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Biomedical subjects

V J Carr

Publications and source records attributed to V J Carr.

At least 19 recordsLinked to original sources
PubMed2004

Are foster parents reliable informants of children's behaviour problems?

BACKGROUND: Clinicians and researchers primarily measure behavioural and emotional problems of children in foster care from carer-report checklists. Yet the reliability of these reports is not adequately established. The present study examines one indicator of reliability for foster parent checklist reports: interrater agreement between foster parents and teachers. METHODS: Estimates of interrater agreement of foster parent and teacher responses on the cross-informant scales of the Child Behaviour Checklist (CBCL) and the Teacher Report Form (TRF) were obtained for 47 children in long-term foster care, aged 5-11 years. The estimates included calculations of agreement for continuous measures of problem behaviour, as well as for categorical determinations of clinically significant behaviour. RESULTS: Correlations of CBCL and TRF mean raw scores for the total problems (r = 0.71) and externalizing (r = 0.78) scales exceeded those described in prior studies of parent-teacher agreement, while correlation for internalizing scores (r = 0.23) was similar to that found previously. Teachers and foster parents demonstrated moderate to good agreement (kappa = 0.70-0.79) in identifying clinically significant total problems and externalizing problems, but poor agreement in identifying internalizing problems. CONCLUSIONS: Discrepancies between these and prior findings are discussed. For children in long-term foster care, foster parents or teachers may be used as informants for total problems, externalizing problems, and social-attention-thought problems. The reliability of data on internalizing symptoms is less certain.

Child↗
PubMed2003

Attitudes toward psychiatry among students entering medical school.

OBJECTIVE: To survey the attitudes of Australian medical students to determine their views about the relative attractiveness of psychiatry as a career compared with other specialties, and against findings from a North American study. METHOD: We surveyed 655 first-year medical students attending six Australian Universities. RESULTS: Responses indicated that Australian medical students view psychiatry as distinctly less 'attractive' than other career options, as reported in the North American sample. In comparison with other disciplines, psychiatry was regarded as more interesting and intellectually challenging, but also as lacking a scientific foundation, not being enjoyable and failing to draw on training experiences. CONCLUSION: Our findings suggest that psychiatry has an image problem that is widespread, reflecting community perceptions and the specialist interests of medical students on recruitment. If psychiatry is to improve its 'attractiveness' as a career option, identified image problems need to be corrected and medical student selection processes re-considered.

Adult↗
PubMed2001

A generalised deficit can account for problems in facial emotion recognition in schizophrenia.

Neuroimaging research has shown localised brain activation to different facial expressions. This, along with the finding that schizophrenia patients perform poorly in their recognition of negative emotions, has raised the suggestion that patients display an emotion specific impairment. We propose that this asymmetry in performance reflects task difficulty gradations, rather than aberrant processing in neural pathways subserving recognition of specific emotions. A neural network model is presented, which classifies facial expressions on the basis of measurements derived from human faces. After training, the network showed an accuracy pattern closely resembling that of healthy subjects. Lesioning of the network led to an overall decrease in the network's discriminant capacity, with the greatest accuracy decrease to fear, disgust and anger stimuli. This implies that the differential pattern of impairment in schizophrenia patients can be explained without having to postulate impairment of specific processing modules for negative emotion recognition.

Anger↗
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

Use of quantitative rating scales to assess outcome in schizophrenia prevention studies.

OBJECTIVE: To present a summary of quantitative scales relevant to schizophrenia prevention studies. METHOD: Fifteen scales were reviewed and summarised in terms of structure, domains assessed, previous use and psychometric properties. Instruments of symptom measurement, role functioning and global functioning were considered, along with multidimensional instruments and other scales of potential interest to research in schizophrenia prevention. RESULTS AND CONCLUSIONS: No scales of potential value in measuring premorbid risk for schizophrenia have been sufficiently tested for reliability and validity in the context of primary prevention of schizophrenia. The absence of a sufficiently sensitive and specific means for identifying those at high risk of schizophrenia before the onset of psychosis is a major barrier to valid measurement of the outcome of attempts at primary prevention. However, there have been advances in the development of instruments relevant to the goals of secondary and tertiary prevention. Most studies use instruments developed for patients with established psychoses and have applied them to early psychosis groups with some success, although possible 'floor' effects may confound measurement in the 'prodromal' period.

Humans↗
PubMed1999

Repetition of deliberate self-poisoning in an Australian hospital-treated population.

OBJECTIVES: To describe the hospital-treated prevalences for repeat deliberate self-poisoning (RDSP) and the demographic characteristics of the RDSP group, and to compare the RDSP and non-RDSP groups. DESIGN: Prospective longitudinal cohort study, with a one- to four-year follow-up. SETTING: The Hunter Area Toxicology Service (HATS), a regional toxicology treatment centre in New South Wales. SUBJECTS: 1238 consecutive DSP patients referred to hospital, 1992-1994, with follow-up through 1995. OUTCOME MEASURES: Deliberate self-poisoning (DSP) admissions within one year (RDSP-1), within six months (RDSP-6m), and within 28 days (RDSP-28d) of any other DSP admission by the same patient; length of stay; demographic characteristics; and drugs ingested. RESULTS: 175 patients (14.1%) repeated DSP during the study; 165 (13.3%) were classified as RDSP-1, giving a patient prevalence of hospitalisation in the range of 14.6 to 20.7 per 100,000 per year. Fifty-six RDSP-28d patients (33.9% of RDSP-1) accounted for 49.8% of the RDSP-1 admissions, and 123 RDSP-6m patients (74.5% of RDSP-1) accounted for 83.5% of RDSP-1 admissions. For RDSP-1, the male:female ratio was 1:1.9, with 35.7% unemployed, 29.1% pensioners and 15.8% married or in de facto relationships. RDSP-1 patients had a shorter length of stay (3 h), which was not clinically important. RDSP was more likely for the 25-34 years age group (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.17-4.29) and the 35-44 years age group (OR, 2.12; 95% CI, 1.02-4.39) than the 10-18 years group, and more likely for women than men (OR, 1.69; 95% CI, 1.17-2.46). Being married/de facto reduced the risk for repetition (OR, 0.55; 95% CI, 0.31-0.96) compared with being single. Medications indicated for psychiatric illness were most commonly used for DSP. CONCLUSIONS: Many patients who repeat DSP do so after a very brief interval and account for a disproportionate number of hospitalisations. Availability of psychiatric medications for DSP patients is a possible area of intervention.

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↗