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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]

This commentary speaks to several issues that arise from the papers in this special issue. Two articles--Kessler (2002) and Mirowsky and Ross (2002)--focus on a major measurement issue: dimensional versus diagnostic-type assessments. One topic requires greater attention: the correspondence of these measures with the underlying states they supposedly measure--constructs in the psychometric tradition and empirically defined illnesses in the medical or psychiatric tradition. Conclusions about the nature of these unobserved states remain tentative at this time. Three articles--Keyes (2002), Schwartz (2002), and Umberson, Williams, and Anderson (2002)--address the expansion of mental health outcomes. The existing reliance on emotional distress is problematic for sociological research because a single disorder is not a good proxy for estimates of the overall mental health consequences of social arrangements. Although these papers present diverse and sometimes conflicting perspectives, collectively they demonstrate that no one approach to outcomes is best for all research questions. [ABSTRACT FROM AUTHOR]

Objectives: It has been proposed that legislation for same-sex marriage has a positive mental health benefit. The purpose of this paper is to review and evaluate the empirical and conceptual links between same-sex marriage and mental health.Conclusions: There are substantive methodological issues in the four surveys and comparisons undertaken. Difficulties with the validity of the evidence are discussed. Conceptual difficulties in the arguments relating to victimisation as well as the psychology of marriage are highlighted. It was concluded that it is premature to make claims of causality vis-a-vis same-sex marriage legislation and mental health. [ABSTRACT FROM AUTHOR]

Objectives: This paper looks to examine the emerging role of carers as essential components in the management of individuals affected by severe mental illness in the context of modern legal and health policy environments. Conclusions: Cultural and legal concepts of confidentiality within the doctor–patient relationship are complex. Increasingly, evidence is recognizing the essential role of carers in the quality management of individuals affected by severe mental illness and this emphasis is being further supported by innovative health policy and legislation. A public health definition for the role of carers may be a more appropriate way to consider their role in mental health management strategies. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to introduce the term 'predicament suicide' and add to the evidence that suicide may occur in the absence of Axis I diagnoses. Method: The term 'predicament suicide' was described as suicide which occurs when the individual without mental disorder is in unacceptable circumstances from which they cannot find an acceptable alternative means of escape. Accounts of suicide that satisfied these criteria, and could be illustrated by images, were sought. Results: Four accounts were identified: Ajax, Brutus, Mayor Freyberg and Commander Donnicke. Conclusions: Predicament suicide appears to be a useful designation. This work added evidence indicating that suicide may occur in the absence of an Axis I mental disorder. [ABSTRACT FROM AUTHOR]

Aim: This paper uses the public record to explore the relationship between reputation damage and suicide. Method: The public record of the last 20 years was examined for examples of individuals without evidence of mental disorder who suffered actual or threatened reputation damage and suicided shortly thereafter. Results: Fifteen individual cases were identified; 18 additional cases, less comprehensively detailed, were mentioned in reports of The Wood Royal Commission and Operation Auxin. All cases were male. Of the 15 individual cases, the average age was 55 years, with a range of 40 to 76 years. The available details of the 18 additional cases were consistent with these findings. Conclusion: Middle-aged males without clear evidence of mental disorder, who suffer actual or threatened reputation damage, may be at increased risk of suicide. Naming and shaming needs to be conducted with caution. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to examine the background to the emblematic psychiatric term, schizophrenia, the historical, cultural and social factors affecting the two men who defined modern psychiatric practice, and anticipate what lies ahead in the next century. Conclusions: The term schizophrenia was created by Swiss psychiatrist Eugene Bleuler and first used on 24 April 1908. The condition was first described by German psychiatrist Emil Kraepelin and called dementia praecox. After a century, it is impossible to think of the practice of psychiatry without schizophrenia. [ABSTRACT FROM AUTHOR]

It is time to move beyond education about qualitative research theory and methods to using them to understand and improve psychiatric practice. There is a good fit between this agenda and current thinking about research use that broadens definitions of evidence beyond the results of experiments. This paper describes a qualitative program evaluation to illustrate what kind of useful knowledge is generated and how it can be created through a clinician-researcher partnership. The linkage and exchange model of effective knowledge translation described involves interaction between clinicians and researchers throughout the research process and results in mutual learning through the planning, disseminating, and application of existing or new qualitative research in decision making. [ABSTRACT FROM AUTHOR]

This paper presents a case study that illuminates the clinical and practical challenges that accompany the treatment of people with serious mental illness (SMI) and criminal involvement. We discuss the historical conditions that led to the influx of a large number of people with SMI into the criminal justice system. We discuss the case history of Richard P., which illustrates the use of Assertive Community Treatment (ACT) to care for criminally involved people with SMI. We focus on the ACT model that was employed by Thresholds to treat Richard P. It was known as the Thresholds Jail Program. We track his progress in the program and explicate the case management considerations that are most salient in treating offenders with SMI. [ABSTRACT FROM AUTHOR]

Objective: This paper provides a conceptual, historical and legislative overview of fitness issues. These include fitness to be interrogated or charged, to plead, to be tried and to be sentenced in the context of Australia and New Zealand. Conclusions: Legislation regarding fitness issues needs to strike a balance between protecting the rights of mentally impaired defendants to a fair trial process and recognizing that mental illness in itself does not absolutely preclude participation in a trial process or necessarily diminish criminal responsibility. Although the key determinants of fitness seem to be the ability to cope with court processes and communicate with counsel, the application of clinical judgement to legal criteria is not always straightforward. [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]

In relation to treatment-related research in the United States, there is relatively little systematic effort focused on the combination of risk and prevention for anxiety pathology. This article broadly discusses risk factor research and prevention program development for anxiety psychopathology. The authors also specifically discuss papers in this special issue that are focused on these topics. Risk factor research should be used by clinical researchers to inform prevention programs, and reciprocally, prevention knowledge should be effectively utilized to drive new, clinically focused risk factor research. [ABSTRACT FROM AUTHOR]

Objective: Some groups of young people experience elevated rates of mental disorders and low rates of uptake of mental health services. Because an association between staff competence and uptake of services has been demonstrated a key objective of this paper is to identify relevant staff learning needs. Method: A learning needs analysis was undertaken of adolescent mental health workers employed in the health and education sectors in NSW, Australia, to explore their learning needs regarding Aboriginal, same-sex attracted and culturally and linguistically diverse young people. Results: Significant differences were found between learning needs in relation to location but no significant differences were found in relation to agency or experience. Participants ranked their learning needs as high and their knowledge and skills in working with depression and related disorders in these young people as low. Conclusion: This article highlights issues that may be of interest to clinicians and their managers regarding training, policy and service delivery. [ABSTRACT FROM AUTHOR]

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]

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: 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]

As part of the Canadian Community Health Survey (CCHS) biennial strategy, the provincial survey component of the first CCHS cycle (Cycle 1.2) focused on different aspects of the mental health and well-being of Canadians living in private dwellings. Moreover, the survey collected data on prevalences of specific mental disorders and problems, use of mental health services, and economic and personal costs of having a mental illness. Data collection began in May 2002 and extended over 8 months. More than 85% of all interviews were conducted face-to-face and used a computer-assisted application. The survey obtained a national response rate of 77%. This paper describes several key aspects of the questionnaire content, the sample design, interviewer training, and data collection procedures. A brief overview of the CCHS regional component (Cycle 1.1) is also given. [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]

This paper introduces and applies an operationalization of mental health as a syndrome of symptoms of positive feelings and positive functioning in life. Dimensions and scales of subjective well-being are reviewed and conceived of as mental health symptoms. A diagnosis of the presence of mental health, described as flourishing, and the absence of mental health, characterized as languishing, is applied to data from the 1995 Midlife in the United States study of adults between the ages of 25 and 74 (n = 3, 032). Findings revealed that 17.2 percent fit the criteria for flourishing, 56.6 percent were moderately mentally healthy, 12.1 percent of adults fit the criteria for languishing, and 14.1 percent fit the criteria for DSM-III-R major depressive episode (12-month), of which 9.4 percent were not languishing and 4.7 percent were also languishing. The risk of a major depressive episode was two times more likely among languishing than moderately mentally healthy adults, and nearly six times greater among languishing than flourishing adults. Multivariate analyses revealed that languishing and depression were associated with significant psychosocial impairment in terms of perceived emotional health, limitations of activities of daily living, and workdays lost or cutback. Flourishing and moderate mental health were associated with superior profiles of psychosocial functioning. The descriptive epidemiology revealed that males, older adults, more educated individuals, and married adults were more likely to be mentally healthy. Implications for the conception of mental health and the treatment and prevention of mental illness are discussed. [ABSTRACT FROM AUTHOR]

This paper coin pares the conceptions of mental illness held by a group of psychiatrists and a random sample of the general public in the same locality. The hypothesis was that the public, but not the psychiatrists, would tend to consider troublesome behavior as being more indicative of mental illness than non-troublesome behavior. Statements representing five pairs of troublesome non-troublesome types of behavior were rated by both groups as indicators of mental illness. Analysis of the data, using the statements at face value and with a weighting system, did not support the hypothesis. Both public and psychiatrists appear to have similar views but not in the expected order. Most notably, manic behavior ranked very low among the conceptions of mental illness. This finding accords with recent reports of a decline in the incidence of manic- depressive psychoses. Is this decline due to changes in modern society that alter public and psychiatric conceptions of mental illness? [ABSTRACT FROM AUTHOR]

Objective: This paper outlines evidence of efficacious outcomes from mixing people living with diverse mental health challenges and/or intellectual disability. The intention was to show how mixing up people who are differently challenged can be efficacious in (re)habilitation terms. Two separate experiences of sharing personal narratives were involved, along with creative expressions in music, art and filming, combined with group gatherings providing discerning feedback for each other on members’ day-to-day progress. After 12 months of ‘open urban tribe’ gatherings in Sydney, where participants formed a community of belonging, the model was adapted for use in Alice Springs. The original group developed a cycle of interactive ritual rhythms, and these became a special feature of their self-help, peer support approach. The Sydney project modelled community-based rehabilitation, and that process then informed the processes initiated in a rural, remote location. Methods: Regular whole tribe gatherings ‘in the circle’ combined with mentoring ‘aunties and uncles’. By sharing stories and giving personal feedback on their progress, participants developed skills and confidence in self expression. Relating to each other and the group, and sharing creative expressions (group craft activities, dancing, small group performing) added depth to the experience of participants... [ABSTRACT FROM AUTHOR]

Objective: Despite recognition of the extremely high rates of mental illness among custodial populations and the fact that Indigenous people represent around one-quarter of Australia's custodial population, little is known about the mental health of Aboriginal and Torres Strait Islander people in custody. Mental health is an important component of social and emotional wellbeing for Indigenous people and this paper considers current evidence regarding the mental health status of Indigenous Australians in custody. Method: A systematic review was undertaken of the quantitative literature relating to the mental health problems of Indigenous people in custody in Australia. Results: Despite high incarceration rates for Indigenous people and evidence that both mental health problems and rates of mental illness are extremely high in this group, studies in this area are few and limited in scope. Conclusion: The first step toward addressing the marked social and mental health problems for Indigenous people in custody is to systematically identify the nature and extent of these problems. [ABSTRACT FROM AUTHOR]