in pindolol/antidepressant augmentation strategies which remains to be examined.

Paired blood and breast-milk samples were collected from 10 nursing mothers receiving sertraline. Samples were collected at steady state when the patients had been taking stable doses of 50-150 mg/day over several weeks. Sertraline concentrations in both fluids were determined using a specific, validated HPLC method. Plasma and milk concentrations showed a wide inter-individual variability for the same dose. Mean plasma concentrations were linearly related to dose, but this was not the case for breast-milk concentrations. An overall milk to plasma ratio of 1.76+/-1.72 was recorded. The average dose to the infants ranged from 1.1 to 31.1 mg/kg, which is less than 2 per cent of the maternal dose per day. Further studies are necessary to determine if these doses are detrimental to the development of the infant. Copyright 2000 John Wiley & Sons, Ltd.

The melatonin supersensitivity to light has been suggested as a biological marker of bipolar disorder. However previous studies have been inconsistent with regard to light induced suppression of melatonin and raising questions regarding its reproducibility and reliability. The present study examined the test re-test reliability of the melatonin suppression by light in healthy subjects. Study was divided into two parts. The first examined the melatonin suppression by 200 lux of light while the second examined effect 500 lux of light. Subjects were tested twice, separated by one week for each part of the study. On each night subjects reported to the study at 1800 h. The first sample was collected at 2100 h (in the light). Subjects were then placed in a dark room, with a background light intensity of 10–20 lux. Further blood samples were collected at regular intervals. After each collection, blood samples were centrifuged and plasma separated and stored frozen at –20oC. Plasma melatonin concentrations were d...

The hormone melatonin is secreted at night from the pineal gland, with light being a potent inhibitor of its secretion. Age related decreases in plasma melatonin concentrations have indicated that this may be related to pineal calcification with aging. Recently, it was shown that the melatonin sensitivity to light may be a biological marker of bipolar disorder. However, on average, patients were older than the control group in most studies, and it is not known if age has an effect on the melatonin suppression by light. To test this hypothesis, the present study investigated the effect of age on the melatonin sensitivity to dim light (200 lux). Participants were grouped into three age groups. On the testing night, they were placed in a dark room from 21.00 h to 02.30 h. Light exposure was for an hour from midnight to 01.00 h. Blood samples were collected at regular intervals for measurement of plasma melatonin. No significant differences were found in the percentage suppression of melatonin within the age groups defined in the present study (P > 0.5). No correlation was also found between age and percentage suppression of melatonin (r2 = 0.007; P > 0.1). Our results suggest that the melatonin suppression by light (200 lux) is not affected by age.

Patients with bipolar disorder have been shown to have a supersensitive melatonin suppression to dim white light (200 and 500 lux) compared to normal healthy subjects. Previous studies suggest menstrual cycle dependant changes in the melatonin rhythm, but it is not known if the melatonin sensitivity to light changes during the menstrual cycle. The present study investigated the melatonin suppression to dim white light (200 lux) in different stages of the menstrual cycle. No significant differences in the percent suppression of melatonin were found across the stages of the menstrual cycle ( p =.97). Our findings suggest that the menstrual cycle hormonal changes do not affect the melatonin sensitivity to dim light in healthy controls.

It is well known that the pineal hormone melatonin is suppressed by light. The melatonin suppression by dim light has also been suggested as a possible trait marker of bipolar disorder. However, there is large inter individual differences in the light responses. It is possible that methodological factors may contribute to the variable responses observed. Most studies in the past have been conducted in different seasons under different lighting conditions. It is possible the external lighting conditions may affect the melatonin suppression to dim light. Hence we examined the melatonin suppression by dim light in (1) a large group of subjects randomly tested once in one of the four seasons (part one) and (2) small group of subjects tested in all seasons (part two). Subjects were placed in a dark room from 2100 h to 0230 h. Light exposure was between midnight and 0100 h in a sitting position. Blood samples were collected at regular intervals for measurement of plasma melatonin. No statistically significant seasonal differences in the percentage suppression of melatonin were found in both parts of the study (p>0·5). The study suggests that seasonal changes in external lighting do not affect the melatonin suppression by dim light in healthy controls. Copyright © 1999 John Wiley & Sons, Ltd.

Selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs), like the tricyclic antidepressants and monoamine oxidase inhibitors, are associated with a well recognised syndrome following discontinuation or dose reduction. There appear to be differences in the incidence of discontinuation syndromes within the class of SSRIs. Published case reports and adverse drug reaction reports both suggest the highest incidence of the syndrome with paroxetine and the lowest incidence with fluoxetine, while other SSRIs are associated with an intermediate incidence. Open label comparison and placebo-controlled double-blind studies support this contention. There is little evidence to separate discontinuation syndromes with different SSRIs on the basis of clinical presentation. Although the pathogenesis of SSRI discontinuation syndromes is unknown, both pharmacodynamic and pharmacokinetic factors may explain differences in incidence with individual SSRIs. SSRI discontinuation syndromes are usually mild and transient, and prevention is the most effective management strategy.

Light is involved in providing entrainment of circadian rhythms and the suppression of the pineal hormone melatonin. In patients with affective disorders, there have been indications of circadian as well as seasonal variation in illness, which may be reflected in melatonin production. Varying sensitivity to light has been noted within healthy individuals as well as in some patients with affective disorders. Recent evidence suggests that patients with panic disorder may have an altered and phase-delayed melatonin rhythm. The present study examined the nocturnal plasma melatonin rhythm in patients with panic disorder, and also examined their melatonin sensitivity to dim light. The melatonin rhythm was examined in 6 patients with panic disorder and 8 controls. The melatonin sensitivity to dim white light (200 lx) was examined in 8 patients with panic disorder and 63 controls and was compared to that of a group of 7 patients with other anxiety disorders. Patients with panic disorder demonstrated a trend towards higher and delayed peak melatonin levels compared to controls. Patients with panic disorder also had a subsensitive melatonin suppression by dim white light, compared to controls and patients with other anxiety disorders ( p < 0.005). The phase-delayed circadian rhythm observed in patients with panic disorder may be secondary to the subsensitivity of the melatonin response to light. It is hypothesized that the subsensitivity may be due to abnormal neurotransmitter/receptor systems involved in regulation of melatonin suppression and circadian rhythmicity, and may lead to phase-delayed circadian rhythms. The melatonin subsensitivity to light may be used as a biological marker of panic disorder.

Objective. To examine the biopsychosocial background of persons aged 15–24 years who had committed suicide in Victoria, compared with young people who presented to hospital after attempting suicide and who were either hospitalized or given outpatient treatment. From these data it was hoped to develop a screening instrument to delineate attempters at high risk to suicide. Design. A prospective study was undertaken using a standardized youth suicide interview schedule of all suicides in the 15–24-year age group in Victoria, compared with a sample of those presenting to public hospital emergency departments following attempted suicide. Data on completed suicides were collected by the staff of the Coroner's Office and Victoria Police, while psychiatric staff of Victorian hospitals assisted the collection of data on suicide attempters. Main outcome measures. Data comprised demographic features, method of suicide or attempt, reasons for the event, social and personal history, psychiatric background and life stressors. Results. One hundred and forty-eight completed suicides were compared with 105 hospitalized suicide attempters and 101 non-hospitalized suicide attempters. The majority of those completing suicide were male (86 percent), while those attempting suicide were predominantly female (64 percent in both groups). Those completing suicide typically used violent methods, while attempted suicides were mainly from overdose. The most common reported reasons for suicide were psychiatric problems and generalized feelings of worthlessness. Relationship problems and family conflict were the dominant reasons in both groups of suicide attempters. The data suggest that completed suicide was not related to specific events. Unemployment was cited as a reason for suicide in less than 5 percent of cases. Significantly, those who attempted suicide were more likely to have sought help prior to the attempt (hospitalized 64 percent and non-hospitalized 66 percent) compared with those who successfully suicided (12 percent). Conclusions. These data did not support common assumptions about suicide. Suicide threats or attempts do not discriminate between subsequent attempts and completed suicide. Approximately 88 percent of those who completed suicide displayed no discernible help-seeking behaviour. No specific events were related to completed suicide, indeed, those who completed suicide appeared to have experienced fewer stressful life events than those who attempted suicide. Over half the subjects lived at home. For attempters, there was a history of physical abuse, not reported for those who completed suicide. The majority of subjects were not heavy drug or alcohol users. These data suggest: (1) research needs to address the antecedents of suicidal behaviour, not the behaviour itself; (2) we need to explore the role of such causal factors as feelings of worthlessness and interpersonal skills, rather than homelessness and unemployment; and (3) suicide completers and attempters are heterogeneous groups, to be helped separately. © 1998 John Wiley & Sons, Ltd.

Depressive illness in the presence of medical illness is common and the relationship between them is complex. Often the medical illness can cause the depression.

A cross-sectional study was performed to investigate the prevalence and predictors of suicidal ideation and past suicide attempt in an Australian sample of human immunodeficiency virus (HIV)-positive and HIV-negative homosexual and bisexual men. Sixty-five HIV-negative and 164 HIV-positive men participated. A suicidal ideation score was derived from using five items selected from the Beck Depression Inventory and the General Health Questionnaire (28-item version). Lifetime and current prevalence rates of psychiatric disorder were evaluated with the Diagnostic Interview Schedule Version-III-R. The HIV-positive (Centers for Disease Control and Prevention [CDC] Stage IV) men (n = 85) had significantly higher total suicidal ideation scores than the asymptomatic HIV-positive men (CDC Stage II/III) (n = 79) and the HIV-negative men. High rates of past suicide attempt were detected in the HIV-negative (29%) and HIV-positive men (21%). Factors associated with suicidal ideation included being HIV-positive, the presence of current psychiatric disorder, higher neuroticism scores, external locus of control, and current unemployment. In the HIV-positive group analyzed separately, higher suicidal ideation was discriminated by the adjustment to HIV diagnosis (greater hopelessness and lower fighting spirit), disease factors (greater number of current acquired immunodeficiency syndrome [AIDS]-related conditions), and background variables (neuroticism). Significant predictors of a past attempted suicide were a positive lifetime history of psychiatric disorder (particularly depression diagnoses), a lifetime history of infection drug use, and a family history of suicide attempts. The findings indicate increased levels of suicidal ideation in symptomatic HIV-positive men and highlight the role that multiple psychosocial factors associated with suicidal ideation and attempted suicide play in this population.

Background: Negative symptoms of schizophrenia are often confounded by overlapping depressive and parkinsonian symptoms. The role of medication as an aetiological factor in the development of these symptoms is an important issue for prevention and treatment. Methods: A total of 45 inpatients in chronic wards who met RDC criteria for schizophrenia were assessed with the Hamilton depression rating scale (HDRS) and negative symptom rating scale (NSRS) and the targeting abnormal kinetic effect scale (TAKE). Results: No significant correlation was found between the total scores on the vegetative superfactor of the HDRS and the NSRS. Duration of neuroleptic treatment was positively correlated with depressive symptoms (r=0.299, P

Nathan PJ, Maguire KP, Burrows GD, Norman T.R. The effect of atenolol, a β1-adrenergic antagonist, on nocturnal plasma melatonin secretion: Evidence for a dose-response relationship in humans. J. Pineal Res. 1997; 23:131–135. © Munksgaard, Copenhagen Abstract Pineal β1-adrenergic receptors are involved in the regulation of melatonin secretion. The involvement of β1adrenergic receptors has been demonstrated by the ability of acute administration ofβ-antagonists to suppress the nocturnal rise of circulating melatonin and its urinary metabolite 6-sulphatoxymelatonin (aMT6s). The present study was undertaken to examine the relationship between increasing doses of atenolol and nocturnal plasma melatonin concentrations. Six healthy subjects participated in the study for a period of 5 weeks. Subjects were administered placebo, 12.5, 25, 37.5, and 50 mg doses of atenolol in a randomized single blind design. Each dose was separated by a 1 week washout period. Blood samples were collected at regular intervals from 19.00 hr to 06.00 hr. Repeated measures analysis of variance showed a dose-dependent decrease in plasma melatonin concentrations (P < 0.01). A Student Newman-Keuls post hoc test indicated significant differences between placebo and all doses of atenolol (P < 0.05). The results demonstrate a dose-dependent relationship between β1-receptor blockade and suppression of nocturnal plasma melatonin in humans.

Many new and accessible forms of gambling have been introduced in Australia in the last decade, with a concomitant increase in research into gambling behaviour and its treatment. This article reviews the clinical characteristics of gambling and proposes a continuum from social gambling, through problem gambling, to the more severe form of pathological gambling. The role of stress and anxiety as precipitating and perpetuating factors in problem gambling is discussed, highlighted by data on the aetiology of problem gambling from the Addiction Research Institute. The article concludes with a review of treatment implications for problem gambling. © 1997 John Wiley & Sons, Ltd.

Parental grieving for the loss of a baby following miscarriage or stillbirth can involve intense emotional distress and have implications for the quality of the relationship shared by the grieving parents. Evidence suggests that a relationship may be placed at risk during the grief process, with different forms and rates of grieving between the couple creating barriers to effective communication and increasing feelings of vulnerability. Fifty-one adults who had experienced the loss of a baby as a result of miscarriage or stillbirth took part in this preliminary study to identify gender differences in coping strategies used by males and females in dealing with their loss. Results suggested not only gender differences in chosen coping strategies, but also differences between women depending on the type of loss experienced (ie miscarriage or stillbirth). While men tended to worry, use social support and ignore the situation, women were more likely to seek spiritual support, use tension reduction, wishful thinking and seek support from others who had experienced the same loss. A tendency to use self-blame was also evident in the responses of the female subjects, in particular women who had suffered a miscarriage.©1997 John Wiley & Sons, Ltd.

Several new agents for the treatment of depression have been introduced in recent years. While there are certain advantages for these agents over existing drugs, their efficacy and speed of onset of action is not different. The efficacy, adverse effects and toxicity of the various classes of antidepressants is reviewed. Newer agents such as the SSRIs or mirtazapine may be better drugs of first choice than the tricyclics in terms of patient acceptability and safety.

The present study investigated the effect of dim white light on nocturnal plasma melatonin in males and females. Subjects were exposed to light between 2400hr and 0100hr. No significant gender differences were found with both 200lux (p > 0.1) and 500lux (p > 0.1) of light. Furthermore the amplitude of the melatonin rhythm was not significantly different with gender. This suggests that at low intensities the melatonin sensitivity to light is not differentially regulated between sexes.

Anxiety is a common experience in chronic illness but for many with end-stage liver disease it is also associated with the stress of waiting for a donor organ to become available. Quality of life, work, family and social roles are all impaired and these losses may also contribute to depression. This article investigated anxiety and depression associated with end-stage liver disease and changes in these mood states following successful liver transplantation. Patients with non-alcoholic cirrhosis and healthy volunteers comprised the control groups. Significant reductions in the measurement of anxiety and positive mood changes occurred as early as 1 month post transplant and were maintained across the course of the study. However, qualitative data suggest that discrete episodes of anxiety may still exist post transplant. These episodes appear to be related to maintaining the newly acquired ‘wellness’ and availability of support. Most patients were able to resume work by 9 months post transplant. © 1997 by John Wiley & Sons, Ltd.

Forty schizophrenic patients were included in a study of the relationship between serotonin function as measured by 3 H-paroxetine binding to platelet membranes and aggressive behaviour. Patients classified as either aggressive or non-aggressive were paired by age, sex and duration of illness. 3 H-Paroxetine binding variations were avoided by taking samples for each pair between 09:00 and 11:00 h, within 4 days of each other, and by assaying pairs of samples together. The mean K d for the aggressive group was 0.193 ± 0.126 nM and the mean K d for the non-aggressive group was 0.176+0.164 nM. The mean B max for the aggressive group was 1451 ±386 fmol/mg protein while the mean for the non-aggressive group was 1549 ± 375 fmol/mg protein. There was no significant difference between the groups for either parameter, K d or B max . There were no significant correlations between psychopathology ratings including positive and negative symptoms, depression, suicidal thoughts, impulse control, as well as both past and present history of aggression, hostility and irritability traits, psychopathic deviance and either B max and K d . This study finds no relationship between aggressive behaviour and peripheral serotonin function as measured by 3 H-paroxetine binding to platelet membranes.

Objective: To review the contemporary landscape regarding pharmacological treatments for schizophrenia. Method: Selective literature review. Results: Newer antipsychotic agents include aripiprazole, asenapine, paliperidone, sertindole and ziprasidone. Each has some particular benefits and some shortcomings. Overall treatment efficacy (for positive symptoms at least) has not advanced substantially but some newer agents might have a better profile than older typical agents for negative and cognitive symptoms. Metabolic side effects and hyperprolactinaemia remain a problem with some of the newer agents and appropriate monitoring is required. Conclusions: Whilst newer antipsychotics have been welcome additions to our pharmacological armamentarium, mostly in terms of tolerability, we have still not seen a ‘quantum leap’ agent brought to market. Mechanisms of action apart from post-synaptic dopamine blockade appear worthy of further investigation in this regard.

The effect on nocturnal melatonin secretion of acute administration of the indirectly acting serotonin (5-HT) receptor agonists d-fenfluramine (30 mg) and paroxetine (20 mg) and a partial 5-HT1A receptor agonist ipsapirone (20 mg) was investigated in healthy male volunteers and compared to a placebo condition. Each subject (n = 8) received each drug on one occasion over a 4 week study period, with drug administration separated by 1 week. A randomized, counter-balanced design was used. Drugs or placebo were administered at 2,000 hours in the light, and all blood samples were collected throughout the night in the dark at regular intervals until 0600 hours. Neither d-fenfluramine, paroxetine, or ipsapirone following acute dosage had a statistically significant effect on nocturnal melatonin synthesis. The lack of effect seen with d-fenfluramine, paroxetine, and ipsapirone may be due to limitations imposed by the dose requirements.

Antipsychotics, both the long established typical drugs and the recently introduced atypical drugs clozapine and risperidone, are highly effective in acute and maintenance treatment of schizophrenia. However, typical antipsychotics are associated with tardive dyskinesia after long term use, and many other clinical situations arise for which discontinuation of therapy may be appropriate. For patients who have recovered from a first episode of psychosis, it is recommended that antipsychotics are continued for 1 to 2 years before withdrawal is considered. Patients who have experienced recurrent psychotic episodes need long term maintenance treatment and there is no simple guide as to when discontinuation might be attempted. The risk of potentially dangerous psychotic relapse is high in most circumstances. Long term prognosis may also be worsened by the occurrence of repeated psychotic relapses. Additionally, there can be withdrawal reactions, which are mostly attributable to cholinergic rebound. The problems of discontinuation are minimised by very gradual dosage reduction and, occasionally, the temporary addition of anticholinergic medications. A key principle for maintenance treatment is the use of the lowest effective dose of antipsychotic, established by trial and error. If discontinuation of typical antipsychotic medication is essential, an option is to switch to risperidone or clozapine. Because of the problems associated with both continuation and withdrawal of antipsychotics, the decision to discontinue should be made with the informed consent of the patient and their carers.

Remoxipride, a substituted benzamide, is a selective D-2 antagonist with an atypical neuroleptic profile. Previous studies have demonstrated its antipsychotic efficacy against haloperidol and, more recently, thioridazine. Of the 144 patients enrolled in the Australian remoxipride-thioridazine comparative trial, 28 presented for their first episode of schizophrenia and/or had no previous neuroleptic treatment. These patients form the subject of this paper.

Platelet [3H]-paroxetine binding was analysed in 26 patients (13F, 13M) with obsessive compulsive disorder and 26 normal controls (13F, 13M). For patients with obsessive compulsive disorder, Bmax was 2127 ± 480 fmol/mg protein (mean±SD) compared to control Bmax values of 1926 ± 696 fmol/mg protein. The mean Kd value for the patients was 0.075 ± 0.025 nM and for the controls was 0.076 ± 0.032 nM. Analysis of covariance indicated a significant effect of sex on both Kd and Bmax but no effect of diagnosis (obsessive compulsive disorder versus normal controls) or season of sampling. The data provide no evidence for an abnormality of the platelet uptake mechanism as assessed by the measurement of [3H]-paroxetine binding to the platelet transporter in obsessive compulsive disorder.

Platelet [ 3 H]paroxetine binding was measured in 20 patients (14 females, six males) with panic disorder and 20 normal controls (14 females, six males). For patients with panic disorder, B max was 1987 ± 1135 fmol/mg protein (mean ± SD) compared with control B max values of 1626 ± 611 fmol/mg protein. The mean K d value for the patients was 0.076 ± 0.056 nM and for the controls was 0.083 ± 0.033 nM. ANCOVA indicated no significant effect of sex, diagnosis (panic disorder vs. normal controls) or season of sampling on either K d or B max . The data provide no evidence for an abnormality of the platelet uptake mechanism in panic disorder.

Serotonin receptors - from genes to pathology relapse, recurrence and chronicity in depression nicotine and major depression - a genetically based association with clinical implications the treatment of depression in primary care a double-blind study with Fluvoxamine versus Desipramine combined with placebo or Haloperidol in delusional depression - preliminary results methodological issues in collaborative multicentre placebo-controlled studies in the treatment of depression efficacy and safety of anti-depressants in the elderly. (Part contents).

Depression and anxiety disorders are under-recognised in clinical practice. They are relatively common psychiatric disorders, affecting 2 to 5% of the population per year.

OBJECTIVE: To determine the trends in youth suicide in Victoria and Australia as a whole, and their relation to youth unemployment. DESIGN: We used Australian Bureau of Statistics data to analyse suicide trends between 1907 and 1990 in young people aged 15-24 years and made an in-depth study of youth suicides between 1980 and 1990, for which computerised data are available. RESULTS: There has been a steady increase in youth suicide both in Victoria and Australia as a whole since 1960 in males but not females. There were significant differences in age, sex and area of residence in both the rate and the method of suicide. The increase in youth suicide was not associated with the rise in unemployment. Male (not female) suicide rates were higher in non-metropolitan areas and areas of high youth unemployment. The reasons for the increase in youth suicide remain obscure. CONCLUSIONS: There is a need for a prospective in-depth study to determine factors in the aetiology of youth suicide, with particular reference to possible areas for prevention. Language: en