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Biomedical subjects

T J Lewin

Publications and source records attributed to T J Lewin.

At least 19 recordsLinked to original sources
PubMed2001

Randomized controlled trial of brief cognitive-behavioural interventions among regular users of amphetamine.

AIMS: To identify whether brief cognitive-behavioural interventions are feasible among regular users of amphetamine, to assess the effectiveness of intervention overall and to pilot two- and four-session interventions. DESIGN: Subjects were assigned randomly to individually receive a cognitive-behavioural intervention (n = 32) of either two or four sessions' duration or a self-help booklet (control condition; n = 32). SETTING: Subjects were volunteers recruited from needle exchange schemes and treatment centres in Newcastle, Australia. PARTICIPANTS: Regular (at least monthly) users of amphetamine were recruited. INTERVENTION: Either four sessions of cognitive-behaviour therapy, consisting of a motivational interview and skills training in avoidance of high-risk situations, coping with craving and relapse prevention, or two sessions consisting of a motivational interview and discussion of skills. MEASUREMENTS: The Opiate Treatment Index was the main measure at pre-treatment and 6-month follow-up. FINDINGS: There was a significant reduction in amphetamine use among the sample as a whole, with inconclusive differences between intervention subgroups. There was a moderate overall intervention effect, with the intervention group reporting over twice the reduction in daily amphetamine use as the control group. Significantly more people in the cognitive-behavioural intervention condition abstained from amphetamine at 6-month follow-up compared to the control condition. CONCLUSION: Brief cognitive-behavioural interventions appear feasible among regular users of amphetamine. A larger randomised controlled trial of the effectiveness of such interventions appears warranted.

Adult↗
PubMed2001

The NISAD Schizophrenia Research Register: why do we need a database of schizophrenia volunteers?

OBJECTIVE: This paper documents the establishment of the Schizophrenia Research Register of the Neuroscience Institute of Schizophrenia and Allied Disorders (NISAD). This register aims to provide a volunteer pool of people with a clinical diagnosis of schizophrenia who are willing to consider participating in research projects. This unique resource is accessible to the general scientific research community. METHOD: The Register, which operates as a standalone, computerized relational database, maintains demographic and clinical information about individuals with schizophrenia recruited through media campaigns, and general health and non-government support agencies. Preliminary data are reported on the first 400 people with schizophrenia who registered on the database, together with selected comparisons with data from the national Low Prevalence (psychotic) Disorders Study (LPDS). RESULTS: Individuals currently on the Register have a mean age of 38.74 years (SD = 11.41) and are predominantly Australian born (85.1%), which is consistent with data from the LPDS. However, the gender distribution is more balanced compared with the LPDS (53.8% vs 65.4% males) and proportionately more registrants are married or in de facto relationships (18.4% vs 10.8%). Registrants also tend to have lower current symptomatology and higher functioning relative to participants in the LPDS. CONCLUSIONS: The Register provides a unique and invaluable educational and research resource, as well as a complementary recruitment source for researchers who would otherwise rely on samples drawn primarily from mental health services.

Adult↗
PubMed2000

Comparison of integrated and consultation-liaison models for providing mental health care in general practice in New South Wales, Australia.

Comparison of integrated and consultation-liaison models for providing mental health care in general practice in New South Wales, Australia The characteristics of a new service providing integrated mental health care in general practice are described and comparisons made with an earlier consultation-liaison (C-L) psychiatry service in general practice, including the range and severity of psychiatric problems, levels of general practitioner (GP) and psychiatrist involvement, and patterns of care. Clinical audit checklists were completed by two experienced mental health nurses for the first 100 patients referred to the service, which was conducted in conjunction with 8 general practices in the Port Stephens region of New South Wales, Australia. The mean age of the first 100 referrals was 38.05 years, 63.0% were female, and 55.0% were referred from GPs. Outcome measures included: referral information, patients' demographic and diagnostic characteristics, psychosocial functioning, psychotropic medication, management, and number of contacts with the mental health nurses. Relative to the earlier C-L psychiatry service in general practice, the integrated service treated a broader range of diagnostic groups with higher levels of disability. There were higher rates of mood (48.0%) and psychotic (20.0%) disorders and lower rates of adjustment (2.0%) disorders. One-third of patients were seen by an additional agency, other than the mental health nurses or GPs. Patients averaged 4.95 contacts with the mental health nurses, with marked variations according to diagnostic group. To date, the new service has been well received. It is highly accessible, acceptable to GPs and patients, caters for a broad range of psychopathology, including severe mental illness, and appears to be sufficiently versatile to be adaptable to a variety of treatment settings.

Adult↗
PubMed2000

The spectrum of mucin-producing adenocarcinoma of the pancreas.

The clinical distinction between cystic and mucinous carcinomas of the pancreas has been poorly defined. Therefore we sought to stratify the entity known as pancreatic mucinous adenocarcinoma based on pathologic and clinical criteria. Clinical data and pathology specimens were reviewed for patients (n = 40) who had been diagnosed as having mucin-producing pancreatic adenocarcinoma and had undergone either resection or intraoperative biopsy of their pancreatic tumor during a 40-year period at the UCLA Medical Center. Based on histologic criteria, three distinct classes of pancreatic adenocarcinoma were identified: mucinous noncystic (colloid) adenocarcinoma (group I), mucinous cystadenocarcinoma (group II), and ductal adenocarcinoma (group III). Based on clinical behavior, groups I and III were indistinguishable. Compared to patients from groups I and III, those from group II were younger, more likely to be female, and had a better prognosis. Among mucin-producing adenocarcinomas of the pancreas, mucinous noncystic adenocarcinoma and ductal adenocarcinoma share similar clinical features, whereas true cystic lesions represent a distinct clinical entity.

Adenocarcinoma, Mucinous↗
PubMed1999

Factors associated with medium-term response to psychostimulant medication.

OBJECTIVE: To determine, in a sample of children first prescribed psychostimulants for attention deficit hyperactivity disorder (ADHD) between 1992 and 1994, which child and family factors, components of assessment, and aspects of management, were associated with a favourable treatment response, and with parental satisfaction with management. METHODOLOGY: Data were obtained by mail survey in March 1995. Factors considered potentially significant to treatment response and parental satisfaction were entered in a three-step hierarchical multiple regression equation. RESULTS: Responses were received from 788 (59.7%) of a possible 1319 parents. Items making a significant individual contribution to both improvement and parental satisfaction were: younger age of the child; amount of information provided by the clinician; shorter interval between review appointments; continued use of medication; and fewer treatment side effects. items contributing only to treatment response were: longer time taken over establishing the diagnosis; and the use of parent and teacher checklists in assessment. CONCLUSIONS: These data support early intervention for ADHD. A considered approach to assessment which includes the use of parent and teacher checklists is recommended. Providing adequate information to parents and children is essential. Review intervals of less than 6 months appear to foster better outcomes.

Adolescent↗
PubMed1999

Confirmation that Child Behavior Checklist clinical scales discriminate juvenile mania from attention deficit hyperactivity disorder.

OBJECTIVE: To determine whether boys meeting diagnostic criteria for juvenile mania and attention deficit hyperactivity disorder (mania-ADHD) may be distinguished from boys with ADHD alone on a range of clinical and family variables. METHODOLOGY: Boys aged 9-13 years with mania-ADHD (n = 25), ADHD alone (n = 99), or no psychiatric diagnosis (n = 27) were compared on parent and teacher report Child Behavior Checklists (CBCL) and Conners Questionnaires, self-report CBCLs, patterns of comorbidity, intellectual functioning, and family variables. RESULTS: Mania-ADHD subjects had significantly higher mean ratings than ADHD only subjects on the parent CBCL for the Withdrawn, Thought Problems, Delinquent Behavior and Aggressive Behavior scales and significantly higher rates of comorbid depression, anxiety and psychotic symptoms. Other variables did not distinguish the mania-ADHD and ADHD only groups. CONCLUSIONS: These data confirm previous research indicating that the CBCL may be used to assist in the clinical identification of manic children.

Adolescent↗
PubMed1999

Long-term changes in defense style among patients recovering from major depression.

The long-term stability of ego defenses was examined in a group of 68 patients with major depression being treated in a rural private psychiatric practice. Current symptomatology and dispositional characteristics, including defense style (40-item Defense Style Questionnaire), were assessed pretreatment and at approximately 6 months and 2 years after treatment commenced. Age- and gender-matched comparison groups were also selected from two community-based studies that utilized similar instruments and time periods. The major depression group reported significantly lower usage of mature defenses initially, but with recovery they moved progressively toward the range of mature defenses displayed by the nonpatient comparison group. Neurotic defenses were relatively stable throughout the study, as were immature defenses during the first 6 months. Comparisons between patients who discontinued treatment (N = 24) and those who remained in treatment (N = 33) revealed similar rates of symptom reduction; however, the latter group reported continuing reductions in their use of immature defenses, to a level below that of the nonpatient comparison group.

Adult↗
PubMed1999

Effortful and automatic information processing in boys with ADHD and specific learning disorders.

Boys with Attention Deficit Hyperactivity Disorder (ADHD, N = 50), Specific Learning Disorder (LD, N = 45), combined Specific Learning Disorder and ADHD (LD/ADHD, N = 25), and controls (N = 51) completed effortful and automatic information processing tasks based on Treisman and Gelade's (1980) "information integration theory". ADHD and LD/ADHD subjects did not differ from controls at baseline or under feedback and reward conditions, suggesting that they were investing similar levels of mental effort in the tasks. The LD group had a superior performance in the effortful task and an inferior performance in the automatic task compared with the other groups at baseline. The data suggest a potential method of distinguishing primary LD from learning difficulties that occur secondary to ADHD.

Adolescent↗
PubMed1998

Illusory conjunctions and perceptual grouping in a visual search task in schizophrenia.

This report describes part of a series of experiments, conducted within the framework of feature integration theory, to determine whether patients with schizophrenia show deficits in preattentive processing. Thirty subjects with a DSM-III-R diagnosis of schizophrenia and 30 age-, gender-, and education-matched normal control subjects completed two computerized experimental tasks, a visual search task assessing the frequency of illusory conjunctions (i.e. false perceptions) under conditions of divided attention (Experiment 3) and a task which examined the effects of perceptual grouping on illusory conjunctions (Experiment 4). We also assessed current symptomatology and its relationship to task performance. Contrary to our hypotheses, schizophrenia subjects did not show higher rates of illusory conjunctions, and the influence of perceptual grouping on the frequency of illusory conjunctions was similar for schizophrenia and control subjects. Nonetheless, specific predictions from feature integration theory about the impact of different target types (Experiment 3) and perceptual groups (Experiment 4) on the likelihood of forming an illusory conjunction were strongly supported, thereby confirming the integrity of the experimental procedures. Overall, these studies revealed no firm evidence that schizophrenia is associated with a preattentive abnormality in visual search using stimuli that differ on the basis of physical characteristics.

Adult↗
PubMed1998

Preattentive visual search and perceptual grouping in schizophrenia.

To help determine whether patients with schizophrenia show deficits in the stimulus-based aspects of preattentive processing, we undertook a series of experiments within the framework of feature integration theory. Thirty subjects with a DSM-III-R diagnosis of schizophrenia and 30 age-, gender-, and education-matched normal control subjects completed two computerized experimental tasks, a visual search task assessing parallel and serial information processing (Experiment 1) and a task which examined the effects of perceptual grouping on visual search strategies (Experiment 2). We also assessed current symptomatology and its relationship to task performance. While the schizophrenia subjects had longer reaction times in Experiment 1, their overall pattern of performance across both experimental tasks was similar to that of the control subjects, and generally unrelated to current symptomatology. Predictions from feature integration theory about the impact of varying display size (Experiment 1) and number of perceptual groups (Experiment 2) on the detection of feature and conjunction targets were strongly supported. This study revealed no firm evidence that schizophrenia is associated with a preattentive abnormality in visual search using stimuli that differ on the basis of physical characteristics. While subject and task characteristics may partially account for differences between this and previous studies, it is more likely that preattentive processing abnormalities in schizophrenia may occur only under conditions involving selected 'top-down' factors such as context and meaning.

Adult↗
PubMed1998

Rates of treatment of schizophrenia by general practitioners. A pilot study.

OBJECTIVE: To investigate how many people with schizophrenia are being treated by general practitioners (GPs) and what the associations are between GP characteristics and the number of patients with schizophrenia in their practice. DESIGN AND SETTING: Pilot study by postal survey of all GPs in the Hunter/Taree region. PARTICIPANTS: 349 of 495 GPs (70.5%) replied to the survey--245 urban GPs and 104 rural GPs from the Hunter/Taree region of New South Wales. MAIN OUTCOME MEASURES: GP estimates of the number of patients with schizophrenia currently being treated and by whom. RESULTS: Three-quarters of the GPs in the region were treating patients with schizophrenia, proportionately more in rural areas (87.5%) than in urban areas (70.2%). The typical GP was treating three patients with schizophrenia, two conjointly with specialist services and one without specialist support. It was estimated that the GP-treated prevalence for schizophrenia is 35.5 per 10,000 adults. CONCLUSION: Although individual GPs treat a small number of patients with schizophrenia, collectively they treat most of the patients with this disorder. Because schizophrenia has such a high burden of illness for the patient and the community, we need to find suitable mechanisms for evaluating and enhancing the treatment of schizophrenia in general practice.

Adolescent↗
PubMed1998

Patterns of current and lifetime substance use in schizophrenia.

A structured interview and standardized rating scales were used to assess a sample of 194 outpatients with schizophrenia in a regional Australian mental health service for substance use, abuse, and dependence. Case manager assessments and urine drug screens were also used to determine substance use. Additional measurements included demographic information, history of criminal charges, symptom self-reports, personal hopefulness, and social support. The sample was predominantly male and showed relative instability in accommodations, and almost half had a history of criminal offenses, most frequently drug or alcohol related. The 6-month and lifetime prevalence of substance abuse or dependence was 26.8 and 59.8 percent, respectively, with alcohol, cannabis, and amphetamines being the most commonly abused substances. Current users of alcohol comprised 77.3 percent and current users of other nonprescribed substances (excluding tobacco and caffeine) comprised 29.9 percent of the sample. Rates of tobacco and caffeine consumption were high. There was a moderate degree of concordance between case manager determinations of a substance-use problem and research diagnoses. Subjects with current or lifetime diagnoses of substance abuse/dependence were predominantly young, single males with higher rates of criminal charges; however, there was no evidence of increased rates of suicide attempts, hospital admissions, or daily doses of antipsychotic drugs in these groups compared with subjects with no past or current diagnosis of substance abuse or dependence. Subjects with a current diagnosis of substance use were younger at first treatment and currently more symptomatic than those with no past or current substance use diagnosis. The picture emerging from this study replicates the high rate of substance abuse in persons with schizophrenia reported in North American studies but differs from the latter in finding a slightly different pattern of substances abused (i.e., absence of cocaine), reflecting relative differences in the availability of certain drugs.

Adult↗
PubMed1998

Recovery from post-earthquake psychological morbidity: who suffers and who recovers?

OBJECTIVE: We sought to identify the psychosocial characteristics of high earthquake exposure subjects that were associated with the development of post-disaster morbidity and with recovery. METHOD: Data reported are from 515 participants in a longitudinal study of the psychosocial effects of the 1989 Newcastle (Australia) earthquake. Subjects were allocated to three subgroups (low morbidity; recovered; and persistent morbidity) on the basis of their Impact of Event Scale scores across the four phases of the study. Differences between these subgroups were examined on a broad range of variables. RESULTS: Several background, dispositional, coping style and exposure-related factors characterised those who developed psychological morbidity, only a small subset of which differentiated between those who recovered and those with persistent morbidity. CONCLUSIONS: Post-earthquake morbidity persists longer in those who are older, have a history of emotional problems, have higher neuroticism, use more neurotic defenses, and report higher levels of post-disaster life events.

Adaptation, Psychological↗
PubMed1997

A synthesis of the findings from the Quake Impact Study: a two-year investigation of the psychosocial sequelae of the 1989 Newcastle earthquake.

This paper summarises the major findings from the Quake Impact Study (QIS), a four-phase longitudinal project that was conducted in the aftermath of the 1989 Newcastle (Australia) earthquake. A total of 3,484 subjects participated in at least one component of the QIS, comprising a stratified sample of 3,007 drawn from community electoral rolls and 477 from specially targeted supplementary samples (the injured, the displaced, the owners of damaged businesses, and the helpers). Subjects' initial earthquake experiences were rated in terms of weighted indices of exposure to threat and disruption. Psychological morbidity was measured at each phase using the General Health Questionnaire (GHQ-12) and the Impact of Event Scale (IES). Selected findings and key conclusions are presented for each of six areas of investigation: service utilisation during the first 6 months post-disaster; patterns of earthquake experience and short-term (6-month) psychosocial outcome; earthquake exposure and medium term (2-year) psychosocial outcome; vulnerability factors and medium-term psychosocial outcome; specific community groups at increased risk (e.g., the elderly and immigrants from non-English-speaking backgrounds); the effects of stress debriefing for helpers. Threshold morbidity (i.e., likely caseness) rates are also presented for a broad range of subgroups. In addition to presenting an overview of the QIS, this paper synthesises the major findings and discusses their implications for future disaster management and research from a mental health perspective.

Adult↗
PubMed1997

Psychosocial sequelae of the 1989 Newcastle earthquake: II. Exposure and morbidity profiles during the first 2 years post-disaster.

BACKGROUND: A sample of 1089 Australian adults was selected for the longitudinal component of the Quake Impact Study, a 2-year, four-phase investigation of the psychosocial effects of the 1989 Newcastle earthquake. Of these, 845 (78%) completed a survey 6 months post-disaster as well as one or more of the three follow-up surveys. METHODS: The phase 1 survey was used to construct dimensional indices of self-reported exposure to threat the disruption and also to classify subjects by their membership of five 'at risk' groups (the injured; the displaced; owners of damaged small businesses; helpers in threat and non-threat situations). Psychological morbidity was assessed at each phase using the 12-item General Health Questionnaire (GHQ-12) and the Impact of Event Scale (IES). RESULTS: Psychological morbidity declined over time but tended to stabilize at about 12 months post-disaster for general morbidity (GHQ-12) and at about 18 months for trauma-related (IES) morbidity. Initial exposure to threat and/or disruption were significant predictors of psychological morbidity throughout the study and had superior predictive power to membership of the targeted 'at risk' groups. The degree of ongoing disruption and other life events since the earthquake were also significant predictors of morbidity. The injured reported the highest levels of distress, but there was a relative absence of morbidity among the helpers. CONCLUSIONS: Future disaster research should carefully assess the threat and disruption experiences of the survivors at the time of the event and monitor ongoing disruptions in the aftermath in order to target interventions more effectively.

Adult↗
PubMed1997

Psychosocial sequelae of the 1989 Newcastle earthquake: III. Role of vulnerability factors in post-disaster morbidity.

BACKGROUND: This paper examines the contributions of dispositional and non-dispositional factors to post-disaster psychological morbidity. Data reported are from the 845 participants in the longitudinal component of the Quake Impact Study. METHODS: The phase 1 survey was used to construct dimensional indices of threat and disruption exposure. Subsequently, a range of dispositional characteristics were measured, including neuroticism, personal hopefulness and defence style. The main morbidity measures were the General Health Questionnaire (GHQ-12) and Impact of Event Scale (IES). RESULTS: Dispositional characteristics were the best predictors of psychological morbidity throughout the 2 years post-disaster, contributing substantially more to the variance in morbidity (12-39%) than did initial exposure (5-12%), but the extent of their contribution was greater for general (GHQ-12) than for post-traumatic (IES) morbidity. Among the non-dispositional factors, avoidance coping contributed equally to general and post-traumatic morbidity (pr = 0.24). Life events since the earthquake (pr = 0.18), poor social relationships (pr = -0.25) and ongoing earthquake-related disruptions (pr = 0.22) also contributed to general morbidity, while only the latter contributed significantly to post-traumatic morbidity (pr = 0.15). CONCLUSIONS: Medium-term post-earthquake morbidity appears to be a function of multiple factors whose contributions vary depending on the type of morbidity experienced and include trait vulnerability, the nature and degree of initial exposure, avoidance coping and the nature and severity of subsequent events.

Adaptation, Psychological↗
PubMed1997

An evaluation of the effectiveness of a consultation-liaison psychiatry service in general practice.

OBJECTIVE: This study evaluated the 6-month outcome of patients referred by their general practitioner (GP) to a consultation-liaison (C-L) psychiatry service provided to eight group general practices. METHOD: Over a 12-month period, there were 307 referrals to the C-L psychiatry service of whom 86 consented to take part in an outcome study. Two different control groups were examined comprising patients seen by the same GPs but not referred to the C-L service, who were matched with the C-L referrals on the basis of either demographic characteristics (n = 86) or initial symptomatology (n = 59). Clinical interviews were conducted at recruitment to the outcome study using the Composite International Diagnostic Interview (CIDI), while postal questionnaires were used at both the initial and 6-month assessments. RESULTS: Data reported include DSM-III-R clinical audit and CIDI diagnoses, changes in current symptomatology (SCL-90-R) and changes in global ratings of physical health, emotional health, social relationships and ability to perform everyday duties. Consultation-liaison referrals without symptom-matched controls (n = 27), being patients with higher levels of symptoms initially, were more likely to be referred to other psychiatric services for treatment. They also showed more marked improvement over time on the selected outcome measures. However, there were no significant differences in the patterns of change over time between symptom-matched C-L referrals and their non-referred controls. CONCLUSIONS: The findings from the 6-month outcome study raise doubts about the overall benefit of the current C-L service relative to usual GP care. Improving the quality of psychiatric care in general practice is likely to require a range of interrelated strategies, including C-L psychiatry services, GP education and well-functioning links with public mental health services.

Activities of Daily Living↗