Improving family functioning and child outcome in methadone maintained families: the Parents Under Pressure programme

Twelve families responded to posters displayed in a methadone clinic for inclusion in a pilot study assessing the viability and potential utility of an intensive, multi-component family-focused intervention, the Parents Under Pressure programme. The programme was designed to improve child behaviour, decrease parental stress and improve family functioning in methadone-maintained families by targeting affect regulation, mood, views of self as a parent, drug use and parenting skills. Nine of the families completed the programme delivered in their homes; eight were recontacted at 3 months. Each family reported significant improvements in three domains: parental functioning, parent - child relationship and parental substance use and risk behaviour. In addition to the changes in family functioning, the majority of families reported a decrease in concurrent alcohol use, HIV risk-taking behaviour and maintenance dose of methadone. The families reported high levels of satisfaction with the programme. It is recommended that future studies include independent measures (e.g. behavioural observations) of child outcome and parental functioning. The results were optimistic and provided the impetus to evaluate the treatment programme using a randomized controlled trial.

Drug use patterns and mental health of regular amphetamine users during a reported 'heroin drought'

Aims The present study extends the findings of a pilot study conducted among regular amphetamine users in Newcastle, NSW, in 1998. It compares key features between current participants in a state capital city (Brisbane) and a regional city (Newcastle) and between the 1998 and current Newcastle sample. Design Cross-sectional survey. Setting Brisbane and Newcastle, Australia. Participants The survey was conducted among 214 regular amphetamine users within the context of a randomized controlled trial of brief interventions for amphetamine use. Measurements Demographic characteristics, past and present alcohol and other drug use and mental health, treatment, amphetamine-related harms and severity of dependence. Findings The main findings were as follows: (i) the rate of mental health problems was high among regular amphetamine users and these problems commonly emerged after commencement of regular amphetamine use; (ii) there were regional differences in drug use with greater accessibility to a wider range of drugs in a state capital city and greater levels of injecting risk-taking behaviour outside the capital city environment; and (iii) there was a significant increase in level of amphetamine use and percentage of alcohol users, a trend for a higher level of amphetamine dependence and a significant reduction in the percentage of people using heroin and benzodiazepines among the 2002 Newcastle cohort compared to the 1998 cohort. Conclusions Further longitudinal research is needed to elucidate transitions from one drug type to another and from recreational to injecting and regular use and the relationship between drug use and mental health in prospective studies among users. Implications Intervention research should evaluate the effectiveness of interventions aimed at: preventing transition to injecting and regular use of amphetamines; toward reducing levels of depression among amphetamine users and interventions among people with severe psychopathology and personality disorders; and toward reducing the prevalence of tobacco dependence among amphetamine users.

A transdisciplinary approach to adolescent forensic mental health

Objective: To examine new strategies which may be implemented to address the significant mental health and substance abuse problems of young people within the juvenile justice system. Method: Wide-ranging literature review of mental health problems within the juvenile justice population is given, illustrating the high prevalence of mental health problems within this cohort of young people. Reference is made to the differing demographics and agendas of the American justice system compared to that found in Australia. Results: It is suggested that new initiatives stemming from quality Australian studies are required in order to facilitate reform within adolescent forensic mental health. Psychiatrists need to be at the forefront of innovative policy delivery within the juvenile justice system. Conclusions: A transdisciplinary approach is required to meet the changing needs of young people within the juvenile justice system. Such a system of care recognizes that these young people and their families have multiple needs that cross traditional boundaries and a collaborative approach across agencies is essential at both the policy and practical level. Psychiatrists have an important role to play in the development of these services. A systemic process to address such needs is offered.

External health locus of control and general self-efficacy: Moderators of emotional distress among university students

A belief that doctors or family control one's health outcomes (external health locus of control), and a belief in one's own ability to achieve desired outcomes (general self-efficacy), may influence distress experienced in relation to a physical illness. This study examined the interaction between illness severity, external health locus of control and general self-efficacy in relation to distress. Illness severity was defined as acute or chronic illness, with the latter expected to be more stressful. Participants described a serious illness they experienced, and completed self-report scales in relation to it. Results confirmed that chronic illnesses were associated with more distress than acute illnesses across the sample. Hierarchical multiple regression analyses supported the predicted effects on distress of a three-way interaction involving external health locus of control, general self-efficacy and illness severity (acute vs. chronic). Analysis of these results may assist in explaining inconsistencies in previous research, and offer a model for understanding the role of person variables in emotional distress.

Eating disorders in children and adolescents: an update

Purpose of review Children and adolescents with eating disorders frequently present to child mental health and paediatric services and have significant morbidity, psychosocial impairment and mortality. Efforts to treat these individuals have been hampered by a poor evidence base for effective interventions. This article reviews research published during 2004 with a primary focus on this challenging clinical area. Recent findings Research published during 2004 has replicated past epidemiological findings and expanded our understanding of the relationship of family meal structure and disordered eating. Research has provided assistance in the well known clinical conundrums of excessive exercising in anorexia nervosa and predicting when return of menses will occur. There has also been clarification of adolescent bingeing. Potential advances include a new, noninvasive method of measuring body composition and investigations in adolescents on leptin, neuro and gastrointestinal peptides. Importantly, further evidence of the effectiveness of family therapy for anorexia nervosa and short-term benefits from intervention programs have been published. Summary The research base that will influence clinical practice in child and adolescent eating disorders is increasing. More research is required in all areas of intervention.

A preliminary case series on the use of quetiapine for posttraumatic stress disorder in juveniles within a youth detention center

Juveniles within the youth justice system have high rates of psychiatric morbidity, including posttraumatic stress disorder (PTSD). This case series describes 6 young people aged 15 to 17 years within a youth detention center who met the criteria for PTSD and reported an improvement in symptoms after 6 weeks of treatment with low-dose quetiapine. The primary outcome measure used was the Traumatic Symptom Checklist in Children. The dose of quetiapine ranged from 50 to 200 mg/d; T scores for PTSD symptoms decreased from 75 (SD, +/- 5.2; range, 68-82) to 54 (SD: +/- 7.4; range, 43-62) (P <= 0.01). Significant improvements in symptoms of dissociation (P <= 0.01), anxiety (P < 0.01), depression (P < 0.01).. and anger (P < 0.05) were also noted over the 6-week evaluation period. Low-dose quetiapine was tolerated well, with no persisting side effects or adverse events. Nighttime sedation was reported, although this was viewed as beneficial. All young people opted to continue with treatment after the assessment period. This preliminary case series suggests that juveniles in detention who have PTSD may benefit from treatment with quetiapine. Caution is needed in interpreting these findings. Both larger open-label and blinded trials are war-ranted to define the use of quetiapine in the treatment of PTSD in the adolescent forensic population.

Long-term outcome of a school-based, universal approach to prevention of depression in adolescents

In this study. the authors examined the 2-, 3-, and 4-year outcomes of a school-based, universal approach to the prevention of adolescent depression. Despite initial short-term positive effects, these benefits were not maintained over time. Adolescents who completed the teacher-administered cognitive-behavioral intervention did not differ significantly from adolescents in the monitoring-control condition in terms of changes in depressive symptoms, problem solving, attributional style, or other indicators of psychopathology from preintervention to 4-year follow-up. Results were equivalent irrespective of initial level of depressive symptoms.

Acculturation and eating disorders in Asian and Caucasian Australian adolescent girls

The present study aimed to compare the attitudes and psychopathology of eating disorders between Asian and Caucasian adolescent girls; and investigate the relationship between acculturation and the attitudes and psychopathology of eating disorders in subgroups of Asian girls. Two groups of non-clinical adolescent girls in Perth, Western Australia, were compared using a survey method. There were 17 Asian and 25 Caucasian adolescent girls, aged 14-17 drawn from private high schools in Perth who were screened using the Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI-2), and an acculturation index. The psychopathology scores for eating disorders of the Asian group were significantly higher than that of the Caucasian group in terms of total EDI-2 score, Interpersonal Distrust, Maturity Fears, Impulse Regulation and Social Insecurity subscales. Eating attitudes measured by Dieting subscale of the EAT-26 was significantly different. Within the Asian group, the less acculturated girls had higher scores on the EAT-26 and the EDI-2 than the more acculturated. Less acculturated Asian girls appeared to have unhealthier attitudes and psychopathology toward eating.

Seclusion of children and adolescents: Psychopathological and family factors

This paper describes the use of seclusion in a child and adolescent inpatient unit, including precipitating events, management strategies, details of seclusion episodes and individual and family risk factors. Inpatient ward documentation of seclusion episodes, demographic data and measures of individual psychopathology and impairment, parent mental health, life events and family functioning were used to compare secluded, non-secluded and outpatient groups. Secluded individuals had elevated psychopathology compared with non-secluded inpatients and outpatients. Their families reported poorer parental mental health and family functioning and more recent stressful life events. The results indicate that seclusion is most common among high-risk inpatients.

A genetically informed study of the association between harsh punishment and offspring behavioral problems

Conclusions about the effects of harsh parenting on children have been limited by research designs that cannot control for genetic or shared environmental confounds. The present study used a sample of children of twins and a hierarchical linear modeling statistical approach to analyze the consequences of varying levels of punishment while controlling for many confounding influences. The sample of 887 twin pairs and 2,554 children came from the Australian Twin Registry. Although corporal punishment per se did not have significant associations with negative childhood outcomes, harsher forms of physical punishment did appear to have specific and significant effects. The observed association between harsh physical punishment and negative outcomes in children survived a relatively rigorous test of its causal status, thereby increasing the authors' conviction that harsh physical punishment is a serious risk factor for children.

Genetic and environmental influences on extreme personality dispositions in adolescent female twins

Background: The objective was to determine whether the pattern of environmental and genetic influences on deviant personality scores differs from that observed for the normative range of personality, comparing results in adolescent and adult female twins. Methods: A sample of 2,796 female adolescent twins ascertained from birth records provided Junior Eysenck Personality Questionnaire data. The average age of the sample was 17.0 years ( S. D. 2.3). Genetic analyses of continuous and extreme personality scores were conducted. Results were compared for 3,178 adult female twins. Results: Genetic analysis of continuous traits in adolescent female twins were similar to findings in adult female twins, with genetic influences accounting for between 37% and 44% of the variance in Extraversion (Ex), Neuroticism (N), and Social Non-Conformity (SNC), with significant evidence of shared environmental influences (19%) found only for SNC in the adult female twins. Analyses of extreme personality characteristics, defined categorically, in the adolescent data and replicated in the adult female data, yielded estimates for high N and high SNC that deviated substantially (p < .05) from those obtained in the continuous trait analyses, and provided suggestive evidence that shared family environment may play a more important role in determining personality deviance than has been previously found when personality is viewed continuously. However, multiple-threshold models that assumed the same genetic and environmental determinants of both normative range variation and extreme scores gave acceptable fits for each personality dimension. Conclusions: The hypothesis of differences in genetic or environmental factors responsible for N and SNC among female twins with scores in the extreme versus normative ranges was partially supported, but not for Ex.

Use of latent profile analysis to identify eating disorder phenotypes in an adult Australian twin cohort

Context: The relationships among the different eating disorders that exist in the community are poorly understood, especially for residual disorders in which bingeing or purging occurs in the absence of other behaviors. Objective: To examine a community sample for the number of mutually exclusive weight and eating profiles. Design: Data regarding lifetime eating disorder symptoms and weight range were submitted to a latent profile analysis. Profiles were compared regarding personality, current eating and weight, retrospectively reported life events, and lifetime depressive psychopathology. Setting: Longitudinal study among female twins from the Australian Twin Registry in whom eating was assessed by a telephone interview. Participants: A community sample of 1002 twins (individuals) who had participated in earlier waves of data collection. Main Outcome Measures: Number and clinical character of latent profiles. Results: The best fit was a 5-profile solution with women who were (1) of normal weight with few lifetime eating disorders (4.3%), (2) overweight (10.6% had a lifetime eating disorder), (3) underweight and generally had no eating disorders except for 5.3% who had restricting anorexia nervosa, (4) of low to normal weight (89.0% had a lifetime eating disorder), and (5) obese (37.0% had a lifetime eating disorder). Each profile contained more than 1 type of lifetime eating disorder except for the third profile. Women in the first and third profiles had the best functioning, with women in the fourth and fifth profiles having similarly poorer functioning. The women in the fourth group had a symptom profile distinctive from the other 4 groups in terms of severity; they were also more likely to have had lifetime major depression and suicidality. Conclusion: Lifetime weight ranges and the severity of eating disorder symptoms affected clustering more than the type of eating disorder symptom.

Evaluation of universal, indicated, and combined cognitive-behavioral approaches to the prevention of depression among adolescents

A cluster, stratified randomized design was used to evaluate the impact of universal, indicated, and combined universal plus indicated cognitive-behavioral approaches to the prevention of depression among 13- to 15-year-olds initially reporting elevated symptoms of depression. None of the intervention approaches differed significantly from a no-intervention condition or from each other on changes in depressive symptoms, anxiety, externalizing problems, coping skills, and social adjustment. All high-symptom students, irrespective of condition, showed a significant decline in depressive symptoms and improvement in emotional well-being over time although they still demonstrated elevated levels of psychopathology compared with the general population of peers at 12-month follow-up. There were also no significant intervention effects for the universal intervention in comparison with no intervention for the total sample of students in those conditions.

Acculturation and eating disorders in Asian and Caucasian Australian university students

This study aimed to compare the attitudes and psychopathology of eating disorders of Asian and Caucasian university students using a survey method. The study also investigated the relationship between acculturation, attitudes and psychopathology of eating disorders in sub-groups of Asian girls. There were 130 Asian and 110 Caucasian adolescent girls, aged 18–24 who were screened using the Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI-2) and an Acculturation Index. The Asian group did not have higher mean EAT score than the Caucasian group, but had higher mean score in some sub-scales of the EDI-2. Eating disordered attitudes and psychopathology was not significantly different in the low compared to the high accultured Asian girls. This study suggests that Asian and Caucasian university students in Western Australia are equally susceptible to eating disorders, and that the level of acculturation does not modify the susceptibility of Asian students for eating disorders.