Australian & New Zealand Journal of Psychiatry

Cost-containment of medical care has become of increasing importance to both medical administrators and politicians. Recently, studies have examined the impact of psychological and psychiatric treatments on medical care utilisation and hospitalisation rates and the cost-effectiveness of such treatments. These studies have demonstrated that interventions based on a consideration of psychosocial factors in physical illness are effective in reducing the morbidity, and mortality, of a wide range of illnesses and that they lead to reduced medical care utilisation and a lower rate of hospital treatment. It has also been demonstrated that holistic management based on the ‘biopsychosocial’ model of illness is cost-effective and that there is an overall reduction of expenditure after allowing for the cost of the psychological or psychiatric treatment. It is concluded that further development of consultation-liaison psychiatry should be encouraged to promote awareness of the influence of psychosocial factors on physical illness and their early management as both clinically important and cost-effective.

For 11 years the N.S.W. mental health legislation was under review. The new legislation was finally enacted in 1983. Several different committees worked on the development of the legislation over the 11-year period. Two government departments, the Department of Health and the Attorney-General's Department, were involved in the preparation of the legislation. As a result, many parts of the Act represent an uneasy compromise between the medical-humanitarian and legal points of view. The process of development of the definition of a mentally ill person, which is traced in this article, exemplifies this. Features of the new definition are critically reviewed and potential problems discussed.

The childhood antecedents of psychiatric disorder in adult life are reviewed with regard to four groups of conditions that show sharply contrasting patterns of linkage between childhood and adult life. For emotional disorders the links are weak and the mechanisms largely unknown. About half of schizophrenic psychoses are preceded by non-psychotic abnormalities of behaviour in childhood; the processes involved are probably largely constitutional. Affective disorders only infrequently begin in childhood and the behavioural percursors of adult depression do not constitute a clearly recognisable pattern. However, adverse experiences in childhood may create a vulnerability to later depression. The child-adult linkages are strongest with conduct disturbance in childhood and adult personality disorder, the mechanisms in this continuity are probably both constitutional and environmental.

The phenomena of dreams have been accorded significance by all branches of mankind of which there is record. Australian Aborigines in their traditional cultures are no exception, although unfortunately the printed record of their dreams is meagre. This paper reports nine dreams which were volunteered by Arnhem Landers of the present day. The subjects they dreamed about represent a melange of traditional and introduced concerns competing for attention, including lifting a taboo, portents and auguries, a shark attack, a brake failure in a truck, a mysterous light in a cave, a visit from the dead, a disappointing love tryst, a drink problem and the Christian revival movement. The ordinary dreams of Aborigines resemble those of modern Western subjects in aspects such as frequency, duration, clarity of recall, shifts in attention and derailment of the narrative, but they differ from them in being accorded more significance and in being more reflected upon during waking hours. In this respect, Aborigines infer a closer connection between the dream and the waking life.

A psychiatrist trained in Jungian analytical psychology looks at the dreams of nine Australian Aborigines from Arnhem Land. Religious imagery and the theme of intercultural conflict predominate. The relationship between religious imagery and the concept of Self in Jungian psychology and Self psychology is discussed.

This study compares firesetting children with an age- and sex-matched group of non-firesetting children referred to a child psychiatric outpatient service. Firesetting was associated with male sex, separated parents and with previous contact with welfare agencies. It was not associated with socioeconomic status. Firesetters were distinguished from the contrast group by higher levels of conduct disordered behaviour, particularly in children above the age of 11 years. Both groups had similar high levels of emotional disorder at all ages. These clinical features emphasise that firesetters have a mixed clinical picture with widespread psychopathology.

A factor analytic study of responses to a 60-item General Health Questionnaire of people in general practice and in the community in Perth, Western Australia, was performed. Five identified factors, accounting for 46% of the variance, were very similar to factors identified in an English general practice study but differed from two published Australian studies. The statistic of a relative GHQ profile was generated to compare these factors in various sets of data. There was no significant difference between the relative GHQ profile in the community and general practice data or between demographic factors such as sex, social class and country of birth. The major positive finding was of an excess of overtly psychological factors in ‘cases’ compared with an excess of more physical factors in ‘non-cases’.

The purpose of the present study was to clarify the role of EMG-based relaxation training for a diverse group of chronic pain patients by examining in detail both process and outcome changes. Eighteen pain clinic patients were each given 10 sessions of relaxation training using frontalis feedback. The results of the study do not support the use of relaxation training as a standard procedure for chronic pain patients. Psychophysiological assessment carried out before and after training indicated some reduction in EMG levels, with less change in GSR and HR activity. No significant alteration occurred in mean pain and medication measures after training, although there was a trend for sedative/hypnotic usage to be smaller. Most important, individual differences in outcome were not consistently related to process variables monitored during training. This lack of association supports the view that physiological change is not necessary for clinical benefit after relaxation training.

The dexamethasone suppression test (DST) has been used for several years to assist in the diagnosis of melancholia. However, recent studies have cast doubt upon the diagnostic efficacy of the test. Twenty of the original studies that assessed this application of the DST were reviewed using six methodological criteria considered essential for the evaluation of a diagnostic test. None of the papers complied with all the criteria and only seven of the papers satisfied more than three criteria. These findings suggest that methodological problems might account for discrepancies between the original claims made for the test and the current status of the test.

This study compares the utility of a cortisol suppression index with the standard dexamethasone suppression test as a diagnostic aid for major depressive disorder. In 50 patients the cortisol suppression index was found to have similar sensitivity while also having greater specificity and diagnostic confidence than the dexamethasone suppression test. By avoiding the need for a late-evening blood sample, the cortisol suppression index may be an acceptable alternative to the current procedure.

A consecutive series of 45 women admitted to an obstetric unit were given the dexamethasone suppression test (DST) on days three to five post-partum, 82% being abnormal. The likelihood of an abnormal DST on one or both occasions increased linearly across the days of testing. Subjects completed the Beck self-report depression measure and the General Health Questionnaire at baseline and at six weeks. Baseline cortisol levels were not associated with baseline morbidity as assessed on the questionnaires and were not predictive of morbidity assessed at the six-week follow-up. It is concluded that the immediate post-partum period be included as a false-positive influence on the DST.