Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis

BACKGROUND

There are insufficient data from nationwide surveys on the prevalence of specific psychotic disorders and associated co-morbidities.

METHOD

The 2010 Australian national psychosis survey used a two-phase design to draw a representative sample of adults aged 18-64 years with psychotic disorders in contact with public treatment services from an estimated resident population of 1 464 923 adults. This paper is based on data from 1642 participants with an International Classification of Diseases (ICD)-10 psychotic disorder. Its aim is to present estimates of treated prevalence and lifetime morbid risk of psychosis, and to describe the cognitive, physical health and substance use profiles of participants.

RESULTS

The 1-month treated prevalence of psychotic disorders was 3.10 cases per 1000 population aged 18-64 years, not accounting for people solely accessing primary care services; lifetime morbid risk was 3.45 per 1000. Mean premorbid intelligence quotient was approximately 0.5 s.d.s below the population mean; current cognitive ability (measured with a digit symbol coding task) was 1.6 s.d.s below the population mean. For both cognitive tests, higher scores were significantly associated with better independent functioning. The prevalence of the metabolic syndrome was high, affecting 60.8% of participants, and pervasive across diagnostic groups. Of the participants, two-thirds (65.9%) were current smokers, 47.4% were obese and 32.4% were sedentary. Of the participants, half (49.8%) had a lifetime history of alcohol abuse/dependence and 50.8% lifetime cannabis abuse/dependence.

CONCLUSIONS

Our findings highlight the need for comprehensive, integrative models of recovery to maximize the potential for good health and quality of life for people with psychotic illness.

Prospective study of early bereavement on psychological and behavioural cardiac risk factors

BACKGROUND

Increasing evidence supports the role of emotional stress in the onset of cardiovascular disease. Although bereavement is a major emotional stress with both acute and more long-term features, the mechanism of its association with cardiovascular risk is not well understood, in particular because of limited studies of acute bereavement. The aim of the study was to identify psychological and behavioural changes in acute bereavement and potential modifiers of these changes.

METHODS

Bereaved (n= 62) and non-bereaved individuals (n= 50) were evaluated within 2 weeks and at 6 months following loss using the Centre for Epidemiologic Studies -- Depression, Spielberger State Anxiety and Anger, Social Support Questionnaire and changes in appetite, cigarette and alcohol consumption, cortisol and lipids.

RESULTS

Compared with non-bereaved, acutely bereaved had increased symptoms of depression (26.7 +/- 1.7 vs 5.9 +/- 0.7, P < 0.001), anxiety (47.4 +/- 2.0 vs 28.2 +/- 1.4, P < 0.001) and anger (median 16.0 vs 15.0, P < 0.001). Greater depressive symptoms were associated with being unprepared for the death, decreased sleep duration and younger age. Acutely, bereaved slept less than non-bereaved (5.8 +/- 0.2 vs 7.2 +/- 0.2 h, P < 0.001). Reduced sleep time was associated with increased anger and depression and decreased satisfaction with social support. Compared with the non-bereaved, the acutely bereaved had higher cortisol (median 306 vs 266, P= 0.003), reduced appetite (P < 0.001) and lower total cholesterol (median 4.9 vs 5.4, P= 0.006) and low-density lipoprotein (median 2.4 vs 2.9, P < 0.001).

CONCLUSION

These results offer insight into the psychological, behavioural and physical changes that may contribute to cardiovascular risk in bereavement.

Neurological changes induced by a mobile phone

Dysaesthesiae of the scalp after mobile phone use have been previously reported, but the basis for this has not been clear. We report a case of a 34-year-old journalist who complained of symptoms associated with use of a mobile phone. She agreed to a provocation study with her phone. Current perception threshold testing before and after exposure showed marked changes in the C-fibre nerves of the affected area compared with the opposite side. The case is supportive of a neurological basis for some cases of dysaesthesiae associated with mobile phone use.

Neurological abnormalities associated with CDMA exposure

Dysaesthesiae of the scalp and neurological abnormality after mobile phone use have been reported previously, but the roles of the phone per se or the radiations in causing these findings have been questioned. We report finding a neurological abnormality in a patient after accidental exposure of the left side of the face to mobile phone radiation [code division multiple access (CDMA)] from a down-powered mobile phone base station antenna. He had headaches, unilateral left blurred vision and pupil constriction, unilateral altered sensation on the forehead, and abnormalities of current perception thresholds on testing the left trigeminal ophthalmic nerve. His nerve function recovered during 6 months follow-up. His exposure was 0.015-0.06 mW/cm(2) over 1-2 h. The implications regarding health effects of radiofrequency radiation are discussed.

Cardiovascular risk factors for people with mental illness

OBJECTIVE

The objective of this study was to document the prevalence of risk factors for cardiovascular disease among people with chronic mental illness.

METHOD

A cross-sectional survey was conducted of 234 outpatients attending a community mental health clinic in the North-western Health Care Network in Melbourne, Australia. Prevalence of smoking, alcohol consumption, body mass index, hypertension, salt intake, exercise and history of hypercholesterolemia was assessed.

RESULTS

Compared with a community sample, the mentally ill had a higher prevalence of smoking, overweight and obesity, lack of moderate exercise, harmful levels of alcohol consumption and salt intake. No differences were found on hypertension. Men, but not women, with mental illness were less likely to undertake cholesterol screening.

CONCLUSIONS

Psychiatric outpatients have a high prevalence of cardiovascular risk factors which may account for the higher rate of cardiovascular mortality among the mentally ill. Further research is needed to trial and evaluate interventions to effectively modify risk factors in this vulnerable population.

Management of radiofrequency radiation overexposures

BACKGROUND

Radiofrequency radiation (RFR) has been in use for some time but is now proliferative with the burgeoning radiocommunications industry.

OBJECTIVE

To inform the profession of the possible health effects from overexposure to radiofrequency radiation (RFR) and the clinical approach to cases. An introduction to the health effects of overexposure to RFR is given. A clinical approach to integrating the patient's symptoms and the circumstances of the exposure is given. Emergency treatment and ongoing care is outlined, and sources of expert advice given.

CONCLUSION

Overexposure to RFR is a complex injury. Advice is given in this article for emergency care and planning ongoing care.

Risk factors for HIV/AIDS and hepatitis C among the chronic mentally ill

OBJECTIVE

The objective of this study was to document the prevalence of risk factors for HIV/AIDS and hepatitis C among people with chronic mental illness treated in a community setting.

METHOD

234 patients attending four community mental health clinics in the North-western Health Care Network in Melbourne, Australia, completed an interviewer-administered questionnaire which covered demographics, risk behaviour and psychiatric diagnosis.

RESULTS

The sample was 58% male, and 79% of the sample had a primary diagnosis of schizophrenia. Forty-three per cent of mentally ill men and 51% of mentally ill women in the survey had been sexually active in the 12 months preceding the survey. One-fifth of mentally ill men and 57% of mentally ill women who had sex with casual partners never used condoms. People with mental illness were eight times more likely than the general population to have ever injected illicit drugs and the mentally ill had a lifetime prevalence of sharing needles of 7.4%.

CONCLUSIONS

The prevalence of risk behaviours among the study group indicate that people with chronic mental illness should be regarded as a high-risk group for HIV/AIDS and hepatitis C. It is essential that adequate resources and strategies are targeted to the mentally ill as they are for other high-risk groups.

Microwave sickness: a reappraisal

Microwave sickness (MWS) has been a disputed condition. The syndrome involves the nervous system and includes fatigue, headaches, dysaesthesia and various autonomic effects in radiofrequency radiation workers. This paper describes the early reports of the syndrome from Eastern Europe and notes the scepticism expressed about them in the West, before considering comprehensive recent reports by Western specialists and a possible neurological basis for the condition. It is concluded that MWS is a medical entity which should be recognized as a possible risk for radiofrequency radiation workers.

Neurological abnormalities associated with mobile phone use

Dysaesthesiae of the scalp after mobile phone use have been previously reported but the pathological basis of these symptoms has been unclear. We report finding a neurological abnormality in a patient after prolonged use of a mobile phone. He had permanent unilateral dysaesthesiae of the scalp, slight loss of sensation, and abnormalities on current perception threshold testing of cervical and trigeminal nerves. A neurologist found no other disease. The implications regarding health effects of mobile phones and radio-frequency radiation is discussed.

Comments on "A critical review of epidemiologic studies of radiofrequency exposure and human cancers"

Comments on Elwood's article: A critical review of epidemiologic studies of radiofrequency exposure and human cancers. Environ Health Perspect 107(suppl 1):155-168 (1999).

Radiofrequency electrocution (196 MHz)

Radiofrequency (RF) electrocutions are uncommon. A case of electrocution at 196 MHz is presented partly because there are no previous reports with frequencies as high as this, and partly to assist in safety standard setting. A 53-year-old technician received two brief exposures to both hands of 2A current at 196 MHz. He did not experience shock or burn. Progressively over the next days and months he developed joint pains in the hands, wrists and elbows, altered temperature and touch sensation and parasthesiae. Extensive investigation found no frank neurological abnormality, but there were changes in temperature perception in the palms and a difference in temperature between hands. His symptoms were partly alleviated with ultra-sound therapy, phenoxybenzamine and glyceryl trinitrate patches locally applied, but after several months he continues to have some symptoms. The biophysics and clinical aspects are discussed. It is postulated that there was mainly surface flow of current and the micro-vasculature was effected. Differences to 50 Hz electrocution are noted. Electrocution at 196 MHz, even in the absence of burns may cause long-term morbidity to which physicians should be alerted. Safety standards should consider protection from electrocution at these frequencies.

Training to enhance partnerships between mental health professionals and family caregivers: a comparative study

A training program for mental health staff was collaboratively developed and delivered by family caregivers and professionals. It addressed calls for less blaming attitudes toward families and increased contact between professionals and families. Two levels of training were compared. Twenty-seven staff members completed a 30-hour extended 12-week program. Eighty-two percent of all eligible staff from area teams attended a brief program involving three or six hours of training. Self-ratings of competence and attitudes toward families improved only for staff receiving extended training. Contacts with families increased for those in the extended program but not for all types of teams, suggesting that length of training and service type may limit the impact of training.

Preliminary report: symptoms associated with mobile phone use

Mobile phone use is ubiquitous, although the alleged health effects of low level radio-frequency radiation (RFR) used in transmission are contentious. Following isolated reports of headache-like symptoms arising in some users, a survey has been conducted to characterize the symptoms sometimes associated with mobile phone usage. A notice of interest in cases was placed in a major medical journal and this was publicized by the media. Respondents were interviewed by telephone using a structured questionnaire. Forty respondents from diverse occupations described unpleasant sensations such as a burning feeling or a dull ache mainly occurring in the temporal, occipital or auricular areas. The symptoms often began minutes after beginning a call, but could come on later during the day. The symptoms usually ceased within an hour after the call, but could last until evening. Symptoms did not occur when using an ordinary handset, and were different from ordinary headaches. There were several reports suggestive of intra-cranial effects. Three respondents reported local symptoms associated with wearing their mobile phone on their belts. There was one cluster of cases in a workplace. Seventy-five per cent of cases were associated with digital mobile phones. Most of the respondents obtained relief by altering their patterns of telephone usage or type of phone. Cranial and other diverse symptoms may arise associated with mobile phone usage. Physicians and users alike should be alert to this. Further work is needed to determine the range of effects, their mechanism and the possible implications for safety limits of RFR.

Daytime sleepiness and sleep habits of Australian workers

Excessive daytime sleepiness in the general community is a newly recognized problem about which there is little standardized information. Our aim was to measure the levels of daytime sleepiness and the prevalence of excessive daytime sleepiness in a sample of Australian workers and to relate that to their self-reported sleep habits at night and to their age, sex, and obesity. Sixty-five percent of all 507 employees working during the day for a branch of an Australian corporation answered a sleep questionnaire and the Epworth sleepiness scale (ESS) anonymously. Normal sleepers, without any evidence of a sleep disorder, had ESS scores between 0 and 10, with a mean of 4.6 +/- 2.8 (standard deviation). They were clearly separated from the "sleepy" patients suffering from narcolepsy or idiopathic hypersomnia whose ESS scores were in the range 12-24, as described previously. ESS scores > 10 were taken to represent excessive daytime sleepiness, the prevalence of which was 10.9%. This was not related significantly to age (22-59 years), sex, obesity, or the use of hypnotic drugs but was related significantly but weakly to sleep-disordered breathing (frequency of snoring and apneas), the presence of insomnia, and reduced time spent in bed (insufficient sleep).

Cancer incidence and mortality and proximity to TV towers

OBJECTIVE

To determine whether there is an increased cancer incidence and mortality in populations exposed to radiofrequency radiations from TV towers.

DESIGN

An ecological study comparing cancer incidence and mortality, 1972-1990, in nine municipalities, three of which surround the TV towers and six of which are further away from the towers. (TV radiofrequency radiation decreases with the square of the distance from the source.) Cancer incidence and mortality data were obtained from the then Commonwealth Department of Human Services and Health. Data on frequency, power, and period of broadcasting for the three TV towers were obtained from the Commonwealth Department of Communications and the Arts. The calculated power density of the radiofrequency radiation in the exposed area ranged from 8.0 microW/cm2 near the towers to 0.2 microW/cm2 at a radius of 4km and 0.02 microW/cm2 at 12 km.

SETTING

Northern Sydney, where three TV towers have been broadcasting since 1956.

OUTCOME MEASURES

Rate ratios for leukaemia and brain tumour incidence and mortality, comparing the inner with the outer areas.

RESULTS

For all ages, the rate ratio for total leukaemia incidence was 1.24 (95% confidence interval [CI], 1.09-1.40). Among children, the rate ratio for leukaemia incidence was 1.58 (95% CI, 1.07-2.34) and for mortality it was 2.32 (95% CI, 1.35-4.01). The rate ratio for childhood lymphatic leukaemia (the most common type) was 1.55 (95% CI, 1.00-2.41) for incidence and 2.74 (95% CI, 1.42-5.27) for mortality. Brain cancer incidence and mortality were not increased.

CONCLUSION

We found an association between increased childhood leukaemia incidence and mortality and proximity to TV towers.

Cost to industry of illnesses related to alcohol and smoking. A study of Telecom Australia employees

OBJECTIVE

To estimate the direct cost to industry of absenteeism attributable to drinking alcohol and smoking.

DESIGN

Review of sick leave and superannuation data in the staff records of Telecom Australia (nearly 80,000 staff) for the financial year 1991-92 to identify illnesses related to alcohol or smoking. Costs were calculated by reference to tables of aetiological fractions, which statistically attribute a proportion of an illness to alcohol or smoking.

MAIN OUTCOME MEASURE

The cost of employee absences attributable to alcohol or smoking expressed in the value of the person's daily salary.

RESULTS

Illness attributable to smoking or alcohol accounted for 25% of sick leave. The estimated costs were $5,500,000 for alcohol and $16,500,000 for smoking. The total cost of $22,000,000 averages $275 per employee per year. If this cost is extrapolated to the rest of the Australian workforce, the total would exceed $2,000,000,000 a year.

CONCLUSION

Limitations in the data mean that our results are likely to be underestimates. The direct costs to industry of ill health caused by alcohol and smoking are substantial and warrant preventive and rehabilitative programs.

Health assessment for commercial driving. The general practitioners' role

Death and injury rates associated with commercial vehicle driving are unacceptably high. Pre-existing medical conditions may contribute to road accidents and the National Road Transport Commission (NRTC) has developed a set of uniform guidelines, based on best available evidence, which might preclude at risk individuals from holding commercial licences. Standardised clinical examinations performed by general practitioners (GPs) will be used to assist regulatory authorities in their licensing procedures. This article sets out the process of development of the guidelines as well as the construction and use of a medical assessment form to be used by GPs in facilitating the licensing process in each State.