A Prospective Cohort Study Of Mortality, Abstinence, Criminality And Psychiatric Comorbidity
Funder
National Health and Medical Research Council
Funding Amount
$419,500.00
Summary
Over 70 000 Australians are dependent on heroin. Heroin dependence is remarkably persistent and is, in many cases, a lifelong condition. Long term treatment outcome and abstinence from heroin among this group are poor. Mortality among heroin users is high, with heroin users dying at a rate 13 times that of peers. Despite the extent of the problem, the natural history of heroin users has not yet been studied in Australia. The current study will be the first Australian study of the natural history ....Over 70 000 Australians are dependent on heroin. Heroin dependence is remarkably persistent and is, in many cases, a lifelong condition. Long term treatment outcome and abstinence from heroin among this group are poor. Mortality among heroin users is high, with heroin users dying at a rate 13 times that of peers. Despite the extent of the problem, the natural history of heroin users has not yet been studied in Australia. The current study will be the first Australian study of the natural history of heroin users. The study will follow up a large cohort of heroin users over a three year period. Estimates will be obtained of mortality rates, abstinence rates, criminal careers, and psychiatric problems among heroin users. It will also examine factors that predict abstinence, mortality, criminality and levels of psychopathology, and determine the health costs associated with heroin use careers. The study will provide essential data on how heroin use progresses, and on what factors predict a better outcome for heroin users.Read moreRead less
Emerging Severe Mental Illness In Young People: Clinical Staging, Neurobiology, Prediction & Intervention From Vulnerabi
Funder
National Health and Medical Research Council
Funding Amount
$6,229,421.00
Summary
Mental disorders, such as psychotic and severe mood disorders, are the largest cause of disability in Australia. However, there is still little known about illness onset, relapse and progression. We have developed a clinical staging model with transition points from symptomfree to subthreshold status, to threshold disorder to chronic disability. We will investigate neurobiological and psychosocial factors which increase the risk of progression through these stages and use this model as a basis f ....Mental disorders, such as psychotic and severe mood disorders, are the largest cause of disability in Australia. However, there is still little known about illness onset, relapse and progression. We have developed a clinical staging model with transition points from symptomfree to subthreshold status, to threshold disorder to chronic disability. We will investigate neurobiological and psychosocial factors which increase the risk of progression through these stages and use this model as a basis for examining the effectiveness of interventions, for example to prevent, delay or ameliorate onset and relapse, and promote vocational recovery. Thus major clinical and public health benefits and an understanding of factors that contribute to the onset and progression of illness will result.Read moreRead less
Chronic Gastrointestinal Symptoms And Diabetes Mellitus: Risk Factors And Mechanisms
Funder
National Health and Medical Research Council
Funding Amount
$271,527.00
Summary
Why many people with diabetes mellitus are afflicted by gastrointestinal (GI) symptoms remains uncertain. Irreversible damage to the nerves controlling the gut (autonomic neuropathy) is often considered to be important. An alternative cause of increased GI symptomatology in diabetics is poor glucose control. Some studies have shown that acute shifts in glucose levels induce changes in the gut relevant to the onset of GI symptoms. For example, high glucose levels acutely cause slower stomach empt ....Why many people with diabetes mellitus are afflicted by gastrointestinal (GI) symptoms remains uncertain. Irreversible damage to the nerves controlling the gut (autonomic neuropathy) is often considered to be important. An alternative cause of increased GI symptomatology in diabetics is poor glucose control. Some studies have shown that acute shifts in glucose levels induce changes in the gut relevant to the onset of GI symptoms. For example, high glucose levels acutely cause slower stomach emptying times, leading to feelings of fullness. Though the effects of chronic glucose levels are yet to be properly explored, population data show that poor control in the long-term is related to an increase in symptoms. The aim of this prospective study is to determine the roles played by both autonomic neuropathy and glucose control in the development of GI symptoms among diabetics. All past research has been cross-sectional, and so cannot tell us if one or both of these factors cause GI problems in diabetes. For example, it is possible that autonomic neuropathy causes an increase in GI symptoms such as nausea and fullness, which in turn induces poor glucose control though lack of appetite or inadequate stomach emptying. Upon study inclusion, all study participants will undergo a series of autonomic tests. At 3 month intervals for a period of 30 months, they will be asked to complete a 2-week diary card detailing their GI symptoms and glucose readings, and also supply blood and urine samples for analysis twice each year. Two years from the study outset, participants will again complete the autonomic test series. Psychiatric co-morbidity will be investigated using the Composite Diagnostic Interview (CIDI-Auto) at the autonomic testing time points. The study will be undertaken at the Gastroenterology Research Unit at Nepean Hospital, in collaboration with the Royal Adelaide Hospital, centres with proven track records in diabetes investigation.Read moreRead less
Longitudinal Treatment Outcomes For Methamphetamine Dependence: A Treatment Cohort Study
Funder
National Health and Medical Research Council
Funding Amount
$720,500.00
Summary
Australia has a substantial and growing population of problematic stimulant users, namely dependent or injecting methamphetamine users, with methamphetamine injection accounting for one-third of all injecting drug use. Methamphetamine dependence has been associated with serious physical and mental health problems, including psychosis, depression, stroke and general poor health and wellbeing. Increasing numbers of people are presenting for treatment of methamphetamine dependence and many are expe ....Australia has a substantial and growing population of problematic stimulant users, namely dependent or injecting methamphetamine users, with methamphetamine injection accounting for one-third of all injecting drug use. Methamphetamine dependence has been associated with serious physical and mental health problems, including psychosis, depression, stroke and general poor health and wellbeing. Increasing numbers of people are presenting for treatment of methamphetamine dependence and many are experiencing other psychiatric problems like drug-induced psychosis and depression. Currently little is known about people who present for treatment of methamphetamine dependence, including how many have other serious mental health problems that need treatment in their own right. Nor is it known whether the treatment they receive for their methamphetamine use is effective in reducing their drug use or improving their mental health status. The current study will provide much needed information on people seeking treatment for methamphetamine dependence in Australia, including their psychiatric status, and whether the treatment they receive for methamphetamine dependence is effective in reducing their drug use and related health problems or improving their mental health status. These aims will be met by assessing drug use, psychiatric status, treatment experience as well as general health and well being among a cohort of people entering treatment for methamphetamine use in Sydney. Responses to treatment will be assessed at 3 months and 12 months following treatment entry and outcomes will be compared to a group of methamphetamine users not receiving treatment. This is the first study in Australia to assess the effectiveness of treatment that is provided to methamphetamine users in an everyday treatment setting. It is also the first study internationally to focus on treatment outcome for methamphetamine dependence in a community setting.Read moreRead less
A Randomised Controlled Trial Of NMDA Antagonist, Memantine, For The Treatment Of Borderline Personality Disorder
Funder
National Health and Medical Research Council
Funding Amount
$993,067.00
Summary
Borderline Personality Disorder (BPD) affects 5.9% of Australians and is a poorly understood mental illness with no clear medication treatment. The key symptoms of BPD all stem from impaired cognitive processes. Our early data shows improvement of symptoms with memantine - a cognitive enhancing drug used in Alzheimer’s disease.We plan to conduct a clinical trial; giving either 20mg memantine or placebo to 150 people with BPD across 2 Victorian sites.
Childhood Cognitive Antecedents Of Adult Psychopathology: Follow-up Of The Port Pirie Lead Cohort Into Adulthood
Funder
National Health and Medical Research Council
Funding Amount
$587,263.00
Summary
The role of childhood factors in the development of adult psychiatric disorder is an important public health concern. Indvividuals identified before birth and followed across the life course offer the most powerful means of establishing predictors for particular types of psychiatric disorder. Not only do these studies enable researchers to more clearly determine the exact age of onset of disorder but they also give us insight into the background and hence possible risk factors that may have lead ....The role of childhood factors in the development of adult psychiatric disorder is an important public health concern. Indvividuals identified before birth and followed across the life course offer the most powerful means of establishing predictors for particular types of psychiatric disorder. Not only do these studies enable researchers to more clearly determine the exact age of onset of disorder but they also give us insight into the background and hence possible risk factors that may have lead to the development of that disorder. Early identification of disorder can significantly reduce public health cost and reduce the burden on the community by enabling individuals to get help before their symptoms become too severe and unmanageable. Few long-term studies have investigated the combined role of pre-natal, developmental, parental characteristics, biological and childhood cognitive risk factors in the development of adult psychiatric dysfunction. Even fewer studies have examinined this interrelationship in a group of individuals who have been exposed to an environmental toxin such as lead. This study will follow-up 723 adults from the lead smelting city of Port Pirie who were originally recruited between 1979 and 1982. All adults were exposed to lead to some degree in childhood and have been followed over various time points over the course their lives. This project will be conducted 27 years since they were first involved, and will hence be one of the longest studies to be conducted in this field. The extensive information already collected on this group of individuals will enable us to create a very comprehensive picture of risk and protective factors for various types of adult disorder.Read moreRead less
Case-control Studies Of Completed And Attempted Suicide In Young People In NSW
Funder
National Health and Medical Research Council
Funding Amount
$819,000.00
Summary
Youth suicide rates have been increasing dramatically over the last three to four decades. The causes and determinants of these suicide rate changes remain unclear, as do the causes and determinants of the suicides themselves. Despite a range of risk factors being identified by researchers, predicting an individual suicide is difficult due to the range of factors involved and the complex interactions between them. This study will investigate associations between individual and environmental fact ....Youth suicide rates have been increasing dramatically over the last three to four decades. The causes and determinants of these suicide rate changes remain unclear, as do the causes and determinants of the suicides themselves. Despite a range of risk factors being identified by researchers, predicting an individual suicide is difficult due to the range of factors involved and the complex interactions between them. This study will investigate associations between individual and environmental factors for both completed suicides and suicide attempts in young people aged 18-34 years living in NSW. The study will be undertaken in Sydney, Newcastle and in identified rural areas. The study is embedded in existing treatment, counselling and support services and will aid their improvement and augmentation. Cases of suicide and attempted suicide will be compared with community controls, and also completed suicides with attempted suicides, to identify potentially modifiable risk factors associated with suicidal behaviour. This will provide more comprehensive information relating to how various risk factors interact and influence suicidal behaviour, including in rural areas with significant Aboriginal and Torres Strait Islander communities. Information from this study will improve prevention initiatives and assist with community strategic development and provide evidence to enhance current health service and coronial interventions.Read moreRead less
Psychiatric Morbidity, Quality Of Life And Coping Styles Of Patients With Early Stage & Advanced Prostate Cancer
Funder
National Health and Medical Research Council
Funding Amount
$281,018.00
Summary
Prostate cancer affects thousands of men each year. Advances in treatment are continuing, but side-effects frequently create disruptions to daily living. If the quality of care for prostate cancer patients is to be further improved, there is much to be learned about the psychosocial impact of the disease and its treatment across its different phases. There has not been a systematic prospective study of psychosocial adjustment in men with prostate cancer. In this study, we longitudinally follow t ....Prostate cancer affects thousands of men each year. Advances in treatment are continuing, but side-effects frequently create disruptions to daily living. If the quality of care for prostate cancer patients is to be further improved, there is much to be learned about the psychosocial impact of the disease and its treatment across its different phases. There has not been a systematic prospective study of psychosocial adjustment in men with prostate cancer. In this study, we longitudinally follow two separate groups of men with prostate cancer, those with early disease and those with advanced illness. We focus on the particular side-effects of urinary incontinence, impotence and bowel symptoms and the potential these have to affect the patient's sense of wellbeing. We use a standardised interview and questionnaires to assess for the presence of psychiatric disorders and psychological problems, overall quality of life and coping styles in these men. We seek to recognise the predictors of men who may have coping problems. A statistical approach termed pathway analysis will help us understand the relative contributions of different factors associated with these problems. The outcome of this systematic, longitudinal study will be a body of knowledge concerning risk factors for poorer psychosocial adjustment and optimum coping strategies for managing the impact of prostate cancer and its treatment, thereby empowering a range of targeted interventions to be developed to enhance the wellbeing and quality of life of these men.Read moreRead less