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Kisely S, Bull C, Trott M, Arnautovska U, Siskind D, Warren N, Najman JM. Emergency department presentations for deliberate self-harm and suicidal ideation in 25-39 year olds following agency-notified child maltreatment: results from the Childhood Adversity and Lifetime Morbidity (CALM) study - CORRIGENDUM. Epidemiol Psychiatr Sci 2024; 33:e23. [PMID: 38604777 PMCID: PMC11022252 DOI: 10.1017/s204579602400026x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
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Kisely S, Bull C, Trott M, Arnautovska U, Siskind D, Warren N, Najman JM. Emergency department presentations for deliberate self-harm and suicidal ideation in 25-39 years olds following agency-notified child maltreatment: results from the Childhood Adversity and Lifetime Morbidity (CALM) study. Epidemiol Psychiatr Sci 2024; 33:e18. [PMID: 38532726 PMCID: PMC11022258 DOI: 10.1017/s2045796024000192] [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: 11/14/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
AIMS To compare prospective reports of child maltreatment (CM) with emergency department (ED) presentations for deliberate self-harm (DSH) and suicidal ideation in individuals aged between 25 and 39 years old. METHODS Linked records between the Mater-University of Queensland Study of Pregnancy birth cohort and Queensland administrative health data were used, which included notifications to child protection agencies for CM. ED presentations for individuals aged between 25 and 39 years of age for suicidal ideation, suicidal behaviour or poisoning by paracetamol or psychotropic medications where the intention was unclear were examined using logistic regression analyses. RESULTS A total of 609 (10.1%) individuals were the subject of one or more CM notifications for neglect or physical, sexual or emotional abuse before the age of 15 years. Of these, 250 (4.1%) presented at least once to ED for DSH and/or suicidal ideation between 25 and 39 years of age. In adjusted analysis, any notification of CM was associated with significantly increased odds of presenting to ED for these reasons (aOR = 2.80; 95% CI = 2.04-3.84). In sensitivity analyses, any notification of CM increased the odds of the combined outcome of DSH and suicidal ideation by 275% (aOR = 2.75; 95% CI = 1.96-4.06) and increased the odds of DSH alone by 269% (aOR = 2.69; 95% CI = 1.65-4.41). CONCLUSIONS All CM types (including emotional abuse and neglect) were associated with ED presentations for DSH and suicidal ideation in individuals between 25 and 39 years of age. These findings have important implications for the prevention of DSH, suicidal ideation and other health outcomes. They also underscore the importance of trauma-informed care in ED for all individuals presenting with DSH and suicidal ideation.
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Affiliation(s)
- S. Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - C. Bull
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - M. Trott
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - U. Arnautovska
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - D. Siskind
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - N. Warren
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - J. Moses Najman
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- School of Social Sciences, The University of Queensland, St Lucia, QLD, Australia
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Kisely S, Siskind D, Scott JG, Najman JM. Self-reported child maltreatment and cardiometabolic risk in 30-year-old adults. Intern Med J 2023; 53:1121-1130. [PMID: 35607779 PMCID: PMC10947207 DOI: 10.1111/imj.15824] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Childhood maltreatment (CM) is associated with both dietary fat intake and obesity in later life. There is less information on associations with metabolic risk factors and specific types of CM such as physical, sexual and emotional abuse, as well as neglect. AIMS To assess the association between five types of self-reported CM and a range of obesity and metabolic indicators in a subsample of a birth cohort. METHODS This was a study of 1689 adults born in a major metropolitan maternity hospital in Australia and followed up 30 years later. Body mass index, bioimpedance and fasting lipid levels/insulin resistance were measured. Details on self-reported CM were collected using the Child Trauma Questionnaire. We adjusted for birth weight, parental income and relationship at participants' birth, as well as maternal age and alcohol or tobacco use. We also adjusted for participants' smoking, depression, educational level, marital and employment status at follow up. RESULTS One-fifth reported maltreatment (n = 362), most commonly emotional neglect (n = 175), followed by emotional abuse (n = 128), physical neglect (n = 123), sexual (n = 121) and physical abuse (n = 116). On adjusted analyses, there were significant associations for CM, particularly neglect or emotional abuse, and one or more of the following outcomes: obesity, the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio and HDL levels. Results for other outcomes were more equivocal. CONCLUSIONS Of child maltreatment types, emotional abuse and neglect show the strongest associations with obesity and several cardiometabolic risk factors, therefore highlighting the public health importance of early intervention to reduce childhood adversity.
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Affiliation(s)
- Stephen Kisely
- Metro South Addiction and Mental Health ServiceBrisbaneQueenslandAustralia
- School of Clinical MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
- Departments of Psychiatry, Community Health and EpidemiologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Dan Siskind
- Metro South Addiction and Mental Health ServiceBrisbaneQueenslandAustralia
- School of Clinical MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - James G. Scott
- Mental Health ProgramQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
- Metro North Mental Health ServiceBrisbaneQueenslandAustralia
- School of Public HealthThe University of Queensland, Public Health BuildingBrisbaneQueenslandAustralia
| | - Jake M. Najman
- School of Public HealthThe University of Queensland, Public Health BuildingBrisbaneQueenslandAustralia
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Northwood K, Pearson E, Arnautovska U, Kisely S, Pawar M, Sharma M, Vitangcol K, Wagner E, Warren N, Siskind D. Optimising plasma clozapine levels to improve treatment response: an individual patient data meta-analysis and receiver operating characteristic curve analysis. Br J Psychiatry 2023; 222:241-245. [PMID: 36994656 DOI: 10.1192/bjp.2023.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Although clozapine is the most efficacious medication for treatment-refractory schizophrenia, not all patients will have an adequate response. Optimising clozapine dose using therapeutic drug monitoring could therefore maximise response. AIMS Using individual patient data, we undertook a receiver operating characteristic (ROC) curve analysis to determine an optimal therapeutic range for clozapine levels to guide clinical practice. METHOD We conducted a systematic review of PubMed, PsycINFO and Embase for studies that provided individual participant level data on clozapine levels and response. These data were analysed using ROC curves to determine the prediction performance of plasma clozapine levels for treatment response. RESULTS We included data on 294 individual participants from nine studies. ROC analysis yielded an area under the curve of 0.612. The clozapine level at the point of optimal diagnostic benefit was 372 ng/mL; at this level, the response sensitivity was 57.3%, and specificity 65.7%. The interquartile range for treatment response was 223-558 ng/mL. There was no improvement in ROC performance with mixed models including patient gender, age or length of trial. Clozapine dose and clozapine concentration to dose ratio did not provide significantly meaningful prediction of response to clozapine. CONCLUSIONS Clozapine dose should be optimised based on clozapine therapeutic levels. We found that a range between 250 and 550 ng/mL could be recommended, while noting that a level of >350 ng/mL is the most optimal for response. Although some patients may not respond without clozapine levels >550 ng/mL, the benefits should be weighed against the increased risk of adverse drug reactions.
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Affiliation(s)
- Korinne Northwood
- Metro South Addiction and Mental Health Service, Metro South Health, Australia and Faculty of Medicine, University of Queensland, Australia
| | - E Pearson
- College of Medicine and Public Health, Flinders University, Australia
| | - U Arnautovska
- Metro South Addiction and Mental Health Service, Metro South Health, Australia and Faculty of Medicine, University of Queensland, Australia
| | - S Kisely
- Metro South Addiction and Mental Health Service, Metro South Health, Australia and Faculty of Medicine, University of Queensland, Australia
| | - M Pawar
- Metro South Addiction and Mental Health Service, Metro South Health, Australia
| | - M Sharma
- Department of Mental Health, Monash Health, Australia
| | - K Vitangcol
- Faculty of Medicine, University of Queensland, Australia
| | - E Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - N Warren
- Metro South Addiction and Mental Health Service, Metro South Health, Australia and Faculty of Medicine, University of Queensland, Australia
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Metro South Health, Australia and Faculty of Medicine, University of Queensland, Australia
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Brazel M, Allison S, Bastiampillai T, Kisely S, Loi SM, Looi JC. Australian older persons mental health inpatient and ambulatory services in 2015-2020 - A descriptive analysis and commentary. Australas Psychiatry 2023; 31:43-46. [PMID: 36337025 DOI: 10.1177/10398562221135492] [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: 11/09/2022]
Abstract
OBJECTIVE To provide a commentary on Australian state/territory older persons mental health service (OPMHS) expenditure, inpatient and outpatient services and key performance indicators (KPIs). METHOD Descriptive analysis of data from the Australian Institute of Health and Welfare (AIHW), the Australian Bureau of Statistics and the World Health Organisation. RESULTS Between 2015-16 and 2019-20, annual expenditure on OPMHS in Australia increased by an average of only 2.3%, compared to 2.9% for all population groups, despite an increase in the number of over 65 year olds. Per capita recurrent expenditure on OPMHS decreased by an average of 1% annually. Australia's total mental health beds increased, whereas OPMHS beds decreased, mainly due to a reduction in non-acute beds. Outcomes for OPMHS admissions were similar to other age groups, except for a longer length of stay and reduced readmission rate. Older Australians accessed ambulatory mental health care at a lower rate and had a lower rate of improvement after a completed episode. CONCLUSIONS OPMHS expenditure has not increased at commensurate levels compared to other populations. The mental health of people aged over 65 appears to be a neglected policy priority in Australia. The Royal Commission into Aged Care Quality and Safety may herald service and expenditure changes.
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Affiliation(s)
- Matthew Brazel
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University School of Medicine and Psychology, 34381Canberra Hospital, Canberra, ACT, Australia; and Department of Psychiatry, 34381The Canberra Hospital, Garran, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Stephen Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; School of Medicine, 1974University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samantha M Loi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; University of Melbourne, Psychiatry, Grattan Street, Parkville VIC, Australia; and Melbourne Health, Neuropsychiatry NorthWestern Mental Health, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, 34381Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
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Abstract
The poor physical health (including oral health) of people with mental disorders is a global problem. The burden of oral diseases among this group is substantial given their high prevalence and ability to increase the personal, social, and economic impacts of mental disorders. This article summarizes causes of mental disorders and oral diseases, critically reviews current evidence on interventions to reduce the burden of oral diseases in people with mental disorders, and suggests future research directions. The relationship between mental disorders and oral diseases is complex due to the shared social determinants and bidirectional interaction mechanisms that involve interconnected social, psychological, behavioral, and biological processes. Research has, to date, failed to produce effective and scalable interventions to tackle the burden of oral diseases among people with mental disorders. Transformative research and actions informed by a dynamic involvement of biological, behavioral, and social sciences are needed to understand and tackle the complex relationship between mental disorders and oral diseases, as well as inform the design of complex interventions. Examples of future research on complex public health, health service, and social care interventions are provided. The design and testing of these interventions should be carried out in real-world settings, underpinned by the principles of coproduction and systems thinking, and conducted by a transdisciplinary team. We propose this starts with setting research priorities and developing complex intervention theory, which we report to support future research to improve oral health and hence physical and mental health in this disadvantaged group.
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Affiliation(s)
- E Joury
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, The Royal London Hospital, London, UK
| | - S Kisely
- PA-Southside Clinical Unit, School of Clinical Medicine, Faculty of Medicine, the University of Queensland, Woolloongabba, QLD, Australia
| | - R G Watt
- Research Department of Epidemiology & Public Health, University College London, London, UK
| | - N Ahmed
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - A J Morris
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - F Fortune
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, London, UK
| | - K Bhui
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
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Nasir BF, Kisely S, Hides L, Brennan‐Olsen S, Kondalsamy‐Chennakesavan S, Nicholson GC, Gill NS, Beccaria G, Toombs M. Translating research into action: The design and development of an Indigenous specific suicide intervention skills training program (I-ASIST). Aust J Rural Health 2022; 30:870-875. [PMID: 35834238 PMCID: PMC10947038 DOI: 10.1111/ajr.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
Note: We respectfully refer to Aboriginal and Torres Strait Islander people as Indigenous in this study. OBJECTIVE To design and develop an Indigenous specific suicide intervention skills program that focuses on education and intervention training as an effective suicide prevention strategy. METHOD Using a co-designed wrap-around framework, we developed a program in collaboration with >90 communities, stakeholders and service providers across Australia to understand knowledge, awareness and sense of connectedness between at-risk groups and health services or support groups. RESULTS The I-ASIST training provides participants with the necessary skills and knowledge to apply a suicide intervention model. The framework behind the intervention model provides caregivers the awareness to recognise when someone may be at risk of suicide. It then gives them the skills to connect with a person at risk of suicide and to understand and clarify that risk, steps to keep that person safe for a specific period and then provide them with the resources or links required for further help. The program enables the development of knowledge through interactive strategies through cultural recognition and empowerment of participants. Based on a social-enterprise model, I-ASIST has been translated into a certified program supported by LivingWorks Australia. CONCLUSION Based on a strengths-based and self-determination model of co-design, this grass roots innovative framework creates suicide safer communities.
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Affiliation(s)
- Bushra Farah Nasir
- Toowoomba Regional Clinical Unit, Medical School, Faculty of MedicineThe University of QueenslandToowoombaQldAustralia
| | - Stephen Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Faculty of MedicineThe University of QueenslandBrisbaneQldAustralia
| | - Leanne Hides
- School of Psychology, Faculty of Health and Behavioural SciencesThe University of QueenslandBrisbaneQldAustralia
| | - Sharon Brennan‐Olsen
- School of Health and Social DevelopmentDeakin University, Geelong Waterfront CampusGeelongVic.Australia
- Institute for Health TransformationDeakin University, Geelong Waterfront CampusGeelongVic.Australia
| | | | - Geoffrey C. Nicholson
- Toowoomba Regional Clinical Unit, Medical School, Faculty of MedicineThe University of QueenslandToowoombaQldAustralia
| | - Neeraj S. Gill
- Faculty of HealthUniversity of CanberraCanberraACTAustralia
- Toowoomba Regional Clinical Unit, Faculty of MedicineThe University of QueenslandToowooombaQldAustralia
| | - Gavin Beccaria
- School of Psychology and CounsellingUniversity of Southern QueenslandToowoombaQldAustralia
| | - Maree Toombs
- Faculty of MedicineThe University of QueenslandHerstonQldAustralia
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Kisely S, Siskind D. Excess mortality from cancer in people with mental illness-Out of sight and out of mind. Acta Psychiatr Scand 2021; 144:315-317. [PMID: 34519045 DOI: 10.1111/acps.13363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen Kisely
- Metro South Addiction and Mental Health Service, Brisbane, Qld, Australia.,School of Clinical Medicine, University of Queensland, Woolloongabba, Qld, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, Qld, Australia.,School of Clinical Medicine, University of Queensland, Woolloongabba, Qld, Australia
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Ewais T, Begun J, Kenny M, Hay K, Houldin E, Chuang KH, Tefay M, Kisely S. Mindfulness based cognitive therapy for youth with inflammatory bowel disease and depression - Findings from a pilot randomised controlled trial. J Psychosom Res 2021; 149:110594. [PMID: 34399198 DOI: 10.1016/j.jpsychores.2021.110594] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/21/2021] [Accepted: 07/31/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mindfulness-based cognitive therapy (MBCT) is a promising adjunctive treatment for adolescents and young adults (AYAs) with Inflammatory Bowel Disease (IBD) and comorbid depression. OBJECTIVES This pilot randomised controlled trial (RCT) aimed to evaluate feasibility and efficacy of an adapted MBCT program for AYA, aged 16-29, with IBD. METHODS Sixty-four AYAs were randomly allocated to MBCT (n = 33) or treatment as usual (TAU) (n = 31). Primary outcome measure was the depression score on Depression, Anxiety and Stress Scale. Secondary outcomes included anxiety, stress, IBD-related quality of life, coping, mindfulness, post-traumatic growth, medication adherence, IBD activity, inflammatory markers, microbiome characteristics and brain functional connectivity. RESULTS Study recruitment rate was 75%, retention rate 70%, and session attendance 92%. Intention to treat analyses revealed that, compared to TAU group, MBCT group had significantly lower depression (∆ = -6.0; 95%CI = -10.8 to -1.2; P = 0.015) and stress (∆ = -5.1; 95%CI = -10.1 to -0.0; P = 0.049), higher active coping (∆ = 1.0;95%CI = 0.1-1.9; P = 0.022), and total mindfulness scores (∆ = 10.9;95%CI = 1.1-20.8; P = 0.030) at 8 weeks (post-therapy), and improved coping by positive reframing (∆ = 1.1;95%CI = 0.0-2.2; P = 0.043) and planning (∆ = 0.9;95%CI = 0.0-1.9; P = 0.045), mindful awareness (∆ = 5.2.;95%CI = 2.0-8.5; P = 0.002) and total mindfulness scores (∆ = 10.8.;95%CI = 0.4-21.1; P = 0.042) at 20 weeks. On per protocol analysis, MBCT group had significantly lower depression (∆ = -6.3; 95%CI = -11.4 to -1.2; P = 0.015), stress (∆ = -6.0; 95%CI = -11.2 to -0.5; P = 0.032), increased active coping (∆ = 0.9;95%CI = 0-1.7; P = 0.05) at 8 weeks, and mindful awareness (∆ = 5.4; 95%CI = 2.1-8.6; P = 0.001) at 20 weeks. CONCLUSION In AYAs with IBD, MBCT is feasible and beneficial in improving depression, stress, mindfulness and adaptive coping. It holds promise as an important component of integrated IBD care. Trial registration number ACTRN12617000876392, U1111-1197-7370; Pre-results.
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Affiliation(s)
- T Ewais
- School of Medicine, Mater Clinical School and Princess Alexandra Clinical School, Raymond Terrace, The University of Queensland, South Brisbane, Queensland 4101, Australia; Mater Young Adult Health Centre, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Mater Research Institute, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia; School of Medicine, Griffith University, Gold Coast, Queensland 5005, Australia.
| | - J Begun
- School of Medicine, Mater Clinical School and Princess Alexandra Clinical School, Raymond Terrace, The University of Queensland, South Brisbane, Queensland 4101, Australia; Mater Young Adult Health Centre, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Mater Research Institute, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
| | - M Kenny
- The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - K Hay
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Queensland 4006, Australia.
| | - Evan Houldin
- Queensland Brain Institute, St Lucia, Queensland 4072, Australia.
| | | | - M Tefay
- Mater Young Adult Health Centre, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
| | - S Kisely
- School of Medicine, Mater Clinical School and Princess Alexandra Clinical School, Raymond Terrace, The University of Queensland, South Brisbane, Queensland 4101, Australia; Metro South Health Service, Wooloongabba, Queensland 4102, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
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Kisely S, Lalloo R. A state-wide study of dental comorbidities in psychiatric disorders resulting in avoidable emergency department presentations. Aust Dent J 2021; 66:423-429. [PMID: 34325489 DOI: 10.1111/adj.12870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Attendances at emergency departments (EDs) for dental conditions are unnecessary and come at a significant cost to health services. METHODS A population-based record-linkage analysis of a retrospective cohort over 2 years across state-based facilities in Queensland. This was to determine if people with mental illness were more likely than the general population to attend EDs for a range of non-traumatic or avoidable dental conditions. RESULTS There were 1 381 428 individuals in the linked database, of whom 177 157 (13%) had a psychiatric history and 22 046 (1.5%) had one or more avoidable dental presentations. These were toothache (n = 9619), dental abscesses (n = 8449), caries (n = 1826), stomatitis (n = 1213) and gum disease (n = 939). After adjusting for confounders, psychiatric patients were significantly more likely to present with toothache, dental abscesses and caries but not stomatitis or gum disease. Depending on the dental outcome, other risk factors were male sex, lower income, rurality and Indigenous status. CONCLUSIONS Given these findings, possible interventions should include an increased emphasis on assessing oral health in mental health or primary care, especially in non-metropolitan areas, as well as early dental referral. Service planning for this population should including easier navigation of dental services, availability outside normal office hours and free outreach dental clinics.
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Affiliation(s)
- S Kisely
- School of Medicine, The University of Queensland, Woolloongabba, Queensland, Australia.,Addiction and Mental Health Services, Metro South Health, Woolloongabba, Queensland, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - R Lalloo
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
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Siskind D, Dark F, Carney K, Gore-Jones V, Kar Ray M, Steginga A, Suetani S, Kisely S. Placing rehabilitation at the core of assertive community treatment. Australas Psychiatry 2021; 29:47-51. [PMID: 32469640 DOI: 10.1177/1039856220928876] [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: 11/15/2022]
Abstract
OBJECTIVES Assertive community treatment (ACT) teams are increasingly being adapted to suit the needs of consumers who have never experienced long-term institutional care yet struggle to retain community tenure and quality of life due to residual functional disabilities associated with severe mental illness. Support needs can be provided by the growing disability support sector but recovery-orientated rehabilitation services delivered by specialist rehabilitation clinicians are also required. The Mobile Intensive Rehabilitation Team (MIRT) within the Metro South Addiction and Mental Health Service has adapted the ACT model to deliver assertive outreach that aims to work collaboratively with the person and their chosen supports to improve their function and their sense of self-efficacy in illness self-management. We described the characteristics of the consumers referred to MIRT over a 20-month time period, and reported on on their discharge location. CONCLUSION After two years with MIRT, half the participants were discharged out of case-management. Being on clozapine was a barrier to discharge from case-management despite functional improvement. Psychiatric hospitalisations predicted longer duration working with MIRT.
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Affiliation(s)
- Dan Siskind
- Metro South Addiction and Mental Health Service, Australia; and University of Queensland, School of Clinical Medicine, Australia
| | - Frances Dark
- Metro South Addiction and Mental Health Service, Australia; and University of Queensland, School of Clinical Medicine, Australia
| | - Kylie Carney
- Metro South Addiction and Mental Health Service, Australia
| | | | - Manaan Kar Ray
- Metro South Addiction and Mental Health Service, Australia
| | - Anne Steginga
- Metro South Addiction and Mental Health Service, Australia
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Australia; and Griffith University, Australia
| | - Stephen Kisely
- Metro South Addiction and Mental Health Service, Australia; and University of Queensland, School of Clinical Medicine, Australia
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Warren N, O'Gorman C, Blum S, Kisely S, Swayne A, Flavell J, Siskind D. Evaluation of the proposed anti-N-methyl-d-aspartate receptor encephalitis clinical diagnostic criteria in psychiatric patients. Acta Psychiatr Scand 2020; 142:52-57. [PMID: 32474904 DOI: 10.1111/acps.13197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The gold standard for diagnosing anti-NMDAR encephalitis is demonstration of the antibody in CSF. Clinical diagnostic criteria have been proposed for when this is not available in a timely manner which is evaluated, in this study, for a psychiatric population. METHODS This study retrospectively assessed the proposed criteria in patients presenting to psychiatric services for the first time with known anti-NMDAR antibody status. Antibody-positive cases were derived from the literature (conception to December 2019) and a state-wide (Queensland, Australia) cohort. Antibody-negative cases were derived from a service-wide (Metro South, Queensland, Australia) cohort of psychiatric cases which underwent antibody testing for routine organic screening. Sensitivity and specificity were calculated at 1 week following admission and the point of discharge. RESULTS The proposed criteria were applied to 641 cases (500 antibody-positive and 141 antibody-negative), demonstrating a sensitivity which increased from around 19% after 1 week to 49% by the point of discharge. Specificity was 100% at both time points. The mean average time to become positive using the proposed criteria was 19.5 days compared to 34.9 days for return of antibody testing. CONCLUSIONS High specificity of the proposed criteria, seen in this study, suggests that cases which are positive can be considered for expedited commencement of treatment. However, if clinical suspicion is high despite criteria being negative, it is essential to test CSF for anti-NMDAR antibody.
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Affiliation(s)
- N Warren
- Metro South Addiction and Mental Health, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - C O'Gorman
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia.,Mater Centre for Neurosciences, Mater Hospital, Brisbane, Australia
| | - S Blum
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia.,Mater Centre for Neurosciences, Mater Hospital, Brisbane, Australia
| | - S Kisely
- Metro South Addiction and Mental Health, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - A Swayne
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia.,Mater Centre for Neurosciences, Mater Hospital, Brisbane, Australia
| | - J Flavell
- Metro South Addiction and Mental Health, Brisbane, Australia
| | - D Siskind
- Metro South Addiction and Mental Health, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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13
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Siskind D, Russell A, Gamble C, Baker A, Cosgrove P, Burton L, Kisely S. Metabolic measures 12 months after a randomised controlled trial of treatment of clozapine associated obesity and diabetes with exenatide (CODEX). J Psychiatr Res 2020; 124:9-12. [PMID: 32087425 DOI: 10.1016/j.jpsychires.2020.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/24/2020] [Accepted: 02/17/2020] [Indexed: 10/25/2022]
Abstract
Clozapine is associated with obesity and type 2 diabetes. Glucagon-like-peptide-1 (GLP-1) receptor agonists such as exenatide can counter clozapine-associated GLP-1 dysregulation. Our 24-week randomized, controlled, open-label, pilot trial of once-weekly extended-release subcutaneous exenatide or usual care (CODEX) (n = 28), found exenatide was associated with significantly greater weight loss. We examined whether this effect was maintained at 12-months post-intervention. We followed up CODEX trial participants at 12-months post trial endpoint, collecting information on weight, BMI, waist circumference, blood pressure, fasting glucose, HbA1c, and use of metformin. The primary outcome of interest was change in weight from trial baseline to 12-months post endpoint and trial endpoint to 12-months post endpoint compared between former exenatide and usual care participants. Only HbA1c differed between baseline and 12-months post endpoint between the exenatide and control groups. From endpoint to 12-month follow up there were significantly greater increases among the former exenatide versus former usual care participants for weight, BMI, HbA1c and proportion with >5% weight gain. Stratifying results by whether participants used metformin post trial did not alter proportion with >5% weight gain. Although there were no significant differences in weight and BMI between baseline and 12-month post endpoint, there were significant increases in weight and BMI in the 12 months post endpoint for the former exenatide group. This was irrespective of metformin use and is in keeping with studies of other GLP-1RA agents. Further studies on GLP-1RAs use beyond 24 weeks for people with clozapine associated weight gain are needed.
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Affiliation(s)
- Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, Australia; University of Queensland, School of Medicine, Brisbane, Australia.
| | - A Russell
- University of Queensland, School of Medicine, Brisbane, Australia; Princess Alexandra Hospital, Australia
| | - C Gamble
- Metro South Addiction and Mental Health Service, Brisbane, Australia; Queensland Center for Mental Health Research Brisbane, Qld, Australia
| | - A Baker
- Queensland Center for Mental Health Research Brisbane, Qld, Australia
| | - P Cosgrove
- Queensland Center for Mental Health Research Brisbane, Qld, Australia
| | - L Burton
- Queensland Center for Mental Health Research Brisbane, Qld, Australia
| | - S Kisely
- Metro South Addiction and Mental Health Service, Brisbane, Australia; University of Queensland, School of Medicine, Brisbane, Australia
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14
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Betts KS, Kisely S, Alati R. Predicting common maternal postpartum complications: leveraging health administrative data and machine learning. BJOG 2019; 126:702-709. [DOI: 10.1111/1471-0528.15607] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2018] [Indexed: 12/29/2022]
Affiliation(s)
- KS Betts
- School of Public Health Curtin University Bentley WA Australia
| | - S Kisely
- School of Medicine University of Queensland Brisbane QLD Australia
| | - R Alati
- School of Public Health Curtin University Bentley WA Australia
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15
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Myles N, Myles H, Xia S, Large M, Kisely S, Galletly C, Bird R, Siskind D. Meta-analysis examining the epidemiology of clozapine-associated neutropenia. Acta Psychiatr Scand 2018; 138:101-109. [PMID: 29786829 DOI: 10.1111/acps.12898] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [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] [Accepted: 04/20/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clozapine is associated with life-threatening neutropenia. There are no previous meta-analyses of the epidemiology of clozapine-associated neutropenia. OBJECTIVES To determine the cumulative incidence of mild, moderate and severe neutropenia, incidence of death related to severe neutropenia, case fatality rate of neutropenia and the longitudinal incidence of neutropenia following exposure to clozapine. DATA SOURCES A systematic search of Medline, EMBASE and PsycINFO using search terms [clozapine OR clopine OR zaponex OR clozaril] AND [neutropenia OR agranulocytosis]. METHODS Random effects meta-analysis to determine event rates and longitudinal incidence of events per 100 person-years of exposure. RESULTS A total of 108 studies were included. The incidence of clozapine-associated neutropenia was 3.8% (95% CI: 2.7-5.2%) and severe neutropenia 0.9% (95% CI: 0.7-1.1%). The incidence of death related to neutropenia following prescription of clozapine was 0.013% (95% CI: 0.01-0.017%). The case fatality rate of severe neutropenia was 2.1% (95% CI: 1.6-2.8%). The peak incidence of severe neutropenia occurred at one month of exposure and declined to negligible levels after one year of treatment. CONCLUSION Severe neutropenia associated with clozapine is a rare event and occurs early with a substantial decline in risk after one year of exposure. Death from clozapine-associated neutropenia is extremely rare. Implications for haematological monitoring are discussed.
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Affiliation(s)
- N Myles
- Haematology Directorate, SA Pathology, Adelaide, SA, Australia.,School of Medicine, University of Queensland, St Lucia, Qld, Australia
| | - H Myles
- Country Health, Glenside, SA, Australia.,Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - S Xia
- Prince of Wales Hospital, Randwick, NSW, Australia
| | - M Large
- Prince of Wales Hospital, Randwick, NSW, Australia.,School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
| | - S Kisely
- School of Medicine, University of Queensland, St Lucia, Qld, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - C Galletly
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia.,Northern Adelaide Local Health Network, Adelaide, SA, Australia.,Mental Health, Ramsey Healthcare, Gilberton, SA, Australia
| | - R Bird
- Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.,School of Medicine, Griffith University, Parkwood, Qld, Australia
| | - D Siskind
- School of Medicine, University of Queensland, St Lucia, Qld, Australia.,Metro South Addiction and Mental Health Service, Woolloongabba, Qld, Australia
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16
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Kisely S, Campbell LA, Robertson H, Crossman D, Martin K, Campbell J. Routine measurement of mental health service outcomes: Health of the Nation Outcome Scales in Nova Scotia. Psychiatr bull 2018. [DOI: 10.1192/pb.bp.107.017756] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodAlthough the Health of the Nation Outcome Scales (HoNOS) were designed for routine clinical use, completion rates in clinical settings rarely exceed 60%. We evaluated two initiatives to increase completion rates: timely feedback to clinicians, useful at individual, team and service levels, and improved supporting materials (tabulated glossaries for all versions covering the life-span).ResultsClinicians in South Shore Health district provided ratings on all outpatient referrals over 12 months as part of routine care. Data were captured using the Nova Scotia routine administrative data system. Completion rates rose from 61% to 86% (n=1190). Clinicians' ratings of the instrument's ease of use were significantly improved.Clinical ImplicationsUse of a tabulated glossary and enhanced feedback of clinically useful information improved clinician support for the routine measurement of health outcomes with HoNOS.
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17
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Cockburn N, Pradhan A, Taing MW, Kisely S, Ford PJ. Oral health impacts of medications used to treat mental illness. J Affect Disord 2017; 223:184-193. [PMID: 28759866 DOI: 10.1016/j.jad.2017.07.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many psychotropic medications affect oral health. This review identified oral side effects for antidepressant, antipsychotic, anticonvulsant, antianxiety and sedative drugs that are recommended in Australia for the management of common mental illnesses and provides recommendations to manage these side-effects. METHODS The Australian Therapeutic Guidelines and the Australian Medicines Handbook were searched for medications used to treat common mental health conditions. For each medication, the generic name, class, and drug company reported side-effects were extracted from the online Monthly Index of Medical Specialties (eMIMs) and UpToDate databases. Meyler's Side Effect of Drugs Encyclopaedia was used to identify additional oral adverse reactions to these medications. RESULTS Fifty-seven drugs were identified: 23 antidepressants, 22 antipsychotics or mood stabilisers, and 12 anxiolytic or sedative medications. Xerostomia (91%) the most commonly reported side effect among all classes of medications of the 28 identified symptoms. Other commonly reported adverse effects included dysguesia (65%) for antidepressants, and tardive dyskinesia (94%) or increased salivation (78%) for antipsychotic medications. CONCLUSIONS While xerostomia has often been reported as a common adverse effect of psychotropic drugs, this review has identified additional side effects including dysguesia from antidepressants and tardive dyskinesia and increased salivation from antipsychotics. Clinicians should consider oral consequences of psychotropic medication in addition to other side-effects when prescribing. For antidepressants, this would mean choosing duloxetine, agomelatine and any of the serotonin re-uptake inhibitors except sertraline. In the case of antipsychotics and mood stabilisers, atypical agents have less oral side effects than older alternatives.
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Affiliation(s)
- N Cockburn
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Herston, Brisbane 4006 QLD, Australia.
| | - A Pradhan
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Herston, Brisbane 4006 QLD, Australia
| | - M W Taing
- The University of Queensland, School of Pharmacy, Pharmacy Australia Centre of Excellence, Woolloongabba, Brisbane 4102 QLD, Australia
| | - S Kisely
- The University of Queensland, School of Medicine, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane 4102 QLD, Australia; Dalhouise University, Departments of Psychiatry, Community Health and Epidemiology, Halifax, Nova Scotia, Canada
| | - P J Ford
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Herston, Brisbane 4006 QLD, Australia
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18
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Land R, Siskind D, McArdle P, Kisely S, Winckel K, Hollingworth SA. The impact of clozapine on hospital use: a systematic review and meta-analysis. Acta Psychiatr Scand 2017; 135:296-309. [PMID: 28155220 DOI: 10.1111/acps.12700] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [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] [Accepted: 01/09/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of this study was to perform a systematic review and meta-analysis of studies reporting the impact of clozapine on hospital use in people with a psychotic illness. METHOD PubMed, EMBASE, PsycINFO and the Cochrane Schizophrenia Group Trials Register were systematically searched from inception to 12 October 2016. We included all trials and observational studies, except case reports. RESULTS Thirty-seven studies were included. Clozapine significantly reduced the proportion of people hospitalised compared to control medicines (RR = 0.74; 95% CI: 0.69-0.80, P < 0.001, 22 studies, n = 44 718). There were significantly fewer bed days after clozapine treatment compared to before clozapine treatment in both controlled (MD = -34.41 days; 95% CI: -68.22 to -0.60 days, P = 0.046, n = 162) and uncontrolled studies (MD = -52.86 days; 95% CI: -79.86 days to -25.86 days, P < 0.001, n = 2917). Clozapine and control medicines had a similar time to rehospitalisation (-19.90 days; 95% CI: -62.42 to 22.63 days, P = 0.36). CONCLUSION Clozapine treatment reduced the number of people hospitalised and the number of bed days after treatment compared with before treatment. Clozapine has the potential to reduce acute hospital use among people with treatment refractory schizophrenia.
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Affiliation(s)
- R Land
- School of Pharmacy, University of Queensland, Woolloongabba, Qld, Australia
| | - D Siskind
- School of Medicine, University of Queensland, Herston, Qld, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, Qld, Australia
| | - P McArdle
- School of Medicine, University of Queensland, Herston, Qld, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, Qld, Australia
| | - S Kisely
- School of Medicine, University of Queensland, Herston, Qld, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, Qld, Australia
| | - K Winckel
- School of Pharmacy, University of Queensland, Woolloongabba, Qld, Australia.,Pharmacy Department, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - S A Hollingworth
- School of Pharmacy, University of Queensland, Woolloongabba, Qld, Australia
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19
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Lesage A, Rochette L, Émond V, Pelletier É, St-Laurent D, Diallo FB, Kisely S. A Surveillance System to Monitor Excess Mortality of People With Mental Illness in Canada. Can J Psychiatry 2015; 60:571-9. [PMID: 26720826 PMCID: PMC4679166 DOI: 10.1177/070674371506001208] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Outcome measures are rarely available for surveillance and system performance monitoring for mental disorders and addictions. Our study aims to demonstrate the feasibility and face validity of routinely measuring the mortality gap in the Canadian context at the provincial and regional levels using the methods and data available to the Canadian Chronic Disease Surveillance System (CCDSS) of the Public Health Agency of Canada. METHODS We used longitudinal data from the Quebec Integrated Chronic Disease Surveillance System, which also provides aggregated data to the CCDSS. This includes data from the health insurance registry physician claims and the hospital discharge abstract for all mental disorder diagnoses (International Classification of Diseases [ICD]-9 290-319 or ICD-10 F00-F99). Patients were defined as having had received a mental disorder diagnosis at least once during the year. Life expectancy was measured using Chiang's method for abridged life tables, complemented by the Hsieh method for adjustment of the last age interval. RESULTS We found a lower life expectancy among psychiatric patients of 8 years for men and 5 years for women. For patients with schizophrenia, life expectancy was lowered by 12 years for men and 8 years for women. Cardiovascular disease and cancer were the most common causes of premature death. Findings were consistent across time and regions of the province. Lower estimates of the mortality gap, compared with literature, could be explained by the inclusion of primary care patients and methods. CONCLUSIONS Our study demonstrates the feasibility of using administrative data to measure the impact of current and future mental health plans in Canada provided the techniques can be replicated in other Canadian provinces.
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Affiliation(s)
- Alain Lesage
- Professor, Department of Psychiatry, University of Montreal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec; Invited Psychiatric Expert, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Louis Rochette
- Statistician, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Valérie Émond
- Head, Chronic Disease Surveillance Unit, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Éric Pelletier
- Epidemiologist, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Danielle St-Laurent
- Scientific Director, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Fatoumata Binta Diallo
- Research Coordinator, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec
| | - Stephen Kisely
- Professor, Queensland Centre for Health Data Services, University of Queensland, Brisbane, Australia
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20
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Kisely S, Chang A, Crowe J, Galletly C, Jenkins P, Loi S, Looi JC, Macfarlane MD, McVie N, Parker S, Power B, Siskind D, Smith G, Merry S, Macfarlane S. Getting started in research: systematic reviews and meta-analyses. Australas Psychiatry 2015; 23:16-21. [PMID: 25504401 DOI: 10.1177/1039856214562077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Systematic reviews are one of the major building blocks of evidence-based medicine. This overview is an introduction to conducting systematic reviews and meta-analyses. CONCLUSIONS Systematic reviews and meta-analyses of randomised controlled trials (RCTs) represent the most robust form of design in the hierarchy of research evidence. In addition, primary data do not have to be collected by the researcher him/herself, and there is no need for approval from an ethics committee. Systematic reviews and meta-analyses are not as daunting as they may appear to be, provided the scope is sufficiently narrow and an appropriate supervisor available.
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Affiliation(s)
- Stephen Kisely
- Committee for Research, Royal Australian and New Zealand College of Psychiatrists (RANZCP), Melbourne, VICUniversity of Queensland School of Medicine, Wooloongabba, QLD, Australia
| | - Alice Chang
- Committee for Research, RANZCP, Melbourne, VIC, Australia
| | - Jim Crowe
- Committee for Research, RANZCP, Melbourne, VIC, Australia
| | | | - Peter Jenkins
- Committee for Research, RANZCP, Melbourne, VIC, Australia
| | - Samantha Loi
- Committee for Research, RANZCP, Melbourne, VICAcademic Unit for Psychiatry of Old Age, Saint Vincent's Health, Saint George's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Jeffrey C Looi
- Committee for Research, RANZCP, Melbourne, VICAcademic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra, ACTACT Health Directorate, Mental Health Service, Canberra Hospital, Woden, ACT, Australia
| | - Matthew D Macfarlane
- Committee for Research, RANZCP, Melbourne, VICGraduate School of Medicine, University of Wollongong, Wollongong, NSWIllawarra Shoalhaven Local Health District, NSW, Australia
| | - Ness McVie
- Committee for Research, RANZCP, Melbourne, VIC, Australia
| | - Stephen Parker
- Committee for Research, RANZCP, Melbourne, VIC, Australia
| | - Brian Power
- Committee for Research, RANZCP, Melbourne, VICSchool of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WASouth Metropolitan Area Health Service, Perth, WA, Australia
| | - Dan Siskind
- Committee for Research, RANZCP, Melbourne, VICSchool of Medicine, University of Queensland, Wooloongabba, QLD, Australia
| | - Geoff Smith
- Committee for Research, RANZCP, Melbourne, VICWA Centre for Mental Health Policy Research, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WACentre for Research into Disability and Society, Curtin University, Perth, WA Australia
| | - Sally Merry
- Committee for Research, RANZCP, Melbourne, VIC, AustraliaPsychological Medicine, University of Auckland, Auckland, New Zealand
| | - Stephen Macfarlane
- Committee for Research, RANZCP, Melbourne, VICAged Psychiatry Service, Alfred Health, Caulfield, VIC, Australia
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Abstract
BACKGROUND Deep brain stimulation (DBS) is increasingly being applied to psychiatric conditions such as obsessive-compulsive disorder (OCD), major depression and anorexia nervosa. Double-blind, randomized controlled trials (RCTs) of active versus sham treatment have been limited to small numbers. We therefore undertook a systematic review and meta-analysis of the effectiveness of DBS in psychiatric conditions to maximize study power. METHOD We conducted a systematic literature search for double-blind, RCTs of active versus sham treatment using Pubmed/Medline and EMBASE up to April 2013. Where possible, we combined results from studies in a meta-analysis. We assessed differences in final values between the active and sham treatments for parallel-group studies and compared changes from baseline score for cross-over designs. RESULTS Inclusion criteria were met by five studies, all of which were of OCD. Forty-four subjects provided data for the meta-analysis. The main outcome was a reduction in obsessive symptoms as measured by the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patients on active, as opposed to sham, treatment had a significantly lower mean score [mean difference (MD) -8.93, 95% confidence interval (CI) -13.35 to -5.76, p < 0.001], representing partial remission. However, one-third of patients experienced significant adverse effects (n = 16). There were no differences between the two groups in terms of other outcomes. CONCLUSIONS DBS may show promise for treatment-resistant OCD but there are insufficient randomized controlled data for other psychiatric conditions. DBS remains an experimental treatment in adults for severe, medically refractory conditions until further data are available.
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Affiliation(s)
- S Kisely
- The University of Queensland Rural Clinical School,QLD,Australia
| | - K Hall
- The University of Queensland Rural Clinical School,QLD,Australia
| | - D Siskind
- Metro South Health Service, Woolloongabba, QLD,Australia
| | - J Frater
- Metro South Health Service, Woolloongabba, QLD,Australia
| | - S Olson
- Metro South Health Service, Woolloongabba, QLD,Australia
| | - D Crompton
- Metro South Health Service, Woolloongabba, QLD,Australia
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22
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Crowe E, Pandeya N, Brotherton JML, Dobson AJ, Kisely S, Lambert SB, Whiteman DC. Effectiveness of quadrivalent human papillomavirus vaccine for the prevention of cervical abnormalities: case-control study nested within a population based screening programme in Australia. BMJ 2014; 348:g1458. [PMID: 24594809 PMCID: PMC3942076 DOI: 10.1136/bmj.g1458] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To measure the effectiveness of the quadrivalent human papillomavirus (HPV) vaccine against cervical abnormalities four years after implementation of a nationally funded vaccination programme in Queensland, Australia. DESIGN Case-control analysis of linked administrative health datasets. SETTING Queensland, Australia. PARTICIPANTS Women eligible for free vaccination (aged 12-26 years in 2007) and attending for their first cervical smear test between April 2007 and March 2011. High grade cases were women with histologically confirmed high grade cervical abnormalities (n = 1062) and "other cases" were women with any other abnormality at cytology or histology (n = 10,887). Controls were women with normal cytology (n = 96,404). MAIN OUTCOME MEASURES Exposure odds ratio (ratio of odds of antecedent vaccination (one, two, or three vaccine doses compared with no doses) among cases compared with controls), vaccine effectiveness ((1-adjusted odds ratio) × 100), and number needed to vaccinate to prevent one cervical abnormality at first screening round. We stratified by four age groups adjusted for follow-up time, year of birth, and measures of socioeconomic status and remoteness. The primary analysis concerned women whose first ever smear test defined their status as a case or a control. RESULTS The adjusted odds ratio for exposure to three doses of HPV vaccine compared with no vaccine was 0.54 (95% confidence interval 0.43 to 0.67) for high grade cases and 0.66 (0.62 to 0.70) for other cases compared with controls with normal cytology, equating to vaccine effectiveness of 46% and 34%, respectively. The adjusted numbers needed to vaccinate were 125 (95% confidence interval 97 to 174) and 22 (19 to 25), respectively. The adjusted exposure odds ratios for two vaccine doses were 0.79 (95% confidence interval 0.64 to 0.98) for high grade cases and 0.79 (0.74 to 0.85) for other cases, equating to vaccine effectiveness of 21%. CONCLUSION The quadrivalent HPV vaccine conferred statistically significant protection against cervical abnormalities in young women who had not started screening before the implementation of the vaccination programme in Queensland, Australia.
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Affiliation(s)
- Elizabeth Crowe
- The University of Queensland, School of Population Health, Brisbane, Australia
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23
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Kisely S. EPA-1813 – Does Coercion in the Community Improve Patient Outcomes? Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78930-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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24
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Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ 2013; 346:f2539. [PMID: 23694688 PMCID: PMC3660620 DOI: 10.1136/bmj.f2539] [Citation(s) in RCA: 526] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To examine the mortality experience of psychiatric patients in Western Australia compared with the general population. DESIGN Population based study. SETTING Western Australia, 1985-2005. PARTICIPANTS Psychiatric patients (292,585) registered with mental health services in Western Australia. MAIN OUTCOME MEASURES Trends in life expectancy for psychiatric patients compared with the Western Australian population and causes of excess mortality, including physical health conditions and unnatural causes of death. RESULTS When using active prevalence of disorder (contact with services in previous five years), the life expectancy gap increased from 13.5 to 15.9 years for males and from 10.4 to 12.0 years for females between 1985 and 2005. Additionally, 77.7% of excess deaths were attributed to physical health conditions, including cardiovascular disease (29.9%) and cancer (13.5%). Suicide was the cause of 13.9% of excess deaths. CONCLUSIONS Despite knowledge about excess mortality in people with mental illness, the gap in their life expectancy compared with the general population has widened since 1985. With most excess deaths being due to physical health conditions, public efforts should be directed towards improving physical health to reduce mortality in people with mental illness, in addition to ongoing efforts to prevent suicide.
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Affiliation(s)
- David Lawrence
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, PO Box 855 West Perth WA 6872 Australia.
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Abstract
CONTEXT There is a 30% higher case fatality rate from cancer in psychiatric patients even though their incidence of cancer is no greater than in the general population. The reasons are unclear, but if increased cancer mortality were due to lifestyle only, cancer incidence should be similarly increased. Other hypotheses include delays in presentation, leading to more advanced staging at diagnosis, and difficulties in treatment access following diagnosis. OBJECTIVE To assess why psychiatric patients are no more likely than the general population to develop cancer but are more likely to die of it. DESIGN, SETTING, AND PATIENTS A population-based record-linkage analysis compared psychiatric patients with the Western Australian population, using an inception cohort to calculate rates and hazard ratios. Mental health records were linked with cancer registrations and death records from January 1, 1988, to December 31, 2007, in Western Australia. MAIN OUTCOME MEASURES Metastases, incidence, mortality, and access to cancer interventions. RESULTS There were 6586 new cancers in psychiatric patients. Cancer incidence was lower in psychiatric patients than in the general population in both males (rate ratio = 0.86; 95% CI, 0.82-0.90) and females (rate ratio = 0.92; 95% CI, 0.88-0.96), although mortality was higher (males: rate ratio = 1.52; 95% CI, 1.45-1.60; females: rate ratio = 1.29; 95% CI, 1.22-1.36). The proportion of cancer with metastases at presentation was significantly higher in psychiatric patients (7.1%; 95% CI, 6.5%-7.8%) than in the general population (6.1%; 95% CI, 6.0%-6.2%). Psychiatric patients had a reduced likelihood of surgery (hazard ratio = 0.81; 95% CI, 0.76-0.86), especially resection of colorectal, breast, and cervical cancers. They also received significantly less radiotherapy for breast, colorectal, and uterine cancers and fewer chemotherapy sessions. CONCLUSIONS Although incidence is no higher than in the general population, psychiatric patients are more likely to have metastases at diagnosis and less likely to receive specialized interventions. This may explain their greater case fatality and highlights the need for improved cancer screening and detection.
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Affiliation(s)
- Stephen Kisely
- Griffith Institute for Health and Medical Research, Griffith University, Gold Coast.
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Kisely S, Campbell LA, Cox M. The effect of study design on the reporting of mortality due to colorectal cancer in adults with mental illness in Nova Scotia. Can J Psychiatry 2012; 57:389-94. [PMID: 22682577 DOI: 10.1177/070674371205700609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Some studies suggest a higher case fatality from colorectal cancer (CRC) in psychiatric patients even though the incidence is no greater than in the general population. However, this finding is not universal and may be confounded by study design (for example, inception, compared with historical, cohort), mean cohort age, or delays in presentation with more advanced staging at diagnosis. We assessed how study design and cancer stage at presentation affected outcomes in psychiatric patients. METHODS A retrospective historical cohort of CRC presentations was used comparing psychiatric patients with control subjects. Psychiatric status was defined by either health service use or psychotropic prescription, and outcomes by logistic or Cox proportional hazards regression. RESULTS There were 3501 new presentations of CRC from 2001 to 2005. Psychiatric cases, as defined by in- or outpatient contacts, made up 15.9% (n = 558) of patients with CRC. There was no association between psychiatric status and stage at presentation, surgical intervention, or mortality after adjusting for confounders. There was a reduced likelihood of resection, an indicator of curative treatment, when on a selective serotonin reuptake inhibitor or serotonin noradrenergic reuptake inhibitor (n = 194; AOR 0.54; 95% CI 0.30 to 0.97) or antipsychotics (n = 28; AOR 0.27; 95% CI 0.08 to 0.92). CONCLUSIONS The association between psychiatric status and CRC may vary by study design and how psychiatric status is defined. These factors should be considered when interpreting any association between mental illness and cancer. As in studies of all-cause and cardiac mortality, historical cohorts of prevalent psychiatric cases may be less sensitive than inception cohorts of new patients, possibly because the excess of deaths is greatest within 7 years of initial presentation for a psychiatric disorder.
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Affiliation(s)
- Stephen Kisely
- Queensland Centre for Health Data Services, School of Population Health, The University of Queensland, Herston, Australia.
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Lawrence D, Lawn S, Kisely S, Bates A, Mitrou F, Zubrick SR. The potential impact of smoke-free facilities on smoking cessation in people with mental illness. Aust N Z J Psychiatry 2011; 45:1053-60. [PMID: 22017657 DOI: 10.3109/00048674.2011.619961] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this paper was to estimate the degree to which smoke-free facilities may facilitate smoking cessation in smokers with mental illness by estimating the proportion of smokers with mental illness who receive inpatient treatment, their smoking rates and average durations of stay. METHOD Smoking and hospitalization rates were estimated from the Australian National Survey of Mental Health and Wellbeing. Information on duration of inpatient treatment was calculated from the Western Australian Mental Health Information System. RESULTS Of Australia's estimated 3,567,000 current adult smokers, 32.4% had a mental illness in the past 12 months, and 66.6% had a lifetime mental illness. However, only 1.4% of smokers were hospitalized for a mental health problem in the past 12 months, and 6.3% had ever been hospitalized for a mental health problem. Of those hospitalized for mental health treatment in the past 12 months, 61.2% were current smokers. In 2007 median duration of inpatient mental health admissions was 1 day, and 57% of admissions had duration of 2 days or less. CONCLUSIONS The majority of smokers with mental illness are not treated in inpatient facilities, and where inpatient admissions occur they are generally of short duration. While smoking cessation is an important goal in treatment of smokers with mental illness, support after discharge from inpatient care is important for longer term cessation. Other strategies will be required to support smoking cessation efforts for the majority of smokers with mental illness not in contact with mental health services.
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Affiliation(s)
- David Lawrence
- Centre for Child Health Research, The University of Western Australia, Telethon Institute for Child Health Research, PO Box 855, West Perth, Western Australia 6872, Australia.
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Campbell LA, Jackson L, Bassett R, Bowes MJ, Donahue M, Cartwright J, Kisely S. Can we use medical examiners’ records for suicide surveillance and prevention research in Nova Scotia? ACTA ACUST UNITED AC 2011. [DOI: 10.24095/hpcdp.31.4.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction
Medical examiners’ records can contribute to our understanding of the extent of suicide in a population, as well as associated sociodemographic and other factors.
Methods
Using a mixed methods approach, the key objective of this pilot study was to determine the sources and types of information found in the Nova Scotia Medical Examiner Service (NSMES) records that might inform suicide surveillance and targeted prevention efforts. A secondary objective was to describe the one-year cohort of 108 individuals who died by suicide in 2006 in terms of available sociodemographic information and health care use in the year prior to death.
Results
Data extraction revealed inconsistencies both across and within files in terms of the types and amounts of sociodemographic and other data collected, preventing correlational analyses. However, linkage of the records to administrative databases revealed frequent health care use in the month prior to death.
Conclusion
The introduction of systematic data collection to NSMES investigations may yield a comprehensive dataset useful for policy development and population level research.
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Affiliation(s)
- LA Campbell
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Capital District Health Authority, Halifax, Nova Scotia, Canada
| | - L Jackson
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
- Atlantic Health Promotion Research Centre Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Bassett
- Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
| | - MJ Bowes
- Nova Scotia Medical Examiner Service, Halifax, Nova Scotia, Canada
| | - M Donahue
- Capital District Health Authority, Halifax, Nova Scotia, Canada
| | - J Cartwright
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Kisely
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Health LinQ, University of Queensland, Queensland, Australia
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Campbell LA, Jackson L, Bassett R, Bowes MJ, Donahue M, Cartwright J, Kisely S. Can we use medical examiners' records for suicide surveillance and prevention research in Nova Scotia? Chronic Dis Inj Can 2011; 31:165-171. [PMID: 21978640] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Medical examiners' records can contribute to our understanding of the extent of suicide in a population, as well as associated sociodemographic and other factors. METHODS Using a mixed methods approach, the key objective of this pilot study was to determine the sources and types of information found in the Nova Scotia Medical Examiner Service (NSMES) records that might inform suicide surveillance and targeted prevention efforts. A secondary objective was to describe the one-year cohort of 108 individuals who died by suicide in 2006 in terms of available sociodemographic information and health care use in the year prior to death. RESULTS Data extraction revealed inconsistencies both across and within files in terms of the types and amounts of sociodemographic and other data collected, preventing correlational analyses. However, linkage of the records to administrative databases revealed frequent health care use in the month prior to death. CONCLUSION The introduction of systematic data collection to NSMES investigations may yield a comprehensive dataset useful for policy development and population level research.
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Affiliation(s)
- L A Campbell
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Abstract
OBJECTIVES Papers using qualitative methods are increasingly common in psychiatric journals. This overview is an introduction to critically appraising a qualitative paper for clinicians who are more familiar with quantitative methods. CONCLUSIONS Qualitative research uses data from interviews (semi-structured or unstructured), focus groups, observations or written materials. Data analysis is inductive, allowing meaning to emerge from the data, rather than the more deductive, hypothesis centred approach of quantitative research. This overview compares and contrasts quantitative and qualitative research methods. Quantitative concepts such as reliability, validity, statistical power, bias and generalisability have qualitative equivalents. These include triangulation, trustworthiness, saturation, reflexivity and applicability. Reflexivity also shares features of transference. Qualitative approaches include: ethnography, action-assessment, grounded theory, case studies and mixed methods. Qualitative research can complement quantitative approaches. An understanding of both is useful in critically appraising the psychiatric literature.
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Affiliation(s)
- Stephen Kisely
- Health LinQ, University of Queensland, Brisbane, QLD, Australia.
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Langille D, Asbridge M, Kisely S. P2-S1.04 Associations of symptoms of depression with multiple sexual risk behaviours in Nova Scotia adolescents. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kisely S, Campbell LA, Cartwright J, Bowes MJ, Jackson L. Factors associated with not seeking professional help or disclosing intent prior to suicide: a study of medical examiners' records in Nova Scotia. Can J Psychiatry 2011; 56:436-40. [PMID: 21835107 DOI: 10.1177/070674371105600707] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Individual-level data from clinical settings lack information on people who did not seek professional help prior to suicide. We used records of the Nova Scotia Medical Examiner Service (NSMES) to compare people who had contact with a health professional prior to suicide with those who did not. METHOD We linked data from the NSMES to routine administrative data of the province. RESULTS The NSMES recorded 108 suicides in Nova Scotia from January 1, 2006, to December 31, 2006; there were 90 male and 18 female suicide deaths. Mean and median age at death were 44.73 (SD 13.33) and 44 years, respectively. Patients aged 40 to 49 years made up one-third of the cases (n = 35) and this was the decade of life with the highest number of suicides. This was also the group least likely to have suicidal intent recorded in the NSMES files (χ(2) = 3.86, df = 1, P = 0.05). Otherwise, there were no significant differences between people who sought help, or disclosed intent, prior to suicide and people who did not. The samples in all cases were predominately male and single. CONCLUSIONS People aged 40 to 49 years were the age group with the highest absolute number of suicides, but were the least likely to have suicidal intent recorded in the NSMES files. This finding merits further investigation. Medical examiner or coroner data may provide additional information not obtained elsewhere for the surveillance of suicide.
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Affiliation(s)
- Stephen Kisely
- Queensland Centre for Health Data Services, University of Queensland, Brisbane, Australia.
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Russell MW, Campbell LA, Kisely S, Persaud D. The development of community health indicators: a district-wide approach. Chronic Dis Can 2011; 31:65-70. [PMID: 21466756] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION In response to high rates of chronic disease, the Capital District Health Authority in Nova Scotia recognized a need to move from a focus on acute care in decision making to one that also values a population health approach guided by community health indicators. METHODS Stakeholders were surveyed on the choice, knowledge and utility of selected indicators. RESULTS Respondents reported high scores for changes in their knowledge and attitude regarding community health indicators, and identified priority indicators for action.Decision makers' use of community health indicators was increased by stakeholder involvement, supporting evidence in plain language, and wide dissemination.
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Affiliation(s)
- M W Russell
- Community Health, Capital Health, Halifax, Nova Scotia, Canada.
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Abstract
OBJECTIVE to investigate the burden of excess mortality among people with mental illness in developed countries, how it is distributed, and whether it has changed over time. METHOD we conducted a systematic search of MEDLINE, restricting our attention to peer-reviewed studies and reviews published in English relating to mortality and mental illness. Because of the large number of studies that have been undertaken during the last 30 years, we have selected a representative cross-section of studies for inclusion in our review. RESULTS there is substantial excess mortality in people with mental illness for almost all psychiatric disorders and all main causes of death. Consistently elevated rates have been observed across settings and over time. The highest numbers of excess deaths are due to cardiovascular and respiratory diseases. With life expectancy increasing in the general population, the disparity in mortality outcomes for people with mental illness is increasing. CONCLUSIONS without the development of alternative approaches to promoting and treating the physical health of people with mental illness, it is possible that the disparity in mortality outcomes will persist.
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Affiliation(s)
- David Lawrence
- Centre for Developmental Health, Curtin University of Technology and Telethon Institute for Child Health Research, Perth, Australia.
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Affiliation(s)
- Stephen Kisely
- Professor and Director, The University of Queensland, Health LinQ: The Queensland Centre for Health Data Services, Brisbane, Australia; Professor, Department of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia
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Abstract
There are many factors that contribute to the poor physical health of people with severe mental illness (SMI), including lifestyle factors and medication side effects. However, there is increasing evidence that disparities in healthcare provision contribute to poor physical health outcomes. These inequalities have been attributed to a combination of factors including systemic issues, such as the separation of mental health services from other medical services, healthcare provider issues including the pervasive stigma associated with mental illness, and consequences of mental illness and side effects of its treatment. A number of solutions have been proposed. To tackle systemic barriers to healthcare provision integrated care models could be employed including co-location of physical and mental health services or the use of case managers or other staff to undertake a co-ordination or liaison role between services. The health care sector could be targeted for programmes aimed at reducing the stigma of mental illness. The cognitive deficits and other consequences of SMI could be addressed through the provision of healthcare skills training to people with SMI or by the use of peer supporters. Population health and health promotion approaches could be developed and targeted at this population, by integrating health promotion activities across domains of interest. To date there have only been small-scale trials to evaluate these ideas suggesting that a range of models may have benefit. More work is needed to build the evidence base in this area.
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Affiliation(s)
- David Lawrence
- Centre for Developmental Health, Curtin Health Innovation Research Institute, Telethon Institute for Child Health Research, Perth, Western Australia, Australia.
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Kisely S, Campbell LA, Peddle S, Hare S, Pyche M, Spicer D, Moore B. A controlled before-and-after evaluation of a mobile crisis partnership between mental health and police services in Nova Scotia. Can J Psychiatry 2010; 55:662-8. [PMID: 20964945 DOI: 10.1177/070674371005501005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Police are often the front-line response to people experiencing mental health crises. This study examined the impact of an integrated mobile crisis team formed in partnership between mental health services, municipal police, and emergency health services. The service offered short-term crisis management, with mobile interventions being attended by a plainclothes police officer and a mental health professional. METHODS We used a mixed-methods design encompassing: a controlled before-and-after quantitative comparison of the intervention area with a control area without access to such a service, for 1 year before and 2 years after program implementation; and qualitative assessments of the views of service recipients, families, police officers, and health staff at baseline and 2 years afterward. RESULTS The integrated service resulted in increased use by people in crisis, families, and service partners (for example, from 464 to 1666 service recipients per year). Despite increased service use, time spent on-scene and call-to-door time were reduced. At year 2, the time spent on-scene by police (136 minutes) was significantly lower than in the control area (165 minutes) (Student t test = 3.4, df = 1649, P < 0.001). After adjusting for confounders, people seen by the integrated team (n = 295) showed greater engagement than control subjects as measured by outpatient contacts (b = 1.3, chi square = 92.7, df = 1, P < 0.001). The service data findings were supported by the qualitative results of focus groups and interviews. CONCLUSIONS Partnerships between the police department and mental health system can improve collaboration, efficiency, and the treatment of people with mental illness.
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Affiliation(s)
- Stephen Kisely
- University of Queensland, Health LinQ, Brisbane, Australia
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Campbell LA, Kisely S. Prescribing preferred medications improves adherence in people with severe mental illness. Evidence-Based Mental Health 2010. [DOI: 10.1136/ebmh1089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVE Among mental health outcome measures that have been developed for routine use, most of the information concerns the Health of the Nation Outcome Scales (HoNOS). This instrument is widely used in Europe, Australia, and New Zealand, but not in Canada. We tested its sensitivity and predictive validity under conditions that would resemble, as closely as possible, routine use. METHOD Treating clinicians were asked to assess patients of all ages referred to outpatient mental health facilities of 2 district health authorities in Nova Scotia using either the HoNOS for adults or the HoNOS for Children and Adolescents (HoNOSCA). Data were entered using the existing routine administrative data system. RESULTS We obtained at least 1 rating on 4620 patients, giving a completion rate of 82%. On follow-up, ratings for the global score and most of the individual items were sensitive to change (n = 808). After adjusting for confounders, a baseline HoNOS score was significantly associated with subsequent in and outpatient service use including admissions, bed days, and psychiatric contacts (n = 1359). CONCLUSIONS HoNOS has satisfactory sensitivity and predictive validity for routine use. We could introduce the adult version and HoNOSCA simultaneously and collect data using routine databases. Given the widespread routine use of HoNOS internationally, using the same outcome measure in Canada would enable comparisons of illness severity and outcomes between jurisdictions.
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Affiliation(s)
- Stephen Kisely
- Professor and Director, University of Queensland, Queensland Centre for Health Data Services, Australia
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Abbass A, Kisely S, Kroenke K. Short-term psychodynamic psychotherapy for somatic disorders. Systematic review and meta-analysis of clinical trials. Psychother Psychosom 2009; 78:265-74. [PMID: 19602915 DOI: 10.1159/000228247] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 07/18/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Somatic symptom disorders are common, disabling and costly. Individually provided short-term psychodynamic psychotherapies (STPP) have shown promising results. However, the effectiveness of STPP for somatic symptom disorders has not been reviewed. METHODS We undertook a systematic review of randomized controlled trials and controlled before and after studies. The outcomes included psychological symptoms, physical symptoms, social-occupational function, healthcare utilization and treatment continuation. RESULTS A total of 23 studies met the inclusion criteria and covered a broad range of somatic disorders. Thirteen were RCTs and 10 were case series with pre-post outcome assessment. Of the included studies, 21/23 (91.3%), 11/12 (91.6%), 16/19 (76.2%) and 7/9 (77.8%) reported significant or possible effects on physical symptoms, psychological symptoms, social-occupational function and healthcare utilization respectively. Meta-analysis was possible for 14 studies and revealed significant effects on physical symptoms, psychiatric symptoms and social adjustment which were maintained in long-term follow-up. Random-effect modeling attenuated some of these relationships. There was a 54% greater treatment retention in the STPP group versus controls. CONCLUSION STPP may be effective for a range of medical and physical conditions underscoring the role of patients' emotional adjustment in overall health. Future research should include high-quality randomized and clinical effectiveness studies with attention to healthcare use and costs.
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Affiliation(s)
- Allan Abbass
- Department of Psychiatry, Centre for Emotions and Health, Dalhousie University, Halifax, NS, Canada.
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Uman LS, Chambers CT, McGrath PJ, Kisely S, Matthews D, Hayton K. Assessing the quality of randomized controlled trials examining psychological interventions for pediatric procedural pain: recommendations for quality improvement. J Pediatr Psychol 2009; 35:693-703. [PMID: 19966314 DOI: 10.1093/jpepsy/jsp104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Systematic reviews of randomized controlled trials (RCTs) support the efficacy of psychological interventions for procedural pain management. However, methodological limitations (e.g., inadequate randomization) have affected the quality of this research, thereby weakening RCT findings. METHODS Detailed quality coding was conducted on 28 RCTs included in a systematic review of psychological interventions for pediatric procedural pain. RESULTS The majority of RCTs were of poor to low quality (criteria reported in <50% of RCTs). Commonly reported criteria addressed study background, conditions, statistical analyses, and interpretation of results. Commonly nonreported criteria included treatment administration, evaluation of treatment efficacy (effect sizes, summary statistics, intention-to-treat analyses), caregiver demographics, follow-up, and participant flow. Quality was greater in more recent trials, and did not vary by journal type (psychology vs. medical). CONCLUSION Despite poor quality ratings, quality reporting in psychological RCTs for pediatric procedural pain has improved over time. Recommendations for quality enhancement are provided.
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Affiliation(s)
- Lindsay S Uman
- Centre for Pediatric Pain Research (West), 8th Floor Children's Site (K8536), IWK Health Centre, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8.
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Abstract
BACKGROUND Most data on the quality of vascular care for individuals with psychiatric conditions come from countries without universal healthcare. AIMS To investigate the treatment of people with psychosis admitted for ischaemic heart disease or stroke under universal healthcare. METHOD A population-based study of administrative data comparing Canadians with and without a history of schizophrenia or related psychosis (n = 65,039). RESULTS Of 49 248 admissions for ischaemic heart disease, 1285 had a history of psychosis. Despite a higher 1-year mortality, they were less likely to receive guideline-consistent treatment: e.g. coronary artery bypass grafting (adjusted odds ratio (OR) = 0.35, 95% CI 0.25-0.48), beta-blockers (adjusted OR = 0.82, 95% CI 0.71-0.95) and statins (adjusted OR = 0.51, 95% CI 0.41-0.63). Of 15 791 admissions for stroke, 594 had a history of psychosis. Despite higher 1-year mortality rates, they were less likely to receive cerebrovascular arteriography or warfarin. CONCLUSIONS People with a history of psychosis do not receive equitable levels of vascular care under universal healthcare.
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Affiliation(s)
- Stephen Kisely
- Queensland Centre for Health Data Services, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia.
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Abstract
OBJECTIVE There is increasing interest in the use of administrative data for surveillance and research in Australia. The purpose of the present study was to evaluate the usefulness of such data for the surveillance of mood and anxiety disorder using databases from the following Canadian provinces: British Columbia, Ontario, Quebec and Nova Scotia. METHOD A population-based record-linkage analysis was done using data from physician billings and hospital discharge abstracts, and community-based clinics using a case definition of ICD-9 diagnoses of 296.0-296.9, 311.0, and 300.0-300.9. RESULTS The prevalence of treated mood and/or anxiety disorder was similar in Nova Scotia, British Columbia, and Ontario at approximately 10%. The prevalence for Quebec was slightly lower at 8%. Findings from the provinces showed consistency across age and sex despite variations in data coding. Women tended to show a higher prevalence overall of mood and anxiety disorder than men. There was considerably more variation, however, when treated anxiety (300.0-300.9) and mood disorders (296.0-296.9, 311.0) were considered separately. Prevalence increased steadily to middle age, declining in the 50s and 60s, and then increased after 70 years of age. CONCLUSIONS Administrative data can provide a useful, reliable and economical source of information for the surveillance of treated mood and/or anxiety disorder. Due to the lack of specificity, however, in the diagnoses and data capture, it may be difficult to conduct surveillance of mood and anxiety disorders as separate entities. These findings may have implications for the surveillance of mood and anxiety disorders in Australia with the development of a national network for the extraction, linkage and analysis of administrative data.
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Affiliation(s)
- Stephen Kisely
- University of Queensland, St Lucia, Brisbane, Qld 4072, Australia.
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Kisely S, Lin E, Lesage A, Gilbert C, Smith M, Campbell LA, Vasiliadis HM. Use of administrative data for the surveillance of mental disorders in 5 provinces. Can J Psychiatry 2009; 54:571-5. [PMID: 19726010 DOI: 10.1177/070674370905400810] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the usefulness of administrative data for the surveillance of mental illness in Canada using databases in the following 5 provinces: British Columbia, Ontario, Quebec, Nova Scotia, and Alberta. METHOD We used a population-based record-linkage analysis with data from physician billings, hospital discharge abstracts, and community-based clinics. The following diagnostic codes from the International Classification of Diseases, Ninth Edition, were used to define cases: 290 to 319, inclusive. RESULTS The prevalence of treated psychiatric disorder was similar in Nova Scotia, British Columbia, Alberta, and Ontario at about 15%. The prevalence for Quebec was slightly lower at 12%. Findings from the provinces showed remarkable consistency across age and sex, despite variations in data coding. Women tended to show a higher prevalence overall of treated mental disorders than men. Prevalence increased steadily to middle age, declining in the 50s and 60s, and then increasing again after age 70 years. CONCLUSIONS Provincial and territorial administrative data can provide a useful, reliable, and economical source of information for the surveillance of treated mental disorders. Such a surveillance system can provide longitudinal data at little cost to support health service provision and planning.
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Affiliation(s)
- Stephen Kisely
- Queensland Centre for Health Data Services, University of Queensland, Brisbane, Australia.
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Abstract
OBJECTIVES This paper describes the experience and evaluation of a shared care project targeted at marginalized individuals living in the North End of Halifax, Nova Scotia. This population has high rates of psychiatric disorder, often comorbid with chronic medical conditions, and people have difficulty in obtaining the help they need. This primary care liaison service covers all ages and includes outreach to emergency shelters, transitional housing and drop-in centres. Collaborative care improved access, satisfaction and outcomes for marginalized individuals in urban settings. Primary care providers with access to the service reported greater comfort in dealing with mental health problems, and satisfaction with collaborative care, as well as mental health services in general. Results were significantly better than those of control practices when such data were available. The median wait time was 6 days in comparison with 39.5 days for the comparison site. CONCLUSIONS This model can complement other initiatives to improve the health of marginalized populations, and may be relevant to Australia.
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Affiliation(s)
- Stephen Kisely
- School of Medicine, Griffith University, Meadowbrook, QLD, Australia.
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Kisely S, Cox M, Campbell LA, Cooke C, Gardner D. An epidemiologic study of psychotropic medication and obesity-related chronic illnesses in older psychiatric patients. Can J Psychiatry 2009; 54:269-74. [PMID: 19321033 DOI: 10.1177/070674370905400408] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Adverse effects from medication vary with age. Weight gain with several psychotropics is well known in adults but less information is available related to extent and complications of psychotropic-induced weight gain in older psychiatric patients. We determined the relative incidence of 2 obesity-related conditions (diabetes and hypertension) in older psychiatric patients receiving antipsychotics, antidepressants, and mood stabilizers. METHOD A population-based case-control study of all psychiatric patients aged 67 years or older in contact with either specialist services or primary care using administrative data from Nova Scotia. RESULTS We identified incident cases of diabetes (n = 608) and of hypertension (n = 1056), as well as an equal number of control subjects for each condition. Amitryptiline, selective serotonin reuptake inhibitors (SSRIs), and olanzapine were associated with an increased risk of presenting with hypertension 6 months after initial prescription. By contrast, conventional antipsychotics were associated with a reduced incidence of hypertension. Olanzapine was also significantly associated with diabetes after 6 months (OR adj = 2.58, 95% CI 1.12 to 5.92). The findings for SSRIs and olanzapine remained significant after adjusting for potential confounders such as sociodemographic characteristics, schizophrenia, beta blockers, thiazide diuretics, and corticosteroids. CONCLUSIONS Our results suggest that the association of psychotropics and 2 obesity-related conditions, hypertension and diabetes, applies to older psychiatric patients as well as younger populations. Within drug classes, there are drugs that have a greater association than others, and this may be a factor when choosing a specific agent.
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Affiliation(s)
- Stephen Kisely
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Abstract
OBJECTIVE The goal of this study was to determine whether the introduction of community treatment orders, which allow for conditional release from a psychiatric hospital, reduced inpatient episode durations in Western Australia by providing an alternative to extended inpatient stays. METHODS The design compared 129 persons given community treatment orders and 117 matched control patients without such orders-all of whom were hospitalized during the same period both before and after the introduction of the community treatment order law that allows for conditional release. A multivariate analysis of covariance was used to evaluate the impact of community treatment orders on change in inpatient episode duration. RESULTS The model showed a significant effect on inpatient episode duration (R(2)=.23, adjusted R(2)=.17, N=243, F=3.99, df=17 and 226, p<.001), indicating that community treatment orders (after taking all control factors into account) enabled a 19.16-day reduction per episode of inpatient care (t=2.13, df=1, p=.034) for persons given conditional release. Community-initiated treatment orders intended to prevent hospitalization, yet failing to do so, were associated with increased duration of subsequent hospitalizations (35.18 days; t=-3.36, df=1, p<.001). CONCLUSIONS Community treatment orders can be a useful tool for some but not necessarily all objectives. In the form of conditional release, orders reduce the likelihood of extended hospital stays. As a means to prevent hospitalization, the utility of community treatment orders is more complex, being dependent on services provided and on the judicious selection of persons for these orders.
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Affiliation(s)
- Steven P Segal
- School of Social Welfare, University of California, 120 Haviland Hall (MC 7400), Berkeley, CA 94720-7400, USA.
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Kisely S. Applying the lessons of tobacco and alcohol control to cannabis. Can J Psychiatry 2008; 53:799. [PMID: 19087477 DOI: 10.1177/070674370805301205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen Kisely
- School of Medicine, Griffith University, Meadowbrook, Queensland, Australia.
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Affiliation(s)
- Stephen Kisely
- School of Medicine, Griffith University, Meadowbrook, Queensland, Australia.
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Abstract
BACKGROUND Little is known about social anxiety in MS. OBJECTIVE We estimated the prevalence of social anxiety symptoms and their association with demographic and clinical features in a clinic-attending sample of patients with MS. METHODS Patients attending the Dalhousie MS Research Unit for regularly scheduled visits completed the Social Phobia Inventory (SPIN), the Hospital Anxiety and Depression Scale (HADS), and the Health Utilities Index (HUI). Neurological disability was determined by ratings on the Expanded Disability Status Scale (EDSS). RESULTS A total of 251 patients completed self-report scales of anxiety and depression symptoms. In all, 245 (98%) provided sufficient data for analysis. In all, 30.6% (n=75) had clinically significant social anxiety symptoms as defined by a SPIN threshold score of 19. Half of those with social anxiety had general anxiety (HADSA>or=11) and a quarter had depression (HADSD>or=11). Severity of social anxiety symptoms was associated with reduced health-related quality of life and not related to neurological disability. CONCLUSIONS Social anxiety symptoms are common in persons with MS, contribute to overall morbidity, but are unrelated to the overall severity of neurologic disability. Greater awareness and routine systematic inquiry of social anxiety symptoms is an important component of comprehensive care for persons with MS.
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Affiliation(s)
- K Poder
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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