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Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of this paper was to examine self-efficacy and perceived appropriateness among rural general practitioners (GPs) in regards to screening and intervention for physical, lifestyle and mental health issues. Method: Fifty GPs from 25 practices in eight rural Queensland towns completed a written survey designed for the study. Results: General practitioners rated opportunistic screening or assessment for smoking and for detection of relapse of mental disorders as the most appropriate, with even cardiovascular and diabetes risk falling behind these. Self-efficacy was highest for medical disorders for smoking assessment. It was significantly lower for alcohol, mental health issues, and addressing risks of physical disorder in people with mental disorders. Conclusions: High appropriateness ratings suggest that current strategies to boost self-efficacy of GPs in addressing mental health issues are timely. [ABSTRACT FROM AUTHOR]

Objectives: To describe some of the policy implications of the Australian National Survey of Mental Health and Wellbeing. Methods: A review of the initial findings from the Survey published by the Australian Bureau of Statistics and the five papers in this issue of the Journal, was done. Results: Mental disorders are highly prevalent with the prevalence essentially unchanged since Australia's 1997 mental health survey. Mental disorders are often comorbid with each other and with physical disorders. Despite the disability they cause, most people with disorders do not seek treatment. This is largely because they do not perceive a need for treatment. Conclusions: National epidemiological surveys are important for service planning. They are especially important in gaining an understanding of the population not accessing services. Innovative strategies, including action on mental health literacy, will be necessary to increase the treatment rates for common mental disorders. [ABSTRACT FROM AUTHOR]

Objective: This paper outlines a rationale for expanding research and clinical innovations focused upon relapse prevention following a first episode of psychosis. Some general principles for further progress are extracted from an overview of the first-episode psychosis (FEP) relapse literature. A cognitive behaviour therapy intervention for relapse prevention for FEP, that has been developed at the Early Psychosis Prevention and Intervention Centre, is described to illustrate these principles. Conclusions: Further progress is needed in refining interventions specific to the prevention of relapse following FEP. Future progress is dependent upon improved understanding of the interaction of biological, interpersonal and psychological processes underpinning relapse. [ABSTRACT FROM AUTHOR]

Objective: To review various concepts of psychiatric comorbidity, their implications, surrounding controversies and underlying issues. A further aim is to propose an alternative term that might be more clinically useful and meaningful for describing the coexistence of mental disorders. Conclusions: There is wide dissatisfaction with the concepts of psychiatric comorbidity because of different meanings, speculations on which they are often based and consequent confusion. Although the coexistence of mental disorders should be studied further so that any patterns in the corresponding relationships can be elucidated, there is a need for conceptual clarity and making the concept more meaningful for clinical practice and treatment. With that in mind, this present paper proposes avoidance of the term comorbidity and introduction of the term ‘co-occurrence’. The latter is defined in this article, and the distinction made between diagnostic co-occurrence and clinically significant co-occurrence. [ABSTRACT FROM AUTHOR]

Objective: People with borderline personality disorder (BPD) confront multiple agencies with behaviours that are often alarming and bewildering. However, different service providers appear to respond to the same patient population in different ways. We aimed to explore the emotional reactions, concerns and beliefs related to working with the person with BPD by health and non-health related agencies. Method: A specifically designed questionnaire was completed by different agencies prior to their receiving educational training on an organizational and community-based model of care for people with BPD. Results: Police believed that people with BPD are best medicated and hospitalized until they are no longer suicidal. A universal human response was noted as was support for interagency collaboration. Conclusions: Different agencies respond in different ways towards people with BPD. These differences reflect ideological splits between agency groups. [ABSTRACT FROM AUTHOR]

Aim: This article examines whether neurocognitive deficits or age prevents people with borderline personality disorder from being considered responsible and competent. Method: A review of the literature was undertaken relating to borderline personality disorder (BPD), personal responsibility and competency. Result: Neither neurobiological differences nor age automatically disqualify the person with BPD from being responsible and competent for decisions relating to their own life and death. Conclusion: Clinical, legal and ethical literature support this result and thereby re-establishes a basis for the recognition and respect of an individual's dignity. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: A systematic literature review of randomized clinical trials (RCTs) assessing depression treatments in primary care for Latinos is conducted. The authors rate the methodological quality of studies, examine cultural and linguistic adaptations, summarize clinical outcomes and cost-effectiveness findings, and draw conclusions for improving depression care among this diverse population. Method: Electronic bibliographic databases, Web sites, and manual searches are used to identify nine peer-reviewed articles covering four RCTs. Results: Across trials, collaborative care models were more effective than usual care in reducing depression and improving functioning and accessibility to guideline-congruent care. Conclusion: The use of evidence-based treatments in primary care seems to be an effective and cost-effective strategy to reduce mental health care disparities among Latinos served in primary care. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Daycare stress can be indexed by cortisol, and elevated levels of cortisol have been implicated in the onset and development of mental health disorders. Our objective was to quantify the associations between daycare and cortisol and to identify individual and environmental conditions under which daycare attendance is associated with cortisol concentrations. Methods: We used Cohen effect size statistics to quantify these associations and to compare them across 11 published studies that were identified with MEDLINE and PsycINFO. Results: Cortisol levels increased during the daycare day, whereas they decreased when children stayed at home. The mean effect size was d = 0.72. The magnitude of the daycare-stress relation seemed to vary under 3 specific conditions. First, the effect size was larger for children in low-quality daycare (d = 1.15), whereas there was essentially little or no effect for children in high-quality daycare (d = 0.10). Second, the effect size was larger for preschoolers (aged 39 to 59 months) (d = 1.17) than for infants (aged 3 to 16 months) (d = 0.11) or school-aged children (aged 84 to 106 months) (d = 0.09). Third, children with difficult temperaments in daycare were more likely to exhibit a rising pattern of cortisol, compared with children who were not difficult. Conclusions: Our review suggests that daycare attendance in relatively low-quality daycare conditions and for children with difficult temperaments may result in atypical cortisol elevation. Although the link between atypical cortisol elevation and mental health requires further study, programs aimed at improving the quality of daycare services during the preschool years are expected to lead to better physiological adaptation to daycare and to reduce the risks of mental health problems. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article focuses on the role of family, mental health care practice and general practice to manage schizophrenia in Great Britain. In controlling the florid symptoms of schizophrenia, neuroleptic drugs have proven highly effective. Patients and their carers have got good assistatance from education about the nature of schizophrenia to recognize the signs and symptoms of the disorder as well as the patterns that emerge over time.

Objectives: To investigate the shared mental health care experience of the psychiatry department of a small urban general hospital, which serves an ethnoculturally diverse population.Methods: A chart survey was undertaken of all patients referred by community physicians to a new shared care program between January 1991 and December 1995. Selected demographic and diagnostic characteristics were collected and analyzed.Results: Seven hundred and thirteen patients were assessed. They were principally female, ethnoculturally varied, and highly comorbid. The most striking association involved mood and substance-related disorders.Conclusion: The Doctors Hospital experience shows that the shared care approach can reach large numbers of patients through a multiplier effect. Additionally, this approach has the potential to enhance access for ethnoculturally varied and diagnostically complex groups. [ABSTRACT FROM AUTHOR]

Among relatives of formerly hospitalized patients, attitudes toward the etiology of mental illness, the mental hospital, the normaley of former patients, and the responsibility of patients for their condition were assessed by means of short, structured scales. These attitudes were found to be associated with education, age, and verbal ability. There was no relationship, however, between these attitudes and social class, independent of education. The analysis suggests that "enlightened" attitudes toward mental illness can be more parsimoniously accounted for on the basis of differential verbal skills than on the basis of differences in "style of life." Attitudes of relatives were also found to be associated with the post hospital behavior of the patients. Difficulty may be anticipated in implementing procedures to modify the attitudes of patients' family members, for their attitudes appear to be "rooted" in a set of diverse elements that includes socialization as well as situational variables. [ABSTRACT FROM AUTHOR]

Objectives: Psychiatrists use biopsychosocial models in identifying aetiological factors in assessing their patients and similar approaches in planning management. Models in decision making will be influenced by previous experience, training, age and gender, among other factors. Critical thinking and evidence base are both important components in the process of reaching clinical decisions. Expected outcome of treatment may be another factor. The way we think influences our decision making, clinical or otherwise. With patients expecting and taking larger roles in their own management, there needs to be a shift towards patient-centred care in decision making. Conclusions: Further exploration in how clinical decisions are made by psychiatrists is necessary. An understanding of the manner in which therapeutic alliances are formed between the clinician and the patient is necessary to understand decision making. [ABSTRACT FROM AUTHOR]