Risk Factors For Compliance With Command Hallucinations In Psychotic Disorders
Funder
National Health and Medical Research Council
Funding Amount
$180,290.00
Summary
There is widespread public concern about the danger individuals with schizophrenia or related disorders pose to themselves and to the community. Whilst a number of violence risk factors such as being male, exhibiting hostility, and having a prior history of violence are well established, they are of limited use to clinicians in making management decisions. Our study will investigate a different approach to identify individuals and occasions when a sufferer might require more intensive care or ob ....There is widespread public concern about the danger individuals with schizophrenia or related disorders pose to themselves and to the community. Whilst a number of violence risk factors such as being male, exhibiting hostility, and having a prior history of violence are well established, they are of limited use to clinicians in making management decisions. Our study will investigate a different approach to identify individuals and occasions when a sufferer might require more intensive care or observation. Most individuals with schizophrenia experience auditory hallucinations. Amongst these hallucinations, voices that command the individual to undertake a particular action are common; many of these involve significant potential harm to the hallucinator or to other persons. We will attempt to identify those factors that are associated with an individual obeying command hallucinations. Variables to be examined include the characteristics of the hallucinated voices, and the beliefs of the subject about the power of the voices. Subjects will be interviewed to find out whether they have delusions that are consistent with their hallucinations, whether they suffer from Antisocial Personality Disorder, or are dependent on alcohol or drugs. We will also determine whether subjects who report being raised by authoritarian parents, who are dependent on the approval of others, or who see external factors as determining the occurrence of major events in their lives, are more likely to act on their hallucinations. Two groups of 100 patients will be studied. One group will be representative of people living in the community with schizophrenia. The other group will be people with schizophrenia who have been treated by the State Forensic Psychiatric Services. Statistical models will be developed in order to determine the accuracy with which compliance with command hallucinations can be predicted. These models with also reveal which risk factors are the most important.Read moreRead less
Developmental Influences On Brain Structure And Connectivity: Implications For Emerging Borderline Personality Disorder
Funder
National Health and Medical Research Council
Funding Amount
$147,611.00
Summary
Borderline personality disorder (BPD) is a severe, debilitating mental illness that has usual onset in adolescence. Research has highlighted the importance of adolescent brain development, particularly the maturation of brain connections, in onset of mental illness. Brain mapping techniques will be applied to gain a better understanding of BPD onset and progression within an approach that integrates neurobiology and psychosocial context. This is critical for understanding development of BPD.
Efficacy Of Treatment For Resistant Command Hallucinations.
Funder
National Health and Medical Research Council
Funding Amount
$343,875.00
Summary
Auditory hallucinations (AHs), often described as voices, are a common symptom of schizophrenia and psychoses. Command hallucinations (CHs) are a type of AH in which the voice heard by the patient commands him or her to perform a particular action. The nature of the directive may vary from inconsequential actions to commands to harm the patient or others. There is widespread public concern about the danger individuals with schizophrenia or related disorders pose to themselves and to the communit ....Auditory hallucinations (AHs), often described as voices, are a common symptom of schizophrenia and psychoses. Command hallucinations (CHs) are a type of AH in which the voice heard by the patient commands him or her to perform a particular action. The nature of the directive may vary from inconsequential actions to commands to harm the patient or others. There is widespread public concern about the danger individuals with schizophrenia or related disorders pose to themselves and to the community. There is firm evidence pointing to the important role that CHs play in propelling psychotic individuals into serious and damaging actions. We have found, however, that most individuals who comply with dangerous CHs do so, not because they are angry, violent, antisocial or wish to cause harm, but because they feel powerless to resist. Though CHs are one of the most disturbing symptoms of psychosis, standard treatment has proved to be of limited benefit. This study will evaluate the effectiveness of Treatment of Resistant Command Hallucinations (TORCH), an innovative treatment for CHs. TORCH is an extension of an existing treatment for psychosis that we previously developed. TORCH aims to reduce the distress, worry and harmful or self-defeating behaviour associated with CHs by arming the patient with effective strategies that will enhance resistance and reduce compliance. The project has clear implications for improved clinical and therapeutic management of CHs with major public health, clinical and forensic repercussions. The consequences of being formally assessed as being at risk of acting violently result in the potential for substantial restrictions on the freedom of the individual. The availability of TORCH may prompt a less restrictive management of individuals at risk of dangerous behaviour and promote a more optimistic attitude amongst clinicians. Relatives and carers also stand to benefit through reduction in perplexing and fear-inducing behaviours.Read moreRead less
The Neurobiology Of Auditory Hallucinations: Characterisation Of Dysfunction Within A Neural Circuitry Model.
Funder
National Health and Medical Research Council
Funding Amount
$299,625.00
Summary
This is a highly innovative research proposal which is based on years of extensive research by our group. Auditory hallucinations are a prominent and potentially disabling symptom of psychosis, however it is extremely difficult to study them scientifically. Past research by our group (and other groups internationally) has indicated that an extensive network in the brain is activated whenever auditory hallucinations occur, but the source of this brain activity is unclear. It was thought that the ....This is a highly innovative research proposal which is based on years of extensive research by our group. Auditory hallucinations are a prominent and potentially disabling symptom of psychosis, however it is extremely difficult to study them scientifically. Past research by our group (and other groups internationally) has indicated that an extensive network in the brain is activated whenever auditory hallucinations occur, but the source of this brain activity is unclear. It was thought that the source may be the same brain circuits that are involved in generating inner speech or monitoring it, but our past research has ruled out these possibilities. Instead, our recent work suggests that auditory hallucinations may be associated with poorly functioning connections within central auditory processing circuits, specifically between left and right auditory association cortical regions. We conceptualise hallucinations as an abnormal and involuntary form of memory retrieval consequent to this dysfunction. Our study will pioneer methods of measuring connectivity in the brain circuits identified in our model, using a combination of functional magnetic resonance imaging (fMRI) and electroencephalographic (EEG) techniques in tandem with tests of central auditory processing. We believe that sufferers may benefit from understanding the physical processes which cause hallucinations. We also believe that a better understanding of hallucinations may lead to a better understanding of schizophrenia and the psychoses, which may in turn help in the development of better ways of treating these illnesses.Read moreRead less
THE ROLE OF CHANGES IN THE HIPPOCAMPAL SEROTONIN TRANSPORTER IN THE PATHOLOGY OF SCHIZOPHRENIA
Funder
National Health and Medical Research Council
Funding Amount
$340,317.00
Summary
Schizophrenia is a serious mental illness that affects approximately 1% of the Australian population. The cause of the illness remains unknown but many lines of evidence suggest that changes in the function of a chemical neurotransmitter, serotonin, are involved in the disease process. We have shown a change in the serotonin transporter, a critical component of the brain which controls the actions of serotonin, in the an area of the brain called the hippocampus in subjects with schizophrenia. Th ....Schizophrenia is a serious mental illness that affects approximately 1% of the Australian population. The cause of the illness remains unknown but many lines of evidence suggest that changes in the function of a chemical neurotransmitter, serotonin, are involved in the disease process. We have shown a change in the serotonin transporter, a critical component of the brain which controls the actions of serotonin, in the an area of the brain called the hippocampus in subjects with schizophrenia. This proposal seeks to elucidate the mechanisms by which a change in the serotonin transporter may affect other important molecules in the hippocampus. In addition, we will continue our research designed to assess the usefulness of the 5,7-dihydroxytryptamine treated rat as a possible tool for the study of changes in the serotonin transporter.Read moreRead less
Dysfunction In Anterior Cingulate Brain Networks: Implementations For Psychiatric And Substance Use Disorders
Funder
National Health and Medical Research Council
Funding Amount
$380,558.00
Summary
Psychiatric and substance use disorders are associated with significant morbidity and mortality. Recent evidence points to discrete brain networks as being critically involved in the neurobiology of these disorders. Using novel brain imaging techniques, this research will increase our knowledge of how these brain networks are involved in these disorders. This will represent an important step towards elucidating their biological underpinnings and improving outcomes for affected patients.
A Sham-controlled Study Of Transcranial Direct Current Stimulation (tDCS) As A Treatment For Depression
Funder
National Health and Medical Research Council
Funding Amount
$423,154.00
Summary
This study tests the effectiveness and safety of a potential new treatment for depression, which involves mild stimulation of the brain, given through pads placed on the scalp. There is no anaesthetic or seizure and the treatment is painless. The treatment is given on an outpatient basis, three times per week, for 10 sessions, each session taking approximately half an hour. If found to be effective and safe, this new treatment could be an alternative to antidepressant medication.
A Study Of The Medial Temporal Lobe In High-risk And Established Schizophrenia Using T2 Relaxometry
Funder
National Health and Medical Research Council
Funding Amount
$358,245.00
Summary
Neurodevelopmental models of schizophrenia suggest that this disorder is associated with a structural brain abnormality present from very early life. This model predicts that brain changes are present before the onset of schizophrenia, and do not change. Our work supports the idea that damage is present from the outset of illness - however, this damage was not evident in a high-risk group of individuals who later developed psychosis. When these patients were rescanned after the onset of the illn ....Neurodevelopmental models of schizophrenia suggest that this disorder is associated with a structural brain abnormality present from very early life. This model predicts that brain changes are present before the onset of schizophrenia, and do not change. Our work supports the idea that damage is present from the outset of illness - however, this damage was not evident in a high-risk group of individuals who later developed psychosis. When these patients were rescanned after the onset of the illness, they exhibited reductions in the volumes of structures that are regarded as critical to the symptoms of schizophrenia. The lack of structural changes in this group before the onset of psychosis may have a number of possible explanations. However, it may be that a number of factors produce the observed changes in the temporal lobe in schizophrenia. Thus, high-risk subjects may have a vulnerability to hippocampal damage that becomes apparent during the transition to psychosis. In order to explore this, our study will examine changes in the hippocampi in three groups of patients, and compare them with matched normal control subjects. The patient groups are: (i) individuals at high-risk, (ii) first-episode psychosis patients and (iii) patients with chronic schizophrenia. The study will rescan the high-risk group to examine hippocampal changes once they have become psychotic. T2 relaxometry is a non-invasive way to examine whether changes in the brain are present in patients with schizophrenia from the outset of illness. T2 will also let us examine the high-risk individuals to see whether such changes are also apparent premorbidly. Using T2 we will be able to examine the nature of these structural changes and assess what processes are in evidence. Our MRI findings present a challenge to the neurodevelopmental hypothesis of schizophrenia. The use of T2 in this study will allow a thorough examination of these findings and will have major implications for this hypothesis.Read moreRead less