Biomedical subjects
R D Goldney
Publications and source records attributed to R D Goldney.
Compulsory admission of the mentally ill: adequacy of documentation.
The issues that are involved in the compulsory detention and treatment of persons with mental illness are complex. There has been an improvement in the adequacy of documentation of such persons in the first five years of operation of the new South Australian Mental Health Act, 1976-1977. However, an appreciable proportion of documents still do not appear to comply adequately with the statutory requirements. This may be related not only to shortcomings in the medical documentation, but also to ambiguities and possible overlapping in the criteria for compulsory detention and treatment.
Assessment in undergraduate psychiatric education.
An assessment of medical students' psychiatric performance demonstrated no association between the ability to rate psychopathology or to observe interview behaviour and traditional written methods of academic achievement. This is in accordance with those few studies which have addressed this issue and indicates that there may well be at least three independent skills involved in clinical decision-making: the ability to engage in interpersonal interaction and elicit information; and the ability to acquire and use academic knowledge. This is consistent with work suggesting that maturational and learning processes influence clinical reasoning, and demonstrates that each component should be addressed in assessing students in psychiatry.
Safety of the combination of lithium and neuroleptic drugs.
A retrospective study of 60 manic patients treated with neuroleptic medications alone and 69 manic patients treated with a combination of neuroleptic drugs and lithium revealed no difference between groups in side effects and complications of treatment. Similarly, when comparisons were made between patients treated with haloperidol only and those treated with haloperidol and lithium, there were no differences in side effects and complications. The results counter sporadic clinical reports suggesting a toxic interaction between lithium and neuroleptic drugs.
Assessment by relatives of elderly patients with psychiatric illness.
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The safe use of high dose neuroleptics in a psychiatric intensive care unit.
A review of the use of high dose neuroleptics in the management of acute psychoses in a psychiatric intensive care unit confirms the previously reported safety of such regimes. The risk of extreme unwanted effects, such as cardiac arrest and sudden death, was considerably less than the risk of suicide as an inpatient. Although high doses of neuroleptics appear to be relatively safe, there is no advantage, in terms of the length of admission required in the intensive care unit, in using a dose of neuroleptic above the equivalent of 60-80 mg of haloperidol in any one 24-hour period.
Arthur Koestler: was his suicide rational?
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The aftermath of suicide: a comparison of attitudes of those bereaved by suicide, social workers and a community sample.
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Mental health in marriage: the roles of need for affiliation, sensitivity to rejection, and other factors.
This study reports on the associations between a number of personality factors and spouse mental health, happiness, and communication (N = 78). Lower Affiliative Drive and higher Sensitivity to Rejection emerge in this sample as being associated in wives (but not husbands) with increased psychological morbidity. Wives had higher levels of both Need for Affiliation and Sensitivity to Rejection than husbands, which possibly may lead to higher internal conflict for them. Although causality cannot necessarily be assumed, these results are consistent with the hypothesis that wives' mental health is more "relationship related" than that of husbands.
A holiday home for long-stay psychiatric patients.
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Suicide in association with psychiatric hospitalisation.
A review of 46 subjects who suicided after having contact with a psychiatric hospital is presented. There were 33 men and 11 women, both with a mean age of 37 years. In comparison with a control group, those who suicided had a greater number of hospital admissions, a greater length of hospitalisation, were more often unemployed, had a history of more previous suicide attempts, more often received the diagnosis of schizophrenia or manic depressive illness (depressed phase), were more often overly depressed at their last contact, and were more often prescribed neuroleptic medications. Although these differences emerged, suicide is an infrequent event, and these factors lack specificity in prediction. The important association of psychiatric illness with subsequent suicide is noted.
Parental representation in young women who attempt suicide.
A reliable and valid Parental Bonding Instrument was administered to young women who had attempted suicide. Results indicated low parental care and high overprotection. These results are consistent with theoretical formulations of suicidal behaviour, and taken with other studies help provide a profile of parental characteristics which may be associated with such behaviour.
The psychiatric library.
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Survivor-victims and crisis care.
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Elucidation of psychological factors in compensable injury.
While personal emotional problems relating to relationships have recently been acknowledged in the literature as an important component in the clinical course of compensable injury, there are few guidelines on how to detect them. Four broad questions have been suggested to guide the practitioner in clinical practice, and examples are given to illustrate the influence of the setting in which the injury occurred, the meaning of the injury for the patient, the possible influence of transference and counter-transference factors, and the importance of concurrent family problems. It is suggested that by addressing these questions, the clinician with no special knowledge of psychiatry will be better placed to determine whether psychological factors may be significant, and whether psychiatric referral is indicated.
Factorial structure of the aftermath of suicide instrument.
Initial factor-analytic studies of the Aftermath of Suicide Instrument suggested that there may be four broad areas of social reaction to suicide. In a replication study, this 25-item questionnaire was administered to a community sample of 54 persons aged between 21 and 77 years. Factor analysis of their responses identified five factors, but only one of these was similar to any of the original factors. This marked variation is probably due to differences in the population sampled, with the present group of respondents more heterogeneous. While the content of the Aftermath of Suicide Instrument remains valid, it appears that its factorial structure requires further clarification. This is consistent with the emotional and clinical complexities of the subject of suicide.