Research - Psychological and Behavioural Medicine - Monash Medical Centre
The following describes our areas of work and interest. Opportunities exist for postgraduate students to undertake doctoral studies in any of these or related fields.
Instrument Development
Brief Case-find for Depression (BCD)
References
Clarke D.M., McKenzie D.P., Marshall R.J., Smith G.C. The construction of a brief case-finding instrument for depression in the physically ill. Integrative Psychiatry 1994; 10: 117-123.
Jefford M, Mileshkin L, Richards K, Thomson J, Matthews JP, Zalcberg J, Jennens R, McLachlan S-A, Wein S, Antill Y, Clarke DM. Rapid screening for depression: validation of the Brief Case-find for Depression (BCD) in medical oncology and palliative care patients. British Journal of Cancer 2004 (in press).
Monash Interview for Liaison Psychiatry (MILP)
References
Clarke D.M., Smith G.C., Herrman H.E., McKenzie D.P. The Monash Interview for Liaison Psychiatry (MILP): development, reliability and procedural validity. Psychosomatics 1998; 39: 318-328.
Yap R.H.C., Clarke D.M. An expert system for psychiatric diagnosis using the DSM-III-R, DSM-IV and ICD-10 classifications. Proceedings of the American Informatics Association 1996; (October); 229-233.
Demoralisation Scale (DS)
Demoralisation, characterised by feelings of hopelessness, helplessness and existential despair, can be differentiated from anhedonia characterised by loss of ability to experience pleasure.
- 24-item self report version of the Demoralisation Scale
- Population norms are being measured in 2004
References
Kissane DW, Wein S, Love A, Lee XQ, Lee PL, Clarke DM. The demoralisation scale: a report of its development and preliminary validation (submitted).
Measurement of levels of psychiatric morbidity in the medically ill
This has particularly been in the general medical and surgical inpatient setting, and in women with breast cancer.
Evaluation of screening instruments in the medically ill
This has involved the use and comparison of commonly used instruments, such as the GHQ, BDI and HADS, and the development of a 4-item depression case-finding instrument (Brief Case-find for Depression - see above).
Publications
McKenzie D.P., Clarke D.M., Low L.H. A method of constructing parsimonious diagnostic and screening tests. International Journal of Methods in Psychiatric Research 1992; 2: 71-79.
Clarke D.M., Smith G.C., Herrman H.E. A comparative study of screening instruments for mental disorders in general hospital patients. International Journal of Psychiatry in Medicine 1993; 23: 323-337.
Clarke D.M., McKenzie D.P. A caution on the use of cut-points applied to screening instruments or diagnostic criteria. Journal of Psychiatric Research 1994; 28: 185-188.
Love A.W., Kissane D.W., Bloch S., Clarke D.M. Diagnostic efficiency of the Hospital Anxiety and Depression Scale in women with early stage breast cancer. Australian and New Zealand Journal of Psychiatry 2002; 36: 246-250.
Clarke D.M., McKenzie D.P. An examination of the efficiency of the 12-item SPHERE questionnaire as a screening instrument for common mental disorders in primary care Australian and New Zealand Journal of Psychiatry 2003; 37: 236-239.
Love AW., Grabsch B., Clarke D.M., Bloch S., Kissane D.W. Screening for depression in women with metastatic breast cancer: a comparison of the Beck Depression Inventory Short Form and the Hospital Anxiety and Depression Scale. Australian and New Zealand Journal of Psychiatry 2004; 38: 526-531.
Statistics
This has been particularly in relation to measurement and screening.
Publications
McKenzie D.P., Clarke D.M. Cuttoff: a FORTRAN program for establishing thresholds for screening indices. Educational and Psychological Measurement. 1992; 52: 891-893.
McKenzie D.P., Clarke D.M., Low L.H. A method of constructing parsimonious diagnostic and screening tests. International Journal of Methods in Psychiatric Research 1992; 2: 71-79.
Clarke D.M., McKenzie D.P. Screening for psychiatric morbidity in the general hospital: Methods for comparing the validity of different screening instruments. International Journal of Methods in Psychiatric Research 1991; 1: 79-87.(Erratum published 1996; 6: 175).
McKenzie D.P., Mackinnon A.J., Peladeau N., Onghena P., Bruce P.C., Clarke D.M., Harrigan S., McGorry P.D. Comparing correlated kappas by resampling: is one level of agreement significantly different from another? Journal of Psychiatric Research 1996; 30: 483-492.
McKenzie D.P., MacKinnon A.J., Clarke D.M. KAPCOM: a program for the comparison of kappa coefficients obtained from the same sample of observations. Perceptual and Motor Skills 1997; 85: 899-902.
McKenzie D.P., Vida S., MacKinnon A. Onghena P., Clarke D.M.. Accurate confidence intervals for measures of test performance. Psychiatry Research 1997; 69: 207-209.
Application of a clinical database to consultation-liaison psychiatry and evaluation of patients referred to a consultation-liaison service
The MICROCARES clinical database has been used routinely at Monash Medical Centre in the consultation-liaison service and has allowed a number of descriptive studies to occur that serve as benchmarks for consultation-liaison psychiatry.
A fresh examination of psychopathology in the medically ill
This project sought to examine, without the constraint of standard psychiatric classifications such as DSM or ICD, the nature of distress in the medically ill - particularly depression, anxiety and somatization. The work involved the development and validation of a structured clinical interview (MILP), the examination of consecutive admissions to hospital, and the follow-up 3 months after discharge. The result of this research has been the elucidation of demoralisation, anhedonia and grief as distinct depressive subtypes.
Publications
Clarke D.M., Mackinnon A., Smith G.C., McKenzie D.P., Herrman H.E. Dimensions of psychopathology in the medically ill: a latent trait analysis. Psychosomatics 2000; 41: 418-425.
Clarke D.M., Kissane D.W. Demoralisation: its phenomenology and importance. Australian and New Zealand Journal of Psychiatry 2002; 36: 733-742.
Clarke D.M., Smith G.C., Dowe D.L., McKenzie D.P. An empirically-derived taxonomy of common distress syndromes in the medically ill. Journal of Psychosomatic Research 2003; 54: 323-330.
Psychotherapy in the medically ill
This work has involved collaboration with Professor David Kissane (now at the Memorial SDloan-Kettering Cancer centre, New York) and colleagues at the University of Melbourne Centre for Palliative Care. Two trials of group psychotherapy for women with breast cancer have been completed.
An exciting new study just piloted is an individual brief psychotherapy for medically ill patients suffering demoralisation.
References
Kissane D.W., Bloch S., Smith G.C., Miach P., Clarke D.M., Ikin J., Love A., Ranieri N., McKenzie D.P. Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. Psycho-Oncology 2003; 12: 532-546.
Kissane DW, Grabsch B, Clarke DM, Christie G, Clifton D, Gold S, Hill C, Morgan A, McDermott, Smith GC. Supportive-expressive group therapy: the transformation of existential ambivalence into creative living while enhancing adherence to anti-cancer therapies. Psycho-Oncology (in press).
Kissane D.W., Clarke D.M., Street A.A. Demoralization syndrome - a relevant diagnosis for palliative care. Journal of Palliative Care 2001; 17: 12-21 (Correspondence published JPC 2001; 17:290-291).
Clarke D.M., Kissane D.W. Demoralisation: its phenomenology and importance. Australian and New Zealand Journal of Psychiatry 2002; 36: 733-742.
Clarke D.M. Faith and hope. Australasian Psychiatry 2003; 11: 164-168.
Psychological medicine and general practice
This work has been done in collaboration with the Department of General Practice at Monash University and has focussed on the development and effectiveness of education in up-skilling general practitioners to better recognize and treat patients with psychological disturbance.
Publications
McCall L., Blashki G., Judd F., Piterman L., Clarke D.M., Liaw T., Martyres R., Hogan C., Pring W. Collaboration in educational development: inter-university and inter-departmental co-operation. Focus on Health Professional Education 2000; 2: 50-58.
McCall L., Clarke D.M., Rowley G. Does a continuing medical education course in psychiatry change GP knowledge, attitude and practice and patient outcome. Primary Care Mental Health 2004; 2: 13-22.
McCall L, Clarke DM, Rowley G. Subjective experiences of GPs undertaking continuing medical education in mental health: a qualitative study of motivation and process of change. Primary Care Mental Health 2004; 2: 23-35.
Clarke D.M., Coleman J. Balint groups: examining the doctor-patient relationship. Australian Family Physician 2002; 31: 41-44.
McCall L., Clarke D.M., Rowley G. A questionnaire to measure general practitioners' attitudes to their role in the management of patients with depression and anxiety. Australian Family Physician 2002; 31: 299-303.
Blashki G., McCall L., Piterman L., Judd F., Clarke D.M., Stone L., Davis J., Cockram A., Pring B, Martyres R, Hogan C, Liaw T. A Graduate Certificate and Master in General Practice Psychiatry by distance education, 1998-2001. Australian Family Physician 2002; 31: 394-397.
Other Areas
Eating Disorders
Publications
Clarke D.M., Wahlqvist M.L., Strauss B.J.G. Undereating and undernutrition in the elderly: integrating biopsychosocial aspects. Age & Ageing 1998; 27: 527-534.
Clarke D.M., Wahlqvist M.L., Rassias C.R., Strauss B.J.G. Psychological factors in nutritional disorders of the elderly: part of the spectrum of eating disorders. International Journal of Eating Disorders 1999; 25: 345-348
Psychological medicine applied to clinical ethics - Publications
Publications
Clarke D.M. Autonomy, rationality and the wish to die. Journal of Medical Ethics 1999; 25: 457-462.
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