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Biomedical subjects

D Silove

Publications and source records attributed to D Silove.

At least 37 records · Page 2Linked to original sources
PubMed1997

Compounding of premigration trauma and postmigration stress in asylum seekers.

Unauthorized immigrants arriving in Western countries increasingly are being subjected to stringent restrictions while their residency claims are assessed. The present study was a investigation of premigration exposure to organized violence and postmigration stressors in 40 individuals seeking asylum who were attending a community welfare center in Sydney, Australia. Almost 80% reported exposure to premigration trauma such as witnessing murders, having their lives threatened, being separated from family members, and brainwashing; 25% had been tortured. Asylum seekers reported a marked decline in socioeconomic status. Common ongoing sources of severe stress included fears of being repatriated, barriers to work and social services, separation from family, and issues related to the process of pursuing refugee claims. More than one third had problems obtaining health services in Australia--the same number who reported similar difficulties in their home countries. Although based on a selective and culturally heterogeneous sample, the results suggest that salient aspects of the asylum-seeking process may compound the stressors suffered by an already traumatized group.

Acculturation↗
PubMed1997

The influence of culture on psychiatric assessment: the Vietnamese refugee.

The influence of culture on psychiatric diagnostic assessments remains controversial. The authors outline differences between the emic approach to assessment, which is informed by ethnographic concepts of the centrality of culture in shaping the psyche and its expressions, and the etic approach, which downplays cultural effects and focuses on the universal elements in manifestations of psychological distress. Based on the experience of assessing Vietnamese refugees in Australia, the authors explore semantic, contextual, and conceptual factors that may impede the psychiatric assessment of patients from other cultures. Areas of misinterpretation are illustrated using examples from the Vietnamese language. The authors discuss how variations in politicohistorical experiences within ethnic populations may result in differences in the modes of expressing and understanding mental illness. Recognition of the tension between etic and emic perspectives allows the clinician to draw on the most useful elements of each in assessing and treating individual patients.

Cross-Cultural Comparison↗
PubMed1997

Satisfaction of Vietnamese patients and their families with refugee and mainstream mental health services.

OBJECTIVE: The study examined levels of satisfaction with mainstream mental health services and specialized mental health services for refugees among Vietnamese psychiatric patients and their relatives. Demographic, diagnostic, symptomatic, and service-related issues that might influence satisfaction were investigated. METHODS: Eighty-six Vietnamese patients were identified from case notes of mainstream inpatient services (N = 31), mainstream community services (N = 7), and a specialized refugee treatment unit (N = 48). During an interview, a scale measuring satisfaction with treatment as well as measures of anxiety, depression, and posttraumatic stress disorder was administered to them. A modified satisfaction scale was administered to 56 relatives. RESULTS: Patients and relatives were, on average, moderately satisfied with treatment. Patients expressed greater satisfaction with the specialized treatment unit for refugees than with mainstream services, a finding that was not influenced by diagnostic differences or symptom levels at the time patients responded. Further analyses controlling for multiple comparisons revealed that the extent of the information provided and the ease of negotiating changes in treatment were the most salient variables in distinguishing satisfaction levels across the two types of treatment centers. Patients' fluency in English and their relatives' level of education were inversely associated with satisfaction scores, tentatively suggesting that the greater the ability of patients and their families to evaluate services, the less likely they were to express satisfaction with treatment. CONCLUSIONS: Specialized mental health services for refugees may be more acceptable to refugee populations than their mainstream counterparts, perhaps because better communication with patients and their families is possible in the specialized services. Patients and families who are in a position to evaluate services fully are more likely to be critical of treatments offered.

Acculturation↗
PubMed1997

Anxiety, depression and PTSD in asylum-seekers: assocations with pre-migration trauma and post-migration stressors.

BACKGROUND: Research into the mental health of refugees has burgeoned in recent times, but there is a dearth of studies focusing specifically on the factors associated with psychiatric distress in asylum-seekers who have not been accorded residency status. METHOD: Forty consecutive asylum-seekers attending a community resource centre in Sydney, Australia, were interviewed using structured instruments and questionnaires. RESULTS: Anxiety scores were associated with female gender, poverty, and conflict with immigration officials, while loneliness and boredom were linked with both anxiety and depression. Thirty subjects (79%) had experienced a traumatic event such as witnessing killings, being assaulted, or suffering torture and captivity, and 14 subjects (37%) met full criteria for PTSD. A diagnosis of PTSD was associated with greater exposure to pre-migration trauma, delays in processing refugee applications, difficulties in dealing with immigration officials, obstacles to employment, racial discrimination, and loneliness and boredom. CONCLUSIONS: Although based on correlational data derived from'a convenient' sample, our findings raise the possibility that current procedures for dealing with asylum-seekers may contribute to high levels of stress and psychiatric symptoms in those who have been previously traumatised.

Adult↗
PubMed1997

Is there an adult form of separation anxiety disorder? A brief clinical report.

OBJECTIVE: The aim of this clinical report is to investigate whether symptoms of separation anxiety disorder can occur in adulthood. CLINICAL PICTURE: Three cases are described to illustrate that adults may experience: wide-ranging separation anxiety symptoms, such as extreme anxiety and fear, when separated from major attachment figures; avoidance of being alone; and fears that harm will befall those close to them. Symptoms of panic appeared to be secondary to separation anxiety, and none of the patients fulfilled criteria for dependent personality disorder. TREATMENT: Group cognitive behavioural treatment focusing on preventing panic attacks and generalised anxiety did not appear to have an impact on core separation anxiety symptoms. OUTCOME: Exacerbations of separation anxiety appeared to be closely linked to actual or threatened ruptures to primary bonds. CONCLUSIONS: Separation anxiety disorder may be a neglected diagnosis in adulthood. Formal nosological systems such as the DSM may need to be revised to incorporate adult manifestations of the disorder.

Adult↗
PubMed1996

Ethical considerations in the management of asylum seekers on hunger strike.

Hunger strikes have confronted physicians with complex ethical dilemmas throughout history. Asylum seekers under threat of forced repatriation have emerged as a new category of hunger strikers, posing novel challenges for management. The management of 3 Cambodian asylum seekers on hunger strike admitted to a hospital in Sydney, New South Wales, Australia, posted important ethical dilemmas for the physicians and mental health experts involved in their care. Several factors confounded the task of assessment and decision making, including language and cultural barriers, the patients' past exposure to persecution by authorities, and the complexities of the legal procedures being pursued. Different rules appeared to govern the actions of the hunger strikers, the medical team, and the immigration authorities, creating a ¿malignant triangle¿ of mounting confrontation. Recent recommendations for the management of asylum-seeking hunger strikers include the appointment of an external physician of confidence and the writing of a confidential advance directive specifying the hunger striker's wishes about resuscitation in the event of collapse. In addition, we consider the value of constituting an ad hoc ethics committee to advise the responsible physician on points of conflict in managing the hunger strike. The advantages and limitations of these proposals in relation to the particular cultural, historical, and contextual issues relevant to asylum seekers are examined herein.

Advance Directives↗
PubMed1996

Anxiety and depression in general practice patients: prevalence and management.

OBJECTIVE: To determine the prevalence of anxiety and depression in general practice patients and assess management of these conditions by general practitioners (GPs). METHOD: A random sample of 212 GPs were approached to be interviewed and to conduct a patient survey and audit on 50 consecutive patient consultations during 1993. PARTICIPANTS: 117 GPs (55% response rate) and 4867 patients (85%) who completed questionnaires suitable for analysis. SETTING: General practices in two areas (divisions of general practice) in Sydney, New South Wales. RESULTS: Thirty-six per cent of patients had abnormal scores on a General Health Questionnaire (GHQ-12); they were more likely to be women or to be unemployed. Twenty per cent of these patients had been treated for depression or anxiety in the previous 12 months; 52% were prescribed drug therapy, and were more likely to be older, male or unemployed. Seventy per cent of patients reported having been offered therapy by their GP that did not involve drugs. Twenty-four per cent had been referred to another health professional; they were more likely to be younger, or men, or patients attending their usual doctor. CONCLUSIONS: A brief screening instrument may improve GPs' detection rate of patients with anxiety or depression. The high prevalence of these conditions in unemployed people deserves particular attention by GPs. Both drug and non-drug therapies are being more appropriately applied in general practice than previously.

Adult↗
PubMed1996

Pathological gambling: forensic issues.

OBJECTIVE: The aim of this paper is to review the literature describing the hypothesised link between crime and pathological gambling and its relevance to arguments of diminished responsibility. METHOD: An attempt was made to include all publications in the psychiatry and psychology literature which made reference to pathological gambling and criminal behaviours. Given the limited research in this field, specific unpublished conference papers were also included in the review. RESULTS: Evidence supports the contention that pathological gamblers are at high risk for committing criminal offences in order to maintain their habitual gambling behaviours. An antisocial personality disorder while acting to increase the risk factor is in itself an insufficient explanation for the observed link. As a result of the acceptance of pathological gambling as a psychiatric disorder, the judicial system is being increasingly confronted with an argument of diminished responsibility for gambling-related offences committed by pathological gamblers. CONCLUSION: A diagnosis of pathological gambling does not diminish legal responsibility but is a factor that should be considered in sentencing. Referral to psychiatric services reduces the risk of recidivism.

Adolescent↗
PubMed1995

Delayed-type hypersensitivity skin testing: normal values in the Australian population.

In our human psychoimmunological studies we have utilized a standardized assessment kit, the cell-mediated immunity (CMI) Multitest system, for determining delayed-type hypersensitivity (DTH) skin responses to a panel of ubiquitous antigens. Although the kit had been assessed in large populations of healthy controls in the U.S.A. and Europe, few data were available with regard to normative values in the Australian population. There are cogent reasons to suspect that results for the test will vary depending on geographical location, age cohort, compliance with specific immunization schedules and rates of natural exposure to certain diseases in differing populations. Most of our patient cohorts have a preponderance of female subjects and most standardization had been conducted in males. We tested medically and psychologically healthy males (n = 66) and females (n = 53). The percentage of positive responses to individual antigens was similar to other Australian studies but lower than that reported internationally. The mean number of positive responses was 3.7 for men and 2.8 for women, while the mean induration diameter was 17.5 mm for men and 12.2 mm for women. Three per cent of men and 5.6% of women were anergic (no positive responses), while a further 10.6% of men and 9.4% of women fell into the "hypoergic" category. These results, and those from other studies, indicate that the pattern of response to the CMI Multitest differs in healthy Australians. Therefore, researchers need to exercise caution when selecting patient and control samples (controlling for exposure factors), applying the test, reporting results (i.e. including all relevant parameters-with an emphasis on dimensional rather than categorical scores) and when designating subjects as having "impaired" responses.

Adolescent↗
PubMed1995

Biochemical correlates of in vivo cell-mediated immune dysfunction in patients with depression: a preliminary report.

We have previously demonstrated that at least 50% of patients with melancholia have impaired cell-mediated immunity (CMI) as assessed by delayed-type hypersensitivity (DTH) skin responses to a standardized battery of antigens. Hypercortisolaemia and increased circulating catecholamines both occur in patients with severe depressive disorders and each has been proposed as a possible mediator of observed immune abnormalities in patients with mood disorders. As part of a larger study, we collected 24 h urine samples from 28 patients with major depression and measured concentrations of urinary free cortisol (UFC), the noradrenaline metabolite dihydroxyphenylglycol (DHPG), adrenaline, and the dopamine metabolite DOPAC. CMI multitest skin testing revealed a reduced or absent response in 54% of subjects. Those with reduced DTH skin responses demonstrated increased urinary adrenaline (P < 0.02), with trends toward increased UFC (P = 0.052) and increased DHPG (P = 0.06). These differences could not be attributed to differences in age or depression severity. Correlational analyses demonstrated inverse associations between the extent of DTH responsiveness and 24 h levels of urinary adrenaline and DHPG, with similar trends evident for UFC and DOPAC. These results suggest that both circulating catecholamines and cortisol may play roles in the reduction of CMI in patients with severe depression.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1995

Is early separation anxiety a specific precursor of panic disorder-agoraphobia? A community study.

The present study aimed to examine memories of early separation anxiety symptoms in a community sample of women at heightened risk to neurotic disorder. The chief finding was that subjects with a lifetime history of panic disorder-agoraphobia (PD-Ag) returned statistically higher scores on a retrospective measure of early separation anxiety compared to subjects with either generalized anxiety or other phobic disorders, a result which was not accounted for by differences in neuroticism or General Health Questionnaire scores. Although limited by its retrospective design and the problem of co-morbidity in subclassifying the anxiety disorders, the present study does provide added support for the hypothesis--endorsed by DSM-III-R--that there is a developmental link between early separation anxiety and panic disorder.

Adult↗
PubMed1995

Genetic factors in early separation anxiety: implications for the genesis of adult anxiety disorders.

An important contemporary conceptualization of anxiety has suggested that heightened early separation anxiety is specifically associated with the risk of adult panic disorder, with hereditary factors underlying that cluster of anxiety disorders. Yet there is a dearth of studies examining whether early separation anxiety is inherited. The present twin study, based on a retrospective approach, revealed a substantial genetic contribution to separation anxiety in females but not in males, with unique environmental influences being important in both gender groups. Although speculative, an evolutionary explanation is offered to account for the apparent gender difference in the inheritance of early separation anxiety. It is hypothesized that, in some women, phylogenetic vestiges of separation anxiety may conflict with their need to compete in an individualistic manner in the modern workplace. Whether such an attachment-autonomy conflict accounts for the increased rate of panic disorder and agoraphobia in women is worthy of further study.

Adolescent↗
PubMed1995

Impact of recounting trauma stories on the emotional state of Cambodian refugees.

Twenty Cambodian refugees with premigration histories of trauma received an average of 16 sessions of individual therapy from a Cambodian bicultural counselor at a trauma treatment center in Sydney, Australia. Nineteen of the 20 patients reported that during treatment they had been willing to talk about their trauma histories, a finding that raises doubts about the commonly held belief that Asians are not psychologically minded and avoid disclosing emotionally sensitive information to health care workers. However, self-disclosing therapy alone did not appear to benefit these patients. Only four patients found talking about their trauma story directly helpful in improving their emotional state, and three of the four found the relief to be transitory.

Adaptation, Psychological↗
PubMed1994

Type A personality in Australian twins.

We examined the genetic and environmental determinants of Type A behavior in 200 pairs of same-sex twins as measured by the structured interview (SI) of Rosenman and Friedman and by the Bortner questionnaire (BARS). As noted previously, these measures are poorly correlated (r = .30). Quite different heritabilities were found for the two measures (63% for SI, 23% for BARS), and the correlation between the two was found to be largely genetic. Although the sample size meant that differences in correlation between MZ and DZ twins on the BARS were not significant in univariate analyses, they were suggestive of twin competition effects, as other twin studies have found. We conclude that further genetic analyses should concentrate on component behaviors rather than the overall Type A construct.

Adolescent↗
PubMed1994

Opposite sex-linked behaviors and homosexual feelings in the predominantly heterosexual male majority.

Whether homosexual feelings are distributed categorically or dimensionally remains controversial. In an earlier series of studies, medical students anonymously reported a dimensional distribution of homosexual feelings, the ratio of homosexual to heterosexual feelings in men correlating with opposite sex-linked behaviors in childhood and adolescence, and, in both sexes, with current degree of opposite sex identity. Prevalence of homosexual feelings was markedly higher than that found in nonanonymous studies. In the present investigation, a study of male twins allowed investigation of the findings in 411 educationally more representative subjects. Awareness of some homosexual feelings was reported in adolescence by 20% and currently by 12%. As with medical students, the majority of those who reported some homosexual feelings were predominantly heterosexual, which could be considered to indicate such feelings were distributed dimensionally. Correlations between degree of homosexual feelings and avoidance of contact sport in childhood and adolescence, current wish to be of the opposite sex, and opposite sex identity remained present when subjects with equally bisexual and predominantly homosexual feelings were excluded from analysis. The finding that the majority of men with homosexual feelings are predominantly heterosexual renders implausible the theory that homosexual feelings result from fear of heterosexuality.

Adolescent↗
PubMed1993

Adults who feared school: is early separation anxiety specific to the pathogenesis of panic disorder?

Although juvenile separation anxiety disorder is maintained to be a predisposing factor to adult panic disorder in DSM-III-R, past research has failed to clarify (a) whether it is separation anxiety per se or school refusal that is the pathogenic risk factor and (b) whether affected youngsters are specifically at risk of developing panic disorder rather than symptoms of general anxiety or phobias in later life. The present study of 74 adults who responded to media publicity found that a measure of early separation anxiety but not a history of school refusal was associated with risk of adult panic disorder according to DSM-III-R criteria. In contrast, separation anxiety scores were not associated with the presence or absence of general anxiety symptoms or phobic-avoidance in adulthood. Subjects with higher separation anxiety scores were more likely to have either a sibling or child with school refusal. Although the present study is limited in its method to mailed survey responses and, in part, to retrospective data, the results do provide additional support for Klein's influential separation anxiety theory of panic disorder.

Adult↗
PubMed1993

Impaired in vivo immune responses in patients with melancholia.

Previous attempts to establish a relationship between impaired cell-mediated immunity (CMI) and major mood disorders have been limited by a failure to explore the relevance of depressive subcategories or to assess CMI by in vivo methods. In this case-control study CMI was assessed in 57 patients with major depression (31 with melancholic, 26 with non-melancholic disorders), and in age- and sex-matched controls by both in vitro and in vivo immunological techniques. Compared with control subjects and patients with non-melancholic depression, patients with melancholia demonstrated reduced in vivo CMI as assessed by delayed-type hypersensitivity (DTH) skin responses. Although increasing age, severity of depression, hospital admission for treatment, and reported weight loss are correlates of melancholia, none of these factors alone, or in combination, accounted for the differences in DTH responses observed between the two depressive subtypes. These data suggest that impaired CMI in vivo may be limited to those with melancholic disorders. At this stage the factors which account for this effect are unclear.

Age Factors↗