Garry Walter - Academia.edu (original) (raw)
Papers by Garry Walter
Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, Jan 28, 2015
We aim to outline the notion of predicament suicide and progress in the field. The term predicame... more We aim to outline the notion of predicament suicide and progress in the field. The term predicament suicide was initially applied when the individual without mental disorder completed suicide to escape intolerable circumstances. Subsequently, painful untreated or unresponsive mental disorder was conceptualized as an internal predicament and the term was applied to all suicide. It continues to be used in both the restricted and broad forms. Our group has substantiated the restricted form by describing suicide in the setting of financial loss, forced marriage and other predicaments. The broad form gave rise to the Operationalized Predicaments of Suicide tool for use in quantitative research. Some literature from other workers supports the general thrust of the notion.
Minerva pediatrica
Over the past decade, there has been greater acceptance of the existence of bipolar disorder (BD)... more Over the past decade, there has been greater acceptance of the existence of bipolar disorder (BD) in adolescents. The onset of BD during this period severely affects the acquisition of key developmental skills. Debate around diagnosis, comorbidity and treatment is strong and little is known about the long-term impact BD has on an adolescents as they approach adulthood, from both illness and functional perspectives. A review of psychological and medical databases using the search terms ''adolescent onset'', ''pediatric onset'', ''juvenile onset'', ''bipolar disorder'', ''course'' and ''outcome'' was conducted. Emphasis was placed on the information available from studies, which have described the outcome of adolescent onset BD either prospectively, retrospectively, or both. Twelve studies were identified that focused on the long-term course of adolescent onset BD. Findings on the course an...
Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent
In the ongoing quest for improved diagnostic markers of bipolar illness, the focus of research ha... more In the ongoing quest for improved diagnostic markers of bipolar illness, the focus of research has gradually shifted to examining the onset of mood difficulties early in life and investigating the potential corollaries of such early onset such as cognitive impairment, disruption of social and emotional functioning, and constriction of quality of life. This article considers the disruptions to cognitive functioning that accompany bipolar disorder and compares adult and child profiles to ascertain the likelihood of identifying a neurocognitive biomarker of the illness. A succinct review of the literature pertaining to cognition in both adult and childhood populations is synthesised following Medline and PsychINFO searches using key-terms including 'cognition', 'bipolar disorder', 'neurocognitive' 'child', 'adolescent' and a range of neuropsychological domain names. In addition, literature known to the authors was scrutinised and relevant referen...
The Malaysian journal of medical sciences : MJMS, 2012
Current clinical wisdom is that the vast majority of those who complete suicide suffer from a men... more Current clinical wisdom is that the vast majority of those who complete suicide suffer from a mental disorder. Uncritical adherence to this belief may limit our understanding and restrict the full range of prevention activities. We aimed to examine the public record for accounts of suicide by men who had been, or were about to be, investigated or apprehended for "sex only" child sex offences, with a view to presenting a collection of case histories, and identifying examples of suicide in the apparent absence of mental disorder other than pedophilia. The public record (hard and electronic copy) was examined. Twenty case histories were identified of men with no apparent mental disorder (other than pedophilia) who completed suicide shortly after exposure or threatened public exposure and/or early or potential legal punishment. This evidence strongly suggests that exposure or threatened public exposure of pedophilia and/or early or potential legal punishment creates a predicam...
Journal of quality in clinical practice, 2000
There is limited information on the views of mental health staff about computers. The present stu... more There is limited information on the views of mental health staff about computers. The present study aimed to ascertain the patterns of use, attitudes and expectations of staff from a comprehensive mental health service regarding computers before and after the purchase of new equipment and training. A questionnaire was sent to staff of the Central Sydney Mental Health Services working in sites targeted for new computer equipment and training. Most respondents, especially those with computer experience or who had worked in mental health for less than 5 years, viewed computers favourably. At the same time, half the respondents did not feel they had sufficient access to a computer at work and the vast majority had not received training as intended. Commitments to provide computer equipment and training must be followed through, otherwise staff may feel disenchanted and computers may be regarded less favourably. A measure of the positive views about computer use ('positivity index...
Clinical case reports, 2015
The Medical journal of Australia, Jan 19, 2009
To investigate the frequency of, and factors associated with, Australian doctors' involvement... more To investigate the frequency of, and factors associated with, Australian doctors' involvement in medicolegal matters. Cross-sectional survey of Australian doctors (specialists, trainees and general practitioners) insured with the medical insurance company Avant. A self-report questionnaire was mailed to Avant members in September 2007 to gather data on their involvement in medicolegal matters. Information on psychiatric morbidity and alcohol consumption was also collected using the General Health Questionnaire and the Alcohol Use Disorders Identification Test. Occurrence and type of past and current medicolegal matters with which doctors have been involved. Of 8500 doctors invited to participate, 2999 returned completed surveys (36% response rate). Sixty-five per cent of respondents had been involved in a medicolegal matter at some time, and 14% were involved in a current matter. The two most common types of medicolegal matter were claims for compensation and complaints to a hea...
The Medical journal of Australia, Jan 2, 2010
To identify factors associated with psychiatric morbidity and hazardous alcohol use in Australian... more To identify factors associated with psychiatric morbidity and hazardous alcohol use in Australian doctors. Cross-sectional postal survey of 2999 doctors (including all major specialty groups, trainees and general practitioners) insured with an Australian medical insurance company. The potential for psychiatric morbidity was measured by the General Health Questionnaire (GHQ), and the potential for hazardous alcohol use by the Alcohol Use Disorders Identification Test (AUDIT). The survey was conducted in 2007. Demographic, work-related and personality factors associated with a GHQ score > 4 and an AUDIT score > or = 8. Factors significantly associated with psychiatric morbidity in doctors were: having a current medicolegal matter, not taking a holiday in the previous year, working long hours, type of specialty, and having personality traits of neuroticism and introversion. Factors significantly associated with potentially hazardous alcohol use were being male, being Australian-t...
The Journal of Neuropsychiatry and Clinical Neurosciences, 2014
In recently depressed adolescents, attention and emotional reactivity improved significantly comp... more In recently depressed adolescents, attention and emotional reactivity improved significantly compared with baseline. Working memory did not improve. This supports the position that, in adolescent depression, attention is state dependent compared with other executive functions that are trait dependent.
Journal of Eating Disorders, 2013
The prevalence of eating disorders in the non-Western world appears to be increasing and much res... more The prevalence of eating disorders in the non-Western world appears to be increasing and much research into the cross-cultural aspects of eating disorders is needed. This bibliometric study analyses the profile of cross-cultural studies into eating disorders published from 1970 through to 2011. 1,417 articles were indexed by Medline and PsychInfo from 1970 to 2011. There has been an exponential increase in publications in this field. Four articles were published in 1970-74 and this increased to 427 in 2004-9. Comparative and empirical studies were the most common types of publications. Of all the ethnic groups studied, Africans and African Americans were subject of the most publications. Pacific Islanders and South Europeans had the fewest publications. It is heartening that there has been a large increase in published studies about eating disorders across cultures. This suggests greater awareness and interest in the field. However, the results from one particular ethnic group cannot always be applied directly to another. Some ethnic and cultural groups have been poorly studied and warrant more research attention. As more patients from such backgrounds present for treatment, more research is needed to provide culturally appropriate and acceptable care.
Clinical Case Reports, 2014
Issues in Mental Health Nursing, 2014
Substance Abuse, 2014
To the best of our knowledge, there is no validated instrument for measuring knowledge of psychia... more To the best of our knowledge, there is no validated instrument for measuring knowledge of psychiatric aspects of alcohol use disorder (AUD) amongst medical students. Our aim was to develop an instrument for this purpose and to describe the instrument's psychometric properties. We also investigated whether the instrument could demonstrate a significant change in scores following an educational intervention consisting of a 60-minute PowerPoint lecture on AUD, associated handouts, and role-plays. The Knowledge of Psychiatric Aspects of Alcohol Questionnaire (KPAAQ) was developed from the Kaplan and Saddock textbook synopsis chapter on alcohol related disorders. The questionnaire included 6 categories of clinically relevant material: metabolism of alcohol, short-term effects of alcohol, long-term effects of alcohol, AUD, alcohol withdrawal, and alcohol use in pregnancy. The KPAAQ was administered to 75 medical students in Years 4 and 5 from the Hebrew University in Jerusalem, Israel, during a relevant clinical rotation. Following the initial administration of the KPAAQ, the students attended a 60-minute lecture (in Hebrew) based on material from the University of Sydney's learning module on alcohol. The KPAAQ was readministered to the students immediately following the lecture. The KPAAQ demonstrated good reliability (Cronbach α =.92 for all questions) and validity r(209) =.674, P <.001. Knowledge of alcohol and alcoholism significantly increased after the educational intervention (F(2, 154) = 151.60, P <.001). Post hoc comparisons using the Scheffe test revealed a significant positive change in knowledge after students received the intervention (mean difference = 33, P <.001). These initial findings suggest that the KPAAQ is a reliable and valid instrument for assessing medical student knowledge of psychiatric aspects of AUD over 6 clinical categories.
Postgraduate Medical Journal, 2013
To descriptively assess medical students&... more To descriptively assess medical students' concerns for their mental and emotional state, perceived need to conceal mental problems, perceived level of support at university, knowledge and use of student support services, and experience of stresses of daily life. From March to September 2011, medical students at an Australian university were invited to complete an anonymous online survey. 475 responses were received. Students rated study and examinations (48.9%), financial concerns (38.1%), isolation (19.4%) and relationship concerns (19.2%) as very or extremely stressful issues. Knowledge of available support services was high, with 90.8% indicating they were aware of the university's medical centre. Treatment rates were modest (31.7%). Students' concerns about their mental state were generally low, but one in five strongly felt they needed to conceal their emotional problems. Despite widespread awareness of appropriate support services, a large proportion of students felt they needed to conceal mental and emotional problems. Overall treatment rates for students who were greatly concerned about their mental and emotional state appeared modest, and, although comparable with those of similarly aged community populations, may reflect undertreatment. It would be appropriate for universities to address stressors identified by students. Strategies for encouraging distressed students to obtain appropriate assessment and treatment should also be explored. Those students who do seek healthcare are most likely to see a primary care physician, suggesting an important screening role for these health professionals.
The Medical Journal of Australia, 2013
MB BS, MD, FRANZCP, Professor of Psychiatry 1
Journal of the American Academy of Child & Adolescent Psychiatry, 2000
To examine the extent to which clinicians from different cultures agree when rating the quality o... more To examine the extent to which clinicians from different cultures agree when rating the quality of a child's family environment and the effect of country, language, and training factors on these ratings. Eighty-seven health professionals from Malaysia, Spain, Australia, Indonesia, the United States, Denmark, and Singapore rated 7 case vignettes using the Global Family Environment Scale. Half (54%) were psychiatrists. One quarter (26%) performed the ratings after attending a training session, the rest (n = 64, 74%) after reading a training manual. Overall, interrater agreement (intraclass r) was 0.84 (95% confidence interval: 0.68-0.96). There were no significant differences in agreement according to country, language, training, or professional group, although there were country differences in the ratings given to 2 vignettes. The majority of raters found the description of the anchor points (86%), training manual (95%), and case vignettes (97%) clear. Clinicians from different cultures seem to be able to make global ratings of the quality of the family environment that are reliable and consistent when using case vignettes. This can be achieved with little training. Global ratings of the quality of the family environment may be a useful tool in mental health research and clinical work.
Journal of Neuropsychiatry, 2013
A group of 20 drug-naïve depressed adolescents and 20 matched controls underwent cognitive evalua... more A group of 20 drug-naïve depressed adolescents and 20 matched controls underwent cognitive evaluations and assessment of emotional reactivity. Emotional reactivity correlated only with attention and only in depressed patients. The cognitive-emotional construct may enhance the understanding of adolescent depression and aid diagnosis.
Journal of Child and Adolescent Psychiatric Nursing, 2011
E-mail interviewing-not to be confused with &... more E-mail interviewing-not to be confused with "online surveying"-shows promise for researchers working with adolescent mental health populations as a data collection method. To explore potential advantages, constraints, and applications of e-mail interviewing as a research method for staff working with adolescent mental health populations. At face value, there appear to be several advantages to e-mail interviewing with young populations and further exploration of this method is warranted.
Issues in Mental Health Nursing, 2014
Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, Jan 28, 2015
We aim to outline the notion of predicament suicide and progress in the field. The term predicame... more We aim to outline the notion of predicament suicide and progress in the field. The term predicament suicide was initially applied when the individual without mental disorder completed suicide to escape intolerable circumstances. Subsequently, painful untreated or unresponsive mental disorder was conceptualized as an internal predicament and the term was applied to all suicide. It continues to be used in both the restricted and broad forms. Our group has substantiated the restricted form by describing suicide in the setting of financial loss, forced marriage and other predicaments. The broad form gave rise to the Operationalized Predicaments of Suicide tool for use in quantitative research. Some literature from other workers supports the general thrust of the notion.
Minerva pediatrica
Over the past decade, there has been greater acceptance of the existence of bipolar disorder (BD)... more Over the past decade, there has been greater acceptance of the existence of bipolar disorder (BD) in adolescents. The onset of BD during this period severely affects the acquisition of key developmental skills. Debate around diagnosis, comorbidity and treatment is strong and little is known about the long-term impact BD has on an adolescents as they approach adulthood, from both illness and functional perspectives. A review of psychological and medical databases using the search terms ''adolescent onset'', ''pediatric onset'', ''juvenile onset'', ''bipolar disorder'', ''course'' and ''outcome'' was conducted. Emphasis was placed on the information available from studies, which have described the outcome of adolescent onset BD either prospectively, retrospectively, or both. Twelve studies were identified that focused on the long-term course of adolescent onset BD. Findings on the course an...
Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent
In the ongoing quest for improved diagnostic markers of bipolar illness, the focus of research ha... more In the ongoing quest for improved diagnostic markers of bipolar illness, the focus of research has gradually shifted to examining the onset of mood difficulties early in life and investigating the potential corollaries of such early onset such as cognitive impairment, disruption of social and emotional functioning, and constriction of quality of life. This article considers the disruptions to cognitive functioning that accompany bipolar disorder and compares adult and child profiles to ascertain the likelihood of identifying a neurocognitive biomarker of the illness. A succinct review of the literature pertaining to cognition in both adult and childhood populations is synthesised following Medline and PsychINFO searches using key-terms including 'cognition', 'bipolar disorder', 'neurocognitive' 'child', 'adolescent' and a range of neuropsychological domain names. In addition, literature known to the authors was scrutinised and relevant referen...
The Malaysian journal of medical sciences : MJMS, 2012
Current clinical wisdom is that the vast majority of those who complete suicide suffer from a men... more Current clinical wisdom is that the vast majority of those who complete suicide suffer from a mental disorder. Uncritical adherence to this belief may limit our understanding and restrict the full range of prevention activities. We aimed to examine the public record for accounts of suicide by men who had been, or were about to be, investigated or apprehended for "sex only" child sex offences, with a view to presenting a collection of case histories, and identifying examples of suicide in the apparent absence of mental disorder other than pedophilia. The public record (hard and electronic copy) was examined. Twenty case histories were identified of men with no apparent mental disorder (other than pedophilia) who completed suicide shortly after exposure or threatened public exposure and/or early or potential legal punishment. This evidence strongly suggests that exposure or threatened public exposure of pedophilia and/or early or potential legal punishment creates a predicam...
Journal of quality in clinical practice, 2000
There is limited information on the views of mental health staff about computers. The present stu... more There is limited information on the views of mental health staff about computers. The present study aimed to ascertain the patterns of use, attitudes and expectations of staff from a comprehensive mental health service regarding computers before and after the purchase of new equipment and training. A questionnaire was sent to staff of the Central Sydney Mental Health Services working in sites targeted for new computer equipment and training. Most respondents, especially those with computer experience or who had worked in mental health for less than 5 years, viewed computers favourably. At the same time, half the respondents did not feel they had sufficient access to a computer at work and the vast majority had not received training as intended. Commitments to provide computer equipment and training must be followed through, otherwise staff may feel disenchanted and computers may be regarded less favourably. A measure of the positive views about computer use ('positivity index...
Clinical case reports, 2015
The Medical journal of Australia, Jan 19, 2009
To investigate the frequency of, and factors associated with, Australian doctors' involvement... more To investigate the frequency of, and factors associated with, Australian doctors' involvement in medicolegal matters. Cross-sectional survey of Australian doctors (specialists, trainees and general practitioners) insured with the medical insurance company Avant. A self-report questionnaire was mailed to Avant members in September 2007 to gather data on their involvement in medicolegal matters. Information on psychiatric morbidity and alcohol consumption was also collected using the General Health Questionnaire and the Alcohol Use Disorders Identification Test. Occurrence and type of past and current medicolegal matters with which doctors have been involved. Of 8500 doctors invited to participate, 2999 returned completed surveys (36% response rate). Sixty-five per cent of respondents had been involved in a medicolegal matter at some time, and 14% were involved in a current matter. The two most common types of medicolegal matter were claims for compensation and complaints to a hea...
The Medical journal of Australia, Jan 2, 2010
To identify factors associated with psychiatric morbidity and hazardous alcohol use in Australian... more To identify factors associated with psychiatric morbidity and hazardous alcohol use in Australian doctors. Cross-sectional postal survey of 2999 doctors (including all major specialty groups, trainees and general practitioners) insured with an Australian medical insurance company. The potential for psychiatric morbidity was measured by the General Health Questionnaire (GHQ), and the potential for hazardous alcohol use by the Alcohol Use Disorders Identification Test (AUDIT). The survey was conducted in 2007. Demographic, work-related and personality factors associated with a GHQ score > 4 and an AUDIT score > or = 8. Factors significantly associated with psychiatric morbidity in doctors were: having a current medicolegal matter, not taking a holiday in the previous year, working long hours, type of specialty, and having personality traits of neuroticism and introversion. Factors significantly associated with potentially hazardous alcohol use were being male, being Australian-t...
The Journal of Neuropsychiatry and Clinical Neurosciences, 2014
In recently depressed adolescents, attention and emotional reactivity improved significantly comp... more In recently depressed adolescents, attention and emotional reactivity improved significantly compared with baseline. Working memory did not improve. This supports the position that, in adolescent depression, attention is state dependent compared with other executive functions that are trait dependent.
Journal of Eating Disorders, 2013
The prevalence of eating disorders in the non-Western world appears to be increasing and much res... more The prevalence of eating disorders in the non-Western world appears to be increasing and much research into the cross-cultural aspects of eating disorders is needed. This bibliometric study analyses the profile of cross-cultural studies into eating disorders published from 1970 through to 2011. 1,417 articles were indexed by Medline and PsychInfo from 1970 to 2011. There has been an exponential increase in publications in this field. Four articles were published in 1970-74 and this increased to 427 in 2004-9. Comparative and empirical studies were the most common types of publications. Of all the ethnic groups studied, Africans and African Americans were subject of the most publications. Pacific Islanders and South Europeans had the fewest publications. It is heartening that there has been a large increase in published studies about eating disorders across cultures. This suggests greater awareness and interest in the field. However, the results from one particular ethnic group cannot always be applied directly to another. Some ethnic and cultural groups have been poorly studied and warrant more research attention. As more patients from such backgrounds present for treatment, more research is needed to provide culturally appropriate and acceptable care.
Clinical Case Reports, 2014
Issues in Mental Health Nursing, 2014
Substance Abuse, 2014
To the best of our knowledge, there is no validated instrument for measuring knowledge of psychia... more To the best of our knowledge, there is no validated instrument for measuring knowledge of psychiatric aspects of alcohol use disorder (AUD) amongst medical students. Our aim was to develop an instrument for this purpose and to describe the instrument's psychometric properties. We also investigated whether the instrument could demonstrate a significant change in scores following an educational intervention consisting of a 60-minute PowerPoint lecture on AUD, associated handouts, and role-plays. The Knowledge of Psychiatric Aspects of Alcohol Questionnaire (KPAAQ) was developed from the Kaplan and Saddock textbook synopsis chapter on alcohol related disorders. The questionnaire included 6 categories of clinically relevant material: metabolism of alcohol, short-term effects of alcohol, long-term effects of alcohol, AUD, alcohol withdrawal, and alcohol use in pregnancy. The KPAAQ was administered to 75 medical students in Years 4 and 5 from the Hebrew University in Jerusalem, Israel, during a relevant clinical rotation. Following the initial administration of the KPAAQ, the students attended a 60-minute lecture (in Hebrew) based on material from the University of Sydney's learning module on alcohol. The KPAAQ was readministered to the students immediately following the lecture. The KPAAQ demonstrated good reliability (Cronbach α =.92 for all questions) and validity r(209) =.674, P <.001. Knowledge of alcohol and alcoholism significantly increased after the educational intervention (F(2, 154) = 151.60, P <.001). Post hoc comparisons using the Scheffe test revealed a significant positive change in knowledge after students received the intervention (mean difference = 33, P <.001). These initial findings suggest that the KPAAQ is a reliable and valid instrument for assessing medical student knowledge of psychiatric aspects of AUD over 6 clinical categories.
Postgraduate Medical Journal, 2013
To descriptively assess medical students&... more To descriptively assess medical students' concerns for their mental and emotional state, perceived need to conceal mental problems, perceived level of support at university, knowledge and use of student support services, and experience of stresses of daily life. From March to September 2011, medical students at an Australian university were invited to complete an anonymous online survey. 475 responses were received. Students rated study and examinations (48.9%), financial concerns (38.1%), isolation (19.4%) and relationship concerns (19.2%) as very or extremely stressful issues. Knowledge of available support services was high, with 90.8% indicating they were aware of the university's medical centre. Treatment rates were modest (31.7%). Students' concerns about their mental state were generally low, but one in five strongly felt they needed to conceal their emotional problems. Despite widespread awareness of appropriate support services, a large proportion of students felt they needed to conceal mental and emotional problems. Overall treatment rates for students who were greatly concerned about their mental and emotional state appeared modest, and, although comparable with those of similarly aged community populations, may reflect undertreatment. It would be appropriate for universities to address stressors identified by students. Strategies for encouraging distressed students to obtain appropriate assessment and treatment should also be explored. Those students who do seek healthcare are most likely to see a primary care physician, suggesting an important screening role for these health professionals.
The Medical Journal of Australia, 2013
MB BS, MD, FRANZCP, Professor of Psychiatry 1
Journal of the American Academy of Child & Adolescent Psychiatry, 2000
To examine the extent to which clinicians from different cultures agree when rating the quality o... more To examine the extent to which clinicians from different cultures agree when rating the quality of a child's family environment and the effect of country, language, and training factors on these ratings. Eighty-seven health professionals from Malaysia, Spain, Australia, Indonesia, the United States, Denmark, and Singapore rated 7 case vignettes using the Global Family Environment Scale. Half (54%) were psychiatrists. One quarter (26%) performed the ratings after attending a training session, the rest (n = 64, 74%) after reading a training manual. Overall, interrater agreement (intraclass r) was 0.84 (95% confidence interval: 0.68-0.96). There were no significant differences in agreement according to country, language, training, or professional group, although there were country differences in the ratings given to 2 vignettes. The majority of raters found the description of the anchor points (86%), training manual (95%), and case vignettes (97%) clear. Clinicians from different cultures seem to be able to make global ratings of the quality of the family environment that are reliable and consistent when using case vignettes. This can be achieved with little training. Global ratings of the quality of the family environment may be a useful tool in mental health research and clinical work.
Journal of Neuropsychiatry, 2013
A group of 20 drug-naïve depressed adolescents and 20 matched controls underwent cognitive evalua... more A group of 20 drug-naïve depressed adolescents and 20 matched controls underwent cognitive evaluations and assessment of emotional reactivity. Emotional reactivity correlated only with attention and only in depressed patients. The cognitive-emotional construct may enhance the understanding of adolescent depression and aid diagnosis.
Journal of Child and Adolescent Psychiatric Nursing, 2011
E-mail interviewing-not to be confused with &... more E-mail interviewing-not to be confused with "online surveying"-shows promise for researchers working with adolescent mental health populations as a data collection method. To explore potential advantages, constraints, and applications of e-mail interviewing as a research method for staff working with adolescent mental health populations. At face value, there appear to be several advantages to e-mail interviewing with young populations and further exploration of this method is warranted.
Issues in Mental Health Nursing, 2014