ORCID Profile
0000-0002-2008-5190
Current Organisations
University of Reading
,
The University of Newcastle
,
Hunter New England Local Health District
,
Royal College of Psychiatrists
,
Royal Australian and New Zealand College of Psychiatrists
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Publications
Additional file 1: of An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges
Publisher: Figshare
Date: 2017
Nonpsychotic morbidity in a general hospital: early detection based on presenting complaint.
Publisher: Elsevier BV
Date: 1990
DOI: 10.1016/0163-8343(90)90037-D
Abstract: Patients with nonpsychotic minor mental morbidity frequently present with nonspecific somatic symptoms in primary health care settings. This often leads to inappropriate medical management. In this study a group of nonpsychotic psychiatric patients in a general hospital clinic presented with nonspecific somatic complaints as the reason for seeking medical attention (presenting complaint). It was observed that screening of patients with such a presenting complaint lasting for three months or more could differentiate nonpsychotic minor psychiatric morbidity from physical morbidity with high specificity, positive predictive value, and moderate sensitivity. The practical usefulness of such a screening criterion for the nonpsychiatrist physician in a primary medical care setting is discussed.
How stigmatising is schizophrenia in India?
Publisher: SAGE Publications
Date: 06-2000
DOI: 10.1177/002076400004600206
Abstract: Stigma is a social devaluation of a person because of personal attribute leading to an experience of sense of shame, disgrace and social isolation. The nature of stigma in schizophrenia and its relationship to attribution was studied in one hundred and fifty-nine urban patients of Madras, India who fulfilled DSM-IV criteria for schizophrenia. The response of the primary care givers to fourteen questions on stigma and 14 on what they thought attributed to the illness was elicited. Based on the mean stigma score, the entire s le was ided into two groups- those with high and low stigma. Marriage, fear of rejection by neighbour, and the need to hide the fact from others were some of the more stigmatising aspects. Many care givers reported feelings of depression and sorrow. Discriminant function analysis showed that female sex of the patient and a younger age of both patient and caregiver were related to higher stigma. Among attribution items, having no explanation to offer, and attributions to faulty biological functioning, character of life style, substance abuse and intimate interpersonal relationship discriminated between the two groups. The relevance of stigma in the cultural context is described.
Spontaneous dyskinesia and parkinsonism in never-medicated, chronically ill patients with schizophrenia: 18-month follow-up.
Publisher: Royal College of Psychiatrists
Date: 08-2002
DOI: 10.1017/S0007125000161859
Abstract: Spontaneous dyskinesia and parkinsonism have been reported in never-medicated patients with schizophrenia but there has been no previous study of the natural history of these conditions.
An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges
Publisher: Figshare
Date: 2017
The timing of anthropogenic emergence in simulated climate extremes
Publisher: IOP Publishing
Date: 09-2015
Cognitive decline in elderly medical and surgical inpatients
Publisher: Medknow
Date: 2005
Continuation of Treatment With Clozapine After an Episode of Neutropenia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-04-2021
Duration of Untreated Psychosis and Treatment Outcome in Schizophrenia Patients Untreated for Many Years
Publisher: SAGE Publications
Date: 05-2004
DOI: 10.1080/J.1440-1614.2004.01361.X
Abstract: Objective: The duration of untreated psychosis (DUP) influences treatment outcome in schizophrenia but its relevance in untreated patients, ill for a very long duration, is not known. This study examined outcome and factors related to it after one year of treatment of schizophrenia patients who were ill for many years and not previously treated. Method: Among 75 never-treated patients with schizophrenia detected in a community survey in Chennai, India, 49 took treatment and were followed up prospectively for one year. Evaluation at intake and outcome was carried out using standardized methods. Results: A good clinical outcome in 29%, social outcome in 35%, occupational outcome in 51% and global outcome in 31% was observed at the end of one year. Patients with poor global outcome did not significantly differ from those with good outcome on demographic and clinical variables at intake but for the presence of delusions and formal thought disorder. The proportion with good outcome in clinical, work and global measures fell steadily with increasing DUP. This difference was significant for clinical and global outcomes after a DUP of 5 years. Conclusions: The relationship between DUP and response to treatment held good even in chronic stages of schizophrenia with longer DUP associated with poorer outcome.
Relationship Between Cognition and Work Functioning Among Patients With Schizophrenia in an Urban Area of India
Publisher: American Psychiatric Association Publishing
Date: 11-2005
DOI: 10.1176/APPI.PS.56.11.1423
Abstract: Employment rates and work functioning are poor among patients with schizophrenia and are related to cognitive dysfunction. This study examined the relationship between work functioning and cognition, other clinical and demographic variables, and measures of social functioning among patients with schizophrenia in an urban area of India. This study evaluated cognitive dysfunction and work functioning among 88 patients with chronic schizophrenia. Attention, executive function, and memory were tested with a battery of neuropsychological tests. Work and social functions were evaluated with standardized instruments. Fifty-nine patients (67 percent) were employed, most in a mainstream environment. Moderate to significant work dysfunction was present among 21 patients (24 percent). When multivariate analysis was performed, cognitive deficits did not relate significantly to current employment status or to level of performance at work. Negative symptoms predicted employment status, and poor social functioning predicted poor work performance. The relationship between work and cognitive status in schizophrenia was not as strong as has been previously reported in this population. It was speculated that social factors, such as the compelling need to be employed, a supportive work environment, and the number of years of formal education, were factors underlying the high level of work functioning in this group despite cognitive deficits.
Benign ethnic neutropenia and clozapine treatment protocol in Australia
Publisher: SAGE Publications
Date: 21-10-2020
An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges
Publisher: Figshare
Date: 2017
Obesity and Metabolic Syndrome in a Psychiatric Rehabilitation Service
Publisher: SAGE Publications
Date: 07-2007
DOI: 10.1080/00048670701392841
Abstract: Objective: People with schizophrenia and bipolar disorders suffer from increased rates of obesity and metabolic syndrome. Metabolic disorders add to the burden of disease and affect treatment and rehabilitation outcomes. This study aimed to study the prevalence of obesity and metabolic syndrome in people with chronic psychotic disorders in a psychiatric rehabilitation setting. Method: All patients in the psychiatry rehabilitation program were assessed for obesity and metabolic syndrome using the definition of International Diabetes Federation (2005) was conducted as part of clinical protocol recently introduced into practice. Results: A total of 221 patients were assessed. The prevalence of obesity was 59% and metabolic syndrome 68%. Metabolic syndrome was more frequent in patients receiving polypharmacy with multiple antipsychotics and mood stabilisers. Rates of nontreatment for metabolic disorders ranged from 30% to 88%. Conclusions: The rates of obesity and metabolic syndrome in patients with chronic severe mental disorders on antipsychotic drug treatment were 2 to 3 times that in the general population. A majority of them were untreated. Detection, monitoring and appropriate treatment of obesity and metabolic disorders should be a component of an assertive care management program to reduce morbidity and mortality and improve rehabilitation outcomes.
A multiregion assessment of observed changes in the areal extent of temperature and precipitation extremes
Publisher: American Meteorological Society
Date: 12-2015
DOI: 10.1175/JCLI-D-14-00753.1
Abstract: This study examines trends in the area affected by temperature and precipitation extremes across five large-scale regions using the climate extremes index (CEI) framework. Analyzing changes in temperature and precipitation extremes in terms of areal fraction provides information from a different perspective and can be useful for climate monitoring. Trends in five temperature and precipitation components are analyzed, calculated using a new method based on standard extreme indices. These indices, derived from daily meteorological station data, are obtained from two global land-based gridded extreme indices datasets. The four continental-scale regions of Europe, North America, Asia, and Australia are analyzed over the period from 1951 to 2010, where sufficient data coverage is available. These components are also computed for the entire Northern Hemisphere, providing the first CEI results at the hemispheric scale. Results show statistically significant increases in the percentage area experiencing much-above-average warm days and nights and much-below-average cool days and nights for all regions, with the exception of North America for maximum temperature extremes. Increases in the area affected by precipitation extremes are also found for the Northern Hemisphere regions, particularly Europe and North America.
Additional file 1: of Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)
Publisher: Figshare
Date: 2017
Relationship of extrapyramidal symptoms to age at onset and drug treatment in middle-aged and elderly schizophrenic patients.
Publisher: Elsevier BV
Date: 2001
DOI: 10.1016/S0920-9964(00)00008-6
Abstract: The relationship between antipsychotic drugs and dyskinesias and other extrapyramidal symptoms (EPS) in schizophrenia is not simple. There is a need to study variables that may influence the occurrence of EPS in schizophrenic patients receiving drugs. The present study examined the relationship of age at onset of illness and treatment to the development of EPS in 122 middle-aged and elderly schizophrenic patients, 84 treated and 38 who had never received antipsychotic drugs. The illness had an early onset (before 45years, EOS) in 68 patients and a late onset (after 45years, LOS) in 54 patients. The patients were evaluated for dyskinesia and parkinsonism using abnormal involuntary movements scale (AIMS) and Simpson-Angus scale. The prevalence of dyskinesia and parkinsonism was similar in all the patient groups. The scores on limb-axial and severity subscales of AIMS were significantly higher in the treated than the untreated patients of the early onset group. This was not so with the late onset patients. The total parkinsonism score was higher among the treated, notably the LOS patients. The development of dyskinesia and parkinsonism in schizophrenia is possibly related to the age at onset of the illness. In late onset forms the ageing of the patient and a possible neurological abnormality related to schizophrenia might enhance the EPS-inducing effect of drugs.
The nonspecific symptom screening method
Publisher: Elsevier BV
Date: 03-1991
DOI: 10.1016/0163-8343(91)90021-N
Abstract: Detection of nonpsychotic morbidity in primary care patients presenting with nonspecific and somatic symptoms has been difficult because of several factors related to the patients, primary care clinicians, and working conditions of the over-crowded clinic. The available standardized screening questionnaires do not overcome many of these difficulties when used for routine clinical purposes. A screening method based only on nonspecific symptoms, which could be easily incorporated into the routine initial clinical work-up of a patient, was developed in this study and has been found to have good validity and reliability for screening nonpsychotic morbidity. The method of construction of the screen and its clinical applicability and limitations are discussed.
Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)
Publisher: Figshare
Date: 2017
Schizophrenic patients who were never treated--a study in an Indian urban community.
Publisher: Cambridge University Press (CUP)
Date: 09-1998
DOI: 10.1017/S0033291798007077
Abstract: Background. A significant number of patients with severe psychiatric disorders remain untreated in the community although health services are available. The factors related to non-treatment are not well understood. Method. A door-to-door survey was conducted on an Indian urban population of 100 000 using standardized screening and clinical instruments as a part of a larger epidemiological study. Treatment status was determined from multiple sources of information. Results. Nearly one-third of 261 schizophrenia patients were found never to have received treatment. They were older in age and ill for a longer duration than those who had been treated and were more symptomatic and severely disabled. They were more often uneducated and orced and lived with larger extended/joint families. This last factor was considered as being the important factor in determining whether the patient received treatment. Conclusion. The larger extended/joint family, which was able to compensate and cope with the dysfunctional member, seemed to be the crucial factor related to non-treatment of the schizophrenic patient.
The risk for Torsades de Pointes and polypharmacy in schizophrenia
Publisher: Elsevier BV
Date: 02-2021
A working reality: Evaluating enhanced intersectoral links in supported employment for people with psychiatric disabilities
Publisher: Wiley
Date: 20-07-2010
DOI: 10.1111/J.1440-1630.2009.00844.X
Abstract: Supported employment (SE) programmes have been found to improve the rates of competitive employment for people with severe mental illness. Evidence has suggested that the most effective SE model is one in which the employment specialist is co-located with mental health services. However, this may not always be achievable. The aim of this study was to investigate the effectiveness of the enhanced intersectoral links approach to SE. A total of 43 people with a mental illness participated in the programme in which formal links were created between a community mental health team and three employment services. The outcomes of the programme were evaluated over 24 months. Of all participants, 77% achieved a competitive employment outcome, with 60.6% remaining in employment at the end of the evaluation period. The average duration of employment was 44.8 weeks. For those who were unable to maintain a job, the average period of employment was 14.2 weeks. The study found that participants with less severe symptoms at baseline were more likely to obtain employment and those who had worked in the year preceding entry into the programme were employed for a higher proportion of time. The factors related to job loss were the short-term nature of the position, cognitive difficulties and social skills. The study found that the enhanced intersectoral links approach was effective in achieving outcomes consistent with international studies of SE programmes and may offer a viable alternative to the co-location of employment specialists with community mental health teams.
At issue: management of medication noncompliance in schizophrenia by families in India.
Publisher: Oxford University Press (OUP)
Date: 2002
DOI: 10.1093/OXFORDJOURNALS.SCHBUL.A006960
Abstract: Noncompliance with medication during a symptomatic phase is a common problem in the treatment of schizophrenia patients. In India, a majority of patients live with their families and those families supervise patients' medication intake. In a study of patients attending an urban outpatient care center in India, it was noted that when the patients were acutely ill and refused to take medication, the families administered medication to them without patients' knowledge, under the supervision of the psychiatrist. This method had been practiced by families in half the cases of patient noncompliance. Many families felt that there was no other viable alternative under the circumstances. Only a minority of patients was aware of having received medication through this method, and many of them reacted negatively to it. However, the patients were subsequently taking treatment voluntarily following the reduction in the severity of the behavioral disorder with the involuntary treatment. The issues involved in this form of treatment are discussed with regard to the social and health care environment in the country.
Specific Mental Health Disorders: Psychotic Disorders
Publisher: Elsevier
Date: 2017
An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges
Publisher: Springer Science and Business Media LLC
Date: 17-01-2017
Smoking in schizophrenia -- all is not biological.
Publisher: Elsevier BV
Date: 07-2002
DOI: 10.1016/S0920-9964(01)00187-6
Abstract: High rate of tobacco smoking reported in schizophrenia has been related to the effect of nicotine on the neurobiology of schizophrenia. Nicotine is said to alleviate psychotic symptoms in some patients. The relationship between smoking and psychiatric status may not be simply a biological one as several sociocultural and economic factors could influence smoking behaviour. In this study in India on 286 urban male outpatients with schizophrenia, only 38% were found to be current smokers. This was significantly more than in other psychiatric patients studied (major affective disorders and non-psychotic disorders) but not medically ill controls and not higher than the rates for the general male population in India. Smokeless use of tobacco was infrequent in the study population. More than half of the patients did not experience any positive effects due to smoking. Lack of economic independence and restrictions imposed by the family appeared to be crucial factors that controlled the prevalence of smoking among schizophrenia patients. As smoking is a leading cause of preventable morbidity and mortality, there is a serious need to review the neurobiological issue of smoking in schizophrenia considering the influence culture and social practices could have upon the behaviour.
Urban-rural differences in psychiatric rehabilitation outcomes
Publisher: Wiley
Date: 24-03-2010
DOI: 10.1111/J.1440-1584.2010.01127.X
Abstract: Employing rural and urban patient populations, the aim of the study was to examine the differences in rehabilitation intervention outcomes, particularly in regard to the social and clinical determinants. The study employed a retrospective, cross-sectional analysis of patient outcome and characteristics. Community-based psychiatric rehabilitation service in regional and rural Australia. A total of 260 patients were included in the service evaluation phase of the study and 86 in the second part of the study. Participants were community-based and suffered from a chronic mental illness. Clinical and functional outcomes were measured using the Health of Nations Outcome Scale and the 16-item Life Skills Profile. The outcome score employed was the difference between scores at intake and at the last complete assessment. Clinical and sociodemographic characters were recorded using a proforma developed for the study. Patients from rural Maitland had a significantly larger mean reduction in total scores and classified more often as 'Improved' on both the Health of Nations Outcome Scale and Life Skills Profile than patients from either of the urban areas (P < 0.01). Study of randomly selected patients showed that those from an urban area had a more complex illness with multiple needs and less often received family support than their rural counterparts. For rural communities the improvement in rehabilitation outcomes might be attributable to a more benign form of the illness and the availability of higher levels of social capital.
Low prevalence of obesity and metabolic syndrome in never-treated chronic schizophrenia
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.SCHRES.2010.05.010
Abstract: Antipsychotic medication and lifestyle factors are implicated in the high rates of obesity and metabolic syndrome in schizophrenia. While the two Consensus Statements made in 2004 concluded they were unclear whether psychiatric disorders per se accounted for increased prevalence of metabolic disorders several later studies have presented the case for an association between schizophrenia and metabolic disorders, especially impaired glucose metabolism and Type 2 diabetes mellitus, independent of antipsychotic drug treatment. This is a comparative study of 51 patients with chronic schizophrenia who never received antipsychotic drug treatment and 51 healthy controls. Physical and laboratory assessments were made to measure body-mass index and diagnose metabolic syndrome using the International Diabetes Federation (2006) criteria. The study observed a significantly lower mean body-mass index in patients (19.4) than controls (22.7) and very low and comparable rates of metabolic syndrome (3.9% in patients, 7.8% in controls). Economic affordability and lifestyles modified by living conditions were discussed as factors underlying the high rates of underweight in the patient population and low rates of metabolic disorders in all the study subjects. The study concluded that schizophrenia in the absence of antipsychotic drug treatment is not a factor contributing to high prevalence of metabolic abnormalities. Lifestyle factors and the social and economic circumstances that drive them should be considered for better understanding and management of excess weight gain and metabolic abnormalities in people with schizophrenia.
Genetic variation in South Indian castes: evidence from Y-chromosome, mitochondrial, and autosomal polymorphisms.
Publisher: Springer Science and Business Media LLC
Date: 12-2008
Abstract: Major population movements, social structure, and caste endogamy have influenced the genetic structure of Indian populations. An understanding of these influences is increasingly important as gene mapping and case-control studies are initiated in South Indian populations. We report new data on 155 in iduals from four Tamil caste populations of South India and perform comparative analyses with caste populations from the neighboring state of Andhra Pradesh. Genetic differentiation among Tamil castes is low (R ST = 0.96% for 45 autosomal short tandem repeat (STR) markers), reflecting a largely common origin. Nonetheless, caste- and continent-specific patterns are evident. For 32 lineage-defining Y-chromosome SNPs, Tamil castes show higher affinity to Europeans than to eastern Asians, and genetic distance estimates to the Europeans are ordered by caste rank. For 32 lineage-defining mitochondrial SNPs and hypervariable sequence (HVS) 1, Tamil castes have higher affinity to eastern Asians than to Europeans. For 45 autosomal STRs, upper and middle rank castes show higher affinity to Europeans than do lower rank castes from either Tamil Nadu or Andhra Pradesh. Local between-caste variation (Tamil Nadu R ST = 0.96%, Andhra Pradesh R ST = 0.77%) exceeds the estimate of variation between these geographically separated groups (R ST = 0.12%). Low, but statistically significant, correlations between caste rank distance and genetic distance are demonstrated for Tamil castes using Y-chromosome, mtDNA, and autosomal data. Genetic data from Y-chromosome, mtDNA, and autosomal STRs are in accord with historical accounts of northwest to southeast population movements in India. The influence of ancient and historical population movements and caste social structure can be detected and replicated in South Indian caste populations from two different geographic regions.
Duration of untreated psychosis and treatment outcome in schizophrenia patients untreated for many years
Publisher: SAGE Publications
Date: 05-2004
Body Mass Index as a Screening Test for Metabolic Syndrome in Schizophrenia and Schizoaffective Disorders
Publisher: SAGE Publications
Date: 12-2007
DOI: 10.1080/10398560701636906
Abstract: Objective: The aim of this paper was to identify a simple screening measure for detecting metabolic syndrome (MetS) in people with schizophrenia and schizoaffective disorders. Method: A total of 202 patients with chronic schizophrenia and schizoaffective disorders on antipsychotic medications were assessed for MetS using the criteria defined by the International Diabetes Federation. Receiver operating characteristic (ROC) analysis was applied using body mass index (BMI) as the test variable for diagnosis of MetS. Results: The prevalence of MetS was 69.3%. Logistic regression analysis identified BMI and gender as significant predictors of MetS. ROC analysis identified BMI .7 as the criterion value with highest accuracy in terms of specificity and sensitivity. The likelihood ratios were robust at this cut-off score. The area under the curve was 0.75. Conclusion: BMI is a quick and easy measure, and can be used as a screening test for MetS in any clinical or community setting.
‘We’re encouraging people to become involved in their own rescue’
Publisher: SAGE Publications
Date: 04-2019
Insight and psychopathology in never-treated schizophrenia
Publisher: Elsevier BV
Date: 05-2007
DOI: 10.1016/J.COMPPSYCH.2006.10.006
Abstract: Insight is a feature of schizophrenia related to psychopathology, which could be modified by treatment. The real relationship will be more evident in the never-treated state. This study compared insight and its relationship to psychopathology in 143 never-treated patients with chronic schizophrenia with 183 treated patients. The treated patients had not received any structured intervention for improvement of insight. The item on insight and judgment from the Positive and Negative Syndrome Scale for schizophrenia was used as a measure of insight. Never-treated patients were more ill and poorer in insight than the TT group. Sex, age, duration of illness, negative symptoms related to insight only in the TT group. Positive symptoms score correlated with insight in both the groups, but negative symptoms correlated with insight only among the treated patients. Delusions, uncooperativeness, and poor attention predicted 27% of variation in the level of insight in the never-treated, whereas age duration of illness and symptoms of emotional withdrawal, difficulty in abstract thinking, and uncooperativeness predicted 30.3% of variation in insight of the TT group. The observed differences between the never-treated and treated subjects were due to influence of treatment on the association between insight and psychopathology. A subgroup of patients with a treatment-resistant trait of negative symptoms associated with poor insight was hypothesized.
Focus on psychiatry in India
Publisher: Royal College of Psychiatrists
Date: 04-2004
Abstract: India is a country with a population of over 1 billion, and immense ersity in the languages spoken, levels of literacy, and social and cultural practices. Organising mental health services for this predominantly rural population is indeed a daunting task. Compounding this problem are low budgetary resources, the presence of competing and conflicting healing systems, scarcity of mental health personnel, ‘brain drain’, and the stigma of seeking help for problems related to the mind. This paper looks at the mental health scene in India with respect to services and research. It deals with conditions such as schizophrenia, acute psychoses, minor mental morbidity and drug misuse, highlighting aspects unique to the Indian scene. Indian families exhibit great tenacity in caring for relatives who are ill, and are a great resource in treatment and rehabilitation.
A multiregion model evaluation and attribution study of historical changes in the area affected by temperature and precipitation extremes
Publisher: American Meteorological Society
Date: 03-11-2016
Abstract: The skill of eight climate models in simulating the variability and trends in the observed areal extent of daily temperature and precipitation extremes is evaluated across five large-scale regions, using the climate extremes index (CEI) framework. Focusing on Europe, North America, Asia, Australia, and the Northern Hemisphere, results show that overall the models are generally able to simulate the decadal variability and trends of the observed temperature and precipitation components over the period 1951–2005. Climate models are able to reproduce observed increasing trends in the area experiencing warm maximum and minimum temperature extremes, as well as, to a lesser extent, increasing trends in the areas experiencing an extreme contribution of heavy precipitation to total annual precipitation for the Northern Hemisphere regions. Using simulations performed under different radiative forcing scenarios, the causes of simulated and observed trends are investigated. A clear anthropogenic signal is found in the trends in the maximum and minimum temperature components for all regions. In North America, a strong anthropogenically forced trend in the maximum temperature component is simulated despite no significant trend in the gridded observations, although a trend is detected in a reanalysis product. A distinct anthropogenic influence is also found for trends in the area affected by a much-above-average contribution of heavy precipitation to annual precipitation totals for Europe in a majority of models and to varying degrees in other Northern Hemisphere regions. However, observed trends in the area experiencing extreme total annual precipitation and extreme number of wet and dry days are not reproduced by climate models under any forcing scenario.
Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)
Publisher: Figshare
Date: 2017
Use of two long acting injectable antipsychotics for treatment-resistant schizophrenia
Publisher: SAGE Publications
Date: 08-10-2018
Metabolic syndrome in antipsychotic naïve patients with schizophrenia: pooled analysis of data from three Indian studies
Publisher: Wiley
Date: 20-01-2014
DOI: 10.1111/EIP.12117
Abstract: This study aimed to assess the prevalence of metabolic syndrome (MS) and subthreshold MS in antipsychotic naïve patients with schizophrenia by pooling the data from three different centres in India. One hundred thirty-seven antipsychotic naïve patients with schizophrenia were evaluated for MS using common criteria for clinical diagnosis. Twenty-six patients (19%) met consensus criteria. Additionally, 56 patients (40.9%) fulfilled one criterion and 32 patients (23.3%) fulfilled two criteria of MS out of five criteria. One-fifth of antipsychotic naïve patients with schizophrenia had MS and another two-third had at least one metabolic abnormality. Awareness of such a high risk is vitally important for rational selection of antipsychotic medications as well as effective implementation of preventive measures.
Schizophrenia, recovery and the individual-cultural considerations
Publisher: SAGE Publications
Date: 23-12-2019
Abstract: The concept of recovery in mental health has been embraced by many services across the world. Placing the in idual (self) at the core of service delivery constituted a profound shift from service-driven models of care. However, cultures described as in idualistic or collectivist may hold very different views of in iduality. In cultures with collectivist orientation, the notion of ‘in idualism’ is integrated into the structure and dynamics of the family. The families in such cultures play a major and lifetime role in caring for its members, making decisions and acting in consideration of the welfare of all. The needs and priorities of in iduals, especially women, may be superseded by those of their families. This commentary is on the effect of culture on the identity of self in the recovery process and its relevance to mental health care. In multicultural societies like Australia that include Indigenous people, the process of acculturation may be different. For the Indigenous people, the shift was from a collectivist culture to one that was predominantly in idualistic. In the provision of recovery-oriented mental health care, there needs to be an awareness of the cultural variations in the relational dynamics of in idualism.
Community Reintegration of Long-Stay Hospitalised Mental Health Consumers During COVID-19 Pandemic
Publisher: Informa UK Limited
Date: 13-10-2023
Psychopathology in never-treated schizophrenia
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/J.COMPPSYCH.2005.04.009
Abstract: The effect of drug treatment and its adverse effects confound studies on symptoms and associated factors in schizophrenia. Knowledge of psychopathology in the untreated state would identify the natural state of the illness and is relevant to understand pathology underlying the illness. We report here symptoms of schizophrenia as measured by Positive and Negative Syndrome Scale in 143 patients with schizophrenia living in the community never treated with antipsychotic drugs. Positive symptoms were more frequent than negative ones. Negative subscale scores correlated negatively with positive subscale scores and positively with general psychopathology subscale scores. Age correlated negatively with negative and general psychopathology subscale scores independent of duration of illness. Duration of illness and the proportion of life spent in psychosis did not correlate with any Positive and Negative Syndrome Scale scores. The factors (negative, positive, anxiety-depression, motor, and excitement) extracted by a forced 5-factor analysis explained 56% of variance. This factor structure resembled that of treated patients reported in most studies except for the identification of a motor symptom cluster. Psychopathology in the never-treated schizophrenia varied in some aspects from descriptions in the treated state. The differences can be said to demarcate the natural features of the illness from medication effects on the relationship of symptoms with one another and to sex, age, duration of illness, and age at onset.
Cognitive dysfunction and associated factors in patients with chronic schizophrenia
Publisher: Medknow
Date: 2005
An attempt to discontinue clozapine – Worth a try?
Publisher: SAGE Publications
Date: 07-09-2018
Cross-cultural differences in recovery from schizophrenia: What to compare?
Publisher: SAGE Publications
Date: 14-11-2019
Electrocardiographic abnormalities and psychotropic polypharmacy in schizophrenia and schizoaffective disorders
Publisher: SAGE Publications
Date: 27-11-2022
DOI: 10.1177/10398562211047462
Abstract: Sudden cardiac death (SCD) is a significant cause for increased mortality in people with schizophrenia and schizoaffective disorders. Cardiac arrhythmia is one cause of SCD. Electrocardiographic (ECG) abnormalities predictive of arrhythmias are associated with antipsychotic drug use. This chart audit examined the types and frequency of ECG abnormalities (ECG-Abs) in 169 patients with schizophrenia and schizoaffective disorder in a long-stay inpatient unit. We examined the association of ECG-Abs with demographic details and psychotropic drug prescription using chi-square test, Fisher’s Exact test, independent two-s le t-test, Pearson’s correlation, and one-way ANOVA. Eighty-eight patients (52.1%) recorded at least one ECG-Ab, and 20.7% had two or more ECG-Abs. The use of multiple antipsychotics, with or without other psychotropic drugs, did not associate significantly with the presence or number of ECG-Abs. A significant proportion of patients with schizophrenia and schizoaffective disorder have ECG-Abs other than prolonged QTc interval, which can predispose them to cardiac arrhythmias. The abnormalities were not limited to patients on psychotropic polypharmacy. ECG evaluation is indicated for all patients and should consider various electrical abnormalities to identify arrhythmia risk.
Cross-Cultural Study of Recovery in People with Schizophrenia: Methodology
Publisher: Springer Science and Business Media LLC
Date: 24-08-2022
Design and Clinical Characteristics of a Homogeneous Schizophrenia Pedigree Sample from Tamil Nadu, India
Publisher: SAGE Publications
Date: 2009
DOI: 10.1080/00048670902873631
Abstract: Objective: The genetic complexity of schizophrenia may be compounded by the diagnostic imprecision inherent in distinguishing schizophrenia from closely related mood and substance use disorders. Further complexity may arise from studying genetically and/or environmentally erse ethnic groups. Reported here are the ascertainment, demographic features and clinical characteristics, of a diagnostically and ethnically homogeneous schizophrenia pedigree s le from Tamil Nadu, India. Also reported is the theoretical power to detect genetic linkage in the subset of affected sibling pairs. Method: Affected sibling pair and trio pedigrees were identified by caste/ethnicity. Affected probands and siblings fulfilled DSM-IV criteria for schizophrenia or schizoaffective disorder. Results: The present s le consisted of 159 affected sibling pairs and 187 parent–offspring trios originating primarily from the Tamil Brahmin caste, but also incorporating pedigrees from genetically similar, geographically proximal caste groups. Consistent with previous studies in Tamil Nadu, a very low prevalence of affective psychoses such as schizoaffective disorder, was observed, with most affected in iduals having schizophrenia (499/504). Also observed were extremely low rates of nicotine (12.4%), alcohol (1.1%) and illicit drug use (0%). Most affected in iduals exhibited negative symptoms ( %) and a severe, chronic course. All participants lived in the same geographic and climatic region and most affected in iduals resided with close family members, increasing uniformity of the sociocultural environment. In affected sibling pairs, power to detect linkage to small-effect risk loci was modest, but this homogeneous s le may be enriched for loci of larger effect. Conclusions: This Indian schizophrenia s le exhibits diagnostic and ethnic homogeneity with high consistency of sociocultural environmental features. These characteristics should assist efforts to identify risk genes for schizophrenia.
Adverse Incidents in Acute Psychiatric Inpatient Units: Rates, Correlates and Pressures
Publisher: SAGE Publications
Date: 2008
DOI: 10.1080/00048670701881520
Abstract: Objective: This paper reports findings from a multicentre service evaluation project conducted in acute psychiatric inpatient units in NSW, Australia. Overall rates of aggression, absconding and early readmission are reported, as well as length-of-stay profiles and associations between these outcomes and selected sociodemographic and clinical characteristics routinely collected by health services. Method: Data from the 11 participating units were collected for a 12month period from multiple sources, including electronic medical records, routine clinical modules, incident forms, and shift based project-specific logs. For the current analyses, two admission-level datasets were used, comprising aggregated patient-level events (n=3242 admissions) and basic sociodemographic, clinical, admission and discharge information (n=5546 admissions by 3877 patients). Results: The participating units were under considerable strain: 23.3% of admissions were high acuity 60.4% had previous hospital stays 47.6% were involuntary 25–30% involved adverse incidents bed occupancy averaged 88.4% median length of stay was 8days (mean=14.59days) and 17.4% had a subsequent early readmission. Reportable aggressive incidents (11.2% of admissions) were intermittent (averaging 0.55 incidents per month per occupied bed) and associated with younger age, personality disorder, less serious aggression, longer periods of hospitalization, and subsequent early readmission. Less serious aggressive incidents (15.0% of admissions) were maximal in the first 24h (averaging 3.73 incidents per month per occupied bed) and associated with younger age, involuntary status, bipolar and personality disorders, the absence of depression, and longer hospital stays. Absconding (15.7% of admissions) peaked in the second week following admission and was associated with drug and alcohol disorder, younger age, and longer periods of hospitalization. Conclusions: By examining relationships between a core set of risk factors and multiple short-term outcomes, we were able to identify several important patterns, which were suggestive of the need for a multi-level approach to intervention, shifting from a risk management focus during the early phase of hospitalization to a more targeted, therapeutic approach during the later phase. But the latter approach may not be achievable under current circumstances with existing resources.
Initiating care for untreated schizophrenia patients and results of one year follow-up.
Publisher: SAGE Publications
Date: 06-2001
DOI: 10.1177/002076400104700207
Abstract: A number of schizophrenia patients live untreated in the community in the developing countries. There is little recorded experience of how such patients would respond to treatment after years of untreated illness. A cohort of 72 never-treated chronic schizophrenia patents in Chennai, India were directed to attend a health facility. A substantial proportion of them (68%) came for treatment. Unemployed status of male patients, living in a joint family setting and families initially unaware of the psychiatric nature of the problem were the factors that related to failure to seek treatment. Patients sex, age, education, marital status, economic status, age at onset and duration of illness, degree of disability and clinical symptoms (except self-neglect) were not related to taking treatment. Those who attended were treated with typical antipsychotic drugs and followed up for one year. Evaluation was done using the Present State Examination and Psychiatric History and Sociodemographic Schedule and Disability Assessment Schedule. The clinical outcome was good (Best Remission) in 29%. There was no impairment in social functioning in 35% and 51 % has no impairment in occupational functioning at the end of one year.
Additional file 1: of An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges
Publisher: Figshare
Date: 2017
An investigation of some unexpected frost day increases in southern Australia
Publisher: Bureau of Meteorology, Australia
Date: 12-2014
DOI: 10.22499/2.6404.002
Beliefs about causation of schizophrenia: do Indian families believe in supernatural causes?
Publisher: Springer Science and Business Media LLC
Date: 16-05-2001
Abstract: Beliefs about the causation of schizophrenia could influence the attitudes patients' families adopt towards the patient and may also influence their help-seeking behaviour. Indian families have been typically described as often believing in causes like supernatural forces and therefore seeking help from magico-religious healers. In the changing mental health scenario in India, this impression needs verification. Key relatives living with 254 chronic schizophrenia patients were interviewed and asked to name the causes they believed were behind the illness. A list of possible causes was provided for the families to select from, and relatives were also encouraged to mention other possible causes, not featured in the list. The possible causes identified and the factors related to attributions made were analysed. A supernatural cause was named by only 12% of the families and as the only cause by 5%. Psychosocial stress was most commonly cited cause, followed by personality defect and heredity. A small number of families (14%) could not name any cause and 39% named more than one cause. Patient gender and education, duration of illness and the key relative's education and the nature of relationship were related to the type of causal attributions made. Families living with patients suffering chronic schizophrenia receiving treatment in urban India rarely subscribe to the idea of supernatural causation of the illness. The causal attributions made by them are fairly rational and understandable, given the relative lack of exposure to proper information about the illness.
Measuring observed mental state in acute psychiatric inpatients
Publisher: Springer Science and Business Media LLC
Date: 23-08-2008
DOI: 10.1007/S00127-008-0427-9
Abstract: Relationships within acute psychiatric units between patient-level experiences and events and fluctuations in mental state have rarely been examined. Data from a multi-centre service evaluation (11 units, 5,546 admissions) were used to examine mental state patterns and associations with clinical characteristics, events and adverse incidents. During the 12-month evaluation period, nursing staff completed shift-level ratings using a new rating scale, the observed mental state (OMS) scale, which assessed active psychopathology (emotional distress, disinhibition, psychosis, cognitive impairment) and withdrawal (45,885 sets of day/afternoon shift ratings). The OMS scale performed satisfactorily and is worth considering elsewhere (e.g., active psychopathology: internal consistency, alpha=0.72 short-term stability, r=0.72 sensitivity to change, adjusted standardised difference, ASD=0.71). Levels of active psychopathology were much higher on shifts in which reportable (ASD=1.47) and less serious aggression occurred (ASD=1.44), compared with other shifts in which pro re nata medications were also administered (ASD=0.76), suggesting that medication usage often followed these events, and possibly that agitation and distress levels either rose rapidly or went initially unnoticed on these shifts. Although mental state improved steadily across the admission, one-fifth of the patients with schizophrenia received OMS psychosis ratings in the moderate to severe range during the days prior to discharge. Observed mental state ratings were strongly linked with diagnosis and reflected key events and incidents. Routine recording using the OMS scale may assist clinical decision-making and evaluation in acute psychiatric units.
Spontaneous dyskinesia in first-degree relatives of chronically ill, never-treated people with schizophrenia
Publisher: Royal College of Psychiatrists
Date: 07-2003
DOI: 10.1192/BJP.183.1.45
Abstract: We have suggested recently that there may be a subgroup of schizophrenia, namely schizophrenia with dyskinesia and striatal pathology Might movement disorders be more common in relatives of those with schizophrenia and dyskinesia than in relatives of those without dyskinesia? To determine the prevalence of abnormal movements in first-degree relatives of people with schizophrenia who themselves do or do not have abnormal movements. Chronically ill, never-treated people with schizophrenia in south India ( n =70) and their first-degree relatives ( n =181) were examined for dyskinesia using the Abnormal Involuntary Movements Scale (AIMS) and for parkinsonism by the Simpson and Angus scale. Of all relatives, 25 (14%) had dyskinetic movements in at least one body area and 6 (3%) had parkinsonism. Siblings of people with schizophrenia and dyskinesia, compared with siblings of people without dyskinesia, had a higher total AIMS score and more had mild dyskinetic movements in at least one area (5/15 v. 3/34, P =0.04). There were no between-group differences in parkinsonism. Dyskinesia but not parkinsonism is more common in siblings of people with schizophrenia who have the corresponding movement disorder.
The long-term home-making functioning of women with schizophrenia.
Publisher: Elsevier BV
Date: 1999
Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)
Publisher: Springer Science and Business Media LLC
Date: 03-01-2017
Additional file 1: of Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)
Publisher: Figshare
Date: 2017
Obesity and metabolic syndrome in a psychiatric rehabilitation service.
Publisher: Cambridge University Press (CUP)
Date: 12-2006
Shift climate profiles and correlates in acute psychiatric inpatient units
Publisher: Springer Science and Business Media LLC
Date: 09-11-2011
DOI: 10.1007/S00127-011-0448-7
Abstract: Inpatient psychiatric units are dynamic in nature, potentially creating a different treatment experience for each person, which may be difficult to quantify. Among the goals of this multi-centre service evaluation project was an assessment of shift-to-shift changes in unit-level events and their impact on the social-emotional environment. Over 1 year, various nurse-completed logs were used within the 11 participating Australian psychiatric units (n = 5,546 admissions) to record patient- and unit-level events per shift, including ratings of the overall social-emotional climate using a novel shift climate ratings (SCR) scale (n = 8,176 shifts). These were combined with admission-level patient characteristics to investigate shift climate profiles and correlates. Occupancy rates averaged 88% and two-thirds of admissions were involuntary. The psychometric performance of the SCR scale was considered to be satisfactory (e.g., high internal consistency, unidimensional factor structure, and evidence of discriminant and predictive validity). A series of hierarchical regressions revealed considerable variation in SCR total scores, with poorer climates being significantly associated with: day/afternoon shifts higher occupancy levels higher proportions of experienced staff, and male, older, or involuntary patients higher rates of less serious aggressive incidents reporting of additional staffing demands and unit location in a stand-alone psychiatric hospital. The day-to-day social-emotional climate can have important consequences for patient engagement and recovery. Improved understanding of the role played by unit, staff and patient characteristics, together with routine monitoring, should facilitate the development and evaluation of targeted interventions to reduce adverse incidents and improve the overall social-emotional climate.
Understanding the role of sea surface temperature-forcing for variability in global temperature and precipitation extremes
Publisher: Elsevier BV
Date: 09-2018
Additional file 2: of Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)
Publisher: Figshare
Date: 2017
Extrapyramidal symptoms in unmedicated schizophrenia
Publisher: Elsevier BV
Date: 05-2005
DOI: 10.1016/J.JPSYCHIRES.2004.08.002
Abstract: Studies of spontaneous extrapyramidal symptoms, dyskinesia and parkinsonism, in unmedicated schizophrenia are of importance in understanding their underlying pathology and relation to the psychosis. This is a study of extrapyramidal symptoms using Abnormal Involuntary Movements Scale for dyskinesia and Simpson-Angus Scale for parkinsonism in 143 schizophrenia patients who never received antipsychotic medication. Psychopathology was measured using the Positive and Negative Syndrome Scale. Dyskinesia was present in 35% of patients and parkinsonism in 15%. The two disorders coexisted in 11 subjects. Orofacial dyskinesia, rigidity and tremor were common symptoms noted. There was no significant change in the rates and total scores of dyskinesia and parkinsonism with gender, age, duration of illness or age at onset of psychosis. Dyskinesia was unrelated to psychopathology. Parkinsonism score correlated positively with the motor symptom cluster of psychopathology. Dyskinesia and parkinsonism scores correlated positively with each other and parkinsonism score discriminated presence of dyskinesia. The associations between the spontaneous abnormal movements and other aspects of schizophrenia differed from those described in treated patients. Dyskinesia and parkinsonism are an integral part of the schizophrenia disease process whose relationship with other factors could be influenced by antipsychotic drug treatment.
Strong Evidence for a Novel Schizophrenia Risk Locus on Chromosome 1p31.1 in Homogeneous Pedigrees From Tamil Nadu, India
Publisher: American Psychiatric Association Publishing
Date: 02-2009
DOI: 10.1176/APPI.AJP.2008.08030442
Abstract: The study of ethnically homogeneous populations may help to identify schizophrenia risk loci. The authors conducted a genomewide linkage scan for schizophrenia in an Indian population. Participants were 441 in iduals (262 affected probands and siblings) who were recruited primarily from one ethnically homogeneous group, the Tamil Brahmin caste, although in iduals from other geographically proximal castes also participated. Genotyping of 124 affected sibling pair pedigrees was performed with 402 short tandem repeat polymorphisms. Linkage analyses were conducted using nonparametric exponential LOD (logarithm of the odds ratio for linkage) scores and parametric heterogeneity LOD scores. Parametric heterogeneity scores were calculated using simple dominant and recessive models, correcting for multiple statistics. The data were examined for evidence of consanguinity. Genomewide significance levels were determined using 10,000 gene dropping simulations. These findings revealed genomewide significant linkage to chromosome 1p31.1, through the use of both exponential and heterogeneity LOD scores, incorporating correction for multiple statistics and mild consanguinity. The estimated sibling recurrence risk associated with this putative locus was 1.95. Analysis for heterogeneity LOD scores also detected suggestive linkage to chromosomes 13q22.1 and 16q12.2. Using 117 tag single nucleotide polymorphisms (SNPs), family-based association analyses of phosphodiesterase 4B (PDE4B), the closest schizophrenia candidate gene, detected no convincing evidence of association, suggesting that the chromosome 1 peak represents a novel risk locus. This is the first study-to the authors' knowledge-to report significant linkage of schizophrenia to chromosome 1p31.1. Further investigation of this chromosome region in erse populations is warranted to identify underlying sequence variants.
Tumor necrosis factor haplotype analysis amongst schizophrenia probands from four distinct populations in the Asia-Pacific region.
Publisher: Wiley
Date: 20-05-2003
DOI: 10.1002/AJMG.B.20059
Abstract: A single nucleotide polymorphism (TNF(-308A)) within the promoter region of the gene encoding tumor necrosis factor (TNF), has been significantly associated with schizophrenia in a study of Italian patients and control subjects Boin et al. [2001: Mol Psychiatry 6:79-82]. We have applied case-control analyses to examine TNF promoter haplotypes (containing TNF(-308) and two additional promoter variants: TNF(-376) and TNF(-238)) in four schizophrenia cohorts drawn from Australian, Indian Fijian, Indigenous Fijian, and Brahmin populations. In addition, we have applied the sibling transmission disequilibrium (STD) test to promoter haplotypes within 81 trios drawn from Australian Caucasian pedigrees with multiple schizophrenia cases, and 86 trios drawn from the Brahmin population of Tamil Nadu province in Southern India. Within each of these cohorts, we found no evidence of recombination between these tightly linked promoter variants, supporting previous studies which demonstrated that only a subset of the eight possible haplotypes exist. Of the four observed haplotypes, we and others have observed only one carries the TNF(-308A) variant allele. We report no significant differences in TNF promoter haplotype frequencies between the patient and control groups within each population, although the Indian Fijian cohort showed a trend towards reduced TNF(-308A) alleles amongst schizophrenia cases (P = 0.07). We found no evidence of bias in TNF promoter haplotype transmission to schizophrenia probands. Very similar results were obtained when only the TNF(-308) polymorphism was considered. Taken together, these data provide no support for the involvement of TNF promoter variants TNF(-308), TNF(-376), and TNF(-238) in schizophrenia susceptibility within four ethnically distinct cohorts.
How do men with schizophrenia fare at work? A follow-up study from India.
Publisher: Elsevier BV
Date: 05-1997
Claimed Simulation of Insanity
Publisher: Royal College of Psychiatrists
Date: 10-1990
Abstract: The coping strategy of claimed simulation of insanity observed at the onset of psychotic episodes in a manic patient is reported here. There is a need for systematic research on coping strategies in affective psychosis in order to develop techniques to help contain or prevent relapses.
Rehospitalisation of Patients with Enduring Schizophrenia After Discharge from a Long-Stay Inpatient Psychiatric Rehabilitation Unit
Publisher: Springer Science and Business Media LLC
Date: 02-08-2023
Association Study of the Dystrobrevin-Binding Gene With Schizophrenia in Australian and Indian Samples
Publisher: Cambridge University Press (CUP)
Date: 08-2006
DOI: 10.1375/TWIN.9.4.531
Abstract: Numerous studies have reported association between variants in the dystrobrevin binding protein 1 (dysbindin) gene ( DTNBP1 ) and schizophrenia. However, the pattern of results is complex and to date, no specific risk marker or haplotype has been consistently identified. The number of single nucleotide polymorphisms (SNPs) tested in these studies has ranged from 5 to 20. We attempted to replicate previous findings by testing 16 SNPs in s les of 41 Australian pedigrees, 194 Australian cases and 180 controls, and 197 Indian pedigrees. No globally significant evidence for association was observed in any s le, despite power calculations indicating sufficient power to replicate several previous findings. Possible explanations for our results include s le differences in background linkage dis-equilibrium and/or risk allele effect size, the presence of multiple risk alleles upon different haplotypes, or the presence of a single risk allele upon multiple haplotypes. Some previous associations may also represent false positives. Examination of Caucasian HapMap phase II genotype data spanning the DTNBP1 region indicates upwards of 40 SNPs are required to satisfactorily assess all nonredundant variation within DTNBP1 and its potential regulatory regions for association with schizophrenia. More comprehensive studies in multiple s les will be required to determine whether specific DTNBP1 variants function as risk factors for schizophrenia.
Nature and treatment of delusional parasitosis: a different experience in India.
Publisher: Wiley
Date: 12-1994
DOI: 10.1111/J.1365-4362.1994.TB01019.X
Abstract: Delusional parasitosis has been described as a rare syndrome, often involving elderly women who respond poorly to treatment except to pimozide. Nineteen cases of delusional parasitosis given antipsychotic treatment other than pimozide were followed up and the responses assessed in a structured manner. The frequency of the syndrome was higher than generally reported and the patients were younger and had been ill for a shorter period. There was good response to antipsychotic treatments using trifluoperazine, haloperidol, chlorpromazine, and electroconvulsive therapy, and 11 cases showed complete remission, five of them maintaining the recovery for more than 3 years. Delusional parasitosis is not as rare as described: it does not need to be chronic, and can involve young patients. Antipsychotic treatments other than pimozide are equally effective in delusional parasitosis especially if the patients are young and seen early in the illness. The frequency and nature of the disorder observed could probably be due to regional cultural factors.
Structural Brain Differences Between Never-Treated Patients With Schizophrenia, With and Without Dyskinesia, and Normal Control Subjects
Publisher: American Medical Association (AMA)
Date: 04-2002
DOI: 10.1001/ARCHPSYC.59.4.332
Abstract: In south India, abnormal movements indistinguishable from tar e dyskinesia have been observed in chronically ill patients with schizophrenia who have never received antipsychotic medication. The present study, using magnetic resonance imaging, examines brain structure in such patients, in those without dyskinesia, and in normal control subjects. Chronically ill patients with schizophrenia with and without dyskinesia and controls were identified in villages south of Chennai, India (each group, n = 31). Patients' mental state was assessed by the Positive and Negative Syndrome Scale for schizophrenia, dyskinesia by the Abnormal Involuntary Movements Scale, and parkinsonism by the Simpson and Angus scale. In patients and controls, magnetic resonance imaging measured the volume of the caudate and lentiform nuclei and the lateral ventricle-hemisphere ratio. The left lentiform nucleus was significantly (11%) larger in patients with dyskinesia compared with controls, and the right lateral ventricle-hemisphere ratio was significantly (33%) larger in patients without dyskinesia compared with controls. In all 3 groups, there were significant positive correlations between age and ventricle-hemisphere ratio. In controls, but not in patients, there were significant negative correlations between age and the volume of the caudate and lentiform nuclei. Never-treated patients with dyskinesia may have striatal pathologic conditions and may represent a subgroup of patients with schizophrenia in those without abnormal movements, cortical atrophy is more apparent. The schizophrenic process may interfere with normal age-related anatomical changes in the basal ganglia.
Additional file 2: of Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)
Publisher: Figshare
Date: 2017
A qualitative study of clinicians’ perspectives on reasons for delays in clozapine initiation
Publisher: SAGE Publications
Date: 31-05-2023
DOI: 10.1177/10398562231177824
Abstract: To elicit mental health clinicians’ views on the reasons for delayed initiation of clozapine treatment. Thematic analysis of transcripts from a semi-structured interview of 15 mental health clinicians. Four major themes emerged from data analysis: Patient and Carer Factors, Medication factors, Protocol factors, and Prescriber factors. Patient and carer anxiety over side effects and experience of stigma, difficulties in implementing the monitoring protocol, problems with community managing of treatment, prescriber preferences and practices, and gaps in mental health services were some of the reasons identified. Education and support to patients and carers, a modified monitoring protocol, establishing clozapine clinics, improved early intervention services, and upskilling of clinicians can promote early clozapine initiation.
Related Organisations
University Of Reading
Location: United Kingdom of Great Britain and Northern Ireland
Royal College Of Psychiatrists
Location: United Kingdom of Great Britain and Northern Ireland
Royal Australian And New Zealand College Of Psychiatrists
Location: Australia
Related Funding Activities
No related grants have been discovered for Srinivasan Tirupati.