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Pourzinal D, Yang J, McMahon KL, Copland DA, Mitchell L, O'Sullivan JD, Byrne GJ, Dissanayaka NN. Hippocampal resting-state connectivity is associated with posterior-cortical cognitive impairment in Parkinson's disease. Brain Behav 2024; 14:e3454. [PMID: 38468574 DOI: 10.1002/brb3.3454] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 03/13/2024] Open
Abstract
AIM Frontal and posterior-cortical cognitive subtypes in Parkinson's disease (PD) present with executive/attention and memory/visuospatial deficits, respectively. As the posterior-cortical subtype is predicted to progress rapidly toward dementia, the present study aimed to explore biological markers of this group using resting-state functional magnetic resonance imaging (rs-fMRI). METHODS K-means cluster analysis delineated subtypes (cognitively intact, frontal, posterior-cortical, and globally impaired) among 85 people with PD. A subset of PD participants (N = 42) and 20 healthy controls (HCs) underwent rs-fMRI. Connectivity of bilateral hippocampi with regions of interest was compared between posterior-cortical, cognitively intact, and HC participants using seed-based analysis, controlling for age. Exploratory correlations were performed between areas of interest from the group analysis and a series of cognitive tests. RESULTS The posterior-cortical subtype (N = 19) showed weaker connectivity between the left hippocampus and right anterior temporal fusiform cortex compared to the cognitively intact (N = 11) group, p-false discovery rate (FDR) = .01, and weaker connectivity between bilateral hippocampi and most fusiform regions compared to HCs (N = 20). No differences were found between HCs and cognitively intact PD. Exploratory analyses revealed strongest associations between connectivity of the right anterior temporal fusiform cortex and left hippocampus with category fluency (p-FDR = .01). CONCLUSION Results suggest that weakened connectivity between the hippocampus and fusiform region is a unique characteristic of posterior-cortical cognitive deficits in PD. Further exploration of hippocampal and fusiform functional integrity as a marker of cognitive decline in PD is warranted.
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Affiliation(s)
- Dana Pourzinal
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
| | - Jihyun Yang
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Leander Mitchell
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - John D O'Sullivan
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Gerard J Byrne
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Nadeeka N Dissanayaka
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Australia
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Byrne GJ. Rasch modeling of IQCODE scores in people with dementia. Int Psychogeriatr 2024; 36:153-154. [PMID: 35975290 DOI: 10.1017/s1041610222000710] [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: 11/07/2022]
Affiliation(s)
- Gerard J Byrne
- Academy of Psychiatry, Faculty of Medicine, University of Queensland, Herston, QLD4006, Australia
- Mental Health Centre, Royal Brisbane & Women's Hospital, Herston, QLD4029, Australia
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Roper A, Brooks D, Mitchell LK, Pachana NA, Au TR, Byrne GJ, O'Sullivan JD, Dissanayaka NN. Feasibility and Acceptability of a Videoconferencing CBT Intervention for Anxiety in People with Parkinson's Disease. Clin Gerontol 2024:1-16. [PMID: 38277135 DOI: 10.1080/07317115.2024.2306861] [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: 01/27/2024]
Abstract
OBJECTIVES In people with Parkinson's disease (PwPD), non-motor symptoms such as anxiety are common and have negative impacts on their quality of life. There are currently few interventions that address anxiety in PwPD, and access to diagnosis and treatment is often limited for those living in rural areas. The aim of this study was to evaluate the feasibility and acceptability of a telehealth videoconferencing CBT intervention for anxiety in PwPD. METHODS A pre- and post-test feasibility study (N = 10) was conducted and evaluated utilizing the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). RESULTS Lack of access to the internet and videoconferencing technology were identified as barriers to participation. Physical health issues also impacted recruitment and retention. Non-completers were significantly older and less likely to have a carer involved in the intervention. Clinician adoption of the intervention was low while participant acceptability of videoconferencing technology varied and required carer support. CONCLUSIONS Providing access to technology and support to overcome technological issues, as well as telehealth training for clinicians, are recommended in future studies to improve recruitment, retention, and implementation. CLINICAL IMPLICATIONS Identification of barriers and facilitators provides future studies with the knowledge to tailorize their program to better suit PwPD.
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Affiliation(s)
- Amy Roper
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Deborah Brooks
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Tiffany R Au
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Gerard J Byrne
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - John D O'Sullivan
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
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Arnold R, Murphy-Smith J, Ng CH, Mischoulon D, Byrne GJ, Bousman CA, Stough C, Berk M, Sarris J. Predictors of the placebo response in a nutraceutical randomized controlled trial for depression. J Integr Med 2024; 22:46-53. [PMID: 38331652 DOI: 10.1016/j.joim.2024.01.007] [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] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 08/10/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The placebo response in depression studies is the change in symptoms amongst those who receive an inactive treatment. Many well-designed randomized controlled trials (RCTs) of depression have a high proportion of placebo responders, with little understanding as to why. The present study assesses characteristics associated with the placebo response in a nutraceutical trial with a large proportion of placebo responders. METHODS This is a secondary analysis of a nutraceutical depression RCT which identified no overall treatment benefit relative to placebo (n = 69 in placebo group). We investigated participant characteristics such as socio-demographics, clinical features, and recruitment methods, and their association with the placebo response. Monoaminergic genetic polymorphisms were also assessed. Placebo response was measured based on change in Montgomery-Asberg Depression Rating Scale score. The association of these hypothesis-driven variables of interest and the placebo response was examined using linear mixed effects models. RESULTS Greater levels of education, particularly pursuing post-high school education, better self-reported general health, marriage/de facto, greater improvement in the first trial week, and more failed antidepressant therapies in the current depressive episode were associated with greater placebo response. An increased placebo response was not found in those recruited via social media nor in those with concomitant antidepressant therapy. Single nucleotide polymorphisms from the tryptophan hydroxylase 1 (TPH1) gene (A779C and A218C) were weakly associated with greater placebo response, although the evidence was attenuated after accounting for multiple comparisons. CONCLUSION This is, to our knowledge, the first study within nutraceutical research for depression to assess the association between participant characteristics and variation in the placebo response. Several variables appeared to predict the placebo response. Such findings may encourage future trial designs which could dampen placebo response, improve assay sensitivity, and allow for treatment effects to be potentially more detectable. Please cite this article as: Arnold R, Murphy-Smith J, Ng CH, Mischoulon D, Byrne GJ, Bousman CA, Stough C, Berk M, Sarris J. Predictors of the placebo response in a nutraceutical randomized controlled trial for depression. J Integr Med. 2024; 22(1): 46-53.
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Affiliation(s)
- Rosemary Arnold
- Professorial Unit, the Melbourne Clinic, Department of Psychiatry, University of Melbourne, Richmond 3121, Australia
| | - Jenifer Murphy-Smith
- Professorial Unit, the Melbourne Clinic, Department of Psychiatry, University of Melbourne, Richmond 3121, Australia
| | - Chee H Ng
- Professorial Unit, the Melbourne Clinic, Department of Psychiatry, University of Melbourne, Richmond 3121, Australia
| | - David Mischoulon
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Gerard J Byrne
- Faculty of Medicine, Discipline of Psychiatry, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, the University of Queensland, Brisbane 4006, Australia
| | - Chad A Bousman
- Departments of Medical Genetics, Psychiatry, Physiology & Pharmacology and Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada; Department of Psychiatry, the University of Melbourne, Melbourne 3052, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University, Melbourne 3122, Australia
| | - Michael Berk
- Department of Psychiatry, the University of Melbourne, Melbourne 3052, Australia; The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong 3220, Australia; The Centre of Excellence in Youth Mental Health, the University of Melbourne, Parkville 3052, Australia; Florey Institute of Neuroscience and Mental Health, the University of Melbourne, Parkville 3052, Australia
| | - Jerome Sarris
- Florey Institute of Neuroscience and Mental Health, the University of Melbourne, Parkville 3052, Australia; NICM Health Research Institute, Western Sydney University, Westmead, NSW 2145, Australia.
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Cribb L, Sarris J, Savage KM, Byrne GJ, Metri NJ, Scholey A, Stough C, Bousman CA. Effect of kava (Piper methysticum) on peripheral gene expression among individuals with generalized anxiety disorder: A post hoc analysis of a randomized controlled trial. Phytother Res 2023; 37:5897-5903. [PMID: 37767766 DOI: 10.1002/ptr.7999] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/23/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023]
Abstract
Kava is a South Pacific plant-based medicine with anxiolytic properties, but little is known about the impact kava has on gene expression or whether gene expression can serve as a marker of kava response. This study aimed to determine whether kava treatment alters the expression of genes with physiological relevance to anxiety pathophysiology and whether the baseline expression of these physiologically relevant genes modifies the efficacy of kava treatment. In this post hoc analysis, we examined the expression of 48 genes relevant to the pathophysiology of anxiety collected from a double-blind randomized controlled trial that assessed the efficacy of kava treatment in generalized anxiety disorder. Peripheral blood gene expression was measured in 71 (34 kava, 37 placebo) adults at baseline and in 40 (19 kava, 21 placebo) after 8 weeks of treatment by reverse transcription polymerase chain reaction (PCR). Results revealed that kava decreased the expression of a subunit of the GABAA -rho receptor gene (GABRR2) and catechol-O-methyltransferase (COMT), a gene related to catecholamine metabolism. Kava efficacy was not found to be modified by baseline (pretreatment) expression of relevant genes. Although these results did not withstand statistical correction for multiple comparisons and require external validation, they support the notion that kava's mechanism of action includes interaction with GABAergic and catecholaminergic systems.
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Affiliation(s)
- Lachlan Cribb
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Karen M Savage
- Department of Psychiatry, ACT Health, Canberra, Australia
| | - Gerard J Byrne
- Department of Psychiatry, ACT Health, Canberra, Australia
- School of Clinical Medicine, Discipline of Psychiatry, The University of Queensland, Queensland, Australia
| | - Najwa-Joelle Metri
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Hawthorn, Swinburne University of Technology, Victoria, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Hawthorn, Swinburne University of Technology, Victoria, Australia
| | - Chad A Bousman
- Department of Medical Genetics, Psychiatry, Physiology & Pharmacology Calgary, Alberta, Canada
- Department of Psychiatry Parkville, Victoria, Australia
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Dissanayaka N, Pourzinal D, Byrne GJ, Yang J, McMahon KL, Pontone GM, O'Sullivan JD, Adam R, Littleford R, Chatfield M, Lehn A, Mari Z, Bakker A. Levetiracetam for the treatment of mild cognitive impairment in Parkinson's disease: a double-blind controlled proof-of-concept trial protocol. Pilot Feasibility Stud 2023; 9:189. [PMID: 37993889 PMCID: PMC10664284 DOI: 10.1186/s40814-023-01406-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Mild memory impairment, termed amnestic mild cognitive impairment (aMCI), is associated with rapid progression towards dementia in Parkinson's disease (PD). Studies have shown hyperactivation of hippocampal DG/CA3 subfields during an episodic memory task as a biomarker of aMCI related to Alzheimer's disease. This project investigates the feasibility of a trial to establish the efficacy of a repurposed antiepileptic drug, levetiracetam, in low doses as a putative treatment to target DG/CA3 hyperactivation and improve episodic memory deficits in aMCI in PD. Based on previous work, it is hypothesized that levetiracetam will normalize DG/CA3 overactivation in PD-aMCI participants and improve memory performance. METHODS Twenty-eight PD-aMCI participants, 28 PD participants without memory impairment (PD-nMI), and 28 healthy controls will be recruited. PD-aMCI participants will undertake a 12-week randomized, placebo-controlled, double-blind cross-over trial with a 14-day treatment of 125 mg levetiracetam or placebo twice daily, separated by a 4-week washout period. After each treatment period, participants will complete an episodic memory task designed to tax hippocampal subregion-specific function during high-resolution functional magnetic resonance imaging (fMRI). PD-nMI and healthy controls will undergo the fMRI protocol only, to compare baseline DG/CA3 subfield activity. RESULTS Episodic memory task performance and functional activation in the DG/CA3 subfield during the fMRI task will be primary outcome measures. Global cognition, PD severity, and adverse events will be measured as secondary outcomes. Recruitment, eligibility, and study completion rates will be explored as feasibility outcomes. CONCLUSIONS This study, the first of its kind, will establish hippocampal subregion functional impairment and proof of concept of levetiracetam as an early therapeutic option to reduce dementia risk in PD. TRIAL REGISTRATION ClinicalTrials.gov, NCT04643327 . Registered on 25 November 2020.
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Affiliation(s)
- Nadeeka Dissanayaka
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia.
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, Australia.
| | - Dana Pourzinal
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Jihyun Yang
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gregory M Pontone
- Department of Neurology, Johns Hopkins University, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, USA
| | - John D O'Sullivan
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | - Robert Adam
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | - Roberta Littleford
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Mark Chatfield
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University, Baltimore, USA
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, USA
| | - Arnold Bakker
- Department of Neurology, Johns Hopkins University, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, USA
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Pourzinal D, Yang J, Sivakumaran K, McMahon KL, Mitchell L, O'Sullivan JD, Byrne GJ, Dissanayaka NN. Longitudinal follow up of data-driven cognitive subtypes in Parkinson's disease. Brain Behav 2023; 13:e3218. [PMID: 37574595 PMCID: PMC10570472 DOI: 10.1002/brb3.3218] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023] Open
Abstract
AIM The dual syndrome hypothesis proposes that there are two cognitive subtypes in Parkinson's disease (PD): a frontal subtype with executive/attention impairment and gradual cognitive decline, and a posterior-cortical subtype with memory/visuospatial deficits and rapid cognitive decline. We aimed to compare the rate of global cognitive decline between subtypes derived using data-driven methods and explore their longitudinal performance within specific cognitive domains to better understand the prognosis of each subtype. METHOD Frontal, posterior-cortical, globally impaired, and cognitively intact PD subtypes were identified at baseline using k-means clustering (N = 85), and 29 participants (34%) returned for follow-up assessments on average 4.87 years from baseline. Linear mixed effects models compared progression of subtypes on global cognition; psychological symptoms; parkinsonism; and the memory, attention, executive, language, and visuospatial cognitive domains. RESULTS The frontal subtype was lost to attrition. While rate of change in parkinsonism, anxiety, and apathy differed between subtypes, there was no difference in the rate of global cognitive decline. However, the posterior-cortical subtype declined most rapidly in verbal memory, card sorting, trail making, and judgement of line orientation (JLO), while the cognitively intact group declined most rapidly on verbal memory and semantic fluency. The globally impaired subtype declined most rapidly in JLO, although this should be interpreted with caution due to high attrition. CONCLUSION Despite limited sample size, the present study supports the differential progression of the posterior-cortical subtype compared to cognitively intact and globally impaired PD. These results encourage further, large-scale longitudinal investigations of cognitive subtypes in PD.
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Affiliation(s)
- Dana Pourzinal
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Jihyun Yang
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Kumareshan Sivakumaran
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
| | - Katie L. McMahon
- School of Clinical Sciences, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Leander Mitchell
- School of PsychologyThe University of QueenslandSt. LuciaAustralia
| | - John D. O'Sullivan
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalHerstonQLDAustralia
| | - Gerard J. Byrne
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- Mental Health ServiceRoyal Brisbane and Women's HospitalHerstonQLDAustralia
| | - Nadeeka N. Dissanayaka
- Faculty of MedicineThe University of Queensland Centre for Clinical ResearchHerstonQLDAustralia
- School of PsychologyThe University of QueenslandSt. LuciaAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalHerstonQLDAustralia
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Yang J, Pourzinal D, Byrne GJ, McMahon KL, Copland DA, O'Sullivan JD, Mitchell L, Dissanayaka NN. Global assessment, cognitive profile, and characteristics of mild cognitive impairment in Parkinson's disease. Int J Geriatr Psychiatry 2023; 38:e5955. [PMID: 37318156 DOI: 10.1002/gps.5955] [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] [Received: 11/06/2022] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive deficits are evident throughout the course of Parkinson's disease (PD), with 24% of patients experiencing subtle cognitive disturbances at the time of diagnosis, and with up to 80% of patients developing PD dementia (PDD) at advanced stages of the disease PD patients with mild cognitive impairment (MCI), an at-risk phenotype of PDD, present with heterogeneous clinical characteristics that complicate the management of PD. OBJECTIVES This study aims to examine the characteristics of PD-MCI by using the Movement Disorder Society (MDS) diagnostic criteria and evaluate the validity of global cognitive scales in identifying PD-MCI. METHODS Seventy-nine (79) PD patients completed neuropsychological assessments and a comprehensive cognitive battery. PD-MCI was classified according to the level 2 MDS task force criteria. Mini-Mental State Examination (sMMSE), Montreal Cognitive Assessment (MoCA) and Parkinson's Disease Cognitive Rating Scale (PDCRS) were examined against a level 2 dichotomised PD-MCI diagnosis. Characteristics of PD-MCI were evaluated using logistic regression analysis. RESULTS Twenty-seven patients met criteria for PD-MCI (34%). The MoCA and PDCRS demonstrated high validity to screen for PD-MCI. Impairments in multiple cognitive domains were observed in 77.8% of PD-MCI patients. There were significantly more males in the PD-MCI group compared to PD patients without MCI (p < 0.01). CONCLUSIONS PD patients with MCI exhibited impairments in the attention/working memory, executive function and memory domains. Heterogeneous cognitive characteristics in PD warrant further investigation into specific cognitive subtypes to advance understanding and effective evaluation of PD-MCI.
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Affiliation(s)
- Jihyun Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Leander Mitchell
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
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Abstract
PURPOSE OF REVIEW To provide an overview of recently published work on anxiety, focusing on generalized anxiety disorder (GAD) and its treatment. RECENT FINDINGS Self-reported anxiety symptoms were highly prevalent during the COVID-19 global pandemic in both the general population and in selected groups. There remains divided opinion about whether internet-based cognitive behavioural therapy (CBT) is noninferior to face-to-face CBT for GAD. A systematic review of drug treatment for GAD showed efficacy for selective serotonin reuptake inhibitors (SNRIs), agomelatine, and quetiapine. There may be a place for repetitive transcranial magnetic stimulation in the treatment of GAD. There was some evidence of efficacy for complementary therapies, including physical exercise, yoga, acupuncture, and Withania somnifera (ashwagandha). However, a systematic review of cannabidiol and tetrahydrocannabinol found insufficient evidence of efficacy in anxiety disorders. SUMMARY Antidepressants and quetiapine show efficacy in the treatment of GAD. Internet-based psychological interventions have a place in the treatment of GAD when face-to-face treatment is inaccessible. There is increasing evidence for the use of physical exercise in the management of GAD. Some other complementary therapies, including cannabinoids, require further, methodologically sound, research.
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Affiliation(s)
- Gerard J Byrne
- Academy of Psychiatry, School of Medicine, University of Queensland
- Mental Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Pekin C, McHale M, Seymour M, Strodl E, Hopkins G, Mitchell D, Byrne GJ. Psychopathology and eating behaviour in people with type 2 diabetes referred for bariatric surgery. Eat Weight Disord 2022; 27:3627-3635. [PMID: 36495463 PMCID: PMC9803743 DOI: 10.1007/s40519-022-01502-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Psychopathology and disordered eating behaviours are putative pre-operative risk factors for suboptimal outcomes post-bariatric surgery. Documented psychopathology prevalence rates vary in bariatric candidate samples. Further, less attention has been paid to vulnerable subgroups such as people with diabetes who might be at an elevated risk. For these reasons, this study aimed to investigate the rates of psychopathology and disordered eating in pre-surgical candidates with type 2 diabetes mellitus (T2DM). METHODS Participants were 401 consecutive patients from a state-wide bariatric surgery service for people with T2DM. Psychopathology was measured using multi-modal assessment including diagnostic interview and battery of validated questionnaires. The mean age of the sample was 51 years with a mean BMI of 46 kg/m2. The majority of the sample was female (60.6%), born in Australia (87%) and 18.2% identified as Aboriginal and/or Torres Strait Islander. RESULTS Rates of current psychopathology in this sample included: major depressive disorder (MDD; 16.75%), generalised anxiety disorder (GAD; 20.25%), insomnia (17.75%) and binge eating disorder (BED; 10.75%). There were no significant differences on measures between people who endorsed Aboriginal and/or Torres Strait Islander status compared to those who did not endorse. The mean total score on the BES was 21.82 ± 10.40 (range 0-39), with 8.2% of participants meeting criteria for severe binge eating. Presence of an eating disorder was not significantly associated with degree of glycemic compensation. Average emotional eating scores were significantly higher in this study, compared to reference samples. Significantly increased binge eating severity and emotional eating severity was revealed for people with T2DM and comorbid MDD, social anxiety and eating disorders. Binge eating severity was associated with GAD, food addiction, substance use disorders, and history of suicide attempt but not emotional eating severity. CONCLUSION Amongst people with T2DM seeking bariatric surgery, MDD, GAD and emotional eating were common. Psychopathology in a sample of people with T2DM seeking bariatric surgery was significantly associated with severity of disordered eating. These findings suggest people with T2DM seeking bariatric surgery may be vulnerable to psychopathology and disordered eating with implications for early identification and intervention. LEVEL OF EVIDENCE Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- C Pekin
- Faculty of Medicine, Academy of Psychiatry, University of Queensland, Brisbane, QLD, Australia.
- Department of Psychology, Royal Brisbane & Women's Hospital and School of Psychology, University of Queensland, Brisbane, QLD, Australia.
| | - M McHale
- Department of Psychology, Royal Brisbane & Women's Hospital and School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - M Seymour
- Faculty of Medicine, Department of Endocrinology and Diabetes, Royal Brisbane & Women's Hospital, University of Queensland, Brisbane, QLD, Australia
| | - E Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - G Hopkins
- Division of Surgery Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - D Mitchell
- Division of Surgery Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - G J Byrne
- Faculty of Medicine, Academy of Psychiatry, University of Queensland, Brisbane, QLD, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
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11
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Pourzinal D, Yang J, Lawson RA, McMahon KL, Byrne GJ, Dissanayaka NN. Systematic review of data-driven cognitive subtypes in Parkinson disease. Eur J Neurol 2022; 29:3395-3417. [PMID: 35781745 PMCID: PMC9796227 DOI: 10.1111/ene.15481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 05/26/2022] [Accepted: 06/30/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Recent application of the mild cognitive impairment concept to Parkinson disease (PD) has proven valuable in identifying patients at risk of dementia. However, it has sparked controversy regarding the existence of cognitive subtypes. The present review evaluates the current literature pertaining to data-driven subtypes of cognition in PD. METHODS Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, systematic literature searches for peer-reviewed articles on the topic of cognitive subtyping in PD were performed. RESULTS Twenty-two relevant articles were identified in the systematic search. Subtype structures showed either a spectrum of severity or specific domains of impairment. Domain-specific subtypes included amnestic/nonamnestic, memory/executive, and frontal/posterior dichotomies, as well as more complex structures with less definitive groupings. Preliminary longitudinal evidence showed some differences in cognitive progression among subtypes. Neuroimaging evidence provided insight into distinct patterns of brain alterations among subtypes. CONCLUSIONS Recurring phenotypes in the literature suggest strong clinical relevance of certain cognitive subtypes in PD. Although the current literature is limited, it raises critical questions about the utility of data-driven methods in cognitive research. The results encourage further integration of neuroimaging research to define the latent neural mechanisms behind divergent subtypes. Although there is no consensus, there appears to be growing consistency and inherent value in identifying cognitive subtypes in PD.
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Affiliation(s)
- Dana Pourzinal
- Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchHerstonQueenslandAustralia
| | - Jihyun Yang
- Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchHerstonQueenslandAustralia
| | - Rachael A. Lawson
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Katie L. McMahon
- School of Clinical Sciences, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Gerard J. Byrne
- Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchHerstonQueenslandAustralia,Mental Health Service, Royal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Nadeeka N. Dissanayaka
- Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchHerstonQueenslandAustralia,School of PsychologyUniversity of QueenslandSt LuciaQueenslandAustralia,Department of NeurologyRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
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12
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Pacas Fronza G, Liddle J, Mitchell LK, Byrne GJ, Pachana NA, Dissanayaka NN. Phenomenology of anxiety in people living with mild to moderate dementia: A conceptual meta-ethnographic review. Dementia (London) 2022; 21:2677-2699. [PMID: 36018575 DOI: 10.1177/14713012221123706] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This conceptual review aims to integrate findings from published qualitative studies focusing on individual experiences of people living with dementia to generate a better understanding and conceptualisation of anxiety in dementia, including its subclinical manifestations. The review aims to inform the clinical practice to facilitate the development of targeted psychological interventions and provision of holistic support to people living with dementia. DESIGN The review was conducted according to the guide for reporting meta-ethnographic qualitative syntheses eMERGe and the PRISMA guidelines. RESULTS The search yielded a total of 2947 studies, out of which 13 were included in the final qualitative synthesis. The interpretive synthesis identified common experiences of people living with mild to moderate dementia, characterised by clusters of themes around worry, emotional experiences, and behavioural reactions in response to the diagnosis of dementia and its symptoms. These represent the components of a conceptual framework of anxiety in mild to moderate dementia, where anxiety is triggered by negative appraisals of living with an irreversible neurodegenerative disease. Stemming from these appraisals of dementia progression and its impact on the person's overall future, the content of worrisome thoughts and concerns include the loss of self and identity, losing independence and the ability to perform previous activities, concerns about being a burden to loved ones, and worry about the impact on interpersonal relationships. CONCLUSION This conceptualisation of anxiety in dementia, including its subclinical manifestations facilitates the development of psychological interventions and provision of holistic support to people living with dementia.
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Affiliation(s)
- Gabriela Pacas Fronza
- UQ Centre for Clinical Research, Faculty of Medicine, 1974The University of Queensland, Herston, Brisbane, QLD, Australia
| | - Jacki Liddle
- School of Information Technology and Electrical Engineering, 1974The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Leander K Mitchell
- School of Psychology, 1974The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, 1974The University of Queensland, Herston, Brisbane, QLD, Australia.,Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Nancy A Pachana
- School of Psychology, 1974The University of Queensland, St Lucia, Brisbane, QLD, Australia.,School of Business, 1974The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, 1974The University of Queensland, Herston, Brisbane, QLD, Australia.,School of Psychology, 1974The University of Queensland, St Lucia, Brisbane, QLD, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
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13
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Yang J, McMahon KL, Copland DA, Pourzinal D, Byrne GJ, Angwin AJ, O'Sullivan JD, Dissanayaka NN. Semantic fluency deficits and associated brain activity in Parkinson's disease with mild cognitive impairment. Brain Imaging Behav 2022; 16:2445-2456. [PMID: 35841523 DOI: 10.1007/s11682-022-00698-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
People living with Parkinson's disease (PD) with poor verbal fluency have an increased risk of developing dementia. This study examines the neural mechanisms underpinning semantic fluency deficits in patients with PD with mild cognitive impairment (PD-MCI) compared to those without MCI (PD-NC) and control participants without PD (non-PD). Thirty-seven (37) participants with PD completed a cognitive assessment battery to identify MCI (13 PD-MCI). Twenty sex- and age-matched non-PD patients also participated. Participants were scanned (3T Siemens PRISMA) while performing semantic fluency, semantic switching, and automatic speech tasks. The number of responses and fMRI data for semantic generation and semantic switching were analyzed. Participants also completed a series of verbal fluency tests outside the scanner, including letter fluency. Participants with PD-MCI performed significantly worse than PD-NC and non-PD participants during semantic fluency and semantic switching tasks. PD-MCI patients showed greater activity in the right angular gyrus than PD-NC and non-PD patients during semantic switching. Increased right angular activity correlated with worse verbal fluency performance outside the scanner. Our study showed that the PD-MCI group performed worse on semantic fluency than either the PD-NC or non-PD groups. Increased right angular gyrus activity in participants with PD-MCI during semantic switching suggests early compensatory mechanisms, predicting the risk of future dementia in PD.
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Affiliation(s)
- Jihyun Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Katie L McMahon
- School of Clinical Sciences and Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Anthony J Angwin
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston Queensland, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston Queensland, Australia.
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia.
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14
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Seow PS, Byrne GJ, Arnold E, Pachana NA. Relationships Between Aging Attitudes and Successful Aging Outcomes in Middle-age and Older Women. Clin Gerontol 2022:1-13. [PMID: 35593153 DOI: 10.1080/07317115.2022.2072791] [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: 11/03/2022]
Abstract
OBJECTIVES This study aimed to explore the relationships between aging attitudes and the outcomes of successful aging, including whether aging attitudinal types moderate psychological adjustment in the context of medical and mental health diagnoses. METHODS In total, 409 community-dwelling women aged 40-79 years in Australia completed the Reactions to Aging Questionnaire (RAQ), Geriatric Depression Scale, Center of Epidemiological Studies Depression Scale, and Geriatric Anxiety Inventory. Information about medical and mental health diagnoses were collected. RESULTS Overall, aging attitudes and all three RAQ subscales were negatively correlated with scores on measures of depression and anxiety, and number of medical diagnoses. Attitudinal types toward aging were found to moderate the relationship between the number of mental health diagnoses and scores on the psychological measures of depression but not anxiety. Unique RAQ domain-specific relationships were found with the number of mental health diagnoses. CONCLUSIONS The findings support the link between aging attitudes and psychological outcomes, the potential clinical value of RAQ attitudinal typologies classification as well as a multidimensional conceptualization of aging attitudes. CLINICAL IMPLICATIONS The findings reinforce the need for efforts to reduce ageism on a societal level, as well as informing clinical decision-making with older clients.
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Affiliation(s)
- Pei Shing Seow
- School of Psychology, The University of Queensland, Queensland, Queensland, Australia
| | - Gerard J Byrne
- Academy of Psychiatry & Centre for Clinical Research, Faculty of Medicine, University of Queensland, Queensland, Queensland, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Elizabeth Arnold
- Academy of Psychiatry & Centre for Clinical Research, Faculty of Medicine, University of Queensland, Queensland, Queensland, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Queensland, Queensland, Australia
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15
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Johnson JCS, Byrne GJ, Pelecanos AM. The prevalence of subthreshold psychiatric symptoms and associations with alcohol and substance use disorders: from a nationally representative survey of 36,309 adults. BMC Psychiatry 2022; 22:270. [PMID: 35428242 PMCID: PMC9012038 DOI: 10.1186/s12888-022-03834-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/08/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Our aim was to describe a broad number of subthreshold psychiatric symptoms (SPS) in a nationally representative population and evaluate associations with substance use. SPS describe groups of symptoms with significant pathology, but that do not quite meet full psychiatric diagnostic criteria. They have been associated with significant impairment and cost. METHODS The National Epidemiologic Survey on Alcohol and Related Conditions-III was a multistage, weighted, cross-sectional survey completed in the United States in 2013 comprising 36,309 noninstitutionalized adults. We report lifetime prevalence rates of 14 SPS related to mood, anxiety, trauma, eating, and personality disorders. We then evaluate associations with lifetime alcohol use disorders (AUD) and all substance use disorders (SUD) using logistic regression and adjusted odds ratios. SPS and psychiatric diagnoses were mutually exclusive (could not co-occur). RESULTS Lifetime prevalence of having at least one of 14 SPS was 57% compared with 37% for the related psychiatric disorders. This was similar for males and females, in contrast to psychiatric disorders in which prevalence was 42% in females and 31% in males. Otherwise, overall SPS and disorders had similar prevalence patterns across sociodemographic characteristics. Subthreshold personality symptoms had the highest prevalence rates (schizotypal 21.3%, antisocial 18.3%, and borderline 17.6%), followed by posttraumatic stress (13.1%). Subthreshold bipolar and depression had lifetime prevalence rates of 2.7 and 8.5%, respectively. Prevalence rates of subthreshold anxiety symptoms ranged from 2.2% (agoraphobia) to 9.8% (specific phobia). Subthreshold eating disorder related symptoms had the lowest prevalence rates (anorexia 1.5% and bulimia 1.7%). Half (seven) of the SPS had significantly increased odds of lifetime AUD. This number increased to 12 for all SUD. Subthreshold antisocial personality symptoms had the highest odds of AUD (2.2; 95% CI 2.00-2.37) and SUD (3.5; 95% CI 3.22-3.81). CONCLUSIONS We found high lifetime SPS prevalence rates and significant associations with AUD and SUD. To our knowledge, this is the first published study evaluating a broad number of SPS. This indicates possible opportunities for early intervention and prevention but requires additional research and development of infrastructure and guidelines to better understand and manage patients who experience SPS.
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Affiliation(s)
- Jeremy C. S. Johnson
- grid.1003.20000 0000 9320 7537The University of Queensland, Mental Health Centre, K Floor, Royal Brisbane & Women’s Hospital, Herston, QLD 4029 Australia ,grid.416100.20000 0001 0688 4634Department of Psychiatry, Royal Brisbane & Women’s Hospital, Butterfield St, Herston, QLD 4029 Australia
| | - Gerard J. Byrne
- grid.1003.20000 0000 9320 7537The University of Queensland, Mental Health Centre, K Floor, Royal Brisbane & Women’s Hospital, Herston, QLD 4029 Australia ,grid.416100.20000 0001 0688 4634Department of Psychiatry, Older Persons’ Mental Health Service, Royal Brisbane & Women’s Hospital, Butterfield St, Herston, QLD 4029 Australia
| | - Anita M. Pelecanos
- grid.1049.c0000 0001 2294 1395Statistics Unit, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, QLD 4006 Australia
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16
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Thangavelu K, Hayward JA, Pachana NA, Byrne GJ, Mitchell LK, Wallis GM, Au TR, Dissanayaka NN. Designing Virtual Reality Assisted Psychotherapy for Anxiety in Older Adults Living with Parkinson's Disease: Integrating Literature for Scoping. Clin Gerontol 2022; 45:235-251. [PMID: 31903862 DOI: 10.1080/07317115.2019.1709597] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/18/2022]
Abstract
Objective: This review integrates literature to discuss the potential use of virtual reality (VR) in treatment of anxiety in Parkinson's disease (PD) and inform next steps.Methods: A systematic search was performed to identify studies of VR use in PD, using four databases. Data were reported in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analyzes extension for Scoping Reviews (PRISMA-ScR).Results: Thirty-two studies met the inclusion criteria with four VR studies from the same study group directly assessing the effects of anxiety on motor symptoms in PD. Primary studies implementing a VR protocol in PD identified focus areas of understanding and alleviating freezing of gait (FOG), balance training, and cognitive and motor rehabilitation, and informed design considerations.Conclusion: VR in PD studies suggested established feasibility. With appropriate design considerations, a VR based protocol could improve anxiety outcomes in PD.Clinical implications: VR in PD provides control of a patient's field of view, which can be exploited to induce specific responses, provide visual feedback, analysis of patient actions, and introduce safe challenges in the context of training. VR assisted Cognitive Behavioral Therapy (CBT) tailored to suit subtypes of anxiety disorders in PD have the potential to improve the efficacy and effectiveness of psychotherapy in PD.
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Affiliation(s)
- Karthick Thangavelu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Joshua A Hayward
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Mental Health Service, Royal Brisbane & Woman's Hospital, Brisbane, Australia
| | | | - Guy M Wallis
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Tiffany R Au
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane & Woman's Hospital, Brisbane, Australia
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17
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Dissanayaka NN, Forbes EJ, Yang JHJ, Pourzinal D, O'Sullivan JD, Mitchell LK, Copland DA, McMahon KL, Byrne GJ. Anxiety disorders are associated with verbal memory impairment in patients with Parkinson's disease without dementia. J Neurol 2021; 269:1600-1609. [PMID: 34347150 DOI: 10.1007/s00415-021-10736-x] [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] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Preliminary evidence has demonstrated a link between anxiety and memory impairment in Parkinson's disease (PD). This study further investigated this association using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for anxiety disorders and a standardized cognitive test battery. METHODS A convenience sample of 89 PD patients without dementia was recruited from neurology outpatient clinics. A cross-sectional design was applied. Participants completed two semi-structured interviews. The first interview diagnosed DSM-5 anxiety disorders, unspecified anxiety disorder, and no anxiety. The second interview applied a neurocognitive test battery comprising two tests for each domain. Logistic regression models compared cognitive characteristics associated with anxiety disorders to no anxiety. RESULTS Clinically significant anxiety was associated with immediate verbal memory impairment compared to the no anxiety group (OR, 95% CI 0.52, 0.30-0.89; p = 0.018), controlling for sex and age. The anxiety disorders group demonstrated immediate (OR, 95% CI 0.46, 0.26-0.83; p = 0.010) and delayed (OR, 95% CI 0.63, 0.40-0.99; p = 0.047) verbal memory impairments compared to those without anxiety, controlling for sex and age. This association remained for immediate (OR, 95% CI 0.43, 0.22-0.84; p = 0.013), but not delayed verbal memory impairment (OR, 95% CI 0.65, 0.39-1.06; p = 0.081) when additionally controlling for disease severity, education and levodopa dose. CONCLUSION These findings present first evidence that anxiety disorders are associated with verbal memory impairment in PD and have implications for the management and treatment of anxiety in PD.
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Affiliation(s)
- Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia. .,School of Psychology, The University of Queensland, Brisbane, Australia. .,Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Elana J Forbes
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia
| | - Ji Hyun J Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
| | - Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.,Mental Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
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18
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Pourzinal D, Yang JHJ, Bakker A, McMahon KL, Byrne GJ, Pontone GM, Mari Z, Dissanayaka NN. Hippocampal correlates of episodic memory in Parkinson's disease: A systematic review of magnetic resonance imaging studies. J Neurosci Res 2021; 99:2097-2116. [PMID: 34075634 DOI: 10.1002/jnr.24863] [Citation(s) in RCA: 3] [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] [Received: 02/25/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
The present review asks whether magnetic resonance imaging (MRI) studies are able to define neural correlates of episodic memory within the hippocampus in Parkinson's disease (PD). Systematic searches were performed in PubMed, Web of Science, Medline, CINAHL, and EMBASE using search terms related to structural and functional MRI (fMRI), the hippocampus, episodic memory, and PD. Risk of bias was assessed for each study using the Newtown-Ottawa Scale. Thirty-nine studies met inclusion criteria; eight fMRI, seven diffusion MRI (dMRI), and 24 structural MRI (14 exploring whole hippocampus and 10 exploring hippocampal subfields). Critical analysis of the literature revealed mixed evidence from functional and dMRI, but stronger evidence from sMRI of the hippocampus as a biomarker for episodic memory impairment in PD. Hippocampal subfield studies most often implicated CA1, CA3/4, and subiculum volume in episodic memory and cognitive decline in PD. Despite differences in imaging methodology, study design, and sample characteristics, MRI studies have helped elucidate an important neural correlate of episodic memory impairment in PD with both clinical and theoretical implications. Natural progression of this work encourages future research on hippocampal subfield function as a potential biomarker of, or therapeutic target for, episodic memory dysfunction in PD.
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Affiliation(s)
- Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Ji Hyun J Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Arnold Bakker
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Katie L McMahon
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,Mental Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, Brisbane, QLD, Australia
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19
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Forbes EJ, Byrne GJ, O'Sullivan JD, Yang J, Marsh R, Dissanayaka NN. Defining Atypical Anxiety in Parkinson's Disease. Mov Disord Clin Pract 2021; 8:571-581. [PMID: 33981790 PMCID: PMC8088112 DOI: 10.1002/mdc3.13193] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/14/2021] [Accepted: 02/28/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Anxiety is a major complication in Parkinson's disease (PD). Many PD patients experience clinically significant anxiety not meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) anxiety disorder criteria. This atypical anxiety (anxiety disorder not otherwise specified [NOS]) is often under-recognized and its diagnosis is underdeveloped. OBJECTIVES This study aimed to identify the demographic, psychiatric, and clinical characteristics of anxiety disorder NOS in PD. METHODS A cross-sectional design studied a convenience sample of 184 PD patients without dementia recruited from neurology outpatient clinics. A semi-structured interview using DSM-IV criteria categorized PD patients into current anxiety disorder NOS (n = 28), DSM-IV anxiety disorders (n = 42) or no anxiety (n = 86) groups. Logistic regression modeling identified characteristics associated with the anxiety disorder NOS group compared to DSM-IV anxiety and no anxiety groups. RESULTS The anxiety disorder NOS group was associated with motor complications of PD therapy, episodic, persistent and social anxiety symptoms, depression, non-motor experiences of daily living, poor quality of life, and female sex compared to the no anxiety group. Compared to DSM-IV anxiety, those with anxiety disorder NOS demonstrated greater global cognitive impairment, more severe motor complications of PD therapy, a greater severity and functional impact of dyskinesias, and greater complexity of motor fluctuations. Persistent, episodic, and social anxiety symptoms did not significantly differ between anxiety disorder NOS and DSM-IV anxiety groups. CONCLUSIONS These findings suggest that PD-specific symptoms characterize anxiety in a subgroup of PD patients who do not fulfill DSM-IV criteria for anxiety disorders.
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Affiliation(s)
- Elana J. Forbes
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Gerard J. Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Mental Health ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - John D. O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Jihyun Yang
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Rodney Marsh
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Asia‐Pacific Centre for NeuromodulationUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Nadeeka N. Dissanayaka
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
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Molde H, Nordhus IH, Torsheim T, Engedal K, Bendixen AB, Byrne GJ, Márquez-González M, Losada A, Feng L, Ow EKT, Pisitsungkagarn K, Taephant N, Jarukasemthawee S, Champagne A, Landreville P, Gosselin P, Ribeiro O, Diefenbach GJ, Blank K, Beaudreau SA, Laks J, de Araújo NB, Fonseca RP, Kochhann R, Camozzato A, van den Brink RHS, Fluiter M, Naarding P, Pelzers LPRM, Lugtenburg A, Oude Voshaar RC, Pachana NA. A Cross-National Analysis of the Psychometric Properties of the Geriatric Anxiety Inventory. J Gerontol B Psychol Sci Soc Sci 2021; 75:1475-1483. [PMID: 30624724 DOI: 10.1093/geronb/gbz002] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/07/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Assessing late-life anxiety using an instrument with sound psychometric properties including cross-cultural invariance is essential for cross-national aging research and clinical assessment. To date, no cross-national research studies have examined the psychometric properties of the frequently used Geriatric Anxiety Inventory (GAI) in depth. METHOD Using data from 3,731 older adults from 10 national samples (Australia, Brazil, Canada, The Netherlands, Norway, Portugal, Spain, Singapore, Thailand, and United States), this study used bifactor modeling to analyze the dimensionality of the GAI. We evaluated the "fitness" of individual items based on the explained common variance for each item across all nations. In addition, a multigroup confirmatory factor analysis was applied, testing for measurement invariance across the samples. RESULTS Across samples, the presence of a strong G factor provides support that a general factor is of primary importance, rather than subfactors. That is, the data support a primarily unidimensional representation of the GAI, still acknowledging the presence of multidimensional factors. A GAI score in one of the countries would be directly comparable to a GAI score in any of the other countries tested, perhaps with the exception of Singapore. DISCUSSION Although several items demonstrated relatively weak common variance with the general factor, the unidimensional structure remained strong even with these items retained. Thus, it is recommended that the GAI be administered using all items.
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Affiliation(s)
- Helge Molde
- Department of Clinical Psychology, University of Bergen, Norway
| | - Inger Hilde Nordhus
- Department of Clinical Psychology, University of Bergen, Norway.,Department of Behavioural Sciences in Medicine, University of Oslo, Norway
| | | | - Knut Engedal
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway and Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Toensberg, Norway
| | - Anette Bakkane Bendixen
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway and Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Toensberg, Norway
| | - Gerard J Byrne
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - María Márquez-González
- Biological and Health Psychology Department, Faculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Andres Losada
- Department of Medicine, Clinical Psychology Area, Universidad Rey Juan Carlos, Madrid, Spain
| | - Lei Feng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elisabeth Kuan Tai Ow
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | | | | | | | | | | | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, Aveiro University, Portugal
| | | | - Karen Blank
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut
| | - Sherry A Beaudreau
- Sierra Pacific Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System and Psychiatry and Behavioral Sciences, Stanford University of Medicine, Palo Alto, California
| | - Jerson Laks
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Brazil
| | | | - Rochele Paz Fonseca
- Graduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Brazil
| | - Renata Kochhann
- Graduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Brazil
| | - Analuiza Camozzato
- Universidade Federal de Ciências da Saúde de Porto Alegre UFCSPA, Brazil
| | - Rob H S van den Brink
- Rob Giel Research center (RGOc), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mario Fluiter
- Mental Health Center GGZ Noord-Holland Noord, Heerhugowaard, The Netherlands
| | - Paul Naarding
- GGNet Mental Health, Division of Old Age Psychiatry, Warnsveld & Apeldoorn, The Netherlands
| | | | | | - Richard C Oude Voshaar
- Rob Giel Research center (RGOc), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
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Lupton MK, Robinson GA, Adam RJ, Rose S, Byrne GJ, Salvado O, Pachana NA, Almeida OP, McAloney K, Gordon SD, Raniga P, Fazlollahi A, Xia Y, Ceslis A, Sonkusare S, Zhang Q, Kholghi M, Karunanithi M, Mosley PE, Lv J, Borne L, Adsett J, Garden N, Fripp J, Martin NG, Guo CC, Breakspear M. A prospective cohort study of prodromal Alzheimer's disease: Prospective Imaging Study of Ageing: Genes, Brain and Behaviour (PISA). Neuroimage Clin 2020; 29:102527. [PMID: 33341723 PMCID: PMC7750170 DOI: 10.1016/j.nicl.2020.102527] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/11/2020] [Accepted: 12/04/2020] [Indexed: 12/20/2022]
Abstract
This prospective cohort study, "Prospective Imaging Study of Ageing: Genes, Brain and Behaviour" (PISA) seeks to characterise the phenotype and natural history of healthy adult Australians at high future risk of Alzheimer's disease (AD). In particular, we are recruiting midlife and older Australians with high and low genetic risk of dementia to discover biological markers of early neuropathology, identify modifiable risk factors, and establish the very earliest phenotypic and neuronal signs of disease onset. PISA utilises genetic prediction to recruit and enrich a prospective cohort and follow them longitudinally. Online surveys and cognitive testing are used to characterise an Australia-wide sample currently totalling over 3800 participants. Participants from a defined at-risk cohort and positive controls (clinical cohort of patients with mild cognitive impairment or early AD) are invited for onsite visits for detailed functional, structural and molecular neuroimaging, lifestyle monitoring, detailed neurocognitive testing, plus blood sample donation. This paper describes recruitment of the PISA cohort, study methodology and baseline demographics.
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Affiliation(s)
| | - Gail A Robinson
- School of Psychology, The University of Queensland, St. Lucia, Brisbane, Australia; Queensland Brain Institute, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Robert J Adam
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Australia; Royal Brisbane and Women's Hospital Mental Health Services, University of Queensland, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Stephen Rose
- CSIRO Health and Biosecurity, Australian E-Health Research Centre, Brisbane, Australia
| | - Gerard J Byrne
- Royal Brisbane and Women's Hospital Mental Health Services, University of Queensland, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Olivier Salvado
- CSIRO Health and Biosecurity, Australian E-Health Research Centre, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Australia; WA Centre for Health and Ageing of the University of Western Australia, Australia
| | - Kerrie McAloney
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Scott D Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Parnesh Raniga
- CSIRO Health and Biosecurity, Australian E-Health Research Centre, Brisbane, Australia
| | - Amir Fazlollahi
- CSIRO Health and Biosecurity, Australian E-Health Research Centre, Brisbane, Australia
| | - Ying Xia
- CSIRO Health and Biosecurity, Australian E-Health Research Centre, Brisbane, Australia
| | - Amelia Ceslis
- School of Psychology, The University of Queensland, St. Lucia, Brisbane, Australia
| | | | - Qing Zhang
- CSIRO Health and Biosecurity, Australian E-Health Research Centre, Brisbane, Australia
| | - Mahnoosh Kholghi
- CSIRO Health and Biosecurity, Australian E-Health Research Centre, Brisbane, Australia
| | - Mohan Karunanithi
- CSIRO Health and Biosecurity, Australian E-Health Research Centre, Brisbane, Australia
| | - Philip E Mosley
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; Queensland Brain Institute, The University of Queensland, St. Lucia, Brisbane, Australia; Neurosciences Queensland, Brisbane, Queensland, Australia
| | - Jinglei Lv
- Sydney Imaging & School of Biomedical Engineering, The University of Sydney, Sydney, Australia
| | - Léonie Borne
- The University of Newcastle, Newcastle, Australia
| | - Jessica Adsett
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Natalie Garden
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jurgen Fripp
- CSIRO Health and Biosecurity, Australian E-Health Research Centre, Brisbane, Australia
| | | | - Christine C Guo
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Michael Breakspear
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; The University of Newcastle, Newcastle, Australia
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Pourzinal D, Yang JHJ, Byrne GJ, O'Sullivan JD, Mitchell L, McMahon KL, Copland DA, Dissanayaka NN. Identifying subtypes of mild cognitive impairment in Parkinson's disease using cluster analysis. J Neurol 2020; 267:3213-3222. [PMID: 32535681 DOI: 10.1007/s00415-020-09977-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The concept of Mild Cognitive Impairment (MCI) in Parkinson's disease (PD) has shown the potential for identifying at-risk dementia patients. Identifying subtypes of MCI is likely to assist therapeutic discoveries and better clinical management of patients with PD (PWP). Recent cluster-based approaches have demonstrated dominance in memory and executive impairment in PD. The present study will further explore the role of memory and executive impairment and associated clinical features in non-demented PWP. METHOD A K-means cluster analysis was performed on ten "frontal" and "posterior" cognitive variables derived from a dataset of 85 non-demented PWP. The resulting cluster structure was chosen based on quantitative, qualitative, theoretical, and clinical validity. Cluster profiles were then created through statistical analysis of cognitive and clinical/demographic variables. A descriptive analysis of each cluster's performance on a comprehensive PD-MCI diagnostic battery was also explored. RESULTS The resulting cluster structure revealed four distinct cognitive phenotypes: (1) frontal-dominant impairment; (2) posterior-cortical-dominant impairment; (3) global impairment, and (4) cognitively intact. Demographic profiling revealed significant differences in the age, gender split, global cognitive ability, and motor symptoms between these clusters. However, there were no significant differences between the clusters on measures of depression, apathy, and anxiety. CONCLUSION These results validate the existence of distinct cognitive phenotypes within PD-MCI and encourage future research into their clinical trajectory and neuroimaging correlates.
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Affiliation(s)
- Dana Pourzinal
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Ji Hyun J Yang
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
| | - Leander Mitchell
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Katie L McMahon
- School of Clinical Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Building 71/918, Herston, Brisbane, QLD, 4029, Australia.
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia.
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.
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Sarris J, Byrne GJ, Bousman CA, Cribb L, Savage KM, Holmes O, Murphy J, Macdonald P, Short A, Nazareth S, Jennings E, Thomas SR, Ogden E, Chamoli S, Scholey A, Stough C. Kava for generalised anxiety disorder: A 16-week double-blind, randomised, placebo-controlled study. Aust N Z J Psychiatry 2020; 54:288-297. [PMID: 31813230 DOI: 10.1177/0004867419891246] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 01/23/2023]
Abstract
OBJECTIVE Previous randomised, double-blind, placebo-controlled studies have shown that Kava (a South Pacific medicinal plant) reduced anxiety during short-term administration. The objective of this randomised, double-blind, placebo-controlled study was to perform a larger, longer-term trial assessing the efficacy and safety of Kava in the treatment of generalised anxiety disorder and to determine whether gamma-aminobutyric acid transporter (SLC6A1) single-nucleotide polymorphisms were moderators of response. METHODS The trial was a phase III, multi-site, two-arm, 16-week, randomised, double-blind, placebo-controlled study investigating an aqueous extract of dried Kava root administered twice per day in tablet form (standardised to 120 mg of kavalactones twice/day) in 171 currently non-medicated anxious participants with diagnosed generalised anxiety disorder. The trial took place in Australia. RESULTS An analysis of 171 participants revealed a non-significant difference in anxiety reduction between the Kava and placebo groups (a relative reduction favouring placebo of 1.37 points; p = 0.25). At the conclusion of the controlled phase, 17.4% of the Kava group were classified as remitted (Hamilton Anxiety Rating Scale score < 7) compared to 23.8% of the placebo group (p = 0.46). No SLC6A1 polymorphisms were associated with treatment response, while carriers of the rs2601126 T allele preferentially respond to placebo (p = 0.006). Kava was well tolerated aside from poorer memory (Kava = 36 vs placebo = 23; p = 0.044) and tremor/shakiness (Kava = 36 vs placebo = 23; p = 0.024) occurring more frequently in the Kava group. Liver function test abnormalities were significantly more frequent in the Kava group, although no participant met criteria for herb-induced hepatic injury. CONCLUSION While research has generally supported Kava in non-clinical populations (potentially for more 'situational' anxiety as a short-term anxiolytic), this particular extract was not effective for diagnosed generalised anxiety disorder.
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Affiliation(s)
- Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia.,Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Gerard J Byrne
- Discipline of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Chad A Bousman
- Departments of Medical Genetics, Psychiatry and Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Lachlan Cribb
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Karen M Savage
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Oliver Holmes
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jenifer Murphy
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Patricia Macdonald
- Discipline of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Anika Short
- Discipline of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Sonia Nazareth
- Discipline of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Jennings
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | - Edward Ogden
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Suneel Chamoli
- Department of Psychiatry, ACT Health, Canberra, ACT, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
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Sarris J, Murphy J, Stough C, Mischoulon D, Bousman C, MacDonald P, Adams L, Nazareth S, Oliver G, Cribb L, Savage K, Menon R, Chamoli S, Berk M, Ng CH, Byrne GJ. S-Adenosylmethionine (SAMe) monotherapy for depression: an 8-week double-blind, randomised, controlled trial. Psychopharmacology (Berl) 2020; 237:209-218. [PMID: 31712971 DOI: 10.1007/s00213-019-05358-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 05/27/2019] [Accepted: 09/02/2019] [Indexed: 02/07/2023]
Abstract
RATIONALE Dysregulation of the one carbon cycle is documented in depression. Thereby, S-adenosylmethionine (SAMe), a one-carbon cycle nutraceutical compound with a favourable side effect profile, has a theoretical rationale for efficacy. However, further controlled studies are required to confirm SAMe's efficacy. OBJECTIVES To test the efficacy of SAMe versus placebo in unmedicated DSM-5 diagnosed (major depressive disorder) (MDD) patients with mild-to-moderate levels of depressive symptoms. METHODS We conducted an 8-week, double-blind, randomised controlled trial testing 800 mg/day of SAMe monotherapy versus placebo in 49 patients with MDD (Montgomery-Åsberg Depression Rating Scale [MADRS] score 14-25) who were not currently taking antidepressants. One-carbon cycle biomarkers, brain-derived neurotropic factor (BDNF), and relevant single nucleotide polymorphisms (SNPs) were analysed as potential treatment moderators. RESULTS A clinically relevant differential reduction from baseline to week 8 of 3.76 points occurred on the primary outcome (MADRS) in favour of SAMe. This however was not significant (p = 0.13) on an adjusted linear mixed model, notwithstanding a medium to large effect size of 0.72. A high placebo response rate of 53% occurred (> 50% reduction on MADRS). Exploratory analyses showed that SAMe was however effective in reducing depression amongst participants with milder depression severity (MADRS ≤ 22, p = 0.045). Response was not moderated by BDNF, SNPs, or one-carbon cycle biomarkers, although increased folate concentrations were correlated with improved symptoms in the SAMe group (r = - 0.57, p = 0.026). The treatment was safe and well tolerated. CONCLUSIONS Although a differential reduction in depression symptoms between groups was observed in favour of SAMe, the results of this pilot study were not statistically significant. TRIAL REGISTRATION ANZCTR-Australian New Zealand Clinical Trials Registry; No.: ACTRN12613001299796; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364900.
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Affiliation(s)
- Jerome Sarris
- NICM Health Research Institute, Westmead, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia.
| | - Jenifer Murphy
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - David Mischoulon
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chad Bousman
- Departments of Medical Genetics, Psychiatry, and Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Patricia MacDonald
- Faculty of Medicine, Discipline of Psychiatry, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, The University of Queensland, Brisbane, Australia
| | - Laura Adams
- Faculty of Medicine, Discipline of Psychiatry, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, The University of Queensland, Brisbane, Australia
| | - Sonia Nazareth
- Faculty of Medicine, Discipline of Psychiatry, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, The University of Queensland, Brisbane, Australia
| | - Georgina Oliver
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
| | - Lachlan Cribb
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
| | - Karen Savage
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Ranjit Menon
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
| | - Suneel Chamoli
- Faculty of Medicine, Discipline of Psychiatry, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, The University of Queensland, Brisbane, Australia
| | - Michael Berk
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
- IMPACT SRC, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
- Orygen, The Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Chee H Ng
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
| | - Gerard J Byrne
- Faculty of Medicine, Discipline of Psychiatry, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, The University of Queensland, Brisbane, Australia
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Dissanayaka NNW, Au TR, Angwin AJ, Iyer KK, O'Sullivan JD, Byrne GJ, Silburn PA, Marsh R, Mellick GD, Copland DA. Depression symptomatology correlates with event-related potentials in Parkinson's disease: An affective priming study. J Affect Disord 2019; 245:897-904. [PMID: 30699874 DOI: 10.1016/j.jad.2018.11.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Received: 07/12/2018] [Revised: 11/01/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression is a predominant non-motor symptom of Parkinson's disease (PD), which is often under recognised and undertreated. To improve identification of depression in PD it is imperative to examine objective brain-related markers. The present study addresses this gap by using electroencephalography (EEG) to evaluate the processing of emotionally valanced words in PD. METHODS Fifty non-demented PD patients, unmedicated for depression or anxiety, completed an affective priming task while EEG was simultaneously recorded. Prime and target word pairs of negative or neutral valence were presented at a short 250 ms stimulus onset asynchrony. Participants were asked to evaluate the valence of the target word by button press. Depression was measured using an established rating scale. Repeated measures analysis of covariance and correlational analyses were performed to examine whether event-related potentials (ERP) varied as a function of depression scores. RESULTS Key ERP findings reveal reduced responses in parietal midline P300, N400 and Late Positive Potential (LPP) difference waves between congruent and incongruent neutral targets in patients with higher depression scores. LIMITATIONS Comparisons of ERPs were limited by insufficient classification of participants with and without clinical depression. A majority of PD patients who had high depression scores were excluded from the analysis as they were receiving antidepressant and/or anxiolytic medications which could interfere with ERP sensitivity. CONCLUSIONS The present study suggests that the Pz-P300, N400 and LPP are ERP markers relates to emotional dysfunction in PD. These findings thus advance current knowledge regarding the neurophysiological markers of a common neuropsychiatric deficit in PD.
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Affiliation(s)
- Nadeeka N W Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia; School of Psychology, The University of Queensland, St Lucia, Brisbane QLD4067, Australia.
| | - Tiffany R Au
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia
| | - Anthony J Angwin
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane QLD4067, Australia
| | - Kartik K Iyer
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia; Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia
| | - Peter A Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Brisbane QLD4067, Australia
| | - Rodney Marsh
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Brisbane QLD4067, Australia
| | - George D Mellick
- Griffith Institute for Drug Discovery, Griffith University, Nathan, Brisbane QLD4111, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane QLD4067, Australia
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Kua ZJ, Pachana NA, Byrne GJ, O'Sullivan JD, Marsh R, Torbey E, Silburn PA, Mellick GD, Dissanayaka NNW. How Well Do Caregivers Detect Depression and Anxiety in Patients With Parkinson Disease? J Geriatr Psychiatry Neurol 2018; 31:227-236. [PMID: 30071791 DOI: 10.1177/0891988718788641] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 11/15/2022]
Abstract
Depression and anxiety are prevalent in Parkinson disease (PD) yet underrecognized in clinical practice. Caregiver reports are frequently utilized to aid in the assessment of neuropsychiatric symptoms but little is known about caregivers' ability to recognize them in patients with PD. This study sought to examine the accuracy of caregiver reports. Eighty patient-caregiver dyads were involved. Accuracy of caregiver recognition was assessed by examining the level of agreement between caregiver ratings on the Neuropsychiatric Inventory and patients' diagnosis of depression and anxiety on the Mini-International Neuropsychiatric Interview (MINI)-Plus. The agreement between caregiver report and MINI-Plus diagnosis was low for both depression (6.3%) and anxiety (17.5%). The presence of depression was overreported, while anxiety was largely underestimated by caregivers. Caregiver distress significantly predicted inaccurate caregiver identification of depression ( R2 = .51, P < .001) and anxiety ( R2 = .08, P < .05). Results indicate that caregivers may be poor at recognizing depression and anxiety in patients with PD. Utilization of caregiver report should take into account potential biases that affect caregiver judgment.
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Affiliation(s)
- Zhong Jie Kua
- 1 School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,2 UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,3 Department of Psychological Medicine, Changi General Hospital, Singapore
| | - Nancy A Pachana
- 1 School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Gerard J Byrne
- 1 School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,2 UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,4 Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - John D O'Sullivan
- 2 UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,4 Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Rodney Marsh
- 4 Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,5 Mental Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Elizabeth Torbey
- 1 School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,2 UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter A Silburn
- 6 Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - George D Mellick
- 6 Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia.,7 Griffith Institute for Drug Discovery (GRIDD), Griffith University, Brisbane, Queensland, Australia
| | - Nadeeka N W Dissanayaka
- 1 School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,2 UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,5 Mental Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Abstract
Background Angiogenesis is a prerequisite for tumor growth and metastasis. Vascular cell adhesion molecule-1 (VCAM-1) is expressed on endothelial cells as a result of vascular endothelial growth factor (VEGF) stimulation. Purpose To determine if measurement in serum of VEGF or VCAM-1 provides an accurate measure of tumor angiogenesis. Methods VCAM-1 and VEGF were measured in the serum of women with early and advanced breast cancer by ELISA. Levels were compared to levels of VCAM-1 and VEGF in women with normal breasts and levels of the endothelial glycoprotein von Willebrand factor. Levels of VEGF and VCAM-1 in women with early breast cancer were correlated with established clinicopathological prognostic markers and intratumoral microvessel density (IMD). Results In early breast cancer serum VCAM-1 correlated closely with the microvessel density in tumors (r=0.61, p<0.001). Women with lymph node-positive and high-grade tumors had higher levels of serum VCAM-1 than women with lymph node-negative and low-grade tumors. Serum VEGF demonstrated no correlation with established prognostic features or IMD. Levels of VCAM-1 and VEGF were raised in women with advanced breast cancer. Conclusion Serum VCAM-1 is a surrogate marker of angiogenesis in breast cancer and its measurement may help in the assessment of antiangiogenic drugs currently in phase II trials.
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Affiliation(s)
- G J Byrne
- Department of Surgery, University Hospital of South Manchester, UK
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31
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Mills NT, Maier R, Whitfield JB, Wright MJ, Colodro-Conde L, Byrne EM, Scott JG, Byrne GJ, Hansell NK, Vinkhuyzen AAE, CouvyDuchesne B, Montgomery GW, Henders AK, Martin NG, Wray NR, Benyamin B. Investigating the relationship between iron and depression. J Psychiatr Res 2017; 94:148-155. [PMID: 28715705 DOI: 10.1016/j.jpsychires.2017.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 02/25/2017] [Revised: 06/03/2017] [Accepted: 07/07/2017] [Indexed: 12/22/2022]
Abstract
Lower levels of circulating iron have been associated with depression. Our objective was to investigate the phenotypic and genetic relationship between measures of circulating levels of iron (serum iron, transferrin, transferrin saturation, and ferritin) and depressive symptoms. Data were available from ongoing studies at QIMR Berghofer Medical Research Institute (QIMRB), including twin adolescents (mean age 15.1 years, standard deviation (SD) 3.2 years), and twin adults (mean age 23.2 years, SD 2.2 years). In the adolescent cohort, there were 3416 participants from 1688 families. In the adult cohort there were 9035 participants from 4533 families. We estimated heritabilities of, and phenotypic and genetic correlations between, traits. We conducted analyses that linked results from published large-scale genome-wide association studies (including iron and Major Depressive Disorder) with our study samples using single SNP and multi-SNP genetic risk score analyses, and LD score regression analyses. In both cohorts, measures of iron, transferrin, transferrin saturation, and log 10 of ferritin (L10Fer) were all highly heritable, while depressive measures were moderately heritable. In adolescents, depression measures were higher in those in the middle 10th versus top 10th percentile of transferrin saturation measures (p = 0.002). Genetic profile risk scores of the iron measures were not significantly associated with depression in study participants. LD score analyses showed no significant genetic relationship between iron and depression. Genetic factors strongly influence iron measures in adolescents and adults. Using several different strategies we find no evidence for a genetic contribution to the relationship between blood measures of iron and measures of depression.
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Affiliation(s)
- Natalie T Mills
- Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia; Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, 5000, Australia; Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Australia.
| | - Robert Maier
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Australia; Institute for Molecular Bioscience, The University of Queensland, Brisbane, 4072, Australia
| | - John B Whitfield
- Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia
| | - Margaret J Wright
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Australia
| | - Lucia Colodro-Conde
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia
| | - Enda M Byrne
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Australia; Institute for Molecular Bioscience, The University of Queensland, Brisbane, 4072, Australia
| | - James G Scott
- The University of Queensland, UQ Centre for Clinical Research, Herston, 4029, Australia; Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, 4006, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, 4076, Australia
| | - Gerard J Byrne
- Academic Discipline of Psychiatry, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Narelle K Hansell
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Australia
| | - Anna A E Vinkhuyzen
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Australia; Institute for Molecular Bioscience, The University of Queensland, Brisbane, 4072, Australia
| | - Baptiste CouvyDuchesne
- Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia; Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Australia; Institute for Molecular Bioscience, The University of Queensland, Brisbane, 4072, Australia
| | - Grant W Montgomery
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Australia; Institute for Molecular Bioscience, The University of Queensland, Brisbane, 4072, Australia
| | - Anjali K Henders
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Australia; Institute for Molecular Bioscience, The University of Queensland, Brisbane, 4072, Australia
| | - Nicholas G Martin
- Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia
| | - Naomi R Wray
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Australia; Institute for Molecular Bioscience, The University of Queensland, Brisbane, 4072, Australia
| | - Beben Benyamin
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Australia; Institute for Molecular Bioscience, The University of Queensland, Brisbane, 4072, Australia
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Dissanayaka NNW, Au TR, Angwin AJ, O'Sullivan JD, Byrne GJ, Silburn PA, Marsh R, Mellick GD, Copland DA. N400 and emotional word processing in Parkinson’s disease. Neuropsychology 2017; 31:585-595. [DOI: 10.1037/neu0000333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Murphy JA, Sarris J, Byrne GJ. A Review of the Conceptualisation and Risk Factors Associated with Treatment-Resistant Depression. Depress Res Treat 2017; 2017:4176825. [PMID: 28840042 PMCID: PMC5559917 DOI: 10.1155/2017/4176825] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 05/30/2017] [Accepted: 06/11/2017] [Indexed: 01/14/2023]
Abstract
Major depression does not always remit. Difficult-to-treat depression is thought to contribute to the large disease burden posed by depression. Treatment-resistant depression (TRD) is the conventional term for nonresponse to treatment in individuals with major depression. Indicators of the phenomenon are the poor response rates to antidepressants in clinical practice and the overestimation of the efficacy of antidepressants in medical scientific literature. Current TRD staging models are based on anecdotal evidence without an empirical rationale to rank one treatment strategy above another. Many factors have been associated with TRD such as inflammatory system activation, abnormal neural activity, neurotransmitter dysfunction, melancholic clinical features, bipolarity, and a higher traumatic load. This narrative review provides an overview of this complex clinical problem and discusses the reconceptualization of depression using an illness staging model in line with other medical fields such as oncology.
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Affiliation(s)
- Jenifer A. Murphy
- ARCADIA Research Group, Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Richmond, VIC, Australia
| | - Jerome Sarris
- ARCADIA Research Group, Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Richmond, VIC, Australia
- NICM, School of Health and Science, Western Sydney University, Campbelltown, NSW, Australia
| | - Gerard J. Byrne
- Discipline of Psychiatry, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Dissanayaka NNW, Pye D, Mitchell LK, Byrne GJ, O'Sullivan JD, Marsh R, Pachana NA. Cognitive Behavior Therapy for Anxiety in Parkinson's Disease: Outcomes for Patients and Caregivers. Clin Gerontol 2017; 40:159-171. [PMID: 28452666 DOI: 10.1080/07317115.2016.1240131] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 01/10/2023]
Abstract
OBJECTIVE Anxiety negatively impacts the quality of life of Parkinson's disease (PD) patients and caregivers. Despite high prevalence, there is a paucity of trials investigating effective treatments for anxiety in PD. This uncontrolled study investigated the use of a manualized and tailored Cognitive Behavior Therapy (CBT) for anxiety in PD. METHODS Participants completed 6 weekly CBT sessions. Pre-, post- and follow-up (3 and 6 months) assessments were made. Change in outcomes were analysed using t-tests and Reliability Change Index. Of 17 PD patients who agreed to CBT, 12 completed the intervention. RESULTS This study showed a significant reduction in Hamilton Anxiety Rating Scale scores in PD immediately post CBT (t(11) = 3.59, p < .01), maintained at 3-month (t(8) = 2.83, p = .02) and 6-month (t(7) = 2.07, p = .04) follow-up. A reduction in caregiver burden (t(11) = 2.68, p = .03) was observed post intervention. Improvements in motor disability (t(11) = 2.41, p = .04) and cognitive scores (t(11) = -2.92, p = .01) were also observed post intervention and at follow-up. CONCLUSIONS Tailored CBT can be used to treat anxiety in PD. CLINICAL IMPLICATIONS This study provides preliminary evidence suggesting that tailored CBT reduces anxiety in PD with persisting benefits, and lowers caregiver burden.
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Affiliation(s)
- Nadeeka N W Dissanayaka
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
| | - Deidre Pye
- a The University of Queensland , Brisbane , Australia
| | | | - Gerard J Byrne
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
| | - John D O'Sullivan
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
| | - Rodney Marsh
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
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Savage KM, Stough CK, Byrne GJ, Scholey A, Bousman C, Murphy J, Macdonald P, Suo C, Hughes M, Thomas S, Teschke R, Xing C, Sarris J. Kava for the treatment of generalised anxiety disorder (K-GAD): study protocol for a randomised controlled trial. Trials 2015; 16:493. [PMID: 26527536 PMCID: PMC4630875 DOI: 10.1186/s13063-015-0986-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/30/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Generalised anxiety disorder (GAD) is a chronic and pervasive condition that generates high levels of psychological stress, and it is difficult to treat in the long term. Current pharmacotherapeutic options for GAD are in some cases only modestly effective, and may elicit undesirable side effects. Through targeted actions on the gamma-aminobutyric acid (GABA) pathway, the South Pacific medicinal plant kava (Piper methysticum) is a non-addictive, non-hypnotic anxiolytic with the potential to treat GAD. The evidence for the efficacy of kava for treating anxiety has been affirmed through clinical trials and meta-analyses. Recent research has also served to lessen safety concerns regarding the use of kava due to hepatotoxic risk, which is reflected in a recent German court overturning the previous kava ban in that country (which may in turn influence a reinstatement by the European Union). The aim of current research is to assess the efficacy of an 'aqueous noble cultivar rootstock extract' of kava in GAD in a larger longer term study. In addition, we plan to investigate the pharmacogenomic influence of GABA transporters on response, effects of kava on gene expression, and for the first time, the neurobiological correlates of treatment response via functional and metabolic imaging. METHODS/DESIGN This clinical trial is funded by the Australian National Health and Medical Research Council (APP1063383) and co-funded by MediHerb (Integria Healthcare (Australia) Pty. Ltd). The study is a phase III, multi-site, two-arm, 18-week, randomised, double-blind, placebo-controlled study using an aqueous extract of noble kava cultivar (standardised to 240 mg of kavalactones per day) versus matching placebo in 210 currently anxious participants with diagnosed GAD who are non-medicated. The study takes place at two sites: the Centre for Human Psychopharmacology (Swinburne University of Technology), Hawthorn, Melbourne, Australia; and the Academic Discipline of Psychiatry (The University of Queensland) based at the Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia. Written informed consent will be obtained from each participant prior to commencement in the study. The primary outcome is the Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH-A). The secondary outcomes involve a range of scales that assess affective disorder symptoms and quality of life outcomes, in addition to the study of mediating biomarkers of response (assessed via genomics and neuroimaging). DISCUSSION If this study demonstrates positive findings in support of the superiority of kava over placebo in the treatment of GAD, and also is shown to be safe, then this plant-medicine can be considered a 'first-line' therapy for GAD. Genomic and neuroimaging data may reveal clinical response patterns and provide more evidence of the neurobiological activity of the plant extract. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov: NCT02219880 Date: 13 August 2014:.
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Affiliation(s)
- Karen M Savage
- The University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Melbourne, Australia.
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
| | - Con K Stough
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
| | - Gerard J Byrne
- Department of Psychiatry, The University of Queensland, Melbourne, Australia.
| | - Andrew Scholey
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
| | - Chad Bousman
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
- Department of Psychiatry, The University of Melbourne, Parkville, Australia.
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.
- Department of General Practice, The University of Melbourne, Parkville, Australia.
| | - Jenifer Murphy
- The University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Melbourne, Australia.
| | - Patricia Macdonald
- Department of Psychiatry, The University of Queensland, Melbourne, Australia.
| | - Chao Suo
- Brain and Mental Health Laboratory, School of Psychological Science, Monash University, Monash, Australia.
| | - Matthew Hughes
- Swinburne University of Technology, Brain and Psychological Sciences Centre, Swinburne, Australia.
| | - Stuart Thomas
- School of Psychological Science, Monash University, Monash, Australia.
| | - Rolf Teschke
- Department of Internal Medicine II, Section of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Johann Wolfgang Goethe University of Frankfurt/Main, Frankfurt, Germany.
| | - Chengguo Xing
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Duluth, USA.
| | - Jerome Sarris
- The University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Melbourne, Australia.
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
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Abstract
BACKGROUND This study examines non-verbal (design) and verbal (phonemic and semantic) fluency in prodromal Huntington's disease (HD). An accumulating body of research indicates subtle deficits in cognitive functioning among prodromal mutation carriers for HD. METHODS Performance was compared between 32 mutation carriers and 38 non-carriers in order to examine the magnitude of impairment across fluency tasks. The predicted years to onset (PYTO) in mutation carriers was calculated by a regression equation and used to divide the group according to whether onset was predicted as less than 12.75 years (HD+CLOSE; n = 16) or greater than 12.75 years (HD+DISTANT; n = 16). RESULTS The results indicate that both non-verbal and verbal fluency is sensitive to subtle impairment in prodromal HD. HD+CLOSE group produced fewer items in all assessed fluency tasks compared to non-carriers. HD+DISTANT produced fewer drawings than non-carriers in the non-verbal task. PYTO correlated significantly with all measures of non-verbal and verbal fluency. CONCLUSION The pattern of results indicates that subtle cognitive deficits exist in prodromal HD, and that less structured tasks with high executive demands are the most sensitive in detecting divergence from the normal range of functioning. These selective impairments can be attributed to the early involvement of frontostriatal circuitry and frontal lobes.
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Affiliation(s)
- Tarja-Brita Robins Wahlin
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Medicine, University of Queensland, Brisbane, Qld., Australia
| | - Mary A. Luszcz
- School of Psychology, Flinders University, Adelaide, S.A., Australia
| | - Åke Wahlin
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Gerard J. Byrne
- School of Medicine, University of Queensland, Brisbane, Qld., Australia
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Dissanayaka NN, White E, O'Sullivan JD, Marsh R, Silburn PA, Copland DA, Mellick GD, Byrne GJ. Characteristics and Treatment of Anxiety Disorders in Parkinson's Disease. Mov Disord Clin Pract 2015; 2:155-162. [PMID: 30363816 PMCID: PMC6183244 DOI: 10.1002/mdc3.12157] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/12/2015] [Accepted: 12/14/2014] [Indexed: 01/18/2023] Open
Abstract
Background: Anxiety disorders are common in Parkinson's disease (PD) and are undertreated. The current study investigates demographic and PD-specific factors associated with Diagnostic and Statistical Manual (DSM-IV) anxiety disorders and subsyndromal anxiety in PD. It also examines the use of pharmacological and nonpharmacological treatments for anxiety in PD. Methods: Ninety nondemented PD patients completed a semistructured interview. Logistic regression models were constructed examining associations between several demographic, disease-specific, and treatment factors, as well as both current syndromal, DSM-IV anxiety disorders, and subsyndromal anxiety. Results: Associations were found between current DSM-IV anxiety disorder, as well as female gender, younger age, more severe stages of PD, and poor activities of daily living. Subsyndromal anxiety was related to a younger onset age of PD. Relationships were also found between both anxiety groups and more complications of PD therapy, as well as higher depression scores. There were no associations between anxiety and levodopa equivalent daily dosage, motor disability, and cognition. In our sample, 57% of patients with current DSM-IV anxiety disorders or subsyndromal anxiety were not currently treated with pharmacotherapy. Of those who currently received such treatment, 83% still experienced current anxiety disorders. Results suggest that anxiety is poorly recognized and treated in PD. Conclusions: Clinical trials investigating the efficacy of pharmacotherapy, tailored psychotherapy, and combination therapy primarily focusing on anxiety are much needed, with the aim of establishing novel targeted treatment protocols for the management of subtypes of anxiety disorders in PD.
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Affiliation(s)
- Nadeeka N.W. Dissanayaka
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- School of PsychologyThe University of QueenslandBrisbaneQueenslandAustralia
| | - Elizabeth White
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
| | - John D. O'Sullivan
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
| | - Rodney Marsh
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Mental Health ServiceRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
| | - Peter A. Silburn
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
| | - David A. Copland
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of Health & Rehabilitation SciencesUniversity of QueenslandSt LuciaBrisbaneQueenslandAustralia
| | - George D. Mellick
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- Eskitis Institute for Drug DiscoveryGriffith UniversityNathanBrisbaneQueenslandAustralia
| | - Gerard J. Byrne
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of PsychologyThe University of QueenslandBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Mental Health ServiceRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
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Miloyan B, Byrne GJ, Pachana NA. Threshold and subthreshold generalized anxiety disorder in later life. Am J Geriatr Psychiatry 2015; 23:633-41. [PMID: 25240936 DOI: 10.1016/j.jagp.2014.08.010] [Citation(s) in RCA: 24] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 08/22/2014] [Accepted: 08/22/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Symptoms and disorders of anxiety are highly prevalent among older adults; however, late-life anxiety disorders remain underdiagnosed. The objective of this study was to (1) estimate the prevalence of late-life threshold and subthreshold generalized anxiety disorder (GAD), (2) examine sociodemographic and health correlates associated with membership in these groups, (3) assess 3-year conversion rates of these groups, and (4) explore characteristics associated with 3-year conversion to GAD. METHODS Using Waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions, 13,420 participants aged 55-98 years were included in this study. RESULTS Subthreshold GAD was more highly prevalent than threshold GAD and was interposed between asymptomatic and GAD groups in terms of severity of health characteristics. Although most participants with subthreshold and threshold GAD were asymptomatic by Wave 2, differences in disability persisted. Subthreshold GAD at baseline was not a predictor of threshold GAD at follow-up. CONCLUSION These findings suggest that late-life GAD should be conceptualized as a dimensional rather than categorical construct. The temporal stability of anxiety-associated disability further suggests that subthreshold GAD bears clinical significance. However, the suitability and efficacy of interventions for minimizing negative sequelae in this group remain to be determined.
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Affiliation(s)
- Beyon Miloyan
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia.
| | - Gerard J Byrne
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
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Sarris J, Stough C, Bousman C, Murphy J, Savage K, Smith DJ, Menon R, Chamoli S, Oliver G, Berk M, Byrne GJ, Ng C, Mischoulon D. An adjunctive antidepressant nutraceutical combination in treating major depression: Study protocol, and clinical considerations. Advances in Integrative Medicine 2015. [DOI: 10.1016/j.aimed.2015.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dissanayaka NNNW, White E, O'Sullivan JD, Marsh R, Pachana NA, Byrne GJ. The clinical spectrum of anxiety in Parkinson's disease. Mov Disord 2015; 29:967-75. [PMID: 25043800 DOI: 10.1002/mds.25937] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/11/2014] [Accepted: 05/13/2014] [Indexed: 12/24/2022] Open
Abstract
Anxiety is common in Parkinson's disease (PD), and contributes to increased disability and poorer quality of life. In spite of its significant impact, the symptomatology, chronology, and neurobiology of anxiety in PD are all poorly understood, and this hinders accurate diagnosis and development of effective treatment strategies. This review investigates and updates literature related to the clinical spectrum of anxiety in PD. The reported prevalence of anxiety in PD varies considerably, with emerging interest in the frequency of the DSM-IV residual category of "Anxiety disorder, not otherwise specified" (Anxiety disorder NOS), which is observed in up to 25% of PD patients. By design, there are no standardized diagnostic criteria for Anxiety disorder NOS, because this is the category applied to individuals who do not meet diagnostic criteria for any other current anxiety disorder. Anxiety rating scales incompletely capture anxiety symptoms that relate specifically to PD symptoms and the complications arising from PD therapy. Consequently, these scales have been deemed inappropriate for use in PD, and there remains a need for the development of a new PD-specific anxiety scale. Research establishing accurate symptom profiles of anxiety in PD is sparse, although characterizing such symptomatology would likely improve clinical diagnosis and facilitate targeted treatment strategies. Research into the neurobiological and psychological underpinnings of anxiety in PD remains inconclusive. Anxiety can precede the onset of PD motor symptoms or can develop after a diagnosis of PD. Further investigations focused on the chronology of anxiety and its relationship to PD diagnosis are required.
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Affiliation(s)
- Nadeeka N N W Dissanayaka
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Neurology Research Centre, Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
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Gardiner PA, Byrne GJ, Mitchell LK, Pachana NA. Financial capacity in older adults: a growing concern for clinicians. Med J Aust 2015; 202:82-5. [PMID: 25627739 DOI: 10.5694/mja14.00201] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 07/03/2014] [Indexed: 11/17/2022]
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Henderson S, Porter RJ, Basset D, Battersby M, Baune BT, Byrne GJ, Ellis PM, Everall I, Glue P, Hazell P, Hood SD, Kelly BJ, Kirkby KC, Kissane D, Luty SE, Mellsop G, Mitchell PB, Mulder R, Raphael B, Tonge B, Malhi GS. Why academic psychiatry is endangered. Aust N Z J Psychiatry 2015; 49:9-12. [PMID: 25524517 DOI: 10.1177/0004867414563453] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Scott Henderson
- National Institute for Mental Health Research, Australian National University, Canberra, Australia
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago - Christchurch, New Zealand
| | - Darryl Basset
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | | | - Bernhard T Baune
- Department of Psychiatry, University of Adelaide, Adelaide, Australia
| | - Gerard J Byrne
- Academic Discipline of Psychiatry, School of Medicine, University of Queensland, Brisbane, Australia
| | - Pete M Ellis
- Department of Psychological Medicine, University of Otago - Wellington, Wellington, New Zealand
| | - Ian Everall
- Department of Psychiatry, University of Melbourne, Victoria, Australia The Florey Institute for Neuroscience and Mental Health and the University of Melbourne, Victoria, Australia
| | - Paul Glue
- Department of Psychological Medicine, University of Otago - Dunedin, Dunedin, New Zealand
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sean D Hood
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Brian J Kelly
- Discipline of Psychiatry, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Kenneth C Kirkby
- Psychiatry, School of Medicine, University of Tasmania, Hobart, Australia
| | - David Kissane
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Suzanne E Luty
- Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - Graham Mellsop
- Waikato Clinical School, University of Auckland, New Zealand
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia Brain Sciences and School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - Beverley Raphael
- Psychological Medicine, Australian National University, Canberra, Australia
| | - Bruce Tonge
- Centre for Developmental Psychiatry and Psychology, School of Clinical Science, Monash University, Clayton, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia
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Abstract
BACKGROUND This study investigated symptom patterns that might distinguish between individuals with and without a diagnosis of Social Phobia (SP) across the adult lifespan. METHODS A sample of 5411 self-reported social worriers was derived from Wave 1 (2001 and 2002) of the U.S. National Epidemiological Survey of Alcohol and Related Conditions (NESARC). Participants were stratified into four age groups (18-29 years, 30-44 years, 45-64 years, 65-96 years), and further divided into two diagnostic groups (self-reported social worriers with and without a SP diagnosis). RESULTS Binary logistic regression analyses revealed that a core set of symptoms was associated with SP across the adult lifespan. There were also successive reductions in the number of symptoms associated with SP in each age group, such that older adults endorsed numerically fewer SP symptoms. LIMITATIONS Though our sample size is smaller than ideal for the nature of our analyses, the NESARC represents one of the largest existing clinical datasets we know of. CONCLUSIONS Despite age-related reductions in symptom frequency, a core set of SP symptoms consistently distinguished between diagnostic groups, irrespective of age.
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Affiliation(s)
- Beyon Miloyan
- School of Psychology, University of Queensland, Brisbane, QLD 4072, Australia.
| | - Adam Bulley
- School of Psychology, University of Queensland, Brisbane, QLD 4072, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, QLD 4072, Australia
| | - Gerard J Byrne
- School of Medicine, University of Queensland, Brisbane, Australia; Royal Brisbane & Women׳s Hospital, Brisbane, Australia
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McCarthy R, Byrne-Davis L, Hart J, Yuill G, Slattery H, Jackson M, Byrne GJ. A feasible, acceptable and effective way to teach health care workers in low- and middle-income countries a method to manage acutely ill obstetric women. Midwifery 2014; 31:19-24. [PMID: 24878358 DOI: 10.1016/j.midw.2014.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 03/31/2014] [Accepted: 04/25/2014] [Indexed: 11/15/2022]
Abstract
Maternal mortality is unacceptably high in Sub Saharan Africa, which accounts for 56% of all maternal deaths (WHO, 2012). Most maternal deaths are avoidable but with prompt recognition and timely intervention it is not inevitable that acute or critical maternal illness deteriorates to fatality (Firth and Ttendo, 2012). This paper discusses a project to provide multidisciplinary training in Maternal-Acute Illness Management (M-AIM) in a low resource setting in order to actively address the third delay to women accessing emergency obstetric care: prompt receipt of effective care on reaching a medical facility.
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Affiliation(s)
- Rose McCarthy
- School of Nursing, Midwifery & Social Work, Mary Seacole Building, University of Salford, Frederick Rd Campus, Salford M6 6PU, UK.
| | - Lucie Byrne-Davis
- Manchester Medical School, ATR4, Education Research Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK.
| | - Jo Hart
- Manchester Medical School, Stopford Building, Oxford Rd, Manchester, Greater Manchester M13 9PT, UK.
| | - Gordon Yuill
- Stepping Hill Hospital, Poplar Grove, Stockport, Cheshire SK2 7JE, UK.
| | - Helen Slattery
- University Hospital of South Manchester NHS FT, Southmoor Road, Manchester M23 9LT, UK.
| | - Matthew Jackson
- University Hospital of South Manchester NHS FT, Southmoor Road, Manchester M23 9LT, UK.
| | - Gerard J Byrne
- University Hospital of South Manchester NHS FT, Southmoor Road, Manchester M23 9LT, UK.
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Gonçalves DC, Coelho CM, Byrne GJ. The use of healthcare services for mental health problems by middle-aged and older adults. Arch Gerontol Geriatr 2014; 59:393-7. [PMID: 24856982 DOI: 10.1016/j.archger.2014.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/16/2014] [Accepted: 04/24/2014] [Indexed: 11/18/2022]
Abstract
Although mental disorders occur commonly in later life, it has been reported that older adults are reluctant to seek help for their mental health problems. The purpose of this research study was to analyze the contact with healthcare professionals, self-perceived mental health problems and unmet needs, as reported by a nationally representative sample of community-dwelling adults. We report a cross-sectional analysis of all the respondents of the Australian National Survey of Mental Health and Wellbeing aged 55 years and older (N=3178). Results indicated that 306 (9.6%) participants had a DSM-IV classifiable mental disorder based on self-identified symptoms over the preceding 12 months. Of these, 146 (48%) reported that they had not consulted a healthcare professional to deal with their mental health problems. Among those who consulted with a healthcare professional, the general practitioner was the main point of contact. Medication and psychotherapy/counseling were the most frequent form of help obtained. Informational and instrumental help, such as help to sort out practical problems and to look after oneself, were the most reported unmet needs. These results suggest a gap in the provision of healthcare services for mental health problems directed toward the specific needs of aging adults. The reported unmet needs might be met by increasing awareness amongst healthcare professionals regarding mental health problems in later stages of life and by improving the access of older people to the services commonly provided by multidisciplinary teams.
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Affiliation(s)
- Daniela C Gonçalves
- Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, 2nd floor, Walton Street, Jericho OX2 6NW, UK; School of Medicine, University of Queensland, Herston, QLD 4029, Australia
| | - Carlos M Coelho
- Centro Algoritmi, University of Minho, Campus Azurém, 4800-058 Guimarães, Portugal
| | - Gerard J Byrne
- School of Medicine, University of Queensland, Herston, QLD 4029, Australia; Royal Brisbane & Women's Hospital, Herston, QLD 4029, Australia.
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46
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Looi JCL, Byrne GJ, Macfarlane S, McKay R, O'Connor DW. Systemic approach to behavioural and psychological symptoms of dementia in residential aged care facilities. Aust N Z J Psychiatry 2014; 48:112-5. [PMID: 23888078 DOI: 10.1177/0004867413499078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jeffrey C L Looi
- 1Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, Australia
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Lo AH, Woodman RJ, Pachana NA, Byrne GJ, Sachdev PS. Associations Between Lifestyle and Cognitive Function Over Time in Women Aged 40–79 Years. ACTA ACUST UNITED AC 2014; 39:371-83. [DOI: 10.3233/jad-130971] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ada H.Y. Lo
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Richard J. Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, South Australia, Australia
| | - Nancy A. Pachana
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Gerard J. Byrne
- School of Medicine, University of Queensland, and Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Perminder S. Sachdev
- Brain and Ageing Research Program, School of Psychiatry, University of New South Wales, and Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
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Affiliation(s)
- Shanthi I Sarma
- Older Persons Mental Health; Robina Hospital; Gold Coast Queensland Australia
| | - Gerard J Byrne
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Older Persons’ Mental Health Service; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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Pachana NA, Egan SJ, Laidlaw K, Dissanayaka N, Byrne GJ, Brockman S, Marsh R, Starkstein S. Clinical issues in the treatment of anxiety and depression in older adults with Parkinson's disease. Mov Disord 2013; 28:1930-4. [PMID: 24123116 DOI: 10.1002/mds.25689] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/27/2013] [Accepted: 08/04/2013] [Indexed: 11/08/2022] Open
Abstract
A significant proportion of persons affected by Parkinson's disease (PD) are over age 65 years. Mental health issues are often less a focus of treatment in this population than physical manifestations of the illness. Anxiety or depression alone, as well as comorbid depression and anxiety, are underrecognized in patients with PD and are associated with deleterious effects on physical and interpersonal functioning, negatively impacting quality of life and well-being. We offer a brief overview of salient clinical points with respect to assessment and treatment approaches to enhance efficacy of the treatment of mental health symptoms in older adults with PD. Cognitive behavior therapy involves the patient learning to overcome behavioral avoidance associated with anxiety and challenge unhelpful negative cognitions. It is suggested that cognitive behavior therapy is an effective approach to treatment of anxiety and depression in PD and should be offered as a treatment to patients.
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Affiliation(s)
- Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
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Flanagan KJ, Copland DA, Chenery HJ, Byrne GJ, Angwin AJ. Alzheimer's disease is associated with distinctive semantic feature loss. Neuropsychologia 2013; 51:2016-25. [DOI: 10.1016/j.neuropsychologia.2013.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 06/05/2013] [Accepted: 06/09/2013] [Indexed: 10/26/2022]
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