1
|
Dadi AF, He V, Brown K, Hazell-Raine K, Reilly N, Giallo R, Rae KM, Hazell P, Guthridge S. Association between maternal mental health-related hospitalisation in the 5 years prior to or during pregnancy and adverse birth outcomes: a population-based retrospective cohort data linkage study in the Northern Territory of Australia. Lancet Reg Health West Pac 2024; 46:101063. [PMID: 38659431 PMCID: PMC11040136 DOI: 10.1016/j.lanwpc.2024.101063] [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] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/13/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
Background Mental health conditions prior to or during pregnancy that are not addressed can have adverse consequences for pregnancy and birth outcomes. This study aimed to determine the extent to which women's mental health-related hospitalisation (MHrH) prior to or during pregnancy was associated with a risk of adverse birth outcomes. Methods We linked the perinatal data register for all births in the Northern Territory, Australia, from the year 1999 to 2017, to hospital admissions records to create a cohort of births to women aged 15-44 years with and without MHrH prior to or during pregnancy. We used Modified Poisson Regression and Latent Class Analysis to assess the association between maternal MHrH and adverse birth outcomes (i.e., stillbirth, preterm birth, low birth weight, and short birth length). We explored a mediation effect of covariates on theoretical causal paths. We calculated the adjusted Population Attributable Fraction (PAF) and Preventive Fractions for the Population (PFP) for valid associations. Findings From 72,518 births, 70,425 births (36.4% for Aboriginal women) were included in the analysis. The Latent Class Analys identified two classes: high (membership probability of 10.5%) and low adverse birth outcomes. Births to Aboriginal women with MHrH were around two times more likely to be in the class of high adverse birth outcomes. MHrH prior to or during pregnancy increased the risk of all adverse birth outcomes in both populations with risk ranging from 1.19 (95% CI: 1.05, 1.35) to 7.89 (1.17, 53.37). Eight or more antenatal care visits and intrauterine growth restriction mostly played a significant mediation role between maternal MHrH and adverse birth outcomes with mediation effects ranging from 1.04 (1.01, 1.08) to 1.39 (1.14, 1.69). MHrH had a low to high population impact with a PAF ranging from 16.1% (5.1%, 25.7%) to 87.3% (14.3%, 98.1%). Eight or above antenatal care visits avert extra adverse birth outcomes that range from 723 (332-765) stillbirths to 3003 (1972-4434) preterm births. Interpretation Maternal MHrH is a modifiable risk factor that explained a low to moderate risk of adverse birth outcomes in the Northern Territory. The knowledge highlights the need for the development and implementation of preconception mental health care into routine health services. Funding The Child and Youth Development Research Partnership (CYDRP) data repository is supported by a grant from the Northern Territory Government.
Collapse
Affiliation(s)
- Abel Fekadu Dadi
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Vincent He
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kiarna Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Tiwi, NT 0810, Australia
| | - Karen Hazell-Raine
- Faculty of Health, Charles Darwin University, Darwin, Australia
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Nicole Reilly
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney and St John of God Burwood Hospital, Sydney, Australia
- Faculty of Science, Medicine and Health, Graduate School of Medicine, University of Wollongong, Australia
| | - Rebecca Giallo
- Faculty of Health, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Kym M. Rae
- Mater Research Institute, Aubigny Place, Raymond Terrace, South Brisbane, QLD, Australia
| | - Philip Hazell
- School of Medicine, Charles Darwin University, Australia
- School of Medicine, The University of Sydney, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| |
Collapse
|
2
|
Bhide S, Efron D, Ukoumunne OC, Anderson V, Nicholson JM, Silk T, Hazell P, Gulenc A, Sciberras E. Family Functioning in Children With ADHD and Subthreshold ADHD: A 3-Year Longitudinal Study. J Atten Disord 2024; 28:480-492. [PMID: 38084374 PMCID: PMC10838481 DOI: 10.1177/10870547231217089] [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: 02/03/2024]
Abstract
OBJECTIVE To compare family functioning over time for elementary school children with Attention-Deficit/Hyperactivity Disorder (ADHD; N = 179) and subthreshold ADHD (ST-ADHD; N = 86), to children without ADHD (Control; N = 212). METHOD ADHD was assessed using the Conners 3 ADHD Index and Diagnostic Interview Schedule for Children IV. At baseline, 18-month follow-up and 36-month follow-up, parents completed measures assessing a range of family functioning domains. RESULTS At baseline, the ADHD group reported higher psychological distress, less parenting self-efficacy, less parenting consistency, and more stressful life events; and both groups reported poorer family quality of life (QoL) and greater parenting anger. Trajectories were largely similar to controls (i.e., stable over time), but unlike controls, ADHD and ST-ADHD groups showed lessening parent-partner support and parenting warmth, respectively; and both groups showed worsening aspects of family QoL. CONCLUSION Families of children with ADHD and ST-ADHD report persistently poor or worsening family functioning; highlighting a need for tailored psycho-social supports.
Collapse
Affiliation(s)
- Sampada Bhide
- School of Pychology, Deakin University, Geelong, VIC, Australia
- Allied Health - Psychology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Medical School, The University of Melbourne, Parkville, VIC, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
| | - Obioha C Ukoumunne
- National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, United Kingdom
| | - Vicki Anderson
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Medical School, The University of Melbourne, Parkville, VIC, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
| | - Tim Silk
- School of Pychology, Deakin University, Geelong, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Philip Hazell
- Discipline of Psychiatry, School of Medicine, The University of Sydney and Westmead Hospital, NSW, Australia
| | - Alisha Gulenc
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Emma Sciberras
- School of Pychology, Deakin University, Geelong, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| |
Collapse
|
3
|
Fuelscher I, Hyde C, Thomson P, Vijayakumar N, Sciberras E, Efron D, Anderson V, Hazell P, Silk TJ. Longitudinal Trajectories of White Matter Development in Attention-Deficit/Hyperactivity Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:1103-1112. [PMID: 36963498 DOI: 10.1016/j.bpsc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Few longitudinal studies have investigated whether white matter development reflects differential outcomes for children with and without attention-deficit/hyperactivity disorder (ADHD). To examine whether deviations from typical trajectories of white matter development were associated with the persistence or remission of ADHD symptoms, this study examined microstructural and morphological properties of 71 white matter tracts from 390 high angular diffusion scans acquired prospectively for 62 children with persistent ADHD, 37 children remitted from ADHD, and 85 children without ADHD. METHODS Participants (mean age at wave 1 = 10.39 years, scan interval = 18 months) underwent up to 3 magnetic resonance imaging assessments. White matter tracts were reconstructed using TractSeg, a semiautomated method. For each tract, we derived measures of fiber density (microstructure) and fiber bundle cross-section (morphology) using fixel-based analysis. Linear mixed models were used to compare trajectories of fiber development between the persistent ADHD, remitted ADHD, and non-ADHD groups. RESULTS Compared with the non-ADHD group, the remitted and persistent ADHD groups showed accelerated fiber development in thalamic pathways, striatal pathways, and the superior longitudinal fasciculus. In the remitted ADHD group, accelerated fiber development in corticospinal, frontopontine, striatal-premotor, and thalamo-premotor pathways was associated with greater reductions in ADHD symptom severity. The persistent ADHD group showed ongoing white matter alterations along sensorimotor pathways. CONCLUSIONS These results suggest that variations in white matter development are associated with different clinical trajectories in ADHD. The findings advance our understanding of the neurobiological mechanisms underpinning ADHD symptom progression and provide novel evidence in support of developmental models of ADHD.
Collapse
Affiliation(s)
- Ian Fuelscher
- School of Psychology, Deakin University, Geelong, Victoria, Australia.
| | - Christian Hyde
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Phoebe Thomson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Emma Sciberras
- School of Psychology, Deakin University, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daryl Efron
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Philip Hazell
- Discipline of Psychiatry, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy J Silk
- School of Psychology, Deakin University, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| |
Collapse
|
4
|
Hazell P, Balzer BWR, Garden F, Handelsman DJ, Paxton K, Hawke C, Ivers R, Skinner SR, Luscombe G, Steinbeck KS. Association of urinary sex hormones with mood and behavior changes in a community adolescent cohort. PLoS One 2023; 18:e0293040. [PMID: 37844097 PMCID: PMC10578568 DOI: 10.1371/journal.pone.0293040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To examine the contribution of variation in sex hormone excretion to mood and behavioral changes in adolescent females and males. DESIGN Prospective, longitudinal observational cohort study. METHODS Participants were 342 volunteers aged 10-12 years living in rural Australia. Urinary estradiol and testosterone levels measured by liquid chromatography-mass spectrometry were obtained at three-month intervals for three years. Integrated measures (area-under-curve) of urinary steroid excretion summarised as absolute and variability during each 12-month period of the study. Psychosocial data were gathered annually with the primary outcome of depressive symptomatology. Secondary outcomes were the other subscales of the Youth Self-Report, impulsive-aggression, sleep habits, and self-harm. RESULTS 277 (158 male) participants contributed data over the full duration of the study and could be included in the analyses. In females, analyses of absolute urine hormone levels found no relationship between estradiol and any outcome, but higher testosterone was significantly associated with depression and poorer sleep. Greater variability of both urine estradiol and testosterone was associated with lower total psychopathology, anxious/depressed and social problems scores. Greater variability in urine estradiol was associated with lower attention problems and impulsive aggression in females. In males, higher testosterone and estradiol levels were associated with rule-breaking, and poorer sleep, and no associations were found for gonadal hormone variability for males. CONCLUSIONS Longitudinal measurement of both iso-sexual and contra-sexual gonadal hormones contributes to a more nuanced view of the impact of sex steroids on mood and behavior in adolescents. These findings may enlighten the understanding of the impact of sex steroids during normal male and female puberty with implications for hormone replacement therapies as well as management of common mood and behavioral problems.
Collapse
Affiliation(s)
- Philip Hazell
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Ben W. R. Balzer
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
- The University of New South Wales Faculty of Medicine, School of Women’s and Children’s Health, Randwick, NSW, Australia
- Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Frances Garden
- Ingham Institute for Medical Research, The University of New South Wales, Liverpool, NSW, Australia
| | - David J. Handelsman
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Karen Paxton
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Catherine Hawke
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Rebecca Ivers
- The University of New South Wales Faculty of Medicine, School of Public Health and Community Medicine, Kensington, NSW, Australia
| | - S. Rachel Skinner
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
- Specialty of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Sydney, NSW, Australia
| | - Georgina Luscombe
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Katharine S. Steinbeck
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Camperdown, NSW, Australia
- Specialty of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Sydney, NSW, Australia
| |
Collapse
|
5
|
Iffland M, Livingstone N, Jorgensen M, Hazell P, Gillies D. Pharmacological intervention for irritability, aggression, and self-injury in autism spectrum disorder (ASD). Cochrane Database Syst Rev 2023; 10:CD011769. [PMID: 37811711 PMCID: PMC10561353 DOI: 10.1002/14651858.cd011769.pub2] [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: 10/10/2023]
Abstract
BACKGROUND Pharmacological interventions are frequently used for people with autism spectrum disorder (ASD) to manage behaviours of concern, including irritability, aggression, and self-injury. Some pharmacological interventions might help treat some behaviours of concern, but can also have adverse effects (AEs). OBJECTIVES To assess the effectiveness and AEs of pharmacological interventions for managing the behaviours of irritability, aggression, and self-injury in ASD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 11 other databases and two trials registers up to June 2022. We also searched reference lists of relevant studies, and contacted study authors, experts and pharmaceutical companies. SELECTION CRITERIA We included randomised controlled trials of participants of any age with a clinical diagnosis of ASD, that compared any pharmacological intervention to an alternative drug, standard care, placebo, or wait-list control. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Primary outcomes were behaviours of concern in ASD, (irritability, aggression and self-injury); and AEs. Secondary outcomes were quality of life, and tolerability and acceptability. Two review authors independently assessed each study for risk of bias, and used GRADE to judge the certainty of the evidence for each outcome. MAIN RESULTS We included 131 studies involving 7014 participants in this review. We identified 26 studies as awaiting classification and 25 as ongoing. Most studies involved children (53 studies involved only children under 13 years), children and adolescents (37 studies), adolescents only (2 studies) children and adults (16 studies), or adults only (23 studies). All included studies compared a pharmacological intervention to a placebo or to another pharmacological intervention. Atypical antipsychotics versus placebo At short-term follow-up (up to 6 months), atypical antipsychotics probably reduce irritability compared to placebo (standardised mean difference (SMD) -0.90, 95% confidence interval (CI) -1.25 to -0.55, 12 studies, 973 participants; moderate-certainty evidence), which may indicate a large effect. However, there was no clear evidence of a difference in aggression between groups (SMD -0.44, 95% CI -0.89 to 0.01; 1 study, 77 participants; very low-certainty evidence). Atypical antipsychotics may also reduce self-injury (SMD -1.43, 95% CI -2.24 to -0.61; 1 study, 30 participants; low-certainty evidence), possibly indicating a large effect. There may be higher rates of neurological AEs (dizziness, fatigue, sedation, somnolence, and tremor) in the intervention group (low-certainty evidence), but there was no clear evidence of an effect on other neurological AEs. Increased appetite may be higher in the intervention group (low-certainty evidence), but we found no clear evidence of an effect on other metabolic AEs. There was no clear evidence of differences between groups in musculoskeletal or psychological AEs. Neurohormones versus placebo At short-term follow-up, neurohormones may have minimal to no clear effect on irritability when compared to placebo (SMD -0.18, 95% CI -0.37 to -0.00; 8 studies; 466 participants; very low-certainty evidence), although the evidence is very uncertain. No data were reported for aggression or self -injury. Neurohormones may reduce the risk of headaches slightly in the intervention group, although the evidence is very uncertain. There was no clear evidence of an effect of neurohormones on any other neurological AEs, nor on any psychological, metabolic, or musculoskeletal AEs (low- and very low-certainty evidence). Attention-deficit hyperactivity disorder (ADHD)-related medications versus placebo At short-term follow-up, ADHD-related medications may reduce irritability slightly (SMD -0.20, 95% CI -0.40 to -0.01; 10 studies, 400 participants; low-certainty evidence), which may indicate a small effect. However, there was no clear evidence that ADHD-related medications have an effect on self-injury (SMD -0.62, 95% CI -1.63 to 0.39; 1 study, 16 participants; very low-certainty evidence). No data were reported for aggression. Rates of neurological AEs (drowsiness, emotional AEs, fatigue, headache, insomnia, and irritability), metabolic AEs (decreased appetite) and psychological AEs (depression) may be higher in the intervention group, although the evidence is very uncertain (very low-certainty evidence). There was no evidence of a difference between groups for any other metabolic, neurological, or psychological AEs (very low-certainty evidence). No data were reported for musculoskeletal AEs. Antidepressants versus placebo At short-term follow-up, there was no clear evidence that antidepressants have an effect on irritability (SMD -0.06, 95% CI -0.30 to 0.18; 3 studies, 267 participants; low-certainty evidence). No data for aggression or self-injury were reported or could be included in the analysis. Rates of metabolic AEs (decreased energy) may be higher in participants receiving antidepressants (very low-certainty evidence), although no other metabolic AEs showed clear evidence of a difference. Rates of neurological AEs (decreased attention) and psychological AEs (impulsive behaviour and stereotypy) may also be higher in the intervention group (very low-certainty evidence) although the evidence is very uncertain. There was no clear evidence of any difference in the other metabolic, neurological, or psychological AEs (very low-certainty evidence), nor between groups in musculoskeletal AEs (very low-certainty evidence). Risk of bias We rated most of the studies across the four comparisons at unclear overall risk of bias due to having multiple domains rated as unclear, very few rated as low across all domains, and most having at least one domain rated as high risk of bias. AUTHORS' CONCLUSIONS Evidence suggests that atypical antipsychotics probably reduce irritability, ADHD-related medications may reduce irritability slightly, and neurohormones may have little to no effect on irritability in the short term in people with ASD. There was some evidence that atypical antipsychotics may reduce self-injury in the short term, although the evidence is uncertain. There was no clear evidence that antidepressants had an effect on irritability. There was also little to no difference in aggression between atypical antipsychotics and placebo, or self-injury between ADHD-related medications and placebo. However, there was some evidence that atypical antipsychotics may result in a large reduction in self-injury, although the evidence is uncertain. No data were reported (or could be used) for self-injury or aggression for neurohormones versus placebo. Studies reported a wide range of potential AEs. Atypical antipsychotics and ADHD-related medications in particular were associated with an increased risk of metabolic and neurological AEs, although the evidence is uncertain for atypical antipsychotics and very uncertain for ADHD-related medications. The other drug classes had minimal or no associated AEs.
Collapse
Affiliation(s)
- Michelle Iffland
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
| | - Nuala Livingstone
- Cochrane Evidence Production and Methods Directorate , Cochrane, London, UK
| | - Mikaela Jorgensen
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Donna Gillies
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
- Sydney, Australia
| |
Collapse
|
6
|
Tuncturk M, Ermis C, Buyuktaskin D, Turan S, Saglam Y, Alarslan S, Guler D, Sut E, Unutmaz G, Guzel AB, Atay Canbek O, Inal N, Karacetin G, Hazell P. Electroconvulsive therapy or clozapine for adolescents with treatment-resistant schizophrenia: an explorative analysis on symptom dimensions. Int J Psychiatry Clin Pract 2023; 27:257-263. [PMID: 36576216 DOI: 10.1080/13651501.2022.2160764] [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] [Received: 08/08/2022] [Revised: 11/16/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study sought to compare pre-intervention patient characteristics and post-intervention outcomes in a naturalistic sample of adolescent inpatients with treatment-resistant psychotic symptoms who received either electroconvulsive therapy (ECT) or clozapine. METHODS Data of adolescents with schizophrenia/schizoaffective disorder receiving ECT or clozapine were retrospectively collected from two tertiary-care psychiatry-teaching university hospitals. Subscale scores of the Positive and Negative Symptom Scale (PANSS) factors were calculated according to the five-factor solution. Baseline demographics, illness characteristics, and post-intervention outcomes were compared. RESULTS There was no significant difference between patients receiving ECT (n = 13) and clozapine (n = 66) in terms of age, sex, and the duration of hospital stay. The ECT group more commonly had higher overall illness and aggression severity. Smoking was less frequent in the clozapine group. Baseline resistance/excitement symptom severity was significantly higher in the ECT group, while positive, negative, affect, disorganisation, and total symptom scores were not. Both interventions provided a significant reduction in PANSS scores with large effect sizes. CONCLUSION Both ECT and clozapine yielded high effectiveness rates in adolescents with treatment-resistant schizophrenia/schizoaffective disorder. Youth receiving ECT were generally more activated than those who received clozapine.
Collapse
Affiliation(s)
- Mustafa Tuncturk
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | | | | | - Serkan Turan
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, Bursa, Turkey
| | - Yesim Saglam
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Sezen Alarslan
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Duru Guler
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ekin Sut
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Guldal Unutmaz
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ayse Beste Guzel
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ozge Atay Canbek
- Department of Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Neslihan Inal
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gul Karacetin
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Philip Hazell
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| |
Collapse
|
7
|
Malhi GS, Bell E, Bassett D, Boyce P, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Murray G. Positioning of psychodynamic psychotherapy in the treatment of depression: A comparison of the RANZCP 2020 and NICE 2022 guidelines. Australas Psychiatry 2023:10398562231159329. [PMID: 36829304 DOI: 10.1177/10398562231159329] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE To compare the 2022 NICE guidelines (NG222) and 2020 RANZCP clinical practice guidelines (MDcpg2020) recommendations for the treatment of depression using psychodynamic psychotherapy. CONCLUSIONS Both guidelines recommend psychological interventions first-line. However, only short-term psychodynamic psychotherapy (STPP) is recommended, and in the NG222 it is ranked last for less severe depression and 7th for more severe depression. In contrast, cognitive behavioural therapy and behavioural activation are deemed the more clinically effective and cost-effective psychological therapies. And antidepressants play a significant role - largely in more severe depression.
Collapse
Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, 4334The University of Sydney, St Leonards, NSW, Australia; CADE Clinic and Mood-T, Royal North Shore Hospital, St Leonards, NSW, Australia; Department of Psychiatry, 6396University of Oxford, Oxford, UK
| | - Erica Bell
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, 4334The University of Sydney, St Leonards, NSW, Australia; CADE Clinic and Mood-T, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- Faculty of Health and Medical Sciences, 532966University of Western Australia, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, 4334University of Sydney, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, 4334University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Melbourne, VIC, Australia
| | - Bill Lyndon
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, 522555University of Sydney, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, 2494University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, 2494University of Otago, Christchurch, New Zealand
| | - Greg Murray
- Centre for Mental Health, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
8
|
Thomson P, Vijayakumar N, Fuelscher I, Malpas CB, Hazell P, Silk TJ. White matter and sustained attention in children with attention/deficit-hyperactivity disorder: A longitudinal fixel-based analysis. Cortex 2022; 157:129-141. [PMID: 36283135 DOI: 10.1016/j.cortex.2022.09.006] [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] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/29/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022]
Abstract
Sustained attention is a cognitive function with known links to academic success and mental health disorders such as attention/deficit-hyperactivity disorder (ADHD). Several functional networks are critical to sustained attention, however the association between white matter maturation in tracts linking functional nodes and sustained attention in typical and atypical development is unknown. 309 diffusion-weighted imaging scans were acquired from 161 children and adolescents (80 ADHD, 81 control) at up to three timepoints over ages 9-14. A fixel-based analysis approach was used to calculate mean fiber density and fiber-bundle cross section in tracts of interest. Sustained attention was measured using omission errors and response time variability on the out-of-scanner sustained attention to response task. Linear mixed effects models examined associations of age, group and white matter metrics with sustained attention. Greater fiber density in the bilateral superior longitudinal fasciculus (SLF) I and right SLF II was associated with fewer attention errors in the control group only. In ADHD and control groups, greater fiber density in the left ILF and right thalamo-premotor pathway, as well as greater fiber cross-section in the left SLF I and II and right SLF III, was associated with better sustained attention. Relationships were consistent across the age span. Results suggest that greater axon diameter or number in the dorsal and middle SLF may facilitate sustained attention in neurotypical children but does not assist those with ADHD potentially due to disorder-related alterations in this region. Greater capacity for information transfer across the SLF was associated with attention maintenance in 9-14-year-olds regardless of diagnostic status, suggesting white matter macrostructure may also be important for attention maintenance. White matter and sustained attention associations were consistent across the longitudinal study, according with the stability of structural organization over this time. Future studies can investigate modifiability of white matter properties through ADHD medications.
Collapse
Affiliation(s)
- Phoebe Thomson
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | | | - Ian Fuelscher
- School of Psychology, Deakin University, Melbourne, Australia
| | - Charles B Malpas
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Discipline of Psychiatry, The University of Sydney, Sydney, Australia
| | - Timothy J Silk
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; School of Psychology, Deakin University, Melbourne, Australia
| |
Collapse
|
9
|
Rai S, Griffiths KR, Breukelaar IA, Barreiros AR, Boyce P, Hazell P, Foster SL, Malhi GS, Harris AWF, Korgaonkar MS. Common and differential neural mechanisms underlying mood disorders. Bipolar Disord 2022; 24:795-805. [PMID: 35972439 DOI: 10.1111/bdi.13248] [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: 12/30/2022]
Abstract
BACKGROUND Despite homogenous clinical presentations between bipolar and unipolar disorders, there are distinct neurobiological differences. Chronicity of illness may be a factor impacting and sustaining certain neural features. The goal of this study was to investigate common and shared neural mechanisms underlying mood disorders, and possible sustained neural changes relating to illness chronicity by investigating a cohort of euthymic patients with bipolar disorder (BD), unipolar depression who had responded to treatment (treatment-sensitive depression, TSD), and a chronically treatment-resistant depressed (TRD) group. METHODS One hundred and seventy-two participants (40 BD, 39 TSD, 40 TRD, and 53 age-gender-matched healthy controls) underwent resting-state fMRI scans. Seed-based and independent component analyses were performed to investigate group differences in resting-state connectivity between the four groups. RESULTS All three clinical groups had significantly lower connectivity within the frontoparietal network (FPN) relative to controls. TRD and BD were significantly different from TSD (TRD, BD > TSD) but were not significantly different from each other. TRDs were also significantly different from both BD and TSD for salience network connectivity with the posterior cingulate (DMN) and the FPN with frontal pole (DMN). Additionally, the BD group exhibited greater DMN-FPN (sgACC-RDLPFC) connectivity relative to TRD, TSD, and controls, which was correlated with a previous number of depressive episodes, in the BD group only. CONCLUSIONS BD demonstrated shared and differential connectivity features relative to symptomatic TRD and euthymic TSD groups. The increased sgACC-RDLPFC connectivity in BD and its correlation with a number of depressive episodes could be a neural feature associated with illness chronicity.
Collapse
Affiliation(s)
- Sabina Rai
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristi R Griffiths
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - Isabella A Breukelaar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Ana R Barreiros
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Philip Boyce
- Specialty of Psychiatry, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Philip Hazell
- Specialty of Psychiatry, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Sheryl L Foster
- Department of Radiology, Westmead Hospital, New South Wales, Australia.,Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Gin S Malhi
- Specialty of Psychiatry, The University of Sydney School of Medicine, Sydney, New South Wales, Australia.,Department of Psychiatry, CADE Clinic, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Anthony W F Harris
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia.,Specialty of Psychiatry, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia.,Specialty of Psychiatry, The University of Sydney School of Medicine, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Murray G, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Malhi GS. What works for whom when treating major depression with psychotherapy? Aust N Z J Psychiatry 2022; 56:1200-1202. [PMID: 35608123 DOI: 10.1177/00048674221100425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Erica Bell
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Saint Leonards, NSW, Australia
- CADE Clinic & Mood-T Service, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | | | - Philip Boyce
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Saint Leonards, NSW, Australia
- CADE Clinic & Mood-T Service, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
11
|
Malhi GS, Bell E, Boyce P, Mulder R, Bassett D, Hamilton A, Morris G, Bryant R, Hazell P, Hopwood M, Lyndon B, Porter R, Singh AB, Murray G. NICE guideline for depression ranks short-term psychodynamic psychotherapy (STTP). Bipolar Disord 2022; 24:467-471. [PMID: 36065569 DOI: 10.1111/bdi.13251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- CADE Clinic, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Erica Bell
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- CADE Clinic, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Philip Boyce
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Darryl Bassett
- Consultant Psychiatrist, Perth, Western Australia, Australia
| | - Amber Hamilton
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- CADE Clinic, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Grace Morris
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- CADE Clinic, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip Hazell
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, Victoria, Australia
| | - Bill Lyndon
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| |
Collapse
|
12
|
Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. An Evidence-Based Perspective on The 2020 Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines. Australas Psychiatry 2022; 30:447-451. [PMID: 35508360 DOI: 10.1177/10398562221100703] [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: 01/07/2023]
Abstract
OBJECTIVE To rebut the claims made in an opinion piece by Anaf and colleagues regarding the recommendations for psychotherapy within the 2020 RANZCP Mood Disorders Clinical Practice Guidelines (CPG). CONCLUSIONS The CPG attaches importance to psychological interventions and recommends their administration as first-line in the treatment of depression. The concerns raised by Anaf and colleagues have no basis and are readily dismissed by referring to the guidelines. Therefore, we strongly encourage clinicians to formulate their own views by reading the guidelines for themselves.
Collapse
Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, Kolling Institute, The University of Sydney, St Leonards, New South Wales, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, NSW, Australia.,Department of Psychiatry, University of Oxford, UK
| | - Erica Bell
- Academic Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, Kolling Institute, 4334The University of Sydney, Sydney, New South Wales, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, NSW, Australia
| | - Darryl Bassett
- Division of Psychiatry, School of Medicine, 532966University of Western Australia, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Faculty of Medicine and Health, Sydney Medical School, 7799University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- Discipline of Psychiatry, Faculty of Medicine and Health, Sydney Medical School, 522555University of Sydney, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, 2494University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, 2494University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, 2104Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
13
|
Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. Evidence is king: A defence of evidence-based recommendations. Bipolar Disord 2022; 24:351-353. [PMID: 35789518 DOI: 10.1111/bdi.13235] [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: 11/28/2022]
Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia.,CADE Clinic & Mood-T Service, Northern Sydney Local Health District, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Erica Bell
- Academic Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia.,CADE Clinic & Mood-T Service, Northern Sydney Local Health District, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Darryl Bassett
- Consultant Psychiatrist, Perth, Western Australia, Australia
| | - Philip Boyce
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip Hazell
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.,Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, Victoria, Australia
| | - Bill Lyndon
- Specialty of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW To examine recent evidence that informs the treatment of depression in children and adolescents. RECENT FINDINGS There are no new leads in the prevention and early intervention of depression in children and adolescents. For acute treatment of major depressive disorder, talking therapies are moving increasingly to internet-based platforms. Family therapy may have a slight edge over individual psychotherapy in the short-term. Patients with severe depression with endogenous features have a more robust response to pharmacotherapy than do patients with mild-to-moderate depression. Findings in relation to reward sensitivity and changes in brain-derived neurotrophic factor levels contradict research conducted in adults, suggesting developmental differences in the mechanisms underlying depression. Ketamine infusion could have a role for adolescents with treatment refractory depression. There was no new evidence concerning relapse prevention. SUMMARY Most new findings have been concerned with moderators and mediators of treatment.
Collapse
Affiliation(s)
- Philip Hazell
- University of Sydney School of Medicine, Concord West, Australia
| |
Collapse
|
15
|
Rai S, Griffiths KR, Breukelaar IA, Barreiros AR, Chen W, Boyce P, Hazell P, Foster SL, Malhi GS, Harris AWF, Korgaonkar MS. Default-mode and fronto-parietal network connectivity during rest distinguishes asymptomatic patients with bipolar disorder and major depressive disorder. Transl Psychiatry 2021; 11:547. [PMID: 34689161 PMCID: PMC8542033 DOI: 10.1038/s41398-021-01660-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 11/08/2022] Open
Abstract
Bipolar disorder (BD) is commonly misdiagnosed as major depressive disorder (MDD). This is understandable, as depression often precedes mania and is otherwise indistinguishable in both. It is therefore imperative to identify neural mechanisms that can differentiate the two disorders. Interrogating resting brain neural activity may reveal core distinguishing abnormalities. We adopted an a priori approach, examining three key networks documented in previous mood disorder literature subserving executive function, salience and rumination that may differentiate euthymic BD and MDD patients. Thirty-eight patients with BD, 39 patients with MDD matched for depression severity, and 39 age-gender matched healthy controls, completed resting-state fMRI scans. Seed-based and data-driven Independent Component analyses (ICA) were implemented to examine group differences in resting-state connectivity (pFDR < 0.05). Seed analysis masks were target regions identified from the fronto-parietal (FPN), salience (SN) and default-mode (DMN) networks. Seed-based analyses identified significantly greater connectivity between the subgenual cingulate cortex (DMN) and right dorsolateral prefrontal cortex (FPN) in BD relative to MDD and controls. The ICA analyses also found greater connectivity between the DMN and inferior frontal gyrus, an FPN region in BD relative to MDD. There were also significant group differences across the three networks in both clinical groups relative to controls. Altered DMN-FPN functional connectivity is thought to underlie deficits in the processing, management and regulation of affective stimuli. Our results suggest that connectivity between these networks could potentially distinguish the two disorders and could be a possible trait mechanism in BD persisting even in the absence of symptoms.
Collapse
Affiliation(s)
- Sabina Rai
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, NSW, Australia.
| | - Kristi R Griffiths
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, NSW, Australia
| | - Isabella A Breukelaar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Ana R Barreiros
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, NSW, Australia
| | - Wenting Chen
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, NSW, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sheryl L Foster
- Department of Radiology, Westmead Hospital, Sydney, NSW, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Anthony W F Harris
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, NSW, Australia
- Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, NSW, Australia.
- Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
16
|
Skidmore S, Hawke C, Luscombe G, Hazell P, Steinbeck K. Weight perception and symptoms of depression in rural Australian adolescents. Australas Psychiatry 2021; 29:508-512. [PMID: 33993753 DOI: 10.1177/10398562211009250] [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: 11/17/2022]
Abstract
OBJECTIVE To investigate associations between measured and perceived weight, and symptoms of depression in rural Australian adolescents. METHOD At baseline a prospective rural adolescent cohort study collected demographic data, measured weight and height, weight self-perception, and presence of depression (Short Mood and Feelings Questionnaire). Using World Health Organisation's (WHO) age and gender body mass index (BMI) standardisations, participants were classified into four perceptual groups: PG1 healthy/perceived healthy; PG2 overweight/perceived overweight; PG3 healthy/perceived overweight; and PG4 overweight/perceived healthy. Logistic regression analyses explored relationships between these groups and symptoms of depression. RESULTS Data on adolescents (n = 339) aged 9-14. PG1 contained 63% of participants, PG2 18%, PG3 4% and PG4 14%. Across the cohort, 32% were overweight and 13% had symptoms of depression. PG2 (overweight/perceived overweight) were more likely to experience symptoms of depression than PG1 (healthy/perceived healthy; Adjusted Odds Ratio [AOR] 3.1, 95% CI 1.5-6.7). Females in PG3 (healthy/perceived overweight) were more likely to experience symptoms of depression (38%) than males (14%) and females in PG1 (10%, AOR 5.4, 95% CI 1.1-28.2). CONCLUSIONS Results suggest that perceptions of being overweight may be a greater predictor for symptoms of depression than actual weight. This has public health implications for youth mental health screening and illness prevention.
Collapse
Affiliation(s)
- Samuel Skidmore
- Trainee - Royal Australian and New Zealand College of Psychiatrists, South Eastern Sydney Local Health District, Randwick, Australia.,The University of Sydney Discipline of Child and Adolescent Health, Westmead, NSW, Australia.,Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia
| | - Catherine Hawke
- Deputy Head of School, The University of Sydney School of Rural Health, Orange, NSW, Australia.,The University of Sydney Discipline of Child and Adolescent Health, Westmead, NSW, Australia.,Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia
| | - Georgina Luscombe
- Associate Professor Rural Research, The University of Sydney School of Rural Health, Sydney, NSW, Australia.,The University of Sydney Discipline of Child and Adolescent Health, Westmead, NSW, Australia.,Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia
| | - Philip Hazell
- Conjoint Professor of Child and Adolescent Psychiatry, The University of Sydney School of Medicine, Sydney, NSW, Australia.,The University of Sydney Discipline of Child and Adolescent Health, Westmead, NSW, Australia.,Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia
| | - Katharine Steinbeck
- The University of Sydney Discipline of Child and Adolescent Health, Westmead, NSW, Australia.,Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia
| |
Collapse
|
17
|
Stephens K, O'Loughlin R, Green JL, Anderson V, Rinehart N, Nicholson JM, Hazell P, Silk TJ, Efron D, Sciberras E. The Association Between Autism Symptoms and Child Functioning in a Sample With ADHD Recruited From the Community. J Atten Disord 2021; 25:1129-1134. [PMID: 31711354 DOI: 10.1177/1087054719886352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Although autism spectrum disorder (ASD) symptoms are associated with poorer functioning in children with attention-deficit/hyperactivity disorder (ADHD), it is unclear which ASD symptom domains are most impairing. This study investigated whether specific ASD symptom domains were associated with child functioning in children with ADHD. Method: Parents of 164 children with ADHD completed a diagnostic interview to assess ADHD and comorbidities. Parents reported on ASD symptoms (Social Communication Questionnaire) and child quality of life (Pediatric Quality of Life Inventory 4.0). Parents and teachers completed the Strengths and Difficulties Questionnaire (emotional, conduct, and peer problems). Results: Repetitive and stereotyped behaviors were independently associated with emotional (p = .02) and conduct (p = .03) problems, and poorer quality of life (p = .004). Reciprocal social interaction deficits were independently associated with peer problems (p = .03). Conclusion: Reciprocal social interaction deficits and repetitive and stereotyped behaviors are important areas that should be focused on in ADHD assessment and treatment.
Collapse
Affiliation(s)
- Kate Stephens
- Deakin University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rachel O'Loughlin
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jessica L Green
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital Melbourne, Victoria, Australia.,University of Melbourne, Victoria, Australia
| | | | | | | | - Timothy J Silk
- Deakin University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital Melbourne, Victoria, Australia.,University of Melbourne, Victoria, Australia
| | - Emma Sciberras
- Deakin University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| |
Collapse
|
18
|
Abstract
Child or adolescent psychiatric inpatient units are expensive; therefore, a lot is expected of them. Short stay units are best used for diagnostic clarification, the initiation and supervision of complex treatment, and acute containment of risk. Longer stay units provide a recovery-focused programme to address mental health problems that have not responded to intensive treatment in other settings. Both types of unit form part of the wider system of care that supports young people with mental health problems. The operational characteristics of such units will ensure timely, safe and effective interventions to young people who will likely go on to receive most of their clinical care in the community.
Collapse
Affiliation(s)
- Philip Hazell
- Specialty of Psychiatry, The University of Sydney School of Medicine, Concord West, NSW, Australia
| |
Collapse
|
19
|
Rai S, Griffiths K, Breukelaar IA, Barreiros AR, Chen W, Boyce P, Hazell P, Foster S, Malhi GS, Bryant RA, Harris AWF, Korgaonkar MS. Investigating neural circuits of emotion regulation to distinguish euthymic patients with bipolar disorder and major depressive disorder. Bipolar Disord 2021; 23:284-294. [PMID: 33369067 DOI: 10.1111/bdi.13042] [Citation(s) in RCA: 9] [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] [Received: 06/08/2020] [Revised: 11/20/2020] [Accepted: 12/20/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Up to 40% of patients with bipolar disorder (BD) are initially diagnosed as having major depressive disorder (MDD), and emotional lability is a key aspect of both sets of mood disorders. However, it remains unknown whether differences in the regulation of emotions through cognitive reappraisal may serve to distinguish BD and MDD. Therefore, we examined this question in euthymic BD and MDD patients. METHODS Thirty-eight euthymic BD, 33 euthymic MDD and 37 healthy control (HC) participants, matched for age, gender and depression severity, engaged in an emotion regulation (ER) cognitive reappraisal task during an fMRI scan were examined. Participants either reappraised (Think condition) or passively watched negative (Watch condition) or neutral (Neutral condition) pictures and rated their affect. Activation and connectivity analyses were used to examine group differences in reappraisal (Think vs Watch) and reactivity (Watch vs Neutral) conditions in ER-specific neural circuits. RESULTS Irrespective of group, participants rated most negatively the images during the Watch condition relative to Think and Neutral conditions, and more negatively to Think relative to Neutral. Notably, BD participants exhibited reduced subgenual anterior cingulate activation (sgACC) relative to MDD during reappraisal, but exhibited greater sgACC activation relative to MDD during reactivity, whereas MDD participants elicited greater activation in right amygdala relative to BD during reactivity. We found no group differences in task-related connectivity. CONCLUSIONS Euthymic BD and MDD patients engage differential brain regions to process and regulate emotional information. These differences could serve to distinguish the clinical groups and provide novel insights into the underlying pathophysiology of BD.
Collapse
Affiliation(s)
- Sabina Rai
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Kristi Griffiths
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Isabella A Breukelaar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Ana R Barreiros
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Wenting Chen
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sheryl Foster
- Department of Radiology, Westmead Hospital, Westmead, NSW, Australia.,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Anthony W F Harris
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
20
|
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for SH in adults. This review therefore updates a previous Cochrane Review (last published in 2016) on the role of psychosocial interventions in the treatment of SH in adults. OBJECTIVES To assess the effects of psychosocial interventions for self-harm (SH) compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing interventions of specific psychosocial treatments versus treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, or a combination of these, in the treatment of adults with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratio (ORs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMDs) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 76 trials with a total of 21,414 participants. Participants in these trials were predominately female (61.9%) with a mean age of 31.8 years (standard deviation [SD] 11.7 years). On the basis of data from four trials, individual cognitive behavioural therapy (CBT)-based psychotherapy may reduce repetition of SH as compared to TAU or another comparator by the end of the intervention (OR 0.35, 95% CI 0.12 to 1.02; N = 238; k = 4; GRADE: low certainty evidence), although there was imprecision in the effect estimate. At longer follow-up time points (e.g., 6- and 12-months) there was some evidence that individual CBT-based psychotherapy may reduce SH repetition. Whilst there may be a slightly lower rate of SH repetition for dialectical behaviour therapy (DBT) (66.0%) as compared to TAU or alternative psychotherapy (68.2%), the evidence remains uncertain as to whether DBT reduces absolute repetition of SH by the post-intervention assessment. On the basis of data from a single trial, mentalisation-based therapy (MBT) reduces repetition of SH and frequency of SH by the post-intervention assessment (OR 0.35, 95% CI 0.17 to 0.73; N = 134; k = 1; GRADE: high-certainty evidence). A group-based emotion-regulation psychotherapy may also reduce repetition of SH by the post-intervention assessment based on evidence from two trials by the same author group (OR 0.34, 95% CI 0.13 to 0.88; N = 83; k = 2; moderate-certainty evidence). There is probably little to no effect for different variants of DBT on absolute repetition of SH, including DBT group-based skills training, DBT individual skills training, or an experimental form of DBT in which participants were given significantly longer cognitive exposure to stressful events. The evidence remains uncertain as to whether provision of information and support, based on the Suicide Trends in At-Risk Territories (START) and the SUicide-PREvention Multisite Intervention Study on Suicidal behaviors (SUPRE-MISS) models, have any effect on repetition of SH by the post-intervention assessment. There was no evidence of a difference for psychodynamic psychotherapy, case management, general practitioner (GP) management, remote contact interventions, and other multimodal interventions, or a variety of brief emergency department-based interventions. AUTHORS' CONCLUSIONS Overall, there were significant methodological limitations across the trials included in this review. Given the moderate or very low quality of the available evidence, there is only uncertain evidence regarding a number of psychosocial interventions for adults who engage in SH. Psychosocial therapy based on CBT approaches may result in fewer individuals repeating SH at longer follow-up time points, although no such effect was found at the post-intervention assessment and the quality of evidence, according to the GRADE criteria, was low. Given findings in single trials, or trials by the same author group, both MBT and group-based emotion regulation therapy should be further developed and evaluated in adults. DBT may also lead to a reduction in frequency of SH. Other interventions were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to the use of these interventions is inconclusive at present.
Collapse
Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
21
|
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of interventions in the treatment of SH in children and adolescents is lacking, especially when compared with the evidence for psychosocial interventions in adults. This review therefore updates a previous Cochrane Review (last published in 2015) on the role of interventions for SH in children and adolescents. OBJECTIVES To assess the effects of psychosocial interventions or pharmacological agents or natural products for SH compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator, placebo, alternative pharmacological treatment, or a combination of these) for children and adolescents (up to 18 years of age) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialized Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic Reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing specific psychosocial interventions or pharmacological agents or natural products with treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, placebo, alternative pharmacological treatment, or a combination of these, in children and adolescents with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence internals (CIs). For continuous outcomes, we calculated the mean difference (MD) or standardised mean difference (SMD) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 17 trials with a total of 2280 participants. Participants in these trials were predominately female (87.6%) with a mean age of 14.7 years (standard deviation (SD) 1.5 years). The trials included in this review investigated the effectiveness of various forms of psychosocial interventions. None of the included trials evaluated the effectiveness of pharmacological agents in this clinical population. There was a lower rate of SH repetition for DBT-A (30%) as compared to TAU, EUC, or alternative psychotherapy (43%) on repetition of SH at post-intervention in four trials (OR 0.46, 95% CI 0.26 to 0.82; N = 270; k = 4; high-certainty evidence). There may be no evidence of a difference for individual cognitive behavioural therapy (CBT)-based psychotherapy and TAU for repetition of SH at post-intervention (OR 0.93, 95% CI 0.12 to 7.24; N = 51; k = 2; low-certainty evidence). We are uncertain whether mentalisation based therapy for adolescents (MBT-A) reduces repetition of SH at post-intervention as compared to TAU (OR 0.70, 95% CI 0.06 to 8.46; N = 85; k = 2; very low-certainty evidence). Heterogeneity for this outcome was substantial ( I² = 68%). There is probably no evidence of a difference between family therapy and either TAU or EUC on repetition of SH at post-intervention (OR 1.00, 95% CI 0.49 to 2.07; N = 191; k = 2; moderate-certainty evidence). However, there was no evidence of a difference for compliance enhancement approaches on repetition of SH by the six-month follow-up assessment, for group-based psychotherapy at the six- or 12-month follow-up assessments, for a remote contact intervention (emergency cards) at the 12-month assessment, or for therapeutic assessment at the 12- or 24-month follow-up assessments. AUTHORS' CONCLUSIONS Given the moderate or very low quality of the available evidence, and the small number of trials identified, there is only uncertain evidence regarding a number of psychosocial interventions in children and adolescents who engage in SH. Further evaluation of DBT-A is warranted. Given the evidence for its benefit in adults who engage in SH, individual CBT-based psychotherapy should also be further developed and evaluated in children and adolescents.
Collapse
Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
22
|
Evans S, Bhide S, Quek J, Nicholson JM, Anderson V, Hazell P, Mulraney M, Sciberras E. Mindful Parenting Behaviors and Emotional Self-Regulation in Children With ADHD and Controls. J Pediatr Psychol 2021; 45:1074-1083. [PMID: 32929486 DOI: 10.1093/jpepsy/jsaa073] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Mindfulness is defined as paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally and these behaviors can be applied to parenting. Thus far, it is not understood whether mindful parenting (MP) differs in parents of children with and without attention-deficit/hyperactivity disorder (ADHD), and how MP relates to other parenting practices and children's self-regulation. METHODS This study examined the relationships between MP, parenting behaviors and children's self-regulation in 120 families with child ADHD (85% male; mean age = 11.93) and 105 control families (62% male; mean age = 11.98). Parents completed measures of MP (Interpersonal Mindfulness in Parenting Scale), parenting behaviors (parenting warmth, consistency, and anger assessed with the Longitudinal Study of Australian Children measures), psychological distress (Kessler 6), and children's self-regulation (Social Skills Improvement System-self-control subscale). RESULTS When compared with controls, parents of children with ADHD reported significantly lower MP. Higher MP was associated with lower levels of parent psychological distress, higher levels of parenting warmth and consistency, lower levels of parenting anger, and higher child emotion self-regulation in both groups. In mediation analyses, MP was indirectly associated with child emotion self-regulation through lower parenting anger, with the model accounting for 55% of the variance in child self-regulation. CONCLUSIONS MP is a useful construct for understanding parent behaviors, and children's emotion self-regulation.
Collapse
Affiliation(s)
| | | | | | - Jan M Nicholson
- Murdoch Children's Research Institute, Royal Children's Hospital.,Judith Lumley Centre, La Trobe University
| | - Vicki Anderson
- Murdoch Children's Research Institute, Royal Children's Hospital.,Psychology Service, Royal Children's Hospital.,Melbourne School of Psychological Science, University of Melbourne
| | | | - Melissa Mulraney
- Murdoch Children's Research Institute, Royal Children's Hospital
| | - Emma Sciberras
- School of Psychology, Deakin University.,Murdoch Children's Research Institute, Royal Children's Hospital
| |
Collapse
|
23
|
Ellis LA, Blakely B, Hazell P, Woolfenden S, Hiscock H, Sarkozy V, Gould B, Hibbert PD, Arnolda G, Ting HP, Wiles LK, Molloy CJ, Churruca K, Warwick M, Braithwaite J. Guideline adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states. PLoS One 2021; 16:e0245916. [PMID: 33556083 PMCID: PMC7869992 DOI: 10.1371/journal.pone.0245916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/08/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess General Practitioner (GP) and pediatrician adherence to clinical practice guidelines (CPGs) for diagnosis, treatment and management of attention deficit hyperactivity disorder (ADHD). METHOD Medical records for 306 children aged ≤15 years from 46 GP clinics and 20 pediatric practices in Australia were reviewed against 34 indicators derived from CPG recommendations. At indicator level, adherence was estimated as the percentage of indicators with 'Yes' or 'No' responses for adherence, which were scored 'Yes'. This was done separately for GPs, pediatricians and overall; and weighted to adjust for sampling processes. RESULTS Adherence with guidelines was high at 83.6% (95% CI: 77.7-88.5) with pediatricians (90.1%; 95% CI: 73.0-98.1) higher than GPs (68.3%; 95% CI: 46.0-85.8; p = 0.02). Appropriate assessment for children presenting with signs or symptoms of ADHD was undertaken with 95.2% adherence (95% CI: 76.6-99.9), however ongoing reviews for children with ADHD prescribed stimulant medication was markedly lower for both pediatricians (51.1%; 95% CI: 9.6-91.4) and GPs (18.7%; 95% CI: 4.1-45.5). CONCLUSION Adherence to CPGs for ADHD by pediatricians was generally high. Adherence by GPs was lower across most domains; timely recognition of medication side effects is a particular area for improvement.
Collapse
Affiliation(s)
- Louise A. Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Brette Blakely
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Philip Hazell
- Discipline of Psychiatry, School of Medicine, University of Sydney, Camperdown, New South Wales, Australia
| | - Sue Woolfenden
- School of Women and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Harriet Hiscock
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Vanessa Sarkozy
- Tumbatin Developmental Clinic, Sydney Children’s Hospital Network, School of Women and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Bronwyn Gould
- General Practitioner, Paddington, New South Wales, Australia
| | - Peter D. Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hsuen P. Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise K. Wiles
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Charlotte J. Molloy
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Meagan Warwick
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- * E-mail:
| | | |
Collapse
|
24
|
Abstract
Objectives: To investigate (a) whether children with ADHD experience higher levels of overt and relational peer victimization (PV) than children without ADHD and (b) child, family, and school predictors of PV in children with ADHD. Method: 173 children with ADHD and 199 non-ADHD controls were recruited through 43 Melbourne schools at mean age 7.3 years. Parent- and teacher-reported PV (Social Experience Questionnaire) data were collected at mean age 8.9 years. Potential child, family, and school predictors of PV were measured at baseline. Results: Children with ADHD experienced higher levels of PV than children without ADHD by both parent- and teacher-report. Child predictors accounted for the greatest variance in PV, and the strongest predictors of PV were teacher-reported conduct problems, and medication use. Conclusion: Children with ADHD are at higher risk of PV compared with non-ADHD controls. Recognizing and addressing PV is important to reduce additional impairment in children with ADHD.
Collapse
Affiliation(s)
- Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Victoria, Australia
| | - Michell Wijaya
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,The University of Melbourne, Victoria, Australia
| | - Philip Hazell
- The University of Sydney, New South Wales, Australia
| | - Emma Sciberras
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,The University of Melbourne, Victoria, Australia.,Deakin University, Melbourne, Victoria, Australia
| |
Collapse
|
25
|
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of pharmacological agents and/or natural products in the treatment of SH is lacking, especially when compared with the evidence for psychosocial interventions. This review therefore updates a previous Cochrane Review (last published in 2015) on the role of pharmacological interventions for SH in adults. OBJECTIVES To assess the effects of pharmacological agents or natural products for SH compared to comparison types of treatment (e.g. placebo or alternative pharmacological treatment) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic Reviews [CDSR]), together with MEDLINE. Ovid Embase and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing pharmacological agents or natural products with placebo/alternative pharmacological treatment in individuals with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment acceptability, treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence internals (CIs). For continuous outcomes we calculated the mean difference (MD) or standardised mean difference (SMD) and 95% CI. The overall certainty of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from seven trials with a total of 574 participants. Participants in these trials were predominately female (63.5%) with a mean age of 35.3 years (standard deviation (SD) 3.1 years). It is uncertain if newer generation antidepressants reduce repetition of SH compared to placebo (OR 0.59, 95% CI 0.29 to 1.19; N = 129; k = 2; very low-certainty evidence). There may be a lower rate of SH repetition for antipsychotics (21%) as compared to placebo (75%) (OR 0.09, 95% CI 0.02 to 0.50; N = 30; k = 1; low-certainty evidence). However, there was no evidence of a difference between antipsychotics compared to another comparator drug/dose for repetition of SH (OR 1.51, 95% CI 0.50 to 4.58; N = 53; k = 1; low-certainty evidence). There was also no evidence of a difference for mood stabilisers compared to placebo for repetition of SH (OR 0.99, 95% CI 0.33 to 2.95; N = 167; k = 1; very low-certainty evidence), or for natural products compared to placebo for repetition of SH (OR 1.33, 95% CI 0.38 to 4.62; N = 49; k = 1; lo- certainty) evidence. AUTHORS' CONCLUSIONS Given the low or very low quality of the available evidence, and the small number of trials identified, there is only uncertain evidence regarding pharmacological interventions in patients who engage in SH. More and larger trials of pharmacotherapy are required, preferably using newer agents. These might include evaluation of newer atypical antipsychotics. Further work should also include evaluation of adverse effects of pharmacological agents. Other research could include evaluation of combined pharmacotherapy and psychological treatment.
Collapse
Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
26
|
Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 225] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
Collapse
Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
27
|
Mulraney M, Silk TJ, Gulenc A, Efron D, Hazell P, Sciberras E. Persistence of disruptive mood dysregulation disorder in children with attention-deficit/hyperactivity disorder. J Affect Disord 2021; 278:502-505. [PMID: 33017677 DOI: 10.1016/j.jad.2020.09.109] [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: 05/14/2020] [Revised: 08/06/2020] [Accepted: 09/26/2020] [Indexed: 11/27/2022]
Abstract
Disruptive mood dysregulation disorder (DMDD) is common in children with ADHD yet it is not known how persistent DMDD is in this population. As such we aimed to investigate the persistence of disruptive mood dysregulation disorder (DMDD) in a community sample of children with ADHD. The sample comprised children (n = 136) participating in a cohort study with data available at age 7 and age 10. DMDD status was ascertained using proxy items from the Diagnostic Interview Schedule for Children, Version IV. Of those with DMDD at age 7 (n = 30), eight (21.1%) had DMDD that persisted at age 10. In the first study investigating the longitudinal course of DMDD in ADHD one in five children with ADHD+DMDD at age 7 continued to meet diagnostic criteria for DMDD three years later.
Collapse
Affiliation(s)
- Melissa Mulraney
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Timothy J Silk
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; School of Psychology, Deakin University, Geelong, Australia
| | - Alisha Gulenc
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia
| | - Philip Hazell
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Emma Sciberras
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; School of Psychology, Deakin University, Geelong, Australia
| |
Collapse
|
28
|
Vijayakumar N, Youssef GJ, Allen NB, Anderson V, Efron D, Hazell P, Mundy L, Nicholson JM, Patton G, Seal ML, Simmons JG, Whittle S, Silk T. A longitudinal analysis of puberty-related cortical development. Neuroimage 2020; 228:117684. [PMID: 33385548 DOI: 10.1016/j.neuroimage.2020.117684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 01/27/2023] Open
Abstract
The brain undergoes extensive structural changes during adolescence, concurrent to puberty-related physical and hormonal changes. While animal research suggests these biological processes are related to one another, our knowledge of brain development in humans is largely based on age-related processes. Thus, the current study characterized puberty-related changes in human brain structure, by combining data from two longitudinal neuroimaging cohorts. Beyond normative changes in cortical thickness, we examined whether individual differences in the rate of pubertal maturation (or "pubertal tempo") was associated with variations in cortical trajectories. Participants (N = 192; scans = 366) completed up to three waves of MRI assessments between 8.5 and 14.5 years of age, as well as questionnaire assessments of pubertal stage at each wave. Generalized additive mixture models were used to characterize trajectories of cortical development. Results revealed widespread linear puberty-related changes across much of the cortex. Many of these changes, particularly within the frontal and parietal cortices, were independent of age-related development. Males exhibiting faster pubertal tempo demonstrated greater thinning in the precuneus and frontal cortices than same-aged and -sex peers. Findings suggest that the unique influence of puberty on cortical development may be more extensive than previously identified, and also emphasize important individual differences in the coupling of these developmental processes.
Collapse
Affiliation(s)
| | | | - Nicholas B Allen
- Department of Psychology, University of Oregon, Eugene, USA; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia; Clinical Sciences Research, Murdoch Children's Research Institute, Parkville, Australia; Royal Children's Hospital, Melbourne, Australia
| | - Daryl Efron
- Health Services, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Discipline of Psychiatry, The University of Sydney, Sydney, Australia
| | - Lisa Mundy
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - George Patton
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia
| | - Marc L Seal
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Developmental Imaging, Murdoch Children's Research Institute, Parkville, Australia
| | - Julian G Simmons
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Sarah Whittle
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Tim Silk
- School of Psychology, Deakin University, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Developmental Imaging, Murdoch Children's Research Institute, Parkville, Australia
| |
Collapse
|
29
|
Malhi GS, Bell E, Boyce P, Bassett D, Berk M, Bryant R, Gitlin M, Hamilton A, Hazell P, Hopwood M, Lyndon B, McIntyre RS, Morris G, Mulder R, Porter R, Singh AB, Yatham LN, Young A, Murray G. The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders: Bipolar disorder summary. Bipolar Disord 2020; 22:805-821. [PMID: 33296123 DOI: 10.1111/bdi.13036] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To provide a succinct, clinically useful summary of the management of bipolar disorder, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg2020 ). METHODS To develop the MDcpg2020 , the mood disorders committee conducted an extensive review of the available literature to develop evidence-based recommendations (EBR) based on National Health and Medical Research Council (NHMRC) guidelines. In the MDcpg2020 , these recommendations sit alongside consensus-based recommendations (CBR) that were derived from extensive deliberations of the mood disorders committee, drawing on their expertise and clinical experience. This guideline summary is an abridged version that focuses on bipolar disorder. In collaboration with international experts in the field, it synthesises the key recommendations made in relation to the diagnosis and management of bipolar disorder. RESULTS The bipolar disorder summary provides a systematic approach to diagnosis, and a logical clinical framework for management. It addresses the acute phases of bipolar disorder (mania, depression and mixed states) and its longer-term management (maintenance and prophylaxis). For each phase it begins with Actions, which include important strategies that should be implemented from the outset wherever possible. These include for example, lifestyle changes, psychoeducation and psychological interventions. In each phase, the summary advocates the use of Choice medications for pharmacotherapy, which are then used in combinations along with additional Alternatives to manage acute symptoms or maintain mood stability and provide prophylaxis. The summary also recommends the use of electroconvulsive therapy (ECT) for each of the acute phases but not for maintenance therapy. Finally, it briefly considers bipolar disorder in children and its overlap in adults with borderline personality disorder. CONCLUSIONS The bipolar disorder summary provides up to date guidance regarding the management of bipolar disorder, as set out in the MDcpg2020 . The recommendations are informed by evidence and clinical expertise and experience. The summary is intended for use by psychiatrists, psychologists and primary care physicians but will be of interest to anyone involved in the management of patients with bipolar disorder.
Collapse
Affiliation(s)
- Gin S Malhi
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, The Florey Institute and the Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Michael Gitlin
- Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amber Hamilton
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Grace Morris
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
30
|
Malhi GS, Bell E, Singh AB, Bassett D, Berk M, Boyce P, Bryant R, Gitlin M, Hamilton A, Hazell P, Hopwood M, Lyndon B, McIntyre RS, Morris G, Mulder R, Porter R, Yatham LN, Young A, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: Major depression summary. Bipolar Disord 2020; 22:788-804. [PMID: 33320412 DOI: 10.1111/bdi.13035] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To provide a succinct, clinically useful summary of the management of major depression, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg2020 ). METHODS To develop the MDcpg2020 , the mood disorders committee conducted an extensive review of the available literature to develop evidence-based recommendations (EBR) based on National Health and Medical Research Council (NHMRC) guidelines. In the MDcpg2020 , these recommendations sit alongside consensus-based recommendations (CBR) that were derived from extensive deliberations of the mood disorders committee, drawing on their expertise and clinical experience. This guideline summary is an abridged version that focuses on major depression. In collaboration with international experts in the field, it synthesises the key recommendations made in relation to the diagnosis and management of major depression. RESULTS The depression summary provides a systematic approach to diagnosis, and a logical clinical framework for management. The latter begins with Actions, which include important strategies that should be implemented from the outset. These include lifestyle changes, psychoeducation and psychological interventions. The summary advocates the use of antidepressants in the management of depression as Choices and nominates seven medications that can be trialled as clinically indicated before moving to Alternatives for managing depression. Subsequent strategies regarding Medication include Increasing Dose, Augmenting and Switching (MIDAS). The summary also recommends the use of electroconvulsive therapy (ECT), and discusses how to approach non-response. CONCLUSIONS The major depression summary provides up to date guidance regarding the management of major depressive disorder, as set out in the MDcpg2020 . The recommendations are informed by research evidence in conjunction with clinical expertise and experience. The summary is intended for use by psychiatrists, psychologists and primary care physicians, but will be of interest to all clinicians and carers involved in the management of patients with depressive disorders.
Collapse
Affiliation(s)
- Gin S Malhi
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | | | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, The Florey Institute and the Department of Psychiatry, The University of Melbourne, Parkville, Vic., Australia
| | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Michael Gitlin
- Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amber Hamilton
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, Vic., Australia
| | - Bill Lyndon
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Grace Morris
- Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
31
|
Efron D, Nicholson JM, Anderson V, Silk T, Ukoumunne OC, Gulenc A, Hazell P, Jongeling B, Sciberras E. ADHD at Age 7 and Functional Impairments at Age 10. Pediatrics 2020; 146:peds.2020-1061. [PMID: 33023991 DOI: 10.1542/peds.2020-1061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Attention-deficit/hyperactivity disorder (ADHD) cohort studies have typically involved clinical samples and have usually recruited children across wide age ranges, limiting generalizability across complexity and developmental stage. We compared academic, emotional-behavioral and social functioning at age 10, and predictors of outcomes, in a nonreferred cohort of children recruited at age 7, between those with full-syndrome (FS) ADHD and controls with no ADHD. METHODS This was a prospective cohort study with a 3-year follow-up period. Children were recruited from 43 socioeconomically diverse schools in Melbourne, Australia. Multi-informant outcomes at age 10 were academic functioning (Wide Range Achievement Test 4; Social Skills Improvement System), emotional-behavioral functioning (Strengths and Difficulties Questionnaire total), and social functioning (Strengths and Difficulties Questionnaire peer problems). Outcomes were compared across the groups by using adjusted random-effects linear regression analyses. RESULTS In total, 477 children (62% male) were recruited at a mean (SD) age of 7.3 years (0.4). There were 179 participants with FS ADHD, 86 with ST ADHD, and 212 controls. Sample retention was 78.2% at 3-year follow-up. Both the FS and ST groups were functioning worse than controls on almost all outcome measures. The best predictors of outcome for children with ADHD were working memory (academic outcome, P < .001), ADHD symptom severity (emotional-behavioral outcome, parent: P < .001; teacher: P < .01), and autism spectrum disorder symptoms (emotional-behavioral outcome, parent P = .003; social outcome, parent P = .001). CONCLUSIONS Children with FS and ST ADHD at age 7 experience persisting functional impairments across domains at age 10. The predictors identified at age 7 present potential targets for intervention to ameliorate impairments.
Collapse
Affiliation(s)
- Daryl Efron
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; .,Department of Paediatrics, Medical School, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, Medical School, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Tim Silk
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Obioha C Ukoumunne
- National Institute for Health Research Applied Research Collaboration South West Peninsula and University of Exeter, Exeter, United Kingdom
| | - Alisha Gulenc
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Philip Hazell
- Discipline of Psychiatry, School of Medicine, The University of Sydney and Westmead Hospital, Westmead, New South Wales, Australia
| | - Brad Jongeling
- Joondalup Child Development Service, Perth, Joondalup, Western Australia; and.,Department of Paediatrics, Medical School, University of Western Australia, Perth, Western Australia
| | - Emma Sciberras
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
32
|
Stephens K, Silk TJ, Anderson V, Hazell P, Enticott PG, Sciberras E. Associations Between Limbic System White Matter Structure and Socio-Emotional Functioning in Children with ADHD + ASD. J Autism Dev Disord 2020; 51:2663-2672. [PMID: 33043414 DOI: 10.1007/s10803-020-04738-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Children with attention deficit/hyperactivity disorder (ADHD) combined with autism spectrum disorder (ASD) symptoms (ADHD + ASD) have poorer social and emotional functioning than those with ADHD alone. However, no studies have specifically examined the associations between ASD symptoms, measures of social and emotional functioning and limbic system white matter microstructure. Tractography on the cingulum, uncinate fasciculus and fornix were performed for 151 children with (N = 78) and without (N = 73) ADHD. Participants in the ADHD group who scored 11 or above on the Social Communication Questionnaire were classified as the ADHD + ASD group (N = 16). Significant differences in mean cingulum FA were present between the control group and the ADHD (all) group, however, no significant differences were seen between the ADHD and ADHD + ASD groups. Despite this, significant associations were seen between mean FA of the left cingulum and emotional problems for the ADHD + ASD group. Results give greater insights into the specific biological basis of emotional problems in the ADHD + ASD group, indicating that the cingulum may play a role.
Collapse
Affiliation(s)
- Kate Stephens
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Timothy J Silk
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Murdoch Children's Research Institute, Parkville, Vic, Australia.,University of Melbourne, Parkville, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Parkville, Vic, Australia.,University of Melbourne, Parkville, Australia.,The Royal Children's Hospital, Parkville, Vic, Australia
| | | | - Peter G Enticott
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University, Geelong, VIC, Australia. .,Murdoch Children's Research Institute, Parkville, Vic, Australia. .,University of Melbourne, Parkville, Australia.
| |
Collapse
|
33
|
Barreiros AR, Breukelaar IA, Chen W, Erlinger M, Antees C, Medway M, Boyce P, Hazell P, Williams LM, Malhi GS, Harris AWF, Korgaonkar MS. Neurophysiological markers of attention distinguish bipolar disorder and unipolar depression. J Affect Disord 2020; 274:411-419. [PMID: 32663971 DOI: 10.1016/j.jad.2020.05.048] [Citation(s) in RCA: 4] [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: 12/13/2019] [Revised: 03/30/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Attentional deficits are common in both symptomatic and symptom-remitted patients with bipolar disorder (BP) and major depressive disorder (MDD). However, whether the level of neurocognitive impairment in attentional processing is different between these two disorders, or not, is still unclear. Thus, we investigated the P300 event-related potential component as a biomarker of cognitive dysfunction to differentiate BP and MDD. METHODS Twenty-three age and gender matched BP, 20 MDD and 23 healthy controls (HC) were part of a discovery cohort to identify neurophysiological differences between groups and build a classification model of these disorders. The replication of this model was then tested in an independent second cohort of 17 BP, 19 MDD and 19 HC. All participants were symptom-remitted for at least two weeks. We compared neural responses to target stimuli during an auditory oddball task, computing peak amplitude and latency of the P300 component extracted from the midline centro-parietal electrode. RESULTS BP had significantly smaller P300 amplitudes compared to both MDD and HC, whereas there were no differences between MDD and HC. The differences between groups were replicated in the second cohort, however the accuracy level of the classification model was only 53.5%. LIMITATIONS Small sample sizes may have led to low accuracy levels of the classification model. CONCLUSION Specific neural mechanisms of attention and context updating seem not to recover with symptom remission in BP. These findings contribute to the detection of a potential electrophysiological marker for BP, which may allow its differentiation from unipolar major depressive disorder.
Collapse
Affiliation(s)
- Ana R Barreiros
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia.
| | - Isabella A Breukelaar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia
| | - Wenting Chen
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia
| | - May Erlinger
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia
| | - Cassandra Antees
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia
| | - Meredith Medway
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Leanne M Williams
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto VA, Palo Alto, CA, USA
| | - Gin S Malhi
- Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia; CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Anthony W F Harris
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia.
| |
Collapse
|
34
|
Affiliation(s)
- Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah E Hetrick
- Department of Psychological Medicine; University of Auckland; Auckland New Zealand
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
| | - Philip Hazell
- Discipline of Psychiatry; The University of Sydney School of Medicine; Sydney Australia
| |
Collapse
|
35
|
Affiliation(s)
- Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah E Hetrick
- Department of Psychological Medicine; University of Auckland; Auckland New Zealand
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
| | - Philip Hazell
- Discipline of Psychiatry; The University of Sydney School of Medicine; Sydney Australia
| |
Collapse
|
36
|
Affiliation(s)
- Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah E Hetrick
- Department of Psychological Medicine; University of Auckland; Auckland New Zealand
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
| | - Philip Hazell
- Discipline of Psychiatry; The University of Sydney School of Medicine; Sydney Australia
| |
Collapse
|
37
|
Malhi GS, Bell E, Porter RJ, Boyce P, Mulder R, Hopwood M, Hazell P, Bassett D, Bryant RA, Lyndon B, Murray G, Berk M. Lithium should be borne in mind: Five key reasons. Aust N Z J Psychiatry 2020; 54:659-663. [PMID: 32597261 DOI: 10.1177/0004867420934189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/10/2023]
Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Philip Boyce
- Discipline of Psychiatry, Faculty of Medicine and Health, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Malcolm Hopwood
- Professorial Psychiatry Unit, Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Faculty of Medicine and Health, School of Medicine, The University of Sydney, Concord West, NSW, Australia
| | - Darryl Bassett
- University of Western Australian Medical School, Faculty of Health and Medical Science, University of Western Australia, Perth, WA, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.,Florey Institute for Neuroscience and Mental Health, Department of Psychiatry and Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
38
|
Malhi GS, Bell E, Boyce P, Hazell P, Murray G, Bassett D, Bryant RA, Hopwood M, Lyndon B, Mulder R, Porter RJ, Singh A, Gershon S. Make lithium great again! Bipolar Disord 2020; 22:325-327. [PMID: 32521095 DOI: 10.1111/bdi.12942] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 01/01/2023]
Affiliation(s)
- Gin S Malhi
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Philip Hazell
- School of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Vic, Australia
| | - Darryl Bassett
- Faculty of Health and Medical Science, University of Western Australian Medical School, University of Western Australia, Perth, WA, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, Vic, Australia
| | - Bill Lyndon
- Clinical Senior Lecturer, Department of Psychiatry, The University of Sydney, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet Singh
- School of Medicine, Deakin University, Geelong, Vic, Australia
| | - Samuel Gershon
- Emeritus Professor Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Mind and Brain Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| |
Collapse
|
39
|
Breukelaar IA, Erlinger M, Harris A, Boyce P, Hazell P, Grieve SM, Antees C, Foster S, Gomes L, Williams LM, Malhi GS, Korgaonkar MS. Investigating the neural basis of cognitive control dysfunction in mood disorders. Bipolar Disord 2020; 22:286-295. [PMID: 31604366 DOI: 10.1111/bdi.12844] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 12/25/2022]
Abstract
OBJECTIVES Dysfunction of cognitive control is a feature of both bipolar disorder (BP) and major depression (MDD) and persists through to remission. However, it is unknown whether these disorders are characterized by common or distinct disruptions of cognitive control function and its neural basis. We investigated this gap in knowledge in asymptomatic BP and MDD participants, interpreted within a framework of normative function. METHODS Participants underwent fMRI scans engaging cognitive control through a working memory task and completed a cognitive battery evaluating performance across multiple subdomains of cognitive control, including attention, impulsivity, processing speed, executive function, and memory. Analysis was performed in two stages: (i) cognitive control-related brain activation and deactivation were correlated with cognitive control performance in 115 healthy controls (HCs), then, (ii) significantly correlated regions from (i) were compared between 25 asymptomatic BP, 25 remitted MDD, and with 25 different HCs, matched for age and gender. RESULTS Impulsivity and executive function performance were significantly worse in BP compared to both MDD and HCs. Both BP and MDD had significantly poorer memory performance compared to HCs. Greater deactivation of the medial prefrontal cortex (MPFC) during the fMRI task was associated with better executive function in healthy controls. Significantly less deactivation in this region was present in both BP and MDD compared to HCs. CONCLUSIONS Failure to deactivate the MPFC, a key region of the default mode network, during working memory processing is a shared neural feature present in both bipolar and major depression and could be a source of common cognitive dysfunction.
Collapse
Affiliation(s)
- Isabella A Breukelaar
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
| | - May Erlinger
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
| | - Anthony Harris
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Stuart M Grieve
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia.,Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre and Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Cassandra Antees
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
| | - Sheryl Foster
- Department of Radiology, Westmead Hospital, Westmead, NSW, Australia.,The Discipline of Medical Radiation Sciences, Faculty of Health Science, The University of Sydney, Lidcombe, NSW, Australia
| | - Lavier Gomes
- Department of Radiology, Westmead Hospital, Westmead, NSW, Australia
| | - Leanne M Williams
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.,Palo Alto VA, MIRECC, Palo Alto, CA, USA
| | - Gin S Malhi
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Saint Leonards, NSW, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
40
|
Hazell P, Balzer B, Kelly P, Paxton K, Hawke C, Ivers R, Skinner R, Luscombe G, Steinbeck KS. Serial measurement of mood via text messaging in young people. Child Adolesc Psychiatry Ment Health 2020; 14:5. [PMID: 32015755 PMCID: PMC6988358 DOI: 10.1186/s13034-020-0313-0] [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: 05/13/2019] [Accepted: 01/17/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To support longitudinal research into mood in adolescents we sought to assess the feasibility of collecting mood data via Short Message Service (SMS) over 3 years, and to investigate the relationship between SMS data and self-report measures of depression. METHODS Prospective cohort study of young people aged 9 to 14 years at baseline. Participants completed Short Mood and Feelings Questionnaire (SMFQ) and the Youth Self Report Anxious/Depressed ((YSR)/AD) and Withdrawn/Depressed (YSR/WD) scales at baseline and annually for 3 years. In addition, at 3 monthly intervals they responded to an SMS asking them to rate their mood from 0 to 9 (9 highest). RESULTS 277 young people (43% female) completed all four waves of the survey. There was a 87% response rate to requests for SMS Mood ratings. Mean SMS Mood decreased over time for females (p = 0.006) but not males (p = 0.45). We found an inverse association between SMS Mood and the SMFQ, YSR/AD and YSR/WD, scales in females and the SMFQ and YSR/WD scales in males. 45% of participants reported at least one SMS Mood rating score below 5, while 5% reported clusters of low SMS scores. Clusters of low SMS Mood scores were associated with SMFQ scores in the clinical range at 24 (OR = 4.45) and 36 months (OR = 4.72), and YSR/WD in the clinical range at 36 months (OR = 4.61). CONCLUSIONS SMS Mood ratings represent a feasible means to augment but not replace assessment of mood obtained using standard instruments.
Collapse
Affiliation(s)
- Philip Hazell
- 0000 0004 1936 834Xgrid.1013.3University of Sydney School of Medicine, Sydney, Australia
| | - Ben Balzer
- 0000 0004 1936 834Xgrid.1013.3University of Sydney School of Medicine, Sydney, Australia
| | - Patrick Kelly
- 0000 0004 1936 834Xgrid.1013.3University of Sydney School of Medicine, Sydney, Australia
| | - Karen Paxton
- 0000 0004 1936 834Xgrid.1013.3University of Sydney School of Medicine, Sydney, Australia
| | - Catherine Hawke
- 0000 0004 1936 834Xgrid.1013.3University of Sydney School of Medicine, Sydney, Australia
| | - Rebecca Ivers
- 0000 0004 4902 0432grid.1005.4University of New South Wales School of Public Health and Community Medicine, Sydney, Australia
| | - Rachel Skinner
- 0000 0004 1936 834Xgrid.1013.3University of Sydney School of Medicine, Sydney, Australia
| | - Georgina Luscombe
- 0000 0004 1936 834Xgrid.1013.3University of Sydney School of Medicine, Sydney, Australia
| | - Katharine S. Steinbeck
- 0000 0004 1936 834Xgrid.1013.3University of Sydney School of Medicine, Sydney, Australia
| |
Collapse
|
41
|
Witt K, Townsend E, Arensman E, Gunnell D, Hazell P, Taylor Salisbury T, Van Heeringen K, Hawton K. Psychosocial Interventions for People Who Self-Harm: Methodological Issues Involved in Trials to Evaluate Effectiveness. Arch Suicide Res 2020; 24:S32-S93. [PMID: 30955501 DOI: 10.1080/13811118.2019.1592043] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We have assessed the methodological quality of randomized controlled trials (RCTs) of interventions to prevent self-harm repetition and suicide. Trials were identified in two systematic reviews of RCTs of psychosocial treatments following a recent (within six months) episode of self-harm indexed in any of five electronic databases (CCDANCTR-Studies and References, CENTRAL, Medline, Embase, and PsycINFO) between 1 January, 1998 and 29 April, 2015. A total of 66 trials were included, 55 in adults and 11 in children and adolescents. While evidence for efficacy of some approaches has grown, there were few trials from low-to-middle income countries, little information on interventions for males, information on the control condition was often limited, data on suicides were often not reported, and, while trials have increased in size in recent years, most have included too few participants to detect clinically significant results. There are major limitations in many trials of interventions for individuals who self-harm. Improved methodology, especially with regard to study size, provision of details of control therapy, and evaluation of key outcomes, would enhance the evidence base for clinicians and service users.
Collapse
|
42
|
Reddihough DS, Marraffa C, Mouti A, O’Sullivan M, Lee KJ, Orsini F, Hazell P, Granich J, Whitehouse AJO, Wray J, Dossetor D, Santosh P, Silove N, Kohn M. Effect of Fluoxetine on Obsessive-Compulsive Behaviors in Children and Adolescents With Autism Spectrum Disorders: A Randomized Clinical Trial. JAMA 2019; 322:1561-1569. [PMID: 31638682 PMCID: PMC6806436 DOI: 10.1001/jama.2019.14685] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Selective serotonin receptor inhibitors are prescribed to reduce the severity of core behaviors of autism spectrum disorders, but their efficacy remains uncertain. OBJECTIVE To determine the efficacy of fluoxetine for reducing the frequency and severity of obsessive-compulsive behaviors in autism spectrum disorders. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, placebo-controlled clinical trial. Participants aged 7.5-18 years with autism spectrum disorders and a total score of 6 or higher on the Children's Yale-Brown Obsessive Compulsive Scale, modified for pervasive developmental disorder (CYBOCS-PDD) were recruited from 3 tertiary health centers across Australia. Enrollment began November 2010 and ended April 2017. Follow-up ended August 2017. INTERVENTIONS Participants were randomized to receive fluoxetine (n = 75) or placebo (n = 71). Study medication was commenced at 4 or 8 mg/d for the first week, depending on weight, and then titrated to a maximum dose of 20 or 30 mg/d over 4 weeks. Treatment duration was 16 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the total score on the CYBOCS-PDD (scores range from 0-20; higher scores indicate higher levels of maladaptive behaviors; minimal clinically important difference, 2 points) at 16 weeks postrandomization, analyzed with a linear regression model adjusted for stratification factors (site, age at baseline, and intellectual disability), with an additional prespecified model that included additional adjustment for baseline score, sex, communication level, and imbalanced baseline and demographic variables. RESULTS Among the 146 participants who were randomized (85% males; mean age, 11.2 years), 109 completed the trial; 31 in the fluoxetine group and 21 in the placebo group dropped out or did not complete treatment. The mean CYBOCS-PDD score from baseline to 16 weeks decreased in the fluoxetine group from 12.80 to 9.02 points (3.72-point decrease; 95% CI, -4.85 to -2.60) and in the placebo group from 13.13 to 10.89 points (2.53-point decrease; 95% CI, -3.86 to -1.19). The between-group mean difference at 16 weeks was -2.01 (95% CI, -3.77 to -0.25; P = .03) (adjusted for stratification factors), and in the prespecified model with further adjustment, it was -1.17 (95% CI, -3.01 to 0.67; P = .21). CONCLUSIONS AND RELEVANCE In this preliminary study of children and adolescents with autism spectrum disorders, treatment with fluoxetine compared with placebo resulted in significantly lower scores for obsessive-compulsive behaviors at 16 weeks. Interpretation is limited by the high dropout rate, null findings of prespecified analyses that accounted for potentially confounding factors and baseline imbalances, and CIs for the treatment effect that included the minimal clinically important difference. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12608000173392.
Collapse
Affiliation(s)
- Dinah S. Reddihough
- Royal Children’s Hospital, Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine Marraffa
- Royal Children’s Hospital, Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Anissa Mouti
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Molly O’Sullivan
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Katherine J. Lee
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Francesca Orsini
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Philip Hazell
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Joanna Granich
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew J. O. Whitehouse
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - John Wray
- Child Development Service, Western Australian Department of Health, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - David Dossetor
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Paramala Santosh
- Institute of Psychiatry, Psychology and Neurosciences, Department of Child Psychiatry, King’s College London, London, United Kingdom
| | - Natalie Silove
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Michael Kohn
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
- Adolescent and Young Adult Medicine, Westmead Hospital, Adolescent and Young Adult Services Western Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
43
|
Bhide S, Sciberras E, Anderson V, Hazell P, Nicholson JM. Association Between Parenting Style and Socio-Emotional and Academic Functioning in Children With and Without ADHD: A Community-Based Study. J Atten Disord 2019; 23:463-474. [PMID: 27474160 DOI: 10.1177/1087054716661420] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In a community-based study, we examined parenting style and its relationship to functioning in 6- to 8-year-old children ( n = 391; 66.2% male) with ADHD ( n = 179), compared with non-ADHD controls ( n = 212). METHOD Parenting style was assessed using parent-reported (93.5% female) measures of warmth, consistency, and anger. Child socio-emotional and academic functioning was measured via parent- and teacher-reported scales, and direct academic assessment. RESULTS Parents reported less consistency and more anger in the ADHD group compared with non-ADHD controls, with no differences in warmth. Parenting warmth, consistency, and anger were associated with parent-reported aspects of socio-emotional functioning for children with ADHD and non-ADHD controls, after adjusting for socio-demographic variables, externalizing comorbidities, and ADHD symptom severity. Parenting style was no longer related to academic functioning and most teacher-reported outcomes after adjustment. CONCLUSION Generic parenting interventions that promote warm, consistent, and calm parenting may help alleviate socio-emotional impairments in children with ADHD.
Collapse
Affiliation(s)
- Sampada Bhide
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,2 University of Melbourne, Australia
| | - Emma Sciberras
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,2 University of Melbourne, Australia.,3 The Royal Childrens Hospital, Melbourne, Australia.,4 Deakin University, Melbourne, Australia
| | - Vicki Anderson
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,2 University of Melbourne, Australia.,3 The Royal Childrens Hospital, Melbourne, Australia
| | | | - Jan M Nicholson
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,6 La Trobe University, Melbourne, Australia
| |
Collapse
|
44
|
Affiliation(s)
- Philip Hazell
- Thomas Walker Hospital, University of Sydney School of Medicine, Concord West, NSW, Australia
| |
Collapse
|
45
|
Efron D, Gulenc A, Sciberras E, Ukoumunne OC, Hazell P, Anderson V, Silk TJ, Nicholson JM. Prevalence and Predictors of Medication Use in Children with Attention-Deficit/Hyperactivity Disorder: Evidence from a Community-Based Longitudinal Study. J Child Adolesc Psychopharmacol 2019; 29:50-57. [PMID: 30508385 DOI: 10.1089/cap.2018.0095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/12/2022]
Abstract
OBJECTIVES To determine, in a community-based sample of primary school-aged children meeting diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), (1) the proportion of children with ADHD treated with medication; (2) predictors of medication use; and (3) the association between medication use and psychological service utilization. METHODS Grade 1 children with ADHD were recruited through 43 schools in Melbourne, Australia, using a two-stage screening and case confirmation procedure. Parent report of medication treatment, clinician diagnosis, and psychological service use were collected at ages 7 and 10 years. Medication use was analyzed by ADHD subtype. Predictors of medication treatment examined included ADHD symptom severity and persistence, externalizing comorbidities, poor academic performance, and social disadvantage. Unadjusted and adjusted logistic regression were used to identify the predictors of medication status. RESULTS One hundred seventy-nine children with ADHD were recruited. At baseline, 17.3% had been clinically diagnosed with ADHD, increasing to 37.7% at age 10 years. At baseline, 13.6% were taking ADHD medications, increasing to 25.6% at age 10. Children with the combined and hyperactive-impulsive subtypes were more likely to be taking medication than those with inattentive subtype (age 7: p = 0.002; age 10: p = 0.03). ADHD symptom severity (Conners 3 ADHD Index) at baseline was concurrently and prospectively associated with medication use at both ages (both p = 0.01), and ADHD symptom severity at age 10 was also associated with medication use at age 10 (p = 0.01). Baseline area-level disadvantage was associated with medication use at age 7 (p = 0.04). At 10 years, children receiving medication were more likely, compared with those who were not, to be receiving psychological services (p = 0.001). CONCLUSIONS In this study, only a minority of children meeting diagnostic criteria for ADHD were diagnosed clinically or treated with ADHD medication by age 10. The strongest predictors of medication treatment were ADHD symptom severity and area disadvantage.
Collapse
Affiliation(s)
- Daryl Efron
- 1 Department of Paediatrics, The University of Melbourne, Parkville, Australia.,2 The Royal Children's Hospital, Parkville, Australia.,3 Department of Health Services, Murdoch Children's Research Institute, Parkville, Australia
| | - Alisha Gulenc
- 2 The Royal Children's Hospital, Parkville, Australia.,3 Department of Health Services, Murdoch Children's Research Institute, Parkville, Australia
| | - Emma Sciberras
- 1 Department of Paediatrics, The University of Melbourne, Parkville, Australia.,3 Department of Health Services, Murdoch Children's Research Institute, Parkville, Australia.,4 School of Psychology, Deakin University, Geelong, Australia
| | - Obioha C Ukoumunne
- 5 NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, United Kingdom
| | - Philip Hazell
- 6 Discipline of Psychiatry, Sydney Medical School, Sydney, Australia
| | - Vicki Anderson
- 1 Department of Paediatrics, The University of Melbourne, Parkville, Australia.,2 The Royal Children's Hospital, Parkville, Australia.,3 Department of Health Services, Murdoch Children's Research Institute, Parkville, Australia
| | - Timothy J Silk
- 1 Department of Paediatrics, The University of Melbourne, Parkville, Australia.,3 Department of Health Services, Murdoch Children's Research Institute, Parkville, Australia.,4 School of Psychology, Deakin University, Geelong, Australia
| | - Jan M Nicholson
- 3 Department of Health Services, Murdoch Children's Research Institute, Parkville, Australia.,7 Judith Lumley Centre, La Trobe University, Melbourne, Australia
| |
Collapse
|
46
|
Silk TJ, Malpas CB, Beare R, Efron D, Anderson V, Hazell P, Jongeling B, Nicholson JM, Sciberras E. A network analysis approach to ADHD symptoms: More than the sum of its parts. PLoS One 2019; 14:e0211053. [PMID: 30657783 PMCID: PMC6338383 DOI: 10.1371/journal.pone.0211053] [Citation(s) in RCA: 17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/07/2019] [Indexed: 01/14/2023] Open
Abstract
In interpreting attention-deficit/hyperactivity disorder (ADHD) symptoms, categorical and dimensional approaches are commonly used. Both employ binary symptom counts which give equal weighting, with little attention to the combinations and relative contributions of individual symptoms. Alternatively, symptoms can be viewed as an interacting network, revealing the complex relationship between symptoms. Using a novel network modelling approach, this study explores the relationships between the 18 symptoms in the Diagnostic Statistical Manual (DSM-5) criteria and whether network measures are useful in predicting outcomes. Participants were from a community cohort, the Children’s Attention Project. DSM ADHD symptoms were recorded in a face-to-face structured parent interview for 146 medication naïve children with ADHD and 209 controls (aged 6–8 years). Analyses indicated that not all symptoms are equal. Frequencies of endorsement and configurations of symptoms varied, with certain symptoms playing a more important role within the ADHD symptom network. In total, 116,220 combinations of symptoms within a diagnosis of ADHD were identified, with 92% demonstrating a unique symptom configuration. Symptom association networks highlighted the relative importance of hyperactive/impulsive symptoms in the symptom network. In particular, the ‘motoric’-type symptoms as well as interrupts as a marker of impulsivity in the hyperactive domain, as well as loses things and does not follow instructions in the inattentive domain, had high measures of centrality. Centrality-measure weighted symptom counts showed significant association with clinical but not cognitive outcomes, however the relationships were not significantly stronger than symptom count alone. The finding may help to explain heterogeneity in the ADHD phenotype.
Collapse
Affiliation(s)
- Timothy J. Silk
- School of Psychology, Deakin University, Geelong, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Charles B. Malpas
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Australia
| | - Richard Beare
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Daryl Efron
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- The Royal Children’s Hospital, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children’s Research Institute, Melbourne, Australia
- The Royal Children’s Hospital, Melbourne, Australia
| | - Philip Hazell
- Discipline of Psychiatry, University of Sydney, Sydney, Australia
| | - Brad Jongeling
- Joondalup Child Development Centre, Perth, Australia
- Department of Paediatrics, University of Western Australia, Perth, Australia
| | - Jan M. Nicholson
- Murdoch Children’s Research Institute, Melbourne, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University, Geelong, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- The Royal Children’s Hospital, Melbourne, Australia
| |
Collapse
|
47
|
Hazell P. Use of psychotropic medications in general paediatric practice. J Paediatr Child Health 2018; 54:1073-1076. [PMID: 30294990 DOI: 10.1111/jpc.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/29/2018] [Accepted: 06/03/2018] [Indexed: 11/28/2022]
Abstract
Paediatricians contribute the greatest proportion of prescriptions for psychotropic medication to children between the ages of 3 and 14 years in Australia. Medications indicated for attention-deficit hyperactivity disorder are the most commonly prescribed, followed by antidepressants and antipsychotics. Outside treatment for attention-deficit hyperactivity disorder, most prescribing is 'off label'. There are few searchable, up-to-date resources to guide psychotropic prescribing to children. The skill level required to manage pharmacotherapy is determined by the condition and the characteristics of the patient. Psychotropic medication should always be considered within the context of other interventions and environmental factors that influence emotions, cognition and behaviour. Beware the 'medication fallacy' that arises out of a misconception that if one medication does not work, there must be another that will.
Collapse
Affiliation(s)
- Philip Hazell
- Discipline of Psychiatry, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
48
|
Korgaonkar MS, Erlinger M, Breukelaar IA, Boyce P, Hazell P, Antees C, Foster S, Grieve SM, Gomes L, Williams LM, Harris AWF, Malhi GS. Amygdala Activation and Connectivity to Emotional Processing Distinguishes Asymptomatic Patients With Bipolar Disorders and Unipolar Depression. Biol Psychiatry Cogn Neurosci Neuroimaging 2018; 4:361-370. [PMID: 30343134 DOI: 10.1016/j.bpsc.2018.08.012] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/06/2018] [Accepted: 08/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mechanistically based neural markers, such as amygdala reactivity, offer one approach to addressing the challenges of differentiating bipolar and unipolar depressive disorders independently from mood state and acute symptoms. Although emotion-elicited amygdala reactivity has been found to distinguish patients with bipolar depression from patients with unipolar depression, it remains unknown whether this distinction is traitlike and present in the absence of an acutely depressed mood. We addressed this gap by investigating patients with bipolar disorder (BP) and unipolar major depressive disorder (MDD) in remission. METHODS Supraliminal and subliminal processing of faces exhibiting threat, sad, happy, and neutral emotions during functional magnetic resonance imaging was completed by 73 participants (23 BP patients and 25 MDD patients matched for age and gender, number of depressive episodes and severity; 25 age- and gender-matched healthy control subjects). We compared groups for activation and connectivity for the amygdala. RESULTS BP patients had lower left amygdala activation than MDD patients during supraliminal and subliminal threat, sad, and neutral emotion processing and for subliminal happy faces. BP patients also exhibited lower amygdala connectivity to the insula and hippocampus for threat and to medial orbitofrontal cortex for happy supraliminal and subliminal processing. BP patients also demonstrated greater amygdala-insula connectivity for sad supraliminal and subliminal face processing. Both patient groups were distinct from control subjects across several measures for activation and connectivity. CONCLUSIONS Independent of valence or level of emotional awareness, amygdala activation and connectivity during facial emotion processing can distinguish BP patients and MDD patients. These findings provide evidence that this neural substrate could be a potential trait marker to differentiate these two disorders largely independent of illness state.
Collapse
Affiliation(s)
- Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, New South Wales, Australia; Discipline of Psychiatry, University of Sydney School of Medicine, New South Wales, Australia.
| | - May Erlinger
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, New South Wales, Australia
| | - Isabella A Breukelaar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, New South Wales, Australia
| | - Philip Boyce
- Discipline of Psychiatry, University of Sydney School of Medicine, New South Wales, Australia
| | - Philip Hazell
- Discipline of Psychiatry, University of Sydney School of Medicine, New South Wales, Australia
| | - Cassandra Antees
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, New South Wales, Australia
| | - Sheryl Foster
- Department of Radiology, Westmead Hospital, Westmead, New South Wales, Australia; Discipline of Medical Radiation Sciences, Faculty of Health Science, The University of Sydney, New South Wales, Australia
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre and University of Sydney School of Medicine, New South Wales, Australia; Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Lavier Gomes
- Department of Radiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Leanne M Williams
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, New South Wales, Australia; Psychiatry and Behavioral Sciences, Stanford University, Stanford, Palo Alto, California; Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Anthony W F Harris
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, New South Wales, Australia; Discipline of Psychiatry, University of Sydney School of Medicine, New South Wales, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, University of Sydney School of Medicine, New South Wales, Australia; Clinical Assessment Diagnostic Evaluation (CADE) Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
49
|
Witt K, de Moraes DP, Salisbury TT, Arensman E, Gunnell D, Hazell P, Townsend E, van Heeringen K, Hawton K. Treatment as usual (TAU) as a control condition in trials of cognitive behavioural-based psychotherapy for self-harm: Impact of content and quality on outcomes in a systematic review. J Affect Disord 2018; 235:434-447. [PMID: 29679896 DOI: 10.1016/j.jad.2018.04.025] [Citation(s) in RCA: 21] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/27/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Randomized controlled trials (RCTs) are the mainstay of evaluations of the efficacy of psychosocial interventions. In a recent Cochrane systematic review we analysed the efficacy of cognitive behavioural-based psychotherapies compared to treatment as usual (TAU) in adults who self-harm. In this study we examine the content and reporting quality of TAU in these trials and their relationship to outcomes. METHODS Five electronic databases (CCDANCTR-Studies and References, CENTRAL, MEDLINE, EMBASE, and PsycINFO) were searched for RCTs, indexed between 1 January 1998 and 30 April 2015, of cognitive-behavioural interventions compared to TAU for adults following a recent (within six months) episode of self-harm. Comparisons were made between outcomes for trials which included different categories of TAU, which were grouped as: multidisciplinary treatment, psychotherapy only, pharmacotherapy only, treatment by primary care physician, minimal contact, or unclear. RESULTS 18 trials involving 2433 participants were included. The content and reporting quality of TAU varied considerably between trials. The apparent effectiveness of cognitive behavioural psychotherapy varied according to TAU reporting quality and content. Specifically, effects in favour of cognitive-behavioural psychotherapy were strongest in trials in which TAU content was not clearly described (Odds Ratio: 0.29, 95% Confidence Interval 0.15-0.62; three trials) compared to those in which TAU comprised multidisciplinary treatment (Odds Ratio: 0.79, 95% CI 0.63 to 0.97; 12 trials). LIMITATIONS The included trials had high risk of bias with respect to participant and clinical personnel blinding, and unclear risk of bias for selective outcome reporting. CONCLUSIONS TAU content and quality represents an important source of heterogeneity between trials of psychotherapeutic interventions for prevention of self-harm. Before clinical trials begin, researchers should plan to carefully describe both aspects of TAU to improve the overall quality of investigations.
Collapse
Affiliation(s)
- Katrina Witt
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Tatiana Taylor Salisbury
- Institute of Psychiatry, Psychology and Neurology, King's College London, London, UK; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ella Arensman
- National Suicide Research Foundation and School of Public Health, University College Cork, Republic of Ireland
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Sydney, Australia
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Kees van Heeringen
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Gent University, Gent, Belgium
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK.
| |
Collapse
|
50
|
Hazell P. Is it clinically defensible to treat children longer term with second generation antipsychotics? Expert Opin Drug Saf 2018; 17:657-659. [DOI: 10.1080/14740338.2018.1479741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Philip Hazell
- Child and Adolescent Psychiatry, Discipline of Psychiatry, University of Sydney, Australia
| |
Collapse
|