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Ladyman C, Sweeney B, Sharkey K, Bei B, Wright T, Mooney H, Huthwaite M, Cunningham C, Firestone R, Signal TL. A scoping review of non-pharmacological perinatal interventions impacting maternal sleep and maternal mental health. BMC Pregnancy Childbirth 2022; 22:659. [PMID: 35999501 PMCID: PMC9395885 DOI: 10.1186/s12884-022-04844-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/18/2021] [Accepted: 06/15/2022] [Indexed: 01/24/2023] Open
Abstract
Background A woman’s vulnerability to sleep disruption and mood disturbance is heightened during the perinatal period and there is a strong bidirectional relationship between them. Both sleep disruption and mood disturbance can result in significant adverse outcomes for women and their infant. Thus, supporting and improving sleep in the perinatal period is not only an important outcome in and of itself, but also a pathway through which future mental health outcomes may be altered. Methods Using scoping review methodology, we investigated the nature, extent and characteristics of intervention studies conducted during the perinatal period (pregnancy to one-year post-birth) that reported on both maternal sleep and maternal mental health. Numerical and descriptive results are presented on the types of studies, settings, sample characteristics, intervention design (including timeframes, facilitation and delivery), sleep and mood measures and findings. Results Thirty-seven perinatal interventions were identified and further described according to their primary focus (psychological (n = 9), educational (n = 15), lifestyle (n = 10), chronotherapeutic (n = 3)). Most studies were conducted in developed Western countries and published in the last 9 years. The majority of study samples were women with existing sleep or mental health problems, and participants were predominantly well-educated, not socio-economically disadvantaged, in stable relationships, primiparous and of White race/ethnicity. Interventions were generally delivered across a relatively short period of time, in either the second trimester of pregnancy or the early postnatal period and used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep and the Edinburgh Postnatal Depression Scale (EPDS) to measure mood. Retention rates were high (mean 89%) and where reported, interventions were well accepted by women. Cognitive Behavioural Therapies (CBT) and educational interventions were largely delivered by trained personnel in person, whereas other interventions were often self-delivered after initial explanation. Conclusions Future perinatal interventions should consider spanning the perinatal period and using a stepped-care model. Women may be better supported by providing access to a range of information, services and treatment specific to their needs and maternal stage. The development of these interventions must involve and consider the needs of women experiencing disadvantage who are predominantly affected by poor sleep health and poor mental health.
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Affiliation(s)
- Clare Ladyman
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - Bronwyn Sweeney
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - Katherine Sharkey
- The Warren Alpert Medical School, Brown University, 222 Richmond St, Providence, RI, 02903, USA
| | - Bei Bei
- Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk Clayton Campus, Clayton, Victoria, 3800, Australia
| | - Tanya Wright
- School of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Hannah Mooney
- Ngāti Raukawa, Te Atiawa, Ngā Rauru, Te Āti Haunui-a-Pāpārangi, School of Social Work, College of Health, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, 23 Mein St, Newtown, Wellington, 6242, New Zealand
| | - Chris Cunningham
- Ngāti Raukawa; Ngāti Toarangatira; Te Atiawa; Te Ati Haunui-a-Pāpārangi, Research Centre for Hauora & Health, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - Ridvan Firestone
- Research Centre for Hauora & Health, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand.
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Barthow C, Hood F, Crane J, Huthwaite M, Weatherall M, Parry-Strong A, Krebs J. A randomised controlled trial of a probiotic and a prebiotic examining metabolic and mental health outcomes in adults with pre-diabetes. BMJ Open 2022; 12:e055214. [PMID: 35332040 PMCID: PMC8948404 DOI: 10.1136/bmjopen-2021-055214] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIMS To evaluate the effect of the probiotic Lactobacillus rhamnosus HN001 and/or cereal enriched with oat-derived beta-glucan (OBG) on metabolic and mental health outcomes when administered to adults with pre-diabetes. DESIGN 2×2 factorial design randomised, parallel-groups placebo-controlled; double-blinded for probiotic, single-blinded for cereals. PARTICIPANTS Community-dwelling adults aged 18-80 years with pre-diabetes: glycated haemoglobin (HbA1c) 41-49 mmol/mol. INTERVENTIONS Capsules containing Lactobacillus rhamnosus (HN001) (6×109 colony-forming units/day), or placebo capsules; and cereal containing 4 g/day OBG or calorie-matched control cereal, taken daily, for 6 months. Study groups were: (A) HN001 capsules+OBG cereal; (B) HN001 capsules+control cereal; (C) placebo capsules+OBG cereal and (D) placebo capsules+control cereal. OUTCOME MEASURES Primary outcome: HbA1c at 6 months. SECONDARY OUTCOMES fasting plasma glucose, fasting insulin, homeostatic model assessment of insulin resistance, fasting lipids, blood pressure, body weight, waist circumference, body mass index and mental well-being. RESULTS 153 participants were randomised. There was complete HbA1c outcome data available for 129 participants. At 6 months the mean (SD) HbA1c was 45.9 (4.4) mmol/mol, n=66 for HN001, and 46.7 (4.3) mmol/mol, n=63 for placebo capsules; 46.5 (4.0) mmol/mol, n=67 for OBG and 46.0 (4.6) mmol/mol n=62 for control cereal. The estimated difference between HN001-placebo capsules was -0.83, 95% CI -1.93 to 0.27 mmol/mol, p=0.63, and between OBG-control cereals -0.17, 95% CI -1.28 to 0.94 mmol/mol, p=0.76. There was no significant interaction between treatments p=0.79. There were no differences between groups or significant interactions between treatments for any of the secondary outcomes. CONCLUSIONS This study found no evidence of clinical benefit from the supplementation with either HN001 and/or cereal containing 4 g OBG on HbA1c and all secondary outcomes relevant to adults with pre-diabetes. TRIAL REGISTRATION NUMBER Australian New Zealand Clincial Trials Registry number ACTRN12617000990325.
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Affiliation(s)
- Christine Barthow
- Department of Medicine, Univeristy of Otago, Wellington, New Zealand
| | - Fiona Hood
- Department of Medicine, Univeristy of Otago, Wellington, New Zealand
| | - Julian Crane
- Department of Medicine, Univeristy of Otago, Wellington, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Mark Weatherall
- Department of Medicine, Univeristy of Otago, Wellington, New Zealand
| | - Amber Parry-Strong
- Centre for Endocrine, Diabetes and Obesity Research, Capital and Coast District Health Board, Wellington, New Zealand
| | - Jeremy Krebs
- Department of Medicine, Univeristy of Otago, Wellington, New Zealand
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McKinlay E, Hilder J, Hood F, Morgan S, Barthow C, Gray B, Huthwaite M, Weatherall M, Crane J, Krebs J, Pullon S. Uncertainty and certainty: perceptions and experiences of prediabetes in New Zealand primary care – a qualitative study. J Prim Health Care 2022; 14:138-145. [DOI: 10.1071/hc21066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
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Ladyman C, Gander P, Huthwaite M, Sweeney B, Signal TL. Sleep HAPi: A Feasibility and Descriptive Analysis of an Early and Longitudinal Sleep Education Intervention for Pregnant Women. Behav Sleep Med 2021; 19:427-444. [PMID: 32497446 DOI: 10.1080/15402002.2020.1772265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/14/2022]
Abstract
Background: Poor sleep and prior depression are key predictors of perinatal depression, with research suggesting depressive symptoms may emerge in early pregnancy. Sleep is a potentially modifiable risk factor for depression. This pilot study examined the feasibility and acceptability of a six-month sleep education intervention designed to optimize sleep and minimize depressive symptoms throughout pregnancy. Sleep measures and depressive symptoms are described from 12 weeks gestation to 12 weeks postpartum.Participants: A community sample of nulliparous pregnant women with a history of depression were recruited prior to 14 weeks gestation.Methods: An individualized sleep education program was developed and participants engaged in three trimester specific sleep education sessions. Feasibility and acceptability were determined via recruitment and retention rates and participant feedback. Depressive symptoms and sleep were measured at five time points throughout the study.Results: 22 women enrolled in the study and 15 completed the intervention. Participants reported the intervention as highly acceptable. There was minimal change in all dimensions of sleep across pregnancy, but sleep measures were significantly worse at six weeks postpartum and improved by 12 weeks postpartum. Depressive symptoms were significantly lower at the conclusion of the intervention and 12 weeks postpartum compared to trimester 1.Conclusions: This sleep education program appears feasible, acceptable and may be effective in minimizing depressive symptoms in pregnant women with a history of depression. Trials with larger and more diverse samples are warranted and further studies to ascertain efficacy should be undertaken with a control group.
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Affiliation(s)
- Clare Ladyman
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Philippa Gander
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Bronwyn Sweeney
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
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Ladyman C, Signal TL, Sweeney B, Jefferies M, Gander P, Paine SJ, Huthwaite M. Multiple dimensions of sleep are consistently associated with chronically elevated depressive symptoms from late pregnancy to 3 years postnatal in Indigenous and non-Indigenous New Zealand women. Aust N Z J Psychiatry 2021; 55:687-698. [PMID: 33176439 DOI: 10.1177/0004867420972762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/17/2022]
Abstract
INTRODUCTION Poor sleep and depressive symptoms are common throughout the perinatal period, but little is known about the extended time course of depression and the sleep dimensions associated with these trajectories. OBJECTIVE This study investigated different depression trajectories in New Zealand Māori and non-Māori women from late pregnancy to 3 years postnatal. Relationships between multiple dimensions of sleep and these depression trajectories were also investigated. METHODS Data from 856 women (30.6% Māori and 69.4% non-Māori) from the longitudinal Moe Kura cohort study were used. Depressive symptoms and multiple dimensions of sleep (quality, duration, latency, continuity and daytime sleepiness) were collected at 36 weeks' gestation, 12 weeks postnatal and 3 years postnatal. Trajectory analysis was completed using latent class analysis. RESULTS Latent class analysis revealed two distinct groups of depressive symptom trajectories: 'chronic high' and 'stable mild' for both Māori and non-Māori women. Māori women in both trajectories were more likely than non-Māori women to have clinically significant depressive symptoms at every time point. Poorer sleep quality, latency, continuity and greater daytime sleepiness were consistently associated with the chronic high depressive symptom trajectory at all three time points, after controlling for sociodemographic factors. CONCLUSION A significant proportion of Māori and non-Māori women experience chronically high depressive symptoms during the perinatal period and the following years. Across this extended time frame, Māori women have a higher probability of experiencing clinically significant depressive symptoms compared to non-Māori women. These persistent patterns of depressive symptoms occur concurrently with multiple dimensions of poor sleep. Given the well-described impact of maternal depression on the mother, child, family and community, this highlights the importance of healthcare professionals asking about mothers' sleep quality, continuity, latency and daytime sleepiness as potential indicators of long-term mood outcomes.
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Affiliation(s)
- Clare Ladyman
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Bronwyn Sweeney
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Mona Jefferies
- Health Services Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Philippa Gander
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine (Wellington), University of Otago, Wellington, New Zealand
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Ladyman C, Signal TL, Sweeney B, Gander P, Paine SJ, Huthwaite M. A pilot longitudinal sleep education intervention from early pregnancy and its effect on optimizing sleep and minimizing depressive symptoms. Sleep Health 2020; 6:778-786. [PMID: 32536473 DOI: 10.1016/j.sleh.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/22/2020] [Accepted: 05/01/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Investigate the efficacy of a pilot longitudinal sleep education program for optimizing sleep and minimizing depressive symptoms in nulliparous pregnant women. DESIGN Early and longitudinal sleep education intervention pilot study. SETTING Community-based convenience sample of New Zealand women. PARTICIPANTS 15 nulliparous women who were involved in a pilot of a longitudinal sleep education intervention during pregnancy (N = 15) were compared to a comparison group (n = 76) from another observational study with the same time points. Groups were matched on depression history and parity. INTERVENTION A longitudinal sleep education program was developed. Women in the intervention group participated in three individualized and trimester specific education sessions designed to increase sleep knowledge and improve sleep practices. The comparison group received no sleep education. MEASUREMENTS Self-reports of depressive symptoms and five dimensions of sleep (duration, quality, continuity, latency, daytime sleepiness) were compared between groups using linear mixed model analysis of variance. RESULTS At the conclusion of the intervention, the intervention group had fewer depressive symptoms with none experiencing clinically significant depressive symptoms, while 21% of the comparison group were considered to have clinically significant depressive symptoms. The intervention group also had better sleep quality, sleep initiation and sleep continuity than the comparison group at late pregnancy. CONCLUSIONS Findings suggest that a longitudinal sleep education intervention commencing early in pregnancy may be effective in optimizing sleep and minimizing depressive symptoms for nulliparous women with a history of depression. Further investigation of sleep education interventions to improve maternal mental health in pregnancy and postnatally is warranted.
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Affiliation(s)
- Clare Ladyman
- Massey University, Sleep/Wake Research Centre, College of Health, Wellington, New Zealand.
| | - T Leigh Signal
- Massey University, Sleep/Wake Research Centre, College of Health, Wellington, New Zealand
| | - Bronwyn Sweeney
- Massey University, Sleep/Wake Research Centre, College of Health, Wellington, New Zealand
| | - Philippa Gander
- Massey University, Sleep/Wake Research Centre, College of Health, Wellington, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine (Wellington), University of Otago, Wellington, New Zealand
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Every-Palmer S, Romans SE, Stubbs R, Tomlinson A, Gandhi S, Huthwaite M. Experiences of Weight-Loss Surgery in People With Serious Mental Illness: A Qualitative Study. Front Psychiatry 2020; 11:419. [PMID: 32477191 PMCID: PMC7236816 DOI: 10.3389/fpsyt.2020.00419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 04/23/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Bariatric surgery is seldom accessed by people with serious mental illness, despite high rates of obesity in this population. It is sometimes assumed that patients with complex psychiatric histories will have poor post-surgical weight loss or exacerbation of psychiatric symptoms, although this is unsubstantiated. OBJECTIVES A qualitative descriptive study to explore personal experiences and the impact of bariatric surgery on physical and mental well-being and life-quality in individuals with serious mental illness. METHODS Nine adults with a history of bariatric surgery and concurrent severe depressive disorder, bipolar disorder, or schizoaffective disorder were interviewed about their experiences of bariatric surgery and its outcomes using semi-structured interview schedules. Data were transcribed and inductive thematic analysis undertaken. RESULTS Five broad themes emerged: (1) surgery was highly effective for weight loss, and resulted in subjective improvements in physical health, quality of life, and mental health described as being able to live a life; (2) recovering from surgery was a tough road, notably in the post-operative period where negative sequelae often anteceded benefits; (3) post-operative support was important, but sometimes insufficient, including from families, mental health services, and surgical teams; (4) most considered surgery life-changing, recommending it to others with mental illness and obesity, two had different experiences; (5) participants considered it discriminatory that people with mental illness were not referred or declined weight loss surgery. CONCLUSIONS Participants benefited from bariatric surgery and felt it should be offered to others with mental illness, but with additional care and support.
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Affiliation(s)
- Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
- *Correspondence: Susanna Every-Palmer,
| | - Sarah E. Romans
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Richard Stubbs
- Wakefield Obesity Surgery, Wakefield Hospital, Wellington, New Zealand
| | - Anneka Tomlinson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sophie Gandhi
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Barthow C, Hood F, McKinlay E, Hilder J, Cleghorn C, Huthwaite M, Weatherall M, Parry-Strong A, Pullon S, Gray B, Wickens K, Crane J, Krebs J. Food 4 Health - He Oranga Kai: Assessing the efficacy, acceptability and economic implications of Lactobacillus rhamnosus HN001 and β-glucan to improve glycated haemoglobin, metabolic health, and general well-being in adults with pre-diabetes: study protocol for a 2 × 2 factorial design, parallel group, placebo-controlled randomized controlled trial, with embedded qualitative study and economic analysis. Trials 2019; 20:464. [PMID: 31358022 PMCID: PMC6664750 DOI: 10.1186/s13063-019-3553-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/02/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The rates of pre-diabetes and type 2 diabetes mellitus are increasing worldwide, producing significant burdens for individuals, families, and healthcare systems. In New Zealand, type 2 diabetes mellitus and pre-diabetes disproportionally affect Māori, Pacific, and South Asian peoples. This research evaluates the efficacy, acceptability, and economic impact of a probiotic capsule and a prebiotic cereal intervention in adults with pre-diabetes on metabolic and mental health and well-being outcomes. METHODS Eligible adults (n = 152) aged 18-80 years with pre-diabetes (glycated haemoglobin 41-49 mmol/mol) will be enrolled in a 2 × 2 factorial design, randomised, parallel-group, placebo-controlled trial. Computer-generated block randomization will be performed independently. Interventions are capsulated Lactobacillus rhamnosus HN001 (6 × 109 colony-forming units/day) (A) and cereal containing 4 g β-glucan (B), placebo capsules (O1), and calorie-matched control cereal (O2). Eligible participants will receive 6 months intervention in the following groups: AB, AO1, BO2, and O1O2. The primary outcome is glycated haemoglobin after 6 months. Follow-up at 9 months will assess the durability of response. Secondary outcomes are glycated haemoglobin after 3 and 9 months, fasting glucose, insulin resistance, blood pressure, body weight, body mass index, and blood lipid levels. General well-being and quality of life will be measured by the Short-Form Health Survey 36 and Depression Anxiety Stress Scale 21 at 6 and 9 months. Outcome assessors will be blind to capsule allocation. An accompanying qualitative study will include 24 face-to-face semistructured interviews with an ethnically balanced sample from the β-glucan arms at 2 months, participant focus groups at 6 months, and three health professional focus groups. These will explore how interventions are adopted, their acceptability, and elicit factors that may support the uptake of interventions. A simulation model of the pre-diabetic New Zealand population will be used to estimate the likely impact in quality-adjusted life years and health system costs of the interventions if rolled out in New Zealand. DISCUSSION This study will examine the efficacy of interventions in a population with pre-diabetes. Qualitative components provide rich description of views on the interventions. When combined with the economic analysis, the study will provide insights into how to translate the interventions into practice. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12617000990325. Prospectively registered on 10 July 2017.
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Affiliation(s)
- Christine Barthow
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Fiona Hood
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Jo Hilder
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Christine Cleghorn
- Department of Public Health, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Amber Parry-Strong
- Centre for Endocrine, Diabetes and Obesity Research (CEDOR), PO Box 7902, Wellington South, Wellington, New Zealand
| | - Sue Pullon
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Ben Gray
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Kristin Wickens
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
| | - Jeremy Krebs
- Department of Medicine, University of Otago, PO Box 7343, Wellington South, Wellington, 6242 New Zealand
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Huthwaite M, Tucker M, McBain L, Romans S. Off label or on trend: a review of the use of quetiapine in New Zealand. N Z Med J 2018; 131:45-50. [PMID: 29723178] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Mark Huthwaite
- Senior Lecturer, Department of Psychological Medicine, University of Otago, Wellington
| | - Marilyn Tucker
- Clinical Advisory Pharmacist, Compass Health, Wellington
| | - Lynn McBain
- Head of Department, Department of Primary Health Care and General Practice, University of Otago Wellington and Medical Director Compass Health Wellington
| | - Sarah Romans
- Head of Department, Department of Psychological Medicine, University of Otago, Wellington
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Affiliation(s)
- Peter Gallagher
- Medical Education Unit; University of Otago Wellington; Wellington New Zealand
| | - Helen Moriarty
- Department of Primary Health Care and General Practice; University of Otago Wellington; Wellington New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine; University of Otago Wellington; Wellington New Zealand
| | - Bee Lim
- Department of Primary Health Care and General Practice; University of Otago Wellington; Wellington New Zealand
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Signal TL, Paine SJ, Sweeney B, Muller D, Priston M, Lee K, Gander P, Huthwaite M. The prevalence of symptoms of depression and anxiety, and the level of life stress and worry in New Zealand Māori and non-Māori women in late pregnancy. Aust N Z J Psychiatry 2017; 51:168-176. [PMID: 26792830 DOI: 10.1177/0004867415622406] [Citation(s) in RCA: 28] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To describe the prevalence of symptoms of depression and anxiety, and the level of life stress and worry in late pregnancy for Māori and non-Māori women. METHODS In late pregnancy, women completed a questionnaire recording their prior history of mood disorders; self-reported current depressive symptoms (⩾13 on the Edinburgh Postnatal Depression Scale), current anxiety symptoms (⩾6 on the anxiety items from the Edinburgh Postnatal Depression Scale), significant life stress (⩾2 items on life stress scale) and dysfunctional worry (>12 on the Brief Measure of Worry Scale). RESULTS Data were obtained from 406 Māori women (mean age = 27.6 years, standard deviation=6.3 years) and 738 non-Māori women (mean age = 31.6 years, standard deviation=5.3 years). Depressive symptoms (22% vs 15%), anxiety symptoms (25% vs 20%), significant life stress (55% vs 30%) and a period of poor mood during the current pregnancy (18% vs 14%) were more prevalent for Māori than non-Maori women. Less than 50% of women who had experienced ⩾2 weeks of poor mood during the current pregnancy had sought help. Being young was an independent risk factor for depressive symptoms, significant life stress and dysfunctional worry. A prior history of depression was also consistently associated with a greater risk of negative affect in pregnancy. CONCLUSION Antenatal mental health requires at least as much attention and resourcing as mental health in the postpartum period. Services need to specifically target Māori women, young women and women with a prior history of depression.
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Affiliation(s)
- T Leigh Signal
- 1 Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Sarah-Jane Paine
- 1 Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Bronwyn Sweeney
- 1 Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Diane Muller
- 1 Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Monique Priston
- 2 School of Population Health, The University of Western Australia, Crawley, Australia
| | - Kathryn Lee
- 3 School of Nursing, University of California, San Francisco, CA, USA
| | - Philippa Gander
- 1 Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Mark Huthwaite
- 4 Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Every-Palmer S, Ellis PM, Nowitz M, Stanley J, Grant E, Huthwaite M, Dunn H. The Porirua Protocol in the Treatment of Clozapine-Induced Gastrointestinal Hypomotility and Constipation: A Pre- and Post-Treatment Study. CNS Drugs 2017; 31:75-85. [PMID: 27826741 DOI: 10.1007/s40263-016-0391-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 01/07/2023]
Abstract
BACKGROUND Clozapine, an antipsychotic used in treatment-resistant schizophrenia, causes slow gastrointestinal transit in 50-80% of patients. Clozapine-induced gastrointestinal hypomotility is both common and serious, and potential complications include severe constipation, ileus, bowel obstruction and related complications, with a higher mortality rate than clozapine-related agranulocytosis. Little evidence exists on its prevention and management. METHOD Using a well-validated radiopaque marker ('Metcalf') method, we compared colonic transit times (CTTs) of clozapine-treated inpatients not receiving laxatives with their transit times when receiving laxatives, with treatment prescribed according to the Porirua Protocol for clozapine-related constipation (docusate and senna augmented by macrogol 3350 in treatment-resistant cases). RESULTS The median age of participants was 35 years, and median clozapine dose, plasma level and duration of treatment were 575 mg/day, 506 ng/mL and 2.5 years, respectively. Overall, 14 participants (10 male) were enrolled and all completed the study. Transit times improved markedly with laxative treatment. Median colonic transit without laxatives was 110 h (95% confidence interval [CI] 76-144 h), over four times longer than normative values (p < 0.0001). Median CTT with laxatives was 62 h (95% CI 27-96 h), a 2-day reduction in average transit time (p = 0.009). The prevalence of gastrointestinal hypomotility decreased from 86% pre-treatment to 50% post-treatment (p = 0.061). Severe gastrointestinal hypomotility decreased from 64 to 21% (p = 0.031). Subjective reporting of constipation did not correlate well with objective hypomotility, and did not change significantly with treatment. CONCLUSION Treating clozapine-treated patients with docusate and senna augmented by macrogol appears effective in reducing CTTs in clozapine-induced constipation. Randomised controlled trials are the next step. Australian New Zealand Clinical Trial Registry ACTRN12616001405404 (registered retrospectively).
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Affiliation(s)
- Susanna Every-Palmer
- Te Korowai Whāriki Central Regional Forensic Service, Capital and Coast District Health Board, Ratonga Rua-O-Porirua, Raiha Street, Porirua, PO Box 50-233, Wellington, New Zealand. .,Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand.
| | - Pete M Ellis
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand
| | - Mike Nowitz
- Department of Medicine, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand
| | - James Stanley
- Biostatistics Group, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand
| | - Eve Grant
- Te Korowai Whāriki Central Regional Forensic Service, Capital and Coast District Health Board, Ratonga Rua-O-Porirua, Raiha Street, Porirua, PO Box 50-233, Wellington, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand
| | - Helen Dunn
- Pharmacy Department, Capital and Coast District Health Board, Private Bag 7902, Wellington South, New Zealand
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Every-Palmer S, Nowitz M, Stanley J, Grant E, Huthwaite M, Dunn H, Ellis PM. Clozapine-treated Patients Have Marked Gastrointestinal Hypomotility, the Probable Basis of Life-threatening Gastrointestinal Complications: A Cross Sectional Study. EBioMedicine 2016; 5:125-34. [PMID: 27077119 PMCID: PMC4816835 DOI: 10.1016/j.ebiom.2016.02.020] [Citation(s) in RCA: 56] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/22/2016] [Accepted: 02/09/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Gastrointestinal side effects are particularly common with clozapine and occur with other antipsychotics, ranging from mild constipation to fatal bowel obstruction and/or ischemia. While this adverse-effect spectrum has been attributed to 'gastrointestinal hypomotility', gastrointestinal transit times in antipsychotic-treated patients have not previously been measured, making this mechanism speculative. METHODS Using standardized radiopaque marker ('Metcalf') methods we established colonic transit times of antipsychotic-treated psychiatric inpatients and compared them with population normative values. We analyzed results by antipsychotic type, antipsychotic dose equivalent, anticholinergic load, duration of treatment, gender, ethnicity, and age. OUTCOMES For patients not prescribed clozapine, median colonic transit time was 23 h. For patients prescribed clozapine, median transit time was 104.5 h, over four times longer than those on other antipsychotics or normative values (p < 0.0001). Eighty percent of clozapine-treated patients had colonic hypomotility, compared with none of those prescribed other antipsychotics (olanzapine, risperidone, paliperidone aripiprazole, zuclopenthixol or haloperidol). In the clozapine group, right colon, left colon and rectosigmoid transit times were all markedly abnormal suggesting pan-colonic pathology. Hypomotility occurred irrespective of gender, age, ethnicity, or length of clozapine treatment. Transit times were positively correlated with clozapine plasma level (rho = 0.451, p = 0.045), but not with duration of treatment, total antipsychotic load or demographic factors. INTERPRETATION Clozapine, unlike the other antipsychotics examined, causes marked gastrointestinal hypomotility, as previously hypothesized. Pre-emptive laxative treatment is recommended when starting clozapine.
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Affiliation(s)
- Susanna Every-Palmer
- Te Korowai Whāriki Central Regional Forensic Service, Capital and Coast District Health Board, New Zealand
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Mike Nowitz
- Department of Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - James Stanley
- Biostatistics Group, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Eve Grant
- Te Korowai Whāriki Central Regional Forensic Service, Capital and Coast District Health Board, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Helen Dunn
- Pharmacy Department, Capital and Coast District Health Board, Private Bag 7902, Wellington South, New Zealand
| | - Pete M. Ellis
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
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Howe LD, Signal TL, Paine SJ, Sweeney B, Priston M, Muller D, Lee K, Huthwaite M, Gander P. Self-reported sleep in late pregnancy in relation to birth size and fetal distress: the E Moe, Māmā prospective cohort study. BMJ Open 2015; 5:e008910. [PMID: 26438138 PMCID: PMC4606387 DOI: 10.1136/bmjopen-2015-008910] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore associations between features of sleep during pregnancy and adverse outcomes for the infant. SETTING E Moe, Māmā is a cohort study in Aotearoa/New Zealand that investigates self-reported sleep and maternal health in late pregnancy and the postpartum period. PARTICIPANTS Women (N=633; 194 Māori) reported detailed information on their sleep duration, quality, disturbances, disorders (snoring, breathing pauses, twitching legs, restless legs) and daytime sleepiness between 35 and 37 weeks gestation. OUTCOME MEASURES Birthweight and fetal distress during labour were extracted from medical records. Associations between each sleep variable and small or large for gestational age (SGA/LGA) using customised birthweight centile or fetal distress were estimated using multinomial/logistic regression, controlling for potential confounders. Secondary analyses considered differences in associations between Māori and non-Māori women. RESULTS There was some indication that breathing pauses (a measure of sleep apnoea) were associated with both SGA (OR 2.8, 95% CI 0.9 to 9.0, p=0.08) and LGA (OR 2.0, 95% CI 0.7 to 5.7, p=0.20), with the association for LGA being stronger when only pregnancy-onset breathing pauses were considered (OR 3.5, 95% CI 1.3 to 9.6, p=0.01). There was also some evidence that pregnancy-onset leg twitching (OR 3.3, 95% CI 1.1 to 10.0, p=0.03) and frequent sleep disturbance due to feeling too hot or too cold (OR 1.7, 95% CI 0.9 to 3.6, p=0.13) were associated with higher risk of fetal distress. Other sleep measures, including snoring, were not associated with SGA, LGA or fetal distress. Many of the associations we observed were considerably stronger in Māori compared with non-Māori women. CONCLUSIONS We did not find evidence of previously reported associations between snoring and SGA. Our findings tentatively suggest that self-reported breathing pauses and leg twitching in late pregnancy are associated with infant outcomes, and highlight ethnic inequalities.
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Affiliation(s)
- Laura D Howe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Sleep-Wake Research Centre, Massey University, Wellington, New Zealand
| | - T Leigh Signal
- Sleep-Wake Research Centre, Massey University, Wellington, New Zealand
| | - Sarah-Jane Paine
- Sleep-Wake Research Centre, Massey University, Wellington, New Zealand
| | - Bronwyn Sweeney
- Sleep-Wake Research Centre, Massey University, Wellington, New Zealand
| | - Monique Priston
- Sleep-Wake Research Centre, Massey University, Wellington, New Zealand
| | - Diane Muller
- Sleep-Wake Research Centre, Massey University, Wellington, New Zealand
| | - Kathy Lee
- University of California, San Francisco, California, USA
| | | | - Philippa Gander
- Sleep-Wake Research Centre, Massey University, Wellington, New Zealand
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Signal TL, Paine SJ, Sweeney B, Priston M, Muller D, Smith A, Lee KA, Huthwaite M, Reid P, Gander P. Prevalence of abnormal sleep duration and excessive daytime sleepiness in pregnancy and the role of socio-demographic factors: comparing pregnant women with women in the general population. Sleep Med 2014; 15:1477-83. [DOI: 10.1016/j.sleep.2014.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/26/2014] [Accepted: 07/01/2014] [Indexed: 12/22/2022]
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Abstract
OBJECTIVE We aimed to systematically compile a list of 10 movies to facilitate self-directed learning in psychiatry by medical students. METHOD The selected areas were those of the top five mental health conditions from the Global Burden of Disease 2010 study. The search strategy for movies covered an extensive range of sources (published literature and websites), followed by closer examination and critical viewing of a sample. RESULTS Out of a total of 503 potential movies that were identified, 23 were selected for viewing and more detailed critique. The final top 10 were: for depressive and anxiety disorders: Ordinary People (1980), Silver Linings Playbook (2012); for illicit drug use: Trainspotting (1996), Winter's Bone (2010), Rachel Getting Married (2008), Half Nelson (2006); for alcohol use disorders: Another Year (2010), Passion Fish (1992); and for schizophrenia: The Devil and Daniel Johnston (2006), and An Angel at My Table (1990). CONCLUSIONS The final selection of 10 movies all appeared to have relatively high entertainment value together with rich content in terms of psychiatric themes. Further research could evaluate the extent to which medical students actually watch such movies, by assessing the level of withdrawals from a medical school library and surveying student responses.
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Affiliation(s)
- Nick Wilson
- University of Otago, Wellington, New Zealand
| | - Deb Heath
- Starship Hospital, Auckland District Health Board, Auckland, New Zealand
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Abstract
OBJECTIVES Managing insomnia is a common challenge for psychiatrists and their patients. We have observed an increasing use of quetiapine as a hypnosedative. METHODS We conducted an audit with the aim of establishing the prescribing patterns of local general psychiatrists in New Zealand, comparing them with established guidelines and determining the extent of the prescribing of quetiapine as a hypnosedative. Participant psychiatrists were recruited from peer review groups. Each participant provided anonymised prescribing information from 10 patients and noted their intention when prescribing. RESULTS Twenty-five clinicians (58% response rate) responded with prescriptions for 100 in-patients and 177 community mental health patients. 60% of in-patients and 62% of community patients were prescribed medications to aid with sleep. The most commonly prescribed medications were zopiclone, quetiapine and benzodiazepines. Prescribing adhered with the recommended guidelines for 20% of benzodiazepine and 35% of zopiclone prescriptions. Two thirds (60%) of the community prescriptions for quetiapine were primarily for hypnosedation. CONCLUSIONS There is little concordance between guidelines for hypnosedative prescribing and the practices of general psychiatrists. Less zopiclone and fewer benzodiazepines were prescribed than in other studies, while more quetiapine was prescribed. The 'off-label' use of quetiapine and the duration of zopiclone and benzodiazepine use are discussed.
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Affiliation(s)
- Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Mark Cleghorn
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Joanna MacDonald
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Abstract
BACKGROUND This article presents findings from a prospective, longitudinal cohort educational study investigating empathy communication in clinical consultations. It reports on changes in students' self-report empathy during medical undergraduate training, investigates how well peers can assess student competence in motivational interviewing/brief interventions (MI/BI) skills and explores the relationship between students' self-report empathy and peer- or tutor-assessments of competence. METHODS 72 medical students completed the Jefferson Scale of Physician Empathy at three time points: at the beginning of their fifth year medical training (Time 1), after a specific MI/BI training session during their fifth year medical training (Time 2) and 1 year later during a revision session in year 6. Competence in BI/MI consultation was assessed using the validated tool Behaviour Change Counselling Index. RESULTS A significant decline in medical students' empathy scores was observed from year 5 to year 6, consistent with international findings. Peer assessments and tutor ratings of competence in MI/BI skills performance were moderately correlated, but peer assessments were negatively correlated with medical students' self-rated empathy. Senior medical students who self-rated as more empathic received lower competence evaluations of MI/BI skills from their peers. Interventions to further investigate teaching and learning of empathy are discussed.
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Affiliation(s)
- Bee Teng Lim
- Department of Public Health, University of Otago, Wellington South, New Zealand.
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Huthwaite M, Short J, Garg V. Pathways to practice: overseas trained psychiatrists' experiences of the processes involved in commencing professional practice in Australasia. Australas Psychiatry 2012; 20:24-7. [PMID: 22357671 DOI: 10.1177/1039856211430143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 11/15/2022]
Abstract
OBJECTIVE There are significant shortages in the psychiatric workforce in Australasia, particularly in the rural and remote regions of Australia and New Zealand. In response to these shortages, mental health services have recruited large numbers of overseas trained psychiatrists (OTP). These are specialist psychiatrists, trained and recognised as such in other countries. Our objective was to ascertain how OTPs experience the processes of commencing professional practice in Australasia. METHOD OTPs were surveyed to identify the pathways to obtaining specialist registration and College Fellowship in Australasia and to explore their experiences as they engaged in this process. RESULTS Although limited by a low response rate, the data does highlight a level of discontentment among those OTPs surveyed. The key issues identified related to the examination process, poor communication between different agencies (including the RANZCP), visa and residency related issues, medical board registration difficulties and notable differences between Australia and New Zealand. CONCLUSION There is a negative perception among OTPs regarding the existing pathways to registration as specialist psychiatrists and the attainment of Fellowship. We submit that the RANZCP has a central and important role in resolving some of the underlying issues and supporting OTPs as vital and valued members of the workforce in Australia and New Zealand.
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Menkes DB, Shieffelbien LM, Huthwaite M. Hypnosedative access and risk of harm. N Z Med J 2011; 124:69-73. [PMID: 22072169] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM To review PHARMAC's decision, effective 1 September 2010, to remove the 1-month restriction on funded prescription of hypnotics and anxiolytics. METHOD We consider the evidence for an association between access to these medicines and risk of harm. RESULTS Prescription volumes and reported harms have both increased over the last decade in New Zealand; available studies and clinical experience suggest a causal link. Preliminary data collected since PHARMAC's funding change suggest an exacerbation of the problem. CONCLUSION The decision to relax funding restrictions on hypnosedatives is expected to increase drug-related harms in a sub-population of users. Improved pharmacovigilance could inform policy regarding these agents.
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Affiliation(s)
- David B Menkes
- Waikato Clinical School, Private Bag 3200, Hamilton 3240, New Zealand.
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Abstract
BACKGROUND The communication of empathy is key in physician-patient interactions. We introduced drama training in "How to act-in-role" to medical students and evaluated the effect of this. METHODS A quasi-experimental design was employed, with 72 students in the control and 77 students in the intervention group. The students' empathy scores were obtained using the Jefferson Scale of Physician Empathy (JSPE) during the introductory course. Both groups received tutorials in motivational interviewing and brief intervention skills. The students in the intervention group also received training in "How to act-in-role". The JSPE was repeated for both groups. The students subsequently undertook observed structured clinical examinations (OSCE). Both tutors and students evaluated the student's OSCE performance as well as their motivational interviewing skills using the Behavior Change Counseling Index (BECCI). RESULTS Our findings show that while the students in both groups did not significantly differ in baseline empathy scores, the intervention group reported significantly higher empathy scores post-intervention. The intervention group also received significantly higher tutor ratings for their motivational interviewing (BECCI score) and overall OSCE performances. In conclusion, the teaching innovation "How to act-in-role" was effective not only in increasing medical students' self-reported empathy but also their competence in consultation skills.
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Affiliation(s)
- Bee Teng Lim
- Department of Psychological Medicine, Wellington School of Medicine and Health Sciences, New Zealand
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Abstract
A new treatment using a saccadic eye-movement desensitisation (EMD) procedure has recently been introduced to treat post-traumatic stress disorder, a disorder that has been difficult to treat in the past. The treatment is claimed to be very rapid and successful. This paper reports the treatment of a woman with posttraumatic stress disorder following a horrific road traffic accident using the EMD procedure.
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Affiliation(s)
- J Spector
- Shrodells Unit, Watford General Hospital
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