Australian & New Zealand Journal of Psychiatry

It is important for psychiatrists to recognise that vulnerability to the trace element manganese is different in the adult, foetal and neonatal nervous systems, and that different syndromes may result from exposure.

The literature on psychological aspects of Irritable Bowel Syndrome (IBS) is reviewed. Psychiatric and/or psychometric assessment of IBS samples has consistently revealed a high prevalence of psychological symptoms by comparison with non-psychiatric patient and healthy control groups. Various psychological factors have been implicated in the aetiology of IBS and in the decision to seek medical help, including psychoneurotic personality traits, abnormal illness behaviour and life event stress. Controlled studies of psychological intervention for IBS, while scarce, suggest that supportive psychotherapy and hypnotherapy may be helpful. The long-term efficacy of such treatments remains to be demonstrated.

Thirty-eight panic disorder and 48 generalised anxiety disorder subjects were asked to complete a number of questionnaires aimed at developing a general clinical picture of the two disorders. The results indicated that panic disorder is characterised by a sudden onset around the mid- to late-20s age group and is distinguished by symptoms which are chiefly hyperventilatory in nature and are accompanied by thoughts of serious physical or mental illness. Generalised anxiety disorder is characterised by a gradual onset of symptoms. Somatic symptoms associated with this disorder are generally accompanied by a realisation that the symptoms are the result of anxiety and are harmless. The two groups did not appear to differ greatly on a number of other scales except that the generalised anxiety disorder subjects scored higher on measures of manifest anxiety and social phobia.

The prevalence of schizophrenia in a large hostel for homeless men in an inner city area was found to be in the order of 15%. Concern is expressed that this figure represents a recent increase in the number of mentally ill among homeless men and may be related to changes in the management of chronic mental illness. Literature relating mental illness and homelessness is reviewed.

The Quality Assurance Project is developing explicit and detailed treatment outlines for each of the major psychiatric disorders. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists, and the views of a panel of nominated experts. The recommendations for the treatment of obsessive-compulsive disorder were as follows: for those patients who have no significant personality disorder, either short-term dynamic psychotherapy or cognitive behaviour therapy is indicated if the illness has lasted less than a year or if obsessions are the predominant symptoms. When compulsions predominate, particularly when they have been present for more than a year, response prevention is the treatment of choice. Tricyclic antidepressants and cingulo-tractomy are also worthy of consideration in patients with persisting symptoms. Psychotherapy or cognitive behaviour therapy are the approaches recommended for compulsive personality disorder.

Somatisation disorder (Briquet's syndrome) is a recent addition to psychiatric nosology. It represents an attempt to describe a syndrome of ‘hysteria’, the term initially applied to this polysymptomatic disorder by Guze and his colleagues. The manner of identification of this syndrome, however, has been the subject of criticism. This brief review suggests that the ideas of Janet, who worked at Salpetriere 30 to 40 years after Briquet, may provide a more precise approach to diagnosis. Furthermore, his hypotheses about predisposition to this disorder are seen to offer a preliminary way towards its understanding. Recent experimental evidence lends some support to Janet's hypotheses.

This paper deals with the problem of multiple inference in psychiatric research, an issue which arises whenever a researcher has to make more than one statistical inference in a single research study. It frequently arises in psychiatric research because of multivariate study designs, with subjects being measured on more than one dependent variable with the intention of studying differences between groups in mean scores. The disadvantages of the commonly adopted strategy of using multiple univariate tests (e.g. multiple t-tests) are outlined. Two broad strategies — Bonferroni-adjusted univariate tests and multivariate statistical analysis — are introduced. Their advantages and disadvantages are discussed in terms of their usefulness in confirmatory and exploratory research in psychiatry.

As Australia, shaped by new policies of immigration and multiculturalism, grows more cosmopolitan, the challenge for psychiatry is to gain greater familiarity with the new ethnic minority groups, including their cultural personalities and backgrounds. The problem faced by the Burmese group in Australia is distinctive and poignant. Some 20,000 Burmese immigrated following World War II, chiefly to Western Australia in the first place, uniting and consolidating their families. Following the military coup and the Revolutionary Council Government of the early 60s, further emigration from Burma was cut off. This meant that the Burmese in Australia, already under stress arising from cultural differences, were prevented from developing the extensive internal social support systems that characterise other major ethnic groups. The author, a Burmese doctor working in a psychiatric setting in Sydney, draws attention to aspects of his country and its people which should be helpful for psychiatric and related professions.

Successful psychiatric treatment for rural Africans should incorporate their traditional belief that illness should be viewed in terms of magical, social, physical and religious parameters. Traditional healers divide illness into those of natural causation and those of traditional cultural aetiology which are peculiar to African people. Natural illness includes epilepsy, familial/genetic disorders, mental retardation and schizophrenia. Traditional, cultural disorders often cause difficulties for Western-trained psychiatrists because sorcery, spirit possession and ancestral worship are central to their aetiology and treatment as practised by traditional healers. They, in a state of altered consciousness, use a process of divination to determine why and from whom the misfortune originated. With this in mind, reputable traditional healers were consulted in therapy-resistant cases of culture-bound syndromes in Africans. Their high rate of success in treating these cases was notable. More recognition should be given to the reputable traditional healers.

Coroners' statistics indicated there were 684 suicides for the whole of Hong Kong in 1981. This gave a crude suicide rate of 18.1 per 100,000 population aged 15 years and over and constituted 2.7% of all deaths reported in that year. Only a few data were recorded in all coroners' files but additional data were obtained from police records on 168 of these suicides. The age and sex distribution among the suicides as well as the effect of marital and employment status on suicide rates were found to be similar to western countries. Jumping from a height was the most common method of suicide (47.2%) followed by hanging (30.8%). Psychiatric illness and chronic physical disability were two most important precipitating causes of suicide (39.8% and 35.7% respectively). Twenty per cent had a history of previous attempts with one-third occurring within six months of their completed suicide. Over 40% had communicated their suicide intention to others, while 19% left a note. ‘Psychiatric’ cases as a group had special features: there were more in the younger age groups, more with records of previous suicide attempts and more chose readily available methods.

Residents of three large rural cities were surveyed to investigate the influence of ‘psychiatric exposure’ and demographic variables on community attitudes toward mental illness. Samples drawn from the three communities, which differed according to the availability of mental health services, were administered the Opinions About Mental Illness Scale, with questionnaire items that elicited measures of the amount of contact with mental illness and standard demographic data. Multiple regression analyses showed that demographic but not ‘exposure’ variables had a significant influence on community attitudes. Contrary to previous findings, the older, less-educated members of the public were more positive in their opinions on mental health issues. Other variables to have an influence on attitudes were ethnic origin and occupational status.

A survey of 312 patients attending 13 Sydney general practices suggested that preparedness to accept psychiatric referral by a general practitioner related most clearly to preparedness to consult the general practitioner in the first instance and the perceived likelihood of the general practitioner suggesting a psychological problem, while the sociodemographic characteristics of the patient did not appear of relevance. Data on actual psychiatric referrals by the contributing general practitioners suggested a higher psychiatric referral by practices in lower social class regions of Sydney and a differential referral pattern, with referral to a community psychiatric facility being rare in other than low social class general practices.