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Ratheesh A, Speed M, Salagre E, Berk M, Rohde C, Østergaard SD. Prior psychiatric morbidity and differential psychopharmacological treatment patterns: Exploring the heterogeneity of bipolar disorder in a nationwide study of 9594 patients. Bipolar Disord 2024. [PMID: 38649302 DOI: 10.1111/bdi.13432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Individuals with bipolar disorders (BD) have heterogenic pre-onset illness courses and responses to treatment. The pattern of illness preceding the diagnosis of BD may be a marker of future treatment response. Here, we examined associations between psychiatric morbidity preceding the diagnosis of BD and pharmacological treatment patterns in the 2 years following diagnosis. METHODS In this register-based study, we included all patients with a diagnosis of BD attending Danish Psychiatric Services between January 1, 2012 and December 31, 2016. We examined the association between a diagnosis of substance use disorder, psychosis (other than schizophrenia or schizoaffective disorder), unipolar depression, anxiety/OCD, PTSD, personality disorder, or ADHD preceding BD and pharmacological treatment patterns following the diagnosis of BD (lithium, valproate, lamotrigine, antidepressants, olanzapine, risperidone, and quetiapine) via multivariable Cox proportional hazards regression adjusted for age, sex, and year of BD diagnosis. RESULTS We included 9594 patients with a median age of 39 years, 58% of whom were female. Antidepressants, quetiapine, and lamotrigine were the most commonly used medications in BD and were all linked to prior depressive illness and female sex. Lithium was used among patients with less diagnostic heterogeneity preceding BD, while valproate was more likely to be used for patients with prior substance use disorder or ADHD. CONCLUSION The pharmacological treatment of BD is linked to psychiatric morbidity preceding its diagnosis. Assuming that these associations reflect well-informed clinical decisions, this knowledge may inform future clinical trials by taking participants' prior morbidity into account in treatment allocation.
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Affiliation(s)
- Aswin Ratheesh
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Maria Speed
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Estela Salagre
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Berk
- School of Medicine, Barwon Health, Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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2
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Scott J, Iorfino F, Capon W, Crouse J, Nelson B, Chanen AM, Dwyer D, Conus P, Bechdolf A, Ratheesh A, Raballo A, Yung A, Berk M, McKenna S, Hockey S, Hutcheon A, Scott E, McGorry P, Shah J, Hickie IB. Staging 2·0: refining transdiagnostic clinical staging frameworks to enhance reliability and utility for youth mental health. Lancet Psychiatry 2024:S2215-0366(24)00060-9. [PMID: 38643773 DOI: 10.1016/s2215-0366(24)00060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/23/2024]
Abstract
Globally, 75% of depressive, bipolar, and psychotic disorders emerge by age 25 years. However, these disorders are often preceded by non-specific symptoms or attenuated clinical syndromes. Difficulties in determining optimal treatment interventions for these emerging mental disorders, and uncertainties about accounting for co-occurring psychopathology and illness trajectories, have led many youth mental health services to adopt transdiagnostic clinical staging frameworks. In this Health Policy paper, an international working group highlights ongoing challenges in applying transdiagnostic staging frameworks in clinical research and practice, and proposes refinements to the transdiagnostic model to enhance its reliability, consistent recording, and clinical utility. We introduce the concept of within-stage heterogeneity and describe the advantages of defining stage in terms of clinical psychopathology and stage modifiers. Using examples from medicine, we discuss the utility of categorising stage modifiers into factors associated with progression (ie, potential predictors of stage transition) and extension (ie, factors associated with the current presentation that add complexity to treatment selection). Lastly, we suggest how it is possible to revise the currently used transdiagnostic staging approach to incorporate these key concepts, and how the revised framework could be applied in clinical and research practice.
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Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - William Capon
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Jacob Crouse
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Barnaby Nelson
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew M Chanen
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Dominic Dwyer
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Philippe Conus
- General Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, CCM, Charité Universitatsmedizin, Berlin, Germany
| | - Aswin Ratheesh
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Raballo
- Faculty of Biomedical Sciences, Universita della Svizzera Italiana, Lugano, Switzerland
| | - Alison Yung
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University and Barwon Health, Geelong, VIC, Australia
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University and Barwon Health, Geelong, VIC, Australia
| | - Sarah McKenna
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Samuel Hockey
- Lived Experience Working Group, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Alexis Hutcheon
- Lived Experience Working Group, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Pat McGorry
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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3
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Amminger GP, Rice S, Davey CG, Quinn AL, Hermens DF, Zmicerevska N, Nichles A, Hickie I, Incerti L, Weller A, Joseph S, Hilton Z, Pugh C, Rayner M, Reid N, Ratheesh A, Yung AR, Yuen HP, Mackinnon A, Hetrick S, Parker A, Street R, Berger M, Berk M, McGorry PD, Lin A. The Addition of Fish Oil to Cognitive Behavioral Case Management for Youth Depression: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Clinical Trial. Biol Psychiatry 2024; 95:426-433. [PMID: 37355004 DOI: 10.1016/j.biopsych.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Clinical trials suggest that long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) (fish oil) may reduce depressive symptoms in adults with major depressive disorder. Therefore, n-3 PUFAs may be a potential treatment for depression in youth. METHODS Participants were 15- to-25 year-old individuals with major depressive disorder who sought care in one of three government-funded mental health services for young people in metropolitan Melbourne, Perth, or Sydney, Australia. Participants were randomly assigned in a double-blind, parallel-arm design to receive either fish oil (840 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid) or placebo capsules as adjunct to cognitive behavioral case management. All participants were offered 50-minute cognitive behavioral case management sessions every 2 weeks delivered by qualified therapists (treatment as usual) at the study sites during the intervention period. The primary outcome was change in the interviewer-rated Quick Inventory of Depressive Symptomatology, Adolescent Version, score at 12 weeks. Erythrocyte n-3 PUFA levels were assessed pre-post intervention. RESULTS A total of 233 young people were randomized to the treatment arms: 115 participants to the n-3 PUFA group and 118 to the placebo group. Mean change from baseline in the Quick Inventory of Depressive Symptomatology score was -5.8 in the n-3 PUFA group and -5.6 in the placebo group (mean difference, 0.2; 95% CI, -1.1 to 1.5; p = .75). Erythrocyte PUFA levels were not associated with depression severity at any time point. The incidence and severity of adverse events were similar in the two groups. CONCLUSIONS This placebo-controlled trial and biomarker analysis found no evidence to support the use of fish oil for treatment in young people with major depressive disorder.
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Affiliation(s)
- G Paul Amminger
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Simon Rice
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher G Davey
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Amelia L Quinn
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Natalia Zmicerevska
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Alissa Nichles
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Ian Hickie
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Lisa Incerti
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Amber Weller
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Joseph
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Zarah Hilton
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Charlotte Pugh
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Madeline Rayner
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Nate Reid
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alison R Yung
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Hok Pan Yuen
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Mackinnon
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Hetrick
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Alexandra Parker
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Rebekah Street
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Maximus Berger
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Patrick D McGorry
- Orygen, Melbourne, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
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Ratheesh A, Bechdolf A. Clinical risk prediction for bipolar disorder: If, when and how? Aust N Z J Psychiatry 2024; 58:193-194. [PMID: 38351492 DOI: 10.1177/00048674241233861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy und Psychosomatic, Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, CCM, Charité - Universitätsmedizin, Berlin, Germany
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5
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Destrée L, McGorry P, Chanen A, Ratheesh A, Davey C, Polari A, Amminger P, Yuen HP, Hartmann J, Dwyer D, Spooner R, Nelson B. Transdiagnostic risk identification: A validation study of the Clinical High At Risk Mental State (CHARMS) criteria. Psychiatry Res 2024; 333:115745. [PMID: 38271886 DOI: 10.1016/j.psychres.2024.115745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
A set of clinical criteria, the Clinical High At-Risk Mental State (CHARMS) criteria, have been developed to identify symptomatic young people who are at-risk of disorder progression. The current study aimed to validate the CHARMS criteria by testing whether they prospectively identify individuals at-risk of progressing from attenuated symptomatology to a first episode of serious mental disorder, namely first episode psychosis, first episode mania, severe major depression, and borderline personality disorder. 121 young people completed clinical evaluations at baseline, 6- and 12-month follow-up. The Kaplan-Meier method was used to assess transition rates. Cox regression and LASSO were used to examine baseline clinical predictors of transition. Linear mixed effects modelling was used to examine symptom severity. 28 % of CHARMS+ individuals transitioned to a Stage 2 disorder by 12-month follow-up. The CHARMS+ group had more severe symptoms at follow-up than the CHARMS- group. 96 % of Stage 2 transitions were initially to severe depression. Meeting criteria for multiple CHARMS subgroups was associated with higher transition risk: meeting one at-risk group = 24 %; meeting two at-risk groups = 17 %, meeting three at-risk groups = 55 %, meeting four at-risk groups = 50 %. The strongest baseline predictor of transition was severity of depressive symptoms. The CHARMS criteria identified a group of individuals at-risk of imminent onset of severe mental disorder, particularly severe depression. Larger scale studies and longer follow-up periods are required to validate and extend these findings.
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Affiliation(s)
- Louise Destrée
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Victoria, Australia; Orygen, Parkville, VIC, Australia.
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew Chanen
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher Davey
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Paul Amminger
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jessica Hartmann
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Dominic Dwyer
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Rachael Spooner
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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6
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Gates J, Bendall S, Tremain H, Shelton C, Hammond D, Macneil C, McGorry P, Berk M, Cotton S, Murray G, Ratheesh A. Research Letter: What do Australian consumers with lived experience of bipolar disorder want from early intervention services? Aust N Z J Psychiatry 2024; 58:280-283. [PMID: 38095079 DOI: 10.1177/00048674231215021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
- Jesse Gates
- Orygen, Parkville, VIC, Australia
- Melbourne Health, Melbourne, VIC, Australia
| | - Sarah Bendall
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Hailey Tremain
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Clare Shelton
- Orygen, Parkville, VIC, Australia
- Melbourne Health, Melbourne, VIC, Australia
| | - Dylan Hammond
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Craig Macneil
- Orygen, Parkville, VIC, Australia
- Melbourne Health, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health and Deakin University, Geelong, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry, and the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Sue Cotton
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Melbourne Health, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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7
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Bryce S, Cheng N, Dalton A, Ojinnaka A, Stainton A, Zbukvic I, Ratheesh A, O'Halloran C, Uren J, Gates J, Daglas-Georgiou R, Wood SJ, Allott K. Cognitive health treatment priorities and preferences among young people with mental illness: The your mind, your choice survey. Early Interv Psychiatry 2024; 18:94-101. [PMID: 37198726 DOI: 10.1111/eip.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
AIM Cognitive impairments negatively impact the everyday functioning of young people with mental illness. However, no previous study has asked young people (1) how much of a priority cognitive functioning is within mental health treatment, and (2) what types of cognition-focused treatments are most appealing. The current study aimed to address these questions. METHODS Your Mind, Your Choice was a survey-based study involving an Australian sample of young people who were receiving mental health treatment. The survey asked participants to (1) provide demographic and mental health history, (2) rate the importance of 20 recovery domains, including cognition, when receiving mental health treatment, (3) share their experiences of cognitive functioning, and (4) rate their likelihood of trying 14 different behavioural, biochemical, and physical treatments that may address cognitive functioning. RESULTS Two-hundred and forty-three participants (Mage = 20.07, SD = 3.25, range = 15-25, 74% female) completed the survey. Participants reported that addressing cognitive functioning in mental health care was very important (M = 76.33, SD = 20.7, rated on a scale from 0 = not important to 100 = extremely important), ranking cognition among their top six treatment needs. Seventy percent of participants reported experiencing cognitive difficulties, but less than one-third had received treatment for these difficulties. Compensatory training, sleep interventions and psychoeducation were ranked as treatments that participants were most likely to try to support their cognitive functioning. CONCLUSIONS Young people with mental ill-health commonly experience cognitive difficulties and would like this to be a focus of treatment; however, this need is often unmet and should be a focus of research and implementation.
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Affiliation(s)
- Shayden Bryce
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
- Alfred Mental and Addiction Health, Melbourne, Australia
| | - Nicholas Cheng
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | | | | | - Alexandra Stainton
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Isabel Zbukvic
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | | | - Jacquie Uren
- Alfred Mental and Addiction Health, Melbourne, Australia
- Headspace Early Psychosis, Alfred Health, Melbourne, Australia
| | | | - Rothanthi Daglas-Georgiou
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Kelly Allott
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
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8
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Stainton A, Cheng N, Bryce S, Dalton A, Ojinnaka A, Zbukvic I, Ratheesh A, O'Halloran C, Uren J, Gates J, Daglas-Georgiou R, Wood SJ, Allott K. Cognition is a treatment priority for young people with psychosis: Findings from the Your Mind, Your Choice survey. Schizophr Res 2023; 262:30-31. [PMID: 37922840 DOI: 10.1016/j.schres.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/13/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Alexandra Stainton
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.
| | - Nicholas Cheng
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Shayden Bryce
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Alfred Mental and Addiction Health, Melbourne, Australia
| | | | | | - Isabel Zbukvic
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | | | - Jacquie Uren
- Alfred Mental and Addiction Health, Melbourne, Australia; Headspace Early Psychosis, Alfred Health, Melbourne, Australia
| | | | - Rothanthi Daglas-Georgiou
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; School of Psychology, University of Birmingham, UK
| | - Kelly Allott
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
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9
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Tse NY, Ratheesh A, Ganesan S, Zalesky A, Cash RFH. Functional dysconnectivity in youth depression: Systematic review, meta-analysis, and network-based integration. Neurosci Biobehav Rev 2023; 153:105394. [PMID: 37739327 DOI: 10.1016/j.neubiorev.2023.105394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/11/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023]
Abstract
Youth depression has been associated with heterogenous patterns of aberrant brain connectivity. To make sense of these divergent findings, we conducted a systematic review encompassing 19 resting-state fMRI seed-to-whole-brain studies (1400 participants, comprising 795 youths with major depression and 605 matched healthy controls). We incorporated separate meta-analyses of connectivity abnormalities across the levels of the most commonly seeded brain networks (default-mode and limbic networks) and, based on recent additions to the literature, an updated meta-analysis of amygdala dysconnectivity in youth depression. Our findings indicated broad and distributed findings at an anatomical level, which could not be captured by conventional meta-analyses in terms of spatial convergence. However, we were able to parse the complexity of region-to-region dysconnectivity by considering constituent regions as components of distributed canonical brain networks. This integration revealed dysconnectivity centred on central executive, default mode, salience, and limbic networks, converging with findings from the adult depression literature and suggesting similar neurobiological underpinnings of youth and adult depression.
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Affiliation(s)
- Nga Yan Tse
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
| | - Aswin Ratheesh
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Saampras Ganesan
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia; Department of Biomedical Engineering, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia; Department of Biomedical Engineering, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Australia
| | - Robin F H Cash
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia; Department of Biomedical Engineering, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Australia
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Ratheesh A, Hammond D, Watson M, Betts J, Siegel E, McGorry P, Berk M, Cotton S, Chanen A, Nelson B, Bechdolf A. Bipolar At-Risk Criteria and Risk of Bipolar Disorder Over 10 or More Years. JAMA Netw Open 2023; 6:e2334078. [PMID: 37713195 PMCID: PMC10504610 DOI: 10.1001/jamanetworkopen.2023.34078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/28/2023] [Indexed: 09/16/2023] Open
Abstract
Importance Predicting the onset of bipolar disorder (BD) could facilitate preventive treatments. Among risk measures, bipolar at-risk (BAR) criteria have shown promise in predicting onset of bipolar disorder in the first year in clinical cohorts; however, it is not known whether BAR criteria are associated with the onset of BD in the longer term. Objective To assess the association of BAR criteria with onset of BD over 10 to 13 years follow-up. Design, Setting, and Participants This prospective cohort study, completed between May 1, 2020, and November 7, 2022, included consenting people seeking help for nonpsychotic major mental health difficulties, including mood, personality, and substance use disorders, who were originally recruited at ages 15 to 25 years from a tertiary youth mental health setting in metropolitan Melbourne, Victoria, Australia, from May 1, 2008, to September 30, 2010. Exposure Meeting BAR criteria at baseline. Criteria included subthreshold mania, cyclothymic features, subthreshold depression, and family history of BD. A matched clinical comparison group was recruited from the same help-seeking population. Main Outcomes and Measures The primary outcome was expert consensus diagnosis of BD I or II based on the Mini International Neuropsychiatric Interview, self-reported information collected through online assessments, and linked data on mental health service utilization in Victoria over 10 to 13 years of follow-up. Results Among 69 eligible participants, follow-up data were available for 60 (88.2%). The mean (SD) age at the end of follow-up was 32.9 (2.8) years, and 49 (81.7%) were women. A total of 28 participants met BAR criteria, and 32 were in the comparison group. In the BAR group, 8 patients (28.6%) developed BD over a mean (SD) of 11.1 (0.7) years of follow-up, and no patients in the comparison group developed BD. The risk of developing BD was higher in the BAR group than in the non-BAR group (χ21 = 70.0; P < .001). The proportions of transitions to BD were equal in the first and second halves of the follow-up period. Conclusions and relevance In this cohort study of participants seeking care for mental health difficulties, patients meeting the BAR criteria were significantly more likely to transition to BD over a decade after ascertainment compared with patients not meeting the BAR criteria. The findings suggest that those meeting BAR criteria may benefit from longer-term monitoring and support. Evaluation of predictive properties in longer-term studies using a risk measure will help with implementation of BAR criteria in clinical settings.
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Affiliation(s)
- Aswin Ratheesh
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Dylan Hammond
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Watson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Betts
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Emma Siegel
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Susan Cotton
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew Chanen
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin, Berlin, Germany
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11
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Allott K, Yuen HP, Baldwin L, O'Donoghue B, Fornito A, Chopra S, Nelson B, Graham J, Kerr MJ, Proffitt TM, Ratheesh A, Alvarez-Jimenez M, Harrigan S, Brown E, Thompson AD, Pantelis C, Berk M, McGorry PD, Francey SM, Wood SJ. Effects of risperidone/paliperidone versus placebo on cognitive functioning over the first 6 months of treatment for psychotic disorder: secondary analysis of a triple-blind randomised clinical trial. Transl Psychiatry 2023; 13:199. [PMID: 37301832 DOI: 10.1038/s41398-023-02501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
The drivers of cognitive change following first-episode psychosis remain poorly understood. Evidence regarding the role of antipsychotic medication is primarily based on naturalistic studies or clinical trials without a placebo arm, making it difficult to disentangle illness from medication effects. A secondary analysis of a randomised, triple-blind, placebo-controlled trial, where antipsychotic-naive patients with first-episode psychotic disorder were allocated to receive risperidone/paliperidone or matched placebo plus intensive psychosocial therapy for 6 months was conducted. A healthy control group was also recruited. A cognitive battery was administered at baseline and 6 months. Intention-to-treat analysis involved 76 patients (antipsychotic medication group: 37; 18.6Mage [2.9] years; 21 women; placebo group: 39; 18.3Mage [2.7]; 22 women); and 42 healthy controls (19.2Mage [3.0] years; 28 women). Cognitive performance predominantly remained stable (working memory, verbal fluency) or improved (attention, processing speed, cognitive control), with no group-by-time interaction evident. However, a significant group-by-time interaction was observed for immediate recall (p = 0.023), verbal learning (p = 0.024) and delayed recall (p = 0.005). The medication group declined whereas the placebo group improved on each measure (immediate recall: p = 0.024; ηp2 = 0.062; verbal learning: p = 0.015; ηp2 = 0.072 both medium effects; delayed recall: p = 0.001; ηp2 = 0.123 large effect). The rate of change for the placebo and healthy control groups was similar. Per protocol analysis (placebo n = 16, medication n = 11) produced similar findings. Risperidone/paliperidone may worsen verbal learning and memory in the early months of psychosis treatment. Replication of this finding and examination of various antipsychotic agents are needed in confirmatory trials. Antipsychotic effects should be considered in longitudinal studies of cognition in psychosis.Trial registration: Australian New Zealand Clinical Trials Registry ( http://www.anzctr.org.au/ ; ACTRN12607000608460).
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Affiliation(s)
- Kelly Allott
- Orygen, Parkville, VIC, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lara Baldwin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, University College Dublin, Belfield, Ireland
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Sidhant Chopra
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Melissa J Kerr
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Susy Harrigan
- Department of Social Work, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
- Centre for Mental Health, Melbourne School of Global and Population Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ellie Brown
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew D Thompson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Warwick, UK
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
- NorthWestern Mental Health, Western Hospital Sunshine, St Albans, VIC, Australia
| | - Michael Berk
- Orygen, Parkville, VIC, Australia
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Shona M Francey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Stephen J Wood
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
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12
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Thompson A, Fitzsimons J, Killackey E, Ahern S, Amminger P, Alvarez-Jimenez M, Berk M, Cotton S, McNeil J, McGorry P, Nelson B, O'Donoghue B, Ratheesh A, Rickwood D, Yung A, Wood S. The Australian Early Psychosis Collaborative Consortium (AEPCC): Improving Clinical Care in Early Psychosis. Australas Psychiatry 2023:10398562231174691. [PMID: 37171091 DOI: 10.1177/10398562231174691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The field of early psychosis has undergone considerable expansion over the last few decades and has a strong evidence base of effectiveness. Like all areas of healthcare, however, early psychosis services need to more consistently deliver higher quality care to achieve better outcomes for patients and families. A national clinical research infrastructure is urgently required to enable the sector to deliver the highest quality care and expand and translate evidence more quickly and efficiently. This paper describes the establishment of the Australian Early Psychosis Collaborative Consortium (AEPCC) that aims to achieve this. CONCLUSION AEPCC is the first of its kind in Australia (and internationally). It will deliver the required clinical research infrastructure through the implementation of a clinical quality registry, clinical trials and translation network, and lived experience network. AEPCC will provide a critical resource to better understand the state of early psychosis care, and trial new interventions on a scale that has not previously been possible in Australia.
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Affiliation(s)
- Andrew Thompson
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Joanna Fitzsimons
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Paul Amminger
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael Berk
- Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Sue Cotton
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Patrick McGorry
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Barnaby Nelson
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Aswin Ratheesh
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Debra Rickwood
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alison Yung
- Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Stephen Wood
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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13
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Destrée L, Albertella L, Jobson L, McGorry P, Chanen A, Ratheesh A, Davey C, Polari A, Amminger P, Yuen HP, Hartmann J, Spooner R, Fontenelle LF, Nelson B. The association between stressful experiences and OCD symptoms in young adults at transdiagnostic risk. J Affect Disord 2023; 328:128-134. [PMID: 36812805 DOI: 10.1016/j.jad.2023.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/06/2022] [Accepted: 02/14/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND It is unclear whether there is a specific association between stressful experiences and obsessive-compulsive symptoms or whether this relationship is due to stressful experiences increasing risk for psychopathology generally. AIMS The current study examined the association between stressful experiences and obsessive-compulsive symptom dimensions, while adjusting for coexisting psychiatric symptoms and psychological distress in a young adult transdiagnostic at-risk sample. METHODS Forty-three participants completed self-report measures assessing obsessive-compulsive symptoms, stressful experiences, and a range of other psychiatric symptoms. Regression models examined the relationship between stressful experiences and different obsessive-compulsive symptoms dimensions (i.e., symmetry, fear of harm, contamination, and unacceptable thoughts), adjusting for the influence of coexisting psychiatric symptoms and psychological distress. RESULTS The results showed that there was an association between stressful experiences and obsessive-compulsive symptoms dimension of symmetry. Symptoms of borderline personality disorder were positively associated with the obsessive-compulsive symptom dimensions of symmetry and fear of harm symptoms. Symptoms of psychosis were found to be negatively associated with the obsessive-compulsive symptoms dimension of fear of harm. CONCLUSIONS These findings have implications for understanding the psychological mechanisms that underlie symmetry symptoms and highlight the need to study OCS dimensions separately to inform more precise, mechanism-targeted interventions.
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Affiliation(s)
- Louise Destrée
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Victoria, Australia; Orygen, Parkville, VIC, Australia.
| | - Lucy Albertella
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Victoria, Australia
| | - Laura Jobson
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Victoria, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew Chanen
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher Davey
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Paul Amminger
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jessica Hartmann
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Rachael Spooner
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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14
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Ratheesh A, Hammond D, Gao C, Marwaha S, Thompson A, Hartmann J, Davey C, Zammit S, Berk M, McGorry P, Nelson B. Empirically driven transdiagnostic stages in the development of mood, anxiety and psychotic symptoms in a cohort of youth followed from birth. Transl Psychiatry 2023; 13:103. [PMID: 36990979 PMCID: PMC10052262 DOI: 10.1038/s41398-023-02396-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/24/2023] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
Staging models with transdiagnostic validity across mood, psychotic, and anxiety disorders could advance early intervention efforts as well as our understanding of the common underpinnings of such psychopathology. However, there are few well-supported operationalisations for such transdiagnostic models, particularly in community-based samples. We aimed to explore the inter-relationships among mood, psychotic, and anxiety symptom stages, and their common risk factors to develop data-informed transdiagnostic stages. We included participants from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective ongoing birth cohort study. We developed operational thresholds for stages of depressive, hypomanic, anxiety, and psychotic symptoms based on the existing literature, refined further by expert consensus. We selected 1b level as the primary stage or outcome of interest. This represents moderate symptoms that are likely to be associated with the onset of the need for clinical mental health care. We used questionnaire and clinic data completed by young people ages 18 and 21 years. We used descriptive methods and network analyses to examine the overlap among Stage 1b psychopathology. We then examined the patterns of relationships between several risk factors and 1b stages using logistic regressions. Among 3269 young people with data available to determine all symptom stages, 64.3% were female and 96% Caucasian. Descriptive and network analyses indicated that 1b level depressive, anxiety, and psychotic symptom stages were inter-related while hypomania was not. Similarly, anxiety, depressive, and psychotic 1b stages were associated with the female sex, more emotional and behavioral difficulties in early adolescence, and life events in late adolescence. Hypomania was not related to any of these risk factors. Given their inter-relationships and similar risk factors, anxiety, psychotic and depressive, symptoms could be combined to form a transdiagnostic stage in this cohort. Such empirical transdiagnostic stages could help with prognostication and indicated prevention in youth mental health.
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Affiliation(s)
- Aswin Ratheesh
- Orygen, Parkville, Australia.
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | - Dylan Hammond
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Caroline Gao
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Andrew Thompson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Division of Mental Health and Wellbeing, Warwick Medical school, University of Warwick, Coventry, England
| | - Jessica Hartmann
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Christopher Davey
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Stanley Zammit
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael Berk
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Barwon Health, Geelong, Australia
| | - Patrick McGorry
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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15
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O'Gorman KM, Schmaal L, Ratheesh A, Habib G, Tokatlidis O, Jackson-Simpson J, Cotton SM, Rice SM. Characteristics and clinical needs of young tertiary students attending a specialist mood disorders clinic. Australas Psychiatry 2023:10398562231162224. [PMID: 36913715 DOI: 10.1177/10398562231162224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To investigate the clinical characteristics of tertiary students and non-students attending a specialist clinic for severe mood disorders. METHOD Medical record audit of clients discharged from the Youth Mood Clinic (YMC). Data extracted included depressive symptomatology, suicidal ideation, self-harm, suicide attempt, tertiary education engagement, drop-out and deferral. RESULTS Data from 131 clients (M age = 19.58 years, SD = 2.66) were analysed, including 46 tertiary students. Relative to non-students, at intake, tertiary students reported more severe depressive symptomatology (d = 0.43). They were more likely to experience suicidal ideation at intake (V = 0.23), and during treatment (V = 0.18). Tertiary students were also more likely to be living separately to their family of origin (V = 0.20) but were less likely to have experienced parental separation (V = 0.19). 21.73% of tertiary students dropped out or deferred study during care. CONCLUSION In this cohort, those engaged in tertiary education experience more severe depression and more commonly experienced suicidal ideation. These young people require targeted support for their mental health while they undertake tertiary education.
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Affiliation(s)
- Kieran M O'Gorman
- Orygen, Parkville, VIC, Australia and Centre for Youth Mental Health, 2281The University of Melbourne, Parkville, VIC, Australia
| | - Lianne Schmaal
- Orygen, Parkville, VIC, Australia and Centre for Youth Mental Health, 2281The University of Melbourne, Parkville, VIC, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia and Centre for Youth Mental Health, 2281The University of Melbourne, Parkville, VIC, Australia
| | - George Habib
- Student Success, Students and Scholarly Services, 2281The University of Melbourne, Parkville, VIC, Australia
| | - Orania Tokatlidis
- Counselling and Psychological Services, and Student Success, Students and Scholarly Services, 2281The University of Melbourne, Parkville, VIC, Australia
| | - Jennifer Jackson-Simpson
- Orygen, Parkville, VIC, Australia and Centre for Youth Mental Health, 2281The University of Melbourne, Parkville, VIC, Australia
| | - Sue M Cotton
- Orygen, Parkville, VIC, Australia and Centre for Youth Mental Health, 2281The University of Melbourne, Parkville, VIC, Australia
| | - Simon M Rice
- Orygen, Parkville, VIC, Australia and Centre for Youth Mental Health, 2281The University of Melbourne, Parkville, VIC, Australia
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16
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Ratheesh A, Berk M, Schmaal L. Can we overcome the heterogeneity of mood disorders in clinical trials? Aust N Z J Psychiatry 2023; 57:309-311. [PMID: 36786223 DOI: 10.1177/00048674231158266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Michael Berk
- IMPACT, Deakin University, Parkville, VIC, Australia
| | - Lianne Schmaal
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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17
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Ratheesh A, McGorry P. Trends in antipsychotic prescribing in children and adolescents: more is not necessarily better. Lancet Psychiatry 2023; 10:75-76. [PMID: 36638817 DOI: 10.1016/s2215-0366(23)00003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Aswin Ratheesh
- Orygen, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Patrick McGorry
- Orygen, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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18
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Watson M, Filia K, Stevens A, Cotton S, Nelson B, Ratheesh A. A systematic review and meta-analysis of global and social functioning among people at risk of bipolar disorder. J Affect Disord 2023; 321:290-303. [PMID: 36306929 DOI: 10.1016/j.jad.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Functional status could predict development of bipolar disorder (BD) or have clinical significance. The relationship between BD risk and functioning is poorly understood. We undertook a systematic review examining the global and social functioning of those at risk for BD. METHODS We examined observational studies comparing a risk sample with healthy controls or full-threshold BD participants, using measures of global or social functioning. Risk status included family history of BD, meeting risk criteria, or having prodromal symptomatology, or premorbid functioning of persons with BD. Medline, PsycINFO, and Embase were searched. The Newcastle-Ottawa Scale for Cross-Sectional Studies was used to assess quality. Meta-analyses were performed where possible. RESULTS 7215 studies were screened and 40 studies were included (8474 participants). Risk samples had poorer functioning than controls, and superior functioning to participants with BD. Meta-analysis indicated poorer global functioning among persons with familial risk compared to healthy controls (mean global functional difference: 5.92; 95 % confidence interval: 7.90, 3.95; mean premorbid functioning difference: 2.31; 95 % confidence interval: 0.70, 3.92). Studies with higher proportions of female participants had slightly poorer global functioning. High heterogeneity was attributable functional measures and potentially functionally differential subgroups within the risk samples. LIMITATIONS Broader measures of functioning, such as neurocognition and behavioural measures, were excluded. Measures of global functioning are limited by conflating functioning and symptoms. CONCLUSIONS Functioning in the BD risk populations is intermediate to that of healthy controls and persons with BD, indicating their value in definitions of BD risk, in itself a likely heterogeneous state.
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Affiliation(s)
- M Watson
- The University of Melbourne, Centre for Youth Mental Health, Parkville 3052, Australia; The University of Melbourne, Melbourne Medical School, Parkville 3052, Australia
| | - K Filia
- Orygen, Parkville 3052, Australia
| | | | - S Cotton
- Orygen, Parkville 3052, Australia
| | - B Nelson
- Orygen, Parkville 3052, Australia
| | - A Ratheesh
- Orygen, Parkville 3052, Australia; The University of Melbourne, Centre for Youth Mental Health, Parkville 3052, Australia.
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19
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Ratheesh A, Hett D, Ramain J, Wong E, Berk L, Conus P, Fristad MA, Goldstein T, Hillegers M, Jauhar S, Kessing LV, Miklowitz DJ, Murray G, Scott J, Tohen M, Yatham LN, Young AH, Berk M, Marwaha S. A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention. Int J Bipolar Disord 2023; 11:1. [PMID: 36595095 PMCID: PMC9810772 DOI: 10.1186/s40345-022-00275-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II. METHODS We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the 'early course' of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach. RESULTS From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course. CONCLUSIONS AND RECOMMENDATIONS While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness course. Specifically, there is a compelling need to compare the relative benefits of lithium with other pharmacological agents in preventing recurrences. In addition to symptomatic outcomes, there should be a greater focus on functional impact and tolerability. Effective pharmacological and psychological interventions should be offered to those in early course of BD, balancing potential risks using shared decision-making approaches.
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Affiliation(s)
- A. Ratheesh
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - D. Hett
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
| | - J. Ramain
- grid.8515.90000 0001 0423 4662TIPP Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - E. Wong
- grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - L. Berk
- grid.414257.10000 0004 0540 0062IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - P. Conus
- grid.8515.90000 0001 0423 4662TIPP Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - M. A. Fristad
- grid.261331.40000 0001 2285 7943Nationwide Children’s Hospital, The Ohio State University, Columbus, USA
| | - T. Goldstein
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | - M. Hillegers
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - S. Jauhar
- grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.415717.10000 0001 2324 5535South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK
| | - L. V. Kessing
- grid.475435.4Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D. J. Miklowitz
- grid.19006.3e0000 0000 9632 6718Semel Institute for Neuroscience and Human Behavior, Los Angeles School of Medicine, University of California, Los Angeles, USA
| | - G. Murray
- grid.1027.40000 0004 0409 2862Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - J. Scott
- grid.1006.70000 0001 0462 7212Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - M. Tohen
- grid.266832.b0000 0001 2188 8502Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM USA
| | - L. N. Yatham
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - A. H. Young
- grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.415717.10000 0001 2324 5535South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK
| | - M. Berk
- grid.414257.10000 0004 0540 0062IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - S. Marwaha
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
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20
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Berger M, Li E, Rice S, Davey CG, Ratheesh A, Adams S, Jackson H, Hetrick S, Parker A, Spelman T, Kevin R, McGregor IS, McGorry P, Amminger GP. Cannabidiol for Treatment-Resistant Anxiety Disorders in Young People: An Open-Label Trial. J Clin Psychiatry 2022; 83. [PMID: 35921510 DOI: 10.4088/jcp.21m14130] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Background: Treatment resistance is a significant problem among young people experiencing moderate-to-severe anxiety, affecting nearly half of all patients. This study investigated the safety and efficacy of cannabidiol (CBD), a non-intoxicating component of Cannabis sativa, for anxiety disorders in young people who previously failed to respond to standard treatment. Methods: In this open-label trial, 31 young people aged 12-25 years with a DSM-5 anxiety disorder and no clinical improvement despite treatment with cognitive-behavioral therapy and/or antidepressant medication were enrolled between May 16, 2018, and June 28, 2019. All participants received add-on CBD for 12 weeks on a fixed-flexible schedule titrated up to 800 mg/d. The primary outcome was improvement in anxiety severity, measured with the Overall Anxiety Severity and Impairment Scale (OASIS), at week 12. Secondary outcomes included comorbid depressive symptoms, Clinical Global Impressions scale (CGI) score, and social and occupational functioning. Results: Mean (SD) OASIS scores decreased from 10.8 (3.8) at baseline to 6.3 (4.5) at week 12, corresponding to a -42.6% reduction (P < .0001). Depressive symptoms (P < .0001), CGI-Severity scale scores (P = .0008), and functioning (P = .04) improved significantly. Adverse events were reported in 25 (80.6%) of 31 participants and included fatigue, low mood, and hot flushes or cold chills. There were no serious and/or unexpected adverse events. Conclusions: These findings suggest that CBD can reduce anxiety severity and has an adequate safety profile in young people with treatment-resistant anxiety disorders. Randomized controlled trials are needed to confirm the efficacy and longer-term safety of this compound. Trial Registration: New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12617000825358.
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Affiliation(s)
- Maximus Berger
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Corresponding author: Dr Maximus Berger, 35 Poplar Rd, Melbourne, VIC 3052, Australia
| | - Emily Li
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Simon Rice
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | - Aswin Ratheesh
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sophie Adams
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Sarah Hetrick
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Alexandra Parker
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Institute for Health and Sport, Victoria University, Melbourne, Australia
| | | | - Richard Kevin
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, Australia.,School of Psychology, University of Sydney, Sydney, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, Australia.,School of Psychology, University of Sydney, Sydney, Australia
| | - Patrick McGorry
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - G Paul Amminger
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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21
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Cotton S, Filia K, Watson A, Mackinnon AJ, Hides L, Gleeson JFM, Berk M, Conus P, Lambert M, Schimmelmann B, Herrman H, Rayner V, Ratheesh A, McGorry PD. A protocol for the first episode psychosis outcome study (FEPOS): ≥15 year follow-up after treatment at the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. Early Interv Psychiatry 2022; 16:715-723. [PMID: 34415106 DOI: 10.1111/eip.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Specialist early intervention (SEI) service models are designed to treat symptoms, promote social and vocational recovery, prevent relapse, and resource and up-skill patients and their families. The benefits of SEI over the first few years have been demonstrated. While early recovery can be expected to translate to better long-term outcomes by analogy with other illnesses, there is limited evidence to support this from follow-up studies. The current study involves the long-term follow-up of a sub-set of first episode psychosis (FEP) patients, with a range of diagnoses, who were first treated at Orygen's Early Psychosis Prevention and Intervention Centre (EPPIC) between 1998 and 2000. The aim of this paper is to present the methodology for this follow-up study. METHODS Between January 1998 and December 2000, 786 patients between the ages of 15-29 years were treated at EPPIC, located in Melbourne, Australia. Our cohort consists of 661 people (82 were transferred/discharged and 43 were not diagnosed with a psychotic disorder at time of discharge). The 18-month treatment characteristics of this cohort have been extensively examined in the First Episode Psychosis Outcome Study (FEPOS). The ≥15 year outcomes of this cohort are being examined in this study, known as FEPOS15. RESULTS Participant follow-up is ongoing. In order to extend and assess broader outcomes of the cohort, data linkage with health-related databases will be conducted. CONCLUSION This study will provide a comprehensive evaluation of the long-term trajectory of psychotic disorders after treatment for FEP in a SEI service.
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Affiliation(s)
- Sue Cotton
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Kate Filia
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Amity Watson
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew J Mackinnon
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leanne Hides
- Lives Lived Well Professor of Alcohol, Drugs and Mental Health, Brisbane, Queensland, Australia.,National Centre for Youth Substance Use Research, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,School of Psychology, Queensland University of Technology, Brisbane, Queensland, Australia
| | - John F M Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Michael Berk
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Geelong, Victoria, Australia.,University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | - Philippe Conus
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Martin Lambert
- Centre for Psychosis and Integrated Care, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benno Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Helen Herrman
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Victoria Rayner
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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22
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Cotton SM, Filia KM, Lambert M, Berk M, Ratheesh A, Schimmelmann BG, Macneil C, Hasty M, McGorry PD, Conus P. Not in education, employment and training status in the early stages of bipolar I disorder with psychotic features. Early Interv Psychiatry 2022; 16:609-617. [PMID: 34313390 DOI: 10.1111/eip.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/30/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a lack of existing research regarding young people with bipolar I disorder (BD-I) and psychotic features, who are not in education, employment, and training (NEET). Thus, the aims of the study were to: (a) establish rates of NEET at service entry to a specialist early intervention service; (b) delineate premorbid and current variables associated with NEET status at service entry and (c) examine correlates of NEET status at discharge. METHOD Medical file audit methodology was utilized to collect information on 118 patients with first episode psychotic mania treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. NEET status was determined using the modified vocation status index (MVCI). Bivariate and multivariable logistic variables were used to examine relationships between premorbid, service entry and treatment variables, and NEET status at service entry and discharge. RESULTS The NEET rate was 33.9% at service entry, and 39.2% at discharge. Variables associated with NEET status at service entry were premorbid functioning and polysubstance use. NEET status at service entry was the only significant correlate of NEET status at discharge. When service entry NEET was taken out of the model, substance use during treatment was predictive of NEET status at discharge. CONCLUSIONS NEET status at service entry was related to a history of premorbid decline, and risk factors such as substance use and forensic issues. NEET status can decline during treatment, and utility of vocational intervention programs specifically for BD, in addition to specialist early intervention, needs to be examined.
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Affiliation(s)
- Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Kate M Filia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Berk
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia.,IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Aswin Ratheesh
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Craig Macneil
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Melissa Hasty
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Departement de Psychiatrie CHUV, Université de Lausanne, Prilly, Switzerland
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23
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Tham M, Bendall S, Carlyon-Stewart T, Polari A, Hartmann J, Kerr M, Amminger P, McGorry P, Nelson B, Ratheesh A. My child's future mental health: Carer's engagement with risk identification in an intervention study for youth with at-risk mental states. Early Interv Psychiatry 2022; 16:626-631. [PMID: 34414674 DOI: 10.1111/eip.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
AIM Prevention and early intervention efforts of serious mental illnesses has yielded promising results. However, alongside benefits, several ethical concerns have been raised, including the effects of being identified as being at-risk. In these debates, the voice of parents or carers is conspicuously absent. This is especially concerning as several at-risk interventions are trialled in under-age youth where parents consent on behalf of young people. Therefore, this study aimed to understand carer's experiences of their teenager being identified as at risk for psychosis. METHODS Semi-structured interviews were conducted with seven carers who had provided consent for their teenager to participate in a stepped intervention study for youth at-risk for psychosis. Questions explored their experiences regarding having their teenager being identified as at-risk. Transcripts were analysed using thematic analysis. RESULTS We identified five main themes from seven female carers' experiences of risk identification including: (a) recall of risk information was limited, or variable, (b) goal of risk disclosure was perceived to be positive, (c) negative emotions were associated with knowledge of risk, (d) relief from uncertainty and helplessness and (e) effects of risk disclosure were mediated by individual circumstance. CONCLUSION Overall, the results demonstrate that carers' experience of risk disclosure varied with factors surrounding their individual circumstances, and the process of disclosure. Whilst participants acknowledged potential adverse effects associated with risk disclosure, many still adopted a positive outlook. Tailoring safe and effective disclosure of risk to suit the needs of youth and carers could outweigh the potential risks.
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Affiliation(s)
- Michael Tham
- Orygen Research Centre, Parkville, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Bendall
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Carlyon-Stewart
- Orygen Research Centre, Parkville, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea Polari
- Orygen Research Centre, Parkville, Victoria, Australia.,Orygen Specialist Programs, Orygen Youth Health, Parkville, Victoria, Australia
| | - Jessica Hartmann
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Kerr
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Amminger
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen Research Centre, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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24
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Hasty MK, Macneil CA, Cotton SM, Berk M, Kader L, Ratheesh A, Ramain J, Chanen AM, Conus P. Personality disorder among youth with first episode psychotic mania: An important target for specific treatment? Early Interv Psychiatry 2022; 16:256-263. [PMID: 33768702 DOI: 10.1111/eip.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/16/2021] [Accepted: 03/12/2021] [Indexed: 12/01/2022]
Abstract
AIM Personality disorder is a common co-occurrence ('comorbidity') among patients with bipolar disorder and appears to affect outcome negatively. However, there is little knowledge about the impact of this comorbidity in the early phases of bipolar disorder. We examined the prevalence and effect of personality disorder co-occurrence on outcome in a cohort of youth with first episode mania with psychotic features. METHODS Seventy-one first episode mania patients, aged 15-29, were assessed at baseline, 6, 12, and 18 months as part of a randomized controlled trial of olanzapine and chlorpromazine as add-on to lithium in first episode mania with psychotic features. The current study involved secondary analysis of trial data. RESULTS A co-occurring clinical personality disorder diagnosis was present in 16.9% of patients. Antisocial and narcissistic personality disorders were the most common diagnoses. Patients with co-occurring personality disorder had higher rates of readmission to hospital, lower rates of symptomatic recovery and poorer functional levels at 6 months, but these differences disappeared after 12 and 18 months. CONCLUSIONS In the early phase of bipolar disorder, patients with personality disorder comorbidity display delayed symptomatic and functional recovery and increased likelihood to need hospital readmissions. These observations suggest that routine assessment for personality disorder and specific interventions are important in order to improve short-term treatment efficacy in this subgroup.
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Affiliation(s)
| | | | - Sue M Cotton
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Berk
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Aswin Ratheesh
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Ramain
- Department of Psychiatry CHUV, Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Lausanne University, Lausanne, Switzerland
| | - Andrew M Chanen
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Philippe Conus
- Orygen, Melbourne, Victoria, Australia.,Department of Psychiatry CHUV, Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Lausanne University, Lausanne, Switzerland
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25
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Ratheesh A, Alvarez-Jimenez M. The future of digital mental health in the post-pandemic world: Evidence-based, blended, responsive and implementable. Aust N Z J Psychiatry 2022; 56:107-109. [PMID: 34996319 DOI: 10.1177/00048674211070984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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26
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Dodd S, Bauer M, Carvalho AF, Eyre H, Fava M, Kasper S, Kennedy SH, Khoo JP, Lopez Jaramillo C, Malhi GS, McIntyre RS, Mitchell PB, Castro AMP, Ratheesh A, Severus E, Suppes T, Trivedi MH, Thase ME, Yatham LN, Young AH, Berk M. A clinical approach to treatment resistance in depressed patients: What to do when the usual treatments don't work well enough? World J Biol Psychiatry 2021; 22:483-494. [PMID: 33289425 DOI: 10.1080/15622975.2020.1851052] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Major depressive disorder is a common, recurrent, disabling and costly disorder that is often severe and/or chronic, and for which non-remission on guideline concordant first-line antidepressant treatment is the norm. A sizeable percentage of patients diagnosed with MDD do not achieve full remission after receiving antidepressant treatment. How to understand or approach these 'refractory', 'TRD' or 'difficult to treat' patients need to be revisited. Treatment resistant depression (TRD) has been described elsewhere as failure to respond to adequate treatment by two different antidepressants. This definition is problematic as it suggests that TRD is a subtype of major depressive disorder (MDD), inferring a boundary between TRD and depression that is not treatment resistant. However, there is scant evidence to suggest that a discrete TRD entity exists as a distinct subtype of MDD, which itself is not a discrete or homogeneous entity. Similarly, the boundary between TRD and other forms of depression is predicated at least in part on regulatory and research requirements rather than biological evidence or clinical utility. AIM This paper aims to investigate the notion of treatment failure in order to understand (i) what is TRD in the context of a broader formulation based on the understanding of depression, (ii) what factors make an individual patient difficult to treat, and (iii) what is the appropriate and individualised treatment strategy, predicated on an individual with refractory forms of depression? METHOD Expert contributors to this paper were sought internationally by contacting representatives of key professional societies in the treatment of MDD - World Federation of Societies for Biological Psychiatry, Australasian Society for Bipolar and Depressive Disorders, International Society for Affective Disorders, Collegium Internationale Neuro-Psychopharmacologium and the Canadian Network for Mood and Anxiety Treatments. The manuscript was prepared through iterative editing. OUTCOMES The concept of TRD as a discrete subtype of MDD, defined by failure to respond to pharmacotherapy, is not supported by evidence. Between 15 and 30% of depressive episodes fail to respond to adequate trials of 2 antidepressants, and 68% of individuals do not achieve remission from depression after a first-line course of antidepressant treatment. Failure to respond to antidepressant treatment, somatic therapies or psychotherapies may often reflect other factors including; biological resistance, diagnostic error, limitations of current therapies, psychosocial variables, a past history of exposure to childhood maltreatment or abuse, job satisfaction, personality disorders, co-morbid mental and physical disorders, substance use or non-adherence to treatment. Only a subset of patients not responding to antidepressant treatment can be explained through pharmacokinetic or pharmacodynamics mechanisms. We propose that non remitting MDD should be personalised, and propose a strategy of 'deconstructing depression'. By this approach, the clinician considers which factors contribute to making this individual both depressed and 'resistant' to previous therapeutic approaches. Clinical formulation is required to understand the nature of the depression. Many predictors of response are not biological, and reflect a confluence of biological, psychological, and sociocultural factors, which may influence the illness in a particular individual. After deconstructing depression at a personalised level, a personalised treatment plan can be constructed. The treatment plan needs to address the factors that have contributed to the individual's hard to treat depression. In addition, an individual with a history of illness may have a lot of accumulated life issues due to consequences of their illness, and these should be addressed in a recovery plan. LIMITATIONS A 'deconstructing depression' qualitative rubric does not easily provide clear inclusion and exclusion criteria for researchers wanting to investigate TRD. CONCLUSIONS MDD is a polymorphic disorder and many individuals who fail to respond to standard pharmacotherapy and are considered hard to treat. These patients are best served by personalised approaches that deconstruct the factors that have contributed to the patient's depression and implementing a treatment plan that adequately addresses these factors. The existence of TRD as a discrete and distinct subtype of MDD, defined by two treatment failures, is not supported by evidence.
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Affiliation(s)
- Seetal Dodd
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Barwon Health, University Hospital Geelong, Geelong, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Andre F Carvalho
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Department of Psychiatry, University of Toronto and Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Harris Eyre
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto and Centre for Depression and Suicide Studies, St Michael's Hospital, Toronto, Canada
| | | | | | - Gin S Malhi
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto and Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Mood Disorders Psychopharmacology Unit, Toronto, Canada.,Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, Australia
| | - Angela Marianne Paredes Castro
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Aswin Ratheesh
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Trisha Suppes
- VA Health Care System, Palo Alto, CA, and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Barwon Health, University Hospital Geelong, Geelong, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
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Hartmann JA, McGorry PD, Destree L, Amminger GP, Chanen AM, Davey CG, Ghieh R, Polari A, Ratheesh A, Yuen HP, Nelson B. Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach. Front Psychiatry 2021; 11:553578. [PMID: 33488413 PMCID: PMC7819892 DOI: 10.3389/fpsyt.2020.553578] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 12/02/2020] [Indexed: 12/26/2022] Open
Abstract
Most psychiatric disorders develop during adolescence and young adulthood and are preceded by a phase during which attenuated or episodic symptoms and functional decline are apparent. The introduction of the ultra-high risk (UHR) criteria two decades ago created a new framework for identification of risk and for pre-emptive psychiatry, focusing on first episode psychosis as an outcome. Research in this paradigm demonstrated the comorbid, diffuse nature of emerging psychopathology and a high degree of developmental heterotopy, suggesting the need to adopt a broader, more agnostic approach to risk identification. Guided by the principles of clinical staging, we introduce the concept of a pluripotent at-risk mental state. The clinical high at risk mental state (CHARMS) approach broadens identification of risk beyond psychosis, encompassing multiple exit syndromes such as mania, severe depression, and personality disorder. It does not diagnostically differentiate the early stages of psychopathology, but adopts a "pluripotent" approach, allowing for overlapping and heterotypic trajectories and enabling the identification of both transdiagnostic and specific risk factors. As CHARMS is developed within the framework of clinical staging, clinical utility is maximized by acknowledging the dimensional nature of clinical phenotypes, while retaining thresholds for introducing specific interventions. Preliminary data from our ongoing CHARMS cohort study (N = 114) show that 34% of young people who completed the 12-month follow-up assessment (N = 78) transitioned from Stage 1b (attenuated syndrome) to Stage 2 (full disorder). While not without limitations, this broader risk identification approach might ultimately allow reliable, transdiagnostic identification of young people in the early stages of severe mental illness, presenting further opportunities for targeted early intervention and prevention strategies.
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Affiliation(s)
- Jessica A. Hartmann
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Patrick D. McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Louise Destree
- BrainPark, The Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - G. Paul Amminger
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew M. Chanen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G. Davey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Rachid Ghieh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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28
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Sunder P, Chia MF, Filia K, Macneil C, Hasty M, Davey C, McGorry P, Berk M, Cotton S, Ratheesh A. Does guideline-concordant care predict naturalistic outcomes in youth with early stage bipolar I disorder? J Affect Disord 2021; 278:23-32. [PMID: 32949870 DOI: 10.1016/j.jad.2020.09.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/04/2020] [Accepted: 09/04/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The impact of guideline concordance on naturalistic maintenance treatment outcomes in BD is not known. We sought to evaluate the effect of guideline-concordant care on symptomatic, course and functional outcomes in youth with early-stage BD-I. METHODS In this file audit study, we examined the prospective course of 64 clients with first treatment seeking manic episode of BD-I. Eighteen-month outcome measures included Clinical Global Impressions Scale - Bipolar Version (CGI-BP), Social and Occupational Functioning Assessment Scale (SOFAS) and number of relapses. Correlations and hierarchical linear regressions were used to examine the relationships between guideline concordance and outcomes, while controlling for potential confounders. RESULTS Although higher guideline-concordant care in the maintenance phase was associated with a higher discharge CGI-BP score and thus worse outcome, baseline CGI-BP and insight were more predictive of illness severity at follow-up than guideline concordance. There was no association with SOFAS and guideline-concordant care at follow-up. Greater concordance with maintenance medication guideline statements was also associated with greater number of relapses even after controlling for sex, medication adherence, duration of care and baseline illness severity. LIMITATIONS This study was limited by sample size and its single pool of clients which may limit generalizability. CONCLUSIONS Contrary to our hypotheses, higher guideline concordance was associated with worse outcomes, although this relationship was moderated by the client's illness characteristics, severity and insight. More unwell youth with poor insight, greater severity, and mixed/rapid cycling features may need other interventions or modified guidelines.
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Affiliation(s)
- Priya Sunder
- Orygen, Parkville, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Ming-Fang Chia
- Orygen, Parkville, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Kate Filia
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | | | | | - Christopher Davey
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Patrick McGorry
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Michael Berk
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Sue Cotton
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.
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29
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Alvarez-Jimenez M, Rice S, D'Alfonso S, Leicester S, Bendall S, Pryor I, Russon P, McEnery C, Santesteban-Echarri O, Da Costa G, Gilbertson T, Valentine L, Solves L, Ratheesh A, McGorry PD, Gleeson J. A Novel Multimodal Digital Service (Moderated Online Social Therapy+) for Help-Seeking Young People Experiencing Mental Ill-Health: Pilot Evaluation Within a National Youth E-Mental Health Service. J Med Internet Res 2020; 22:e17155. [PMID: 32788151 PMCID: PMC7453330 DOI: 10.2196/17155] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/12/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background Mental ill-health is the leading cause of disability worldwide. Moreover, 75% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this gap, our team has developed a multimodal, scalable digital mental health service (Enhanced Moderated Online Social Therapy [MOST+]) merging real-time, clinician-delivered web chat counseling; interactive user-directed online therapy; expert and peer moderation; and peer-to-peer social networking. Objective The primary aim of this study is to ascertain the feasibility, acceptability, and safety of MOST+. The secondary aims are to assess pre-post changes in clinical, psychosocial, and well-being outcomes and to explore the correlations between system use, perceived helpfulness, and secondary outcome variables. Methods Overall, 157 young people seeking help from a national youth e-mental health service were recruited over 5 weeks. MOST+ was active for 9 weeks. All participants had access to interactive online therapy and integrated web chat counseling. Additional access to peer-to-peer social networking was granted to 73 participants (46.5%) for whom it was deemed safe. The intervention was evaluated via an uncontrolled single-group study. Results Overall, 93 participants completed the follow-up assessment. Most participants had moderate (52/157, 33%) to severe (96/157, 61%) mental health conditions. All a priori feasibility, acceptability, and safety criteria were met. Participants provided mean scores of ≥3.5 (out of 5) on ease of use (mean 3.7, SD 1.1), relevancy (mean 3.9, SD 1.0), helpfulness (mean 3.5, SD 0.9), and overall experience (mean 3.9, SD 0.8). Moreover, 98% (91/93) of participants reported a positive experience using MOST+, 82% (70/93) reported that using MOST+ helped them feel better, 86% (76/93) felt more socially connected using it, and 92% (86/93) said they would recommend it to others. No serious adverse events or inappropriate use were detected, and 97% (90/93) of participants reported feeling safe. There were statistically significant improvements in 8 of the 11 secondary outcomes assessed: psychological distress (d=−0.39; P<.001), perceived stress (d=−0.44; P<.001), psychological well-being (d=0.51; P<.001), depression (d=−0.29; P<.001), loneliness (d=−0.23; P=.04), social support (d=0.30; P<.001), autonomy (d=0.36; P=.001), and self-competence (d=0.30; P<.001). There were significant correlations between system use, perceived helpfulness, and a number of secondary outcome variables. Conclusions MOST+ is a feasible, acceptable, and safe online clinical service for young people with mental ill-health. The high level of perceived helpfulness, the significant improvements in secondary outcomes, and the correlations between indicators of system use and secondary outcome variables provide initial support for the therapeutic potential of MOST+. MOST+ is a promising and scalable platform to deliver standalone e-mental health services as well as enhance the growing international network of face-to-face youth mental health services.
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Affiliation(s)
- Mario Alvarez-Jimenez
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Simon Rice
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Simon D'Alfonso
- Orygen, Parkville, Australia.,The School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | - Steven Leicester
- headspace National Youth Mental Health Foundation, Melbourne, Australia
| | - Sarah Bendall
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Ingrid Pryor
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Penni Russon
- Orygen, Parkville, Australia.,School of Culture and Communications, The University of Melbourne, Melbourne, Australia
| | - Carla McEnery
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | | | - Gustavo Da Costa
- The School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | | | - Lee Valentine
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Laia Solves
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataro, Mataro, Spain
| | - Aswin Ratheesh
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Patrick D McGorry
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia.,Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
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30
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Stevens M, Ratheesh A, Watson A, Filia K, Donoghue BO, Cotton SM. Rates, types and associations of sexual risk behaviours and sexually transmitted infections in those with severe mental illness: a scoping review. Psychiatry Res 2020; 290:112946. [PMID: 32450411 DOI: 10.1016/j.psychres.2020.112946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022]
Abstract
The aim of this scoping review was to: (i) determine rates and types of sexual risk behaviours and sexually-transmitted infections (STIs) in those with severe mental illness (SMI); and (ii) delineate correlates of poor sexual health outcome. The online databases OVID MedLine and PsycINFO were searched from databases inception to February 2018 for any literature with a focus on sexual risk behaviours (inconsistent condom use, multiple sexual partners, substance use and transactional sexual acts) or STIs in SMI populations. Fourteen studies were identified; the quality of these studies ranged from poor to moderate. Outcome definitions were heterogeneous, precluding meta-analysis. We found rates of sexual risk behaviours and STIs to be more common among those with SMI than the rates in the general Australian population. Current studies do not acknowledge the relationship of sexual risk behaviours and STI risk and hence do not provide a full model of sexual health outcomes in those with SMI. In order to improve sexual health outcomes in SMI populations, further research is required of greater methodological rigor, with consensus in the definition of sexual risk behaviours, clarifying causal relationships and where in the course of SMI that these outcomes emerge.
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Affiliation(s)
- Meg Stevens
- Melbourne Medical School, The University of Melbourne, VIC, Australia
| | - Aswin Ratheesh
- Centre for Youth Mental Health, The University of Melbourne, VIC, Parkville, Australia; Orygen, Parkville, VIC, Australia; Orygen Youth Health, Parkville, VIC
| | - Amity Watson
- Centre for Youth Mental Health, The University of Melbourne, VIC, Parkville, Australia; Orygen, Parkville, VIC, Australia
| | - Kate Filia
- Centre for Youth Mental Health, The University of Melbourne, VIC, Parkville, Australia; Orygen, Parkville, VIC, Australia
| | - Brian O Donoghue
- Centre for Youth Mental Health, The University of Melbourne, VIC, Parkville, Australia; Orygen, Parkville, VIC, Australia; Orygen Youth Health, Parkville, VIC
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, VIC, Parkville, Australia; Orygen, Parkville, VIC, Australia.
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31
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Daglas R, Cotton S, Allott K, Yücel M, Macneil C, Hasty M, Murphy B, Pantelis C, Hallam K, Henry L, Conus P, Ratheesh A, Kader L, Wong M, McGorry P, Berk M. A single-blind, randomised controlled trial on the effects of lithium and quetiapine monotherapy on the trajectory of cognitive functioning in first episode mania: A 12-month follow-up study. Eur Psychiatry 2020; 31:20-8. [DOI: 10.1016/j.eurpsy.2015.09.460] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/25/2015] [Accepted: 09/27/2015] [Indexed: 11/30/2022] Open
Abstract
AbstractBackgroundCognitive deficits have been reported during the early stages of bipolar disorder; however, the role of medication on such deficits remains unclear. The aim of this study was to compare the effects of lithium and quetiapine monotherapy on cognitive performance in people following first episode mania.MethodsThe design was a single-blind, randomised controlled trial on a cohort of 61 participants following first episode mania. Participants received either lithium or quetiapine monotherapy as maintenance treatment over a 12-month follow-up period. The groups were compared on performance outcomes using an extensive cognitive assessment battery conducted at baseline, month 3 and month 12 follow-up time-points.ResultsThere was a significant interaction between group and time in phonemic fluency at the 3-month and 12-month endpoints, reflecting greater improvements in performance in lithium-treated participants relative to quetiapine-treated participants. After controlling for multiple comparisons, there were no other significant interactions between group and time for other measures of cognition.ConclusionAlthough the effects of lithium and quetiapine treatment were similar for most cognitive domains, the findings imply that early initiation of lithium treatment may benefit the trajectory of cognition, specifically verbal fluency in young people with bipolar disorder. Given that cognition is a major symptomatic domain of bipolar disorder and has substantive effects on general functioning, the ability to influence the trajectory of cognitive change is of considerable clinical importance.
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32
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Francey SM, O’Donoghue B, Nelson B, Graham J, Baldwin L, Yuen HP, Kerr MJ, Ratheesh A, Allott K, Alvarez-Jimenez M, Fornito A, Harrigan S, Thompson AD, Wood S, Berk M, McGorry PD. Psychosocial Intervention With or Without Antipsychotic Medication for First-Episode Psychosis: A Randomized Noninferiority Clinical Trial. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa015] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
This triple-blind (participants, clinicians, and researchers) randomized controlled noninferiority trial examined whether intensive psychosocial intervention (cognitive-behavioral case management, CBCM) for first-episode psychosis (FEP) in 15–25 year-olds managed in a specialized early intervention for psychosis service was noninferior to usual treatment of antipsychotic medication plus CBCM delivered during the first 6 months of treatment. To maximize safety, participants were required to have low levels of suicidality and aggression, a duration of untreated psychosis (DUP) of less than 6 months, and be living in stable accommodation with social support. The primary outcome was level of functioning as assessed by the Social and Occupational Functioning Scale (SOFAS) at 6 months. Ninety young people were randomized by computer, 46 to placebo, and 44 antipsychotic medication and 33% of those who commenced trial medication completed the entire 6-month trial period. On the SOFAS, both groups improved, and group differences were small and clinically trivial, indicating that treatment with placebo medication was no less effective than conventional antipsychotic treatment (mean difference = −0.2, 2-sided 95% confidence interval = −7.5 to 7.0, t = 0.060, P = .95). Within the context of a specialized early intervention service, and with a short DUP, the immediate introduction of antipsychotic medication may not be required for all cases of FEP in order to see functional improvement. However, this finding can only be generalized to a very small proportion of FEP cases at this stage, and a larger trial is required to clarify whether antipsychotic-free treatment can be recommended for specific subgroups of those with FEP.
Trial Registration: ACTRN12607000608460 (www.anzctr.org.au).
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Affiliation(s)
- Shona M Francey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Brian O’Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jessica Graham
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Lara Baldwin
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Hok Pan Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Melissa J Kerr
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Monash Biomedical Imaging, Monash University, Clayton, Australia
| | - Susy Harrigan
- Centre for Mental Health, Melbourne School of Global and Population Health, The University of Melbourne, Parkville, Australia
| | - Andrew D Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Stephen Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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33
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Berk M, Mohebbi M, Dean OM, Cotton SM, Chanen AM, Dodd S, Ratheesh A, Amminger GP, Phelan M, Weller A, Mackinnon A, Giorlando F, Baird S, Incerti L, Brodie RE, Ferguson NO, Rice S, Schäfer MR, Mullen E, Hetrick S, Kerr M, Harrigan SM, Quinn AL, Mazza C, McGorry P, Davey CG. Youth Depression Alleviation with Anti-inflammatory Agents (YoDA-A): a randomised clinical trial of rosuvastatin and aspirin. BMC Med 2020; 18:16. [PMID: 31948461 PMCID: PMC6966789 DOI: 10.1186/s12916-019-1475-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/27/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Inflammation contributes to the pathophysiology of major depressive disorder (MDD), and anti-inflammatory strategies might therefore have therapeutic potential. This trial aimed to determine whether adjunctive aspirin or rosuvastatin, compared with placebo, reduced depressive symptoms in young people (15-25 years). METHODS YoDA-A, Youth Depression Alleviation with Anti-inflammatory Agents, was a 12-week triple-blind, randomised, controlled trial. Participants were young people (aged 15-25 years) with moderate to severe MDD (MADRS mean at baseline 32.5 ± 6.0; N = 130; age 20.2 ± 2.6; 60% female), recruited between June 2013 and June 2017 across six sites in Victoria, Australia. In addition to treatment as usual, participants were randomised to receive aspirin (n = 40), rosuvastatin (n = 48), or placebo (n = 42), with assessments at baseline and weeks 4, 8, 12, and 26. The primary outcome was change in the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to week 12. RESULTS At the a priori primary endpoint of MADRS differential change from baseline at week 12, there was no significant difference between aspirin and placebo (1.9, 95% CI (- 2.8, 6.6), p = 0.433), or rosuvastatin and placebo (- 4.2, 95% CI (- 9.1, 0.6), p = 0.089). For rosuvastatin, secondary outcomes on self-rated depression and global impression, quality of life, functioning, and mania were not significantly different from placebo. Aspirin was inferior to placebo on the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) at week 12. Statins were superior to aspirin on the MADRS, the Clinical Global Impressions Severity Scale (CGI-S), and the Negative Problem Orientation Questionnaire scale (NPOQ) at week 12. CONCLUSIONS The addition of either aspirin or rosuvastatin did not to confer any beneficial effect over and above routine treatment for depression in young people. Exploratory comparisons of secondary outcomes provide limited support for a potential therapeutic role for adjunctive rosuvastatin, but not for aspirin, in youth depression. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12613000112763. Registered on 30/01/2013.
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Affiliation(s)
- Michael Berk
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia. .,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia. .,The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia. .,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia. .,Department of Psychiatry, University of Melbourne, Parkville, Australia. .,Barwon Health, PO Box 281, Geelong, Victoria, 3220, Australia.
| | - Mohammadreza Mohebbi
- The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia.,Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
| | - Olivia M Dean
- The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Barwon Health, PO Box 281, Geelong, Victoria, 3220, Australia
| | - Sue M Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Andrew M Chanen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Seetal Dodd
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia.,Barwon Health, PO Box 281, Geelong, Victoria, 3220, Australia
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - G Paul Amminger
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Mark Phelan
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Amber Weller
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Andrew Mackinnon
- Black Dog Institute, University of New South Wales, Sydney, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Francesco Giorlando
- Department of Psychiatry, University of Melbourne, Parkville, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Shelley Baird
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Lisa Incerti
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Rachel E Brodie
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Natalie O Ferguson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Simon Rice
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Miriam R Schäfer
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Edward Mullen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Sarah Hetrick
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Melissa Kerr
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Susy M Harrigan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Department of Social Work, Monash University, Melbourne, Australia
| | - Amelia L Quinn
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Catherine Mazza
- The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia
| | - Patrick McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Christopher G Davey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
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Faedda GL, Baldessarini RJ, Marangoni C, Bechdolf A, Berk M, Birmaher B, Conus P, DelBello MP, Duffy AC, Hillegers MHJ, Pfennig A, Post RM, Preisig M, Ratheesh A, Salvatore P, Tohen M, Vázquez GH, Vieta E, Yatham LN, Youngstrom EA, Van Meter A, Correll CU. An International Society of Bipolar Disorders task force report: Precursors and prodromes of bipolar disorder. Bipolar Disord 2019; 21:720-740. [PMID: 31479581 DOI: 10.1111/bdi.12831] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To clarify the clinical features preceding the onset of bipolar disorder (BD) has become a public health priority for the prevention of high morbidity and mortality. BD remains frequently under- or misdiagnosed, and under- or mistreated, often for years. METHODS We assessed the predictive value of precursors and prodromes of BD. We assessed precursors of first-lifetime manic or hypomanic episodes with/without mixed features in retrospective and prospective studies. The task force evaluated and summarized separately assessments of familial risk, premorbid personality traits, retrospective, and prospective studies. RESULTS Cyclothymic features, a family history of BD, retrospectively reported attenuated manic symptoms, prospectively identified subthreshold symptoms of hypomania, recurrence of depression, panic anxiety and psychotic features, have been identified as clinical precursors of BD. The prodromal symptoms like [hypo]mania often appears to be long enough to encourage early identification and timely intervention. CONCLUSIONS The predictive value of any risk factor identified remains largely unknown. Prospective controlled studies are urgently needed for prevention and effective treatment.
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Affiliation(s)
- Gianni L Faedda
- Mood Disorders Center, New York, NY, USA.,International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
| | - Ross J Baldessarini
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Mailman Research Center, McLean Hospital, Boston, MA, USA
| | - Ciro Marangoni
- Department of Psychiatry-District 3, ULSS 9 Scaligera, Verona, Italy
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichschain, Charite Universitätsmedizin, Berlin, Germany
| | - Michael Berk
- IMPACT Strategic Research Centre, University Hospital Geelong, Barwon Health, Deakin University, Geelong, VIC, Australia.,Orygen, The National Center of Excellence in Youth Mental Health, Parkville, VIC, Australia.,The Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Lausanne, Switzerland
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Anne C Duffy
- Department of Psychiatry, Student Wellness Services, Queen's University, Kingston, ON, Canada
| | - Manon H J Hillegers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, USA.,Department of Psychiatry, George Washington University School of Medicine, Washington, DC, USA
| | - Martin Preisig
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Aswin Ratheesh
- IMPACT Strategic Research Centre, University Hospital Geelong, Barwon Health, Deakin University, Geelong, VIC, Australia.,Orygen, The National Center of Excellence in Youth Mental Health, Parkville, VIC, Australia.,The Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Paola Salvatore
- Department of Psychiatry, Harvard Medical School, Mailman Research Center, McLean Hospital, Boston, MA, USA.,Psychiatry Section, Department of Neuroscience, School of Medicine, University of Parma, Parma, Italy
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Gustavo H Vázquez
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.,Psychiatry, Queen's University, Kingston, ON, Canada
| | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Lakshmi N Yatham
- Department of Psychiatry, Mood Disorders Centre, University of British Columbia, Vancouver, BD, Canada
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna Van Meter
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA.,The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA.,The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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35
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Weller A, Gleeson J, Alvarez-Jimenez M, McGorry P, Nelson B, Allott K, Bendall S, Bartholomeusz C, Koval P, Harrigan S, O'Donoghue B, Fornito A, Pantelis C, Paul Amminger G, Ratheesh A, Polari A, Wood SJ, van der El K, Ellinghaus C, Gates J, O'Connell J, Mueller M, Wunderink L, Killackey E. Can antipsychotic dose reduction lead to better functional recovery in first-episode psychosis? A randomized controlled-trial of antipsychotic dose reduction. The reduce trial: Study protocol. Early Interv Psychiatry 2019; 13:1345-1356. [PMID: 30488637 DOI: 10.1111/eip.12769] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/04/2018] [Accepted: 11/08/2018] [Indexed: 01/04/2023]
Abstract
UNLABELLED Antipsychotic medication has been the mainstay of treatment for psychotic illnesses for over 60 years. This has been associated with improvements in positive psychotic symptoms and a reduction in relapse rates. However, there has been little improvement in functional outcomes for people with psychosis. At the same time there is increasing evidence that medications contribute to life shortening metabolic and cardiovascular illnesses. There is also uncertainty as to the role played by antipsychotic medication in brain volume changes. AIM The primary aim of the study is, in a population of young people with first-episode psychosis, to compare functional outcomes between an antipsychotic dose reduction strategy with evidence-based intensive recovery treatment (EBIRT) group (DRS+) and an antipsychotic maintenance treatment with EBIRT group (AMTx+) at 24-months follow-up. METHODS Our single-blind randomized controlled trial, within a specialist early psychosis treatment setting, will test the whether the DRS+ group leads to better vocational and social recovery than, the AMTx+ group over a 2-year period in 180 remitted first-episode psychosis patients. Additionally, we will examine the effect of DRS+ vs AMTx+ on physical health, brain volume and cognitive functioning. This study will also determine whether the group receiving DRS+ will be no worse off in terms of psychotic relapses over 2 years follow-up. RESULTS This paper presents the protocol, rationale and hypotheses for this study which commenced recruitment in July 2017. CONCLUSION This study will provide evidence as to whether an antipsychotic dose-reduction recovery treatment leads to improved functioning and safer outcomes in first-episode psychosis patients. In addition, it will be the first-controlled experiment of the effect of exposure to antipsychotic maintenance treatment on brain volume changes in this population.
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Affiliation(s)
- Amber Weller
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Gleeson
- Australian Catholic University, Melbourne, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly Allott
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Bendall
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cali Bartholomeusz
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Koval
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Susy Harrigan
- Centre for Mental Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Health, Melbourne, Victoria, Australia
| | - Alex Fornito
- Monash Clinical and Imaging Neuroscience, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Melbourne, Victoria, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - G Paul Amminger
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Health, Melbourne, Victoria, Australia
| | - Andrea Polari
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Health, Melbourne, Victoria, Australia
| | - Stephen J Wood
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,School of Psychology, University of Birmingham, Edgbaston, UK
| | - Kristi van der El
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carli Ellinghaus
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jesse Gates
- Melbourne Health, Melbourne, Victoria, Australia
| | | | - Marianne Mueller
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lex Wunderink
- Friesland Mental Health Services, Leeuwarden, Netherlands
| | - Eóin Killackey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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36
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Chanen AM, Betts J, Jackson H, McGorry P, Nelson B, Cotton SM, Bartholomeusz C, Jovev M, Ratheesh A, Davey C, Pantelis C, McCutcheon L, Francey S, Bhaduri A, Lowe D, Rayner V, Thompson K. Aripiprazole compared with placebo for auditory verbal hallucinations in youth with borderline personality disorder: Protocol for the VERBATIM randomized controlled trial. Early Interv Psychiatry 2019; 13:1373-1381. [PMID: 30689305 DOI: 10.1111/eip.12774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/15/2018] [Accepted: 12/06/2018] [Indexed: 01/11/2023]
Abstract
AIM Up to half of patients with borderline personality disorder report auditory verbal hallucinations that are phenomenologically indistinguishable from those in schizophrenia, occur early in the course of the disorder, and are enduring, distressing and disabling. In clinical practice, this symptom is widely assumed to be unresponsive to treatment with antipsychotic medication and early intervention is rarely offered. The Verbal Experiences Response in Borderline personality disorder to Aripiprazole TrIal Medication (VERBATIM) study aims to be the first controlled trial to investigate the effectiveness of conventional pharmacotherapy for this symptom in this patient group. METHOD VERBATIM is a 12-week, triple-blind, single-centre, parallel groups randomised controlled trial, with a 27-week follow-up period. Participants between the ages of 15 and 25 years receive either aripiprazole or placebo daily, commencing at 2 mg and increasing to 10 mg by day 15. Further dose escalations (up to 30 mg) may occur, as clinically indicated. This trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry ACTRN12616001192471 on 30/08/2016. RESULTS The primary outcome is severity of auditory verbal hallucinations assessed using the Psychotic Symptom Rating Scale. Secondary outcomes include the severity of general psychopathology, borderline personality pathology, social and occupational functioning and change in brain resting state connectivity. The primary endpoint is week 12 and secondary endpoint is week 39. CONCLUSION The results will inform treatment decisions for individuals with borderline personality disorder who present with auditory verbal hallucinations.
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Affiliation(s)
- Andrew M Chanen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Jennifer Betts
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sue M Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cali Bartholomeusz
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martina Jovev
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Christopher Davey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Louise McCutcheon
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Shona Francey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Amit Bhaduri
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Danielle Lowe
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria Rayner
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine Thompson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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37
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Cotton SM, Berk M, Jackson H, Murray G, Filia K, Hasty M, Chanen A, Davey C, Nelson B, Ratheesh A, MacNeil C. Improving functional outcomes in early-stage bipolar disorder: The protocol for the REsearch into COgnitive and behavioural VERsatility trial. Early Interv Psychiatry 2019; 13:1470-1479. [PMID: 30740882 DOI: 10.1111/eip.12797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/29/2018] [Accepted: 01/13/2019] [Indexed: 01/26/2023]
Abstract
AIM Young people with bipolar disorder (BD) commonly experience reduced quality of life, persistent symptoms and impaired functional recovery despite often superior school performance. Compromised long-term functioning can ensue. There is evidence that psychological therapies alongside pharmacology may be more efficacious earlier in the course of the disorder. Intervention in the early stages may thus reduce the burden and risk associated with BD and mitigate the impact of the disorder on normal developmental trajectories. To date, however, the availability of evidence-based psychological therapies for young people with early BD is limited. Furthermore, there are no large-scale randomized controlled trials (RCTs) of such interventions. METHODS The study is a prospective, single-blind, RCT examining the effectiveness of an adjunctive individualized and manualized psychological intervention, compared with treatment as usual within youth-specific early intervention services. The REsearch into COgnitive and behavioural VERsatility (RECOVER) intervention is delivered over a 6-month period. About 122 young people in the early stages of BD-I (at least one manic episode in the previous 2 years, with no more than five lifetime treated/untreated manic or hypomanic episodes) will be recruited. The assessments will occur at baseline, 3, 6 (primary endpoint, end of treatment), 9, 12, 15 and 18 months. RESULTS Recruitment will commence in January 2019 and is anticipated to occur over a 3.5-year period. CONCLUSIONS To date, there are no evidence-based psychological therapies tailored to young people with early BD. We will test whether early psychological intervention in the course of BD can reduce the symptomatic, psychological, vocational and social impacts that are seen in entrenched disorder.
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Affiliation(s)
- Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,IMPACT Strategic Research Centre, Deakin University, School of Medicine, Geelong, Victoria, Australia.,The Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Henry Jackson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Greg Murray
- Centre for Mental Health, Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Kate Filia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Hasty
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Andrew Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | - Christopher Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | - Craig MacNeil
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
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Cotton SM, Berk M, Watson A, Wood S, Allott K, Bartholomeusz CF, Bortolasci CC, Walder K, O'Donoghue B, Dean OM, Chanen A, Amminger GP, McGorry PD, Burnside A, Uren J, Ratheesh A, Dodd S. ENACT: a protocol for a randomised placebo-controlled trial investigating the efficacy and mechanisms of action of adjunctive N-acetylcysteine for first-episode psychosis. Trials 2019; 20:658. [PMID: 31779696 PMCID: PMC6883553 DOI: 10.1186/s13063-019-3786-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background First-episode psychosis (FEP) may lead to a progressive, potentially disabling and lifelong chronic illness; however, evidence suggests that the illness course can be improved if appropriate treatments are given at the early stages. Nonetheless, the efficacy of antipsychotic medications is suboptimal, particularly for negative and cognitive symptoms, and more efficacious and benign treatments are needed. Previous studies have shown that the antioxidant amino acid N-acetylcysteine (NAC) reduces negative symptoms and improves functioning in chronic schizophrenia and bipolar disorder. Research is scarce as to whether NAC is beneficial earlier in the course of illness. The primary aim of this study is to determine the efficacy of treatment with adjunctive NAC (2 g/day for 26 weeks) compared with placebo to improve psychiatric symptoms in young people experiencing FEP. Secondary aims are to explore the neurobiological mechanisms underpinning NAC and how they relate to various clinical and functional outcomes at 26- and 52-week follow-ups. Methods/design ENACT is a 26-week, randomised controlled trial of adjunctive NAC versus placebo, with a 26-week non-treatment follow-up period, for FEP. We will be recruiting 162 young people aged 15–25 years who have recently presented to, and are being treated at, the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. The primary outcome is the Total Score on the Positive and Negative Syndrome Scale which will be administered at baseline, and weeks 4, 8, 12, 26 (primary endpoint), and 52 (end of study). Secondary outcomes include: symptomatology, functioning, quality of life, neurocognition, blood-derived measures of: inflammation, oxidative and nitrosative stress, and magnetic resonance spectroscopy measures of glutathione concentration. Discussion Targeted drug development for FEP to date has generally not involved the exploration of neuroprotective agents. This study has the potential to offer a new, safe, and efficacious treatment for people with FEP, leading to better treatment outcomes. Additionally, the neuroprotective dimension of this study may lead to a better long-term prognosis for people with FEP. It has the potential to uncover a novel treatment that targets the neurobiological mechanisms of FEP and, if successful, will be a major advance for psychiatry. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12618000413224. Registered on 21 March 2018.
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Affiliation(s)
- S M Cotton
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - M Berk
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, School of Medicine, Geelong, VIC, Australia.,The Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - A Watson
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - S Wood
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,School of Psychology, University of Birmingham, Edgbaston, UK
| | - K Allott
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - C F Bartholomeusz
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - C C Bortolasci
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - K Walder
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - B O'Donoghue
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - O M Dean
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, School of Medicine, Geelong, VIC, Australia.,The Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - A Chanen
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - G P Amminger
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - P D McGorry
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - A Burnside
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - J Uren
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - A Ratheesh
- Orygen the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - S Dodd
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, School of Medicine, Geelong, VIC, Australia
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39
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Jauhar S, Ratheesh A, Davey C, Yatham LN, McGorry PD, McGuire P, Berk M, Young AH. The case for improved care and provision of treatment for people with first-episode mania. Lancet Psychiatry 2019; 6:869-876. [PMID: 31248840 DOI: 10.1016/s2215-0366(19)30082-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022]
Abstract
The care of people with first-episode mania has been overlooked in comparison with the care of patients with other non-affective psychoses, despite evidence suggesting targeted treatments might be of benefit for this patient group. In this Personal View, we outline the general epidemiology of first-episode mania in the context of bipolar disorder, the natural history of mania (with an emphasis on its recurrent nature), current evidence for pharmacological, psychological, and service-level interventions, current guidelines for the treatment of first-episode mania, and provide a patient's point of view of the care pathway (appendix). We note the paucity of high-quality evidence for interventions in first-episode mania and the lack of agreement among treatment guidelines in relation to treatment, especially maintenance treatment. We suggest that, based on high morbidity and clinical need, research evidence to inform guideline development is necessary, and in the interim, clearer guidance on treatment and diagnosis should be given; specifically, we have suggested that patients should be cared for within a first-episode psychosis service, when such a service exists.
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Affiliation(s)
- Sameer Jauhar
- Department of Psychological Medicine, Psychology and Neuroscience, King's College London, London; Early intervention Pathway, Psychosis Clinical Academic Group, South London and Maudsley National Health Service Foundation Trust, London.
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Christopher Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Phillip McGuire
- Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London; Early intervention Pathway, Psychosis Clinical Academic Group, South London and Maudsley National Health Service Foundation Trust, London
| | - Michael Berk
- The Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia; IMPACT Strategic Research Centre, School of Medicine and Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Allan H Young
- Department of Psychological Medicine, Psychology and Neuroscience, King's College London, London
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40
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Chia MF, Cotton S, Filia K, Phelan M, Conus P, Jauhar S, Marwaha S, McGorry PD, Davey C, Berk M, Ratheesh A. Early intervention for bipolar disorder - Do current treatment guidelines provide recommendations for the early stages of the disorder? J Affect Disord 2019; 257:669-677. [PMID: 31377603 DOI: 10.1016/j.jad.2019.07.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/03/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Interventions early in the course of bipolar disorder (BD) may have the potential to limit its functional and symptomatic impact. However, the implementation of specific early interventions for BD has been limited which may at least partly be due to the lack of guidelines focused on the early illness stages. We therefore aimed to review the current recommendations for early stage BD from clinical practice guidelines. METHODS We searched PubMED and PsychINFO for clinical guidelines for BD published in the ten years prior to 1 November 2018. Recommendations from identified guidelines that addressed early stage BD or first episode mania were consolidated and compared. We also reviewed the guidelines relating to adolescents with BD to complement the guidelines related to those in the early illness course. RESULTS We identified fourteen international and national guidelines on BD or affective psychoses. Most guidelines contained a separate section on adolescents, but only a few referred specifically to early stage BD. There were no consistent recommendations for early stage disorder, except with respect to the indications for maintenance medication treatments. For adolescents, there was a consistent recommendation for the use of second generation antipsychotics for treating acute mania. LIMITATION The main limitation is that the identified guidelines did not include primary data that clearly separated illness and developmental stages. CONCLUSIONS There is a lack of emphasis on early BD among widely-respected current clinical guidelines, likely reflecting the dearth of primary data. Future evidence or consensus-based recommendations could significantly inform clinical practice for this population.
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Affiliation(s)
- Ming Fang Chia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Kate Filia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | | | - Philippe Conus
- Lausanne University and Hospital (CHUV), Lausanne, Switzerland
| | - Sameer Jauhar
- Department of Psychosis Studies, Institute of Psychiatry, King's College, London, UK
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Christopher Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Orygen Youth Health, Parkville, Australia
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Deakin University IMPACT Strategic Research Centre, Geelong, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Orygen Youth Health, Parkville, Australia.
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41
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Jauhar S, Ratheesh A, Davey C, Yatham LN, McGorry PD, McGuire P, Berk M, Young AH. First episode mania: we should have intervened earlier. Lancet Psychiatry 2019; 6:807-808. [PMID: 31544759 DOI: 10.1016/s2215-0366(19)30340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Sameer Jauhar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Aswin Ratheesh
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Christopher Davey
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Lakshmi N Yatham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Patrick D McGorry
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Phillip McGuire
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Michael Berk
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
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42
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O'Donoghue B, Francey SM, Nelson B, Ratheesh A, Allott K, Graham J, Baldwin L, Alvarez-Jimenez M, Thompson A, Fornito A, Polari A, Berk M, Macneil C, Crisp K, Pantelis C, Yuen HP, Harrigan S, McGorry P. Staged treatment and acceptability guidelines in early psychosis study (STAGES): A randomized placebo controlled trial of intensive psychosocial treatment plus or minus antipsychotic medication for first-episode psychosis with low-risk of self-harm or aggression. Study protocol and baseline characteristics of participants. Early Interv Psychiatry 2019; 13:953-960. [PMID: 30024100 DOI: 10.1111/eip.12716] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 04/04/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
Abstract
AIM It is now necessary to investigate whether recovery in psychosis is possible without the use of antipsychotic medication. This study will determine (1) whether a first-episode psychosis (FEP) group receiving intensive psychosocial interventions alone can achieve symptomatic remission and functional recovery; (2) whether prolonging the duration of untreated psychosis (DUP) in a sub-group according to randomisation will be associated with a poorer outcome and thereby establish whether the relationship between DUP and outcome is causative; and (3) whether neurobiological changes observed in FEP are associated with the psychotic disorder or antipsychotic medication. Baseline characteristics of participants will be presented. METHODS This study is a triple-blind randomized placebo-controlled non-inferiority trial. The primary outcome is the level of functioning measured by the Social and Occupational Functioning Assessment Scale at 6 months. This study is being conducted at the Early Psychosis Prevention and Intervention Centre, Melbourne and includes young people aged 15 to 24 years with a DSM-IV psychotic disorder, a DUP less than 6 months and not high risk for suicide or harm to others. Strict discontinuation criteria are being applied. Participants are also undergoing three 3-Tesla-MRI scans. RESULTS Ninety participants have been recruited and baseline characteristics are presented. CONCLUSIONS Staged treatment and acceptability guidelines in early psychosis will determine whether antipsychotic medications are indicated in all young people with a FEP and whether antipsychotic medication can be safely delayed. Furthermore, the relative contribution of psychotic illness and antipsychotic medication in terms of structural brain changes will also be elucidated. The findings will inform clinical practice guidelines.
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Affiliation(s)
- Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Orygen Youth Health, Melbourne, Australia
| | - Shona M Francey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Orygen Youth Health, Melbourne, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Orygen Youth Health, Melbourne, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Jessica Graham
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Lara Baldwin
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Orygen Youth Health, Melbourne, Australia.,Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Warwick, UK
| | - Alex Fornito
- Brain and Mental Health Hub, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences and Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Andrea Polari
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Orygen Youth Health, Melbourne, Australia
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Deakin University, School of Medicine, IMPACT Strategic Research Centre, Geelong, Australia
| | | | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Carlton South, Vic Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Hok P Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Susy Harrigan
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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43
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Eaton S, Harrap B, Downey L, Thien K, Bowtell M, Bardell-Williams M, Ratheesh A, McGorry P, O'Donoghue B. Incidence of treated first episode psychosis from an Australian early intervention service and its association with neighbourhood characteristics. Schizophr Res 2019; 209:206-211. [PMID: 31130401 DOI: 10.1016/j.schres.2019.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 03/26/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Psychotic disorder incidence varies geographically and is associated with neighbourhood characteristics, including social deprivation, population density, unemployment, social capital or social fragmentation. Yet it is not known whether these findings are applicable to Australia's unique geography. This study aimed to determine whether the incidence of first episode psychosis (FEP) varies according to neighbourhood characteristics in an Australian cohort. METHOD This study included all young people, aged 15 to 24, with an FEP who attended Orygen Youth Health in Melbourne, from a geographically defined catchment area encompassing Northern and Western Melbourne, over a 44-month period. Neighbourhood demographic data was collected from the 2011 Australian National Census. Negative binomial regression was used to determine incidence rate ratios controlled for age, sex and migrant status. RESULTS A total of 747 young people had an FEP during the 44-month study period and 722 were included in this study. Of these, 58.0% were males and 67.9% had a non-affective psychotic disorder; the mean age of the cohort was 19.1 years. The incidence of FEP in young people aged 15 to 24 in the catchment area was 123.2 per 100,000 person-years. There was a higher incidence of FEP in neighbourhoods of greatest social deprivation (IRR = 1.65, CI = 1.06-2.51, p = .02), highest unemployment (IRR = 1.56, CI = 1.04-2.35, p = .03) and above average social fragmentation (IRR = 1.42, CI = 1.02-1.97, p = .04), when controlled for age, sex and migrant status. CONCLUSIONS This study highlights variation in psychotic disorder incidence and the need for this disparity to be reflected in appropriate resource allocation.
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Affiliation(s)
- Scott Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Benjamin Harrap
- Melbourne Epicentre, Melbourne Health and The University of Melbourne, 300 Grattan Street, Royal Melbourne Hospital, Victoria 3052, Australia
| | - Linglee Downey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Kristen Thien
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Meghan Bowtell
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Melissa Bardell-Williams
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052, Australia.
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44
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Hartmann JA, Nelson B, Spooner R, Paul Amminger G, Chanen A, Davey CG, McHugh M, Ratheesh A, Treen D, Yuen HP, McGorry PD. Broad clinical high-risk mental state (CHARMS): Methodology of a cohort study validating criteria for pluripotent risk. Early Interv Psychiatry 2019; 13:379-386. [PMID: 28984077 DOI: 10.1111/eip.12483] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/08/2017] [Accepted: 07/17/2017] [Indexed: 12/30/2022]
Abstract
AIM The development of the ultra-high risk (UHR) criteria for psychosis created a new paradigm for the prevention research in psychiatry. Since (1) prevention research faces the challenge of achieving adequate statistical power when focusing on single low-incidence syndromes and (2) early clinical phenotypes are overlapping and non-specific, this study broadens the UHR state beyond psychosis as an outcome. The CHARMS (clinical high at-risk mental state) study aims to prospectively validate a set of trans-diagnostic criteria to identify help-seeking young people at risk of developing a range of serious mental illnesses. METHODS This paper describes the methodology of the CHARMS study, which involves applying the CHARMS criteria to a cohort of help-seeking young people aged 12 to 25 attending youth mental health services in Melbourne. New referrals meeting the CHARMS criteria are allocated to the CHARMS+ group; referrals not meeting CHARMS threshold are allocated to CHARMS- group (control group); referrals meeting criteria for a full-threshold disorder are excluded. Transition status and clinical and functional outcomes are re-assessed at 6 and 12 months. CONCLUSIONS This study will be the first to introduce and validate clinical criteria to identify a broader at-risk patient population, which may facilitate young people's access to clinical services and early treatment by reducing the reliance on "caseness" defined according to current diagnostic categories being required for service entry. These criteria may introduce a new, trans-diagnostic approach for understanding risk factors and pathogenic mechanisms that drive the onset of severe mental illness and the next generation of preventive intervention trials.
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Affiliation(s)
- Jessica A Hartmann
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Rachael Spooner
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - G Paul Amminger
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Andrew Chanen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Christopher G Davey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Meredith McHugh
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Devi Treen
- Institute of Neuropsychiatry and Addictions (INAD) - Parc de Salut Mar Barcelona, Barcelona, Spain
| | - Hok Pan Yuen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Patrick D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Bardell-Williams M, Eaton S, Downey L, Bowtell M, Thien K, Ratheesh A, Killackey E, McGorry P, O'Donoghue B. Rates, determinants and outcomes associated with the use of community treatment orders in young people experiencing first episode psychosis. Int J Law Psychiatry 2019; 62:85-89. [PMID: 30616858 DOI: 10.1016/j.ijlp.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/31/2018] [Accepted: 11/24/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Community treatment orders (CTOs) are a controversial form of involuntary treatment for individuals affected by mental health disorders and yet little is known about the use of CTOs in first presentations. Therefore, this study aimed to determine the rates, determinants and outcomes associated with the use of CTOs in young people with a first episode of psychosis (FEP). METHODS This epidemiological cohort study included all individuals aged 15-24 who presented with a FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne between 01.01.2011 and 31.12.13. RESULTS A total of 544 young people presented with a FEP during the study period and of these, 93 (17.3%) were subject to a CTO during their episode of care. A total of 69.7% of CTOs were commenced after the first three months of treatment and the median duration of CTOs was 168.5 days. Males, a diagnosis of a schizophrenia spectrum disorder and a concurrent substance abuse disorder were associated with the use of CTOs. Additionally, young people with more severe positive psychotic symptoms were more likely to be subject to a CTO. At the time of discharge, only 38.7% of those subject to a CTO were in education or employment compared to 65.4% of those who had not been subject to a CTO. CONCLUSIONS The majority of CTOs are commenced after at least three months of treatment, however the optimal timing of CTO implementation needs to be determined. The poor functioning of young people on a CTO should be the focus of future interventional studies.
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Affiliation(s)
- Melissa Bardell-Williams
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Scott Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Linglee Downey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Meghan Bowtell
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Kristen Thien
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Orygen Youth Health, 35 Poplar Rd, Parkville, Melbourne, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Orygen Youth Health, 35 Poplar Rd, Parkville, Melbourne, Australia.
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Hartmann JA, Nelson B, Ratheesh A, Treen D, McGorry PD. At-risk studies and clinical antecedents of psychosis, bipolar disorder and depression: a scoping review in the context of clinical staging. Psychol Med 2019; 49:177-189. [PMID: 29860956 DOI: 10.1017/s0033291718001435] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Identifying young people at risk of developing serious mental illness and identifying predictors of onset of illness has been a focus of psychiatric prediction research, particularly in the field of psychosis. Work in this area has facilitated the adoption of the clinical staging model of early clinical phenotypes, ranging from at-risk mental states to chronic and severe mental illness. It has been a topic of debate if these staging models should be conceptualised as disorder-specific or transdiagnostic. In order to inform this debate and facilitate cross-diagnostic discourse, the present scoping review provides a broad overview of the body of literature of (a) longitudinal at-risk approaches and (b) identified antecedents of (homotypic) illness progression across three major mental disorders [psychosis, bipolar disorder (BD) and depression], and places these in the context of clinical staging. Stage 0 at-risk conceptualisations (i.e. familial high-risk approaches) were identified in all three disorders. However, formalised stage 1b conceptualisations (i.e. ultra-high-risk approaches) were only present in psychosis and marginally in BD. The presence of non-specific and overlapping antecedents in the three disorders may support a general staging model, at least in the early stages of severe psychotic or mood disorders.
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Affiliation(s)
- Jessica A Hartmann
- Orygen, the National Centre of Excellence in Youth Mental Health,Melbourne,Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health,Melbourne,Australia
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health,Melbourne,Australia
| | - Devi Treen
- Department of Child and Adolescent Psychiatry and Psychology,Hospital Sant Joan de Déu,Barcelona
| | - Patrick D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health,Melbourne,Australia
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Abstract
BACKGROUND The superior efficacy of clozapine in treatment resistant schizophrenia has been clearly demonstrated, yet there are often delays in the commencement of clozapine. In this study, we aimed to determine; the proportion of young people with a first episode of psychosis (FEP) who would be considered eligible for clozapine treatment, the theoretical delay in commencing clozapine and to compare the outcomes of those treated with clozapine to those who were eligible but not treated with clozapine. METHODS This study was conducted at Orygen Youth Health (OYH), a youth mental health service for young people aged 15-24. All clients who were treated at the Early Psychosis Prevention and Intervention Centre (EPPIC) clinic between 01.01.2011 and 31.12.2013 were included. RESULTS 544 young people presented with a FEP in the study period and 9.4% (N = 51) subsequently fulfilled criteria for treatment-resistant schizophrenia. Of these individuals, thirty (58.8%) were commenced on clozapine, in addition to a further eleven. The median delay to the commencement of clozapine was 42 weeks (I.Q.R. = 7.5-64). Of those commenced on clozapine, 76.6% achieved remission of positive psychotic symptoms and 50% were in employment or education by the time of discharge or transfer to the adult mental health services. The rate of discontinuation of clozapine was 24.4% and 60.0% of discontinuations were due to cardiac complications and the remainder were due to non-compliance. CONCLUSIONS These findings suggest that early intervention for psychosis services have a crucial role in ensuring timely initiation of clozapine in individuals with a diagnosis of treatment-resistant schizophrenia.
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Affiliation(s)
- Kristen Thien
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Meghan Bowtell
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Scott Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Melissa Bardell-Williams
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Linglee Downey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052, Australia.
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48
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Bowtell M, Ratheesh A, McGorry P, Killackey E, O'Donoghue B. Clinical and demographic predictors of continuing remission or relapse following discontinuation of antipsychotic medication after a first episode of psychosis. A systematic review. Schizophr Res 2018; 197:9-18. [PMID: 29146020 DOI: 10.1016/j.schres.2017.11.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/28/2017] [Accepted: 11/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical guidelines recommend maintenance treatment with antipsychotic medication for one to two years following remission of symptoms after a first episode of psychosis. However, recent research has suggested that this may not be indicated. Consistent predictors of outcome would be beneficial to guide clinicians as to which individuals are likely to have a successful discontinuation. OBJECTIVES This study reviews the literature with the aim of identifying demographic and clinical predictors of either relapse or continued remission in those with a first episode of psychosis following discontinuation of antipsychotic medication. METHODOLOGY Data Sources: A systematic search of PubMed, CINAHL, and PsychInfo databases was performed. Eligibility Criteria: Cohort, case-control and clinical trials that were published in English, included participants with a first episode of psychosis, and examined clinical and demographic predictors of relapse or continued remission after antipsychotic discontinuation. RESULTS Eleven studies fulfilled inclusion criteria. No positive findings were replicated across cohorts. Predictors of relapse: male sex, unemployment, prior psychiatric admission, premorbid adjustment, childhood isolation, premorbid functioning, schizoid-schizotypal traits, schizophrenia diagnosis, concomitant medication, and more severe negative symptoms. Some positive findings must be interpreted in the context of conflicting and replicated negative findings: sex, employment status, level of education, premorbid functioning, symptom severity, and schizophrenia diagnosis. Other replicated non-predictive findings: age, ethnicity, marital status, family history, disorganized thoughts, affective symptoms, cannabis abuse, clinical global impression, social integration, duration and dose of antipsychotic treatment, and compliance. CONCLUSION No positive findings have been replicated across study cohorts. Non-predictive findings have been replicated.
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Affiliation(s)
- Meghan Bowtell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne; Orygen Youth Health, 35 Poplar rd, Parkville, VIC 3052, Australia.
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne.
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne.
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne; Orygen Youth Health, 35 Poplar rd, Parkville, VIC 3052, Australia.
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49
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Affiliation(s)
- Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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50
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Affiliation(s)
- Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, , Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, , Australia
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, , Australia.,Department of Psychiatry, University of Melbourne, Melbourne, , Australia.,Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Australia.,Florey Institute for Neuroscience and Mental Health, Melbourne, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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