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Biomedical subjects

N Buhrich

Publications and source records attributed to N Buhrich.

At least 19 recordsLinked to original sources
PubMed2001

Mortality among homeless people with schizophrenia in Sydney, Australia: a 10-year follow-up.

OBJECTIVE: The aims were first, to describe deaths in a cohort of homeless people compared to the general population and secondly, to compare deaths among the individuals with schizophrenia to those without schizophrenia. METHOD: Mortality was assessed in a cohort of 708 homeless subjects, 506 with schizophrenia who were referred 10 years previously to psychiatric outreach clinics. Standardized mortality ratios (SMRs) were calculated. RESULTS: Eighty-three people (12%) had died, 19 from suicide. The SMR was 3.76 for homeless men and 3.14 for homeless women. There was a non-significant trend for higher excess mortality among men without schizophrenia compared to men with schizophrenia. SMRs for suicide were significantly elevated among homeless men. CONCLUSION: Homeless people in inner Sydney have death rates three to four times higher than people in the general population of New South Wales. Excess mortality was greatest for younger age groups.

Adult↗
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

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↗
PubMed2000

Misuse of anticholinergic drugs by people with serious mental illness.

This study assessed misuse of anticholinergic drugs in a population of 50 patients with serious mental illness who were assertively managed by a community-based outreach team in Sydney, Australia. One-third of the subjects reported having misused anticholinergics over the previous month. All anticholinergics were misused, and trihexyphenidyl (benzhexol) was misused most frequently. Most subjects misused at least one other drug as well. On direct questioning, the reason given most frequently was "to get high"; on indirect questioning, reasons were related more to peer participation and feelings of futility. Marginalized patients living in the community are vulnerable to the misuse of anticholinergic drugs.

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↗
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↗
PubMed1997

Intravenous sedation of involuntary psychiatric patients in New South Wales.

OBJECTIVE: Intravenous sedation of involuntary psychiatric patients is practised in almost all hospitals in New South Wales. Despite its widespread use, little has been published about the medications used or their safety and efficacy. The present study reports the frequency and reasons for intravenous sedation, the medications used, and the incidence of adverse effects. METHOD: Eighteen of 21 acute psychiatric admission units in the State were reviewed. The medical records of a random sample of 495 patients admitted involuntarily during 1990 were examined and information from the progress notes, drug charts and physical observations was recorded and subjected to statistical analysis. RESULTS: Of the 495 patients, 132 (27%) were intravenously sedated. Eighty-six percent (86%) of patients received a combination of haloperidol or diazepam, usually 20 mg of each drug. The threat of violence was the most significant patient characteristic predicting the use of intravenous sedation. Patients with mania or intoxication were relatively more likely to be intravenously sedated than other diagnostic categories. Patients admitted via accident and emergency departments and those admitted to teaching and metropolitan general hospitals compared to rural and large psychiatric hospitals were significantly more likely to receive intravenous sedation. The most common complications of intravenous sedation were dystonia (37%), hypotension (8%) and confusion (5%). The incidence of phlebitis and other extrapyramidal side-effects was probably under-reported. CONCLUSION: About one in four involuntary psychiatric patients receive intravenous sedation in NSW. Intravenous sedation is more likely when patients are admitted through accident and emergency departments to teaching or metropolitan hospitals, and pose a threat of violence. Intravenous sedation was shown to be a safe procedure given certain precautions.

Adult↗
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↗
PubMed1996

Delivery of medication to psychiatric patients in community health services in New South Wales.

OBJECTIVE: We investigated the supply and monitoring of medication to patients who attend community mental health services in NSW. METHOD: The staff at four metropolitan and one rural community centre health service were interviewed. Information sought included policies and procedures concerning medication, the delivery of medication to patients, and staff reports concerning their knowledge and practice related to the legal requirements of the New South Wales Poisons Act 1966. RESULTS: Sixty-five (62%) of 104 coordinators, medical officers and staff who were responsible for case managing patients were interviewed. The centres all differed in their existing policies and practices and the extent to which they were supported by their local hospital and retail pharmacies. Only one centre had a designated pharmacist and this was a part-time position. CONCLUSIONS: The delivery of medication at most centres is a fairly ad hoc arrangement with staff organising medication as best as they can. At times the supply of medication to patients fails to comply with legal and New South Wales Department of Health requirements.

Community Mental Health Services↗
PubMed1994

Opposite sex-linked behaviors and homosexual feelings in the predominantly heterosexual male majority.

Whether homosexual feelings are distributed categorically or dimensionally remains controversial. In an earlier series of studies, medical students anonymously reported a dimensional distribution of homosexual feelings, the ratio of homosexual to heterosexual feelings in men correlating with opposite sex-linked behaviors in childhood and adolescence, and, in both sexes, with current degree of opposite sex identity. Prevalence of homosexual feelings was markedly higher than that found in nonanonymous studies. In the present investigation, a study of male twins allowed investigation of the findings in 411 educationally more representative subjects. Awareness of some homosexual feelings was reported in adolescence by 20% and currently by 12%. As with medical students, the majority of those who reported some homosexual feelings were predominantly heterosexual, which could be considered to indicate such feelings were distributed dimensionally. Correlations between degree of homosexual feelings and avoidance of contact sport in childhood and adolescence, current wish to be of the opposite sex, and opposite sex identity remained present when subjects with equally bisexual and predominantly homosexual feelings were excluded from analysis. The finding that the majority of men with homosexual feelings are predominantly heterosexual renders implausible the theory that homosexual feelings result from fear of heterosexuality.

Adolescent↗
PubMed1994

Self-inflicted enucleation of both eyes.

Categories of self-injurious behaviour are briefly reviewed. Serious and bizarre self injurious behaviour is usually psychotic in origin. The literature concerning self-inflicted enucleation of the eyes is reviewed and two additional patients, both with a diagnosis of schizophrenia, are reported. The lack of pain and the lack of concern shown by the patients and their management are discussed.

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↗
PubMed1991

Sexual orientation, sexual identity, and sex-dimorphic behaviors in male twins.

Sexual orientation, sexual identity, and sex-dimorphic behaviors were assessed concurrently and retrospectively, for childhood, in 95 pairs of male monozygotic (MZ) twins and 63 pairs of dizygotic (DZ) twins. There was a significantly higher rate of adult homosexuality among the MZ than among DZ twins. We employed a model-fitting approach using LISREL to test for genetic and environmental influences on variation for each trait singly and on the covariation among all six traits (three for childhood and three for adulthood). Univariate analyses confirmed the presence of familial factors for five of the six variables but were generally unable to distinguish shared environmental from genetic influences. Hierarchical tests of multivariate models supported the existence of an additive genetic factor contributing to the covariance among the variables. More restrictive multivariate models yielded a significant genetic influence on sexual orientation. Because of the different rates of orientation by zygosity and because of the restrictive nature of some of the multivariate models, our results are best considered tentative but do suggest that further biometrically oriented studies of sexual orientation and its correlates would be worthwhile.

Adult↗