ORCID Profile
0000-0001-7389-2546
Current Organisation
Deakin University
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Publisher: Bentham Science Publishers Ltd.
Date: 19-12-2015
Publisher: Wiley
Date: 06-10-2020
DOI: 10.1111/DAR.13183
Abstract: There has been a rapid increase in smoking crystalline meth hetamine in Australia. We compare the clinical and demographic characteristics of those who smoke versus inject the drug in a cohort of people who use meth hetamine. Participants ( N = 151) were dependent on meth hetamine, aged 18–60 years, enrolled in a pharmacotherapy trial for meth hetamine dependence, and reported either injecting ( n = 54) or smoking ( n = 97) meth hetamine. Measures included the Timeline Followback, Severity of Dependence Scale, Amphetamine Withdrawal Questionnaire, Craving Experience Questionnaire and the Brief Psychiatric Rating Scale (symptoms of depression, hostility, psychosis and suicidality). Simultaneous regression was used to identify independent demographic correlates of smoking meth hetamine and to compare the clinical characteristics of participants who smoked versus injected. Compared to participants who injected meth hetamine, those who smoked meth hetamine were younger and less likely to be unemployed, have a prison history or live alone. Participants who smoked meth hetamine used meth hetamine on more days in the past 4 weeks than participants who injected meth hetamine (26 vs. 19 days, P = 0.001) they did not differ significantly in their severity of meth hetamine dependence, withdrawal, craving or psychiatric symptoms ( P 0.05). After adjustment for demographic differences, participants who smoked had lower craving [b (SE) = −1.1 (0.5), P = 0.021] and were less likely to report psychotic symptoms [b (SE) = −1.8 (0.7), P = 0.013] or antidepressant use [b (SE) = −1.1 (0.5), P = 0.022]. Smoking crystalline meth hetamine is associated with a younger less marginalised demographic profile than injecting meth hetamine, but a similarly severe clinical profile.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
Publisher: Wiley
Date: 30-05-2017
DOI: 10.1111/DAR.12414
Abstract: Meth hetamine dependence is a growing problem in Australia and globally. Currently, there are no approved pharmacotherapy options for the management of meth hetamine dependence. N-acetylcysteine is one potential pharmacotherapy option. It has received growing attention as a therapy for managing addictions because of its capacity to restore homeostasis to brain glutamate systems disrupted in addiction and thereby reduce craving and the risk of relapse. N-acetylcysteine also has antioxidant properties that protect against meth hetamine-induced toxicity and it may therefore assist in the management of the neuropsychiatric and neurocognitive effects of meth hetamine. This commentary overviews the actions of N-acetylcysteine and evidence for its efficacy in treating addiction with a particular focus on its potential utility for meth hetamine dependence. We conclude that the preliminary evidence indicates a need for full-scale trials to definitively establish whether N-acetylcysteine has a therapeutic benefit and the nature of this benefit, for managing meth hetamine dependence. [McKetin R, Dean O, Baker A. L, Carter G, Turner A, Kelly P. J, Berk M. A potential role for N-acetylcysteine in the management of meth hetamine dependence. Drug Alcohol Rev 2017 :153-159].
Publisher: BMJ
Date: 04-2019
DOI: 10.1136/BMJOPEN-2018-025145
Abstract: Remission rates for mood disorders, including depressive and bipolar disorders, remain relatively low despite available treatments, and many patients fail to respond adequately to these interventions. Evidence suggests that personality disorder may play a role in poor outcomes. Although personality disorders are common in patients with mood disorders, it remains unknown whether personality disorder affects treatment outcomes in mood disorders. We aim to review currently available evidence regarding the role of personality disorder on pharmacological interventions in randomised controlled trials for adults with mood disorders. A systematic search of Cochrane Central Register of Controlled Clinical Trials (CENTRAL) via cochranelibrary.com, PubMed via PubMed, EMBASE via embase.com, PsycINFO via Ebsco and CINAHL Complete via Ebsco databases will be conducted to identify randomised controlled trials that have investigated pharmacological interventions in participants aged 18 years or older for mood disorders (ie, depressive disorders and bipolar spectrum disorders) and have also included assessment of personality disorder. One reviewer will screen studies against the predetermined eligibility criteria, and a second reviewer will confirm eligible studies. Data will be extracted by two independent reviewers. Methodological quality and risk of bias will be assessed using the Cochrane Risk of Bias tool. A systematic review, and if sufficient evidence is identified, a meta-analysis will be completed. Meta-analysis will be conducted using the standardised mean difference approach and reported with 95% CIs. A random effects model will be employed and statistical heterogeneity will be evaluated using the I 2 statistic. Prespecified subgroup analyses will be completed. As this systematic review will use published data, ethics permission will not be required. The outcomes of this systematic review will be published in a relevant scientific journal and presented at a research conference. CRD42018089279.
Publisher: Korean College of Neuropsychopharmacology
Date: 30-05-2023
Publisher: Wiley
Date: 29-08-2018
DOI: 10.1111/NHS.12368
Abstract: In this cross-sectional study, we evaluated the quality of discharge documentation for stroke patients discharged home. Participants were stroke patients discharged from a regional tertiary acute and rehabilitation hospital in Australia from 2014 to 2015. Compliance with expected discharge documentation and its relationship with readmission was measured using an audit instrument for stroke patients (n = 54), and a post-discharge survey of carers was conducted. There were deficits in the documentation of the mechanism of stroke (70%), functional assessments (58%), pending test results (39%), types of support services required after discharge (35%), and patient/carer meetings with the multi-disciplinary stroke team (20%). Readmission was associated with lower compliance scores for information provided to patients or their carer. The survey results suggested that carer burden was high for carers of stroke patients discharged home. Documentation of carer/family meetings with the stroke team, functional assessments, medications, and adequate support services needs to be improved. General practitioners and carers need this information, so that they can address the post-discharge needs of these vulnerable patients.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Hindawi Limited
Date: 20-09-2018
DOI: 10.1002/DA.22841
Publisher: SAGE Publications
Date: 29-10-2020
Abstract: We aimed to explore the relationships between diet quality, dietary inflammatory potential or body mass index and outcomes of a clinical trial of nutraceutical treatment for bipolar depression. This is a sub-study of a randomised controlled trial of participants with bipolar depression who provided dietary intake data ( n = 133). Participants received 16 weeks adjunctive treatment of either placebo or N-acetylcysteine-alone or a combination of mitochondrial-enhancing nutraceuticals including N-acetylcysteine (combination treatment). Participants were followed up 4 weeks post-treatment discontinuation (Week 20). Diet was assessed by the Cancer Council Victoria Dietary Questionnaire for Epidemiological Studies, Version 2, converted into an Australian Recommended Food Score to measure diet quality, and energy-adjusted dietary inflammatory index score to measure inflammatory potential of diet. Body mass index was also measured. Generalised estimating equation models were used to assess whether diet quality, energy-adjusted dietary inflammatory index score and/or body mass index were predictors of response to significant outcomes of the primary trial: depression symptoms, clinician-rated improvement and functioning measures. In participants taking combination treatment compared to placebo, change in depression scores was not predicted by Australian Recommended Food Score, dietary inflammatory index or body mass index scores. However, participants with better diet quality (Australian Recommended Food Score) reported reduced general depression and bipolar depression symptoms ( p = 0.01 and p = 0.03, respectively) and greater clinician-rated improvement ( p = 0.02) irrespective of treatment and time. Participants who had a more anti-inflammatory dietary inflammatory index had less impairment in functioning ( p = 0.01). Combination treatment may attenuate the adverse effects of pro-inflammatory diet ( p = 0.03) on functioning. Participants with lower body mass index who received combination treatment ( p = 0.02) or N-acetylcysteine ( p = 0.02) showed greater clinician-rated improvement. These data support a possible association between diet (quality and inflammatory potential), body mass index and response to treatment for bipolar depression in the context of a nutraceutical trial. The results should be interpreted cautiously because of limitations, including numerous null findings, modest s le size and being secondary analyses.
Publisher: Korean College of Neuropsychopharmacology
Date: 31-05-2019
Publisher: Springer Science and Business Media LLC
Date: 05-07-2016
Publisher: SAGE Publications
Date: 26-09-2013
Abstract: To determine whether a six-session group cognitive behaviour therapy (CBT) programme results in a greater reduction in depression symptoms than a brief intervention alone in cardiac patients with clinically significant symptoms of depression. Fifty-seven community dwelling cardiac patients scoring on the Beck Depression Inventory-II (BDI-II) received a single-session brief intervention. They were then block randomised to either six sessions of group CBT ( n = 25) or no further intervention (BI n = 32). All were re-assessed at 2, 6 and 12 months. Differences between treatment groups in the primary (BDI-II) and secondary [rates of depression anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale-Anxiety (HADS-A)] outcomes were examined using generalised linear mixed models with a random intercept term for the in idual. Significant improvements were seen for the total group from baseline to 12 months on BDI-II and HADS-A scores. However, no differences were found between the CBT and BI conditions on change in BDI-II score, rates of major depressive episode or HADS-A score. Post hoc analysis on the total group found 12-month symptom non-remission was associated with higher baseline BDI-II score ( p = 0.03), more visits to health professionals 12 months prior to baseline ( p = 0.05) and a greater likelihood of either drinking alcohol over recommended levels or smoking at baseline ( p = 0.01). Group CBT of up to six sessions did not result in greater reductions in depression or anxiety symptoms compared with a single-session brief intervention. Further work should focus on the efficacy and role of brief interventions, and addressing smoking and alcohol misuse in cardiac patients with depression.
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.ADDBEH.2019.106249
Abstract: To reduce smoking and improve other health behaviours of people living with severe mental illness, healthy lifestyle interventions have been recommended. One approach to improving the availability of these types of interventions is to utilise the mental health peer workforce. The current study aimed to evaluate the feasibility of peer-workers facilitating a telephone delivered healthy lifestyle intervention within community based mental health settings. The study also examined preliminary outcomes of the intervention. The study was conducted as a randomised controlled feasibility trial. In addition to treatment as usual, participants randomised to the Treatment Condition were offered BHC. This was an 8-session telephone delivered coaching intervention that encouraged participants to decrease their smoking, increase their intake of fruit and vegetables, and reduce their leisure screen time. Participants in the waitlist Control Condition continued to complete treatment as usual. All participants were engaged with Neami National, an Australian community mental health organisation. Peer-workers were also current employees of Neami National. Forty-three participants were recruited. The average number of sessions completed by participants in the Treatment Condition was 5.7 (SD = 2.6 out of 8-sessions). Seventeen participants (77%) completed at least half of the sessions, and nine participants (40%) completed all eight sessions. Participant satisfaction was high, with all participants followed up rating the quality of the service they received as 'good' or 'excellent'. When compared to the Control Condition, people in the Treatment Condition demonstrated greater treatment effects on smoking and leisure screen time. There was only a negligible effect on servings of fruit and vegetable. Results were promising regarding the feasibility of peer-workers delivering BHC. Good retention rates and high consumer satisfaction ratings in the Treatment Condition demonstrated that peer-workers were capable of delivering the intervention to the extent that consumers found it beneficial. The current results suggest that a sufficiently powered, peer delivered randomised controlled trial of BHC is warranted. Australian New Zealand Clinical Trials Registry (ANZCTR Trial ID ACTRN123615000564550).
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/BMJOPEN-2020-044569
Abstract: Despite available pharmacological and psychological treatments, remission rates for bipolar disorder remain relatively low. Current research implicates the experience of childhood trauma as a potential moderator of poor treatment outcomes among in iduals with bipolar disorder. To date, the evidence reporting the influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder has not been systematically reviewed. MEDLINE Complete, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials will be searched to identify randomised and nonrandomised studies of pharmacological and/or psychological interventions for bipolar disorder, which also assessed childhood trauma. To be eligible for inclusion, studies must have been conducted with adolescents or adults (≥10 years). Data will be screened and extracted by two independent reviewers. The methodological quality of the included studies will be assessed with the Cochrane Collaboration’s Risk of Bias tool and the Newcastle-Ottawa Scale. If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I² statistics. This systematic review will use only previously published data. Therefore, ethical approval is not required. The results will be written in concordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, published in peer-reviewed journals and presented at relevant conferences. CRD42020201891.
Publisher: Elsevier BV
Date: 11-2021
Publisher: MDPI AG
Date: 09-03-2023
DOI: 10.3390/IJMS24065250
Abstract: Minocycline has anti-inflammatory, antioxidant, and anti-apoptotic properties that explain the renewed interest in its use as an adjunctive treatment for psychiatric and neurological conditions. Following the completion of several new clinical trials using minocycline, we proposed an up-to-date systematic review and meta-analysis of the data available. The PICO (patient opulation, intervention, comparison and outcomes) framework was used to search 5 databases aiming to identify randomized controlled trials that used minocycline as an adjunctive treatment for psychiatric and neurological conditions. Search results, data extraction, and risk of bias were performed by two independent authors for each publication. Quantitative meta-analysis was performed using RevMan software. Literature search and review resulted in 32 studies being included in this review: 10 in schizophrenia, 3 studies in depression, and 7 in stroke, with the benefit of minocycline being used in some of the core symptoms evaluated 2 in bipolar disorder and 2 in substance use, without demonstrating a benefit for using minocycline 1 in obsessive-compulsive disorder, 2 in brain and spinal injuries, 2 in amyotrophic lateral sclerosis, 1 in Alzheimer’s disease, 1 in multiple systems atrophy, and 1 in pain, with mixes results. For most of the conditions included in this review the data is still limited and difficult to interpret, warranting more well-designed and powered studies. On the other hand, the studies available for schizophrenia seem to suggest an overall benefit favoring the use of minocycline as an adjunctive treatment.
Publisher: Cambridge University Press (CUP)
Date: 12-07-2019
DOI: 10.1017/S0033291719001314
Abstract: Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9. We conducted an in idual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy. 16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard ( N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies ( N = 27), with similar results for studies that used other types of interviews ( N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01). PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Publisher: Frontiers Media SA
Date: 13-03-2019
Publisher: Cambridge University Press (CUP)
Date: 25-05-2018
DOI: 10.1017/S0033291718001125
Abstract: The mental and physical health of in iduals with a psychotic illness are typically poor. Access to psychosocial interventions is important but currently limited. Telephone-delivered interventions may assist. In the current systematic review, we aim to summarise and critically analyse evidence for telephone-delivered psychosocial interventions targeting key health priorities in adults with a psychotic disorder, including (i) relapse, (ii) adherence to psychiatric medication and/or (iii) modifiable cardiovascular disease risk behaviours. Ten peer-reviewed and four grey literature databases were searched for English-language studies examining psychosocial telephone-delivered interventions targeting relapse, medication adherence and/or health behaviours in adults with a psychotic disorder. Study heterogeneity precluded meta-analyses. Twenty trials [13 randomised controlled trials (RCTs)] were included, involving 2473 participants (relapse prevention = 867 medication adherence = 1273 and health behaviour = 333). Five of eight RCTs targeting relapse prevention and one of three targeting medication adherence reported at least 50% of outcomes in favour of the telephone-delivered intervention. The two health-behaviour RCTs found comparable levels of improvement across treatment conditions. Although most interventions combined telephone and face-to-face delivery, there was evidence to support the benefit of entirely telephone-delivered interventions. Telephone interventions represent a potentially feasible and effective option for improving key health priorities among people with psychotic disorders. Further methodologically rigorous evaluations are warranted.
Publisher: Informa UK Limited
Date: 02-01-2017
DOI: 10.1080/15504263.2016.1276657
Abstract: Smokers with mental illness and their health care providers are often concerned that smoking cessation will worsen mental health. Smokers with mental illness tend to be more nicotine-dependent and experience more severe symptoms of nicotine withdrawal, some of which are difficult to distinguish from psychiatric symptoms. In addition, smoking cessation can increase the blood levels and hence side effects of some psychotropic medications. Improved monitoring of nicotine withdrawal and medication side effects may help distinguish temporary withdrawal symptoms from psychiatric symptoms and facilitate targeted treatment to help smokers with mental illness manage the acute phase of nicotine withdrawal. The aim of this research was to examine the acceptability and feasibility to quitline counselors of implementing structured assessments of nicotine withdrawal and common medication side effects in people with mental illness who are quitting smoking using a telephone smoking cessation service. Monitoring involves administering (once pre-cessation and at each contact post-cessation) (1) the Minnesota Nicotine Withdrawal Scale, assessing eight symptoms: anger, anxiety, depression, cravings, difficulty concentrating, increased appetite, insomnia, and restlessness and (2) an adverse side effects checklist of 5 to 10 symptoms, for ex le, dry mouth and increased thirst. Following a 1-day update training in mental health, quitline counselors were asked to offer these assessments to callers disclosing mental illness in addition to usual counseling. Group interviews with counselors were conducted 2 months later to examine implementation barriers and benefits. Barriers included awkwardness in integrating a new structured practice into counseling, difficulty in limiting some callers to only the content of new items, and initial anxieties about how to respond to changes in some symptoms. Benefits included the ability to provide objective feedback on changes in symptoms, as this identified early benefits of quitting, provided reassurance for clients, and provided an opportunity for early intervention where symptoms worsened. Structured monitoring of withdrawal symptoms and medication side effects was able to be integrated into the quitline's counseling and was valued by counselors and clients. Given evidence of its benefits in this limited pilot study, we recommend it be considered for larger-scale adoption by quitlines.
Publisher: Elsevier
Date: 2017
Publisher: Korean College of Neuropsychopharmacology
Date: 31-08-2023
DOI: 10.9758/CPN.22.981
Publisher: JMIR Publications Inc.
Date: 08-09-2021
Abstract: Health applications for stroke are a growing area of research that has yielded promising results. However, little is known about how stroke survivors engage with the internet, social media, and other digital technologies on a day-to-day basis. his study had three main objectives: to describe the type, frequency, and purpose of technology use among a cohort of low-morbidity stroke survivors to investigate associations between social media use and participant factors, including sociodemographics, physical function, and independence in activities of daily living and to investigate associations between stroke-related health risk factors and the use of the internet to search for health and medical information. his study is a secondary analysis of data obtained during a national randomized controlled trial— i Prevent 2 sup nd /sup Stroke /i . The participants were stroke survivors recruited from 2 Australian stroke registries who completed 2 telephone-administered surveys to collect data on demographics and stroke characteristics health risk factors (diet quality, physical activity, blood pressure medication, alcohol intake, anxiety and depression, and smoking status) physical functioning independence in activities of daily living and questions about what technology they had access to, how often they used it, and for what purposes. Participants were eligible if they had no more than a moderate level of disability (modified Rankin score ≤3) and had access to the internet. Multivariable logistic regression was used to assess the associations between social media use and sociodemographics, physical function, and independence in activities of daily living as well as associations between stroke-related health risk factors and the use of the internet to search for health and medical information. ata from 354 participants were included in the analysis. Approximately 79.1% (280/354) of participants used the internet at least daily, 40.8% (118/289) accessed social media on their phone or tablet daily, and 46.4% (134/289) looked up health and medical information at least monthly. Women were 2.7 times more likely to use social media (adjusted odds ratio 2.65, 95% CI 1.51-4.72), and people aged & years were significantly less likely to use social media compared with those aged & years (adjusted odds ratio 0.17, 95% CI 0.07-0.44). Health risk factors were not found to be associated with searching for health- or medical-related information. he internet appears to be a viable platform to engage with stroke survivors who may not be high-morbidity to conduct research and provide information and health interventions. This is important given that they are at high risk of recurrent stroke regardless of their level of disability. Exploring the technology use behaviors and the possibility of eHealth among survivors who experience higher levels of morbidity or disability because of their stroke is an area of research that warrants further study.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2012
DOI: 10.1161/STROKEAHA.111.643296
Abstract: Screening tools for depression and psychological distress commonly used in medical settings have not been well validated in stroke populations. We aimed to determine the accuracy of common screening tools for depression or distress in detecting caseness for a major depressive episode compared with a clinician-administered structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders Fourth Edition as the gold standard. Seventy-two participants ≥3 weeks poststroke underwent a diagnostic interview for major depressive episode and completed the Patient Health Questionnaire-2 and -9, Hospital Anxiety and Depression Scale, Beck Depression Inventory-II, Distress Thermometer, and Kessler-10. Internal consistency, sensitivity, specificity, likelihood ratios, and posttest probabilities were calculated. Each measure was validated against the gold standard using receiver operating characteristic curves with comparison of the area under the curve for all measures. Internal consistency ranged from acceptable to excellent for all measures (Cronbach α=0.78–0.94). Areas under the curve (95% CI) for the Patient Health Questionnaire-2, Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale depression and total score, Beck Depression Inventory-II, and Kessler-10 ranged from 0.80 (0.69–0.89) for the Kessler-10 to 0.89 (0.79–0.95) for the Beck Depression Inventory-II with no significant differences between measures. The Distress Thermometer had an area under the curve (95% CI) of 0.73 (0.61–0.83), significantly smaller than the Beck Depression Inventory-II ( P .05). Apart from the Distress Thermometer, selected scales performed adequately in a stroke population with no significant difference between measures. The Patient Health Questionnaire-2 would be the most useful single screen given free availability and the shortest number of items.
Publisher: Wiley
Date: 21-12-2019
DOI: 10.1111/NHS.12590
Abstract: Many stroke patients are discharged home due to advances in treatment approaches and reduced residual disability. The aim of this study was to understand health professionals' perspectives on the discharge process and continuity of care during the transition between hospital and home for stroke survivors. In this qualitative, descriptive study, we used focus groups with 25 health professionals involved in discharge processes for transition from hospital to home in 2014, in a regional area of Australia. Discontinuity in the discharge process was affected by pressure to discharge patients, discharge medications and associated risks, inadequate or late discharge summaries, and challenges involving carers. Discontinuity in post-discharge services and follow up was affected by availability of post-discharge services, number of services arranged at the time of discharge, general practitioner follow up after discharge, delays and waiting lists, carer problems, and long-term follow up. There were complex organizational barriers to the continuity of care for stroke survivors discharged home. It is important to address these deficits so that stroke survivors and their carers can make the transition home with minimal risk and adequate support following a stroke.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.JPSYCHORES.2019.109892
Abstract: Two previous in idual participant data meta-analyses (IPDMAs) found that different diagnostic interviews classify different proportions of people as having major depression overall or by symptom levels. We compared the odds of major depression classification across diagnostic interviews among studies that administered the Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). Data accrued for an IPDMA on HADS-D diagnostic accuracy were analysed. We fit binomial generalized linear mixed models to compare odds of major depression classification for the Structured Clinical Interview for DSM (SCID), Composite International Diagnostic Interview (CIDI), and Mini International Neuropsychiatric Interview (MINI), controlling for HADS-D scores and participant characteristics with and without an interaction term between interview and HADS-D scores. There were 15,856 participants (1942 [12%] with major depression) from 73 studies, including 15,335 (97%) non-psychiatric medical patients, 164 (1%) partners of medical patients, and 357 (2%) healthy adults. The MINI (27 studies, 7345 participants, 1066 major depression cases) classified participants as having major depression more often than the CIDI (10 studies, 3023 participants, 269 cases) (adjusted odds ratio [aOR] = 1.70 (0.84, 3.43)) and the semi-structured SCID (36 studies, 5488 participants, 607 cases) (aOR = 1.52 (1.01, 2.30)). The odds ratio for major depression classification with the CIDI was less likely to increase as HADS-D scores increased than for the SCID (interaction aOR = 0.92 (0.88, 0.96)). Compared to the SCID, the MINI may diagnose more participants as having major depression, and the CIDI may be less responsive to symptom severity.
Publisher: Springer Science and Business Media LLC
Date: 04-06-2019
Publisher: Wiley
Date: 23-07-2019
DOI: 10.1111/DAR.12966
Abstract: Insight is a multi-dimensional construct that predicts treatment outcomes of people with mental illness. Research into insight in substance dependent populations is limited and measures of cognitive insight have not been validated for this population. A cross sectional survey was conducted with residents of nine residential substance dependence treatment facilities in Australia. Cognitive insight was assessed using the Beck Cognitive Insight Scale (BCIS). Psychological distress was assessed using the Kessler 6 (K6). Participants (N = 312) were primarily male (68.6%), with an average age of 37.51 years (SD = 9.85). Meth hetamine (45.2%) and alcohol (35.9%) were the primary substances of use. A confirmatory factor analysis confirmed the two-factor model of the BCIS (CMIN/DF = 2.91, CFI = 0.84). Removing two items from the Self-Reflection subscale improved model fit (CMIN/DF = 2.71, CFI = 0.84, Χ We found that a 12-item version of the BCIS had good psychometric properties in this substance-using population. Further research is needed to explore whether insight can predict treatment outcomes for substance use.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
Publisher: Elsevier BV
Date: 12-2020
Publisher: BMJ
Date: 12-2015
Publisher: Elsevier BV
Date: 06-2020
DOI: 10.1016/J.JCLINEPI.2020.02.002
Abstract: Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores ≥10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 ≥10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. In idual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status. A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 ≥10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%) pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%) and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 ≥10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 ≥14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 ≥14 (95% prediction interval: -13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: -16.4%, 15.0%). PHQ-9 ≥10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in in idual studies.
Publisher: S. Karger AG
Date: 08-10-2019
DOI: 10.1159/000502294
Abstract: b i Background: /i /b Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. b i Objective: /i /b To use an in idual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. b i Methods: /i /b Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. b i Results: /i /b Data were included for 54 of 72 identified eligible studies ( i n /i participants = 16,688, i n /i cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22–0.24 lower compared to fully structured interviews and 0.06–0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82–0.92) and 0.86 (0.82–0.88). b i Conclusions: /i /b The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.
Publisher: Wiley
Date: 27-09-2020
DOI: 10.1002/HPJA.296
Abstract: Informal caregivers may experience unique barriers to engaging in healthy lifestyles, consequently increasing their risk of chronic disease. Among a convenience s le of informal caregivers, this study aimed to: (a) assess the self-reported health risk behaviours of low fruit and vegetable consumption, low physical activity, current smoking and hazardous alcohol consumption (b) examine the demographic, caree condition and country of residence variables associated with each health risk behaviour and (c) report the engagement in multiple health risk behaviours. An online cross-sectional survey among caregivers in Australia, Canada, New Zealand, the United Kingdom and the United States was conducted. Self-reported health risk behaviours were assessed and compared to key Australian healthy living guidelines. Logistic regression modelling identified participant factors associated with each health risk behaviour. Overall, 384 caregivers were included in the analysis. Hazardous alcohol consumption was the only self-reported health risk behaviour which was much higher than in the general population (60.0%). Caregiver age (P = .018) and country of residence (P = .015) were associated with hazardous alcohol consumption. A majority of caregivers reported engaging in three health risk behaviours (55.0%). Caregivers are engaging in a range of health risk behaviours however, rates of hazardous alcohol consumption among the s le were high. Health promotion interventions targeted to address alcohol consumption should consider caregiver age and country of residence. SO WHAT?: This study highlights the health risk behaviours caregivers engage in across a number of countries, and suggests that caregivers require further support to manage alcohol consumption in particular.
Publisher: SAGE Publications
Date: 23-12-2021
Abstract: Garcinia mangostana Linn. (“mangosteen”) pericarp contains bioactive compounds that may target biological pathways implicated in schizophrenia. We conducted a double-blind randomized placebo-controlled trial evaluating the efficacy of adjunctive mangosteen pericarp, compared to placebo, in the treatment of schizophrenia. People diagnosed with schizophrenia or schizoaffective disorder ( Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), recruited across 2 sites (Brisbane and Victoria, Australia), were randomized to receive 24 weeks of adjunctive mangosteen pericarp (1,000 mg/day) or matched placebo. The primary outcome measure was the Positive and Negative Symptom Scale total score. Secondary outcomes included positive and negative symptoms, general psychopathology, clinical global severity and improvement, participant reported overall improvement, depressive symptoms, functioning, quality of life, and safety data at 24 and 28 weeks (4 weeks postdiscontinuation). Data were collected from July 2016 to February 2019. Baseline assessments were conducted on 148 people (mangosteen = 74, placebo = 74) data analyses were conducted on 136 (92%) participants with postbaseline data. The treatment group had significantly higher symptom severity compared to placebo, and both groups significantly improved on all symptom, functioning, and quality of life measures over time. No between-group differences were found for the rate of change between baseline and 24 or 28 weeks. Despite promising preclinical and clinical work, our results do not support mangosteen pericarp extract as an adjunctive treatment for schizophrenia or schizoaffective disorder.
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.APMR.2012.09.009
Abstract: To explore clinicians' and patients' perceptions of acceptability of an electronic screening and decision support system for poststroke depression. A mixed-methods study involved participants from 2 convenience s les. Outpatient stroke and rehabilitation clinics. Stroke patients (n=62) completed surveys. Seven clinicians working at clinics targeted by the depression screening process were interviewed using semi-structured interviews. Not applicable. Patient data were analyzed from an acceptability survey. Qualitative data analysis involved an inductive thematic approach with constant comparison. Most patients found screening easy to complete and understand, important, and a good way of conveying information to the clinician. Most clinicians did not systematically discuss mood disturbances, with attenuating factors and barriers to identification both influencing identification. Variations in the management of mood centered on the use of pharmacotherapy and role overlap with general practitioners. The screening process assisted with identification and saved time during diagnosis and management. The positive perceptions of patients and clinicians identified in this study support the concept of routine screening and feedback for poststroke depression. This process has the potential to improve poststroke depression practice to meet national guidelines however, evaluation of impact on patient outcome is required.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: Elsevier BV
Date: 10-2021
Publisher: Oxford University Press (OUP)
Date: 12-11-2014
Abstract: Depression is common following an acute cardiac event and can occur at a time when behaviour change is strongly recommended to reduce the risk of further cardiovascular events. The 'Beating Heart Problems' programme was designed to support cardiac patients in behaviour change and mood management. The programme was based on cognitive behaviour therapy and motivational interviewing. A randomized controlled trial (RCT) comparing the 8-week group programme with usual care was undertaken between 2007 and 2010. All patients attended a hospital-based clinic for assessment of physiological risk factors at baseline (6 weeks after their acute event), and at 4- and 12-month follow up. Psychological and behavioural indicators were assessed by self-report questionnaires. Of the 275 patients enrolled into the RCT, 42 (15%) had Beck Depression Inventory-II scores >13 at baseline. Treatment and control group comparisons were undertaken for this subgroup, using growth curve modelling and testing for group differences over time in psychological, physiological, health behaviour, and self-efficacy measures. Significantly greater improvements (p < 0.01) in depression symptoms and self-rated health were reported for the intervention group, as well as significantly larger gains in confidence in managing depression (p < 0.05) and anger (p < 0.01). Trends (0.05 < p < 0.10) for larger treatment group improvements were also seen for anxiety symptoms and confidence in managing anxiety. A group secondary-prevention programme that integrates behavioural and mood management strategies leads to decreased depression, increased confidence, and improved health perceptions in depressed cardiac patients.
Publisher: SAGE Publications
Date: 28-07-2017
Abstract: It is unclear whether blockade of the angiotensin system has effects on mental health. Our objective was to determine the impact of angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor (AT1R) blockers on mental health domain of quality of life. Meta-analysis of published literature. PubMed and clinicaltrials.gov databases. The last search was conducted in January 2017. Randomized controlled trials comparing any angiotensin converting enzyme inhibitor or AT1R blocker versus placebo or non-angiotensin converting enzyme inhibitor or non-AT1R blocker were selected. Study participants were adults without any major physical symptoms. We adhered to meta-analysis reporting methods as per PRISMA and the Cochrane Collaboration. Eleven studies were included in the analysis. When compared with placebo or other antihypertensive medications, AT1R blockers and angiotensin converting enzyme inhibitors were associated with improved overall quality of life (standard mean difference = 0.11, 95% confidence interval = [0.08, 0.14], p < 0.0001), positive wellbeing (standard mean difference = 0.11, 95% confidence interval = [0.05, 0.17], p < 0.0001), mental (standard mean difference = 0.15, 95% confidence interval = [0.06, 0.25], p < 0.0001), and anxiety (standard mean difference = 0.08, 95% confidence interval = [0.01, 0.16], p < 0.0001) domains of QoL. No significant difference was found for the depression domain (standard mean difference = 0.05, 95% confidence interval = [0.02, 0.12], p = 0.15). Use of angiotensin blockers and inhibitors for the treatment of hypertension in otherwise healthy adults is associated with improved mental health domains of quality of life. Mental health quality of life was a secondary outcome in the included studies. Research specifically designed to analyse the usefulness of drugs that block the angiotensin system is necessary to properly evaluate this novel psychiatric target.
Publisher: Springer Science and Business Media LLC
Date: 17-05-2021
DOI: 10.1007/S43465-020-00327-9
Abstract: Fractures through the physis account for 18–30% of paediatric fractures and can lead to growth arrest in 5–10% of these cases. Long-term radiographic follow-up is usually necessary to monitor for signs of growth arrest at the affected physis. Given plain radiographs of a physeal fracture obtained throughout patient follow-up, different surgeons may hold different opinions about whether or not early growth arrest has occurred despite using identical radiographs to guide decision-making. This study aims to assess the inter-rater and intra-rater reliability of early growth arrest diagnosis among orthopaedic surgeons given a set of identical plain radiographs. A retrospective chart review was conducted on patients aged 2–18 years previously treated for a physeal fracture at a paediatric tertiary care hospital between 2011 and 2018. De-identified anteroposterior (AP) and lateral radiographs of 39 patients from the date of injury and minimum one-year post-injury were administered in a survey to international paediatric orthopaedic surgeons. Each surgeon was asked whether they would diagnose the patient with growth arrest based on the radiographs provided. Surgeons were asked to complete this process again two weeks after the initial review, but using identical shuffled radiographs. Inter-rater and intra-rater reliability was calculated using appropriate kappa statistics. A total of 11 paediatric orthopaedic surgeons completed the first round of the survey, and 9 of these 11 completed the second round. The inter-rater reliability for the first round was 0.22 [95% CI (0.06, 0.35)] and 0.21 [95% CI (0.02, 0.32)] for the second round. The average kappa for intra-rater reliability was − 0.05 [95% CI (− 0.31, 0.21)]. Comparison by injury side showed no significant variation in diagnosis { p = 0.509, OR = 0.90, [95% CI (0.67, 1.22)]}, while comparison by location of injury varied significantly ( p = 0.003). Radiographic diagnosis of growth arrest among paediatric orthopaedic surgeons demonstrated ‘fair’ inter-rater agreement and no intra-rater agreement, suggesting critical differences in identifying growth arrest on plain radiographs. Further research is necessary to develop an improved diagnostic approach for growth arrest among orthopaedic surgeons. Diagnostic level III.
Publisher: Korean College of Neuropsychopharmacology
Date: 31-05-2022
Publisher: EDITORA SCIENTIFIC
Date: 02-2020
Publisher: BMJ
Date: 2019
DOI: 10.1136/BMJINNOV-2017-000257
Abstract: Stroke events often result in long-term negative health outcomes. People who experience a first stroke event are 30%–40% more likely to experience a second stroke event within 5 years. An online secondary prevention programme for stroke survivors may help stroke survivors improve their health risk behaviours and lower their risk of a second stroke. This paper describes the development and early iteration testing of the usability and acceptability of an online secondary prevention programme for stroke survivors (Prevent 2nd Stroke, P2S). P2S aims to address six modifiable health risk behaviours of stroke: blood pressure, physical activity, nutrition, depression and anxiety, smoking, and alcohol consumption. P2S was developed as an eight-module online secondary prevention programme for stroke survivors. Modelled on the DoTTI (Design and development, Testing early iterations, Testing for effectiveness, Integration and implementation) framework for the development of online programmes, the following stages were followed during programme development: (1) content development and design and (2) testing early iteration. The programme was pilot-tested with 15 stroke survivors who assessed P2S on usability and acceptability. In stage 1, experts provided input for the content development of P2S. In stage 2, 15 stroke survivors were recruited for usability testing of P2S. They reported high ratings of usability and acceptability of P2S. P2S was generally regarded as ‘easy to use’ and ‘relevant to stroke survivors’. Participants also largely agreed that it was appropriate to offer lifestyle advice to stroke survivors through the internet. The study found that an online secondary prevention programme was acceptable and easily usable by stroke survivors. The next step is to conduct a randomised controlled trial to assess the effectiveness of the programme regarding behaviour change and determine the cost-effectiveness of the intervention.
Publisher: Public Library of Science (PLoS)
Date: 08-05-2019
Publisher: Frontiers Media SA
Date: 19-03-2019
Publisher: Cambridge University Press (CUP)
Date: 19-08-2019
Publisher: Frontiers Media SA
Date: 04-03-2015
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.HLC.2013.10.093
Abstract: Return to work is an important indicator of recovery after acute cardiac events. This study aimed to determine rates of work resumption and identify predictors of non-return to work and delayed resumption of work. 401 currently employed patients consecutively admitted after acute coronary syndrome or to undergo coronary artery bypass graft surgery were recruited. Patient characteristics, perceptions and occupational outcomes were investigated via interviews and self-report questionnaires. Twenty-three patients were lost to follow-up. Of the 378 completers, 343 (90.7%) patients resumed work, while 35 (9.3%) did not. By four months, 309 (91.1%) patients had returned to work. At 12 months, 302 (79.9%) of the 378 patients were employed, 32 (8.5%) unemployed and 20 (5.3%) retired. The employment status of 24 (6.3%) patients was unknown. Non-return to work was significantly more likely if patients were not intending to return to work or were uncertain, had a negative perception of health, had a comorbidity other than diabetes and reported financial stress. Significant predictors of delayed return to work were cardiac rehabilitation attendance, longer hospital stay, past angina, having a manual job, physically active work, job dissatisfaction, no confidante and depression. Patients at risk of poor occupational outcomes can be identified early. Strategies to improve vocational rehabilitation require further investigation.
Publisher: Cambridge University Press (CUP)
Date: 30-06-2020
DOI: 10.1017/NEU.2020.25
Abstract: The aims of this study were to evaluate changes in inflammatory and oxidative stress levels following treatment with N -acetylcysteine (NAC) or mitochondrial-enhancing agents (CT), and to assess the how these changes may predict and/or moderate clinical outcomes primarily the Montgomery-Åsberg Depression Rating Scale (MADRS). This study involved secondary analysis of a placebo-controlled randomised trial ( n = 163). Serum s les were collected at baseline and week 16 of the clinical trial to determine changes in Interleukin-6 (IL-6) and total antioxidant capacity (TAC) following adjunctive CT and/or NAC treatment, and to explore the predictability of the outcome or moderator effects of these markers. In the NAC-treated group, no difference was observed in serum IL-6 and TAC levels after 16 weeks of treatment with NAC or CT. However, results from a moderator analysis showed that in the CT group, lower IL-6 levels at baseline was a significant moderator of MADRS χ 2 (df) = 4.90, p = 0.027) and Clinical Global Impression-Improvement (CGI-I, χ 2 (df) = 6.28 p = 0.012). In addition, IL-6 was a non-specific but significant predictor of functioning (based on the Social and Occupational Functioning Assessment Scale (SOFAS)), indicating that in iduals with higher IL-6 levels at baseline had a greater improvement on SOFAS regardless of their treatment ( p = 0.023). Participants with lower IL-6 levels at baseline had a better response to the adjunctive treatment with the mitochondrial-enhancing agents in terms of improvements in MADRS and CGI-I outcomes.
Publisher: Public Library of Science (PLoS)
Date: 10-12-2020
DOI: 10.1371/JOURNAL.PONE.0243502
Abstract: The purpose of this study was to assess the frequency of unmet needs of carers among a convenience s le of carers, and the participant factors associated with unmet needs, to inform the development of interventions that will support a range of caregivers. The aims of this study were to: (1) assess the most frequently reported moderate-high unmet needs of caregivers and (2) examine the age, gender, condition of the care recipient, and country variables associated with types of unmet needs reported by informal caregivers. An online cross-sectional survey among informal caregivers in English-speaking countries was conducted. Self-reported unmet needs were assessed using an unmet needs measure with the following five unmet needs domains: (1) Health information and support for care recipient (2) Health service management (3) Communication and relationship (4) Self-care and (5) Support services accessibility. Informal caregivers were asked “In the last month, what was your level of need for help with…”, and the ten highest ranked moderate-high unmet needs presented as ranked proportions. Logistic regression modelling examined the factors associated with types of unmet needs. Overall, 457 caregivers were included in the final analysis. Seven of the ten highest ranked unmet needs experienced by caregivers in the last month were in the Self-care domain, including “Reducing stress in your life” (74.1%). Significant associations were found between younger caregiver age (18–45 years) and reporting moderate-high unmet needs in Health Information and support for care recipient, Health service management, and Support services accessibility (all p’ s = 0.05). Caregivers are not experiencing significant differences in unmet needs between countries and caree/care recipient conditions, suggesting that general interventions could be developed to support a range of caregivers across countries. Increased awareness of informal caregivers’ unmet needs, particularly for younger caregivers, among health care providers may improve support provision to caregivers.
Publisher: Springer Singapore
Date: 2016
Publisher: Elsevier BV
Date: 08-2001
Publisher: CRC Press
Date: 08-05-2017
Publisher: SAGE Publications
Date: 07-2010
DOI: 10.3109/00048671003646751
Abstract: Objective: To utilize existing medical record information in order to examine the relationship between depression, anxiety, levels of social support and clinical outcomes in cardiac rehabilitation attendees. Method: In a tertiary care centre 389 records for cardiac rehabilitation outpatients were analysed. Hospital Anxiety and Depression Scales scores collected at week 4 of their cardiac rehabilitation programme were linked with medical record information on demographic, lifestyle, medical and other coronary heart disease risk factors, as well as follow-up cardiovascular events and readmissions for an average of 2.6 years. Variables of interest were anxiety and depression scores and proxy measures of social support. Clinical outcome measures were number of hospital admissions, length of stay and mortality. Results: Multiple variable analysis revealed higher anxiety scores were associated with more hospital admissions and higher depression scores were associated with longer length of stay after controlling for other established prognostic risk factors. Depression, anxiety and social support were not associated with mortality, however there was a low mortality rate in the present study. Conclusion: A comprehensive summary of the characteristics of cardiac rehabilitation patients was gathered through the linkage and examination of existing clinical databases. The results of this study provide some support for a prognostic role of depressive and anxiety symptoms and highlight the need for screening for psychological distress and provision of appropriate interventions when indicated.
Publisher: Springer Science and Business Media LLC
Date: 10-07-2013
Abstract: Depression is an independent risk factor for coronary artery disease. Autonomic instability may play a mediating or moderating role in this relationship however this is not well understood. The objective of this study was to explore cardiac autonomic function and cardiac arrhythmia in depression, the correlation between depression severity and Heart Rate Variability (HRV) related indices, and the prevalence of arrhythmia. In iduals (n = 53) with major depression as assessed by the Diagnostic and Statistical Manual of Mental Disorders, who had a Hamilton Rating Scale for Depression (HAMD) score ≥20 and a Zung Self-Rating Depression Scale score 53 were compared to 53 healthy in iduals, matched for age and gender. Multichannel Electrocardiograph ECG-92C data were collected over 24 hours. Long-term changes in HRV were used to assess the following vagally mediated changes in autonomic tone, expressed as time domain indices: Standard deviation of the NN intervals (SDNN), standard deviation of 5 min averaged NN intervals (SDANN), Root Mean Square of the Successive Differences (RMSSD) and percentage of NN intervals 50 ms different from preceding interval (pNN50). Pearson’s correlations were conducted to explore the strength of the association between depression severity (using the SDS and HRV related indices, specifically SDNN and low frequency domain / high frequency domain (LF/HF)). The values of SDNN, SDANN, RMSSD, PNN50 and HF were lower in the depression group compared to the control group ( P .05). The mean value of the LF in the depression group was higher than the in control group ( P .05). Furthermore the ratio of LF/HF was higher among the depression group than the control group ( P .05). A linear relationship was shown to exist between the severity of the depression and HRV indices. In the depression group, the prevalence of arrhythmia was significantly higher than in the control group ( P .05), particularly supraventricular arrhythmias. Our findings suggest that depression is accompanied by dysfunction of the cardiac autonomic nervous system, and further, that depression severity is linked to severity of this dysfunction. In iduals with depression appear to be susceptible to premature atrial and/or ventricular disease.
Publisher: Bentham Science Publishers Ltd.
Date: 25-08-2014
DOI: 10.2174/1567202611666140522123504
Abstract: Post-stroke depression is an important psychological consequence of ischemic stroke, and affects around one third of stroke patients at any time post-stroke. It has a negative impact on patient morbidity and mortality, and as such development of effective post-stroke recognition and treatment strategies are very important. There are several therapeutic strategies for post-stroke depression, including both pharmacological and non-pharmacological approaches. In this review, we present evidence regarding the underlying biology of post-stroke depression, commonalities between post-stroke depression and Major Depressive Disorder and explore several treatment approaches, including antidepressant therapy, psychotherapy, surgical therapy, electroconvulsive therapy, acupuncture, music therapy and natural products. Further experimental and clinical studies are required, particularly in emerging fields such as the role of nutraceuticals in the treatment of stroke.
Publisher: JMIR Publications Inc.
Date: 30-05-2022
DOI: 10.2196/33291
Abstract: eHealth applications for stroke are a growing area of research that has yielded promising results. However, little is known about how stroke survivors engage with the internet, social media, and other digital technologies on a day-to-day basis. This study had three main objectives: to describe the type, frequency, and purpose of technology use among a cohort of low-morbidity stroke survivors to investigate associations between social media use and participant factors, including sociodemographics, physical function, and independence in activities of daily living and to investigate associations between stroke-related health risk factors and the use of the internet to search for health and medical information. This study is a secondary analysis of data obtained during a national randomized controlled trial—Prevent 2nd Stroke. The participants were stroke survivors recruited from 2 Australian stroke registries who completed 2 telephone-administered surveys to collect data on demographics and stroke characteristics health risk factors (diet quality, physical activity, blood pressure medication, alcohol intake, anxiety and depression, and smoking status) physical functioning independence in activities of daily living and questions about what technology they had access to, how often they used it, and for what purposes. Participants were eligible if they had no more than a moderate level of disability (modified Rankin score ≤3) and had access to the internet. Multivariable logistic regression was used to assess the associations between social media use and sociodemographics, physical function, and independence in activities of daily living as well as associations between stroke-related health risk factors and the use of the internet to search for health and medical information. Data from 354 participants were included in the analysis. Approximately 79.1% (280/354) of participants used the internet at least daily, 40.8% (118/289) accessed social media on their phone or tablet daily, and 46.4% (134/289) looked up health and medical information at least monthly. Women were 2.7 times more likely to use social media (adjusted odds ratio 2.65, 95% CI 1.51-4.72), and people aged years were significantly less likely to use social media compared with those aged years (adjusted odds ratio 0.17, 95% CI 0.07-0.44). Health risk factors were not found to be associated with searching for health- or medical-related information. The internet appears to be a viable platform to engage with stroke survivors who may not be high-morbidity to conduct research and provide information and health interventions. This is important given that they are at high risk of recurrent stroke regardless of their level of disability. Exploring the technology use behaviors and the possibility of eHealth among survivors who experience higher levels of morbidity or disability because of their stroke is an area of research that warrants further study.
Publisher: S. Karger AG
Date: 2015
DOI: 10.1159/000369483
Publisher: Elsevier BV
Date: 2021
Publisher: Informa UK Limited
Date: 12-05-2022
DOI: 10.1080/09638288.2020.1756470
Abstract: To synthesise research describing the long-term unmet needs of carers who are providing care to a stroke survivor at home who is at least 3 months post-discharge. A systematic review with a narrative synthesis of the English-language qualitative and quantitative studies identified from MEDLINE, CINAHL, PsycINFO, EMBASE, AMED, and Scopus was undertaken. Five quantitative studies, seven qualitative studies, and one mixed-method study were included in the review. Five themes of unmet needs were identified from the synthesis: (1) Obtaining adequate information, (2) Taking care of oneself, (3) Service accessibility, (4) Emotional and psychological, and (5) Relationship. Commonly reported needs across the 13 final studies included the need for support from health care and/or service providers, help with self-care, and help with coping and managing emotions. Variables associated with unmet needs included the severity of the stroke that the stroke survivor experienced and the length of hospital stay. Evidence from this review suggests that carers are experiencing a range of long-term unmet needs, particularly in education and training, coping and managing their own emotions, and accessing much-needed services. Recommendations to support carers at home include continuing engagement, assessment, and support from health care providers and services to meet the needs of carers throughout the stroke recovery process.IMPLICATIONS FOR REHABILITATIONCarers of stroke survivors experience complex long-term unmet needs around managing the recovery process of the stroke survivor when they have been discharged from hospital and returned home.Evidence suggests that continuing engagement and support from health care providers and services may assist carers in meeting their unmet needs.Healthcare professionals should provide help in accessing training and services.Support is required to help carers cope and to manage their emotions.
Publisher: BMJ
Date: 2018
DOI: 10.1136/BMJOPEN-2017-019571
Abstract: Stroke events deeply affect not only the stroke survivor but also often the quality of life and physical and psychological health of the family and friends who care for them. There is a need for further information about the unmet needs of these informal carers in order to develop support services and interventions. The primary objective of this review is to report and synthesise the research describing the unmet needs of carers of stroke survivors. A systematic review of quantitative and qualitative studies that report on the unmet needs of carers will be conducted. The following databases will be searched for relevant articles: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Allied and Complementary Medicine Database and Scopus. No publication date constraints will be applied. Studies will be limited to those published in English and conducted among humans. Eligible studies will report on the unmet needs of informal carers of stroke survivors, defined as family members, friends and other unpaid caregivers. Studies which focus on formal, clinical or medical caregivers will be excluded. A narrative synthesis and pooled analysis of the main outcomes will be reported. This review will be submitted to a peer-reviewed journal. Our findings are expected to provide new insights into the unmet needs of stroke survivors’ carers. Knowledge about the unmet needs of carers will inform the development and refinement of interventions and services to address these needs and better support carers of stroke survivors. The findings of this systematic review will be disseminated publicly and in peer-reviewed journals and may be the topic of research presentations. CRD42017067391 .
Publisher: Springer Science and Business Media LLC
Date: 25-01-2019
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.ADDBEH.2009.02.002
Abstract: Substance misuse among people with severe mental disorders is very common and has been associated with a number of adverse outcomes. Most trials among people with severe mental disorders have reported general substance misuse outcomes and have argued that longer treatments are likely to be more effective. Such studies have not specifically compared intervention effectiveness for alcohol vs. cannabis misuse. The present paper reports findings from a synthesis of datasets from three randomized controlled trials (N=248) comparing brief (1-session advice or motivational interviewing, MI) and extended (10 sessions MI/cognitive-behaviour therapy CBT) interventions for substance misuse among people with psychosis or major depression and outcomes are reported separately for alcohol and cannabis use. Whilst there were comparable rates of reduction in alcohol consumption for the BI and intensive MI/CBT, BI tended to be associated with less reduction in cannabis use. A stepped care approach for substance misuse in people with severe mental disorders may help to improve cannabis outcomes, including monitoring of both mental health and substance misuse domains, with interventions stepped up or down according to treatment response. Future studies should evaluate the effectiveness of stepped care approaches.
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/BMJOPEN-2019-035080
Abstract: Due to the anti-inflammatory, antioxidant and anti-apoptotic properties of minocycline, clinical trials have evaluated the potential of this drug to treat several psychiatric and neurological disorders, including major depressive disorder, schizophrenia, bipolar disorder, stroke and amyotrophic lateral sclerosis. This protocol proposes a systematic review (and potential meta-analysis) that aims to identify and critically evaluate randomised controlled trials of minocycline for treating psychiatric and neurological disorders. PubMed, Embase, Cochrane Central Register of Controlled Clinical Trials, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be used to identify randomised controlled trials that used minocycline to treat psychiatric and neurological disorders. Double-blind, randomised, controlled, clinical trials of participants aged 18 years or older and written in English will be included in the review. Data will be extracted by two independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed and the Cochrane Collaboration’s ‘Risk of Bias’ tool will be used to assess the risk of bias in all studies included in the systematic review. The Grading of Recommendations, Assessment, Development and Evaluation system will be used to access the overall quality of the level of evidence of the studies. If sufficient evidence is identified, a meta-analysis will be conducted using the standardised mean difference approach and reported with 95% CIs. Heterogeneity of evidence will be evaluated using the I 2 model. This systematic review will evaluate only published data therefore, ethical approval is not required. The systematic review will be published in a peer-reviewed journal and presented at relevant research conferences. CRD42020153292.
Publisher: Cold Spring Harbor Laboratory
Date: 03-05-2022
DOI: 10.1101/2022.05.02.22274560
Abstract: Recent data indicates high prevalence of post-traumatic stress disorder (PTSD) in bipolar disorder (BD). PTSD may play a role in poor treatment outcomes and quality of life for people with BD. Despite this, few studies have examined the pharmacological treatment interventions and outcomes for this comorbidity. This systematic review will bring together currently available evidence regarding the impact of comorbid PTSD on pharmacological treatment outcomes in adults with BD. A systematic search of Embase, MEDLINE Complete, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL) will be conducted to identify randomised and non-randomised studies of pharmacological interventions for adults with diagnosed bipolar disorder and PTSD. Data will be screened and extracted by two independent reviewers. Literature will be searched from the creation of the databases until April 1 2021. Risk of bias will be assessed using the Newcastle-Ottawa Scale and the Cochrane Collaborations Risk of Bias tool. A meta-analysis will be conducted if sufficient evidence is identified in the systematic review. The meta-analysis will employ a random-effects model and be evaluated using the I 2 statistic. This review and meta-analysis will be the first to systematically explore and integrate the available evidence on the impact of PTSD on pharmacological treatments and outcome in those with BD. The results and outcomes of this systematic review will provide directions for future research and be published in relevant scientific journals and presented at research conferences. The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42020182540).
Publisher: EDITORA SCIENTIFIC
Date: 05-2019
Publisher: Frontiers Media SA
Date: 03-09-2019
Publisher: SAGE Publications
Date: 12-2009
DOI: 10.3109/00048670903270415
Abstract: Objective: In a general medical hospital with limited mental health resources, a clinical need arose for an effective treatment for depression and anxiety symptoms in cardiac rehabilitation patients. Method: A total of 628 cardiac rehabilitation outpatients at a tertiary care centre were screened with the Hospital Anxiety and Depression Scale at week 4 of their programme, and 182 of 558 responders (33%) scored ≥8 on the Depression and/or Anxiety subscales. A 6 week group cognitive behaviour therapy programme was developed to assist these identified patients. The resulting programme, BraveHeart, was piloted on 39 patients still experiencing significant symptoms of depression or anxiety at the end of rehabilitation. Patients were assessed at baseline, after treatment, 1 and 6 months after treatment using the Hospital Anxiety and Depression Scale and the Beck Depression Inventory-II. Results: Significant improvement in levels of depression and anxiety symptoms occurred from baseline to post-treatment assessment, and this change was maintained at 6 months, with moderate–strong effect sizes. Feedback from the group members was positive. Conclusions: A specialized group treatment programme for cardiac patients with existing depression and anxiety was created that resulted in significant reductions in symptoms.
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.HLC.2015.11.002
Abstract: Cognitive decline post-cardiac surgery is of clinical concern. To better understand it a sensitive and specific measure of post-surgery brain impairment is required. The cerebral territory most likely to be adversely affected by surgery is the posterior "watershed" territory. We have designed a psychophysical task involving reading letters defined by motion aimed at measuring the integrity of a cortical area (MT) located in this territory. Patients undergoing coronary artery bypass grafting (CABG) and a healthy control group were given the psychophysical test twice, pre- and post-surgery for the patient group. There was no overall difference in performance between the surgery group and the control group at either pre- or post-surgery testing. However, multivariate analysis of surgical variables such as body temperature and embolic load to the brain as measured by Transcranial Doppler showed that patients with warmer core temperatures and higher embolic loads performed significantly worse on the motion defined letter reading tasks than those with more favourable surgical variables. These results demonstrate that high embolic load and warm core body temperatures lead to poor motion perception post-cardiac surgery, implying damage to the posterior watershed cortex.
Publisher: Physicians Postgraduate Press, Inc
Date: 27-05-2015
DOI: 10.4088/JCP.14L09378
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.PSYCHRES.2014.06.035
Abstract: The study objective was to evaluate the feasibility of a telephone delivered intervention consisting of motivational interviewing and cognitive behavioural strategies aimed at improving diet and physical activity in people diagnosed with psychotic disorders. Twenty participants diagnosed with a non-acute psychotic disorder were recruited. The intervention consisted of eight telephone delivered sessions targeting fruit and vegetable (F&V) consumption and leisure screen time, as well as smoking and alcohol use (as appropriate). F&V frequency and variety, and overall diet quality (measured by the Australian Recommended Food Score, ARFS), leisure screen time, overall sitting and walking time, smoking, alcohol consumption, mood, quality of life, and global functioning were examined before and 4-weeks post-treatment. Nineteen participants (95%) completed all intervention sessions, and 17 (85%) completed follow-up assessments. Significant increases from baseline to post-treatment were seen in ARFS fruit, vegetable and overall diet quality scores, quality of life and global functioning. Significant reductions in leisure screen time and overall sitting time were also seen. Results indicated that a telephone delivered intervention targeting key cardiovascular disease risk behaviours appears to be feasible and relatively effective in the short-term for people diagnosed with psychosis. A randomized controlled trial is warranted to replicate and extend these findings.
Publisher: Springer Science and Business Media LLC
Date: 09-08-2016
Publisher: SAGE Publications
Date: 30-01-2020
Abstract: Researchers increasingly use meta-analysis to synthesize the results of several studies in order to estimate a common effect. When the outcome variable is continuous, standard meta-analytic approaches assume that the primary studies report the s le mean and standard deviation of the outcome. However, when the outcome is skewed, authors sometimes summarize the data by reporting the s le median and one or both of (i) the minimum and maximum values and (ii) the first and third quartiles, but do not report the mean or standard deviation. To include these studies in meta-analysis, several methods have been developed to estimate the s le mean and standard deviation from the reported summary data. A major limitation of these widely used methods is that they assume that the outcome distribution is normal, which is unlikely to be tenable for studies reporting medians. We propose two novel approaches to estimate the s le mean and standard deviation when data are suspected to be non-normal. Our simulation results and empirical assessments show that the proposed methods often perform better than the existing methods when applied to non-normal data.
Publisher: Springer Science and Business Media LLC
Date: 17-02-2019
Publisher: Elsevier BV
Date: 12-2020
DOI: 10.1016/J.JPSYCHORES.2020.110256
Abstract: Validated diagnostic interviews are required to classify depression status and estimate prevalence of disorder, but screening tools are often used instead. We used in idual participant data meta-analysis to compare prevalence based on standard Hospital Anxiety and Depression Scale - depression subscale (HADS-D) cutoffs of ≥8 and ≥11 versus Structured Clinical Interview for DSM (SCID) major depression and determined if an alternative HADS-D cutoff could more accurately estimate prevalence. We searched Medline, Medline In-Process & Other Non-Indexed Citations via Ovid, PsycINFO, and Web of Science (inception-July 11, 2016) for studies comparing HADS-D scores to SCID major depression status. Pooled prevalence and pooled differences in prevalence for HADS-D cutoffs versus SCID major depression were estimated. 6005 participants (689 SCID major depression cases) from 41 primary studies were included. Pooled prevalence was 24.5% (95% Confidence Interval (CI): 20.5%, 29.0%) for HADS-D ≥8, 10.7% (95% CI: 8.3%, 13.8%) for HADS-D ≥11, and 11.6% (95% CI: 9.2%, 14.6%) for SCID major depression. HADS-D ≥11 was closest to SCID major depression prevalence, but the 95% prediction interval for the difference that could be expected for HADS-D ≥11 versus SCID in a new study was -21.1% to 19.5%. HADS-D ≥8 substantially overestimates depression prevalence. Of all possible cutoff thresholds, HADS-D ≥11 was closest to the SCID, but there was substantial heterogeneity in the difference between HADS-D ≥11 and SCID-based estimates. HADS-D should not be used as a substitute for a validated diagnostic interview.
Publisher: Public Library of Science (PLoS)
Date: 24-09-2014
Publisher: Public Library of Science (PLoS)
Date: 19-04-2022
DOI: 10.1371/JOURNAL.PMED.1003966
Abstract: The aim of this trial was to evaluate the effectiveness of an online health behaviour change intervention—Prevent 2nd Stroke (P2S)—at improving health-related quality of life (HRQoL) amongst stroke survivors at 6 months of follow-up. A prospective, blinded-endpoint randomised controlled trial, with stroke survivors as the unit of randomisation, was conducted between March 2018 and November 2019. Adult stroke survivors between 6 and 36 months post-stroke with capacity to use the intervention (determined by a score of ≥4 on the Modified Rankin Scale) and who had access and willingness to use the internet were recruited via mail-out invitations from 1 national and 1 regional stroke registry. Participants completed baseline ( n = 399) and 6-month follow-up ( n = 356 89%) outcome assessments via computer-assisted telephone interviewing (CATI). At baseline the s le had an average age of 66 years (SD 12), and 65% were male. Randomisation occurred at the end of the baseline survey CATI assessors and independent statisticians were blind to group allocation. The intervention group received remote access for a 12-week period to the online-only P2S program ( n = 199 n = 28 lost at follow-up). The control group were emailed and posted a list of internet addresses of generic health websites ( n = 200 n = 15 lost at follow-up). The primary outcome was HRQoL as measured by the EuroQol Visual Analogue Scale (EQ-VAS self-rated global health) the outcome was assessed for differences between treatment groups at follow-up, adjusting for baseline measures. Secondary outcomes were HRQoL as measured by the EQ-5D (descriptive health state), diet quality, physical activity, alcohol consumption, smoking status, mood, physical functioning, and independent living. All outcomes included the variable ‘stroke event (stroke/transient ischaemic attack/other)’ as a covariate, and analysis was intention-to-treat. At 6 months, median EQ-VAS HRQoL score was significantly higher in the intervention group than the control group (85 vs 80, difference 5, 95% CI 0.79–9.21, p = 0.020). The results were robust to the assumption the data were missing at random however, the results were not robust to the assumption that the difference in HRQoL between those with complete versus missing data was at least 3 points. Significantly higher proportions of people in the intervention group reported no problems with personal care (OR 2.17, 95% CI 1.05–4.48, p = 0.0359) and usual activities (OR 1.66, 95% CI 1.06–2.60, p = 0.0256) than in the control group. There were no significant differences between groups on all other secondary outcomes. The main limitation of the study is that the s le comprises mostly ‘well’ stroke survivors with limited to no disability. The P2S online healthy lifestyle program improved stroke survivors’ self-reported global ratings of HRQoL (as measured by EQ-VAS) at 6-month follow-up. Online platforms represent a promising tool to engage and support some stroke survivors. Australian New Zealand Clinical Trials Registry ACTRN12617001205325 .
Publisher: Springer Science and Business Media LLC
Date: 09-08-2019
Publisher: Oxford University Press (OUP)
Date: 24-05-2013
Abstract: While there is evidence of poor health behaviours in anxious and depressed cardiac patients, it is possible that sociodemographic factors explain these associations. Few previous studies have adequately controlled for confounders. The present study investigated health behaviours in anxious and depressed cardiac patients, while accounting for sociodemographic confounders. A consecutive s le of 275 patients admitted to hospital after acute myocardial infarction (32%) or for coronary bypass surgery (40%) or percutaneous coronary intervention (28%) was interviewed six weeks after hospital discharge. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Smoking, physical activity, alcohol intake and dietary fat intake were assessed by self-report. Backward stepwise logistic regression was used to identify the factors independently associated with anxiety and depression. In total, 41 patients (15.2%) were 'depressed' (HADS-D ≥8) while 68 (25.2%) were 'anxious' (HADS-A ≥8). Depressed patients reported higher rates of smoking (χ2)= 4.47, p = 0.034), lower physical activity (F = 8.63, p < 0.004) and higher dietary fat intake (F = 7.22, p = 0.008) than non-depressed patients. Anxious patients reported higher smoking rates (χ2)= 5.70, p = 0.024) and dietary fat intake (F = 7.71, p = 0.006) than non-anxious patients. In multivariate analyses, an association with depression was retained for both diet and physical activity, and an association with anxiety was retained for diet. Low social support and younger age were significant confounders with depression and anxiety respectively. While the high smoking rates evidenced in anxious and depressed patients were explained by sociodemographic factors, their poor diet and low physical activity (depressed patients only) were independent of these factors. Given the impact of lifestyle modification on survival after a cardiac event, anxious and depressed patients should be a priority for cardiac rehabilitation and other secondary prevention programmes.
Publisher: EDITORA SCIENTIFIC
Date: 07-10-2015
DOI: 10.1590/1516-4446-2013-1341
Abstract: Bipolar disorder places a significant burden on in iduals, caregivers and family, and the broader community. Current treatments are believed to be more effective against manic symptoms, leaving a shortfall in recovery during the depressive phase of the illness. The current study draws on recent evidence suggesting that, in addition to increased oxidative load, alterations in mitochondrial function occur in bipolar disorder. This 16-week study aims to explore the potential benefits of N-acetylcysteine (NAC) alone or in combination (CT) with selected nutraceuticals believed to enhance mitochondrial function. The study includes adults diagnosed with bipolar disorder currently experiencing an episode of depression. Participants are asked to take NAC, CT, or placebo in addition to any usual treatments. A post-discontinuation visit is conducted 4 weeks following the treatment phase. The primary outcome of the study will be mean change on the Montgomery-Asberg Depression Rating Scale. Secondary outcomes include functioning, substance use, mania ratings, and quality of life. Blood s les will be collected at baseline and week 16 to explore biochemical alterations following treatment. This study may provide a novel adjunctive treatment for bipolar depression. Analysis of biological s les may assist in understanding the therapeutic benefits and the underlying etiology of bipolar depression. Australian and New Zealand Clinical Trial Registry ACTRN12612000830897.
Publisher: Elsevier BV
Date: 12-2017
Publisher: SAGE Publications
Date: 28-11-2019
Abstract: In iduals with bipolar disorder (BD) generally engage in low levels of physical activity (PA), and yet few studies have investigated the relationship between PA and change in BD symptom severity. The aim of this subanalysis of an adjunctive nutraceutical randomized controlled trial for the treatment of bipolar depression was to explore the relationship between PA, the active adjunctive treatments (a nutraceutical “mitochondrial cocktail”), and clinical outcomes. Participants with bipolar depression were randomized to receive N-acetylcysteine alone, N-acetylcysteine with a combination of nutraceuticals (chosen for the potential to increase mitochondrial activity), or placebo for 16 weeks. Participants ( n = 145) who completed the International Physical Activity Questionnaire–Short Form (IPAQ-SF measured at Week 4) were included in this exploratory subanalysis. Assessments of BD symptoms, functioning, and quality of life were completed at monthly visits up until Week 20. Generalised Estimating Equations were used to explore whether IPAQ-SF scores were a moderator of treatment received on outcomes of the study. Week-4 PA was not related to changes in Montgomery Åsberg Depression Rating Scale scores across the study until Week 20. However, participants who engaged in more PA and who received the combination treatment were more likely to have a reduction in scores on the Bipolar Depression Rating Scale ( P = 0.03). However, this was not consistent in all domains explored using the IPAQ-SF. Participants who engaged in higher levels of PA also experienced greater improvement in social and occupational functioning and less impairment in functioning due to their psychopathology and improvement in quality of life at Week 20, irrespective of treatment. This study provides novel evidence of the association between PA and reduction in BD symptoms in a nutraceutical clinical trial. However, further research assessing the potential synergistic effects of PA in BD is required.
No related grants have been discovered for Alyna Turner.