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.
Research Interests: Psychiatry, Psychotherapy, Traumatic Stress, Australia, Family Practice, and 13 moreMedicine, Comorbidity, Anxiety, Humans, Pubmed, Male, Acute Stress Disorder, Clinical Sciences, Adult, Public health systems and services research, ANXIETY, Guidance and Counseling Intervention Programs, and Referral
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ABSTRACT 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... more
ABSTRACT 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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ObjectiveDisturbances in circadian rhythms have been associated with major depression and may be an underlying mechanism for the disorder. Resynchronisation of circadian rhythms may provide a new approach to treatment, especially by... more
ObjectiveDisturbances in circadian rhythms have been associated with major depression and may be an underlying mechanism for the disorder. Resynchronisation of circadian rhythms may provide a new approach to treatment, especially by manipulating melatonin secretion. Melatonin is secreted at night and is a stable marker of circadian rhythms. The timing of its secretion can be changed by exogenous melatonin, agonism of specific melatonin receptors in the suprachiasmatic nucleus, its suppression by light and by sleep deprivation.MethodAs part of a series of papers [‘Chronobiology of mood disorders’ Malhi & Kuiper. Acta Psychiatr Scand 2013;128 (Suppl. 444): 2–15; and ‘Getting depression clinical practice guidelines right: time for change?’ Kuiper et al. Acta Psychiatr Scand 2013;128 (Suppl. 444): 24–30.] addressing chronobiology, in this article, we conducted a selective review of studies that have examined the antidepressant effects of exogenous melatonin, light therapy, sleep deprivation and melatonin receptor agonists.ResultsAntidepressant effects were identified for bright light therapy, especially for seasonal affective disorder; sleep deprivation, although its antidepressant effect is time limited; and for the novel antidepressant agomelatine with agonistic properties for the MT1 and MT2 receptors and antagonism of 5HT2c receptor. The role of melatonin as an antidepressant has yet to be demonstrated.ConclusionShifting the circadian secretion of melatonin using the strategies reviewed offers a new approach to treating depression.
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Research Interests: Psychology, Cognitive Science, Psychiatry, Anxiety Disorders, Nonparametric Statistics, and 15 moreMedicine, Anxiety, Humans, Generalized Anxiety Disorder, Female, Male, Clinical Sciences, Aged, Middle Aged, Randomized Controlled Trial, ANXIETY, Anxiolytic, Neurosciences, Elderly patient, and Patient selection
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Objective: To describe a case of neuroleptic malignant syndrome associated with risperidone. Clinical picture: An elderly patient with bipolar affective disorder presented with neuroleptic malignant syndrome and relapse of hypomania after... more
Objective: To describe a case of neuroleptic malignant syndrome associated with risperidone. Clinical picture: An elderly patient with bipolar affective disorder presented with neuroleptic malignant syndrome and relapse of hypomania after commencing risperidone. Treatment: Risperidone was ceased and the patient monitored closely. Outcome: The symptoms of neuroleptic malignant syndrome were resolved. Conclusion: To our knowledge this is the first such case reported, and suggests that risperidone, like other neuroleptics, is associated with neuroleptic malignant syndrome.
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Research Interests: Pathology, Cognitive Science, Neurology, Magnetic Resonance Imaging, Epilepsy, and 15 moreMorphometry, Medicine, Crisis, Hippocampus, Humans, Cerebral Cortex, Female, Male, Exploration, Clinical Sciences, Adult, Cortical Dysplasia, Nuclear Magnetic Resonance Imaging, Neurosciences, and Hippocampal formation
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© 1997 Dr. Malcolm HopwoodDescriptions of the development of psychiatric symptoms in response to traumatic experience can be found in literature dating back to some of the earliest writings found. Amongst these symptoms there have always... more
© 1997 Dr. Malcolm HopwoodDescriptions of the development of psychiatric symptoms in response to traumatic experience can be found in literature dating back to some of the earliest writings found. Amongst these symptoms there have always been descriptions consistent with what we would now term Post Traumatic Stress Disorder (PTSD). Tomb (1994) describes how such symptoms historically have been most frequently described in relation to combat experience and are contained in such classical texts as Homer’s Iliad. Recognition that such symptoms also occur in association with non combat related trauma is a relatively recent event. This can be seen in description of response to traumas such as The Boston Coconut Grove Fire (Adler 1943) and the Buffalo Creek Dam collapse (Gleser et al 1981). Combined with the massive number of combat veterans with combat experience related to psychiatric disability following the World Wars, significant impetus appears to have developed for separate classification and understanding of trauma related psychiatric symptoms. Together, these forces led to the creation of the diagnostic category of PTSD for the first time in the American Psychiatric Associations DSMIII (APA 1980). In this series of studies, we are thus aiming to further the understanding of the neurobiology of Post Traumatic Stress Disorder by specifically examining a group of male Australian Vietnam veterans with current PTSD, comparing them to two control Vietnam veteran populations, one group of those veterans who previously met criteria for a diagnosis of PTSD and a third group who never have met criteria for a diagnosis of PTSD. We examined these three groups in a number of ways. Firstly, to further understand aspects of central noradrenergic receptor function we utilised a clonidine growth hormone challenge test. Consistent with previous literature on the HPA axis in PTSD from North American we utilised a modified dexamethasone suppression test to investigate feedback within the HPA axis. Finally, we investigated serotonergic receptor function peripherally with a further study of platelet paroxetine binding and performed the first large study examining central serotonergic receptor function using the d-fenfluamine prolactin challenge test. Before describing the methodology and results of these studies I will review relevant findings to these three systems from studies of animal and human models of stress, clinical populations with PTSD and their treatment and previous experimental analysis of relevant biological variables in subjects with PTSD
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Congress is a special time for members of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), but it is especially pleasing to see so many of the attendees at Congress here tonight at the College ceremony celebrating... more
Congress is a special time for members of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), but it is especially pleasing to see so many of the attendees at Congress here tonight at the College ceremony celebrating the achievements of our members. I am doubly pleased not just because it demonstrates a genuine dedication to be here when compared to the exciting Hong Kong nightlife, but because this ceremony goes to the heart of College business over the last year. Tonight’s ceremony brings us together to welcome new Fellows and celebrate their attaining Fellowship, as well as giving us the opportunity to recognise the accomplishments of our esteemed colleagues.
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Age-friendly cities are crucial to achieve the WHO goal of healthy aging. Such cities promote opportunities for health, participation, and security, thus enhancing quality of life as people age. Older people commonly experience... more
Age-friendly cities are crucial to achieve the WHO goal of healthy aging. Such cities promote opportunities for health, participation, and security, thus enhancing quality of life as people age. Older people commonly experience psychosocial challenges such as anxiety, depression, substance abuse, loss of autonomy, grief, fear, and loneliness. Australian and Canadian cities continue to seek innovation to improve healthy urban aging and create more age-friendly environments for older adults. There is increasing evidence on the effectiveness and feasibility of mobile technology in health promotion and closing psychological treatment gaps. Older adults have been demonstrated to engage frequently with mobile devices, particularly text messaging. In this article, we conceptualize the Text4HealthyAging, an evidence-based text messaging innovation to support healthy urban aging in Canadian and Australian cities.
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Background Globally, methamphetamine use has increased in prevalence in recent years. In Australia, there has been a dramatic increase in numbers of people seeking treatment, including residential rehabilitation, for methamphetamine use... more
Background Globally, methamphetamine use has increased in prevalence in recent years. In Australia, there has been a dramatic increase in numbers of people seeking treatment, including residential rehabilitation, for methamphetamine use disorder (MUD). While residential rehabilitation is more effective for MUD than withdrawal treatment (i.e. “detoxification”) alone, relapse rates remain high, with approximately half of rehabilitation clients using methamphetamine within 3 months of rehabilitation. “Approach bias modification” (ABM) is a computerised cognitive training approach that aims to dampen automatically triggered impulses to approach drugs and drug-related stimuli. ABM has been demonstrated to reduce alcohol relapse rates, but no randomised controlled trials of ABM for MUD have yet been conducted. We aim to test whether a novel “personalised” form of ABM, delivered during rehabilitation, reduces post-treatment methamphetamine use, relative to a sham-training control condition...
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The authors assessed and compared the accuracy of 123I beta-CIT SPECT and FDG PET for the diagnosis of dementia with Lewy bodies in subjects with Alzheimer's disease and dementia with Lewy bodies matched for degree of cognitive... more
The authors assessed and compared the accuracy of 123I beta-CIT SPECT and FDG PET for the diagnosis of dementia with Lewy bodies in subjects with Alzheimer's disease and dementia with Lewy bodies matched for degree of cognitive impairment. The authors also examined SERT binding in these subjects. (non-author abstract)
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Research Interests: Psychology, Clinical Psychology, Traumatic Brain Injury, Medicine, Anxiety, and 15 moreHumans, Aggression, Amnesia, Psychological Intervention, Medline, Meta Analysis, Clinical Sciences, Randomized Controlled Trial, Psychotropic Drugs, ANXIETY, Neurotrauma, Clinical Protocols, Neurosciences, Irritability, and GuideLine
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Improved metrics of Post‐traumatic stress disorder (PTSD) treatment response that extend beyond a focus on symptom reduction to incorporate meaningful, patient‐centred indicators of functioning are needed in veteran populations. The aim... more
Improved metrics of Post‐traumatic stress disorder (PTSD) treatment response that extend beyond a focus on symptom reduction to incorporate meaningful, patient‐centred indicators of functioning are needed in veteran populations. The aim of this study was to extend previous research by investigating whether indicators of functioning can successfully distinguish against symptom response categories derived from the Post‐Traumatic Stress Disorder Checklist (PCL‐5) pre‐ and post‐ PTSD treatment. Participants were 472 veterans receiving hospital‐based treatment for PTSD. In addition to the PCL‐5, measures included quality of life, social relationships, physical health and psychological distress. Four mutually exclusive, progressive response categories were used to define treatment response including: No Response, Response, Response and Below Threshold, and Remission. PTSD symptom reductions were associated with corresponding improvements in broader indicators of functioning. However, it w...
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OBJECTIVE Anger is a salient feature of posttraumatic mental health which is linked to posttraumatic stress disorder (PTSD) and may have implications for treatment. However, the nature of associations involving anger and PTSD remains... more
OBJECTIVE Anger is a salient feature of posttraumatic mental health which is linked to posttraumatic stress disorder (PTSD) and may have implications for treatment. However, the nature of associations involving anger and PTSD remains unclear. The aim of the present study was to examine bidirectional influences involving anger and International Classification of Diseases (ICD)-11 PTSD symptom clusters over time among treatment-seeking veterans. METHOD Current or ex-serving members (n = 742; 92.4% male) who participated in an accredited outpatient PTSD treatment program were administered measures of PTSD symptoms (PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition [PCL-5]) and anger (Dimensions of Anger Reactions Scale-5 [DAR-5]) at treatment intake, discharge, and three-month follow-up. Bidirectional influences were assessed using cross-lagged panel analyses. RESULTS The majority of participants (78%) exhibited significant anger problems at intake. Cross-lagged analyses showed anger was associated with relative increases in PTSD symptoms of intrusive reexperiencing and avoidance at posttreatment, whereas no reverse effects of any PTSD symptoms on anger were observed. Anger continued to influence changes in heightened sense of threat and avoidance symptoms at three-months posttreatment. CONCLUSIONS Anger influences change in specific PTSD symptoms over time among military veterans in treatment and may interfere with treatments for PTSD. Veterans who present to clinical services with anger problems may benefit from anger interventions prior to commencing trauma-focused treatment. The findings have additional implications for conceptual models of the relationship between anger and PTSD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Introduction Post-traumatic stress disorder (PTSD) is a severe and debilitating condition affecting a significant proportion of the veteran community. A substantial number of veterans with PTSD fail to benefit from trauma-focused... more
Introduction Post-traumatic stress disorder (PTSD) is a severe and debilitating condition affecting a significant proportion of the veteran community. A substantial number of veterans with PTSD fail to benefit from trauma-focused psychological therapies or pharmacotherapy or are left with residual symptoms, and therefore, investigation of new and innovative treatment is required. Theta Burst Stimulation (TBS) is a novel form of Repetitive Transcranial Magnetic Stimulation, which has been shown to improve depression symptoms and associated cognitive deficits. The current pilot study aimed to explore the acceptability, safety, and tolerability of intermittent TBS (iTBS) as a treatment for PTSD in Australian veterans. Materials and Methods This study employed a case series, repeated-measures design. Eight Australian Defence Force veterans with PTSD received 20 bilateral iTBS treatments (1 session per day, 5 days per week over a 4-week period) and were assessed on a range of mental heal...
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Objective: To characterise adolescents admitted to a voluntary adolescent inpatient unit and investigate treatment outcomes. Method: A retrospective cohort design was employed. Health of the Nation Outcome Scales for Children and... more
Objective: To characterise adolescents admitted to a voluntary adolescent inpatient unit and investigate treatment outcomes. Method: A retrospective cohort design was employed. Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) pre- and post-admission scores were collected, measuring global functioning. Demographic variables such as age, gender, primary diagnosis, comorbidity and length of stay (LOS) were analysed. Data were collected from May 2017 to April 2018. All adolescents admitted to the inpatient unit were included. Results: The majority of adolescents ( n = 72; HoNOSCA data available on n = 57) were 16 years of age (26%), female (82%) and with a primary diagnosis of a mood disorder (57%). Most adolescents improved at the time of discharge. Self-injury and emotional symptoms had greater reductions according to clinician and adolescent-self-ratings ( p < 0.01). Mean change (improvement) in HoNOSCA total score was 7.3 (SD 7.5) based on clinician rati...
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IntroductionImproving mental healthcare for adolescents is a global policy priority. Despite demands for community-based services, many adolescents require more intensive interventions, such as an inpatient admission. This is typically at... more
IntroductionImproving mental healthcare for adolescents is a global policy priority. Despite demands for community-based services, many adolescents require more intensive interventions, such as an inpatient admission. This is typically at a point of crisis, often accompanied by intense emotional dysregulation, impairment of coping function and impulsivity. However, limited evidence exists on how best to support this group while they are in inpatient care, aside from pharmacological treatments which have a limited role in adolescents. Little is known about the models of care (MoC) offered in inpatient units, whether adolescents perceive these as helpful and the perspectives of caregivers and clinicians. Here, we describe a protocol which aims to explore and evaluate an inpatient MoC.Methods and analysisWe designed a longitudinal, mixed-methods, case study. The population consists of adolescents, caregivers and clinicians at a single inpatient unit in Melbourne, Australia. Standardise...
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ObjectivesTo extend current published guidance regarding the management of major depression in clinical practice, by examining complex cases that reflect real‐world patients, and to integrate evidence and experience into... more
ObjectivesTo extend current published guidance regarding the management of major depression in clinical practice, by examining complex cases that reflect real‐world patients, and to integrate evidence and experience into recommendations.MethodsThe authors who contributed to recently published clinical practice guidelines were invited to identify important gaps in extant guidance. Drawing on clinical experience and shared knowledge, they then generated four fictional case studies to illustrate the real‐world complexities of managing mood disorders. The cases focussed specifically on issues that are not usually addressed in clinical practice guidelines.ResultsThe four cases are discussed in detail and each case is summarised using a life chart and accompanying information. The four cases reflect important real‐world challenges that clinicians face when managing mood disorders in day‐to‐day clinical practice. To partly standardise the presentation of each case and for ease of reference we provide a Time Line, History Box and Management Chart, along with a synopsis where relevant. Discussion and formulation of the cases illustrate how to manage the complexities of each case and provide one possible pathway to achieving functional recovery.ConclusionThese cases draw on the combined clinical experience of the authors and illustrate how to approach diagnostic decision‐making when treating major depressive disorder and having to contend with complex presentations. The cases are designed to stimulate discussion and provide a real‐world context for the formulation of mood disorders.
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This article is a detailed response to the criticisms levelled by the authors of an accompanying viewpoint, which claims that the positioning of repetitive transcranial magnetic stimulation (rTMS) in the 2020 Royal Australian and New... more
This article is a detailed response to the criticisms levelled by the authors of an accompanying viewpoint, which claims that the positioning of repetitive transcranial magnetic stimulation (rTMS) in the 2020 Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines for the management mood disorders (MDcpg2020) is incorrect. We, the authors of the MDcpg2020, strongly refute these assertions and argue that first we have determined the positioning of rTMS using the same criteria as those applied to other treatments for depression. Second, in accordance with National Health and Medical Research Council (NHMRC) guidelines, the processes by which we have developed the MDcpg2020 have been guided by best practice and have been overseen throughout by the RANZCP. Third, our objective and detailed examination of the relevant research has shown that the evidence needed to support the positioning of rTMS alongside standard therapies for depression is severely deficient. And therefore, as a consequence, we set out clearly both our logic and reasoning with respect to interpreting rTMS data and outline our evidence-informed position in which rTMS remains a potential alternative therapy that can be considered in certain clinical circumstances once both suitable psychological and pharmacological treatments have been trialled. We also discuss why, until further research is conducted, rTMS is perhaps best regarded as an experimental therapy and an investigational tool, and to assist in this regard, we propose a framework for consideration by those conducting rTMS studies in the future. Thus, based on current knowledge, we conclude that rTMS does not have a sufficient evidence base to warrant recognition as a standard therapy for depression alongside established treatments such as psychological interventions, pharmacotherapy, and electroconvulsive therapy. Furthermore, there is no clinical profile for depressed patients that might benefit from rTMS and therefore tolerability alone is not good enough reason to promote rTMS in the management of major depression.
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Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent,... more
Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent, and often do not reflect the deficits demonstrated in patients with traumatic brain injury (TBI) or SCZ. We sought to determine the extent of executive dysfunction in PFTBI relative to three comparison cohorts. Measures of executive function were administered to dually diagnosed patients with PFTBI (n = 10) including tests of mental inhibition and switching, processing speed, and attention: the Stroop Task, Trail Making Test (TMT), and the Attention subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Demographically comparable patients with TBI (n = 10), SCZ (n = 23), and healthy controls (n = 23) underwent an identical battery. Significant executive dysfunction was evident in patients with PFTBI on all measures. Relative to all three comparison cohorts patients with PFTBI performed most poorly. These data present novel evidence of substantially impaired executive function across four task types in PFTBI and suggest that TBI and psychosis have an additive influence on executive function deficits. Treatment programs requiring substantial executive engagement are not suitable for patients dually diagnosed with PFTBI.
Research Interests: Psychology, Cognitive Science, Neuropsychology, Psychosis, Attention, and 15 moreAdolescent, Medicine, Executive Function, Humans, Female, Male, Executive Functions, Aged, Middle Aged, Adult, Neurosciences, Cognition disorders, Brain injuries, Psychiatric Status Rating Scales, and Neuropsychological Tests
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OBJECTIVE The objective of this review is to synthesize systematic reviews of the effectiveness of pharmacotherapy vs any other comparator for the management of post-traumatic brain injury depression in adults. INTRODUCTION Depression... more
OBJECTIVE The objective of this review is to synthesize systematic reviews of the effectiveness of pharmacotherapy vs any other comparator for the management of post-traumatic brain injury depression in adults. INTRODUCTION Depression following a traumatic brain injury can have a considerable impact on the life of the individual, their family members, and the health care system. There have been several recent systematic reviews and meta-analyses on pharmacologic treatment for depression post-traumatic brain injury. These reviews differ in conduct, quality, and reporting, and have discordant results and conclusions. Therefore, an umbrella review can provide prescribers with a summary of the evidence. INCLUSION CRITERIA This review will consider systematic reviews of studies of adults 16 years or older who have sustained a traumatic brain injury of any severity at any time in the past, who are receiving pharmacotherapy for depression of any severity in any health care setting. Studies that include the following outcomes will be considered: change in symptoms of depression and occurrence of harms. METHODS MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Database of Systematic Reviews, Epistemonikos, and PROSPERO will be searched, as well as Google Scholar, ResearchGate, TRIP Medical Database, and hand searching journals. There will be no restriction on publication date. Only systematic reviews published in English will be considered. Screening of articles, assessment of methodological quality, and data extraction will be performed independently by two reviewers. A Grading of Recommendations, Assessment, Development and Evaluation Summary of Findings will be presented. Data will be summarized in narrative form with supporting tables. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020184915.
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Objective To compare the 2022 NICE guidelines (NG222) and 2020 RANZCP clinical practice guidelines (MDcpg2020) recommendations for the treatment of depression using psychodynamic psychotherapy. Conclusions Both guidelines recommend... more
Objective To compare the 2022 NICE guidelines (NG222) and 2020 RANZCP clinical practice guidelines (MDcpg2020) recommendations for the treatment of depression using psychodynamic psychotherapy. Conclusions Both guidelines recommend psychological interventions first-line. However, only short-term psychodynamic psychotherapy (STPP) is recommended, and in the NG222 it is ranked last for less severe depression and 7th for more severe depression. In contrast, cognitive behavioural therapy and behavioural activation are deemed the more clinically effective and cost-effective psychological therapies. And antidepressants play a significant role – largely in more severe depression.
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Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent,... more
Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent, and often do not reflect the deficits demonstrated in patients with traumatic brain injury (TBI) or SCZ. We sought to determine the extent of executive dysfunction in PFTBI relative to three comparison cohorts. Measures of executive function were administered to dually diagnosed patients with PFTBI (n = 10) including tests of mental inhibition and switching, processing speed, and attention: the Stroop Task, Trail Making Test (TMT), and the Attention subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Demographically comparable patients with TBI (n = 10), SCZ (n = 23), and healthy controls (n = 23) underwent an identical battery. Significant executive dysfunction was evident in patients with PFTBI on all measures. Relative to all three comparison cohorts patients with PFTBI performed most poorly. These data present novel evidence of substantially impaired executive function across four task types in PFTBI and suggest that TBI and psychosis have an additive influence on executive function deficits. Treatment programs requiring substantial executive engagement are not suitable for patients dually diagnosed with PFTBI.
Research Interests: Psychology, Cognitive Science, Neuropsychology, Psychiatry, Attention, and 15 moreAdolescent, Medicine, Executive Function, Humans, Female, Male, Executive Functions, Aged, Middle Aged, Adult, Neurosciences, Cognition disorders, Brain injuries, Psychiatric Status Rating Scales, and Neuropsychological Tests
Australian & New Zealand Journal of Psychiatry, 56(4) In the recent Federal budget, the Australian Government committed to funding repetitive transcranial magnetic stimulation (rTMS) using Medicare items from November 2021 to tackle... more
Australian & New Zealand Journal of Psychiatry, 56(4) In the recent Federal budget, the Australian Government committed to funding repetitive transcranial magnetic stimulation (rTMS) using Medicare items from November 2021 to tackle ‘treatment-resistant’ depression (TRD).1 However, the threshold for this, namely ‘two different classes of antidepressants,’ is too low and unnecessarily rigid. Furthermore, many aspects for this indication are poorly defined and open to interpretation. To be eligible, patients must have received two courses of antidepressants and a course of psychological therapy, but despite these measures, patients remain unwell. This broad ‘indication’ is worrying given that rTMS remains an experimental therapy and both ‘TRD’ and what constitutes remaining unwell are poorly defined. Furthermore, the nature and extent of psychological therapy is not specified. However, of greater concern, and the focus of this article, is the arbitrary specification of two medication classes, which is not in keeping with the options and strategies available to treat depression successfully. In recent articles, we have highlighted the gaps in the evidence and the limited efficacy of rTMS in the management of depression using this treatment modality. We have also drawn attention to the possibility that the majority of the effects of TMS are attributable to Placebo and Non-Specific Effects (PANSE) rather than the specific action of brain stimulation per se (Malhi and Bell, 2021). Furthermore, we have shown that rTMS is at best an experimental intervention because it has yet to conclusively establish (1) efficacy as a treatment for depression (against placebo), (2) comparative efficacy (against other established treatments) and (3) identify a clinical phenotype for whom it is best suited. In other words, what kind of depression is likely to benefit from the intervention and when should it be considered; these studies are yet to be conducted. Meanwhile, in clinical practice, we have argued that experimental treatments should only be considered once all recognised and well-established therapies have been given reasonable consideration and suitably trialled. We remain of the view that TRD and similar constructs, such as difficult to treat depression (DTD), set up a negative therapeutic relationship, are not clinically meaningful and should be supplanted by our channelling response paradigm. This offers a more positive and clinically relevant means of determining a treatment pathway for depression. However, if for pragmatic purposes a threshold of reasonable treatment strategies is needed, then this should be determined on the basis of evidence and logic. Hence, in this brief article, we focus on what may be considered a reasonable threshold to trigger the consideration of an experimental strategy in the management of depression, such as TMS in particular, but also other treatments, for example, esketamine. Note, we have not examined the equally critical issue of gauging wellness, which because of its complexity requires sophisticated appraisal, but have chosen instead to rTMS and treatment-resistant depression: The need to consider class action!
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Objective To rebut the claims made in an opinion piece by Anaf and colleagues regarding the recommendations for psychotherapy within the 2020 RANZCP Mood Disorders Clinical Practice Guidelines (CPG). Conclusions The CPG attaches... more
Objective To rebut the claims made in an opinion piece by Anaf and colleagues regarding the recommendations for psychotherapy within the 2020 RANZCP Mood Disorders Clinical Practice Guidelines (CPG). Conclusions The CPG attaches importance to psychological interventions and recommends their administration as first-line in the treatment of depression. The concerns raised by Anaf and colleagues have no basis and are readily dismissed by referring to the guidelines. Therefore, we strongly encourage clinicians to formulate their own views by reading the guidelines for themselves.
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Research Interests: Psychology, Psychiatry, Bipolar Disorder, Treatment, Medicine, and 12 moreMood, Mania, Major Depressive Disorder, Psychoeducation, Psychological Intervention, Clinical Sciences, Mood Disorders, Bipolar Disorders, Neurosciences, GuideLine, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Psychology, Medicine, Challenging Behaviour, Psychological Intervention, Randomized Controlled Trial, and 6 moreAcquired Brain Injury, Guidance and Counseling Intervention Programs, Neuropsychological Rehabilitation, Goal Attainment Scaling, Psychology and Cognitive Sciences, and Medical and Health Sciences
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SummaryComparing the recommendations of two recently published national clinical practice guidelines for depression, this editorial highlights the concordance of advice concerning the selection and sequencing of therapies. Lifestyle and... more
SummaryComparing the recommendations of two recently published national clinical practice guidelines for depression, this editorial highlights the concordance of advice concerning the selection and sequencing of therapies. Lifestyle and psychological interventions feature prominently and there is broad agreement regarding medication choice and optimisation strategies. The guidelines are therefore a useful resource.
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Supplementary_File_1_-_list_of_BD_agents_from_search for A Systematic Review of Nutraceuticals for the Treatment of Bipolar Disorder: Une revue systématique des nutraceutiques pour le traitement du trouble bipolaire by Melanie M. Ashton,... more
Supplementary_File_1_-_list_of_BD_agents_from_search for A Systematic Review of Nutraceuticals for the Treatment of Bipolar Disorder: Une revue systématique des nutraceutiques pour le traitement du trouble bipolaire by Melanie M. Ashton, Bianca E. Kavanagh, Wolfgang Marx, Michael Berk, Jerome Sarris, Chee H. Ng, Malcolm Hopwood, Lana J. Williams and Olivia M. Dean in The Canadian Journal of Psychiatry
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This article is a detailed response to the criticisms levelled by the authors of an accompanying viewpoint, which claims that the positioning of repetitive transcranial magnetic stimulation (rTMS) in the 2020 Royal Australian and New... more
This article is a detailed response to the criticisms levelled by the authors of an accompanying viewpoint, which claims that the positioning of repetitive transcranial magnetic stimulation (rTMS) in the 2020 Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines for the management mood disorders (MDcpg2020) is incorrect. We, the authors of the MDcpg2020, strongly refute these assertions and argue that first we have determined the positioning of rTMS using the same criteria as those applied to other treatments for depression. Second, in accordance with National Health and Medical Research Council (NHMRC) guidelines, the processes by which we have developed the MDcpg2020 have been guided by best practice and have been overseen throughout by the RANZCP. Third, our objective and detailed examination of the relevant research has shown that the evidence needed to support the positioning of rTMS alongside standard therapies for depression is severe...
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BACKGROUND Challenging behaviours are common and disabling consequences of acquired brain injury (ABI), causing stress for close-others and disrupting community integration. Positive Behaviour Support (PBS) interventions have support from... more
BACKGROUND Challenging behaviours are common and disabling consequences of acquired brain injury (ABI), causing stress for close-others and disrupting community integration. Positive Behaviour Support (PBS) interventions have support from case studies as a means of reducing these behaviours, but controlled trials are lacking. OBJECTIVES This study aimed to evaluate, with a randomised waitlist-controlled trial, the efficacy of a 12-month PBS intervention, termed PBS+PLUS, in reducing challenging behaviours after ABI. METHODS Participants included 49 individuals with ABI (PBS+PLUS Intervention and Waitlist Treatment-as-usual groups) and their close-others. The design was a randomised waitlist-controlled trial with 12-month follow-up. PBS+PLUS involved setting collaborative goals toward a more meaningful life with the individual with ABI and addressing barriers to achieving these, including challenging behaviours, through skill-building, restructuring environments and executive strategies. The primary outcome measure was the Overt Behaviour Scale (OBS). The Challenging Behaviour Self-Efficacy Scale (CBSES) was a secondary outcome, assessing close-others' self-efficacy in addressing challenging behaviour. Measures were completed at baseline and every 4 months. Data analyses involved mixed-effects and negative binomial regressions examining change over time by group. RESULTS The PBS+PLUS Intervention group included 24 participants and the Waitlist group 25 participants. On the OBS, the Intervention group showed a significant reduction in challenging behaviour over the 12-month intervention. However, the Waitlist group showed similar improvement on the OBS over the 12-month waitlist period. The Waitlist group was not denied an intervention from other providers during this period. Gains continued for 8 months post-intervention. The PBS+PLUS intervention resulted in significantly greater gains in close-others' confidence in addressing challenging behaviours on the CBSES, relative to those in the Waitlist group, who showed no such gains. CONCLUSIONS Although we cannot say this intervention is more effective than any other, the study did show that PBS+PLUS can result in significant and sustained reductions in challenging behaviour in individuals with severe ABI and increased confidence of close-others in addressing these difficult behaviours. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY: #ACTRN12616001704482.
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Supplemental Material, 19037-e-CJP-2019-134-OR.R1-__Abstract_for_translation-134 for Physical Activity as a Predictor of Clinical Trial Outcomes in Bipolar Depression: A Subanalysis of a Mitochondrial-Enhancing Nutraceutical Randomized... more
Supplemental Material, 19037-e-CJP-2019-134-OR.R1-__Abstract_for_translation-134 for Physical Activity as a Predictor of Clinical Trial Outcomes in Bipolar Depression: A Subanalysis of a Mitochondrial-Enhancing Nutraceutical Randomized Controlled Trial by Melanie M. Ashton, Mohammadreza Mohebbi, Alyna Turner, Wolfgang Marx, Michael Berk, Gin S. Malhi, Chee H. Ng, Sue M. Cotton, Seetal Dodd, Jerome Sarris, Malcolm Hopwood, Brendon Stubbs and Olivia M. Dean in The Canadian Journal of Psychiatry
Symptoms of depression are common following traumatic brain injury (TBI), impacting survivors’ ability to return to work, participate in leisure activities, and placing strain on relationships. Depression symptoms post TBI are often... more
Symptoms of depression are common following traumatic brain injury (TBI), impacting survivors’ ability to return to work, participate in leisure activities, and placing strain on relationships. Depression symptoms post TBI are often managed with pharmacotherapy, however, there is little research evidence to guide clinical practice. There have been a number of recent systematic reviews examining pharmacotherapy for post TBI depression. The aim of this umbrella review was to synthesize systematic reviews and meta-analyses of the effectiveness of pharmacotherapy for the management of post TBI depression in adults. Eligible reviews examined any pharmacotherapy against any comparators, for the treatment of depression in adults who had sustained TBI. Seven databases were searched, with additional searching of online journals, Research Gate, Google Scholar and the TRIP Medical Database to identify published and unpublished systematic reviews and meta-analyses in English up to May 2020. A s...
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Supplemental material, sj-docx-1-anp-10.1177_0004867420979353 for The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders by Gin S Malhi, Erica Bell, Darryl Bassett, Philip Boyce,... more
Supplemental material, sj-docx-1-anp-10.1177_0004867420979353 for The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders by Gin S Malhi, Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray in Australian & New Zealand Journal of Psychiatry
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Research Interests: Psychology, Depression, Neuropsychopharmacology, Medicine, Post traumatic stress disorder, and 15 moreHumans, Prolactin, Alcoholism, Female, Male, The, Middle Aged, Adult, Fenfluramine, Area Under Curve, Serotonin Uptake Inhibitors, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, Tobacco use disorder, and Medical and Health Sciences
Negative symptoms of schizophrenia are often confounded by overlapping depressive and parkinsonian symptoms. The role of medication as an aetiological factor in the development of these symptoms is an important issue for prevention and... more
Negative symptoms of schizophrenia are often confounded by overlapping depressive and parkinsonian symptoms. The role of medication as an aetiological factor in the development of these symptoms is an important issue for prevention and treatment. A total of 45 inpatients in chronic wards who met RDC criteria for schizophrenia were assessed with the Hamilton depression rating scale (HDRS) and negative symptom rating scale (NSRS) and the targeting abnormal kinetic effect scale (TAKE). No significant correlation was found between the total scores on the vegetative superfactor of the HDRS and the NSRS. Duration of neuroleptic treatment was positively correlated with depressive symptoms (r=0.299, P &lt; 0.05) and negative symptoms (r=0.443, P &lt; 0.001). Dose of antipsychotic was also correlated positively with negative symptoms (r=0.260, P &lt; 0.05). Age was negatively correlated with depressive symptoms as assessed by the HDRS (r=0.306, P &lt;0.05). The data suggest that depressive and negative symptoms can be separated in chronic schizophrenia, while pointing to a possible role of antipsychotic medication in the aetiology. The study was conducted in a small chronically hospitalised population treated with relatively high doses of antipsychotics. It is not clear that the results obtained here would be applicable to an acute patient population.
Research Interests: Psychology, Depression, Schizophrenia, Kinetics, Medicine, and 15 moreHumans, Affective Disorders, Chronic Disease, Female, Male, Rating Scale, Middle Aged, Institutionalization, Adult, Depressive Symptoms, Behavioral symptoms, Hamilton Depression Rating Scale, Antipsychotic agents, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Psychiatry, Post traumatic stress disorder, Biological Sciences, Biological Psychiatry, Serotonin, and 15 moreSeasonality, Humans, Major Depressive Disorder, Male, Membrane transport proteins, Middle Aged, Adult, Seasons, Elsevier, Reference Values, Control Group, Paroxetine, Psychology and Cognitive Sciences, Blood platelets, and Medical and Health Sciences
Patients with panic disorder or depression have abnormal responses to the alpha 2-adrenergic receptor partial agonist clonidine. Evidence linking anxiety to noradrenergic dysfunction and the presence of anxiety symptoms in both depression... more
Patients with panic disorder or depression have abnormal responses to the alpha 2-adrenergic receptor partial agonist clonidine. Evidence linking anxiety to noradrenergic dysfunction and the presence of anxiety symptoms in both depression and panic suggest that abnormal responses to clonidine in these disorders could be due to the anxiety symptoms. To explore a possible link between &quot;nonspecific&quot; anxiety symptoms and abnormal responses to clonidine, patients with DSM-III-defined generalized anxiety disorder were given intravenous infusions of clonidine hydrochloride. Responses of plasma growth hormone, 3-methoxy-4-hydroxyphenylglycol, heart rate, blood pressure, and psychological states were determined in 11 patients with generalized anxiety disorder and 14 healthy subjects. Clonidine produced significantly smaller growth hormone responses in patients than in healthy controls. The two groups did not differ in 3-methoxy-4-hydroxyphenylglycol, heart rate, blood pressure, or psychological responses to clonidine. These results are compared with data from similar studies on patients with panic disorder and depression. The blunting of the growth hormone response to clonidine in all three disorders could be due to the presence of generalized anxiety symptoms. Subsensitivity of postsynaptic alpha 2-adrenoreceptors may be present in all three disorders; however, there are alternative interpretations of growth hormone blunting in response to clonidine. Blunting was observed in DSM-III-defined generalized anxiety disorder, whether or not the DSM-III-R criterion of excessive worry was also present.
Research Interests: Endocrinology, Anxiety Disorders, Medicine, Anxiety, Growth Hormone, and 15 moreHumans, Internal Medicine, Blood Pressure, Female, Male, Heart rate, Depressive Disorder, Adult, Biological markers, ANXIETY, Archives General Psychiatry, Clonidine, Personality Inventory, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Psychology, Neuropsychology, Psychiatry, Schizophrenia, Traumatic Brain Injury, and 14 moreLanguage, Medicine, Humans, Female, Male, Verbal behavior, Young Adult, Middle Aged, Adult, Psychotic Disorders, Brain injuries, Neuropsychological Tests, Psychology and Cognitive Sciences, and Medical and Health Sciences
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OBJECTIVE The objective of this review is to synthesize systematic reviews of the effectiveness of pharmacotherapy vs any other comparator for the management of post-traumatic brain injury depression in adults. INTRODUCTION Depression... more
OBJECTIVE The objective of this review is to synthesize systematic reviews of the effectiveness of pharmacotherapy vs any other comparator for the management of post-traumatic brain injury depression in adults. INTRODUCTION Depression following a traumatic brain injury can have a considerable impact on the life of the individual, their family members, and the health care system. There have been several recent systematic reviews and meta-analyses on pharmacologic treatment for depression post-traumatic brain injury. These reviews differ in conduct, quality, and reporting, and have discordant results and conclusions. Therefore, an umbrella review can provide prescribers with a summary of the evidence. INCLUSION CRITERIA This review will consider systematic reviews of studies of adults 16 years or older who have sustained a traumatic brain injury of any severity at any time in the past, who are receiving pharmacotherapy for depression of any severity in any health care setting. Studies...
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To provide a succinct, clinically useful summary of the management of major depression, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg2020).
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Australian & New Zealand Journal of Psychiatry, 54(11) We are all familiar with the term ‘muscle memory’. Obviously, this does not refer to a ‘memory’ in the usual sense, within the muscular system of the body; it simply refers to the... more
Australian & New Zealand Journal of Psychiatry, 54(11) We are all familiar with the term ‘muscle memory’. Obviously, this does not refer to a ‘memory’ in the usual sense, within the muscular system of the body; it simply refers to the fact that as an action is rehearsed and becomes familiar, it becomes automatic and no longer requires conscious effort, and as a consequence is easier to achieve because it has been learned. Technically, it usually involves consolidating a motor task – and is thus a form of procedural memory that is also sometimes referred to as motor memory. It has a complex basis that involves the imprinting of emotion on memory and decision-making (Tyng et al., 2017). Day to day it serves an essential function and is thought to make tasks such as driving, typing and playing certain sports and musical instruments easier and more efficient. In a similar vein, we propose the novel term ‘prescription memory’, to refer to the prescription of medications because of habit and familiarity rather than case-by-case deliberation. This is not to say that no thought is put into deciding which medication to prescribe, because the decision is undoubtedly informed by knowledge and clinical experience when first formulated. However, in this context, prescription memory (PM) refers to pursuing rehearsed prescribing patterns rather than thinking anew and truly engaging with alternatives and different possibilities for optimally tailored care. In practice, busy clinicians are tempted to make prescription decisions because of a patient’s diagnosis – which automatically brings to mind certain possibilities and their prior experience with specific medications, and this understandably results in some medications being ‘favoured’. Clinically, this is an important problem because it can limit consideration of salient factors that may inform an evidence-based decision. Thought processes that are necessary to make a reasoned decision require free will and choice and are thought to be linked to the concept of moral responsibility (Tyng et al., 2017). This does not suggest that by prescribing a set choice one is not exercising moral responsibility or being ethical, but by not re-evaluating various options and exercising choice on every occasion, perhaps best practice is not always being followed, and this may be perceived as unethical. Importantly, careful consideration and thought may not ultimately change what is actually prescribed or how things are managed, but by not exercising choice and considering various options and alternatives, something may be lost in the therapeutic process. This is the risk inherent in PM which may also limit versatility in dosing and the employment of different strategies. Furthermore, PM may also thwart the efforts of clinicians both to keep abreast of therapeutic advances in their field and to tailor therapy to subtypes of illness. In most cases, PM is learned because the doctor has become familiar with prescribing certain medications and these appear to be effective in their particular ‘hands’ and this is appealing. It may also reflect limited access to various medications in certain settings or jurisdictions of care. Naturally, the more experience a doctor gains in prescribing a particular medication, the more PM is reinforced. One could argue that PM is beneficial in this regard, as doctors gain extensive experience of certain molecules, in regard to both efficacy and tolerability (i.e. side effects), which in practice is often equally problematic as medications not having the desired effect (Papakostas et al., 2007). Alas, as with many matters in medicine, not everything is clear cut. And so, while PM is limiting in some regards, it also constitutes experience. Prescription memory: Is it time to change the script?
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BACKGROUND Epidemiological studies suggest a relationship between posttraumatic stress disorder (PTSD) and dementia. OBJECTIVE This study assessed whether Alzheimer's disease (AD) imaging biomarkers were elevated in Vietnam veterans... more
BACKGROUND Epidemiological studies suggest a relationship between posttraumatic stress disorder (PTSD) and dementia. OBJECTIVE This study assessed whether Alzheimer's disease (AD) imaging biomarkers were elevated in Vietnam veterans with PTSD. METHODS The study compared cognition, amyloid-β, tau, regional brain metabolism and volumes, and the effect of APOE in 83 veterans with and without PTSD defined by the Clinician's Administered PTSD Scale. RESULTS The PTSD group had significantly lower education, predicted premorbid IQ, total intracranial volume, and Montreal Cognitive Assessment score compared with the controls. There was no difference between the two groups in the imaging or genetic biomarkers for AD. CONCLUSION Our findings do not support an association between AD pathology and PTSD of up to 50 years duration. Measures to assess cognitive reserve, a factor that may delay the onset of dementia, were lower in the PTSD group compared with the controls and this may account for the previously observed higher incidence of dementia with PTSD.
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Objectives Individuals with bipolar disorder (BD) generally engage in low levels of physical activity (PA), and yet few studies have investigated the relationship between PA and change in BD symptom severity. The aim of this subanalysis... more
Objectives Individuals with bipolar disorder (BD) generally engage in low levels of physical activity (PA), and yet few studies have investigated the relationship between PA and change in BD symptom severity. The aim of this subanalysis of an adjunctive nutraceutical randomized controlled trial for the treatment of bipolar depression was to explore the relationship between PA, the active adjunctive treatments (a nutraceutical “mitochondrial cocktail”), and clinical outcomes. Methods Participants with bipolar depression were randomized to receive N-acetylcysteine alone, N-acetylcysteine with a combination of nutraceuticals (chosen for the potential to increase mitochondrial activity), or placebo for 16 weeks. Participants ( n = 145) who completed the International Physical Activity Questionnaire–Short Form (IPAQ-SF; measured at Week 4) were included in this exploratory subanalysis. Assessments of BD symptoms, functioning, and quality of life were completed at monthly visits up until ...
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IntroductionFirst line pharmacological treatments for bipolar disorder (BD) can leave shortfalls in recovery leading to patients seeking alternative and adjunctive treatments such as nutraceuticals. This protocol for a systematic review... more
IntroductionFirst line pharmacological treatments for bipolar disorder (BD) can leave shortfalls in recovery leading to patients seeking alternative and adjunctive treatments such as nutraceuticals. This protocol for a systematic review and proposed meta-analysis aims to answer the research question: in patients with BD, how does use of nutraceutical treatments compare with placebo in reducing depressive and mania symptoms?Methods and analysisClinical trials will be identified through database searches using PubMed via PubMed, EMBASE via embase.com, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) via cochranelibrary.com and CINAHL Complete via EBSCO. Search terms for BD and specific nutraceuticals (75 total search terms) will be used. Double-blind, randomised, controlled, clinical trials of adults with BD will be included in the review. Risk of bias will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.Ethics and d...
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Limited research exists regarding the therapeutic operations of adolescent mental health inpatient units, particularly in terms of nonpharmacological therapeutic interventions. This review collates what is known about reported... more
Limited research exists regarding the therapeutic operations of adolescent mental health inpatient units, particularly in terms of nonpharmacological therapeutic interventions. This review collates what is known about reported nonpharmacological therapeutic interventions for young people admitted to general or non-disorder-specific adolescent mental health inpatient settings. A descriptive review of this nature was not located in the literature. The aim was to identify what is currently known about reported nonpharmacological therapeutic interventions. The purpose was to consider gaps and contribute to further work being undertaken in describing an exemplary inpatient model of care for adolescents. Sources included CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO. Studies included were those published in English, between the years 2000 and 2018. Exclusions included residential, community, outpatient, forensic settings, and studies detailing pharmacological interventions. Ten studies were identified. This descriptive review provides an objective foundation to inform an exemplary inpatient model of care currently being investigated. There is a critical need to understand these interventions to identify key components of an inpatient model of care. Such knowledge will provide guidance for future services seeking to create an exemplary model of care. Furthermore, these results can influence current practice by improving quality and delivery of inpatient care.
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Background: Certain nutrient supplements (nutraceuticals) may target neurobiological pathways perturbed in bipolar disorder (BD) such as inflammation, oxidative stress, and mitochondrial dysfunction. Nutraceuticals thus may have a... more
Background: Certain nutrient supplements (nutraceuticals) may target neurobiological pathways perturbed in bipolar disorder (BD) such as inflammation, oxidative stress, and mitochondrial dysfunction. Nutraceuticals thus may have a potential role as adjunctive treatments for BD. Methods: A search of Embase via embase.com , PubMed via PubMed, Cumulated index to nursing and allied health literature (CINAHL) Complete via EBSCO, and Cochrane Central Register of Controlled Clinical Trials via cochranelibrary.com was conducted to identify published randomized controlled trials assessing the efficacy of nutraceuticals on mood symptomatology in adults with BD. Search terms for BD, nutraceuticals, and clinical trials (total search terms = 75) were used to search from inception to February 20, 2020. The Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials was used to assess the risk of bias. Results: A total of 1,712 studies were identified through the search. Afte...
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Bipolar depression is characterized by neurobiological features including perturbed oxidative biology, reduction in antioxidant levels, and a concomitant rise in oxidative stress markers. Bipolar depression manifests systemic... more
Bipolar depression is characterized by neurobiological features including perturbed oxidative biology, reduction in antioxidant levels, and a concomitant rise in oxidative stress markers. Bipolar depression manifests systemic inflammation, mitochondrial dysfunction, and changes in brain growth factors. The depressive phase of the disorder is the most common and responds the least to conventional treatments. Garcinia mangostana Linn, commonly known as mangosteen, is a tropical fruit. The pericarp's properties may reduce oxidative stress and inflammation and improve neurogenesis, making mangosteen pericarp a promising add-on therapy for bipolar depression. Participants will receive 24 weeks of either 1,000 mg mangosteen pericarp or placebo per day, in addition to their usual treatment. The primary outcome is change in severity of mood symptoms, measured using the Montgomery-Åsberg Depression Rating Scale (MADRS), over the treatment phase. Secondary outcomes include global psychopa...
An association between obstructive sleep apnea (OSA) and Alzheimer's disease has been suggested but little is known about amyloid-β and tau deposition in this syndrome. To determine amyloid and tau burden and cognitive function in OSA... more
An association between obstructive sleep apnea (OSA) and Alzheimer's disease has been suggested but little is known about amyloid-β and tau deposition in this syndrome. To determine amyloid and tau burden and cognitive function in OSA in comparison to those without a diagnosis of OSA. The status of OSA was determined by asking participants about history of polysomnographic diagnosis of OSA and the use of Continuous Positive Airway Pressure (CPAP). A comprehensive neuropsychological battery measured cognitive function. Positron emission tomography (PET) was used to measure standardized uptake value ratio (SUVR) of 18F-florbetaben and 18F-AV1451, to quantify amyloid and tau burden. 119 male Vietnam veterans completed assessment. Impairment in visual attention and processing speed and increased body mass index (BMI) were seen in subjects with OSA compared with those without a diagnosis OSA. The cortical uptake of 18F-florbetaben was higher in the OSA group than in the control group...
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To describe the characteristics of psychiatrists working in the area of intellectual and developmental disability mental health (IDDMH) across Australia and New Zealand. A secondary analysis of data collected by the Royal Australian and... more
To describe the characteristics of psychiatrists working in the area of intellectual and developmental disability mental health (IDDMH) across Australia and New Zealand. A secondary analysis of data collected by the Royal Australian and New Zealand College of Psychiatrists 2014 workforce survey. Characteristics of the IDDMH workforce ( n=146 psychiatrists) were compared with those of the broader psychiatry workforce ( n=1050 psychiatrists). The IDDMH workforce were more likely than the broader psychiatry workforce to be working across both the public and private health sectors, be engaged in outreach work, endorse specialty practice areas pertinent to IDDMH, treat younger patients and work more clinical hours per week. Part-time status and retirement plans of the IDDMH workforce matched those of the broader psychiatry workforce. While some elements of the IDDMH workforce profile suggest this workforce is tailored to the needs of the population, the potential shortage of IDDMH psychi...
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Many individuals in post-traumatic amnesia (PTA) following traumatic brain injury (TBI) experience neurobehavioral symptoms (NBS) in addition to disorientation and amnesia. These symptoms are associated with low rehabilitation engagement,... more
Many individuals in post-traumatic amnesia (PTA) following traumatic brain injury (TBI) experience neurobehavioral symptoms (NBS) in addition to disorientation and amnesia. These symptoms are associated with low rehabilitation engagement, self-inflicted harm, and risk of violence. The aim of this systematic review was to evaluate the efficacy and harms of pharmacological interventions for NBS in PTA following TBI in adults. Studies in English published before December 2017 were reviewed. Six databases were searched, with additional hand searching of key journals, clinical trials registries, and international drug regulators. Evidence quality was assessed using Joanna Briggs Institute Critical Appraisal Instruments. Thirteen studies were identified: three randomized controlled trials (RCTs), three cohort studies, and seven case series. In the RCTs, neither amantadine nor sertraline reduced NBS. Less rigorous studies reported reduced NBS in patients administered haloperidol, ziprasido...
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The objective of this systematic review is to synthesize current evidence on the effectiveness of pharmacotherapy as compared to all comparators for the management of pseudobulbar affect in adults 16 years and over who have sustained a... more
The objective of this systematic review is to synthesize current evidence on the effectiveness of pharmacotherapy as compared to all comparators for the management of pseudobulbar affect in adults 16 years and over who have sustained a traumatic brain injury. The specific review question is: What is the effectiveness of pharmacotherapy for the management of pseudobulbar affect in adults 16 years and over who have sustained a traumatic brain injury?
To understand the current situation, needs and challenges in the area of postgraduate training in psychiatry in Asia and identify implementable solutions.Leaders in psychiatric education from nine Asia Pacific countries prepared country... more
To understand the current situation, needs and challenges in the area of postgraduate training in psychiatry in Asia and identify implementable solutions.Leaders in psychiatric education from nine Asia Pacific countries prepared country reports, based on a suggested list of items and met for a day to discuss and identify implementable solutions to improve the current unsatisfactory status of postgraduate training in psychiatry. Except Japan, all the other countries have a very low number of psychiatrists per 100 000 population - far lower than the global target of 10 psychiatrist per 100 000 population. The undergraduate teaching in psychiatry in majority of the countries is restricted to 20 h of lectures given during the 4-6 semester and 2-3 weeks of clinical ward placements. The duration as well as the overall quality of postgraduate training and methods of assessment and accreditation varies widely across and within countries. Numerous gaps that need to be addressed to enhance th...
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The term 'mood stabiliser' is ill-defined and lacks clinical utility. We propose a framework to evaluate medications and effectively communicate their mood stabilising properties - their acute and prophylactic efficacy across the... more
The term 'mood stabiliser' is ill-defined and lacks clinical utility. We propose a framework to evaluate medications and effectively communicate their mood stabilising properties - their acute and prophylactic efficacy across the domains of mania and depression. The standardised framework provides a common definition to facilitate research and clinical practice. The Treatment Algorithm Group (TAG) was supported logistically by Servier who provided financial assistance with travel and accommodation for those TAG members travelling interstate or overseas to attend the meeting in Sydney (held on 18 November 2017). None of the committee were paid to participate in this project and Servier have not had any input into the content, format or outputs from this project.
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Adolescent mental health research is a developing area. Inpatient units are the most widely used acute element of adolescent mental health services internationally. Little is known about inpatient units, particularly when it comes to... more
Adolescent mental health research is a developing area. Inpatient units are the most widely used acute element of adolescent mental health services internationally. Little is known about inpatient units, particularly when it comes to measuring improvement for adolescents. Clinical outcome measurement in the broad context has gathered momentum in recent years, driven by the need to assess services. The measurement of outcomes for adolescents who access inpatient care is critical, as they are particularly vulnerable and are often considered the most difficult to treat. Following the PRISMA guidelines, the aim of this review was to assess whether adolescent inpatient units are effective and understand how outcomes are measured. CINAHL, MEDLINE with Full Text, ERIC, PsycINFO, and Cochrane databases were systematically searched. Studies were included if the inpatient units were generic and adolescents were between the mean age of 12-25 years. Furthermore, studies published in English wit...
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The objective of this systematic review is to synthesize the best available evidence on the effectiveness and harms of pharmacotherapy as compared to all types of comparators for the management of neurobehavioral symptoms in... more
The objective of this systematic review is to synthesize the best available evidence on the effectiveness and harms of pharmacotherapy as compared to all types of comparators for the management of neurobehavioral symptoms in post-traumatic amnesia in adults aged 16 years and over who have sustained a traumatic brain injury. This review forms part of a larger project which aims to gather the evidence for the pharmacological treatment of neurobehavioral symptoms post traumatic brain injury as a prelude to the development of a clinical guideline.
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In December 2015, the Royal Australian and New Zealand College of Psychiatrists published a comprehensive set of mood disorder clinical practice guidelines for psychiatrists, psychologists and mental health professionals. This guideline... more
In December 2015, the Royal Australian and New Zealand College of Psychiatrists published a comprehensive set of mood disorder clinical practice guidelines for psychiatrists, psychologists and mental health professionals. This guideline summary, directed broadly at primary care physicians, is an abridged version that focuses on bipolar disorder. It is intended as an aid to the management of this complex disorder for primary care physicians working in collaboration with psychiatrists to implement successful long term management. Main recommendations: The guidelines address the main phases of bipolar disorder with a particular emphasis on long term management, and provide specific clinical recommendations. Mania: All physicians should be able to detect its early signs so that treatment can be initiated promptly. At the outset, taper and cease medications with mood-elevating properties and institute measures to reduce stimulation, and transfer the patient to specialist care. Bipolar de...
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The objective of this systematic review is to synthesize the current evidence on the effectiveness and harms of pharmacotherapy in the management of depression in adults who have sustained a traumatic brain injury.
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Behaviours of Concern (BoC) are a debilitating consequence of Traumatic Brain Injury (TBI). Whilst perspectives of clinicians, carers and family members on BoC have been previously explored, few qualitative studies have included... more
Behaviours of Concern (BoC) are a debilitating consequence of Traumatic Brain Injury (TBI). Whilst perspectives of clinicians, carers and family members on BoC have been previously explored, few qualitative studies have included individuals with TBI. The aim of this study was to explore the lived experience of BoC in individuals with TBI, their close others and clinicians. Eleven males with TBI and BoC were recruited and 25 semi-structured qualitative interviews were conducted (9 individuals with TBI, 9 close others, 7 clinicians). A six-phase thematic analysis approach was utilised. Frequent and persistent BoC were reported and the key themes identified included the brain injury, control, environment, mood, identity, social relationships, and meaningful participation. Whilst the brain injury contributed to BoC in all cases, the way the other themes manifested and interacted was variable. This study enriches our understanding of factors associated with BoC. Themes emerging from this...
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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.
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The use of traditional psychostimulants (methylphenidate and dexamphetamine) and stimulant-like drugs (modafinil and armodafinil) for the treatment of depression is a growing concern given the lack of research evidence supporting their... more
The use of traditional psychostimulants (methylphenidate and dexamphetamine) and stimulant-like drugs (modafinil and armodafinil) for the treatment of depression is a growing concern given the lack of research evidence supporting their effectiveness. The current article describes the role of stimulants in treating depression - specifically their risks and benefits and their potential use alongside antidepressants. Clinically, the rapid amelioration of depressive symptoms with traditional psychostimulants is often dramatic but short-lived, and this suggests that they likely operate via different mechanisms to conventional antidepressants. More importantly, there is little evidence from randomised controlled trials supporting their efficacy in treating depression, although modafinil has been shown to be effective in reducing prominent depressive symptoms, such as fatigue. Research is urgently required to clarify psychostimulants' mechanisms of action and to evaluate their long-ter...
Research Interests: Depression, Bipolar Disorder, Humans, Major Depressive Disorder, Amphetamine, and 8 moreCombination drug therapy, Methylphenidate, Dextroamphetamine, Randomized Controlled Trials as Topic, Psychology and Cognitive Sciences, Central nervous system stimulants, Medical and Health Sciences, and Antidepressive agents
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... more
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. 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. Recent world events including terrorist attacks, wars in Afghanistan and Iraq, and Middle East turmoil have...
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To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. Articles and information sourced... more
To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for moo...
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Despite a compendium of pharmacotherapies available for treating psychiatric illnesses, suboptimal response to these therapies is typical and thought to be in part a result of genetic variation. This notion has sparked a personalised... more
Despite a compendium of pharmacotherapies available for treating psychiatric illnesses, suboptimal response to these therapies is typical and thought to be in part a result of genetic variation. This notion has sparked a personalised psychiatry movement, which has in turn led to the development of several commercial pharmacogenetic-based decision support tools marketed to psychiatrists as an alternative to typical, trial-and-error, prescribing. However, there is considerable uncertainty about the validity and usefulness of these tools and whether there is sufficient evidence to support their adoption. In this Personal View, we provide an introduction to these tools and assess their potential usefulness in psychiatry practice. We conclude with clinical considerations and development strategies for improving future pharmacogenetic-based decision support tools for clinical use.
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Major depressive disorder is a common diagnosis associated with a high burden of disease that has proven to be highly heterogeneous and unreliable. Treatments currently available demonstrate limited efficacy and effectiveness. New drug... more
Major depressive disorder is a common diagnosis associated with a high burden of disease that has proven to be highly heterogeneous and unreliable. Treatments currently available demonstrate limited efficacy and effectiveness. New drug development is urgently required but is likely to be hindered by diagnostic limitations. D.J.C. has received grants and personal fees from Eli Lilly, Janssen-Cilag, Roche, Allergen, Bristol-Myers Squibb, Pfizer, Lundbeck, AstraZeneca, Hospira, Organon, Sanofi-Aventis, and Wyeth during the writing of this review. C.P. has received grant support from Janssen-Cilag, Eli Lilly, Hospira (Mayne), AstraZeneca, and received honoraria for consultancy to Janssen-Cilag, Eli Lilly, Hospira (Mayne), AstraZeneca, Pfizer, Schering Plough, and Lundbeck. Over the past 2 years he has participated on advisory boards for Janssen-Cilag and Lundbeck, and received honoraria for talks presented at educational meetings organised by AstraZeneca, Janssen-Cilag and Lundbeck. M.H. has received personal fees or grants from Lundbeck, AstraZeneca and Servier during the writing of this review. A.H.Y. reports personal fees from Lundbeck, Sunovion, AstraZeneca and Janssen outside the submitted work. I.P.E. has received personal fees or grants from Lundbeck, AstraZeneca, and Abbvie during the writing of this review. © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Due to neuropsychological conceptualizations of orbitoprefrontal cortex (OFC) dysfunction underpinning impulsive aggression and the incidence of such behaviour in post-traumatic stress disorder (PTSD), this study aimed to explore... more
Due to neuropsychological conceptualizations of orbitoprefrontal cortex (OFC) dysfunction underpinning impulsive aggression and the incidence of such behaviour in post-traumatic stress disorder (PTSD), this study aimed to explore olfactory identification (OI) ability in war veterans with PTSD as a probe of putative OFC dysfunction; and to explore the utility of OI ability in predicting aggressive and impulsive behavior in this clinical population. Participants comprised 31 out-patient male war veterans with PTSD (mean=58.23 years, s.d.=2.56) recruited from a Melbourne Veterans Psychiatry Unit, and 31 healthy age- and gender-matched controls (mean=56.84 years, s.d.=7.24). All participants were assessed on clinical measures of PTSD, depression, anxiety, and alcohol misuse; olfactory identification; neurocognitive measures of dorsolateral prefrontal, lateral prefrontal and mesial temporal functioning; and self-report measures of aggression and impulsivity. War veterans with PTSD exhibited significant OI deficits (OIDs) compared to controls, despite uncompromised performance on cognitive measures. OIDs remained after covaring for IQ, anxiety, depression and alcohol misuse, and were significant predictors of aggression and impulsivity. This research contributes to emerging evidence of orbitoprefrontal dysfunction in the pathophysiology underlying PTSD. This is the first study to report OIDs as a predictor of aggression and impulsivity in this clinical population. It prompts further exploration of the potential diagnostic utility of OIDs in the assessment of PTSD. Such measures may help delineate the clinical complexity of PTSD, and support more targeted interventions for individuals with a greater susceptibility to aggressive and impulsive behaviors.
Research Interests: Psychology, Depression, Stress, Prefrontal Cortex, Anxiety, and 15 morePsychological Medicine, Temporal Lobe, Identification, Humans, Aggression, Alcoholism, Male, Veterans, Middle Aged, Arousal, Public health systems and services research, ANXIETY, Neurosciences, Impulsive behavior, and Neuropsychological Tests
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Patients who develop psychosis following a traumatic brain injury (PFTBI) show impaired neurocognition; however, the degree of impairment has not been empirically investigated using a standardised battery. We administered the Repeatable... more
Patients who develop psychosis following a traumatic brain injury (PFTBI) show impaired neurocognition; however, the degree of impairment has not been empirically investigated using a standardised battery. We administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to patients with PFTBI (n=10), and to three groups of controls: traumatic brain injury (TBI) (n=10), schizophrenia (n=23), and nonclinical controls (n=23). The results confirmed that the cognitive neuropsychological profile of dually-diagnosed patients with PFTBI is significantly and substantially impaired. Seventy per cent of patients with PFTBI received a neuropsychological classification between the "extremely low" and "low average" ranges. Group-wise analyses on the RBANS indices indicated that patients with PFTBI had the lowest (Immediate Memory, Attention, Delayed Memory, Total Score), or equal lowest (visuospatial, equivalent with schizophrenia patients) scores...
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The "jumping to conclusions" (JTC) bias has received significant attention in the schizophrenia and delusion literature as an important aspect of cognition characterising psychosis. The JTC bias has not been explored in... more
The "jumping to conclusions" (JTC) bias has received significant attention in the schizophrenia and delusion literature as an important aspect of cognition characterising psychosis. The JTC bias has not been explored in psychosis following traumatic brain injury (PFTBI). JTC was investigated in 10 patients with PFTBI using the beads task (ratios 85:15 and 60:40). Probabilistic predictions, draws-to-decision, self-rated decision confidence, and JTC bias were recorded. Responses from 10 patients with traumatic brain injury (TBI), 23 patients with schizophrenia, and 23 nonclinical controls were compared. Relationships were explored between draws-to-decision and current intelligence quotient, affective state, executive function, delusions (severity and type), and illness chronicity (duration). Groups were comparable on JTC measures. Delusion severity and type were not related to draws-to-decision for either trial. In the entire sample, executive function (reduced mental flexib...
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To describe a case of neuroleptic malignant syndrome associated with risperidone. An elderly patient with bipolar affective disorder presented with neuroleptic malignant syndrome and relapse of hypomania after commencing risperidone.... more
To describe a case of neuroleptic malignant syndrome associated with risperidone. An elderly patient with bipolar affective disorder presented with neuroleptic malignant syndrome and relapse of hypomania after commencing risperidone. Risperidone was ceased and the patient monitored closely. The symptoms of neuroleptic malignant syndrome were resolved. To our knowledge this is the first such case reported, and suggests that risperidone, like other neuroleptics, is associated with neuroleptic malignant syndrome.
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Research Interests: Psychology, Traumatic Stress, Australia, Treatment, Stress, and 15 moreTreatment Outcome, Vietnam, Dreams, Humans, Mental Imagery, Posttraumatic stress disorder, Chronic Disease, Male, Follow-up studies, Standardisation, Middle Aged, Pilot study, Traumatic, Treatment Effect, and Severity of Illness Index
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This study examined whether stroke lesions involving left hemisphere prefrontal or basal ganglia structures are associated with poststroke depression. A consecutive series of first-ever stroke patients with single small lesions on CT scan... more
This study examined whether stroke lesions involving left hemisphere prefrontal or basal ganglia structures are associated with poststroke depression. A consecutive series of first-ever stroke patients with single small lesions on CT scan were examined for the presence and severity of poststroke depressive disorder. Lesions involving left prefrontal or basal ganglia structures were compared with other left hemisphere lesions and all right hemisphere lesions. Forty-one patients were examined. Patients with lesions involving left hemisphere prefrontal or basal ganglia structures had a higher frequency of depressive disorder (9/12; 75%) than other left hemisphere lesions (1/12; 8%) or those with right hemisphere lesions (5/17; 29%), P = 0.002. These findings suggest that damage to neural pathways within left hemisphere prefrontal or basal ganglia structures is associated with depressed mood following stroke.
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ABSTRACT Older people have high rates of mental health disorders such as mood and anxiety disorders, bipolar affective disorder, psychotic disorders, and dementia. All of these disorders are associated with significant morbidity and... more
ABSTRACT Older people have high rates of mental health disorders such as mood and anxiety disorders, bipolar affective disorder, psychotic disorders, and dementia. All of these disorders are associated with significant morbidity and mortality and have been historically under-recognised and under-treated. Recent advances in psychopharmacology have brought great benefit to many young patients with these conditions where they are supported by a clear evidence base. To date, this evidence base has been incompletely developed for older people leaving the prescriber with many difficult decisions. There is moderate and growing evidence supporting the use of antidepressants in this population. The use of mood stabilisers and antipsychotics for indications other than the behavioural and psychological symptoms of dementia currently occurs in the absence of effective evidence. J Pharm Pract Res 2007; 37: 153-6.
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ABSTRACT To perform a narrative review of the efficacy of docosahexaenoic acid (DHA) supplementation as a treatment for major depressive disorder (MDD) and as prevention and treatment for postnatal depression (PND).
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Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent,... more
Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent, and often do not reflect the deficits demonstrated in patients with traumatic brain injury (TBI) or SCZ. We sought to determine the extent of executive dysfunction in PFTBI relative to three comparison cohorts. Measures of executive function were administered to dually diagnosed patients with PFTBI (n = 10) including tests of mental inhibition and switching, processing speed, and attention: the Stroop Task, Trail Making Test (TMT), and the Attention subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Demographically comparable patients with TBI (n = 10), SCZ (n = 23), and healthy controls (n = 23) underwent an identical battery. Significant executive dysfunction was evident in patients with PFTBI on all measures. Relative to all three comparison cohorts patients with PFTBI performed most poorly. These data present novel evidence of substantially impaired executive function across four task types in PFTBI and suggest that TBI and psychosis have an additive influence on executive function deficits. Treatment programs requiring substantial executive engagement are not suitable for patients dually diagnosed with PFTBI.
Research Interests: Psychology, Cognitive Science, Schizophrenia, Attention, Adolescent, and 15 moreExecutive Function, Humans, Female, Male, Aged, Middle Aged, Adult, Psychotic Disorders, Neurosciences, Cognition disorders, Brain injuries, Statistics as Topic, Psychiatric Status Rating Scales, Trauma Severity Indices, and Neuropsychological Tests
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Due to neuropsychological conceptualizations of orbitoprefrontal cortex (OFC) dysfunction underpinning impulsive aggression and the incidence of such behaviour in post-traumatic stress disorder (PTSD), this study aimed to explore... more
Due to neuropsychological conceptualizations of orbitoprefrontal cortex (OFC) dysfunction underpinning impulsive aggression and the incidence of such behaviour in post-traumatic stress disorder (PTSD), this study aimed to explore olfactory identification (OI) ability in war veterans with PTSD as a probe of putative OFC dysfunction; and to explore the utility of OI ability in predicting aggressive and impulsive behavior in this clinical population. Participants comprised 31 out-patient male war veterans with PTSD (mean=58.23 years, s.d.=2.56) recruited from a Melbourne Veterans Psychiatry Unit, and 31 healthy age- and gender-matched controls (mean=56.84 years, s.d.=7.24). All participants were assessed on clinical measures of PTSD, depression, anxiety, and alcohol misuse; olfactory identification; neurocognitive measures of dorsolateral prefrontal, lateral prefrontal and mesial temporal functioning; and self-report measures of aggression and impulsivity. War veterans with PTSD exhibited significant OI deficits (OIDs) compared to controls, despite uncompromised performance on cognitive measures. OIDs remained after covaring for IQ, anxiety, depression and alcohol misuse, and were significant predictors of aggression and impulsivity. This research contributes to emerging evidence of orbitoprefrontal dysfunction in the pathophysiology underlying PTSD. This is the first study to report OIDs as a predictor of aggression and impulsivity in this clinical population. It prompts further exploration of the potential diagnostic utility of OIDs in the assessment of PTSD. Such measures may help delineate the clinical complexity of PTSD, and support more targeted interventions for individuals with a greater susceptibility to aggressive and impulsive behaviors.
Research Interests: Psychology, Depression, Stress, Prefrontal Cortex, Anxiety, and 15 morePsychological Medicine, Temporal Lobe, Identification, Humans, Aggression, Alcoholism, Male, Veterans, Middle Aged, Arousal, Public health systems and services research, ANXIETY, Neurosciences, Impulsive behavior, and Neuropsychological Tests
The authors studied six patients with refractory temporal lobe epilepsy and postictal psychosis using quantitative MRI and histopathology, and compared the results with 45 patients with temporal lobe epilepsy without postictal psychosis.... more
The authors studied six patients with refractory temporal lobe epilepsy and postictal psychosis using quantitative MRI and histopathology, and compared the results with 45 patients with temporal lobe epilepsy without postictal psychosis. Total hippocampal volumes were not different between the two groups. However, patients with postictal psychosis had a relatively preserved anterior hippocampus, and temporal lobe dysplasia was more frequent (p = 0.006, chi-square test). These findings may be associated with the clinical symptoms.
Research Interests: Pathology, Cognitive Science, Neurology, Magnetic Resonance Imaging, Morphometry, and 15 moreQuantitative analysis, Crisis, Hippocampus, Humans, Cerebral Cortex, Female, Male, Exploration, Temporal Lobe Epilepsy, Clinical Sciences, Adult, Psychotic Disorders, Quantitative Analysis, Nuclear Magnetic Resonance Imaging, and Neurosciences
Research Interests: Psychology, Traumatic Stress, Australia, Treatment, Stress, and 15 moreTreatment Outcome, Vietnam, Dreams, Humans, Mental Imagery, Posttraumatic stress disorder, Chronic Disease, Male, Follow-up studies, Standardisation, Middle Aged, Pilot study, Traumatic, Treatment Effect, and Severity of Illness Index
Research Interests: Psychology, Anger, Mental Health, Fear, Social Support, and 15 morePublic Health, Comorbidity, Humans, Posttraumatic stress disorder, Aggression, Alcoholism, Alcohol Drinking, Male, Interpersonal Relations, Social Environment, Middle Aged, Questionnaires, Severity of Illness Index, Psychiatric Status Rating Scales, and Personality Inventory
In this study, we reanalyzed the Forbes et al. (2002) data set to examine the Minnesota Multiphasic Personality Inventory (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen,... more
In this study, we reanalyzed the Forbes et al. (2002) data set to examine the Minnesota Multiphasic Personality Inventory (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Kaemmer, 1989) as a differential predictor of change across posttraumatic stress disorder symptom clusters following treatment in 141 Vietnam veterans. A series of partial correlation and linear multivariate regression analyses, controlling for initial symptom severity, identified several scales predictive of symptom change. None of the MMPI-2 scales, however, emerged as predictors of change in reexperiencing symptoms. Social alienation and marital distress were the most potent predictors for avoidance symptoms. Anger, alcohol use, and hypomania were the most potent predictors for the hyperarousal symptoms. Of the personality disorders, borderline personality was the strongest predictor of change in the avoidance and hyperarousal clusters. Further replication of the findings of this article and those reported by Forbes et al. (2002) is required.
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This study sought to examine the impact of personality factors on symptom change following treatment for 141 Vietnam veterans with chronic combat-related posttraumatic stress disorder (PTSD) using the Minnesota Multiphasic Personality... more
This study sought to examine the impact of personality factors on symptom change following treatment for 141 Vietnam veterans with chronic combat-related posttraumatic stress disorder (PTSD) using the Minnesota Multiphasic Personality Inventory-2 (Butcher, Dahlstrom, Graham, Tellegen, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Kaemmer, 1989). A series of partial correlation and linear multivariate regression analyses identified social alienation, associated with anger and substance use, as the most potent negative predictor of symptom change. Of the scales assessing personality disorder, Borderline Personality was identified as the strongest negative predictor of outcome. Regression analyses examining the most salient scales identified 5 items that contributed 14% of the variance in the prediction of change scores independently of the 21% accounted for by pretreatment PTSD severity.
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To document and illustrate qualitative features of fluctuating cognition as described by care givers of patients with probable dementia with Lewy bodies (DLB) and Alzheimer&#39;s disease (AD). To determine whether the quality of the... more
To document and illustrate qualitative features of fluctuating cognition as described by care givers of patients with probable dementia with Lewy bodies (DLB) and Alzheimer&#39;s disease (AD). To determine whether the quality of the fluctuations differs between DLB and AD. To examine the clinical utility of two recently developed rating scales. Care givers of 13 patients with early probable DLB and 12 patients with early probable AD were interviewed using the Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale, both developed recently. Descriptions of fluctuating cognition were recorded verbatim, analysed, and rated. Descriptions of fluctuating cognition in DLB had a spontaneous, periodic, transient quality, which appeared to reflect an interruption in the ongoing flow of awareness or attention that impacted on functional abilities. Descriptions of fluctuations in AD frequently highlighted episodes of memory failure, or a more enduring state shift in the form of &quot;good&quot; and &quot;bad&quot; days, typically occurring in response to the cognitive demands of the immediate environment. These qualitative differences could be detected reliably by independent raters, but were not always captured in standard severity scores. Fluctuations occurring in DLB have particular characteristics that are distinguishable from fluctuations occurring in AD. Interpretation and application of the fluctuation criterion continues to limit the diagnostic sensitivity of the consensus criteria for DLB. Findings suggest that explicit documentation and a wider appreciation of these distinctions could improve the reliability with which less experienced clinicians identify this core diagnostic feature in the clinical setting.
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The objective of this study was to describe the clinical characteristics of minor depression after stroke and to compare this disorder with poststroke major depression and the nondepressed state. Ninety-four stroke inpatients were... more
The objective of this study was to describe the clinical characteristics of minor depression after stroke and to compare this disorder with poststroke major depression and the nondepressed state. Ninety-four stroke inpatients were examined 8 weeks after stroke and reexamined 15 months later. Twenty-one (22%) of the 94 patients suffered from minor depression, 14 (15%) suffered from major depression, and 59 (63%) were not depressed. Minor depressed patients were twice as symptomatic as nondepressed patients but were only half as symptomatic as major depressed patients. Minor depressed patients were more likely than nondepressed patients to have a previous history of stroke and were more physically disabled. They were less likely than major depressed patients to have a family history of affective disorder. Depression symptom severity was associated with greater physical disability among minor but not major depressed patients. Fewer minor than major depressed patients were depressed at 15 months. These findings suggest that poststroke major and minor depression may be different depressive syndromes. Some cases of minor depression may be construed as an adjustment reaction to stroke disability.
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To describe a case of neuroleptic malignant syndrome associated with risperidone. An elderly patient with bipolar affective disorder presented with neuroleptic malignant syndrome and relapse of hypomania after commencing risperidone.... more
To describe a case of neuroleptic malignant syndrome associated with risperidone. An elderly patient with bipolar affective disorder presented with neuroleptic malignant syndrome and relapse of hypomania after commencing risperidone. Risperidone was ceased and the patient monitored closely. The symptoms of neuroleptic malignant syndrome were resolved. To our knowledge this is the first such case reported, and suggests that risperidone, like other neuroleptics, is associated with neuroleptic malignant syndrome.
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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... more
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. This study investigated the phenomenology of PTSD dreams in 40 veterans, using structured interview and self-report measures. 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. 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.
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Research Interests:
Disturbances in circadian rhythms have been associated with major depression and may be an underlying mechanism for the disorder. Resynchronisation of circadian rhythms may provide a new approach to treatment, especially by manipulating... more
Disturbances in circadian rhythms have been associated with major depression and may be an underlying mechanism for the disorder. Resynchronisation of circadian rhythms may provide a new approach to treatment, especially by manipulating melatonin secretion. Melatonin is secreted at night and is a stable marker of circadian rhythms. The timing of its secretion can be changed by exogenous melatonin, agonism of specific melatonin receptors in the suprachiasmatic nucleus, its suppression by light and by sleep deprivation. As part of a series of papers [&#39;Chronobiology of mood disorders&#39; Malhi &amp; Kuiper. Acta Psychiatr Scand 2013;128 (Suppl. 444): 2-15; and &#39;Getting depression clinical practice guidelines right: time for change?&#39; Kuiper et al. Acta Psychiatr Scand 2013;128 (Suppl. 444): 24-30.] addressing chronobiology, in this article, we conducted a selective review of studies that have examined the antidepressant effects of exogenous melatonin, light therapy, sleep deprivation and melatonin receptor agonists. Antidepressant effects were identified for bright light therapy, especially for seasonal affective disorder; sleep deprivation, although its antidepressant effect is time limited; and for the novel antidepressant agomelatine with agonistic properties for the MT1 and MT2 receptors and antagonism of 5HT2c receptor. The role of melatonin as an antidepressant has yet to be demonstrated. Shifting the circadian secretion of melatonin using the strategies reviewed offers a new approach to treating depression.
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Background: This study investigated whether patients suffering from post-stroke depressive disorder had a similar disturbance in central serotonergic function to that described in non-brain injured depressed patients. Methods:... more
Background: This study investigated whether patients suffering from post-stroke depressive disorder had a similar disturbance in central serotonergic function to that described in non-brain injured depressed patients. Methods: Twenty-three depressed patients (nine major, 14 minor) and 38 non-depressed patients were examined 4–8 weeks post-stroke with a structured interview, rating scales and MRI brain scans. Patients were administered 30 mg d-fenfluramine orally and plasma prolactin and d-fenfluramine concentrations were measured for 6 h post-dose. Results: The prolactin response was significantly blunted in major depression compared to minor depression and non-depressed patients as measured by both delta prolactin and area under the prolactin versus time curve. There was no significant relationship between prolactin response and lesion lateralization or any of the measured clinical characteristics. Limitations: The major limitation of the study is the relatively small number in eac...
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ABSTRACT Background: Chronic Post Traumatic Stress Disorder (PTSD) represents a significant and frequent cause of long term disability amongst war veterans. Available estimates suggest that up to 15% of Vietnam War veterans still suffer... more
ABSTRACT Background: Chronic Post Traumatic Stress Disorder (PTSD) represents a significant and frequent cause of long term disability amongst war veterans. Available estimates suggest that up to 15% of Vietnam War veterans still suffer from PTSD, now some 25 years since the end of the war. This condition has proved relatively refractory, with most forms of treatment showing modest benefits only, once subject to rigorous examination. The pharmacotherapy of Chronic PTSD. Trials of a range of agents including antidepressant medications such as the tricyclics and serotonin specific uptake inhibitors have shown modest and variable benefits beyond treating comorbid depression. It is possible that newer antidepressant medications may prove to have a clearer role in the treatment of PTSD. In the case of Venlafaxine, the combined serotonergic and noradrenergic properties of the compound may result in greater efficacy in chronic PTSD, with particularly action in a broader range of the symptomatology seen in this disorder. Objective: We aimed to conduct a preliminary examination of the efficacy and tolerability of the serotonin-noradrenaline re-uptake inhibitor in the treatment of Chronic PTSD in war veterans. Method: We conducted an open label 12 week trial of the use of the serotonin-noradrenaline reuptake inhibitor Venlafaxine in a group of Vietnam Veterans with PTSD. PTSD was diagnosed according to DSMIIIR criteria utilising the Clinician Assisted PTSD Scale (CAPS). Patients were commenced on a dose of 37.5 mg bd of Venlafaxine and the dose increased to a maximum of 375 mg per day depending on response. Efficacy was monitored by utilising the Clinic Global Impression (CGI), the Montgomery and Asberg Depression Rating Scale (MADRS) and the Impact of Event Scale (IES). Results: The study has been completed with recruitment of 33 participants, 24 of whom completed the study period. Data is currently undergoing analysis, but initial review suggests that Venlafaxine will be of at least equivalent efficacy to other antidepressant medication utilised in the treatment of PTSD. It is now appropriate that further examination of Venlafaxine&#39;s use in this condition be undertaken utilising larger sample size and placebocontrolled double blind methodology take place.
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Research Interests: Depression, Social Interaction, Personality Disorders, Family, Evaluation, and 24 moreStress, Vietnam, Comparative Study, Comorbidity, War, Humans, Major Depressive Disorder, Posttraumatic stress disorder, Hospitalization, Chronic Disease, Female, Male, Veterans, Attitude, Family Functioning, Path Analysis, Interpersonal Relations, Middle Aged, Arousal, Questionnaires, Alcohol Abuse, Personal Satisfaction, Ambulatory Care, and Severity of Illness Index
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.
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Presentation of patients with recurrent stupor associated with apparently elevated levels of an endogenous benzodiazepine-like agent, endozepine-4, has been reported from several centers, and a new syndrome, endozepine stupor has been... more
Presentation of patients with recurrent stupor associated with apparently elevated levels of an endogenous benzodiazepine-like agent, endozepine-4, has been reported from several centers, and a new syndrome, endozepine stupor has been proposed. We recently reported a case with typical features of this syndrome, which proved to be an example of surreptitious administration of exogenous benzodiazepine. This and other examples of clandestine drug use, together with uncertainties about the validity of tests used to distinguish exogenous and endogenous benzodiazepines, prompted us to undertake a reappraisal of this clinical syndrome.
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Research Interests: Psychology, Depression, Metallurgy, Suicide, Drug interactions, and 27 moreAdolescent, Comorbidity, Humans, Autoimmune diseases, Business and Management, Absenteeism, Female, Cognitive Therapy, Male, Differential Diagnosis, Risk factors, Clinical Sciences, Aged, Prevalence, Middle Aged, Questionnaires, Adult, Coronary heart disease, Morbidity, Public health systems and services research, Risk Factors, Health Psychology and Behavioral Medicine, Disease Management, Iatrogenic Disease, Occupations, Nervous System Diseases, and La revue du praticien
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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; 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, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; 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.
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Neuroimaging is increasingly used to supplement the clinical diagnosis of dementia with Lewy bodies (DLB) by showing reduced occipital metabolism and perfusion and reduced striatal dopaminergic innervation. We aimed to optimize the... more
Neuroimaging is increasingly used to supplement the clinical diagnosis of dementia with Lewy bodies (DLB) by showing reduced occipital metabolism and perfusion and reduced striatal dopaminergic innervation. We aimed to optimize the interpretation of (18)F-FDG PET images for differentiating DLB from Alzheimer disease (AD) and to compare the results with dopamine transporter imaging using (123)I-beta-carbomethoxy-3ss-(4-iodophenyl)tropane ((123)I-beta-CIT) SPECT. Fourteen subjects with a clinical diagnosis of DLB and 10 with AD underwent both (18)F-FDG PET and (123)I-beta-CIT SPECT. Four DLB and 1 AD diagnoses were subsequently confirmed at autopsy. Diagnostic accuracy was calculated for visual interpretation by 3 readers of standard 3-plane and stereotactic surface projection (18)F-FDG PET images, receiver-operating-characteristic analysis of regional (18)F-FDG uptake, and a cutoff value for the striatal-to-occipital binding ratio of beta-CIT defined by receiver-operating-characteristic analysis. Visual interpretation of 3-plane (18)F-FDG PET images had a sensitivity of 83% and specificity of 93% for DLB, slightly higher than the results with the stereotactic surface projection images. Regionally, hypometabolism in the lateral occipital cortex had the highest sensitivity (88%), but relative preservation of the mid or posterior cingulate gyrus (cingulate island sign) had the highest specificity (100%). Region-of-interest analysis revealed that occipital hypometabolism and relative preservation of the posterior cingulate both had a sensitivity of 77% and specificity of 80%. beta-CIT achieved 100% accuracy and greater effect size than did (18)F-FDG PET (Cohen d = 4.1 vs. 1.9). Both (18)F-FDG PET and (123)I-beta-CIT SPECT appear useful for the diagnosis of DLB, although the latter provides more robust results. The cingulate island sign may enhance the specificity of (18)F-FDG PET.
Research Interests: Nuclear medicine, Positron Emission Tomography, Nuclear, Humans, Female, and 12 moreCocaine, Male, Differential Diagnosis, ROC Curve, Clinical Sciences, Aged, Autopsy, Single Photon Emission Computed Tomography, Sensitivity and Specificity, Alzheimer Disease, Dementia With Lewy Bodies, and Cohort Studies
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Considerable research has focused on the use of the MMPI to assess posttraumatic stress disorder (PTSD) through identification of mean profile configurations and the development of PTSD subscales. Little work, however, has addressed the... more
Considerable research has focused on the use of the MMPI to assess posttraumatic stress disorder (PTSD) through identification of mean profile configurations and the development of PTSD subscales. Little work, however, has addressed the heterogeneity of profiles evident in PTSD populations. This study investigated the MMPI-2 profiles of 158 Australian treatment-seeking Vietnam veterans with combat-related PTSD to identify distinct subgroups. Three robust subgroups were identified on the basis of their MMPI-2 profile and compared on PTSD and associated symptomatology. These subgroups consisted of a mild PTSD group with subclinical personality pathology, and two severe PTSD groups that differed in levels of personality disturbance and general psychopathology. Most notably, differences between these latter two groups occurred in the areas of externalization, alienation, and propensity for acting out. These groups were labeled as subclinical, trauma profile, and global. The groups demonstrated significant differences in the patterns of recovery after treatment. The subclinical group demonstrated little change after treatment. In contrast, the trauma profile and global groups both improved, although the trauma profile group demonstrated greater PTSD symptom reduction than the global group.
Research Interests: Psychology, Cognitive Science, MMPI-2, Psychometrics, Personality Disorders, and 18 moreAustralia, Prediction, Treatment, Stress, Treatment Outcome, Comparative Study, Comorbidity, Test Validation, Humans, Questionnaire, Cognitive Therapy, Male, Veterans, Cluster Analysis, Mental Disorders, Clinical Sciences, Middle Aged, and Reproducibility of Results
A longitudinal framework was used to examine the competing hypotheses of (a) whether family functioning predicts changes in posttraumatic stress disorder (PTSD) symptoms or (b) whether PTSD symptoms predict changes in family functioning.... more
A longitudinal framework was used to examine the competing hypotheses of (a) whether family functioning predicts changes in posttraumatic stress disorder (PTSD) symptoms or (b) whether PTSD symptoms predict changes in family functioning. Veterans (N = 311) admitted to a treatment program completed a series of questionnaires at 3 time points: at intake, from intake to completion of a treatment program, and at the 6-month follow-up. Alcohol use and general mental health symptoms were also measured at intake. A cross-lagged panel model using structural equation modeling analyses indicated that family functioning was a moderate predictor of PTSD symptoms at posttreatment and at the 6-month follow-up. PTSD was not a significant predictor of family functioning across time and alcohol use, and general mental health symptoms did not affect the overall findings. Further analyses of PTSD symptom clusters indicated that the avoidance symptom cluster was most strongly related to family functioning. Targeting family relationships for treatment may be important in the future for veterans with PTSD.
Research Interests: Psychology, Psychometrics, Mental Health, Posttraumatic Stress Disorder (PTSD), Family, and 21 moreTreatment Outcome, Family Psychology, Post traumatic stress disorder, Humans, Personality Assessment Inventory, Posttraumatic stress disorder, Chronic Disease, Alcohol Drinking, Male, Veterans, Follow-up studies, Family Functioning, Structural Equation Model, Victoria, Aged, Middle Aged, Questionnaires, Longitudinal Studies, Adult, Alcohol Use, and Family Conflict
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Diagnosing depression in primary care settings is challenging. Patients are more likely to present with somatic symptoms, and typically with mild depression. Use of assessment scales is variable. In this context, it is uncertain how... more
Diagnosing depression in primary care settings is challenging. Patients are more likely to present with somatic symptoms, and typically with mild depression. Use of assessment scales is variable. In this context, it is uncertain how general practitioners (GPs) determine the severity of depressive illness in clinical practice. The aim of the current paper was to identify which symptoms are used by GPs when diagnosing depression and when determining severity. A total of 1760 GPs participated in the RADAR Program, an educational program focusing on the diagnosis and management of clinical depression. GPs identified a maximum of four patients whom they diagnosed with depression and answered questions regarding their diagnostic decision-making process for each patient. Overall, assessment of depression severity was influenced more by somatic symptoms collectively than emotional symptoms. Suicidal thoughts, risk of self-harm, lack of enjoyment and difficulty with activities were amongst the strongest predictors of a diagnosis of severe depression. The conclusions are threefold: (1) collectively, somatic symptoms are the most important predictors of determining depression severity in primary care; (2) GPs may equate risk of self-harm with suicidal intent; (3) educational initiatives need to focus on key depressive subtypes derived from emotional, somatic and associated symptoms.