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Greene SL, Scamvougeras A, Norman A, Bonomo Y, Castle DJ. The fentanyls: pharmacological and clinical aspects relevant to Australia. Australas Psychiatry 2020; 28:542-544. [PMID: 32392080 DOI: 10.1177/1039856220917317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE North American and other jurisdictions have seen an alarming rise in the abuse of the fentanyls, with related overdose deaths. We sought to review this group of drugs to alert Australian psychiatrists and drug and alcohol clinicians to their clinical effects and potential harms. CONCLUSIONS The extreme potency of the fentanyls underlie their lethality. Vigilance and investment from both policy makers and health care providers are required to mitigate harm from a possible future Australian fentanyl epidemic.
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Phillipou A, Abel LA, Gurvich C, Castle DJ, Rossell SL. Eye movements in anorexia nervosa: State or trait markers? Int J Eat Disord 2020; 53:1678-1684. [PMID: 32720354 DOI: 10.1002/eat.23345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Differences in saccadic eye movements are widely reported in mental illnesses, and can indirectly inform our understanding of neurobiological and cognitive underpinnings of psychiatric conditions, including anorexia nervosa (AN). Preliminary research has suggested that individuals with AN may show specific eye movement abnormalities; whether these deficits are representative of state or trait effects is, however, unclear. The aim of this study was to identify whether there are demonstrable differences in performance on saccadic eye movement tasks in individuals with current AN (c-AN), those who are weight-restored from AN (wr-AN), biological sisters of individuals with AN (AN-sis), and healthy controls (HC). METHODS Eighty participants took part in the study (n = 20/group). A set of saccadic eye movement tasks was administered, including prosaccade, antisaccade, memory-guided saccade, and visual scanpath tasks. RESULTS The c-AN group showed an increased rate of inhibitory errors to 10° targets on the memory-guided saccade task. DISCUSSION The results are discussed in terms of the potential role of the superior colliculus in AN, and that the findings may reflect a state measure of AN.
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Neill E, Tan EJ, Toh WL, Selvendra A, Morgan VA, Rossell SL, Castle DJ. Examining which factors influence age of onset in males and females with schizophrenia. Schizophr Res 2020; 223:265-270. [PMID: 32883558 DOI: 10.1016/j.schres.2020.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Data from the 2010 Australian National Survey of High Impact Psychosis (SHIP) was used to examine (1) what variables influence age of onset (AOO) for males and females, and (2) whether influencing variables were different between the sexes. METHOD Data from 622 schizophrenia patients in the SHIP sample was used. These included early life factors, encompassing family psychiatric history, childhood development, trauma and parental loss. Factors occurring within 12 months of diagnosis were also used, including drug/alcohol abuse and premorbid work and social adjustment. Based on the recognised differences in symptom profiles and AOO between the sexes, these factors were regressed separately for males and females. RESULTS Stepwise linear regressions showed that a family history of psychiatric disorders was significantly associated with earlier AOO in both sexes. Other variables differed between males and females. Specifically, for females, an earlier AOO was associated with poor premorbid social adjustment and the loss of a family member in childhood. Older AOO was associated with immigrant status. For males, a younger AOO was associated with unemployment at onset, poor premorbid work adjustment, parental divorce in childhood, and lifetime cannabis use. A higher premorbid IQ was associated with an older AOO. CONCLUSION Familial predisposition to psychiatric illness is related to earlier AOO of schizophrenia independent of sex. Males appear to have more individual-based predictive factors while females seem to have more community/social-based influences. Future directions for research in schizophrenia are suggested.
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Fehily CMC, Bartlem KM, Wiggers JH, Wye PM, Clancy RV, Castle DJ, Wilson A, Rissel CE, Wutzke S, Hodder RK, Colyvas K, Murphy F, Bowman JA. Effectiveness of embedding a specialist preventive care clinician in a community mental health service in increasing preventive care provision: A randomised controlled trial. Aust N Z J Psychiatry 2020; 54:620-632. [PMID: 32403938 PMCID: PMC7285986 DOI: 10.1177/0004867420914741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Clinical practice guidelines recommend that community mental health services provide preventive care for clients' chronic disease risk behaviours; however, such care is often not routinely provided. This study aimed to assess the effectiveness of offering clients an additional consultation with a specialist clinician embedded within a community mental health service, in increasing client-reported receipt of, and satisfaction with, preventive care. METHOD A randomised controlled trial was undertaken in one Australian community mental health service. Participants (N = 811) were randomised to receive usual care (preventive care in routine consultations; n = 405) or usual care plus the offer of an additional consultation with a specialist preventive care clinician (n = 406). Blinded interviewers assessed at baseline and 1-month follow-up the client-reported receipt of preventive care (assessment, advice and referral) for four key risk behaviours individually (smoking, poor nutrition, alcohol overconsumption and physical inactivity) and all applicable risks combined, acceptance of referrals and satisfaction with preventive care received. RESULTS Analyses indicated significantly greater increases in 12 of the 18 preventive care delivery outcomes in the intervention compared to the usual care condition from baseline to follow-up, including assessment for all risks combined (risk ratio = 4.00; 95% confidence interval = [1.57, 10.22]), advice for all applicable risks combined (risk ratio = 2.40; 95% confidence interval = [1.89, 6.47]) and offer of referral to applicable telephone services combined (risk ratio = 20.13; 95% confidence interval = [2.56, 158.04]). For each component of care, there was a significant intervention effect for at least one of the individual risk behaviours. Participants reported high levels of satisfaction with preventive care received, ranging from 77% (assessment) to 87% (referral), with no significant differences between conditions. CONCLUSION The intervention had a significant effect on the provision of the majority of recommended elements of preventive care. Further research is needed to maximise its impact, including identifying strategies to increase client uptake.
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Yolland CO, Hanratty D, Neill E, Rossell SL, Berk M, Dean OM, Castle DJ, Tan EJ, Phillipou A, Harris AW, Barreiros AR, Hansen A, Siskind D. Meta-analysis of randomised controlled trials with N-acetylcysteine in the treatment of schizophrenia. Aust N Z J Psychiatry 2020; 54:453-466. [PMID: 31826654 DOI: 10.1177/0004867419893439] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE There is accumulating evidence that adjunctive treatment with N-acetylcysteine may be effective for schizophrenia. This study aimed to conduct a comprehensive meta-analysis examining the efficacy of randomised control trials investigating N-acetylcysteine as an adjunct treatment for schizophrenia and the first to investigate cognition as an outcome. METHODS We systematically reviewed Medline, EmCare, PsycINFO, Embase, CINAHL Complete, China Knowledge Resource Integrated Database and the Cochrane Clinical Trials online registry for randomised control trials of N-acetylcysteine for schizophrenia. We undertook pairwise meta-analyses of N-acetylcysteine vs placebo for psychosis symptoms and cognition. RESULTS Seven studies, including n = 220 receiving N-acetylcysteine and n = 220 receiving placebo, met inclusion criteria for the pairwise meta-analyses. Positive and Negative Syndrome Scale negative and total scores were significantly improved in the N-acetylcysteine group after 24 weeks of treatment. The cognitive domain of working memory improved with N-acetylcysteine supplementation. CONCLUSION Evidence supports the notion that N-acetylcysteine may be a useful adjunct to standard treatment for the improvement of schizophrenia symptoms, as well as the cognitive domain of working memory. Treatment effects were observed at the later time point (⩾24 weeks), suggesting that longer interventions are required for the success of N-acetylcysteine treatment.
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Abstract
SummaryIn the context of the discovery of the cerebral ligand for the cannabis receptor, and the elucidation of its genetic sequence, we discuss the psychomimetic properties of Cannabis sativa, and explore the relationship between cannabis intoxication and mood. We suggest that renewed study of acute cannabis encephalopathy would be rewarding not only in deepening our understanding of consciousness in healthy adults, but also in helping us to understand the perceptual world of the child, the elderly, and some of our patients.
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Toh WL, Grace SA, Rossell SL, Castle DJ, Phillipou A. Body parts of clinical concern in anorexia nervosa versus body dysmorphic disorder: a cross-diagnostic comparison. Australas Psychiatry 2020; 28:134-139. [PMID: 30931578 DOI: 10.1177/1039856219839477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Anorexia nervosa and body dysmorphic disorder share a hallmark clinical feature of severe body image disturbance. This study aimed to document major demographic and clinical characteristics in anorexia nervosa versus body dysmorphic disorder, and it was the first to compare specific body parts related to body image dissatisfaction across these disorders directly. METHODS Anorexia nervosa (n=26) and body dysmorphic disorder (n=24) patients were administered a range of clinical measures, including key questions about the specificities of their body image concerns. RESULTS Results revealed increased psychiatric and personality co-morbidities in anorexia nervosa relative to body dysmorphic disorder. The anorexia nervosa group was mostly preoccupied with three body zones typically linked to weight concerns, whereas the body dysmorphic disorder group fixated on facial features, hair and skin. CONCLUSIONS These findings may help inform differential diagnosis in complex cases and aid in the formulation of targeted interventions.
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Minshall C, Castle DJ, Thompson DR, Pascoe M, Cameron J, McCabe M, Apputhurai P, Knowles SR, Jenkins Z, Ski CF. A psychosocial intervention for stroke survivors and carers: 12-month outcomes of a randomized controlled trial. Top Stroke Rehabil 2020; 27:563-576. [PMID: 32191569 DOI: 10.1080/10749357.2020.1738677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background and Purpose: Stroke can have a devastating impact on the mental and physical health of stroke survivors and their carers. We aimed to evaluate the effectiveness of a novel psychosocial intervention designed to improve health outcomes in both groups.Methods: We conducted a randomized controlled trial of a personalized psychosocial intervention (eight 1-hour weekly sessions plus one booster) compared to usual care for adult stroke survivors and carers. Participants recruited from hospital services and community referrals completed questionnaires at baseline, 3, 6, and 12 months. Primary outcomes were quality of life and self-efficacy; secondary outcomes were depressive and anxiety symptoms, coping, illness perception, work and social adjustment, carer strain, and carer satisfaction. Mixed-effect model repeated measures analysis between groups and across time was conducted.Results: Of the 173 participants recruited (89 stroke survivors; 84 carers), a total of 137 participants - 73 stroke survivors (intervention n = 42; usual care n = 31) and 64 carers (intervention n = 35; usual care n = 29) - underwent analysis up to 12 months. No statistically significant differences were found in the primary outcomes between groups over time, though a significant improvement in carer satisfaction was found at 6 months in the intervention group compared to the usual care group.Conclusion: A personalized psychosocial intervention resulted in a significant improvement in carer satisfaction at 6 months but in no other outcomes. A lack of available services and barriers to social engagement may have impeded the effectiveness of this intervention.
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Meikle SE, Liknaitzky P, Rossell SL, Ross M, Strauss N, Thomas N, Murray G, Williams M, Castle DJ. Psilocybin-assisted therapy for depression: How do we advance the field? Aust N Z J Psychiatry 2020; 54:225-231. [PMID: 31752499 DOI: 10.1177/0004867419888575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the quest for new treatment options for depression, attention is being paid to the potential role of psychedelic drugs. Psilocybin is of particular interest given its mechanism of action, its benefits in early trials and its relatively low side effects burden. This viewpoint outlines a number of key issues that remain to be elucidated about its potential use in the clinical environment, including clarification of the profile of people most likely to benefit and those who might experience adverse effects, longer-term outcomes and the role of psychotherapeutic input alongside the drug itself. There are also opportunities to understand better, the neurobiology underpinning its effects.
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Suhaimi AF, Ibrahim N, Tan KA, Silim UA, Moore G, Ryan B, Castle DJ. Effectiveness of a culturally adapted biopsychosocial intervention (POHON SIHAT) in improving self-efficacy in patients with diabetes attending primary healthcare clinics in Putrajaya, Malaysia: study protocol of a randomised controlled trial. BMJ Open 2020; 10:e033920. [PMID: 32066607 PMCID: PMC7044963 DOI: 10.1136/bmjopen-2019-033920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION People with diabetes are often associated with multifaceted factors and comorbidities. Diabetes management frameworks need to integrate a biopsychosocial, patient-centred approach. Despite increasing efforts in promotion and diabetes education, interventions integrating both physical and mental health components are still lacking in Malaysia. The Optimal Health Programme (OHP) offers an innovative biopsychosocial framework to promote overall well-being and self-efficacy, going beyond education alone and has been identified as relevant within the primary care system. Following a comprehensive cultural adaptation process, Malaysia's first OHP was developed under the name 'Pohon Sihat' (OHP). The study aims to evaluate the effectiveness of the mental health-based self-management and wellness programme in improving self-efficacy and well-being in primary care patients with diabetes mellitus. METHODS AND ANALYSIS This biopsychosocial intervention randomised controlled trial will engage patients (n=156) diagnosed with type 2 diabetes mellitus (T2DM) from four primary healthcare clinics in Putrajaya. Participants will be randomised to either OHP plus treatment as usual. The 2-hour weekly sessions over five consecutive weeks, and 2-hour booster session post 3 months will be facilitated by trained mental health practitioners and diabetes educators. Primary outcomes will include self-efficacy measures, while secondary outcomes will include well-being, anxiety, depression, self-care behaviours and haemoglobin A1c glucose test. Outcome measures will be assessed at baseline, immediately postintervention, as well as at 3 months and 6 months postintervention. Where appropriate, intention-to-treat analyses will be performed. ETHICS AND DISSEMINATION This study has ethics approval from the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR-17-3426-38212). Study findings will be shared with the Ministry of Health Malaysia and participating healthcare clinics. Outcomes will also be shared through publication, conference presentations and publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03601884.
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Rossell SL, Labuschagne I, Castle DJ, Toh WL. Delusional themes in Body Dysmorphic Disorder (BDD): Comparisons with psychotic disorders and non-clinical Controls. Psychiatry Res 2020; 284:112694. [PMID: 31785950 DOI: 10.1016/j.psychres.2019.112694] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 01/08/2023]
Abstract
The prevailing nosological classification of body dysmorphic disorder (BDD) encompasses an optional specifier "with absent insight/delusional beliefs" for patients who hold high conviction of the veracity of their disorder-specific beliefs. Yet limited research has examined the explicit nature of delusional beliefs in BDD. The current study therefore aimed to compare themes of delusional ideation in BDD relative to schizophrenia (SCZ) and healthy controls (HCs). Participants had a primary diagnosis of BDD (n = 44) or SCZ (n = 55), or were HCs (n = 55) with no personal or immediate family history of a diagnosable mental health disorder. Assessment of multidimensional delusional ideation was based on the Peters Delusional Inventory (PDI). Results showed that BDD and SCZ groups endorsed significantly more items, and had significantly elevated preoccupation and conviction than the HC group. Only the SCZ group exhibited significantly elevated distress relative to HC participants. In addition, BDD (akin to SCZ) participants were more likely to endorse somatic (appearance-related), control and thought alienation themes than the HC group. These findings suggest that delusional beliefs in BDD may not be strictly appearance-related, but rather span broader themes. This conveys therapeutic implications in terms of designing and administering targeted treatments aimed at delusional thinking in BDD.
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Knowles SR, Apputhurai P, O’Brien CL, Ski CF, Thompson DR, Castle DJ. Exploring the relationships between illness perceptions, self-efficacy, coping strategies, psychological distress and quality of life in a cohort of adults with diabetes mellitus. PSYCHOL HEALTH MED 2019; 25:214-228. [DOI: 10.1080/13548506.2019.1695865] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Castle DJ. The complexities of the borderline patient: how much more complex when considering physical health? Australas Psychiatry 2019; 27:552-555. [PMID: 31070464 DOI: 10.1177/1039856219848833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Borderline Personality Disorder is associated with a substantially reduced life expectancy, mostly due to physical health conditions that are life-shortening. This clinical review highlights pertinent risk issues for such conditions in Borderline Personality Disorder and suggests ways in which clinicians might address these. METHODS Selective literature review. RESULTS People with Borderline Personality Disorder have a reduced life expectancy of some 20 years, attributable largely to physical health maladies, notably cardiovascular. Risk factors include obesity, sedentary lifestyle, poor diet and smoking. Added to these are other physical health problems, including poor sexual health, self-harm, substance use and blood-borne viruses. Chronic pain and opioid and benzodiazepine use are also common in people with Borderline Personality Disorder. Some psychiatric medications commonly used in people with Borderline Personality Disorder - notably certain antipsychotic agents - can add to the metabolic burden. Barriers to care include self-stigma and erratic adherence to medical care, as well as stigma on the part of clinicians, who often do not screen or provide adequate care for the physical health problems suffered by people with Borderline Personality Disorder. CONCLUSIONS Clinicians need to be aware of the physical health problems in people with Borderline Personality Disorder and ensure appropriate screening and interventions, both preventative and therapeutic, are offered routinely.
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Phillipou A, Kirkovski M, Castle DJ, Gurvich C, Abel LA, Miles S, Rossell SL. High-definition transcranial direct current stimulation in anorexia nervosa: A pilot study. Int J Eat Disord 2019; 52:1274-1280. [PMID: 31433523 DOI: 10.1002/eat.23146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a serious psychiatric condition often associated with poor outcomes. Biologically informed treatments for AN, such as brain stimulation, are lacking, in part due to the unclear nature of the neurobiological contributions to the illness. However, recent research has suggested a specific neurobiological target for the treatment of AN, namely stimulation of the inferior parietal lobe (IPL). The aim of this study was to stimulate-noninvasively-the left IPL in individuals with AN using high-definition transcranial direct current stimulation (HD-tDCS). METHOD Twenty participants will be randomized to receive 10 daily sessions of HD-tDCS or sham HD-tDCS (placebo). Assessments will be carried out at baseline and end point, as well as 4- and 12-week follow-ups. DISCUSSION This pilot investigation will primarily determine the feasibility and acceptability of this intervention.
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Grace SA, Labuschagne I, Castle DJ, Rossell SL. Intranasal oxytocin alters amygdala-temporal resting-state functional connectivity in body dysmorphic disorder: A double-blind placebo-controlled randomized trial. Psychoneuroendocrinology 2019; 107:179-186. [PMID: 31146138 DOI: 10.1016/j.psyneuen.2019.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 12/21/2022]
Abstract
The aetiology of body dysmorphic disorder (BDD) is poorly understood. Recent evidence from functional brain imaging studies suggests that BDD is associated with aberrant task-based functional connectivity and that intranasal oxytocin (OXT) may improve network connectivity in BDD patients. Thus, the aim of this study was to investigate the effect of intranasal OXT on amygdala resting-state functional connectivity (rsFC) in BDD. In a randomized, double-blind, cross-over design, 19 BDD participants and 17 demographically matched healthy control participants received intranasal OXT (24 IU) or placebo prior to resting-state functional magnetic resonance imaging. The left and right amygdala were seeded as regions of interest, and temporal correlations between the amygdalae and all other voxels comprising cortical and subcortical grey matter were investigated. Compared to healthy controls, BDD patients showed greater baseline (placebo) rsFC between the left amygdala and two clusters within the left temporal lobe and one cluster within the superior frontal gyrus which was reversed following OXT administration. The control group also showed significantly greater rsFC between the left amygdala and anterior prefrontal cortex in the OXT session compared to placebo. Whilst preliminary, these findings suggest that BDD patients exhibit abnormal amygdala-temporal connectivity at rest, and OXT might have a role in changing this functional relationship.
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Rajoo Y, Wong J, Cooper G, Raj IS, Castle DJ, Chong AH, Green J, Kennedy GA. The relationship between physical activity levels and symptoms of depression, anxiety and stress in individuals with alopecia Areata. BMC Psychol 2019; 7:48. [PMID: 31337438 PMCID: PMC6651906 DOI: 10.1186/s40359-019-0324-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/17/2019] [Indexed: 01/28/2023] Open
Abstract
Background Alopecia Areata (AA) is an autoimmune condition that is characterised by non-scarring hair loss. Its aesthetic repercussions can lead to profound changes in psychological well-being. Although physical activity (PA) has been associated with better mental health outcomes in diverse populations, the association in individuals with AA has not been established. The aim of this study was to examine the associations between PA and mental health outcomes in individuals with AA to inform intervention strategies for this specific population. Methods A cross-sectional study was conducted among individuals who were diagnosed with AA. A total of 83 respondents aged (40.95 ± 13.24 years) completed a self-report questionnaire consisting of International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Depression and Anxiety Stress Scale (DASS-21). Three-way contingency Chi-square analyses were used to determine the associations between PA, mental health outcomes and participants with hair loss of more than 50% on the scalp. Results 81.9% of the participants did not meet PA guidelines. Participants with hair loss of more than 50% on the scalp, and who did not meet PA guidelines, were significantly more likely to experience symptoms of severe depression (p = .003), moderate anxiety (p = .04) and mild stress (p = .003) than those who met guidelines Conclusion Findings suggest that increased PA participation in AA individuals with severe hair loss is associated with improved mental health status. Intervention efforts for this specific population should consider barriers and enablers to PA participation as they face challenges that differ from the general population.
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Castle DJ, Strauss N, Norman A, Bonomo Y. Medical Marijuana: The Australian Experience. MISSOURI MEDICINE 2019; 116:270-273. [PMID: 31527965 PMCID: PMC6699817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Minshall C, Pascoe MC, Thompson DR, Castle DJ, McCabe M, Chau JPC, Jenkins Z, Cameron J, Ski CF. Psychosocial interventions for stroke survivors, carers and survivor-carer dyads: a systematic review and meta-analysis. Top Stroke Rehabil 2019; 26:554-564. [PMID: 31258017 DOI: 10.1080/10749357.2019.1625173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To evaluate the effectiveness of psychosocial interventions on depressive symptoms, anxiety symptoms, quality of life, self-efficacy, coping, carer strain and carer satisfaction among stroke survivors, carers and survivor-carer dyads. Data sources: MEDLINE, CINAHL, PsycINFO, SocINDEX, Cochrane Library, Web of Science and Scopus databases and the grey literature were searched up to September 2018. Methods: A systematic review and meta-analysis of randomized controlled trials of psychosocial interventions for stroke survivors, carers and survivor-carer dyads, compared to usual care. Outcomes measured were depressive symptoms, anxiety symptoms, quality of life, coping, self-efficacy, carer strain, and carer satisfaction. Results: Thirty-one randomized controlled trials (n = 5715) were included in the systematic review which found improvements in depressive symptoms, anxiety symptoms, quality of life and coping, though the number of trials assessing each outcome varied. A meta-analysis (11 trials; n = 1280) on depressive symptoms found that in seven trials psychosocial interventions reduced depressive symptoms in stroke survivors (SMD: -0.36, 95% CI -0.73 to 0.00; p = .05) and in six trials reduced depressive symptoms in carers (SMD: -0.20, 95% CI -.40 to 0.00; p = .05). Conclusion: Psychosocial interventions reduced depressive symptoms in stroke survivors and their carers. There was limited evidence that such interventions reduced anxiety symptoms, or improved quality of life and coping for stroke survivors and carers and no evidence that they improved self-efficacy, carer strain or carer satisfaction.
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Yeo V, Dowsey M, Alguera-Lara V, Ride J, Lancsar E, Castle DJ. Antipsychotic choice: understanding shared decision-making among doctors and patients. J Ment Health 2019; 30:66-73. [DOI: 10.1080/09638237.2019.1630719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Silim UA, Suhaimi AF, Moore G, Ryan B, Castle DJ. Beyond psychiatry: motivations for considering an Australian wellbeing program within Malaysian health services. Australas Psychiatry 2019; 27:262-266. [PMID: 30931582 DOI: 10.1177/1039856219834074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore the relevance and adaptability of the Optimal Health Program for mental and primary healthcare providers in Malaysia. METHODS Evaluate stakeholder engagement and training programme for psychiatrists, family medicine specialists, public health specialists, physicians, clinical psychologists, counsellors, and representatives from a patient support group. Evaluate the programme for applicability, as well as participant's knowledge and confidence in using key components. RESULTS The training was very well received in terms of content, training materials and facilitation style. Development of culturally specific materials will be needed. Improvement in the self-rating measurement for knowledge and confidence in using key Optimal Health Program components was reported at the completion of the 2-day training. CONCLUSIONS The Optimal Health Program has potential as a comprehensive socio-culturally responsive self-management programme that is relevant within mental health services and adaptable for task-sharing of mental health care in Malaysia.
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Unadkat A, Subasinghe S, Harvey RJ, Castle DJ. Methamphetamine use in patients presenting to emergency departments and psychiatric inpatient facilities: what are the service implications? Australas Psychiatry 2019; 27:14-17. [PMID: 30382752 DOI: 10.1177/1039856218810155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES: The aim of this study is to understand better the service implications of patients presenting to an inner city Australian Emergency Department (ED) and Acute Psychiatric Inpatient Service (AIS) with a history of recent crystal methamphetamine use. METHODS: An audit was taken of all patients with recent crystal methamphetamine use presenting to St Vincent's Hospital Melbourne ED and AIS over the month of September 2017. Recorded information included patient demographics, diagnosis, aggressive episodes, restrictive interventions and other risk incidents. RESULTS: Methamphetamine was related to 21.7% of AIS admissions. Of these individuals, half were involved in aggression towards staff. In the ED, 65.7% of patients with amphetamine use were aggressive to staff and 50% were aggressive towards other patients. There were high rates of physical (69.2%) and mechanical restraint (61.5%) in the ED setting. Methamphetamine use in the AIS was commonly associated with enduring psychotic disorders, whilst those managed exclusively in the ED were most commonly in an acute intoxicated state. CONCLUSIONS: Methamphetamine use presents a significant challenge to EDs and acute mental health services. Additional resources are required to manage these patients and their impact on the health system needs to be factored into future service planning.
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Beilharz F, Castle DJ, Phillipou A, Rossell SL. Visual training program for body dysmorphic disorder: protocol for a novel intervention pilot and feasibility trial. Pilot Feasibility Stud 2018; 4:189. [PMID: 30598835 PMCID: PMC6302469 DOI: 10.1186/s40814-018-0384-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 12/07/2018] [Indexed: 01/08/2023] Open
Abstract
Background Body dysmorphic disorder (BDD) is a characterised by perceived defects or flaws in appearance which are associated with distressing thoughts, repetitive or obsessive behaviours, and significant impairment in social and occupational functioning. A core feature of BDD involves abnormalities of visual processing, although this is not typically a focus of psychological and psychiatric treatments. While current treatments generally show moderate effectiveness in the short-term, those with BDD can have high relapse rates, as they still 'see' their flaws or defects. The current research trials a visual training program designed to remediate visual abnormalities and reduce symptom severity of BDD. Methods This is a single-group open-label pilot study assessing the feasibility and potential efficacy of a 10-week visual training program. This pilot trial will be conducted at Swinburne University of Technology, Melbourne, Australia, and will recruit up to 20 participants diagnosed with BDD. These participants will complete pre- and post-assessments and a 10-week visual training program encompassing three phases of basic visual processing, face and emotion recognition, and self-perception. The primary outcomes focus on feasibility and acceptability of the intervention, with secondary outcomes exploring clinical outcomes related to symptom severity, quality of life and eye movements. Discussion This pilot trial will translate the empirical findings of abnormalities in visual processing among those diagnosed with BDD, to an innovative treatment method across a range of visual processing levels. This trial will assess the feasibility and potential efficacy of such a visual training program, paving the way for further research including a future definitive randomised control trial. Trial registration Australian New Zealand Clinical Trial Registry, ACTRN 12618000274279, Registered 22nd February 2018.
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Hahn LA, Mackinnon A, Foley DL, Morgan VA, Waterreus A, Watts GF, Castle DJ, Liu D, Galletly CA. Counting up the risks: How common are risk factors for morbidity and mortality in young people with psychosis? Early Interv Psychiatry 2018; 12:1045-1051. [PMID: 27860281 DOI: 10.1111/eip.12406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 08/02/2016] [Accepted: 09/20/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study examined the prevalence of risk factors for cardiovascular (CV)-related morbidity and mortality in young people with psychosis aged 18 to 24 years. METHODS The study included 132 people aged 18 to 24 years who participated in the 2010 second Australian national survey of people living with psychosis. The 2009 World Health Organisation (WHO) Global Health Risks report was used as a framework to determine which specific risk factors were present in each in these young people. The risk factors assessed in this study were smoking, alcohol use, hypertension, overweight/obesity, physical inactivity, high blood glucose, high cholesterol and poor diet. Each risk factor was defined according to WHO criteria. A count of the total number of risk factors present for each participant was determined. Data for male and female participants were compared. RESULTS Young men had an average of 2.9 (SD 1.2) risk factors. Young women had an average of 2.4 (SD 1.2) risk factors. The most common risk factors were low fruit and vegetable intake (77.9%), cigarette smoking (67.7%), overweight/obesity (55%) and physical inactivity (39.8%). There were no significant differences between men and women in the number of risk factors present, or the prevalence of individual risk factors. CONCLUSION This study demonstrated that many of the risk factors that ultimately contribute to disability and premature death are present at an early age in people with psychosis. Preventive measures need to be an integral component of early intervention services for this client population to avert progression to serious CV morbidity and early mortality.
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Parker G, Tavella G, Macqueen G, Berk M, Grunze H, Deckersbach T, Dunner DL, Sajatovic M, Amsterdam JD, Ketter TA, Yatham LN, Kessing LV, Bassett D, Zimmerman M, Fountoulakis KN, Duffy A, Alda M, Calkin C, Sharma V, Anand A, Singh MK, Hajek T, Boyce P, Frey BN, Castle DJ, Young AH, Vieta E, Rybakowski JK, Swartz HA, Schaffer A, Murray G, Bayes A, Lam RW, Bora E, Post RM, Ostacher MJ, Lafer B, Cleare AJ, Burdick KE, O'Donovan C, Ortiz A, Henry C, Kanba S, Rosenblat JD, Parikh SV, Bond DJ, Grunebaum MF, Frangou S, Goldberg JF, Orum M, Osser DN, Frye MA, McIntyre RS, Fagiolini A, Manicavasagar V, Carlson GA, Malhi GS. Revising Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for the bipolar disorders: Phase I of the AREDOC project. Aust N Z J Psychiatry 2018; 52:1173-1182. [PMID: 30378461 DOI: 10.1177/0004867418808382] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To derive new criteria sets for defining manic and hypomanic episodes (and thus for defining the bipolar I and II disorders), an international Task Force was assembled and termed AREDOC reflecting its role of Assessment, Revision and Evaluation of DSM and other Operational Criteria. This paper reports on the first phase of its deliberations and interim criteria recommendations. METHOD The first stage of the process consisted of reviewing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and recent International Classification of Diseases criteria, identifying their limitations and generating modified criteria sets for further in-depth consideration. Task Force members responded to recommendations for modifying criteria and from these the most problematic issues were identified. RESULTS Principal issues focussed on by Task Force members were how best to differentiate mania and hypomania, how to judge 'impairment' (both in and of itself and allowing that functioning may sometimes improve during hypomanic episodes) and concern that rejecting some criteria (e.g. an imposed duration period) might risk false-positive diagnoses of the bipolar disorders. CONCLUSION This first-stage report summarises the clinical opinions of international experts in the diagnosis and management of the bipolar disorders, allowing readers to contemplate diagnostic parameters that may influence their clinical decisions. The findings meaningfully inform subsequent Task Force stages (involving a further commentary stage followed by an empirical study) that are expected to generate improved symptom criteria for diagnosing the bipolar I and II disorders with greater precision and to clarify whether they differ dimensionally or categorically.
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