Diagnosis and treatment of mental disorders: a survey of Singapore mental health professionals

Background: A series of surveys of mental health literacy have been undertaken in Australia, involving members of the general public as well as general practitioners and mental health professionals, whereby respondents consider vignettes of depression and of schizophrenia, offer a diagnosis and rate a series of possible interventions for their judged helpfulness. A similar survey was undertaken in Singapore and is reported in this paper. Methods: The survey was undertaken at a large state psychiatric hospital with staff (psychiatrists, allied health professionals, psychiatrically and generally trained nursing staff) rating a vignette of mania, in addition to the vignettes derived in Australia for depression and schizophrenia, and with the Australian intervention options extended somewhat to respect Singapore facilities. Results: Responses of those in the four professional groups were compared. The psychiatrists were highly accurate in generating diagnoses, other staff somewhat less so for diagnosing depression (with a percentage instead choosing a diagnosis of stress) and mania (with a percentage instead diagnosing a schizophrenic condition). Reported helpfulness ratings identified those interventions judged consensually as likely to be helpful or harmful, as well as establishing some differences across the four professional groups. Conclusions: The consensus decisions of helpful treatments for depression and schizophrenia revealed very similar findings to judgements made by Australian professionals. The treated outcome of schizophrenia was judged as somewhat worse than that for mania and depression. While non-medical staff differed from psychiatrists in judging the comparative utility of some drug interventions and lifestyle issues, there was clear evidence of a relatively dominant 'medical model' to recommended treatments, while traditional healing practices and services were rated as distinctly unhelpful.

Asymmetric MRI magnet design using a hybrid numerical method

This paper describes a hybrid numerical method for the design of asymmetric magnetic resonance imaging magnet systems. The problem is formulated as a field synthesis and the desired current density on the surface of a cylinder is first calculated by solving a Fredholm equation of the first kind. Nonlinear optimization methods are then invoked to fit practical magnet coils to the desired current density. The field calculations are performed using a semi-analytical method. A new type of asymmetric magnet is proposed in this work. The asymmetric MRI magnet allows the diameter spherical imaging volume to be positioned close to one end of the magnet. The main advantages of making the magnet asymmetric include the potential to reduce the perception of claustrophobia for the patient, better access to the patient by attending physicians, and the potential for reduced peripheral nerve stimulation due to the gradient coil configuration. The results highlight that the method can be used to obtain an asymmetric MRI magnet structure and a very homogeneous magnetic field over the central imaging volume in clinical systems of approximately 1.2 m in length. Unshielded designs are the focus of this work. This method is flexible and may be applied to magnets of other geometries. (C) 1999 Academic Press.

Encapsulation of lemon oil by paste method using beta-cyclodextrin: Encapsulation efficiency and profile of oil volatiles

Microencapsulation of lemon oil was undertaken by kneading with beta-cyclodextrin, at a beta-cyclodextrin to lemon oil ratio of 88:12 (w/w). The resulting paste samples of the complex were vacuum- or spray-dried. Ten selected lemon oil flavor volatiles (alpha-pinene, sabinene, beta-pinene, beta-myrcene, limonene, gamma-terpinene, terpinolene, linalool, neral, and geranial) in the complex were analyzed periodically after 1, 2, 5, 10, 15, 20, and 30 min of kneading time. The results indicated that the levels of these volatiles were not significantly different (P > 0.05) irrespective of mixing time or type of the drying (vacuum- or spray-drying) used. An optimum mixing time was found to be 15 min, at which time the maximum encapsulation of lemon oil (97.7 mg/g of beta-cyclodextrin) was obtained in the complex powder.

Endorsement of CIDI psychosis screening items in the Australian Survey of Mental Health and Well being

This paper presents preliminary analysis of the endorsement of the CIDI Psychosis Screening items in a large Australian community sample. CIDI interviews were completed on a representative sample of 10,641 individuals living in private dwellings in Australia. The items examined constructs related to thought control/interference (G1), ideas of reference (G2), and special powers (G3). If endorsed, each item had a follow-up probe (G1A telepathy; G2A things arranged with special meaning; G3A -- group acceptability). The final item (G4) asked if the respondent had been told that they had schizophrenia. This paper presents the frequency of endorsement, and examines the impact of age and sex on these items. Endorsement of the items was G1 =5.86°/,,, G1A=0.70%, G2=4.84%, G2A=l.31%, G3=3.41%, G3A=2.65%, and G4=0.65%. If screen-positives are defined as two or more 'hits', then 0.41% of the sample met this criterion. Younger participants were significantly more likely to be screen-positive. Items G1, G1A, G2 and G2A were endorsed more frequently by younger participants while there were no significant age effects identified in items G3 or G4. There was a nonsignificant trend for females to endorse item G1 more frequently than males (p = 0.07), but there were no signficant gender differences on the other items. Many individuals who were 'screen-negative' for psychosis endorsed CIDI items related to thought controls, ideas of reference and special powers, suggesting that there may be a 'continuum' of experiences in the population. The impact of age on the distribution of these measures suggests either differential biological vulnerability to these experiences and/or differential cultural factors influencing endorsement of the items. The implications of these findings on our understanding of the symptoms of psychosis will be discussed. The survey was funded by the Commonwealth Dept. of Health and Family Services. The Stanley Foundation supported this project.

Comparison of trends in method-specific suicide rates in Australia and England & Wales, 1968-97

Objective: To compare secular trends in method-specific suicide rates among young people in Australia and England & Wales between 1968 and 1997. Methods: Australian data were obtained from the Australian Bureau of Statistics, and for England & Wales from the Office for National Statistics. Overall and method-specific suicide rates for 15-34 year old males and females were calculated using ICD codes E950-9 and E980-9 except E988.8. Results: In both settings, suicide rates have almost doubled in young males over the past 30 years (from 16.8 to 32.9 per 100,000 in Australia and from 10.1 to 19.0 in England & Wales). Overall rates have changed little in young females. In both sexes and in both settings there have been substantial increases in suicide by hanging (5-7 fold increase in Australia and four-fold increase in England & Wales). There have also been smaller increases in gassing in the 1980s and '90s. In females, the impact of these increases on overall rates has been offset by a decline in drug overdose, the most common method in females. Conclusions: Rates of male suicide have increased substantially in both settings in recent years, and hanging has become an increasingly common method of suicide. The similarity in observed trends in both settings supports the view that such changes may have common causes. Research should focus on understanding why hanging has increased in popularity and what measures may be taken to diminish it.

The Fornax spectroscopic survey I. Survey strategy and preliminary results on the redshift distribution of a complete sample of stars and galaxies

The Fornax Spectroscopic Survey will use the Two degree Field spectrograph (2dF) of the Angle-Australian Telescope to obtain spectra for a complete sample of all 14000 objects with 16.5 less than or equal to b(j) less than or equal to 19.7 in a 12 square degree area centred on the Fornax Cluster. The aims of this project include the study of dwarf galaxies in the cluster (both known low surface brightness objects and putative normal surface brightness dwarfs) and a comparison sample of background field galaxies. We will also measure quasars and other active galaxies, any previously unrecognised compact galaxies and a large sample of Galactic stars. By selecting all objects-both stars and galaxies-independent of morphology, we cover a much larger range of surface brightness and scale size than previous surveys. In this paper we first describe the design of the survey. Our targets are selected from UK Schmidt Telescope sky survey plates digitised by the Automated Plate Measuring (APM) facility. We then describe the photometric and astrometric calibration of these data and show that the APM astrometry is accurate enough for use with the 2dF. We also describe a general approach to object identification using cross-correlations which allows us to identify and classify both stellar and galaxy spectra. We present results from the first 2dF field. Redshift distributions and velocity structures are shown for all observed objects in the direction of Fornax, including Galactic stars? galaxies in and around the Fornax Cluster, and for the background galaxy population. The velocity data for the stars show the contributions from the different Galactic components, plus a small tail to high velocities. We find no galaxies in the foreground to the cluster in our 2dF field. The Fornax Cluster is clearly defined kinematically. The mean velocity from the 26 cluster members having reliable redshifts is 1560 +/- 80 km s(-1). They show a velocity dispersion of 380 +/- 50 km s(-1). Large-scale structure can be traced behind the cluster to a redshift beyond z = 0.3. Background compact galaxies and low surface brightness galaxies are found to follow the general galaxy distribution.

Computation of bifurcation boundaries for power systems: A new Delta-plane method

This paper is devoted to the problems of finding the load flow feasibility, saddle node, and Hopf bifurcation boundaries in the space of power system parameters. The first part contains a review of the existing relevant approaches including not-so-well-known contributions from Russia. The second part presents a new robust method for finding the power system load flow feasibility boundary on the plane defined by any three vectors of dependent variables (nodal voltages), called the Delta plane. The method exploits some quadratic and linear properties of the load now equations and state matrices written in rectangular coordinates. An advantage of the method is that it does not require an iterative solution of nonlinear equations (except the eigenvalue problem). In addition to benefits for visualization, the method is a useful tool for topological studies of power system multiple solution structures and stability domains. Although the power system application is developed, the method can be equally efficient for any quadratic algebraic problem.

Perceived need for mental health care, findings from the Australian National Survey of Mental Health and Well-being

Background. The Australian National Survey of Mental Health and Well-being was designed to detect and describe psychiatric morbidity, associated disability, service use and perceived need for care. The survey employed a single-phase interview methodology, delivering a field questionnaire to a clustered probability sample of 10641 Australians. Perceived need was sampled with an instrument designed for this survey, the Perceived Need for Care Questionnaire (PNCQ). This questionnaire gathers information about five categories of perceived need, assigning each to one of four levels of perceived need. Reliability and validity studies showed satisfactory performance of the instrument. Methods. Perceived need for mental health care in the Australian population has been analysed using PNCQ data, relating this to diagnostic and service utilization data from the above survey. Results. The survey findings indicate that an estimated 13.8 % of the Australian population have perceived need for mental health care. Those who met interview criteria for a psychiatric diagnosis and also expressed perceived need make up 9.9 % of the population. An estimated 11.0% of the population are cases of untreated prevalence, a minority (3.6% of the population) of whom expressed perceived need for mental health care. Among persons using services, those without a psychiatric diagnosis based on interview criteria (4.4% of the population), showed high levels of perceived met need. Conclusions. The overall rate of perceived need found by this methodology lies between those found in the USA and Canada. The findings suggest that service use in the absence of diagnosis elicited by survey questionnaires may often represent successful intervention. In the survey, untreated prevalence was commonly not accompanied by perceived need for mental health care.

Novel silica gel supported TiO2 photocatalyst synthesized by CVD method

TiO2 in anatase crystal phase is a very effective catalyst in the photocatalytic oxidation of organic compounds in water. To improve the recovery rate of TiO2 photocatalysts, which in most cases are in fine powder form, the chemical vapor deposition (CVD) method was used to load TiO2 onto a bigger particle support, silica gel. The amount of titania coating was found to depend strongly on the synthesis parameters of carrier gas flow rate and coating time. XPS and nitrogen ads/desorption results showed that most of the TiO2 particles generated from CVD were distributed on the external surface of the support and the coating was stable. The photocatalytic activities of TiO2/silica gel with different amounts of titania were evaluated for the oxidation of phenol aqueous solution and compared with that of Degussa P25. The optimum titania loading rate was found around 6 wt % of the TiO2 bulk concentration. Although the activity of the best TiO2/silica gel sample was still lower than that of P25, the synthesized TiO2/silica gel catalyst can be easily separated from the treated water and was found to maintain its TiO2 content and catalytic activity.

A simplified, sequential, phosphorus fractionation method

Hedley er al. (1982) developed what has become the most widely used land modified), phosphorus (P) fractionation technique. It consists of sequential extraction of increasingly less phytoavailable P pools. Extracts are centrifuged at up to 25000 g (RCF) and filtered to 0.45 mu m to ensure that soil is not lost between extractions. In attempting to transfer this method to laboratories with limited facilities, it was considered that access to high-speed centrifuges, and the cost of frequent filtration may prevent adoption of this P fractionation technique. The modified method presented here was developed to simplify methodology, reduce cost, and therefore increase accessibility of P fractionation technology. It provides quantitative recovery of soil between extractions, using low speed centrifugation without filtration. This is achieved by increasing the ionic strength of dilute extracts, through the addition of NaCl, to flocculate clay particles. Addition of NaCl does not change the amount of P extracted. Flocculation with low speed centrifugation produced extracts comparable with those having undergone filtration (0.025 mu m). A malachite green colorimetric method was adopted for inorganic P determination, as this simple manual method provides high sensitivity with negligible interference from other anions. This approach can also be used for total P following digestion, alternatively non-discriminatory methods, such as inductively coupled plasma atomic emission spectroscopy, may be employed.

Review of "Comorbidity, disability and the need for treatment for DSM-IV psychiatric disorders in an insured population"

Background: This study presents estimates of 12 month and current prevalences of DSM-IV disorders, and the related comor-bidity, disability and service utilization, derived from a national probability sample in Australia. Methods: The DSM-IV psychiatric disorders among persons aged 18 and over in the Australian population were assessed with data collected by lay interviewers using the Composite International Diagnostic Interview, other screening interviews and measures of disability and service utilization. The response rate was 78.1% and the final sample size was 10,641 adults. Results: Close to 20% reported at least one twelve month disorder and 13% a disorder current within the past 30 days. ICD-10 diagnoses were also derived, DSM-IV was the more conservative classification whether or not the new clinical significance criteria was applied. Major depression, any personality disorder, and alcohol dependence were the three most common twelve month disorders, generalized anxiety disorder replaced alcohol dependence as the third most common current disorder. The sexes has similar rates of any disorder, but women had higher rates of affective and anxiety disorders, men higher rates of substance use disorders. Prevalence of most disorders declined with age and education, and were lower among those employed or married. Respondents whose symptoms met criteria for three or more disorders in the past year had greatly increased rates of disability and of mental health consultations. The affective and somatoform disorders were associated with the highest rates of disability. Only 36% of people with a mental disorder this year had consulted for a mental problem, and most had seen a general practitioner. We identified those with a current disorder who were disabled or multiply comorbid - only half had consulted and of those who had not, more than half said they did not need treatment. Conclusions: The 12 month prevalence was lower than reported in the US National Comorbidity Survey but method factors might account for this. The relationships between prevalence and demographic variables, and between comorbidity, disability and service utilization were similar to those found in the US survey. Australia has a national health insurance scheme with total coverage and access to medical help is available to all, commonly at little or no cost. We identify the high rate of not consulting among those with a current disorder, and additional disability or multiple comorbidity, as an important public health problem. Kessler argued for more research on barriers to professional help seeking. This report reinforces his conclusion and shows that economic barriers are not the dominant issue.