Instruments that prospectively predict bipolar disorder - a systematic review

BACKGROUND: Identification of earlier stages of Bipolar Disorder (BD), even prior to the first manic episode, may help develop interventions to prevent or delay the onset of BD. However, reliable and valid instruments are necessary to ascertain such earlier stages of BD. The aim of the current review was to identify instruments that had predictive validity and utility for BD for use in early intervention (EI) settings for the prevention of BD. METHODS: We undertook a systematic examination of studies that examined participants without BD I or II at baseline and prospectively explored the predictive abilities of instruments for BD onset over a period of 6 months or more. The instruments and the studies were rated with respect to their relative validity and utility predicting onset of BD for prevention or early intervention. Odds ratios and area under the curve (AUC) values were derived when not reported. RESULTS: Six studies were included, identifying five instruments that examined sub-threshold symptoms, family history, temperament and behavioral regulation. Though none of the identified instruments had been examined in high-quality replicated studies for predicting BD, two instruments, namely the Child Behavioral Checklist - Pediatric BD phenotype (CBCL-PBD) and the General Behavioral Inventory - Revised (GBI-R), had greater levels of validity and utility. LIMITATION: Non-inclusion of studies and instruments that incidentally identified BD on follow-up limited the breadth of the review. CONCLUSION: Instruments that test domains such as subthreshold symptoms, behavioral regulation, family history, and temperament hold promise in predicting BD onset.

An investigation of the potential association between mercury and Autism Spectrum Disorder: an interdisciplinary approach

 Dr Shandley took a novel approach to investigate the mercury-autism hypothesis. Her studies unearthed conflicting results. Contrary to previous biological studies, autistic children did not demonstrate a pattern of mercury toxicity. However, in a world first study, Dr Shandley found that the rate of autism among children with a family history of mercury sensitivity was 6-7 times higher than the general population.

Intensive case management for high-risk patients with first-episode psychosis: service model and outcomes

Background : The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment as usual.

Methods : Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15–24 years) in a naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case management referral and discharge.

Findings : Referrals were predominately unemployed males with low levels of functioning and educational attainment. They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings, admissions, bed days, and crisis contacts.

Interpretation : Characterisation of intensive case management patients validated the clinical research focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream within a well-established first episode of psychosis service showed significant improvement in key service outcomes. Further analysis is needed to determine cost savings and effects on psychosocial outcomes. Targeting intensive case management services to high-risk patients with unmet needs should reduce the distress associated with pathways to care for patients, their families, and the community.

The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies

The objectives of this meta-analysis were to examine the magnitude of the relative risk (RR) of developing type 2 diabetes for overweight and obese populations, compared to those with normal weight, and to determine causes of the variation in RR between various cohort studies. The magnitude of the RR was analyzed by combining 18 prospective cohort studies that matched defined criteria. The variance in RR between studies was explored. The overall RR of diabetes for obese persons compared to those with normal weight was 7.19, 95% CI: 5.74, 9.00 and for overweight was 2.99, 95% CI: 2.42, 3.72. The variation in RR among studies was explored and it was found that the effect of heterogeneity was highly related with sample size, method of assessment of body mass index (BMI) and method of ascertainment of type 2 diabetes. By combining only cohort studies with more than 400 cases of incident diabetes (>median), adjusted by at least three main confounding variables (age, family history of type 2 diabetes, physical activity), measured BMI, and diabetes determined by clinical diagnosis, the RR was 7.28, 95% CI: 6.47, 8.28 for obesity and 2.92, 95% CI: 2.57, 3.32 for overweight.

Persistence and subtype stability of ADHD among substance use disorder treatment seekers

OBJECTIVE: To examine ADHD symptom persistence and subtype stability among substance use disorder (SUD) treatment seekers. METHOD: In all, 1,276 adult SUD treatment seekers were assessed for childhood and adult ADHD using Conners' Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; CAADID). A total of 290 (22.7%) participants met CAADID criteria for childhood ADHD and comprise the current study sample. RESULTS: Childhood ADHD persisted into adulthood in 72.8% (n = 211) of cases. ADHD persistence was significantly associated with a family history of ADHD, and the presence of conduct disorder and antisocial personality disorder. The combined subtype was the most stable into adulthood (78.6%) and this stability was significantly associated with conduct disorder and past treatment of ADHD. CONCLUSION: ADHD is highly prevalent and persistent among SUD treatment seekers and is associated with the more severe phenotype that is also less likely to remit. Routine screening and follow-up assessment for ADHD is indicated to enhance treatment management and outcomes.

Crisis in Clio's family : a study of the discipline of Australian economic history 1918-1965

This thesis presents an intellectual history of the historiography of Australian Economic History between 1918 and 1965. More specifically, it is a contribution to a relatively novel area of research into 'disciplinary history’. It takes as its basic analytical material the four books widely used for significant lengths of time for undergraduate teaching during the period of the study. The thesis consists of five main chapters, plus an appendix which surveys the institutional development of Australian Economic History and provides the empirical basis for the selection of the works named above. After a brief introduction and overview, the next four chapters consist of a detailed study of one of these works, the historical context in which each was written, and an intellectual biography. The fifth chapter is largely theoretical and conceptual. It analyses the epistemological bases of History and Economics and explores the implications of different models of knowledge for the relationship between Economic History and its two antecedent disciplines, History and Economics. Current perceptions of the state of the discipline in Australia and overseas are also examined. There are three main propositions advanced and their implications explored in the fifth chapter. First, that changes which occurred in Australian Economic History during the period 1918-1965 shifted the discipline from the broad area of History to the broad area of Economics. Second, that the inherent tension and fundamental differences between the two disciplinary areas of History and Economics have profound and complex implications for Australian Economic History at a number of levels and in a number of areas. The third proposition posits that the paradigm shift of the 1950s/1960s in Australian Economic History, and the paradigm shift of the 1960s/1970s in Economic History respectively have resulted in crisis. The final part of the chapter summarises the contents of the preceding chapters, and draws some conclusions based on those detailed studies.

The subjective well-being of people caring for a family member with a severe disability at home: a review

This review concerns the life quality of people caring for a relative with a severe disability within their family. It involves the balance between the advantages such care brings to the care recipient and the costs borne by the family. A brief history indicates that the forces that encourage family care are minimally concerned with family welfare. Moreover, an analysis of both qualitative and quantitative data indicates that primary caregivers are at considerable risk of high stress, clinical depression, and abnormally low subjective quality of life. It is concluded that increased public expenditure directed to the care of people with severe disability is urgently required.

Calescharidae, a new family for the Tertiary to Recent Genera Caleschara MacGillivray and Tretosina Canu and Bassler (Bryozoa: Cheilostomata)

A new family of Cheilostomata, the Calescharidae, is introduced for the genus Caleschara MacGillivray and its Recent Australian typespecies, C. denticulata(MacGillivray), which is redefined from type and other material. The Australian Tertiary genus Tretosina Canu & Bassler and its type species,T. arcifera Canu & Bassler, are closely related,and are also assigned to the Calescharidae. The history and significance of family attributions of both genera are outlined, and RecentC. denticulata from Australian and other localities is distinguished from the Late Tertiary Victorian species C. parva Maplestone. Caleschara lithconis, sp. nov., from the Late Eocene of Victoria is one of the earliest known species: its morphology closely resembles a Recent form from the Philippines, C. junctifera Canu & Bassler. Another Recent species, Caleschara minuta (Maplestone) from the GilbertIslands, is a senior synonym of three other Indo-Pacific species,C. levinseni Harmer, C. laxa Canu & Bassler and Floridinella arculifera Canu & Bassler, and resembles the European Paleocene C. squamosa. Three other related species are briefly discussed. Close relationships to other families are problematic and are discussed; divergence in the early history of the cheilostomes is inferred.

Work choices : Increasing productivity, job creation and work-family balance? Not likely!

The introduction of the Workplace Relations (Work Choices) Amendment Act 2005 (Cth) has resulted in one of the most contentious changes to federal labour law in Australia’s history. There is considerable debate as to whether it has fulfilled the government’s expectations of giving ‘flexibility’ and ‘choice’ to both employees and employers or if there has been an overall deterioration in working conditions. In order to identify the impact of this legislation in the workplace, Deakin University surveyed 11,000 AHRI members throughout Australia. Preliminary results are reported in the paper but, even at this early stage, there is sufficient material to critically comment upon the changes to Australia’s industrial relations system. It appears that the vast majority of AHRI members felt that there had been no change in productivity, job creation or work-family balance and that only a few expected an improvement over the next 3 years.

A brief introduction to the history of the ß-amyloid protein (Aß) of Alzheimer's disease

Alzheimer’s disease (AD) is the most common cause of dementia in the elderly. Typically, the disease progresses in a prolonged, inexorable manner [1]. Patients initially show symptoms of mild cognitive impairment, which may include some memory loss. As the disease progresses, more severe memory loss occurs (e.g., retrograde amnesia) leading to confusion and lack of orientation. The patient is often institutionalized in this period, as it becomes increasingly difficult for family members to cope with the constant requirements of care. In later stages of the disease, apathy and stupor can occur, and the patient becomes bedridden.

Importance of assessing family dysfunction in conjunction with standardised measures when treating substance abuse

In this thesis, the link between substance abuse and family dysfunction is examined, and an argument is made for the assessment of family dysfunction when treating clients with substance abuse issues. Family dysfunction has been associated with a broad range of problems in children (e.g., low self esteem, increased risk of child abuse) through to adolescence and adulthood (e.g., increased risk of mental disorders such as depressive disorders, substance abuse disorders, and personality disorders) (Kaplan & Sadock, 1998). It is not the purpose of this thesis to suggest that family dysfunction causes substance abuse but rather to highlight that family dysfunction can in some cases place the individual at greater risk of substance abuse. Therefore, in order to understand the reasons why substance abuse developed and how it is maintained in the present requires the assessment of family dysfunction. Further, the importance of assessing the role and impact that family dysfunction may have had on the client, may help to better understand the nature and extent of substance abuse so that relevant and appropriate treatment goals for change may be set, progress monitored, and risk of relapse reduced. Chapter 1 provides a brief introduction to this thesis, and Chapter 2 is a review of the literature on the impact of family dysfunction including poor parental attachment and supervision, neglect, physical and sexual abuse, in adolescence and adulthood. Four case studies are presented to illustrate how family dysfunction and substance abuse may be related, thus highlighting the importance of assessing family dysfunction when treating substance abuse clients. All of the case studies include an individual with a substance abuse disorder (namely heroin) but they are diverse in terms of the types and extent of family dysfunction. The final chapter discusses the case studies in relation to the literature reviewed. Lastly, it gives consideration to the implication of a history of family dysfunction, and how it may impact negatively on treatment and therefore prognosis.

Regressive logistic and proportional hazards disease models for within-family analyses of measured genotypes, with application to a CYP17 polymorphism and breast cancer

Various statistical methods have been proposed to evaluate associations between measured genetic variants and disease, including some using family designs. For breast cancer and rare variants, we applied a modified segregation analysis method that uses the population cancer incidence and population-based case families in which a mutation is known to be segregating. Here we extend the method to a common polymorphism, and use a regressive logistic approach to model familial aggregation by conditioning each individual on their mother's breast cancer history. We considered three models: 1) class A regressive logistic model; 2) age-of-onset regressive logistic model; and 3) proportional hazards familial model. Maximum likelihood estimates were calculated using the software MENDEL. We applied these methods to data from the Australian Breast Cancer Family Study on the CYP17 5UTR TC MspA1 polymorphism measured for 1,447 case probands, 787 controls, and 213 relatives of case probands found to have the CC genotype. Breast cancer data for first- and second-degree relatives of case probands were used. The three methods gave consistent estimates. The best-fitting model involved a recessive inheritance, with homozygotes being at an increased risk of 47% (95% CI, 28-68%). The cumulative risk of the disease up to age 70 years was estimated to be 10% or 22% for a CYP17 homozygote whose mother was unaffected or affected, respectively. This analytical approach is well-suited to the data that arise from population-based case-control-family studies, in which cases, controls and relatives are studied, and genotype is measured for some but not all subjects.

Re-framing the riot : journalism, creative non-fiction and telling the story of Australia's black history

On 19 November 2004, an Aboriginal man was arrested on Palm Island, off the coast of Townsville in northern Queensland. He was taken to the local watch house on a drunk and disorderly charge. An hour later, he lay dead on a cell floor. His liver, an autopsy showed, had been split in half and his spleen ruptured. But when that autopsy report also found that Mulrunji Doomadgee’s severe injuries were not caused by force, the Palm Island Indigenous community, enraged and grief-stricken, went looking for payback.

The Palm Island “riots” ensured that this Aboriginal death in custody made international news headlines where others barely got a mention, if at all (Hollinsworth, 2005). The ensuing Coronial Inquest and criminal prosecution of the arresting Queensland police officer, Chris Hurley, also were covered consistently by the news media. Senior Sergeant Hurley has, however, so far escaped punishment and the Queensland media’s most recent report of the case was to tell how the Qld Police Union now funds a legal bid to clear his name. Meanwhile, little is heard in the news media of the Doomadgee family, the Palm Island community, or of other deaths in custody occurring steadily through the 18 years since the Royal Commission that was supposed to implement a raft of preventative recommendations.

While the news media’s framing of these issues has most often followed historically predictable and ultimately racist lines, a work of creative non-fiction tells the story with warranted complexity and power. Chloe Hooper’s The Tall Man: Death and Life on Palm Island documents Cameron Doomadgee’s death, the riots, and the ensuing legal farce from the front row. Hooper, in the tradition of Truman Capote, arrived at Palm Island as a white writer from a big city. But by “walking the talk” – being with the Doomadgee family and their community through the hearings and after, Hooper was given extraordinary access to community, history, and significant cultural nuance barely identified by, let alone understood by, non-Indigenous readers.

By focussing on Hooper’s experience with sources and court reporting, compared with some print media coverage, this paper will consider the comparative roles of journalism and creative non-fiction in re-framing the Palm Island “riot”. It will suggest that Hooper’s work subverts some dominant (and racist) news media representations of Australian Indigenous peoples through its use of source relationships in an extended narrative structure.

Not dark yet : a personal history

Spurred on by his encroaching blindness, prominent historian David Walker's Not Dark Yet is a frank, witty and innovative memoir that connects the small, seemingly inconsequential events of daily life to larger historical themes of family, war, patriotism, racial identity, religious belief, knowledge of the world and death.