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Bolton P, Davies K, Grattan S, Lappin JM. Commando care for individuals living with severe mental illness: Equally Well goes beyond metabolic health alone. Aust N Z J Psychiatry 2024:48674241240601. [PMID: 38561868 DOI: 10.1177/00048674241240601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Patrick Bolton
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia
| | - Kimberley Davies
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Grattan
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Julia M Lappin
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
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Gott CA, Thomas M, Allan J, Kennedy J, Black Y, Dark F, Lappin JM. Cognitive remediation therapy - implementation and translation into clinical practice in rural and metropolitan New South Wales mental health services. Australas Psychiatry 2023; 31:584-586. [PMID: 37365838 DOI: 10.1177/10398562231186125] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Cognitive Remediation Therapy (CRT) is an effective intervention in managing the significant cognitive deficits experienced by those living with psychosis. Given its strong evidence base CRT is recommended in Australian and international guidelines for rehabilitation of people with psychosis, however, access to CRT remains limited. In this commentary, we describe recent efforts to implement CRT programs within NSW mental health services. Development of CRT delivery has been successfully achieved in both rural and metropolitan settings, utilising both face-to-face and telehealth methods. CONCLUSIONS The delivery of CRT in public mental health services is feasible and adaptable to diverse settings. We strongly advocate for sustainable implementation of CRT into routine clinical practice. This will require policy and practice change to enable resources for CRT training and delivery to become embedded in the roles of the clinical workforce.
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Affiliation(s)
- Chloe A Gott
- The Tertiary Referral Service for Psychosis, South Eastern Sydney Local Health District, Sydney, NSW, Australia; and
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia
| | - Matt Thomas
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia
- School of Psychology, Charles Sturt University, Bathurst, NSW, Australia; and
- Marathon Health, Bathurst, NSW, Australia
| | - Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, NSW, Australia
| | - Jessica Kennedy
- Dubbo and Region, Mental Health, Drug & Alcohol Services, Western New South Wales Local Health District, NSW, Australia
| | - Yvette Black
- Bloomfield Hospital, Western New South Wales Local Health District, Orange, NSW, Australia
| | - Frances Dark
- Metro South Addiction and Mental Health Services, Brisbane, Queensland, Australia
| | - Julia M Lappin
- The Tertiary Referral Service for Psychosis, South Eastern Sydney Local Health District, Sydney, NSW, Australia; and
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia
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Davies K, Grattan S, Gott C, Ellis R, Lappin JM. The tertiary service for psychosis: Holistic recommendations for people with complex psychosis. Australas Psychiatry 2023; 31:591-597. [PMID: 37467118 PMCID: PMC10566223 DOI: 10.1177/10398562231189115] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To describe (i) the clinical characteristics of individuals referred to the Tertiary Referral Service for Psychosis (TRSP) and (ii) the recommendations TRSP made for future treatment across psychopharmacological and other intervention domains. METHOD Retrospective audit of clinical data collected during the assessment process of individuals who accessed TRSP between 02/06/2020 and 31/12/2022. Categories of recommendations made following collaborative care planning comprised psychopharmacological, neuropsychological, psychological, psychosocial, physical health, substance misuse and other domains. RESULTS Eighty-two individuals were included, with diagnoses most commonly of schizophrenia (54.9%) and schizoaffective disorder (30.5%). The median PANSS score was 88.0 (73-100). Social occupational functioning was very poor (SOFAS M = 37.0, SD = 15.1). Cognitive functioning was poor (RBANS: M = 74.6; SD: 15.0). 67.1% had physical health comorbidities, with high prevalence of smoking (52.4%) and substance misuse (25.6%). Psychopharmacological recommendations (made for 81.7%) included clozapine trial (25.6%), clozapine dose change/augmentation (22.0%) and rationalisation of polypharmacy (12.2%). Neuropsychological (73.2%), psychological (39.0%) and psychosocial (85.4%) recommendations included access to cognitive remediation, psychological therapy and disability support. Physical health and substance misuse interventions were recommended for 91.5% and 20.7%, respectively. CONCLUSIONS Individuals referred to the TRSP had marked clinical and functional impairments. Holistic collaborative care planning complemented psychopharmacological interventions with psychological, psychosocial and physical healthcare recommendations.
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Affiliation(s)
- Kimberley Davies
- The Tertiary Referral Service for Psychosis (TRSP), Randwick, Australia; and
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Australia
| | - Sarah Grattan
- The Tertiary Referral Service for Psychosis (TRSP), Randwick, Australia; and
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Australia
| | - Chloe Gott
- The Tertiary Referral Service for Psychosis (TRSP), Randwick, Australia
| | - Robin Ellis
- The Tertiary Referral Service for Psychosis (TRSP), Randwick, Australia
| | - Julia M Lappin
- The Tertiary Referral Service for Psychosis (TRSP), Randwick, Australia; and
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Australia
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Lappin JM, Darke S, Farrell M. Psychotogenic potential of prescribed drugs. Aust N Z J Psychiatry 2023; 57:777-779. [PMID: 37148132 DOI: 10.1177/00048674231174807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- Julia M Lappin
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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Davies K, Courtney RJ, Summersby-Mitchell M, Morell R, Briggs N, Lappin JM. A systematic review of factors associated with sustained smoking abstinence in people experiencing severe mental illness following participation in a smoking intervention. Aust N Z J Psychiatry 2023; 57:489-510. [PMID: 36744432 DOI: 10.1177/00048674221147206] [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: 02/07/2023]
Abstract
OBJECTIVE People experiencing severe mental illness report higher rates of tobacco smoking than the general population, while rates of quitting and sustaining abstinence are considerably lower. This systematic review aimed to identify factors associated with sustained abstinence in people experiencing severe mental illness following a smoking intervention. METHOD Searches were conducted in PubMed, PsycInfo, Scopus, Embase, Emcare, CINAHL and Cochrane Library from the inception of the e-databases until June 2022. Selection criteria included randomised and non-randomised studies of smoking cessation interventions in which most of the participants were experiencing severe mental illness, and reported a follow-up of 3 months or longer. From an initial 1498 unique retrieved records, 26 references were included detailing 17 smoking cessation intervention studies and 3 relapse prevention intervention studies. Risk of bias was assessed using the RoB2 tool for randomised study designs and the ROBINS-I tool for non-randomised designs. RESULTS Participation in smoking interventions was associated with higher odds of abstinence in the medium-term, but not long-term follow-ups. There was insufficient evidence that any other factors impact sustained abstinence. Most studies were considered to have some risk of bias, largely due to insufficient availability of analysis plans. CONCLUSION Despite an abundance of studies investigating smoking cessation in smokers experiencing severe mental illness, there is limited knowledge on the factors associated with staying quit. The inclusion of people experiencing severe mental illness in large-scale randomised control trials, in which predictors of sustained abstinence are measured in the medium and long term are needed to address this important question.
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Affiliation(s)
- Kimberley Davies
- Discipline of Psychiatry & Mental Health, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Rachel Morell
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Julia M Lappin
- Discipline of Psychiatry & Mental Health, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- National Drug and Alcohol Research Centre, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
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Cohn SL, Mohan A, Lappin JM, Curtis J, Scott JG. Anti- N-Methyl-d-Aspartate Receptor Antibody Testing in First-Episode Psychosis: Universal or Targeted Testing. J Neuropsychiatry Clin Neurosci 2023; 35:98-101. [PMID: 36128677 DOI: 10.1176/appi.neuropsych.21080214] [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: 01/17/2023]
Abstract
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is an immune-mediated disorder that typically presents with rapid development of neuropsychiatric symptoms. As a potentially reversible cause of psychosis, there have been calls internationally for routine serological screening for anti-NMDAR antibodies in patients presenting with first-episode psychosis (FEP). Increased serological testing has, however, exposed several limitations of universal screening and rekindled debate as to which patients should be tested. Screening criteria have been proposed for high-risk clinical features in FEP in which antineuronal antibody testing is indicated. The authors present a clinical vignette and a service audit as well as discuss the limitations of universal screening advocating instead for targeted testing for antineuronal antibodies in patients diagnosed as having FEP.
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Affiliation(s)
- Sarah L Cohn
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (Cohn, Mohan); University of New South Wales, Sydney (Cohn, Mohan, Lappin, Curtis); South Eastern Sydney Local Health District, Sydney (Cohn, Mohan, Lappin, Curtis); Mindgardens Neuroscience Network, Sydney (Curtis); Child and Youth Research Group, QIMR Berghofer Medical Research Institute, and Early Psychosis Service, Metro North Mental Health Service, Herston, Australia (Scott); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia (Scott)
| | - Adith Mohan
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (Cohn, Mohan); University of New South Wales, Sydney (Cohn, Mohan, Lappin, Curtis); South Eastern Sydney Local Health District, Sydney (Cohn, Mohan, Lappin, Curtis); Mindgardens Neuroscience Network, Sydney (Curtis); Child and Youth Research Group, QIMR Berghofer Medical Research Institute, and Early Psychosis Service, Metro North Mental Health Service, Herston, Australia (Scott); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia (Scott)
| | - Julia M Lappin
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (Cohn, Mohan); University of New South Wales, Sydney (Cohn, Mohan, Lappin, Curtis); South Eastern Sydney Local Health District, Sydney (Cohn, Mohan, Lappin, Curtis); Mindgardens Neuroscience Network, Sydney (Curtis); Child and Youth Research Group, QIMR Berghofer Medical Research Institute, and Early Psychosis Service, Metro North Mental Health Service, Herston, Australia (Scott); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia (Scott)
| | - Jackie Curtis
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (Cohn, Mohan); University of New South Wales, Sydney (Cohn, Mohan, Lappin, Curtis); South Eastern Sydney Local Health District, Sydney (Cohn, Mohan, Lappin, Curtis); Mindgardens Neuroscience Network, Sydney (Curtis); Child and Youth Research Group, QIMR Berghofer Medical Research Institute, and Early Psychosis Service, Metro North Mental Health Service, Herston, Australia (Scott); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia (Scott)
| | - James G Scott
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (Cohn, Mohan); University of New South Wales, Sydney (Cohn, Mohan, Lappin, Curtis); South Eastern Sydney Local Health District, Sydney (Cohn, Mohan, Lappin, Curtis); Mindgardens Neuroscience Network, Sydney (Curtis); Child and Youth Research Group, QIMR Berghofer Medical Research Institute, and Early Psychosis Service, Metro North Mental Health Service, Herston, Australia (Scott); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia (Scott)
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Lappin JM, Zahra E, Darke S, Shand F, Sharma S, Draper B, Connors MH, Dear B, Titov N, Campbell G. Presentations to the emergency department with self-harm or suicidal behaviours: A role for digital mental health services? J Psychiatr Res 2022; 154:50-55. [PMID: 35930868 DOI: 10.1016/j.jpsychires.2022.07.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/07/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
UNLABELLED Emergency Department (ED) is an important site for assessing people presenting with self-harm or suicidal behaviors. Digital mental health services (DMHS) offer evidence-based interventions for mental health issues, but are often under-utilised, and information about them is rarely provided in ED. This feasibility study explored whether offering information about a DMHS to individuals presenting to ED with self-harm/suicidal behaviors resulted in self-enrolment in DMHS interventions for anxiety, depression and/or chronic pain. METHODS all individuals aged 18+ presenting with self-harm/suicidal behaviors to a metropolitan ED were screened for symptoms of anxiety, depression and/or chronic pain. Those with these symptoms were invited to participate in a study investigating enrolment with a DMHS. Study participants were provided with information about DMHS and followed up at one month. RESULTS 260 individuals presented with self-harm/suicidal behaviors over the 6-month study period. Many reported low mood (73.5%, n = 191) anxiety (67.2%, n = 174) and/or chronic pain (18.5%, n = 48). Half of those eligible for DMHS agreed at point of ED discharge to be contacted about participation in the DMHS study (51.4%, n = 108). One-third of these participated in the study (35.2%, n = 38). Rates of past-month high-risk SB (65.8%, n = 25), depression (92.1%, n = 35), anxiety (78.9%, n = 30) and chronic pain (57.9%, n = 22) were very high. Of these, 39.5% (n = 15) self-enrolled with the DMHS; almost all (80.0%, n = 13) engaged with an online intervention. CONCLUSIONS A subset of people presenting to emergency department with suicidal behaviors will engage with DMHS. Better understanding is needed of factors contributing to uptake of DMHS in this group.
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Affiliation(s)
- Julia M Lappin
- School of Psychiatry, UNSW, Australia; National Drug and Alcohol Research Centre, UNSW, Australia; South Eastern Sydney Local Health District, Australia.
| | - Emma Zahra
- National Drug and Alcohol Research Centre, UNSW, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre, UNSW, Australia
| | | | | | - Brian Draper
- School of Psychiatry, UNSW, Australia; South Eastern Sydney Local Health District, Australia
| | - Michael H Connors
- School of Psychiatry, UNSW, Australia; South Eastern Sydney Local Health District, Australia
| | - Blake Dear
- Department of Psychology, Macquarie University, Australia
| | - Nickolai Titov
- Department of Psychology, Macquarie University, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW, Australia; School of Psychology, University of Queensland, Australia
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Srasuebkul P, Walker AR, Cvejic RC, Trollor JN, Lappin JM, Curtis J, Samaras K, Dean K, Ward PB, Reppermund S. Hospital service utilisation of people previously hospitalised with different subtypes of psychotic disorder: A record linkage study. Aust N Z J Psychiatry 2022; 57:844-853. [PMID: 35920253 DOI: 10.1177/00048674221115642] [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: 11/16/2022]
Abstract
OBJECTIVE Little research has examined the physical and mental comorbidities, and health service use patterns, of people diagnosed with psychotic disorder subtypes other than schizophrenia spectrum disorders. This study aims to examine the physical and mental comorbidities, and subsequent hospital service use patterns, of individuals previously hospitalised with various psychotic disorder subtypes using linked health service data. METHODS We included individuals hospitalised with a psychotic disorder in New South Wales, Australia, between 1 July 2002 and 31 December 2014 (N = 63,110). We examined the demographic profile of the cohort and rates of subsequent acute hospital care and ambulatory mental health service use. We compared the rates of subsequent hospital admissions, emergency department presentations and ambulatory mental health treatment days of people hospitalised with different psychotic disorder subtypes to people hospitalised with schizophrenia spectrum disorders using Poisson regression. RESULTS People most recently hospitalised with mood/affective disorders and psychotic symptoms had a higher rate of subsequent hospital admissions than those most recently hospitalised with schizophrenia spectrum and delusional disorders (adjusted incident rate ratio = 1.06; 95% confidence interval = [1.02, 1.10]), while people most recently hospitalised with drug-induced and other organic (adjusted incident rate ratio = 1.19; 95% confidence interval = [1.12, 1.27]) and acute psychotic disorders (adjusted incident rate ratio = 1.10; 95% confidence interval = [1.03, 1.18]) had more subsequent emergency department presentations than those most recently hospitalised with schizophrenia spectrum and delusional disorders. All three groups had fewer subsequent mental health ambulatory days than those most recently hospitalised with schizophrenia spectrum and delusional disorders (adjusted incident rate ratios = 0.85-0.91). CONCLUSION The health profiles and subsequent hospital service use patterns of people previously hospitalised with different psychotic disorder subtypes are heterogeneous, and research is needed to develop targeted health policies to meet their specific health needs.
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Affiliation(s)
- Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, UNSW Sydney, Randwick, NSW, Australia
| | - Adrian R Walker
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, UNSW Sydney, Randwick, NSW, Australia
| | - Rachael C Cvejic
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, UNSW Sydney, Randwick, NSW, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, UNSW Sydney, Randwick, NSW, Australia.,Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, UNSW Sydney, Randwick, NSW, Australia
| | - Julia M Lappin
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Randwick, NSW, Australia
| | - Jackie Curtis
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Randwick, NSW, Australia
| | - Katherine Samaras
- Department of Endocrinology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.,Adipose Biology, Clinical Obesity and Nutrition Laboratory, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Randwick, NSW, Australia.,Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Philip B Ward
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Randwick, NSW, Australia.,Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Simone Reppermund
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, UNSW Sydney, Randwick, NSW, Australia.,Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, UNSW Sydney, Randwick, NSW, Australia
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Cvejic RC, Srasuebkul P, Walker AR, Reppermund S, Lappin JM, Curtis J, Samaras K, Dean K, Ward P, Trollor JN. The health service contact patterns of people with psychotic and non-psychotic forms of severe mental illness in New South Wales, Australia: A record-linkage study. Aust N Z J Psychiatry 2022; 56:675-685. [PMID: 34256621 DOI: 10.1177/00048674211031483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe and compare the health profiles and health service use of people hospitalised with severe mental illness, with and without psychotic symptoms. METHODS We conducted a historical cohort study using linked administrative datasets, including data on public hospital admissions, emergency department presentations and ambulatory mental health service contacts in New South Wales, Australia. The study cohort comprised 169,306 individuals aged 12 years and over who were hospitalised at least once with a mental health diagnosis between 1 July 2002 and 31 December 2014. Of these, 63,110 had a recorded psychotic illness and 106,196 did not. Outcome measures were rates of hospital, emergency department and mental health ambulatory service utilisation, analysed using Poisson regression. RESULTS People with psychotic illnesses had higher rates of hospital admission (adjusted incidence rate ratio (IRR) 1.26; 95% confidence interval [1.23, 1.30]), emergency department presentation (adjusted IRR 1.17; 95% confidence interval [1.13, 1.20]) and ambulatory mental health treatment days (adjusted IRR 2.90; 95% confidence interval [2.82, 2.98]) than people without psychotic illnesses. The higher rate of hospitalisation among people with psychotic illnesses was driven by mental health admissions; while people with psychosis had over twice the rate of mental health admissions, people with other severe mental illnesses without psychosis (e.g. mood/affective, anxiety and personality disorders) had higher rates of physical health admissions, including for circulatory, musculoskeletal, genitourinary and respiratory disorders. Factors that predicted greater health service utilisation included psychosis, intellectual disability, greater medical comorbidity and previous hospitalisation. CONCLUSION Findings from this study support the need for (a) the development of processes to support the physical health of people with severe mental illness, including those without psychosis; (b) a focus in mental health policy and service provision on people with complex support needs, and (c) improved implementation and testing of integrated models of care to improve health outcomes for all people experiencing severe mental illness.
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Affiliation(s)
- Rachael C Cvejic
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Adrian R Walker
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Simone Reppermund
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Julia M Lappin
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Jackie Curtis
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Katherine Samaras
- Adipose Biology, Obesity and Clinical Nutrition Laboratory, Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Department of Endocrinology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Kimberlie Dean
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Philip Ward
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
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10
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Lappin JM. Comorbid substance use in psychosis: Someone else's problem? Aust N Z J Psychiatry 2022; 56:5-7. [PMID: 34881671 DOI: 10.1177/00048674211065669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julia M Lappin
- School of Psychiatry, UNSW, Sydney, NSW, Australia.,National Drug and Alcohol Research Centre (NDARC), UNSW, Sydney, NSW, Australia.,South Eastern Sydney Local Health District, Taren Point, NSW, Australia
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11
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Lappin JM, Davies K, O'Donnell M, Walpola IC. Underuse of recommended treatments among people living with treatment-resistant psychosis. Front Psychiatry 2022; 13:987468. [PMID: 36147973 PMCID: PMC9485552 DOI: 10.3389/fpsyt.2022.987468] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND International guidelines recommend that individuals with treatment-resistant psychosis must be treated with clozapine. ECT has also been reported to improve symptom profiles. Identification of clozapine and/or ECT use in real-world practice enables understanding of the extent to which this evidence-base is implemented. SETTING Statewide public health tertiary referral service, the Tertiary Referral Service for Psychosis (TRSP), NSW, Australia. OBJECTIVES To (i) describe clinical characteristics of individuals with treatment-resistant psychosis and to detail the proportion who had received a trial of clozapine or ECT at any point during their illness course; (ii) describe the characteristics of the treatment trials in both those currently on clozapine and those previously on clozapine; (iii) document reasons in relevant individuals why clozapine had never been used. METHODS All TRSP clients who met the criteria for treatment resistance (TR) were included. A detailed casenote review was conducted to examine whether clozapine and/or ECT had ever been prescribed. Characteristics of clozapine and ECT trials were documented. Tertiary service treatment recommendations are described. FINDINGS Thirty-six of 48 individuals had TR. They had marked clinical and functional impairment. A minority were currently receiving clozapine (n = 14/36). Most had received a clozapine trial at some point (n = 32/36). Most experienced persistent clinical symptoms while on clozapine (n = 29/32). Clozapine plasma levels were very rarely reported (4/32). Augmentation and antipsychotic polypharmacy were common among those currently on clozapine. The median clozapine trial duration was 4.0 (IQR: 3.0-20.3) months in individuals previously prescribed clozapine. Reasons for clozapine discontinuation included intolerable side effects (n = 10/18) and poor adherence (n = 7/18). One-quarter of TR individuals had trialed ECT (n = 9/36). Tertiary service recommendations included routine plasma monitoring to optimize dose among people currently on clozapine; clozapine retrial in those previously treated; and clozapine initiation for those who had never received clozapine. ECT was recommended to augment clozapine and as an alternative where clozapine trial/retrial was not feasible. CONCLUSION Among people with TR referred to a tertiary service, clozapine and ECT were underutilized. Clozapine trials are typically terminated without an adequate trial. Strategies to optimize the use of clozapine therapy and ECT in clinical settings are needed to increase the therapeutic effectiveness of evidence-based therapies for treatment-resistant psychosis.
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Affiliation(s)
- Julia M Lappin
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia.,Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW, Australia
| | - Kimberley Davies
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia.,Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW, Australia
| | - Maryanne O'Donnell
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia.,Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW, Australia
| | - Ishan C Walpola
- The Tertiary Referral Service for Psychosis (TRSP), South Eastern Sydney Local Health District, Randwick, NSW, Australia.,Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW, Australia
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12
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Talukder SR, Lappin JM, Boland V, McRobbie H, Courtney RJ. Inequity in smoking cessation clinical trials testing pharmacotherapies: exclusion of smokers with mental health disorders. Tob Control 2021:tobaccocontrol-2021-056843. [PMID: 34862325 DOI: 10.1136/tobaccocontrol-2021-056843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/10/2021] [Accepted: 10/28/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES People suffering from mental health disorder (MHDs) are often under-represented in clinical research though the reasons for their exclusion are rarely recorded. As they have higher rates of smoking and nicotine dependence, it is crucial that they are adequately represented in clinical trials of established pharmacotherapy interventions for smoking cessation. This review aims to examine the practice of excluding smokers with MHDs and reasons for such exclusion in clinical trials evaluating pharmacotherapy treatments for smoking cessation. DATA SOURCE The Cochrane database of systematic reviews was searched until September 2020 for reviews on smoking cessation using pharmacotherapies. STUDY SELECTION Randomised controlled trials (RCTs) within the selected Cochrane reviews were included. DATA EXTRACTION Conducted by one author and independently verified by three authors. DATA SYNTHESIS We included 279 RCTs from 13 Cochrane reviews. Of all studies, 51 (18.3%) explicitly excluded participants with any MHDs, 152 (54.5%) conditionally excluded based on certain MHD criteria and 76 (27.2%) provided insufficient information to ascertain either inclusion or exclusion. Studies of antidepressant medications used for smoking cessation were found to be 3.33 times more likely (95% CI 1.38 to 8.01, p=0.007) to conditionally exclude smokers with MHDs than explicitly exclude compared with studies of nicotine replacement therapy. CONCLUSION Smokers with MHDs are not sufficiently represented in RCTs examining the safety and effectiveness of smoking cessation medications. Greater access to clinical trial participation needs to be facilitated for this group to better address access to appropriate pharmacotherapeutic interventions in this vulnerable population.
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Affiliation(s)
- Saki Rubaiya Talukder
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Julia M Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Veronica Boland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Ryan James Courtney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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13
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Wang TY, Fan TT, Lappin JM, Li XD, Zhao YM, Wu P, Shi J, Bao YP, Lu L. Cognitive improvement among abstinent methamphetamine users: A 2-year prospective longitudinal study. Am J Addict 2021; 30:543-551. [PMID: 34411367 DOI: 10.1111/ajad.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/02/2021] [Accepted: 07/11/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The adverse impact of chronic methamphetamine (MA) use on cognitive function has been described in previous studies, but limited evidence is available for abstinent users from prospective longitudinal studies. The aim of the present study was to assess cognitive function of varying abstinent duration. METHODS This prospective longitudinal study was conducted with baseline and four follow-up interviews every 6 months over 2 years in 358 MA users in Guangdong province, China. The Montreal Cognitive Assessment (MoCA) was used to measure cognitive function. Generalized estimating equation (GEE) analysis was used to examine within-subjects relationships between abstinence and cognitive consequences over time. RESULTS The repeated measure analysis of variance showed significant differences in the total MoCA score and all subscale scores (except Orientation) in the 24 months follow-up. The GEE model showed that abstinence from MA in the past 6 months predicted an increase of 0.66 (95% confidence interval [CI] = 0.29 to 1.05, p = .002) in MoCA score changes compared with the nonabstinence MA users. Abstinence in the past 12, 18, and 24 months predicted an increase in MoCA total score changes of 1.25 (95% CI = -0.23 to 2.74), 2.15 (95% CI = -0.79 to 5.09), and 5.28 (95% CI = -2.01 to 12.58), respectively, but none of these was statistically significant. DISCUSSION AND CONCLUSIONS Cognitive function was potentially improved following 6 months of MA abstinence. SCIENTIFIC SIGNIFICANCE This study extends prior research by long-term follow-up in big sample MA abstinence users. Findings from study support the need for a comprehensive measure to decrease MA use and promote the recovery of cognitive impairment.
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Affiliation(s)
- Tong-Yu Wang
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Peking University Institute of Mental Health, Peking University, Beijing, China.,Beijing Key Laboratory of Drug Dependence, National Institute on Drug Dependence, Peking University, Beijing, China.,Nutrition and Food Hygiene Division, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Teng-Teng Fan
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Peking University Institute of Mental Health, Peking University, Beijing, China
| | - Julia M Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Xiao-Dong Li
- Beijing Changping Huayou Hospital, Beijing, China
| | - Yi-Miao Zhao
- Beijing Key Laboratory of Drug Dependence, National Institute on Drug Dependence, Peking University, Beijing, China.,School of Public Health, Peking University, Beijing, China
| | - Ping Wu
- Beijing Key Laboratory of Drug Dependence, National Institute on Drug Dependence, Peking University, Beijing, China
| | - Jie Shi
- Beijing Key Laboratory of Drug Dependence, National Institute on Drug Dependence, Peking University, Beijing, China
| | - Yan-Ping Bao
- Beijing Key Laboratory of Drug Dependence, National Institute on Drug Dependence, Peking University, Beijing, China.,School of Public Health, Peking University, Beijing, China
| | - Lin Lu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Peking University Institute of Mental Health, Peking University, Beijing, China.,Beijing Key Laboratory of Drug Dependence, National Institute on Drug Dependence, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences, PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
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14
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Lappin JM, Darke S. Methamphetamine and heightened risk for early-onset stroke and Parkinson's disease: A review. Exp Neurol 2021; 343:113793. [PMID: 34166684 DOI: 10.1016/j.expneurol.2021.113793] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/29/2021] [Revised: 06/09/2021] [Accepted: 06/19/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Methamphetamine users are typically young adults, placing them at risk for significant drug-related harms. Neurological harms include stroke and Parkinson's disease, both of which may develop prematurely in the context of methamphetamine use. MATERIAL AND METHODS We conducted a narrative review examining the evidence first, for stroke under 45 years and second, early onset of Parkinson's disease (PD) and parkinsonism related to methamphetamine use. We summarise epidemiological factors and common clinical features, before examining in detail the underlying pathology and causal mechanisms. RESULTS AND DISCUSSION Methamphetamine use among young people (<45 years) is associated with heightened risk for haemorrhagic stroke. Compared to age-matched all-cause fatal stroke, haemorrhage secondary to aneurysmal rupture is more common among young people with methamphetamine-related stroke and is associated with significantly poorer prognosis. Aetiology is related primarily to both acute and chronic hypertension associated with methamphetamine's sympathomimetic action. Evidence from a variety of sources supports a link between methamphetamine use and increased risk for the development of PD and parkinsonism, and with their early onset in a subset of individuals. Despite this, direct evidence of degeneration of dopaminergic neurons in methamphetamine users has not been demonstrated to date. CONCLUSIONS Stroke and Parkinson's Disease/parkinsonism are neurological harms observed prematurely in methamphetamine users.
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Affiliation(s)
- Julia M Lappin
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, Australia; School of Psychiatry, University of New South Wales, NSW, Australia.
| | - Shane Darke
- National Drug & Alcohol Research Centre, University of New South Wales, NSW, Australia
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15
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Yang R, Curtis J, Jensen C, Levy P, Chown K, Lappin JM. Detection and intervention in emerging youth mental health issues: Outcomes from the first year of the CASPAR service. Early Interv Psychiatry 2021; 15:167-173. [PMID: 32243097 DOI: 10.1111/eip.12956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/01/2019] [Revised: 01/27/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is a recognized gap in mental health service provision for youth, a population in whom emerging mental disorders are prevalent and recognized as a target for early intervention. Comprehensive Assessment Service for Psychosis and At-Risk (CASPAR) is a new, community-based service aiming to address the service gap between headspace and tertiary psychiatric services. CASPAR facilitates assessment and short-term early intervention in youth (aged 12-25 years) with emerging mental health issues. Demographic and clinical characteristics are described in all individuals receiving care from CASPAR in its first year of operation. Changes in psychological distress and psychosocial functioning over the course of a treatment episode are reported. METHODS Demographic and clinical data, including measures of functional impairment (Social and Occupational Functioning Assessment Scale [SOFAS]) and psychological distress (Kessler Psychological Distress Scale [K10]), were obtained at baseline and completion of episode of care for all clients. RESULTS 92 young people (53.3% male, mean age 18.7 years) were included, of whom 20 (21.7%) disengaged before treatment endpoint. Clients who disengaged early were more likely to identify as lesbian, gay, bisexual and transgender+ (LGBT+). At follow-up, 61.1% showed improvements in social functioning (SOFAS) and 64.4% in psychological distress (K10). CONCLUSIONS The majority of clients showed improvements in psychological distress and functioning during an episode of care. LGBT+ youth were less likely to remain engaged with the service. The factors associated with initial and continued engagement with youth early intervention services require further examination, particularly in marginalized groups with high mental illness prevalence such as LGBT+ communities.
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Affiliation(s)
- Rachel Yang
- Medical Student, University of New South Wales, Sydney, New South Wales, Australia
| | - Jackie Curtis
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,The Bondi Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Candice Jensen
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,The Bondi Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Philippa Levy
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,The Bondi Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Karen Chown
- The Bondi Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Julia M Lappin
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,The Bondi Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
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16
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Gale-Grant O, Dazzan P, Lappin JM, Donoghue K, Reininghaus U, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Morgan C, Heslin M. Diagnostic stability and outcome after first episode psychosis. J Ment Health 2020; 30:104-112. [DOI: 10.1080/09638237.2020.1818191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Oliver Gale-Grant
- King’s College London, MRC Centre for Neurodevelopmental Disorders, London, UK
- King’s College London, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Paola Dazzan
- King’s College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King’s College London, National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and, London, UK
| | - Julia M. Lappin
- Faculty of Medicine, University of New South Wales, School of Psychiatry, Sydney, Australia
| | - Kim Donoghue
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ulrich Reininghaus
- King’s College London, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tim Croudace
- School of Nursing & Health Sciences, University of Dundee, Dundee, UK
| | - Peter B. Jones
- Cambridgeshire and Peterborough NHS Foundation Trust, University of Cambridge, Cambridge, UK
| | - Robin M. Murray
- King’s College London, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King’s College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Paul Fearon
- Discipline of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Gillian A. Doody
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Craig Morgan
- King’s College London, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Margaret Heslin
- King’s College London, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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17
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Wang Y, Liu M, Lu Q, Farrell M, Lappin JM, Shi J, Lu L, Bao Y. Global prevalence and burden of HIV-associated neurocognitive disorder. Neurology 2020; 95:e2610-e2621. [DOI: 10.1212/wnl.0000000000010752] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/04/2020] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo characterize the prevalence and burden of HIV-associated neurocognitive disorder (HAND) and assess associated factors in the global population with HIV.MethodsWe searched PubMed and Embase for cross-sectional or cohort studies reporting the prevalence of HAND or its subtypes in HIV-infected adult populations from January 1, 1996, to May 15, 2020, without language restrictions. Two reviewers independently undertook the study selection, data extraction, and quality assessment. We estimated pooled prevalence of HAND by a random effects model and evaluated its overall burden worldwide.ResultsOf 5,588 records identified, we included 123 studies involving 35,513 participants from 32 countries. The overall prevalence of HAND was 42.6% (95% confidence interval [CI] 39.7–45.5) and did not differ with respect to diagnostic criteria used. The prevalence of asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia were 23.5% (20.3–26.8), 13.3% (10.6–16.3), and 5.0% (3.5–6.8) according to the Frascati criteria, respectively. The prevalence of HAND was significantly associated with the level of CD4 nadir, with a prevalence of HAND higher in low CD4 nadir groups (mean/median CD4 nadir <200 45.2% [40.5–49.9]) vs the high CD4 nadir group (mean/median CD4 nadir ≥200 37.1% [32.7–41.7]). Worldwide, we estimated that there were roughly 16,145,400 (95% CI 15,046,300–17,244,500) cases of HAND in HIV-infected adults, with 72% in sub-Saharan Africa (11,571,200 cases, 95% CI 9,600,000–13,568,000).ConclusionsOur findings suggest that people living with HIV have a high burden of HAND in the antiretroviral therapy (ART) era, especially in sub-Saharan Africa and Latin America. Earlier initiation of ART and sustained adherence to maintain a high-level CD4 cell count and prevent severe immunosuppression is likely to reduce the prevalence and severity of HAND.
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18
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Ferruccio NP, Tosato S, Lappin JM, Heslin M, Donoghue K, Giordano A, Lomas B, Reininghaus U, Onyejiaka A, Chan RCK, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Morgan C, Dazzan P. Neurological Signs at the First Psychotic Episode as Correlates of Long-Term Outcome: Results From the AESOP-10 Study. Schizophr Bull 2020; 47:118-127. [PMID: 32656567 PMCID: PMC7824991 DOI: 10.1093/schbul/sbaa089] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Minor neurological signs are subtle deficits in sensory integration, motor coordination, and sequencing of complex motor acts present in excess in the early stages of psychosis. Still, it remains unclear whether at least some of these signs represent trait or state markers for psychosis and whether they are markers of long-term disease outcome of clinical utility. We examined the relationship between neurological function at illness onset assessed with the Neurological Evaluation Scale and subsequent illness course in 233 patients from AESOP-10 (Aetiology and Ethnicity in Schizophrenia and Other Psychoses), a 10-year follow-up study of a population-based cohort of individuals recruited at the time of their first episode of psychosis in the United Kingdom. In 56 of these patients, we also explored changes in neurological function over time. We included a group of 172 individuals without psychosis as controls. After 10 years, 147 (63%) patients had developed a non-remitting course of illness, and 86 (37%) a remitting course. Already at first presentation, patients who developed a non-remitting course had significantly more primary, motor coordination, and total signs than both remitting patients and healthy controls. While Motor Coordination signs did not change over time, rates of Primary, Sensory Integration, and Total signs increased, independently of illness course type. These findings suggest that motor coordination problems could be a useful early, quick, and easily detectable marker of subsequent clinical outcome. With other motor abnormalities, a measure of motor incoordination could contribute to the identification of the most vulnerable individuals, who could benefit from targeted and more assertive treatment approaches.
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Affiliation(s)
- Naika P Ferruccio
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sarah Tosato
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Julia M Lappin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Margaret Heslin
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kim Donoghue
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Annalisa Giordano
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ben Lomas
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Adanna Onyejiaka
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Tim Croudace
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Peter B Jones
- University of Cambridge, and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paul Fearon
- Discipline of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Gillian A Doody
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK,To whom correspondence should be addressed; tel: +44-(0)207-848-0700, fax: +44-(0)207-848-0287, e-mail:
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19
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Dazzan P, Lappin JM, Heslin M, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Morgan C. Symptom remission at 12-weeks strongly predicts long-term recovery from the first episode of psychosis. Psychol Med 2020; 50:1452-1462. [PMID: 31364523 PMCID: PMC7385193 DOI: 10.1017/s0033291719001399] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/18/2019] [Accepted: 05/28/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND To determine the baseline individual characteristics that predicted symptom recovery and functional recovery at 10-years following the first episode of psychosis. METHODS AESOP-10 is a 10-year follow up of an epidemiological, naturalistic population-based cohort of individuals recruited at the time of their first episode of psychosis in two areas in the UK (South East London and Nottingham). Detailed information on demographic, clinical, and social factors was examined to identify which factors predicted symptom and functional remission and recovery over 10-year follow-up. The study included 557 individuals with a first episode psychosis. The main study outcomes were symptom recovery and functional recovery at 10-year follow-up. RESULTS At 10 years, 46.2% (n = 140 of 303) of patients achieved symptom recovery and 40.9% (n = 117) achieved functional recovery. The strongest predictor of symptom recovery at 10 years was symptom remission at 12 weeks (adj OR 4.47; CI 2.60-7.67); followed by a diagnosis of depression with psychotic symptoms (adj OR 2.68; CI 1.02-7.05). Symptom remission at 12 weeks was also a strong predictor of functional recovery at 10 years (adj OR 2.75; CI 1.23-6.11), together with being from Nottingham study centre (adj OR 3.23; CI 1.25-8.30) and having a diagnosis of mania (adj OR 8.17; CI 1.61-41.42). CONCLUSIONS Symptom remission at 12 weeks is an important predictor of both symptom and functional recovery at 10 years, with implications for illness management. The concepts of clinical and functional recovery overlap but should be considered separately.
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Affiliation(s)
- Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Julia M. Lappin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Margaret Heslin
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kim Donoghue
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ben Lomas
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Uli Reininghaus
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
| | - Adanna Onyejiaka
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tim Croudace
- School of Nursing & Health Sciences, University of Dundee, Dundee, UK
| | - Peter B. Jones
- University of Cambridge, and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Paul Fearon
- Discipline of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Gillian A. Doody
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Craig Morgan
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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20
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Lappin JM. Commentary on Petersen et al. (2019): Development of problematic substance use in the years that follow diagnosis of schizophrenia. Addiction 2019; 114:2227-2228. [PMID: 31590202 DOI: 10.1111/add.14791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/02/2019] [Accepted: 08/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
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21
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Abstract
Psychostimulant users are typically young adults. We have conducted a narrative review of neuropsychiatric harms associated with the psychostimulants methamphetamine/amphetamine, cocaine and 3,4-methylenedioxymethamphetamine (MDMA), focusing on epidemiological factors, common clinical presentations, underlying causal mechanisms and treatment options. The major neuropsychiatric harms of psychostimulant use are stroke, neurocognitive impairment, Parkinson's disease, seizures and psychotic illness. These arise through a combination of acute monoamine release, longer-term neurotransmitter effects and indirect effects. These effects are moderated by factors in the individual and in the pattern of substance use. Neuropsychiatric harms associated with psychostimulant use can thus lead to severe long-term impairment.
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Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Grant E Sara
- InforMH, NSW Ministry of Health, North Ryde, NSW, Australia.,Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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McKetin R, Leung J, Stockings E, Huo Y, Foulds J, Lappin JM, Cumming C, Arunogiri S, Young JT, Sara G, Farrell M, Degenhardt L. Mental health outcomes associated with of the use of amphetamines: A systematic review and meta-analysis. EClinicalMedicine 2019; 16:81-97. [PMID: 31832623 PMCID: PMC6890973 DOI: 10.1016/j.eclinm.2019.09.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The use of amphetamines is a global public health concern. We summarise global data on use of amphetamines and mental health outcomes. METHODS A systematic review and meta-analysis (CRD 42017081893). We searched Medline, EMBASE, PsycInfo for methamphetamine or amphetamine combined with psychosis, violence, suicidality, depression or anxiety. Included studies were human empirical cross-sectional surveys, case-control studies, cohort studies and randomised controlled trials that assessed the association between methamphetamine and one of the mental health outcomes. Random effects meta-analysis was used to pool results for any use of amphetamines and amphetamine use disorders. FINDINGS 149 studies were eligible and 59 were included in meta-analyses. There was significant heterogeneity in effects. Evidence came mostly from cross-sectional studies. Any use of amphetamines was associated with higher odds of psychosis (odds ratio [OR] = 2.0, 95%CI 1.3-3.3), violence (OR = 2.2, 95%CI 1.2-4.1; adjusted OR [AOR] = 1.4, 95%CI 0.8-2.4), suicidality OR = 4.4, 95%CI 2.4-8.2; AOR = 1.7, 95%CI 1.0-2.9) and depression (OR = 1.6, 95%CI 1.1-2.2; AOR = 1.3, 95%CI 1.2-1.4). Having an amphetamine use disorder was associated with higher odds of psychosis (OR = 3.0, 95%CI 1.9-4.8; AOR = 2.4, 95%CI 1.6-3.5), violence (OR = 6.2, 95%CI 3.1-12.3), and suicidality (OR = 2.3, 95%CI 1.8-2.9; AOR = 1.5, 95%CI 1.3-1.8). INTERPRETATION Methamphetamine use is an important risk factor for poor mental health. High quality population-level studies are needed to more accurately quantify this risk. Clinical responses to methamphetamine use need to address mental health harms.
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Affiliation(s)
- Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Corresponding author.
| | - Janni Leung
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Yan Huo
- Faculty of Health and Behavioural Sciences, The University of Queensland, Australia
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Julia M. Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- School of Psychiatry, University of NSW, Sydney, Australia
| | - Craig Cumming
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health, Richmond, VIC, Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Jesse T. Young
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Grant Sara
- Northern Clinical School, Sydney Medical School, University of Sydney, Australia
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Abstract
Background and Purpose- Fatal stroke during pregnancy and the puerperium is rare. Pregnancy-related hypertension and vascular abnormalities underlie significant proportions of pregnancy-related stroke, but up to one-quarter are of no known cause. Methods- Case series of fatal pregnancy-related stroke. All cases where the cause of death was attributed to stroke during pregnancy/postpartum were retrieved from the National Coronial Information System database (January 1, 2009 to December 31, 2016). Results- Fourteen fatal strokes were identified, all hemorrhagic in origin. Underlying causes included pregnancy-related hypertension, rupture of vascular malformations, vasculitis, and cardiomyopathy. Conclusions- Fatal pregnancy-related stroke occurred secondary to hemorrhages of heterogeneous causes, including pregnancy-related hypertension and previously undiagnosed risk factors.
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Affiliation(s)
- Julia M Lappin
- From the National Drug and Alcohol Research Centre (J.M.L., S.D., J.D., S.K., M.F.), University of New South Wales, Australia.,School of Psychiatry (J.M.L.), University of New South Wales, Australia
| | - Shane Darke
- From the National Drug and Alcohol Research Centre (J.M.L., S.D., J.D., S.K., M.F.), University of New South Wales, Australia
| | - Johan Duflou
- From the National Drug and Alcohol Research Centre (J.M.L., S.D., J.D., S.K., M.F.), University of New South Wales, Australia.,Sydney Medical School, University of Sydney, Australia (J.D.)
| | - Sharlene Kaye
- From the National Drug and Alcohol Research Centre (J.M.L., S.D., J.D., S.K., M.F.), University of New South Wales, Australia
| | - Michael Farrell
- From the National Drug and Alcohol Research Centre (J.M.L., S.D., J.D., S.K., M.F.), University of New South Wales, Australia
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Lappin JM, Heslin M, Lomas B, Jones PB, Doody GA, Reininghaus UA, Croudace T, Craig T, Fearon P, Murray RM, Dazzan P, Morgan C. Early sustained recovery following first episode psychosis: Evidence from the AESOP10 follow-up study. Schizophr Res 2018; 199:341-345. [PMID: 29571751 DOI: 10.1016/j.schres.2018.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Received: 10/26/2017] [Revised: 02/24/2018] [Accepted: 03/10/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the characteristics of individuals with early sustained recovery following first episode psychosis. METHODS Individuals with a first episode psychosis were followed-up for ten years. Comparisons were made between those with Early Sustained Recovery and those with Other Course types. RESULTS Of 345 individuals, n=43 (12.5%) had Early Sustained Recovery. They were more likely than those with Other Course types to be female (OR=2.45; 95% CI: 1.25-4.81); employed (OR=2.39; 95% CI: 1.22-4.69); in a relationship (OR=2.68; 95% CI: 1.35-5.32); have a short DUP (OR=2.86; 95% CI: 1.37-5.88); and have a diagnosis other than schizophrenia, particularly mania (OR=6.39; 95% CI: 2.52-16.18) or brief psychosis (OR=3.64; 95% CI: 1.10-12.10). CONCLUSIONS Sustained recovery from first episode psychosis occurs in a minority.
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Affiliation(s)
- J M Lappin
- School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - M Heslin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - B Lomas
- Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - P B Jones
- University of Cambridge, Cambridge, UK
| | - G A Doody
- University of Nottingham, Nottingham, UK
| | - U A Reininghaus
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University
| | | | - T Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Italy
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Lappin JM, Darke S, Farrell M. Methamphetamine use and future risk for Parkinson's disease: Evidence and clinical implications. Drug Alcohol Depend 2018; 187:134-140. [PMID: 29665491 DOI: 10.1016/j.drugalcdep.2018.02.032] [Citation(s) in RCA: 46] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/21/2018] [Accepted: 02/24/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Methamphetamine use has been posited to be a risk factor for the development of Parkinson's disease (PD) and parkinsonism. The clinical implications of a potential association between methamphetamine use and PD are considered. METHODS A review of methamphetamine and PD and parkinsonism was conducted, including evidence from animal models, clinical and population studies. RESULTS There is biological plausibility to a link between methamphetamine use and PD. Though clinical and epidemiological evidence in this area is scant, a number of studies suggest that methamphetamine is associated with a moderately increased risk of PD and parkinsonism, and may also lead to premature onset of PD. The long lag time between exposure to methamphetamine and onset of PD, the potential for recovery from neurotoxic effects, and tobacco smoking each may attenuate the association. Individual and drug use characteristics that may modulate a user's risk remain poorly understood. CONCLUSIONS The use of methamphetamine may be an initiating event in the development of PD and parkinsonism, in addition to other risk factors that a given individual may hold. Clinicians should be vigilant to signs of prodromal and emerging PD among methamphetamine users. In individuals with premature onset illness, information on current or prior exposure to methamphetamine should be sought.
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Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Fornells-Ambrojo M, Pocock P, Mintah R, Barker C, Craig T, Lappin JM. Co-morbid personality disorder in early intervention psychosis clients is associated with greater key worker emotional involvement. Early Interv Psychiatry 2018; 12:143-152. [PMID: 26552836 DOI: 10.1111/eip.12286] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Abstract
AIM Co-morbid personality disorder (PD) is associated with poorer outcomes in psychosis patients, but it is not known whether these patterns are present at illness onset. This study investigated the prevalence of co-morbid PD in clients of an Early Intervention in Psychosis Service (EIPS) and compared key worker engagement and service use between patients with and without co-morbid PD. METHOD Forty-nine participants were recruited from an inner London NHS EIPS. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) Axis II Disorders was administered to identify whether participants met criteria for a diagnosis of PD. Key workers completed measures investigating the therapeutic relationship and emotional involvement. Data on service use over a 2-year period from the date on which the patient was accepted by the EIPS were collected from electronic clinical records. Service use and key worker informed data were collected blind to PD diagnosis. RESULTS Twenty-two of the 49 (45%) patients met criteria for co-morbid PD. Keyworker worry and tension were significantly higher in relation to patients with co-morbid PD compared with those without. There were no significant differences between groups in appointments offered or attended, but patients with co-morbid PD were significantly less likely to be admitted to hospital than those without. CONCLUSIONS Co-morbid PD is common in EIPS patients. The EIPS model is both assertive and intensive; although this appears to be effective in preventing hospital admissions, this does not equip professionals to manage the higher emotional burden associated with a co-morbid PD diagnosis.
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Affiliation(s)
- Miriam Fornells-Ambrojo
- Research Department of Clinical, Education and Health Psychology, University College London, London, UK.,Southwark Team for Early Intervention in Psychosis, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Phil Pocock
- Research Department of Clinical, Education and Health Psychology, University College London, London, UK
| | - Ruth Mintah
- Southwark Team for Early Intervention in Psychosis, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chris Barker
- Research Department of Clinical, Education and Health Psychology, University College London, London, UK
| | - Thomas Craig
- Health Services Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Julia M Lappin
- Southwark Team for Early Intervention in Psychosis, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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28
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Lappin JM, Ayub MH, Rogers D, Morgan M, Kanyamibwa JY, Shakeshaft A. Routine screening and related interventions significantly improve the effectiveness of emergency department detection and management of alcohol withdrawal syndrome. Emerg Med Australas 2018. [DOI: 10.1111/1742-6723.12959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre; The University of New South Wales; Sydney New South Wales Australia
- School of Psychiatry; The University of New South Wales; Sydney New South Wales Australia
| | - Muhammad H Ayub
- National Drug and Alcohol Research Centre; The University of New South Wales; Sydney New South Wales Australia
| | - David Rogers
- Drug and Alcohol Services; Mid North Coast Local Health District; Port Macquarie New South Wales Australia
| | - Madeleine Morgan
- Drug and Alcohol Services; Kempsey District Hospital; Kempsey New South Wales Australia
| | - Jean-Yves Kanyamibwa
- Drug and Alcohol Services; Kempsey District Hospital; Kempsey New South Wales Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre; The University of New South Wales; Sydney New South Wales Australia
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Abstract
One hundred years ago, D'Arsonval and Beer first described the effects of magnetic fields on human brain function. Placing one's head into a powerful magnet produced phosphenes, vertigo or even syncopes (George & Belmaker, 2000). However, only since 1985 has the technology of fast discharging capacitors developed sufficiently to generate reproducible effects across the intact skull, with peak magnetic field strengths of about 1–2 tesla (Barker et al, 1985). The headline-grabbing news has been about therapeutic applications of transcranial magnetic stimulation (TMS), but in the meantime a revolution in functional brain research has taken place, based on the manipulation of brain activity by focused magnetic fields. TMS applied in this way is, in a manner of speaking, brain imaging in the reverse. While common modes of functional brain imaging, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), demonstrate associations between brain metabolic activity and ‘brain tasks', the causal interpretation of such associations can be difficult. Is the frontal lobe activation observed during a memory task, for example, necessary for performing the task, or does it correspond to monitoring activity that runs parallel to task performance proper? If, on the other hand, focal brain activation during TMS results in a muscle twitch, there is no doubt that stimulation of at least some of the neurons within the magnetic field is sufficient cause for the observed movement. Functional neuroimaging is now often combined with TMS, carried out in the same session in order to exploit the complementary strengths of the methods. Although direct stimulation of association (as opposed to motor or sensory) cortex does not usually result in an observable response, TMS applied in repetitive trains can produce reversible ‘lesions'. By interfering with tasks that are dependent on the functioning of the stimulated neurons, it can thus contribute to the localisation of brain function.
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Su MF, Liu MX, Li JQ, Lappin JM, Li SX, Wu P, Liu ZM, Shi J, Lu L, Bao Y. Epidemiological Characteristics and Risk Factors of Methamphetamine-Associated Psychotic Symptoms. Front Psychiatry 2018; 9:489. [PMID: 30369888 PMCID: PMC6194209 DOI: 10.3389/fpsyt.2018.00489] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022] Open
Abstract
Objective: To explore the epidemiological characteristics and the risk factors for methamphetamine (MA)-associated psychotic symptoms among MA users in China. Methods: A cross-sectional study was conducted between April, 2012 and October, 2015 among individuals for whom MA was the principal drug of use in a Compulsory Drug Detoxification Center in Beijing, Guangdong Province. Demographic, drug use and psychological characteristics were examined using a specifically-designed questionnaire, the Positive and Negative Syndrome Scale, Barratt Impulsive Scale, Hamilton Anxiety Scale and Beck Depression Inventory. Logistic regression was performed to explore the risk factors for MA-associated psychotic symptoms. Results: A total of 1685 participants were included. Participants were predominantly aged 30 or above, unemployed, and were unmarried Han Chinese men, with limited education. The duration of MA use was more than 3 months in 72.3%. 47.8% reported that the dose of MA use was ≥ 0.2 g per occasion of use. 11.5% had used two or more synthetic drugs. The prevalence of MA-associated psychotic symptoms was 17.0% among MA users during periods of abstinence. Multiple logistic regression analyses showed that a higher dose (≥0.2 g per time), a longer duration of MA use (>3 months) a history of heroin use and a history of tobacco use were associated with MA-associated psychotic symptoms, with adjusted odds ratios (ORs) of 1.96 (95% confidence interval [CI]: 1.40-2.76), 1.98 (95% CI: 1.33-2.96) and 2.45 (95% CI: 1.67-3.60), 1.78 (95% CI: 1.27-2.49) respectively. MA-associated psychotic symptoms were less common among married/cohabitating than unmarried (OR = 0.56; 95% CI: 0.39-0.81), and unemployed than employed (OR = 0.65; 95% CI: 0.47-0.92) individuals. MA users with anxiety and depression symptoms had significantly greater risk for MA-associated psychotic symptoms by 9.70 (6.92-13.59) and 1.90 (1.36-2.65) times respectively. Individuals with higher impulsivity were more likely to have MA-associated psychotic symptoms than those with lower (OR = 2.19; CI:1.50-3.20). Conclusion: MA-associated psychotic symptoms occurred frequently among MA users in China. The efforts that facilitate drug users' attempts to reduce MA use, abstain from poly-drug use, and control associated psychiatric symptoms and impulsivity should be supported because of their potential contribution to MA-associated psychotic symptoms in this population.
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Affiliation(s)
- Meng-Fan Su
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,School of Public Health, Peking University, Beijing, China
| | - Mo-Xuan Liu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,School of Public Health, Peking University, Beijing, China
| | - Jin-Qiao Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,School of Public Health, Peking University, Beijing, China
| | - Julia M Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Su-Xia Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Ping Wu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,School of Public Health, Peking University, Beijing, China
| | - Zhi-Min Liu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Lin Lu
- Key Laboratory of Mental Health and Peking University Sixth Hospital, National Clinical Research Center for Mental Disorders, Institute of Mental Health, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences and IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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Lappin JM, Darke S, Farrell M. Stroke and methamphetamine use in young adults: a review. J Neurol Neurosurg Psychiatry 2017; 88:1079-1091. [PMID: 28835475 DOI: 10.1136/jnnp-2017-316071] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [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: 03/17/2017] [Revised: 05/04/2017] [Accepted: 06/13/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Methamphetamine use and stroke are significant public health problems. Strokes among people aged below 45 years are much less common than in older age groups but have significant mortality and morbidity. Methamphetamine is a putative cause of strokes among younger people. METHODS A review of methamphetamine-related strokes was conducted. Bibliographic databases were searched until February 2017 for articles related to methamphetamine and stroke. Both haemorrhagic and ischaemic strokes were considered. RESULTS Of 370 articles screened, 77 were selected for inclusion. There were 81 haemorrhagic and 17 ischaemic strokes reported in case reports and series. Both types were approximately twice as common in males. Route of administration associated with haemorrhagic stroke was typically oral or injecting, but for ischaemic stroke inhalation was most common. Haemorrhagic stroke was associated with vascular abnormalities in a third of cases. One quarter of individuals completely recovered, and a third died following haemorrhagic stroke. One-fifth completely recovered, and one-fifth died following ischaemic stroke. CONCLUSIONS There is a preponderance of haemorrhagic strokes associated with methamphetamine use in young people, and methamphetamine-related stroke is associated with poor clinical outcomes. Mechanisms of methamphetamine-associated stroke include hypertension, vasculitis, direct vascular toxicity and vasospasm. In a period of rising worldwide methamphetamine use, the incidence of methamphetamine-related stroke will increase, with a consequent increase in the burden of disease contributed by such events.
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Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
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Demjaha A, Lappin JM, Stahl D, Patel MX, MacCabe JH, Howes OD, Heslin M, Reininghaus UA, Donoghue K, Lomas B, Charalambides M, Onyejiaka A, Fearon P, Jones P, Doody G, Morgan C, Dazzan P, Murray RM. Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors. Psychol Med 2017; 47:1981-1989. [PMID: 28395674 DOI: 10.1017/s0033291717000435] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND We examined longitudinally the course and predictors of treatment resistance in a large cohort of first-episode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors. METHOD The study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance. RESULTS From the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset. CONCLUSIONS The striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.
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Affiliation(s)
- A Demjaha
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - J M Lappin
- School of Psychiatry, University of New South Wales, Sydney, NSW,Australia
| | - D Stahl
- Department of Biostatistics,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - M X Patel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - J H MacCabe
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - O D Howes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - M Heslin
- Health Service and Population Research Department,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - U A Reininghaus
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - K Donoghue
- Addictions Department,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - B Lomas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - M Charalambides
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - A Onyejiaka
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - P Fearon
- Department of Psychiatry,Trinity College,Dublin, Republic ofIreland
| | - P Jones
- Department of Psychiatry,University of Cambridge,Cambridge,UK
| | - G Doody
- Division of Psychiatry,University of Nottingham,Nottingham,UK
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
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Lappin JM, Sara GE, Farrell M. Methamphetamine-related psychosis: an opportunity for assertive intervention and prevention. Addiction 2017; 112:927-928. [PMID: 27905179 DOI: 10.1111/add.13663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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] [Received: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Julia M Lappin
- School of Psychiatry, University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Grant E Sara
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia.,InforMH, Health System Information and Performance Reporting Branch, NSW Ministry of Health, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Lappin JM, Roxburgh A, Kaye S, Chalmers J, Sara G, Dobbins T, Burns L, Farrell M. Increased prevalence of self-reported psychotic illness predicted by crystal methamphetamine use: Evidence from a high-risk population. International Journal of Drug Policy 2016; 38:16-20. [DOI: 10.1016/j.drugpo.2016.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 10/21/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
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Lappin JM, Heslin M, Jones PB, Doody GA, Reininghaus UA, Demjaha A, Croudace T, Jamieson-Craig T, Donoghue K, Lomas B, Fearon P, Murray RM, Dazzan P, Morgan C. Outcomes following first-episode psychosis – Why we should intervene early in all ages, not only in youth. Aust N Z J Psychiatry 2016; 50:1055-1063. [PMID: 27756771 PMCID: PMC5316960 DOI: 10.1177/0004867416673454] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare baseline demographics and 10-year outcomes of a first-episode psychosis patient incidence cohort in order to establish whether current youth-focussed age-based criteria for early intervention services are justified by patient needs. The patients in this cohort were treated prior to the establishment of early intervention services. The study aimed to test the hypothesis that those who develop psychosis at a younger age have worse outcomes than those who develop psychosis at an older age. METHODS Data on first-episode psychosis patients from the ÆSOP-10 longitudinal follow-up study were used to compare baseline characteristics, and 10-year clinical, functional and service use outcomes between those patients who would and would not have met age-based criteria for early intervention services, in Australia or in the United Kingdom. RESULTS In total, 58% men and 71% women with first-episode psychosis were too old to meet current Australian-early intervention age-entry criteria (χ2 = 9.1, p = 0.003), while 21% men and 34% women were too old for UK-early intervention age-entry criteria (χ2 = 11.1, p = 0.001). The 10-year clinical and functional outcomes did not differ significantly between groups by either Australian- or UK-early intervention age-entry criteria. Service use was significantly greater among the patients young enough to meet early intervention age-criteria (Australia: incidence rate ratio = 1.35 [1.19, 1.52], p < 0.001; United Kingdom: incidence rate ratio = 1.65 [1.41, 1.93], p < 0.001). CONCLUSION Current early intervention services are gender- and age-inequitable. Large numbers of patients with first-episode psychosis will not receive early intervention care under current service provision. Illness outcomes at 10-years were no worse in first-episode psychosis patients who presented within the age range for whom early intervention has been prioritised, though these patients had greater service use. These data provide a rationale to consider extension of early intervention to all, rather than just to youth.
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Affiliation(s)
- Julia M Lappin
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,Julia M Lappin, School of Psychiatry, Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia.
| | - Margaret Heslin
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Gillian A Doody
- Department of Psychiatry, The University of Nottingham, Nottingham, UK
| | - Ulrich A Reininghaus
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Arsime Demjaha
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Timothy Croudace
- School of Nursing and Health Sciences University of Dundee, Dundee, UK
| | - Thomas Jamieson-Craig
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Kim Donoghue
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ben Lomas
- Nottingham University Hospitals NHS Trust, The University of Nottingham, Nottingham, UK
| | - Paul Fearon
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paola Dazzan
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Craig Morgan
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Egerton A, Valmaggia LR, Howes OD, Day F, Chaddock CA, Allen P, Winton-Brown TT, Bloomfield MA, Bhattacharyya S, Chilcott J, Lappin JM, Murray RM, McGuire P. Adversity in childhood linked to elevated striatal dopamine function in adulthood. Schizophr Res 2016; 176:171-176. [PMID: 27344984 PMCID: PMC5147458 DOI: 10.1016/j.schres.2016.06.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/26/2016] [Accepted: 06/05/2016] [Indexed: 01/01/2023]
Abstract
Childhood adversity increases the risk of psychosis in adulthood. Theoretical and animal models suggest that this effect may be mediated by increased striatal dopamine neurotransmission. The primary objective of this study was to examine the relationship between adversity in childhood and striatal dopamine function in early adulthood. Secondary objectives were to compare exposure to childhood adversity and striatal dopamine function in young people at ultra high risk (UHR) of psychosis and healthy volunteers. Sixty-seven young adults, comprising 47 individuals at UHR for psychosis and 20 healthy volunteers were recruited from the same geographic area and were matched for age, gender and substance use. Presynaptic dopamine function in the associative striatum was assessed using 18F-DOPA positron emission tomography. Childhood adversity was assessed using the Childhood Experience of Care and Abuse questionnaire. Within the sample as a whole, both severe physical or sexual abuse (T63=2.92; P=0.005), and unstable family arrangements (T57=2.80; P=0.007) in childhood were associated with elevated dopamine function in the associative striatum in adulthood. Comparison of the UHR and volunteer subgroups revealed similar incidence of childhood adverse experiences, and there was no significant group difference in dopamine function. This study provides evidence that childhood adversity is linked to elevated striatal dopamine function in adulthood.
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Affiliation(s)
- Alice Egerton
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Lucia R. Valmaggia
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Oliver D. Howes
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK,Medical Research Council Clinical Sciences Centre, Institute of Clinical Sciences, Hammersmith Hospital, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Fern Day
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Christopher A. Chaddock
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Paul Allen
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Toby T. Winton-Brown
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Michael A.P. Bloomfield
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK,Medical Research Council Clinical Sciences Centre, Institute of Clinical Sciences, Hammersmith Hospital, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Sagnik Bhattacharyya
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Jack Chilcott
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Julia M. Lappin
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Robin M. Murray
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Philip McGuire
- King's College London, King's Health Partners, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
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Kay-Lambkin FJ, Thornton L, Lappin JM, Hanstock T, Sylvia L, Jacka F, Baker AL, Berk M, Mitchell PB, Callister R, Rogers N, Webster S, Dennis S, Oldmeadow C, MacKinnon A, Doran C, Turner A, Hunt S. Study protocol for a systematic review of evidence for lifestyle interventions targeting smoking, sleep, alcohol/other drug use, physical activity, and healthy diet in people with bipolar disorder. Syst Rev 2016; 5:106. [PMID: 27381332 PMCID: PMC4932766 DOI: 10.1186/s13643-016-0282-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 06/16/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND People with bipolar disorder (BD) have a mortality gap of up to 20 years compared to the general population. Physical conditions, such as cardiovascular disease (CVD) and cancer, cause the majority of excess deaths in psychiatric populations and are the leading causes of mortality in people with BD. However, comparatively little attention has been paid to reducing the risk of physical conditions in psychiatric populations. Unhealthy lifestyle behaviors are among the potentially modifiable risk factors for a range of commonly comorbid chronic medical conditions, including CVD, diabetes, and obesity. This systematic review will identify and evaluate the available evidence for effective interventions to reduce risk and promote healthy lifestyle behaviors in BD. METHODS/DESIGN We will search MEDLINE, Embase, PsychINFO, Cochrane Database of Systematic Reviews, and CINAHL for published research studies (with at least an abstract published in English) that evaluate behavioral or psychosocial interventions to address the following lifestyle factors in people with BD: tobacco use, physical inactivity, unhealthy diet, overweight or obesity, sleep-wake disturbance, and alcohol/other drug use. Primary outcomes for the review will be changes in tobacco use, level of physical activity, diet quality, sleep quality, alcohol use, and illicit drug use. Data on each primary outcome will be synthesized across available studies in that lifestyle area (e.g., tobacco abstinence, cigarettes smoked per day), and panel of research and clinical experts in each of the target lifestyle behaviors and those experienced with clinical and research with individuals with BD will determine how best to represent data related to that primary outcome. Seven members of the systematic review team will extract data, synthesize the evidence, and rate it for quality. Evidence will be synthesized via a narrative description of the behavioral interventions and their effectiveness in improving the healthy lifestyle behaviors in people with BD. DISCUSSION The planned review will synthesize and evaluate the available evidence regarding the behavioral or psychosocial treatment of lifestyle-related behaviors in people with BD. From this review, we will identify gaps in our existing knowledge and research evidence about the management of unhealthy lifestyle behaviors in people with BD. We will also identify potential opportunities to address lifestyle behaviors in BD, with a view to reducing the burden of physical ill-health in this population. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015019993.
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Affiliation(s)
- Frances J Kay-Lambkin
- National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. .,Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia.
| | - Louise Thornton
- National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Julia M Lappin
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Tanya Hanstock
- Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia.,School of Psychology, University of Newcastle, Newcastle, Australia
| | - Louisa Sylvia
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Felice Jacka
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Waurn Ponds, Australia
| | - Amanda L Baker
- Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia
| | - Michal Berk
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Waurn Ponds, Australia
| | - Phillip B Mitchell
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, Faculty of Medicine, The University of Newcastle, Newcastle, Australia
| | - Naomi Rogers
- Brain and Mind Institute, University of Sydney, Sydney, Australia
| | - Stephanie Webster
- National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Simon Dennis
- School of Psychology, University of Newcastle, Newcastle, Australia
| | | | | | | | - Alyna Turner
- Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia.,IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Waurn Ponds, Australia
| | - Sally Hunt
- National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Heslin M, Desai R, Lappin JM, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Dazzan P, Fisher HL, Demjaha A, Craig T, Morgan C. Biological and psychosocial risk factors for psychotic major depression. Soc Psychiatry Psychiatr Epidemiol 2016; 51:233-45. [PMID: 26520449 PMCID: PMC4748002 DOI: 10.1007/s00127-015-1131-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 10/14/2015] [Indexed: 12/22/2022]
Abstract
AIMS Few studies have investigated risk factors for psychotic major depression (PMD). We aimed to investigate the biological and psychosocial risk factors associated with PMD compared with other psychotic disorders. METHODS Based on the aetiology and ethnicity in schizophrenia and other psychoses (ÆSOP) study, we used a case-control study to identify and recruit, at baseline and 10-year follow-up, all first episode cases of psychosis, presenting for the first time to specialist mental health services in defined catchment areas in the UK. Population-based controls were recruited from the same areas. Data were collected on: sociodemographics; social isolation; childhood adversity; life events; minor physical anomalies; and neurological soft signs. RESULTS Living alone (aOR = 2.26, CI = 1.21-4.23), basic level qualification (aOR = 2.89, CI = 1.08-7.74), being unemployed (aOR = 2.12, CI = 1.13-3.96), having contact with friends less than monthly (aOR = 4.24, CI = 1.62-11.14), having no close confidants (aOR = 4.71, CI = 2.08-10.68), having experienced childhood adversity (aOR = 2.57, CI = 1.02-6.44), family history of mental illness (aOR = 10.68, CI = 5.06-22.52), family history of psychosis (aOR = 12.85, CI = 5.24-31.51), and having more neurological soft signs (aOR = 1.15, CI = 1.07-1.24) were all associated with a follow-up diagnosis of PMD and schizophrenia. Few variables associated with PMD were also associated with a diagnosis of bipolar disorder. Minor physical anomalies were associated with a follow-up diagnosis of schizophrenia and bipolar disorder, but not PMD. CONCLUSIONS Risk factors associated with PMD appear to overlap with those for schizophrenia, but less so for bipolar disorder. Future work on the differential aetiology of PMD, from other psychoses is needed to find the 'specifier' between PMD and other psychoses. Future research on aetiology in PMD, and perhaps other psychoses, should account for diagnostic change.
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Affiliation(s)
- M Heslin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - R Desai
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - J M Lappin
- University of New South Wales, Sydney, Australia
| | - K Donoghue
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - B Lomas
- University of Nottingham, Nottingham, UK
| | - U Reininghaus
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Maastricht University, Maastrict, The Netherlands
| | - A Onyejiaka
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | | | - P B Jones
- University of Cambridge, Cambridge, UK
| | - R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - P Fearon
- Trinity College, Dublin, Ireland
| | - G A Doody
- University of Nottingham, Nottingham, UK
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - H L Fisher
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - A Demjaha
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - T Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
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Lappin JM, Morgan C, Chalavi S, Morgan KD, Reinders AATS, Fearon P, Heslin M, Zanelli J, Jones PB, Murray RM, Dazzan P. Bilateral hippocampal increase following first-episode psychosis is associated with good clinical, functional and cognitive outcomes. Psychol Med 2014; 44:1279-1291. [PMID: 23866084 DOI: 10.1017/s0033291713001712] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hippocampal pathology has been proposed to underlie clinical, functional and cognitive impairments in schizophrenia. The hippocampus is a highly plastic brain region; examining change in volume, or change bilaterally, over time, can advance understanding of the substrate of recovery in psychosis. METHOD Magnetic resonance imaging and outcome data were collected at baseline and 6-year follow-up in 42 first-episode psychosis subjects and 32 matched controls, to investigate whether poorer outcomes are associated with loss of global matter and hippocampal volumes. Bilateral hippocampal increase (BHI) over time, as a marker of hippocampal plasticity was hypothesized to be associated with better outcomes. Regression analyses were performed on: (i) clinical and functional outcomes with grey matter volume change and BHI as predictor variables; and (ii) cognitive outcome with BHI as predictor. RESULTS BHI was present in 29% of psychosis participants. There was no significant grey matter loss over time in either patient or control groups. Less severe illness course and lesser symptom severity were associated with BHI, but not with grey matter change. Employment and global function were associated with BHI and with less grey matter loss. Superior delayed verbal recall was also associated with BHI. CONCLUSIONS BHI occurs in a minority of patients following their first psychotic episode and is associated with good outcome across clinical, functional and cognitive domains.
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Affiliation(s)
- J M Lappin
- Institute of Psychiatry, King's College London, London, UK
| | - C Morgan
- Institute of Psychiatry, King's College London, London, UK
| | - S Chalavi
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K D Morgan
- Department of Psychology, University of Westminster, London, UK
| | | | - P Fearon
- Department of Psychiatry, Trinity College Dublin, Dublin, Republic of Ireland
| | - M Heslin
- Institute of Psychiatry, King's College London, London, UK
| | - J Zanelli
- Institute of Psychiatry, King's College London, London, UK
| | - P B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - R M Murray
- Institute of Psychiatry, King's College London, London, UK
| | - P Dazzan
- Institute of Psychiatry, King's College London, London, UK
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Kravariti E, Russo M, Vassos E, Morgan K, Fearon P, Zanelli JW, Demjaha A, Lappin JM, Tsakanikos E, Dazzan P, Morgan C, Doody GA, Harrison G, Jones PB, Murray RM, Reichenberg A. Linear and non-linear associations of symptom dimensions and cognitive function in first-onset psychosis. Schizophr Res 2012; 140:221-31. [PMID: 22766128 DOI: 10.1016/j.schres.2012.06.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 05/09/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Associations between symptom dimensions and cognition have been mainly studied in non-affective psychosis. The present study investigated whether previously reported associations between cognition and four symptom dimensions (reality distortion, negative symptoms, disorganisation and depression) in non-affective psychosis generalise to a wider spectrum of psychoses. It also extended the research focus to mania, a less studied symptom dimension. METHODS Linear and non-linear (quadratic, curvilinear or inverted-U-shaped) associations between cognition and the above five symptom dimensions were examined in a population-based cohort of 166 patients with first-onset psychosis using regression analyses. RESULTS Negative symptoms showed statistically significant linear associations with IQ and processing speed, and a significant curvilinear association with verbal memory/learning. Significant quadratic associations emerged between mania and processing speed and mania and executive function. The contributions of mania and negative symptoms to processing speed were independent of each other. The findings did not differ between affective and non-affective psychoses, and survived correction for multiple testing. CONCLUSIONS Mania and negative symptoms are associated with distinct patterns of cerebral dysfunction in first-onset psychosis. A novel finding is that mania relates to cognitive performance by a complex response function (inverted-U-shaped relationship). The associations of negative symptoms with cognition include both linear and quadratic elements, suggesting that this dimension is not a unitary concept. These findings cut across affective and non-affective psychoses, suggesting that different diagnostic entities within the psychosis spectrum lie on a neurobiological continuum.
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Affiliation(s)
- Eugenia Kravariti
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
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Reeves SJ, Polling C, Stokes PRA, Lappin JM, Shotbolt PP, Mehta MA, Howes OD, Egerton A. Limbic striatal dopamine D2/3 receptor availability is associated with non-planning impulsivity in healthy adults after exclusion of potential dissimulators. Psychiatry Res 2012; 202:60-4. [PMID: 22595510 DOI: 10.1016/j.pscychresns.2011.09.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 09/16/2011] [Accepted: 09/23/2011] [Indexed: 12/18/2022]
Abstract
Positron emission tomography (PET) studies have reported an association between reduced striatal dopamine D2/3 receptor availability and higher scores on self-report measures of trait impulsivity in healthy adults. However, impulsivity is a multi-faceted construct, and it is unclear which aspect(s) of impulsivity might be driving these associations. The current study aimed to investigate the relationship between limbic (ventral) striatal D2/3 receptor availability and individual components of impulsivity (attentional, motor and non-planning) using the Barratt Impulsiveness Scale (BIS-11) and [(11)C]raclopride PET in 23 healthy volunteers. A partial correlational analysis showed a significant association between non-planning impulsiveness (lack of forethought or 'futuring') and limbic D2/3 receptor availability, which was only apparent after the exclusion of potential dissimulators (indexed by high scores on impression management). Our findings suggest that non-planning impulsiveness is associated with individual variation in limbic striatal D2/3 receptor availability and that different facets of impulsivity may have specific neurochemical correlates. Future studies that combine D2/3 receptor imaging with behavioral measures of impulsivity are required to further elucidate the precise relationship between individual components of trait impulsivity and brain dopaminergic function.
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Affiliation(s)
- Suzanne J Reeves
- Department of Old Age Psychiatry, Institute of Psychiatry, Kings College London, UK.
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42
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Schaufelberger MS, Lappin JM, Duran FLS, Rosa PGP, Uchida RR, Santos LC, Murray RM, McGuire PK, Scazufca M, Menezes PR, Busatto GF. Lack of progression of brain abnormalities in first-episode psychosis: a longitudinal magnetic resonance imaging study. Psychol Med 2011; 41:1677-1689. [PMID: 21144111 DOI: 10.1017/s0033291710002163] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Some neuroimaging studies have supported the hypothesis of progressive brain changes after a first episode of psychosis. We aimed to determine whether (i) first-episode psychosis patients would exhibit more pronounced brain volumetric changes than controls over time and (ii) illness course/treatment would relate to those changes. METHOD Longitudinal regional grey matter volume and ventricle:brain ratio differences between 39 patients with first-episode psychosis (including schizophrenia and schizophreniform disorder) and 52 non-psychotic controls enrolled in a population-based case-control study. RESULTS While there was no longitudinal difference in ventricle:brain ratios between first-episode psychosis subjects and controls, patients exhibited grey matter volume changes, indicating a reversible course in the superior temporal cortex and hippocampus compared with controls. A remitting course was related to reversal of baseline temporal grey matter deficits. CONCLUSIONS Our findings do not support the hypothesis of brain changes indicating a progressive course in the initial phase of psychosis. Rather, some brain volume abnormalities may be reversible, possibly associated with a better illness course.
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Affiliation(s)
- M S Schaufelberger
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil.
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Rosa PGP, Schaufelberger MS, Uchida RR, Duran FLS, Lappin JM, Menezes PR, Scazufca M, McGuire PK, Murray RM, Busatto GF. Lateral ventricle differences between first-episode schizophrenia and first-episode psychotic bipolar disorder: A population-based morphometric MRI study. World J Biol Psychiatry 2010; 11:873-87. [PMID: 20545464 DOI: 10.3109/15622975.2010.486042] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The extent to which psychotic disorders fall into distinct diagnostic categories or can be regarded as lying on a single continuum is controversial. We compared lateral ventricle volumes between a large sample of patients with first-episode schizophrenia or bipolar disorder and a healthy control group from the same neighbourhood. METHODS Population-based MRI study with 88 first-episode psychosis (FEP) patients, grouped into those with schizophrenia/schizophreniform disorder (N=62), bipolar disorder (N=26) and 94 controls. RESULTS Right and left lateral ventricular and right temporal horn volumes were larger in FEP subjects than controls. Within the FEP sample, post-hoc tests revealed larger left lateral ventricles and larger right and left temporal horns in schizophrenia subjects relative to controls, while there was no difference between patients with bipolar disorder and controls. None of the findings was attributable to effects of antipsychotics. CONCLUSIONS This large-sample population-based MRI study showed that neuroanatomical abnormalities in subjects with schizophrenia relative to controls from the same neighbourhood are evident at the first episode of illness, but are not detectable in bipolar disorder patients. These data are consistent with a model of psychosis in which early brain insults of neurodevelopmental origin are more relevant to schizophrenia than to bipolar disorder.
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Affiliation(s)
- Pedro G P Rosa
- Department & Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Egerton A, Rees E, Bose SK, Lappin JM, Stokes PRA, Turkheimer FE, Reeves SJ. Truth, lies or self-deception? Striatal D(2/3) receptor availability predicts individual differences in social conformity. Neuroimage 2010; 53:777-81. [PMID: 20558302 DOI: 10.1016/j.neuroimage.2010.06.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 05/28/2010] [Accepted: 06/10/2010] [Indexed: 11/17/2022] Open
Abstract
Previous positron emission tomography (PET) studies have consistently shown a negative association between striatal D(2/3) receptor availability and socially desirable responding (SDR). However, as SDR is a complex personality trait, the functional significance of this relationship is unclear. The aim of the present study was to determine whether the relationship between D(2/3) receptor availability and SDR reflects a tendency to present oneself positively to others, consistent with social conformity (impression management, IM), or the tendency to view one's own behavior positively (self-deceptive enhancement, SDE). Striatal D(2/3) receptor availability was assessed in 23 healthy volunteers using [(11)C]raclopride PET. SDR was assessed using the Lie scale of the revised Eysenck Personality Questionnaire, and IM and SDE were measured using the Paulhus Deception Scales. Analysis of personality variables revealed a positive relationship between Lie and log IM (r=0.64, p=0.01) but not Lie and SDE (r=-0.36, ns). Consistent with previous findings, Lie was negatively associated with D(2/3) receptor availability in the sensorimotor striatum (r=- 0.55, p=0.05), and a similar trend-level relationship was observed for log IM (r=-0.54 p=0.06) but not SDE (r=0.23, ns). Whilst these associations are modest, results suggest that striatal D(2/3) receptor availability may be particularly associated with social conformity, rather than self-deception.
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Affiliation(s)
- Alice Egerton
- Institute of Psychiatry, King's College London, London, UK.
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Egerton A, Shotbolt JP, Stokes PRA, Hirani E, Ahmad R, Lappin JM, Reeves SJ, Mehta MA, Howes OD, Grasby PM. Acute effect of the anti-addiction drug bupropion on extracellular dopamine concentrations in the human striatum: an [11C]raclopride PET study. Neuroimage 2009; 50:260-6. [PMID: 19969097 DOI: 10.1016/j.neuroimage.2009.11.077] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 11/25/2009] [Accepted: 11/26/2009] [Indexed: 11/19/2022] Open
Abstract
Bupropion is an effective medication in treating addiction and is widely used as an aid to smoking cessation. Bupropion inhibits striatal dopamine reuptake via dopamine transporter blockade, but it is unknown whether this leads to increased extracellular dopamine levels at clinical doses in man. The effects of bupropion on extracellular dopamine levels in the striatum were investigated using [(11)C]raclopride positron emission tomography (PET) imaging in rats administered saline, 11 or 25 mg/kg bupropion i.p. and in healthy human volunteers administered either placebo or 150 mg bupropion (Zyban Sustained-Release). A cognitive task was used to stimulate dopamine release in the human study. In rats, bupropion significantly decreased [(11)C]raclopride specific binding in the striatum, consistent with increases in extracellular dopamine concentrations. In man, no significant decreases in striatal [(11)C]raclopride specific binding were observed. Levels of dopamine transporter occupancy in the rat at 11 and 25 mg/kg bupropion i.p. were higher than predicted to occur in man at the dose used. Thus, these data indicate that, at the low levels of dopamine transporter occupancy achieved in man at clinical doses, bupropion does not increase extracellular dopamine levels. These findings have important implications for understanding the mechanism of action underlying bupropions' therapeutic efficacy and for the development of novel treatments for addiction and depression.
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Affiliation(s)
- Alice Egerton
- Psychiatric Imaging, Medical Research Council Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
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Kirkbride JB, Lunn DJ, Morgan C, Lappin JM, Dazzan P, Morgan K, Fearon P, Murray RM, Jones PB. Examining evidence for neighbourhood variation in the duration of untreated psychosis. Health Place 2009; 16:219-25. [PMID: 19875323 PMCID: PMC2812704 DOI: 10.1016/j.healthplace.2009.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 09/24/2009] [Accepted: 09/30/2009] [Indexed: 11/27/2022]
Abstract
Background Family involvement in help-seeking is associated with a shorter duration of untreated psychoses [DUP], but it is unknown whether neighbourhood-level factors are also important. Methods DUP was estimated for all cases of first-episode psychoses identified over 2 years in 33 Southeast London neighbourhoods (n=329). DUP was positively skewed and transformed to the natural logarithm scale. We fitted various hierarchical models, adopting different assumptions with regard to spatial variability of DUP, to assess whether there was evidence of neighbourhood heterogeneity in DUP, having accounted for a priori individual-level confounders. Results Neighbourhood-level variation in DUP was negligible compared to overall variability. A non-hierarchical model with age, sex and ethnicity covariates, but without area-level random effects, provided the best fit to the data. Discussion Neighbourhood factors do not appear to be associated with DUP, suggesting its predictors lie at individual and family levels. Our results inform mental healthcare planning, suggesting that in one urbanised area of Southeast London, where you live does not affect duration of untreated psychosis.
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Affiliation(s)
- J B Kirkbride
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
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Kravariti E, Morgan K, Fearon P, Zanelli JW, Lappin JM, Dazzan P, Morgan C, Doody GA, Harrison G, Jones PB, Murray RM, Reichenberg A. Neuropsychological functioning in first-episode schizophrenia. Br J Psychiatry 2009; 195:336-45. [PMID: 19794203 DOI: 10.1192/bjp.bp.108.055590] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Identifying neurocognitive subtypes in schizophrenia may help establish neurobiologically meaningful subtypes of the disorder, but is frequently confounded by differences in intellectual function between individuals with schizophrenia and controls. AIMS To examine neuropsychological performance in individuals with epidemiologically based, first-onset schizophrenia and intellectually matched controls. METHOD Using standard IQ and reading tests, we examined the proportions of 101 people with epidemiologically derived, first-onset schizophrenia/schizoaffective disorder and 317 community controls, falling into three a priori defined intellectual categories: 'stable good', 'deteriorated poor' and 'stable poor'. Neuropsychological function was compared between intellectually matched participants with schizophrenia and control subgroups. RESULTS Multiple deficits in executive function, processing speed and verbal memory, but not visual/spatial perception/memory, were detected in all participant groups with schizophrenia compared with controls. The average effect size across the affected domains ranged from small to medium to large in the stable good, deteriorated poor and stable poor subgroups of participants with schizophrenia, respectively. CONCLUSIONS Compared with intellectually matched controls, people with epidemiologically derived, first-onset schizophrenia/schizoaffective disorder show multiple deficits in executive function, processing speed and verbal memory.
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Affiliation(s)
- Eugenia Kravariti
- Department of Psychiatry, NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, London.
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Egerton A, Mehta MA, Montgomery AJ, Lappin JM, Howes OD, Reeves SJ, Cunningham VJ, Grasby PM. The dopaminergic basis of human behaviors: A review of molecular imaging studies. Neurosci Biobehav Rev 2009; 33:1109-32. [PMID: 19481108 DOI: 10.1016/j.neubiorev.2009.05.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 05/14/2009] [Accepted: 05/18/2009] [Indexed: 11/16/2022]
Abstract
This systematic review describes human molecular imaging studies which have investigated alterations in extracellular DA levels during performance of behavioral tasks. Whilst heterogeneity in experimental methods limits meta-analysis, we describe the advantages and limitations of different methodological approaches. Interpretation of experimental results may be limited by regional cerebral blood flow (rCBF) changes, head movement and choice of control conditions. We revisit our original study of striatal DA release during video-game playing [Koepp, M.J., Gunn, R.N., Lawrence, A.D., Cunningham, V.J., Dagher, A., Jones, T., Brooks, D.J., Bench, C.J., Grasby, P.M., 1998. Evidence for striatal dopamine release during a video game. Nature 393, 266-268] to illustrate the potentially confounding influences of head movement and alterations in rCBF. Changes in [(11)C]raclopride binding may be detected in extrastriatal as well as striatal brain regions-however we review evidence which suggests that extrastriatal changes may not be clearly interpreted in terms of DA release. Whilst several investigations have detected increases in striatal extracellular DA concentrations during task components such as motor learning and execution, reward-related processes, stress and cognitive performance, the presence of potentially biasing factors should be carefully considered (and, where possible, accounted for) when designing and interpreting future studies.
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Affiliation(s)
- Alice Egerton
- Medical Research Council Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, United Kingdom.
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Kravariti E, Reichenberg A, Morgan K, Dazzan P, Morgan C, Zanelli JW, Lappin JM, Doody GA, Harrison G, Jones PB, Murray RM, Fearon P. Selective deficits in semantic verbal fluency in patients with a first affective episode with psychotic symptoms and a positive history of mania. Bipolar Disord 2009; 11:323-9. [PMID: 19419389 DOI: 10.1111/j.1399-5618.2009.00673.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Neurocognitive dysfunction is likely to represent a trait characteristic of bipolar disorder, but the extent to which it comprises 'core' deficits as opposed to those secondary to longstanding illness or intellectual decline is unclear. We investigated neuropsychological performance in an epidemiologically derived sample of patients with a first affective episode with psychotic symptoms and a positive history of mania, compared to community controls. METHODS Using a nested case-control, population-based study, measures of episodic and working memory, executive function, processing speed, and visual-spatial perception were compared between 35 patients with a first affective episode with psychotic symptoms and a positive history of mania, and 274 community controls, as well as a subgroup of 105 controls matched on current IQ ('good' versus 'poor') and IQ trajectory ('stable', 'declined', or 'improved') with the patients (three controls per case). RESULTS Compared to the extended control sample, probands showed a suggestive deficit in short-term verbal recall, and a significant deficit in semantic fluency. Only the latter was detectable in the comparison with the IQ-matched controls. All other neurocognitive domains showed intact performance or nonsignificant deficits of small effect sizes compared to both control groups. Semantic fluency showed no association with symptoms or duration of untreated illness. CONCLUSIONS Patients with a first affective episode with psychotic symptoms and a positive history of mania show an isolated, selective deficit in semantic verbal fluency, against a background of generally preserved neurocognitive function. This pattern seems to contrast with the more widespread neuropsychological dysfunction seen in schizophrenia.
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Affiliation(s)
- Eugenia Kravariti
- Department of Psychiatry, NIHR Biomedical Research Centre, Maudsley NHS Foundation Trust/Institute of Psychiatry, King's College London, Box 58, De Crespigny Park, London SE5 8AF, UK.
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Lappin JM, Morgan KD, Morgan C, Dazzan P, Reichenberg A, Zanelli JW, Fearon P, Jones PB, Lloyd T, Tarrant J, Farrant A, Leff J, Murray RM. Duration of untreated psychosis and neuropsychological function in first episode psychosis. Schizophr Res 2007; 95:103-10. [PMID: 17644343 DOI: 10.1016/j.schres.2007.05.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 05/25/2007] [Accepted: 05/25/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE We investigated whether duration of untreated psychosis (DUP) prior to first presentation was associated with cognitive function in first episode psychosis (FEP) subjects. We predicted that longer DUP would be associated with greater neurocognitive impairment. METHOD 180 subjects with schizophrenia (and 93 subjects with Other Psychoses) performed a neurocognitive battery assessing IQ, verbal learning, working memory, visual learning and speed of processing. DUP was defined as the number of days between first onset of psychotic symptoms and first contact with psychiatric services. RESULTS Longer DUP was associated with impaired performance in verbal IQ (p=0.04), verbal learning (p=0.02), and verbal working memory (p=0.04) in FEP subjects with schizophrenia. These associations remained significant for verbal IQ when scores were corrected for age, gender, educational level and ethnicity. CONCLUSIONS Longer DUP is associated with poorer neurocognitive ability in schizophrenia subjects at time of first presentation. Since this was a cross-sectional study we can not tell whether longer DUP was a cause or a consequence of the poorer performance.
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Affiliation(s)
- Julia M Lappin
- Kings College Hospital Institute of Psychiatry, Division of Psychological Medicine, PO63, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
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