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Objective: Recognizing the prodrome of a first psychotic episode prospectively creates the opportunity of intervention, which could delay, ameliorate or even prevent onset. Valid criteria and a reliable methodology for identifying possible prodromes are needed. This paper describes an instrument, the Comprehensive Assessment of At-Risk Mental States (CAARMS), which has been designed for such a purpose. It has two functions: (i) to assess psychopathology thought to indicate imminent development of a first-episode psychotic disorder; and (ii) to determine if an individual meets criteria for being at ultra high risk (UHR) for onset of first psychotic disorder. This paper describes the pilot evaluation of the CAARMS. Method: Several methodologies were used to test the CAARMS. First, CAARMS scores in a group of UHR young people and the association between CAARMS scores and the risk of transition to psychotic disorder, were analysed. Second, CAARMS scores in a UHR group were compared to a control group. To assess concurrent validity, CAARMS-defined UHR criteria were compared to the existing criteria for identifying the UHR cohort. To assess predictive validity, the CAARMS-defined UHR criteria were applied to a sample of 150 non-psychotic help-seekers and rates of onset of psychotic disorder at 6-month follow-up determined for the CAARMS-positive (i.e. met UHR criteria) group and the CAARMS-negative (i.e. did not meet UHR criteria) group. The inter-rater reliability of the CAARMS was assessed by using pairs of raters. Results: High CAARMS score in the UHR group was significantly associated with onset of psychotic disorder. The control group had significantly lower CAARMS scores than the UHR group. The UHR criteria assessed by the CAARMS identified a similar group to the criteria measured by existing methodology. In the sample of non-psychotic help-seekers those who were CAARMS-positive were at significantly increased risk of onset of psychotic disorder compared to those who were CAARMS-negative (relative risk of 12.44 (95% CI = 1.5–103.41, p = 0.0025)). The CAARMS had good to excellent reliability. Conclusions: In these preliminary investigations, the CAARMS displayed good to excellent concurrent, discriminant and predictive validity and excellent inter-rater reliability. The CAARMS instrument provides a useful platform for monitoring subthreshold psychotic symptoms for worsening into full-threshold psychotic disorder. [ABSTRACT FROM AUTHOR]

This paper identifies rates of common mental disorders among Māori and non-Māori consulting a general practitioner (GP), and explores the association between ethnicity and social and material deprivation.Survey of GPs and their patients. Participants were randomly selected GPs (n = 70), and their patients (n = 3414, of whom a subset of 786 form the basis of this paper). The main comparison is between self-identified ethnicity, mental disorder assessed by the Composite International Diagnostic Interview, and social and material deprivation measured by NZDep2001 (an area based measure), and an individualized index of deprivation.Rates of mental disorder among Māori general practice attenders were higher than among non-Māori. Overall, Māori women attenders were twice as likely as non-Māori women attenders to have a diagnosable mental disorder. The rates of anxiety, depressive and substance use disorders were all higher for Māori than for others attending GPs. Treatment for psychological problems was offered by the GP at similar rates to both Māori and non-Māori. Although there were differences between Māori and non-Māori in terms of social and material deprivation, higher rates of mental disorder among Māori attending GPs compared to non-Māori cannot be accounted for by these differences alone.These findings support the view that whilst social and material deprivation may play a role in the high rates of mental disorders among Māori general practice attenders, there are additional ethnicity-specific factors involved. Interventions to address Māori mental health (whether by reducing risk factors for mental disorder, by promoting disclosure, early recognition and intervention, or by ensuring access to acceptable and effective treatments) may need to explicitly take those factors into account. [ABSTRACT FROM AUTHOR]

The purpose of the present paper was to determine what is currently documented about Indigenous Australians' understandings of mental health and mental disorders through a meta-synthesis of peer-reviewed qualitative empirical research. The following databases were electronically searched (1995-April 2006): AOA-FT and AIATSIS, Blackwell Synergy, CINAHL and Pre CINHAL, Health source: nursing/academic edition, Medline, Proquest health and medical complete, PsycInfo, Science Direct, Synergy and HealthInfoNet. Eligible studies were those written in English and published in peer-reviewed journals, empirical studies that considered Indigenous people's understandings of mental health and provided details on methodology. Five articles from four qualitative studies met these criteria. Meta-ethnography was used to identify common themes emerging from the original studies. Reciprocal translation was used to synthesize the findings to provide new interpretations extending beyond those presented in the original studies. An overarching theme emerged from the synthesis: the dynamic interconnectedness between the multi-factorial components of life circumstances. Reciprocal translations and synthesis regarding Indigenous understandings of mental health and illness resulted in five themes: (i) culture and spirituality; (ii) family and community kinships; (iii) historical, social and economic factors; (iv) fear and education; and (v) loss. The application of a meta-synthesis to these qualitative studies provided a deeper insight into Indigenous people's understandings of mental health and illness. The importance of understanding Indigenous descriptions and perceptions of mental health issues is crucial to enable two-way understandings between Indigenous people's constructs of wellness and Western biomedical diagnostic labels and treatment pathways for mental disorders and mental health problems. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present paper was to examine the disposition of individuals in Hunan, China who are found not criminally responsible due to a mental disorder or defect. Method: Self-developed questionnaires were mailed to the family members of 240 patients who had received forensic psychiatric evaluations at the forensic psychiatric assessment center of Central South University, between 2001 and 2002. Results: One hundred and seventy questionnaires were fully completed and returned by the patients' family members. According to the answers, 64.1% (109 patients) were found not criminally responsible due to a mental disorder or defect. In 87.6% of the cases, a judgement of guilty was in agreement with the psychiatrist's recommendation concerning criminal responsibility. A total of 61.8% of the patients found not guilty were discharged to their families and did not receive any further psychiatric treatment. Conclusion: In most cases, judicial decisions are consistent with a psychiatrist's opinion of criminal responsibility due to a mental disorder or defect. After such adjudication, further psychiatric treatment is often neglected due to the lack of resources and information. Hunan, China must make a continued investment into the availability and quality of outpatient mental health treatment for forensic patients after they have been discharged. [ABSTRACT FROM AUTHOR]

Objective: To describe the prevalence of mental disorders (period prevalence across aggregated disorders, 12 month and lifetime prevalence) among Māori in Te Rau Hinengaro: The New Zealand Mental Health Survey. Method: Te Rau Hinengaro: The New Zealand Mental Health Survey, undertaken between 2003 and 2004, was a nationally representative face-to-face household survey of 12 992 New Zealand adults aged 16 years and over, including 2595 Māori. Ethnicity was measured using the 2001 New Zealand census ethnicity question. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0), was used to measure disorder. The overall response rate was 73.3%. This paper presents selected findings for the level and pattern of mental disorder prevalence among Māori. Results: Māori lifetime prevalence of any disorder was 50.7%, 12 month prevalence 29.5% and 1 month prevalence 18.3%. The most common 12 month disorders were anxiety (19.4%), mood (11.4%) and substance (8.6%) disorders and the most common lifetime disorders were anxiety (31.3%), substance (26.5%) and mood (24.3%) disorders. Levels of lifetime comorbidity were high with 12 month prevalence showing 16.4% of Māori with one disorder, 7.6% with two disorders and 5.5% with three or more disorders. Twelve-month disorders were more common in Māori females than in males (33.6% vs 24.8%) and in younger age groups: 16–24 years, 33.2%; 25–44 years, 32.9%; 45–64 years, 23.7%; and 65 years and over, 7.9%. Disorder prevalence was greatest among Māori with the lowest equivalized household income and least education. However, differences by urbanicity and region were not significant. Of Māori with any 12 month disorder, 29.6% had serious, 42.6% had moderate and 27.8% had mild disorders. Conclusion: Mental disorders overall and specific disorder groups (anxiety, mood and substance) are common among Māori and measures of severity indicate that disorders have considerable health impact. Findings provide a platform for informing public health policy and health sector responses to meeting mental health needs of Māori. [ABSTRACT FROM AUTHOR]

Objective : Most psychiatric disorders are complex genetic traits involving both genetic and environmental risk factors. This paper aims to review the gene identification strategies being applied by molecular geneticists in their efforts to elucidate the genetic and molecular basis of psychiatric disorders. Future strategies will also be canvassed. Method : The psychiatric genetic literature was reviewed to identify current strategies applied to gene identification, with examples provided where available. The future strategies and applications that will arise from genome projects, including the International Haplotype Mapping Project, are also discussed. Results : Many advances in the techniques of gene discovery, and the increasing resources available, are rapidly being adopted by researchers and applied to the complex problem of identifying susceptibility genes for mental illnesses. Perhaps the single most important advance to date is the Human Genome Project and all that has stemmed from the vast quantity of information that this endeavour has provided. With these technological advances and the massive increase of publicly available genetic resources, several genes have recently been implicated in the susceptibility to psychiatric illnesses including schizophrenia and depression. After many years of fruitless endeavours, these recent reports indicate that the labours of researchers in psychiatric genetics are beginning to show exciting results. Conclusions : Identification of these susceptibility genes holds great promise, with the unravelling of the molecular and biochemical basis of some conditions now being a more realistic and tangible goal. The increasing number of genes being identified augers well for the future treatment of psychiatric disorders. The genes identified, and the pathways of genes and proteins that they implicate, will provide potential novel targets for new therapeutic drugs. Psychiatric genetics appears to be poised for significant advances in our knowledge and understanding of the molecular genetic basis of mental illness. Australian and New Zealand Journal of Psychiatry 2005; 39:542–549 [ABSTRACT FROM AUTHOR]