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Biomedical subjects

G Parker

Publications and source records attributed to G Parker.

At least 145 records · Page 8Linked to original sources
PubMed1998

"Acting out" and "acting in" as behavioral responses to stress: a qualitative and quantitative study.

In a sample of 270 depressed patients, we describe some behaviors in response to stress. One third acknowledged "acting out" behaviors--angry, destructive acts and "out of control" behaviors. Four fifths acknowledged "acting in" behaviors--most commonly withdrawal. As a percentage of subjects acknowledged both response styles (with alternate expression influenced by situation), we developed a dimensional self-report measure within a subsample of 177 who attended a follow-up reassessment. Assignment to four groups with contrasting expressions of "acting out" and "acting in" scores demonstrated differences in age, diagnostic status, age of onset of depression, and self-injurious behaviors.

Acting Out↗
PubMed1998

Neuroleptic management of schizophrenia: a survey and commentary on Australian psychiatric practice.

OBJECTIVE: We seek to assess Australian psychiatrists' views and practices concerning provision of neuroleptic medication to patients with schizophrenia, and to determine whether such management strategies are likely to have changed over time and the extent to which they correspond to published treatment guidelines. METHOD: A sample of 139 psychiatrists based in three Australian capital cities was derived, with respondents completing a brief questionnaire by choosing from a limited-option answer set. Co-authors of this paper comment on the extent to which responses are in line with contemporary recommendations driven by experts or empirical studies. RESULTS: Overall, survey findings indicate that there has been considerable change in clinical practice over the last decade and provide some estimate of the extent to which Australian management practices are congruent with contemporary recommendations. We identify a number of issues of concern (more in relation to dose levels of neuroleptic medication rather than treatment duration) revealed by survey data and make recommendations for addressing a number of practical clinical issues. CONCLUSIONS: As this report focuses on central issues involved in managing schizophrenia, and integrates a number of treatment guidelines, we suggest that it should be of assistance for practice review by clinicians.

Antipsychotic Agents↗
PubMed1998

An aetiological model of non-melancholic depression: study design and validity of the measures.

OBJECTIVE: The aim of this paper is to describe an approach to sub-typing non-melancholic depression and to determine which raters from a variety of backgrounds provided the most valid information on study variables. METHOD: A sample of non-melancholic depressed patients is described. Multiple raters (i.e. patients, psychiatrists, referrers and corroborative witnesses) completed measures of the patient's trait anxiety levels, severity of recent life event stressors and personality functioning. RESULTS: The study and representative data are reported. Congruence between several measures employed indicated that psychiatrist rating of disordered personality was superior to corroborative witness report. Assessment of anxiety traits indicated reasonable agreement between referrers and corroborative witnesses but poor agreement between those ratings and interview-elicited ratings. There were also discrepancies in quantifying 'severity' of life event stress, with patients and their corroborative witnesses rating such events as more severe than either the interviewing psychiatrist or psychiatrists involved in consensus rating sessions. Importantly, the psychiatrists' capacity to quantify the relative contribution of disordered personality, anxiety and life-event stress to the particular depressive episode was supported. CONCLUSIONS: Results indicate some of the difficulties in operationalising determinants that may contribute to and sub-type the non-melancholic depressions, and demonstrate the advantages of using a range of rating strategies and raters. In this study, psychiatrist-generated judgements are clearly favoured, although the advantages of also assessing trait anxiety and life-event stress impact by self-report strategies are conceded. Some techniques for estimating the contribution of disordered personality function, anxiety and life-event stress are offered for both their research and their clinical utility.

Adjustment Disorders↗
PubMed1998

Withdrawal reactions associated with venlafaxine.

OBJECTIVE: The aim of this paper is to describe discontinuation syndromes associated with abrupt and tapered withdrawal fo venlafaxine, and to document that withdrawal symptoms may occur after missing a single dose. CLINICAL PICTURE: We report on two patients prescribed venlafaxine. One developed a broad range of serious side effects after reaching a dose of 300 mg a day, and a severe withdrawal syndrome (including hallucinations) during a slow taper regime. The second had severe discontinuation symptoms during and aborting a slow taper regime, and described withdrawal responses after missing a single dose of venlafaxine. CONCLUSIONS: As for the short-acting selective serotonin re-uptake inhibitors, severe discontinuation reactions may occur with venlafaxine, seemingly marked most distinctly by headache, nausea, fatigue, dizziness and dysphoria, and may make cessation of the drug extremely difficult. Two strategies for addressing the concern are considered.

Adult↗
PubMed1998

Development of a consumer advocacy program.

OBJECTIVE: The aim of the present paper was to describe the development of a consumer advocacy program within the Eastern Suburbs of Sydney (NSW, Australia). METHODS: The program was developed within the context of a research project that investigated the effect on outcome of client-focused approaches to community case management for clients with schizophrenia and bipolar disorder. RESULTS: While the development of the advocacy program was limited by the constraints imposed by the research methodology, the study provided the opportunity to delineate the process involved and identify key components that need to be incorporated into future advocacy programs. CONCLUSIONS: The main guidelines determined were that consumer participation in service delivery needs to be flexible, consumer driven, have broad-based support, ready access to supervision and debriefing, ongoing training and clear job descriptions. Given adequate support, autonomy and funding, consumer advocates can provide a much needed resource for their fellow consumers.

Bipolar Disorder↗
PubMed1998

Neural network subtyping of depression.

OBJECTIVE: To examine the applicability of a neural network classification strategy to examine the independent contribution of psychomotor disturbance (PMD) and endogeneity symptoms to the DSM-III-R definition of melancholia. METHOD: We studied 407 depressed patients with the clinical dataset comprising 17 endogeneity symptoms and the 18-item CORE measure of behaviourally rated PMD. A multilayer perception neural network was used to fit non-linear models of varying complexity. A linear discriminant function analysis was also used to generate a model for comparison with the non-linear models. RESULTS: Models (linear and non-linear) using PMD items only and endogeneity symptoms only had similar rates of successful classification, while non-linear models combining both PMD and symptoms scores achieved the best classifications. CONCLUSIONS: Our current non-linear model was superior to a linear analysis, a finding which may have wider application to psychiatric classification. Our non-linear analysis of depressive subtypes supports the binary view that melancholic and non-melancholic depression are separate clinical disorders rather than different forms of the same entity. This study illustrates how non-linear modelling with neural networks is a potentially fruitful approach to the study of the diagnostic taxonomy of psychiatric disorders and to clinical decision-making.

Behavioral Symptoms↗
PubMed1997

Dysfunctional parenting: over-representation in non-melancholic depression and capacity of such specificity to refine sub-typing depression measures.

We examine the proposition that dysfunctional parenting is more likely to be experienced by those with non-melancholic (compared to melancholic) depression and that, as a consequence, such specificity allows the validity of varying definitions of melancholia to be examined and their utility sharpened. We study a sample of 245 non-psychotic patients meeting DSM-III-R criteria for a major depressive episode and assign them to melancholic and non-melancholic sub-sets according to five separate sub-typing measures (DSM-III-R; DSM-IV; Newcastle; 'Clinical' and CORE criteria). We assess dysfunctional parenting by use of the Parental Bonding Instrument (PBI), and by structured psychiatrist assessment and self-report ratings of a range of dysfunctional parental experiences, with independent assessment and self-report ratings of a range of dysfunctional parental experiences, with independent assessment of the last by reports from corroborative witnesses and from the patients' referring therapists. The five sub-typing measures assigned varying percentages of the sample (24-42%) to a 'melancholic' sub-type. When Newcastle Index assignments were examined, there was no evidence that dysfunctional parenting had any specificity to non-melancholic depression. Neither the DSM-III-R nor DSM-IV systems demonstrated specificity in relation to PBI scores, but several interview-assessed dysfunctional parenting characteristics were over-represented in their non-melancholic sub-sets. 'Clinical' definition showed the greatest over-representation of dysfunctional parenting to those assigned as having non-melancholic depression. The CORE measure, a behaviourally weighted measure of psychomotor disturbance, was the next most differentiating. Importantly, those assigned as having non-melancholic depression by all five measures were more likely to be rated by corroborative witnesses as being exposed to anomalous parenting, validating the subjects' self-reports, arguing against results being an artefact of clinician-based assessment, and supporting the specificity of dysfunctional parenting to a depressive sub-type.

Adolescent↗
PubMed1997

Early onset depression: the relevance of anxiety.

The aim of this study was to determine risk factors that may differentiate early onset from late onset depression. A non-clinical cohort that had been assessed from 1978 to 1993 at 5 yearly intervals and that had a high prevalence rate of lifetime depression took part in the study. We established an appropriate age cut-off to distinguish early onset (i.e. before 26 years) of major and of minor depression, and examined the relevance of a number of possible determinants of early onset depression assessed over the life of the study. Despite several dimensional measures of depression, self-esteem and personality being considered, they generally failed (when assessed early in the study) to discriminate subsequent early onset depression, with the exception of low masculinity scores being a weak predictor of major and/or minor depression. Early onset depression was strongly predicted, however, by a lifetime episode of a major anxiety disorder, with generalised anxiety being a somewhat stronger and more consistent predictor than panic disorder, agoraphobia and minor anxiety disorders (ie social phobia, simple phobia). The possibility that anxiety may act as a key predispositional factor to early onset depression and to a greater number of depressive episodes is important in that clinical assessment and treatment of any existing anxiety disorder may be a more efficient and useful strategy than focussing primarily on the depressive disorder.

Adult↗
PubMed1997

Plumbing the depths: some problems in quantifying depression severity.

We first report further studies of the psychometric properties of the AUSSI), a brief (11-item) self-report depression measure assessing mood state severity and disability in a sample of 270 subjects. Total scores (combining mood state and disability) correlated well with another self-report measure of depression severity, the Beck, but minimally with both Hamilton and DSM-III-R Global Assessment of Function (GAF) scores. For a sub-sample where we had complete data sets (including a corroborative witness [CW] form of the AUSSI), we established moderate levels of agreement between self-report and CW AUSSI scores, important in supporting validity of its disability sub-scale. Against expectation, neither mood nor disability AUSSI scale scores differed across clinically meaningful depressive sub-types, while differentiation was demonstrated for the Hamilton and GAF measures. Differentiation for the Hamilton measure was clearly driven by several type-specific component clinical features, but also presumably contributed to by the clinician-rater format. Our study raises questions about the varying reference bases and semantics used by patients, corroborative witnesses and clinicians in rating depression severity, and which may generate similar or contrasting severity estimates across varying depressive sub-types.

Adolescent↗
PubMed1997

Distinguishing psychotic depression from melancholia.

We contrast 25 patients with "psychotic depression" (PD) against two age- and sex-matched groups of melancholic depressed patients. In terms of clinical features, specificity of PD was suggested for several features, including delusions, morbid cognitions (involving guilt and a sense of deserving punishment), hallucinations and constipation. In addition, the PDs had significantly higher levels of behaviourally rated psychomotor disturbance. A comprehensive list of risk factors to depression (e.g., socio-demographic, family history, parental influences, medical disorders, anxiety, stressors and personality style) were examined, without clear differentiation between the comparison groups apart from the suggestion that being a "worrier" and having tenuous stability under stress was over-represented in the PDs. Findings favour the view that psychotic depression is a sub-type of melancholic depression (accounting for the similar expression of the majority of clinical and possible aetiological variables across our contrasted "types'). Findings also suggest possible benefits from future phenomenological studies of psychotic depression relying more on observer-based rather than self-report or symptom data sets. Aetiological studies would benefit from focussing on those features identified as distinguishing the condition from melancholic depression.

Adult↗
PubMed1997

How distinct is 'distinct quality' of mood?

BACKGROUND: The DSM-IV criteria for melancholia include the clinical feature 'distinct quality', defined as a mood state differing from that experienced in bereavement. Both propositions-its specificity to melancholia and its definition- remain problematical. METHODS: We examine both propositions by analysing an adjective checklist completed by melancholic and non-melancholic depressed subjects, as well as by a bereaved sample. The checklist was refined by a principal components analysis to four scales-one assessing a general 'mood' severity or dysphoric dimension, and the other three assessing dimensions of 'fatigue', 'numbness' and 'guilt'. RESULTS: If the concept of "distinct quality' has validity, we would require specificity of the refined qualitative constructs to melancholic depression. The 'numbness' component met that requirement, but only to a degree. While bereaved subjects did differ from those with melancholic depression on a number of our refined qualitative mood domains, such differences appeared more related to lower levels of depression in the bereaved sample. CONCLUSIONS: We argue for deleting the 'distinct quality' criterion from diagnostic checklists of melancholia until its definition has been improved, its utility demonstrated and its specificity to any depressive subtype established as having clinical significance.

Adult↗
PubMed1997

Fifteen years on: evolving ideas in researching sex differences in depression.

BACKGROUND: A cohort study of a socially homogeneous group of teachers was commenced in 1978 to pursue possible risk factors contributing to the recognized female preponderance of depression. METHODS: Multiple measures of depressive experience included: (i) lifetime rates, duration and number of depressive episodes using two caseness definitions, DSM-III-R major depression and 'all depression' (which included a category of minor depression); (ii) self-report measures of state and trait depression, neuroticism, and self-esteem. DSM-III-R anxiety disorder rates are also reported and co-morbidity with major depression examined. RESULTS: At the 15-year review in 1993, the sample had a mean age of 39 years, there was a trend for a female preponderance in lifetime rates of major depression and 'all depression' (and which was more pronounced with the inclusion of data for anxiety disorders), with statistically significant differences in rates of social and simple phobias and combined anxiety disorders. Mean neuroticism scores were consistently higher for women. CONCLUSIONS: The strong association between anxiety and depressive disorders suggests that greater reporting of anxiety and higher neuroticism scores in women may be a key determinant that contributes to any female preponderance in depression rates.

Adult↗
PubMed1997

Increased rate of psychosis and psychomotor change in depression with age.

BACKGROUND: We examined the phenomenology of depression in younger (< 60 years old) versus older (> or = 60 years) subjects and, more specifically, the interaction between age and psychomotor disturbance associated with depression. METHOD: Two hundred and eighty-five patients with a DSM-III-R diagnosis of unipolar major depression referred to a mood disorders unit were assessed using the CORE rating scale, a sign-based system for defining melancholia. Subjects were also assessed using the Hamilton Rating Scale for Depression, Zung Depression Scale, Newcastle Endogenous Depression Inventory and the General Health Questionnaire. RESULTS: The total CORE score (and each of its subscales) was found to interact with age. Rates of psychotic and melancholic depression increased with age. Elderly depressives suffered more severe depression (higher HRSD scores), appetite loss and weight loss. Level of psychomotor disturbance and rates of psychosis did not differ between those elderly subjects with an early onset (before the age of 60 years) and those with a late onset (at or after 60 years) of depression. CONCLUSIONS: There appear to be robust phenomenological differences in depression between older and younger subjects. The association between age and psychomotor change may assist our understanding of the neurobiology of depression.

Adult↗
PubMed1997

The development of a refined measure of dysfunctional parenting and assessment of its relevance in patients with affective disorders.

BACKGROUND: The Parental Bonding Instrument (PBI) measures fundamental parenting dimensions (care and over-protection), but does not directly assess abusive parenting. METHODS: We describe the development of the Measure of Parenting Style (the MOPS), comprising refined PBI scales assessing parental indifference and over-control, as well as a scale assessing parental abuse. RESULTS: We examine psychometric properties of the MOPS, while several analyses build to the concurrent validity of the abuse scale as an experimental measure. We examine the extent to which both the PBI and the MOPS scales showed specificity of dysfunctional parenting to the non-melancholic depressive subtype, and across a range of anxiety disorders. Non-melancholic depressed patients returned anomalous parenting scale scores (compared to melancholic subjects), but only when such subtyping decisions were clinician-generated. Those receiving DSM-III-R lifetime anxiety diagnoses of panic disorder and of social phobia returned higher PBI protection and MOPS over-control scores than non-anxious subjects, while differences were not established for those with generalized anxiety disorder or obsessive compulsive disorder. CONCLUSIONS: We consider the likely utility of the MOPS scale and note the module capacity of separate MOPS and PBI scales, which allow a set of options for assessing perceived parenting characteristics.

Adolescent↗
PubMed1997

Special feature: the etiology of personality disorders: a review and consideration of research models.

In addition to reviewing representative studies of genetic and environmental factors imputed in the etiology of the personality disorders (PDs), a number of models for conceptualizing and conducting etiological research are considered. In particular, it is proposed that research should initially concede a tripartite model (with separate temperament, personality, and disorder components). Such a model would allow identification of etiological factors having specificity to one or more components, and ones that are nonspecific in having relevance to all components.

Adult↗
PubMed1997

Morbid jealousy as a variant of obsessive-compulsive disorder.

OBJECTIVE: To present a representative case vignette and review several previous reports, and to then suggest that a percentage of those with morbid jealousy may have a variant of obsessive-compulsive disorder (OCD). CLINICAL PICTURE: A patient presented volunteering a diagnosis of depression and anxiety following recent work and marital stresses, before describing recent jealousy and harassment of his wife over an earlier relationship. Obsessional thinking patterns and compulsive behaviours are described, and it is proposed that the picture supports a diagnosis of obsessive-compulsive disorder. TREATMENT AND OUTCOME: The patient was treated as if he had an obsessive-compulsive disorder, and reported dissipation of his concerns after cognitive-behavioural intervention. CONCLUSIONS: The proposition is an important one as a diagnosis of morbid jealousy often invites therapeutic pessimism, and as managements effective for OCD (both drug and behavioural) may well be helpful.

Anxiety Disorders↗