ORCID Profile
0000-0001-7585-2660
Current Organisation
University of Adelaide
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Public Health and Health Services | Philosophy | Philosophy of Cognition | Other Language And Culture | Philosophy of Mind (excl. Cognition) | Language, Communication and Culture not elsewhere classified | Public Health And Health Services Not Elsewhere Classified | Developmental Psychology And Ageing | Discourse and Pragmatics | Health and Community Services | Psychiatry | Philosophy Of Mind (Excl. Cognition) | Public Health and Health Services not elsewhere classified | Nursing not elsewhere classified |
ANZSRC Socio-Economic Objective (SEO)
Behavioural and cognitive sciences | Public Health (excl. Specific Population Health) not elsewhere classified | Health and support services not elsewhere classified | Mental health | Public health not elsewhere classified | Nervous system and disorders | Expanding Knowledge in Psychology and Cognitive Sciences | Health not elsewhere classified | Communication not elsewhere classified | Expanding Knowledge in Philosophy and Religious Studies
Related Links
Publications
Industry-corrupted psychiatric trials
Publisher: Komitet Redakcyjno - Wydawniczy Polskiego Towarzystwa Psychiatrycznego
Date: 30-12-2017
DOI: 10.12740/PP/80136
Abstract: Celem niniejszego artykułu było ujawnienie nieprawidłowości w prowadzeniu badań klinicznych finansowanych przez przemysł farmaceutyczny na podstawie trzech krótkich studiów przypadku przedstawiających skorumpowane badania psychiatryczne przeprowadzone w Stanach Zjednoczonych. Omówione zostały wspólne elementy, które pozwalają na błędne przedstawienie wyników badań klinicznych, w tym proceder ghostwriting w czasopismach medycznych, a także rola tz. Kluczowych liderów opinii, którzy jednocześnie są w konspiracji z przemysłem farmaceutycznym. Ukazano także biznesowa uwikłania największych czasopism medycznych, nie przestrzegających standardów nauki i zasady wzajemnego recenzowania artykułów. Przedstawimy wnioski, z których wynika, że korupcja finansowanych przez przemysł badań klinicznych stanowi jedną z głównych przeszkód rozwoju medycyny opartej na dowodach. Zjawisko korupcji w badaniach klinicznych stanowi jedną z głównych przeszkód w medycynie opartej na dowodach. Jak wykazaliśmy powyżej, wykorzystanie autorów-duchów i kluczowych liderów opinii w „produkcji” artykułów medycznych ułatwiło błędne przedstawienie danych dotyczących skuteczności i bezpieczeństwa w psychiatrycznych badaniach klinicznych, które miały wpływ na praktykę kliniczną. Niestety, w tych trzech przypadkach nie ma nic nadzwyczajnego. Wszystkie badania sponsorowane przez przemysł są podejrzane i powinny być traktowane jako takie. Ponieważ tak mało z nich jest poddawanych kontroli publicznej, a jeszcze mniej jest formalnie wycofanych, ważne jest, aby te artykuły były przejrzyste w celu skorygowania opisywanych efektów naukowych i ochrony pacjentów przed potencjalną szkodą.
Industry-Sponsored Ghostwriting in Clinical Trial Reporting: A Case Study
Publisher: Informa UK Limited
Date: 08-07-2008
DOI: 10.1080/08989620802194384
Abstract: In this case study from litigation, we show how ghostwriting of clinical trial results can contribute to the manipulation of data to favor the study medication. Study 329 for paroxetine pediatric use was negative for efficacy and positive for harm. Yet the ghostwritten publication from this study concluded that paroxetine provided evidence of efficacy and safety and continues to be influential. Despite the role of named authors in revisions of the manuscript, the sponsor company remained in control of the message.
Guidance offers little in the way of ethics or transparency
Publisher: BMJ
Date: 24-04-2012
DOI: 10.1136/BMJ.E2910
Paediatric antiepileptic polytherapy: systematic review of efficacy and neurobehavioural effects and a tertiary centre experience
Publisher: Wiley
Date: 23-04-2018
DOI: 10.1111/APA.14343
Abstract: This paper presents the prevalence of antiepileptic polytherapy at a single tertiary institution and systematically reviews the evidence base for its efficacy and neurobehavioural safety in children. Prevalence of antiepileptic polypharmacy was determined from pharmacy dispensing records at a paediatric tertiary hospital and neurobehavioural comorbidities quantified through casenote review comparison is made with studies evaluating the neurobehavioural safety of antiepileptic polytherapy, identified via systematic literature review. Amongst 262 patients at the hospital, 117 (44.7%) were prescribed polytherapy with patients having an intellectual disability statistically more likely to be prescribed polytherapy than those without (70.5% vs 40.6% p < 0.0001). Systematic review identified no trials addressing the efficacy or neurobehavioural outcomes of polytherapy as a primary outcome. Several observational studies identified associations between polytherapy and neurobehavioural adverse outcomes such as anxiety and behavioural disturbance. Observational studies also suggest that a reduction in polytherapy load is generally not associated with worsening seizure control. Whilst antiepileptic polytherapy is common practice within paediatric epilepsy cohorts attending tertiary care institutions, evidence is lacking to support its efficacy. There are significant practical difficulties to undertaking randomised controlled trials within this population. Nonetheless, clinicians must consider that adverse neurobehavioural consequences of polytherapy might outweigh benefits to seizure control.
Psychodynamic minimalism
Publisher: SAGE Publications
Date: 28-06-2013
Key opinion leaders in psychiatry: A conflicted pathway to career advancement
Publisher: SAGE Publications
Date: 06-2012
Overuse of Antidepressant Drugs for the Treatment of Depression
Publisher: Springer Science and Business Media LLC
Date: 2006
DOI: 10.2165/00023210-200620080-00002
Abstract: The problem of under-diagnosis and under-treatment of depression has been identified as a major public health issue and measures have been taken to increase the recognition of depression and its treatment with antidepressants. The possibility of harm from the overuse of antidepressants has attracted far less attention. This review sets out evidence to show that inappropriate use of antidepressants (i.e. outside clinical indications, in excessive doses and for prolonged periods) constitutes a concerning public health problem. Antidepressant prescribing increased by between 4- and 10-fold in various age groups and countries in the last decade of the 20th century. The population of severely depressed patients (in whom antidepressants are accepted to be an effective treatment) who are not receiving antidepressants is probably much smaller than the population receiving these drugs inappropriately. We sound a note of caution for depression awareness c aigns. These apparently well-reasoned responses to the perceived under-recognition of depression can exacerbate over-prescribing. Unless prescribing patterns change, any benefits from increasing access to antidepressants for those with severe depression will be accompanied by significant harms due to inappropriate prescribing in conditions, such as mild depression, where antidepressants are not indicated.
Perversion: Erotic Form of Hatred or Exciting Avoidance of Reality?
Publisher: Guilford Publications
Date: 06-2001
Aripiprazole in the Maintenance Treatment of Bipolar Disorder: A Critical Review of the Evidence and Its Dissemination into the Scientific Literature
Publisher: Public Library of Science (PLoS)
Date: 03-05-2011
A Critique of the International Consensus Statement on ADHD
Publisher: Springer Science and Business Media LLC
Date: 03-2004
Restrained rehabilitation: an approach to children and adolescents with unexplained signs and symptoms
Publisher: BMJ
Date: 05-2003
DOI: 10.1136/ADC.88.5.399
Abstract: The validation of treatment approaches for children and adolescents diagnosed with unexplained signs and symptoms is made difficult by the variety of clinical presentations and the different developmental levels of different patients. There is little evidence about what combination of approaches is most successful. This article uses what evidence is available to develop a coordinated multidisciplinary rehabilitation package that ensures consistency and can be evaluated. The package is organised around a psychologically informed physical rehabilitation programme. The need for coordination and a common approach between medical, allied health and psychological staff, and family is formally addressed. The approach is illustrated with a case study.
Explanations and unexplanations: Restoring meaning to psychiatry
Publisher: SAGE Publications
Date: 03-2012
Why a rights-based approach is not anti-psychiatry
Publisher: SAGE Publications
Date: 08-03-2019
Elsevier should divest itself of either its medical publishing or pharmaceutical services division
Publisher: Elsevier BV
Date: 08-2009
Inappropriate Data and Measures Lead to Questionable Conclusions
Publisher: American Medical Association (AMA)
Date: 2013
Mental health messages in prominent mental health apps
Publisher: Annals of Family Medicine
Date: 07-2018
DOI: 10.1370/AFM.2260
Some reasons for concern about attention deficit hyperactivity disorder
Publisher: Wiley
Date: 06-1996
DOI: 10.1111/J.1440-1754.1996.TB01552.X
Abstract: Attention deficit hyperactivity disorder (ADHD) is not a disease. The symptoms of its three dimensions (activity, attention and impulsivity) are normally distributed in the population, with an arbitrary level of symptoms being designated pathological. The presence of the ADHD cluster is never grounds for any positive diagnosis it is an indication for further assessment. Positive response to stimulants is not specific to the ADHD population, and is no way diagnostic.
Inadequacy of remote desktop interface for independent reanalysis of data from drug trials
Publisher: BMJ
Date: 09-07-2014
DOI: 10.1136/BMJ.G4353
Suicide and antidepressants in children
Publisher: Therapeutic Guidelines Limited
Date: 10-2005
The statin wars [1] (multiple letters)
Publisher: Elsevier BV
Date: 11-2003
David Caldwell, John Walsh, Elaine W. Vine, & Jon Jureidini (eds.), The discourse of sport: Analyses from social linguistics. London: Routledge, 2017. Pp. 240. Hb. £110.
Publisher: Cambridge University Press (CUP)
Date: 06-2018
Munchausen syndrome by proxy.
Publisher: BMJ
Date: 03-1996
DOI: 10.1136/ADC.74.3.274
Abstract: On 22 September 2020, within the backdrop of the COVID-19 global pandemic, China announced its climate goal for peak carbon emissions before 2030 and to reach carbon neutrality before 2060. This carbon-neutral goal is generally considered to cover all anthropogenic greenhouse gases. The planning effort is now in full swing in China, but the pathway to decarbonization is unclear. The needed transition towards non-fossil fuel energy and its impact on China and the world may be more profound than its reform and development over the past 40 years, but the challenges are enormous. Analysis of four representative scenarios shows significant differences in achieving the carbon-neutral goal, particularly the contribution of non-fossil fuel energy sources. The high target values for nuclear, wind, and bioenergy have approached their corresponding resource limitations, with solar energy being the exception, suggesting solar's critical role. We also found that the near-term policies that allow for a gradual transition, followed by more drastic changes after 2030, can eventually reach the carbon-neutral goal and lead to less of a reduction in cumulative emissions, thus inconsistent with the IPCC 1.5°C scenario. The challenges and prospects are discussed in the historical context of China's socio-economic reform, globalization, international collaboration, and development.
Transparency and accountability in early psychosis intervention research
Publisher: SAGE Publications
Date: 28-06-2013
Mind Magic
Publisher: Macmillan Education UK
Date: 2009
How do we Safely Treat Depression in Children, Adolescents and Young Adults?
Publisher: Springer Science and Business Media LLC
Date: 2009
DOI: 10.2165/00002018-200932040-00002
Abstract: Increasing concerns about the safety and efficacy of antidepressant drugs for children, adolescents and young adults have been countered by claims that reduced prescribing of antidepressants may have dangerous consequences. This leaves clinicians unsure as to how to weigh up the evidence and apply it to their patients. This paper promotes an approach of evaluating the evidence in each study according to the importance of the outcomes being measured in that study. It finds that on important measures such as mortality, hospitalization and quality of life, the evidence is unfavourable for antidepressants in this population. Here, an approach is suggested that primary care physicians might adopt with their depressed young patients. Through a combination of 'watchful waiting' and physical and emotional rehabilitation, physicians can actively intervene without reliance on medication or psychotherapy.
Engagement with health and social care services: Perceptions of homeless young people with mental health problems
Publisher: Hindawi Limited
Date: 11-2006
DOI: 10.1111/J.1365-2524.2006.00643.X
Abstract: The present qualitative study describes and discusses the perspectives and experiences of young homeless people with mental health problems in relation to their interactions with health and social care services. Working in partnership with Streetlink, a supported accommodation assistance programme in Adelaide, Australia, the authors interviewed 10 homeless young people, aged from 16 to 24 years of age, who had experienced mental health problems. In-depth interviews elicited accounts of the best and worst of the participants' experiences of health and social care services. Access to services was not identified as being a significant problem in comparison with the participants' concerns regarding the quality of the services encountered. The central findings stress the importance of a respectful and supportive climate in relation to the qualities of service provision that the young people identified as valuable for their continuing treatment or consultation.
Does Dissociation Offer a Useful Explanation for Psychopathology?
Publisher: S. Karger AG
Date: 2004
DOI: 10.1159/000081981
Abstract: i Background: /i Dissociation is often conceptualised as an altered state of consciousness, a trance-like state in which normal barriers between conscious and unconscious memories, desires and beliefs break down and other amnestic barriers emerge. This review explores whether it is likely that there is a neurophysiology of pathological dissociative processes that will elucidate management. i Method: /i A critical reading of current research, sourced through Medline and Psychinfo searches from 1990 to 2002, using subject headings: dissociative disorders, hypnosis and stress disorder (post-traumatic), as well as keywords: dissociation, hypnosis and trance. i Results: /i Current knowledge does not support the notion of dissociation as a discrete brain state or process. i Conclusions: /i Psychiatric and neurophysiological research and theory development are better directed towards in idual components that contribute to dissociative experience.
The Rise and Fall of Roy Meadow
Publisher: SAGE Publications
Date: 10-2008
Targeted primary care‐based mental health services for young Australians
Publisher: AMPCo
Date: 06-2012
DOI: 10.5694/MJA12.10535
Children in immigration detention: a case of reckless mistreatment
Publisher: Elsevier BV
Date: 08-2011
PAROXETINE IN MAJOR DEPRESSION
Publisher: Elsevier BV
Date: 05-2003
‘Prodromal’ diagnosis of psychosis: Ethical problems in research and clinical practice
Publisher: SAGE Publications
Date: 2012
On the Proposed Changes to the Credibility Gap in Industry-Supported Biomedical Research: A Critical Evaluation
Publisher: Springer Publishing Company
Date: 2012
DOI: 10.1891/1559-4343.14.3.156
Abstract: A task force of pharmaceutical industry employees and medical journal editors propose 10 recommendations to address the problem of erosion of confidence in the reporting of the results of industry-sponsored clinical trials. These recommendations would not restore credibility to industry-sponsored biomedical research. A radical solution is required that severs the relationship between the industry and the journals and restores the integrity of the medical literature.
Alcohol use by parents who present their child to a paediatric emergency department
Publisher: Wiley
Date: 04-1999
DOI: 10.1046/J.1440-1754.1999.T01-1-00345.X
Abstract: Parental alcohol misuse exposes children to risk, but is poorly identified in paediatric settings. We aimed to (i) measure the alcohol use in parents of a s le of children attending emergency and (ii) assess the quality of documentation of this alcohol use by paediatric residents. Parents of children presenting to the Emergency Department of a children's hospital were interviewed regarding their alcohol use, and each completed an AUDIT CORE questionnaire. The child's case notes were reviewed for documentation of parental alcohol use. One hundred and ninety-three parents were interviewed. Although per capita alcohol use for both sexes, and hazardous drinking for females were found to be significantly less than general population figures, rates of hazardous drinking were high for fathers. Yet only 1% of case notes reviewed contained any documentation of parental alcohol use. This small study suggests that although average alcohol intake amongst parents presenting their children to a paediatric emergency department may be lower than for the general population, there is a significant prevalence of undetected hazardous drinking amongst parents.
Data transparency in clinical trials: Implications of Restoring Study 329
Publisher: SAGE Publications
Date: 29-09-2016
Jon Ander Garcia
Publisher: Society for Artistic Research
Date: 18-05-2018
DOI: 10.22501/RC.462955
Munchausen Syndrome by Proxy
Publisher: American Medical Association (AMA)
Date: 07-1996
DOI: 10.1001/ARCHPEDI.1996.02170320099017
Abstract: Munchausen syndrome by proxy often is managed differently from other forms of child maltreatment, although it is differentiated from them only by the active engagement with the medical profession in the production of morbidity. We suggest a more rigorous approach to Munchausen syndrome by proxy, with explicit acknowledgement that it is abuse and that the medical system is critical to its genesis. This leads us to question the broadness with which the label is applied (eg, in cases of imposed upper airway obstruction) and to argue for management strategies closer to those accepted for other forms of child maltreatment.
Mental health-related hospitalisations among adolescents with previous child protection contact from birth to age 11
Publisher: Cold Spring Harbor Laboratory
Date: 21-09-2023
Novel melatonin-based treatments for major depression
Publisher: Elsevier BV
Date: 2012
Study was not a trial of antidepressants
Publisher: BMJ
Date: 02-08-2007
Concerns about research and prevention strategies in Munchausen Syndrome by Proxy (MSBP) abuse
Publisher: Elsevier BV
Date: 04-2003
DOI: 10.1016/S0145-2134(03)00028-0
Abstract: There would seem to be three motives for research into Munchausen Syndrome by Proxy (MSBP) abuse first to enhance treatment second to enhance our understanding of the psychopathology of those who carry out the abuse and third to find interventions to prevent its occurrence. We will argue that only the first justification is valid. The second and third should be questioned for several reasons including: MSBP abuse is the wrong kind of event to think of in terms of categorical diagnosis rare events are inherently difficult to predict and better research targets are available. We propose that research energy would be more productively directed towards furthering our understanding of somatization and certain problematic aspects of modern pediatric practice. We offer suggestions as to appropriate areas for research.
The Black Box Warning: Decreased Prescriptions and Increased Youth Suicide?
Publisher: American Psychiatric Association Publishing
Date: 12-2007
Annual Research Review: Attention deficit hyperactivity disorder late birthdate effect common in both high and low prescribing international jurisdictions: a systematic review
Publisher: Wiley
Date: 14-10-2018
DOI: 10.1111/JCPP.12991
BRIDGE study warrants critique
Publisher: American Medical Association (AMA)
Date: 06-2012
Doubling: a model for international clinical partnerships
Publisher: SAGE Publications
Date: 29-11-2019
Abstract: This article draws attention to an initiative aimed at benefiting colleagues in developing countries, through financial and/or moral support. It describes an attempt to engage The Royal College of Australian and New Zealand Psychiatrists (‘the College’) in supporting this philanthropic activity. It further aims to attract interest from the College and fellows in contributing to international philanthropy. Doubling provides a credible model for facilitating better mental health care in situations where there are trained staff but inadequate resources. The College’s resistance to engagement with this project may represent a missed opportunity for philanthropic support.
Art and Delusion
Publisher: Oxford University Press (OUP)
Date: 2003
Pathological Play
Publisher: SAGE Publications
Date: 10-2000
DOI: 10.1177/1359104500005004013
Abstract: Play is critical to human physical and cognitive development, and disturbance in play can express itself as a distinct and specific form of psychopathology, pathological play. Play becomes pathological when it deviates from healthy play in one or more of three characteristic qualities: the relationship between playing and reality the player’s experience of the play and the relationship of the player to the objects of play (including self and other people, as well as inanimate objects). Healthy play accommodates to the real needs of self and others pathological play avoids reality, through a narrow-minded preoccupation that allows in idual needs to be subjugated to the creation of a pretence or narrative.
The increased use of antidepressants has contributed to the worldwide reduction in suicide rates.
Publisher: Royal College of Psychiatrists
Date: 06-2010
DOI: 10.1192/BJP.BP.109.076166
Abstract: Numerous ecological studies have shown an inverse association between antidepressant use and suicide rates and a smaller number of in idual-based studies have shown an association between current antidepressant use and reduced suicide risk. Such evidence is often cited in support of the notion that antidepressants prevent suicide. However, more recently, the premises underlying this proposition, namely that suicide is caused by depression and that antidepressants relieve depression, have been challenged and the potential harm caused by antidepressants has been highlighted. In this article, Goran Isacsson and Charles Rich debate with Jon Jureidini and Melissa Raven the motion that the increased use of antidepressants has contributed to the worldwide reduction in suicide rates.
Diagnosis, Pathophysiology, and Management of Mood Disorders in Pregnant and Postpartum Women
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
Psychiatric assessment of children and families in immigration detention - Clinical, administrative and ethical issues
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1111/J.1467-842X.2004.TB00041.X
Abstract: This paper reports the clinical, practical and ethical issues arising in the assessment of 10 consecutive referrals from a remote Immigration Reception and Processing Centre to a child and adolescent mental health service (CAMHS) between February and August 2002. The 16 adults and 20 children (age range 11 months to 17 years) were comprehensively assessed by allied health clinicians and child psychiatrists. All children were also assessed by the statutory child protection agency. There were very high levels of mood disturbance and post-traumatic symptoms in this population. All children had at least one parent with psychiatric illness. Of the 10 children aged 6-17 years, all (100%) fulfilled criteria for both post-traumatic stress disorder (PTSD) and major depression with suicidal ideation. Eight children (80%), including three pre-adolescents, had made significant attempts at self harm. Seven (70%) had symptoms of an anxiety disorder and half reported persistent severe somatic symptoms. The majority (80%) of preschool-age children were identified with developmental delay or emotional disturbance. Few clinically based recommendations were implemented. Very high levels of psychopathology were found in child and adult asylum seekers. Much was attributable to traumatic experiences in detention and, for children, the impact of indefinite detention on their caregivers. Multiple obstacles to adequate service provision are identified. Adequate clinical intervention and care was not possible. The impact on involved clinicians is discussed.
NICE recommendations are not evidence based and could expose many to unnecessary harm
Publisher: BMJ
Date: 28-10-2008
DOI: 10.1136/BMJ.A2284
Does drug promotion adversely influence doctor's abilities to make the best decisions for patients?
Publisher: SAGE Publications
Date: 06-0012
DOI: 10.1046/J.1440-1665.2001.00313.X
Abstract: Aim: To increase awareness amongst psychiatrists and trainees of the effects of pharmaceutical promotion and to stimulate careful evaluation of the relationships between psychiatry and the pharmaceutical industry. Method: Key findings from the literature and from 20 years experience with the Medical Lobby for Appropriate Marketing are summarised. Results: The relationship between doctors and pharmaceutical companies is shown to be problematic in a way that might negatively impact on patient care. Conclusions: Patients may benefit if in idual psychiatrists, and the profession as a whole, develop more healthy scepticism about the harm to benefit ratios of relationships with the pharmaceutical industry.
Should Paroxetine Be Used to Treat Depression During Pregnancy?
Publisher: American Psychiatric Association Publishing
Date: 11-2008
Key Opinion Leaders and Paediatric Antidepressant Overprescribing
Publisher: S. Karger AG
Date: 2009
DOI: 10.1159/000214440
In protest [6] (multiple letters)
Publisher: SAGE Publications
Date: 11-2004
Healthy kids check: Lack of transparency and misplaced faith in the benefits of screening
Publisher: SAGE Publications
Date: 10-2012
Partnerships between academic psychiatry and the pharmaceutical industry (multiple letters) [1]
Publisher: SAGE Publications
Date: 03-2005
Conflicted Medical Journals and the Failure of Trust
Publisher: Informa UK Limited
Date: 31-01-2011
DOI: 10.1080/08989621.2011.542683
Abstract: Journals are failing in their obligation to ensure that research is fairly represented to their readers, and must act decisively to retract fraudulent publications. Recent case reports have exposed how marketing objectives usurped scientific testing and compromised the credibility of academic medicine. But scant attention has been given to the role that journals play in this process, especially when evidence of research fraud fails to elicit corrective measures. Our experience with The Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) illustrates the nature of the problem. The now-infamous Study 329 of paroxetine in adolescent depression was negative for efficacy on all eight protocol-specified outcomes and positive for harm, but JAACAP published a report of this study that concluded that "paroxetine is generally well tolerated and effective for major depression in adolescents." The journal's editors not only failed to exercise critical judgment in accepting the article, but when shown evidence that the article misrepresented the science, refused either to convey this information to the medical community or to retract the article.
Antidepressant medication and spontaneous abortion: No significant association? Clinically significant association!
Publisher: American Medical Association (AMA)
Date: 12-2013
Does Venlafaxine Maintenance Therapy Prevent Depression Recurrences or Drug Discontinuation Reactions?
Publisher: Physicians Postgraduate Press, Inc
Date: 23-09-2008
Does the international consensus statement on ADHD leave room for healthy scepticism? (multiple letters)
Publisher: Springer Science and Business Media LLC
Date: 10-2002
Antidepressants fail, but no cause for therapeutic gloom
Publisher: Elsevier BV
Date: 08-2016
Medical Malpractice: Child and Adolescent Psychiatry
Publisher: Elsevier
Date: 2016
Self-management of medication for mental health problems by homeless young people
Publisher: Wiley
Date: 04-08-2006
DOI: 10.1111/J.1447-0349.2006.00420.X
Abstract: Youth homelessness is a growing Australian and international concern associated with considerable health disadvantage, including serious mental health problems. This paper reports findings of a qualitative study that explored young homeless people's experiences of mental health and well-being through in-depth interviews. Thematic analysis identified medication use and management as a central issue for the young people. Reasons identified for medication non-adherence included unwanted side-effects, issues of access and storage, and lack of support from health and social agencies. These problems were compounded by everyday stresses of homelessness. Medication adherence was facilitated by social support, consistent contact with supportive health services, and regular medication supply, often resulting in improved mental health and well-being. For these young people, prioritizing management of medication helped stabilize one aspect of their lives. Health professionals can play an important role in helping them achieving this goal.
Restoring Study 329: Eficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence
Publisher: BMJ
Date: 16-09-2015
DOI: 10.1136/BMJ.H4320
Abstract: To reanalyse SmithKline Beecham's Study 329 (published by Keller and colleagues in 2001), the primary objective of which was to compare the efficacy and safety of paroxetine and imipramine with placebo in the treatment of adolescents with unipolar major depression. The reanalysis under the restoring invisible and abandoned trials (RIAT) initiative was done to see whether access to and reanalysis of a full dataset from a randomised controlled trial would have clinically relevant implications for evidence based medicine. Double blind randomised placebo controlled trial. 12 North American academic psychiatry centres, from 20 April 1994 to 15 February 1998. 275 adolescents with major depression of at least eight weeks in duration. Exclusion criteria included a range of comorbid psychiatric and medical disorders and suicidality. Participants were randomised to eight weeks double blind treatment with paroxetine (20-40 mg), imipramine (200-300 mg), or placebo. The prespecified primary efficacy variables were change from baseline to the end of the eight week acute treatment phase in total Hamilton depression scale (HAM-D) score and the proportion of responders (HAM-D score ≤8 or ≥50% reduction in baseline HAM-D) at acute endpoint. Prespecified secondary outcomes were changes from baseline to endpoint in depression items in K-SADS-L, clinical global impression, autonomous functioning checklist, self-perception profile, and sickness impact scale predictors of response and number of patients who relapse during the maintenance phase. Adverse experiences were to be compared primarily by using descriptive statistics. No coding dictionary was prespecified. The efficacy of paroxetine and imipramine was not statistically or clinically significantly different from placebo for any prespecified primary or secondary efficacy outcome. HAM-D scores decreased by 10.7 (least squares mean) (95% confidence interval 9.1 to 12.3), 9.0 (7.4 to 10.5), and 9.1 (7.5 to 10.7) points, respectively, for the paroxetine, imipramine and placebo groups (P=0.20). There were clinically significant increases in harms, including suicidal ideation and behaviour and other serious adverse events in the paroxetine group and cardiovascular problems in the imipramine group. Neither paroxetine nor high dose imipramine showed efficacy for major depression in adolescents, and there was an increase in harms with both drugs. Access to primary data from trials has important implications for both clinical practice and research, including that published conclusions about efficacy and safety should not be read as authoritative. The reanalysis of Study 329 illustrates the necessity of making primary trial data and protocols available to increase the rigour of the evidence base.
Hysteria
Publisher: Springer Science and Business Media LLC
Date: 06-2002
DOI: 10.1007/S00787-002-0267-1
Abstract: Hysteria, as it involves the medical profession, is a form of sickness that is defined as being without disease or illness. This lack of a biomedical explanation has limited progress in its understanding. In this essay we propose that hysteria might be better thought of as a form of pretending, elaborated in transaction with the medical system. In medicine, to pretend usually means to deceive. From the perspective of play, however, pretend is a state more akin to acting, magic, belief, and hypnosis. We provide a number of reasons why sickness is an attractive focus for pretending. We show how enactments of sickness can be scripted by a group of involved persons, each contributing from their own perspective, as occurs in the parlour game of 'Consequences', except in hysteria the consequences are often dire.
Dispensing of psychotropic medications to Australian children and adolescents before and during the COVID‐19 pandemic, 2013–2021: a retrospective cohort study
Publisher: Wiley
Date: 14-05-2023
DOI: 10.5694/MJA2.51948
Abstract: To determine longitudinal patterns of dispensing of antidepressant, anxiolytic, antipsychotic, psychostimulant, and hypnotic/sedative medications to children and adolescents in Australia during 2013–2021. Retrospective cohort study analysis of 10% random s le of Pharmaceutical Benefits Scheme (PBS) dispensing data. People aged 18 years or younger dispensed PBS‐subsidised psychotropic medications in Australia, 2013–2021. Population prevalence of dispensing of psychotropic medications to children and adolescents, by psychotropic class, gender, and age group (0–6, 7–12, 13–18 years). The overall prevalence of psychotropic dispensing to children and adolescents was 33.8 per 1000 boys and 25.2 per 1000 girls in 2013, and 60.0 per 1000 boys and 48.3 per 1000 girls in 2021. The prevalence of psychotropic polypharmacy was 5.4 per 1000 boys and 3.7 per 1000 girls in 2013, and 10.4 per 1000 boys and 8.3 per 1000 girls in 2021. Prevalent dispensing during 2021 was highest for psychostimulants (boys, 44.0 per 1000 girls, 17.4 per 1000) and antidepressants (boys, 20.4 per 1000 girls, 33.8 per 1000). During 2021, the prevalence of dispensing was higher than predicted by extrapolation of 2013–2019 data for many classes, including antidepressants (boys: +6.1% 95% CI, 1.1–11.1% girls: +22.2% 95% CI, 17.4–26.9%), and psychostimulants (boys: +14.5% 95% CI, 8.0–21.1% girls: +27.7% 95% CI, 18.9–36.6%). The increases were greatest for girls aged 13–18 years (antidepressants: +20.3% 95% CI, 16.9–23.7% psychostimulants: +39.0% 95% CI, 27.9–50.0%). The prevalence of both psychotropic dispensing and psychotropic polypharmacy for children and adolescents were twice as high in 2021 as in 2013. The reasons and appropriateness of the marked increases in psychotropic dispensing during the COVID‐19 pandemic, particularly to adolescent girls, should be investigated.
The Maternal Looking Guide: a perinatal clinical tool to support the emerging mother-infant relationship’
Publisher: Informa UK Limited
Date: 21-10-2023
DOI: 10.1080/02646838.2021.1991566
Abstract: This study explores maternal looking - the unidirectional looking by a mother at her newborn - as a precursor to mother-infant gaze. Phase 1 used video as a means of detailed and disciplined observation to examine how mothers look at their newborns (n = 13). Using an iterative design, intensive analysis identified and categorised patterns of looking and looking-related behaviours. This resulted in a typology of looking. Phase 2 subjected the typology to inter-rater reliability testing, with midwives as multiple raters (n = 24), using the typology to rate standardised tapes of mothers and newborns (n = 10). Phase 1 generated a one-page clinical tool (Maternal Looking Guide). This tool enables the assessment of mothers' looking behaviour over six constructs and allocation to one of three overall categories of looking: those women who are doing well (comfortable), those who need a referral to an expert perinatal service (worrisome) and those to whom something extra could be offered (uncomfortable). In Phase 2 the Maternal Looking Guide achieved moderate reliability. The Maternal Looking Guide is a practical, moderately reliable, clinical tool that can assist midwives and other perinatal workers identify those mothers who may need extra support at this critical perinatal window of opportunity. .
How language shapes psychiatric case formulation
Publisher: Equinox Publishing
Date: 08-02-2017
DOI: 10.1558/CAM.18978
Abstract: The aim of this paper is to describe, analyse, and discuss the process of formulation in the specific context of mental health (MH). Formulation is a fundamental element of the work of psychiatrists and other MH clinicians that is expected to be mastered during training. The literature, however, shows that formulation is rarely explicitly addressed in the psychiatric curriculum rather, it is implicitly developed through modelling, and/or clinical practice. This paper focuses on case formulation in one MH context in Australia. It tracks the iterative formulation of one patient in a hospital emergency department. The analysis uses resources from systemic functional linguistics (SFL) situated within a broader framework of discourse analysis. It highlights patterns of lexical relations and nominalisation as well as the range of conjunctions. These make explicit how the clinicians talk about the patient’s illness and shape their developing understanding into a logical formulation. We see applications of this work for the training of mental health professionals. These data make explicit the ways in which the participating clinicians use language in the process of formulation. By bringing this process to the level of consciousness, it can be discussed and evaluated and become a pedagogic resource.
Narrative and Coherence
Publisher: Wiley
Date: 09-2004
Does direct-to-consumer advertising of antidepressants lead to a net social benefit?
Publisher: Springer Science and Business Media LLC
Date: 2008
Shortcomings in psychosocial history taking in a paediatric emergency department
Publisher: Wiley
Date: 04-1998
DOI: 10.1046/J.1440-1754.1998.00198.X
Abstract: To assess the quality of documentation of the psychosocial history taken from parents who repeatedly bring their infants and young children to an emergency department. We prepared a list of 26 psychosocial items, indicated by the literature to be important elements of a history taken in this setting. We then reviewed subjects' casenotes, and compared each history to this ideal list. Case note review of 104 children under 2 years who had presented to a paediatric emergency department at least five times in 1 year. Documentation of psychosocial history for these subjects was very poor, with a mean of only 5 of the 26 possible psychosocial items mentioned per set of casenotes. The majority of records lacked important information, including basic demographic data. We canvass possible reasons for poor psychosocial history taking, and argue for changes in medical education, the development of techniques to efficiently identify at risk children and families, and improved resources for referral.
Paediatric bipolar disorder is a controversial diagnosis [3]
Publisher: SAGE Publications
Date: 2008
Authors' reply to Sasich and Linden
Publisher: BMJ
Date: 14-10-2015
DOI: 10.1136/BMJ.H5412
Health-service use by children with asthma over a 6-month period
Publisher: Wiley
Date: 2003
DOI: 10.1046/J.1440-1754.2003.00064.X
Abstract: The present study aims to describe the use of health services by children with asthma, and examine disease-specific, parental and sociodemographic variables associated with different levels of health-service utilization. Parents of 135 children attending an emergency room (ER) completed questionnaires measuring the children's asthma symptoms, and sociodemographic and psychological variables. Parents were contacted monthly for 6 months to document the number of planned and unplanned visits to hospital and community health-care services for asthma. At least one further unplanned visit to the ER was made by 37% of children, while 62% made at least one unplanned visit to a general practitioner (GP). Fifty-five per cent made planned review visits to a GP, 30% to paediatricians and 5% to hospital clinics. After controlling for the level of asthma symptoms, parental anxiety and parental perceptions of children's vulnerability were associated with unplanned GP visits (P = 0.05 and P = 0.01, respectively) a planned review visit and the child being admitted to hospital for the index attack were associated with unplanned ER visits (P = 0.05 and P = 0.004, respectively). Children with asthma more frequently attend GP services than hospital services for both planned and unplanned asthma management. Different variables predict the unplanned use of GP and ER services. Understanding these differences is imperative if children and families are to make the most effective use of health services.
Wishful thinking: antidepressant drugs in childhood depression
Publisher: Royal College of Psychiatrists
Date: 10-2005
Combination Pharmacotherapy for Psychiatric Disorders in Children and Adolescents: Prevalence, Efficacy, Risks and Research Needs
Publisher: Springer Science and Business Media LLC
Date: 12-06-2013
DOI: 10.1007/S40272-013-0032-6
Abstract: Polypharmacy, defined as the concomitant use of two or more psychotropic drugs, has become increasingly common in the paediatric and adolescent population over the past two decades. Combining psychotropic drugs leads to possible increases in benefits, but also in risks, particularly given the potential for psychotropic drug interactions. Despite the increasing use of concomitant therapy in children and adolescents, there is very little evidence from controlled clinical trials to provide guidance for prescribers. Even while acknowledging the small evidence base, clinical practice guidelines from eminent medical organizations are either relatively silent on or tend to support the use of concomitant treatments more enthusiastically than the evidence would warrant, so that practice and guidance are running ahead of the science. Our narrative review shows that the published evidence for efficacy and safety of concomitant psychotropic drugs in children and adolescents is scanty. A comprehensive search located 37 studies published over the last decade, of which 18 were randomized controlled trials (RCTs). These focused mainly on stimulants, central sympatholytics (such as clonidine), antipsychotics and 'mood stabilizers'. While several small, often methodologically weak, RCTs demonstrated statistically significant advantages for dual pharmacotherapy over monotherapy, only adding central sympatholytics to stimulants for treating attention-deficit hyperactivity disorder (ADHD) symptoms was supported by substantial studies with an effect size large enough to suggest clinical importance. Non-randomized studies tended to have results that supported concomitant treatment, but all have design-related problems that decrease the reliability of the results. Two studies that specifically examined tolerability of combination pharmacotherapy compared with monotherapy showed significant increases in adverse effects, both subjective and objective, and other studies confirmed a statistically significant increase in adverse effects, including sedation and self-harm. Given the extent of combination therapy occurring, particularly in conditions such as ADHD, and the ambiguous evidence for benefit with clear evidence of harm, we propose that further research should be carried out as a matter of urgency. Until such a time, the attitude to combination pharmacotherapy should be conservative, and combining psychotropic medications should be considered as an 'n of 1' trial to be closely monitored.
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