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Biomedical subjects

H Herrman

Publications and source records attributed to H Herrman.

30 records · Page 2Linked to original sources
PubMed1995

Information for family carers: does it help?

Family carers in Victoria were identified through a statewide telephone survey in 1993. A total of 976 carers was interviewed and a random sample of approximately one in 10 (n = 103) were offered the Carer Support Kit leaflet. The leaflet details the components of the Carer Support Kit (a Federal Government initiative developed in 1992-93) and informs carers how to apply for it through the Victorian Carers' Association. Approximately three-quarters of these carers accepted the offer, and around a third subsequently applied for the kit. Carers who applied for the kit reported significantly more overload and lower life satisfaction than those who did not apply. Only two-thirds of those mailed the kit (just 23 per cent of the eligible study sample) went on to use it. Those who had not used it reported significantly more negative emotions and health problems than those who used it, suggesting that stress and crises could preclude utilisation of the information. A brief evaluation of the components of the kit is presented; however, findings need to be treated with caution in view of the small sample size.

Adult↗
PubMed1994

The use of psychiatric services before imprisonment: a survey and case register linkage of sentenced prisoners in Melbourne.

Information about contact with psychiatric services before imprisonment was obtained for a stratified random sample of sentenced prisoners, who were not receiving prison psychiatric care, in Melbourne's three metropolitan prisons. The sample of 158 men and 31 women was matched with the longitudinal person-linked records of state psychiatric service use in the Victorian Psychiatric Case Register (VPCR). Records of contact with the state services were found for 54 men (34%) and 19 women (61%), including records of in-patient treatment for 25 men (16%) and 15 women (48%). For 64% of individuals with a positive match, the case-note diagnoses were substance use disorders only. Diagnoses of psychotic disorders were recorded for four prisoners, and mood disorders for another six. In addition, clinicians conducted standardized diagnostic interviews and enquired about treatment and personal history. A further 24 prisoners reported specialist psychiatric treatment outside the state treatment sector. This study links the findings from an interview survey of psychiatric morbidity in prisoners with the records available in the VPCR, and emphasizes a number of matters important to the public health. The high rates of previous treatment for substance abuse disorders, the apparent pool of prisoners with largely untreated major depression, and the service needs of those with chronic psychotic disorders are discussed.

Adolescent↗
PubMed1993

The health and wellbeing of informal caregivers: a review and study program.

Informal caregivers are the families and other unpaid caregivers in the home who support people of all ages with severe and chronic mental or physical disabilities. Home care of this sort has been increasing over the past 30 years because of the reduced number of beds in hospitals and nursing homes and increased outpatient and community care. Moreover, with an aging population and increasing rates of disability, the demand for family caregiving will continue to rise. This has important implications for the development of health, community service and social policy. At the same time, however, very little is known about the impact such changes are having on the caregivers of various ages and in various circumstances. The Victorian Health Promotion Foundation is funding a research and intervention program in Melbourne to promote wellbeing and prevent ill-health in caregivers.

Caregivers↗
PubMed1993

Assessment of contributions to disability in people with schizophrenia during rehabilitation.

The aim of this study was to assess a number of the components of disability in patients diagnosed with DSM-IIIR residual schizophrenia. Forty-one patients undergoing hospital and community rehabilitation programs were tested. A range of disability levels was defined with a measure of global assessment of function. A large proportion of the patients also had poor results on frontal lobe testing, persistent positive symptoms, and high levels of emotional distress. There was a trend for higher levels of positive symptoms to be associated with increases in global levels of disability, frontal lobe impairment and emotional distress. The work suggests that rehabilitation programs could be more focused if patients were assessed not only for their overall level of functional disability but also for the level of treatment resistant positive symptoms, frontal lobe impairment and the amount and type of emotional distress and insight.

Activities of Daily Living↗
PubMed1992

Long-term course of hospitalization for schizophrenia: Part I. Risk for rehospitalization.

The probability of rehospitalization following the initial discharge on which a diagnosis of schizophrenia was made is described using data from psychiatric case registers in Victoria, Australia; Maryland, U.S.A.; Denmark; and Salford, England. The percentage eventually rehospitalized, after followup intervals as long as two decades, varies from about 50 to 80 percent in the four service systems. Survival curves for duration in the community without rehospitalization bend sharply in the period between 2 and 3 years following discharge in all four cohorts and are almost flat after 20 years. Early age of onset predicts higher risk for rehospitalization in multivariate proportional hazards models in each cohort. When age of onset is included as a covariate, neither gender nor marital status has consistent or statistically significant effects on risk for rehospitalization.

Adolescent↗
PubMed1992

Long-term course of hospitalization for schizophrenia: Part II. Change with passage of time.

This analysis examines the notion of progressive deterioration in schizophrenia, using long-term followup data on hospital episodes in defined cohorts from psychiatric case registers in Victoria, Australia; Denmark; and Salford, England. The analyses differentiate heterogeneity existing at the first hospitalization for schizophrenia, which produces a widely varying natural course, from heterogeneity that develops over time, as episodes of hospitalization occur. Episodes of hospitalization for schizophrenia tend to cluster earlier rather than later in the treatment career, suggesting a progressive amelioration rather than deterioration. When overall chronicity is adjusted, each additional episode of hospitalization lowers the risk for a further hospitalization by about 10 percent.

Adolescent↗
PubMed1991

Hidden severe psychiatric morbidity in sentenced prisoners: an Australian study.

OBJECTIVE: The aim of this survey was to estimate the prevalence of severe mental disorders in a representative sample of sentenced prisoners. METHOD: The subjects were selected as a random sample of sentenced prisoners in Melbourne's three metropolitan prisons. Interviews were conducted with 158 men and 31 women. Clinicians used the Structured Clinical Interview for DSM-III-R (SCID) to diagnose psychotic, affective, and substance use disorders. RESULTS: Six prisoners (3%) received current diagnoses of psychotic disorders, and 23 (12%) were diagnosed as having current mood disorders, mainly major depression. A lifetime diagnosis of at least one mental disorder each was made for 82% of the respondents, and in 26% more than one lifetime disorder was diagnosed. Sixty-nine percent received lifetime diagnoses of dependence on or abuse of alcohol, other psychoactive substances, or a combination of these. CONCLUSIONS: These findings do not indicate a large-scale shift of deinstitutionalized psychotically ill people from mental hospitals to prisons. They do, however, highlight the diversion into the corrections system of substance-dependent people and the apparent pool of prisoners with largely untreated major depression.

Adolescent↗
PubMed1989

Prevalence of severe mental disorders in disaffiliated and homeless people in inner Melbourne.

The authors determined the prevalence of mental illness in 382 people representative of the occupants of shelters for the homeless and cheap single-room accommodations in inner-city areas of Melbourne. Clinicians were trained to use a standardized diagnostic instrument, the Structured Clinical Interview for DSM-III-R, to diagnose a range of severe mental disorders, including psychotic, affective, and substance-related disorders. Almost half the people interviewed received diagnoses of current disorders, and over 70% received lifetime diagnoses. There was considerable comorbidity. Many factors are likely to contribute to the concentration of people with mental disorders in such homeless and disaffiliated groups.

Adolescent↗
PubMed1989

Schizophrenia and biological determinism.

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.

Humans↗
PubMed1987

Re-evaluation of the evidence on the prognostic importance of schizophrenic and affective symptoms.

An earlier literature noted consistently that depressive symptoms appear to bode well for outcome in schizophrenia and related disorders. Although this view is psychodynamically plausible, most of the studies suggesting it have substantial shortcomings. In particular, most studies have been confounded by the effects of variations in duration and history of disorder, which have a major influence on both affective expression and outcome. A contrary view is that depressive symptoms in patients with schizophrenia and related disorders suggest an increased risk of self-harm and social dysfunction, just as these symptoms do in individuals with other disorders. The substantial risks of mortality and morbidity from self-harm, the link between suicide and depression, and the high prevalence of depressive symptoms in the acute and chronic stages of the disorder have all been documented in people diagnosed as having schizophrenia. Social influences are well known to be crucial to the course and outcome of schizophrenia. The expectations of others and patients' own attitudes to their illness are also known to influence outcome. Despite this, there is no longitudinal study of first admission patients to allow us to examine the possible intervening or other role of depression in the development of chronic disability.

Adaptation, Psychological↗