Objective: Psychiatry has ignored history, anthropology, sociology and literature in the search for enlightenment regarding suicide. Our objective was to determine what, if anything, Aesop's fables had to teach us about suicide in around 600 BCE. Aesop's account is around two centuries older than the oldest text (Herodotus: The histories) previously examined by our group.Method: We examined two translations of Aesop's fables, seeking accounts fitting the following categories: (1) suicidal thinking, (2) suicidal behaviour without fatal consequences, and (3) suicidal behaviour with fatal consequences.Results: One account fitting each of these categories was identified. The triggers were: (i) self-doubt and criticism, (ii) unpleasant predicament (constant fear), and (iii) inescapable physical pain.Conclusion: Evidence indicates that around 600 BCE, suicide was practised as a means of coping with self-doubt and criticism, unpleasant predicaments and inescapable physical pain. Recent scientific evidence confirms these observations.

1 病史 简是一位38岁的患唐氏综合征的单身女性,和81岁的母亲和84岁的父亲生活在一起.她父亲带她来找你看病,因为她最近8个星期以来个人功能明显下降.她父亲告诉你,简变得坐卧不宁,有挑衅性,而且还把自己的头往墙上撞.她父亲还告诉你说,有些事情以前就注意到了但没有跟你说,就是简的父母18个月以前就发现她的一般情况在恶化,思维混乱,记不住事情.

OBJECTIVE:The high prevalence of mental disorders and the barriers to detection and treatment of these in general practice are well recognized. As such, the government has placed great emphasis on training general practitioners (GPs) in primary care mental health and on the provision of support for GPs in the delivery of such services. The current paper aims to evaluate a local, rural training program in mental health for GPs. We hypothesized that local 'context-driven' training would lead to increased knowledge and reported change in practice by GPs with mental health patients.METHOD:Locally developed and delivered 'Level 1' training was offered to GPs through the Better Outcomes in Mental Health Care initiative. The training was provided with 6-hour workshops covering mental health assessment and management planning. The training was evaluated through pre- and 6-week post-questionnaires assessing attitudes and practice with respect to treatment of patients with mental health problems.RESULTS:Forty-nine GPs from the Loddon Campaspe Southern Mallee region of Victoria participated in the training. Following the 6-hour workshop, there was an increase in reported use of psychoeducation for patients with depression, use of cognitive behavioural therapy for patients with anxiety, and ease in obtaining advice to assist with the management of psychosis.CONCLUSIONS:GP mental health education should take into consideration the local context, cover systems issues as well as skills development, and aim to develop personal relationships between mental health clinicians and GPs to enhance outcomes.

Purpose: To explore reasons for the failure of a randomized controlled trial to influence implementation of epilepsy guidelines in primary care, and to generate theory about likely contexts in which guidelines would lead to changes in clinician behavior.Methods: Qualitative study based on focus groups and a single in-depth interview. Participants included 47 primary health care staff selected from a purposive sample of 13 urban and rural general practices.Results: The key reason for the lack of implementation of the Scottish Intercollegiate Guidelines Network epilepsy guideline was an established pattern of general practitioner behavior, supported by practice staff, with which there was little perceived need to change. Secondary to this was a lack of knowledge of the existence and/or content of the guideline and perceived difficulties in implementing them in practice stemming from resource constraints and possible patient resistance. The individual behavior of clinicians was therefore rooted in wider service structures and policies.Conchisions: Guidelines may be more likely to be implemented where there are perceived problems with current service delivery. Attempts to facilitate the implementation of guidelines could also focus on areas where there is already a perceived need for guidance or a disruption in one of the underlying variables that maintain the health professional's role and practice. They may also be more likely where initiatives are focused more widely than individual physician behavior and are more broadly directed toward redesigning the wider care delivery systems by incorporating other providers to provide care coordination, enhancing patient self-management, and using information technology tools.

OBJECTIVE:To examine factors that may contribute to elevated rates of suicide among rural communities in Australia.METHOD:A wide-ranging literature search reviewed possible factors that may contribute to the geographical variation in suicide. Literature was organized to enable examination of compositional and contextual explanations, as well as collective social functioning and social practices.RESULTS:A variety of factors may contribute to elevated rates of suicide in rural compared with urban areas. Collective and contextual (place) factors seem to be of particular importance as possible contributors to the elevated rate of suicide among rural males. These include rural socioeconomic decline; facilitators and barriers to service utilization such as service availability and accessibility, rural culture, community attitudes to mental illness and help seeking; and exposure to firearms.CONCLUSIONS:Compositional, contextual and collective factors are hypothesized to influence the elevated rate of suicide in rural compared with urban areas. These factors need to be tested in empirical studies that consider both individual and community-based risk factors, and are designed to enable exploration of likely within-rural differences.

Objective: To describe the development of a rural primary care psychiatry programme, within a stepped collaborative care model. Conclusion: Development of a system-wide approach to the provision of mental health services offers the opportunity to increase the proportion of people with mental health problems who receive effective treatment. In addition, it enables allocation of resources and matching of interventions to patient preference and clinical need. This is particularly important in rural areas where there is a shortage of specialist mental health services and practitioners.

BACKGROUND Interpersonal counselling (IPC) derives from interpersonal psycho-therapy (IPT) but is briefer in the number and duration of sessions and is particularly suited to the primary care setting. While depression and other psychological symptoms are not necessarily 'caused' by interpersonal problems, they do occur in a social and interpersonal context. Problem areas commonly associated with the onset of depression are unresolved grief, interpersonal disputes, role transition and interpersonal deficits such as social isolation. OBJECTIVE This article discusses IPC and how it can be used in the general practice setting. DISCUSSION The structure of IPC is of a brief treatment of six sessions, each with an explicit focus: assessment, education about the interaction between interpersonal relationships and psychological symptoms, identifying current stress areas and helping the patient deal with these more positively and termination of the IPC relationship. Interpersonal counselling can be utilised general practice to reduce psychological symptoms, restore morale, improve self esteem and the quality of the patient's social adjustment and interpersonal relationships.

Purpose: To determine the effectiveness of two dissemination and implementation strategies to implement a national guideline for epilepsy management in primary care settings.Methods: Three-arm cluster-randomized controlled trial. The participants were general practitioners from 68 practices in Tayside, Scotland, and 1, 133 of their patients with self-reported epilepsy treated with antiepileptic medications (AEDs). Practices were randomized blind to a control, intermediate, or intensive intervention. Control: Postal dissemination of a nationally developed clinical guideline. Intermediate intervention: Postal dissemination of the guideline supported by interactive, accredited workshops, and dedicated, structured protocol documents. Intensive intervention: Intermediate intervention plus a nurse specialist who supported and educated practices in the establishment of epilepsy review clinics. The primary outcome was the SF-36 health-related quality-of-life instrument. Secondary measures were a battery of prevalidated epilepsy-specific quality-of-life instruments. These were administered at baseline and after the intervention phase. Process of care was assessed by case-note review on number of review meetings and counseling sessions for epilepsy before and after the interventions.Results: None of the intervention groups showed any change in the primary or secondary outcome measures or process-of-care measures.Conclusions: None of the intervention strategies led to improvements in patient quality of life or quality of epilepsy care. Further research is needed to discover why the interventions failed, to identify barriers to adoption of guidelines, and to develop strategies that might improve implementation and uptake in the future.

OBJECTIVE:To describe the first 12 months activities of a key component of a General Practice Psychiatry program - the GP practice visit.DESIGN:Questionnaire to evaluate effects on participating general practitioners practice.SETTING:Rural group general practices.SUBJECTS:Thirty-two general practitioners in the Loddon Campaspe Southern Mallee region in Victoria.INTERVENTIONS:Practice visits involved a combination of each of three key activities: primary consultation, secondary consultation and/or case discussion and formal teaching.RESULTS:General practitioners reported a variety of changes in their practice as a result of the visits.CONCLUSION:Practice visits appear to be a useful means of influencing GP's practice. Further work is required to determine whether such changes are accompanied by demonstrable benefits in patient outcome.WHAT IS ALREADY KNOWN:Several models to assist GPs effectively manage mental health problems have been described. These models require regular contact and so have had limited utility in rural settings.WHAT THIS STUDY ADDS:This study suggests that infrequent contact or input, based on well established models, can alter GP's clinical behaviour.

The addition of aqueous pH 7 solutions of 7.2 x 10(-3) M pertechnetate to dilute aqueous 2.5% MeOH solutions containing a water-solubilized sapphyrin, 3,12,13,22-tetraethyl-8,17-bis[bis(hydroxyethyl)amino)carbonylethyl]-2,7.18,23-tetramethylsapphyrin (1), gives rise to spectroscopic changes in the UV-Vis spectrum of 1 that are consistent with anion-binding and sapphyrin deaggregation. The spectroscopic changes induced by pertechnetate were found to differ dramatically from those induced by the addition of either pure water or dilute nitric acid; however, they were found to parallel those seen when sodium phosphate was added to solutions of 1 under analogous experimental conditions. Fits of the spectroscopic titration data to a 1:1 binding profile revealed that the effective K describing the interaction of pertechnetate anion with 1 was ca. 3900 +/- 300 M-1; this value compares to the effective K of 23000 +/- 3000 M-1 that describes the corresponding interaction of sodium phosphate with 1.

As part of an ongoing effort to study the anion binding properties of sapphyrins in various media, a number of previously reported water solubilized sapphyrins were studied in methanol and in buffered, neutral aqueous solutions and found to undergo self-aggregation under these solution phase conditions. The nature of the species produced as the result of self-aggregation and the processes leading to their formation were studied via UV-vis absorbance and fluorescence spectroscopy. In previous work (V. Král, H. Furuta, K. Shreder, V. Lynch, and J. L. Sessler, J. Am. Chem. Soc. 1996, 118 1595-1607) it was found that the addition of phosphate-type anions to water soluble sapphyrins at pH 6.1 gives rise to visible spectroscopic changes consistent with the binding to the aggregated form and the concurrent formation of an anion-bound dimer with effective equilibrium constants on the order of 100-300 M(-1). In this study we show that at high phosphate-to-sapphyrin ratios in neutral, buffered aqueous solutions further deaggregation occurs to produce an anion-bound monomeric form. This highly fluorescent species is formed with effective equilibrium constants on the order of 6-19 M(-1) leading to considerations that sapphyrins could function as fluorescent phosphate anion sensors. In an effort to modulate the deaggregation properties, several new sapphyrin derivatives bearing two meso aryl substituents were prepared and studied. The aggregation properties of these latter systems were analyzed in methanol and, in the case of one water solublized system, in neutral aqueous media. In analogy to what was observed for the beta-alkyl substituted sapphyrins, H-type aggregates were seen for the water solubilized meso-substituted system in aqueous media. However, in contrast to the H-type dimers seen in the case of the meso-free systems in methanol, J-type dimers were observed in the case of the sapphyrins bearing two meso substituents in this solvent. The effective dimerization constants of several of the meso-diaryl sapphyrins were determined in methanol as were their pKa values in aqueous media. The solid state structure of the bis HBr salt of one of the meso-diaryl sapphyrins, specifically 10,15-bis(3,5-di-tert-butylphenyl)-3,22-diethyl-2,23-dimethylsapphyrin, was also determined and found to show elements in common with those of previously reported sapphyrin derivatives. In particular, the two counter anions were found to be hydrogen bound above and below the diprotonated sapphyrin plane.

Specialist clinical psychology skills have become increasingly rare in public mental health services. This lack is particularly problematic in rural and regional Australia, where psychology services of any kind are difficult to access. One model for the reintroduction of these skills is to employ later-year clinical psychology postgraduate trainees under supervision. This model has the advantage of encouraging evidence-based interventions integrated with an emphasis on professional development, evaluation, and applied research. The aim of this paper is to describe the development, implementation and evaluation of a clinical psychology intern program within a regional area mental health service. It is expected the information presented will be useful for other services considering the introduction of these skills using this model.

BACKGROUND The General Practice Psychiatry Program is a collaborative initiative between two universities and two professional colleges. Since 1998 it has offered general practitioners a one year part time Graduate Certificate, and a two year Master of General Practice Psychiatry. The learning is by distance education and multimode, including text packages sent out, tapes, teleconferences and two annual residential weekends with role plays and didactic teaching. OBJECTIVE To describe the development of a Graduate Certificate and Master in General Practice Psychiatry. DISCUSSION The program has been well supported with 141 general practitioners enrolling in the Graduate Certificate and 48 in the Masters during 1998-2001. General practitioners have been enrolling from around Australia, with rural, female and more experienced GPs predominating.

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Background : Studies demonstrating efficacy of psychological therapies have predominantly been conducted in specialist psychiatric settings. Investigation of the effectiveness of these therapies when provided by general practitioners (GPs) in their specific work setting is lacking and much needed. Objectives : To develop and pilot test a new education and treatment program to assist GPs manage patients with a depressive illness. The Focused Education and Psychotherapy Program (FEPP) is intended to provide GPs and patients with a treatment and education program for the management of depressive illness using a psychological intervention within the cost and time constraints of general practice. Methods : Following consultation, we developed a draft program. This program incorporates established psychological therapies, Interpersonal Counselling (IPC) and Cognitive Behavioural strategies with patient education in a general practitioner manual and accompanying patient handbook. FEPP was reviewed by focus groups and was pilot tested using a simulated depressed patient who trialled the program with four GPs. Results : Consultation and pilot testing of the program identified important issues for both GPs and their patients. These were incorporated into the final version of the program, which includes a 12-week acute phase of treatment followed by a maintenance program and is based on IPC and cognitive behavioural strategies, and patient and GP education utilising a manualised format. Conclusions : A practical and accessible form of psychological treatment for the general practice setting has been developed. Effectiveness of this program now needs to be established.

Rural Australians have limited access to care for mental health problems. We describe a collaboration between the University of Melbourne Departments of Psychology and Psychiatry and a rural Area Mental Health Service to provide a specialist anxiety and depression treatment service in rural Victoria. The clinical service and the education and training approach are described.

Sapphyrin was the first expanded porphyrin to be reported in the literature and remains among the most extensively studied. Much of the interest in this macrocycle reflects its ability to bind anions, a phenomenon that has been examined in solution and in the solid state by a wide range of experimental techniques. In this Account, we summarize these studies while also outlining strategies that may be used to synthesize sapphyrins.