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Acevedo N, Rossell S, Castle D, Groves C, Cook M, McNeill P, Olver J, Meyer D, Perera T, Bosanac P. Clinical outcomes of deep brain stimulation for obsessive-compulsive disorder: Insight as a predictor of symptom changes. Psychiatry Clin Neurosci 2024; 78:131-141. [PMID: 37984432 PMCID: PMC10952286 DOI: 10.1111/pcn.13619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/18/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
AIM Deep brain stimulation (DBS) is a safe and effective treatment option for people with refractory obsessive-compulsive disorder (OCD). Yet our understanding of predictors of response and prognostic factors remains rudimentary, and long-term comprehensive follow-ups are lacking. We aim to investigate the efficacy of DBS therapy for OCD patients, and predictors of clinical response. METHODS Eight OCD participants underwent DBS stimulation of the nucleus accumbens (NAc) in an open-label longitudinal trial, duration of follow-up varied between 9 months and 7 years. Post-operative care involved comprehensive fine tuning of stimulation parameters and adjunct multidisciplinary therapy. RESULTS Six participants achieved clinical response (35% improvement in obsessions and compulsions on the Yale Brown Obsessive Compulsive Scale (YBOCS)) within 6-9 weeks, response was maintained at last follow up. On average, the YBOCS improved by 45% at last follow up. Mixed linear modeling elucidated directionality of symptom changes: insight into symptoms strongly predicted (P = 0.008) changes in symptom severity during DBS therapy, likely driven by initial changes in depression and anxiety. Precise localization of DBS leads demonstrated that responders most often had their leads (and active contacts) placed dorsal compared to non-responders, relative to the Nac. CONCLUSION The clinical efficacy of DBS for OCD is demonstrated, and mediators of changes in symptoms are proposed. The symptom improvements within this cohort should be seen within the context of the adjunct psychological and biopsychosocial care that implemented a shared decision-making approach, with flexible iterative DBS programming. Further research should explore the utility of insight as a clinical correlate of response. The trial was prospectively registered with the ANZCTR (ACTRN12612001142820).
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Affiliation(s)
- Nicola Acevedo
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- St Vincent's HospitalMelbourneVictoriaAustralia
| | - Susan Rossell
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- St Vincent's HospitalMelbourneVictoriaAustralia
| | - David Castle
- St Vincent's HospitalMelbourneVictoriaAustralia
- Centre for Addiction and Mental HealthUniversity of TorontoTorontoOntarioCanada
| | | | - Mark Cook
- St Vincent's HospitalMelbourneVictoriaAustralia
| | | | - James Olver
- Department of PsychiatryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Denny Meyer
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Thushara Perera
- Bionics InstituteEast MelbourneVictoriaAustralia
- Department of Medical BionicsThe University of MelbourneMelbourneVictoriaAustralia
| | - Peter Bosanac
- St Vincent's HospitalMelbourneVictoriaAustralia
- Department of PsychiatryUniversity of MelbourneMelbourneVictoriaAustralia
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2
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Meyer GM, Hollunder B, Li N, Butenko K, Dembek TA, Hart L, Nombela C, Mosley P, Akram H, Acevedo N, Borron BM, Chou T, Castaño Montoya JP, Strange B, Barcia JA, Tyagi H, Castle DJ, Smith AH, Choi KS, Kopell BH, Mayberg HS, Sheth SA, Goodman W, Leentjens AFG, Richardson RM, Rossell SL, Bosanac P, Cosgrove GR, Kuhn J, Visser-Vandewalle V, Figee M, Dougherty DD, Siddiqi SH, Zrinzo L, Joyce E, Baldermann JC, Fox MD, Neudorfer C, Horn A. Deep Brain Stimulation for Obsessive-Compulsive Disorder: Optimal Stimulation Sites. Biol Psychiatry 2023:S0006-3223(23)01785-7. [PMID: 38141909 DOI: 10.1016/j.biopsych.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a promising treatment option for treatment-refractory obsessive-compulsive disorder (OCD). Several stimulation targets have been used, mostly in and around the anterior limb of the internal capsule and ventral striatum. However, the precise target within this region remains a matter of debate. METHODS Here, we retrospectively studied a multicenter cohort of 82 patients with OCD who underwent DBS of the ventral capsule/ventral striatum and mapped optimal stimulation sites in this region. RESULTS DBS sweet-spot mapping performed on a discovery set of 58 patients revealed 2 optimal stimulation sites associated with improvements on the Yale-Brown Obsessive Compulsive Scale, one in the anterior limb of the internal capsule that overlapped with a previously identified OCD-DBS response tract and one in the region of the inferior thalamic peduncle and bed nucleus of the stria terminalis. Critically, the nucleus accumbens proper and anterior commissure were associated with beneficial but suboptimal clinical improvements. Moreover, overlap with the resulting sweet- and sour-spots significantly estimated variance in outcomes in an independent cohort of 22 patients from 2 additional DBS centers. Finally, beyond obsessive-compulsive symptoms, stimulation of the anterior site was associated with optimal outcomes for both depression and anxiety, while the posterior site was only associated with improvements in depression. CONCLUSIONS Our results suggest how to refine targeting of DBS in OCD and may be helpful in guiding DBS programming in existing patients.
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Affiliation(s)
- Garance M Meyer
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Barbara Hollunder
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ningfei Li
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Konstantin Butenko
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Till A Dembek
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Lauren Hart
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cristina Nombela
- Biological and Health Psychology, School of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Philip Mosley
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia; Neurosciences Queensland, St. Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia; Queensland Brain Institute, University of Queensland, St. Lucia, Brisbane, Queensland, Australia; Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity, Herston, Queensland, Australia
| | - Harith Akram
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Nicola Acevedo
- Centre for Mental Health, Swinburne University, Melbourne, Victoria, Australia; St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Benjamin M Borron
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tina Chou
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Juan Pablo Castaño Montoya
- Department of Neurosurgery, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Bryan Strange
- Laboratory for Clinical Neuroscience, Center for Biomedical Technology, Universidad Politécnica de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Juan A Barcia
- Department of Neurosurgery, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Himanshu Tyagi
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - David J Castle
- University of Tasmania and Centre for Mental Health Service Innovation, Tasmania, Australia; State-wide Mental Health Service, Tasmania, Australia
| | - Andrew H Smith
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ki Sueng Choi
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brian H Kopell
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Helen S Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sameer A Sheth
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas; Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, Texas
| | - Wayne Goodman
- Department of Electrical and Computer Engineering, Rice University, Houston, Texas; Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, Texas
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University, Melbourne, Victoria, Australia; St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter Bosanac
- St. Vincent's Hospital, Melbourne, Victoria, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - G Rees Cosgrove
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Johanniter Hospital Oberhausen, EVKLN, Oberhausen, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Eileen Joyce
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Juan Carlos Baldermann
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Clemens Neudorfer
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andreas Horn
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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3
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Acevedo N, Castle D, Bosanac P, Rossell S. Phenomenological Changes Associated with Deep Brain Stimulation for Obsessive Compulsive Disorder: A Cognitive Appraisal Model of Recovery. Brain Sci 2023; 13:1444. [PMID: 37891812 PMCID: PMC10605199 DOI: 10.3390/brainsci13101444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
The current scientific enquiry of deep brain stimulation (DBS) does not capture the breadth of DBS-induced changes to an individual's life. Considering that DBS is applied in severe and complex cases, it is ethically and clinically necessary to consider the patient perspective and personally relevant outcomes. This lived experience investigation of people with obsessive compulsive disorder (OCD) undergoing DBS aims to provide a comprehensive evaluation of DBS-induced effects associated with OCD psychopathology. Six patients and six carers completed semi-structured open-ended interviews. A blended approach of interpretative phenomenological, inductive, and thematic analysis techniques was employed. Profound psychopathological changes were expressed; individuals felt more alive, had improved cognitive affective control, greater engagement in the world, and were able to manage their OCD. Through suppression of the condition, self-constructs were able to re-emerge and develop. A framework describing the progression of phenomenological changes, and a theoretical model describing changes in the cognitive appraisal of intrusions influencing recovery are proposed. This is the first identified qualitative investigation of DBS-induced changes in psychiatric patients and carers. Findings have implications for patient education and recovery models of OCD, and scientific understanding of DBS effects.
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Affiliation(s)
- Nicola Acevedo
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC 3122, Australia
- Clinical Services, St Vincent’s Hospital, Melbourne, VIC 3065, Australia
| | - David Castle
- Department of Psychiatry, University of Tasmania, Hobart, TAS 7005, Australia
- Centre for Mental Health Innovation, Hobart, TAS 7005, Australia
- Statewide Mental Health Service, Hobart, TAS, Australia
| | - Peter Bosanac
- Clinical Services, St Vincent’s Hospital, Melbourne, VIC 3065, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Susan Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC 3122, Australia
- Clinical Services, St Vincent’s Hospital, Melbourne, VIC 3065, Australia
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4
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Acevedo N, Castle DJ, Bosanac P, Rossell SL. Call to revise the Royal Australian and New Zealand College of Psychiatrists' clinical memorandum on deep brain stimulation for obsessive-compulsive disorder. Aust N Z J Psychiatry 2023; 57:1304-1307. [PMID: 37395129 PMCID: PMC10517578 DOI: 10.1177/00048674231184410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Nicola Acevedo
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC, Australia
| | | | - Peter Bosanac
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC, Australia
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5
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Haywood D, Baughman FD, Bosanac P, Johnston K, Gnatt I, Haywood J, Gullifer J, Rossell S. Research Directions for Leveraging and Supporting the Lived Experience of Mental Illness within Psychology. Healthcare (Basel) 2023; 11:2318. [PMID: 37628516 PMCID: PMC10454461 DOI: 10.3390/healthcare11162318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
This paper explores the lived experience of mental illness within the field of psychology across higher education and the mental health workforce. There is a high prevalence of mental health issues among psychology students and practitioners, and it is critical not only to provide support for these populations, but also to acknowledge the value of leveraging their lived experience within their education and practice. There has been increased interest in and advocacy for the involvement of those with lived experience of mental illness within mental healthcare service provision to improve patient experiences and outcomes. However, there have been limited acknowledgement and research regarding the role of psychologists with personal lived experiences of mental illness, and how to leverage this experience. Further, there are challenges faced by both psychology students and practising psychologists with lived experience that act as barriers to leveraging their unique skills and experiences. Psychology students with lived experience face stigma, inadequate support, and incongruence between the course material and their personal experiences. Similarly, practising psychologists with lived experience encounter stigma and isolation, indicating the need for a culture change that promotes transparency and understanding. The paper calls for research in five key directions to provide evidence that can be used to support and leverage lived experience in psychology.
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Affiliation(s)
- Darren Haywood
- School of Psychological Sciences, Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
- Department of Mental Health, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (P.B.)
- Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia
| | - Frank D. Baughman
- School of Population Health, Curtin University Western Australia, Bentley, WA 6102, Australia
| | - Peter Bosanac
- Department of Mental Health, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (P.B.)
- Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia
| | - Kim Johnston
- School of Psychological Sciences, Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
| | - Inge Gnatt
- Department of Mental Health, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (P.B.)
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Jennifer Haywood
- School of Population Health, Curtin University Western Australia, Bentley, WA 6102, Australia
| | - Judith Gullifer
- School of Psychological Sciences, Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
| | - Susan Rossell
- Department of Mental Health, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (P.B.)
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
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6
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Acevedo N, J Castle D, Bosanac P, Groves C, L Rossell S. Patient feedback and psychosocial outcomes of deep brain stimulation in people with obsessive-compulsive disorder. J Clin Neurosci 2023; 112:80-85. [PMID: 37119742 DOI: 10.1016/j.jocn.2023.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Abstract
Severe and refractory psychiatric patients can experience complex and profound changes in symptomology, functioning and well-being from deep brain stimulation (DBS) therapy. Currently, the efficacy of DBS is assessed by clinician rated scales of primary symptoms, yet this does not capture the multitude of DBS mediated changes or represent the patient perspective. We aimed to elucidate the patient perspective in psychiatric DBS application by investigating 1) symptomatic, and 2) psychosocial changes, 3) therapeutic expectations and satisfaction, 4) decision-making capacity, and 5) clinical care recommendations from treatment refractory obsessive-compulsive disorder (OCD) DBS patients. Participants enrolled in an open label clinical trial of DBS therapy for OCD who had reached clinical response were invited to participate in a follow up survey. Participants completed a 1) feedback survey relating to goals, expectations, and satisfaction of therapy, and 2) self-report questionnaires on psychosocial functioning including quality of life, cognitive insight, locus of control, rumination, cognitive flexibility, impulsivity, affect, and well-being. Greatest change was reported for quality of life, rumination, affect and cognitive flexibility. Participants reported realistic expectations, high satisfaction, adequate pre-operative education and decision-making capacity; and advocated for greater access to DBS care and more widespread support services. This is the first identified investigation on psychiatric patient perspectives of functioning and therapeutic outcomes following DBS. Insights from the study have implications for informing psychoeducation, clinical practices, and neuroethical debates. We encourage a greater patient-centred and biopsychosocial approach in evaluating and managing OCD DBS patients, by considering personally meaningful goals and addressing symptomatic and psychosocial recovery.
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Affiliation(s)
- Nicola Acevedo
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC, Australia; St Vincent's Hospital, 41 Victoria Parade, Melbourne, VIC, Australia.
| | - David J Castle
- St Vincent's Hospital, 41 Victoria Parade, Melbourne, VIC, Australia; Centre for Addiction and Mental Health, University of Toronto, 27 King's College Cir, Toronto, Canada
| | - Peter Bosanac
- St Vincent's Hospital, 41 Victoria Parade, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Clare Groves
- Clarity Health, 55 Nicholson Street, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC, Australia; St Vincent's Hospital, 41 Victoria Parade, Melbourne, VIC, Australia
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7
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Acevedo N, Castle D, Groves C, Bosanac P, Mosley PE, Rossell S. Clinical recommendations for the care of people with treatment-refractory obsessive-compulsive disorder when undergoing deep brain stimulation. Aust N Z J Psychiatry 2022; 56:1219-1225. [PMID: 35603702 DOI: 10.1177/00048674221100947] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Deep brain stimulation is an emerging therapy for treatment-refractory obsessive-compulsive disorder patients. Yet, accessibility is limited, treatment protocols are heterogeneous and there is no guideline or consensus on the best practices. Here, we combine evidence from scientific investigations, expert opinions and our clinical expertise to propose several clinical recommendations from the pre-operative, surgical and post-operative phases of deep brain stimulation care for treatment-refractory obsessive-compulsive disorder patients. A person-centered and biopsychosocial approach is adopted. Briefly, we discuss clinical characteristics associated with response, the use of improved educational materials, an evaluative consent process, comprehensive programming by an expert clinician, a more global assessment of treatment efficacy, multi-disciplinary adjunct psychotherapy and the importance of peer support programs. Furthermore, where gaps are identified, future research suggestions are made, including connectome surgical targeting, scientific evaluation of hardware models and health economic data. In addition, we encourage collaborative groups of data and knowledge sharing by way of a clinical registry and a peer group of programming clinicians. We aim to commence a discussion on the determinants of deep brain stimulation efficacy for treatment-refractory obsessive-compulsive disorder patients, a rare and severe patient group, and contribute to more standardized and evidence-based practices.
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Affiliation(s)
- Nicola Acevedo
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - David Castle
- Department of Psychiatry, The University of Melbourne, VIC, Australia.,Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Clare Groves
- Clinical service, Clarity Health Care, Melbourne, VIC, Australia
| | - Peter Bosanac
- Department of Psychiatry, The University of Melbourne, VIC, Australia.,St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Philip E Mosley
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia.,Biomedical Informatics Group, CSIRO, Herston, QLD, Australia
| | - Susan Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia.,St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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Acevedo N, Bosanac P, Pikoos T, Rossell S, Castle D. Correction: Acevedo et al. Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review. Brain Sci. 2021, 11, 948. Brain Sci 2022; 12:450. [PMID: 35448043 PMCID: PMC9032057 DOI: 10.3390/brainsci12040450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 12/05/2022] Open
Abstract
The authors wish to correct the following error in this paper [...].
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Affiliation(s)
- Nicola Acevedo
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
| | - Peter Bosanac
- St Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
- Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Toni Pikoos
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
| | - Susan Rossell
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
- St Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
| | - David Castle
- St Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
- Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
- Centre for Addiction and Mental Health, 252 College Street, Toronto, ON M5T 1R7, Canada
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Acevedo N, Bosanac P, Pikoos T, Rossell S, Castle D. Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review. Brain Sci 2021; 11:brainsci11070948. [PMID: 34356182 PMCID: PMC8307974 DOI: 10.3390/brainsci11070948] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 01/16/2023] Open
Abstract
Invasive and noninvasive neurostimulation therapies for obsessive-compulsive and related disorders (OCRD) were systematically reviewed with the aim of assessing clinical characteristics, methodologies, neuroanatomical substrates, and varied stimulation parameters. Previous reviews have focused on a narrow scope, statistical rather than clinical significance, grouped together heterogenous protocols, and proposed inconclusive outcomes and directions. Herein, a comprehensive and transdiagnostic evaluation of all clinically relevant determinants is presented with translational clinical recommendations and novel response rates. Electroconvulsive therapy (ECT) studies were limited in number and quality but demonstrated greater efficacy than previously identified. Targeting the pre-SMA/SMA is recommended for transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). TMS yielded superior outcomes, although polarity findings were conflicting, and refinement of frontal/cognitive control protocols may optimize outcomes. For both techniques, standardization of polarity, more treatment sessions (>20), and targeting multiple structures are encouraged. A deep brain stimulation (DBS) 'sweet spot' of the striatum for OCD was proposed, and CBT is strongly encouraged. Tourette's patients showed less variance and reliance on treatment optimization. Several DBS targets achieved consistent, rapid, and sustained clinical response. Analysis of fiber connectivity, as opposed to precise neural regions, should be implemented for target selection. Standardization of protocols is necessary to achieve translational outcomes.
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Affiliation(s)
- Nicola Acevedo
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
- Correspondence:
| | - Peter Bosanac
- St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
- Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Toni Pikoos
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
| | - Susan Rossell
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
- St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
| | - David Castle
- St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
- Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
- Centre for Addiction and Mental Health, 252 College Street, Toronto, ON M5T 1R7, Canada
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Newton R, Beasley A, Bosanac P, Castle D, Copolov D, Hopwood M, Keks N, Paoletti N, Tiller J. The challenges facing the public mental health sector: implications of the Victorian Psychiatry workforce project. Australas Psychiatry 2019; 27:618-621. [PMID: 31342777 DOI: 10.1177/1039856219852284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
OBJECTIVES This paper reviews the major findings of the Victorian Psychiatry Attraction, Recruitment and Retention Needs Analysis Project and considers some of the implications for the psychiatrist workforce working in public sector psychiatry. CONCLUSIONS The report provides a snapshot of the issues that are impairing the ability of Victorian psychiatrists to comprehensively treat those in our community who have severe mental illness. As the report shows, the issues impacting the profession are multi-faceted and complex, yet surmountable.
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Affiliation(s)
- Richard Newton
- Adjunct Professor, Monash University Clinical School, Department of Psychiatry, Melbourne, VIC, and; Clinical Director, Peninsula Health, Mental Health Service, Frankston, VIC, Australia
| | - Adele Beasley
- Policy and Advocacy Advisor, Victorian Branch RANZCP, Melbourne, VIC, Australia
| | - Peter Bosanac
- Associate Professor, The University of Melbourne, Melbourne, VIC, Australia
| | - David Castle
- Professor, The University of Melbourne, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - David Copolov
- Professor, Monash University, Clayton, VIC, Australia
| | - Mal Hopwood
- Professor, The University of Melbourne, Melbourne, VIC, Australia
| | - Nick Keks
- Professor, Monash University, Burwood, VIC, Australia
| | - Nick Paoletti
- Associate Professor, The University of Melbourne, Melbourne, VIC, Australia
| | - John Tiller
- Emeritus Professor, The University of Melbourne, Melbourne, VIC, Australia
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Bosanac P, Rossell S, Olver J, Groves C, Castle D. Deep brain stimulation in obsessive-compulsive disorder. Aust N Z J Psychiatry 2018; 52:716-717. [PMID: 29565177 DOI: 10.1177/0004867418764306] [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)
- Peter Bosanac
- 1 Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,2 Department of Mental Health, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Susan Rossell
- 3 Centre for Mental Health, Swinburne University, Hawthorn, VIC, Australia
| | - James Olver
- 1 Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,4 Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia
| | - Clare Groves
- 5 Clarity Health Care, Brunswick East, VIC, Australia
| | - David Castle
- 1 Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,2 Department of Mental Health, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
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Bosanac P, Hamilton BE, Lucak J, Castle D. Identity challenges and 'burden of normality' after DBS for severe OCD: a narrative case study. BMC Psychiatry 2018; 18:186. [PMID: 29895269 PMCID: PMC5998583 DOI: 10.1186/s12888-018-1771-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deep Brain Stimulation (DBS) is an emerging and potentially powerful biological treatment for severe Obsessive-Compulsive Disorder (OCD), but the wider impact of the intervention and the sometimes dramatic reduction in symptoms need greater attention in research and practice. The aim of this case study is to explore the subjective experience of preparing for and undergoing DBS as a treatment for severe and treatment-refractory OCD and the experience of the impact of the treatment. METHODS This study of subjective experience before and after DBS is based on narrative analysis of two in-depth interviews conducted in November 2014 (1 year after DBS surgery) with a 30-year-old man and his father, utilizing Consolidated Criteria for Reporting Qualitative Studies (COREQ) criteria. RESULTS The parallel stories show how OCD posed severe challenges to identity and social milestones, with profound positive and negative impact on the person and family. Yet symptom remission was accompanied by expanded horizons, but also by uncertainty and intense distress associated with the changed identity. DISCUSSION The concept of 'burden of normality' is discussed, in light of a treatment experience with DBS for OCD that gives rise to a new array of life challenges and opportunities, with implications for clinical care. CONCLUSIONS The concept of burden of normality has, thus far, not extended to evaluations of people who have had DBS for severe OCD and that of their lived experience and recovery trajectory thereafter. This concept highlights that there is work to be done on expectations of normal living and on the transitioning self-concept, in the post-surgical period.
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Affiliation(s)
- Peter Bosanac
- St. Vincent's Hospital, Melbourne and Department of Psychiatry, University of Melbourne, Melbourne, Australia.
| | | | - James Lucak
- 0000 0000 8606 2560grid.413105.2St Vincent’s Hospital, Melbourne, Australia
| | - David Castle
- 0000 0001 2179 088Xgrid.1008.9St. Vincent’s Hospital, Melbourne and Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Abstract
SummaryDepressive symptoms commonly occur in schizophrenia and have a significant impact on the distress and burden of the illness. Yet they are often overlooked, inadequately characterised by current classification systems and not consistently integrated into treatment. We discuss nosology, practical and clinical implications of symptom differentiation, and the role of causal and confounding factors, including iatrogenic, as targets for therapeutic intervention. The evidence base of psychosocial and psychotropic management is reviewed, with recommendations for the treatment of established syndromal depression in people with schizophrenia.
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Abstract
Summary‘Depot antipsychotics' (‘long-acting injectable antipsychotic medications' or LAIs) are underused in the treatment of schizophrenia (including first episodes) and, possibly, of schizophrenia with comorbid substance use disorders. Patients' and clinicians' beliefs and attitudes, and service barriers, affect best practice and evidence-based care in LAI prescription. Poor medication adherence is a key reason for LAI prescription, but patients receiving LAIs may still relapse or experience significant side-effects. Patients' and clinicians' attitudes towards antipsychotic medication, as well as the quality of their recovery-focused relationship, are key factors in adherence. Clinicians should avoid a dichotomous ‘oralv. LAI’ choice: LAIs may have a place at various stages in the continuum of care and they should be one of the options discussed with any patient requiring long-term treatment, even early in the illness course. Many clinicians need better education about LAIs and greater familiarity with schizophrenia treatment guidelines.
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Newton JR, Bosanac P, Copolov D, Hopwood M, Keks N, Paoletti N, Tiller J, Castle D. Targeting Zero: Implications for public psychiatric services. Aust N Z J Psychiatry 2017; 51:560-562. [PMID: 28378623 DOI: 10.1177/0004867417700732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J Richard Newton
- 1 The University of Melbourne, Melbourne, VIC, Australia.,2 Mental Health Service, Austin Health, Heidelberg, VIC, Australia.,3 Monash University, Clayton, VIC, Australia
| | - Peter Bosanac
- 1 The University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Nick Keks
- 2 Mental Health Service, Austin Health, Heidelberg, VIC, Australia
| | - Nick Paoletti
- 1 The University of Melbourne, Melbourne, VIC, Australia
| | - John Tiller
- 1 The University of Melbourne, Melbourne, VIC, Australia
| | - David Castle
- 1 The University of Melbourne, Melbourne, VIC, Australia
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Bosanac P, Hopwood M, Keks N, Newton R, Tiller JW, Coplov Ao D, Paoletti N, Castle DJ. Recovery is a core goal of psychiatrists. Aust N Z J Psychiatry 2016; 50:935-6. [PMID: 27531936 DOI: 10.1177/0004867416662918] [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: 11/17/2022]
Affiliation(s)
- Peter Bosanac
- St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Malcolm Hopwood
- Albert Road Clinic and Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Nicholas Keks
- Delmont Private Hospital and Monash University, Glen Iris, VIC, Australia
| | - Richard Newton
- MHCSU, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - John Wg Tiller
- Albert Road Clinic, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Nick Paoletti
- Austin Hospital, The University of Melbourne, Heidelberg, VIC, Australia
| | - David J Castle
- St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
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Abstract
OBJECTIVE The place of monoamine oxidase inhibitors (MAOIs) in psychiatry is reviewed, and the question posed as to whether they are now justifiably disregarded by prescribers. METHOD Multiple databases (PubMed, Medline, Embase, Cochrane) were interrogated to provide an overview regarding the use, efficacy and toxicity of MAOIs. Data regarding funded use of these agents in New Zealand were obtained from PHARMAC. RESULTS Evidence supports the use of MAOIs in major depressive disorder, certain anxiety disorders and, to lesser extent, bipolar depression. Older non-selective agents, such as phenelzine and tranylcypromine, have distinctive efficacy in 'atypical' and treatment-resistant depression, but at the cost of serious tolerability problems. Their relegation and perception by clinicians as 'last resort' medications - if considered at all - has occurred in the context of various concerns, notably dietary restrictions, potential adverse drug interactions and the usual requirement for divided doses. CONCLUSIONS Sufficient evidence supports consideration of MAOIs in treatment-refractory and atypical depressive disorders, and in social anxiety disorder. Psychiatrists in training need to gain experience in using these agents.
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Affiliation(s)
- David Menkes
- Associate Professor, Psychiatry, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Peter Bosanac
- Clinical Director, Mental Health and Aged Care Services, St Vincent's Hospital, Melbourne, VIC, and; Associate Professor, Department Psychiatry, University of Melbourne, VIC, Australia
| | - David Castle
- Chair of Psychiatry, St Vincent's Hospital, Melbourne, VIC, and; Professor, Department Psychiatry, University of Melbourne, VIC, Australia
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Bosanac P, Mancuso SG, Castle DJ. Anxiety Symptoms in Psychotic Disorders: Results from the Second Australian National Mental Health Survey. ACTA ACUST UNITED AC 2016; 10:93-100. [DOI: 10.3371/1935-1232-10.2.93] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE To provide a clinically-focused review of the biological treatment of treatment-resistant obsessive compulsive disorder (OCD). CONCLUSIONS There is a paucity of research on how to manage OCD patients who fail to respond adequately to first line therapies. High-dose selective serotonin reuptake inhibitors (SSRIs) and clomipramine have good evidence-based data. Combinations of SSRIs have little support in clinical trials, but the combination of SSRIs and clomipramine can be helpful: careful clinical and cardiac monitoring is required. Certain adjunctive antipsychotics have a reasonable evidence base in OCD, but their use also needs to be weighed against the potential side effect burden. In patients with substantial generalised anxiety symptoms, clonazepam is worth considering. Of the other augmenting strategies, memantine and ondansetron appear useful in some cases, and are well tolerated. Topiramate might ameliorate compulsions to some degree, but it is less well tolerated. If all these strategies, along with expert psychological therapy, fail, careful consideration should be given to deep brain stimulation (DBS), which has an emerging evidence base and which can result in dramatic benefits for some individuals. For some patients, gamma radiosurgery might also still have a place.
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Affiliation(s)
- David Castle
- Professor and Chair of Psychiatry, St. Vincent's Hospital Melbourne, University of Melbourne, Melbourne, VIC, and; Adjunct Professor, Faculty of Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - Peter Bosanac
- Director of Clinical Services, St Vincent's Mental Health, Fitzroy, VIC, and; Associate Professor, Department of Psychiatry, University of Melbourne, Fitzroy, VIC, Australia
| | - Susan Rossell
- Professor, Swinburne University, Melbourne, VIC, Australia
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Abstract
OBJECTIVE We aim to provide a selective clinically focused review of the epidemiology, aetiology and management of comorbid anxiety in people with schizophrenia. METHOD The following databases were reviewed: PubMed, Medline and Embase. RESULTS Anxiety is highly prevalent throughout course of schizophrenia, but is often not identified or its clinical significance is under-appreciated. Also, there is a paucity of rigorous data to support specific treatment guidelines for people with schizophrenia and concurrent anxiety disorders. Psychological treatments such as cognitive behavioural therapy appear effective if targeted carefully, and preliminary data suggest that mindfulness approaches and progressive muscle relaxation may be beneficial. Pharmacological interventions need to be tailored to the individual and target specific symptom sets. There is a growing evidence base about the neurobiology of schizophrenia and concurrent anxiety symptoms or disorders which will hopefully enhance treatment options. CONCLUSIONS Further research is required to guide treatment guidelines for anxiety in people with schizophrenia.
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Affiliation(s)
- Peter Bosanac
- Director of Clinical Services, St Vincent's Mental Health, Fitzroy, VIC, and; Associate Professor, Department of Psychiatry, University of Melbourne, Fitzroy, VIC, Australia
| | - David Castle
- Chair of Psychiatry, St Vincent's Hospital, Fitzroy, VIC, and; Professor, The University of Melbourne, Parkville, VIC, Australia
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Mancuso SG, Newton JR, Bosanac P, Rossell SL, Nesci JB, Castle DJ. Classification of eating disorders: comparison of relative prevalence rates using DSM-IV and DSM-5 criteria. Br J Psychiatry 2015; 206:519-20. [PMID: 25745131 DOI: 10.1192/bjp.bp.113.143461] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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] [Received: 12/15/2013] [Accepted: 09/26/2014] [Indexed: 11/23/2022]
Abstract
DSM-5 contains substantial changes to eating disorder diagnoses. We examined relative prevalence rates of DSM-IV and DSM-5 eating disorder diagnoses using Eating Disorder Examination-Questionnaire diagnostic algorithms in 117 community out-patients. DSM-5 criteria produced a reduction in combined 'other specified feeding or eating disorder' and 'unspecified feeding or eating disorder' from 46% to 29%, an increase in anorexia nervosa diagnoses from 35% to 47%, the same number of bulimia nervosa diagnoses and a 5% rate of binge eating disorder diagnoses.
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Affiliation(s)
- Serafino G Mancuso
- Serafino G. Mancuso, PhD, St Vincent's Mental Health, Melbourne, Department of Psychiatry, The University of Melbourne, Melbourne and Centre for Excellence in Research Methods, Eastern Hill Academic Centre, Department of Medicine, The University of Melbourne, Melbourne; J. Richard Newton, MBChB, MRCPsych, Department of Psychiatry, The University of Melbourne, Melbourne, Mental Health Clinical Service Unit, Austin Health, Melbourne and Department of Psychological Medicine, Monash University, Melbourne; Peter Bosanac, MD, FRANZCP, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne; Susan L. Rossell, PhD, Department of Psychiatry, The University of Melbourne, Melbourne and Psychological and Statistical Sciences, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne; Julian B. Nesci, DPsych(Clin), St Vincent's Mental Health, Melbourne and Mental Health Clinical Service Unit, Austin Health, Melbourne, Australia; David J. Castle, MD, MRCPsych, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - J Richard Newton
- Serafino G. Mancuso, PhD, St Vincent's Mental Health, Melbourne, Department of Psychiatry, The University of Melbourne, Melbourne and Centre for Excellence in Research Methods, Eastern Hill Academic Centre, Department of Medicine, The University of Melbourne, Melbourne; J. Richard Newton, MBChB, MRCPsych, Department of Psychiatry, The University of Melbourne, Melbourne, Mental Health Clinical Service Unit, Austin Health, Melbourne and Department of Psychological Medicine, Monash University, Melbourne; Peter Bosanac, MD, FRANZCP, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne; Susan L. Rossell, PhD, Department of Psychiatry, The University of Melbourne, Melbourne and Psychological and Statistical Sciences, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne; Julian B. Nesci, DPsych(Clin), St Vincent's Mental Health, Melbourne and Mental Health Clinical Service Unit, Austin Health, Melbourne, Australia; David J. Castle, MD, MRCPsych, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Peter Bosanac
- Serafino G. Mancuso, PhD, St Vincent's Mental Health, Melbourne, Department of Psychiatry, The University of Melbourne, Melbourne and Centre for Excellence in Research Methods, Eastern Hill Academic Centre, Department of Medicine, The University of Melbourne, Melbourne; J. Richard Newton, MBChB, MRCPsych, Department of Psychiatry, The University of Melbourne, Melbourne, Mental Health Clinical Service Unit, Austin Health, Melbourne and Department of Psychological Medicine, Monash University, Melbourne; Peter Bosanac, MD, FRANZCP, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne; Susan L. Rossell, PhD, Department of Psychiatry, The University of Melbourne, Melbourne and Psychological and Statistical Sciences, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne; Julian B. Nesci, DPsych(Clin), St Vincent's Mental Health, Melbourne and Mental Health Clinical Service Unit, Austin Health, Melbourne, Australia; David J. Castle, MD, MRCPsych, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Susan L Rossell
- Serafino G. Mancuso, PhD, St Vincent's Mental Health, Melbourne, Department of Psychiatry, The University of Melbourne, Melbourne and Centre for Excellence in Research Methods, Eastern Hill Academic Centre, Department of Medicine, The University of Melbourne, Melbourne; J. Richard Newton, MBChB, MRCPsych, Department of Psychiatry, The University of Melbourne, Melbourne, Mental Health Clinical Service Unit, Austin Health, Melbourne and Department of Psychological Medicine, Monash University, Melbourne; Peter Bosanac, MD, FRANZCP, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne; Susan L. Rossell, PhD, Department of Psychiatry, The University of Melbourne, Melbourne and Psychological and Statistical Sciences, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne; Julian B. Nesci, DPsych(Clin), St Vincent's Mental Health, Melbourne and Mental Health Clinical Service Unit, Austin Health, Melbourne, Australia; David J. Castle, MD, MRCPsych, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Julian B Nesci
- Serafino G. Mancuso, PhD, St Vincent's Mental Health, Melbourne, Department of Psychiatry, The University of Melbourne, Melbourne and Centre for Excellence in Research Methods, Eastern Hill Academic Centre, Department of Medicine, The University of Melbourne, Melbourne; J. Richard Newton, MBChB, MRCPsych, Department of Psychiatry, The University of Melbourne, Melbourne, Mental Health Clinical Service Unit, Austin Health, Melbourne and Department of Psychological Medicine, Monash University, Melbourne; Peter Bosanac, MD, FRANZCP, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne; Susan L. Rossell, PhD, Department of Psychiatry, The University of Melbourne, Melbourne and Psychological and Statistical Sciences, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne; Julian B. Nesci, DPsych(Clin), St Vincent's Mental Health, Melbourne and Mental Health Clinical Service Unit, Austin Health, Melbourne, Australia; David J. Castle, MD, MRCPsych, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - David J Castle
- Serafino G. Mancuso, PhD, St Vincent's Mental Health, Melbourne, Department of Psychiatry, The University of Melbourne, Melbourne and Centre for Excellence in Research Methods, Eastern Hill Academic Centre, Department of Medicine, The University of Melbourne, Melbourne; J. Richard Newton, MBChB, MRCPsych, Department of Psychiatry, The University of Melbourne, Melbourne, Mental Health Clinical Service Unit, Austin Health, Melbourne and Department of Psychological Medicine, Monash University, Melbourne; Peter Bosanac, MD, FRANZCP, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne; Susan L. Rossell, PhD, Department of Psychiatry, The University of Melbourne, Melbourne and Psychological and Statistical Sciences, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne; Julian B. Nesci, DPsych(Clin), St Vincent's Mental Health, Melbourne and Mental Health Clinical Service Unit, Austin Health, Melbourne, Australia; David J. Castle, MD, MRCPsych, St Vincent's Mental Health, Melbourne and Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Bosanac P, Hamilton B, Beatson J, Trett R, Rao S, Mancuso S, Castle D. Mentalization-based intervention to recurrent acute presentations and self-harm in a community mental health service setting. Australas Psychiatry 2015; 23:277-81. [PMID: 25944765 DOI: 10.1177/1039856215586148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES A proof-of-concept study over an 18-month period to determine whether a mentalization-based intervention (MBI) in a metropolitan community mental health service, when added to a recovery-based model of care, would be of clinical benefit to borderline personality disorder (BPD) consumers with a history of recurrent, deliberate self-harm. The feasibility of implementing the intervention, and factors that could improve its implementation, will be evaluated. METHODS Three-monthly focus groups with participating community mental health service case managers (N = 8) assessed the implementation and the impact of an MBI added to a recovery model of care and the way the clinicians worked with consumers with BPD and recurrent, deliberate self-harm in this context. RESULTS Qualitative analysis revealed compatibility of the MBI with a recovery-based case management approach for the above group of consumers, albeit with operational barriers. CONCLUSIONS MBI with consumers with BPD appears to be compatible with recovery-focused psychiatric case management and was accepted by consumers. The case managers perceived that no harm was rendered in terms of deliberate self-harm and acute service utilization. The MBI led to a sense of improved therapeutic alliance in case managers working with consumers.
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Affiliation(s)
- Peter Bosanac
- Director Clinical Services, St Vincent's Mental Health, Fitzroy, VIC, and; Associate Professor, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bridget Hamilton
- Clinical Nurse Consultant, St Vincent's Mental Health, Fitzroy, VIC, and; Senior Lecturer, Coordinator Research Training, Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Josephine Beatson
- St Vincent's Mental Health, Fitzroy, VIC, and; Senior Clinical Adviser, Spectrum, Melbourne, Australia
| | - Robert Trett
- Associate Clinical Director, Spectrum, Melbourne, VIC, Australia
| | - Sathya Rao
- Consultant Psychiatrist, Spectrum, Melbourne, VIC, Australia
| | - Sam Mancuso
- Research Coordinator, University of Melbourne, VIC, Australia
| | - David Castle
- Chair of Psychiatry, St Vincent's Mental Health, Fitzroy, VIC, and; University of Melbourne, Melbourne, VIC, Australia
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Abstract
Depressive symptoms are common in people with schizophrenia and can be associated with suicidality, but are often either missed or dismissed by clinicians. General practitioners have a key role in initial assessment and subsequent monitoring of depressive symptoms, associated risks and physical health in patients with schizophrenia. Liaison with appropriate non-government organisations and public or private specialist mental health services can enhance GPs' management of depression in schizophrenia. Antidepressants, prescribed in tandem with antipsychotics, have a likely therapeutic role for persistent depressive symptoms in schizophrenia, but side effects can be troublesome. Although some of the atypical antipsychotics appear to have primary antidepressant effects, the utility of these agents alone in the setting of persistent depressive symptoms in schizophrenia has not been established.
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Abstract
OBJECTIVE To review the current role and comparative efficacy of short-acting intramuscular (IM) antipsychotics in the management of acute agitation, in current clinical practice. METHOD The efficacy and tolerability of IM antipsychotics in the management of acute agitation in current clinical practice were reviewed in the Medline, PubMed, Cinahl Plus, Scopus-v.4 and PsycInfo databases. RESULTS The comparative efficacy of the rapidly-acting IM atypical antipsychotics (olanzapine, ziprasidone and aripiprazole) is similar to that of the typical antipsychotic, haloperidol. IM olanzapine and ziprasidone were associated with fewer extrapyramidal side-effects and had similar cardiac tolerability to IM haloperidol. CONCLUSIONS Further studies are required in the ongoing development of contemporary, evidence-based clinical guidelines in acute agitation, including head-to-head comparisons of currently utilized IM atypical antipsychotics, sequential treatment or combinations of medications.
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Affiliation(s)
- Peter Bosanac
- Director, Clinical Services, St Vincent's Mental Health Service, Melbourne, VIC, Australia
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Abstract
BackgroundThe prevalence of anxiety symptoms among Australians with psychotic disorders was examined as part of the Survey of High Impact Psychosis (SHIP).MethodsA two-phase design was used. Of 7,955 people who were screen positive for psychosis and eligible, 1825 participants (18-34 years and 35-64 years) were interviewed. Data were collected on symptomatology, substance use, cognitive ability, functioning, disability, physical health, mental health service utilisation, medication use, education, employment and housing. Anxiety symptomatology was divided into generalized anxiety, panic, phobic, social anxiety and obsessive-compulsive symptoms.ResultsThe most common ICD-10 diagnoses were schizophrenia or schizoaffective disorder (63.0%) and bipolar (mania) disorder (17.5%). Overall, 59.8% (n = 1092) of participants reported experiencing anxiety symptoms in the previous 12 months. Female gender was highly associated with all domains of anxiety. Smoking was significantly associated with all domains of anxiety, except generalized anxiety. The presence of any depressive symptoms in the previous 12 months was significantly associated with all anxiety symptoms. Medication side-effects were associated with phobic and obsessive-compulsive symptoms. Social dysfunction was associated with social anxiety, and less so for obsessive-compulsive symptoms.ConclusionsAnxiety symptoms are common in people with psychotic disorders. Appropriate screening and treatment should be a clinical priority.
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Affiliation(s)
- P Bosanac
- St Vincent's Mental Health, University of Melbourne, PO Box 2900, Fitzroy 3065, Melbourne Australia
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Newton J, Bosanac P, Mancuso S, Castle D. Bridging the gap: does a specialist eating disorder service, aimed at developing a continuum of community care, make a difference? Australas Psychiatry 2013; 21:365-70. [PMID: 23671227 DOI: 10.1177/1039856213486303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In 2010, the authors identified in a separate publication, Mind the evidence gap, the sparse evidence-base for the treatment of adult anorexia nervosa and barriers to accessing care. We report on the ensuing development, implementation and first 18-month results of a novel eating disorder service bridging the primary and specialist continuum of care in Victoria, Australia. METHOD Using literature review, stakeholder, and consumer and carer consultation, a model for a community eating disorder service was developed and then implemented. All patients entering the service were then assessed at intake and, if they gave consent, at 12 month follow-up. RESULTS From December 2010 to July 2012, 208 patients accessed The Body Image Eating Disorders Treatment and Recovery Service (BETRS). Fifty-three per cent had a diagnosis of anorexia nervosa and the mean number of co-morbid psychiatric diagnoses was two. Twenty-three per cent attended a day patient programme and showed a significant improvement in their body mass index. Measures of depression, anxiety and eating disorder symptomatology showed a concomitant, significant decrease. CONCLUSIONS The development of BETRS has led to markedly improved access and effectiveness of specialist services in the region.
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Affiliation(s)
- John Newton
- Mental Health Clinical Service Unit, Austin Health, Heidelberg, VIC, Australia.
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Lee SJ, Foley F, Hannagan E, Kulkarni J, Bosanac P, Castle DJ, Hollander Y. Determining the efficacy and tolerance of quetiapine extended release for the management of psychosis and accompanying acute behavioral disturbance in adult acute psychiatry. Ann Clin Psychiatry 2012; 24:271-8. [PMID: 23145383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND This study was conducted to explore the efficacy and tolerability of quetiapine extended release (XR) to treat psychosis and accompanying acute behavioral disturbance in hospitalized psychiatric patients. METHODS Patients with psychosis who displayed aggression were administered quetiapine XR (day 1 mean dose: 293.3 mg). Symptoms and side effects were assessed prospectively over an 8-day period. Symptoms were measured by the Overt Aggression Scale and Brief Psychiatric Rating Scale (BPRS), and side effects were measured using the Simpson-Angus Scale and Barnes Akathisia Rating Scale. RESULTS Fifteen of 16 consenting patients completed the study. Aggression was significantly reduced by day 3. Psychopathology also was significantly reduced, with the greatest improvement in BPRS Thinking Disturbance subscale scores. No significant increase in movement side effects was seen by day 8. Seven participants were administered a concomitant sedating antipsychotic on an as-needed basis, particularly in the first 4 days of treatment; these participants displayed much greater aggression--but not psychopathology--at day 1, and it took longer for their aggression and psychopathology to improve compared with patients treated with quetiapine XR as the sole antipsychotic. CONCLUSIONS Further research is needed before definitive recommendations can be made. However, current findings provide tentative support for quetiapine XR as a safe and effective medication for treating concurrent psychosis and behavioral disturbance, particularly in less severely aggressive patients.
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Affiliation(s)
- Stuart J Lee
- Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University, Melbourne, Victoria, Australia.
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Abstract
AbstractDay treatment programs (DTP) for eating disorders are being recognised as having therapeutic benefits. However, research is needed to evaluate the effectiveness of DTP to establish their validity. This article reports on the evaluation of a pilot DTP in an Australian mental health setting, which utilised an integrative approach combining evidence-based treatments such as dialectical-behavioural therapy and intensive short-term dynamic psychotherapy offered in a group-based setting. Comparison of pre- and post-treatment data outcome measures for eating disorder pathology and comorbid symptoms was undertaken. Patient satisfaction was also evaluated using qualitative methods. Results indicated a significant reduction in depressive symptoms post-treatment, along with a high degree of satisfaction with the treatment. Limitations of this study, along with the implications of the findings and directions for future research, are discussed.
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Monshat K, Bosanac P, Khorsen G, Gaynor N, Nittoli S, Castle D. Are psychiatric Crisis Assessment and Treatment team clinicians on the psychotherapy front line? Australas Psychiatry 2012; 20:40-3. [PMID: 22357674 DOI: 10.1177/1039856211430148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is limited data on the psychological interventions used by Crisis Assessment and Treatment (CAT) team clinicians, even though practice guidelines stipulate part of their role to be the provision of counselling. This study aimed to catalogue and categorise the range of psychotherapeutic interventions utilised by clinicians of a CAT team operating within a metropolitan area. METHODS Self-report, episode of care data was collected regarding clinicians' views of the type of psychotherapeutic intervention they employed and details of what they discussed with patients, and location and duration of interventions. RESULTS Thirty-two care episodes were catalogued. On average, clinicians spent 74% of their total contact time with patients engaged in psychological interventions. A wide range of strategies, drawn from a broad theoretical base, was used. Aside from general approaches aiding engagement, interventions could be classified into the following categories: meta-strategy ('treatment about the treatment'), 'critical', 'practical', specific psychotherapeutic (cognitive-behavioural therapy (CBT) and others), and supportive. CONCLUSIONS Clinicians saw themselves as spending the majority of patient contact time engaged in psychological interventions drawn from a broad theoretical base. Observational studies of what clinicians actually do and empirical investigation of the efficacy thereof may have implications for clinician training and supervision.
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Affiliation(s)
- Kaveh Monshat
- Department of Psychiatry, University of Melbourne, Fitzroy, VIC, Australia.
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Bell L, Stargatt R, Bosanac P, Castle D, Braitberg G, Coventry N. Child and adolescent mental health problems and substance use presentations to an emergency department. Australas Psychiatry 2011; 19:521-5. [PMID: 22011197 DOI: 10.3109/10398562.2011.603329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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
OBJECTIVE The aim of this study was to determine the characteristics and referral pattern of children and adolescents with mental health problems, substance misuse and comorbidity presenting to the emergency department (ED) of a large public hospital. METHOD A file audit of the ED information system was conducted over a 12 month period. Outcome measures included age, gender, diagnostic presentation, assessment, referral and disposal. RESULTS Forty-four substance misuse, 128 mental health and 82 comorbidity presentations were identified; 80% required treatment within 30 minutes. Few substance misuse cases were seen by mental health services and no substance misuse cases were referred for mental health service assessment. All mental health and comorbidity cases were seen by mental health services; 41% were referred to outpatient and 18% to inpatient services. Those with mental health problems displayed high levels of self-mutilation, and those with comorbidity displayed high levels of self-mutilation and substance misuse. Alcohol use was common in the substance misuse group, and over the counter or prescription medications were abused by the mental health and comorbidity groups. CONCLUSIONS This age group places a high demand on the ED. All children and adolescents with recognized mental health symptoms were seen by mental health services, but those with substance misuse were not. Given the long-term problems associated with substance misuse, this is a missed opportunity for intervention.
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Affiliation(s)
- Lisa Bell
- School of Psychological Science, Faculty of Science, Technology and Engineering, La Trobe University, Bundoora, VIC, Australia
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Abstract
AIMS AND OBJECTIVES This paper aims to explore the effectiveness of the mental health nurse practitioner role in the emergency department in the context of the growing use of special units or segregated areas to manage particular kinds of mental health presentations, often complicated by substance use. BACKGROUND In recent years, there has been a significant increase in mental health presentations to emergency departments, often complicated by substance abuse. Emergency departments have introduced a variety of mechanisms to address this growing problem. With the introduction of mental health nurse practitioners, opportunities arise to reconsider these mechanisms. DESIGN Discursive paper. METHODS In this discursive paper, contemporary practices are described in relation to 'special care areas', 'psychiatric emergency centres' and 'short-stay units'. The mental health nurse practitioner role in training and capacity building is also explored and the notion of 'locational processes' described. Rather than being presented as an alternative to short-stay units, the mental health nurse practitioner role is explored in its potential to enhance mental health nursing practice in a sometimes difficult clinical environment. RESULTS The paper provides evidence from literature and practice that the clinical outcome for consumers is enhanced through the mental health nurse practitioner role. CONCLUSIONS It is argued that the introduction of the mental health nurse practitioner role in the emergency department leads to increased staff competence and confidence in interacting with those presenting with mental health issues. The mental health nurse practitioner role also addresses the serious problem of stigma associated with those with a mental health issue. RELEVANCE TO CLINICAL PRACTICE It is expected that those presenting with mental health issues to the emergency department will benefit through the increased assessment and management skills of staff.
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Affiliation(s)
- Daniel Nicholls
- University of Western Sydney, Penrith South DC, New South Wales, Australia.
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Bosanac P, Newton R, Harari E, Castle D. Mind the evidence gap: do we have any idea about how to integrate the treatment of anorexia nervosa into the Australian mental health context? Australas Psychiatry 2010; 18:517-22. [PMID: 20932198 DOI: 10.3109/10398562.2010.499433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this paper is to review recent developments in the treatment of anorexia nervosa (AN) and how this translates to clinical and population-based care in the Australian context. CONCLUSIONS Overall, there is a paucity of high-quality research into treatments for AN, albeit that a number of biological and psychological interventions show promise as avenues for further research. There are significant impediments to the provision of comprehensive longitudinal care for people with AN within Australian mental health services. Evaluation of novel strategies, such as home-based support, is required as part of enhancing options for Australians suffering with AN and their families.
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Affiliation(s)
- Peter Bosanac
- St. Vincents' Mental Health and Senior Lecturer, Dept. Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
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Abstract
OBJECTIVE Availability of new psychotropic agents, and formulations, as well as expanded indications for previously available agents, has had an impact on prescribing patterns in community psychiatric practice. This study tracked changes in patient diagnostic profiles and compared antipsychotic prescribing patterns for patients managed by a continuing care team over a 2.25-year period. METHOD Data pertaining to patient diagnoses and psychotropic medications was obtained from sequential cross-sectional file review and the pharmacy database. Data were collected in late 2004 (n = 224) and early 2007 (n = 294). RESULTS The majority of patients suffered from DSM-IV schizophrenia, schizoaffective and related disorders (68% in 2004, 71% in 2007). Second generation antipsychotic (SGA) medications (79% in 2004, 99% in 2007 of all antipsychotics) were the most widely used agents. Use of quetiapine as a proportion of all oral SGAs increased (8% to 17%) as did that of long-acting risperidone (<1% to 17% of all antipsychotics) paralleled by a decline in long-acting first generation antipsychotic agents (15% to <1%). Significant changes in the prescription of non-benzodiazepine hypnotics and mood stabilizers were also noted. CONCLUSIONS Statistically significant changes in prescribing patterns of antipsychotics during the study period were noted. Likely causes are discussed.
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Affiliation(s)
- Kaveh Monshat
- Department of Psychiatry, University of Melbourne, St Vincent's Hospital, Fitzroy, VIC, Australia.
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Abstract
This paper reviews the literature on early intervention in psychotic disorders, weighs the cons of this approach, and makes suggestions for clinicians and researchers regarding how to interpret and respond to what is still an embryonic evidence-base, notably in terms of any long-term benefits.
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Bosanac P, Kurlender S, Stojanovska L, Hallam K, Norman T, McGrath C, Burrows G, Wesnes K, Manktelow T, Olver J. Neuropsychological study of underweight and "weight-recovered" anorexia nervosa compared with bulimia nervosa and normal controls. Int J Eat Disord 2007; 40:613-21. [PMID: 17607697 DOI: 10.1002/eat.20412] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare executive, memory and visuospatial functioning of DSM-IV anorexia nervosa (AN), bulimia nervosa (BN), and normal controls (NC). METHOD A comparison of women involving: (i) 16 AN with body mass indices (BMI) < or = 17.5 kg/m(2); (ii) 12 AN with BMI > 18.5 kg/m(2) for at least 3 months; (iii) 13 BN; and (iv) 16 NC participants was performed with groups of similar age and intelligence. Groups were assessed with EDE-12, MADRS, HAMA, Cognitive Drug Research (CDR) battery, and Bechara tasks. RESULTS Significant impairments in CDR Power of Attention were present in underweight AN and BN participants. CDR Morse Tapping was significantly impaired in all clinical groups. The BN and weight-recovered AN groups were significantly impaired on CDR immediate word recall. The BN group alone was significantly impaired on CDR delayed word recall. CONCLUSION Attentional impairment is similar in AN and BN. Impaired motor tasks in AN persist after "weight-recovery" and are similar to impairments in BN. BN may be discriminated from AN on word recall.
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Affiliation(s)
- Peter Bosanac
- Department of Psychiatry, University of Melbourne, Austin Hospital, Studley Road, Heidelberg 3084, Melbourne, Australia.
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Abstract
BACKGROUND Atypical antipsychotics may be beneficial in treating the core psychopathology of anorexia nervosa (AN). METHODS An 8 week open-label study of quetiapine was conducted in eight severely ill DSM-IV AN patients consecutively admitted to a specialist eating disorders unit. Participants were assessed by EDE-12, MADRS, YBOCS, SAPS-delusions and CDR neuropsychological battery at baseline, 4 weeks and 8 weeks, and by weekly body mass index (BMI), CGI and extrapyramidal scores. Quetiapine doses ranged from 50 mg to 800 mg per day, according to efficacy and tolerability. RESULTS Seven participants completed 4 weeks and five participants completed 8 weeks. All participants had clinically significant levels of specific eating disorders psychopathology, and mild to moderately severe depressive symptomatology. Apart from initial mild sedation, no subjects experienced any significant adverse events. Over 4 weeks there was no significant difference in BMI, but a significant difference in the EDE-12 restraint score. There were significant differences on BMI and EDE-12 restraint subscale scores over 8 weeks. CONCLUSIONS A double-blind placebo controlled study is required to further evaluate the therapeutic utility of quetiapine in severely ill AN patients beyond multidisciplinary specialist intervention.
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Affiliation(s)
- P Bosanac
- Department of Psychiatry, University of Melbourne, and Austin Hospital, Australia.
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Abstract
OBJECTIVE To review serotonergic and dopaminergic system function in anorexia nervosa in terms of potential modulation by atypical antipsychotic medications. METHOD A systematic review of clinical, neurobiological and functional neuroimaging findings of serotonergic and dopaminergic system activity in anorexia nervosa was conducted via MEDLINE, PsycINFO and EMBASE psychiatry databases, with a critical review of dysregulation of these systems as therapeutic targets for atypical antipsychotics, in context of evidence regarding the utility and efficacy of these medications in this syndrome. RESULTS There is evidence of persistently altered serotonergic and dopaminergic function in anorexia nervosa independent to weight-recovery. Case reports, open-label and single-blinded studies, albeit sparse, suggest that atypical antipsychotics may be beneficial in the management of anorexia nervosa psychopathology beyond weight gain. CONCLUSIONS Double-blind placebo controlled studies of atypical antipsychotics in anorexia nervosa with well defined outcome measures are required.
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Affiliation(s)
- Peter Bosanac
- Austin Health and Department of Psychiatry, The University of Melbourne, Austin Hospital, Austin Health, Victoria, Australia.
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Abstract
OBJECTIVE To provide an overview of the current knowledge on the impact of motherhood on women with schizophrenia and schizoaffective disorder. METHOD The published literature was selectively reviewed and assessed, based on a complete MEDLINE and PsychLIT (1971 to current) search, including English and non-English journals and books. RESULTS Research to date into motherhood and schizophrenic illnesses has been limited by a number of methodological constraints, limiting the ability to draw conclusions and the prevention of relapses and mother-infant difficulties. These constraints have included: a paucity of prospective studies with initial, antenatal recruitment; variable definitions of the length of the puerperium; significant changes in psychiatric classification; the heterogeneity of postpartum psychotic disorders, with the majority being mood or schizoaffective disorder rather than schizophrenia; selection biases inherent in studying mother-baby unit inpatients; difficulties in life events research in general, such as its retrospective nature and confounding, illness factors; and the specificity versus non-specificity of childbirth as a unique or discrete life event. CONCLUSIONS Further study is required to explore: the impact of child care, parenting and having a partner on the course of women with schizophrenic and schizoaffective disorders during the first postpartum year; whether women with postpartum relapses of these mental illnesses are likely to have slower recoveries than those women with the same diagnoses but without young children; and protective factors against postpartum relapse.
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Affiliation(s)
- Peter Bosanac
- Department of Psychiatry, Austin Repatriation Medical Centre, Heidelberg, Victoria, Australia.
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Abstract
In order to determine the effects of guanabenz upon renal function, clearance studies were performed on hypertensive volunteers during sustained steady-state water diuresis. The data reveal an acute fall in renal hemodynamics and a marked reduction in sodium excretion during the 3rd and 4th hour after administration. Tha antinatriuresis was due to decreased filtration and enhanced distal nephron reabsorption of sodium, principally in association with secretion of potassium. Chronic administration of guanabenz for one week produced a sustained reduction in blood pressure, but there was no change in either body weight or 24-hour urinary sodium excretion. Repeat clearance studies revealed no change with either renal hemodynamics or sodium clearance. The data suggest that the acute antinatriuresis is a transient hemodynamic event and chronic therapy with guanabenz will not be complicated by sodium retention, a feature characteristic of other antihypertensive agents.
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