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Clinical outcomes of deep brain stimulation for obsessive-compulsive disorder: Insight as a predictor of symptom changes. Psychiatry Clin Neurosci 2024; 78:131-141. [PMID: 37984432 PMCID: PMC10952286 DOI: 10.1111/pcn.13619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/18/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
AIM Deep brain stimulation (DBS) is a safe and effective treatment option for people with refractory obsessive-compulsive disorder (OCD). Yet our understanding of predictors of response and prognostic factors remains rudimentary, and long-term comprehensive follow-ups are lacking. We aim to investigate the efficacy of DBS therapy for OCD patients, and predictors of clinical response. METHODS Eight OCD participants underwent DBS stimulation of the nucleus accumbens (NAc) in an open-label longitudinal trial, duration of follow-up varied between 9 months and 7 years. Post-operative care involved comprehensive fine tuning of stimulation parameters and adjunct multidisciplinary therapy. RESULTS Six participants achieved clinical response (35% improvement in obsessions and compulsions on the Yale Brown Obsessive Compulsive Scale (YBOCS)) within 6-9 weeks, response was maintained at last follow up. On average, the YBOCS improved by 45% at last follow up. Mixed linear modeling elucidated directionality of symptom changes: insight into symptoms strongly predicted (P = 0.008) changes in symptom severity during DBS therapy, likely driven by initial changes in depression and anxiety. Precise localization of DBS leads demonstrated that responders most often had their leads (and active contacts) placed dorsal compared to non-responders, relative to the Nac. CONCLUSION The clinical efficacy of DBS for OCD is demonstrated, and mediators of changes in symptoms are proposed. The symptom improvements within this cohort should be seen within the context of the adjunct psychological and biopsychosocial care that implemented a shared decision-making approach, with flexible iterative DBS programming. Further research should explore the utility of insight as a clinical correlate of response. The trial was prospectively registered with the ANZCTR (ACTRN12612001142820).
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Diagnostic agreement and concordance between consultation-liaison psychiatry and non-psychiatric (medical and surgical) doctors: changes within junior doctor's terms. Australas Psychiatry 2022; 30:60-63. [PMID: 35086341 DOI: 10.1177/10398562211037338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate whether diagnostic agreement and concordance between non-psychiatric (medical and surgical) doctors and consultation-liaison psychiatry changes within junior doctors' terms. METHOD This was a retrospective cohort analysis of referrals from medical and surgical units to a consultation-liaison psychiatry service. Diagnostic agreement was calculated across all diagnoses and expressed as a percentage. Diagnostic concordance (expressed using Cohen's Kappa) was calculated for the two most common diagnoses of depression and delirium. Diagnostic agreement and concordance in the first two weeks (Timepoint A) were compared to those in the last two weeks (Timepoint B) of junior doctors' terms. RESULTS Around half the referrals (Timepoint A = 48.1%, Timepoint B = 54.0%) were excluded as no diagnosis was listed.Diagnostic agreement over all diagnoses was 31.7% (Timepoint A) and 29.9% (Timepoint B) and was not statistically different. Diagnostic concordance for depression increased from fair to moderate but was not statistically significant. Diagnostic concordance for delirium was substantial for both timepoints and were not statistically different. CONCLUSIONS No statistically significant change in diagnostic accuracy over a junior doctors' term was found in this study.
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How has the COVID pandemic affected functional neurological disorder? A mixed-methods analysis. Gen Hosp Psychiatry 2021; 69:129-130. [PMID: 33451858 PMCID: PMC7959885 DOI: 10.1016/j.genhosppsych.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022]
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Ictal cerebral blood flow in psychogenic non-epileptic seizures: a preliminary SPECT study. J Neurol Neurosurg Psychiatry 2019; 90:1378-1380. [PMID: 31040173 DOI: 10.1136/jnnp-2018-320173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 11/03/2022]
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Inter- and intra-rater variability of testing velocity when assessing lower limb spasticity. J Rehabil Med 2019; 51:54-60. [DOI: 10.2340/16501977-2496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
INTRODUCTION Schizophrenia is increasingly conceived as a disorder of brain network connectivity and organization. However, reports of network abnormalities during the early illness stage of psychosis are mixed. This study adopted a data-driven whole-brain approach to investigate functional connectivity and network architecture in a first-episode psychosis cohort relative to healthy controls and whether functional network properties changed abnormally over a 12-month period in first-episode psychosis. METHODS Resting-state functional connectivity was performed at two time points. At baseline, 29 first-episode psychosis individuals and 30 healthy controls were assessed, and at 12 months, 14 first-episode psychosis individuals and 20 healthy controls completed follow-up. Whole-brain resting-state functional connectivity networks were mapped for each individual and analyzed using graph theory to investigate whether network abnormalities associated with first-episode psychosis were evident and whether functional network properties changed abnormally over 12 months relative to controls. RESULTS This study found no evidence of abnormal resting-state functional connectivity or topology in first-episode psychosis individuals relative to healthy controls at baseline or at 12-months follow-up. Furthermore, longitudinal changes in network properties over a 12-month period did not significantly differ between first-episode psychosis individuals and healthy control. Network measures did not significantly correlate with symptomatology, duration of illness or antipsychotic medication. CONCLUSIONS This is the first study to show unaffected resting-state functional connectivity and topology in the early psychosis stage of illness. In light of previous literature, this suggests that a subgroup of first-episode psychosis individuals who have a neurotypical resting-state functional connectivity and topology may exist. Our preliminary longitudinal analyses indicate that there also does not appear to be deterioration in these network properties over a 12-month period. Future research in a larger sample is necessary to confirm our longitudinal findings.
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Deep brain stimulation in obsessive-compulsive disorder. Aust N Z J Psychiatry 2018; 52:716-717. [PMID: 29565177 DOI: 10.1177/0004867418764306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
BACKGROUND White matter disruptions in schizophrenia have been widely reported, but it remains unclear whether these abnormalities differ between illness stages. We mapped the connectome in patients with recently diagnosed and chronic schizophrenia and investigated the extent and overlap of white matter connectivity disruptions between these illness stages. METHODS Diffusion-weighted magnetic resonance images were acquired in recent-onset (n = 19) and chronic patients (n = 45) with schizophrenia, as well as age-matched controls (n = 87). Whole-brain fiber tracking was performed to quantify the strength of white matter connections. Connections were tested for significant streamline count reductions in recent-onset and chronic groups, relative to separate age-matched controls. Permutation tests were used to assess whether disrupted connections significantly overlapped between chronic and recent-onset patients. Linear regression was performed to test whether connectivity was strongest in controls, weakest in chronic patients, and midway between these extremities in recent-onset patients (controls > recent-onset > chronic). RESULTS Compared with controls, chronic patients displayed a widespread network of connectivity disruptions (p < 0.01). In contrast, connectivity reductions were circumscribed to the anterior fibers of the corpus callosum in recent-onset patients (p < 0.01). A significant proportion of disrupted connections in recent-onset patients (86%) coincided with disrupted connections in chronic patients (p < 0.01). Linear regression revealed that chronic patients displayed reduced connectivity relative to controls, while recent-onset patients showed an intermediate reduction compared with chronic patients (p < 0.01). CONCLUSIONS Connectome pathology in recent-onset patients with schizophrenia is confined to select tracts within a more extensive network of white matter connectivity disruptions found in chronic illness. These findings may suggest a trajectory of progressive deterioration of connectivity in schizophrenia.
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PET imaging of putative microglial activation in individuals at ultra-high risk for psychosis, recently diagnosed and chronically ill with schizophrenia. Transl Psychiatry 2017; 7:e1225. [PMID: 28850113 PMCID: PMC5611755 DOI: 10.1038/tp.2017.193] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 06/23/2017] [Indexed: 01/22/2023] Open
Abstract
We examined putative microglial activation as a function of illness course in schizophrenia. Microglial activity was quantified using [11C](R)-(1-[2-chrorophynyl]-N-methyl-N-[1-methylpropyl]-3 isoquinoline carboxamide (11C-(R)-PK11195) positron emission tomography (PET) in: (i) 10 individuals at ultra-high risk (UHR) of psychosis; (ii) 18 patients recently diagnosed with schizophrenia; (iii) 15 patients chronically ill with schizophrenia; and, (iv) 27 age-matched healthy controls. Regional-binding potential (BPND) was calculated using the simplified reference-tissue model with four alternative reference inputs. The UHR, recent-onset and chronic patient groups were compared to age-matched healthy control groups to examine between-group BPND differences in 6 regions: dorsal frontal, orbital frontal, anterior cingulate, medial temporal, thalamus and insula. Correlation analysis tested for BPND associations with gray matter volume, peripheral cytokines and clinical variables. The null hypothesis of equality in BPND between patients (UHR, recent-onset and chronic) and respective healthy control groups (younger and older) was not rejected for any group comparison or region. Across all subjects, BPND was positively correlated to age in the thalamus (r=0.43, P=0.008, false discovery rate). No correlations with regional gray matter, peripheral cytokine levels or clinical symptoms were detected. We therefore found no evidence of microglial activation in groups of individuals at high risk, recently diagnosed or chronically ill with schizophrenia. While the possibility of 11C-(R)-PK11195-binding differences in certain patient subgroups remains, the patient cohorts in our study, who also displayed normal peripheral cytokine profiles, do not substantiate the assumption of microglial activation in schizophrenia as a regular and defining feature, as measured by 11C-(R)-PK11195 BPND.
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Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury. Spinal Cord 2017; 55:743-752. [DOI: 10.1038/sc.2017.24] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 11/09/2022]
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Stroke Rehab Down Under: Can Rupert Murdoch, Crocodile Dundee, and an Aboriginal Elder Expect the Same Services and Care? Top Stroke Rehabil 2015. [DOI: 10.1310/tsr1601-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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The effectiveness of therapy on outcome following BoNT-A injection for focal spasticity in adults with neurological conditions—systematic review. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Distribution of lower limb spasticity does not influence mobility outcome following traumatic brain injury. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Severity and distribution of spasticity does not limit mobility or influence compensatory strategies following traumatic brain injury. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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ICARUSS, the Integrated Care for the Reduction of Secondary Stroke trial: rationale and design of a randomized controlled trial of a multimodal intervention to prevent recurrent stroke in patients with a recent cerebrovascular event, ACTRN = 12611000264987. Int J Stroke 2015; 10:773-7. [PMID: 25907853 DOI: 10.1111/ijs.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/18/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The majority of strokes, both ischaemic and haemorrhagic, are attributable to a relatively small number of risk factors which are readily manageable in primary care setting. Implementation of best-practice recommendations for risk factor management is calculated to reduce stroke recurrence by around 80%. However, risk factor management in stroke survivors has generally been poor at primary care level. A model of care that supports long-term effective risk factor management is needed. AIM To determine whether the model of Integrated Care for the Reduction of Recurrent Stroke (ICARUSS) will, through promotion of implementation of best-practice recommendations for risk factor management reduce the combined incidence of stroke, myocardial infarction and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. DESIGN A prospective, Australian, multicentre, randomized controlled trial. SETTING Academic stroke units in Melbourne, Perth and the John Hunter Hospital, New South Wales. SUBJECTS 1000 stroke survivors recruited as from March 2007 with a recent (<3 months) stroke (ischaemic or haemorrhagic) or a TIA (brain or eye). RANDOMIZATION Randomization and data collection are performed by means of a central computer generated telephone system (IVRS). INTERVENTION Exposure to the ICARUSS model of integrated care or usual care. PRIMARY OUTCOME The composite of stroke, MI or death from any vascular cause, whichever occurs first. SECONDARY OUTCOMES Risk factor management in the community, depression, quality of life, disability and dementia. STATISTICAL POWER With 1000 patients followed up for a median of one-year, with a recurrence rate of 7-10% per year in patients exposed to usual care, the study will have at least 80% power to detect a significant reduction in primary end-points CONCLUSION The ICARUSS study aims to recruit and follow up patients between 2007 and 2013 and demonstrate the effectiveness of exposure to the ICARUSS model in stroke survivors to reduce recurrent stroke or vascular events and promote the implementation of best practice risk factor management at primary care level.
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Cognitive existential couple therapy (CECT) in men and partners facing localised prostate cancer: a randomised controlled trial. BJU Int 2015; 115 Suppl 5:35-45. [DOI: 10.1111/bju.12991] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Do existing patient-report activity outcome measures accurately reflect day-to-day arm use following adult traumatic brachial plexus injury? J Rehabil Med 2015; 47:438-44. [DOI: 10.2340/16501977-1950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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The International Society of Physical and Rehabilitation Medicine: The way forward – II. J Rehabil Med 2014; 46:97-107. [DOI: 10.2340/16501977-1277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Prevalence and familial patterns of gastrointestinal symptoms, joint hypermobility and diurnal blood pressure variations in patients with anorexia nervosa. J Eat Disord 2013. [PMCID: PMC3980260 DOI: 10.1186/2050-2974-1-s1-o45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Al Khateeb GM, Sarangapani S, Olver J. Assoc Med J 2012; 345:e6566-e6566. [DOI: 10.1136/bmj.e6566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Botulinum toxin assessment, intervention and aftercare for lower limb disorders of movement and muscle tone in adults: international consensus statement. Eur J Neurol 2010; 17 Suppl 2:57-73. [DOI: 10.1111/j.1468-1331.2010.03128.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE Availability of new psychotropic agents, and formulations, as well as expanded indications for previously available agents, has had an impact on prescribing patterns in community psychiatric practice. This study tracked changes in patient diagnostic profiles and compared antipsychotic prescribing patterns for patients managed by a continuing care team over a 2.25-year period. METHOD Data pertaining to patient diagnoses and psychotropic medications was obtained from sequential cross-sectional file review and the pharmacy database. Data were collected in late 2004 (n = 224) and early 2007 (n = 294). RESULTS The majority of patients suffered from DSM-IV schizophrenia, schizoaffective and related disorders (68% in 2004, 71% in 2007). Second generation antipsychotic (SGA) medications (79% in 2004, 99% in 2007 of all antipsychotics) were the most widely used agents. Use of quetiapine as a proportion of all oral SGAs increased (8% to 17%) as did that of long-acting risperidone (<1% to 17% of all antipsychotics) paralleled by a decline in long-acting first generation antipsychotic agents (15% to <1%). Significant changes in the prescription of non-benzodiazepine hypnotics and mood stabilizers were also noted. CONCLUSIONS Statistically significant changes in prescribing patterns of antipsychotics during the study period were noted. Likely causes are discussed.
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A comparison of the CogState Schizophrenia Battery and the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Battery in assessing cognitive impairment in chronic schizophrenia. J Clin Exp Neuropsychol 2009; 31:848-59. [DOI: 10.1080/13803390802592458] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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The impact of a changed environment on arousal levels of patients in a secure extended rehabilitation facility. Australas Psychiatry 2009; 17:207-11. [PMID: 19404817 DOI: 10.1080/10398560902839473] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study sought to investigate the effect of changes of the physical ward environment on levels of arousal and aggression in long-stay patients in a secure extended rehabilitation facility. METHOD Seclusion episodes, extended seclusion episodes, staff report of aggressive incidents and Brief Psychiatric Rating Scale (BPRS) measures of psychopathology were compared in the same group of long-stay rehabilitation patients over a period of 3 months before and 3 months after a move from a temporary, refurbished medical ward to a large, light-filled, purpose-built facility. RESULTS Fifteen patients were present during both investigation periods. The majority were male (80%) and had a diagnosis of schizophrenia (53%) or schizoaffective disorder (13%). There were statistically significant reductions in the mean number of seclusion episodes, mean number of extended seclusion episodes (> 4 hours) and BPRS total score following the move. There were statistically significant increases in ambient light conditions in the new unit. CONCLUSIONS The physical environment of long-stay rehabilitation wards may influence aggressive behaviour and arousal in chronically ill patients.
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Stability of cognitive impairment in chronic schizophrenia over brief and intermediate re-test intervals. Hum Psychopharmacol 2009; 24:113-21. [PMID: 19090506 DOI: 10.1002/hup.998] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined between- and within-subject stability of cognitive performance in individuals with chronic schizophrenia. METHODS Thirty individuals with schizophrenia and 20 healthy controls matched by age, sex, education, and estimated IQ underwent repeated cognitive assessments at baseline and 30 days using computerized tests of psychomotor function, visual attention/information processing, non-verbal learning, and executive function. RESULTS Compared to healthy controls, individuals with schizophrenia scored lower on all cognitive measures and demonstrated greater variability in cognitive performance. Within-subject variability in cognitive performance in both the schizophrenia and healthy control groups remained stable at brief (i.e., hours) and intermediate (i.e., one month) assessments. CONCLUSIONS These results demonstrate the stability of between- and within-subject variability in cognitive performance in schizophrenia, and suggest that variability in cognitive performance may reflect an inherent characteristic of the disorder, rather than differences in test-retest reliability/error of cognitive measures.
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Safety of methylphenidate following traumatic brain injury: Impact on vital signs and side-effects during inpatient rehabilitation. J Rehabil Med 2009; 41:585-7. [DOI: 10.2340/16501977-0369] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Stroke rehab down under: can Rupert Murdoch, Crocodile Dundee, and an Aboriginal elder expect the same services and care? Top Stroke Rehabil 2009; 16:1-10. [PMID: 19443342 DOI: 10.1310/tsr1601-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Australia is the world's sixth largest country, has a relatively small population of 21.5 million, and a blended (public and private) health system. In this article, we explain the stroke rehabilitation infrastructure including consumer organisations, research networks, data collection systems, and registries. This represents a complex but fledgling set of organisations showing great promise for coordination of care and research. The article goes on to expose the inequalities in service provision by describing the paths of stroke survivors in three settings - in the city, in the country, and in remote settings. The complexities and difficulties in treating indigenous stroke survivors are described in a culturally sensitive narrative. The article then discusses the outcomes of the first Australian audit of post acute stroke services completed in December 2008, which describes the journeys of 2,119 stroke survivors at 68 rehabilitation units throughout Australia's 6 states and 2 territories. It demonstrates an average length of stay of 26 days, with 18% of survivors requiring nursing home or other supported accommodation. The article concludes with future directions for stroke rehabilitation in Australia, which include hyperacute rehabilitation trials, studies in 7-days-a-week rehabilitation, and the potential use of robotics.
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Spatial working memory and problem solving in schizophrenia: the effect of symptom stabilization with atypical antipsychotic medication. Psychiatry Res 2008; 160:316-26. [PMID: 18579217 DOI: 10.1016/j.psychres.2007.07.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 04/10/2007] [Accepted: 07/14/2007] [Indexed: 11/19/2022]
Abstract
Reasoning and problem solving in the spatial domain are important aspects of executive function that are reliably impaired in schizophrenia, and the Groton Maze Learning Test(c) (GMLT) provides a valid measure of spatial working memory. In the current study, 34 patients with first-episode schizophrenia and 20 matched controls were assessed for baseline spatial working memory abilities using this hidden maze learning test. Approximately one month after baseline assessment, allowing for symptoms to stabilize in response to treatment with therapeutic doses of atypical antipsychotic medications for individuals with schizophrenia, all participants were again assessed with the GMLT. Prior to pharmacologic intervention, patients with schizophrenia showed significant impairments in performance of all aspects of the GMLT, including measures of learning efficiency and error monitoring. One month of treatment was associated with a reliable improvement in these domains, although impairments in accuracy and error monitoring on this spatial working memory test persisted despite symptomatic improvement. These results indicate that impairments in spatial working memory are present at the earliest stages of the illness, and that such deficits in performance remain present, albeit ameliorated, after treatment with atypical antipsychotic medication.
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Neuropsychological study of underweight and "weight-recovered" anorexia nervosa compared with bulimia nervosa and normal controls. Int J Eat Disord 2007; 40:613-21. [PMID: 17607697 DOI: 10.1002/eat.20412] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare executive, memory and visuospatial functioning of DSM-IV anorexia nervosa (AN), bulimia nervosa (BN), and normal controls (NC). METHOD A comparison of women involving: (i) 16 AN with body mass indices (BMI) < or = 17.5 kg/m(2); (ii) 12 AN with BMI > 18.5 kg/m(2) for at least 3 months; (iii) 13 BN; and (iv) 16 NC participants was performed with groups of similar age and intelligence. Groups were assessed with EDE-12, MADRS, HAMA, Cognitive Drug Research (CDR) battery, and Bechara tasks. RESULTS Significant impairments in CDR Power of Attention were present in underweight AN and BN participants. CDR Morse Tapping was significantly impaired in all clinical groups. The BN and weight-recovered AN groups were significantly impaired on CDR immediate word recall. The BN group alone was significantly impaired on CDR delayed word recall. CONCLUSION Attentional impairment is similar in AN and BN. Impaired motor tasks in AN persist after "weight-recovery" and are similar to impairments in BN. BN may be discriminated from AN on word recall.
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Increased prefrontal cerebral blood flow in first-episode schizophrenia following treatment: longitudinal positron emission tomography study. Aust N Z J Psychiatry 2007; 41:129-35. [PMID: 17464690 DOI: 10.1080/00048670601109899] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Cognitive deficits, particularly those related to executive function and behavioural control, are a core feature of patients with schizophrenia and implicate disturbances of the prefrontal cortex (PFC). Consistent with this, functional imaging studies have identified abnormalities of PFC activity in chronically affected patients. The objective of the current study was to investigate executive-control related neural activity from first onset of the illness through to symptom stabilization. METHOD The authors examined eight neuroleptic-naïve first-episode psychosis (FEP) patients within 3 days of first presentation and eight healthy age- premorbid-IQ, and gender-matched controls (CTL). All FEP patients were later confirmed with a diagnosis of schizophrenia. Subjects underwent H2-15O positron emission tomography (PET) while performing the Stroop interference task that has previously been shown to engage the PFC in healthy samples. In a double-blind paradigm, FEP patients were randomly treated with either haloperidol or risperidone for 8 weeks, after which CTLs and all but one of the FEP patients were re-scanned. RESULTS Behaviorally, there was no change in task performance from baseline to follow up for either the FEPs or CTLs. However, there were significant changes in functional activation in both groups across the same period. For CTLs, task-performance was associated with greater recruitment of posterior brain regions at follow up compared to baseline, while for FEP this involved greater recruitment frontal regions. Concurrently, FEP also showed significant improvement in positive symptomatology. CONCLUSIONS These findings suggest that disturbances of the PFC often seen in FEP may be, at least partially, associated with acute symptom expression. However, it is still unclear whether this increase in frontal activity is due to symptom stabilization per se, the effects of medication, a lack of neurophysiological 'learning' with experience/practice, or a combination of these factors. In the context of the CTLs performance, we interpret the patient findings as reflective of greater neurophysiological effort required for task accomplishment relative to the learned, more automated, processing apparent in the CTLs.
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Abstract
UNLABELLED Anterior cingulate (ACC) hypo-activity is commonly observed in chronically ill schizophrenia patients. However, it is unclear whether this is secondary to persistent illness and/or medication. METHOD We examined eight antipsychotic-naïve first-episode patients and matched healthy controls undergoing PET scanning while performing the Stroop task. RESULTS Group-averaged and single-subject analyses showed ACC activation in both controls and patients, albeit in different sub-regions (paracingulate and cingulate respectively). A direct comparison revealed relative under-activity of the left paracingulate cortex in patients. CONCLUSION These findings suggest that the more pervasive hypo-activation observed in chronic patients may be secondary to persistent illness and/or medication.
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Reply to KSC Yuen et al. Eye (Lond) 2005. [DOI: 10.1038/sj.eye.6701564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
OBJECTIVE To provide a description of the service delivery model of an assertive community treatment (ACT) team in the management of a group of severely mentally ill patients and examine the effectiveness of this team in reducing readmissions to a psychiatric inpatient service. METHOD A clinical case audit was performed on a single day in September 2001. Admission episodes and duration were collected for patients registered with the team in the 12 month period prior to ACT and for a period of 12 months ending on the day of the audit. Forty-three patients were registered with the team at the time of data collection. The majority (79%) were diagnosed with schizophrenia and there were high rates of comorbidity (76%) and disability (mean Global Assessment of Functioning score 45.9). The main outcome measures were the number of readmissions and readmission days before and after the institution of ACT. RESULTS The mean number of readmission days reduced from 70.9 to 10.2 (p<0.05) following the institution of ACT. CONCLUSION Assertive community treatment conducted in a naturalistic clinical environment is effective in significantly reducing the number of readmission days in a group of patients suffering from long-term and persistent severe mental illness.
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A manual and automated MRI study of anterior cingulate and orbito-frontal cortices, and caudate nucleus in obsessive-compulsive disorder: comparison with healthy controls and patients with schizophrenia. Psychiatry Res 2005; 138:99-113. [PMID: 15766634 DOI: 10.1016/j.pscychresns.2004.11.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2004] [Revised: 10/27/2004] [Accepted: 11/30/2004] [Indexed: 11/19/2022]
Abstract
Functional imaging and neuropsychological data suggest that interconnected brain structures including the orbito-frontal cortex (OFC), anterior cingulate cortex (ACC) and caudate nucleus (CN) are involved in the pathophysiology of obsessive-compulsive disorder (OCD), but structural imaging studies investigating these regions have yielded inconclusive results. This may be due to inconsistencies in the identification of anatomical boundaries and methodologies utilised (i.e. automated vs. manual tracing). This magnetic resonance imaging study used manual tracing to measure volumes of selected brain regions (OFC, ACC and CN) in OCD patients and compared them with samples of healthy (HC) and psychiatric (schizophrenia; SCZ) controls (n=18 in each group). Concurrently, automated voxel-based analysis was also used to detect subtle differences in cerebral grey and white matter. For the OCD vs. HC comparison, there were no significant volumetric differences detected using the manual or the automated method (although the latter revealed a deficit in the subcortical white matter of the right temporal region). A direct comparison of the two patient groups showed no significant differences using the manual method. However, a moderate effect size was detected for OFC grey matter (reduced in SCZ), which was supported by findings of reduced OFC volume in the automated analysis. Automated analyses also showed reduced volumes in the dorsal (white matter) and ventral ACC (grey and white matter), as well as the left posterior cingulate (grey and white matter) in SCZ. The findings suggest that in contrast to findings in SCZ, there are very few (if any) gross structural anomalies in OCD.
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The use of porous polyethylene (Medpor) lower eyelid spacers in lid heightening and stabilisation. Br J Ophthalmol 2004; 88:1197-200. [PMID: 15317715 PMCID: PMC1772304 DOI: 10.1136/bjo.2003.029397] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS The management of lower eyelid retraction can be challenging, and established techniques to correct it are not always successful. Previous reports have suggested a role for the ultrathin high density porous polyethylene lower eyelid spacer (Medpor LES) in such patients. The authors report the experience of three surgeons implanting Medpor LES over 1 year, and ascertain whether such implants are a safe and effective alternative to autogenous spacers. METHODS A prospective, interventional, non-comparative case series of consecutive patients. Surgical indications for Medpor LES were noted. Preoperative and postoperative lower marginal reflex distance (L-MRD), vertical palpebral aperture (PA), lagophthalmos, and scleral show inferior to the limbus (LSS) were recorded, together with major and minor complications. RESULTS 32 patients (35 eyelids) had a Medpor LES inserted, 22/32 under local anaesthetic, and nine with adjunctive procedures. Mean follow up was 22 months (range 15-28 months). The Medpor LES was effective in reducing the palpebral aperture (p<0.001) and lagophthalmos (p = 0.04) and raising the lower eyelid height by reducing both L-MRD (p = 0.006) and LSS (p<0.001). However there were major complications in 7/32 patients and minor complications in 8/32, most requiring further surgery. Final outcome was good in 24/35 eyelids and satisfactory in 5/35. CONCLUSIONS Despite a good or satisfactory final outcome in the majority of patients, the value of this technique is limited by complications, and should be reserved for those unsuitable for safer techniques.
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Practice compliance programs: reducing therapeutic misadventures and adverse outcomes. THE JOURNAL OF MEDICAL PRACTICE MANAGEMENT : MPM 2000; 15:187-93. [PMID: 10915505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Contemporary medical group practice administrators navigate a complex world of challenges, questions, and ambiguous circumstances. Adverse outcomes and therapeutic misadventures have significant implications within this world. Practice compliance programs must be developed to reduce risk and liability. As with any negative behavior, event or disruptive action, therapeutic misadventure is easily identified; however, determining a strategy to correct physician behavior, attitude, and action is sensitive and difficult, requiring administrative skill, tact, and patience. This article provides corrective action strategies that can be applied to any therapeutic misadventure encountered in a typical medical group practice. Three categories are identified: problematic behavior, problematic practice patterns, and physician impairment. Measures to correct and alter physician behavior and actions are also described.
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Irish college of ophthalmologists. Ir J Med Sci 1995. [DOI: 10.1007/bf02967216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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111 HEAD INJURY IN A PROFESSIONAL MOTORCYCLIST: Decisions in return to competition. Med Sci Sports Exerc 1994. [DOI: 10.1249/00005768-199405001-00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Using a variety of clinical measures of unilateral neglect 40 right hemisphere lesioned stroke subjects were compared in terms of neuropsychological deficit. The results of the study encourage the view that unilateral neglect is a complex syndrome and subjects who indicate the disorder may vary in systematic dimensions. There are at least two factors contributing to the neglect syndrome--a scanning factor of external stimuli and a disrupted internal representation of space factor. Both the obtained factors were correlated with functional independence at 6 months post-stroke in a further group of 27 right hemisphere lesioned stroke patients. It is probable that most commonly these factors co-exist and form the classical neglect syndrome but theoretically they may occur separately and this leads to implications for management.
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Abstract
Five infants with biopsy proved juvenile xanthogranuloma of the iris were reviewed. Early treatment with subconjunctival injection of steroids and topical steroid drops resulted in regression of the lesion in four patients. One patient, reviewed at the age of 8 months after glaucoma which had developed secondary to the iris xanthogranuloma, had been treated by surgery alone: the visual outcome was very poor.
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Abstract
Mothers of 40 very severely head injured male subjects rated their son's behaviour on the Current Behaviour Scale and their ratings were compared with mothers' ratings of 40 control male subjects. The scale was able to discriminate the two groups, by utilising two factors--loss of emotional control and loss of motivation. The mothers' level of emotional distress was closely related to their reporting of loss of emotional control in their sons, but reporting of loss of motivation, or lowered arousal, was strongly predicted by the functional disability of the son. The utility of refining the measurement of post-trauma behaviour is discussed.
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Acquired Brown's syndrome in a patient with combined lichen sclerosus et atrophicus and morphoea. Br J Ophthalmol 1988; 72:552-7. [PMID: 3046656 PMCID: PMC1041525 DOI: 10.1136/bjo.72.7.552] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A 49-year-old woman with generalised lichen sclerosus et atrophicus and morphoea developed bilateral Brown's syndrome. Some of the skin lesions were in the vicinity of the trochlea. A characteristic feature of morphoea is subcutaneous fibrosis, so we postulate that the cause of the Brown's syndrome was mechanical tethering of the superior oblique tendon by deep subdermal fibrosis. Histopathological diagnosis was made from biopsies of similar lesions on the patient's face.
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Abstract
The case is described of a 39-year-old man with previously undiagnosed chronic schizophrenia and with bilateral keratomalacia secondary to his bizarre diet. He presented with a perforation of the right cornea which required an emergency penetrating keratoplasty. The difficulties of clinical management of a patient with an overt psychosis and the use of serum retinol levels to monitor treatment are described. Causes of vitamin A deficiency seen in Great Britain are discussed.
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Malnutrition in the Third World. West J Med 1985. [DOI: 10.1136/bmj.291.6499.897-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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