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Miller E, James Weightman M, Basu A, Amos A, Brakoulias V. An overview of the peer review process in biomedical sciences. Australas Psychiatry 2024; 32:247-251. [PMID: 38327220 DOI: 10.1177/10398562241231460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This paper aims to provide an introductory resource for beginner peer reviewers in psychiatry and the broader biomedical science field. It will provide a concise overview of the peer review process, alongside some reviewing tips and tricks. CONCLUSION The peer review process is a fundamental aspect of biomedical science publishing. The model of peer review offered varies between journals and usually relies on a pool of volunteers with differing levels of expertise and scope. The aim of peer review is to collaboratively leverage reviewers' collective knowledge with the objective of increasing the quality and merit of published works. The limitations, methodology and need for transparency in the peer review process are often poorly understood. Although imperfect, the peer review process provides some degree of scientific rigour by emphasising the need for an ethical, comprehensive and systematic approach to reviewing articles. Contributions from junior reviewers can add significant value to manuscripts.
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Affiliation(s)
- Edward Miller
- Division of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Michael James Weightman
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ashna Basu
- Prince of Wales Hospital, Sydney, NSW Australia; Discipline of Psychiatry and Mental Health, UNSW, Sydney, NSW, Australia; Committee for Research, Royal Australian and New Zealand College of Psychiatry, Melbourne, VIC, Australia
| | - Andrew Amos
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Vlasios Brakoulias
- School of Medicine and Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia; Specialty of Psychiatry, Faculty of Medicine and Health, The Univesity of Sydney, Sydney, NSW, Australia
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Brakoulias V. A pioneer in the management of Australian psychiatric services: Dr Richard Greenup (1803-1866). Australas Psychiatry 2024; 32:143-146. [PMID: 37649160 PMCID: PMC10913316 DOI: 10.1177/10398562231199574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To provide a brief biography of Dr Richard Greenup and to explore the legacy he has left to one of Australia's longest operating psychiatric services. METHODS This history was obtained by consulting staff working within Cumberland Hospital, New South Wales and by examining primary and secondary sources. RESULTS Greenup was the second surgeon superintendent of 'The Parramatta Lunatic Asylum' from 1852 until 1866 when he was fatally stabbed with a pair of scissors by a patient. Greenup was involved in establishing The University of Sydney and advocated for expanded and improved services for people diagnosed with mental disorders. CONCLUSIONS Greenup recognised the needs of the mentally ill and sought to address similar social and demographic determinants of health to those that we face today. The challenges he faced, and his tragic end remind us of the importance of delivering patient-centred care whilst being mindful of associated risks.
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Affiliation(s)
- Vlasios Brakoulias
- Vlasios Brakoulias, School of Medicine and Translational Health Research Institute, Western Sydney University, PO Box 762, Seven Hills, NSW, 2147, Sydney, NSW, Australia.
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Stevens GJ, Sperandei S, Carter GL, Munasinghe S, Hammond TE, Gunja N, de la Riva A, Brakoulias V, Page A. Efficacy of a short message service brief contact intervention (SMS-SOS) in reducing repetition of hospital-treated self-harm: randomised controlled trial. Br J Psychiatry 2024; 224:106-113. [PMID: 38083861 PMCID: PMC10884824 DOI: 10.1192/bjp.2023.152] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/10/2023] [Accepted: 10/29/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Hospital-treated self-harm is common and costly, and is associated with repeated self-harm and suicide. AIMS To investigate the effectiveness of a brief contact intervention delivered via short message service (SMS) text messages in reducing hospital-treated self-harm re-presentations in three hospitals in Sydney (2017-2019), Australia. Trial registration number: ACTRN12617000607370. METHOD A randomised controlled trial with parallel arms allocated 804 participants presenting with self-harm, stratified by previous self-harm, to a control condition of treatment as usual (TAU) (n = 431) or an intervention condition of nine automated SMS contacts (plus TAU) (n = 373), over 12 months following the index self-harm episode. The primary outcomes were (a) repeat self-harm event rate (number of self-harm events per person per year) at 6-, 12- and 24-month follow-up and (b) the time to first repeat at 24-month follow-up. RESULTS The event rate for self-harm repetition was lower for the SMS compared with TAU group at 6 months (IRR = 0.79, 95% CI 0.61-1.01), 12 months (IRR = 0.78, 95% CI 0.64-0.95) and 24 months (IRR = 0.78, 95% CI 0.66-0.91). There was no difference between the SMS and TAU groups in the time to first repeat self-harm event over 24 months (HR = 0.96, 95% CI 0.72-1.26). There were four suicides in the TAU group and none in the SMS group. CONCLUSIONS The 22% reduction in repetition of hospital-treated self-harm was clinically meaningful. SMS text messages are an inexpensive, scalable and universal intervention that can be used in hospital-treated self-harm populations but further work is needed to establish efficacy and cost-effectiveness across settings.
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Affiliation(s)
- Garry John Stevens
- School of Social Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Sandro Sperandei
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Gregory Leigh Carter
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sithum Munasinghe
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Trent Ernest Hammond
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Penrith, New South Wales, Australia
| | - Naren Gunja
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia; and Emergency Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Anabel de la Riva
- Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Vlasios Brakoulias
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Penrith, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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Leung KCY, Bakr B, Chung C, Parmar M, Elhindi J, Brakoulias V. A streamlined multidisciplinary metabolic clinic in psychiatric recovery service: a pilot study. Front Psychiatry 2024; 15:1344453. [PMID: 38445084 PMCID: PMC10913053 DOI: 10.3389/fpsyt.2024.1344453] [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] [Received: 12/08/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
Background The metabolic syndrome (MetS) is a collection of risk factors for cardiovascular disease and type-2 diabetes, that includes central obesity, hypertension, hyperglycaemia and dyslipidaemia. An audit indicated inadequate MetS screening in an Australian psychiatric recovery service. Objectives We aimed to improve MetS screening, identification and intervention by offering streamlined lifestyle education, clinical reviews and discharge planning. This pilot program prioritized holistic, culturally-sensitive, patient-centric, and trauma-informed approaches to enhance metabolic health outcomes. Methods A Metabolic Clinic was piloted in two psychiatric rehabilitation cottages (n=35), which involved disciplines of dietetics, exercise physiology, diversional therapy, occupational therapy, peer workforce, social work, clinical psychology, pharmacy, nursing and medical. Another cottage (n=15) was assigned as the comparison and received standard care. A 12-week, 3-times-per-week lifestyle and behavioral program, called MetFit, was devised and offered to those identified at screening for the treatment cottages. Outcome measures were feasibility measures, the five metabolic parameters (waist circumference, blood pressure, fasting serum triglycerides, high-density lipoprotein, and glucose), functional measures, and a meal questionnaire. Results The treatment cottages had qualitative advantages in screening and identifying MetS. Of four enrolled consumers in MetFit, an improvement of triglycerides (p=0.08), squats (p=0.02), and push-ups (p=0.07) was observed. Major challenges of enrolment included an overall lack of acknowledgment of its importance, poor motivation of consumers and resources limitation. Conclusions The one-stop provision of groups, peer support and inpatient pathway with multidisciplinary team-integration was generally accepted by consumers and the MDT and has iteratively demonstrated the urgent need for consumer-centered physical care and a cultural shift to foster collaboration within a psychiatric service.
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Affiliation(s)
- Kelvin CY. Leung
- Recovery Service, Cumberland Hospital, WSLHD, Sydney, NSW, Australia
- Research and Education Network, WSLHD, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Bianca Bakr
- Recovery Service, Cumberland Hospital, WSLHD, Sydney, NSW, Australia
| | - Cindy Chung
- Recovery Service, Cumberland Hospital, WSLHD, Sydney, NSW, Australia
| | - Mayuri Parmar
- Recovery Service, Cumberland Hospital, WSLHD, Sydney, NSW, Australia
| | - James Elhindi
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Vlasios Brakoulias
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
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Brakoulias V, Malhi GS. Ethical and respectful debate in scientific publishing. Australas Psychiatry 2024; 32:5-7. [PMID: 38265018 DOI: 10.1177/10398562231226145] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Vlasios Brakoulias
- Editor, Australasian Psychiatry; Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; and School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Gin S Malhi
- Editor, Royal College of Psychiatrists (UK) and The British Journal of Psychiatry, London, UK; Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; and Department of Psychiatry, University of Oxford, Oxford, UK
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6
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Dyason KM, Ozkul B, Knight K, Sara G, Brakoulias V, Farrell LJ, Grisham JR, Perkes IE. Hospital admission characteristics for children and adolescents with OCD in Sydney, Australia. Gen Hosp Psychiatry 2023; 85:236-238. [PMID: 37775419 DOI: 10.1016/j.genhosppsych.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Katelyn M Dyason
- Department of Psychological Medicine, Sydney Children's Hospitals Network, New South Wales, Australia; Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, New South Wales, Australia.
| | - Burcu Ozkul
- Department of Psychological Medicine, Sydney Children's Hospitals Network, New South Wales, Australia; Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, New South Wales, Australia
| | - Katherine Knight
- Department of Psychological Medicine, Sydney Children's Hospitals Network, New South Wales, Australia
| | - Grant Sara
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, New South Wales, Australia; InforMH, Ministry of Health, NSW Health, New South Wales, Australia
| | - Vlasios Brakoulias
- Mental Health, Western Sydney Local Health District, New South Wales, Australia; School of Medicine and Translational Health Research Institute, Western Sydney University, New South Wales, Australia; Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Lara J Farrell
- Griffith University, Centre for Mental Health and School of Applied Psychology, Griffith University, Queensland, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, New South Wales, Australia
| | - Iain E Perkes
- Department of Psychological Medicine, Sydney Children's Hospitals Network, New South Wales, Australia; Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, New South Wales, Australia; Discipline of Paediatrics & Child Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, New South Wales, Australia; School of Psychology, University of New South Wales, New South Wales, Australia
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Stubbs JM, Chong S, Achat HM, Brakoulias V. Sociodemographic characteristics and clinical outcomes for people presenting to emergency departments with mental health diagnoses. Int Emerg Nurs 2023; 71:101372. [PMID: 37852061 DOI: 10.1016/j.ienj.2023.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Hospital emergency departments (EDs) are experiencing a growth in presentations with mental health (MH) diagnoses. AIM Describe and compare sociodemographic characteristics and clinical outcomes for people with MH and non-MH diagnoses. METHODS A retrospective study examined routinely collected data for ED presentations in a health district in western Sydney, Australia from 2016 to 2019. Regression models examined variables according to MH status, overall and by age. RESULTS Individuals with MH diagnoses accounted for 3.4% of 647,787 ED presentations. MH presentations were most commonly female (51.5%), aged 16-39 years (62.5%), arrived after hours (60.3%) and via ambulance (52.8%). MH presentations were more likely to be triaged category 2 (OR = 1.58,95%CI = 1.54-1.63) and not seen on time (OR = 1.20,95%CI = 1.17-1.24). They had higher odds of a longer ED stay (OR = 1.96,95%CI = 1.90-20.1), after which they were less likely to be admitted (OR = 0.56, 95%CI = 0.55-0.58) and more likely to be transferred (OR = 3.81,95%CI = 3.66-3.97) or leave before treatment was completed (OR = 1.83,95%CI = 1.74-1.92). CONCLUSION Characteristics and outcomes for people presenting to ED with a MH diagnosis significantly differ from those without a MH diagnosis. Provision of timely care is a particular concern. Identifying causes for delays within and external to the ED, and implementing targeted strategies to ameliorate them are required to optimise care.
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Affiliation(s)
- Joanne M Stubbs
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Shanley Chong
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Helen M Achat
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Vlasios Brakoulias
- Mental Health Service, Western Sydney Local Health District, Westmead, NSW, Australia; School of Medicine and Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia; Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Cooper DDJ, Perkes IE, Lam-Po-Tang J, Farrell LJ, Brakoulias V, Grisham JR. Finding help for OCD in Australia: development and evaluation of a clinician directory. Australian Psychologist 2023. [DOI: 10.1080/00050067.2023.2189003] [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: 03/29/2023]
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Zheng Y, Meyerowitz-Katz G, Bramwell S, Jayaballa R, Assur Y, Vasani D, Ganapathy R, Maberly G, Brakoulias V. Evaluating the Effectiveness of Joint Specialist Case Conferences in Improving Diabetes Control in Patients With Schizophrenia on Clozapine. J Nerv Ment Dis 2023; 211:221-225. [PMID: 36108285 DOI: 10.1097/nmd.0000000000001590] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Clozapine treatment for schizophrenia is typically long-term and is associated with a high rate of diabetes. Mental health and diabetes specialist teams at a local hospital in Australia have undertaken a series of joint specialist case conferences (JSCCs) where the diabetes team works with the psychiatry team to improve diabetes management. In this retrospective cohort study conducted between 2013 and 2018, we found that glycemic control in clozapine clinics linked with JSCCs was improved significantly compared with that in the non-JSCC clinics. In the non-JSCC clozapine clinics (control), the poor glycemic control rates stayed at a similar level: 23% in 2013 and 24% in 2018. In contrast, whereas the control patients' poor glycemic rate in JSCC clozapine clinics in 2013 was 24%, it decreased markedly in 2018 to 13%. This study indicates that JSCCs can improve diabetes outcomes in a group of patients with severe mental illness.
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Affiliation(s)
| | | | - Sian Bramwell
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown
| | - Rajini Jayaballa
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown
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Malhi GS, Brakoulias V. Impact, integrity and editorial independence. Aust N Z J Psychiatry 2022; 56:1373-1375. [PMID: 36271688 DOI: 10.1177/00048674221132181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Vlasios Brakoulias
- Office of the Mental Health Executive, Western Sydney Local Health District, Westmead, NSW, Australia.,School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.,Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
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Fontenelle LF, Nicolini H, Brakoulias V. Early intervention in obsessive-compulsive disorder: From theory to practice. Compr Psychiatry 2022; 119:152353. [PMID: 36341748 DOI: 10.1016/j.comppsych.2022.152353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/03/2022] [Accepted: 10/24/2022] [Indexed: 01/31/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is frequent and often disabling. Yet, correct diagnosis and appropriate treatment implementation are usually delayed, with undesirable consequences. In this paper we review the rationale for early intervention in OCD and provide recommendations for early intervention services. Two scenarios are discussed, i.e., subclinical (prodromal) obsessive-compulsive symptoms (OCS) and full-blown OCD. Although the typical patient with OCD reports a long history of subclinical OCS, longitudinal studies suggest most individuals with OCS in the community do not convert to full-blown OCD. Thus, research on "at risk" phenotypes for OCD and how they should incorporate different risk factors (e.g., polygenic risk scores) are badly needed. For this specific scenario, preventative treatments that are cheap, well tolerated and highly scalable (e.g., lifestyle interventions) are of major interest. On the other hand, increasing evidence suggests OCD to be a progressive disorder and the severity and duration of illness to be associated with both biological changes and increased clinical complexity, including greater number of physical and psychiatric comorbidities, increased family accommodation and worse treatment response. Therefore, prompt identification and early treatment implementation for full-blown OCD are also critical for ethical, clinical and therapeutic reasons. Based on the existing findings, we argue that, regardless of focusing on subclinical OCS or clinical OCD, early intervention services need to target a childhood age group. In addition to delivering well established treatments to people with full-blown OCD early on their illness, early intervention services also need to provide psychoeducation for patients, families and teachers.
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Affiliation(s)
- Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
| | - Humberto Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico; Clinical Research, Carracci Medical Group, Mexico City, Mexico
| | - Vlasios Brakoulias
- Western Sydney Obsessive-Compulsive and Related Disorders Service, Western Sydney Local Health District Mental Health Service, Sydney, Australia; School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, Australia
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Sperandei S, Page A, Bandara P, Reis A, Saheb R, Gaur P, Munasinghe S, Worne K, Fozzard C, Brakoulias V. The impact of the COVID-19 pandemic on hospital-treated self-harm in Sydney (Australia). Aust N Z J Psychiatry 2022; 56:1515-1522. [PMID: 34996305 DOI: 10.1177/00048674211068393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study investigated trends in hospital-treated self-harm and hospital presenting suicidal ideation in the period before and after COVID-19 public health responses by key socio-demographic groups among those presenting to hospitals in the Western Sydney (Australia) population catchment. METHODS Emergency department presentations for the period January 2016 to June 2021 were used to specify a series of interrupted time-series models to compare the observed and expected event rates of (1) hospital-treated self-harm and (2) hospital presenting suicidal ideation in the period following the onset of COVID-19 public health measures in March 2020. Rate differences between observed and expected rates in the post-implementation period were also estimated in models stratified by sex, age group, country of birth and socio-economic status. RESULTS There was no significant increase in hospital-treated self-harm in the period post-implementation of public health orders (March 2020) compared to the previous period, although there were lower than expected rates of emergency department presentations among non-Australian-born males, males aged 0-14 years and 25-44 years, and females aged 45-64 years. In contrast, there was a significant increase in hospital presenting suicidal ideation, particularly among women (rate difference per 100,000 = 3.91, 95% confidence interval = [1.35, 6.48]) and those aged 15-24 years (both males and females, rate differences ranging from 8.91 to 19.04), and among those residing in lower socio-economic status areas (both males and females, rate differences ranging from 0.90 to 2.33). CONCLUSION There was no increase in hospital-treated self-harm rates in the 15 months post-implementation of COVID-19 public health orders in Western Sydney; however, there was a significant increase in hospital presenting suicidal ideation. The limited change in suicidal behaviour may reflect the success of social and economic supports during this period, the benefits of which may have been different for young people, and those of lower socio-economic status.
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Affiliation(s)
- Sandro Sperandei
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Arianne Reis
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Rowena Saheb
- Towards Zero Suicides, Mental Health Service, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Pankaj Gaur
- Integrated and Community Health, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Sithum Munasinghe
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kathryn Worne
- Mental Health Service, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Carolyn Fozzard
- Mental Health Service, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Vlasios Brakoulias
- Mental Health Service, Western Sydney Local Health District, Westmead, NSW, Australia.,School of Medicine, Western Sydney University, Penrith, NSW, Australia
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Erica Bell
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Cornelia Kaufmann
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia.,Northside Group St Leonards Clinic, Ramsay Health Care, St Leonards, NSW, Australia
| | - Vlasios Brakoulias
- Office of the Mental Health Executive, Western Sydney Local Health District, North Parramatta, NSW, Australia.,School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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14
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Rajendran P, Van Winssen C, Viswasam K, Tariq N, Espinoza D, Starcevic V, Brakoulias V. The psychometric properties of the Nepean Belief Scale as a tool for assessing delusions in schizophrenia and related psychotic disorders. Compr Psychiatry 2022; 117:152337. [PMID: 35863256 DOI: 10.1016/j.comppsych.2022.152337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/20/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine the psychometric characteristics of the Nepean Belief Scale (NBS) in psychiatric inpatients with delusions. The NBS is a five-item, clinician-administered scale that assesses the characteristics of beliefs, i.e. conviction, fixity, fluctuation, resistance and awareness that the belief is unreasonable. METHODS Fifty-five patients were interviewed by two clinicians, within three days of admission to an acute psychiatric unit and were assessed using the NBS, the Brown Assessment of Belief Scale (BABS), the MINI International Neuropsychiatric Interview (MINI) and the Depression Anxiety Stress Scale 21-Item Version (DASS-21). The NBS was administered after two weeks to available participants, to assess test-retest reliability. RESULTS Results demonstrated excellent inter-rater reliability of 0.93, Cronbach's alpha coefficient for internal consistency was 0.77. The NBS was found to have good convergent validity with the BABS and good discriminant validity with the DASS. Two-week test-retest reliability suggests that the NBS is sensitive to therapeutic change. CONCLUSIONS Advantages of the NBS include its brevity, its ability to assess belief-related insight, its clear instructions and its definitions of belief characteristics. Thus, the NBS has the potential to greatly improve our ability to more objectively assess delusional beliefs.
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Affiliation(s)
- Priyadarshini Rajendran
- Blacktown Mental Health Service, Western Sydney Local Health District, Australia; University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of Psychiatry, Australia.
| | - Christine Van Winssen
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of Psychiatry, Australia.
| | - Kirupamani Viswasam
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of Psychiatry, Australia.
| | - Nooria Tariq
- Therapies and Support Services, Blacktown Mental Health Service, Western Sydney Local Health District, Australia.
| | - David Espinoza
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia.
| | - Vladan Starcevic
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of Psychiatry, Australia.
| | - Vlasios Brakoulias
- Blacktown Mental Health Service, Western Sydney Local Health District, Australia; University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of Psychiatry, Australia; School of Medicine and Translational Health Research Institute, Western Sydney University, Australia.
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15
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Sarris J, Byrne G, Castle D, Bousman C, Oliver G, Cribb L, Blair-West S, Brakoulias V, Camfield D, Ee C, Chamoli S, Boschen M, Dean OM, Dowling N, Menon R, Murphy J, Metri NJ, Nguyen TP, Wong A, Jordan R, Karamacoska D, Rossell SL, Berk M, Ng CH. N-acetyl cysteine (NAC) augmentation in the treatment of obsessive-compulsive disorder: A phase III, 20-week, double-blind, randomized, placebo-controlled trial. Prog Neuropsychopharmacol Biol Psychiatry 2022; 117:110550. [PMID: 35304155 DOI: 10.1016/j.pnpbp.2022.110550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/02/2022] [Accepted: 03/10/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Preliminary evidence has suggested that adjunctive N-acetylcysteine (NAC), an antioxidant precursor to glutathione, may reduce symptoms of obsessive-compulsive disorder (OCD). We conducted a 20-week, multi-site, randomized controlled trial to investigate the safety and efficacy of the adjunctive use of NAC in OCD. METHODS The study was a phase III, 20-week, double-blind, randomized controlled trial across multiple sites in Australia investigating 2 g to 4 g per day of NAC (titrated according to response) in 98 participants with DSM-5 diagnosed OCD. Data were analysed using linear mixed effects models for the 89 participants who attended at least one follow-up visit. RESULTS A modified intention-to-treat analysis of the primary outcome found no evidence that NAC reduced symptoms of OCD measured on the Yale-Brown Obsessive-Compulsive Scale, relative to placebo (mean difference at week 20 = 0.53, 95% compatibility interval = -2.18, 3.23; p = 0.70; favouring placebo). There was also no evidence that NAC, compared to placebo, improved outcomes on the secondary measures including anxiety, depression, quality of life, functioning, or clinician/participant impression. NAC was well-tolerated with only mild gastrointestinal adverse events associated with the treatment. CONCLUSION We found no evidence supporting the efficacy of the adjunctive use of NAC in OCD.
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Affiliation(s)
- Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Florey Institute for Neuroscience and Mental Health, Kenneth Myer Building, Royal Parade, Parkville, Melbourne, Victoria, Australia; Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Gerard Byrne
- University of Queensland Centre for Clinical Research, Royal Brisbane & Women's Hospital, Brisbane, Australia; Mental Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - David Castle
- Department of Psychiatry, University of Melbourne, Melbourne, Australia; Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
| | - Chad Bousman
- Departments of Medical Genetics, Psychiatry, Physiology & Pharmacology, and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Georgina Oliver
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lachlan Cribb
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Scott Blair-West
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vlasios Brakoulias
- Western Sydney Local Health District Mental Health Service, Sydney, Australia; Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Australia
| | - David Camfield
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Suneel Chamoli
- University of Queensland Centre for Clinical Research, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Mark Boschen
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Olivia M Dean
- Florey Institute for Neuroscience and Mental Health, Kenneth Myer Building, Royal Parade, Parkville, Melbourne, Victoria, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Nathan Dowling
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ranjit Menon
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jenifer Murphy
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Najwa-Joelle Metri
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Thomas P Nguyen
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; School of Medicine, Western Sydney University, Australia
| | - Andrew Wong
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Rebecca Jordan
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Diana Karamacoska
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Michael Berk
- Florey Institute for Neuroscience and Mental Health, Kenneth Myer Building, Royal Parade, Parkville, Melbourne, Victoria, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth, Mental Health Parkville, Melbourne, Victoria, Australia
| | - Chee H Ng
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Barton R, Aouad P, Hay P, Buckett G, Russell J, Sheridan M, Brakoulias V, Touyz S. Distinguishing delusional beliefs from overvalued ideas in Anorexia Nervosa: An exploratory pilot study. J Eat Disord 2022; 10:85. [PMID: 35739570 PMCID: PMC9229879 DOI: 10.1186/s40337-022-00600-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Characterised by the belief that more weight needs to be lost-despite emaciation, failing organs, medical instability and prospect of death-Anorexia Nervosa (AN) is a condition in which irrational, and highly-skewed, beliefs can be of delusional intensity. However, the nexus between delusion and rational awareness and how this is related to body image acceptance and perception has yet to be examined in AN. The current study aims to investigate the relationship between body dissatisfaction and beliefs of delusional intensity in an adult AN inpatient sample. METHODS Twenty-one adults (n(women) = 20; n(men) = 1), with a mean age of 27 years old (SD = 10), presenting for inpatient treatment for AN (ranging in severity from mild to severe; M(Body Mass Index) = 17 kg/m2; M(Length of Stay) = 22 days) participated in the study. Participants' dominant beliefs (related to AN) and level of insight (delusional; overvalued idea; or fair insight) were measured using either the Brown Assessment of Beliefs Scale (BABS) or the Nepean Beliefs Scale (NBS). The degree of body dissatisfaction was determined by examining the discrepancy between "perceived" and "ideal" body perception. To determine subjective and objective beliefs both the Contour Drawing Rating Scale (subjective) and computerised Body Image Assessment Software (objective) were used. RESULTS Almost one quarter (23.7%; n = 5) of participants appeared to have beliefs of delusional intensity related to their body shape (M = 27.4; SD = 23.03). Although a positive linear trend was indicated, there were no significant differences in body dissatisfaction scores between level-of-insight. Individuals whose belief was categorised as delusional were more likely to hold a negative affective body image state based on their ratings on the body image state survey when compared to the group who had good/fair insight (95% CI [0.53, 18.19]; p = 0.03). CONCLUSIONS The current exploratory pilot study concurs with others in the published literature that demonstrate that approximately 25 percent of participants with AN may have delusional ideas. The implications for treatment in similar samples warrant attention. Future research should also seek to understand the clinical significance of this delusional categorisation, the benefits of its utility in this population, and its relation to the severity of AN or stage of illness.
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Affiliation(s)
- Rachel Barton
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. .,School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Geoffrey Buckett
- Eating Disorder Unit - Northside West Clinic (Ramsay Mental Health), Wentworthville, NSW, Australia
| | - Janice Russell
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Margaret Sheridan
- Northside Clinic (Ramsay Mental Health), St Leonards, NSW, Australia
| | - Vlasios Brakoulias
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.,Northside Clinic (Ramsay Mental Health), St Leonards, NSW, Australia.,Western Sydney Local Health District Mental Health Service, Sydney, NSW, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Abstract
OBJECTIVE This study aims to investigate whether COVID-19 has led to increased usage of benzodiazepines in acute psychiatric settings. METHOD We evaluated the rates of benzodiazepine usage in two acute psychiatric inpatient units over a period of two years, 2019 and 2020 (the year of the pandemic). Rates of oral atorvastatin usage over the same period were used as a comparator. RESULTS We saw a significant increase in the usage of benzodiazepines in the period between April and December 2020 compared to the same period in 2019 despite a decline in the total number of admissions in 2020. Usage peaked further at the time of eased pandemic restrictions which coincided with higher rates of emergency department mental health (MH) presentations and acute MH hospital admissions. We also noticed higher rates of substance use disorder recorded on admission. Hospital leave restrictions due to COVID-19 also led to further restrictions on smoking. CONCLUSION Benzodiazepine usage increased in the context of the COVID-19 pandemic. The study encourages more research to better understand the impact of the pandemic on acute psychiatric settings.
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Affiliation(s)
- Nancy Zaki
- Department of Pharmacy, 60085Cumberland Hospital, Westmead, NSW, Australia
| | - Vlasios Brakoulias
- Office of the Mental Health Executive, Western Sydney Local Health District; School of Medicine and Translational Health Research Institute, Western Sydney University; Faculty of Medicine and Health, the University of Sydney, NSW, Australia
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18
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Metri NJ, Ee C, Wardle J, Ng CH, Siskind D, Brakoulias V, Ho FYY, Wong VWH, Naidoo U, Eaton M, Firth J, Sarris J. Assessing dietary, exercise, and non-pharmacological modalities within psychiatric hospitals. Gen Hosp Psychiatry 2022; 76:31-35. [PMID: 35358900 DOI: 10.1016/j.genhosppsych.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Najwa-Joelle Metri
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Chee H Ng
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Richmond, Victoria, Australia
| | - Dan Siskind
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Vlasios Brakoulias
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia; Western Sydney Local Health District Mental Health Services, Sydney, NSW, Australia
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong
| | | | - Uma Naidoo
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Melissa Eaton
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia; Division of Psychology & Mental Health, The University of Manchester, Manchester, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia; Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Richmond, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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19
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Carmi L, Brakoulias V, Arush OB, Cohen H, Zohar J. A prospective clinical cohort-based study of the prevalence of OCD, obsessive compulsive and related disorders, and tics in families of patients with OCD. BMC Psychiatry 2022; 22:190. [PMID: 35300642 PMCID: PMC8932237 DOI: 10.1186/s12888-022-03807-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/23/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The lifetime prevalence of obsessive - compulsive disorder (OCD) is currently estimated at 2 - 3% and the prevalence in first-degree family members is estimated to range between 10 and 11%. Separating OCD from other anxiety disorders and including it into the new "obsessive - compulsive and related disorders" (OCRDs) category has had a dramatic impact on the diagnosis, while also contributing to the better understanding of the genetics of these disorders. Indeed, grouping OCD with body dysmorphic disorder (BDD), and body-focused repetitive behaviors such as trichotillomania (hair pulling), onychophagia (nail biting), and excoriation (skin picking) into the same diagnostic family has resulted in a much greater lifetime prevalence (> 9%). These diagnostic changes necessitate an updated epidemiological study, thus motivating this investigation. METHODS The study sample comprised of 457 patient's cases from an Israeli and an Australian OCD center. Interviews were completed as a part of the intake or during treatment in each of the centers. Prevalence of OCD, OCRDs, tics, and other psychiatric comorbidities in first- and second-degree relatives was assessed by interviewing the OCD patients. Interviews were conducted by at least two researchers (LC, OBA, JZ) and only family information on which the interviewers have reached consensus was considered. RESULTS Initial analyses revealed an increase of OCD and OCRD prevalence in first- and second-degree family members as compared to the current literature due to reclassification of these disorders in DSM-5. CONCLUSION The new category of OCRD has changed the landscape of epidemiological studies in OCD. Further and broader studies are needed in order to better understand the lifetime prevalence of OCRD in first- and second-degrees family member.
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Affiliation(s)
- Lior Carmi
- grid.413795.d0000 0001 2107 2845Chaim Sheba Medical Center, Post Trauma Center, Ramat-Gan, Israel ,Israeli Center for the Treatment of Obsessive−Compulsive and Related Disorders, Modiin, Israel
| | - Vlasios Brakoulias
- grid.482212.f0000 0004 0495 2383Western Sydney Obsessive−Compulsive and Related Disorders Service, Western Sydney Local Health District – Mental Health Services, North Parramatta, Australia ,grid.1029.a0000 0000 9939 5719School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Oded Ben Arush
- Israeli Center for the Treatment of Obsessive−Compulsive and Related Disorders, Modiin, Israel
| | - Hagit Cohen
- grid.7489.20000 0004 1937 0511Ministry of Health, Anxiety and Stress Research Unit, Faculty of Health Sciences, Beer-Sheva Mental Health Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Joseph Zohar
- Chaim Sheba Medical Center, Post Trauma Center, Ramat-Gan, Israel. .,Israeli Center for the Treatment of Obsessive-Compulsive and Related Disorders, Modiin, Israel.
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20
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Yang W, Tang Z, Wang X, Ma X, Cheng Y, Wang B, Sun P, Tang W, Luo J, Wang C, Li P, Xu G, Yan J, Brakoulias V, Wang Z. The cost of obsessive-compulsive disorder (OCD) in China: a multi-center cross-sectional survey based on hospitals. Gen Psychiatr 2021; 34:e100632. [PMID: 34950853 PMCID: PMC8655608 DOI: 10.1136/gpsych-2021-100632] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is considered a very debilitating disorder with severe loss of quality of life and income. Aims This study estimates the quality of life and economic consequences of OCD in China. Methods The research team interviewed 639 patients with OCD in 13 hospitals in 12 cities in China. The direct method was used to get the direct cost of OCD. Indirect costs associated with OCD were estimated using the human capital approach. Linear regression analysis was conducted for quality of life and generalised linear model analysis was conducted for total cost. Sensitivity analysis was used to analyse the uncertainty of total cost. Results The mean quality of life score for OCD was 52.78 (20.46). The annual total cost of OCD per capita was 24 503.78 (95% CI: 22 621.53 to 26 386.03) renminbi (RMB) (US$3465.88 (95% CI: US$3199.65 to US$3732.11)). The annual cost of OCD in China was estimated to be 37.74 billion (95% CI: 34.95 billion to 40.53 billion) RMB (equal to US$5.34 billion (95% CI: US$4.94 billion to US$5.73 billion)). Sensitivity analysis showed that the total annual cost of OCD in China was between 23.15 billion RMB (US$3.27 billion) and 370.00 billion RMB (US$52.33 billion). Worse social function status, more psychiatric symptoms and higher Yale Brown Obsessive-Compulsive Scale (Y-BOCS) score were associated with worse quality of life. The numbers of clinic visits and hospitalisations, socioeconomic status, education, Y-BOCS scores and age were found to be significantly associated with total cost. Conclusions OCD is associated with low quality of life and high costs in China. The findings call for concerted efforts to improve services for patients with OCD. Improvements may include early detection and diagnosis, the provision of evidence-based treatments and relapse prevention strategies.
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Affiliation(s)
- Weili Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Zhen Tang
- Suzhou Guangji Hospital, Suzhou, Jiangsu Province, China
| | - Xijin Wang
- The First Psychiatric Hospital of Harbin, Harbin, Heilongjiang Province, China
| | - Xiancang Ma
- Department of psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yuqi Cheng
- First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Bin Wang
- Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong Province, China
| | - Ping Sun
- Qingdao Mental Health Center, Qingdao, Shandong Province, China
| | - Wenxin Tang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jia Luo
- The Department of Clinical Psychology, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Changhong Wang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Ping Li
- Department of Psychiatry, Qiqihar Medical University, Qiqihar, Heilongjiang Province, China
| | - Guiyun Xu
- Guangzhou Brain Hospital Affiliated to Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Jun Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Peking University, Beijing, China
| | - Vlasios Brakoulias
- The University of Sydney, Nepean Hospital, Sydney Medical School, Sydney, New South Wales, Australia
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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21
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Herzog SA, Brakoulias V. The Role of Neurophysiological Biomarkers in Obsessive-Compulsive Disorder. Curr Med Chem 2021; 29:5584-5594. [PMID: 34923935 DOI: 10.2174/0929867329666211217094941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/24/2021] [Accepted: 10/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder is a highly debilitating psychiatric disorder with a high rate of treatment resistance. Biomarkers for obsessive-compulsive disorder may assist clinicians by predicting response to treatments and prognosis. OBJECTIVE To review the literature with regards to two of the more easily ascertainable and relatively inexpensive physiological biomarkers, i.e. heart rate variability and electroencephalography. METHODS Narrative review of the literature. RESULTS Decreased heart rate variability has been associated with increased symptom severity of obsessive-compulsive disorder. Findings from electroencephalography have also predicted response to pharmacotherapy and it is likely that biomarkers for OCD will have their greatest utility in predicting response to different pharmacological agents. However, the number of studies is small and results are inconsistent. CONCLUSIONS More research is required to determine whether heart rate variability and electrophysiological studies have a clinical role as biomarkers for obsessive-compulsive disorder.
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Affiliation(s)
- Samuel A Herzog
- Department of Psychiatry, Sydney Medical School (Nepean), The University of Sydney, Nepean Hospital, Sydney. Australia
| | - Vlasios Brakoulias
- Department of Psychiatry, Sydney Medical School (Nepean), The University of Sydney, Nepean Hospital, Sydney. Australia
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22
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Arshad A, Foresti K, Rech MM, Brakoulias V, Zubaran C. Demoralization, depression and anxiety in postpartum women of culturally and linguistic diverse backgrounds in Australia. Eur J Midwifery 2021; 5:45. [PMID: 34708192 PMCID: PMC8496309 DOI: 10.18332/ejm/140791] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/25/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The present study aims to investigate whether mothers from Culturally and Linguistically Diverse (CALD) backgrounds present with higher levels of demoralization in comparison with their non-minority counterparts, and to explore potential correlations between demoralization and anxiety as well as depression in the same sample of mothers. METHODS Women admitted to a public tertiary care teaching hospital were invited to participate in the study within 24–48 hours following delivery. The study compared women who did not regard English as their main spoken language to native English-speaking women. Women were asked to complete the demographic Kissane Demoralization Scale (KDS) and Being a Mother Scale (BaM-13) questionnaires. Participants were contacted by phone, 6 to 8 weeks after they had completed the KDS and the BaM-13 questionnaires, to complete an Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Scale (STAI) questionnaires. RESULTS Mothers of CALD background presented with significantly higher scores on the KDS (p<0.001), STAI (p<0.001) and EPDS (p<0.001) scales in comparison with their non-CALD counterparts. Furthermore, when mothers were reassessed after 6 to 8 weeks, higher KDS scores in the postnatal period predicted significantly higher anxiety and depression scores, according to STAI (p<0.001) and the EPDS (p<0.001), respectively. CONCLUSIONS The results of this study reveal that, mothers of CALD background manifest higher levels of demoralization as well as anxiety and depression in the postpartum period when compared with their non-CALD counterparts.
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Affiliation(s)
- Adeel Arshad
- Department of Mental Health, Western Sydney Local Health District, Sydney, Australia
| | - Katia Foresti
- Sunnyside Clinic, Sydney, Australia.,Hornsby Specialist Centre, Sydney, Australia
| | - Matheus M Rech
- School of Medicine, University of Caxias do Sul, Caxias do Sul, Brazil
| | - Vlasios Brakoulias
- Department of Mental Health, Western Sydney Local Health District, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Carlos Zubaran
- Sunnyside Clinic, Sydney, Australia.,Hornsby Specialist Centre, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia.,School of Medicine, The University of Notre Dame, Sydney, Australia
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23
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Brakoulias V, Pineda J, Fimmano V. Short communication: A report of the first twelve months of an early intervention service for obsessive-compulsive disorder (OCD). Compr Psychiatry 2021; 110:152268. [PMID: 34392077 DOI: 10.1016/j.comppsych.2021.152268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/10/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To present a report on the first twelve months of an early intervention service for patients with obsessive-compulsive and related disorders. METHODS Demographic and clinical data including changes in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Obsessive Compulsive Inventory - Revised (OCI-R) were reported for 48 patients referred to the Western Sydney Obsessive-Compulsive and Related Disorders Service during the first 12 months of its operation. RESULTS The service provided education, training and specialised quaternary level assessment and recommendations to patients who have already been assessed by a psychiatrist and/or mental health worker within early intervention teams for psychosis, anxiety clinics and other public psychiatric services. The service failed to reach OCD sufferers early in their course of illness with the mean time from symptom onset being 9.4 years. The use of objective measures such as the Y-BOCS and OCI-R at follow-up was poor and 86.0% (n = 37) remained in treatment at 12 months. CONCLUSIONS An early intervention service for OCD is unlikely to be able to assist sufferers early in their course of illness if it is associated with quaternary clinical services or early intervention programmes for psychosis. Efforts might be better focused on providing education and on early screening of young people in non-clinical settings.
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Affiliation(s)
- Vlasios Brakoulias
- School of Medicine, Western Sydney University, Translational Health Research Institute, Western Sydney Obsessive-Compulsive and Related Disorders Service, Western Sydney Local Health District Mental Health Service, Australia.
| | - Jane Pineda
- Western Sydney Obsessive-Compulsive and Related Disorders Service, Department of Psychology, Western Sydney Local Health District, Australia
| | - Vincent Fimmano
- Western Sydney Obsessive-Compulsive and Related Disorders Service, Parramatta Early Intervention and Recovery Service, Australia
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Starcevic V, Brakoulias V. 'Things are not what they seem to be': A proposal for the spectrum approach to conspiracy beliefs. Australas Psychiatry 2021; 29:535-539. [PMID: 33852369 DOI: 10.1177/10398562211008182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Conspiracy beliefs (also known as conspiracy theories) become more prominent at times of heightened uncertainty and inconsistent or conflicting explanations provided by the authorities for events like terrorist attacks or pandemics, such as COVID-19. This article aims to examine the relevance of conspiracy beliefs for psychiatry in the context of the dynamics of trust and mistrust. CONCLUSIONS Conspiracy beliefs may be situated on a spectrum of mistrust-related phenomena, which extends from healthy scepticism to persecutory delusions. They can be conceptualised as unfounded and fixed beliefs held with strong conviction about harm inflicted by powerful groups on the community or another group of people, usually with preserved insight that these beliefs differ from those that most people have and with reasons for having such beliefs not necessarily being implausible. It is important for conspiracy beliefs to be distinguished from persecutory delusions.
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Affiliation(s)
- Vladan Starcevic
- Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia
- Department of Psychiatry, Nepean Hospital, Penrith, NSW, Australia
| | - Vlasios Brakoulias
- Western Sydney Local Health District Mental Health Service, Sydney, NSW, Australia
- School of Medicine and Translational Health Research Institute, Western Sydney University, Blacktown Hospital, Sydney, NSW, Australia
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25
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Hammond TE, Lampe L, Campbell A, Perisic S, Brakoulias V. Psychoeducational Social Anxiety Mobile Apps: Systematic Search in App Stores, Content Analysis, and Evaluation. JMIR Mhealth Uhealth 2021; 9:e26603. [PMID: 34546179 PMCID: PMC8493451 DOI: 10.2196/26603] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 01/26/2023] Open
Abstract
Background The wide use of mobile health apps has created new possibilities in social anxiety education and treatment. However, the content and quality of social anxiety apps have been quite unclear, which makes it difficult for people to choose appropriate apps to use on smartphones and tablets. Objective This study aims to identify the psychoeducational social anxiety apps in the two most popular Australian app stores, report the descriptive and technical information provided in apps exclusively for social anxiety, evaluate app quality, and identify whether any apps would be appropriate for people with social anxiety or others who know someone with social anxiety. Methods This systematic stepwise app search was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards and entailed searching for, identifying, and selecting apps in the Australian Apple App and Google Play Stores; downloading, using, and reviewing the identified apps; reporting technical and descriptive information in the app stores, an online app warehouse, and individual apps; evaluating app quality; and deciding whether to recommend the use of the apps. Results In the app stores, 1043 apps were identified that contained the keywords social anxiety, social phobia, or shyness in their names or descriptions. Of these, 1.15% (12/1043) were evaluated (3 iOS apps and 9 Android apps). At the time of evaluation, the apps were compatible with smartphones and tablet devices; 9 were free to download from the app stores, whereas 3 were priced between US $2.95 (Aus $3.99) and US $3.69 (Aus $5.00). Among the evaluated apps, 3 were intended for treatment purposes, 3 provided supportive resources, 1 was intended for self-assessment, and the remaining 5 were designed for multiple purposes. At the time of downloading, app store ratings were available for 5 apps. The overall app quality was acceptable according to the Mobile App Rating Scale (MARS). On the basis of the MARS app quality rating subscale (sections A-D), the apps functioned well in performance, ease of use, navigation, and gestural design. However, app quality was less favorable when rated using the MARS app subjective quality subscale (section E). Conclusions The psychoeducational social anxiety apps evaluated in our study may benefit people with social anxiety, health professionals, and other community members. However, given that none of the apps appeared to contain empirical information or were shown to clinically reduce social anxiety (or aid in managing social anxiety), we cannot recommend their use. App accessibility could be improved by developing apps that are free and available for a wider range of operating systems, both between and within countries and regions. Information communication and technology professionals should collaborate with academics, mental health clinicians, and end users (ie, co-design) to develop current, evidence-based apps.
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Affiliation(s)
- Trent Ernest Hammond
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Kingswood, New South Wales, Australia
| | - Lisa Lampe
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Campbell
- Cyberpsychology Research Group, Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Steve Perisic
- Mental Health Outreach Centre, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia
| | - Vlasios Brakoulias
- School of Medicine, Western Sydney University, Blacktown, New South Wales, Australia
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26
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Amerio A, Russo D, Miletto N, Aguglia A, Costanza A, Benatti B, Odone A, Barroilhet SA, Brakoulias V, Dell’Osso B, Serafini G, Amore M, Ghaemi SN. Polypharmacy as maintenance treatment in bipolar illness: A systematic review. Acta Psychiatr Scand 2021; 144:259-276. [PMID: 33960396 PMCID: PMC8453557 DOI: 10.1111/acps.13312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/27/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Polypharmacy is common in maintenance treatment of bipolar illness, but proof of greater efficacy compared to monotherapy is assumed rather than well known. We systematically reviewed the evidence from the literature to provide recommendations for clinical management and future research. METHOD A systematic review was conducted on the use of polypharmacy in bipolar prophylaxis. Relevant papers published in English through 31 December 2019 were identified searching the electronic databases MEDLINE, Embase, PsycINFO, and the Cochrane Library. RESULTS Twelve studies matched inclusion criteria, including 10 randomized controlled trials (RCTs). The best drug combination in prevention is represented by lithium + valproic acid which showed a significant effect on time to mood relapses (HR = 0.57) compared to valproic acid monotherapy, especially for manic episodes (HR = 0.51). The effect was significant in terms of time to new drug treatment (HR = 0.51) and time to hospitalization (HR = 0.57). A significant reduction in the frequency of mood relapses was also reported for lithium + valproic acid vs. lithium monotherapy (RR=0.12); however, the trial had a small sample size. Lamotrigine + valproic acid reported significant efficacy in prevention of depressive episodes compared to lamotrigine alone. CONCLUSIONS The literature to support a generally greater efficacy with polypharmacy in bipolar illness is scant and heterogeneous. Within that limited evidence base, the best drug combination in bipolar prevention is represented by lithium + valproic acid for manic, but not depressive episodes. Clinical practice should focus more on adequate monotherapy before considering polypharmacy.
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Affiliation(s)
- Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)Section of PsychiatryUniversity of GenoaGenoaItaly,IRCCS Ospedale Policlinico San MartinoGenoaItaly,Department of PsychiatryTufts UniversityBostonMAUSA
| | - Daniel Russo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)Section of PsychiatryUniversity of GenoaGenoaItaly,IRCCS Ospedale Policlinico San MartinoGenoaItaly,Department of Mental HealthA.S.L. CN1CuneoItaly
| | - Norberto Miletto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)Section of PsychiatryUniversity of GenoaGenoaItaly,IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)Section of PsychiatryUniversity of GenoaGenoaItaly,IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Alessandra Costanza
- Department of PsychiatryFaculty of MedicineUniversity of Geneva (UNIGE)GenevaSwitzerland,Department of PsychiatryASO Santi Antonio e Biagio e Cesare Arrigo HospitalAlessandriaItaly
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences Luigi SaccoLuigi Sacco HospitalUniversity of MilanMilanItaly
| | - Anna Odone
- Department of Public Health, Experimental and Forensic MedicineUniversity of PaviaPaviaItaly
| | - Sergio A. Barroilhet
- Department of PsychiatryTufts UniversityBostonMAUSA,Center for Quantitative HealthMassachusetts General HospitalBostonMAUSA,Department of PsychiatryHarvard Medical SchoolBostonMAUSA,Department of PsychiatryClinical Hospital University of ChileSantiagoChile
| | - Vlasios Brakoulias
- Western Sydney Local Health District Mental Health Service and School of MedicineWestern Sydney UniversityBlacktown HospitalSydneyNSWAustralia
| | - Bernardo Dell’Osso
- Department of Biomedical and Clinical Sciences Luigi SaccoLuigi Sacco HospitalUniversity of MilanMilanItaly,“Aldo Ravelli” Center for Nanotechnology and NeurostimulationUniversity of MilanMilanItaly,Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordCAUSA
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)Section of PsychiatryUniversity of GenoaGenoaItaly,IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)Section of PsychiatryUniversity of GenoaGenoaItaly,IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - S. Nassir Ghaemi
- Department of PsychiatryTufts UniversityBostonMAUSA,Department of PsychiatryHarvard Medical SchoolBostonMAUSA
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27
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Brakoulias V, Nguyen PHD, Lin D, Pham NDK. An international survey of different transcranial magnetic stimulation (TMS) protocols for patients with obsessive-compulsive disorder (OCD). Psychiatry Res 2021; 298:113765. [PMID: 33571799 DOI: 10.1016/j.psychres.2021.113765] [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] [Received: 12/22/2020] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
This study aims to evaluate current preferences and trends in the delivery of Transcranial Magnetic Stimulation (TMS) for Obsessive-Compulsive Disorder (OCD). A 10-item online questionnaire was developed and conducted online between April to June 2020, surveying providers of TMS for patients with OCD internationally. A total of 27 valid responses were analysed from 10 countries. The most common target for TMS was the supplementary motor area and stimulation was commonly given bilaterally, but techniques differed between centres. Exposure tasks were not commonly used during TMS. The study calls for more research clarifying the best mode of TMS delivery for OCD.
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Affiliation(s)
- Vlasios Brakoulias
- Department of Psychiatry, Blacktown Hospital, Western Sydney Local Health District - Mental Health Service, Blacktown, NSW, Australia.; Western Sydney University School of Medicine, Campbelltown, NSW, Australia
| | | | - Dongni Lin
- Western Sydney University School of Medicine, Campbelltown, NSW, Australia
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28
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Castle D, Beilharz F, Phillips KA, Brakoulias V, Drummond LM, Hollander E, Ioannidis K, Pallanti S, Chamberlain SR, Rossell SL, Veale D, Wilhelm S, Van Ameringen M, Dell’Osso B, Menchon JM, Fineberg NA. Body dysmorphic disorder: a treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology. Int Clin Psychopharmacol 2021; 36:61-75. [PMID: 33230025 PMCID: PMC7846290 DOI: 10.1097/yic.0000000000000342] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
Body dysmorphic disorder (BDD) is characterized by a preoccupation with a perceived appearance flaw or flaws that are not observable to others. BDD is associated with distress and impairment of functioning. Psychiatric comorbidities, including depression, social anxiety, and obsessive-compulsive disorder are common and impact treatment. Treatment should encompass psychoeducation, particularly addressing the dangers associated with cosmetic procedures, and may require high doses of selective serotonin reuptake inhibitors* (SSRI*) and protracted periods to establish full benefit. If there is an inadequate response to SSRIs, various adjunctive medications can be employed including atypical antipsychotics*, anxiolytics*, and the anticonvulsant levetiracetam*. However, large-scale randomized controlled trials are lacking and BDD is not an approved indication for these medications. Oxytocin* may have a potential role in treating BDD, but this requires further exploration. Cognitive-behavioural therapy has good evidence for efficacy for BDD, and on-line and telephone-assisted forms of therapy are showing promise. CBT for BDD should be customized to address such issues as mirror use, perturbations of gaze, and misinterpretation of others' emotions, as well as overvalued ideas about how others view the individual.
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Affiliation(s)
- David Castle
- Department of Psychiatry, University of Melbourne and St Vincent’s Hospital
| | | | - Katharine A. Phillips
- New York-Presbyterian Hospital and Professor of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Vlasios Brakoulias
- School of Medicine, Western Sydney University and Western Sydney Local Health District, Sydney, Australia
| | - Lynne M. Drummond
- National Services for OCD/BDD, SW London and St George’s NHS Trust, London, UK
| | - Eric Hollander
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Stefano Pallanti
- Albert Einstein College of Medicine, Bronx, New York, USA
- Istituto di Neuroscienze University of Florence, Florence, Italy
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Southampton
- Southern Health NHS Foundation Trust, Southampton
- Department of Psychiatry, University of Cambridge
- Department of Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University and St Vincent’s Hospital, Melbourne, Australia
| | - David Veale
- Department of Psychology, King’s College London and the South London and Maudsley NHS Foundation Trust, London, UK
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Bernardo Dell’Osso
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Jose M. Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
| | - Naomi A. Fineberg
- Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire and Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
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29
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Maraone A, Tarsitani L, Frascarelli M, Petrini F, Roselli V, Tinè M, Cavaggioni G, Brakoulias V, Biondi M, Pasquini M. Psychic euosmia among obsessive-compulsive personality disorder patients: A case control study. World J Psychiatry 2021; 11:50-57. [PMID: 33643861 PMCID: PMC7896246 DOI: 10.5498/wjp.v11.i2.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Psychic euosmia (PE) has been described as a supposed psychological predisposition for which pleasant smells elicit an immediate sense of pleasure, order and calmness in obsessive-compulsive personality disorder (OCPD). In this study we tried to verify the interpretation that PE is the counterpart of disgust that has been associated to contamination and moral purity. Disgust and morality are significantly associated in people with obsessive-compulsive personality traits. We expected that OCPD patients would experience higher levels of PE.
AIM To investigate the PE frequency in OCPD patients and healthy controls (HC) and to evaluate the relationship between PE and disgust.
METHODS A single-center, case-control study was conducted in an outpatient service for obsessive-compulsive and related disorders. The sample consisted of 129 subjects: 45 OCPD patients and 84 HC. In both groups we submitted the Disgust Scale Revised (DS-R) and the self-report Structured Clinical Interview for DSM-5 Screening Personality Questionnaire to which we added an additional yes or no question to investigate the presence of PE. In order to verify differences between groups, t-test was employed for continuous variables and 2 test for categorical variable; odds ratio was employed to analyze group differences in the PE survey. Correlation was explored with Pearson r correlations.
RESULTS No differences were observed between groups in gender composition or education. A slight significant difference was found in mean age (t = 1.988; P = 0.049). The present study revealed significantly higher proportions of PE among OCPD patients when compared to HC (OR: 5.3, 2.28-12.46). Patients with OCPD were more likely to report PE (n = 36; 80%) whereas a much lower proportion endorsed PE in the HC group (n = 36; 42.9%). Interestingly, no differences were observed between groups in mean score for the Disgust Scale. There was also no difference between the two groups in any of the Disgust Scale Revised subscales. Moreover, no significant correlations were observed in the OCPD group between PE and Disgust Scale Revised subscales.
CONCLUSION Results suggested that PE might be part of the clinical spectrum of OCPD, and it does not reflect the counterpart of disgust. This could also indicate that this phenomenon is a manifestation of orderliness or incompleteness. Further studies will need to be undertaken to better understand PE and its significance in OCPD.
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Affiliation(s)
- Annalisa Maraone
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
| | - Lorenzo Tarsitani
- Department of Neurosciences and Mental Health, Umberto I Policlinic, Rome 00185, Italy
| | | | - Federica Petrini
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
| | - Valentina Roselli
- Department of Neurosciences and Mental Health, Umberto I Policlinic, Rome 00185, Italy
| | - Massimiliano Tinè
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
| | | | - Vlasios Brakoulias
- Department of Psychiatry, School of Medicine, Western Sydney University and Western Sydney Local Health District, Blacktown 2145, SNW, Australia
- Department of Psychiatry, Nepean Hospital, Sydney Medical School, The University of Sydney, Penrith 2751, SNW, Australia
| | - Massimo Biondi
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University, Rome 00185, Italy
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30
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Costantini L, Pasquarella C, Odone A, Colucci ME, Costanza A, Serafini G, Aguglia A, Belvederi Murri M, Brakoulias V, Amore M, Ghaemi SN, Amerio A. Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review. J Affect Disord 2021; 279:473-483. [PMID: 33126078 DOI: 10.1016/j.jad.2020.09.131] [Citation(s) in RCA: 178] [Impact Index Per Article: 59.3] [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: 03/12/2020] [Revised: 08/17/2020] [Accepted: 09/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Depression is a leading cause of disability. International guidelines recommend screening for depression and the Patient Health Questionnaire 9 (PHQ-9) has been identified as the most reliable screening tool. We reviewed the evidence for using it within the primary care setting. METHODS We retrieved studies from MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library that carried out primary care-based depression screening using PHQ-9 in populations older than 12, from 1995 to 2018. RESULTS Forty-two studies were included in the systematic review. Most of the studies were cross-sectional (N=40, 95%), conducted in high-income countries (N=27, 71%) and recruited adult populations (N=38, 90%). The accuracy of the PHQ-9 was evaluated in 31 (74%) studies with a two-stage screening system, with structured interview most often carried out by primary care and mental health professionals. Most of the studies employed a cut-off score of 10 (N=24, 57%, total range 5 - 15). The overall sensitivity of PHQ-9 ranged from 0.37 to 0.98, specificity from 0.42 to 0.99, positive predictive value from 0.09 to 0.92, and negative predictive value from 0.8 to 1. LIMITATIONS Lack of longitudinal studies, small sample size, and the heterogeneity of primary-care settings limited the generalizability of our results. CONCLUSIONS PHQ-9 has been widely validated and is recommended in a two-stage screening process. Longitudinal studies are necessary to provide evidence of long-term screening effectiveness.
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Affiliation(s)
- Luigi Costantini
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | | | - Anna Odone
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Vlasios Brakoulias
- School of Medicine, Western Sydney University, Blacktown Hospital, Sydney, NSW, Australia
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Nassir Ghaemi
- Department of Psychiatry, Tufts University, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Psychiatry, Tufts University, Boston, MA, USA
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31
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Perkes IE, Brakoulias V, Lam-Po-Tang J, Castle DJ, Fontenelle LF. Contamination compulsions and obsessive-compulsive disorder during COVID-19. Aust N Z J Psychiatry 2020; 54:1137-1138. [PMID: 32900214 DOI: 10.1177/0004867420952846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- I E Perkes
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Department of Psychological Medicine, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - V Brakoulias
- Mental Health Services, Western Sydney Local Health District, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | | | - D J Castle
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - L F Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,D'Or Institute & Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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32
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Yang W, Gu W, Brakoulias V, Li D, Ji L, Wang Z. The outpatient costs and trends of obsessive-compulsive disorder in Shanghai, China. Psychiatry Res 2020; 291:113102. [PMID: 32544713 DOI: 10.1016/j.psychres.2020.113102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Weili Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shandong First Medical University & Shandong Academy of Medical Sciences, Shandong, China
| | - Wenjie Gu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Vlasios Brakoulias
- The University of Sydney, Nepean Hospital, Sydney Medical School, Department of Psychiatry, Sydney, Australia
| | - Dong Li
- Shandong First Medical University & Shandong Academy of Medical Sciences, Shandong, China
| | - Long Ji
- Shandong First Medical University & Shandong Academy of Medical Sciences, Shandong, China.
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
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33
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Fineberg NA, Hollander E, Pallanti S, Walitza S, Grünblatt E, Dell’Osso BM, Albert U, Geller DA, Brakoulias V, Janardhan Reddy Y, Arumugham SS, Shavitt RG, Drummond L, Grancini B, De Carlo V, Cinosi E, Chamberlain SR, Ioannidis K, Rodriguez CI, Garg K, Castle D, Van Ameringen M, Stein DJ, Carmi L, Zohar J, Menchon JM. Clinical advances in obsessive-compulsive disorder: a position statement by the International College of Obsessive-Compulsive Spectrum Disorders. Int Clin Psychopharmacol 2020; 35:173-193. [PMID: 32433254 PMCID: PMC7255490 DOI: 10.1097/yic.0000000000000314] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022]
Abstract
In this position statement, developed by The International College of Obsessive-Compulsive Spectrum Disorders, a group of international experts responds to recent developments in the evidence-based management of obsessive-compulsive disorder (OCD). The article presents those selected therapeutic advances judged to be of utmost relevance to the treatment of OCD, based on new and emerging evidence from clinical and translational science. Areas covered include refinement in the methods of clinical assessment, the importance of early intervention based on new staging models and the need to provide sustained well-being involving effective relapse prevention. The relative benefits of psychological, pharmacological and somatic treatments are reviewed and novel treatment strategies for difficult to treat OCD, including neurostimulation, as well as new areas for research such as problematic internet use, novel digital interventions, immunological therapies, pharmacogenetics and novel forms of psychotherapy are discussed.
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Affiliation(s)
- Naomi A. Fineberg
- University of Hertfordshire, Hatfield
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Stefano Pallanti
- Istituto di Neuroscienze, University of Florence, Firenze, Italy
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich
- Neuroscience Center Zurich, University of Zurich and ETH Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich
- Neuroscience Center Zurich, University of Zurich and ETH Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Bernardo Maria Dell’Osso
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Psychiatry and Behavioural Sciences, Stanford University, California, USA
- CRC ‘Aldo Ravelli’ for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
| | - Daniel A. Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vlasios Brakoulias
- Western Sydney Obsessive-Compulsive and Related Disorders Service, Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales
- Translational Research Health Institute (THRI), Clinical and Health Psychology Research Initiative (CaHPRI) and School of Medicine, Western Sydney University, Sydney, Australia
| | - Y.C. Janardhan Reddy
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Shyam Sundar Arumugham
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Roseli G. Shavitt
- OCD Spectrum Disorders Program, Institute and Department of Psychiatry, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo-SP, Brazil
| | - Lynne Drummond
- Consultant Psychiatrist, SW London and St George’s NHS Trust and St George’s, University of London, London
| | - Benedetta Grancini
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Vera De Carlo
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Eduardo Cinosi
- University of Hertfordshire, Hatfield
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Cambridge, Cambridge
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridge
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Carolyn I. Rodriguez
- Department of Psychiatry and Behavioural Sciences, Stanford University, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Kabir Garg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
| | - David Castle
- St. Vincent’s Hospital Melbourne and The University of Melbourne, Melbourne, Australia
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Dan J. Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Lior Carmi
- The Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan
- The Data Science Institution, The Interdisciplinary Center, Herzliya
| | - Joseph Zohar
- The Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan
- Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Jose M. Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
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Brakoulias V, Starcevic V, Albert U, Arumugham SS, Bailey BE, Belloch A, Borda T, Dell'Osso L, Elias JA, Falkenstein MJ, Ferrao YA, Fontenelle LF, Jelinek L, Kay B, Lochner C, Maina G, Marazziti D, Matsunaga H, Miguel EC, Morgado P, Pasquini M, Perez-Rivera R, Potluri S, Reddy JYC, Riemann BC, do Rosario MC, Shavitt RG, Stein DJ, Viswasam K, Fineberg NA. The rates of co-occurring behavioural addictions in treatment-seeking individuals with obsessive-compulsive disorder: a preliminary report. Int J Psychiatry Clin Pract 2020; 24:173-175. [PMID: 31916881 DOI: 10.1080/13651501.2019.1711424] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To assess the rates of co-occurring putative 'behavioural addictions' in patients with obsessive-compulsive disorder (OCD).Methods: Twenty-three international centres specialising in the treatment of OCD were invited to participate in a survey of the rates of behavioural addictions and other relevant comorbidity within their samples.Results: Sixteen of 23 (69.6%) invited centres from 13 countries had sufficient data to participate in the survey. The use of validated diagnostic tools was discrepant, with most centres relying on a 'clinical diagnosis' to diagnose behavioural addictions. The final sample comprised of 6916 patients with a primary diagnosis of OCD. The reported rates of behavioural addictions were as follows: 8.7% for problematic internet use, 6.8% for compulsive sexual behaviour disorder, 6.4% for compulsive buying, 4.1% for gambling disorder and 3.4% for internet gaming disorder.Conclusions: Behavioural addictions should be better assessed for patients with OCD. The absence of diagnostic scales developed specifically for behavioural addictions and overlapping obsessive-compulsive phenomena such as compulsive checking of information on the internet may explain the relatively high rate of problematic internet use in this sample. The study encourages better efforts to assess and to conceptualise the relatedness of behavioural addictions to obsessive-compulsive 'spectrum' disorders.
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Affiliation(s)
- Vlasios Brakoulias
- Department of Psychiatry, Sydney Medical School - Nepean, The University of Sydney and Nepean Hospital, Sydney/Penrith, Australia.,School of Medicine, Blacktown Hospital, Western Sydney University, Sydney/Blacktown, Australia
| | - Vladan Starcevic
- Department of Psychiatry, Sydney Medical School - Nepean, The University of Sydney and Nepean Hospital, Sydney/Penrith, Australia
| | - Umberto Albert
- Department of Neuroscience, Rita Levi Montalcini, University of Turin, Torino, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Shyam S Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | | | - Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders, I'TOC, Universidad de Valencia, Spain
| | - Tania Borda
- Bio-Behavioral Institute, Buenos Aires, Argentina.,Department of Psychology, Argentinian Catholic University (UCA), Buenos Aires, Argentina
| | - Liliana Dell'Osso
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Univeristy of Pisa, Pisa, Italy.,Dipartmento di Farmacia, Univeristy of Pisa, Pisa, Italy
| | - Jason A Elias
- McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | | | - Ygor A Ferrao
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Leonardo F Fontenelle
- Department of Psychiatry and Legal Medicine, D'Or Institute for Research and Education, Federal University of Rio de Janeiro.,Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia
| | - Lena Jelinek
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Brian Kay
- Rogers Memorial Hospital, Oconomowoc, WI, USA
| | - Christine Lochner
- Department of Psychiatry, MRC Unit on Anxiety Disorders, University of Stellenbosch, Cape Town, South Africa
| | - Giuseppe Maina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Univeristy of Pisa, Pisa, Italy
| | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Euripedes C Miguel
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS-3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Hospital de Braga, Braga, Portugal
| | - Massimo Pasquini
- Department of Human Neurosciences, University of Rome, Sapienza, Italy
| | | | | | - Janardhan Y C Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | | | - Maria C do Rosario
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Roseli G Shavitt
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Dan J Stein
- Department of Psychiatry, MRC Unit on Anxiety Disorders, University of Stellenbosch, Cape Town, South Africa
| | - Kirupamani Viswasam
- Department of Psychiatry, Sydney Medical School - Nepean, The University of Sydney and Nepean Hospital, Sydney/Penrith, Australia
| | - Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, University of Hertfordshire, Hatfield, UK
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Seymour J, Chapman T, Starcevic V, Viswasam K, Brakoulias V. Changing characteristics of a Psychiatric Emergency Care Centre. An eight year follow-up study. Australas Psychiatry 2020; 28:307-310. [PMID: 29737196 DOI: 10.1177/1039856218772252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to report changes in characteristics of admissions to an established Psychiatric Emergency Care Centre (PECC) eight years after its opening. METHOD Key clinical characteristics of admissions to the PECC were documented for 327 patients in 2015 and compared with the 477 patients in 2007, which is when the centre first opened. The characteristics of admission were evaluated using an audit of medical records from June to December in both 2007 and 2015. RESULTS Statistically significant differences (p<0.05) between 2007 and 2015 were: a reduction in the numbers of patients admitted with depression; a reduction in the numbers of patients diagnosed with adjustment disorder; an increase in the numbers of patients diagnosed with borderline personality disorder; a reduction in pro re nata (prn) use, including a reduction in the need for chemical restraint with midazolam and a decrease in the length of admission in the PECC. CONCLUSIONS The significant reduction in aggression, the use of prn medication and the number of people with longer stays within the PECC support the usefulness of PECCs in relation to patient satisfaction and adherence to admission criteria policy. These factors may be considered as indicators of the efficiency of a PECC.
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Affiliation(s)
- Joanne Seymour
- Nurse Practitioner, Nepean Hospital Triage and Assessment Centre - Nepean Hospital, Penrith, NSW, Australia
| | - Tristan Chapman
- Clinical Nurse Consultant, Nepean Hospital Psychiatric Consultation Liaison - Nepean Hospital, Penrith, NSW, Australia
| | - Vladan Starcevic
- Associate Professor, University of Sydney, Sydney Medical School - Nepean, Discipline of Psychiatry, Sydney/Penrith, NSW, Australia
| | - Kirupamani Viswasam
- Research Assistant, Nepean Hospital, Department of Psychiatry, Penrith, NSW, Australia
| | - Vlasios Brakoulias
- Senior Lecturer, University of Sydney, Sydney Medical School - Nepean, Discipline of Psychiatry, Sydney/Penrith, NSW, Australia
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36
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Van Winssen C, Walters E, Brakoulias V. Amphetamine-type stimulant use in acute psychiatric inpatients with delusions. Aust N Z J Psychiatry 2020; 54:544-545. [PMID: 31813238 DOI: 10.1177/0004867419893447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christine Van Winssen
- Sydney Medical School, Nepean Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Emily Walters
- School of Psychology, University of Technology Sydney, Sydney, NSW, Australia
| | - Vlasios Brakoulias
- Sydney Medical School, Nepean Hospital, The University of Sydney, Sydney, NSW, Australia.,Blacktown Hospital, Western Sydney Local Health District Mental Health Services, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, Australia
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37
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Brakoulias V, Viswasam K, Dwyer A, Raine KH, Starcevic V. Advances in the pharmacological management of obsessive-compulsive disorder in the postpartum period. Expert Opin Pharmacother 2020; 21:163-165. [PMID: 31893946 DOI: 10.1080/14656566.2019.1700229] [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] [Indexed: 10/25/2022]
Abstract
Introduction: Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by obsessions and compulsions. Obsessions are defined as intrusive, recurrent and distressing thoughts, images or impulses, whereas compulsions are defined as repetitive behaviors or mental acts. While there is an associated distress, and indeed oftentimes, the individual's awareness that these behaviors are excessive and unreasonable, the individual continues to be disabled by an inability to cease their compulsions. The postpartum period may herald the onset of OCD or precipitate an exacerbation of the preexisting OCD symptoms. Common OCD symptom clusters occur in the postpartum period, with specific challenges associated with motherhood and lactation.Areas covered: This brief review aims to review the extent and nature of publications evaluating pharmacological treatment of OCD in the postpartum period.Expert opinion: Education and training should aim to improve the recognition and treatment of postpartum OCD. Due to the limited nature of studies, more research is required to assess the role of selective serotonin reuptake inhibitors in the postpartum period.
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Affiliation(s)
- Vlasios Brakoulias
- Western Sydney Obsessive-Compulsive and Related Disorders Service, Western Sydney Local Health District, Sydney, Blacktown, Australia.,School of Medicine, Western Sydney University, Sydney, Blacktown, Australia
| | - Kirupamani Viswasam
- Department of Psychiatry, Nepean Hospital, Sydney, Penrith, Australia.,Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, University of Sydney, Sydney, Penrith, Australia.,Discipline of Psychiatry, The University of Sydney, Sydney/Penrith, Australia
| | - Alice Dwyer
- Raphael Services NSW, Division of Social Outreach, St John of God Health Care, Sydney, Blacktown, Australia
| | - Karen Hazell Raine
- State wide Outreach Perinatal Service for Mental Health, Western Sydney Local Health District, Sydney, Australia.,Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Vladan Starcevic
- Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, University of Sydney, Sydney, Penrith, Australia
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Pasquini M, Brakoulias V, Pallanti S. Editorial: Advances in Biological Approaches to Treating Resistant/Refractory Obsessive-Compulsive and Related Disorders. Front Psychiatry 2020; 11:93. [PMID: 32158408 PMCID: PMC7052322 DOI: 10.3389/fpsyt.2020.00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Massimo Pasquini
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Vlasios Brakoulias
- Department of Psychiatry, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Stefano Pallanti
- Institute of Neuroscience, University of Florence, Florence, Italy.,Department of Psychiatry and Behavioral Science, Stanford University Medical Center, Stanford, CA, United States
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Munir U, Younus A, Brakoulias V. A brief intervention to improve rates and quality of physical examinations for admissions to acute adult psychiatry units. Australas Psychiatry 2019; 27:641-644. [PMID: 31165628 DOI: 10.1177/1039856219847512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the frequency and quality of physical examinations within 24 h of admission to an acute adult psychiatry unit, and whether a brief intervention involving feedback to clinicians could lead to improvement. METHOD Retrospective review of the electronic medical records followed by four brief feedback sessions and email correspondence, followed by a further review of the medical records 1 month later. RESULTS The proportion of patients receiving a physical examination increased from 36/71 (50.7%) in the initial audit to 41/64 (64.1%) in the re-audit. The mean score of the quality of physical examinations improved from 7.5 to 9.3 (out of 15). The greatest improvement on re-audit occurred in the documentation of additional cardiac sounds (33.9% increase), additional breath sounds (17.7% increase), breath sounds (17.1% increase), cardiac sounds (14.2% increase) and bowel sounds (12.5% increase). CONCLUSION This audit supports the use of brief peer-led feedback to improve the rates and quality of physical examinations.
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Affiliation(s)
- Usama Munir
- Psychiatry Registrar, Nepean Hospital, Sydney, NSW, Australia
| | - Adnan Younus
- Consultant Psychiatrist, Nepean Hospital, Sydney, NSW, Australia
| | - Vlasios Brakoulias
- Consultant Psychiatrist, Blacktown Hospital, Sydney, NSW, and; Honorary Senior Lecturer, The University of Sydney, Sydney, NSW, Australia
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40
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Zhou WW, Brakoulias V. Cough medicine for agitation - Nothing to cough about. Aust N Z J Psychiatry 2019; 53:816-817. [PMID: 30897928 DOI: 10.1177/0004867419837367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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41
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Brakoulias V. Commentary on RANZCP clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Aust N Z J Psychiatry 2019; 53:81-82. [PMID: 30511582 DOI: 10.1177/0004867418810177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Vlasios Brakoulias
- Mental Health Services, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
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42
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de Avila RCS, do Nascimento LG, Porto RLDM, Fontenelle L, Filho ECM, Brakoulias V, Ferrão YA. Level of Insight in Patients With Obsessive-Compulsive Disorder: An Exploratory Comparative Study Between Patients With "Good Insight" and "Poor Insight". Front Psychiatry 2019; 10:413. [PMID: 31333508 PMCID: PMC6619338 DOI: 10.3389/fpsyt.2019.00413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/24/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Insight may be defined as the ability to perceive and evaluate external reality and to separate it from its subjective aspects. It also refers to the ability to self-assess difficulties and personal qualities. Insight may be a predictor of success in the treatment of obsessive-compulsive disorder (OCD), so that individuals with poor insight tend to become refractory to treatment. The objective of this study is to investigate factors associated with poor insight in individuals with OCD. Methods: This cross-sectional exploratory study used the Brown Belief Assessment Scale as a parameter for the creation of the comparison groups: individuals who obtained null scores (zero) composed the group with preserved or good insight (n = 148), and those with scores above the 75% percentile composed the group with poor insight (n = 124); those with intermediate scores were excluded. Sociodemographic characteristics and clinical and psychopathological aspects, intrinsic and extrinsic to the typical symptoms of OCD, were compared in a univariate analysis. A logistic regression was used to determine which factors associated with critical judgment remained significant. Results: Individuals in the poor insight group differed from those with good insight in regard to: more prevalent use of neuroleptics (p = 0.05); higher untreated time interval (p < 0.001); higher total Yale-Brown obsessive-compulsive scale score and the obsessions and compulsions factors (all factors with p < 0.001); higher dimensional Yale-Brown obsessive-compulsive scale total and dimensional scores (p from 0.04 to 0.001); higher prevalence of contamination/cleaning (p = 0.006) and hoarding (p < 0.001) symptoms dimensions; more prevalent sensory phenomena (p = 0.023); higher levels of depression (p = 0.007); and more prevalent comorbidity with bipolar affective disorder (p = 0.05) and post-traumatic stress disorder (PTSD) (p = 0.04). After analyzing the logistic regression, we conclude that the most important factors associated with poor insight are: the presence of any sensory phenomena (OR: 2.24), use of neuroleptics (OR: 1.66), and hoarding symptoms (OR: 1.15). Conclusion: The variability of insight in patients with OCD seems to be an important psychopathological characteristic in the differentiation of possible subtypes of OCD, since the poor insight is associated with sensory phenomena and greater use of neuroleptics, which makes it possible to conjecture the role of dopaminergic neurocircuits in the neurobiology of this disorder. In addition, there is also an association with the symptoms of hoarding content, admittedly one of the symptomatic contents with less response to conventional OCD treatments. Studies based on neurobiological aspects such as neuroimaging and neuropsychology may help to elucidate more consistently the role of insight in patients with OCD and the repercussions concerning available treatments.
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Affiliation(s)
- Richard Chuquel Silveira de Avila
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Laura Gratsch do Nascimento
- Departamento de Psicologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Rafaella Landell de Moura Porto
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Leonardo Fontenelle
- Departamento de Psiquiatria, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Vlasios Brakoulias
- School of Medicine of Western Sydney University, University of Sydney, Sydney, NSW, Australia
| | - Ygor Arzeno Ferrão
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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43
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Brakoulias V, Starcevic V, Albert U, Arumugham SS, Bailey BE, Belloch A, Borda T, Dell'Osso L, Elias JA, Falkenstein MJ, Ferrao YA, Fontenelle LF, Jelinek L, Kalogeraki L, Kay B, Laurito LD, Lochner C, Maina G, Marazziti D, Martin A, Matsunaga H, Miguel EC, Morgado P, Mourikis I, Pasquini M, Perez Rivera R, Potluri S, Reddy JYC, Riemann BC, do Rosario MC, Shavitt RG, Stein DJ, Viswasam K, Wang Z, Fineberg NA. Treatments used for obsessive-compulsive disorder-An international perspective. Hum Psychopharmacol 2019; 34:e2686. [PMID: 30628745 DOI: 10.1002/hup.2686] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive-compulsive disorder (OCD). METHODS Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated. RESULTS The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD. CONCLUSIONS The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended.
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Affiliation(s)
- Vlasios Brakoulias
- Department of Psychiatry, Nepean Hospital, Sydney Medical School, The University of Sydney, Penrith, NSW, Australia
| | - Vladan Starcevic
- Department of Psychiatry, Nepean Hospital, Sydney Medical School, The University of Sydney, Penrith, NSW, Australia
| | - Umberto Albert
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Brenda E Bailey
- Department of Psychiatry, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders, I'TOC, Faculty of Psychology, Universidad de Valencia, Valencia, Spain
| | - Tania Borda
- Department of Psychiatry, Bio-Behavioral Institute BA, Buenos Aires, Argentina.,Department of Psychology, Argentinian Catholic University (UCA), Buenos Aires, Argentina
| | - Liliana Dell'Osso
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Dipartmento di Farmacia, University of Pisa, Pisa, Italy
| | - Jason A Elias
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Martha J Falkenstein
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Ygor A Ferrao
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Leonardo F Fontenelle
- Department of Psychiatry and Legal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychiatry, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria
| | - Lena Jelinek
- Department of Psychology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Leto Kalogeraki
- Behavioral Therapy Department/Outpatient Clinic for OCD and Related Disorders, Division of Psychiatry I, National and Kapodistrian University of Athens, Athens, Greece
| | - Brian Kay
- Department of Psychiatry, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Luana D Laurito
- Department of Psychiatry and Legal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychiatry, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria
| | - Christine Lochner
- MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Giuseppe Maina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Dipartmento di Farmacia, University of Pisa, Pisa, Italy
| | - Andrew Martin
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Euripedes C Miguel
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,Department of Psychiatry, ICVS-3Bs-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Department of Psychiatry, Hospital de Braga, Braga, Portugal
| | - Irakis Mourikis
- Behavioral Therapy Department/Outpatient Clinic for OCD and Related Disorders, Division of Psychiatry I, National and Kapodistrian University of Athens, Athens, Greece
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Sriramya Potluri
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Janardhan Y C Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Brian C Riemann
- Department of Psychiatry, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | | | - Roseli G Shavitt
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Dan J Stein
- MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Kirupumani Viswasam
- Department of Psychiatry, Nepean Hospital, Sydney Medical School, The University of Sydney, Penrith, NSW, Australia
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Psychiatry, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Naomi A Fineberg
- Department of Psychiatry, Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Hatfield, UK
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Brakoulias V, Stockings E. A systematic review of the use of risperidone, paliperidone and aripiprazole as augmenting agents for obsessive-compulsive disorder. Expert Opin Pharmacother 2018; 20:47-53. [PMID: 30360669 DOI: 10.1080/14656566.2018.1540590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is often viewed as a difficult to treat disorder. In some patients, antipsychotics are used to augment the action of serotonin reuptake inhibitors (SRIs), particularly when there is only a partial response to treatment. AREAS COVERED This comprehensive literature review aims to assess the effectiveness and tolerability of three commonly used atypical antipsychotic agents: risperidone, paliperidone and aripiprazole, as augmentation agents in the treatment of OCD. EXPERT OPINION Antipsychotic augmentation should only be trialed once treatment with selective SRIs at high dose and exposure and response prevention therapy have failed. Currently, there is evidence to support the use of risperidone, paliperidone and aripiprazole as augmentation agents for OCD in adult samples but more studies with larger samples are needed to assess predictors of response to antipsychotic augmentation and to detect any differential effects between the three agents. At this point in time, the choice of antipsychotic is best determined by the side effect profile of the drug and a patient's medication history.
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Affiliation(s)
- Vlasios Brakoulias
- a Department of Psychiatry , The University of Sydney and Nepean Hospital, Sydney Medical School - Nepean, Discipline of Psychiatry , Sydney/Penrith , NSW , Australia.,b UNSW/Usyd Co-Chair for Research Collaboration for Early and Mid-Career Researchers , Sydney , NSW , Australia
| | - Emily Stockings
- b UNSW/Usyd Co-Chair for Research Collaboration for Early and Mid-Career Researchers , Sydney , NSW , Australia.,c National Drug and Alcohol Research Centre , UNSW , Sydney , NSW , Australia
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Rehn S, Eslick GD, Brakoulias V. A Meta-Analysis of the Effectiveness of Different Cortical Targets Used in Repetitive Transcranial Magnetic Stimulation (rTMS) for the Treatment of Obsessive-Compulsive Disorder (OCD). Psychiatr Q 2018; 89:645-665. [PMID: 29423665 DOI: 10.1007/s11126-018-9566-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Randomised and sham-controlled trials (RCTs) of repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) have yielded conflicting results, which may be due to the variability in rTMS parameters used. We performed an updated systematic review and meta-analysis on the effectiveness of rTMS for the treatment of OCD and aimed to determine whether certain rTMS parameters, such as cortical target, may be associated with higher treatment effectiveness. After conducting a systematic literature review for RCTs on rTMS for OCD through to 1 December 2016 using MEDLINE, PubMed, Web of Science, PsycINFO, Google, and Google Scholar, we performed a random-effects meta-analysis with the outcome measure as pre-post changes in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores. To determine whether rTMS parameters may have influenced treatment effectiveness, studies were further analysed according to cortical target, stimulation frequency, and length of follow-up. Data were obtained from 18 RCTs on rTMS in the treatment of OCD. Overall, rTMS yielded a modest effect in reducing Y-BOCS scores with Hedge's g of 0.79 (95% CI = 0.43-1.15, p < 0.001). Stimulation of the supplementary motor area yielded the greatest reductions in Y-BOCS scores relative to other cortical targets. Subgroup analyses suggested that low frequency rTMS was more effective than high frequency rTMS. The effectiveness of rTMS was also greater at 12 weeks follow-up than at four weeks follow-up. Our meta-analysis implies that low frequency rTMS applied over the supplementary motor area may offer the greatest effectiveness in the treatment of OCD. The therapeutic effects of rTMS also appear to persist post-treatment and may offer beneficial long-term effectiveness. With our findings, it is suggested that future large-scale studies focus on the supplementary motor area and include follow-up periods of 12 weeks or more.
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Affiliation(s)
- Simone Rehn
- School of Psychology, The University of Sydney, Sydney, NSW, Australia. .,Department of Psychiatry, Nepean Hospital, Level 5 South Block, PO Box 63, Penrith/Sydney, NSW, 2751, Australia.
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney/Penrith, NSW, Australia
| | - Vlasios Brakoulias
- Sydney Medical School - Nepean, Discipline of Psychiatry, The University of Sydney, Sydney/Penrith, NSW, Australia
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Brakoulias V, Perkes IE, Tsalamanios E. A call for prevention and early intervention in obsessive-compulsive disorder. Early Interv Psychiatry 2018; 12:572-577. [PMID: 29239120 DOI: 10.1111/eip.12535] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 10/22/2016] [Revised: 10/08/2017] [Accepted: 11/08/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evidence suggests that many people with obsessive-compulsive disorder (OCD) have subclinical symptoms years before the development of their disorder and that early treatment may reduce its severity. AIM To explore prevention and early intervention strategies for OCD. METHODS A narrative literature review was conducted. RESULTS The literature in relation to the prevention of OCD is sparse. Genetic and environmental factors appear to be relevant to the aetiology of OCD, for example, the observation that hoarding symptoms and contamination/cleaning symptoms are more likely to also be present in first-degree relatives. Psychoeducation and the reduction of family accommodation, that is the act of parents, siblings or partners accommodating to the high-risk individual's requests to comply with their compulsions, are promising areas for prevention and early intervention in high-risk groups. Tertiary prevention has also been limited by an inadequate number of trained clinicians to deliver evidence-based treatments. CONCLUSIONS Much more research is needed in relation to the prevention of OCD. There is limited scope for primary prevention with respect to biological aetiological factors, but there is potential for strategies addressing environmental factors (eg, family factors). The effectiveness of psychoeducation for parents with OCD as a primary prevention strategy for OCD in their children requires scientific evaluation. Improving access to effective treatments for OCD would also improve tertiary prevention.
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Affiliation(s)
- Vlasios Brakoulias
- Sydney Medical School - Nepean, Discipline of Psychiatry, University of Sydney, Sydney/Penrith, Australia
| | - Iain E Perkes
- Brain Mind Centre, University of Sydney, Sydney/Camperdown, Australia
| | - Emmanouil Tsalamanios
- Department of Child and Adolescent Psychiatry, General Hospital Asklepieio Voulas, Athens, Greece
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Hannan A, Berle D, Milicevic D, Dale E, Starcevic V, Brakoulias V, Viswasam K. Routine treatment duration for clients attending a community based anxiety disorders clinic. Australas Psychiatry 2018; 26:307-310. [PMID: 27590079 DOI: 10.1177/1039856216666157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the average duration of treatment at a community-based anxiety disorders clinic. METHOD Data were collected on primary disorder, the presence of co-occurring disorders and treatment length (both in terms of number of sessions and weeks of therapy) for 248 consecutive clients. RESULTS The mean number of sessions was 13, and average treatment length was 29 weeks. There was substantial variation in treatment duration (range for number of sessions = 1-128, range for treatment duration = 0-186 weeks). CONCLUSION Clients with anxiety disorders were often treated in relatively few sessions, in line with randomised controlled trials (RCTs). However, a number of clients required many more sessions and were treated for a longer period of time than clients in RCTs. Health services should be cautious in mandating limits to therapy duration for anxiety disorders given the wide range in the duration of treatment for clients in our sample.
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Affiliation(s)
- Anthony Hannan
- Senior Clinical Psychologist, Nepean Anxiety Disorders Clinic, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia
| | - David Berle
- Senior Research Fellow, School of Psychiatry, University of New South Wales, Randwick, and; Senior Research Fellow, St John of God Health Care, Richmond Hospital, Sydney, NSW, Australia
| | - Denise Milicevic
- Senior Clinical Psychologist, Nepean Anxiety Disorders Clinic, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia
| | - Erin Dale
- Clinical Psychologist, Nepean Anxiety Disorders Clinic, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia
| | - Vladan Starcevic
- Associate Professor, Discipline of Psychiatry, Sydney Medical School - Nepean, Sydney, NSW, Australia
| | - Vlasios Brakoulias
- Conjoint Senior Lecturer, Discipline of Psychiatry, Sydney Medical School - Nepean, Sydney, NSW, Australia
| | - Kirupamani Viswasam
- Research Assistant, Department of Psychiatry, Nepean Hospital, Sydney, NSW, Australia
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Brakoulias V, Starcevic V, Milicevic D, Hannan A, Viswasam K, Brown C. The Nepean Belief Scale: preliminary reliability and validity in obsessive-compulsive disorder. Int J Psychiatry Clin Pract 2018; 22:84-88. [PMID: 28885070 DOI: 10.1080/13651501.2017.1374413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the psychometric characteristics of the Nepean Belief Scale (NBS), a short clinician-administered scale that assesses the characteristics and intensity of beliefs in obsessive-compulsive disorder (OCD). METHODS The NBS was administered by two clinicians to 27 subjects with OCD as part of a larger study that included a comprehensive assessment using the Yale-Brown Obsessive Compulsive Symptom Scale (Y-BOCS), the Overvalued Ideas Scale (OVIS) and the Symptom Checklist 90-Revised (SCL-90R). Test-retest reliability of the NBS was assessed by administering the scale 5 days after initial administration. RESULTS The 5-item NBS proved easy to use with an assessment time of less than 5 min. Its interrater reliability revealed 99.5% concordance, while the kappa for test-retest reliability was 0.98 (95% CI = 0.95-1.00). Cronbach alpha coefficient for internal consistency was 0.87. The NBS was found to have excellent convergent and discriminant validity. CONCLUSIONS Preliminary results suggest that the NBS could be a useful shorter alternative to the currently more widely used instruments for assessing beliefs such as the OVIS and the Brown Assessment of Belief Scale. The NBS has clear instructions and definitions, excellent interrater reliability and convergent validity, and it more accurately measures belief-related insight.
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Affiliation(s)
- Vlasios Brakoulias
- a Department of Psychiatry , The University of Sydney, Nepean Hospital, Sydney Medical School , Penrith , NSW , Australia
| | - Vladan Starcevic
- a Department of Psychiatry , The University of Sydney, Nepean Hospital, Sydney Medical School , Penrith , NSW , Australia
| | | | - Anthony Hannan
- b Nepean Anxiety Disorders Clinic , Penrith , NSW , Australia
| | - Kirupamani Viswasam
- a Department of Psychiatry , The University of Sydney, Nepean Hospital, Sydney Medical School , Penrith , NSW , Australia
| | - Christopher Brown
- c NHMRC Clinical Trials Centre , The University of Sydney , Sydney , NSW , Australia
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Affiliation(s)
- Vladan Starcevic
- Discipline of Psychiatry, Nepean Hospital, Sydney Medical School Nepean, The University of Sydney, Penrith, NSW, Australia
| | - Vlasios Brakoulias
- Discipline of Psychiatry, Nepean Hospital, Sydney Medical School Nepean, The University of Sydney, Penrith, NSW, Australia
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Marazziti D, Albert U, Dell'Osso B, Tundo A, Cuniberti F, Maina G, Moroni I, Benatti B, Mucci F, Massimetti G, Piccinni A, Brakoulias V. Italian prescribing patterns in obsessive-compulsive disorder. Hum Psychopharmacol 2017; 32. [PMID: 28967153 DOI: 10.1002/hup.2641] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/15/2017] [Accepted: 08/30/2017] [Indexed: 01/03/2023]
Abstract
The aim of the present study was to investigate psychopharmacological prescribing patterns in a large sample (n = 1815) of patients suffering from obsessive-compulsive disorder (OCD) recruited in 4 Italian centers specialized in OCD, in comparison to available national and international guidelines. The centers were asked to complete a specific data sheet questionnaire on patients' therapeutic status. Statistical analyses were carried out by SPSS. The results showed that almost all patients referred to the centers of Milan, Pisa and Rome received psychotropic medications, whereas only 59.9% (313) did so in Turin. Selective serotonin reuptake inhibitors were the most used drugs ranging between 49.0% and 71.5%. Clomipramine was prescribed more often in Rome and Pisa than in Milan and Turin. The same was true for other tricyclic antidepressants. Second-generation antipsychotics were more often prescribed in Pisa and in Milan. Mood stabilizers were almost exclusively used in Pisa. Taken together, the overall findings would suggest that, although the main Italian centers specialized in OCD follow available guidelines, a certain degree of variability does exist. This may depend on the different educational background, availability of other specific therapeutic strategies, as well as varying levels of severity and comorbidity of the patients.
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Affiliation(s)
- Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Umberto Albert
- Rita Levi Montalcini Department of Neuroscience, University of Turin, and San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Bernardo Dell'Osso
- Dipartimento di Fisiopatologia-Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - Francesco Cuniberti
- Rita Levi Montalcini Department of Neuroscience, University of Turin, and San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Turin, and San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Ilenia Moroni
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Beatrice Benatti
- Dipartimento di Fisiopatologia-Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
| | - Federico Mucci
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Armando Piccinni
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Vlasios Brakoulias
- Department of Psychiatry, Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia
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