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OBJECTIVES: Narcissistic personality disorder as captured in categorical diagnostic systems (e.g., DSM-5) emphasizes grandiose features more associated with masculine norms and under-emphasizes vulnerable features more associated with femininity. This poses significant implications in diagnostic outcome and clinical treatment in women with narcissistic preoccupations. Research finds that clinicians using the DSM-5 categorical system tend to diagnose vulnerable narcissism in women as other 'feminized' personality disorders (e.g., borderline), but no research has explored gender differences in narcissism using the new ICD-11 dimensional framework for personality disorders. This study investigated the clinical utility of the ICD-11 approach in capturing gender differences in narcissistic presentations. METHODS: Adopting an online vignette-based study, mental health clinicians (N = 157; 71.3% female) completed ratings of ICD-11 personality disorder severity and trait domains for two cases reflecting 'grandiose' and 'vulnerable' narcissism in hypothetical male or female patients. RESULTS: The results showed that ratings of core impairments in personality functioning and overall severity were consistent irrespective of patient or clinician gender, contrasting prior research using categorical models. CONCLUSION: While some differences were observed in trait domain (e.g., negative affectivity) between patient gender, these results suggest the clinical utility of the ICD-11 model as emphasizing elements of personality functioning in the process of assessment and diagnosis, therefore potentially being less susceptible to influences of gender stereotype in aiding clinical conceptualization.

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BACKGROUND: Both the latest edition of the DSM-5 as well as the new ICD-11 have established a new focus in the diagnosis of personality disorders: the assessment of personality functioning. This recent shift in focus converges with long-standing psychodynamic conceptualizations of personality pathology, particularly Kernberg's object relations model. Although a significant amount of research supports these models in adults, much less is known about the validity of these frameworks in youth. Considering the paucity of brief measures of personality functioning in adolescents, the current study aimed to develop and investigate the validity of the Inventory of Personality Organization for Adolescents-Short Form, a theoretically-informed measure assessing severity and core domains of functioning in adolescents. METHODS: A total sample of N = 525 adolescents aged 13 to 19 years were recruited through a community University-Health Psychology Clinic as current patients (n = 94) or who responded to an online research call (n = 431). RESULTS: Results indicate that a bifactor model provided the best fit to the data and consisted of a general factor reflecting core self-other functioning and three specific factors, representing additional dimensions of personality organization. CONCLUSIONS: A brief 15-item version of the IPO-A was successfully derived for time-efficient screening of personality pathology in youth. Similarities with the ICD-11 framework are discussed.

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OBJECTIVE: Levels of vitamin E have been reported to be lower in patients suffering major depression, but whether this is due to inadequate dietary intake or the pathophysiology of depression is not known, and was the subject of the present study. SETTING: Wollongong, Australia. METHODS: Plasma vitamin E (alpha-tocopherol) was measured in 49 adults with major depression, age (mean+/-s.d.): 47+/-12 y. In a subset (n=19) usual dietary intake of vitamin E was determined by diet history. RESULTS: Subjects had significantly lower plasma alpha-tocopherol (4.71+/-0.13 mumol/mmol cholesterol) than has previously been reported for healthy Australians, and plasma alpha-tocopherol was inversely related to depression score (by Beck Depression Inventory) (r=-0.367, P<0.009). Diet analysis indicated that 89% of subjects met or exceeded the recommended intake for vitamin E, and dietary intake was not related to plasma alpha-tocopherol level in this subset. CONCLUSION: These findings suggest that plasma levels of alpha-tocopherol are lower in depression, but this is not likely to be the result of inability to meet recommended dietary intake. .

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This phenomenological study was conducted to investigate the biopsychosocial impact of end-stage renal disease on dialysis patients and their partners. Forty-four participants were interviewed separately (22 patients and their partners) by way of two open-ended questions, and multiple themes were identified from verbatim transcripts. Both the patients and partners viewed their relationship very positively, and both were overwhelmed by the impact of dialysis on their lives. Anger, depression and hopelessness were evident in the patients, whilst a pervasive sadness, resentment, guilt and loss were prevalent in the partners. This study gives a unique perspective on the negative impact which dialysis can have on couples, yet it also suggests that some are able to cope in a positive way despite the many life-style adjustments required by dialysis. The results of this study indicate that nurses need to recognize and respond to the tremendous emotional impact that chronic illness and its treatment can have on families in an era where it is possible to sustain life for years with the use of life support technology.

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A psychosocial profile was developed of 122 pregnant adolescents attending a public hospital antenatal clinic in a large regional Australian area. Participants completed the Rosenberg Self-Esteem Scale and the Support Behaviours Inventory and were interviewed to obtain psychosocial and demographic information. Results revealed that those who were most likely to have either or a combination of poor self-esteem, lack of social support, be unemployed or smoke, were more likely to be living alone or with friends, not have a partner or have a partner for a shorter period, have a partner who was older, have previous children, have not planned their pregnancy and have less education. The degree of social support was significantly associated with self-esteem. Over half of the sample smoked, and over half were unemployed. These results underscore the importance of addressing psychosocial factors in the implementation of care for the pregnant adolescent.

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This study investigated the relationship between the mastery of maladaptive interpersonal patterns (assessed from narratives told during psychotherapy) and outcome of psychotherapy. Transcripts from the psychodynamic psychotherapy of 41 patients were scored using a content analysis mastery scale. Changes in mastery level over the course of therapy were significantly related to changes in observer and therapist ratings. In addition, the patients' own judgments of changes in their symptoms and main problems paralleled changes in the mastery of interpersonal conflicts found in their narratives. These results are consistent with the proposition that symptoms abate with the mastery of core interpersonal conflicts.

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A 35 year old male was cognitively assessed prior to cessation of 18 years of daily cannabis use and monitored for several weeks post cessation. Brain event-related potential (ERP) measures of selective attention reflecting a difficulty in filtering out complex irrelevant information showed no indication of improvement over 6 weeks of abstinence. In contrast, when tested in the acutely intoxicated state prior to cessation of use, a dramatic normalisation of the ERP signature of this individual was observed. A treatment program based on supportive-expressive psychotherapy was administered and depression, anxiety and general psychological health were monitored over the course of withdrawal from cannabis.

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The presence of social-evaluative anxiety in opioid users has been consistently recognized by clinicians, but as yet has not been systematically investigated. Scores on the Social Avoidance and Distress (SAD) Scale and the Fear of Negative Evaluation (FNE) Scale were obtained from the randomly selected files of 159 opioid users presenting for treatment at an inner city drug advisory service. Approximately one-quarter of the sample reported anxiety which may be considered psychologically and socially disfunctional. The prevalence of social-evaluative anxiety reported in this sample has implications for the provision of appropriate and effective treatment for this distressed population.

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The need for minimum standards of service delivery in drug and alcohol treatment agencies is outlined, and the Australian standards developed to date are discussed. It is argued that such standards are insufficient to assure the efficacy of treatment approaches used in treatment agencies, although they are an important and necessary precursor to the implementation of patterns of optimum care. The nature of optimum care standards is outlined and one methodology for developing optimum standards is described.