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CAE '70
the journey continues

OET Practice Reading Test Part A : ~ IVIentalllln~s~~J

Read the four texts and then complete the summary task at the end by filling in
the missing words. Write your answers in the answer column on the right hand
side. Each answer may require one word or a phrase.

TURN OVER

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TEXT 1
Research

Prevalence of metabolic syndrome among Australians

with s1evere mental illness

AlexandHr P John, Radhakrishnan Koloth, Milan Dragovic and Stephen C B Lim

MJA 2009; 190 (4): 176-179

Abstract
Objective:

To assess the prevalence of metabolic syndrome and its

association with sociodemographic, clinical and lifestyle
variables among Australian patients with a variety of psychiatric
disorders.

Design and setting:

Cross-sectional study of patients attending a public mental

health service in Western Australia between July 2005 and
September 2006.

Participants:

Patients who were aged 18-65 years; diagnosed with

schizophren1ia, schizoaffective disorder, bipolar disorder, major
depressive disorder with psychotic symptoms, drug-induced
psychosis or borderline personality disorder; and currently
taking at least one antipsychotic drug for a minimum of 2 weeks.

Main outcome measures:

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Prevalence of metabolic syndrome diagnosed with International

Diabetes Federation criteria; fasting blood glucose and lipid
levels; sociodemographic and lifestyle characteristics.

Results:

Of 219 patients invited to participate, 203 agreed and had

complete data. Prevalence of metabolic syndrome was 54%
overall, and highest among patients with bipolar disorder or
schizoaffective disorder (both 67% ), followed by schizophrenia
(51%). Sociodemographic variables, including age and ethnic
background, were not significantly associated with metabolic
syndrome, but a strong association was seen with mean body
mass index. Other cardiovascular risk factors, such as smoking
and substance misuse, were common among participants.

Conclusions:

Prevalence of metabolic syndrome in this population was almost

double that in the general Australian population, and patients
with schizophrenia had a prevalence among the highest in the
developed world. Prevalence was also high in patients with a
variety of other psychiatric disorders.

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TEXT 2

Editorials

The medical care of people with psychosis

Timothy J R Lambert
MJA 2009; 190 (4): 171-172

Early detection and prevention applies to medical comorbidity as well as

psychiatric symptoms

Having a psychotic illness has been and remains a

barrier to all forms of effective medical care. All serious mental

illness is associated with undue medical morbidity and
mortality.1 ,2 Such morbidity stems from a complex web of
interactions between the illness itself, various aspects of the
patient's environment, the nature of the antipsychotic
medication and, most worryingly, barriers to the acceptance
within the wider medical profession of adequate screening and
treatment for comorbidity.3 As 70% of patients with persistent
psychoses receive some or all of their treatment from non-
psychiatric physicians,4 this is an important issue for the broader
profession.

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TEXT 3
Supplement

New directions in the epidemiology of schizophrenia

John J McGrath and Ezra S Susser

MJA 2009; 190 (4): S7-S9

Abstract
New primary data and systematic reviews have prompted the
review of some long-held views about the epidemiology of
schizophrenia.
The incidence and prevalence of schizophrenia show
prominent variation between locations.

Males are more likely to develop schizophrenia than females

(1.4:1).

Migrant status, urban birth or residence, and advanced

paternal age are associated with an increased risk of developing
schizophrenia.

• Prenatal infection and nutrition are associated with an

increased risk of schizophrenia.

• Individuals with schizophrenia have a 2-3-fold increased

mortality risk compared with the general population. This
differential mortality gap may have worsened in recent decades.

Epidemiology is good for generating candidate exposures but

poor at proving them. Cross-disciplinary projects between
epidemiology and neuroscience may help us understand the
pathways leading to schizophrenia.

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Text 4
!Patient privacy versus protecting the patient and the
!health system from harm: a case study

Dawn E DeWitt, Stephanie A Ward, Sandeep Prabhu and Bruce Warton

MJA 2009; 191 (4): 213-216

• A 71-year-old man who presented to hospital with chest pain

and a history of cardiovascular disease was repeatedly
hospitalised over the course of a month for care that included
multiple investi~~ations, intensive care, transfer to and from a
metropolitan hospital, discharge, and readmissions for collapse,
hemiparesis, and vision change.

The medical team excluded underlying disease related to his

initial chest pain and subsequent neurological symptoms. A
search for (undisclosed) prior hospitalisations revealed multiple
previous admissions and invasive investigations at hospitals
across Australia, resulting in a diagnosis of Munchausen
syndrome.

In our view, this case highlights conflicts between privacy

legislation and doctors' mandates to protect the patient from harm,
as well as their duty to attend to the financial viability of health
services by communicating with other potential health care
providers.

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sch1zophrema are highlighted m recent 1. tr 1 1 , · • · ·
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This gap has worsened
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An 12. . throws light on •
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suffering from psychosis. All serious

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14. illness is associated with

unnecessary 15. and 14. '._:__
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some or all of their treatment from 17. 16. .:/( j ' -

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A 71-year-old man eventually

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case in point. He suffered repeated
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hospitalisation and invasive

investigations at hospitals across
Australia, resulting in collapse.
19. and vision change. I /, ,.
His case highlights the conflict between 19 . r i ' ' :: : ; -~~~ ~ r J
privacy legislation and the duty of
doctors to protect the patient from
harm.

Another study assessed the incidence \(

of 20. and its associated
20.
sociodemographic, clinical and ,. '
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23. . The results showed 23. / I

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that. 24. 1 ~,~f't·:·.j r;., ., ,of the 24. J
25. patients studied suffered 25.
from 26. syndrome, with the 26. .. .. I
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highest rate among patients with 27. / .··· , / ;" ..-" t' / ' .•
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Prevalence of 29. syndrome 29. '
was significantly associatE~d with 30.
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30. index.
Patients with metabolic syndrome and
schizophrenia had a prevalence among
the highest in the 31.
31' ' '.

Researchers suggest that 32.

32. projects between 33. I
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33. and neuroscience 34. f I

would help us better.34. the 35. '

35. to schizophrenia.

THAT IS THE END OF THE READING TEST

TOTAL SCORE: /35

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