Interventions for co-occurring addictive and other mental disorders (AMDs)

While research on the management of co-occurring addictive and mental disorders (AMDs) has grown substantially in recent years, we still have little guidance on specific strategies. Consideration of epidemiological research and ethical principles can supplement existing clinical trials in providing a way forward. High frequencies of co-occurring disorders, equity of access for affected individuals and potential clashes between services in priorities and procedures, suggest that a stepped model of care by a single service may often be required. Typically, problems are multiple rather than dual, with potential for mutual influence, suggesting a need for interventions that are sensitive to and encompass complex co-occurring problems. Motivational problems are endemic, initial gains are often partial and unstable, and relapses potentially have serious consequences, suggesting a need for long-term, assertive follow-up. Principles such as these provide a solid framework for designing both services and interventions. However, there is a continuing need for controlled trials that unpack effective components of interventions, and increase their impact.

Reasons for cannabis use in men with and without psychosis

Psychoses are relatively low prevalence disorders that have a disproportionately negative impact on individuals and society. Cannabis use is one factor that can exacerbate the negative consequences associated with psychotic disorders. Relatively few studies have examined the effects or reasons for using cannabis self-reported by individuals with psychosis. The present study is the first known to compare directly such factors in individuals with and without psychosis, within a single study. At baseline and follow-up participants with psychosis most commonly reported using cannabis for positive mood alteration (36% and 42%), coping with negative affect (27% and 29%) and for social activity reasons (38% and 29%). The control group most commonly reported using cannabis for relaxation (34% and 43%) and social activity reasons (49% and 51%). Participants with psychosis were less likely to report relaxation as the most important effect after use (27%) or expect it at follow-up (49%) compared to the control group (53% and 70%). In both groups, addiction and positive affect enhancement were the composite variable scores correlated most consistently with concurrent amount and frequency of use.

Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders

Objectives: To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders. Method: We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential solutions had been generated by focus groups. Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79% and 42% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70% of staff. Another set of problems involved coordination of client care across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities. Conclusions: A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.

A 1H-MRS investigation of the medial temporal lobe in antipsychotic-naïve and early-treated first episode psychosis

Schizophrenia is associated with significant brain abnormalities, including changes in brain metabolites as measured by proton magnetic resonance spectroscopy (MRS). What remains unclear is the extent to which these changes are a consequence of the emergence of psychotic disorders or the result of treatment with antipsychotic medication. We assessed 34 patients with first episode psychosis (15 antipsychotic naïve) and 19 age- and gender-matched controls using short-echo MRS in the medial temporal lobe bilaterally. Overall, there were no differences in any metabolite, regardless of treatment status. However, when the analysis was limited to patients with a diagnosis of schizophrenia, schizophreniform or schizoaffective disorder, significant elevations of creatine/phosphocreatine (Cr/PCr) and myo-inositol (mI) were found in the treated group. These data indicate a relative absence of temporal lobe metabolic abnormalities in first episode psychosis, but suggest that some treatment-related changes in mI might be apparent in patients with schizophrenia-spectrum diagnoses. Seemingly illness-related Cr/PCr elevations were also specific to the diagnosis of schizophrenia-spectrum disorder and seem worthy of future study.

Members abroad - Australia - Brisbane and the Gold Coast

Brisbane's sub-tropical climate, vegetation and urban history as a British settlement, endow the region with many characteristics that are familiar in KwaZulu-Natal. Brisbane settlement, firstly as a penal conlony to accommodate the hardiest criminals dispatched from Sydney, was established in 1825 on a wide river, several kilometers upstream from Moreton Bay with the Pacific Ocean beyond. The penal colony was short lived and was soon opened up to free settlement in 1842. The growth of the fledgling town was characterized by brick warehouse and service buildings to the port that was established on its riverbanks, resembling those of the old Point Road area in Durban. Government and administration buildings heralded Brisbane as the captial city of the State of Queensland, annexed from New South Wales in 1859. Morphological studies reveal that Brisbane had reached its first zenith around 1930 as a commerical city of four and five storey buildings. The urban form remained stagnant until the post-1960's building boom and the developments from this period on, consolidated land amalgamations largely ignoring the urban characteristics of the established city. Public space was poorly observed, resulting in a city that had turned its back on the river. It is only in recent times that the currency of good urban design, under the custodial direction of the City Council, has fostered a re-engagemed urban realm that, enabled by the recent building boom, has delivered high quality urban environments

Members abroad - Australia : Paul Sanders

I have been an academic since joining the University of Natal in 1998 and, following a period as a visiting lecturer in Brisbane in 2001, I joined the staff at QUT on an ongoing basis in 2003. I was appointed as Architecture Co-ordinator in 2006, and this role involves the leadership of the architectur discipline of 17 full time academics. I am currently enrolled in a PhD course in the field of urban morphology. This research proposes a theory on the relevance of mapping the evolutionary aspects of historical urban form to develop a measure for evaluating architecural elements and deriving parameters for new buildings. My participation in a QUT design team contributed to a recent successful invited competition bid for an Urban Transit Centre in Hangzhou, China. The Centre will include retail, business, entertainment, residential and service components at the heart of the Binjiang district on the 11.5ha core area with 32ha surrounding urban design precinct. The project has received the approval to commence and is to be implemented over the next three years!

Members abroad - Australia : Lindy Osborne

When I arrived in Queensland's capital in 1996, Brisbane was commonly referred to as an 'overgrown country town'. This might have been an acceptable description in the 1990s, but it cannot be applied any longer. Brisbane, affectionaly referred to by the locals as Bris-Vegas, has now come of age. Following Sydney and Melbourne, Brisbane is the third most populous city in Australia with a population of approximately two million. Interestingly, the 2006 Census showed that 22 per cent of Brisbane's population was born overseas, the three main countries of birth being the UK, New Zealand and South Africa. Brisbane City is centred on its most dominant environmental element, the Brisbane River, which effectively carves Brisbane into two areas - the Northside and the Southside. The 2001 addition of Cox Rayner's Goodwill Pedestrian and Cycle Bridge signified Brisbane's acceptance and affectionate embrace of its River resulting in a long overdue linage between Brisbane's North and South. It connects the City's key precincts - the Northside CBD through Queensland University of Technology (QUT), across Brisbane River, to the recreational precinct of the Southside Southbank Parklands. The Southside cultural precinct of Southbank is the home to Queensland's Art Gallery, Performing Arts Complex, State Library and Museum -each of which were designed by Brisbane Stalwart Architect Robin Gibson, in the 1970s and '80s. The CBD component of the Brisbane River is flanked by a number of Institutional Facilities, including the campuses of QUT, Griffith University and the Southbank Education and Training Precinct (SETP), which combine to form a cross-river educational precinct. The past decade has born witness to a city which has keenly supported emerging architects in addition to the more entrenched stalwarts of the profession, resulting in a youthful, relaxed and unpretentious sub-tropical city. Viva Bris-Vegas!

Deposition of combustion aerosols in the human respiratory tract : comparison of theoretical predictions with experimental data

Total deposition of petrol, diesel and environmental tobacco smoke (ETS) aerosols in the human respiratory tract for nasal breathing conditions was computed for 14 nonsmoking volunteers, considering the specific anatomical and respiratory parameters of each volunteer and the specific size distribution for each inhalation experiment. Theoretical predictions were 34.6% for petrol, 24.0% for diesel, and 18.5% for ETS particles. Compared to the experimental results, predicted deposition values were consistently smaller than the measured data (41.4% for petrol, 29.6% for diesel, and 36.2% for ETS particles). The apparent discrepancy between experimental data on total deposition and modeling results may be reconciled by considering the non-spherical shape of the test aerosols by diameter-dependent dynamic shape factors to account for differences between mobility-equivalent and volume-equivalent or thermodynamic diameters. While the application of dynamic shape factors is able to explain the observed differences for petrol and diesel particles, additional mechanisms may be required for ETS particle deposition, such as the size reduction upon inspiration by evaporation of volatile compounds and/or condensation-induced restructuring, and, possibly, electrical charge effects.

Exploring donation decisions: Beliefs and preferences for organ donation in Australia

We explored common beliefs and preferences for posthumous and living organ donation in Australia where organ donation rates are low and little research exists. Content analysis of discussions revealed the advantage of prolonging/saving life whereas disadvantages differed according to donation context. A range of people/groups perceived to approve and disapprove of donation were identified. Barriers for posthumous donation included a family’s objection, with the type of organ needed important for living donation. Motivators included knowledge about potential organ recipients. Donation preferences favored loved ones, with weaker preferences for recipients who were perceived as morally questionable or responsible for their illness.

Shifting the child protection juggernaut to earlier intervention

"For every complex problem there is a solution that is simple, neat and wrong (M.L. Mencken, US writer and social commentator). Nowhere is this quote more apt than when applied to finding over-simplified solutions to the complex problem of looking after the safety and well-being of vulnerable children. The easiest formula is, of course, to ‘rescue children from dysfunctional families’, a line taken recently in the monograph by the right wing think tank, Centre for Independent Studies (Sammut & O’Brien 2009). It is reasoning with fatal flaws. This commentary provides a timely reminder of the strong arguments which lie behind the national and international shift to supporting children and families through universal and specialist community-based services, rather than weighting all resources into statutory child protection interventions. A brief outline of the value of developing the resources to support children in their families, and the problems with 'rescuing' children through the child protection system are discussed.