The prevention of mental disorders in young people

The prevention of some mental disorders in young people appears to be possible. Several small and medium randomised controlled trials show that some anxiety, affective and substance-use disorders can be prevented. These trials show that the interventions are efficacious, but whether they will be effective in routine practice is not known. The evidence is sufficiently good to warrant a large community trial in which the roll-out is staged and school communties evaluated before and after the roll-out.

Olanzapine vs risperidone in the management of schizophrenia: a randomized double-blind trial in Australia and New Zealand

Improved drug therapy for schizophrenia may represent the best strategy for reducing the costs of schizophrenia and the recurrent chronic course of the disease. Olanzapine and risperidone are atypical antipsychotic agents developed to meet this need. We report a multicenter, double-blind, parallel, 30-week study designed to compare the efficacy, safety, and associated resource use for olanzapine and risperidone in Australia and New Zealand. The study sample consisted of 65 patients who met DSM-IV criteria for schizophrenia, schizoaffective disorder, or schizophreniform disorder. Olanzapine-treated patients showed a significantly greater reduction in Positive and Negative Syndrome Scale (PANSS) total, Brief Psychiatric Rating Scale (BPRS) total, and PANSS General Psychopathology scores at endpoint compared to the risperidone-treated patients. Response rates through 30 weeks showed a significantly greater proportion of olanzapine-treated patients had achieved a 20% or greater improvement in their PANSS total score compared to risperidone-treated patients. Olanzapine and risperidone were equivalent in their improvement of PANSS positive and negative scores and Clinical Global Impression-Severity of Illness scale (CGI-S) at endpoint. Using generic and disease-specific measures of quality of life, olanzapine-treated patients showed significant within-group improvement in most measures, and significant differences were observed in favor of olanzapine over risperidone in Quality of Life Scale (QLS) Intrapsychic Foundation and Medical Outcomes Study Short Form 36-item instrument (SF-36) Role Functioning Limitations-Emotional subscale scores. Despite the relatively small sample size, our study suggests that olanzapine has a superior risk:benefit profile compared to risperidone. (C) 2002 Elsevier Science B.V. All rights reserved.

Homocysteine, Alzheimer genes and proteins, and measures of cognition and depression in older men

The epsilon4 allele of apolipoprotem E (APOE), and the plasma levels of APOE, amyloid beta-protein precursor, arnyloid beta1-40 (Abeta40) and homocysteine, (Hcy) have all been correlated with the presence of dementia. Mutations in the methylnetetrahydrofolate reductase enzyme (MTHFR) have been associated with elevated levels of Hcy. This study explored the association of these factors with cognition and depression in community dwelling older men. Two hundred and ninety-nine men, mean age 78.9 years (SD 2.8), were studied in this cross-sectional survey. Mean plasma Hcy was 13.5 (SD 5.3) mumol/L. The MTHFR genotype had no obvious impact on Hey levels. Ln Hcy and Ln Abeta40 were both inversely correlated with calculated glomerular filtration rate (cGFR), r = -0.41 (p < 0.001) and r = -0.28 (p < 0.001), respectively. There was a positive correlation between Ln Hey and Ln Abeta40, r = 0.19 (p < 0.001), which remained significant after adjusting for cGFR, with a doubling of Hcy associated with a 24% increase of Abeta40. The e4 allele was associated with increased depressive symptoms as measured by the Geriatric Depression Scale-15, Odds ratio (OR) = 2.59 (95% CI 1.06-6.34) and poorer performance on the Clock Drawing Test, OR = 2.32 (95% CI: 1.25-4.29). There was a positive association between Abeta40 and Hcy, even after adjustment for cGFR in this sample of well, community dwelling older men. This association may help elucidate the link between elevated levels of Hey and Alzheimer's disease.

Falls prevention in rural general practice: what stands the test of time and where to from here?

Objective: General practitioner recall of the 1992-96 'Stay on Your Feet'(SOYF) program and its influence on practice were surveyed five years post-intervention to gauge sustainability of the SOYF General Practice (GP) component. Methods: A survey assessed which SOYF components were still in existence, current practice related to falls prevention, and interest in professional development. All general practitioners (GPs) situated within the boundaries of a rural Area Health Service were mailed a survey in late 2001. Results: Response rate was 66.5% (139/ 209). Of 117 GPs in practice at the time of SOYF, 80.2% reported having heard of SOYF and 74.4% of those felt it had influenced practice. Half (50.9%) still had a copy of the SOYF GP resource and of those, 58.6% used it at least 'occasionally'. Three-quarters of GPs surveyed (75.2%) checked medications 'most/almost all' of the time with patients over 60 years; 46.7% assessed falls risk factors; 41.3% gave advice; and 22.6% referred to allied health practitioners. GPs indicated a strong interest in falls prevention- related professional development. There was no significant association between use of the SOYF resource package and any of the current falls prevention practices (all chi(2)>0.05). Conclusions and implications: There was high recall of SOYF and a general belief that it influenced practice. There was little indication that use of the resource had any lasting influence on GPs' practices. In future, careful thought needs to go into designing a program that has potential to affect long-term change in GPs' falls prevention practice.

Cognitive behavioral therapy for older adults: Practical guidelines for the use of homework assignments

There is emerging evidence to support the effectiveness of cognitive behavior therapy (CBT) for older adults. However, there are a number of clinical difficulties that practitioners often encounter when using homework assignments with the older adult population. In this article, we provide a brief summary of the research findings on homework in CBT, review common obstacles to the use of homework, and provide concrete suggestions for the adaptation of homework assignments to increase their potential effectiveness with older adults. We also describe several types of homework assignments that may be most helpful, augmenting these suggestions with clinical examples.

Coping with stereotype threat: Denial as an impression management strategy

Four experiments tested the hypothesis that people who are concerned with impression management cope with stereotype threat through denial. Consistent with this hypothesis, temporary employees threatened by a stereotype of incompetence (Study 1) and hostel-dwelling older adults (Study 2) were more likely to deny incompetence if they were high in impression management. African Americans (Study 3) showed a similar pattern of denying cognitive incompetence, which emerged primarily when they were interviewed by a White experimenter and had attended a predominantly Black high school. In Study 4, White students who expected to take an IQ test and were threatened by a stereotype of being less intelligent than Asians were more likely to deny that intelligence is important if they were high in impression management.

Aging, inhibition, and social inappropriateness

This study explores the hypothesis that age-related declines in inhibitory ability are associated with increases in socially inappropriate behavior. Consistent with this hypothesis, older participants were less likely than younger participants to differentiate between public and private settings when inquiring about potentially embarrassing issues, according to their peers. Additionally, this indiscriminate public inquiry was associated with decreased closeness with participants' peers, particularly for older adults. Finally, this age-related increase in social inappropriateness was mediated by inhibitory deficits associated with aging. These results suggest that age-related deficits in inhibitory ability may cause people to become socially inappropriate against their will.

The effects of adolescent cannabis use: How should the empirical evidence inform drug policy for young people? : Meeting abstract

Ethics as a subject is now consistently taught in medical schools within Australia. The theoretical Ethical models used, and the associated clinical discussions, vary between schools. Registrars have further theoretical Ethics teaching within Psychiatry Fellowship Training, and ongoing clinical work that is likely to provide exposure to complex and frequent Ethical dilemmas. As Psychiatry Trainees approach subspecialty training in Child and Adolescent Psychiatry they therefore have a rich experience of both theoretical Ethics teaching and clinical exposure to Ethical issues. In this symposium, the difficulties Child and Adolescent Psychiatry Trainees may have in the integration of multiple theoretical Ethical models are discussed. It is suggested that these difficulties make Ethics Teaching for Child and Adolescent Psychiatry Trainees particularly challenging. This is important given the complex Ethical issues often present when working with Children and their Families. The three main Ethical models of Deontology, Virtue Ethics and Consequentialism are described and their usefulness for the Child and Adolescent Psychiatrist examined. Limitations of these models, and “Four Principles” approaches (such as that of Beauchamp and Childress), for Child and Adolescent Psychiatry, are also considered. Clinical cases are included for discussion. Finally, the ways in which these models may be used to enhance Child and Adolescent Psychiatry Training, and subsequent clinical practice as a Child and Adolescent Psychiatrist, are discussed. The integration of different theoretical Ethical models is considered, with implications identified for clinical practice.