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Biomedical subjects

M Teesson

Publications and source records attributed to M Teesson.

At least 19 recordsLinked to original sources
PubMed2001

Characteristics of DSM-IV and ICD-10 cannabis dependence among Australian adults: results from the National Survey of Mental Health and Wellbeing.

A representative sample (n = 10641) of Australian adults completed a structured diagnostic interview assessing the prevalence of mental and substance use disorders in the last year. The prevalence of DSM-IV (1.5%) and ICD-10 (1.7%) cannabis dependence was similar. DSM-IV and ICD-10 dependence criteria comprised unidimensional syndromes. The most common symptoms among dependent and non-dependent users were difficulties with controlling use and withdrawal, although there were marked differences in symptom prevalence. Dependent users reported a median of four symptoms. There was good to excellent diagnostic concordance (kappas = 0.7-0.9) between systems for dependence but not for abuse/harmful use (Y = 0.4). These findings provide some support for the validity of cannabis dependence.

Adolescent↗
PubMed2001

Cannabis use and dependence among Australian adults: results from the National Survey of Mental Health and Wellbeing.

AIMS: To examine: (i) the prevalence of cannabis use and DSM-IV cannabis dependence among Australian adults, and (ii) correlates of level of cannabis involvement. DESIGN: Cross-sectional survey assessing substance use and DSM-IV substance use disorders (abuse and dependence). Setting and participants. A household survey of a nationally representative sample of 10 641 Australians aged 18 years and older. MEASUREMENTS: Trained interviewers administered a structured, modified version of the Composite International Diagnostic Interview (CIDI). FINDINGS: In the past 12 months, 2.2% (95%CI:1.8, 2.6) of adults were diagnosed with DSM-IV cannabis use disorder, comprising cannabis dependence (1.5%; 95%CI: 1.2, 1.8) and cannabis abuse (0.7%, 95%CI: 0.6, 0.8). Almost one-third of cannabis users (31.7%; 95%CI: 27.7, 35.7) met criteria for cannabis dependence (21%; 95%CI: 16.7, 25.3) and abuse (10.7%; 95%CI: 8.0, 13.4). Multinomial logistic regression revealed that compared to non-dependent cannabis users, non-users were more likely to be female, aged 25 + years, out of the labour force and married/de facto, and displayed lower levels of co-morbidity. In contrast, dependent cannabis users were more likely to be 18-24 years old, unemployed, and displayed higher levels of co-morbidity than non-dependent users. CONCLUSIONS: Cannabis use disorders affect approximately 300 000 Australian adults. A better understanding of the factors associated with cannabis dependence may help identify groups who have difficulties controlling use and aid the development of strategies for reducing cannabis-related harm.

Adolescent↗
PubMed2001

Does case management work? The evidence and the abuse of evidence-based medicine.

OBJECTIVES: This study reviews typologies of psychiatric case management and then discusses the efficacy, effectiveness and cost effectiveness of psychiatric case management, with particular focus on evidence from Australia and the UK. Subsequently, it aims to examine the way such evidence has been interpreted in the context of UK psychiatric research and services. Finally it examines the ways in which, by the selective reviewing or editorializing of evidence, case management has been brought into disrepute in the UK. METHOD: This study reviews literature of the recent evidence for case management, and asks three questions of case management: has it been shown to be efficacious in controlled research, is it effective in applied settings, and is it cost effective? An examination is then made of the concurrent representations of the UK evidence in both the academic literature and the media. RESULTS: There is strong evidence for the efficacy effectiveness and cost-effectiveness of case management in psychiatry, the closer it conforms to active and assertive community treatment models. It appears, however, that studies and evidence-based reviews of case management have possibly been misused and misrepresented in a highly charged atmosphere of professional media debate. The potential for this abuse is not limited to psychiatry and remains a challenge for all evidence-based practice. CONCLUSION: On the evidence, assertive community treatment case management is one of the most effective interventions in psychiatry today. Despite improving the evidence base for practice (e.g. as has occurred for case-management in psychiatry), evidence-based medicine (EBM) is still susceptible to compromise and misrepresentation, due to unexamined or undeclared bias. Unless this potential for abuse is recognized and checked, EBM in psychiatry is in danger of being discredited at the hand of some of its own proponents. There is a need for more rigorous pursuit of evidence-based psychiatry, including more systematic declaration of bias in all research, whether quantitative or qualitative in design.

Australia↗
PubMed2000

Substance use disorders among homeless people in inner Sydney.

BACKGROUND: The study aimed to assess the prevalence of alcohol and drug use disorders among homeless people in inner Sydney, to compare the Australian findings with the international literature and to examine treatment seeking. METHOD: Two hundred and ten homeless men and women randomly selected from the dining rooms of inner Sydney refuges were interviewed. DSM-IV diagnoses over the past 12 months were based on the Composite International Diagnostic Interview (CIDI). RESULTS: Half the homeless men and 15% of the women had a diagnosis of alcohol use disorder in the past 12 months. One in five had an opiate use disorder, one in five a cannabis use disorder and one in ten a sedative or stimulant use disorder. CONCLUSIONS: Drug use disorders were more prevalent in this Australian sample than in comparable international studies.

Adult↗
PubMed2000

Lifetime prevalence of trauma among homeless people in Sydney.

OBJECTIVE: The experience of lifetime trauma among homeless women in the USA is well documented. Less information is available concerning homeless men. There are no prevalence studies concerning lifetime trauma among homeless people in Australia. Our aim was to assess the lifetime prevalence of trauma as reported by homeless men and women in Sydney. METHOD: We interviewed 119 men and 38 women who were visiting or residing at the seven largest refuges for homeless people in inner Sydney, using the lifetime trauma section of the Composite International Diagnostic Interview. RESULTS: All women and over 90% of men reported at least one event of trauma in their life. Fifty-eight per cent suffered serious physical assault and 55% witnessed someone being badly injured or killed. Half the women and 10% of men reported that they had been raped. CONCLUSION: The experience of at least one lifetime event of trauma is almost universal among homeless people in Sydney and is considerably higher than for the USA general population. Reasons for such high prevalence rates are discussed. Depression and posttraumatic stress disorder are associated with a history of trauma. Health professionals need to be aware of past events of trauma among individuals who are homeless.

Adult↗
PubMed2000

Alcohol- and drug-use disorders in Australia: implications of the National Survey of Mental Health and Wellbeing.

OBJECTIVE: This study reports the prevalence and correlates of ICD-10 alcohol- and drug-use disorders in the National Survey of Mental Health and Wellbeing (NSMHWB) and discusses their implications for treatment. METHOD: The NSMHWB was a nationally representative household survey of 10641 Australian adults that assessed participants for symptoms of the most prevalent ICD-10 and DSM-IV mental disorders, including alcohol- and drug-use disorders. RESULTS: In the past 12 months 6.5% of Australian adults met criteria for an ICD-10 alcohol-use disorder and 2.2% had another ICD-10 drug-use disorder. Men were at higher risk than women of developing alcohol- and drug-use disorders and the prevalence of both disorders decreased with increasing age. There were high rates of comorbidity between alcohol- and other drug-use disorders and mental disorders and low rates of treatment seeking. CONCLUSIONS: Alcohol-use disorders are a major mental health and public health issue in Australia. Drug-use disorders are less common than alcohol-use disorders, but still affect a substantial minority of Australian adults. Treatment seeking among persons with alcohol- and other drug-use disorders is low. A range of public health strategies (including improved specialist treatment services) are needed to reduce the prevalence of these disorders.

Adolescent↗
PubMed2000

Measuring disability, need and outcome in Australian community mental health services.

OBJECTIVE: This study trialled routine measurement of disability, need and outcome in mental health services within Sydney. METHOD: Fifteen community mental health clinicians with a combined caseload of 283 patients participated in the study. The Health of the Nation Outcome Scales (HoNOS) was used to assess disability and outcome and the patient and staff versions of the Camberwell Assessment of Need (CAN) were used to assess need. RESULTS: The HoNOS and CAN appear to be promising contenders for routine use. Patients receiving assertive case management were rated as having higher levels of disability and need than patients receiving standard case management. Significant change in outcome was demonstrated with the HoNOS. CONCLUSIONS: To ensure the continued measurement of consumer outcome, issues such as staff education, training, and the development of computerised information systems should be addressed.

Adult↗
PubMed2000

Prevalence of cognitive impairment among homeless people in inner Sydney.

The prevalence of cognitive impairment was assessed among a cohort of homeless men and women selected randomly from the dining rooms of the seven largest hostels offering emergency shelter in inner Sydney. They were interviewed using sections of the Composite International Diagnostic Interview 2.0. A total of 204 subjects (155 men and 49 women) were interviewed, of whom 20 (10 percent) showed evidence of cognitive impairment as assessed by the Mini Mental State Examination. Subjects with cognitive impairment were significantly older than those without impairment (mean ages of 57 and 41, respectively). Reasons for cognitive impairment among homeless individuals are complex and remain to be elucidated.

Adult↗
PubMed1999

Measurement of need for care: a trial of the Camberwell Assessment of Need and the Health of the Nation Outcome Scales.

OBJECTIVE: The accurate assessment of the individual needs of clients has been the focus of increasing discussion in mental health service delivery and evaluation. There is evidence to suggest that clinicians and clients differ in their perceptions of need and that staff assessments alone may not be sufficient for determining need for care. This study addresses these discrepancies in an Australian setting. METHOD: The Camberwell Assessment of Need (short version) and the Health of the Nation Outcome Scales (HoNOS) were completed on a sample of 78 clients of a mental health service in inner Sydney. RESULTS: Clinicians identified a mean number of 7.3 needs per client (SD = 5.0) compared with 6.0 (SD = 2.4) identified by clients. The mean kappa coefficient for agreement between clinicians and clients in identification of the 22 need areas was 0.18 (range = 0-0.45), indicating poor to moderate agreement. Similarly, client ratings of need were only moderately correlated with clinician ratings of disability on the HoNOS (Pearson's r = 0.35). Clinician ratings of disability and unmet need were highly correlated (Pearson's r = 0.80), whereas ratings of disability and met need were moderately correlated (Pearson's r = 0.52). CONCLUSIONS: Individual needs assessments using the CAN are applicable in this Australian setting. Staff and clients differ in their assessment of need. It is important to consider both the role of the rater and the context in which they are making the ratings when applying need and disability assessments in clinical practice.

Adult↗
PubMed1999

Intensive case management in Australia: a randomized controlled trial.

This study compared intensive case management (ICM) with standard clinical case management in a well-resourced community mental health service in Australia. A total of 73 severely disabled clients of an existing clinical service were randomly allocated to either ICM (caseload 10 clients per clinician) or standard case management (caseload up to 30 clients per clinician) and followed up for 12 months. A greater proportion of clients receiving ICM showed improved social functioning, these clients had fewer psychiatric hospital admissions involving police, and were more likely to engage and remain in treatment compared to those who received standard case management. Clients receiving ICM did not show a reduction in hospitalization duration or total number of episodes. It is suggested that future studies of ICM should focus on which aspects of treatment produce positive outcomes, how they can be applied to routine clinical settings, and over what period of time outcomes are sustained.

Adolescent↗
PubMed1999

The 12-month prevalence of substance use and ICD-10 substance use disorders in Australian adults: findings from the National Survey of Mental Health and Well-Being.

AIMS: To present the prevalence of substance use and ICD-10 substance use disorders in the adult Australian population using data from the National Survey of Mental Health and Well-Being (NSMHWB). DESIGN: A cross-sectional survey assessing substance use and ICD substance use disorders (harmful use and dependence). SETTING AND PARTICIPANTS: A household survey of a nationally representative sample of 10,641 Australian adults (aged 18 years or older). MEASUREMENTS: Trained survey interviewers administered a structured interview based on the Composite International Diagnostic Interview (CIDI). FINDINGS: In the past 12 months 6.5% of the sample had an ICD-10 alcohol use disorder (95% CI: 6.2, 6.9), and 2.2% had another drug use disorder (95% CI: 2.0, 2.4). More males than females had substance use disorders: 9.5% of males (95% CI: 8.5, 10.5) and 3.6% of females (95% CI: 3.2, 4.0) met criteria for an alcohol use disorder, and 3.2% of males (95% CI: 2.8, 3.6) and 1.3% of females (95% CI: 0.9, 1.7) met criteria for another drug use disorder within the past 12 months. The prevalence of substance use disorders decreased with increasing age: 10.5% of respondents aged 18-34 years met criteria for an alcohol use disorder and 4.8% met criteria for a drug use disorder. The rates of these disorders among those aged 55 years or older were 1.8% and 0.1%, respectively. Substance use disorders were more prevalent among the unemployed, those who had never married and those who were Australian-born. CONCLUSIONS: The prevalence of substance use disorders in the Australian population is comparable to that in other English-speaking countries.

Adult↗
PubMed1998

Intensive case management: a cost-effectiveness analysis.

OBJECTIVE: The objective of this study was to compare the outcomes and costs of intensive case management with routine case management for a group of severely disabled patients with a mental illness. METHOD: A cost-effectiveness analysis was conducted alongside a randomised controlled trial. Seventy-three patients, who reside in the eastern suburbs of Sydney, were randomly allocated to either intensive or routine case management. Staff providing intensive case management and substantially lower caseloads than staff providing routine case management. The main health outcome measured was patients' level of functioning as measured by the Life Skills Profile. Costing data were collected from hospital services, mental health services, general health services, community services and informal carers. RESULTS: At 12 months, outcome and costing data were analysed on 58 patients and hospitalisation data were analysed on 68 patients. Significantly more patients in the intensive case management group remained in treatment (chi 2 = 6.00, df = 1, p < 0.01) and showed a clinically significant improvement in functioning from baseline to 12 months (chi 2 = 4.50, df = 1, p < 0.05). The mean cost per patient was $7745 more in the intensive group than in the routine group (t = 1.49, df = 56, p > 0.01) over 12 months. The cost-effectiveness ratio indicated a cost of $27,661 per year for one additional patient in the intensive case management group to make a clinically significant improvement in functioning. CONCLUSION: Intensive case management led to an increased rate of retention in treatment and a clinically significant improvement in functioning. Further comparative cost-effectiveness studies are required to determine whether $27,661 per year for one patient to make a clinically significant improvement in functioning is a cost-effective use of mental health resources.

Adolescent↗
PubMed1996

Impact of a psychiatric outreach service for homeless persons with schizophrenia.

Since 1988 a 24-hour psychiatric out reach service has been in operation in the inner city of Sydney to provide services to residents of refuges for the homeless. A total of 506 homeless persons with schizophrenia were referred to the outreach service between April 1988 and mid-1992, of whom 91 failed to attend. Hospitalization data were collected for the four years before and the four years after each individual's referral to the service. After the introduction of the service, the rate and duration of psychiatric hospital admissions for residents with schizophrenia who were treated by the outreach service decreased significantly, whereas those who failed to attend showed no such decrease.

Adult↗
PubMed1994

Proximity and anticipation of a negative outcome in phobias.

Thirty-five patients being treated for one of three anxiety disorders were asked to rate the likelihood of a negative outcome prior to entering a feared situation, while in the situation and after leaving the situation. Ratings made in anticipation were consistently higher than ratings made either in the situation or after leaving it. In contrast, normal Ss, about to undertake tourist rides perceived as being mildly dangerous, rated the likelihood of negative outcome as highest when actually in the situation.

Adult↗
PubMed1993

Prevalence of schizophrenia among women in refuges for the homeless.

There are considerably more homeless mentally ill men than women. However the rate of mental illness among homeless women appears to be relatively greater than for men. We found the lifetime prevalence of schizophrenia among a cohort of 54 women residing in refuges for the homeless in inner Sydney to be approximately 30%. Only three of the women had a history of prolonged stay in a psychiatric institution. Schizophrenic women had resided at the refuges for longer than non-schizophrenic women.

Adult↗
PubMed1992

Mobile community treatment in inner city and suburban Sydney.

Intensive and assertive community based treatment was provided to 27 inner city and 45 suburban severely and chronically mentally ill patients in Sydney. The teams use assertive outreach methods to address the needs of these most difficult to treat patients who have only sporadically complied with outpatient treatment and who frequently required hospitalisation. The staff-patient ratio at 1:10 on both teams is much higher than in the conventional mental health centres. Preliminary outcomes indicate that the number of hospital bed days of the suburban patients dropped by 67%, that stability in accommodation for inner city patients increased, and that functioning improved significantly for patients treated by both teams.

Adult↗
PubMed1990

Follow-up of community placement of the chronic mentally ill in New South Wales.

A total of 208 long-stay hospital patients in New South Wales, Australia, who were discharged to supported community accommodations were studied to determine their adjustment in the community. For 172 patients, measurements were obtained of the patients' satisfaction with their accommodations, the caretakers' perceptions of the patients' impairment and management difficulty, and the restrictiveness of practices in the various accommodations. Most patients were considered to be functioning well, although 22 of the more impaired and difficult patients were rehospitalized at the time of the study. Seventy-eight percent of the patients preferred living in the community, and only 7 percent preferred a hospital. The patients benefited from the supported, subsidized, permanent housing available in the community and required low levels of mental health care.

Adult↗