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Biomedical subjects

D Silove

Publications and source records attributed to D Silove.

At least 73 records · Page 4Linked to original sources
PubMed1988

Twin study of genetic and environmental effects on lipid levels.

A study of 106 pairs of monozygotic (MZ) and 94 pairs of dizygotic (DZ) twins tested the hypothesis that part of the previously described genetic influence on blood lipid levels can be ascribed to closer similarities among MZ than among DZ twin pairs in environmental factors that affect lipid levels. Participants were adult twin volunteers (age 17-66; 64 male and 136 female pairs) who were selected from the NH & MRC Twin Registry or were respondents to advertisements. They completed a 4-day weighed food diary from which mean nutrient intake was derived. Information on lifestyle and demographic variables was obtained by questionnaire and a nonfasting blood sample was taken for measures of total, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol and the HDL2 and HDL3 subfractions. Height and weight were measured, and body mass index (BMI) was calculated (kg/m2). Estimates of the heritability of sex-adjusted lipid levels were 0.72 for total cholesterol, 0.79 for HDL cholesterol, 0.69 for HDL2, 0.20 for HDL3, 1.06 for LDL cholesterol, and 0.44 for sex-adjusted BMI. In all cases except for HDL3, genetic variance was statistically significant. After adjusting for the effects of environmental variables in three different ways, the estimates of heritability were somewhat lower for total cholesterol, HDL2, and BMI, and those for HDL cholesterol (borderline) and LDL cholesterol (definitely) remained statistically significant but were decreased. A genetic influence on HDL3 was not found. Adjusted heritability estimates obtained from one method of analysis were 0.35 for total cholesterol, 0.49 for HDL, 0.04 for HDL2, -0.34 for HDL3, 0.66 for LDL, and 0.32 for BMI. These results suggest that the assumptions made in the classical twin study approach are not appropriate when examining genetic effects on lipid levels or BMI, or indeed on any biological variable that may be affected by environmental factors that tend to be more similar in MZ twins than in DZ twins. In these circumstances, more complex models may be needed to differentiate between genetic and environmental influences.

Adolescent↗
PubMed1988

Pseudodementia in schizophrenia and mania.

The importance of differentiating depressive pseudodementia from true dementia seems to be well recognized by psychiatrists, yet there seems less recognition that other functional psychoses in the elderly can present with symptoms of cognitive impairment. In this report, we describe two patients--one suffering from late onset schizophrenia and one from a manic illness--who were diagnosed as suffering from dementia in the early stages of their illnesses. We discuss some of the difficulties in making diagnoses in these cases which include an historical tendency for clinicians, including psychiatrists, to assume an organic aetiology for first presentation psychoses in old age. Although the concept of pseudodementia has been criticised in recent years, we conclude that it retains its clinical utility in that it orientates the clinician to the importance of recognizing treatable functional psychoses in the elderly.

Aged↗
PubMed1988

Current perspectives on immunology and psychiatry.

We selectively review recent research findings in the field of psychoimmunology which test the hypotheses that immunological dysfunction may be aetiologically related to mental illnesses such as schizophrenia, and that certain morbid affective states such as depression and other forms of psychosocial distress may be the cause of immunosuppression and through this mechanism affect the outcome of illnesses such as cancer. Our examination of research implicating immunological or infective mechanisms in the aetiology of schizophrenia indicates that most studies have been unable to control for major methodological difficulties but the compatibility of these theories with the dopamine hypothesis suggests that further research attention is warranted. More clearly, there is growing evidence demonstrating a link between depression, other states of psychological distress and immunosuppression, but the clinical significance of these findings remains uncertain. The complex relationship between stress and the outcome of illnesses such as cancer is discussed and the possible implications of these findings for clinical psychiatry are suggested.

Animals↗
PubMed1987

Severe threat in the genesis of panic disorder.

The hypothesis that panic disorder is a separate biological disease has attracted a great deal of controversy in recent years. One of the cornerstones of this theory is that panic attacks arise spontaneously, suggesting that the illness is generated by an autonomous physiological process. A number of cases are reported that illustrate Beck's theory that cognitive factors are central to the genesis of acute anxiety. Evidence for a developmental/cognitive theory of anxiety is discussed, and it is concluded that a purely biological model for panic disorder is inadequate.

Adaptation, Psychological↗
PubMed1987

Parasuicide: interaction between inadequate parenting and recent interpersonal stress.

We report a controlled study in which we searched for links between early family adversity and recent interpersonal stress in parasuicidal patients. Our subjects reported fewer adverse experiences in childhood than did the younger, predominantly female, patients investigated in previous studies. Nevertheless, 47% of our parasuicidal group, as compared to 19% of control subjects, reported a sequential pattern of relationship difficulties starting in childhood. The pattern of early exposure to neglectful and overprotective parenting followed by recent conflict or separations in adulthood was found to discriminate most clearly between the parasuicidal and control groups. We suggest that factors such as low self-esteem, a sense of helplessness in the face of adversity and an abiding insecurity in intimate relationships may variously account for this heightened vulnerability. We conclude that a history of adverse relationships beginning in childhood should alert primary care-givers to the risk of suicidal behaviour in patients who are exposed to distressing separations or interpersonal conflict.

Adult↗
PubMed1986

The contest between psychiatrists and lawyers over involuntary detention: the effects of recent changes in mental health legislation in New South Wales.

New mental health legislation was enacted in New South Wales in 1983 and, although the reformed Act remains unproclaimed, some of the new procedures have already been introduced into psychiatric hospitals. The spirit of the Act is clearly aimed at protecting the rights of the mentally ill, who are often unable to act as their own advocates. To ensure this protection, it is now routine for solicitors to represent detained patients in their pleas for release. In this report we describe three recent cases that illustrate the difficulties that arise when solicitors and psychiatrists contest the legitimacy of detention orders. The atmosphere of judicial hearings is becoming increasingly adversarial and the public disclosure of sensitive information can provoke unnecessary distress in patients and their families. In the zeal to preserve civil rights, the special needs of psychiatric patients can be obscured, sacrificing the patients' rights to confidentiality, privacy and appropriate treatment. While the involuntary detention of patients is a matter of the utmost seriousness, current procedures, which seem to be modelled on those of the criminal legal system, are proving to be inappropriate to the needs of psychiatric patients.

Adolescent↗
PubMed1986

Perceived parental characteristics and reports of early parental deprivation in agoraphobic patients.

It is commonly believed that patients with agoraphobia have suffered more frequently from aberrant family experiences in childhood. Some authors have described an excess of parental deprivation and others have incriminated parental overprotectiveness. Recent studies have failed to confirm these impressions but, instead, find that agoraphobic patients recall deficits in parental warmth and care during their early years. This report of a Sydney case-control study adds support to the view that parental overprotectiveness in isolation is unlikely to place the child at greater risk of developing agoraphobia in the future. Only when the child experiences a sense of parental neglect and lack of care, either alone or in combination with overprotection, does the risk of agoraphobia in adulthood appear to be increased.

Adult↗
PubMed1985

The economic costs of schizophrenia. Implications for public policy.

The direct and indirect costs associated with schizophrenia in Australia were calculated using the incidence approach and compared with similar costings of myocardial infarction in Australia and the United States. In Australia schizophrenia affects one-twelfth as many people as does myocardial infarction, yet costs half as much. This is because the stream of costs associated with each case of schizophrenia is six times the stream of costs associated with myocardial infarction. To illustrate the utility of this costing approach, the information was used to estimate the cost-benefit ratio likely to follow the introduction of social intervention strategies. The information also showed that Australian support for research in schizophrenia is inadequate when compared with that for myocardial infarction and quite out of proportion to the cost of schizophrenia to the community.

Adolescent↗
PubMed1985

Estimating the economic costs of schizophrenia.

The economic costs of schizophrenia in New South Wales, Australia, were estimated using an incidence-based approach. The incidence of the disease was obtained from a case register. Direct treatment costs were calculated from length of stay data, the probability of readmission, and a direct costing of inpatient and outpatient care. Indirect costs were calculated from tables of average weekly earnings and work-force participation rates modified for the expected types of outcome. The prodrome was costed similarly. Costs were $139 million (in 1975 U.S. dollars), or $29 per head of the population of the State. A sensitivity analysis indicated that the likely margin of error of the estimate was plus or minus 15 percent. Comparison with the costs of myocardial infarction (in the same State at the same time and costed by the same methods) demonstrated that schizophrenia is a costly disease.

Adolescent↗
PubMedDate not supplied

Is early separation anxiety a risk factor for adult panic disorder?: a critical review.

Heightened levels of early separation anxiety (SA) have long been linked to the risk of adult panic disorder (PD), suggesting that the two types of anxiety arise from a common diathesis--a proposition that has considerably influenced the classification of the anxiety disorders. However, the SA-PD link remains contentious, with some recent studies failing to confirm that putative association. All published research studies investigating the relationship of early SA to PD and/or other anxiety disorders were reviewed. Taken as a whole, the evidence provides support for the SA-PD hypothesis, although the specificity of that relationship needs further clarification. Problems of sample selection, retrospective measurement of early SA and comorbid diagnoses limit the certainty with which inferences can be drawn from existing data. Nevertheless, a recent community-based study provides additional support for the SA-PD hypothesis. Possible developmental pathways linking SA to PD are considered. One possibility that has not received adequate research attention is that early SA disorder (SAD) may persist into adulthood, rendering the sufferer vulnerable to panic and other anxiety symptoms when confronted with salient life stressors. We conclude that it is premature to reject the SA hypothesis of PD. Only well-designed longitudinal studies can map the complex developmental pathways linking early and later manifestations of morbid anxiety.

Adolescent↗
PubMedDate not supplied

Separation anxiety in adulthood: a phenomenological investigation.

Separation anxiety disorder is well recognized as a juvenile psychiatric disorder, but it appears to be rarely diagnosed in adulthood. Drawing on our clinical impressions and a review of the relevant literature, we sought to investigate whether separation anxiety symptoms could be identified in adulthood. Forty-four subjects recruited by a media campaign were administered a semistructured interview and a self-report checklist for adult separation anxiety (ASA) symptoms, as well as the Separation Anxiety Symptom Inventory (SASI), a retrospective measure of early separation anxiety symptoms. Diagnoses of major depressive disorder (MDD), panic disorder (PD), agoraphobia (Ag), and dependent personality disorder were made using the SCID-P and SCID-II. Thirty-six subjects met criteria for a putative diagnosis of ASA based on a global clinical rating and/or endorsement of DSM-IV-derived criteria. Although most subjects dated the separation anxiety symptoms to their juvenile years, it was notable that one third reported the first onset of separation anxiety symptoms in adulthood. Although comorbid lifetime anxiety or depressive disorders were common, the majority of subjects reported that the separation anxiety symptoms predated other axis I disorders. Only six subjects (17%) were diagnosed with dependent personality disorder. Although limited by the method of sampling, this preliminary study suggests the need to examine more systematically whether a form of separation anxiety disorder may occur in adulthood.

Adult↗
PubMedDate not supplied

Psychiatric morbidity following motor vehicle accidents: a review of methodological issues.

Motor vehicle accidents (MVAs), even those of a nonserious nature, appear to increase the risk of severe psychiatric morbidity in survivors. The present review examines the evidence indicating the levels of psychiatric morbidity in MVA survivors. Although no consistent profile has emerged, the most commonly reported symptoms are depression, anxiety, irritability, driving phobia, anger, sleep disturbances, and headache, with rates of posttraumatic stress disorder (PTSD) across studies of 0% to 100%. Variability in the type and severity of psychiatric outcomes may be due, in part, to methodological inadequacies in many studies, particularly the use of biased population samples, inclusion of subjects exposed to varied types of accidents, an absence of a clear definition of PTSD, a reliance on clinical judgment rather than the use of objective psychometric measures, the failure to include ratings of injury severity, and the absence of assessments for past exposure to traumatic events or preexisting posttraumatic reactions. The most important concern relates to the use of nonrepresentative samples, usually patients referred for medicolegal assessment in whom issues of compensation are of central importance. Gender and age differences distinguish the compensation group from the general population of MVA survivors, who therefore may also differ in the vulnerability to posttraumatic morbidity. It is argued that more systematic research on unselected subject samples is critical to establish epidemiological data on the true nature and extent of psychiatric morbidity following MVAs.

Accidents, Traffic↗
PubMedDate not supplied

Expert opinions about the ICD-10 category of enduring personality change after catastrophic experience.

The inclusion of enduring personality change after catastrophic experience (EPCACE) as a diagnostic category in the ICD-10 represents a turning point in the evolution of the nosology of traumatic stress syndromes, yet many aspects of the diagnosis remain contentious. Given the absence of published research concerning this category, an exploratory survey of international experts was conducted using a questionnaire focusing on key aspects of the category, namely whether respondents used the diagnosis of EPCACE in their practice; which features were most salient in making a diagnosis of posttraumatic personality change; the types and characteristics of traumatic events that were judged to be most likely to cause EPCACE; and the possible limitations of the ICD-10 diagnosis. A response rate of 56.3% was obtained. A substantial portion of trauma experts working in the field of human-engendered violence recognize the possibility that certain traumas can result in personality change. However, questions were raised about the specificity of the criteria proposed for the category of EPCACE in ICD-10. A composite profile of proposed additional features suggests that a more comprehensive array of adaptational changes are recognized than are encompassed by EPCACE.

Expert Testimony↗
PubMedDate not supplied

Continuities of separation anxiety from early life into adulthood.

The study investigates whether a putative diagnosis of separation anxiety disorder can be identified in adulthood and whether there are continuities between juvenile and adult forms of the disorder. Seventy patients with conventional adult diagnoses of panic disorder and generalized anxiety disorder attending an anxiety clinic were administered an interview and checklist to assess separation anxiety (SA) symptoms in adulthood. Memories of early SA were assessed using the Separation Anxiety Symptom Inventory (SASI). A subsample (n = 31) was used to calibrate the checklist against assignment to a category of adult separation anxiety disorder (ASAD) based on the structured interview. In an expanded sample (n = 70), patients assigned to the ASAD category returned statistically higher scores on the SASI, with the severity of juvenile SA symptoms accounting for 33% of the variance of adult SA scores (p < .001). Assignment of subjects to the putative ASAD category was not associated with any conventional adult anxiety diagnosis and symptoms of SA appeared to predate the onset of the other anxiety disorders. One possible explanation for the data is that, in some individuals, early onset separation anxiety disorder may persist into adulthood, but the symptoms may either be overlooked or, alternatively, obscured by secondary features such as panic.

Adolescent↗
PubMedDate not supplied

A self-report questionnaire for measuring separation anxiety in adulthood.

Little attention has been given to measuring symptoms of separation anxiety (SA) in adulthood. The development of an Adult Separation Anxiety Questionnaire (ASA-27) is described and compared to a previously derived Adult Separation Anxiety Semistructured Interview (ASA-SI). Principal components analysis revealed a coherent construct of SA with high internal consistency (Cronbach's alpha =.95) and sound test-retest reliability (r =.86; P <.001). A receiver operation characteristic (ROC) analysis against the semistructured interview yielded a high area under the curve index (AUC = 0.9) suggesting that the questionnaire is an adequate alternative measure of SA. Results of this study support previous research suggesting that a construct of SA may be readily measured in adults.

Adult↗
PubMedDate not supplied

Comprehensive health assessment for newly arrived refugee children in Australia.

Providing appropriate and responsive care to refugees from diverse backgrounds and with unique health needs is challenging. Refugee children may present with a wide range of conditions, which may be unfamiliar to health professionals in developed countries. Additionally, refugees may experience unfamiliarity with the Australian health system and distrust of authority figures and/or medical practitioners. This article provides an overview of the priority areas in health and health management for paediatric refugee patients for paediatricians as well as other relevant health care providers caring for this group. Specific issues covered include general health assessment, infectious diseases, immunization, growth and nutrition, oral health, development and disability, mental health and child protection. Comprehensive health assessment can assist in identifying children at risk of poor health and to provide them with timely and effective care, advocacy and appropriate referral.

Australia↗
PubMedDate not supplied

An issue of access: delivering equitable health care for newly arrived refugee children in Australia.

Newly arrived refugees and asylum seekers are faced with many difficulties in accessing effective health care when settling in Australia. Cultural, language and financial constraints, lack of awareness of available services, and lack of health provider understanding of the complex health concerns of refugees can all contribute to limiting access to health care. Understanding the complexities of a new health care system under these circumstances and finding a regular health provider may be difficult. In some cases there may be a fundamental distrust of government services. The different levels of health entitlements by visa category and (for some) detention on arrival in Australia may further complicate the provision and use of health services for providers and patients. Children are particularly at risk of suboptimal health care due to the impact of these factors combined with the effect of resettlement stresses on parents' ability to care for their children. Unaccompanied and separated children, and those in detention experience additional challenges in accessing care. This article aims to increase awareness among health professionals caring for refugee children of the challenges faced by this group in accessing and receiving effective health care in Australia. Particular consideration is given to the issues of equity, rights of asylum seekers, communication and cultural sensitivities in health care provision, and addressing barriers to health care. The aim of the paper is to alert practitioners to the complex issues surrounding the delivery of health care to refugee children and provide realistic recommendations to guide practice.

Australia↗