Malcolm Hopwood
University of Melbourne, Psychiatry, Faculty Member
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Research Interests: Psychiatry, Nutraceuticals, Depression, Bipolar Disorder, Obesity, and 15 moreMedicine, Older Adults, Social Desirability, Internal Medicine, Placebo, Scale, Mechanisms, Body Mass Index, Science Technology, Diet Quality, Dsm Iv, Medical Comorbidity, Psychology and Cognitive Sciences, Adjunctive Treatment, and Medical and Health Sciences
Insomnia is a risk factor for the development of posttraumatic stress disorder (PTSD) while it is also plausible that PTSD symptoms can maintain insomnia symptoms. The present study examined longitudinal bidirectional relationships... more
Insomnia is a risk factor for the development of posttraumatic stress disorder (PTSD) while it is also plausible that PTSD symptoms can maintain insomnia symptoms. The present study examined longitudinal bidirectional relationships between insomnia and PTSD symptoms in treatment-seeking veterans. Participants were 693 ex-serving members of the Australian Defence Force who participated in an accredited, hospital-based outpatient PTSD program. Participants completed self-reported assessments of PTSD and insomnia symptoms at four time points: intake, discharge, 3-month, and 9-months posttreatment follow-up. Cross-lagged pathway analyses indicated significant bi-directional pathways between insomnia symptoms and PTSD symptoms at most time points. A final cross-lagged model between insomnia symptoms and the PTSD symptom clusters indicated that the PTSD symptom paths on insomnia symptoms, between intake and discharge, were attributable to reexperiencing PTSD symptoms. In contrast, across posttreatment follow-up time points there were significant paths of insomnia symptoms on all PTSD symptom clusters except from insomnia at 3-months to avoidance symptom at 9-months. PTSD symptoms and insomnia symptoms have bidirectional associations over time that may lead to the mutual maintenance or exacerbation of each condition following PTSD treatment. Where residual insomnia symptoms are present post-treatment, a sleep-focussed intervention is indicated and a sequenced approach to treatment recommended.
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Recent studies suggest that mixed-handedness is a risk factor for posttraumatic stress disorder (PTSD). This study examined whether mixed-handed veterans with combat-related PTSD respond more poorly to psychosocial treatment. Consistency... more
Recent studies suggest that mixed-handedness is a risk factor for posttraumatic stress disorder (PTSD). This study examined whether mixed-handed veterans with combat-related PTSD respond more poorly to psychosocial treatment. Consistency of hand preference was assessed in 150 Vietnam combat veterans with PTSD using the Edinburgh Handedness Inventory (R. C. Oldfield, 1971). Growth modeling analyses using Mplus (L. K. Muthén & B. Muthén, 2002) identified that PTSD veterans with mixed-handedness reported significantly less treatment improvement on the PTSD Checklist (F. W. Weathers, B. T. Litz, D. S. Herman, J. A. Huska, & T. M. Keane, 1993) than did veterans with consistent handedness. These data suggest that mixed-handedness is associated with poorer PTSD treatment response. Several possible explanations for this finding are discussed.
Research Interests: Psychology, Clinical Psychology, Traumatic Stress, Treatment Outcome, Medicine, and 15 moreMultivariate Analysis, Humans, Posttraumatic stress disorder, United States, Male, Veterans, Psychosocial, Risk factors, Middle Aged, Pilot study, Risk Factors, Pilot Projects, Treatment Response, Traumatic, and Functional Laterality
Objective: Consensus on the parameters of trauma-related dreams required to meet criteria for post-traumatic stress disorder (PTSD) is critical when: (i) the diagnosis requires a single re-experiencing symptom; and (ii) trauma dreams are... more
Objective: Consensus on the parameters of trauma-related dreams required to meet criteria for post-traumatic stress disorder (PTSD) is critical when: (i) the diagnosis requires a single re-experiencing symptom; and (ii) trauma dreams are prevalent in survivors without PTSD. Method: This study investigated the phenomenology of PTSD dreams in 40 veterans, using structured interview and self-report measures. Results: Dream content varied between replay, non-replay, and mixed, but affect was largely the same as that experienced at the time of trauma across all dream types. ANOVA indicated no difference between dream types on PTSD severity or nightmare distress. Conclusions: The findings provide preliminary support for non-replay dreams to satisfy the DSM B2 diagnostic criterion when the affect associated with those dreams is the same as that experienced at the time of the traumatic event.
Research Interests: Psychology, Traumatic Stress, Dreams, Medicine, Distress, and 15 moreAffect, Humans, Nightmare, Veterans, DREAM, Aged, Middle Aged, Adult, Self report, Wounds and Injuries, Psychological Stress, Severity of Illness Index, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, and Medical and Health Sciences
Depressive symptoms frequently accompany physical illness, but the association between the two is complex. The combination has detrimental implications for the patient's health outcome, quality of life, medical treatment and health... more
Depressive symptoms frequently accompany physical illness, but the association between the two is complex. The combination has detrimental implications for the patient's health outcome, quality of life, medical treatment and health care use. The presence of physical symptoms of the medical illness can lead to challenges in recognising and diagnosing depression. This is best dealt with by placing greater emphasis on the psychological symptoms of depression. Recognition may be improved through use of appropriate screening tools for depression in medically ill patients. The management of depression in the setting of medical illness involves both general and specific approaches. General approaches include optimal treatment of the medical illness, exclusion of treatments that are associated with depressive symptoms, and simple general health strategies aimed at improving sleep and exercise. Good evidence exists for selective psychotherapeutic approaches and antidepressant treatments, but care is required to avoid drug–drug and illness–drug interactions with the latter.
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Research Interests: Clinical Psychology, Mental Health, Family, Medicine, Family Psychology, and 15 morePost traumatic stress disorder, Humans, Personality Assessment Inventory, Chronic Disease, Alcohol Drinking, Male, Family Functioning, Aged, Middle Aged, Longitudinal Studies, Adult, Alcohol Use, Family Conflict, Personality Inventory, and Alcohol use disorder
We examined the efficacy of naltrexone (an opioid antagonist) for alcohol dependence in a sample of alcohol-dependent men. A 12-week randomized placebo-controlled clinical trial. The outpatient clinic of a combined war veteran and general... more
We examined the efficacy of naltrexone (an opioid antagonist) for alcohol dependence in a sample of alcohol-dependent men. A 12-week randomized placebo-controlled clinical trial. The outpatient clinic of a combined war veteran and general teaching hospital in Melbourne, Australia. Male alcohol-dependent subjects recruited from the community and from veteran groups. Alcohol-dependent subjects were treated with 50 mg of naltrexone or placebo daily for 12 weeks. Both treatment groups attended a weekly education support group. Subjects were assessed weekly. Primary study outcomes were the maintenance of abstinence and relapse to drinking. Fifty-five subjects were randomized to naltrexone and 56 to placebo. Forty subjects did not complete 12 weeks of therapy (17 naltrexone, 23 placebo). In the intention-to-treat sample (N = 111) fewer naltrexone treated subjects relapsed (p = 0.001). Among patients who completed the 12-week trial, naltrexone reduced the consumption of alcohol. Naltrexone was well tolerated and there were few adverse experiences. These findings demonstrate that naltrexone is effective in preventing relapse to drinking in the setting of limited psychosocial treatment. Further studies should examine the duration of treatment needed to maintain the effect long term.
Research Interests: Addiction, Survival Analysis, Adolescent, Medicine, Humans, and 15 morePlacebo, Alcoholism, Male, Abstinence, Aged, Middle Aged, Psychological Tests, Alcohol dependence, Adult, Analysis of Variance, Randomized Controlled Trial, Chi Square Distribution, Naltrexone, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Engineering, Psychology, Mental Health, Training, Disaster Mental Health, and 12 moreCapacity Building, Disaster Preparedness, Natural Disasters, Psychosocial, Summative Assessment, Natural disaster, Bushfire, Clinical Sciences, Disaster Recovery, Capacity, Public health systems and services research, and Mental capacity
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Objective Menopausal symptoms are common in midlife women and have broad impacts on their daily functioning and quality of life. Black cohosh extracts have been widely used to relieve menopausal symptoms. However, the comparative benefits... more
Objective Menopausal symptoms are common in midlife women and have broad impacts on their daily functioning and quality of life. Black cohosh extracts have been widely used to relieve menopausal symptoms. However, the comparative benefits of different combined black cohosh regimens remain inconclusive. The aim of the current updated meta-analysis is to address the comparative efficacies of different black cohosh regimens in improving menopausal symptoms. Methods Random-effect model pairwise meta-analysis of randomized controlled trials was conducted to investigate the treatment effect on menopausal symptoms by the black cohosh extract both alone or combined with other related active ingredients. The outcomes studied were changes in menopausal symptoms after treatment with black cohosh extracts in menopausal women. Results Twenty-two articles including information on 2,310 menopausal women were included in the analyses. Black cohosh extracts were associated with significant improvements in overall menopausal symptoms (Hedges’ g = 0.575, 95% CI = 0.283 to 0.867, P < 0.001), as well as in hot flashes (Hedges’ g = 0.315, 95% CIs = 0.107 to 0.524, P = 0.003), and somatic symptoms (Hedges’ g = 0.418, 95% CI = 0.165 to 0.670, P = 0.001), compared with placebo. However, black cohosh did not significantly improve anxiety (Hedges’ g = 0.194, 95% CI = −0.296 to 0.684, P = 0.438) or depressive symptoms (Hedges’ g = 0.406, 95% CI = −0.121 to 0.932, P = 0.131). The dropout rate for black cohosh products was similar to that for placebo (odds ratio = 0.911, 95% CI = 0.660 to 1.256, P = 0.568). Conclusions This study provides updated evidence regarding the potentially beneficial effects of black cohosh extracts for relieving menopausal symptoms in menopausal women.
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Objective: We describe a clinical audit program aimed at addressing metabolic syndrome risk factors in people with psychotic disorders; describe the interventions utilised by clinicians; and present metabolic outcomes achieved. Method:... more
Objective: We describe a clinical audit program aimed at addressing metabolic syndrome risk factors in people with psychotic disorders; describe the interventions utilised by clinicians; and present metabolic outcomes achieved. Method: Clinical audit with evaluation of interventions and prevs post-intervention assessment of metabolic parameters by 267 Australian psychiatrists. Results: A total of 1484 patients (51.2% male) on antipsychotics were enrolled: 44.2% met criteria for metabolic syndrome at baseline (V1). Interventions targeting Metabolic Syndrome (MetS) encompassed lifestyle management (dietary, exercise advice) and adjustment of dose or switch of antipsychotic (41%), lifestyle only (23%), switch antipsychotic only (15%), or some other combination of these (21%). Olanzapine and quetiapine were the medications most likely to be discontinued and replaced by other antipsychotics, most commonly lurasidone. Modest improvements we seen in key metabolic parameters, with a 24% decrease in prevalence of the metabolic syndrome. Conclusions: It is possible to address metabolic risk factors in patients with psychotic disorders in routine clinical practice; choice of ‘low risk’ antipsychotics is a key strategy.
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ABSTRACT Introduction A range of evidence-based treatments are available for PTSD. However, many veterans with PTSD do not engage in these treatments. Concurrently, various novel PTSD treatments with little or no evidence based are... more
ABSTRACT Introduction A range of evidence-based treatments are available for PTSD. However, many veterans with PTSD do not engage in these treatments. Concurrently, various novel PTSD treatments with little or no evidence based are increasingly popular among veterans. This qualitative study explored the expectations, experiences, and perceptions of help-seeking veterans with PTSD to improve understanding of how these veterans make treatment decisions. Materials and Methods Fifteen treatment-seeking veterans with PTSD participated in the study. Participants took part in semi-structured interviews. Data were analyzed using interpretative phenomenological analysis. Results A number of themes and subthemes emerged from the data, providing a detailed account of the factors that influenced participants’ treatment decisions. Most participants were in an acute crisis when they made the initial decision to seek treatment for their PTSD. In choosing a specific treatment, they tended to follow recommendations made by other veterans or health professionals or orders or directions from their superiors, health providers, or employers. Few participants actively considered the scientific evidence supporting different treatments. Participants had a strong preference for treatment provided by or involving other veterans. They reported finding PTSD treatments helpful, although some were not convinced of the value of evidence-based treatments specifically. Many participants reported negative experiences with treatment providers. Conclusions These findings will inform strategies to improve engagement of veterans in evidence-based PTSD treatments and advance progress toward veteran-centered care.
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Objective The Better Health Access Initiative added 32 Medicare Benefits Schedule (MBS) item numbers in 2006 to increase the number of people with access to mental health care. We investigated trends in the provision of outpatient... more
Objective The Better Health Access Initiative added 32 Medicare Benefits Schedule (MBS) item numbers in 2006 to increase the number of people with access to mental health care. We investigated trends in the provision of outpatient Medicare-subsidised psychiatric services since the introduction of these item numbers in 2006 through 2019. Methods Medicare Benefits Schedule aggregated item-number claims data were obtained from the Services Australia Medicare website, between January 2006 and December 2019 inclusive, for face-to-face psychiatrist consultations. Item number rates were collated and graphed per 100,000 population according to year and item number. Results There has been an increase in the number of claims for new patient assessments (291–296) and a reduction in most ongoing care Medicare item numbers, especially longer appointments that are often associated with psychotherapy provision (306–308). Conclusion There have been changes in private psychiatric practice in Australia over the past 14 years. There are several possible causes for these changes and further research is required to determine the impact on patient care.
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Research Interests: Library Science, Mental Health, Depression, Australia, Medicine, and 13 moreIschaemic heart disease, Anxiety, Population, Humans, Major Depressive Disorder, Clinical Sciences, Public health systems and services research, ANXIETY, Early Diagnosis, Psychiatric Status Rating Scales, Neuropsychological Tests, Personality Inventory, and mass Screening
Research Interests: Neuroscience, Psychiatry, Nutraceuticals, Mental Health, Depression, and 15 moreBipolar Disorder, Folic acid, Medicine, Canadian Psychiatry, Mania, Efficacy, Randomized Controlled Trial, Nutraceutical, Dietary Supplement, Double Blind, Placebo Controlled Trial, Psychology and Cognitive Sciences, Medical and Health Sciences, acetylcysteine, and Cochrane Library
Accessible summaryWhat is known on the subject? Little is known about adolescent inpatient units, key features which define them, and how these essential services operate and deliver care. What the paper adds to existing knowledge?... more
Accessible summaryWhat is known on the subject? Little is known about adolescent inpatient units, key features which define them, and how these essential services operate and deliver care. What the paper adds to existing knowledge? Adolescent inpatient unit studies are limited in their descriptions of settings in terms of how they operate and key features. The proposed preliminary checklist is a practical tool to assist clinicians, policy makers, and researchers when reporting to ensure comprehensive descriptions of adolescent inpatient settings. What are the implications for practice? This could be used to inform service design processes for inpatient and other mental health service models which is of critical importance in the context of reforms and implementation of these in Australia currently. Greater attention to operational models, services, and philosophies of practice will improve reporting and allow for the advancement of knowledge, comparison of study results, and a clear...
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Background: Post-traumatic stress disorder (PTSD) is an anxiety disorder which occurs following exposure to a traumatic, potentially life threatening event. It is frequently comorbid with other anxiety and mood disorders, substance misuse... more
Background: Post-traumatic stress disorder (PTSD) is an anxiety disorder which occurs following exposure to a traumatic, potentially life threatening event. It is frequently comorbid with other anxiety and mood disorders, substance misuse and physical symptoms that may cloud its presentation. In itself, PTSD is a frequently chronic disabling condition associated with a marked impact on social, occupational and family functioning that also carries an increased risk of suicide. Early intervention once the disorder is present, represents the most effective chance of reducing disability. Appropriate diagnosis and referral are among the key skills required by the general practitioner to deal with this condition. Objective: This article aims to provide an overview of PTSD for GPs including clinical features, epidemiological aspects, approach to assessment and treatment, and specialist resources available. Discussion: Recent world events including terrorist attacks, wars in Afghanistan and Iraq, and Middle East turmoil have raised community awareness of the impact of trauma. General practitioners are in a unique position to be involved in the early diagnosis and treatment of PTSD, which has been shown to improve outcome.