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Andrewes HE, Cavelti M, Hulbert C, Cotton SM, Betts JK, Jackson HJ, McCutcheon L, Gleeson J, Davey CG, Chanen AM. An analysis of real-time suicidal ideation and its relationship with retrospective reports among young people with borderline personality disorder. Suicide Life Threat Behav 2024. [PMID: 38375970 DOI: 10.1111/sltb.13058] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION This study aimed to analyze the real-time variability of suicidal ideation intensity and the relationship between real-time and retrospective reports of suicidal ideation made on the Beck Scale for Suicidal Ideation (BSS), among young people with borderline personality disorder (BPD). METHODS Young people (15-25-year olds) with BPD (N = 46), recruited from two government-funded mental health services, rated the intensity of their suicidal ideation six times per day for 7 days before completing the BSS. RESULTS For 70% of participants, suicidal ideation changed in intensity approximately five times across the week, both within and between days. BSS ratings were most highly correlated with the highest real-time ratings of suicidal ideation. However, this was not significantly different from the relationship between the BSS and both the average and most recent ratings. Median ratings of suicidal ideation intensity were higher on the BSS compared with an equivalent question asked in real time. CONCLUSION Findings suggest that young people with BPD experience high levels of fluctuation in their intensity of suicidal ideation across a week and that retrospective reports of suicidal ideation might be more reflective of the most intense experience of suicidal ideation across the week.
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Affiliation(s)
- Holly E Andrewes
- 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
| | - Marialuisa Cavelti
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan 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
| | - Jennifer K 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 J Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Louise McCutcheon
- 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
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Christopher G 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
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - 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
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Abstract
Recent years have seen escalating media, public and scientific interest in psychedelic medicine. Australia and New Zealand have been late to this research; however, in the past 2 years, rapid developments suggest that this is changing. Here, we argue for the need to critically review existing evidence in this field to guide future directions. We focus on (±)3,4-methylenedioxymethamphetamine-assisted psychotherapy for post-traumatic stress disorder, currently the most advanced area of clinical psychedelic research. Food and Drug Administration approval of this approach is likely in 2023, based on a series of promising findings. We provide a detailed overview of Phase 2 and 3 studies published to date. We identify several concerns related to this body of evidence, including methodological/design limitations and broader factors - such as robust involvement of advocacy groups in research and reliance on non-government financing leading to simplistic public messaging - that compound the methodological issues identified. We propose steps for future improvement, including the need for large, high-quality, independent efficacy trials with design enhancements, effectiveness trials and for researchers to consider their own engagement with media and public messaging around these modalities. We argue that, notwithstanding promising findings to date, rigorous and dispassionate science is needed to move the field forward and safeguard the welfare of participants.
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Affiliation(s)
- Gillinder Bedi
- Centre for Youth Mental Health, Research and Translation, The University of Melbourne, Parkvillle, VIC, Australia
- Orygen, Research and Translation, Parkville, VIC, Australia
| | - Susan M Cotton
- Centre for Youth Mental Health, Research and Translation, The University of Melbourne, Parkvillle, VIC, Australia
- Orygen, Research and Translation, Parkville, VIC, Australia
| | - Alexandre A Guerin
- Centre for Youth Mental Health, Research and Translation, The University of Melbourne, Parkvillle, VIC, Australia
- Orygen, Research and Translation, Parkville, VIC, Australia
| | - Henry J Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
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3
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Clarke EL, Allott K, Anderson JFI, Gao CX, Filia KM, Killackey E, Cotton SM. Heterogeneity of quality of life in the later stages of first-episode psychosis recovery. Qual Life Res 2023; 32:769-780. [PMID: 36378390 PMCID: PMC9992035 DOI: 10.1007/s11136-022-03277-x] [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] [Accepted: 10/07/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE First-episode psychosis (FEP) is characterised by wide heterogeneity in terms of symptom presentation and illness course. However, the heterogeneity of quality of life (QoL) in FEP is not well understood. We investigated whether subgroups can be identified using participants' responses on four QoL domains (physical health, psychological, social relationships, and environmental) 18-months into the recovery phase of FEP. We then examined the discriminant validity of these subgroups with respect to clinical, cognitive, and functioning features of FEP. METHOD Demographic and clinical characteristics, QoL, cognition, and functioning were assessed in 100 people with FEP at the 18-month follow-up of a randomised controlled trial of Individual Placement Support, which aims to facilitate vocational recovery. QoL was measured using the World Health Organisation's QoL-BRIEF. A two-stage clustering approach using Ward's method and Squared Euclidean Distance with a k-means confirmation was conducted. Multinomial logistic regressions were used to establish external validity. RESULTS Three QoL subgroups emerged: a 'good' subgroup with relatively high QoL across all domains (31%), an 'intermediate' subgroup with relatively low psychological QoL (48%) and a 'poor' subgroup with markedly low social relationship QoL (21%). Negative symptoms, depressive symptoms, social/occupational functioning, and social inclusion at follow-up predicted subgroup membership. Sensitivity analysis found similar results. CONCLUSION Although some individuals with FEP have QoL comparable to individuals without mental ill health, QoL can remain concerningly low despite treatment efforts. Future research on interventions that target factors associated with poor QoL, such as low social inclusion, is required to counteract prolonged poor QoL in FEP.
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Affiliation(s)
- E L Clarke
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - K Allott
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - J F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - C X Gao
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - K M Filia
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - E Killackey
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - S M Cotton
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
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Birchall O, Bennett M, Lawson N, Cotton SM, Vogel AP. Instrumental swallowing assessment in adults in residential aged care homes: Practice patterns and opportunities. Australas J Ageing 2023; 42:108-117. [PMID: 35938310 PMCID: PMC10947304 DOI: 10.1111/ajag.13122] [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] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe practice patterns in the use of instrumental swallowing assessment (ISA) for older adults in residential aged care homes (RACHs). METHODS A retrospective audit of medical records of residents living in RACHs in Melbourne, Australia to extract data on speech-language pathologist (SLP) involvement, indications for ISA and ISA practice patterns. RESULTS Medical files of 323 residents across four Melbourne facilities were reviewed. 36% (n = 115) of residents were referred to SLP for swallowing assessment. Referral to SLP was related to length of stay (U = 7393.00, p < 0.001), dementia status (χ2 [1] = 7.06, p = 0.008), texture modification (χ2 [1] = 93.34, p < 0.001) and an existing dysphagia diagnosis (χ2 [1] = 112.89, p < 0.001). There were no referrals for ISA and no instances of ISA being used. Among 115 residents who were referred to SLP for swallowing assessment, there were 33 instances where ISA might be clinically relevant according to ISA indicators. CONCLUSIONS Instrumental swallowing assessment is not being used for the management of swallowing in RACHs in Australia despite a clinical need for ISA and a potential role for ISA to improve swallowing care quality. Lack of timely ISA may fail to meet the complex health-care needs of older adults living with dysphagia in RACHs, increasing their vulnerability to complications of dysphagia and its management.
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Affiliation(s)
- Olga Birchall
- Centre for Neurosciences of SpeechThe University of MelbourneMelbourneVictoriaAustralia
- Department of Audiology and Speech PathologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Michelle Bennett
- School of Allied HealthAustralian Catholic UniversityNorth SydneyNew South WalesAustralia
| | - Nadine Lawson
- Speech Pathology DepartmentCabrini HospitalMalvernVictoriaAustralia
| | - Susan M. Cotton
- Orygen, The National Centre of Excellence in Youth Mental HealthParkvilleVictoriaAustralia
- Centre for Youth Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Adam P. Vogel
- Centre for Neurosciences of SpeechThe University of MelbourneMelbourneVictoriaAustralia
- Department of Neurodegeneration, Hertie Institute for Clinical Brain ResearchUniversity of TübingenTubingenGermany
- RedenlabMelbourneVictoriaAustralia
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Russell SE, Wrobel AL, Dean OM, Berk M, Dodd S, Ng CH, Malhi GS, Cotton SM, Sarris J, Turner A. Mixed Methods Thematic Analysis of a Randomised Controlled Trial of Adjunctive Mitochondrial Agents for Bipolar Depression. Clin Psychopharmacol Neurosci 2022; 20:300-310. [PMID: 35466101 PMCID: PMC9048011 DOI: 10.9758/cpn.2022.20.2.300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/06/2021] [Indexed: 11/18/2022]
Abstract
Objective There is often a shortfall in recovery following treatment for an episode of bipolar disorder (BD). Exploration of participant's experience provides vital information to enhance statistical outcomes for novel therapy trials. This study used mixed-methods to explore participants' experience of a trial testing N -acetyl cysteine (NAC) and mitochondrially active nutraceuticals for BD depression. Methods Case report forms from a randomised controlled trial (RCT) of BD depression (n = 148) were analysed using a pragmatic adaption of grounded theory and thematic analysis. Results Thematic analysis of 148 study participants indicated numerous changes in participant experience over time. For example, perceived environmental stressors reported by participants decreased over the trial in both treatment groups. Quantitative analysis of the themes revealed more positive theme reports in the combination treatment arm compared to the placebo arm and there were more negative themes identified in the placebo arm, compared to the NAC arm. Conclusion This approach revealed additional results not elucidated in the primary quantitative analysis. This emphasises the value of mixed-methods research in capturing participants' experiences in RCTs and detecting possible latent benefits and risks. Such methods can detect latent target signals in novel therapy trials conducted in BD and generate novel hypotheses.
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Affiliation(s)
- Samantha E. Russell
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Anna L. Wrobel
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Olivia M. Dean
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
- Department of Psychiatry, University of Melbourne, The Melbourne Clinic, Richmond, Australia
| | - Seetal Dodd
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Chee H. Ng
- Department of Psychiatry, University of Melbourne, The Melbourne Clinic, Richmond, Australia
| | - Gin S. Malhi
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Department of Psychiatry, The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Sydney, Australia
- Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Westmead, Australia
| | - Susan M. Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jerome Sarris
- Department of Psychiatry, University of Melbourne, The Melbourne Clinic, Richmond, Australia
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | - Alyna Turner
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, Australia
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6
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Filia K, Menssink J, Gao CX, Rickwood D, Hamilton M, Hetrick SE, Parker AG, Herrman H, Hickie I, Sharmin S, McGorry PD, Cotton SM. Social inclusion, intersectionality, and profiles of vulnerable groups of young people seeking mental health support. Soc Psychiatry Psychiatr Epidemiol 2022; 57:245-254. [PMID: 34091699 DOI: 10.1007/s00127-021-02123-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND headspace centres provide enhanced primary mental healthcare for young people. A priority is to provide services for all young people irrespective of a range of social disadvantages or social exclusion. The aims of this study were to: (i) delineate extent of social inclusion across domains of housing, studying/employment, functioning, alcohol, and other drug use; and (ii) map profiles of young people deemed vulnerable to experiencing additional barriers to accessing services based on their social inclusion domains (e.g., those living in unstable housing, not in employment/education, and/or experiencing intersecting or multiple forms of disadvantage or difficulties), including detailing their clinical characteristics. METHODS Young people were recruited from five headspace centres. Data relevant to social inclusion were examined. Multivariate logistic regression models were used to determine overlap between vulnerable groups, functional, social, clinical, and behavioural factors. RESULTS 1107 young people participated, aged 12-25 years (M = 18.1 years, SD = 3.3), most living in stable housing (96.5%) and engaged in studying/employment (84.8%). Specific vulnerabilities were evident in young people with NEET status (15.2%); in unstable accommodation (3.5%); of culturally diverse backgrounds (CALD) (12.2%); living in regional areas (36.1%); and identifying as lesbian, gay, bisexual, transgender, intersex, queer/questioning, and asexual plus (LGBTIQA+; 28.2%). Higher levels of distress, substance use, functional impairment, and lower social support were reported by those who were NEET and/or in unstable housing. LGBTIQA+ status was associated with high distress, depressive symptoms, and suicidal ideation. CONCLUSIONS Most participants reported good social support, stable housing, and engagement in work or education. Those deemed vulnerable were likely to experience social exclusion across multiple domains and reported more mental health problems. The co-occurrence of mental ill-health and social exclusion highlights the importance of integrated mental healthcare.
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Affiliation(s)
- K Filia
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia.
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.
| | - J Menssink
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - C X Gao
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - D Rickwood
- headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - M Hamilton
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - S E Hetrick
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - A G Parker
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - H Herrman
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - I Hickie
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - S Sharmin
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - P D McGorry
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - S M Cotton
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Herniman SE, Wood SJ, Cotton SM, Allott KA, Davey C, Berk M, Phillips LJ. The specific phenotype of depression in recent onset schizophrenia spectrum disorders: A symptom profile and network comparison to recent onset major depressive disorder without psychotic features. Schizophr Res 2022; 240:52-60. [PMID: 34942537 DOI: 10.1016/j.schres.2021.11.048] [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: 10/23/2020] [Revised: 10/25/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
The specific phenotype of depression in recent-onset schizophrenia spectrum disorders (SSD) and its relation to non-psychotic depression is unknown. Symptom profile and network analysis are complementary statistical techniques that may provide important insights into the presentation and relative importance of individual symptoms that give rise to depression. The aim of the current study was to characterise the profile and network of depressive symptoms in SSD and compare it to individuals with major depressive disorder (MDD) without psychotic features. This study involved analysis of baseline data pertaining to 109 individuals with comorbid SSD and depression and 283 with MDD without psychotic features. Study cohorts were the Psychosis Recent Onset GRoningen Survey (PROGR-S) and Youth Depression Alleviation (YoDA) trials, respectively. Profile and network analyses revealed that SSD and MDD differed in the profile and relative importance of individual depressive symptoms. While reported sadness was the primary hallmark of depression in both SSD and MDD, individuals with depression in SSD were more likely to sleep more, and have lower lassitude and pessimism. While sadness had great importance in MDD and SSD, in SSD but not MDD lassitude, sleep, appetite, concentration difficulties, and inability to feel were important in the network of depressive symptoms. The specific phenotype of depression might be different in SSD compared to MDD. Symptom inequivalence or underlying functional mechanisms in SSD might result in depression in SSD that is similar to MDD with atypical features.
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Affiliation(s)
- Sarah E Herniman
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Stephen J Wood
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; School of Psychology, University of Birmingham, Birmingham, UK
| | - Susan M Cotton
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Kelly A Allott
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Christopher Davey
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Michael Berk
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Lisa J Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Filia KM, Cotton SM, Watson AE, Jayasinghe A, Kerr M, Fitzgerald PB. Understanding the Barriers and Facilitators to Employment for People with Bipolar Disorder. Psychiatr Q 2021; 92:1565-1579. [PMID: 34097245 DOI: 10.1007/s11126-021-09931-w] [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] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
People with Bipolar Disorder (BD) consistently report a desire for employment; however, this is not reflected in employment figures. Individuals' perceptions of barriers to employment, along with endorsement of facilitators to employment remain under-investigated. We aimed to address this limitation by: (i) first examining differences in employed versus unemployed individuals (demographic, clinical, functioning); then (ii) identifying barriers and/or facilitators to employment, perception of same, and subsequent impact on employment. We assessed demographics, functioning, and illness-related characteristics in 35 participants with BD (19 employed, 16 unemployed). Participants were asked to indicate perception of common barriers and facilitators to employment. Groups did not differ regarding demographic or clinical variables. High levels of absenteeism, termination of last role and commonly perceived barriers were attributed to mental ill-health. 93.3% of unemployed participants reportedly desired employment, and more perceived barriers were observed in the unemployed group. Identified facilitators included increased support and flexible work strategies. A comprehensive understanding of perceptions of limiting and helpful factors related to employment for people with BD was obtained. These findings have implications for service provision, encouraging targeted discussion, and tailored treatment approaches to individual's unique perceptions of factors related to employment.
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Affiliation(s)
- K M Filia
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.
| | - S M Cotton
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - A E Watson
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - A Jayasinghe
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,School of Psychology, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - M Kerr
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - P B Fitzgerald
- Department of Psychiatry, Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University, 888 Toorak Road, Camberwell, VIC, 3124, Australia
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9
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Gleeson J, Alvarez-Jimenez M, Betts JK, McCutcheon L, Jovev M, Lederman R, Herrman H, Cotton SM, Bendall S, McKechnie B, Burke E, Koval P, Smith J, D'Alfonso S, Mallawaarachchi S, Chanen AM. A pilot trial of moderated online social therapy for family and friends of young people with borderline personality disorder features. Early Interv Psychiatry 2021; 15:1564-1574. [PMID: 33260274 DOI: 10.1111/eip.13094] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022]
Abstract
AIM We evaluated the acceptability, usability and safety of Kindred, a novel online intervention for carers of young people with borderline personality disorder (BPD) using a pre-post pilot trial design. The secondary aim explored whether Kindred use was associated with clinical improvements for caregivers on measures of burden of caregiving, stress, expressed emotion, family communication, disability, coping and knowledge of BPD and for patients on measures of severity of BPD symptoms and level of functional impairment. METHODS The trial site was the Helping Young People Early program for young people with BPD at Orygen in Melbourne, Australia. Informed consent was obtained from 20 adult carers (i.e., relatives or friends) and 10 young people aged 15-25 with BPD. Kindred, which was available for 3 months, incorporated online psychoeducation, carer-to-carer social networking and guidance from expert and peer moderators. Assessments were completed at baseline and 3 months follow-up. Multiple indicators of acceptability, usability and safety were utilized. RESULTS Seventeen carers were enrolled in Kindred and eight young people completed baseline measures. A priori acceptability, usability and safety criteria were met. Carer burden, stress, expressed emotion, family communication, quality of life, functioning, coping and perceived knowledge of BPD improved at follow-up. Sixty-six percent of the young people (4/6) reported that they believed Kindred had improved their carers' understanding of BPD. CONCLUSION Kindred was shown to be acceptable, usable and safe, with encouraging improvements in both carer and young person outcomes. Kindred warrants evaluation of its efficacy via an randomized controlled trial.
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Affiliation(s)
- John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jennifer K Betts
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Louise McCutcheon
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | - Reeva Lederman
- School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Helen Herrman
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Susan M Cotton
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Sarah Bendall
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | | | - Peter Koval
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Jesse Smith
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Simon D'Alfonso
- Orygen, Melbourne, Australia.,School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Sumudu Mallawaarachchi
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Andrew M Chanen
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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Cotton SM, Menssink J, Filia K, Rickwood D, Hickie IB, Hamilton M, Hetrick S, Parker A, Herrman H, McGorry PD, Gao C. The psychometric characteristics of the Kessler Psychological Distress Scale (K6) in help-seeking youth: What do you miss when using it as an outcome measure? Psychiatry Res 2021; 305:114182. [PMID: 34455216 DOI: 10.1016/j.psychres.2021.114182] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/31/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
This is the first study to describe psychometric properties of the Kessler Psychological Distress Scale (K6) in a large cohort of help-seeking young people presenting to primary mental health care services. The aim was to determine whether the K6 was appropriate for monitoring outcomes in such settings. 1067 young people were recruited from Australian headspace services. We examined dimensionality of the K6, measurement invariance, and how the K6 correlated with the the Patient Health Questionnaire-9 (PHQ-9)and the Generalised Anxiety Disorder-7 Scale (GAD-7). Standardised Response Mean (SRM) and Cohen's d effect size (ES) were used to examine 3-month stability of the K6. The best-fitting model was a two-factor model: (i) nervous and restlessness; and (ii) hopeless, worthless, depressed and effort. Measurement non-invariance was observed for sex and age groups. K6 strongly correlated with the PHQ-9 and GAD-7. The K6 was less sensitive to change compared to these other two measures. There was some support for the K6 being a screener for young people presenting to primary care; however, there issues arise with its use as an outcome measure. These issues include measurement non-invariance, concern about the dimensionality and focus of items, and its sensitivity to change.
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Affiliation(s)
- S M Cotton
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia.
| | - J Menssink
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia
| | - K Filia
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia
| | - D Rickwood
- headspace National Youth Mental Health Foundation Ltd, Melbourne VIC, Australia; Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - I B Hickie
- Brain and Mind, University of Sydney, Camperdown, NSW, Australia
| | - M Hamilton
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia
| | - S Hetrick
- Department of Psychological Medicine, The University of Auckland, Auckland, Australia
| | - A Parker
- Orygen, Parkville, Melbourne VIC, Australia; Victoria University, Institute of Health and Sport, Melbourne VIC, Australia
| | - H Herrman
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia
| | - P D McGorry
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia
| | - C Gao
- Orygen, Parkville, Melbourne VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne VIC, Australia
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11
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Liao Z, Allott K, Anderson JFI, Killackey E, Cotton SM. Quality of life in first episode psychosis: a cluster analytic approach. Qual Life Res 2021; 31:1807-1817. [PMID: 34661805 DOI: 10.1007/s11136-021-03014-w] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Quality of life is increasingly recognised as an important outcome for young people with first episode psychosis (FEP). The first aim was to determine whether distinct homogenous subgroups of young people with FEP could be delineated based on profiles on quality of life domains (Physical Health, Psychological, Social relationships and Environmental). The second aim was to examine the discriminant validity of these subgroups with respect to demographic, functioning and clinical features of FEP. METHOD Quality of life, demographic characteristics, clinical characteristics, cognition and functioning were assessed in 145 people with FEP. Cluster analysis using Ward's methods and Squared Euclidean Distance with a k-means verification were employed to identify subgroups with homogenous quality of life profiles. The clusters were externally validated using multinomial logistic regressions. RESULTS Three distinct quality of life profiles were identified: one with good quality of life across all domains (30%), one with poor quality of life particularly in Psychological and Social relationships domains (28%), and one 'intermediate' group with comparatively low Psychological quality of life (42%). Depression, semantic verbal fluency, social inclusion and social/occupational functioning showed associations with group membership. CONCLUSION Our results suggest the potential of maintaining relatively good quality of life despite the experience of FEP. Future research on interventions to improve quality of life may consider the potential of addressing depression, social inclusion and social/occupational functioning.
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Affiliation(s)
- Z Liao
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - K Allott
- Orygen, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia
| | - J F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - E Killackey
- Orygen, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia
| | - S M Cotton
- Orygen, Parkville, Melbourne, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia.
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12
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Birchall O, Bennett M, Lawson N, Cotton SM, Vogel AP. The Role of Instrumental Swallowing Assessment in Adults in Residential Aged Care Homes: A National Modified Delphi Survey Examining Beliefs and Practices. Dysphagia 2021; 37:510-522. [PMID: 33835262 DOI: 10.1007/s00455-021-10296-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/25/2021] [Indexed: 12/31/2022]
Abstract
Many adults in residential aged care homes (RACHs) live with oropharyngeal dysphagia (OD) and its physiological, psychosocial, and economic sequalae. Timely, evidence-based assessment of OD can help healthcare teams to create OD management plans that optimize consumer health and minimize healthcare costs. Instrumental swallowing assessment (ISA), specifically flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing studies (VFSS), is generally accepted to be an important component of dysphagia assessment and management in older adults. However, its role in RACHs has not been empirically examined. This study aimed to explore the role and use of ISA in adults in RACHs from the perspective of speech-language-pathologists (SLPs) experienced in a RACH setting and/or FEES and VFSS. A three-round electronic Delphi study was conducted to guide 58 SLPs in Australia towards consensus using a combination of multiple-choice questions, statements with five-point Likert scale agreement options, and open-ended questions. Participants' responses were analyzed using descriptive statistics and content analysis after each survey round. Feedback about group responses was provided before subsequent surveys. Consensus was defined as 70% or greater agreement. Participants reached consensus about obstacles and facilitators to the use of ISA in RACHs. Participants agreed that FEES was a valuable tool in RACHs and that a mobile service model may have advantages over standard off-site assessment. SLPs believed that appropriate governance processes, infrastructure and education were necessary to develop a safe, high-quality service. These views support equitable access to ISA across settings, aligning with person-centered care, re-ablement, and care-in-place.
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Affiliation(s)
- Olga Birchall
- Centre for Neurosciences of Speech, The University of Melbourne, Melbourne, Australia.
- Department of Audiology and Speech Pathology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Michelle Bennett
- School of Allied Health, Australian Catholic University, North Sydney, Sydney, Australia
| | - Nadine Lawson
- Speech Pathology Department, Cabrini Hospital, Malvern, Australia
| | - Susan M Cotton
- The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Adam P Vogel
- Centre for Neurosciences of Speech, The University of Melbourne, Melbourne, Australia
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Redenlab, Melbourne, Australia
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13
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Turner A, Baker A, Dean OM, Walker AJ, Dodd S, Cotton SM, Scott JG, Kavanagh BE, Ashton MM, Brown E, McGrath JJ, Berk M. Adjunctive Garcinia mangostana Linn. (Mangosteen) Pericarp for Schizophrenia: A 24-Week Double-blind, Randomized, Placebo Controlled Efficacy Trial: Péricarpe d'appoint Garcinia mangostana Linn (mangoustan) pour la schizophrénie : un essai d'efficacité de 24 semaines, à double insu, randomisé et contrôlé par placebo. Can J Psychiatry 2021; 66:354-366. [PMID: 33355478 PMCID: PMC8172349 DOI: 10.1177/0706743720982437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Garcinia mangostana Linn. ("mangosteen") pericarp contains bioactive compounds that may target biological pathways implicated in schizophrenia. We conducted a double-blind randomized placebo-controlled trial evaluating the efficacy of adjunctive mangosteen pericarp, compared to placebo, in the treatment of schizophrenia. METHODS People diagnosed with schizophrenia or schizoaffective disorder (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), recruited across 2 sites (Brisbane and Victoria, Australia), were randomized to receive 24 weeks of adjunctive mangosteen pericarp (1,000 mg/day) or matched placebo. The primary outcome measure was the Positive and Negative Symptom Scale total score. Secondary outcomes included positive and negative symptoms, general psychopathology, clinical global severity and improvement, participant reported overall improvement, depressive symptoms, functioning, quality of life, and safety data at 24 and 28 weeks (4 weeks postdiscontinuation). Data were collected from July 2016 to February 2019. RESULTS Baseline assessments were conducted on 148 people (mangosteen = 74, placebo = 74); data analyses were conducted on 136 (92%) participants with postbaseline data. The treatment group had significantly higher symptom severity compared to placebo, and both groups significantly improved on all symptom, functioning, and quality of life measures over time. No between-group differences were found for the rate of change between baseline and 24 or 28 weeks. CONCLUSION Despite promising preclinical and clinical work, our results do not support mangosteen pericarp extract as an adjunctive treatment for schizophrenia or schizoaffective disorder.
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Affiliation(s)
- Alyna Turner
- 2104Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrea Baker
- 90131Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
| | - Olivia M Dean
- 2104Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Adam J Walker
- 2104Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Seetal Dodd
- 2104Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Susan M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
- Orygen, Parkville, Australia
| | - James G Scott
- 90131Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
- Metro North Mental Health Service, Herston, Queensland, Australia
- Mental Health Programme, QIMRBerghofer Medical Research Institute, Herston, Queensland, Australia
| | - Bianca E Kavanagh
- 2104Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Melanie M Ashton
- 2104Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Ellie Brown
- 2104Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
- Orygen, Parkville, Australia
| | - John J McGrath
- 90131Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
- Queensland Brain Institute, 1974University of Queensland, St Lucia, Australia
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus V, Denmark
| | - Michael Berk
- 2104Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
- Orygen, Parkville, Australia
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Gleeson J, Alvarez-Jimenez M, Betts JK, McCutcheon L, Jovev M, Lederman R, Herrman H, Cotton SM, Bendall S, McKechnie B, Burke E, Koval P, Smith J, D'Alfonso S, Mallawaarachchi S, Chanen AM. A pilot trial of moderated online social therapy for family and friends of young people with borderline personality disorder features. Early Interv Psychiatry 2020. [PMID: 33260274 DOI: 10.1111/eip.13094.] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM We evaluated the acceptability, usability and safety of Kindred, a novel online intervention for carers of young people with borderline personality disorder (BPD) using a pre-post pilot trial design. The secondary aim explored whether Kindred use was associated with clinical improvements for caregivers on measures of burden of caregiving, stress, expressed emotion, family communication, disability, coping and knowledge of BPD and for patients on measures of severity of BPD symptoms and level of functional impairment. METHODS The trial site was the Helping Young People Early program for young people with BPD at Orygen in Melbourne, Australia. Informed consent was obtained from 20 adult carers (i.e., relatives or friends) and 10 young people aged 15-25 with BPD. Kindred, which was available for 3 months, incorporated online psychoeducation, carer-to-carer social networking and guidance from expert and peer moderators. Assessments were completed at baseline and 3 months follow-up. Multiple indicators of acceptability, usability and safety were utilized. RESULTS Seventeen carers were enrolled in Kindred and eight young people completed baseline measures. A priori acceptability, usability and safety criteria were met. Carer burden, stress, expressed emotion, family communication, quality of life, functioning, coping and perceived knowledge of BPD improved at follow-up. Sixty-six percent of the young people (4/6) reported that they believed Kindred had improved their carers' understanding of BPD. CONCLUSION Kindred was shown to be acceptable, usable and safe, with encouraging improvements in both carer and young person outcomes. Kindred warrants evaluation of its efficacy via an randomized controlled trial.
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Affiliation(s)
- John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jennifer K Betts
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Louise McCutcheon
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | - Reeva Lederman
- School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Helen Herrman
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Susan M Cotton
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Sarah Bendall
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | | | - Peter Koval
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Jesse Smith
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Simon D'Alfonso
- Orygen, Melbourne, Australia.,School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Sumudu Mallawaarachchi
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Andrew M Chanen
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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15
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Birchall O, Bennett M, Lawson N, Cotton SM, Vogel AP. Instrumental Swallowing Assessment in Adults in Residential Aged Care Homes: A Scoping Review. J Am Med Dir Assoc 2020; 22:372-379.e6. [PMID: 33069625 DOI: 10.1016/j.jamda.2020.08.028] [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] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To systematically describe evidence on the use of instrumental swallowing assessment for residents of aged care homes. DESIGN Scoping review using the Joanna Briggs Institute methodology for scoping reviews. SETTING AND PARTICIPANTS Published peer-reviewed and gray literature written in English between 2000 and 2020 about instrumental swallowing assessment (ISA) in adults in residential aged care homes (RACHs). MEASURES A systematic, 3-tiered search of databases including Medline, CINAHL, Embase, Scopus, and Cochrane Database of Systematic Reviews, and gray literature databases was conducted. Content analysis identified common themes. RESULTS Forty-two sources, 30 from peer-reviewed journals, 12 gray literature publications, and 66 websites of mobile ISA providers that discussed videofluoroscopic swallowing studies (VFSS) and/or fiberoptic endoscopic evaluation of swallowing (FEES) use in RACHs were included. Most peer-reviewed sources were referenced narratives or surveys of speech pathology practice patterns (53.3%). Researchers in 3 studies used onsite mobile FEES and in 2 studies off-site VFSS, with adults living in RACHs, as part of their research design (16.7%). There were 66 mobile instrumental swallowing assessment provider websites, based within the United States. Three countries (Australia, United States, United Kingdom) had professional guidelines that stipulated minimal requirements for the safe and appropriate provision of ISA services across settings. Themes identified across sources included (1) the approach to swallowing management and clinical indicators for ISA, (2) the role of ISA, (3) service and consumer influences on ISA, and (4) mobile FEES. CONCLUSIONS AND IMPLICATIONS There is a paucity of quality research on instrumental swallowing assessment in adults living in RACHs. There are broad regional and international variances in the way that videofluoroscopy and FEES are accessed and used. A more robust evidence base is required to guide health professionals to design tailored ISA care pathways for residents of RACHs, to achieve high-quality health, social, and economic outcomes.
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Affiliation(s)
- Olga Birchall
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia.
| | - Michelle Bennett
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Nadine Lawson
- Speech Pathology Department, Cabrini Hospital, Malvern, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; Redenlab, Melbourne, Australia
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16
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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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Caruana E, Allott K, Farhall J, Parrish EM, Davey CG, Chanen AM, Killackey E, Cotton SM. Factors associated with vocational disengagement among young people entering mental health treatment. Early Interv Psychiatry 2019; 13:961-968. [PMID: 30019851 DOI: 10.1111/eip.12718] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 11/27/2022]
Abstract
AIM Most mental disorders have their onset by age 25, disrupting normative vocational engagement. Factors associated with vocational disengagement at first contact with specialist treatment are important for service planning. The aim of this paper was to investigate the association between theoretically important factors and vocational disengagement for youth entering mental health treatment. METHODS A file audit was used to extract vocational data of 145 young people aged 15 to 25 years entering treatment in 2011 at a public youth mental health service in Melbourne, Australia. Comparisons were made across three specialist programs for: psychosis (n = 50), mood disorders (n = 52) and borderline personality pathology (n = 43). Individual characteristics were entered into univariate and multivariate logistic regressions to investigate their associations with vocational disengagement. RESULTS Educational disengagement was associated with being older (OR = 4.38, P = 0.004) and not living with parents (OR = 2.87, P = 0.038). Unemployment and being NEET (Not in Education, Employment or Training) were both associated with not having commenced tertiary education (OR = 0.23, P = 0.022; OR = 0.05, P = 0.002; respectively). Being NEET was also associated with being older (OR = 6.18, P = 0.004). Primary diagnostic grouping was not associated with vocational disengagement, once accounting for other factors. CONCLUSIONS The likelihood of vocational disengagement did not differ across disorder groups, implying that intervention should be "transdiagnostic" and might best target education first, specifically post-secondary qualifications. Other domains or variables not measured in this study are also likely to be important, and this might include young people's support systems and symptom severity. Qualitative studies may be useful for exploring further factors relevant to vocational engagement.
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Affiliation(s)
- Emma Caruana
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria.,North Western Mental Health, Parkville, Victoria
| | - Emma M Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,Northeastern University, Boston, Massachusetts
| | - Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,Orygen Youth Health, Parkville, Victoria
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,North Western Mental Health, Parkville, Victoria.,Orygen Youth Health, Parkville, Victoria
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
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18
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Caruana E, Farhall J, Cotton SM, Parrish E, van-der-El K, Davey CG, Chanen AM, Bryce SD, Killackey E, Allott K. Vocational engagement among young people entering mental health treatment compared with their general population peers. Early Interv Psychiatry 2019; 13:692-696. [PMID: 29968285 DOI: 10.1111/eip.12712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/12/2018] [Revised: 05/23/2018] [Accepted: 06/10/2018] [Indexed: 11/26/2022]
Abstract
AIM To compare rates of vocational engagement for youth entering specialist mental health treatment with the general population. METHODS A file audit retrieved vocational data for 145 youth aged 15 to 25 entering treatment. Clinical and population data were stratified by age and sex and compared between cohorts. RESULTS Compared to the population, young people entering mental health treatment were less likely to have completed at least Year 11 in school (77% vs 42%, P < 0.001); and demonstrated higher rates of "Not in Education, Employment or Training" (9% vs 33%, P < 0.001). Individuals aged 15 to 18 years entering treatment experienced greater rates of educational disengagement than the population (30% vs 11%, P < 0.001), whereas people aged 19 to 25 years showed higher unemployment rates (52% vs 35%, P = 0.003). CONCLUSIONS Youth entering specialist mental health treatment have marked levels of vocational disengagement compared to demographically-matched peers. Early vocational intervention for these young people is essential.
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Affiliation(s)
- Emma Caruana
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia.,North Western Mental Health, Parkville, Victoria, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Emma Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kristi van-der-El
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Shayden D Bryce
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Monash School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, 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, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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19
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Turner A, McGrath JJ, Dean OM, Dodd S, Baker A, Cotton SM, Scott JG, Kavanagh BE, Ashton MM, Walker AJ, Brown E, Berk M. Protocol and Rationale: A 24-week Double-blind, Randomized, Placebo Controlled Trial of the Efficacy of Adjunctive Garcinia mangostanaLinn. (Mangosteen) Pericarp for Schizophrenia. Clin Psychopharmacol Neurosci 2019; 17:297-307. [PMID: 30905130 PMCID: PMC6478095 DOI: 10.9758/cpn.2019.17.2.297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022]
Abstract
Objective Garcinia mangostana Linn., commonly known as mangosteen, is a tropical fruit with a thick pericarp rind containing bioactive compounds that may be beneficial as an adjunctive treatment for schizophrenia. The biological underpinnings of schizophrenia are believed to involve altered neurotransmission, inflammation, redox systems, mitochondrial dysfunction, and neurogenesis. Mangosteen pericarp contains xanthones which may target these biological pathways and improve symptoms; this is supported by preclinical evidence. Here we outline the protocol for a double-blind randomized placebo-controlled trial evaluating the efficacy of adjunctive mangosteen pericarp (1,000 mg/day), compared to placebo, in the treatment of schizophrenia. Methods We aim to recruit 150 participants across two sites (Geelong and Brisbane). Participants diagnosed with schizophrenia or schizoaffective disorder will be randomized to receive 24 weeks of either adjunctive 1,000 mg/day of mangosteen pericarp or matched placebo, in addition to their usual treatment. The primary outcome measure is mean change in the Positive and Negative Symptom Scale (total score) over the 24 weeks. Secondary outcomes include positive and negative symptoms, general psychopathology, clinical global severity and improvement, depressive symptoms, life satisfaction, functioning, participants reported overall improvement, substance use, cognition, safety and biological data. A 4-week post treatment interview at week 28 will explore post-discontinuations effects. Results Ethical and governance approvals were gained and the trial commenced. Conclusion A positive finding in this study has the potential to provide a new adjunctive treatment option for people with schizophrenia and schizoaffective disorder. It may also lead to a greater understanding of the pathophysiology of the disorder.
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Affiliation(s)
- Alyna Turner
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health.,Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital
| | - John J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health.,Queensland Brain Institute, University of Queensland.,National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University
| | - Olivia M Dean
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital.,Florey Institute of Neuroscience and Mental Health, University of Melbourne
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital.,Centre for Youth Mental Health, The University of Melbourne
| | - Andrea Baker
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health
| | - Susan M Cotton
- Centre for Youth Mental Health, The University of Melbourne.,Orygen, The National Centre of Excellence in Youth Mental Health
| | - James G Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health.,Metro North Mental Health Service.,Faculty of Medicine, The University of Queensland
| | - Bianca E Kavanagh
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health
| | - Melanie M Ashton
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health.,Florey Institute of Neuroscience and Mental Health, University of Melbourne.,Department of Psychiatry, University of Melbourne, Professorial Unit, The Melbourne Clinic
| | - Adam J Walker
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health
| | - Ellie Brown
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health.,Centre for Youth Mental Health, The University of Melbourne.,Orygen, The National Centre of Excellence in Youth Mental Health
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital.,Florey Institute of Neuroscience and Mental Health, University of Melbourne.,Orygen, The National Centre of Excellence in Youth Mental Health
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20
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Andrewes HE, Hulbert C, Cotton SM, Betts J, Chanen AM. Relationships between the frequency and severity of non-suicidal self-injury and suicide attempts in youth with borderline personality disorder. Early Interv Psychiatry 2019; 13:194-201. [PMID: 28718985 DOI: 10.1111/eip.12461] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 12/22/2016] [Revised: 03/24/2017] [Accepted: 05/14/2017] [Indexed: 11/27/2022]
Abstract
AIM Non-suicidal self-injury (NSSI) is a recognized indicator of suicide risk. Yet, the ubiquity of this behaviour in borderline personality disorder (BPD) limits its utility as a predictor of risk. Consequently, this study aimed to elucidate the relationship between other features of NSSI, including frequency and severity, and suicide attempts. METHOD Participants included 107 youth (15 to 25 year olds) with BPD who were assessed for BPD severity, depressive symptoms, 12-month frequency of NSSI and suicide attempts, as well as the levels of treatment sought following each self-harm event. RESULTS Three-quarters (75.7%) of youth with BPD reported NSSI and two-thirds (66.4%) reported a suicide attempt over the previous 12 months. The frequency of NSSI over the previous 12 months did not show a linear or quadratic relationship with the number of suicide attempts when adjusting for severity of depression, impulsivity and interpersonal problems. NSSI severity was not associated with more frequent suicide attempts. Only impulsivity and depression were uniquely predictive of suicide attempt frequency. A relative increase in the frequency and severity of NSSI occurred in the months prior to a suicide attempt. CONCLUSION The prevalence of NSSI and suicide attempts among youth presenting for their first treatment of BPD appear to be perilously high, considerably higher than rates reported by adults with BPD. Findings suggest that clinicians should give more weight to average levels of impulsivity and depression, rather than the absolute frequency and severity of NSSI, when assessing for risk of suicide attempts. Notwithstanding this, a relative increase in the frequency and severity of NSSI appears to be predictive of a forthcoming suicide attempt.
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Affiliation(s)
- Holly E Andrewes
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Andrew M Chanen
- 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, Northwestern Mental Health, Melbourne, Australia
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21
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Berk M, Turner A, Malhi GS, Ng CH, Cotton SM, Dodd S, Samuni Y, Tanious M, McAulay C, Dowling N, Sarris J, Owen L, Waterdrinker A, Smith D, Dean OM. Correction to: A randomised controlled trial of a mitochondrial therapeutic target for bipolar depression: mitochondrial agents, N-acetylcysteine, and placebo. BMC Med 2019; 17:35. [PMID: 30771791 PMCID: PMC6377937 DOI: 10.1186/s12916-019-1280-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/22/2022] Open
Abstract
The original article [1] contained two minor errors.
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Affiliation(s)
- Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, P.O. Box 291, Geelong, VIC, Australia. .,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North, Main Block, Parkville, VIC, Australia. .,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, VIC, Australia. .,Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia.
| | - Alyna Turner
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, P.O. Box 291, Geelong, VIC, Australia.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North, Main Block, Parkville, VIC, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Callaghan, NSW, Australia
| | - Gin S Malhi
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,ARCHI, Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, the Melbourne Clinic, 130 Church St Richmond, Melbourne, VIC, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Rd, Parkville, VIC, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, P.O. Box 291, Geelong, VIC, Australia.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North, Main Block, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Rd, Parkville, VIC, Australia
| | - Yuval Samuni
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, P.O. Box 291, Geelong, VIC, Australia
| | - Michelle Tanious
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Claire McAulay
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Nathan Dowling
- Department of Psychiatry, University of Melbourne, the Melbourne Clinic, 130 Church St Richmond, Melbourne, VIC, Australia
| | - Jerome Sarris
- Department of Psychiatry, University of Melbourne, the Melbourne Clinic, 130 Church St Richmond, Melbourne, VIC, Australia.,NICM, School of Health and Science, Western Sydney University, Campbelltown, NSW, Australia
| | - Lauren Owen
- School of Psychology, University of Central Lancashire, Preston, UK
| | | | - Deidre Smith
- Department of Psychiatry, University of Melbourne, the Melbourne Clinic, 130 Church St Richmond, Melbourne, VIC, Australia
| | - Olivia M Dean
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, P.O. Box 291, Geelong, VIC, Australia.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North, Main Block, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, VIC, Australia
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Killackey E, Allott K, Jackson HJ, Scutella R, Tseng YP, Borland J, Proffitt TM, Hunt S, Kay-Lambkin F, Chinnery G, Baksheev G, Alvarez-Jimenez M, McGorry PD, Cotton SM. Individual placement and support for vocational recovery in first-episode psychosis: randomised controlled trial. Br J Psychiatry 2019; 214:76-82. [PMID: 30251616 DOI: 10.1192/bjp.2018.191] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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] [Indexed: 11/23/2022]
Abstract
BACKGROUND High unemployment is a hallmark of psychotic illness. Individual placement and support (IPS) may be effective at assisting the vocational recoveries of young people with first-episode psychosis (FEP).AimsTo examine the effectiveness of IPS at assisting young people with FEP to gain employment (Australian and Clinical Trials Registry ACTRN12608000094370). METHOD Young people with FEP (n = 146) who were interested in vocational recovery were randomised using computer-generated random permuted blocks on a 1:1 ratio to: (a) 6 months of IPS in addition to treatment as usual (TAU) or (b) TAU alone. Assessments were conducted at baseline, 6 months (end of intervention), 12 months and 18 months post-baseline by research assistants who were masked to the treatment allocations. RESULTS At the end of the intervention the IPS group had a significantly higher rate of having been employed (71.2%) than the TAU group (48.0%), odds ratio 3.40 (95% CI 1.17-9.91, z = 2.25, P = 0.025). However, this difference was not seen at 12- and 18-month follow-up points. There was no difference at any time point on educational outcomes. CONCLUSIONS This is the largest trial to our knowledge on the effectiveness of IPS in FEP. The IPS group achieved a very high employment rate during the 6 months of the intervention. However, the advantage of IPS was not maintained in the long term. This seems to be related more to an unusually high rate of employment being achieved in the control group rather than a gross reduction in employment among the IPS group.Declaration of interestNone.
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Affiliation(s)
- Eóin Killackey
- Professor of Functional Recovery in Youth Mental Health, Orygen,The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health,The University of Melbourne,Australia
| | - Kelly Allott
- Senior Research Fellow, Orygen,The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health,The University of Melbourne,Australia
| | - Henry J Jackson
- Professor, Melbourne School of Psychological Sciences,The University of Melbourne,Australia
| | - Rosanna Scutella
- Senior Research Fellow, Melbourne Institute,The University of Melbourne,Australia
| | - Yi-Ping Tseng
- Senior Research Fellow, Melbourne Institute,The University of Melbourne,Australia
| | - Jeff Borland
- Professor, Melbourne Institute and Department of Economics,The University of Melbourne,Australia
| | - Tina-Marie Proffitt
- Research Fellow and Neuropsychologist, Orygen,The National Centre of Excellence in Youth Mental Health,Centre for Youth Mental Health,The University of Melbourne andSchool of Psychology,University of Waikato,Australia
| | - Sally Hunt
- Research Fellow, School of Medicine and Public Health,University of Newcastle,Australia
| | - Frances Kay-Lambkin
- Associate Professor, School of Medicine and Public Health,University of Newcastle,Australia
| | - Gina Chinnery
- National Vocational Services Manager, Orygen,The National Centre of Excellence in Youth Mental Health, Australia
| | | | - Mario Alvarez-Jimenez
- Associate Professor, Orygen,The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health,The University of Melbourne,Australia
| | - Patrick D McGorry
- Professor, Orygen,The National Centre of Excellence in Youth Mental Health andCentre for Youth Mental Health,The University of Melbourne, Australia
| | - Susan M Cotton
- Professor, Orygen,The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health,The University of Melbourne,Australia
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Berk M, Turner A, Malhi GS, Ng CH, Cotton SM, Dodd S, Samuni Y, Tanious M, McAulay C, Dowling N, Sarris J, Owen L, Waterdrinker A, Smith D, Dean OM. A randomised controlled trial of a mitochondrial therapeutic target for bipolar depression: mitochondrial agents, N-acetylcysteine, and placebo. BMC Med 2019; 17:18. [PMID: 30678686 PMCID: PMC6346513 DOI: 10.1186/s12916-019-1257-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [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: 08/14/2018] [Accepted: 01/09/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A phasic dysregulation of mitochondrial bioenergetics may operate in bipolar disorder, increased in mania and decreased in depression. We aimed to examine efficacy of two add-on treatments in bipolar depression: N-acetylcysteine (NAC) and NAC with a combination of nutraceutical agents that may increase mitochondrial biogenesis. METHODS A three-arm 16-week, double-blind, randomised, placebo-controlled trial, adjunctive to usual treatment, was conducted. Participants (n = 181) with bipolar disorder and current depressive symptoms were randomised to 2000 mg/day NAC (n = 59), 2000 mg/day NAC with the combination nutraceutical treatment (CT, n = 61), or placebo (n = 61). The primary outcome was change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline to week 16. Young Mania Rating Scale, Clinical Global Impression (CGI)-Improvement and CGI-Severity scales, Patient Global Impression scale, Social and Occupational Functioning Assessment Scale (SOFAS), Longitudinal Interval Follow-Up Evaluation - Range of Impaired Functioning Tool (LIFE-RIFT), and Quality of Life Enjoyment, and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) were secondary outcomes. RESULTS One hundred forty-eight participants had post-randomisation data and were analysed (NAC = 52, CT = 47, Placebo = 49). No between-group differences were found for the rate of change between baseline and 16 weeks on any of the clinical and functioning variables. Improvements in MADRS, BDRS, SOFAS, and LIFE-RIFT scores from baseline to the week 20 post-discontinuation visit were significantly greater in the CT group compared to those in the placebo. At week 20, the CGI-I was significantly lower in the CT group versus placebo. Gastrointestinal symptoms were significantly greater in the NAC than in the placebo group. CONCLUSIONS These overall negative results, with no significant differences between groups detected at the primary outcome but some positive secondary signals, suggest either delayed benefit of the combination or an improvement of symptoms on withdrawal which warrants further exploration regarding the composition, mechanisms, and application of mitochondrial agents in illnesses characterised by mitochondrial dysfunction. TRIAL REGISTRATION ANZCTR ( ACTRN12612000830897 ).
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Affiliation(s)
- Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, P.O. Box 291, Geelong, VIC, Australia. .,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North, Main Block, Parkville, VIC, Australia. .,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, VIC, Australia. .,Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia.
| | - Alyna Turner
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, P.O. Box 291, Geelong, VIC, Australia.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North, Main Block, Parkville, VIC, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Callaghan, NSW, Australia
| | - Gin S Malhi
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,ARCHI, Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, the Melbourne Clinic, 130 Church St Richmond, Melbourne, VIC, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Rd, Parkville, VIC, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, P.O. Box 291, Geelong, VIC, Australia.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North, Main Block, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Rd, Parkville, VIC, Australia
| | - Yuval Samuni
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, P.O. Box 291, Geelong, VIC, Australia
| | - Michelle Tanious
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Claire McAulay
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Nathan Dowling
- Department of Psychiatry, University of Melbourne, the Melbourne Clinic, 130 Church St Richmond, Melbourne, VIC, Australia
| | - Jerome Sarris
- Department of Psychiatry, University of Melbourne, the Melbourne Clinic, 130 Church St Richmond, Melbourne, VIC, Australia.,NICM, School of Health and Science, Western Sydney University, Campbelltown, NSW, Australia
| | - Lauren Owen
- School of Psychology, University of Central Lancashire, Preston, UK
| | | | - Deidre Smith
- Department of Psychiatry, University of Melbourne, the Melbourne Clinic, 130 Church St Richmond, Melbourne, VIC, Australia
| | - Olivia M Dean
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, P.O. Box 291, Geelong, VIC, Australia.,Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North, Main Block, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, VIC, Australia
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24
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Jones MG, Rice SM, Cotton SM. Incorporating animal-assisted therapy in mental health treatments for adolescents: A systematic review of canine assisted psychotherapy. PLoS One 2019; 14:e0210761. [PMID: 30653587 PMCID: PMC6336278 DOI: 10.1371/journal.pone.0210761] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/01/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION As interest in Animal-Assisted Interventions (AAI) grows, there is increasing need to differentiate informal activities from formal and professionally directed therapies, including mental health focussed Canine-Assisted Psychotherapy (CAP). There have been no reviews focusing exclusively on CAP and the distinct developmental period of adolescence. The aims of this study were to identify the characteristics of CAP interventions, their impacts and their acceptability, tolerability and feasibility for adolescents with mental health disorders. METHOD A systematic review identified studies incorporating canines into mental health treatments for adolescents aged 10-19 years. Studies reporting qualitative or quantitative psychological or psychosocial outcomes were included. RESULTS Seven studies were scrutinised. Intervention characteristics varied, including a range of formats, settings, locations, doses, and facilitators. Information on the role of the canines in sessions was sparse. CAP had a positive impact on primary diagnoses and symptomatology, conferring additional benefits to standard treatments for internalising disorders, post-traumatic stress disorder, and equivalent effects for anxiety, anger and externalising disorders. CAP was associated with positive impacts on secondary factors including increased engagement and socialisation behaviours, and reductions in disruptive behaviours within treatment sessions. Global functioning also improved. There was insufficient evidence that CAP improved factors associated with self-esteem, subjective wellbeing, or coping. Good attendance and retention rates indicated high levels of acceptability. Moderate to high tolerability was also indicated. Feasibility may be limited by additional training and logistical requirements. RECOMMENDATIONS We recommend the development of theoretically informed, standardised (manualised) intervention protocols that may subsequently form the basis of efficacy and effectiveness testing. Such protocols should clearly describe canine-participant-facilitator interactions via a formalised nomenclature; spontaneous (animal-led), adjunctive (facilitator-led), and experiential (participant-led). CONCLUSIONS There is emerging evidence to suggest that CAP improves the efficacy of mental health treatments in self-selected adolescent populations via reductions in primary symptomatology, and via secondary factors that improve therapeutic processes and quality, such as engagement and retention.
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Affiliation(s)
- Melanie G. Jones
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
- Lead The Way Institute, Boronia, Victoria, Australia
| | - Simon M. Rice
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
| | - Susan M. Cotton
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
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25
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Ashton MM, Berk M, Ng CH, Hopwood M, Dodd S, Turner A, Brown E, Jacka FN, Cotton SM, Khoo JP, Chatterton ML, Kavanagh BE, Nadjidai SE, Lo Monaco SL, Harvey BH, Sarris J, Malhi GS, Dowling NL, Dean OM. Efficacy of adjunctive Garcinia mangostana Linn (mangosteen) pericarp for bipolar depression: study protocol for a proof-of-concept trial. ACTA ACUST UNITED AC 2018; 41:245-253. [PMID: 30328970 PMCID: PMC6794139 DOI: 10.1590/1516-4446-2018-0114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/03/2018] [Indexed: 12/15/2022]
Abstract
Objective: Bipolar depression is characterized by neurobiological features including perturbed oxidative biology, reduction in antioxidant levels, and a concomitant rise in oxidative stress markers. Bipolar depression manifests systemic inflammation, mitochondrial dysfunction, and changes in brain growth factors. The depressive phase of the disorder is the most common and responds the least to conventional treatments. Garcinia mangostana Linn, commonly known as mangosteen, is a tropical fruit. The pericarp’s properties may reduce oxidative stress and inflammation and improve neurogenesis, making mangosteen pericarp a promising add-on therapy for bipolar depression. Methods: Participants will receive 24 weeks of either 1,000 mg mangosteen pericarp or placebo per day, in addition to their usual treatment. The primary outcome is change in severity of mood symptoms, measured using the Montgomery-Åsberg Depression Rating Scale (MADRS), over the treatment phase. Secondary outcomes include global psychopathology, quality of life, functioning, substance use, cognition, safety, biological data, and cost-effectiveness. A follow-up interview will be conducted 4 weeks post-treatment. Conclusion: The findings of this study may have implications for improving treatment outcomes for those with bipolar disorder and may contribute to our understanding of the pathophysiology of bipolar depression. Clinical trial registration: Australian and New Zealand Clinical Trial Registry, ACTRN12616000028404.
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Affiliation(s)
- Melanie M Ashton
- Deakin University, Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, The Melbourne Clinic, University of Melbourne, Richmond, Australia
| | - Michael Berk
- Deakin University, Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.,Orygen, National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre of Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic, University of Melbourne, Richmond, Australia
| | - Malcolm Hopwood
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Australia
| | - Seetal Dodd
- Deakin University, Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia.,Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.,Centre of Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Alyna Turner
- Deakin University, Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia.,Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Ellie Brown
- Deakin University, Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia.,Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Felice N Jacka
- Deakin University, Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.,Black Dog Institute, Sydney, Australia
| | - Susan M Cotton
- Orygen, National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre of Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Jon-Paul Khoo
- Deakin University, Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Mary Lou Chatterton
- Centre for Population Health Research, Deakin Health Economics, Deakin University, Geelong, Australia
| | - Bianca E Kavanagh
- Deakin University, Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Sarah E Nadjidai
- Department of Psychiatry, The Melbourne Clinic, University of Melbourne, Richmond, Australia
| | - Samantha L Lo Monaco
- Deakin University, Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia.,School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - Brian H Harvey
- Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University, Potchefstroom, South Africa.,Medical Research Council Unit (MRC) Unit on Risk and Resilience, University of Cape Town, Cape Town, South Africa
| | - Jerome Sarris
- Department of Psychiatry, The Melbourne Clinic, University of Melbourne, Richmond, Australia.,NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Gin S Malhi
- Academic Department of Psychiatry, Northern Sydney Local Health District, St. Leonards, Australia.,Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia.,Clinical Assessment Diagnostic Evaluation (CADE) Clinic, Royal North Shore Hospital, St. Leonards, Australia
| | - Nathan L Dowling
- Department of Psychiatry, The Melbourne Clinic, University of Melbourne, Richmond, Australia
| | - Olivia M Dean
- Deakin University, Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
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Abstract
OBJECTIVE Social inclusion is increasingly recognized as an important contributor to positive mental health outcomes, particularly for people with mental illness. There is a lack of consensus regarding what it means to be socially included and what the key contributors to social inclusion may be. The aim of this investigation was to determine such key contributors, as identified by those with professional experience. METHOD A thematic analysis of literature regarding social inclusion was conducted to obtain the opinions of professionals regarding key contributors of social inclusion. Seventy-one pieces of literature were reviewed: peer-reviewed literature (academic literature regarding social inclusion in general [n = 25] and social inclusion and mental illness [n = 26]), and gray literature (organizational reports [n = 20]). Within- and between-groups analyses were performed to determine group differences and increase understanding of which contributors were deemed important consistently across groups. RESULTS A comprehensive list of 90 contributors to social inclusion and exclusion was compiled, categorized into 13 domains based on commonalities. Contributors related to employment and education, housing and neighborhood, and social activities and support were highly cited. Differences were observed between-groups regarding specificity of contributors, with organizational reports reporting more detailed contributors. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE A comprehensive and specific understanding of social inclusion was obtained. This improved understanding will allow for better measurement of social inclusion which will assist in evaluating programs and interventions, identifying areas of greatest need, and in planning services, policy and strategies to target specific contributors proven to improve social inclusion and subsequent mental health outcomes. (PsycINFO Database Record
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Affiliation(s)
- Kate M Filia
- Orygen, the National Centre of Excellence in Youth Mental Health
| | | | - Susan M Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health
| | - Andrew Gardner
- Orygen, the National Centre of Excellence in Youth Mental Health
| | - Eoin J Killackey
- Orygen, the National Centre of Excellence in Youth Mental Health
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Caruana E, Cotton SM, Farhall J, Parrish EM, Chanen A, Davey CG, Killackey E, Allott K. A Comparison of Vocational Engagement Among Young People with Psychosis, Depression and Borderline Personality Pathology. Community Ment Health J 2018; 54:831-841. [PMID: 29159496 DOI: 10.1007/s10597-017-0197-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/07/2017] [Accepted: 11/04/2017] [Indexed: 12/13/2022]
Abstract
Poor vocational engagement is well documented among young people experiencing first-episode psychosis (FEP). The aim of the present study was to establish and compare rates of vocational engagement across young people with first-episode psychosis, depression, and borderline personality pathology. A file audit was used to collect vocational data of young people aged 15-25 entering tertiary mental health treatment in 2011. Rates of vocational engagement were similar across groups, indicating that like those with FEP, young people with depression and borderline personality pathology experience impaired vocational engagement and are in need of targeted vocational interventions. Post hoc analysis indicated that that the depression group had significantly more people who were partially vocationally engaged compared with the psychosis group, suggesting that vocational interventions might need to be targeted differently across different diagnostic groups. Future research should explore risk factors for vocational disengagement across diagnostic groups in order to inform intervention development.
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Affiliation(s)
- E Caruana
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia. .,La Trobe University, Bundoora, VIC, 3083, Australia.
| | - S M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - J Farhall
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.,North Western Mental Health, Parkville, VIC, Australia
| | - E M Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - A Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,North Western Mental Health, Parkville, VIC, Australia.,Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - C G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - E Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - K Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
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Andrewes HE, Hulbert C, Cotton SM, Betts J, Chanen AM. Patterns of Non-Suicidal Self-Injury and Their Relationship with Suicide Attempts in Youth with Borderline Personality Disorder. Arch Suicide Res 2018; 22:465-478. [PMID: 28759336 DOI: 10.1080/13811118.2017.1358226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The study aimed to identify the relationships between patterns of non-suicidal self-injury (NSSI), their severity, and suicide attempts among 107 youth (aged 15-25 years) with borderline personality disorder (BPD). Two principal patterns were identified via a graphical representation of retrospectively reported 12-month histories of NSSI. These were habitual (NSSI occurring at regular intervals) and random patterns (NSSI inconsistently spaced). Habitual patterns of NSSI were associated with lower severity and fewer suicide attempts than random patterns. Within-person comparisons revealed a reduction in NSSI engaged within a habitual pattern and an increase in NSSI engaged within a random pattern in the month prior to a suicide attempt. Findings suggest that the accuracy of risk assessments among youth with BPD might be improved by identifying an individual's historical pattern of NSSI, as well as any relative increase in NSSI engaged within a random pattern or relative reduction in NSSI engaged within a habitual pattern.
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Abstract
OBJECTIVES Animal-assisted therapy (AAT) is a growing field in Australia, and therapy dogs are becoming increasingly common in clinical settings. This paper aims to highlight the current issues facing AAT in Australia and to make recommendations on how to progress the field. We acknowledge that there are several ways that therapy dogs may enhance treatment outcomes for clients, such as reductions in stress and acute anxious arousal, and improvements in engagement and rapport. These psychological and physiological advantages, however, may not be sustained once interaction with the dog ceases. Clinicians require adequate training and support to develop and implement interventions that are based on sound theoretical foundations, and take advantage of the adjunctive benefits of animal presence. CONCLUSIONS A series of recommendations are made for the professionalisation of AAT, including the development of consensus definitions, clinical governance, accreditation, research and evaluation.
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Affiliation(s)
- M G Jones
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, and; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, and; Lead the Way, Animal-Assisted Interventions Institute, Melbourne, VIC, Australia
| | - S M Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, and; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - S M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, and; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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30
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Ratheesh A, Cotton SM, Davey CG, Lin A, Wood S, Yuen HP, Bechdolf A, McGorry PD, Yung A, Berk M, Nelson B. Pre-onset risk characteristics for mania among young people at clinical high risk for psychosis. Schizophr Res 2018; 192:345-350. [PMID: 28768599 DOI: 10.1016/j.schres.2017.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/08/2017] [Revised: 03/18/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Psychosis and mania share conceptual, genetic and clinical features, which suggest the possibility that they have common antecedents. Participants identified to be at-risk for psychosis might also be at-risk for mania. We aimed to identify the rate and predictors of transition to mania in a cohort of youth with clinical or familial risk for psychosis. METHODS Among a cohort of 416 young people with an at-risk mental state for psychosis defined using the Ultra-High-Risk (UHR) criteria, 74.7% were followed up between 5 and 13years from their baseline assessment. We undertook a matched case-control examination of those who developed mania over the follow-up period compared to those who did not develop mania or psychosis. Transition to mania was determined using either a structured clinical interview, or diagnoses from a state-wide public mental health contact registry. Clinical characteristics and risk factors were examined at baseline using information from structured interviews, clinical file notes, rating scales and unstructured assessments. RESULTS Eighteen participants developed mania (UHR-Manic transition or UHR-M, 4.3%). In comparison with participants matched on age, gender and baseline-study who developed neither mania nor psychosis, more UHR-M participants had subthreshold manic symptoms or were prescribed antidepressants at baseline. They also had lower global functioning. DISCUSSION In addition to the UHR criteria, features such as subthreshold manic symptoms and antidepressant use may help identify at-risk groups that predict the onset of mania in addition to transition to psychosis. Presence of manic symptoms may also indicate syndrome specificity early in the prodromal phase.
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Affiliation(s)
- Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
| | - Susan M Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of 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, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Stephen Wood
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia; School of Psychology, University of Birmingham, UK
| | - Hok Pan Yuen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Andreas Bechdolf
- Vivantes Hospital am Urban and Vivantes Hopital im Friedrichshain, Charite Medical University, Berlin, Germany
| | - Patrick D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Alison Yung
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Michael Berk
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
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Uren J, Cotton SM, Killackey E, Saling MM, Allott K. Cognitive clusters in first-episode psychosis: Overlap with healthy controls and relationship to concurrent and prospective symptoms and functioning. Neuropsychology 2017; 31:787-797. [DOI: 10.1037/neu0000367] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Hanlon MC, Campbell LE, Single N, Coleman C, Morgan VA, Cotton SM, Stain HJ, Castle DJ. Men and women with psychosis and the impact of illness-duration on sex-differences: The second Australian national survey of psychosis. Psychiatry Res 2017. [PMID: 28633054 DOI: 10.1016/j.psychres.2017.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 12/16/2022]
Abstract
We aimed to examine and compare sex-differences in people receiving treatment for psychotic illnesses in community settings, based on long or short duration of illness; expecting association between longer illness-duration and worse outcomes in women and men. Clinical, demographic and service-use data from the Survey of High Impact Psychosis were analysed by sex and duration of illness (≤5 years; ≥6 years), using independent t-tests, chi-square tests, one-way ANOVA, and Cramer's V. Of the 1825 participants, 47% had schizophrenia, 17.5% bipolar and 16.1% schizo-affective disorders. More women than men had undertaken post-school education, maintained relationships, and been living in their own homes. Women with a shorter-illness-duration showed social functioning equivalent to non-ill women in the general population. Men tended to have an early illness onset, show premorbid dysfunction, be single, show severe disability, and to use illicit substances. Men with a longer-illness-duration were very socially disadvantaged and isolated, often experiencing homelessness and substance use. Men with a short-illness-duration were most likely to be in paid employment, but two-thirds earned less than $AUD500 per fortnight. Men with longer-illness-duration showed most disability, socially and globally. Interventions should be guided by diagnosis, but also by a person's sex and duration of illness.
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Affiliation(s)
- Mary-Claire Hanlon
- The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, NSW, Australia; Calvary Mater Newcastle, Waratah, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Linda E Campbell
- The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Priority Research Centre GrowUpWell and the School of Psychology, University of Newcastle, Australia
| | | | | | - Vera A Morgan
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, WA, Australia; North Metropolitan Health Service Mental Health, Perth, WA, Australia
| | - Susan M Cotton
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Helen J Stain
- Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, NSW, Australia; School of Social and Health Sciences, Leeds Trinity University, Horsforth, Leeds, UK
| | - David J Castle
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
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Berk M, Post R, Ratheesh A, Gliddon E, Singh A, Vieta E, Carvalho AF, Ashton MM, Berk L, Cotton SM, McGorry PD, Fernandes BS, Yatham LN, Dodd S. Staging in bipolar disorder: from theoretical framework to clinical utility. World Psychiatry 2017; 16:236-244. [PMID: 28941093 PMCID: PMC5608827 DOI: 10.1002/wps.20441] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [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] [Indexed: 12/13/2022] Open
Abstract
Illness staging is widely utilized in several medical disciplines to help predict course or prognosis, and optimize treatment. Staging models in psychiatry in general, and bipolar disorder in particular, depend on the premise that psychopathology moves along a predictable path: an at-risk or latency stage, a prodrome progressing to a first clinical threshold episode, and one or more recurrences with the potential to revert or progress to late or end-stage manifestations. The utility and validity of a staging model for bipolar disorder depend on its linking to clinical outcome, treatment response and neurobiological measures. These include progressive biochemical, neuroimaging and cognitive changes, and potentially stage-specific differences in response to pharmacological and psychosocial treatments. Mechanistically, staging models imply the presence of an active disease process that, if not remediated, can lead to neuroprogression, a more malignant disease course and functional deterioration. Biological elements thought to be operative in bipolar disorder include a genetic diathesis, physical and psychic trauma, epigenetic changes, altered neurogenesis and apoptosis, mitochondrial dysfunction, inflammation, and oxidative stress. Many available agents, such as lithium, have effects on these targets. Staging models also suggest the utility of stage-specific treatment approaches that may not only target symptom reduction, but also impede illness neuroprogression. These treatment approaches range from prevention for at-risk individuals, to early intervention strategies for prodromal and newly diagnosed individuals, complex combination therapy for rapidly recurrent illness, and palliative-type approaches for those at chronic, late stages of illness. There is hope that prompt initiation of potentially disease modifying therapies may preclude or attenuate the cognitive and structural changes seen in the later stages of bipolar disorder. The aims of this paper are to: a) explore the current level of evidence supporting the descriptive staging of the syndromal pattern of bipolar disorder; b) describe preliminary attempts at validation; c) make recommendations for the direction of further studies; and d) provide a distillation of the potential clinical implications of staging in bipolar disorder within a broader transdiagnostic framework.
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Affiliation(s)
- Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia,Department of PsychiatryUniversity of MelbourneMelbourneAustralia,Orygen, the National Centre of Excellence in Youth Mental HealthParkvilleAustralia,Centre for Youth Mental Health, University of MelbourneMelbourneAustralia,Florey Institute for Neuroscience and Mental HealthMelbourneAustralia
| | - Robert Post
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health SciencesWashingtonDCUSA
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental HealthParkvilleAustralia,Centre for Youth Mental Health, University of MelbourneMelbourneAustralia
| | - Emma Gliddon
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia
| | - Ajeet Singh
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia
| | - Eduard Vieta
- Bipolar Disorders Program, Department of Psychiatry and PsychologyInstitute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Andre F. Carvalho
- Translational Psychiatry Research Group and Department of Clinical MedicineFaculty of Medicine, Federal University of CearáFortalezaBrazil,Institute for Clinical Research and Education in MedicinePaduaItaly
| | - Melanie M. Ashton
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia
| | - Lesley Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia,Department of PsychiatryUniversity of MelbourneMelbourneAustralia
| | - Susan M. Cotton
- Orygen, the National Centre of Excellence in Youth Mental HealthParkvilleAustralia,Centre for Youth Mental Health, University of MelbourneMelbourneAustralia
| | - Patrick D. McGorry
- Orygen, the National Centre of Excellence in Youth Mental HealthParkvilleAustralia,Centre for Youth Mental Health, University of MelbourneMelbourneAustralia
| | - Brisa S. Fernandes
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongAustralia,Department of PsychiatryUniversity of MelbourneMelbourneAustralia,Orygen, the National Centre of Excellence in Youth Mental HealthParkvilleAustralia
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Andrewes HE, Hulbert C, Cotton SM, Betts J, Chanen AM. An ecological momentary assessment investigation of complex and conflicting emotions in youth with borderline personality disorder. Psychiatry Res 2017; 252:102-110. [PMID: 28259033 DOI: 10.1016/j.psychres.2017.01.100] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 08/29/2016] [Revised: 12/18/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
Non-suicidal self-injury (NSSI) is a prevalent behaviour among people with borderline personality disorder (BPD) but many aspects of the emotional changes that trigger and maintain this behaviour are unknown. This study examines the relationships between NSSI and the number of negative ('negative complex') and opposing valence ('conflicting') emotions. One hundred and seven youth (aged 15-25 years) with first-presentation BPD were assessed using a combination of self-report and ecological momentary assessment to investigate trait levels of emotional acceptance and in vivo changes in the number of negative complex and conflicting emotions before and after self-injurious thoughts and behaviours. Multilevel modelling revealed that changes in the number of negative complex emotions mirrored distress levels before and after self-injurious thoughts and behaviours, approximating a quadratic curve. Increases in the number of negative complex emotions reported prior to self-injurious thoughts and behaviours were associated with lower acceptance of negative emotions. These findings indicate that the number of negative emotions experienced contributes to distress prior to engagement in NSSI. The relationship between non-acceptance of negative emotions and negative complex emotions prior to NSSI suggests that improved emotional awareness and acceptance should be a focus for early interventions aimed at reducing self-injury.
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Affiliation(s)
- Holly E Andrewes
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Andrew M Chanen
- 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, NorthWestern Mental Health, Melbourne, Australia.
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Ratheesh A, Cotton SM, Davey CG, Adams S, Bechdolf A, Macneil C, Berk M, McGorry PD. Ethical considerations in preventive interventions for bipolar disorder. Early Interv Psychiatry 2017; 11:104-112. [PMID: 27027848 DOI: 10.1111/eip.12340] [Citation(s) in RCA: 12] [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] [Received: 07/31/2015] [Revised: 01/17/2016] [Accepted: 02/18/2016] [Indexed: 11/28/2022]
Abstract
AIM Early intervention and prevention of serious mental disorders such as bipolar disorder has the promise of decreasing the burden associated with these disorders. With increasing early and preventive intervention efforts among cohorts such as those with a familial risk for bipolar disorder, there is a need to examine the associated ethical concerns. The aim of this review was to examine the ethical issues underpinning the clinical research on pre-onset identification and preventive interventions for bipolar disorder. METHODS We undertook a PubMed search updated to November 2014 incorporating search terms such as bipolar, mania, hypomania, ethic*(truncated), early intervention, prevention, genetic and family. RESULTS Fifty-six articles that were identified by this method as well as other relevant articles were examined within a framework of ethical principles including beneficence, non-maleficence, respect for autonomy and justice. The primary risks associated with research and clinical interventions include stigma and labelling, especially among familial high-risk youth. Side effects from interventions are another concern. The benefits of preventive or early interventions were in the amelioration of symptoms as well as the possibility of minimizing disability, cognitive impairment and progression of the illness. Supporting the autonomy of individuals and improving access to stigma-free care may help moderate the potential challenges associated with the risks of interventions. CONCLUSIONS Concerns about the risks of early identification and pre-onset interventions should be balanced against the potential benefits, the individuals' right to choice and by improving availability of services that balance such dilemmas.
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Affiliation(s)
- Aswin Ratheesh
- Orygen, The National Centre for Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Susan M Cotton
- Orygen, The National Centre for Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christopher G Davey
- Orygen, The National Centre for Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Sophie Adams
- Orygen, The National Centre for Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Andreas Bechdolf
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charite Universitätsmedizin, Berlin, Germany
| | - Craig Macneil
- Orygen, The National Centre for Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Berk
- Orygen, The National Centre for Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Department of Psychiatry, Deakin University, Geelong, Victoria, Australia.,IMPACT Strategic Research Centre, Geelong, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre for Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Ratheesh A, Davey C, Hetrick S, Alvarez-Jimenez M, Voutier C, Bechdolf A, McGorry PD, Scott J, Berk M, Cotton SM. A systematic review and meta-analysis of prospective transition from major depression to bipolar disorder. Acta Psychiatr Scand 2017; 135:273-284. [PMID: 28097648 DOI: 10.1111/acps.12686] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [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] [Accepted: 11/23/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Some people with major depressive disorder (MDD) may be at a pre-onset stage for bipolar disorder (BD), where early identification or prevention efforts may be feasible. We aimed to identify rates and characteristics predictive of transition to BD in prospective follow-up studies of people with MDD. METHODS Using a systematic search strategy, we identified studies with a diagnostic ascertainment of MDD and BD of an adequate standard, and where the minimum length of follow-up was 6 months. We examined the incidence and point prevalence of BD and the pooled odds ratios (OR) for baseline predictors. RESULTS From 5554 unique publications, 56 were included. Nearly a quarter of adults (22.5%) and adolescents with MDD followed up for a mean length of 12-18 years developed BD, with the greatest risk of transition being in the first 5 years. The meta-analysis identified that transition from MDD to BD was predicted by family history of BD (OR = 2.89, 95% CI: 2.01-4.14, N = 7), earlier age of onset of depression (g = -0.33, SE = 0.05, N = 6) and presence of psychotic symptoms (OR = 4.76, 95% CI: 1.79-12.66, N = 5). CONCLUSIONS Participants with the identified risk factors merit closer observation and may benefit from prevention efforts, especially if outcomes broader than BD are considered.
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Affiliation(s)
- A Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - C Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - S Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - M Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - C Voutier
- Royal Melbourne Hospital Library, Melbourne, Vic., Australia
| | - A Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charite Universitätsmedizin, Berlin, Germany
| | - P D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - J Scott
- University of Newcastle, Newcastle upon Tyne, UK
| | - M Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic.,Florey Institute of Neuroscience and Mental Health, Parkville, Vic.,Impact Strategic Research Centre, Deakin University, Geelong, Vic, Australia
| | - S M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
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Andrewes HE, Hulbert C, Cotton SM, Betts J, Chanen AM. Ecological momentary assessment of nonsuicidal self-injury in youth with borderline personality disorder. Personal Disord 2016; 8:357-365. [PMID: 27505188 DOI: 10.1037/per0000205] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 11/08/2022]
Abstract
Nonsuicidal self-injury (NSSI) is highly prevalent among individuals with borderline personality disorder (BPD). The aim of this study was to investigate the cognitive, emotional, and contextual experience of NSSI in 107 youth (aged 15-25 years) with BPD who had minimal prior exposure to treatment. Using ecological momentary assessment, participants completed a randomly prompted questionnaire about their affect, self-injurious thoughts, and behaviors six times per day for 6 days. Twenty-four youth with BPD engaged in 52 counts of NSSI, with 56 motives identified. Open-ended questions revealed that on occasions of NSSI, a large minority of participants could identify neither their motives (27%, n = 15) nor the environmental precipitants (46%, n = 24) for NSSI. Changes in affect revealed a pattern of increasing negative and decreasing positive affect prior to NSSI, with a reduction in negative and an increase in positive affect following NSSI. These changes were absent for those who did not engage in NSSI. Initial self-injurious thoughts and changes in negative and positive affect occurred a median of 35, 15, and 10 hr prior to NSSI, respectively. These findings suggest that youth with BPD have limited capacity to reflect on their motives and environment preceding NSSI. The patterns of affect change indicate that NSSI is maintained by reward incentives as well as negative reinforcement. The time between initial self-injurious thoughts and engagement in NSSI reveals a window of opportunity for intervention. (PsycINFO Database Record
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Affiliation(s)
- Holly E Andrewes
- Melbourne School of Psychological Sciences, University of Melbourne
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, University of Melbourne
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health
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Reser MP, Allott KA, Killackey E, Farhall J, Cotton SM. Exploring cognitive heterogeneity in first-episode psychosis: What cluster analysis can reveal. Psychiatry Res 2015; 229:819-27. [PMID: 26272022 DOI: 10.1016/j.psychres.2015.07.084] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 09/10/2014] [Revised: 07/25/2015] [Accepted: 07/30/2015] [Indexed: 01/19/2023]
Abstract
Variable outcomes in first-episode psychosis (FEP) are partly attributable to heterogeneity in cognitive functioning. To aid identification of those likely to have poorer or better outcomes, we examined whether purported cognitive profiles identified through use of cluster analysis in chronic schizophrenia were evident in FEP. We also aimed to assess whether there was a relationship between cognitive profile and factors independent of the solution, providing external validation that the cognitive profiles represented distinct subgroups. Ward's method hierarchical cluster analysis, verified by a k-means cluster solution, was performed using data obtained from a cognitive test battery administered to 128 participants aged 15-25 years. Four cognitive profiles were identified. A continuity element was evident; participants in cluster four were more cognitively impaired compared to participants in cluster three, who appeared more cognitively intact. Clusters one and two were distinguishable across measures of attention and working memory and visual recognition memory, most likely reflecting sample specific patterns of deficit. Participants in cluster four had significantly lower premorbid and current IQ and higher negative symptoms compared to participants in cluster three. The distinct levels and patterns of cognition found in chronic schizophrenia cohorts are also evident across diagnostic categories in FEP.
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Affiliation(s)
- Maree P Reser
- Department of Psychology and Counselling, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Kelly A Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3053, Australia; Centre for Youth Mental Health, The University of Melbourne, Victoria 3010, Australia
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3053, Australia; Centre for Youth Mental Health, The University of Melbourne, Victoria 3010, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3053, Australia; Centre for Youth Mental Health, The University of Melbourne, Victoria 3010, Australia.
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Ratheesh A, Cotton SM, Betts JK, Chanen A, Nelson B, Davey CG, McGorry PD, Berk M, Bechdolf A. Prospective progression from high-prevalence disorders to bipolar disorder: Exploring characteristics of pre-illness stages. J Affect Disord 2015; 183:45-8. [PMID: 26001662 DOI: 10.1016/j.jad.2015.04.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 03/20/2015] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Identification of risk factors within precursor syndromes, such as depression, anxiety or substance use disorders (SUD), might help to pinpoint high-risk stages where preventive interventions for Bipolar Disorder (BD) could be evaluated. METHODS We examined baseline demographic, clinical, quality of life, and temperament measures along with risk clusters among 52 young people seeking help for depression, anxiety or SUDs without psychosis or BD. The risk clusters included Bipolar At-Risk (BAR) and the Bipolarity Index as measures of bipolarity and the Ultra-High Risk assessment for psychosis. The participants were followed up for 12 months to identify conversion to BD. Those who converted and did not convert to BD were compared using Chi-Square and Mann Whitney U tests. RESULTS The sample was predominantly female (85%) and a majority had prior treatment (64%). Four participants converted to BD over the 1-year follow up period. Having an alcohol use disorder at baseline (75% vs 8%, χ(2)=14.1, p<0.001) or a family history of SUD (67% vs 12.5%, χ(2)=6.0, p=0.01) were associated with development of BD. The sub-threshold mania subgroup of BAR criteria was also associated with 12-month BD outcomes. The severity of depressive symptoms and cannabis use had high effects sizes of association with BD outcomes, without statistical significance. CONCLUSIONS AND LIMITATIONS The small number of conversions limited the power of the study to identify associations with risk factors that have previously been reported to predict BD. However, subthreshold affective symptoms and SUDs might predict the onset of BD among help-seeking young people with high-prevalence disorders.
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Affiliation(s)
- 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.
| | - Susan M Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia
| | - Jennifer K Betts
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia
| | - Andrew Chanen
- 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
| | - Christopher G Davey
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth 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
| | - Michael Berk
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; IMPACT Strategic Research Centre, Deakin University, Geelong, Australia; Florey Institute of Neurosciences and Mental Health, Parkville, Australia
| | - Andreas Bechdolf
- Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia; Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban, Charite Medical University, Berlin, Germany; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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Ratheesh A, Berk M, Davey CG, McGorry PD, Cotton SM. Instruments that prospectively predict bipolar disorder - A systematic review. J Affect Disord 2015; 179:65-73. [PMID: 25845751 DOI: 10.1016/j.jad.2015.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 09/19/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Identification of earlier stages of Bipolar Disorder (BD), even prior to the first manic episode, may help develop interventions to prevent or delay the onset of BD. However, reliable and valid instruments are necessary to ascertain such earlier stages of BD. The aim of the current review was to identify instruments that had predictive validity and utility for BD for use in early intervention (EI) settings for the prevention of BD. METHODS We undertook a systematic examination of studies that examined participants without BD I or II at baseline and prospectively explored the predictive abilities of instruments for BD onset over a period of 6 months or more. The instruments and the studies were rated with respect to their relative validity and utility predicting onset of BD for prevention or early intervention. Odds ratios and area under the curve (AUC) values were derived when not reported. RESULTS Six studies were included, identifying five instruments that examined sub-threshold symptoms, family history, temperament and behavioral regulation. Though none of the identified instruments had been examined in high-quality replicated studies for predicting BD, two instruments, namely the Child Behavioral Checklist - Pediatric BD phenotype (CBCL-PBD) and the General Behavioral Inventory - Revised (GBI-R), had greater levels of validity and utility. LIMITATION Non-inclusion of studies and instruments that incidentally identified BD on follow-up limited the breadth of the review. CONCLUSION Instruments that test domains such as subthreshold symptoms, behavioral regulation, family history, and temperament hold promise in predicting BD onset.
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Affiliation(s)
- Aswin Ratheesh
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre For Youth Mental Health, University of Melbourne, Australia.
| | - Michael Berk
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre For Youth Mental Health, University of Melbourne, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Australia; Impact Strategic Research Centre, Deakin University, Australia
| | - Christopher G Davey
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre For Youth Mental Health, University of Melbourne, Australia
| | - Patrick D McGorry
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre For Youth Mental Health, University of Melbourne, Australia
| | - Susan M Cotton
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre For Youth Mental Health, University of Melbourne, Australia
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Takagi MJ, Lubman DI, Cotton SM, Verdejo-García A, Vilar-López R, Yücel M. A signal detection analysis of executive control performance among adolescent inhalant and cannabis users. Subst Use Misuse 2014; 49:1920-7. [PMID: 25099310 DOI: 10.3109/10826084.2014.935793] [Citation(s) in RCA: 10] [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] [Indexed: 11/13/2022]
Abstract
BACKGROUND Inhalant users have multiple comorbid issues (e.g., polydrug use) that complicate identifying inhalant-specific cognitive deficits. OBJECTIVES The aim of the present study was to use signal detection theory to identify inhalant-specific differences in executive control. METHODS We examined three well-matched groups: 19 inhalant users, 19 cannabis users, and 19 controls using Stroop and Go/No-Go tasks. RESULTS Inhalant users demonstrated significantly lower d-prime scores relative to controls, but not cannabis users, on both tasks, suggesting possible executive deficits relative to controls. CONCLUSIONS/IMPORTANCE: The results of this study raise questions regarding inhalant toxicity and the vulnerability of the adolescent brain to drugs of abuse.
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Affiliation(s)
- Michael J Takagi
- 1Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne , Melbourne, Victoria , Australia
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González-Blanch C, Gleeson JF, Cotton SM, Crisp K, McGorry PD, Alvarez-Jimenez M. Longitudinal relationship between expressed emotion and cannabis misuse in young people with first-episode psychosis. Eur Psychiatry 2014; 30:20-5. [PMID: 25174270 DOI: 10.1016/j.eurpsy.2014.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 02/18/2014] [Revised: 06/26/2014] [Accepted: 07/01/2014] [Indexed: 11/16/2022] Open
Abstract
Carers' expressed emotion (EE) and patients' cannabis misuse are two of the most robust predictors of psychotic relapse. We aimed to examine the temporal relationship between EE and cannabis misuse. Sixty-three key carers of young people with first-episode psychosis (FEP) were assessed at baseline and 7-month follow-up. EE was measured in carers using the Family Questionnaire (FQ) and cannabis misuse in patients using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Correlational and hierarchical logistic regression analyses were conducted to examine the temporal relationship between EE components (i.e. criticism and emotional over involvement) and cannabis misuse. Carers' criticism at baseline significantly predicted cannabis misuse according to the ASSIST at 7-month follow-up. The association remained significant after controlling for baseline symptom severity and social functioning (B=0.15, P=.02). Conversely, baseline cannabis misuse was not associated with carers' criticism at 7-month follow-up. Patients in families with high criticism showed a tendency to increase cannabis misuse over time whereas the opposite trend was observed in those with carers with low criticism. A family environment characterized by high criticism may become a key risk factor for worsening cannabis misuse over time in young people with FEP. Further studies should investigate the potential mechanisms (e.g., patient's anxiety or perceived stress) through which criticism increases cannabis misuse in FEP.
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Affiliation(s)
- C González-Blanch
- Mental Health Centre, University Hospital "Marqués de Valdecilla", Santander, Spain.
| | - J F Gleeson
- School of Psychology, Australian Catholic University, Melbourne, Australia
| | - S M Cotton
- Centre for Youth Mental Health, University of Melbourne, Australia; Orygen Youth Health Research Centre, Melbourne, Australia
| | - K Crisp
- Orygen Youth Health, Melbourne, Australia
| | - P D McGorry
- Centre for Youth Mental Health, University of Melbourne, Australia; Orygen Youth Health Research Centre, Melbourne, Australia
| | - M Alvarez-Jimenez
- Centre for Youth Mental Health, University of Melbourne, Australia; Orygen Youth Health Research Centre, Melbourne, Australia
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Allott KA, Cotton SM, Chinnery GL, Baksheev GN, Massey J, Sun P, Collins Z, Barlow E, Broussard C, Wahid T, Proffitt TM, Jackson HJ, Killackey E. The relative contribution of neurocognition and social cognition to 6-month vocational outcomes following Individual Placement and Support in first-episode psychosis. Schizophr Res 2013; 150:136-43. [PMID: 23938175 DOI: 10.1016/j.schres.2013.07.047] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [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: 02/04/2013] [Revised: 07/04/2013] [Accepted: 07/25/2013] [Indexed: 11/26/2022]
Abstract
AIMS To examine whether baseline neurocognition and social cognition predict vocational outcomes over 6 months in patients with first-episode psychosis (FEP) enrolled in a randomised controlled trial of Individual Placement and Support (IPS) versus treatment as usual (TAU). METHODS 135 FEP participants (IPS n=69; TAU n=66) completed a comprehensive neurocognitive and social cognitive battery. Principal axis factor analysis using PROMAX rotation was used to determine the underlying cognitive structure of the battery. Setwise (hierarchical) logistic and multivariate linear regressions were used to examine predictors of: (a) enrolment in education and employment; and (b) hours of employment over 6 months. Neurocognition and social cognition factors were entered into the models after accounting for premorbid IQ, baseline functioning and treatment group. RESULTS Six cognitive factors were extracted: (i) social cognition; (ii) information processing speed; (iii) verbal learning and memory; (iv) attention and working memory; (v) visual organisation and memory; and (vi) verbal comprehension. Enrolment in education over 6 months was predicted by enrolment in education at baseline (p=.002) and poorer visual organisation and memory (p=.024). Employment over 6 months was predicted by employment at baseline (p=.041) and receiving IPS (p=.020). Better visual organisation and memory predicted total hours of paid work over 6 months (p<.001). CONCLUSIONS Visual organisation and memory predicted the enrolment in education and duration of employment, after accounting for premorbid IQ, baseline functioning and treatment. Social cognition did not contribute to the prediction of vocational outcomes. Neurocognitive interventions may enhance employment duration in FEP.
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Affiliation(s)
- Kelly A Allott
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Australia.
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Killackey E, Allott K, Cotton SM, Jackson H, Scutella R, Tseng YP, Borland J, Proffitt TM, Hunt S, Kay-Lambkin F, Chinnery G, Baksheev G, Alvarez-Jimenez M, McGorry PD. A randomized controlled trial of vocational intervention for young people with first-episode psychosis: method. Early Interv Psychiatry 2013; 7:329-37. [PMID: 23848427 DOI: 10.1111/eip.12066] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [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: 12/17/2012] [Accepted: 05/20/2013] [Indexed: 11/26/2022]
Abstract
AIM Young people who are experiencing first-episode psychosis (FEP) are at increased risk of being unemployed compared to either their same age peers in the general population, or those with other mental illnesses. Significant research has been conducted examining employment interventions for those with chronic psychotic illness. This has yielded strong results in favour of an intervention called individual placement and support (IPS). However, significantly less work has examined the benefit of this approach to those in FEP when the potential for vocational rehabilitation is perhaps greater. This study adds to the knowledge of vocational intervention in first-episode psychotic illness. Additionally, it expands this work into the areas of cognition, social cognition, social inclusion and economics. METHODS The study is a single-blind, randomized controlled trial comparing receiving high-quality FEP treatment as usual plus IPS (IPS + TAU) to a FEP treatment as usual (TAU) intervention alone within a specialized FEP service. RESULTS The study recruited 146 people attending a first-episode psychosis service over 2 years. They were assessed at baseline, 6 months (end of intervention) 12 and 18 months with a battery covering psychopathology, economic, demographic, social cognitive, cognitive and diagnostic variables. CONCLUSIONS This paper describes the methodology for the largest attempted study of IPS in FEP. This study has the capacity to answer questions about the benefits on illness and economic impacts of vocational recovery in FEP. Further, it has the capacity to extend knowledge about the contribution of cognitive and social cognitive factors to recovery in this domain.
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Affiliation(s)
- Eóin Killackey
- Orygen Youth Health Research Centre, The University of Melbourne, Melbourne, Victoria, Australia.
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Mossaheb N, Schäfer MR, Schlögelhofer M, Klier CM, Cotton SM, McGorry PD, Amminger GP. Effect of omega-3 fatty acids for indicated prevention of young patients at risk for psychosis: when do they begin to be effective? Schizophr Res 2013; 148:163-7. [PMID: 23778032 DOI: 10.1016/j.schres.2013.05.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 11/22/2012] [Revised: 04/30/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
Abstract
The results of a recent double-blind, randomized, placebo-controlled trial performed in 81 young patients at ultra-high risk for psychosis indicated that a 12-week intervention of 1.2g/day of ω-3 polyunsaturated fatty acids (PUFA) significantly reduced the risk of transition to psychosis and improved positive, negative and general symptoms as well as functioning. The aim of this post-hoc analysis was to determine at which time point ω-3 PUFAs start to significantly differ from placebo in improving psychopathology and functioning in young people at risk of developing psychosis. Analyses were performed using the mixed model repeated-measures analysis of variance. Compared to placebo, ω-3 PUFAs' significant effects on the amplitude of the reduction in General and Total PANSS scores are evident after the first four weeks of treatment; a reduction of positive symptoms and a lower mean PANSS positive score were apparent after eight weeks, whereas the significant drop in negative symptoms and the significant change and higher mean scores in global functioning occur later at 12weeks. The delay of onset of ω -3 PUFAs seems comparable to that of antipsychotics and antidepressants.
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Affiliation(s)
- Nilufar Mossaheb
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Waehringer Guertel 18-10, 1090 Vienna, Austria.
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Dean OM, Jeavons S, Malhi GS, Cotton SM, Tanious M, Kohlmann K, Hewitt K, Moss K, Allwang C, Schapkaitz I, Robbins J, Cobb H, Dodd S, Bush A, Berk M. Deserves a hearing? A case report of remitting tinnitus with N-acetyl cysteine. Afr J Psychiatry (Johannesbg) 2013; 16:238-240. [PMID: 24051561 DOI: 10.4314/ajpsy.v16i4.31] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- O M Dean
- 1. Deakin University, School of Medicine, Barwon Health, Geelong, Australia; 2. The Florey Institute of Neuroscience and Mental Health, Parkville, Australia; 3. University of Melbourne, Department of Psychiatry, Parkville, Australia
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Cotton SM, Lambert M, Schimmelmann BG, Mackinnon A, Gleeson JFM, Berk M, Hides L, Chanen AM, Scott J, Schöttle D, McGorry PD, Conus P. Differences between first episode schizophrenia and schizoaffective disorder. Schizophr Res 2013; 147:169-174. [PMID: 23528796 DOI: 10.1016/j.schres.2013.02.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 07/19/2012] [Revised: 02/24/2013] [Accepted: 02/26/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The diagnostic and clinical overlap between schizophrenia and schizoaffective disorder is an important nosological issue in psychiatry that is yet to be resolved. The aim of this study was to compare the clinical and functional characteristics of an epidemiological treated cohort of first episode patients with an 18-month discharge diagnosis of schizophrenia (FES) or schizoaffective disorder (FESA). METHODS This study was part of the larger First Episode Psychosis Outcome Study (FEPOS) which involved a medical file audit study of all 786 patients treated at the Early Psychosis Prevention and Intervention Centre between 1998 and 2000. Of this cohort, 283 patients had an 18-month discharge diagnosis of FES and 64 had a diagnosis of FESA. DSM-IV diagnoses and clinical and functional ratings were derived and validated by two consultant psychiatrists. RESULTS Compared to FES patients, those with FESA were significantly more likely to have a later age of onset (p=.004), longer prodrome (p=.020), and a longer duration of untreated psychosis (p<.001). At service entry, FESA patients presented with a higher illness severity (p=.020), largely due to the presence of more severe manic symptoms (p<.001). FESA patients also had a greater number of subsequent inpatient admissions (p=.017), had more severe depressive symptoms (p=.011), and higher levels of functioning at discharge. DISCUSSION The findings support the notion that these might be considered two discernable disorders; however, further research is required to ascertain the ways and extent to which these disorders are discriminable at presentation and over time.
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Affiliation(s)
- S M Cotton
- Orygen Youth Health Research Centre, Melbourne Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
| | - M Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - B G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Switzerland
| | - A Mackinnon
- Orygen Youth Health Research Centre, Melbourne Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - J F M Gleeson
- School of Psychology, Australian Catholic University, Australia
| | - M Berk
- Orygen Youth Health Research Centre, Melbourne Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; Deakin University, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, Parkville, Australia
| | - L Hides
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - A M Chanen
- Orygen Youth Health Research Centre, Melbourne Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - J Scott
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - D Schöttle
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - P D McGorry
- Orygen Youth Health Research Centre, Melbourne Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - P Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland
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Cotton SM, McCann TV, Gleeson JF, Crisp K, Murphy BP, Lubman DI. Coping strategies in carers of young people with a first episode of psychosis. Schizophr Res 2013; 146:118-24. [PMID: 23490761 DOI: 10.1016/j.schres.2013.02.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 12/16/2012] [Revised: 01/25/2013] [Accepted: 02/06/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Carers of young people with first episode psychosis (FEP) often face burden. Understanding ways in which carers cope is not only important for providing support to them but might maximise patient outcomes. The aim of this study was to examine strategies carers use to cope with the burden of caring for a young person with FEP. METHODS The study was part of a randomized controlled trial focusing on the effectiveness of a problem-solving bibliotherapy intervention for carers of FEP patients, in terms of promoting coping and reducing psychological distress. Baseline data on the Ways of Coping (WOC) scale was available for 124 carers aged between 18 and 66 years. Principal component analysis with PROMAX rotation was used to determine the number of factors that could be used to characterise coping behaviour. Regression analyses were used to determine how the factors were related to carers' demographics, burden, psychological well-being and expressed emotion. RESULTS Approximately half of the carers reported that they frequently use positive coping techniques such as self-talk, active problem solving, and positive reframing. The factor analysis yielded five factors: (i) cognitive-escape coping; (ii) optimistic coping; (iii) seeking connections; (iv) tension reduction; and (v) distancing. The relationships between these factors and demographic characteristics, carers' perception of burden, expressed emotion, and psychological distress are reported. CONCLUSIONS Avoidance coping strategies are related to psychological distress, emotional over-involvement, and increased carer burden. Interventions facilitating the use of adaptive problem solving and positive re-appraisal will promote carer coping and reduce psychological distress.
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Affiliation(s)
- S M Cotton
- Orygen Youth Health Research Centre, Locked Bag 10, Parkville Victoria 3052, Australia.
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Bechdolf A, Ratheesh A, Wood SJ, Tecic T, Conus P, Nelson B, Cotton SM, Chanen AM, Amminger GP, Ruhrmann S, Schultze-Lutter F, Klosterkötter J, Fusar Poli P, Yung AR, Berk M, McGorry PD. Rationale and first results of developing at-risk (prodromal) criteria for bipolar disorder. Curr Pharm Des 2012; 18:358-75. [PMID: 22239567 DOI: 10.2174/138161212799316226] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/17/2011] [Indexed: 11/22/2022]
Abstract
Bipolar affective disorder (BD) is a severe, recurrent and disabling disorder with devastating consequences for individuals, families and society. Although these hazards and costs provide a compelling rationale for development of early detection and early intervention strategies in BD, the development of at-risk criteria for first episode mania is still in an early stage of development. In this paper we review the literature with respect to the clinical, neuroantomical and neuropsychological data, which support this goal. We also describe our recently developed bipolar at-risk criteria (BAR). This criteria comprises the peak age range of the first onset of bipolar disorder, genetic risk, presenting with sub-threshold mania, cyclothymic features or depressive symptoms. An initial pilot evaluation of the BAR criteria in 22 subjects indicated conversion rates to proxies of first-episode mania of 23% within 265 days on average, and high specificity and sensitivity of the criteria. If prospective studies confirm the validity of the BAR criteria, then the criteria would have the potential to open up new avenues of research for indicated prevention in BD and might therefore offer opportunities to ameliorate the severity of, or even prevent BD.
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Affiliation(s)
- A Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany.
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Cotton SM, Lambert M, Schimmelmann BG, Mackinnon A, Gleeson JFM, Berk M, Hides L, Chanen A, McGorry PD, Conus P. Depressive symptoms in first episode schizophrenia spectrum disorder. Schizophr Res 2012; 134:20-6. [PMID: 21937197 DOI: 10.1016/j.schres.2011.08.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [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] [Received: 05/07/2011] [Revised: 08/28/2011] [Accepted: 08/29/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Depressive symptoms in 'non-affective' first episode schizophrenia spectrum disorders (FES) are common, but poorly understood, resulting in a range of conceptual and clinical management issues. This study had three aims: (i) to determine the prevalence of moderate to severe depressive symptoms (defined as a Clinical Global Impressions Scale-Bipolar Disorder (CGI-BP depression) score >3) in a large representative sample of FES patients; (ii) to compare the clinical and functional characteristics of FES patients with and without these depressive symptoms at service entry; and (iii) to compare the characteristics of FES patients with and without persistent depressive symptoms. METHODS Medical file audit methodology was employed to collect information on 405 patients with FES treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. RESULTS 26.2% (n=106) of the patients had moderate to severe depression at service entry. At service entry and at discharge, those with depressive symptoms had greater insight into their illness but did not differ from those without depressive symptoms in terms of severity of overall psychopathology. Substance use was significantly less common in those with depressive symptoms at service entry and at discharge. Of those who were depressed at baseline, 14.2% (n=15) continued to have moderate to severe depressive symptoms at discharge. DISCUSSION Depressive symptoms are common in patients with FES. Understanding the nature and characteristics of depression in FES has important clinical implications for both early intervention and treatment.
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Affiliation(s)
- S M Cotton
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Australia.
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