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A succession of interconnected environmental factors is believed to contribute substantially to the development of autism spectrum disorder (ASD). This exploratory study therefore aims to identify potential risk factors for ASD that are associated with pregnancy, birth and infant feeding. Demographic and health-related data on children aged 3–13 years (N = 4306) was collected through an online survey completed by biological mothers. A fitted logistic regression model identified advanced maternal age, prenatal bleeding, pre-eclampsia, perinatal pethidine usage, foetal distress before birth and male sex of child as associated with an increased risk of ASD, whereas longer gestational duration demonstrated a protective effect. These findings highlight potential risk factors and predictor interrelationships which may contribute to overall ASD risk.

BACKGROUND Anxiety disorders and depression are prevalent disorders with high comorbidity, leading to greater chronicity and severity of symptoms. Given accessibility to treatment issues, more evaluation is needed assessing the potential benefit of fully-automated self-help transdiagnostic (TD) digital interventions. Innovating beyond the current TD ‘one-size-fits-all’ shared mechanistic approach may also lead to greater improvements. OBJECTIVE The primary objective of the study was to test the preliminary effectiveness of a new fully-automated self-help biopsychosocial TD digital intervention (Life Flex) which aims to treat anxiety and/or depression, as well as improve emotional regulation, emotional, social and psychological wellbeing, optimism and health related quality of life. METHODS This was a ‘real-world’ pre-during-post-follow-up quasi-experimental trial design evaluation of Life Flex. Participants (N=241) were assessed at pre-intervention (Week 0), post-intervention (Week 8), and at a 1- and 3-month follow-up (Week 12 and 20 respectively). RESULTS The results provided preliminary support for the Life Flex program as being effective in significantly reducing anxiety (GAD-7), depression (PHQ-9), psychological distress (K-6), and emotional dysregulation (DERS-36), and increasing emotional, social and psychological wellbeing (MHC-SF), optimism (R-LOT) and health-related quality of life (EQ-5D Utility Index and Health Rating) (all P CONCLUSIONS Given the paucity of evidence on fully-automated self-help TD digital interventions for anxiety and/or depressive symptomatology, and general treatment accessibility issues, this study provides preliminary evidence for biopsychosocial TD interventions like Life Flex being able to fill the mental health service delivery gap. However further research is required, especially testing Life Flex against comparator conditions, dismantling ‘content’ studies, and the potential collection of biomarker measurements alongside psychologically-based metrics. CLINICALTRIAL ACTRN12615000480583

A succession of interconnected environmental factors is believed to contribute substantially to the development of autism spectrum disorder (ASD). This exploratory study therefore aims to identify potential risk factors for ASD that are associated with pregnancy, birth and infant feeding. Demographic and health-related data on children aged 3-13 years (N = 4306) was collected through an online survey completed by biological mothers. A fitted logistic regression model identified advanced maternal age, prenatal bleeding, pre-eclampsia, perinatal pethidine usage, foetal distress before birth and male sex of child as associated with an increased risk of ASD, whereas longer gestational duration demonstrated a protective effect. These findings highlight potential risk factors and predictor interrelationships which may contribute to overall ASD risk.

Gait abnormalities are frequently reported in autism. The empirical literature, however, is characterized by inconsistent findings concerning which aspects of gait are affected. We conducted a meta-analysis to summarize study findings that examined temporal and spatial (i.e., two-dimensional) gait parameters in pediatric and adult samples comprising individuals with autism and healthy controls. After searching electronic databases, a total of 18 studies were identified and included in this review. Results from the meta-analyses revealed autism is associated with a wider step width, slower walking speed, longer gait cycle, longer stance time and longer step time. Additionally, autism appears to be associated with greater intra-individual variability on measures of stride length, stride time and walking speed. Meta-regression analyses revealed cadence and gait cycle duration differences, between autism and control groups, become more pronounced with age. Overall, this review demonstrates that autism is associated with gait abnormalities. However, assessment of the methodological quality of the studies reveal, additional research is required to understand the extent that gait abnormalities are specifically linked to autism, or whether they may be secondary to other factors commonly found in this group, such as increased weight. LAY SUMMARY: It is often noted by clinicians that individuals with autism have an awkward or unusual walking style, which is also referred to as gait. In this report, we reviewed past studies that compared gait in individuals with and without autism. Our review indicates autism is associated with an abnormal gait. However, it is not yet clear whether gait abnormalities are caused by autism, or arise due to other factors such as heavier weight, which often co-occurs in this group.

Online mental health services provide a point-of-access to mental healthcare that may otherwise be unavailable or limited, particularly in developing countries. Nevertheless, there is a lack of research into individual differences between those who prefer online mental health services and those who prefer traditional in-person services, and whether these differences vary as a function of culture. This study investigated differences in preferences for online or in-person mental health services on e-health literacy, age, education level, and comfort using the internet in a general community sample recruited from Australia and India. A total of 487 participants (31.6% male; mean age = 33.55, SD = 12.20, range 18–78), 297 Australians and 190 Indians, completed an online or paper-and-pencil survey. A significant negative relationship between age and e-health literacy was found with younger ages associated with higher e-health literacy. Furthermore, e-health literacy scores were significantly higher for the Australian sample. Age, e-health literacy, country-of-residence, education level, and comfort in using the internet did not predict mental health service preference. The results suggest that preference for in-person or online mental healthcare is independent of demographic and cultural factors and indicate that online mental health services may be acceptable to Indian health service consumers.

Introduction The risk for developing a gambling problem is greater among offspring who have a problem gambling parent, yet little research has directly examined the mechanisms by which this transmission of problem gambling occurs. For this reason, the present study sought to examine the degree to which children's expectancies and motives relating to gambling explain, at least in part, the intergenerational transmission of problem gambling. Methods Participants (N = 524; 56.5% male) were recruited from educational institutions, and retrospectively reported on parental problem gambling. Problem gambling was measured using the Problem Gambling Severity Index and a range of positive and negative expectancies and gambling motives were explored as potential mediators of the relationship between parent-and-participant problem gambling. Results The relationship between parent-and-participant problem gambling was significant, and remained so after controlling for sociodemographic factors and administration method. Significant mediators of this relationship included self-enhancement expectancies (feeling in control), money expectancies (financial gain), over-involvement (preoccupation with gambling) and emotional impact expectancies (guilt, shame, and loss), as well as enhancement motives (gambling to increase positive feelings) and coping motives (gambling to reduce or avoid negative emotions). All mediators remained significant when entered into the same model. Conclusions The findings highlight that gambling expectancies and motives present unique pathways to the development of problem gambling in the offspring of problem gambling parents, and suggest that gambling cognitions may be potential candidates for targeted interventions for the offspring of problem gamblers.

Background and Objectives Although parenting practices are articulated as underlying mechanisms or protective factors in several theoretical models, their role in the intergenerational transmission of gambling problems has received limited research attention. This study therefore examined the degree to which parenting practices (positive parenting, parental involvement, and inconsistent discipline) moderated the intergenerational transmission of paternal and maternal problem gambling. Methods Students aged 12–18 years (N = 612) recruited from 17 Australian secondary schools completed a survey measuring parental problem gambling, problem gambling severity, and parenting practices. Results Participants endorsing paternal problem gambling (23.3%) were 4.3 times more likely to be classified as at-risk/problem gamblers than their peers (5.4%). Participants endorsing maternal problem gambling (6.9%) were no more likely than their peers (4.0%) to be classified as at-risk/problem gamblers. Paternal problem gambling was a significant predictor of offspring at-risk/problem gambling after controlling for maternal problem gambling and participant demographic characteristics. The relationship between maternal problem gambling and offspring at-risk/problem gambling was buffered by parental involvement. Discussion and Conclusions Paternal problem gambling may be important in the development of adolescent at-risk/problem gambling behaviours and higher levels of parental involvement buffers the influence of maternal problem gambling in the development of offspring gambling problems. Further research is therefore required to identify factors that attenuate the seemingly greater risk of transmission associated with paternal gambling problems. Scientific Significance Parental involvement is a potential candidate for prevention and intervention efforts designed to reduce the intergenerational transmission of gambling problems. (Am J Addict 2017;26:707–712)

Identifying and understanding gender differences associated with the development, maintenance and consequences of problem gambling has important implications for improving prevention and treatment interventions. The current paper systematically reviews the most recent evidence (2012–2015) examining gender differences in the prevalence of problem gambling and the characteristics associated with problem gambling. Twenty-nine articles, including treatment-seeking and community representative adult and adolescent samples, were included. Males were typically more likely than females to be either at-risk or problem gamblers, although this finding may be an artefact of other characteristics, such as preferred gambling activity. There was consistent evidence that male problem gambling was associated with impulsivity, substance and alcohol use, while female problem gambling was associated with unemployment, psychological distress and childhood abuse. The majority of findings, however, were mixed or limited by the small number of studies, highlighting the need for further gender-sensitive research to improve prevention and intervention approaches.

Background This study investigated the validity of conceptualising elevated stress in parents of children who exhibit challenging behaviour within the framework of posttraumatic stress disorder (PTSD). It was hypothesised that parents of children with autism spectrum disorder (ASD), and parents of children with a rare disease would endorse greater PTSD symptomatology than parents of typically developing (TD) children, and that challenging child behaviours would positively predict PTSD symptomatology. Method The Life Events Checklist for DSM-5, Developmental Behaviour Checklist (Parent) and PTSD Checklist for DSM-5 were administered to 395 parents. Results Significantly more PTSD symptomatology was reported by parents of children with ASD and parents of children with a rare disease than parents of TD children, and challenging child behaviours positively predicted PTSD symptomatology in both groups. Conclusion A PTSD framework may validly explain elevated stress among some parents of children with ASD and parents of children with a rare disease, and has important implications for support delivered to parents by healthcare providers.

A fundamental challenge to the timely diagnosis of Autism Spectrum Disorder (ASD) is the reliance on the observation of a set of aberrant behavior. Consequently, the diagnostic process requires that the child reach an age where the behaviors would typically be exhibited. The identification of a reliable biological marker (biomarker) could be of considerable benefit to the diagnostic process. As a diagnostic biomarker, porphyrins present an attractive prospect as previous studies have reported consistent findings of children with ASD showing significant elevations in porphyrin levels in contrast to controls. Furthermore, there is some evidence that ASD severity may be associated with porphyrins, which would be a valuable characteristic of any ASD biomarker. Importantly, for practical use, porphyrins can be tested non-invasively via a sample of urine. The present study sought to investigate whether porphyrin profiles can reliably be used to (a) differentiate ASD cases from healthy controls; and (b) predict ASD severity. The study compared the porphyrin levels of three groups of children aged 2-6 years: Group 1-children diagnosed with ASD (n = 70); Group 2-healthy, normally developing siblings of children diagnosed with ASD (n = 36); and Group 3-healthy, normally developing children with no known blood relative diagnosed with ASD (n = 54). The results of logistic regression analyses failed to find support for the hypotheses that porphyrin levels could be used as a valid tool to detect ASD cases or predict severity. Autism Res 2014, 7: 535-542. © 2014 International Society for Autism Research, Wiley Periodicals, Inc.

The present study investigated the intergenerational transmission of problem gambling and the potential mediating role of parental psychopathology (problem drinking, drug use problems, and mental health issues). The study comprised 3953 participants (1938 males, 2015 females) recruited from a large-scale Australian community telephone survey of adults retrospectively reporting on parental problem gambling and psychopathology during their childhood. Overall, 4.0% [95%CI 3.0, 5.0] (n=157) of participants reported paternal problem gambling and 1.7% [95%CI 1.0, 2.0] (n=68) reported maternal problem gambling. Compared to their peers, participants reporting paternal problem gambling were 5.1 times more likely to be moderate risk gamblers and 10.7 times more likely to be problem gamblers. Participants reporting maternal problem gambling were 1.7 times more likely to be moderate risk gamblers and 10.6 times more likely to be problem gamblers. The results revealed that the relationships between paternal-and-participant and maternal-and-participant problem gambling were significant, but that only the relationship between paternal-and-participant problem gambling remained statistically significant after controlling for maternal problem gambling and sociodemographic factors. Paternal problem drinking and maternal drug use problems partially mediated the relationship between paternal-and-participant problem gambling, and fully mediated the relationship between maternal-and-participant problem gambling. In contrast, parental mental health issues failed to significantly mediate the transmission of gambling problems by either parent. When parental problem gambling was the mediator, there was full mediation of the effect between parental psychopathology and offspring problem gambling for fathers but not mothers. Overall, the study highlights the vulnerability of children from problem gambling households and suggests that it would be of value to target prevention and intervention efforts towards this cohort.

Pink disease (infantile acrodynia) was especially prevalent in the first half of the 20th century. Primarily attributed to exposure to mercury (Hg) commonly found in teething powders, the condition was developed by approximately 1 in 500 exposed children. The differential risk factor was identified as an idiosyncratic sensitivity to Hg. Autism spectrum disorders (ASD) have also been postulated to be produced by Hg. Analogous to the pink disease experience, Hg exposure is widespread yet only a fraction of exposed children develop an ASD, suggesting sensitivity to Hg may also be present in children with an ASD. The objective of this study was to test the hypothesis that individuals with a known hypersensitivity to Hg (pink disease survivors) may be more likely to have descendants with an ASD. Five hundred and twenty-two participants who had previously been diagnosed with pink disease completed a survey on the health outcomes of their descendants. The prevalence rates of ASD and a variety of other clinical conditions diagnosed in childhood (attention deficit hyperactivity disorder, epilepsy, Fragile X syndrome, and Down syndrome) were compared to well-established general population prevalence rates. The results showed the prevalence rate of ASD among the grandchildren of pink disease survivors (1 in 22) to be significantly higher than the comparable general population prevalence rate (1 in 160). The results support the hypothesis that Hg sensitivity may be a heritable/genetic risk factor for ASD.

Information and communication technologies are increasingly being used to remotely deliver psychological services. This delivery method confers clear advantages to both client and therapist, including the accessibility of services by otherwise unserved populations and cost-effective treatment. Remote services can be delivered in a real-time or delayed manner, providing clients with a wealth of therapy options not previously available. The proliferation of these services has outstripped the development and implementation of all but the most rudimentary of regulatory frameworks, potentially exposing clients to substandard psychological services. Integrating mandatory training on the delivery of online psychological services into accredited postgraduate psychology courses would aid in addressing this issue. The purpose of this article is to outline issues of consideration in the development and implementation of such a training programme. An online etherapy training programme developed by Swinburne University's National eTherapy Centre will be used as an example throughout.

Despite the removal of the mercury (Hg)-based preservative thimerosal from vaccines listed on the Australian Immunization Program Schedule for children, concerns remain among some researchers and parents for the safety of the present schedule, in part due to a fear of residual trace levels of Hg. The purpose of this study was to independently assess childhood vaccines for the presence of Hg. Eight vaccines administered to children under the age of 5 yr were assessed for Hg content via a DMA-80 direct mercury analyzer. Seven of the 8 vaccines contained no detectable levels of Hg (less than 1 ppb); however, 1 vaccine (Infanrix hexa) tested positive for Hg at 10 ppb. The result was confirmed and validated by retesting the original sample. Follow-up testing was conducted on three additional samples of Infanrix hexa (one from the same production lot and two from a different lot). All three tested positive for Hg (average of 9.7 ppb). Although the levels of Hg detected are substantially lower than any established exposure safety limits, the results of this study reveal that inaccuracies exist in public health messages, professional communications, and official documentation regarding Hg content in at least one childhood vaccine. In the interests of public health, it is incumbent on vaccine manufacturers and responsible agencies such as the Therapeutic Goods Administration and the Federal Department of Health and Ageing to address this issue as a matter of urgency.

Internet-based interventions with therapist support have proven effective for treating a range of mental health conditions. This study examined whether frequency of therapist contact affected treatment outcomes. Fifty-seven people with panic disorder (including 32 with agoraphobia) were randomly allocated to an 8-week Internet-based cognitive behavioural treatment intervention (Panic Online) with either frequent (three e-mails per week) or infrequent (one e-mail per week) support from a psychologist. Posttreatment, intention-to-treat analyses revealed that both treatments were effective at improving panic disorder and agoraphobia severity ratings, panic-related cognitions, negative affect, and psychological and physical quality of life domains, with no differences between conditions. High end-state functioning was achieved by 28.6% of the frequent and infrequent participants, respectively. Therapist alliance, treatment credibility, and satisfaction also did not differ between groups, despite significantly greater therapist time invested in the frequent contact condition. The results provide evidence that the effectiveness of Internet-based mental health interventions may be independent of the frequency of therapist support and may, therefore, be more cost-effective than previously reported.

This paper reports on the results of an evaluation of Gambler's Helpline (GHL) in Victoria, Australia. Particular focus was given to consumers' experiences of accessing the helpline and the overall effectiveness of the service. GHL callers were recruited to participate in an immediate post-call questionnaire-based telephone interview (N = 90) and one-month follow-up interview (N = 56). The first aim of the study was to present a descriptive profile of those accessing the helpline. The second aim was to examine the effectiveness of the counselling intervention through measures taken post callers' contact to GHL. The final aim was to examine referral uptake at a follow-up. Results of this study reflected positively on GHL. Callers reported general overall satisfaction with the service. Consumer feedback highlighted the importance for GHL counsellors of providing a balance of both emotional and practical support for callers, and the importance for callers to access referrals was identified.

The aim of this paper was to consider the impact on psychologists of one component of the Australian Government's Better Outcomes in Mental Health Care (BOiMHC) program, namely the Access to Allied Psychological Services (ATAPS) component. This supports psychologists and general practitioners (GPs) to work together to provide optimal mental health care, via 102 projects being conducted by Divisions of General Practice. The paper was informed by data from five sources: a project-based minimum dataset; local project evaluation reports; a forum; a survey of projects; and a survey of Australian Psychological Society (APS) members. Taken together, the data from these sources showed that a significant number of psychologists are providing services through the projects, and the majority are finding it a positive and professionally rewarding experience. There is considerable variability regarding models of retaining, locating and referring to psychologists, and there are pros and cons associated with eac...

A fundamental challenge to the timely diagnosis of Autism Spectrum Disorder (ASD) is the reliance on the observation of a set of aberrant behavior. Consequently, the diagnostic process requires that the child reach an age where the behaviors would typically be exhibited. The identification of a reliable biological marker (biomarker) could be of considerable benefit to the diagnostic process. As a diagnostic biomarker, porphyrins present an attractive prospect as previous studies have reported consistent findings of children with ASD showing significant elevations in porphyrin levels in contrast to controls. Furthermore, there is some evidence that ASD severity may be associated with porphyrins, which would be a valuable characteristic of any ASD biomarker. Importantly, for practical use, porphyrins can be tested non-invasively via a sample of urine. The present study sought to investigate whether porphyrin profiles can reliably be used to (a) differentiate ASD cases from healthy controls; and (b) predict ASD severity. The study compared the porphyrin levels of three groups of children aged 2-6 years: Group 1-children diagnosed with ASD (n = 70); Group 2-healthy, normally developing siblings of children diagnosed with ASD (n = 36); and Group 3-healthy, normally developing children with no known blood relative diagnosed with ASD (n = 54). The results of logistic regression analyses failed to find support for the hypotheses that porphyrin levels could be used as a valid tool to detect ASD cases or predict severity.

Chapter 49 considers Anxiety Online - a 'virtual' online clinical assessment and treatment service, and describes an online clinician training program for online low intensity practitioners (‘etherapists’) to work ‘in’ the Anxiety Online virtual clinic, and the challenges and solutions involved.

Posttraumatic stress disorder (PTSD) is a debilitating mental health condition frequently associated with psychiatric comorbidity and diminished quality of life, and it typically follows a chronic, often lifelong, course. Previous research has shown that trauma-related psychopathology (but not necessarily clinical PTSD) can be effectively treated via the Internet. This study is the first of its kind to report on the online treatment of patients with a Diagnostic and Statistical Manual of Mental Disorders (fourth edition) clinical diagnosis of PTSD with therapist support by e-mail only. Preliminary findings are presented of an open trial involving a 10-week Internet-based therapist-assisted cognitive behavioural treatment for PTSD (PTSD Online). Pre and posttreatment measures of PTSD and related symptomatology were compared for 16 participants with a variety of trauma experiences. Participants showed clinically significant reductions in PTSD severity and symptomatology, moderate tolerance of the program content, and high therapeutic alliance ratings. No significant change was found on measures of more general psychological symptoms. The results suggest that PTSD Online appears to be an effective and accessible clinical treatment for people with a confirmed PTSD diagnosis.

Background - There is a growing trend for individuals to seek health information from online sources. Alcohol and other drug (AOD) use is a significant health problem worldwide, but access and use of AOD websites is poorly understood. Objective - To investigate content and functionality preferences for AOD and other health websites. Methods - An anonymous online survey examined general Internet and AOD-specific usage and search behaviors, valued features of AOD and health-related websites (general and interactive website features), indicators of website trustworthiness, valued AOD website tools or functions, and treatment modality preferences. Results - Surveys were obtained from 1214 drug (n = 766) and alcohol website users (n = 448) (mean age 26.2 years, range 16-70). There were no significant differences between alcohol and drug groups on demographic variables, Internet usage, indicators of website trustworthiness, or on preferences for AOD website functionality. A robust website design/navigation, open access, and validated content provision were highly valued by both groups. While attractiveness and pictures or graphics were also valued, high-cost features (videos, animations, games) were minority preferences. Almost half of respondents in both groups were unable to readily access the information they sought. Alcohol website users placed greater importance on several AOD website tools and functions than did those accessing other drug websites: online screening tools (χ²2 = 15.8, P < .001, n = 985); prevention programs (χ²2 = 27.5, P < .001, n = 981); tracking functions (χ²2 = 11.5, P = .003, n = 983); self help treatment programs (χ²2 = 8.3, P = .02, n = 984); downloadable fact sheets for friends (χ²2 = 11.6, P = .003, n = 981); or family (χ²2 = 12.7, P = .002, n = 983). The most preferred online treatment option for both the user groups was an Internet site with email therapist support. Explorations of demographic differences were also performed. While gender did not affect survey responses, younger respondents were more likely to value interactive and social networking features, whereas downloading of credible information was most highly valued by older respondents. Conclusions - Significant deficiencies in the provision of accessible information on AOD websites were identified, an important problem since information seeking was the most common reason for accessing these websites, and, therefore, may be a key avenue for engaging website users in behaviour change. The few differences between AOD website users suggested that both types of websites may have similar features, although alcohol website users may more readily be engaged in screening, prevention and self-help programs, tracking change, and may value fact sheets more highly. While the sociodemographic differences require replication and clarification, these differences support the notion that the design and features of AOD websites should target specific audiences to have maximal impact.

This study was an open trial evaluation of a 10-week therapist-assisted cognitive behavior therapy (CBT) internet intervention (PTSD Online) undertaken with people with a primary clinical diagnosis of posttraumatic stress disorder (PTSD) (n = 22) at pre-assessment. Participants were re-assessed at post-assessment and 3-month follow-up. Significant improvements on PTSD severity ratings and related PTSD symptomatology were observed at post-assessment and maintained at 3-month follow-up. At post-assessment, 69.2% of the sample showed clinically significant improvement and 77% of the sample at follow-up assessment. Non-significant, yet improved, change was observed on all other general psychological measures. Overall, treatment satisfaction was good (69%), participant therapeutic alliance ratings were high (87.5%), and the average total therapist time required was 194.5 min. PTSD Online appears to be an efficacious treatment option for people with PTSD that can be provided entirely remotely, with far less therapist time than traditional face-to-face treatment, and without compromising therapeutic alliance.

Objective The primary aim was to determine if laser acupuncture (LA) is more effective than sham laser in reducing pain and disability in adults with chronic non-specific low back pain. Methods The design was a double blind, two-group parallel randomised controlled trial. The active intervention was an 830 nm (infrared), 10 mW, Ga-Al-As laser diode laser for acupuncture and a sham control. The primary outcome measures were changes in pain (visual analogue scale) and disability (Oswestry Disability Index) at the end of 5–10 treatment sessions. Secondary outcomes were patient global assessment, psychological distress (Depression Anxiety Stress Scale) and subjective wellbeing (Personal Wellbeing Index). Follow up was performed at 6 weeks and 6 months after completion of treatment. Results 100 participants were enrolled and treated in a general practice setting. Per protocol analysis of the primary outcome measures using ANOVA suggested that although there was a significant overall improvement in pain and disability after the course of treatments (pConclusion This study did not show a specific effect for LA using infrared laser at 0.2 Joules per point for chronic low back pain. The overall intervention appeared effective because of placebo and other factors. As there was some concern about baseline inequality between the groups further research using tighter inclusion criteria should attempt to replicate the result and examine if a dose response may exist.

Panic Online (PO) is a well-established evidence-based internet intervention program for panic disorder (PD) (with or without agoraphobia), when supported by a therapist (email or face-to-face). However, there has been no exploration to date as to whether PO is also effective when administered in a selfguided format (i.e., with no therapist assistance provided). The objective of this pilot trial was to examine whether PO as a self-guided program was effective at reducing panic symptomatology and furthermore, whether participants found the program format satisfactory. Pre- and post-treatment clinical interviews were conducted by telephone with six participants and experience of using the self-guided PO program was also explored. Paired samples t-tests revealed that PD and agoraphobia were significantly reduced by posttreatment, but panic frequency (over the previous month) did not significantly change. Qualitatively, all participants reported being satisfied with the program, however all participants reported that access to human support during the intervention (e.g., to answer questions, to be heard, to help motivate) was preferable. Initial pilot data suggests that PO self-guided works effectively as a stand-alone clinical internet-based treatment program for PD, however additional research is required to definitively establish its efficacy. Keyword s: Computer-aided psychotherapy; panic disorder and agoraphobia; self-help; CBT

Therapeutic online games are potentially a valuable way of improving the mental health of young people. The purpose of this paper is to discuss the qualitative component of a formal evaluation conducted on Reach Out Central (ROC), an online game for 16-25 year olds which aims to improve mental health. Participants completing a post-program survey from the evaluation ( n=154) were required to respond to two openended questions; what they liked most, and least, about ROC. Responses indicate that online games can be a successful way of educating, as well as attracting and engaging, young people. Suggestions are made regarding issues future developers should take into consideration when developing programs of a similar nature.

Two recent studies, from France (Nataf et al., 2006) and the United States (Geier & Geier, 2007), identified atypical urinary porphyrin profiles in children with an autism spectrum disorder (ASD). These profiles serve as an indirect measure of environmental toxicity generally, and mercury (Hg) toxicity specifically, with the latter being a variable proposed as a causal mechanism of ASD (Bernard et al., 2001; Mutter et al., 2005). To examine whether this phenomenon occurred in a sample of Australian children with ASD, an analysis of urinary porphyrin profiles was conducted. A consistent trend in abnormal porphyrin levels was evidenced when data was compared with those previously reported in the literature. The results are suggestive of environmental toxic exposure impairing heme synthesis. Three independent studies from three continents have now demonstrated that porphyrinuria is concomitant with ASD, and that Hg may be a likely xenobiotic to produce porphyrin profiles of this nature.

Objective: To identify the health and mental health information needs of people with coronary heart disease (CHD), with and without comorbid depression. Design and setting: A qualitative study conducted in Melbourne in 2006, using thematic analysis of semi-structured interviews on the types of health information that patients with CHD considered useful to assist with the management of their illness. Structured clinical interviews were used to assess current and prior depressive episodes in these patients. Participants: 14 general practice patients (eight with current or prior history of major depression) who had experienced myocardial infarction, coronary artery bypass graft surgery, angioplasty or angina (confirmed via testing). Results: Four themes relating to information on how patients could manage their cardiovascular health and improve their psychosocial wellbeing emerged: psychosocial; physical activity; medical; and information for family. The most prominent information needs included identification and management of risk-related physical symptoms, and psychosocial information, most notably to enhance patients’ social support. Patients considered this information important for alleviating health anxiety and negative affect. Conclusion: This small patient sample endorsed the need for health and mental health information on a range of psychosocial and physical health topics. Participants desired specific types of information to assist with the self-management of their health and to assuage their health concerns.

Background Mental illness is an escalating concern worldwide. The management of disorders such as anxiety and depression largely falls to family doctors or general practitioners (GPs). However, GPs are often too time constrained and may lack the necessary training to adequately manage the needs of such patients. Evidence-based Internet interventions represent a potentially valuable resource to reduce the burden of care and the cost of managing mental health disorders within primary care settings and, at the same time, improve patient outcomes. Objective The present study sought to extend the efficacy of a therapist-assisted Internet treatment program for panic disorder, Panic Online, by determining whether comparable outcomes could be achieved and maintained when Panic Online was supported by either GPs or psychologists. Methods Via a natural groups design, 96 people with a primary diagnosis of panic disorder (with or without agoraphobia) completed the Panic Online program over 12 weeks with the therapeutic assistance of their GP (n = 53), who had received specialist training in cognitive behavioral therapy, or a clinical psychologist (n = 43). Participants completed a clinical diagnostic telephone interview, conducted by a psychologist, and a set of online questionnaires to assess panic-related symptoms at three time periods (pretreatment, posttreatment, and 6 month follow-up). Results Both treatments led to clinically significant improvements on measures of panic and panic-related symptomatology from pretreatment to posttreatment. Both groups were shown to significantly improve over time. Improvements for both groups were maintained at follow-up; however, the groups did differ significantly on two quality of life domains: physical (F1,82 = 9.13, P = .00) and environmental (F1,82 = 4.41, P = .04). The attrition rate was significantly higher among those being treated by their GP (χ21 = 4.40, P = .02, N = 96). Conclusions This study provides evidence that Internet-based interventions are an effective adjunct to existing mental health care systems. Consequently, this may facilitate and enhance the delivery of evidence-based mental health treatments to increasingly large segments of the population via primary care systems and through suitably trained health professionals.

Objectives: Very little is known about mechanisms of idiosyncratic sensitivity to the damaging effects of mercury (Hg); however, there is likely a genetic component. The aim of the present study was to search for genetic variation in genes thought to be involved in Hg metabolism and transport in a group of individuals identified as having elevated Hg sensitivity compared to a normal control group. Materials and Methods: Survivors of pink disease (PD; infantile acrodynia) are a population of clinically identifiable individuals who are Hg sensitive. In the present study, single nucleotide polymorphisms in genes thought to be involved in Hg transport and metabolism were compared across two groups: (i) PD survivors ( n = 25); and (ii) age- and sex-matched healthy controls ( n = 25). Results: Analyses revealed significant differences between groups in genotype frequencies for rs662 in the gene encoding paraoxanase 1 (PON1) and rs1801131 in the gene encoding methylenetetrahydrofolate reductase (MTHFR). Conclusions: We have identified two genetic polymorphisms associated with increased sensitivity to Hg. Genetic variation in MTHFR and PON1 significantly differentiated a group formerly diagnosed with PD (a condition of Hg hypersensitivity) with age- and gender-matched healthy controls.

Background Panic disorder (PD) is one of the most common anxiety disorders seen in general practice, but provision of evidence-based cognitive-behavioural treatment (CBT) is rare. Many Australian GPs are now trained to deliver focused psychological strategies, but in practice this is time consuming and costly.Objective To evaluate the efficacy of an internet-based CBT intervention (Panic Online) for the treatment of PD supported by general practitioner (GP)-delivered therapeutic assistance.Design Panic Online supported by GP-delivered face-to-face therapy was compared to Panic Online supported by psychologist-delivered email therapy.Methods Sixty-five people with a primary diagnosis of PD (78% of whom also had agoraphobia) completed 12 weeks of therapy using Panic Online and therapeutic assistance with his/her GP (n = 34) or a clinical psychologist (n = 31). The mean duration of PD for participants allocated to these groups was 59 months and 58 months, respectively. Participants completed a clinical diagnostic interview delivered by a psychologist via telephone and questionnaires to assess panic-related symptoms, before and after treatment.Results The total attrition rate was 20%, with no group differences in attrition frequency. Both treatments led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity and quality of life. There were no statistically significant differences in the two treatments on any of these measures, or in the frequency of participants with clinically significant PD at post assessment.Conclusions When provided with accessible online treatment protocols, GPs trained to deliver focused psychological strategies can achieve patient outcomes comparable to efficacious treatments delivered by clinical psychologists. The findings of this research provide a model for how GPs may be assisted to provide evidence-based mental healthcare successfully.