Privacy and identity in a changing world.

Objective: To consider the issues of privacy and identity relevant to psychiatric practice in the context of recent technological initiatives and the society that has produced them.

Conclusions: Emerging technologies may have implications for the ways in which Western society relates. These are likely to affect the ways patients present, their concerns and how we may best assist them.

Emergency management of eclampsia and severe pre-eclampsia.

Eclampsia and severe pre-eclampsia are rare, but potentially life-threatening conditions that emergency physicians must be able to diagnose and treat promptly, because initial presentations to the ED are real possibilities. The treatment of the major complications of this disorder, hypertension and seizures, have been the focus of much research. Magnesium sulphate is now the first line agent for acute treatment and prophylaxis of seizures in eclampsia and pre-eclampsia.

Epidemiological analysis of electroconvulsive therapy in Victoria, Australia.

Objective: To determine the population-based utilization rate of electroconvulsive therapy (ECT) in Victoria between 1998-1999, to examine the characteristics of the ECT treated group, and to identify patient factors independently associated with differential rates of ECT treatment.

Method: Electroconvulsive therapy is reported under statute in Victoria, Australia. Crude, age-adjusted and age-sex specific utilization rates were calculated using this statutory data for the 1998-1999 financial year and estimated mid-year populations from the Australian Bureau of Statistics.

Long distance road transport of a patient with Wegener's Granulomatosis and respiratory failure using extracorporeal membrane oxygenation.

Wegener's Granulomatosis is a necrotizing vasculitis that in its most severe form can cause respiratory failure, renal failure and subglottic stenosis requiring surgical airway access. We describe the use of portable extracorporeal membrane oxygenation and the long distance road transport of a patient with Wegener's Granulomatosis who developed respiratory failure that was refractory to conventional mechanical ventilation. We have demonstrated the effective use of portable extracorporeal membrane oxygenation for stabilization and safe acute interhospital transfer over a long distance by road ambulance to a tertiary centre for further management.

Early Onset Dysthymic Disorder in Children and Adolescents: Clinical Implications and Future Directions.

Early onset dysthymic disorder (EODD) is a serious psychiatric disorder that is associated with impaired social and relationship functioning, comorbid psychiatric conditions, a chronic course and increased risk for adult affective disorders. Unlike major depressive disorder (MDD) in childhood, which has been the focus of ongoing research, EODD has been relatively neglected in clinical practice and research. This paper reviews and evaluates EODD research findings and outlines pertinent clinical and research implications.

A randomised, placebo-controlled, double blind study of treatment of Huntington's disease with unsaturated fatty acids.

Huntington's Disease (HD) is a serious dominantly inherited neurodegenerative disorder for which there are no current treatments. Open label and animal studies have suggested that highly unsaturated fatty acids (HUFAs) may be beneficial. Seventeen patients with HD were entered into a randomised, placebo-controlled, double blind trial of HUFA therapy.

Quality management and the Emergency Services Enhancement Program.

Since the introduction of the Emergency Services Enhancement Program (ESEP) in Victoria in 1995, improvements have been demonstrated in the indicators relating to Emergency waiting times, ambulance bypass rates and inpatient bed access block. This study focuses on staff perceptions of changes in these indicators, factors perceived to influence performance improvements and the extent to which ESEP is perceived to have contributed to overall patient care. A questionnaire was directed at four focus groups within each of the hospitals participating in ESEP.

Abnormal executive function in attention deficit hyperactivity disorder: the effect of stimulant medication and age on spatial working memory.

Objective: This study sought to examine the factors associated with spatial working memory and the use of strategies to impairments in spatial working memory in children with attention deficit hyperactivity disorder (ADHD). The developmental trajectories for spatial working memory in medicated and medication naïve children with ADHD were investigated. In addition, the effect of psychostimulant medication on deficits in spatial working memory was examined.

Using program theory to develop key performance indicators for child and adolescent mental health services.

Key Performance Indicators are used increasingly by health services, but their relevance and utility may be questionable. In this article, Program Theory is used to model the irreducible stages in the system of clinical care in Child and Adolescent Mental Health Services, define the major program operations in each of these stages, and specify the intermediate outcomes of each stage and the final outcomes sought. National and State policy standards are used, with practice experience, to identify key program operations and intermediate outcomes sought.

Children with persistent conduct problems who dropout of treatment.

Dropout of treatment is one of the key issues in outcome in a child and adolescent mental health service. We report two studies focusing on the treatment process and the dropout rate of children with persistent conduct problems presenting to a community mental health service, using a prospective design. The first study included 32 children and used a randomised controlled treatment design comparing a CBT approach with conjoint family therapy and an eclectic approach.

Nurse-patient communication in the intensive care unit: a review of the literature.

Patient care within an intensive care unit (ICU) can be a difficult and stressful task for even the most experienced and skilled critical care nurse. Good communication between the patient, relatives and nurse is integral to quality care of the patient and should extend to the entire health-care team. This article reviews the literature on nurse-patient communication in the ICU.

Better mental health services for young people: responsibility, partnerships and projects.

Objective: This paper argues that adolescent psychiatry is best linked with child psychiatry and opposes separate youth mental health programmes for 12-25-year-olds. It reports on the current status of services and considers how adult mental health services (AMHS) can improve services for young adults (18-25-year-olds).

Method: Factors in development, psychopathology, prevention, training and service systems are reviewed to suggest that current child and adolescent mental health service systems (CAMHS) are appropriate for 0-17-year-olds.

Attention deficit hyperactivity disorder: current progress and controversies.

Objective: Attention deficit hyperactivity disorder (ADHD) is a common chronic and disabling condition in children. This paper reviews the taxonomic issues and the major comorbid conditions, neurobiological correlates, treatment and public health issues associated with ADHD.

Method: Pertinent recent papers are reviewed from the psychological and psychiatric literature.

Collaboration between general practitioners and a child and adolescent mental health service.

Objective: The aim of this project was to develop a collaborative working relationship between general practitioners and a child and adolescent mental health service (CAMHS).

Methods: The project focused on changing the policies and culture within CAMHS to be more GP aware and inclusive. The project also provided GPs with an accredited training package on common mental health problems.

Children who are cruel to animals: a revisit.

Objective: There is a paucity of research regarding children who are cruel to animals (CTA). Previous studies have suggested that being CTA is linked with recurrent aggression in adulthood. In this report, children with persistent conduct problems who are CTA are examined.

Sigmoidoscopy. Is it a general practice procedure?

Sigmoidoscopy can readily be learnt and practised by a general practitioner interested in looking after patients with colorectal problems. Examination with a rigid sigmoidoscope has advantages over use of the flexible instrument for the frequent user. Details of the equipment needed for sigmoidoscopy as well as a method, precautions and some typical findings are described.

Comparison of treatments of persistent conduct problems in primary school children: a preliminary evaluation of a modified cognitive-behavioural approach.

Objective: Treatment for persistent conduct problems in primary school children was developed using a modification of cognitive-behavioural therapy (MCBT). Its effectiveness was evaluated by comparing it with conjoint family therapy (FT) and eclectic therapy (ET).

Method: Children with persistent conduct problems were randomly assigned to one of three treatment groups.

The role of core biopsy in the diagnosis of mammographically detected lesions.

Background: Both stereotactic imaging and ultrasound have been used to localize non-palpable breast lesions for core biopsy analysis. In particular, stereotactic core breast biopsy with a dedicated recumbent mammographic unit is an accurate and reliable technique, and this has been substantiated in a number of recent prospective studies comparing percutaneous core biopsy with open excisional biopsy.

Methods: This article reviews biopsies of 521 lesions from 502 cases using both stereotactic localization (469 lesions) and ultrasound (33 lesions).

Schizophrenia, tardive dyskinesia and essential fatty acids.

Several reports have indicated that people suffering from schizophrenia show an associated abnormality in levels of certain essential fatty acids (EFAs) in blood cells. Similar abnormalities have also been noted in association with the presence of tardive dyskinesia (TD). In order to study this further, 72 patients with the diagnosis of schizophrenia or schizoaffective disorder were examined to assess the relationship between psychiatric status, movement disorder (TD) and relative levels of the n-3 and n-6 essential fatty acids in red blood cell membranes and plasma.

Obstructive sleep apnoea. The clinical consequences.

Obstructive sleep apnoea (OSA) results in a variety of clinical consequences and is associated with a number of important common diseases. This article outlines the clinical features and pathophysiology of OSA and explores its protean manifestations.