Department of Psychological Medicine Research

Dr David Dossetor

Area Director of Mental Health, Chair of the Division of Psychological, Developmental & Rehabilitation Medicine and Head of the Centre for the Prevention of Psychological Problems in Children (CPPPC).

Dr Jean Starling

Head, Department of Psychological Medicine

Ruth Urwin

Head, Molecular Psychiatry Laboratory

Dr Sloane Madden

Deputy Head of Department and Head of Eating Disorders

Dr Sandra Heriot

Head, Psychology, University of Sydney

General Contact Information

Postal Address:
Department of Psychological Medicine
The Children's Hospital at Westmead
Locked Bag 4001
Westmead NSW 2145
Australia

Telephone: +61 2 9845 2005
Fax: +61 2 9845 2009

Overview of Department of Psychological Medicine Research

The Department of Psychological Medicine is the largest department of child mental health in NSW, and since the move to Westmead has progressively expanded its research base and interests. There are currently 45 different research projects listed in the department, and all clinicians are encouraged to maintain an area of research interest. The strength of the research is the close interface with clinicians and clinical need. These research projects are managed by the Project Executive Committee of the Department. There are 4 research groups that are specifically identified.

• Molecular Psychiatry
• Eating Disorders
• Psychology (University of Sydney)
• CPPPC

Other areas include: Quality of life, psychopharmacology, child mental health nursing, epidemiology, deafness, conversion disorders and attachment, and developmental neuropsychology and psychiatry. The Department of Psychological Medicine is affiliated with the University of Sydney through the Disciplines of Psychological Medicine, Paediatrics and Child Health and Department of Psychology. Currently the department is involved in approximately 10 PhDs. The research profile of the department is young but progressively we are establishing academic links with other units in the hospital, NSW and internationally.

Group therapy for children and young people with anxiety problems

The Department of Psychological Medicine at The Children's Hospital at Westmead is conducting a research anxiety management group for children and adolescents, in collaboration with the Emotional Health Centre, Macquarie University, Sydney.

What is the Anxiety Clinic?

The Anxiety Clinic is a specialised training and research clinic run by the Department of Psychological Medicine. The purpose of the Clinic is to provide psychological treatment for children and adolescents with anxiety problems. The Clinic is staffed by senior clinical psychologists, research psychologists and intern clinical psychologists. Treatments provided in the Clinic are evidence-based therapies for anxiety disorders. Children will receive either cognitive behavioural therapy (CBT), or acceptance-mindfulness therapy combined with CBT. The treatment consists of ten 90-minute group therapy sessions consisting of 6-8 children in the same age group. Parent groups run concurrently with child and adolescent groups as parental participation assists the young person in learning to manage their anxiety. Pharmacological (medication) treatments are not provided.

Who can be seen at the Clinic?

The Clinic is open to any child aged 7 to 17 years whose primary presenting problem is anxiety. Children do not need to be a hospital patient to participate, with community participants also welcome. The Clinic is not suitable for children and adolescents with complex mental health problems.

How long will it take before a family is seen at the Clinic?

The family may be seen within a few days or within the 10-week waiting period. Referrers and families will be informed about likely waiting times at the time of referral.

Who will the family see at the Clinic?

Referrals will be initially screened by phone by a qualified psychologist. If appropriate, the family will then be offered a face-to-face assessment by a psychologist. If it is apparent at referral, or following an assessment, that the family would receive more suitable help elsewhere, the psychologists will provide referral suggestions.

How long will my child receive treatment at the Clinic?

The treatment program will be completed within 10 weeks. Follow-ups will occur three months following the completion of treatment to monitor the effectiveness of treatment. In the event the family continues to have concerns about their child's psychological health following treatment, appropriate options for further treatment will be discussed with the family.

How much does the treatment cost?

There is no charge for psychological services provided through the Anxiety Clinic.

Who should I contact if I have questions or concerns?

Ms Gillian Evans, Intake Officer, on 02 9845 2005
Dr Karen Hancock on 02 98450408
Eleanor Thackray 02 9845 3017, Secretary of the Ethics Committee which approved this research

Molecular Psychiatry Laboratory

Head: Ruth Urwin
Email: RuthU@chw.edu.au

On December 19, 1996, Ruth Urwin and Prof Kenneth Nunn initiated Molecular Psychiatry research at CHW, Westmead. Although Prof Nunn has recently left CHW and is now at John Hunter Hospital in Newcastle, NSW, Ruth and Ken still conduct their research as a scientist-clinician team.

Overall Aim:

To investigate/define biological mechanisms involved in behaviour and psychiatric disorders

Current project aim:

To investigate the molecular genetics of anorexia nervosa

Future aims:

• To investigate the relationship between genotype and the therapeutic response to specific psychotropic drugs
• To investigate gene-gene interactions in closely connected biological systems
• To investigate gene-environment interactions

Potential impact on clinical practice:

Currently, there are few (if any) biological tests available to aid clinical decisions in psychiatry whether it is for diagnosis or treatment. Through our research (which includes collaboration with others) we are working towards providing such tests which should provide a turning point for psychiatric diagnosis and treatment.

Achievements to date:

In 2002, we discovered a novel 343-bp DNA sequence in the promoter region of the norepinephrine transporter gene and showed that anorexia nervosa (restrictive subtype) is associated with a polymorphism in this novel sequence. This discovery resulted in an international press release by Molecular Psychiatry, the journal in which the finding is published. The publication was a highlight of Nature Publishing Group on August 1, 2002 at http://www.nature.com/nature/view/020801.html and the subject of numerous media interviews and press reports including a front page story in the Sydney Morning Herald at http://www.smh.com.au/articles/2002/08/05/1028157909476.html and a recent segment on ABC TV Catalyst ("Anorexia Gene" at http://www.abc.net.au/catalyst/stories/s914473.htm).

Publications (Peer-reviewed original research)

1. Urwin RE, Bennetts BH, Wilcken B, Lampropoulos B, Beumont PJ, Russell JD, Tanner SL, Nunn KP. Gene-gene interaction between the monoamine oxidase A gene and solute carrier family 6 (neurotransmitter transporter, noradrenalin) member 2 gene in anorexia nervosa (restrictive subtype). Eur J Hum Genet. 2003; 11: 945-50, advance online publication, 24 September 2003; doi:10.1038/sj.ejhg.5201077 (publication ) (European Journal of Human Genetics)

2. Urwin RE, Bennetts BH, Wilcken B, Beumont PJ, Russell JD, Nunn KP. Investigation of epistasis between the serotonin transporter and norepinephrine transporter genes in anorexia nervosa. Neuropsychopharmacology. 2003; 28: 1351-5, advance online publication, 14 May 2003; doi:10.1038/sj.npp.1300204 (publication ) (Neuropsychopharmacology)

3. Urwin RE, Bennetts B, Wilcken B, Lampropoulos B, Beumont P, Clarke S, Russell J, Tanner S, Nunn KP. Anorexia nervosa (restrictive subtype) is associated with a polymorphism in the novel norepinephrine transporter gene promoter polymorphic region. Mol Psychiatry. 2002; 7: 652-7. (publication ) (Molecular Psychiatry)

Eating Disorders

Head: Dr Sloane Madden
Email: SloaneM@chw.edu.au

In the past few years an extensive range of research projects in eating disorders have been developed involving collaboration with researchers from a broad range of disciplines: medical, nursing, allied health and science backgrounds. Currently there are six projects in various stages of recruitment addressing areas of physical health and nutrition, psychological health and epidemiology of eating disorders. Three further projects have been completed during the past year with papers currently being prepared for publication.

Psychology (University of Sydney)

Head: Dr Sandra Heriot
Email: sandrah4@chw.edu.au

Overall Aim:

To enhance research links and collaboration between the University of Sydney (staff and students) and the Department of Psychological Medicine and other departments within CHW.

Current project(s)

1. Evaluation of a treatment program for childhood anxiety disorder with comorbid anger/aggression: The main aim is to evaluate the effectiveness of an intervention program that targets both anxiety and aggressive behaviours in children with primary anxiety disorders and comorbid aggression. The outcome of the combined program will be compared to a standard treatment targeting anxiety. The results will have implications both in terms of improving treatment outcomes, and our understanding of the comorbid anxiety and externalising problems in childhood. In addition, a number of factors will be assessed for their moderating effect on treatment outcome, including problem severity of both anxiety and anger/aggression.
2. Congenital Heart Disease and Associated Anxiety: This study has sought to better understand the basis of anxiety in children with congenital heart disease and to explore the differences that may occur between a congenital heart group and an anxiety disorder group.
3. Emotion regulation and interpersonal schemata in depressed and aggressive youth: To develop a better understanding of factors contributing to aggression and because aggression and depression frequently co-occur (Angold & Costello, 2001), the relation between these two problems is investigated. The study will investigate the emotional and social-cognitive factors related to children's internalising and externalising problem behaviour. This study involves both clinical and community samples.
4. Hope and vicarious futurity: The research will consist of two parts: 1) gathering normative data on an instrument designed to measure vicarious futurity, i.e., the hope that parents have for their children's future, (Vicarious Futurity Scale) and examine its psychometric properties; and, 2) the vicarious futurity of two groups of parents with children who have disabilities will be compared with each other and with the normative sample.
5. The effect of social skills training on the behaviours of children with neurofibromatosis type 1.
6. Understanding acculturation and depression in an adolescent Vietnamese population: This study is comparing acculturation in Australian born Vietnamese to those who have migrated to Australia in terms of ethnic/cultural identity, level of self-esteem, depression, family conflict and values, as well as knowledge and access to mental health services. The information gained from the study will offer insight into how culture affects the expression, perception and response to distress and assist in providing satisfactory and appropriate services.
7. Family environment of conduct-disordered children- Effects combined parent and child treatment program.
8. Improving Hoping and Coping in Adolescents Diagnosed with Leukaemia: A Cognitive-Behavioural Approach: The main aims of this project are: a) to investigate levels of hopefulness and illness perceptions in adolescents with a recent diagnosis of acute lymphoblastic leukaemia; b) to evaluate the effectiveness of a cognitive behavioural treatment package in improving hopefulness and altering illness perceptions in adolescents with leukaemia; and, c) to investigate levels of disease progression, school absenteeism, treatment adherence and psychological problems in adolescents who receive the cognitive-behavioural intervention versus those in a wait-list control group.
9. Promoting adolescent mental health in Mauritius schools: This study involves partial replication of the study by Shochet et al (2001) and aims to encourage whole-school approaches to mental health in order to promote the social and emotional development of young people and to provide a framework within which teachers could set up curricula to develop skills and educate young people about mental health. Mauritius has one of the world's highest suicide rates.
10. The effects of moving on young children's psychosocial adjustment - Identification of factors that moderate or mediate the impact of moving.

Future aims:

• Extension of the pilot studies into treatment of comorbid psychological disorders and development of an overall theoretical model for relating child characteristics to choice of effective treatment.
• Pilot study into emotion-based social skills programs for children with developmental disabilities.
• Evaluation and refinement of research program.

Potential impact on clinical practice:

As indicted above, all studies are linked to clinical practice either in terms of development of explanatory theories/models or effective interventions.

Achievements to date:

Several studies are nearing completion and results and subsequent publications will be due out at the beginning of 2004.

The Centre for the Prevention for Psychological Problems in Children. (CPPPC)

Head: David Dossetor
Email: Davidd@chw.edu.au

CPPPC was founded in 1999 under the Directorship of A/Prof Kenneth Nunn. Its aim is to study problems in the prevention of psychological problems in children with a focus on developing innovative approaches to prevention and early intervention. The unit received project funding for 4 areas from the Commonwealth Second Mental Health Plan.

CPPPC has recently released the annual report for 2002 (available on request) which identifies 18 projects that are in progress or completed. The main areas include: Parenting programs, based on models of emotional intelligence, for several clinical groups; Prevention of Eating Disorders; Intervention for young people with recurrent self mutilation; Acute Mental Health Service needs of young people who present to Emergency Departments; Prevention of the psychological sequelae of chronic illness; Rural prevention and education initiatives; Prevention in culturally and linguistically diverse backgrounds; Children of parents with a mental illness.

Recent Publications (2000 - 2003)

Journal Articles

Stiefel I, Johnson S, Clarke L, Chahoud K. Tape measures in family therapy: an exploration with the GARF. ANZJFT (in press)

Starling J, Rosina R, Nunn K, Dossetor D. Child and adolescent telepsychiatry in New South Wales: moving beyond clinical consultation. Australas Psychiatry. 2003 (in press)

Rhodes, P. The Maudsley Model of family therapy: theory, practice, and empirical support. ANZJFT. 2003 (in press)

Woolfenden S, Dossetor D, Nunn K, Williams K. The presentation of aggressive children and adolescents to emergency departments. J Paediatr Child Health. 2003 (in press).

Dossetor DR, Elliott EJ. Six-year follow-up of preventive interventions for children of divorce: a randomized controlled trial. J Pediatr. 2003; 142: 587-8.

Rhodes, P. Behavioural and family systems interventions in developmental disability: towards an integrative approach. J Intellec Dev Disabil. 2003; 28: 51-64.

Rosina R, Crisp J, Steinbeck K. Treatment adherence of youth and young adults with and without a chronic illness. Nurs Health Sci. 2003; 5: 139-47.

Stiefel I, Renner P, Riordan D. Evidence based: crossing the great divide between research and clinical practice. ANZJFT. 2003; 24: 49-50

Brodie L, Nagy S, English M, Gillies D. Protectiveness without possessiveness: caring for children who require long-term hospitalisation. Neonatal Paediatr Child Health Nurs. 2002; 5: 11-7

Clarke L, Ungerer J, Chahoud K, Johnson S, Stiefel I. Attention deficit hyperactivity disorder and attachment. Clin Child Psychol Psychiatry. 2002; 7: 179-98.

Evans IM, Heriot, SA, Friedman, AG. Behavioural pattern of irritability, hostility and inhibited empathy in children. J Clin Child Psychol Psychiatry. 2002; 7: 211-24.

Hanney L, Kozlowska K. Healing traumatized children: creating illustrated storybooks in family therapy. Family Process. 2002; 41: 37-65

Kozlowska K, Hanney L. The network perspecitve: an integration of attachment and family systems theories. Family Process. 2002; 41: 285-312

Nunn K, Williams K, Ouvrier R. The Australian childhood dementia study. Eur Child Adolesc Psychiatry. 2002; 11: 63-70.

Pratt BM, Woolfenden SR. Interventions for preventing eating disorders in children and adolescents. Cochrane Database Syst Rev. 2002; (2):CD002891.

Rhodes P. Mainstreaming intellectual disability into the history of family therapy. ANZJFT. 2002; 23: 211-4.

Rosina R, Starling J, Nunn K, Dossetor D, Bridgland K. Telenursing: clinical nurse consultancy for rural paediatric nurses. J Telemed Telecare. 2002; 8 Suppl 3: S3: 48-9.

Stiefel I, Harris P, Zollmann AWF. Family constellation - a therapy beyond words. ANZJFT. 2002; 23: 38-44

Woolfenden S, Dossetor D, Williams K. Children and adolescents with acute alcohol intoxication/self-poisoning presenting to the emergency department. Arch Pediatr Adolesc Med. 2002; 156: 345-8.

Heriot, SA, Evans, IM, Foster, TM. An interactional approach to intervention research with children diagnosed with ADHD. J Child Fam Studies. 2001; 10: 287-299.

Books, Book chapters, Department journals, etc. (2000 - 2003)

Psychotropic prescribing in children and adolescents. Nunn K, Dey C, editors: 2003. NSW: CAMHSNET (Written by Psychological Medicine staff and others.)

The clinician (ISSN Number: 1445-4041)
Editor: Prof Kenneth Nunn
(written by psychological medicine staff and others.)
2001 Hope and Anxiety
2001 Endurance & Disruption
2002 Courage and Depression
2003 Sensitivity and Anorexia Nervosa (in press)

Gelber H, Starling J. Telemedicine for child and adolescent psychiatry. In: Wootton R, Yellowlees P, McLaren P, editors. Telepsychiatry and e-mental health. 2003. London: Royal society of medicine press.

Practical child psychiatry: the clinician's guide. Lask B, Nunn KP, Taylor S, editors. 2003. London: BMJ Books

Swanston H, Williams K, Nunn K. The psychological adjustment of children with chronic conditions. Vol 5. In: Korky R, O'Hanlon A, Martin G, Davis C, series editors. Clinical approach to early intervention in child and adolescent mental health. 2000. Adelaide: Australian early intervention network for mental health in young people. http://auseinet.flinders.edu.au/resources/auseinet/chronic.pdf