An Investigation Into The Policies And Provision Of Seclusion In Three Health Care Settings In South Australia
Funder
National Health and Medical Research Council
Funding Amount
$61,088.00
Summary
The study will investigate the policies and practices of seclusion in both traditional nursing and corrections health clinical settings in South Australia; a much under-researched but, nevertheless, important and contentious area. It will compare and contrast the formal policies and guidelines pertaining to seclusion and its place within the therapeutic philosophy of the facility. It will also consider the de facto practices, the physical provisions for seclusion areas and their relationship to ....The study will investigate the policies and practices of seclusion in both traditional nursing and corrections health clinical settings in South Australia; a much under-researched but, nevertheless, important and contentious area. It will compare and contrast the formal policies and guidelines pertaining to seclusion and its place within the therapeutic philosophy of the facility. It will also consider the de facto practices, the physical provisions for seclusion areas and their relationship to the wider ward environment, the ward audit and records of the use of seclusion and related practice. Furthermore, through interviews with direct care staff, it will examine personal and professional reflections on these issues and begin to develop recommendations for best practice. Therefore, by virtue of its clinical and service focus in Nursing and allied health areas, it falls within the criteria for Special Initiative Funding.Read moreRead less
Molecular And Cellular Characterisation Of Schizophrenia Associated Dysfunction In MicroRNA Biogenesis
Funder
National Health and Medical Research Council
Funding Amount
$496,205.00
Summary
We have identified substantial changes in the biogenesis of microRNA in schizophrenia. These small non-coding molecules derived from junk DNA, play a significant role in genetic regulation, with each one capable of silencing hundreds of target genes. This has major implications for schizophrenia, which is known to involve substantial changes in gene activity. The project will identify the molecular basis of this alteration in gene silencing, and its biological implications for schizophrenia.
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
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
A Comparative Clinical Efficacy Trial Of Treatments For Melancholia
Funder
National Health and Medical Research Council
Funding Amount
$309,711.00
Summary
This study seeks to improve treatment of melancholic depression by comparing three treatments, i) a selective serotonin reuptake inhibitor (SSRI), ii) cognitive behaviour therapy (CBT) and, iii) a broad-spectrum antidepressant sequencing treatment approach. We hypothesize that the latter will be superior to both i) SSRI monotherapy, and ii) CBT monotherapy, over a 12-week trial period. Comparisons will be made with the US-based Sequenced Treatment Alternatives to Relieve Depression trial.
Comorbid Affective Disturbance In A Model Of Absence Epilepsy - Shared Causation Linked To Morphological Abnormality?
Funder
National Health and Medical Research Council
Funding Amount
$502,650.00
Summary
People with epilepsy commonly suffer from severe mood disorders, such as depression and anxiety. These disturbances are underdiagnosed and undertreated, and are often more debilitating than the epilepsy. This project will investigate whether treatment of psychiatric disturbance with antidepressants also results in reduced seizure incidence in an animal model of epilepsy. Results generated from the study will provide clinicians strong rationale for aggressive treatment of such mood complaints.
Effectiveness Of Mindfulness Based Cognitive Therapy For Preventing Depressive Relapse In Subjects At Very High Risk
Funder
National Health and Medical Research Council
Funding Amount
$643,317.00
Summary
More than one in twenty Australians experience depression in a single year and it is commonly a relapsing disorder. At least 60% of people who have had a depressive episode will have another, the vast majority within two years of the index episode, 70% of those who have had two episodes will have a third, and 90% of those with three episodes will have a fourth. The economic burden of depression in Australia has been estimated as perhaps $2.8 billion annually. Mindfulness-based cognitive therapy ....More than one in twenty Australians experience depression in a single year and it is commonly a relapsing disorder. At least 60% of people who have had a depressive episode will have another, the vast majority within two years of the index episode, 70% of those who have had two episodes will have a third, and 90% of those with three episodes will have a fourth. The economic burden of depression in Australia has been estimated as perhaps $2.8 billion annually. Mindfulness-based cognitive therapy (MBCT) is an innovative psychological treatment, combining principles of cognitive therapy and mindfulness meditation. It is designed to prevent depressive relapse in people who have recovered from depressive episodes. MBCT aims to teach people to become more aware of, and to relate differently to, their thoughts, feelings and bodily sensations; in particular, to view these thoughts and feelings as passing events in the mind rather than identifying with them. Through gaining these skills in increased awareness of thoughts and feelings, participants in the treatment learn to avoid negative ruminations, which have a powerful role in triggering relapses of depression. Primarily this study aims to examine the effectiveness of MBCT for the first time in Australians with a history of recurring depression. As a large multi-site investigation it will establish the feasibility of bringing MBCT into routine practice in both urban and rural areas of Australia. The study also aims to establish whether the mechanisms by which MBCT is proposed to work - by decreasing rumination, increasing levels of mindfulness and self-awareness - do in fact operate. We also hope to establish whether MBCT also has any impact on anxiety, another disabling condition that commonly occurs with depression. This study will enhance evidence as to whether the treatment of MBCT should be recommended routinely to sufferers with repeated episodes of major depression.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