Mental health

With the release of the fifth edition of the Diagnostic and statistical manual of mental disorders, it is timely to consider whether a refinement to traditional diagnostic practice — clinical staging — will improve clinical care and inform future research into the causes of mental disorders.

Ian B Hickie MB BS, MD, FRANZCP · Jan Scott MB BS, MD, FRCPsych · Patrick D McGorry MD, PhD, FRANZCP

New guidelines from the National Health and Medical Research Council outline best-practice management for people with borderline personality disorder. With the use of effective evidence-based treatments, the prognosis for this disorder has improved for most patients.

Brin F S Grenyer BA(Hons), MSc, PhD

Media reporting about suicide may lead to increased suicidal behaviour in at-risk people, or it may operate positively and reduce the risk of suicide. But media representations of suicide are distinct from community discussions. It is time to have a much richer, more honest and more open public discussion about suicide.

Scott J Fitzpatrick BA(Hons) · Ian H Kerridge BA, MPhil, BMed

What are the potential health benefits and risks of population social–emotional screening of children as young as 3 years of age, and are there other options for ensuring kids’ social and emotional development?

Michael F Daubney MB BS, FRANZCP · Cate M Cameron PhD, MPH, BSocWork(Hons) · Paul A Scuffham PhD, BA

To the Editor: For several years, the Australian Bureau of Statistics (ABS) has cautioned data users of likely underreporting of suicide statistics due to delays in coronial processes and (since 2006) exclusive reliance on the National Coronial Information System, which often contains incomplete information on cause of death.1 In 2009, the ABS introduced data revision processes that allowed additional information received to be added in ...

Jerneja Sveticic · Samara McPhedran · Diego De Leo

A fan of our “Stamps of greatness” series takes the connection between philately and medicine a step further, with an account of a chance moment in history.

Robert M Parker

The 2003 National Heart Foundation of Australia position statement on “stress” and coronary heart disease found depression to be an important risk factor. This consensus statement updates the evidence on depression in patients with coronary heart disease, and provides guidance for health professionals on screening and treatment.

David M Colquhoun MB BS, FRACP, FCSANZ · Stephen J Bunker RN, PhD · David M Clarke PhD, FRACGP, FRANZCP · Nick Glozier MB BS, FRANZCP, PhD · David L Hare DPM, FRACP, FCSANZ · Ian B Hickie MD, FRANZCP, FASSA · James Tatoulis MB BS, MD, FRACS · David R Thompson MA, PhD, FRCN · Geoffrey H Tofler MB BS, MD, FRACP · Alison Wilson MBA · Maree G Branagan MPH

A data-linkage study reveals that, between 1990 and 2005, the prevalence of parents with mental health disorders increased in Western Australia. While factors such as broader service availability may have contributed to this finding, the data highlight high-risk groups that should be a focus for intervention and prevention.

Melissa O’Donnell PhD, MPysch, GradDipEd · Denise Anderson BSc · Vera A Morgan PhD, MSocSc, BA · Natasha Nassar PhD, MPH, BEc · Helen M Leonard MB ChB, MPH · Fiona J Stanley MD, MSc, FAFPHM

Someone once told me that during his life, Winston Churchill would often refer to his depression as a “black dog” — a vile, loathsome creature that would shadow every decision and thought in his mind. But to me, it was not just a dog, but something more sinister and predatory. The beast followed me in the same way that a lapdog would follow its master, though ...

Anonymous

To the Editor: We would like to add a cautionary note to O’Neil’s support for the inclusion of “depression and other psychosocial factors” in the updated National Vascular Disease Prevention Alliance guidelines for assessing cardiovascular disease (CVD) risk. Her statement “it is now clear that depression is also an important risk factor for CVD” is premature.1 Different authors have challenged the suggested relationship and, given ...

Hans G Stampfer · Dana A Hince · Simon B Dimmitt

In reply: I thank Stampfer, Hince and Dimmitt for their response. While I acknowledge that there are aspects of the relationship between cardiovascular disease (CVD) and depression that remain undetermined, recent evidence clearly supports the role of depression as an independent risk factor for CVD and is indeed convincing.1-3 This is especially true in studies that assess depression using diagnostic criteria.4 We know that the ...

Adrienne E O’Neil

Eight years after the first Bali bombing, a cross-sectional study of Australians who were directly affected by the attacks found that they tended to have good physical health but high rates of psychological distress.

Garry J Stevens BSc(Hons), MClinPsych, MAPS · Julie C Dunsmore BSc(Psych)(Hons), MPH, MAPS · Kingsley E Agho BSc(Hons), PhD, MPH · Melanie R Taylor BSc(Hons), PhD, CPsychol · Alison L Jones MD, FRCP, FRCPE · Jason J van Ritten BSc(Hons), GradCertSRM · Beverley Raphael MB BS, MD, FRANZCP

To the Editor: The most common cause of difficult-to-treat depression may be a failure to diagnose bipolar II depression.

Andrew R Robertson · Greg M de Moore · Philip M Boyce

In Reply: Treatment recommendations for bipolar II depression differ minimally from those for bipolar I.

Michael Berk · Seetal Dodd · Lesley Berk

Clifford Bruce Osborne, known as Bruce, had an extensive and diverse medical career that included the rare achievement of Fellowships in three disciplines — general practice (1980), medical administration (1987) and psychiatry (2001). Throughout, Bruce remained committed to compassionate patient care and improved regional health services. Bruce was born on 23 February 1951 and grew up in Dandenong, Victoria. In 1975, he graduated in medicine from Monash University, ...

Hugh M Lowy

To the Editor: Harrison and colleagues present data which confirm that inequitable distribution of mental health care is increasing under the Better Access program.1 They discount our promotion of the central role of general practitioners in the more restricted Better Outcomes program2 and our advocacy for GPs to resume those key activities despite lack of support under the Better Access program.3 The fatal decision that accompanied ...

Sebastian P Rosenberg · Ian B Hickie

In reply: We share Rosenberg and Hickie’s belief that general practitioners should play a central role in mental health care. We showed with Bettering the Evaluation and Care of Health (BEACH) data that GPs have played this role in both Better Outcomes and Better Access.1 Rosenberg and Hickie rely on administrative data to make inferences about clinical practice. They assume that GPs not claiming review items ...

Christopher M Harrison · Graeme C Miller · Helena C Britt

To the Editor: Beatson and Rao’s article1 appeared in the MJA Open supplement subtitled “A guide to management in primary care”. Despite acknowledging that it “can be difficult to distinguish between [borderline personality disorder] and [major depressive disorder]”, the authors offer no specific guidance for general practitioners on how to do this. Beatson and Rao cite no primary care research, although admittedly there is a dearth ...

Darryl L Lacey

In reply: Lacey suggests that the Dimensional Assessment of Personality Pathology – Basic Questionnaire (DAPP-BQ)1 can be a useful tool for the assessment of personality problems by academic general practitioners. We agree. Significant elevations on the DAPP-BQ’s affective lability, identity problems, insecure attachment, and self-harm scores would alert the practitioner to the probable — if not certain — presence of borderline personality disorder (BPD). However, the ...

Josephine A Beatson · Sathya Rao