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Pai N, McGeachie AB, Puig A, Huang THW, Brahmbhatt P. Persistence and adherence to second-generation antipsychotic long-acting injectable medications for schizophrenia: A comparative study in the Australian context. Australas Psychiatry 2023; 31:76-81. [PMID: 36475909 DOI: 10.1177/10398562221142453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine patient characteristics, persistence and adherence to treatment associated with use of second-generation antipsychotic long-acting injectable (SGA LAI) medications in the Australian real-world setting. METHOD Five SGA LAIs were compared using a retrospective 10% sample of prescriptions in Australian Pharmaceutical Benefits Scheme (PBS) data: paliperidone palmitate 1-monthly (PP1M), paliperidone palmitate 3-monthly (PP3M), aripiprazole monohydrate (ARI), risperidone (RLAI) and olanzapine pamoate (OLAI). RESULTS Patients in the PP3M cohort were more persistent with treatment (p < 0.001). Median months of persistence: PP3M (36 months); ARI (18 months); PP1M (11 months); OLAI (8 months); RLAI (4 months). Patients in the PP3M cohort were more adherent to treatment (p < 0.001): PP3M (78%); ARI (51%); PP1M (46%); OLAI (35%); RLAI (33%). CONCLUSIONS Patients on PP3M treatment showed comparatively longer persistence and better adherence. Treatments for schizophrenia with longer dosing intervals may provide patients with symptomatic stability that could allow for reduced hospitalisations/relapse and increased focus on functional recovery.
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Affiliation(s)
- Nagesh Pai
- 8691University of Wollongong, Wollongong, NSW, Australia
| | | | - Andrea Puig
- 6071Janssen Australia and New Zealand, Macquarie Park, NSW, Australia
| | - Tom H-W Huang
- 6071Janssen Australia and New Zealand, Macquarie Park, NSW, Australia
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Suesse B, Lago L, Westley-Wise V, Masso M, Cuenca J, Pai N. Application of mixture distributions for identifying thresholds of frequent and high inpatient mental health service use in longitudinal data. J Ment Health 2023; 32:33-42. [PMID: 33565342 DOI: 10.1080/09638237.2021.1875407] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is a need for greater understanding about frequent and high use of inpatient mental health services, and those with ongoing increased needs. Most studies employ a threshold of frequent use (e.g. numbers of admissions) and high use (e.g. lengthy stays) without justification. AIMS To identify model-driven thresholds for frequent/high inpatient mental health service use and contrast characteristics of patients identified using various models and thresholds. METHOD Retrospective population-based study using 12 years of longitudinal data for 5631 patients admitted with a mental health diagnosis. Two-component negative binomial and poisson mixture (truncated/untruncated) models identified thresholds for frequent/high use in a 12-month period. RESULTS The two-component negative binomial mixture model resulted in the best model fit. Using negative binomial-derived thresholds, 5.3% of patients had a period of frequent use (admitted six or more times), 15.8% of high use (hospitalised for 45 or more days) and 3.5% of heavy use (both frequent and high use). The prevalence of specific mental health disorders (e.g. mood disorder and schizophrenia) among frequent and high use cohorts varied across thresholds. CONCLUSIONS This model-driven approach can be applied to identify thresholds in other cohorts. Threshold choice may depend on the magnitude and focus of potential interventions.
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Affiliation(s)
- Bianca Suesse
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Luise Lago
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Victoria Westley-Wise
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia.,Integrated Care, Mental Health, Planning, Information and Performance Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia
| | - Malcolm Masso
- Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Jose Cuenca
- Research Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia
| | - Nagesh Pai
- Integrated Care, Mental Health, Planning, Information and Performance Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia.,School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong (UOW), Wollongong, NSW, Australia
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3
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Pai N, Vella SL, Castle D. A comparative review of the epidemiology of mental disorders in Australia and India. Asia Pac Psychiatry 2022; 14:e12517. [PMID: 35667856 DOI: 10.1111/appy.12517] [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: 12/21/2021] [Revised: 02/28/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
Mental illness and substance use disorders have been increasing worldwide. Mental illness has a significant impact upon the lives of the individual as well as their loved ones. Mental disorders are known to result in a high level of disability. This article provides a comparative review of the epidemiology of mental disorders in Australia and India, summarizing and comparing prevalence rates in both countries based upon available data. Overall, it is evident that Australia has higher prevalence rates of mental disorders than India, across most diagnostic groups. Australia has the highest prevalence of anxiety disorders whereas India has the highest prevalence of substance use disorders; including tobacco use disorders. The next most prevalent mental disorders in India are depressive disorders. However, there are demographic parameters such as gender and age as well as service-provision differences across the countries that need to be factored into any interpretation of the data. There are also problems associated with different diagnostic instruments with language and cultural nuances that may impact comparisons. We suggest that a joint epidemiological survey between the two countries would help better understand and delineate the key similarities pertaining to the epidemiology of mental disorders in Australia and India. This will in turn assist with the development of policy and treatment of mental disorders.
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Affiliation(s)
- Nagesh Pai
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Shae-Leigh Vella
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - David Castle
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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Abstract
PURPOSE OF REVIEW Social isolation and loneliness are known contributors to all-cause mortality as well as a range of physical and mental health conditions. Therefore, this article reviews current literature pertaining to the effects of social isolation and loneliness on physical and mental health during the current COVID-19 pandemic. RECENT FINDINGS Social isolation and loneliness contribute to a myriad of physical and mental health conditions. Specifically social isolation and loneliness contribute to the development of cardiovascular disease, diabetes mellitus, and cancer. However, most research indicated that poor lifestyle factors explained most of the association. Social isolation and loneliness are also associated with cognitive problems including dementia, immune system problems, and mental health conditions. Further social isolation and loneliness also spur behavioral issues that significantly affect physical and mental health. SUMMARY Evidence suggests that social isolation and loneliness have significant consequences on the physical and mental health of the individual and that the move toward ending all protections against COVID-19 has significant implications for the vulnerable. Further the similarities between the effects of social isolation and loneliness are compared to some of the conditions evident in long-COVID.
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Affiliation(s)
- Nagesh Pai
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong
- Illawarra Health and Medical Research Institute
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Shae-Leigh Vella
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong
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Bartschi JG, Greenwood LM, Montgomery A, Dortants L, Weston-Green K, Huang XF, Pai N, Potter J, Schira MM, Croft R, Solowij N. Cannabidiol as a Treatment for Neurobiological, Behavioral, and Psychological Symptoms in Early-Stage Dementia: A Double-Blind, Placebo-Controlled Clinical Trial Protocol. Cannabis Cannabinoid Res 2022; 8:348-359. [PMID: 36040362 DOI: 10.1089/can.2021.0209] [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] [Indexed: 11/12/2022] Open
Abstract
Rationale: The slowing of disease progression in dementia in the early stages of diagnosis is paramount to improving the quality of life for those diagnosed and their support networks. Accumulating evidence suggests that CBD, a constituent of Cannabis sativa, is associated with neuroprotective, neuroendocrine, and psychotherapeutic effects, suggesting that it may be beneficial to dementia treatment. However, no published human study to date has examined this possibility. This trial aims to determine whether daily treatment with CBD over a 12-week period is associated with improved neurobiological, behavioral, and psychological outcomes in individuals living with early-stage dementia. Methods: Sixty participants with early-stage dementia will be recruited for a randomized, double-blind, placebo-controlled clinical trial. Participants will be randomized into either 99.9% pure CBD or placebo treatment conditions and administered two capsules per day for 12 weeks. Participants will commence a 200 mg/day dose for 2 weeks before escalating to 300 mg/day for the remaining 10 weeks. Neuroimaging and blood-based neuroendocrine profiles will be assessed at baseline and post-treatment. Psychological and behavioral symptoms will be assessed at baseline, 6 weeks, and post-treatment. Monitoring of health and side-effects will be conducted through weekly home visits. Discussion: This study is among the first to investigate the effects of isolated CBD in improving neuroanatomical and neuroendocrine changes, alongside psychological symptoms, during the early stages of dementia diagnosis. The outcomes of this trial have the capacity to inform a potential novel and accessible treatment approach for individuals living with early-stage dementia, and in turn, improve quality of life, prognoses, and treatment outcomes. Trial Registration: This trial has been registered with the Therapeutic Goods Administration (CT-2020-CTN-03849-1v2) and the Australian and New Zealand Clinical Trials Registry (ACTRN12621001364864).
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Affiliation(s)
- Jessica G Bartschi
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, Australia
| | - Lisa-Marie Greenwood
- Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, Australia.,Research School of Psychology, The Australian National University, Canberra, Australia
| | - Amy Montgomery
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Lon Dortants
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, Australia
| | - Katrina Weston-Green
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, Australia.,School of Medicine and Molecular Horizons, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Xu-Feng Huang
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, Australia.,School of Medicine and Molecular Horizons, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Nagesh Pai
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,School of Medicine and Molecular Horizons, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.,Southern Hospitals Network, Illawarra-Shoalhaven Local Health District, Warrawong, Australia
| | - Jan Potter
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,School of Medicine and Molecular Horizons, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.,Southern Hospitals Network, Illawarra-Shoalhaven Local Health District, Warrawong, Australia
| | - Mark M Schira
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Rodney Croft
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Nadia Solowij
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, Australia
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Pai N, Gupta R, Lakra V, Vella SL, Kalra H, Yadav T, Chaturvedi S, Gill NS. Indian psychiatrists in the Australian workforce - From brain drain to brain exchange. Aust N Z J Psychiatry 2022; 56:752-756. [PMID: 34498491 DOI: 10.1177/00048674211044099] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Worldwide doctors have been migrating from low- and middle-income countries to high-income countries for decades. This contributes to dearth of doctors, especially psychiatrists, in low- and middle-income countries - often referred to as 'brain drain'. Australia has a fair share of psychiatrists of Indian origin in its workforce. This article endeavours to re-formulate the migration phenomenon as 'brain exchange' through the experiential insight of the authors along with published literature and discusses the contribution of substantial number of psychiatrists of Indian origin to the Australian society. Furthermore, the article highlights the potential for the Royal Australian and New Zealand College of Psychiatrists to be a leader in this area by facilitating globally responsible practice by giving back to countries from which psychiatrists originate. The key observations and recommendations are transferrable to other similar countries and equally to other medical specialities.
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Affiliation(s)
- Nagesh Pai
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Rahul Gupta
- Hunter New England Mental Health Service, Newcastle, NSW, Australia.,Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Vinay Lakra
- North West Area Mental Health Service, North Western Mental Health, Parkville, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Shae-Leigh Vella
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Harish Kalra
- Ballarat Clinical School, School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.,Grampians Area Mental Health Services, Ballarat, VIC, Australia
| | - Tarun Yadav
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Hunter New England Drug and Alcohol Service, Newcastle, NSW, Australia
| | | | - Neeraj S Gill
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia.,Rural Clinical School, The University of Queensland, Toowoomba, QLD, Australia.,Mental Health and Specialist Services, Gold Coast Health, Gold Coast, QLD, Australia
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Zhang Z, Yu P, Pai N, Chang HCR, Chen S, Yin M, Song T, Lau SK, Deng C. Developing an Intuitive Graph Representation of Knowledge for Nonpharmacological Treatment of Psychotic Symptoms in Dementia. J Gerontol Nurs 2022; 48:49-55. [PMID: 35343842 DOI: 10.3928/00989134-20220308-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Applying person-centered, nonpharmacological interventions to manage psychotic symptoms of dementia is promoted for health care professionals, particularly gerontological nurses, who are responsible for care of older adults in nursing homes. A knowledge graph is a graph consisting of a set of concepts that are linked together by their interrelationship and has been widely used as a formal representation of domain knowledge in health. However, there is lack of a knowledge graph for nonpharmacological treatment of psychotic symptoms in dementia. Therefore, we developed a comprehensive, human- and machine-understandable knowledge graph for this domain, named Dementia-Related Psychotic Symptom Nonpharmacological Treatment Ontology (DRPSNPTO). This graph was built by adopting the established NeOn methodology, a knowledge graph engineering method, to meet the quality standards for biomedical knowledge graphs. This intuitive graph representation of the domain knowledge sets a new direction for visualizing and computerizing gerontological knowledge to facilitate human comprehension and build intelligent aged care information systems. [Journal of Gerontological Nursing, 48(4), 49-55.].
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Pai N, Vella SL. Rise in referrals for adult attention deficit hyperactivity disorder assessment during the Greater Sydney lockdown. Psychiatry Res 2022; 309:114360. [PMID: 35032763 DOI: 10.1016/j.psychres.2021.114360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Nagesh Pai
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.
| | - Shae-Leigh Vella
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
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Sharma R, Halder SL, Zachos M, Radoja C, Grant C, Chauhan U, Brackenridge E, Issenman R, Sherlock M, Dowhaniuk JK, Pai N, Brill H, Ratcliffe E, Narula N, Marshall J, Prowse K. A66 THE IMPACT OF A MULTIDISCIPLINARY ADOLESCENT AND YOUNG ADULT (AYA) INFLAMMATORY BOWEL DISEASE (IBD) ON CLINIC NO SHOW RATES. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859233 DOI: 10.1093/jcag/gwab049.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Transitioning from pediatric to adult health care is associated with significant psychosocial and clinical morbidity. Adolescents not only transition their medical care, but also experience vast changes in the physical, social, and psychological spheres of their lives. The medical team must help navigate these changes to provide optimal care. IBD in adolescence is associated with increased hospitalizations and surgery. This is due to several factors, including medication non-adherence and a failure to attend medical appointments. There has been a greater focus on improving care for this unique population. McMaster Children’s Hospital has integrated the AYA IBD clinic for patients between the ages of 16 and 22. The goal is to transition patients using a developmentally appropriate framework to facilitate self-efficacy and help identify comorbid mental health conditions while building resilience. Aims To explore the impact of the implementation of a dedicated transition clinic on attendance at medical visits for AYA patients with IBD. Methods The total numbers of patients booked in the AYA IBD Clinic was compared to an age matched subset of the patients in the adult McMaster Complex IBD (CIBD) Clinic. These visits were assessed based on whether the visit was: attended, cancelled, or no showed. Visits were then stratified between in-person and virtual visits. Unpaired t tests was performed to compare the AYA IBD clinic and the CIBD clinic. Findings were deemed significant based on p-values <0.05. Results The percentages of patients that attended visits (in-person or virtually) was similar between both clinics at 86% versus 79% Year 1 (Y1) and 76% versus 81% Year 2 (Y2). The number of patients seen in the AYA clinic increased from Y1 (n=92) to Y2 (n=131). The CIBD clinic saw fewer patients between Y1 (n=202) and Y2 (n=79). There were a higher number of patients who cancelled or no showed in Y2 versus Y1 for the AYA virtual visits (13 versus 8) compared to the CIBD clinic (Y2,1 versus Y1,1). Conclusions Our results highlight the challenges of transitioning adolescent patients with IBD. Our retrospective study was not powered to show significance. Given the increase in cancellation and no-show rates in Y2, the AYA clinic has incorporated a patient navigator to issue reminder phone calls and facilitate communication with patients between clinics. Future studies will re-assess how the presence of a patient navigator impacts attendance and cancellation rates. Future studies will also assess how the AYA clinic impacts transition readiness and self-efficacy, which is being measured through validated questionnaires in our clinic. ![]()
Funding Agencies Grants-In-Aid
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Affiliation(s)
- R Sharma
- McMaster University, Hamilton, ON, Canada
| | - S L Halder
- McMaster University, Hamilton, ON, Canada
| | - M Zachos
- McMaster University, Hamilton, ON, Canada
| | - C Radoja
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - C Grant
- McMaster University, Hamilton, ON, Canada
| | - U Chauhan
- McMaster University, Hamilton, ON, Canada
| | | | - R Issenman
- McMaster University, Hamilton, ON, Canada
| | - M Sherlock
- McMaster University, Hamilton, ON, Canada
| | | | - N Pai
- McMaster University, Hamilton, ON, Canada
| | - H Brill
- McMaster University, Hamilton, ON, Canada
| | | | - N Narula
- McMaster University, Hamilton, ON, Canada
| | - J Marshall
- McMaster University, Hamilton, ON, Canada
| | - K Prowse
- McMaster University, Hamilton, ON, Canada
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Pai N, Acar M, Juneja P, Kouhkamari MH, Siva S, Mullan J. Antipsychotic prescribing patterns in Australia: a retrospective analysis. BMC Psychiatry 2022; 22:110. [PMID: 35148707 PMCID: PMC8840322 DOI: 10.1186/s12888-022-03755-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/28/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To examine real-world patterns of antipsychotic use in patients with schizophrenia Australia. METHODS This retrospective cohort analysis was conducted using the Australian Commonwealth Department of Human Services Pharmaceutical Benefits Scheme (PBS) 10% sample data. Included data were for patients aged 16-years or older who initiated treatment for the first time with a PBS-reimbursed antipsychotic medication for schizophrenia between July 2013 and September 2017. Patterns of treatment usage were summarised descriptively. Differences in prescribing patterns by age and prescribing year were reported. Treatment persistence was estimated using Kaplan-Meier methods, with differences explored using log-rank tests. Values of p < 0.05 were considered statistically significant. RESULTS 6,740 patients, representing 8,249 non-unique patients, received prescriptions for antipsychotic medications. Patients were aged 16 years to over 85 years (54.5% were < 55 years) and two-thirds of patients were male (61%). The majority of treatment episodes (62%, n = 5,139/8,249) were prescribed an atypical oral antipsychotic. Typical long-acting antipsychotic therapies (LATs) were prescribed 19% of the treatment episodes (n = 1,608/8,249. There was a small increase in prescribing of atypical LAT and typical LAT and a small decrease in atypical oral and clozapine prescribing over the study period. Treatment persistence was greatest in patients treated with clozapine, than in those treated with atypical LATs. CONCLUSIONS While the majority of patients receive atypical antipsychotic medications, one in five continue to use older typical LAT therapies. Patient age and time on therapy may be associated with choice of therapy. Persistence to atypical LAT therapy is better than for other treatment modalities in this real-world cohort.
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Affiliation(s)
- Nagesh Pai
- School of Medicine, University of Wollongong (UOW), Wollongong, Australia. .,Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, Australia.
| | - Mustafa Acar
- Janssen-Cilag Pty Ltd, North Ryde, NSW Australia
| | | | | | | | - Judy Mullan
- grid.1007.60000 0004 0486 528XSchool of Medicine, University of Wollongong (UOW), Wollongong, Australia
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Pai N. In Response to: Lee S, Kanigere MK, Tibrewal P, Dhillon R and Bastiampillai T (2021). The hospitalist movement and the benefits for Australian psychiatry services. Australian and New Zealand Journal of Psychiatry. Aust N Z J Psychiatry 2022; 56:202. [PMID: 34159797 DOI: 10.1177/00048674211025604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nagesh Pai
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia
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Suesse B, Lago L, Pai N. Are people with treatment resistance among those requiring high inpatient mental health care? A longitudinal casemix profile from an Australian regional area. Aust N Z J Psychiatry 2022; 56:198-199. [PMID: 34590492 DOI: 10.1177/00048674211049990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Bianca Suesse
- Centre for Health Research Illawarra Shoalhaven Population, Australian Health Services Research Institute, Faculty of Business and Law, University of Wollongong, Wollongong, NSW, Australia
| | - Luise Lago
- Centre for Health Research Illawarra Shoalhaven Population, Australian Health Services Research Institute, Faculty of Business and Law, University of Wollongong, Wollongong, NSW, Australia
| | - Nagesh Pai
- Integrated Care, Mental Health, Planning, Information and Performance Directorate, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.,School of Medicine, Faculty of Science, Medicine and Health, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Abstract
BACKGROUND Loneliness is known to be associated with both poorer physical and mental health, being associated with increased mortality. Responses throughout the world to the current COVID-19 pandemic all incorporate varying degrees of social distancing and isolation. There is an imperative to provide a timely review and synthesis of the impact of COVID-19 on loneliness in the general population. METHODS PubMed was searched using the key terms 'COVID-19', 'coronavirus', 'SARS-COV2' and 'loneliness'. Fifty-four articles were identified and screened against the inclusion criteria. The inclusion criteria stipulated that the study needed to incorporate a measure of loneliness with participants being drawn from the general adult population. Twenty-four studies met the inclusion criteria. RESULTS The key data extracted from the 24 reviewed studies are presented and summarised with a focus on key demographics of participants, the research designs utilised, the measures of loneliness employed and the other variables assessed in the studies. Overall, the findings indicate that loneliness has been a significant issue during the current COVID-19 pandemic and loneliness is positively associated with mental health symptoms. However, there were inconsistencies in the results evident across studies. CONCLUSION To our knowledge, this is the first systematic review of research investigating loneliness during the current COVID-19 pandemic in the general adult population. Despite the inconsistencies evident in some of the results across the studies, it is clearly apparent that loneliness is having an impact on the mental health and wellbeing of the general adult population. Furthermore, it is apparent that the current COVID-19 pandemic has had an impact on loneliness in the general adult population and that loneliness is significantly positively associated with mental illness symptomatology. Thus, there is an imperative to address loneliness through public policy and interventions. The limitations of this review are noted and directions given for future research.
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Affiliation(s)
- Nagesh Pai
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Shae-Leigh Vella
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Pai N, Dark F, Castle D. The Importance of Employment for Recovery, in People with Severe Mental Illness. ACTA ACUST UNITED AC 2021; 8:217-219. [PMID: 34660177 PMCID: PMC8510884 DOI: 10.1007/s40737-021-00245-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Nagesh Pai
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW Australia.,Illawarra Shoalhaven Local Health District, Wollongong, NSW Australia
| | - Frances Dark
- Princess Alexandra Mental Health Service, Princess Alexandra Hospital, Woolloongabba, QLD Australia.,Queensland Health, Brisbane, QLD Australia
| | - David Castle
- Department of Psychiatry, Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
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15
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Bird S, Lago L, Eagar K, Pai N. Suicide prevention: Emergency departments are crucial for surveillance of self-harm and suicide-related behaviours. Aust N Z J Psychiatry 2021; 55:729-730. [PMID: 33896209 DOI: 10.1177/00048674211009600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sonia Bird
- Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Luise Lago
- Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Kathy Eagar
- Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Nagesh Pai
- Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia.,School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong (UOW), Wollongong, NSW, Australia.,Illawarra Shoalhaven Local Health District (ISLHD)
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Suesse B, Lago L, Westley-Wise V, Cuenca J, Pai N. Predisposing, enabling and need factors associated with increased use and ongoing increased use of inpatient mental health care: A population-based longitudinal study. Aust N Z J Psychiatry 2021; 55:409-421. [PMID: 33287552 DOI: 10.1177/0004867420976848] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study investigated factors associated with frequent (admissions), high (total length of stay) or heavy (frequent and high) hospital use, and with ongoing increased hospital use, for mental health conditions in a regional health district. METHODS A retrospective population-based study using longitudinal hospital, emergency department and community service use data for people admitted with a mental health condition between 1 January 2012 and 31 December 2016. Multivariate logistic regression models assessed the association of predisposing, enabling and need factors with increased, and ongoing increased, hospital use. RESULTS A total of 5,631 people had at least one mental health admission. Frequent admission was associated with not being married (odds ratio = 2.3, 95% confidence interval = [1.5, 3.3]), no private hospital insurance (odds ratio = 2.2, 95% confidence interval = [1.2, 3.8]), previous mental health service use (community, emergency department, lengthy admissions) and a history of a substance use disorder, childhood trauma, self-harm or chronic obstructive pulmonary disease. High and heavy hospital use was associated with marital status, hospital insurance, admission for schizophrenia, previous mental health service use and a history of self-harm. Ongoing frequent use was less likely among those aged 65 and older (odds ratio = 0.2, 95% confidence interval = [0.1, 1.0]) but more likely among those with a history of depression (odds ratio = 2.2, 95% confidence interval = [1.1, 4.4]). Ongoing high use was also associated with admissions for schizophrenia and a history of self-harm. CONCLUSION Interventions targeted at younger people hospitalised with schizophrenia, a history of depression or self-harm, particularly with evidence of social and or health disadvantage, should be considered to improve long-term consumer and health system outcomes. These data can support policymakers to better understand the context and need for improvements in stepped or staged care for people frequently using inpatient mental health care.
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Affiliation(s)
- Bianca Suesse
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Luise Lago
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Victoria Westley-Wise
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia.,Integrated Care, Mental Health, Planning, Information and Performance Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia
| | - Jose Cuenca
- Research Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia
| | - Nagesh Pai
- Integrated Care, Mental Health, Planning, Information and Performance Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia.,Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong (UOW), Wollongong, NSW, Australia
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17
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Babic I, Sellers D, Else PL, Nealon J, Osborne AL, Pai N, Weston-Green K. Effect of liraglutide on neural and peripheral markers of metabolic function during antipsychotic treatment in rats. J Psychopharmacol 2021; 35:284-302. [PMID: 33570012 DOI: 10.1177/0269881120981377] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that prevents metabolic side effects of the antipsychotic drugs (APDs) olanzapine and clozapine through unknown mechanisms. AIM This study aimed to investigate the effect of chronic APD and liraglutide co-treatment on key neural and peripheral metabolic signals, and acute liraglutide co-treatment on clozapine-induced hyperglycaemia. METHODS In study 1, rats were administered olanzapine (2 mg/kg), clozapine (12 mg/kg), liraglutide (0.2 mg/kg), olanzapine + liraglutide co-treatment, clozapine + liraglutide co-treatment or vehicle for six weeks. Feeding efficiency was examined weekly. Examination of brain tissue (dorsal vagal complex (DVC) and mediobasal hypothalamus (MBH)), plasma metabolic hormones and peripheral (liver and kidney) cellular metabolism and oxidative stress was conducted. In study 2, rats were administered a single dose of clozapine (12 mg/kg), liraglutide (0.4 mg/kg), clozapine + liraglutide co-treatment or vehicle. Glucose tolerance and plasma hormone levels were assessed. RESULTS Liraglutide co-treatment prevented the time-dependent increase in feeding efficiency caused by olanzapine, which plateaued by six weeks. There was no effect of chronic treatment on melanocortinergic, GABAergic, glutamatergic or endocannabionoid markers in the MBH or DVC. Peripheral hormones and cellular metabolic markers were unaltered by chronic APD treatment. Acute liraglutide co-treatment was unable to prevent clozapine-induced hyperglycaemia, but it did alter catecholamine levels. CONCLUSION The unexpected lack of change to central and peripheral markers following chronic treatment, despite the presence of weight gain, may reflect adaptive mechanisms. Further studies examining alterations across different time points are required to continue to elucidate the mechanisms underlying the benefits of liraglutide on APD-induced metabolic side effects.
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Affiliation(s)
- Ilijana Babic
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.,Neurohorizons Laboratory, Molecular Horizons, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia.,Illawarra and Shoalhaven Local Health District, Wollongong, Australia
| | - Dominic Sellers
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Paul L Else
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Jessica Nealon
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Ashleigh L Osborne
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.,Neurohorizons Laboratory, Molecular Horizons, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Nagesh Pai
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia.,Illawarra and Shoalhaven Local Health District, Wollongong, Australia
| | - Katrina Weston-Green
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.,Neurohorizons Laboratory, Molecular Horizons, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia.,Illawarra and Shoalhaven Local Health District, Wollongong, Australia
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Affiliation(s)
- Nagesh Pai
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, NSW, Australia
| | - Shae-Leigh Vella
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, NSW, Australia
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Pai N, Vella SL. Does the Australian mental health system provide mental health or psychiatric care? Returning to Engel 40 years on. Australas Psychiatry 2021; 29:35-36. [PMID: 32538187 DOI: 10.1177/1039856220933128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This article discusses the treatment that is actually provided by the Australian mental health system, arguing that the treatment provided constitutes purely psychiatric care in the sense that it is solely reliant on pharmaceuticals. This issue is framed in the context of an increasing mental health disease burden and the need to move to more holistic care in accordance with that advocated by Engel. CONCLUSION Thus, with the predictions of an increase in mental and substance use in the next 30 years, it is imperative to take measures to try to negate this increasing burden and associated costs. Therefore, returning to the holistic views of Engel and incorporating the psychological and social needs of patients in treatment is recommended as a way to attempt to minimise the impact.
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Affiliation(s)
- Nagesh Pai
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Australia.,Illawarra Shoalhaven Local Health District, Australia
| | - Shae-Leigh Vella
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Australia
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20
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Walsan R, Bonney A, Mayne DJ, Feng X, Vella SL, Pai N. Neighbourhoods and physical health comorbidity in individuals with serious mental illness. Schizophr Res 2020; 222:509-510. [PMID: 32461090 DOI: 10.1016/j.schres.2020.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ramya Walsan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW 2522, Australia.
| | - Andrew Bonney
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW 2522, Australia.
| | - Darren J Mayne
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW 2522, Australia; Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong, NSW 2502, Australia; The University of Sydney, School of Public Health, Sydney, NSW 2006, Australia.
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, University of Wollongong, NSW 2522, Australia; School of Public Health and Community Medicine, University of New South Wales, NSW 2052, Australia; Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, NSW 2500, Australia.
| | - Shae-Leigh Vella
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW 2522, Australia
| | - Nagesh Pai
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW 2522, Australia; Mental Health Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, NSW 2500, Australia.
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21
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Popov J, Hartung E, Hill L, Pai N. A226 CHILD AND PARENT PERCEPTIONS OF FAECAL MICROBIOTA TRANSPLANT (FMT): QUALITATIVE PERSPECTIVES FROM PARTICIPANTS IN A TRIAL OF FMT FOR PEDIATRIC ULCERATIVE COLITIS. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Fecal microbiota transplant (FMT) is being increasingly studied across a range of therapeutic indications, including ulcerative colitis (UC). Pediatric patients may have unique responses to microbiome-based therapeutics, given their younger age, fewer comorbidities, and greater susceptibility to medication-related side effects.
Aims
We recently conducted the first pilot RCT of FMT in Canada for the treatment of pediatric ulcerative colitis (PediFETCh Trial) and conducted qualitative interviews post-study of participants and their parents. This study aims to describe the experience and perceptions of children who received FMT, and their parents.
Methods
Patients enrolled in the PediFETCh Trial (ClinicalTrials.gov: NCT02487238) and their parents were invited to participate in face-to-face, semi-structured interviews. Interviews were audiotaped, transcribed, and analyzed using open coding (NVivo 12 Pro).
Results
8 patients and 8 parents were interviewed. Our data has been summarized into 4 domains and 11 composite themes (Table 1). Most patients and parents saw FMT as a natural treatment. Pre-treatment, patients were concerned with receiving “someone else’s poo” and physical discomfort, while parents were concerned with transmission of enteric infections or psychiatric diseases. Both felt their decision to pursue FMT was influenced by frustration with previous lack of response to medications and a fear of medication side effects. Post-treatment, most patients and families expressed no concerns over potential future side effects as a result of the FMT, and all patients reported feeling “completely normal”. Patients were split between preferring FMT or medication, with convenience of medication being an important factor, while others favored FMT for its perceived naturality and symptomatic improvements. For most families, natural therapies and diet played an important role in influencing their decision to pursue FMT; however, several parents reported that alternative healthcare practitioners did not support their desire to pursue FMT.
Conclusions
The study offers valuable insights into pediatric patients’ and parents’ experiences receiving FMT across several themes. Our results suggest a high rate of acceptance and interest in FMT research by pediatric patients and their parents. These findings suggest strategies to improve future delivery of FMT in clinical trials, and should support inclusion of children in FMT-based studies.
Funding Agencies
Hamilton Health Sciences New Investigator Fund (2015, Spring); Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario (HAH-17-002)
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Affiliation(s)
- J Popov
- Department of Paediatrics, Division of Paediatric Gastroenterology & Nutrition, McMaster University, Hamilton, ON, Canada
| | - E Hartung
- Department of Paediatrics, Division of Paediatric Gastroenterology & Nutrition, McMaster University, Hamilton, ON, Canada
| | - L Hill
- Department of Paediatrics, Division of Paediatric Gastroenterology & Nutrition, McMaster University, Hamilton, ON, Canada
| | - N Pai
- Department of Paediatrics, Division of Paediatric Gastroenterology & Nutrition, McMaster University, Hamilton, ON, Canada
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Hill L, Faraz M, Hartung E, Popov J, Pai N. A242 EXERCISE AND PHYSICAL ACTIVITY IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND RECOMMENDATIONS. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) is a chronic life-long condition affecting 0.25% of the North American population. Childhood onset IBD is particularly aggressive, with disease often characterised by poor growth, severe unpredictable abdominal pain and frequent school absences. Treatment involves lifelong medications, which do not always resolve symptoms and carry increased cumulative risks of infections, malignancy, or other adverse effects. Exercise has been suggested as a method of ameliorating some of the symptoms associated with IBD. To date, few studies have investigated the role of exercise and physical activity in paediatric IBD patients.
Aims
We conducted a systematic review assessing the role of exercise and physical activity in paediatric IBD.
Methods
This Level III systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. An electronic database search of Pubmed, Google Scholar, and Cochrane used the search terms “(physical activity or exercise), (Inflammatory Bowel Disease), and (children or paediatric)”. Of the 1458 articles identified during the two rounds of review, only 21 articles met final inclusion criteria.
Results
Three main themes emerged from the review: 1) prescriptive exercise and physical activity ameliorated symptoms IBD and improved physical well-being, 2) patients who actively engage in exercise and physical activity show improved markers of inflammation and decreased future risk of disease, 3) exercise and physical activity improves the mental health and well-being of paediatric IBD patients. The results recommended 30–60 minutes, 6 times per week of mild to moderate aerobic exercise activity. It was noted that vigorous and high intensity exercise was well-tolerated by most IBD patients. Further, exercise prescription should be tailored to individual needs.
Conclusions
Exercise and physical activity improves mental and physical health and well-being of paediatric IBD patients, including decreasing the risk of future disease exacerbation in patients with mild to moderate disease activity. Clinicians and practitioners should consider actively prescribing exercise and physical activity to IBD patients as part of a standard treatment algorithm.
Funding Agencies
None
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Affiliation(s)
- L Hill
- Department of Exercise Science and Sports Medicine, Faculty of Health Sciences, Cape Town, South Africa
| | - M Faraz
- Applied Clinical Research Program, Department of Health Sciences, Hamilton, ON, Canada
| | - E Hartung
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - J Popov
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - N Pai
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Pai N, Popov J, Hartung E, Hill L, Thabane L, Lee CH, Godin D, Grzywacz K, Moayyedi P. A227 RESULTS OF THE FIRST PAEDIATRIC RANDOMIZED-CONTROLLED PILOT STUDY OF FAECAL MICROBIOTA TRANSPLANT FOR ACTIVE ULCERATIVE COLITIS (PEDIFETCH TRIAL). J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Pai
- Div. of Paediatric Gastroenterology & Nutrition, McMaster University, Hamilton, ON, Canada
| | - J Popov
- Div. of Paediatric Gastroenterology & Nutrition, McMaster University, Hamilton, ON, Canada
| | - E Hartung
- Div. of Paediatric Gastroenterology & Nutrition, McMaster University, Hamilton, ON, Canada
| | - L Hill
- Div. of Paediatric Gastroenterology & Nutrition, McMaster University, Hamilton, ON, Canada
| | - L Thabane
- Dept. of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - C H Lee
- Dept. of Pathology & Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - D Godin
- Div. de Gastroentérologie, Hépatologie & Nutrition, Université de Montréal, Montreal, QC, Canada
| | - K Grzywacz
- Div. de Gastroentérologie, Hépatologie & Nutrition, Université de Montréal, Montreal, QC, Canada
| | - P Moayyedi
- Dept. of Medicine, McMaster University, Hamilton, ON, Canada
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Walsan R, Feng X, Mayne DJ, Pai N, Bonney A. Neighborhood Environment and Type 2 Diabetes Comorbidity in Serious Mental Illness. J Prim Care Community Health 2020; 11:2150132720924989. [PMID: 32450744 PMCID: PMC7252365 DOI: 10.1177/2150132720924989] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/16/2020] [Indexed: 11/15/2022] Open
Abstract
Aim: The aim of this study was to examine the association between neighborhood characteristics and type 2 diabetes (T2D) comorbidity in serious mental illness (SMI). We investigated associations of neighborhood-level crime, accessibility to health care services, availability of green spaces, neighborhood obesity, and fast food availability with SMI-T2D comorbidity. Method: A series of multilevel logistic regression models accounting for neighborhood-level clustering were used to examine the associations between 5 neighborhood variables and SMI-T2D comorbidity, sequentially adjusting for individual-level variables and neighborhood-level socioeconomic disadvantage. Results: Individuals with SMI residing in areas with higher crime rates per 1000 population had 2.5 times increased odds of reporting T2D comorbidity compared to the individuals with SMI residing in lower crime rate areas after controlling for individual and areal level factors (95% CI 0.91-6.74). There was no evidence of association between SMI-T2D comorbidity and other neighborhood variables investigated. Conclusion: Public health strategies to reduce SMI-T2D comorbidity might benefit by targeting on individuals with SMI living in high-crime neighborhoods. Future research incorporating longitudinal designs and/or mediation analysis are warranted to fully elucidate the mechanisms of association between neighborhoods and SMI-T2D comorbidity.
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Affiliation(s)
- Ramya Walsan
- University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New
South Wales, Australia
| | - Xiaoqi Feng
- University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New
South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Darren J. Mayne
- University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New
South Wales, Australia
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nagesh Pai
- University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New
South Wales, Australia
- Mental Health Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrew Bonney
- University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New
South Wales, Australia
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Walsan R, Mayne DJ, Pai N, Feng X, Bonney A. Exploring the geography of serious mental illness and type 2 diabetes comorbidity in Illawarra-Shoalhaven, Australia (2010 -2017). PLoS One 2019; 14:e0225992. [PMID: 31805173 PMCID: PMC6894846 DOI: 10.1371/journal.pone.0225992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives The primary aim of this study was to describe the geography of serious mental illness (SMI)–type 2 diabetes comorbidity (T2D) in the Illawarra-Shoalhaven region of NSW, Australia. The Secondary objective was to determine the geographic concordance if any, between the comorbidity and the single diagnosis of SMI and diabetes. Methods Spatial analytical techniques were applied to clinical data to explore the above objectives. The geographic variation in comorbidity was determined by Moran’s I at the global level and the local clusters of significance were determined by Local Moran’s I and spatial scan statistic. Choropleth hotspot maps and spatial scan statistics were generated to assess the geographic convergence of SMI, diabetes and their comorbidity. Additionally, we used bivariate LISA (Local Indicators of Spatial Association) and multivariate spatial scan to identify coincident areas with higher rates of both SMI and T2D. Results The study identified significant geographic variation in the distribution of SMI–T2D comorbidity in Illawarra Shoalhaven. Consistently higher burden of comorbidity was observed in some urban suburbs surrounding the major metropolitan city. Comparison of comorbidity hotspots with the hotspots of single diagnosis SMI and T2D further revealed a geographic concordance of high-risk areas again in the urban areas outside the major metropolitan city. Conclusion The identified comorbidity hotspots in our study may serve as a basis for future prioritisation and targeted interventions. Further investigation is required to determine whether contextual environmental factors, such as neighbourhood socioeconomic disadvantage, may be explanatory. Implications for public health Ours is the first study to explore the geographic variations in the distribution of SMI and T2D comorbidity. Findings highlight the importance of considering the role of neighbourhood environments in influencing the T2D risk in people with SMI.
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Affiliation(s)
- Ramya Walsan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- * E-mail:
| | - Darren J. Mayne
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, Australia
- The University of Sydney, School of Public Health, Sydney, Australia
| | - Nagesh Pai
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Mental Health Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, Australia
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Andrew Bonney
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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Affiliation(s)
- Nagesh Pai
- Graduate Medicine, School of Medicine, Faculty Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Shae-Leigh Vella
- Graduate Medicine, School of Medicine, Faculty Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Walsan R, Bonney A, Mayne DJ, Pai N, Feng X, Toms R. Serious Mental Illness, Neighborhood Disadvantage, and Type 2 Diabetes Risk: A Systematic Review of the Literature. J Prim Care Community Health 2019; 9:2150132718802025. [PMID: 30255730 PMCID: PMC6158606 DOI: 10.1177/2150132718802025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim of the Study: This review aims to systematically synthesize the body of literature examining the association between neighborhood socioeconomic disadvantage and serious mental illness (SMI)–type 2 diabetes (T2D) co-occurrence. Methods: We conducted an electronic search of four databases: PubMed, Scopus, Medline, and Web of Science. Studies were considered eligible if they were published in English, peer reviewed, quantitative, and focused on the association between neighborhood disadvantage and SMI-T2D comorbidity. Study conduct and reporting complied with PRISMA guidelines, and the protocol is made available at PROSPERO (CRD42017083483). Results: The one eligible study identified reported a higher burden of T2D in persons with SMI but provided only a tentative support for the association between neighborhood disadvantage and SMI-T2D co-occurrence. Conclusion: Research into neighborhood effects on SMI-T2D comorbidity is still in its infancy and the available evidence inconclusive. This points to an urgent need for attention to the knowledge gap in this important area of public health. Further research is needed to understand the health resource implications of the association between neighborhood deprivation and SMI-T2D comorbidity and the casual pathways linking them.
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Affiliation(s)
- Ramya Walsan
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrew Bonney
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Darren J Mayne
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia.,3 Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, Warrawong, New South Wales, Australia
| | - Nagesh Pai
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia.,4 Mental Health Services, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Xiaoqi Feng
- 2 Illawarra Health and Medical Research Institute,Wollongong Hospital, Wollongong, New South Wales, Australia.,5 Population Wellbeing and Environment Research Lab (Powerlab), School of Health and Society, University of Wollongong, New South Wales, Australia
| | - Renin Toms
- 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Walsan R, Mayne DJ, Feng X, Pai N, Bonney A. Examining the Association between Neighbourhood Socioeconomic Disadvantage and Type 2 Diabetes Comorbidity in Serious Mental Illness. Int J Environ Res Public Health 2019; 16:ijerph16203905. [PMID: 31618833 PMCID: PMC6843457 DOI: 10.3390/ijerph16203905] [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] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/26/2019] [Accepted: 10/12/2019] [Indexed: 11/16/2022]
Abstract
This study examined the association between neighbourhood socioeconomic disadvantage and serious mental illness (SMI)-type 2 diabetes (T2D) comorbidity in an Australian population using routinely collected clinical data. We hypothesised that neighbourhood socioeconomic disadvantage is positively associated with T2D comorbidity in SMI. The analysis considered 3816 individuals with an SMI living in the Illawarra and Shoalhaven regions of NSW, Australia, between 2010 and 2017. Multilevel logistic regression models accounting for suburb (neighbourhood) level clustering were used to assess the association between neighbourhood disadvantage and SMI -T2D comorbidity. Models were adjusted for age, sex, and country of birth. Compared with the most advantaged neighbourhoods, residents in the most disadvantaged neighbourhoods had 3.2 times greater odds of having SMI-T2D comorbidity even after controlling for confounding factors (OR 3.20, 95% CI 1.42-7.20). The analysis also revealed significant geographic variation in the distribution of SMI -T2D comorbidity in our sample (Median Odds Ratio = 1.35) Neighbourhood socioeconomic disadvantage accounted for approximately 17.3% of this geographic variation. These findings indicate a potentially important role for geographically targeted initiatives designed to enhance prevention and management of SMI-T2D comorbidity in disadvantaged communities.
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Affiliation(s)
- Ramya Walsan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
| | - Darren J Mayne
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong 2502, Australia.
- The University of Sydney, School of Public Health, Sydney 2006, Australia.
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong 2522, Australia.
- School of Public Health and Community Medicine, University of New South Wales, Kennington 2031, Australia.
| | - Nagesh Pai
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
- Mental Health Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong 2500, Australia.
| | - Andrew Bonney
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia.
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Affiliation(s)
- Nagesh Pai
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Shae-Leigh Vella
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Abstract
OBJECTIVES: Real-world experience from a 6-month product familiarization programme (PFP) for 3-monthly paliperidone palmitate in schizophrenia maintenance treatment. METHODS: Prescribers completed an online questionnaire for each patient at enrolment with further questions at second dose (re-supply) stage and a second survey of their overall experience at the end. RESULTS: Ninety-four patients were enrolled and received a first dose and 23 received a second dose within the 6-month programme; 51.1% had been hospitalised for symptom relapse in the previous 2 years. Reasons for prescribing were convenience of 3-monthly dosing for patients (94.7%) and patient choice (54.6%). Prescribers followed-up at least once-monthly (69.6% cases) and indicated in 48.9% they would consider shared GP care. All patients were satisfied with symptom control and either maintained functioning or showed improvement. Clinicians felt confident with administration and identifying suitable patients and were all 'satisfied' or 'somewhat satisfied' with efficacy and tolerability. All felt patients' treatment goals were either 'met' (81.3%) or 'partly met' (18.7%) and none reported dissatisfaction with relapse prevention. CONCLUSIONS: Convenient 3-monthly dosing was preferred by clinicians and patients, and symptoms were adequately managed. This has the potential to improve adherence and lead to better outcomes as patients only need four intramuscular doses per year.
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Affiliation(s)
- Nagesh Pai
- Foundation Professor of Psychiatry, Graduate Medicine, Faculty of Science, Health and Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Matthew Warden
- Director AIS, St Vincent's Hospital, Melbourne, VIC, Australia
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31
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Affiliation(s)
- Nagesh Pai
- 1 Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,2 Illawarra Shoalhaven Local Health District
| | - Shae-Leigh Vella
- 1 Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Babic I, Gorak A, Engel M, Sellers D, Else P, Osborne AL, Pai N, Huang XF, Nealon J, Weston-Green K. Liraglutide prevents metabolic side-effects and improves recognition and working memory during antipsychotic treatment in rats. J Psychopharmacol 2018; 32:578-590. [PMID: 29493378 DOI: 10.1177/0269881118756061] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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] [Indexed: 01/13/2023]
Abstract
BACKGROUND Antipsychotic drugs (APDs), olanzapine and clozapine, do not effectively address the cognitive symptoms of schizophrenia and can cause serious metabolic side-effects. Liraglutide is a synthetic glucagon-like peptide-1 (GLP-1) receptor agonist with anti-obesity and neuroprotective properties. The aim of this study was to examine whether liraglutide prevents weight gain/hyperglycaemia side-effects and cognitive deficits when co-administered from the commencement of olanzapine and clozapine treatment. METHODS Rats were administered olanzapine (2 mg/kg, three times daily (t.i.d.)), clozapine (12 mg/kg, t.i.d.), liraglutide (0.2 mg/kg, twice daily (b.i.d.)), olanzapine + liraglutide co-treatment, clozapine + liraglutide co-treatment or vehicle (Control) ( n = 12/group, 6 weeks). Recognition and working memory were examined using Novel Object Recognition (NOR) and T-Maze tests. Body weight, food intake, adiposity, locomotor activity and glucose tolerance were examined. RESULTS Liraglutide co-treatment prevented olanzapine- and clozapine-induced reductions in the NOR test discrimination ratio ( p < 0.001). Olanzapine, but not clozapine, reduced correct entries in the T-Maze test ( p < 0.05 versus Control) while liraglutide prevented this deficit. Liraglutide reduced olanzapine-induced weight gain and adiposity. Olanzapine significantly decreased voluntary locomotor activity and liraglutide co-treatment partially reversed this effect. Liraglutide improved clozapine-induced glucose intolerance. CONCLUSION Liraglutide co-treatment improved aspects of cognition, prevented obesity side-effects of olanzapine, and the hyperglycaemia caused by clozapine, when administered from the start of APD treatment. The results demonstrate a potential treatment for individuals at a high risk of experiencing adverse effects of APDs.
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Affiliation(s)
- Ilijana Babic
- 1 Centre for Medical and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia.,2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,3 Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia.,4 School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Ashleigh Gorak
- 2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,4 School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Martin Engel
- 1 Centre for Medical and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia.,2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Dominic Sellers
- 2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,4 School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Paul Else
- 2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,4 School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Ashleigh L Osborne
- 1 Centre for Medical and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia.,3 Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia.,4 School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Nagesh Pai
- 2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,3 Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia.,4 School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Xu-Feng Huang
- 1 Centre for Medical and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia.,2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,4 School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Jessica Nealon
- 2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,4 School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Katrina Weston-Green
- 1 Centre for Medical and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia.,2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,4 School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
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Solowij N, Broyd SJ, Beale C, Prick JA, Greenwood LM, van Hell H, Suo C, Galettis P, Pai N, Fu S, Croft RJ, Martin JH, Yücel M. Therapeutic Effects of Prolonged Cannabidiol Treatment on Psychological Symptoms and Cognitive Function in Regular Cannabis Users: A Pragmatic Open-Label Clinical Trial. Cannabis Cannabinoid Res 2018; 3:21-34. [PMID: 29607408 PMCID: PMC5870061 DOI: 10.1089/can.2017.0043] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Chronic cannabis use has been associated with impaired cognition and elevated psychological symptoms, particularly psychotic-like experiences. While Δ9-tetrahydrocannabinol (THC) is thought to be primarily responsible for these deleterious effects, cannabidiol (CBD) is purported to have antipsychotic properties and to ameliorate cognitive, symptomatic, and brain harms in cannabis users. However, this has never been tested in a prolonged administration trial in otherwise healthy cannabis users. Here, we report the first study of prolonged CBD administration to a community sample of regular cannabis users in a pragmatic trial investigating potential restorative effects of CBD on psychological symptoms and cognition. Materials and Methods: Twenty frequent cannabis users (16 male, median age 25 years) underwent a 10-week open-label trial of 200 mg of daily oral CBD treatment, while continuing to use cannabis as usual. The majority of participants were daily cannabis users who had used cannabis for several years (median 5.5 years of regular use). Participants underwent psychological and cognitive assessments at baseline (BL) and post-treatment (PT) and were monitored weekly throughout the trial. Results: CBD was well tolerated with no reported side effects; however, participants retrospectively reported reduced euphoria when smoking cannabis. No impairments to cognition were found, nor were there deleterious effects on psychological function. Importantly, participants reported significantly fewer depressive and psychotic-like symptoms at PT relative to BL, and exhibited improvements in attentional switching, verbal learning, and memory. Increased plasma CBD concentrations were associated with improvements in attentional control and beneficial changes in psychological symptoms. Greater benefits were observed in dependent than in nondependent cannabis users. Conclusions: Prolonged CBD treatment appears to have promising therapeutic effects for improving psychological symptoms and cognition in regular cannabis users. Our findings require replication given the lack of a placebo control in this pragmatic trial, but suggest that CBD may be a useful adjunct treatment for cannabis dependence.
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Affiliation(s)
- Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,The Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, Australia
| | - Samantha J Broyd
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Camilla Beale
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Julie-Anne Prick
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Lisa-Marie Greenwood
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Hendrika van Hell
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Chao Suo
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Peter Galettis
- The Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, Australia.,Discipline of Clinical Pharmacology, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Nagesh Pai
- Graduate School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Shanlin Fu
- Centre for Forensic Science, University of Technology Sydney, Ultimo, Australia
| | - Rodney J Croft
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Jennifer H Martin
- The Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, Australia.,Discipline of Clinical Pharmacology, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Murat Yücel
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Australia
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Hart L, Farbod Y, Halgren CR, Mbuagbaw L, Zachos M, Pai N. A153 MEASURING QUALITY OF LIFE AND DISEASE ACTIVITY IN PEDIATRIC PATIENTS RECEIVING INDUCTION THERAPY OF EXCLUSIVE ENTERAL NUTRITION OR CORTICOSTEROIDS FOR ACTIVE INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Hart
- McMaster Children’s Hospital, Etobicoke, ON, Canada
| | - Y Farbod
- McMaster University, Hamilton, ON, Canada
| | | | - L Mbuagbaw
- McMaster University, Hamilton, ON, Canada
| | - M Zachos
- McMaster Children’s Hospital, Etobicoke, ON, Canada
| | - N Pai
- McMaster Children’s Hospital, Etobicoke, ON, Canada
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Abstract
OBJECTIVES The objective of the current study was to examine the pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) within an Australian inpatient psychiatric setting. METHOD A retrospective audit of 300 random hospital files of those admitted as inpatients between Nov 2014 and Nov 2015 was undertaken. Data was quantitatively analysed and described. RESULTS The number of inpatients who had a vitamin D determination during their admission was 37/300 (12.33%). The mean vitamin D level of those tested was 51.63 nmol/l. Of those that were tested, 18/37 (48.6%) were mildly to moderately deficient. There was a statistically significant difference in age and length of stay between those that were and were not tested for vitamin D levels, p-value <0.001 and 0.017, respectively. In addition, a simple linear regression indicated a weak association between length of stay and vitamin D levels. CONCLUSION This audit highlights vitamin D screening inadequacy. More research is recommended to establish tangible benefits of supplementation, while local practice provides valuable data for education and policy purposes.
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Affiliation(s)
- Ivana Goluza
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Jay Borchard
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Nalin Wijesinghe
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Kishan Wijesinghe
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Nagesh Pai
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, and; Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
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Pai N, Vella SL. Prolactin monitoring in schizophrenia should be indicated by symptomatology not time. Aust N Z J Psychiatry 2017; 51:1152-1153. [PMID: 28876078 DOI: 10.1177/0004867417730415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nagesh Pai
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Shae-Leigh Vella
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
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Goluza I, Borchard J, Kiarie E, Mullan J, Pai N. Exploration of food addiction in people living with schizophrenia. Asian J Psychiatr 2017; 27:81-84. [PMID: 28558903 DOI: 10.1016/j.ajp.2017.02.022] [Citation(s) in RCA: 9] [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: 11/28/2016] [Revised: 02/15/2017] [Accepted: 02/21/2017] [Indexed: 11/16/2022]
Abstract
The term food addiction (FA) denotes a concept among researchers and lay consumers as a behavioural phenotype related to excessive food consumption. In this study we examined the prevalence of FA using the validated Yale Food Addiction Scale (YFAS) as well as the dimensional symptom count. In addition, we explored associations between participant characteristics and FA diagnosis. Outpatients attending a clozapine clinic and possessing a diagnosis of schizophrenia were invited to complete an anonymous survey using the YFAS. Ninety three surveys were used to calculate the diagnostic YFAS criteria for FA. The prevalence of FA found in this sample was 26.9%. Among individuals who did not meet "diagnostic" criteria FA, 77.4% endorsed 3 or more symptoms but did not report distress or impairment. The most common food addiction symptom was a persistent desire or repeated unsuccessful attempts to cut down consumption (97.9%). The significant finding in association between individual's characteristics and diagnosis of FA was employment. Several factors related to reported results are postulated and discussed. The current study has found the prevalence of FA amongst people living with schizophrenia to be higher than the general populations but not as high as populations with disordered eating.
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Affiliation(s)
- Ivana Goluza
- Illawarra Shoalhaven Local Health District, Research Directorate, Level 8, Block C, Wollongong Hospital Crown St, 2500 NSW, Australia.
| | - Jay Borchard
- Illawarra Shoalhaven Local Health District, Research Directorate, Level 8, Block C, Wollongong Hospital Crown St, 2500 NSW, Australia
| | - Esther Kiarie
- Australian Catholic University, School of Allied Health, Health Sciences, 25A Barker Rd, Strathfield, NSW 2135, Australia
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Graduate Medicine Building 28, Northfields Avenue 2522, NSW, Australia; Australian Health Services Research Institute, Building 234 (iC Enterprise 1) Innovation Campus, University of Wollongong, NSW 2522, Australia
| | - Nagesh Pai
- Illawarra Shoalhaven Local Health District, Research Directorate, Level 8, Block C, Wollongong Hospital Crown St, 2500 NSW, Australia; Graduate School of Medicine, University of Wollongong, Graduate Medicine Building 28, Northfields Avenue 2522, NSW, Australia
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Dawes K, Pai N. Medical student teaching in the private sector. Australas Psychiatry 2017; 25:200. [PMID: 28375056 DOI: 10.1177/1039856216671684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vella SL, Goluza I, Pai N. A comment on Starcevic (2016) the case of food addiction. Aust N Z J Psychiatry 2017; 51:293. [PMID: 27670830 DOI: 10.1177/0004867416669437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shae-Leigh Vella
- 1 Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Ivana Goluza
- 2 Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Nagesh Pai
- 1 Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
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Abstract
Recently interest in the phenomenon of food addiction has increased substantially since the inclusion of gambling disorder in the DSM-5. However the phenomenon of food addiction remains controversial and the designation continues to lack clear consideration. Few researchers have offered an explicit theoretical definition of the phenomenon which is fundamental; as it not only pertains to the aetiology it also directs research and management of the phenomenon. Therefore this review explores 'what is in a name'? Specifically possible aetiologies of food addiction, eating addiction and food addiction as an eating disorder are reviewed and the potential DSM-5 classification espoused. It is evident that the phenomenon requires further research and evaluation in order to delineate whether the phenomenon constitutes a disorder and if the phenomenon is found to be a valid entity the most appropriate designation. As it is too early to draw definitive conclusions regarding the concept all plausible designations and the associated aetiologies require further investigation.
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Affiliation(s)
- Shae-Leigh Vella
- Graduate School of Medicine, University Of Wollongong, Wollongong NSW, 2522, Australia.
| | - Nagesh Pai
- Graduate School of Medicine, University Of Wollongong, Wollongong NSW, 2522, Australia.
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Mills J, Thomas S, Larkin T, Pai N, Deng C. Relationships of hormone levels with hunger, weight gain and problematic eating behaviours in Major Depressive Disorder. Front Hum Neurosci 2017. [DOI: 10.3389/conf.fnhum.2017.224.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
OBJECTIVE This article briefly reviews the literature pertaining to community treatment orders (CTOs) specifically how and why they are utilised and how effective mandated community treatment really is. This review discusses the use of CTOs in the context of the recovery model. CONCLUSIONS This article highlights the shortfalls in the current CTO system while also demonstrating the increase in acute coercive care. The literature pertaining to the effectiveness of CTOs is inconsistent with more recent reviews denoting that there is now robust evidence the CTOs are not effective. Further treatment that aligns with the recovery model as oppose to mandated treatment is known to increase treatment compliance.
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Affiliation(s)
- Nagesh Pai
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Shae-Leigh Vella
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia.
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Pai N. Are the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders meeting the needs of clinicians? Aust N Z J Psychiatry 2016; 50:1015-6. [PMID: 27650689 DOI: 10.1177/0004867416667828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nagesh Pai
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia The Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
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Gould M, Dowhaniuk J, Arredondo J, Cheng J, Azzopardi P, Hu T, Mileski H, Carpenter A, Pai N, Brill H. Clinical and Serologic Patterns in a Large Canadian Paediatric Cohort with Celiac Disease, At Presentation and Follow-Up. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Celiac Disease (CD) is a chronic illness involving an autoimmune response to gluten, leading to small intestinal inflammation in genetically susceptible individuals. A weakness in the North American pediatric CD literature exists around serologic outcomes after initiation of a gluten free diet (GFD). Only one published North American pediatric study looks at normalization of TTG after initiation of a GFD and only assessed TTG normalization at 6 months post diagnosis. Data is also limited on other clinical patters such as levels of anemia and BMI over the course of treatment of CD.
OBJECTIVES: We sought to characterize serologic and clinical patterns in CD over an extended course using one of the largest databases of pediatric CD in North America.
DESIGN/METHODS: A retrospective review of all patients diagnosed with CD at our institution from 1996-2014 was completed. Patients required biopsy-proven CD according to the Marsh criteria. Data abstracted included age at diagnosis, gender, reason for referral, comorbidities, family history of CD and autoimmune conditions, BMI, hemoglobin, MVC, fer-ritin, IgA and anti-TTG levels. A Cochran-Armitage trend test was used to trend anti-TTG and hemoglobin normalization over time
RESULTS: 227 patients were identified who met study criteria. Visits with associated anti-TTG or hemoglobin analysis were categorized by time since diagnosis. At 6-12 months, 12-17 months, 18-23 months, 24-29 months, 30-35 months and 36-41 months from diagnosis 66.7% (n=144), 75% (n=40), 85.6% (n= 76), 86.9 (n= 23), 93.5 (n=62) and 95% (n= 20) of patients had normalized their anti-TTG levels respectively from a baseline of 100% abnormal TTG and 5.7% (n=140), 7.3% (n=41), 5.1% (n=77), 5.0% (n=20), 1.6% (n=60) and 5.0% (n=20) had anemia versus 18% at presentation.
CONCLUSION: The small p-value (p=<0.0001) for the Cochran-Armitage test for anti-TTG normalization indicates the increased probability of a normalized anti-TTG as time from diagnosis increases. Knowledge of the slope of this trend could assist clinicians with better understanding the effectiveness of treatment for their patients. In this cohort, anti-TTG levels normalized over a broad time span, with increasing numbers of patients normalizing their anti-TTG through to the end of the study period. Further research goals aim to determine predictors of early anti-TTG normalization. In this cohort, the proportion of patient with anemia quickly decreased from a baseline of 18%, to general pediatric population levels between 6-12 months after treatment initiation and remained stable in this range through to the end of the study period with a non-significant p value (p=0.06) for trend over time.
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Brill H, Dowhaniuk J, Cheng J, Pai N, Mileski H, Tutelman P, Saab J. Assessment of Gluten Exposures in Children with Celiac Disease. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e73a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Celiac Disease (CD) is one of the most common chronic diseases of childhood. A strict, lifelong gluten-free diet (GFD) remains the sole treatment for CD. Reports of accidental or intentional ingestion of gluten are common, but little is known about the sources or context of such exposures.
OBJECTIVES: We sought to ascertain the self-reported causes for gluten exposure for children with Celiac Disease.
DESIGN/METHODS: Parents of children with biopsy-proven CD followed at McMaster Children’s Hospital were asked to review a 22-item questionnaire listing sources, situations and causes of gluten exposure for their child. The questionnaire encompassed both intentional and unintentional gluten exposures and was developed through consultation with Registered Dietitians and Faculty in the Division of Pediatric Gastroenterology at McMaster Children’s Hospital. Children independently completed a similar 21-item questionnaire adapted for pediatric use. Participants were invited to describe any additional sources or circumstances leading to gluten consumption not captured in the questionnaire.
RESULTS: A total of 123 families participated in the study with a median of 32 months on a GFD. A minimum of one cause of gluten exposure was selected by 65% of parents and 60% of children. Restaurant dining was identified as a source of gluten consumption by 39% of parents, due to a lack of knowledge of the GFD by restaurant staff or poor labeling of menu items. Other commonly selected items on the parent questionnaire included: difficulty while traveling (13%), to avoid exclusion at social events (12%), and a lack of negative symptoms following gluten exposure (9%). Few parents identified cost (2%), or the availability of gluten-free food as a concern (5%). Children most commonly identified restaurant eating (32%), and the lack of any negative symptoms from eating gluten as the main causes of gluten exposure (14%). In this study population, 11% of children acknowledged consuming gluten because they felt left out at either home, school or with friends.
CONCLUSION: This study provides information about the common causes of gluten exposure for children with CD in Ontario, Canada. Restaurant dining and travel were the most commonly identified sources of gluten ingestion. Our study highlights the need for improved menu labeling and education of restaurant staff, requiring both policy changes and dialogue with food service industries. While availability of gluten-free products has greatly improved, exclusion from social activities remain a concern for both children and their parents. Further qualitative studies may build on these identified themes to better understand challenges families face with the GFD.
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Panesar N, Valachova I, Lynch W, Pai N. Establishing a Recovery-Focused Rehabilitation Unit: A Case Example. The Australian Journal of Rehabilitation Counselling 2015. [DOI: 10.1375/jrc.17.1.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis study highlights lessons learnt from establishing a new recovery-focused inpatient rehabilitation unit in a typical regional city of New South Wales. We have learnt that the most important aspects are recruitment, retention and training of dedicated staff and a belief that recovery is possible. Strategies employed to meet the challenges of integrating a recovery-based practice into this type of setting may be transferable to other new services or existing services of a similar nature. We have provided a summary of standard outcome measures reflecting the performance of the unit for the first 2 years of functioning.
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Pai N, Vella SLC. NEGATIVE SYMPTOMS IN SCHIZOPHRENIA: THE PREVAILING CHALLENGES. Journal of Health and Allied Sciences NU 2015. [DOI: 10.1055/s-0040-1703902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractAlthough many advances in the understanding and treatment of schizophrenia have been made many challenges still remain. Most notably is the lack of understanding pertaining to the negative symptoms dimension of schizophrenia and the treatment of such symptomology? Primary negative symptoms affect 20-40% of individuals with schizophrenia and are associated with the greatest impacts upon functional impairment and quality of life. A qualitative review of the prevailing challenges related to the nature, assessment and treatment of negative symptoms was conducted. The current literature in each of the aforementioned areas pertaining to primary negative symptoms was reviewed with a focus upon the key challenges and directions for future research. The results of the qualitative review indicate that the construct of negative symptoms requires further delineation and recent work in the area of the assessment of negative symptoms necessitates further development. In regards to the treatment of negative symptoms no definitive directions are espoused due to the extent of the dearth of knowledge in the area as highlighted in the discussion. The area of negative symptoms research requires multi-disciplinary collaborative research to address the major challenges to the understanding, assessment and treatment of negative symptoms in schizophrenia to improve the quality of life and functional outcomes of those with primary negative symptoms.
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Affiliation(s)
- Nagesh Pai
- Professor, Graduate School of Medicine, University of Wollongong New South Wales, Australia 2522
| | - Shae-Leigh C Vella
- Post Graduate, Graduate School of Medicine, University of Wollongong New South Wales, Australia 2522
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Lian J, Huang XF, Pai N, Deng C. Chronic betahistine co-treatment reverses olanzapine's effects on dopamine D₂ but not 5-HT2A/2C bindings in rat brains. Prog Neuropsychopharmacol Biol Psychiatry 2015; 56:75-80. [PMID: 25149912 DOI: 10.1016/j.pnpbp.2014.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 06/28/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 12/20/2022]
Abstract
Olanzapine is widely prescribed for treating schizophrenia and other mental disorders, although it leads to severe body weight gain/obesity. Chronic co-treatment with betahistine has been found to significantly decrease olanzapine-induced weight gain; however, it is not clear whether this co-treatment affects the therapeutic effects of olanzapine. This study investigated the effects of chronic treatment of olanzapine and/or betahistine on the binding density of the serotonergic 5-HT2A (5-HT2AR) and 5-HT2C (5-HT2CR) receptors, 5-HT transporter (5-HTT), and dopaminergic D₂ receptors (D₂R) in the brain regions involved in antipsychotic efficacy, including the prefrontal cortex (PFC), cingulate cortex (Cg), nucleus accumbens (NAc), and caudate putamen (CPu). Rats were treated with olanzapine (1 mg/kg, t.i.d.) or vehicle for 3.5 weeks, and then olanzapine treatment was withdrawn for 19 days. From week 6, the two groups were divided into 4 groups (n=6) for 5 weeks' treatment: (1) olanzapine-only (1 mg/kg, t.i.d.), (2) betahistine-only (9.6 mg/kg, t.i.d.), (3) olanzapine and betahistine co-treatment (O+B), and (4) vehicle. Compared to the control, the olanzapine-only treatment significantly decreased the bindings of 5-HT2AR, 5-HT2CR, and 5-HTT in the PFC, Cg, and NAc. Similar changes were observed in the rats receiving the O+B co-treatment. The olanzapine-only treatment significantly increased the D₂R binding in the Cg, NAc, and CPu, while the betahistine-only treatment reduced D₂R binding. The co-treatment of betahistine reversed the D₂R bindings in the NAc and CPu that were increased by olanzapine. Therefore, chronic O+B co-treatment has similar effects on serotonin transmission as the olanzapine-only treatment, but reverses the D₂R that is up-regulated by chronic olanzapine treatment. The co-treatment maintains the therapeutic effects of olanzapine but decreases/prevents the excess weight gain.
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Affiliation(s)
- Jiamei Lian
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, 2522, NSW, Australia; Centre for Translational Neuroscience, School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, 2522, NSW, Australia
| | - Xu-Feng Huang
- Centre for Translational Neuroscience, School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, 2522, NSW, Australia; Schizophrenia Research Institute, 384 Victoria Street, Darlinghurst, 2010, NSW, Australia
| | - Nagesh Pai
- Centre for Translational Neuroscience, School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, 2522, NSW, Australia
| | - Chao Deng
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, 2522, NSW, Australia; Centre for Translational Neuroscience, School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, 2522, NSW, Australia; Schizophrenia Research Institute, 384 Victoria Street, Darlinghurst, 2010, NSW, Australia.
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