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Rock D, Cross S, Rock L. Incorporating systems modelling into mental health system planning. Lancet Psychiatry 2024; 11:85-86. [PMID: 38245020 DOI: 10.1016/s2215-0366(23)00433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Daniel Rock
- WA Primary Health Alliance, Perth, WA, Australia; Department of Psychiatry, Medical School, University of Western Australia, Perth, WA 6009, Australia; Faculty of Health, University of Canberra, Canberra, ACT, Australia.
| | - Shane Cross
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lydia Rock
- Department of Internal Medicine, Medical School, University of Western Australia, Perth, WA 6009, Australia
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Cuesta-Briand B, Rock D, Tayba L, Hoimes J, Ngo H, Taran M, Coleman M. GP perspectives on a psychiatry phone line in Western Australia's Great Southern region: implications for addressing rural GP workload. Aust J Prim Health 2024; 30:NULL. [PMID: 37743540 DOI: 10.1071/py23039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Mental illness is a public health challenge disproportionately affecting rural Australians. GPs provide most of the mental health care, and they report increasing levels of burnout and unsustainable workload in the context of increased patient complexity. This may be more salient in rural settings characterised by resource constraints. In this paper, we use evaluation data from a GP psychiatry phone line established in Western Australia's Great Southern region in 2021 to describe GPs' perspectives on the service and reflect on how it may help alleviate rural GP workload. METHODS The sample was recruited among GPs practicing in the region. Data were collected through an online survey and semistructured interviews. Descriptive statistics were used to analyse the survey data. Interview data were subjected to thematic analysis; qualitative survey data were used for triangulation. RESULTS A total of 45GPs completed the survey and 14 were interviewed. Interview data yielded three themes: the criticality of timeliness; the building blocks of confidence; and trust. GPs were highly satisfied with the service, and timeliness and trust were the characteristics underpinning its effectiveness. The service built GPs' confidence in managing mental health and alcohol and other drug use issues through strengthening knowledge and providing reassurance. CONCLUSIONS Our results suggest that a telephone line operated by trusted, local psychiatrists with knowledge of the local mental health ecosystem of support can reduce rural GP workload through building confidence and strengthening personal agency, helping GPs navigate the ethical and clinical labyrinth of managing patient complexity in rural settings.
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Affiliation(s)
- Beatriz Cuesta-Briand
- Rural Clinical School of WA, The University of Western Australia, Crawley, WA 6009, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Subiaco, WA 6008, Australia; and Discipline of Psychiatry, UWA Medical School, The University of Western Australia, Crawley, WA 6009, Australia; and Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
| | - Layale Tayba
- Great Southern Mental Health Service, WA Country Health Service, Albany, WA 6330, Australia
| | - James Hoimes
- Midwest Mental Health Service, WA Country Health Service, Geraldton, WA 6530, Australia
| | - Hanh Ngo
- Rural Clinical School of WA, The University of Western Australia, Crawley, WA 6009, Australia
| | - Michael Taran
- Great Southern Mental Health Service, WA Country Health Service, Albany, WA 6330, Australia
| | - Mathew Coleman
- Rural Clinical School of WA, The University of Western Australia, Crawley, WA 6009, Australia; and Great Southern Mental Health Service, WA Country Health Service, Albany, WA 6330, Australia; and Midwest Mental Health Service, WA Country Health Service, Geraldton, WA 6530, Australia; and Telethon Kids Institute, Nedlands, WA 6009, Australia
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Whiteford H, Bagheri N, Diminic S, Enticott J, Gao CX, Hamilton M, Hickie IB, Khanh-Dao Le L, Lee YY, Long KM, McGorry P, Meadows G, Mihalopoulos C, Occhipinti JA, Rock D, Rosenberg S, Salvador-Carulla L, Skinner A. Mental health systems modelling for evidence-informed service reform in Australia. Aust N Z J Psychiatry 2023; 57:1417-1427. [PMID: 37183347 DOI: 10.1177/00048674231172113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Australia's Fifth National Mental Health Plan required governments to report, not only on the progress of changes to mental health service delivery, but to also plan for services that should be provided. Future population demand for treatment and care is challenging to predict and one solution involves modelling the uncertain demands on the system. Modelling can help decision-makers understand likely future changes in mental health service demand and more intelligently choose appropriate responses. It can also support greater scrutiny, accountability and transparency of these processes. Australia has an emerging national capacity for systems modelling in mental health which can enhance the next phase of mental health reform. This paper introduces concepts useful for understanding mental health modelling and identifies where modelling approaches can support health service planners to make evidence-informed decisions regarding planning and investment for the Australian population.
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Affiliation(s)
- Harvey Whiteford
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Nasser Bagheri
- Mental Health Policy Unit, Health Research Institute, University of Canberra
| | - Sandra Diminic
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Joanne Enticott
- Southern Synergy, Monash Centre of Health Research & Implementation, Monash University, Dandenong, VIC, Australia
| | - Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University
| | - Matthew Hamilton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Long Khanh-Dao Le
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yong Yi Lee
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Katrina M Long
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Patrick McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Graham Meadows
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Dandenong, VIC, Australia
| | - Cathrine Mihalopoulos
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jo-An Occhipinti
- Systems Modelling, Simulation & Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney
| | - Daniel Rock
- WA Primary Health Alliance, Perth, Australia
- Discipline of Psychiatry, Medical School University of Western Australia
- Faculty of Health, University of Canberra
| | - Sebastian Rosenberg
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Capon W, Hickie IB, McKenna S, Varidel M, Richards M, LaMonica HM, Rock D, Scott EM, Iorfino F. Characterising variability in youth mental health service populations: A detailed and scalable approach using digital technology. Australas Psychiatry 2023:10398562231167681. [PMID: 37035873 DOI: 10.1177/10398562231167681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVE This study utilised digital technology to assess the clinical needs of young people presenting for care at headspace centres across Australia. METHOD 1490 young people (12-25 years) who presented to one of 11 headspace services from four geographical locations (urban New South Wales, urban South Australia, regional New South Wales, and regional Queensland) completed a digital multidimensional assessment at initial presentation. Characteristics were compared between services and geographical locations. RESULTS We identified major variation in the demographics, and the type and severity of needs across different services. Individuals from regional services were more likely to be younger, of Aboriginal and Torres Strait Islander origin, and present with psychotic-like symptoms and suicidality, while those in urban areas were more likely to have previously sought help and have problematic alcohol use. Further differences in age, distress, depressive symptoms, psychotic-like experiences, trauma, family history, alcohol use, education/employment engagement, and days out of role were identified between different urban sites. CONCLUSIONS The variability between services provides insight into the heterogeneity of youth mental health populations which has implications for appropriate early intervention and prevention service provisions. We propose that integrating digital technologies has the potential to provide insights for smarter service planning and evaluation.
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Affiliation(s)
- William Capon
- Brain and Mind Centre, 90098The University of Sydney, Camperdown, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, 90098The University of Sydney, Camperdown, NSW, Australia
| | - Sarah McKenna
- Brain and Mind Centre, 90098The University of Sydney, Camperdown, NSW, Australia
| | - Mathew Varidel
- Brain and Mind Centre, 90098The University of Sydney, Camperdown, NSW, Australia
| | - Matthew Richards
- Brain and Mind Centre, 90098The University of Sydney, Camperdown, NSW, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, 90098The University of Sydney, Camperdown, NSW, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Subiaco, WA, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, 90098The University of Sydney, Camperdown, NSW, Australia
| | - Frank Iorfino
- Brain and Mind Centre, 4334The University of Sydney, Camperdown, NSW, Australia
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Salinas-Perez JA, Gutierrez-Colosia MR, Garcia-Alonso CR, Furst MA, Tabatabaei-Jafari H, Kalseth J, Perkins D, Rosen A, Rock D, Salvador-Carulla L. Patterns of mental healthcare provision in rural areas: A demonstration study in Australia and Europe. Front Psychiatry 2023; 14:993197. [PMID: 36815193 PMCID: PMC9939444 DOI: 10.3389/fpsyt.2023.993197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Mental healthcare systems are primarily designed to urban populations. However, the specific characteristics of rural areas require specific strategies, resource allocation, and indicators which fit their local conditions. This planning process requires comparison with other rural areas. This demonstration study aimed to describe and compare specialized rural adult mental health services in Australia, Norway, and Spain; and to demonstrate the readiness of the healthcare ecosystem approach and the DESDE-LTC mapping tool (Description and Evaluation of Services and Directories of Long Term Care) for comparing rural care between countries and across areas. METHODS The study described and classified the services using the DESDE-LTC. The analyses included context analysis, care availability, placement capacity, balance of care, and diversity of care. Additionally, readiness (Technology Readiness Levels - TRL) and impact analyses (Adoption Impact Ladder - AIL) were also assessed by two independent raters. RESULTS The findings demonstrated the usability of the healthcare ecosystem approach and the DESDE-LTC to map and identify differences and similarities in the pattern of care of highly divergent rural areas. Day care had a greater weight in the European pattern of care, while it was replaced by social outpatient care in Australian areas. In contrast, care coordination was more common in Australia, pointing to a more fragmented system that requires navigation services. The share between hospital and community residential care showed no differences between the two regions, but there were differences between catchment areas. The healthcare ecosystem approach showed a TRL 8 (the tool has been demonstrated in a real-world environment and it is ready for release and general use) and an AIL of 5 (the target public agencies provided resources for its completion). Two experts evaluated the readiness of the use of DESDE-LTC in their respective regional studies. All of them were classified using the TRL. DISCUSSION In conclusion, this study strongly supports gathering data on the provision of care in rural areas using standardized methods to inform rural service planning. It provides information on context and service availability, capacity and balance of care that may improve, directly or through subsequent analyses, the management and planning of services in rural areas.
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Affiliation(s)
- Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | - Carlos R Garcia-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Mary Anne Furst
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | | | - David Perkins
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,Centre for Rural and Remote Mental Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alan Rosen
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Daniel Rock
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,WA Primary Health Alliance, Subiaco, WA, Australia.,Discipline of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Luis Salvador-Carulla
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,National Centre for Epidemiology and Population Health (NCEPH), Faculty of Health and Medicine, Australian National University, Canberra, Australia
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Salvador-Carulla L, Furst MA, Tabatabaei-Jafari H, Mendoza J, Riordan D, Moore E, Rock D, Anthes L, Bagheri N, Salinas-Perez JA. Patterns of service provision in child and adolescent mental health care in Australia. J Child Health Care 2022:13674935221146381. [PMID: 36538047 DOI: 10.1177/13674935221146381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Standard description of local care provision is essential for evidence-informed planning. This study aimed to map and compare the availability and diversity of current mental health service provision for children and adolescents in Australia. We used a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE) tool, to describe service availability in eight urban and two rural health districts in Australia. The pattern of care was compared with that available for other age groups in Australia. Outpatient care was found to be the most common type of service provision, comprising 212 (81.2%) of all services identified. Hospital care (acute and non-acute) was more available in urban than in rural areas (20 services [9.7%] vs 1 [1.8%]). The level of diversity in the types of care available for children and adolescents was lower than that for the general adult population, but slightly higher than that for older people in the same areas. Standardised comparison of the pattern of care across regions reduces ambiguity in service description and classification, enables gap analysis and can inform policy and planning.
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Affiliation(s)
- Luis Salvador-Carulla
- Health Research Institute, Health College, University of Canberra, Australia
- Menzies Centre for Health. Faculty of Medicine and Health. 4334University of Sydney, Australia
| | - Mary Anne Furst
- Health Research Institute, Health College, University of Canberra, Australia
| | | | - John Mendoza
- Mental Health & Prison Health, Central Adelaide Local Health Network, SA, Australia ; Brain and Mind Centre, 4334University of Sydney, Australia
| | - Denise Riordan
- Canberra Health Services, Canberra Australia; 102944Centre for Mental health research, Canberra, Australia
| | - Elizabeth Moore
- 2212Office for Mental Health and Wellbeing Australian Capital Territory, Canberra, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Perth, Western Australia & Discipline of Psychiatry, 2720University of Western Australia, Perth, Australia
| | - Lauren Anthes
- 103006Capital Health Network, Deakin West, ACT, Australia
| | - Nasser Bagheri
- Health Research Institute, Health College, University of Canberra, Australia
| | - Jose A Salinas-Perez
- Health Research Institute, Health College, University of Canberra, Australia
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain
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Occhipinti JA, Rose D, Skinner A, Rock D, Song YJC, Prodan A, Rosenberg S, Freebairn L, Vacher C, Hickie IB. Sound Decision Making in Uncertain Times: Can Systems Modelling Be Useful for Informing Policy and Planning for Suicide Prevention? Int J Environ Res Public Health 2022; 19:ijerph19031468. [PMID: 35162491 PMCID: PMC8835017 DOI: 10.3390/ijerph19031468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic demonstrated the significant value of systems modelling in supporting proactive and effective public health decision making despite the complexities and uncertainties that characterise an evolving crisis. The same approach is possible in the field of mental health. However, a commonly levelled (but misguided) criticism prevents systems modelling from being more routinely adopted, namely, that the presence of uncertainty around key model input parameters renders a model useless. This study explored whether radically different simulated trajectories of suicide would result in different advice to decision makers regarding the optimal strategy to mitigate the impacts of the pandemic on mental health. Using an existing system dynamics model developed in August 2020 for a regional catchment of Western Australia, four scenarios were simulated to model the possible effect of the COVID-19 pandemic on levels of psychological distress. The scenarios produced a range of projected impacts on suicide deaths, ranging from a relatively small to a dramatic increase. Discordance in the sets of best-performing intervention scenarios across the divergent COVID-mental health trajectories was assessed by comparing differences in projected numbers of suicides between the baseline scenario and each of 286 possible intervention scenarios calculated for two time horizons; 2026 and 2041. The best performing intervention combinations over the period 2021–2041 (i.e., post-suicide attempt assertive aftercare, community support programs to increase community connectedness, and technology enabled care coordination) were highly consistent across all four COVID-19 mental health trajectories, reducing suicide deaths by between 23.9–24.6% against the baseline. However, the ranking of best performing intervention combinations does alter depending on the time horizon under consideration due to non-linear intervention impacts. These findings suggest that systems models can retain value in informing robust decision making despite uncertainty in the trajectories of population mental health outcomes. It is recommended that the time horizon under consideration be sufficiently long to capture the full effects of interventions, and efforts should be made to achieve more timely tracking and access to key population mental health indicators to inform model refinements over time and reduce uncertainty in mental health policy and planning decisions.
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Affiliation(s)
- Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW 2021, Australia
- Correspondence: ; Tel.: +61-467-522-766
| | - Danya Rose
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Daniel Rock
- Medical School, University of Western Australia, Perth, WA 6009, Australia;
- WA Primary Health Alliance, Perth, WA 6008, Australia
| | - Yun Ju C. Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Ante Prodan
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW 2021, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, NSW 2751, Australia
| | - Sebastian Rosenberg
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Louise Freebairn
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW 2021, Australia
| | - Catherine Vacher
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- St Vincent’s Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
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Staples LG, Webb N, Asrianti L, Cross S, Rock D, Kayrouz R, Karin E, Dear BF, Nielssen O, Titov N. A Comparison of Self-Referral and Referral via Primary Care Providers, through Two Similar Digital Mental Health Services in Western Australia. Int J Environ Res Public Health 2022; 19:905. [PMID: 35055727 PMCID: PMC8775987 DOI: 10.3390/ijerph19020905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022]
Abstract
Digital mental health services (DMHSs) deliver mental health information, assessment, and treatment, via the internet, telephone, or other digital channels. The current study compares two DMHSs operating in Western Australia (WA)-The Practitioner Online Referral System (PORTS) and MindSpot. Both provide telephone and online psychological services at no cost to patients or referrers. However, PORTS is accessed by patients via referral from health practitioners, and is designed to reach those who are financially, geographically, or otherwise disadvantaged. In contrast, MindSpot services are available to all Australian residents and patients can self-refer. This observational study compares characteristics and treatment outcomes for patients of PORTS and MindSpot in WA. Eligible patients were people who resided in WA and registered with either clinic from January 2019 to December 2020. Results showed that PORTS patients were more likely to be older, male, and unemployed. They were less likely to report a tertiary education and were more likely to live in areas with higher levels of socioeconomic disadvantage. Despite these differences, treatment outcomes were excellent for patients from both clinics. Results provide further evidence for the accessibility, acceptability, and effectiveness of DMHSs regardless of referral pathway or patient characteristics.
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Affiliation(s)
- Lauren G. Staples
- MindSpot and PORTS Clinics, MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (N.W.); (L.A.); (S.C.); (R.K.); (E.K.); (B.F.D.); (O.N.); (N.T.)
| | - Nick Webb
- MindSpot and PORTS Clinics, MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (N.W.); (L.A.); (S.C.); (R.K.); (E.K.); (B.F.D.); (O.N.); (N.T.)
| | - Lia Asrianti
- MindSpot and PORTS Clinics, MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (N.W.); (L.A.); (S.C.); (R.K.); (E.K.); (B.F.D.); (O.N.); (N.T.)
| | - Shane Cross
- MindSpot and PORTS Clinics, MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (N.W.); (L.A.); (S.C.); (R.K.); (E.K.); (B.F.D.); (O.N.); (N.T.)
| | - Daniel Rock
- WA Primary Health Alliance, Psychiatry, Medical School, University of Western Australia, Perth 6907, Australia;
| | - Rony Kayrouz
- MindSpot and PORTS Clinics, MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (N.W.); (L.A.); (S.C.); (R.K.); (E.K.); (B.F.D.); (O.N.); (N.T.)
| | - Eyal Karin
- MindSpot and PORTS Clinics, MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (N.W.); (L.A.); (S.C.); (R.K.); (E.K.); (B.F.D.); (O.N.); (N.T.)
| | - Blake F. Dear
- MindSpot and PORTS Clinics, MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (N.W.); (L.A.); (S.C.); (R.K.); (E.K.); (B.F.D.); (O.N.); (N.T.)
| | - Olav Nielssen
- MindSpot and PORTS Clinics, MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (N.W.); (L.A.); (S.C.); (R.K.); (E.K.); (B.F.D.); (O.N.); (N.T.)
| | - Nickolai Titov
- MindSpot and PORTS Clinics, MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (N.W.); (L.A.); (S.C.); (R.K.); (E.K.); (B.F.D.); (O.N.); (N.T.)
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Affiliation(s)
- Alan Rosen
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Illawarra Institute of Mental Health, University of Wollongong, Wollongong, NSW, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Rivervale, WA, Australia.,Discipline of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
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10
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Salinas-Perez JA, Gutierrez-Colosia MR, Furst MA, Suontausta P, Bertrand J, Almeda N, Mendoza J, Rock D, Sadeniemi M, Cardoso G, Salvador-Carulla L. Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland): Modèles de soins de santé mentale dans les régions éloignées: Kimberley (Australie), Nunavik (Canada) et Laponie (Finlande). Can J Psychiatry 2020; 65:721-730. [PMID: 32720514 PMCID: PMC7502882 DOI: 10.1177/0706743720944312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mental health (MH) care in remote areas is frequently scarce and fragmented and difficult to compare objectively with other areas even in the same country. This study aimed to analyze the adult MH service provision in 3 remote areas of Organization for Economic Cooperation and Development countries in the world. METHODS We used an internationally agreed set of systems indicators, terminology, and classification of services (Description and Evaluation of Services and DirectoriEs for Long Term Care). This instrument provided a standard description of MH care provision in the Kimberley region (Australia), Nunavik (Canada), and Lapland (Finland), areas characterized by an extremely low population density and high relative rates of Indigenous peoples. RESULTS All areas showed high rates of deprivation within their national contexts. MH services were mostly provided by the public sector supplemented by nonprofit organizations. This study found a higher provision per inhabitant of community residential care in Nunavik in relation to the other areas; higher provision of community outreach services in the Kimberley; and a lack of day services except in Lapland. Specific cultural-based services for the Indigenous population were identified only in the Kimberley. MH care in Lapland was self-sufficient, and its care pattern was similar to other Finnish areas, while the Kimberley and Nunavik differed from the standard pattern of care in their respective countries and relied partly on services located outside their boundaries for treating severe cases. CONCLUSION We found common challenges in these remote areas but a huge diversity in the patterns of MH care. The implementation of care interventions should be locally tailored considering both the environmental characteristics and the existing pattern of service provision.
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Affiliation(s)
- Jose A. Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mencia R. Gutierrez-Colosia
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
- Asociación Científica Psicost, Dos Hermanas, Sevilla, Spain
| | - Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Petra Suontausta
- Faculty of Social Sciences, Tampere University, Pirkanmaa, Finland
| | | | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
| | - John Mendoza
- ConNetica Consulting, Coolum, Queensland, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Perth, Western Australia, Australia
- Discipline of Psychiatry, The University of Western Australia, Perth, Western Australia, Australia
| | - Minna Sadeniemi
- Unit for Mental Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Center (CHRC), Nova Medical School, Nova University of Lisbon, Portugal
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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11
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Wibawa P, Zombor R, Dragovic M, Hayhow B, Lee J, Panegyres PK, Rock D, Starkstein SE. Anosognosia Is Associated With Greater Caregiver Burden and Poorer Executive Function in Huntington Disease. J Geriatr Psychiatry Neurol 2020; 33:52-58. [PMID: 31213121 DOI: 10.1177/0891988719856697] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anosognosia, or unawareness of one's deficits, is estimated to occur in 25% to 50% of Huntington disease (HD). The relationship between anosognosia and increased caregiver burden found in other dementias has not been determined in HD. METHODS Patient-caregiver dyads presenting to a statewide HD clinic were assessed using the Anosognosia Scale and grouped into "anosognosia" and "no anosognosia." Caregiver burden, measured by Zarit Burden Interview (ZBI) and Caregiver Burden Inventory (CBI), demographic data, and Unified Huntington's Disease Rating Scale, including Mini-Mental State Examination, Stroop, Trail Making, Verbal Fluency, and Symbol Digit Modalities Tests, were compared between groups. RESULTS Of the 38 patients recruited, 10 (26.3%) met criteria for anosognosia. Patients with anosognosia elicited higher caregiver burden ratings on both the ZBI (mean difference 16.4 [12.1], P < .001) and CBI (16.7 [15.0], P < .005) while also demonstrating poorer executive function. Except for CAG burden score, between-group characteristics did not differ significantly. Stroop Interference predicted both anosognosia and caregiver burden. CONCLUSIONS In HD, anosognosia is associated with greater caregiver burden and executive deficits. Its occurrence should prompt further patient assessment and increased caregiver support.
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Affiliation(s)
- P Wibawa
- Neurosciences Unit, North Metropolitan Health Service-Mental Health, Perth, Australia.,Clinical Research Centre, North Metropolitan Health Service-Mental Health, Perth, Australia
| | - R Zombor
- Neurosciences Unit, North Metropolitan Health Service-Mental Health, Perth, Australia
| | - M Dragovic
- Clinical Research Centre, North Metropolitan Health Service-Mental Health, Perth, Australia.,The University of Western Australia, School of Psychiatry and Clinical Neurosciences, Perth, Australia
| | - B Hayhow
- Neurosciences Unit, North Metropolitan Health Service-Mental Health, Perth, Australia.,The University of Western Australia, School of Psychiatry and Clinical Neurosciences, Perth, Australia.,School of Medicine, University of Notre Dame, Fremantle, Australia
| | - J Lee
- Neurosciences Unit, North Metropolitan Health Service-Mental Health, Perth, Australia
| | - P K Panegyres
- Neurosciences Unit, North Metropolitan Health Service-Mental Health, Perth, Australia
| | - D Rock
- The University of Western Australia, School of Psychiatry and Clinical Neurosciences, Perth, Australia.,WA Primary Health Alliance, Perth, Australia
| | - S E Starkstein
- The University of Western Australia, School of Psychiatry and Clinical Neurosciences, Perth, Australia.,Department of Health, Fremantle Hospital, Perth, Australia
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12
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van Spijker BA, Salinas-Perez JA, Mendoza J, Bell T, Bagheri N, Furst MA, Reynolds J, Rock D, Harvey A, Rosen A, Salvador-Carulla L. Service availability and capacity in rural mental health in Australia: Analysing gaps using an Integrated Mental Health Atlas. Aust N Z J Psychiatry 2019; 53:1000-1012. [PMID: 31250654 DOI: 10.1177/0004867419857809] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Access to services and workforce shortages are major challenges in rural areas worldwide. In order to improve access to mental health care, it is imperative to understand what services are available, what their capacity is and where existing funds might be spent to increase availability and accessibility. The aim of this study is to investigate mental health service provision in a selection of rural and remote areas across Australia by analysing service availability, placement capacity and diversity. METHOD This research studies the health regions of Western New South Wales and Country Western Australia and their nine health areas. Service provision was analysed using the DESDE-LTC system for long-term care service description and classification that allows international comparison. Rates per 100,000 inhabitants were calculated to compare the care availability and placement capacity for children and adolescents, adults and older adults. RESULTS The lowest diversity was found in northern Western Australia. Overall, Western New South Wales had a higher availability of non-acute outpatient services for adults, but hardly any acute outpatient services. In Country Western Australia, substantially fewer non-acute outpatient services were found, while acute services were much more common. Acute inpatient care services were more common in Western New South Wales, while sub-acute inpatient services and non-acute day care services were only found in Western New South Wales. CONCLUSION The number and span of services in the two regions showed discrepancies both within and between regions, raising issues on the equity of access to mental health care in Australia. The standard description of the local pattern of rural mental health care and its comparison across jurisdictions is critical for evidence-informed policy planning and resource allocation.
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Affiliation(s)
- Bregje A van Spijker
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Jose A Salinas-Perez
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia.,Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain
| | - John Mendoza
- ConNetica Consulting, Caloundra, QLD, Australia.,Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Tanya Bell
- ConNetica Consulting, Caloundra, QLD, Australia
| | - Nasser Bagheri
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Julia Reynolds
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Daniel Rock
- Discipline of Psychiatry, University of Western Australia Medical School, Perth, WA, Australia.,Western Australian Primary Health Alliance, Perth, WA, Australia
| | - Andrew Harvey
- Western New South Wales Primary Health District, Dubbo, NSW, Australia
| | - Alan Rosen
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Illawarra Institute for Mental Health, University of Wollongong, Wollongong, NSW, Australia.,Far West LHD Mental Health Services, Broken Hill, NSW, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
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13
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Titov N, Rock D, Bezuidenhout G, Webb N, Kayrouz R, Nielssen O, Williams L, Purtell C, Dear BF, Staples LG. Evaluation of The Practitioner Online Referral and Treatment Service (PORTS): the first 18 months of a state-wide digital service for adults with anxiety, depression, or substance use problems. Cogn Behav Ther 2019; 49:307-326. [PMID: 31553266 DOI: 10.1080/16506073.2019.1666162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Practitioner Online Referral and Treatment Service (PORTS) is a new digital mental health service (DMHS) providing assessment, treatment, and consultation across Western Australia, for adults with anxiety, depression, or substance use problems, and experiencing financial hardship or geographical disadvantage. From July 2017 to December 2018, a total of 2,527 individuals were referred to PORTS. Of these, 150 (6%) did not give consent for their results to be analysed. Of the remaining 2,377 patients, 615 (26%) could not be contacted to confirm the referral, 596 (25%) received assessment or information from PORTS, 427 (18%) were referred to another service, and 739 (31%) commenced treatment at PORTS. Almost half (47%) of patients were from areas with significant socio-economic disadvantage. Those referred by another mental health service were more likely to engage in treatment than those referred by a General Practitioner (GP). Overall outcomes were excellent, with large effect sizes (Cohen's d: 1.1-1.4), from assessment to post-treatment and 3-month follow-up, reliable deterioration was low, and GP and patient satisfaction was high. These results indicate that the PORTS DMHS model is a promising method for engaging primary care patients with anxiety and depression, including those experiencing financial and geographical disadvantage.
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Affiliation(s)
- Nickolai Titov
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Daniel Rock
- West Australian Primary Health Alliance (WAPHA) , Perth, Australia.,Psychiatry, Medical School, University of Western Australia , Perth, Australia
| | | | - Nick Webb
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Rony Kayrouz
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Olav Nielssen
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Linda Williams
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Carol Purtell
- MindSpot Clinic, Macquarie University , Sydney, Australia
| | - Blake F Dear
- MindSpot Clinic, Macquarie University , Sydney, Australia.,eCentreClinic, Department of Psychology, Macquarie University , Sydney, Australia
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14
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Porcheret K, Wald L, Fritschi L, Gerkema M, Gordijn M, Merrrow M, Rajaratnam SMW, Rock D, Sletten TL, Warman G, Wulff K, Roenneberg T, Foster RG. Chronotype and environmental light exposure in a student population. Chronobiol Int 2018; 35:1365-1374. [PMID: 29913073 PMCID: PMC6234547 DOI: 10.1080/07420528.2018.1482556] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In humans and most other species, changes in the intensity and duration of light provide a critical set of signals for the synchronisation of the circadian system to the astronomical day. The timing of activity within the 24 h day defines an individual's chronotype, i.e. morning, intermediate or evening type. The aim of this study was to investigate the associations between environmental light exposure, due to geographical location, on the chronotype of university students. Over 6 000 university students from cities in the Northern Hemisphere (Oxford, Munich and Groningen) and Southern Hemisphere (Perth, Melbourne and Auckland) completed the Munich ChronoType Questionnaire. In parallel, light measures (daily irradiance, timing of sunrise and sunset) were compiled from satellite or ground stations at each of these locations. Our data shows that later mid-sleep point on free days (corrected for oversleep on weekends MFSsc) is associated with (i) residing further from the equator, (ii) a later sunset, (iii) spending more time outside and (iv) waking from sleep significantly after sunrise. However, surprisingly, MSFsc did not correlate with daily light intensity at the different geographical locations. Although these findings appear to contradict earlier studies suggesting that in the wider population increased light exposure is associated with an earlier chronotype, our findings are derived exclusively from a student population aged between 17 and 26 years. We therefore suggest that the age and occupation of our population increase the likelihood that these individuals will experience relatively little light exposure in the morning whilst encountering more light exposure later in the day, when light has a delaying effect upon the circadian system.
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Affiliation(s)
- Kate Porcheret
- a Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
| | - Lucien Wald
- b Centre for Observation, Impacts, Energy , MINES ParisTech, PSL Research University , Paris , France
| | - Lin Fritschi
- c School of Public Health , Curtin University , Perth , Australia
| | - Menno Gerkema
- d Chronobiology unit, Groningen Institute for Evolutionary Life Sciences , University of Groningen , Groningen , The Netherlands
| | - Marijke Gordijn
- d Chronobiology unit, Groningen Institute for Evolutionary Life Sciences , University of Groningen , Groningen , The Netherlands.,e Chrono@Work , Groningen , The Netherlands
| | - Martha Merrrow
- f Molecular Chronobiology , Institute of Medical Psychology, LMU Munich , Munich , Germany
| | - Shantha M W Rajaratnam
- g Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences , Monash University , Melbourne , Australia
| | - Daniel Rock
- h WA Primary Health Alliance , Perth , Australia.,i School of Psychiatry and Clinical Neurosciences , The University of Western Australia , Perth , Australia
| | - Tracey L Sletten
- g Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences , Monash University , Melbourne , Australia
| | - Guy Warman
- j Chronobiology Group, Department of Anaesthesiology, School of Medicine, Faculty of Medical and Health Sciences , University of Auckland , Auckland , New Zealand
| | - Katharina Wulff
- a Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
| | - Till Roenneberg
- f Molecular Chronobiology , Institute of Medical Psychology, LMU Munich , Munich , Germany
| | - Russell G Foster
- a Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
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15
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Patel R, Rosen B, Baron P, Beitsch P, Whitworth P, Compagnoni G, Barbosa K, Grady I, Lee L, Schonholz S, Ruiz A, Robertson Y, Rock D. Abstract P4-06-05: Not presented. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-06-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the symposium.
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Affiliation(s)
- R Patel
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - B Rosen
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - P Baron
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - P Beitsch
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - P Whitworth
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - G Compagnoni
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - K Barbosa
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - I Grady
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - L Lee
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - S Schonholz
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - A Ruiz
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - Y Robertson
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
| | - D Rock
- Good Samaritan Hospital, Los Gatos, CA; Advocate Health, Barrington, IL; Roper Hospital, Charleston, SC; Dallas Surgical Group, Dallas, TX; Nashville Breast, Nashville, TN; Alaska Breast Specialists, Anchorage, AK; North Valley Breast Clinic, Redding, CA; Cancer Center of the Desert, Palm Springs, ca; Noble Hospital, Westfield, MA; Metro Surgical Associates, Atlanta, GA; Regional Breast Care, Ft Meyers, FL
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16
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Gottschalk WK, Zeitlow K, Charamalbous L, Ng I, Gagrani S, Mihovilovic M, Saunders A, Rock D, Lou S, Roses A. [P4–432]: CONSEQUENCES OF INCREASED TOMM40 EXPRESSION ON CELLULAR ENERGETICS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- William Kirby Gottschalk
- Duke University Medical CenterDurhamNCUSA
- Duke University School of MedicineDurhamNCUSA
- Tufts University School of MedicineBostonMAUSA
- UT Southwestern Medical CenterAustinTXUSA
- Zinfandel Pharmaceuticals, IncChapel HillNCUSA
| | | | | | - Isaac Ng
- Duke University Medical CenterDurhamNCUSA
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17
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Nguyen T, Hauck YL, Pedruzzi RA, Frayne J, Rock D, Dragovic M. Sexual health and sexual trauma in women with severe mental illness: An exploratory survey of Western Australian community mental health services. Health Care Women Int 2017; 38:705-714. [PMID: 28362243 DOI: 10.1080/07399332.2017.1313845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Australian women attending community mental health services were surveyed to determine the relationship between sexual trauma, sexual activity, and sexual health seeking behaviors. Self-reported history of "forced sex" was 58.4% (n = 122 out of 220). Latent class analysis revealed a three-class model: "sexually active and health seeking," "low sexual activity and health seeking" and "low sexual activity and not health seeking." An association with general practitioner engagement and sexual health seeking behaviors was found. Rates of self-reported sexual trauma reinforce the need for screening and trauma informed care. Groupings may reflect different aspects of recovery associated with sexual health behaviors.
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Affiliation(s)
- Thinh Nguyen
- a Discipline of Psychiatry , University of Western Australia Medical School , Perth , Western Australia , Australia.,b Peel and Rockingham Kwinana Mental Health Service , Rockingham , Western Australia , Australia
| | - Yvonne L Hauck
- c School of Nursing , Midwifery and Paramedicine, Curtin University , Perth , Western Australia , Australia
| | - Rebecca A Pedruzzi
- d Clinical Research Centre , North Metropolitan Mental Health Service , Perth , Western Australia , Australia
| | - Jacqueline Frayne
- e Childbirth and Mental Illness Clinic , King Edward Memorial Hospital , Subiaco , Western Australia , Australia.,f Discipline of General Practice , University of Western Australia , Perth , Western Australia , Australia
| | - Daniel Rock
- a Discipline of Psychiatry , University of Western Australia Medical School , Perth , Western Australia , Australia.,g Western Australian Primary Health Alliance , Perth , Western Australia , Australia
| | - Milan Dragovic
- a Discipline of Psychiatry , University of Western Australia Medical School , Perth , Western Australia , Australia.,d Clinical Research Centre , North Metropolitan Mental Health Service , Perth , Western Australia , Australia
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18
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Ashoorian D, Rock D, Davidson R, Clifford R. Re: Antipsychotic medication side effect assessment tools: A systematic review. Aust N Z J Psychiatry 2017; 51:199-200. [PMID: 27422561 DOI: 10.1177/0004867416659542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Deena Ashoorian
- 1 School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
| | - Daniel Rock
- 2 WA Primary Health Alliance, Rivervale, WA, Australia
- 3 School of Population Health, University of Western Australia, Crawley, WA, Australia
| | - Rowan Davidson
- 1 School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
- 4 North Metropolitan Health Service - Mental Health, Perth, WA, Australia
| | - Rhonda Clifford
- 1 School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
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19
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Stevenson TJ, Visser ME, Arnold W, Barrett P, Biello S, Dawson A, Denlinger DL, Dominoni D, Ebling FJ, Elton S, Evans N, Ferguson HM, Foster RG, Hau M, Haydon DT, Hazlerigg DG, Heideman P, Hopcraft JGC, Jonsson NN, Kronfeld-Schor N, Kumar V, Lincoln GA, MacLeod R, Martin SAM, Martinez-Bakker M, Nelson RJ, Reed T, Robinson JE, Rock D, Schwartz WJ, Steffan-Dewenter I, Tauber E, Thackeray SJ, Umstatter C, Yoshimura T, Helm B. Disrupted seasonal biology impacts health, food security and ecosystems. Proc Biol Sci 2016; 282:20151453. [PMID: 26468242 PMCID: PMC4633868 DOI: 10.1098/rspb.2015.1453] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The rhythm of life on earth is shaped by seasonal changes in the environment. Plants and animals show profound annual cycles in physiology, health, morphology, behaviour and demography in response to environmental cues. Seasonal biology impacts ecosystems and agriculture, with consequences for humans and biodiversity. Human populations show robust annual rhythms in health and well-being, and the birth month can have lasting effects that persist throughout life. This review emphasizes the need for a better understanding of seasonal biology against the backdrop of its rapidly progressing disruption through climate change, human lifestyles and other anthropogenic impact. Climate change is modifying annual rhythms to which numerous organisms have adapted, with potential consequences for industries relating to health, ecosystems and food security. Disconcertingly, human lifestyles under artificial conditions of eternal summer provide the most extreme example for disconnect from natural seasons, making humans vulnerable to increased morbidity and mortality. In this review, we introduce scenarios of seasonal disruption, highlight key aspects of seasonal biology and summarize from biomedical, anthropological, veterinary, agricultural and environmental perspectives the recent evidence for seasonal desynchronization between environmental factors and internal rhythms. Because annual rhythms are pervasive across biological systems, they provide a common framework for trans-disciplinary research.
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Affiliation(s)
- T J Stevenson
- Institute for Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK
| | - M E Visser
- Department of Animal Ecology, Nederlands Instituut voor Ecologie, Wageningen, The Netherlands
| | - W Arnold
- Research Institute of Wildlife Ecology, University of Vienna, Vienna, Austria
| | - P Barrett
- Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, UK
| | - S Biello
- School of Psychology, University of Glasgow, Glasgow, UK
| | - A Dawson
- Centre for Ecology and Hydrology, Penicuik, Midlothian, UK
| | - D L Denlinger
- Department of Entomology, Ohio State University, Columbus, OH, USA
| | - D Dominoni
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - F J Ebling
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - S Elton
- Department of Anthropology, Durham University, Durham, UK
| | - N Evans
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - H M Ferguson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - R G Foster
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M Hau
- Max Planck Institute for Ornithology, Seewiesen, Germany
| | - D T Haydon
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - D G Hazlerigg
- Department of Arctic and Marine Biology, University of Tromso, Tromso, Norway
| | - P Heideman
- Department of Biology, The College of William and Mary, Williamsburg, VA, USA
| | - J G C Hopcraft
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - N N Jonsson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | | | - V Kumar
- Department of Zoology, University of Delhi, Delhi, India
| | - G A Lincoln
- School of Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - R MacLeod
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - S A M Martin
- Department of Animal Ecology, Nederlands Instituut voor Ecologie, Wageningen, The Netherlands
| | - M Martinez-Bakker
- Department of Ecology and Evolution, University of Michigan, Ann Arbor, MI, USA
| | - R J Nelson
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - T Reed
- Aquaculture and Fisheries Development Centre, University of College Cork, Cork, Ireland
| | - J E Robinson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - D Rock
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - W J Schwartz
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - I Steffan-Dewenter
- Department of Animal Ecology and Tropical Biology, University of Wuerzburg, Wuerzburg, Germany
| | - E Tauber
- Department of Genetics, University of Leicester, Leicester, UK
| | - S J Thackeray
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - C Umstatter
- Agroscope, Tanikon, CH-8356 Ettenhausen, Switzerland
| | - T Yoshimura
- Department of Applied Molecular Biosciences, University of Nagoya, Nagoya, Japan
| | - B Helm
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
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Ashoorian D, Davidson R, Rock D, Dragovic M, Clifford R. A clinical communication tool for the assessment of psychotropic medication side effects. Psychiatry Res 2015; 230:643-57. [PMID: 26518225 DOI: 10.1016/j.psychres.2015.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/16/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
The primary aim was to assess usability of the My Medicines and Me Questionnaire (M3Q) as a self-reported questionnaire for mental health patients to subjectively express side effects experienced with their psychotropic medications. The secondary aim was to evaluate patients' attitudes towards treatment and psychotropic medications following dialogue with their clinicians about side effects. Questionnaires were administered at six adult mental health facilities. A total of 205 participants were divided into intervention (facilitated dialogue) and non-intervention groups (no facilitated dialogue). The mean completion time for the M3Q was 15min (SD=6.5) with only 11 (5%) patients requiring assistance. The most commonly reported side effect was sedation (77%) and weight gain was ranked as the most bothersome (23%). The previously validated M3Q provided patients with the opportunity to express the impact these effects had on their lives. Side effects were the most common reason given for non-adherence. There were no significant changes in patient attitudes towards treatment and medications in the intervention group, mainly due to the logistical challenges in the clinicians' ability to view the questionnaire for the subsequent meeting with the patient. The M3Q demonstrated its usability in allowing patients to easily express their subjective experiences with side effects.
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Affiliation(s)
- Deena Ashoorian
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA 6009, Australia.
| | - Rowan Davidson
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA 6009, Australia; North Metropolitan Health Service Mental Health, Mt Hawthorn, WA 6016, Australia
| | - Daniel Rock
- North Metropolitan Health Service Mental Health, Mt Hawthorn, WA 6016, Australia; School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA 6009, Australia; School of Population Health, The University of Western Australia, Crawley, WA 6009, Australia
| | - Milan Dragovic
- North Metropolitan Health Service Mental Health, Mt Hawthorn, WA 6016, Australia; School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA 6009, Australia
| | - Rhonda Clifford
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA 6009, Australia
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Abstract
Historically, mental health services have faced challenges in their ability to attract and retain a competent nursing workforce in the context of an overall nursing shortage. The current economic downturn has provided some respite; however, this is likely to be a temporary reprieve, with significant nursing shortages predicted for the future. Mental health services need to develop strategies to become more competitive if they are to attract and retain skilled nurses and avoid future shortages. Research demonstrates that creating and maintaining a positive nursing practice environment is one such strategy and an important area to consider when addressing nurse retention. This paper examines the impact the nursing practice environment has on nurse retention within the general and mental health settings. Findings indicate, that while there is a wealth of evidence to support the importance of a positive practice environment on nurse retention in the broader health system, there is little evidence specific to mental health. Further research of the mental health practice environment is required.
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Affiliation(s)
- Robina Redknap
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Graylands Hospital, North Metropolitan Health Service, Mental Health, Perth, Western Australia, Australia
| | - Di Twigg
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel Rock
- North Metropolitan Health Service, Mental Health, Perth, Western Australia, Australia.,School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, Western Australia, Australia.,School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Amanda Towell
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Hauck Y, Nguyen T, Frayne J, Garefalakis M, Rock D. Sexual and Reproductive Health Trends Among Women With Enduring Mental Illness: A Survey of Western Australian Community Mental Health Services. Health Care Women Int 2015; 36:499-510. [DOI: 10.1080/07399332.2014.973957] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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23
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Nguyen TN, Faulkner D, Frayne JS, Allen S, Hauck YL, Rock D, Rampono J. Obstetric and neonatal outcomes of pregnant women with severe mental illness at a specialist antenatal clinic. Med J Aust 2014; 199:S26-9. [PMID: 25369845 DOI: 10.5694/mja11.11152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 02/08/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the obstetric and neonatal outcomes of pregnant women with severe mental illness (SMI) who attended a specialist multidisciplinary antenatal clinic in Perth, Western Australia. DESIGN, SETTING AND PARTICIPANTS A retrospective case-note audit of outcomes from the Childbirth and Mental Illness Antenatal Clinic (CAMI clinic) at King Edward Memorial Hospital for pregnant women with severe mental illness (SMI), aged 18-41 years, who gave birth between December 2007 and April 2011, and their babies. MAIN OUTCOME MEASURES Obstetric and neonatal outcomes for 138 women and newborns from singleton live births. Data were compared between three diagnostic groups (schizophrenia, bipolar and non-psychotic SMI), and with WA obstetric and perinatal statistics for 2008. RESULTS 44 women with schizophrenia, 56 with bipolar disorder and 38 with non-psychotic SMI attended antenatal care for an average of 7.7 (SD, 3.3) visits. The proportion of women who smoked tobacco was significantly higher than that in the WA antenatal population (46% v 15%; P < 0.0001). Alcohol use, illicit substance use and psychotropic medication exposure during pregnancy were high. The women were at increased risk of developing gestational diabetes mellitus (15% v 4%; P < 0.0001) and pre-eclampsia (9% v 3%; P < 0.0001), and birth complications were more common. Babies born to CAMI clinic women were less likely to have Apgar scores ≥ 8 at 1 minute and 5 minutes. Pregnant women with schizophrenia had more psychiatric relapses during pregnancy, and had more statutory child welfare involvement. Gestational age at birth and infant birth weights were similar for the pregnant women with SMI and the WA population in 2008. CONCLUSIONS Women attending our specialist clinic had increased rates of obstetric and neonatal complications compared with the general population, and were exposed to a cluster of risk factors. We report encouraging trends in antenatal attendance, gestational age at birth, and birth weights. Managing pregnant women with SMI will require a comprehensive approach aimed at early detection of obstetric complications and psychosocial difficulties, as well as neonatal monitoring. Optimising prepregnancy maternal health and welfare may also be of benefit.
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Affiliation(s)
| | - Deb Faulkner
- Clinical Applications Unit, Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Perth, WA, Australia
| | | | | | | | - Daniel Rock
- Clinical Applications Unit, Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Perth, WA, Australia
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24
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Ashoorian D, Davidson R, Rock D, Gudka S, Clifford R. A review of self-report medication side effect questionnaires for mental health patients. Psychiatry Res 2014; 219:664-73. [PMID: 25034414 DOI: 10.1016/j.psychres.2014.05.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/04/2014] [Accepted: 05/30/2014] [Indexed: 11/18/2022]
Abstract
Side effects of psychotropic medications are important determinants of adherence to treatment. Discussion between the patient and clinician facilitated through the use of a side effect self-report questionnaire (SRQ) could lead to improved communications and treatment adherence. The aim of this review was to 1) identify all currently available side effect SRQs used in the assessment of mental health patients' subjective experiences, 2) evaluate the characteristics of the studies and 3) assess the psychometric properties of each of the questionnaires. Eight electronic databases were searched for peer-reviewed published articles. Six side effect SRQs were identified. Two independent reviewers assessed the quality of the study designs and psychometric properties of the identified SRQs. All questionnaires consisted of closed questions relating to antipsychotic side effects and completion times ranged from 5 to 20 min. Five questionnaires had undergone some form of psychometric testing, ranging from basic to comprehensive. There is a need in everyday clinical practice for a side effect communication tool applicable to all psychotropic medications, which allows the patient to express their subjective beliefs about their medications. This could provide an important contribution to the working relationship between patients and clinicians leading to informed decision-making and improved adherence.
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Affiliation(s)
- Deena Ashoorian
- Pharmacy Program, Center for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, M315, 35 Stirling Highway, Crawley, WA 6009, Australia.
| | - Rowan Davidson
- North Metropolitan Health Service Mental Health, WA 6016, Australia; School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA 6009, Australia
| | - Daniel Rock
- North Metropolitan Health Service Mental Health, WA 6016, Australia; School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA 6009, Australia; School of Population Health, The University of Western Australia, Crawley, WA 6009, Australia
| | - Sajni Gudka
- Pharmacy Program, Center for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, M315, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Rhonda Clifford
- Pharmacy Program, Center for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, M315, 35 Stirling Highway, Crawley, WA 6009, Australia
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25
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Davison S, Hauck Y, Martyr P, Rock D. How mental health clinicians want to evaluate the care they give: a Western Australian study. AUST HEALTH REV 2013; 37:375-80. [PMID: 23601621 DOI: 10.1071/ah12171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 11/21/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To explore how Western Australian mental health clinicians want to evaluate their care. METHODS; Using a participatory action research framework, 10 senior psychiatrists and 11 clinical nurse specialists working in an inpatient mental health setting participated in individual interviews, focus groups and meetings. All interviews were de-identified during transcription and transcripts and field notes were analysed for common themes. RESULTS Participants identified what they wanted to measure, how they wanted to measure it and how these changes could be implemented. Clinicians stressed the importance of measuring context (physical, clinical and service) and process as well as outcome, and of evaluating care at an individual and service level with consumer involvement. What is known about the topic? Completion rates of mandatory national outcome measures in mental health in Australia are variable and clinicians have mixed views as to their value. Several barriers have been identified as to their use including clinical, resource and ownership issues. What does this paper add? Some studies have identified areas of good practice and elicited practical suggestions for improvement but few have asked clinicians how they actually want to evaluate the care they provide. This study explored how mental health clinicians wanted to evaluate their care, using a participatory action research framework that encouraged participants to pinpoint problems and issues, account for their social context and develop actions to address them. What are the implications for practitioners? Clinicians were enthusiastic for high quality care and evaluation, but pessimistic about their ability to introduce sustainable change. Establishing and supporting active and responsible leadership at service level may solve this, as may encouraging local standard setting and benchmarking in collaboration with consumers and carers.
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Affiliation(s)
- Sophie Davison
- North Metropolitan Area Health Service, Mt Claremont, WA 6010, Australia.
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26
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Power BD, Dragović M, Rock D. Clusters according to patient need in a long-stay inpatient population with schizophrenia: does executive dysfunction underpin needs-directed care? Soc Psychiatry Psychiatr Epidemiol 2013; 48:621-30. [PMID: 22961292 DOI: 10.1007/s00127-012-0579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 08/23/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify the external validators of patient clusters according to need in a long-stay inpatient population with schizophrenia. METHODS We recruited without exclusion 112 in-patients with chronic schizophrenia in a long-stay rehabilitation facility of a major psychiatric hospital in Perth, Western Australia. Case managers completed a number of measures for participants, including The Camberwell Assessment of Need-Short Appraisal Schedule, which evaluates health and social needs. Latent class analysis according to patient need was performed to identify clusters within the cohort. One way analysis of variance was used to identify the external validators of these clusters, using variables obtained from the additional study measures (Social Behaviour Schedule, Global Assessment of Function, Basic Everyday Living Skills, Behaviour Rating Inventory of Executive Function-Adult version). RESULTS Three distinct needs-based clusters with different external profiles were identified. A "low unmet needs" group (n = 50) with relatively intact executive function, with the least problematic behaviour and most independent functioning; a "high unmet need (drug abstinent)" group (n = 43) with greatest executive dysfunction, most problematic behaviour and least independent function; a "high unmet need (drug using)" group (n = 19), with less severe executive dysfunction, and intermediate relative to the other groups on measures of social behaviour and independent functioning. CONCLUSIONS The clinical heterogeneity we have identified, which may well be explained by executive dysfunction, suggests further exploration of appropriate assessment and streams of care for those in the rehabilitation setting is warranted.
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Affiliation(s)
- Brian D Power
- North Metropolitan Area Health Service, Perth, Australia.
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27
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Abstract
Few tools assessing neurocognitive dysfunction in schizophrenia are able to measure integrated executive functions in the context of the problem-solving demands of a patient's everyday world. The authors evaluated the BRIEF-A (Behavior Rating Inventory of Executive Function-Adult version) Informant Report in 112 inpatients with chronic schizophrenia in a rehabilitation hospital. Factor analysis yielded a three-factor solution (Emotional Regulation, Problem-Solving, Orderliness). The BRIEF-A is psychometrically robust in this population and, in the absence of patient participation, provides an estimate of executive functions in a population that may otherwise be beyond the reach of formal neurocognitive testing.
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28
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Waters F, Faulkner D, Naik N, Rock D. Effects of polypharmacy on sleep in psychiatric inpatients. Schizophr Res 2012; 139:225-8. [PMID: 22658525 DOI: 10.1016/j.schres.2012.05.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 04/23/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022]
Abstract
The relationship between psychotropic drugs and sleep remains poorly understood. In this study, we examined the relationship between the number (and dosage) of concurrently-taken antipsychotic medications and sleep in a psychiatric inpatient population. Eighty-three long-stay inpatients with severe mental disorders were administered the Pittsburgh Sleep Quality Index questionnaire (PSQI). Results showed that increasing antipsychotics dosages were linked to better sleep, although antipsychotic medications only accounted for a relatively small amount of the variance in sleep quality. The results also showed that, when taken in combination with several antipsychotics, SSRI/SNRI antidepressants failed to show the expected disruptive effects on sleep patterns and daytime functions. Altogether, sleep complaints remained pervasive in 70% of this medicated clinical sample. This suggests that the use of the sedative properties of antipsychotic medication has limited efficacy as a treatment option for sleep dysfunctions, and is not an appropriate substitute for other sleep interventions. Altogether, the results support the case for more systematic screening and interventions for sleep problems in patients with severe psychiatric illness.
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Affiliation(s)
- Flavie Waters
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.
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29
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Nguyen TN, Faulkner D, Frayne JS, Allen S, Hauck YL, Rock D, Rampono J. Obstetric and neonatal outcomes of pregnant women with severe mental illness at a specialist antenatal clinic. ACTA ACUST UNITED AC 2012. [DOI: 10.5694/mjao11.11152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Abstract
OBJECTIVE The 'embodied cognition' hypothesis suggests a close relationship between internal self-representations and the outward expression of social behaviours and emotions. Given self-awareness disturbances in patients with first-rank symptoms (FRS), we hypothesized that these patients would show abnormal social behaviours. In this study, we examined the social interactive skills of patients with first-episode psychosis during an interview, together with changes in performance over time. METHOD We analysed previously unreported data from 227 patients with first-episode psychosis (90 with, and 137 without, FRS) who took part in the WHO multicentre study on the Determinants of Outcome of Severe Mental Disorders. They were assessed on the Psychological Impairment Rating Schedule (PIRS) and examined again after 2 years. RESULTS A principal component analysis on the Psychosocial Impairment Rating Schedule produced two factors (interactive skills; withdrawal from interactions). Patients with FRS showed greater impairments in the domain linked to 'interactive skills', which remained 2 years after the first experience of a psychotic illness. These findings were not explained by clinical characteristics, or presence of non-FRS delusions. CONCLUSION Self-awareness deficits, as indexed by the FRS symptom cluster, are linked to deficits in social interactive behaviours. These abnormalities are indicative of 'social dysmetria' in this group, which involves difficulties conveying motor aspects of behaviours, volition and affect to facilitate mutual communication. These findings point to the utility of behavioural assessment scales in clinical and research settings.
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Affiliation(s)
- F Waters
- Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Perth, Australia
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31
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Waters F, Sinclair C, Rock D, Jablensky A, Foster RG, Wulff K. Daily variations in sleep-wake patterns and severity of psychopathology: a pilot study in community-dwelling individuals with chronic schizophrenia. Psychiatry Res 2011; 187:304-6. [PMID: 21272939 DOI: 10.1016/j.psychres.2011.01.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 12/30/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
Abstract
The daily co-occurrence of change in sleep characteristics and psychopathology was examined in six individuals with schizophrenia and seven healthy controls using a prospective assessment of rest-activity patterns conducted in the person's home for up to 28 days. The results provide preliminary evidence that a change in sleep-wake timing is followed by a change in symptom severity.
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Affiliation(s)
- Flavie Waters
- Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Australia.
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32
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Pearson J, Dahal UP, Rock D, Peng CC, Schenk JO, Joswig-Jones C, Jones JP. The kinetic mechanism for cytochrome P450 metabolism of type II binding compounds: evidence supporting direct reduction. Arch Biochem Biophys 2011; 511:69-79. [PMID: 21530484 DOI: 10.1016/j.abb.2011.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 04/13/2011] [Accepted: 04/14/2011] [Indexed: 11/17/2022]
Abstract
The metabolic stability of a drug is an important property that should be optimized during drug design and development. Nitrogen incorporation is hypothesized to increase the stability by coordination of nitrogen to the heme iron of cytochrome P450, a binding mode that is referred to as type II binding. However, we noticed that the type II binding compound 1 has less metabolic stability at sub-saturating conditions than a closely related type I binding compound 3. Three kinetic models will be presented for type II binder metabolism; (1) Dead-end type II binding, (2) a rapid equilibrium between type I and II binding modes before reduction, and (3) a direct reduction of the type II coordinated heme. Data will be presented on reduction rates of iron, the off rates of substrate (using surface plasmon resonance) and the catalytic rate constants. These data argue against the dead-end, and rapid equilibrium models, leaving the direct reduction kinetic mechanism for metabolism of the type II binding compound 1.
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Affiliation(s)
- Joshua Pearson
- Department of Pharmacokinetics and Drug Metabolism, Amgen Inc., Seattle, WA 98119, United States
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33
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Nguyen TN, Faulkner D, Allen S, Hauck YL, Frayne J, Rock D, Rampono J. Managing pregnant women with serious mental illness: using the Edinburgh Postnatal Depression Scale as a marker of anxiety and depressive symptoms. Aust N Z J Psychiatry 2010; 44:1036-42. [PMID: 21034187 DOI: 10.3109/00048674.2010.503185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the course of depressive and anxiety symptoms using serial measurements of the Edinburgh Postnatal Depression Scale (EPDS) in pregnant women with serious mental illness (SMI) attending a specialist multi-disciplinary antenatal clinic in Perth, Western Australia. METHOD A retrospective review of case notes was undertaken for 48 Western Australian pregnant women with schizophrenia and related psychoses and bipolar affective disorders who attended the Childbirth and Mental Illness (CAMI) antenatal clinic between December 2007 and November 2009. Of these patients, 27 completed the EPDS at booking (first appointment) and at 32 weeks gestation. Additional variables collected were demographic data, gestation at booking, and attendance rates for these 27 women, and for comparison another 21 women who did not complete the EPDS for one or both screening periods. RESULTS Mean total EPDS score decreased from 12.2 (SD 7.6) at booking to 8.5 (SD 6.4) at 32 weeks gestation (p = 0.007). Overall mean attendance rates and number of appointments were similar to the non-SMI population and in keeping with standard guidelines. CONCLUSIONS We speculate from these preliminary findings that being managed by a consistent small multi-disciplinary team and knowing that they will be supported throughout their pregnancy could lead to improvement of anxiety and depressive symptoms in pregnant women with SMI, and has the potential to increase their attendance for antenatal care.
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Affiliation(s)
- Thinh N Nguyen
- King Edward Memorial Hospital, University of Western Australia, Australia.
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34
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Chandler D, Dragović M, Cooper M, Badcock JC, Mullin BH, Faulkner D, Wilson SG, Hallmayer J, Howell S, Rock D, Palmer LJ, Kalaydjieva L, Jablensky A. Impact of Neuritin 1 (NRN1) polymorphisms on fluid intelligence in schizophrenia. Am J Med Genet B Neuropsychiatr Genet 2010; 153B:428-437. [PMID: 19569075 DOI: 10.1002/ajmg.b.30996] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Neuritin 1 (NRN1), an activity-regulated gene with multiple roles in neurodevelopment and synaptic plasticity, is located within the 6p24-p25 interval on chromosome 6, previously identified as linked to a subtype of schizophrenia (SZ) characterized by pervasive cognitive deficit (CD). We have tested the effect of NRN1 sequence variation on susceptibility to SZ and on general cognitive ability in patients and non-psychiatric control subjects by re-sequencing the coding regions of NRN1 and its flanking sequences, and genotyping 19 single-nucleotide polymorphisms (SNPs) in 336 SZ patients and 172 healthy control individuals. All participants completed comprehensive neurocognitive assessment, including tests estimating premorbid/prior IQ and current IQ. Logistic regression analyses found no significant association for any of the 19 SNPs with SZ or its CD subtype. However, linear regression analysis gave significant association (P = 0.024 and P = 0.027 after correction for multiple testing) for polymorphisms rs1475157 and rs9405890 with current IQ in the patient group. In SZ, the rs1475157-rs9405890 haplotypes revealed a highly significant association with the abstraction component of current ("fluid") intelligence (P = 0.0014), and with percentage loss of IQ points between premorbid and current intelligence (P = 0.0041). Results in the control group were not significant after correction. This is the first analysis of association between variation in NRN1 and SZ. The findings suggest a role of NRN1 as a modifier of cognitive functioning in SZ, with implications for future research into the impact of the environment on the development and maintenance of "fluid" intelligence.
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Affiliation(s)
- David Chandler
- Centre for Medical Research/Western Australian Institute for Medical Research, The University of Western Australia, Perth, Australia.,Centre for Clinical Research in Neuropsychiatry and School of Psychiatry and Clinical Neurosciences, Graylands Hospital, The University of Western Australia, Perth, Australia
| | - Milan Dragović
- Centre for Clinical Research in Neuropsychiatry and School of Psychiatry and Clinical Neurosciences, Graylands Hospital, The University of Western Australia, Perth, Australia
| | - Matthew Cooper
- Centre for Medical Research/Western Australian Institute for Medical Research, The University of Western Australia, Perth, Australia.,Centre for Genetic Epidemiology and Biostatistics, The University of Western Australia, Perth, Australia
| | - Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry and School of Psychiatry and Clinical Neurosciences, Graylands Hospital, The University of Western Australia, Perth, Australia
| | - Benjamin H Mullin
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital and School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - Deb Faulkner
- Centre for Clinical Research in Neuropsychiatry and School of Psychiatry and Clinical Neurosciences, Graylands Hospital, The University of Western Australia, Perth, Australia
| | - Scott G Wilson
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital and School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioural Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Sarah Howell
- Centre for Clinical Research in Neuropsychiatry and School of Psychiatry and Clinical Neurosciences, Graylands Hospital, The University of Western Australia, Perth, Australia
| | - Daniel Rock
- Centre for Clinical Research in Neuropsychiatry and School of Psychiatry and Clinical Neurosciences, Graylands Hospital, The University of Western Australia, Perth, Australia
| | - Lyle J Palmer
- Centre for Genetic Epidemiology and Biostatistics, The University of Western Australia, Perth, Australia
| | - Luba Kalaydjieva
- Centre for Medical Research/Western Australian Institute for Medical Research, The University of Western Australia, Perth, Australia
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry and School of Psychiatry and Clinical Neurosciences, Graylands Hospital, The University of Western Australia, Perth, Australia
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Hauck Y, Rock D, Jackiewicz T, Jablensky A. Healthy babies for mothers with serious mental illness: a case management framework for mental health clinicians. Int J Ment Health Nurs 2008; 17:383-91. [PMID: 19128285 DOI: 10.1111/j.1447-0349.2008.00573.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Women with a serious mental illness (SMI), notably schizophrenia, bipolar disorder, and personality disorders are considered high risk for adverse pregnancy and birth outcomes, which in turn, are associated with poor neurodevelopment in the child. Failure to access antenatal care, poor adherence with folate supplementation, an unhealthy lifestyle, and inappropriate health decisions can contribute to poor outcomes. Many women with SMI continue contact with mental health services while pregnant. This primary prevention project aimed to develop a framework for community mental health clinicians to improve the reproductive health outcomes for women with SMI. The consultation process involved discussions with key stakeholders, an environmental scan to determine current service delivery issues, a literature review, and individual and group interviews with community mental health clinicians, consumers, general practitioners, and midwives. Three key elements underpin the framework: early detection and monitoring of pregnancy, providing reproductive choices, and implementing a 'small known team approach' in the management of the pregnant client. Specific modules within the framework focus upon establishing a professional support network, assessing the risk of pregnancy, the early detection of pregnancy, monitoring during pregnancy, preparing for birth, and planning for the postnatal period. Implementation of the framework has the potential to significantly improve obstetric and neonatal outcomes for this high-risk group.
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Affiliation(s)
- Yvonne Hauck
- School of Nursing and Midwifery, Curtin University of Technology, Perth, Western Australia.
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Abstract
BACKGROUND Although behavioural dominance of the right hand in humans is likely to be under genetic control, departures from this population norm, i.e. left- or non-right-handedness, are believed to be influenced by environmental factors. Among many such environmental factors including, for example, low birth weight, testosterone level, and maternal age at birth, season of birth has occasionally been investigated. The overall empirical evidence for the season of birth effect is mixed. METHODS We have investigated the effect of season of birth in an epidemiologically robust sample of randomly selected young people (n = 977), all born in the same year. A Kolmogorov-Smirnov type statistical test was used to determine season of birth. RESULTS Neither the right-handed nor the non-right-handed groups demonstrated birth asymmetry relative to the normal population birth distribution. There was no between-group difference in the seasonal distribution of birth when comparing the right-handed to the non-right-handed groups. CONCLUSION The present study failed to provide support for a season of birth effect on atypical lateralisation of handedness in humans.
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Affiliation(s)
- Sanja Milenković
- Institute for Hygiene and Medical Ecology, School of Medicine, University of Belgrade, Serbia
| | - Daniel Rock
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia.,Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Western Australia, Australia
| | - Milan Dragović
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia.,Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Western Australia, Australia
| | - Aleksandar Janca
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia
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Rock D, Greenberg D, Hallmayer J. Season-of-birth as a risk factor for the seasonality of suicidal behaviour. Eur Arch Psychiatry Clin Neurosci 2006; 256:98-105. [PMID: 16155787 DOI: 10.1007/s00406-005-0614-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 07/25/2005] [Indexed: 10/25/2022]
Abstract
Despite implicating the same biological systems, the relationship between suicide seasonality and season-of-birth has not been examined previously. The purpose of this study was to investigate the interaction between season-of-birth and the seasonality of suicidal behaviour. All adult suicides (N = 2923) and deliberate self harm (DSH) hospitalizations (N = 33321) in Western Australia (1970-96) were examined. A variable population at risk approach was used to determine season-of-birth. Seasonality was established by spectral analysis. We found that DSH has a significant season-of-birth (p = 0.047) and seasonality of occurrence, both peaking in spring. Individuals born in the 90 days centred on the peak birth period, however, show no DSH seasonality. In contrast, suicide has no season-of-birth (p = 0.53). We also found a season-of-birth effect among the DSH group that eliminates any seasonality of DSH among the high-risk by birth group. Further work is needed to identify the possible biological and environmental determinants of this interaction.
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Affiliation(s)
- Daniel Rock
- Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Locked Bag No 1, Claremont, Western Australia, 6901, Australia
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Abstract
The northern spotted owl (Strix occidentalis caurina (Merriam, 1898)) is listed as threatened in both Canada and the United States. As part of a 1998–2004 study of habitat usage, we attached radio tags to 197 northern spotted owls. Owls that died or emigrated from the study areas could be identified with high certainty. The long-term data we obtained enabled us to estimate survivorship using multiple statistical methods. Using a pooled data set, we estimated annual survivorship at 0.927. Using a year-by-year analysis, we obtained some variation in survival by year, but the same overall mean. Using a staggered-entry cohort approach, we obtained an estimate of 0.934. Mean annual survival estimated by program MARK was 0.927. These estimates are outside the confidence intervals of prior studies that used capture–recapture methods. Capture–recapture methods are based on the assumption that birds remain within a demographic study area, but our data suggest that owls may disperse or remain undetected within a study area often enough that capture–recapture methods may overestimate mortality. Our results imply that the true finite population growth rate, λ, may be higher than estimated in prior studies that used capture–recapture methods.
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Hallmayer JF, Kalaydjieva L, Badcock J, Dragović M, Howell S, Michie PT, Rock D, Vile D, Williams R, Corder EH, Hollingsworth K, Jablensky A. Genetic evidence for a distinct subtype of schizophrenia characterized by pervasive cognitive deficit. Am J Hum Genet 2005; 77:468-76. [PMID: 16080121 PMCID: PMC1226211 DOI: 10.1086/432816] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Accepted: 06/16/2005] [Indexed: 11/03/2022] Open
Abstract
A novel phenotyping strategy in schizophrenia, targeting different neurocognitive domains, neurobehavioral features, and selected personality traits, has allowed us to identify a homogeneous familial subtype of the disease, characterized by pervasive neurocognitive deficit. Our genome scan data indicate that this subtype, which accounts for up to 50% of our sample, has a distinct genetic basis and explains linkage to chromosome 6p24 reported previously. If representative of other populations, the ratio of schizophrenia subtypes observed in our families could have a profound impact on sample heterogeneity and on the power of genetic studies to detect linkage and association. Our proposed abbreviated battery of tests should facilitate phenotype characterization for future genetic analyses and allow a focus on a crisply defined schizophrenia subtype, thus promoting a more informed search for susceptibility genes.
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Affiliation(s)
- Joachim F. Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
| | - Luba Kalaydjieva
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
| | - Johanna Badcock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
| | - Milan Dragović
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
| | - Sarah Howell
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
| | - Patricia T. Michie
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
| | - Daniel Rock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
| | - David Vile
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
| | - Rachael Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
| | - Elizabeth H. Corder
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
| | - Kate Hollingsworth
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
| | - Assen Jablensky
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neuroscience, Western Australian Institute for Medical Research, and Centre for Medical Research, The University of Western Australia, and Neurodegenerative Disorders Centre, Queen Elizabeth II Medical Centre, Perth, Australia; School of Behavioural Sciences, The University of Newcastle, Callaghan, Australia; and Center for Demographic Studies, Duke University, Durham, NC
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Abstract
Previous studies have found that rates of suicide have a distinct annual rhythm with a peak in spring. Two recent European studies, however, have found that the amplitude of this rhythm has decreased over time. The purpose of this study was to examine whether such effects are found in Australia. Australian Bureau of Statistics data on all suicides in Australia 1970-1999 were analysed by spectral analysis. We found that suicide, violent suicide and suicide by males are seasonal and that the seasonal amplitude has increased over time. Males who use violent methods determine the seasonal effect. These results support previous findings that suicide and particularly violent suicide have a characteristic seasonal rhythm. However, the progressive increase in the amplitude of this rhythm over time in Australia is in direct contrast to other European findings. We suggest that this may be related to differences in patterns of anti-depressant use and also the effect of migration on the number of seasonally vulnerable individuals in Australia.
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Affiliation(s)
- Daniel Rock
- Centre for Clinical Research in Neuropsychiatry, Locked Bag No. 1, Claremont, Western Australia, 6910, Australia.
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Ioannidis JPA, Trikalinos TA, Law M, Carr A, Carr A, Barr D, Cooper DA, Emery S, Grinspoon S, Ioannidis J, Lewis R, Law M, Lichtenstein K, Murray J, Pizzuti D, Powderly WG, Rozenbaum W, Schambelan M, Puls R, Emery S, Moore A, Miller J, Carr A, Belloso WH, Ivalo SA, Clara LO, Barcan LA, Stern LD, Galich AM, Perman MI, Losso M, Duran A, Toibaro J, Baker D, Vale R, McFarlane R, MacLeod H, Kidd J, Genn B, Carr A, Fielden R, Mallal S, French M, Cain A, Skett J, Maxwell D, Mijch A, Hoy J, Pierce A, McCormick C, De Graaf B, Falutz J, Vatistas J, Dion L, Montaner J, Harris M, Phillips P, Montessori V, Valyi M, Stewart W, Walmsley S, Casciaro L, Lundgren J, Andersen O, Gronholdt A, Beguinot I, Mercié P, Chêne G, Reynes J, Cotte L, Rozenbaum W, Nait-Ighil L, Slama L, Nguyen TH, Rousselle C, Viard JP, Roudière L, Maignan A, Burgard M, Mauss S, Schmutz G, Scholten S, Oka S, Fraser H, Ishihara M, Itoh K, Reiss P, van der Valk M, Leunissen P, Nievaard M, van EckSmit B, Kujik CC, Paton N, Peperstraete B, Karim F, Khim CY, Ong S, Gatell J, Martinez E, Milinkovic A, Churchill D, Timaeus C, Maher T, Perry N, Bray A, Moyle G, Baldwin C, Higgs C, Reynolds B, Carpenter C, Bausserman L, Fiore T, DiSpigno M, Cohen C, Hellinger J, Foy K, Hubka S, Riccio B, El-Sadr W, Raghavan S, Chowdury N, de Vries B, Miller S, Hammer S, Crawford M, Chang S, Dobkin J, Quagliarello B, Gallagher D, Punyanitya M, Kessler H, Tenorio A, Kjos S, Falloon J, Lane HC, Rock D, Ehler L, Lichtenstein K, McClain T, Murphy R, Milne P, Powderly W, Aberg J, Klebert M, Conklin M, Ward D, Green L, Stearn B. HIV Lipodystrophy Case Definition using Artificial Neural Network Modelling. Antivir Ther 2003. [DOI: 10.1177/135965350300800511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective A case definition of HIV lipodystrophy has recently been developed from a combination of clinical, metabolic and imaging/body composition variables using logistic regression methods. We aimed to evaluate whether artificial neural networks could improve the diagnostic accuracy. Methods The database of the case-control Lipodystrophy Case Definition Study was split into 504 subjects (265 with and 239 without lipodystrophy) used for training and 284 independent subjects (152 with and 132 without lipodystrophy) used for validation. Back-propagation neural networks with one or two middle layers were trained and validated. Results were compared against logistic regression models using the same information. Results Neural networks using clinical variables only (41 items) achieved consistently superior performance than logistic regression in terms of specificity, overall accuracy and area under the ROC curve. Their average sensitivity and specificity were 72.4 and 71.2%, as compared with 73.0 and 62.9% for logistic regression, respectively (area under the ROC curve, 0.784 vs 0.748). The discriminating performance of the neural networks was largely unaffected when built excluding 13 parameters that patients may not have readily available. The average sensitivity and specificity of the neural networks remained the same when metabolic variables were also considered (total 60 items) without a clear advantage against logistic regression (overall accuracy 71.8%). The performance of networks considering also body composition variables was similar to that of logistic regression (overall accuracy 78.5% for both). Conclusions Neural networks may offer a means to improve the discriminating performance for HIV lipodystrophy, when only clinical data are available and a rapid approximate diagnostic decision is needed. In this context, information on metabolic parameters is apparently not helpful in improving the diagnosis of HIV lipodystrophy, unless imaging and body composition studies are also obtained.
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Affiliation(s)
- John PA Ioannidis
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Thomas A Trikalinos
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Matthew Law
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
| | - Andrew Carr
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
- HIV, Immunology and Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Australia
| | - A Carr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - D Barr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - DA Cooper
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (Massachusetts General Hospital, Boston, Mass., USA)
| | - S Grinspoon
- (Massachusetts General Hospital, Boston, Mass., USA)
| | | | - R Lewis
- (Agouron Pharmaceuticals, San Diego, Calif., USA)
| | - M Law
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - K Lichtenstein
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - J Murray
- (US Department of Health and Human Services Food and Drug Administration, Washington, DC, USA)
| | - D Pizzuti
- (Bristol-Myers Squibb, Princeton, NJ, USA, representing the European Medicines Evaluation Agency Oversight Committee)
| | - WG Powderly
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - W Rozenbaum
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - M Schambelan
- (University of California, San Francisco, Calif., USA; to September 2000)
| | - R Puls
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Moore
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - J Miller
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Carr
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - WH Belloso
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - SA Ivalo
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LO Clara
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LA Barcan
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LD Stern
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - AM Galich
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - MI Perman
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - M Losso
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - A Duran
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - J Toibaro
- (Hospital J M Ramos Mejía, Buenos Aires)
| | | | | | | | | | | | | | - A Carr
- (St Vincent's Hospital, Sydney)
| | | | | | | | - A Cain
- (Royal Perth Hospital, Perth)
| | - J Skett
- (Royal Perth Hospital, Perth)
| | | | - A Mijch
- (Alfred Hospital and Monash University, Melbourne)
| | - J Hoy
- (Alfred Hospital and Monash University, Melbourne)
| | - A Pierce
- (Alfred Hospital and Monash University, Melbourne)
| | - C McCormick
- (Alfred Hospital and Monash University, Melbourne)
| | - B De Graaf
- (Alfred Hospital and Monash University, Melbourne)
| | - J Falutz
- (Montreal General Hospital, Montreal)
| | | | - L Dion
- (Montreal General Hospital, Montreal)
| | | | | | | | | | - M Valyi
- (St Paul's Hospital, Vancouver)
| | | | | | | | - J Lundgren
- (Hvidovre University Hospital, Copenhagen)
| | - O Andersen
- (Hvidovre University Hospital, Copenhagen)
| | | | | | - P Mercié
- (Hôpital Haut-Lévêque, Bordeaux)
| | - G Chêne
- (Hôpital Haut-Lévêque, Bordeaux)
| | - J Reynes
- (Hôpital Gui de Chauliac, Montpellier)
| | - L Cotte
- (Hôpital Gui de Chauliac, Montpellier)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - P Reiss
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M van der Valk
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - P Leunissen
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M Nievaard
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - B van EckSmit
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - C can Kujik
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - N Paton
- (Tan Tock Seng Hospital, Singapore)
| | | | - F Karim
- (Tan Tock Seng Hospital, Singapore)
| | - C Y Khim
- (Tan Tock Seng Hospital, Singapore)
| | - S Ong
- (Tan Tock Seng Hospital, Singapore)
| | - J Gatell
- (Hospital Clinic Provincial de Barcelona)
| | - E Martinez
- (Hospital Clinic Provincial de Barcelona)
| | | | | | | | | | | | - A Bray
- (Sussex Hospital, Brighton)
| | - G Moyle
- (Chelsea and Westminster Hospital, London)
| | - C Baldwin
- (Chelsea and Westminster Hospital, London)
| | - C Higgs
- (Chelsea and Westminster Hospital, London)
| | - B Reynolds
- (Chelsea and Westminster Hospital, London)
| | | | | | - T Fiore
- (Miriam Hospital, Providence, RI)
| | | | - C Cohen
- (Community Research Initiative of New England, Brookline, Mass.)
| | - J Hellinger
- (Community Research Initiative of New England, Brookline, Mass.)
| | - K Foy
- (Community Research Initiative of New England, Brookline, Mass.)
| | - S Hubka
- (Community Research Initiative of New England, Brookline, Mass.)
| | - B Riccio
- (Community Research Initiative of New England, Brookline, Mass.)
| | - W El-Sadr
- (Harlem Hospital Center, New York, NY)
| | | | | | | | - S Miller
- (Harlem Hospital Center, New York, NY)
| | - S Hammer
- (Columbia University, New York, NY)
| | | | - S Chang
- (Columbia University, New York, NY)
| | - J Dobkin
- (Columbia University, New York, NY)
| | | | | | | | - H Kessler
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - A Tenorio
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - S Kjos
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - J Falloon
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - HC Lane
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - D Rock
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - L Ehler
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | | | - T McClain
- (Denver Infectious Disease Consultants, Denver, Col.)
| | - R Murphy
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - P Milne
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - W Powderly
- (Washington University School of Medicine, St Louis, Mo.)
| | - J Aberg
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Klebert
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Conklin
- (Washington University School of Medicine, St Louis, Mo.)
| | - D Ward
- (Dupont Circle Physician's Group, Washington, DC)
| | - L Green
- (Dupont Circle Physician's Group, Washington, DC)
| | - B Stearn
- (Dupont Circle Physician's Group, Washington, DC)
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Hallmayer JF, Jablensky A, Michie P, Woodbury M, Salmon B, Combrinck J, Wichmann H, Rock D, D'Ercole M, Howell S, Dragović M, Kent A. Linkage analysis of candidate regions using a composite neurocognitive phenotype correlated with schizophrenia. Mol Psychiatry 2003; 8:511-23. [PMID: 12808431 DOI: 10.1038/sj.mp.4001273] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As schizophrenia is genetically and clinically heterogeneous, systematic investigations are required to determine whether ICD-10 or DSM-IV categorical diagnoses identify a phenotype suitable and sufficient for genetic research, or whether correlated phenotypes incorporating neurocognitive performance and personality traits provide a phenotypic characterisation that accounts better for the underlying variation. We utilised a grade of membership (GoM) model (a mathematical typology developed for studies of complex biological systems) to integrate multiple cognitive and personality measurements into a limited number of composite graded traits (latent pure types) in a sample of 61 nuclear families comprising 80 subjects with ICD-10/DSM-IV schizophrenia or schizophrenia spectrum disorders and 138 nonpsychotic first-degree relatives. GoM probability scores, computed for all subjects, allowed individuals to be partly assigned to more than one pure type. Two distinct and contrasting neurocognitive phenotypes, one familial, associated with paranoid schizophrenia, and one sporadic, associated with nonparanoid schizophrenia, accounted for 74% of the affected subjects. Combining clinical diagnosis with GoM scores to stratify the entire sample into liability classes, and using variance component analysis (SOLAR), in addition to parametric and nonparametric multipoint linkage analysis, we explored candidate regions on chromosomes 6, 10 and 22. The results indicated suggestive linkage for the familial neurocognitive phenotype (multipoint MLS 2.6 under a low-penetrance model and MLS>3.0 under a high-penetrance model) to a 14 cM area on chromosome 6, including the entire HLA region. Results for chromosomes 10 and 22 were negative. The findings suggest that the familial neurocognitive phenotype may be a pleiotropic expression of genes underlying the susceptibility to paranoid schizophrenia. We conclude that use of composite neurocognitive and personality trait measurements as correlated phenotypes supplementing clinical diagnosis can help stratify the liability to schizophrenia across all members of families prior to linkage, allow the search for susceptibility genes to focus selectively on subsets of families at high genetic risk, and augment considerably the power of genetic analysis.
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Affiliation(s)
- J F Hallmayer
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.
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Abstract
BACKGROUND Previous studies have shown that surgical repair of paraesophageal hernias is associated with a high recurrence rate, especially when a laparoscopic approach is used. Anatomic recurrence due to crura breakdown is a primary etiology, which has led us to employ prosthetic mesh reinforcement of large hiatal defects (> 5 cm) since 1996. We discuss the evolution of this approach and describe our current technique with limited outcomes in 52 consecutive patients during a 5-year period. METHODS There were 31 males and 21 females, with a mean age of 57 years (range, 32-77 years) with symptomatic reflux and endoscopic or radiologic evidence of a large paraesophageal hernia. Utilizing a laparoscopic approach, the contents of the sac were reduced and the crura approximated with permanent interrupted sutures and a prosthetic mesh was secured over the repair as an on-lay reinforcement buttress. A Nissen (42) or Tilley (9) fundoplication was performed in all but 1 patient, and 18 patients (34%) required a wedge collis gastroplasty. Fifteen patients (28%) had a previous unsuccessful antireflux operation. RESULTS There was no perioperative morbidity or mortality. Follow-up averaged 25 months (range, 7-60 months). Postoperative gastroscopy or barium swallow have been performed in 27 patients to date, with 11 experiencing foregut symptoms. There has been 1 recurrence (1.9%) and no prosthetic erosion. CONCLUSION Early results suggest that prosthetic mesh cruroplasty may be effective in reducing recurrence after laparoscopic repair of large paraesophageal hernias, but long-term follow-up is required in all patients to determine the true incidence of anatomic recurrence and prosthetic erosion.
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Affiliation(s)
- J K Champion
- Department of Surgery, Emory Dunwoody Medical Center, 4575 North Shallowford Road, Atlanta, GA 30338, USA.
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Ott SL, Roberts S, Rock D, Allen J, Erlenmeyer-Kimling L. Positive and negative thought disorder and psychopathology in childhood among subjects with adulthood schizophrenia. Schizophr Res 2002; 58:231-9. [PMID: 12409163 DOI: 10.1016/s0920-9964(01)00339-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED The New York High-Risk Project (NYHRP) is a longitudinal study of offspring of parents with schizophrenia or affective disorder and normal controls. Neuropsychological deficits had been observed at about age 9 in subjects with adulthood schizophrenia. We explored whether in these subjects, early signs of clinical schizophrenia-related symptoms, such as thought disorder or behavioral abnormalities, could also be observed. METHODS We rated thought disorder and symptoms from videotaped interviews at age 9, using the Scale for the Assessment of Thought, Language and Communication (TLC), and the Mental Health Assessment Form (MHAF). With factor analyses we examined the structure of the ratings, and from interpretable factors, scales were assembled. MANOVAs were used to examine the effect of parental risk and adulthood psychiatric diagnosis (schizophrenia-related psychosis (SRP), major affective disorder (MAD), no disorder/other (NoDx/other)) as independent variables (IV) on thought disorder and symptoms as dependent variables. RESULTS Global, positive and negative thought disorder, and negative symptoms were significantly higher in subjects with adulthood schizophrenia-related psychosis than both comparison groups. A significant interaction between the two IVs was effective with respect to positive thought disorder. This scale was particularly elevated among subjects with adulthood schizophrenia-related psychosis at parental risk for affective disorder (all of whom had adulthood schizoaffective disorder). CONCLUSIONS We were able to show that global, negative and positive thought disorder and negative symptoms were present in subjects with adulthood schizophrenia already at mid-childhood, years before onset of psychosis. Further, we found a particularly high propensity to positive symptoms in subjects with adulthood schizophrenia who have also an affective component in their symptoms. This association, previously reported in acute schizophrenia, was here observed years before the first psychotic episode.
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Affiliation(s)
- S L Ott
- Department of Medical Genetics, New York Psychiatric Institute, Unit 06, New York, NY 10032, USA.
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Spear J, Chawla S, O'Reilly M, Rock D. Does the HoNOS 65+ meet the criteria for a clinical outcome indicator for mental health services for older people? Int J Geriatr Psychiatry 2002; 17:226-30. [PMID: 11921150 DOI: 10.1002/gps.592] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND A clinical indicator should demonstrate clinically meaningful change, be relevant, allow comparisons between services, be acceptable to clinicians, and have acceptable validity, reliability and sensitivity to change. The HoNOS 65+ has been suggested as a clinical outcome indicator. The sensitivity to change of the HoNOS 65+ is not known. METHODS This is a prospective study using routine clinical data. A pilot cohort (n = 42) was used to measure the concurrent validity of the HoNOS 65+ with the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and Brief Agitation Rating Scale (BARS). The main cohort of 245 consecutive referrals to a community mental health service for older adults was used to assess sensitivity to change against the CIBIC+. RESULTS The HoNOS 65+ was acceptable to case managers, most HoNOS 65+ items had excellent interrater reliability and the HoNOS 65+ had good concurrent validity. Changes in the HoNOS 65+ scores between assessment and discharge had a moderate, but significant correlation with CIBIC+ scores. CONCLUSION The HoNOS 65+ meets the criteria for a clinical outcome indicator for community mental health services for older people. The HoNOS 65+ is sensitive to change.
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Affiliation(s)
- Jon Spear
- Peel and Rockingham-Kwinana Mental Health Service for Older People, PO Box 288, Goddard Street, Rockingham, Perth, Western Australia 6169, Australia.
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Abstract
This study examines the impact of training and clinical experience on the inter-rater reliability of the HoNOS. Following either standard or modified HoNOS training, two groups of registered mental health nurses (RMHNs) were tested for inter-rater reliability (IRR) using a standard case vignette. In addition, another group of nurses and two nonclinical comparison groups had their IRR tested using the same vignette but without receiving any HoNOS training. There was no significant difference between IRR scores post-training compared with the pre-training scores. This is the case whether the recommended or modified training programmes were used. In addition, there is no significant difference between nurses and the comparison group, characterized by nonclinical work experience in a mental health setting. All four groups achieved adequate IRR. Finally, the comparison group with no regular exposure to mental health patients but experience using rating scales are significantly less reliable than the other four groups. The results suggest two possible interpretations. The first is that the HoNOS scales are so well designed that only familiarity with psychiatric patients and no experience with rating scales is sufficient to achieve adequate IRR even without training. Alternatively, the use of written vignettes does not provide a valid measure of HoNOS IRR.
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Affiliation(s)
- D Rock
- Centre for Clinical Research in Neuropsychiatry, Locked Bag No. 1, Claremont, WA 6010, Australia
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Rock D, Rock D, Jones JP. Inexpensive purification of P450 reductase and other proteins using 2',5'-adenosine diphosphate agarose affinity columns. Protein Expr Purif 2001; 22:82-3. [PMID: 11388803 DOI: 10.1006/prep.2001.1385] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Two reductases, P450 oxidoreductase and P450Bm-3 reductase, were purified on a 2',5'-adenosine diphosphate solid support. Although the efficiency of these columns is well established, the cost of the resin and the eluting material 2'-adenosine can be prohibitive. Herein we show that the less costly 2',3'-adenosine monophosphate is an excellent eluting material.
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Affiliation(s)
- D Rock
- Department of Chemistry, Washington State University, Pullman, WA 99164-4630, USA.
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Michie PT, Kent A, Stienstra R, Castine R, Johnston J, Dedman K, Wichmann H, Box J, Rock D, Rutherford E, Jablensky A. Phenotypic markers as risk factors in schizophrenia: neurocognitive functions. Aust N Z J Psychiatry 2000; 34 Suppl:S74-85. [PMID: 11129319 DOI: 10.1080/000486700226] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To review the literature on neurocognitive measures as risk markers for schizophrenia and to present data from the Perth family study of schizophrenia. Of all the risk markers that have been identified, the most promising are deficits in sustained attention. METHOD Inclusion in the review was determined by whether the research addressed a number of key questions: methods of assessing sustained attention; evidence of sustained attention deficits in patients and first-degree relatives including children; the importance of attentional dysfunction in the schizophrenic process and functional outcome; and the biological basis of sustained attention deficits. RESULTS Sustained attention deficits are evident in both patients and a proportion of their first-degree relatives, a finding replicated in preliminary data from the Perth family study. The literature suggests that the attention deficit is a stable enduring trait that is independent of clinical state. The neural basis of the deficit may be a functional disconnection between prefrontal and parietal cortex. Attention impairment is an important predictor of functional outcome in patients and the development of social dysfunction in adulthood in the at-risk offspring of patients. However, sustained attention deficits that are measured in childhood results in an unacceptable high false-positive rate (21%) when predicting which at-risk offspring of parents with schizophrenia will develop a schizophrenia spectrum disorder, although the overall classification accuracy (78%) is impressive. CONCLUSIONS The main findings are that sustained attention deficits are important risk markers for schizophrenia but need to be supplemented by other neurocognitive risk markers to improve predictive accuracy.
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Affiliation(s)
- P T Michie
- The University of Western Australia, Perth, Australia.
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