Australian & New Zealand Journal of Psychiatry

Psychoanalysis is in decline. Its methods disbar it from serious consideration as a natural science and its claims to therapeutic efficacy are in tatters. The role it performed earlier in the century as part of the narrative knowledge of western culture is in eclipse. Trainees in psychiatry are still, however, on occasion seduced by its faded charms, to their detriment. The time has come to relegate psychoanalysis to its proper place as a moment in the historical development of psychiatry and a ripple in 20th century western culture.

It is argued that personality scales of neuroticism and anxiety are tapping the same personality trait and that this is a risk factor for neurotic disorders. To see whether this trait is modifiable, a meta-analysis was carried out of therapy outcome studies which included a measure of trait anxiety or neuroticism as a dependent measure. This meta-analysis showed that all psychological therapies are to some extent effective. However, rational-emotive and related therapies produced particularly large reductions in trait anxiety/neuroticism (around 1.25 standard deviations). The possibility that rational-emotive education programmes could be used to lower trait anxiety/neuroticism as a preventive measure is discussed.

Studies addressing the issue of media reporting of suicide and subsequent suicide are reviewed. the majority demonstrate a statistically significant association between the amount of such reporting and ensuing increases in suicide. Restraint is clearly indicated. the media could assist by publicising alternative coping mechanisms, rather than “normalizing” suicidal behaviour by reporting it.

We examined the characteristics of a self-report measure for assessing perceptions of parents, the Parental Bonding Instrument (PBI), in an adolescent community sample (N = 2,147; mean age = 15.4 years). Using factor analysis, three PBI dimensions were identified — the original Care factor and two Protection factors: perceived social control and personal intrusiveness. Important sex differences were found which were not evident in the two factor structure recommended by Parker [1, 2]. Relative to sons, daughters saw their fathers as more personally intrusive and their mothers as less socially controlling and much more caring. Overall, adolescents perceived mothers as more caring but more personally intrusive than fathers. Adolescents who saw their father as uncaring and their mother as controlling tended to have the least positive psychosocial profiles.

Conceptual developments in mid-twentieth century medicine, the many factors known to influence course and outcome in schizophrenia, and recent systemic models of brain function all suggest the value of re-assessing the view of schizophrenia as biologically determined. Although the current view of schizophrenia as a brain disease, invoking the natural history model of disease, has mobilised research and public interest, it encourages a new biological determinism in thinking about schizophrenia which current evidence does not warrant and which restricts research and clinical advances.

General Health Questionnaire (GHQ) results are given for a large (N = 1013) sample of South Australian young people (average age 19.6 years), to compare the usefulness of the 12-, 28-, and 30-item forms of the GHQ. Internal reliabilities are generally adequate and the Likert scoring method produces significant correlations with psychological measures such as self-esteem. the case-prevalence rate using the binary scoring method was comparable with other studies, but misclassification rates were unacceptably high when DSM-Ill Axis I diagnosis was used as the criterion for the presence of any psychiatric disorder.

The Levine-Pilowsky depression questionnaire was used to compare the qualitative and quantitative characteristics of depression in 176 patients admitted to a general hospital following a suicide attempt and 65 psychiatric in-patients with a diagnosis of major affective disorder. the study showed that despite significant age and sex differences there was a striking similarity between the groups on all measures of depression. Diagnostic and therapeutic implications of these findings are discussed, and further research directions are suggested.

Recent developments in molecular genetics are examined with particular reference to psychiatry. the new technologies available have allowed significant advances in the understanding of certain illnesses such as familial Alzheimer's disease and Huntington's chorea, and will provide powerful tools to explore many other important psychiatric illnesses. the area of genetic counselling is already characterized by complex ethical issues. We can expect that as the new technologies provide the prospect of positive germ line genetic engineering, these ethical issues will become more complex. It is important that psychiatrists prepare themselves for these future developments and take an active role in leading the debate.

The widely used DSM-Ill criteria for the diagnosis of bulimia essentially define bulimia as a syndrome of guilty, secretive and subjectively hard to control binge over-eating. A self-report questionnaire for bulimic behavior was administered to three community and two hospital populations in South Australia. 13% of females in the community samples could be categorized as bulimic according to the DSM-Ill criteria. Those criteria did not adequately define the behaviour of patients in treatment for bulimia in a Weight Disorders Unit, 85% of whom not only binged, but induced vomiting afterwards. When diagnostic criteria were more closely aligned to clinical experience, the prevalence of bulimia in the community appeared closer to 1–2%. New DSM criteria (DSM-Ill-R) have been proposed and prevalence rates using them fell within the 1–2% range.

A review of the clinical literature to date has shown that the nature of the relationship between phobic disorders and anxiety states is still unclear. As a wide range of symptoms are shared by patients with all DSM-III anxiety disorder diagnoses, at this stage there is still a need to investigate the latent dimensions which distinguish the anxiety disorder subtypes. In the present study 176 patients with the DSM-III diagnoses of agoraphobia with panic attacks, social phobia, panic disorder and generalized anxiety disorder completed the Fear Survey Schedule, Fear Questionnaire, Hostility and Direction of Hostility Questionnaire, Maudsley Personality Inventory, and the Hamilton Anxiety and Depression Scales. Group membership was significantly predicted by a discriminant analysis which yielded a Fear Questionnaire agoraphobia function and a social phobia function. the results from discriminant analysis suggests that agoraphobia and anxiety states may be closely related. Classification errors were also determined, providing further evidence with which to refute the claim that agoraphobia has “all or none” characteristics.

The role of nursing staff in a liaison consultative unit is by no means established in this country although precedents exist in the United States. Nevertheless, there are clear theoretical reasons for including psychiatric nurses in the liaison team. This report concerns a model of intervention based on one of three models identified in the US studies. the model involves a collaborative/consultative relationship between the psychiatric nurse and the psychiatrist, therefore maximising opportunities for successful intervention and cross-referral. Two clinical vignettes illustrate this. the clinical presentations of 200 patients presenting primarily to the nurse specialist are compared with 200 presenting to the psychiatric department. the patterns of referrals and also the agencies referring differed. the differences in those profiles, together with the management implications, are discussed. High stress areas of nursing, such as cardiology, neurosurgery and haematology, provided a fertile area for referrals to the nurse where referrals to the psychiatrists had not been high.

A case study illustrates the aim of this paper, which is to discuss the clinical and theoretical implications of adult patients who have experienced extreme or catastrophic stress in their distant past which may not be immediately “recognisable”. A close relationship between Post-Traumatic Stress Disorder and Borderline Personality Disorder (as defined in DSM-III-R) is suggested.

Accomplishments in the various fields of Australian psychiatry are traced from the first asylums, through the history of the peaks and troughs of progress, down to the present state of disorganisation of the services and the struggle for psychiatry to find an honourable place in Australian history.

One phase of Beethoven's life, between his 45th and 50th year, characterized by very low creativity and overwhelming stress situations, is subjected to a psychiatric interpretation. the historical background is briefly sketched and 5 precipitating stress factors are outlined. the symptoms of his illness are described, using Beethoven's letters as source material. A brief discussion of Beethoven's musical style prior to and after his illness is based on quotations from three eminent musical scholars. A resume of Beethoven's physical and psychological disorders during his life are given and the conclusion is reached that between 1815 and 1820, Beethoven experienced a creative illness which was psychotic in type, ended in recovery and radically changed his musical creativity.

GROW, a community based mutual-help organisation, aims to provide the means for those who have been mentally ill to rehabilitate themselves and grow personally. We measured psychiatric symptoms, group processes, social environment and perceived social support in a sample of GROW group members. We found that GROW does provide the opportunity for and encourages some personal changes and does provide social support. We could not draw any conclusions about GROW'S efficacy as a rehabilitative agent.

A case of pseudodementia in a 10 year old boy was first reported in 1981. When reviewed 8 years after initial presentation, his symptoms were largely unchanged. the case continues to be complicated by claims for compensation and a successful appeal against the initial compensation judgment.

A Chinese female with 10 years' history of a special form of tardive dystonia (Pisa syndrome) is described. Mild improvement has occurred after 5 months' treatment with tetrabenazine despite the long duration of dystonia and the presence of secondary structural changes.

A case of reserpine withdrawal psychosis is reported. This uncommon condition is described as a true withdrawal psychosis and may be due to dopamine receptor supersensitivity.