Sharon Dawe

This study examined correlates of transient versus persistent psychotic symptoms among people dependent on methamphetamine. A longitudinal prospective cohort study of dependent methamphetamine users who did not meet DSM-IV criteria for lifetime schizophrenia or mania. Four non-contiguous one-month observation periods were used to identify participants who had a) no psychotic symptoms, (n=110); (b) psychotic symptoms only when using methamphetamine (transient psychotic symptoms, n=85); and, (c) psychotic symptoms both when using methamphetamine and when abstaining from methamphetamine (persistent psychotic symptoms, n=37). Psychotic symptoms were defined as a score of 4 or greater on any of the Brief Psychiatric Rating Scale items of suspiciousness, hallucinations or unusual thought content. Relative no psychotic symptoms, both transient and persistent psychotic symptoms were associated with childhood conduct disorder and comorbid anxiety disorders. Earlier onset methamphetamine use and being male were more specifically related to transient psychotic symptoms, while a family history of a primary psychotic disorder and comorbid major depression were specifically related to persistent psychotic symptoms. We conclude that there are overlapping but also distinct clinical correlates of transient versus persistent psychotic symptoms, suggesting potentially heterogeneous etiological pathways underpinning the psychotic phenomena seen amongst people who use methamphetamine.

Methamphetamine use can produce symptoms almost indistinguishable from schizophrenia. Distinguishing between the two conditions has been hampered by the lack of a validated symptom profile for methamphetamine-induced psychiatric symptoms. We use data from a longitudinal cohort study to examine the profile of psychiatric symptoms that are acutely exacerbated by methamphetamine use. 164 methamphetamine users, who did not meet DSM-IV criteria for a lifetime primary psychotic disorder, were followed monthly for one year to assess the relationship between days of methamphetamine use and symptom severity on the 24-item Brief Psychiatric Rating Scale. Exacerbation of psychiatric symptoms with methamphetamine use was quantified using random coefficient models. The dimensions of symptom exacerbation were examined using principal axis factoring and a latent profile analysis. Symptoms exacerbated by methamphetamine loaded on three factors: positive psychotic symptoms (suspiciousness, unusual t...

Individuals with fetal alcohol spectrum disorders (FASDs) can experience profound impairments and long-term adverse outcomes. This systematic review adopts a life span perspective providing an extensive analysis of the available literature. Studies were identified from PsycInfo, PubMed, Scopus, Web of Knowledge, CINAHL, ERIC, The Cochrane Central Register of Controlled Trials, and gray literature. Two reviewers independently screened the title and abstract of each reference, and the methodological rigor of the included studies was assessed using the Effective Public Health Project assessment tool. Thirty-two studies met the inclusion criteria, of which the vast majority targeted early to middle childhood. Two studies focused on early intervention in the postnatal period, and 6 studies aimed to improve attention and/or self-regulation in childhood. Three of these provided promising evidence on improving self-regulatory difficulties for children with FASDs. Nine studies focused on improving specific areas of dysfunction. Six studies addressed social skills; 3 of these used an adaptation of a well-validated social skills program. Three studies provided promising initial evidence that parents and caregivers could benefit from support with child behavior and a further 4 studies provided education and advocacy for parents/caregivers, teachers, or child welfare workers. The final 2 studies were aimed at supporting parents who were themselves affected by prenatal alcohol exposure. There is growing evidence for interventions that improve outcomes for early to middle childhood. However, a lack of research exists outside of this developmental period. This lack of research is concerning given the potential positive impact of early intervention, for individuals and, financially, for governments. In addition, the lack of interventions for adolescents and adults further highlights the widening developmental gap and the potential influence of secondary disabilities for this at-risk population.

ABSTRACT Children living in families with parental substance abuse are at high risk of child maltreatment and associated adverse outcomes. A trial of methadone-maintained parents randomised to the Parents under Pressure (PuP) parenting programme reported significant improvements in family functioning relative to standard care or a brief intervention, as indicated by a reduction in scores on the Child Abuse Potential Inventory. We sought to determine the cost-effectiveness of the PuP programme to inform policy and programme implementation. The cost per expected case of child maltreatment prevented was calculated and compared with the estimated lifetime costs of maltreatment and sensitivity analyses were conducted. Compared to usual care, the PuP programme costs an additional AU$8777 (£4880) per family to deliver. Assuming the most conservative estimate of one in five cases of maltreatment prevented, a cost-effectiveness estimate of AU$43 975 (£24 451) per case of potential maltreatment prevented for the PuP group was obtained. This is significantly less than the estimated mean lifetime cost of a case of child maltreatment of AU$200 000 (2013 present value) (£110 000). For 100 families in this population treated with PuP, there would be a net present value saving of an estimated AU$3.1 million (£1.7 million).

... an impulsive temperament with substance abuse, a number of research groups have argued that impulsivity is not a homogenous construct, but rather consists of at least two related dimensions (eg, Dawe & Loxton, 2004; de Wit & Richards, 2004; Miller, Joseph, & Tudway, 2004 ...

ABSTRACT The capacity to regulate emotional impulses and pursue appropriate long-term goals is an integral part of adaptive human functioning. Therefore, it is not surprising that this capacity consistently emerges as a core trait in biologically-based models of personality. Variously labeled as “impulsivity,” “sensation seeking,” or “constraint” amongst other terms, variations in this trait reliably predict the development of substance use problems in prospective studies. Notably, marked increases in this impulsivity trait appear during adolescence – a period of life when substance experimentation and abuse typically begins. In recent years, neuroimaging research has identified the orbitofrontal and anterior cingulate cortices as important neural substrates of trait impulsivity. Interestingly, these same brain regions undergo substantial development during the teenage years. Indeed, there is remarkable consistency in the time course of these neural changes with those at the level of personality, suggesting both the imaging scanner and the self-report questionnaire are tapping into the same underlying construct, albeit with a differing degree of precision. Despite its far greater precision, the scanner itself cannot be practically employed in large-scale prevention programs to identify teens at risk. However, in validating the biological basis of impulsivity, along with behavioral and self-report measures of the trait, neuroimaging research allows one to use these more cost-effective tools in primary prevention with greater confidence. Indeed, there is already evidence demonstrating the ability of such “blunt” tools to focus and improve prevention programs.

... Dawe, Sharon. Abstract. While ... It seems likely that at least 10% of Australian children also live in families with parental substance misuse (Dawe et al., 2007). However, parental substance misuse rarely occurs in isolation. Parents ...

This study investigated the relationship between two biologically-based dimensions of impulsivity,“reward drive” and “rash impulsiveness” as well as the related construct of punishment sensitivity in problem gamblers, with and without alcohol problems, and non-problem gamblers. One hundred and ten adults completed self-report measures of problem gambling, hazardous drinking, rash impulsivity, reward drive and punishment sensitivity. Problem gamblers were more rash-impulsive, reward-driven and more sensitive to ...

It is paradoxical that while indices of health and wellbeing indicate that many in the Western world are living longer and healthier lives, there are a significant number of young women who engage in eating behaviours that are highly detrimental to health and can, in the extreme, result in starvation and death. The phenomenon of disordered eating, in particular highly restrictive eating, has been documented since the late nineteenth century (Gull 1888; Laseque 1873). However, in recent years we have seen a marked increase in the ...