ORCID Profile
0000-0001-6884-0098
Current Organisations
South Eastern Sydney Local Health District
,
UNSW Sydney
,
Mindgardens Neuroscience Network
,
University of New South Wales
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Publications
Health of Carers of Young People with Early Psychosis: A Biopsychosocial Approach
Publisher: Informa UK Limited
Date: 08-03-2019
Cardio-metabolic risk and its management in a cohort of clozapine-treated outpatients.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.SCHRES.2018.02.035
Abstract: To comprehensively assess cardio-metabolic risk factors and their management in a large s le of outpatients treated with clozapine. Observational cross-sectional study of all clozapine users attending specialized clozapine monitoring outpatient clinics in three public hospitals in Sydney, Australia were approached to participate over the one-year period 01/10/2015-30/09/2016. Cardio-metabolic risk factors including metabolic syndrome, risk for future development of diabetes, smoking, physical activity, nutrition, and prescribed medications were assessed at face-to-face interview and through medical record review. Among patients who had cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. Of 451 registered clozapine clinic attenders, 92.2% completed questionnaires and anthropometric measurements. 58.3% met criteria for metabolic syndrome. 79.6% were overweight or obese. 55.9% had blood pressure meeting metabolic syndrome criteria. 46.6% had elevated fasting blood glucose and 55.2% had elevated blood triglycerides. 43.6% were current smokers. Only 10% achieved recommended weekly physical activity levels. Unhealthy food categories were highly consumed. 32.1% were on additional antipsychotics. In the majority of in iduals, cardio-metabolic risk factors were untreated or under-treated. Clozapine use was associated with very high rates of cardiovascular and metabolic risk factors, which were frequently under-treated. Management of both physical and mental health should be prioritized. Polypharmacy should be rationalized. Future research should investigate the effectiveness of smoking cessation and lifestyle interventions in this high-risk population.
Functional neurological disorders: an Australian interdisciplinary perspective
Publisher: Wiley
Date: 14-05-2022
DOI: 10.5694/MJA2.51543
Tackling change in mental health service delivery: A qualitative evaluation of a lifestyle program targeting mental health staff – Keeping our Staff in Mind (KoSiM )
Publisher: Wiley
Date: 15-07-2022
DOI: 10.1002/HPJA.633
Abstract: People with severe mental illness have adverse health outcomes compared to the general population. Lifestyle interventions are effective in improving health outcomes in this population. Current cultural processes in mental health services do not generally incorporate physical health care practices. Innovative education is required to improve knowledge and confidence of staff in the delivery of preventative health measures. The Keeping our Staff in Mind (KoSiM) program delivered a brief lifestyle intervention to mental health staff. A qualitative analysis following the Standards for Reporting Qualitative Research was undertaken. Semi‐structured interviews designed to elicit information about the acceptability of the program and the impact of the intervention on participants' personal and professional lives. The interviews were analysed using thematic analysis, with coding independently developed and reviewed by three authors. Of the 103 eligible participants, 75 were interviewed. Responses revealed four main themes: (i) positive changes in clinician's approach to physical health care, (ii) improvements in attitudes to self‐care and family wellbeing, (iii) positive changes in workplace culture associated with physical health care delivery and (iv) high levels of acceptability of the program. The KoSiM model may be useful in other settings as a means of changing the culture of mental health services to better integrate physical health care as a core part of mental health service provision. A novel approach using staff focussed lifestyle interventions model may cut through the resistance that is encountered when implementing proven methods of clinical intervention where cultural barriers exist.
The age at onset of psychosis and tobacco use
Publisher: Springer Science and Business Media LLC
Date: 08-09-2012
DOI: 10.1007/S00127-011-0431-3
Abstract: There is a well-established but poorly understood association between tobacco use and psychotic illness. The aim of this study was to determine whether tobacco use is associated with an earlier age at onset of psychotic illness. Peer-reviewed publications in English reporting the age at onset of psychosis in tobacco-using and non-tobacco-using groups were located using searches of CINAHL, EMBASE, MEDLINE, PsycINFO and ISI Web of Science, and were supplemented by papers located by manual searches and unpublished data obtained by correspondence with primary researchers. A total of 29 s les reported age at onset data in a consecutive series of patients with a diagnosis of schizophrenia related psychosis or first episode psychosis. Information on study design, study population and effect size was extracted independently by three authors. A random effects meta-analysis was performed. There was no significant difference between smokers and non-smokers in age at the onset of psychosis (standardized mean difference = -0.03). Unlike cannabis use, tobacco use is not associated with an earlier onset of psychosis.
Positive cardiometabolic health for adults with intellectual disability: An early intervention framework
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/PY15130
Abstract: Cardiometabolic morbidity is a significant contributor to the poorer health outcomes experienced by people with intellectual disability (ID). Tailoring cardiometabolic monitoring tools developed for the general population to better fit the altered risk profiles and extra needs of people with ID may help to improve health outcomes. This paper describes a new cardiometabolic monitoring framework designed to address the extra needs of people with ID. The framework was adapted from a generalist guideline after a process of extensive consultation with the original authors and over 30 ID and cardiometabolic experts. In addition to standard cardiometabolic monitoring practice, the framework encourages clinicians to: anticipate and address barriers to care such as communication difficulties and fear of blood tests account for socioeconomic and genetic factors altering baseline cardiometabolic risk and carefully rationalize psychotropic prescription. Together with this framework, a toolkit of free cardiometabolic resources tailored for people with ID and formal and informal carers is included. The monitoring framework promotes a multidisciplinary and holistic approach to cardiometabolic care for people with ID.
Hazard Characterization of Modified Vaccinia Virus Ankara Vector: What Are the Knowledge Gaps?
Publisher: MDPI AG
Date: 29-10-2017
DOI: 10.3390/V9110318
Preventing antipsychotic-induced weight gain in first-episode psychosis: Transitioning dietitians into routine care
Publisher: Wiley
Date: 30-10-2016
A pilot study of a mindfulness informed yoga intervention in young people with psychosis
Publisher: Wiley
Date: 02-2022
DOI: 10.1111/EIP.13264
Abstract: To determine the acceptability and safety of a mindfulness informed yoga intervention as adjunct to usual care for young people with early psychosis. People aged 16–25 years attending a community‐based specialist early psychosis clinic were invited to participate in a 12‐week yoga intervention. The intervention consisted of 1‐h weekly classes of mindfulness informed yoga. Acceptability was measured by uptake, attendance and participants' satisfaction. Safety was measured by incidence of physical injury, participants' level of comfort, distress and anxiety during the sessions, and the following mental health outcomes: positive and negative psychotic, depression, anxiety and stress symptoms, sleep quality and functioning. Of those who consented to the study, 80% (12) participated and on average attended 4.4 yoga classes. There were no physical injuries and participants reported minimal distress and anxiety. Post‐intervention, there was a significant reduction in anxiety symptoms and an improvement in function. Mindfulness‐based yoga interventions are both acceptable and safe as an intervention for youth with early psychosis. Though numbers were small, the study shows promise for yoga as a potentially useful intervention. Importantly, there was no deterioration in mental health outcomes. A larger trial evaluating clinical effectiveness is now timely.
Analysis Still 'being bothered about Billy': Managing the physical health of people with severe mental illness
Publisher: Royal College of General Practitioners
Date: 29-07-2021
Physical and psychological health of carers of young people with first episode psychosis
Publisher: SAGE Publications
Date: 15-01-2018
Abstract: Carers of people with psychosis may experience psychological distress and caregiving burden. However, few studies have examined both psychological and physical health of carers of young people with first episode psychosis (FEP). A total of 32 young people with FEP and 42 of their carers were recruited from a mental health service. Standardised scales were administered to assess carers’ psychological distress and risk for development of Type 2 diabetes. Their body mass index, waist circumference and blood pressure were measured. A total of 24% ( n = 10) of carers experienced high/very high psychological distress and 39.0% ( n = 16) had high risk for Type 2 diabetes. It was common for carers to be overweight ( n = 33, 78.6%) and to have hypertension ( n = 14, 33.3%). Carers’ higher levels of psychological distress were associated with shorter duration of illness in the young person. Caring for a young person with FEP is associated with poor physical and psychological health. Findings show the importance of supporting carers’ physical and psychological health early in treatment of young people with FEP.
Aerobic exercise intervention in young people with schizophrenia spectrum disorders; improved fitness with no change in hippocampal volume
Publisher: Elsevier BV
Date: 05-2015
Improving the health of mental health staff through exercise interventions: a systematic review
Publisher: Informa UK Limited
Date: 15-02-2018
DOI: 10.1080/09638237.2018.1437614
Abstract: Exercise interventions are efficacious in reducing cardiometabolic risk and improving symptoms in people with severe mental illness, yet evidence guiding the implementation and scalability of such efforts is lacking. Given increasing efforts to address the disparity in physical health outcomes facing people with a mental illness, novel approaches to increasing adoption of effective interventions are required. Exercise interventions targeting mental health staff may improve staff health while also creating more positive attitudes towards the role of lifestyle interventions for people experiencing mental illness. We aimed to determine the feasibility, acceptability and effectiveness of exercise interventions delivered to staff working in mental health services. A systematic review was conducted from database inception, until November 2017. Studies recruiting staff participants to receive an exercise intervention were eligible for inclusion. Five studies met the inclusion criteria. Physical health interventions for mental health staff were feasible and acceptable with low dropout rates. Reductions in anthropometric measures and work-related stress were reported. Limited evidence suggests that exercise interventions targeting mental health staff are feasible and acceptable. Further research is required to determine the efficacy of such interventions and the impact such strategies may have on staff culture and patient outcomes.
Bridging the gap: What have we done and what more can we do to reduce the burden of avoidable death in people with psychotic illness?
Publisher: Cambridge University Press (CUP)
Date: 15-01-2016
DOI: 10.1017/S2045796015001043
Abstract: Despite overwhelming evidence demonstrating a persisting gap in life expectancy between those with psychotic illness and the general population, there has been no widespread implementation of interventions to improve the physical wellbeing of people with psychotic illness. This article explores opportunities to ‘Bridge the Gap’ in life expectancy. We describe an Australian evidence-based intervention that has substantially improved the physical health of young people recently commenced on antipsychotic medication. Further epidemiological research, accompanied by cultural change within mental health services, is an essential precursor to the implementation of effective and sustainable lifestyle interventions. There are other relatively neglected areas of physical wellbeing for people with psychotic illness, such as screening and diagnosis of malignancies, which need more research and clinical attention. While there has been progress with intervention development and evaluation, translation of evidence-based short-term intervention studies into feasible and sustainable system-wide changes within routine mental health service settings remains a challenge. Developing an implementation framework to support such change is an urgent priority so as to bridge the persisting premature mortality in people living with psychotic illness.
Prevalence and correlates of food insecurity in community-based individuals with severe mental illness receiving long-acting injectable antipsychotic treatment
Publisher: Cambridge University Press (CUP)
Date: 04-2020
DOI: 10.1017/S0007114520001191
Abstract: People with severe mental illness (SMI) have numerous risk factors that may predispose them to food insecurity (FI) however, the prevalence of FI and its effects on health are under-researched in this population. The present study aimed to describe the prevalence of FI and its relationship to lifestyle factors in people with SMI. This cross-sectional study recruited people with SMI receiving long-acting injectable (LAI) antipsychotic medication from community services at three sites in Sydney, Australia. Assessments were completed on physical health and lifestyle factors. χ 2 Tests, independent-s les t tests and binary logistic regression analyses were calculated to examine relationships between lifestyle factors and FI. In total, 233 people completed the assessments: 154 were males (66 %), mean age 44·8 ( sd 12·7) years, and the majority (70 %) had a diagnosis of schizophrenia. FI was present in 104 participants (45 %). People with FI were less likely to consume fruits (OR 0·42, 95 % CI 0·24, 0·74, P = 0·003), vegetables (OR 0·39, 95 % CI 0·22, 0·69, P = 0·001) and protein-based foods (OR 0·45, 95 % CI 0·25, 0·83, P = 0·011) at least once daily, engaged in less moderate to vigorous physical activity (min) (OR 0·997, 95 % CI 0·993, 1·000, P = 0·044), and were more likely to smoke (OR 1·89, 95 % CI 1·08, 3·32, P = 0·026). FI is highly prevalent among people with SMI receiving LAI antipsychotic medications. Food-insecure people with SMI engage in less healthy lifestyle behaviours, increasing the risk of future non-communicable disease.
Psychiatry HeAL thyself!
Publisher: SAGE Publications
Date: 30-11-2016
Physical activity interventions for people with mental illness: A systematic review and meta-analysis
Publisher: Physicians Postgraduate Press, Inc
Date: 31-03-2014
DOI: 10.4088/JCP.13R08765
y-QUIT: Smoking Prevalence, Engagement, and Effectiveness of an Individualized Smoking Cessation Intervention in Youth With Severe Mental Illness.
Publisher: Frontiers Media SA
Date: 14-12-2018
Adjunctive raloxifene treatment improves attention and memory in men and women with schizophrenia
Publisher: Springer Science and Business Media LLC
Date: 18-05-2015
DOI: 10.1038/MP.2015.11
Significant differences in fMRI related activity between healthy adults and people with schizophrenia during reward-related prediction-errors
Publisher: Springer Science and Business Media LLC
Date: 22-02-2012
DOI: 10.1038/MP.2012.1
An audit of general practitioner involvement in public community mental health care
Publisher: SAGE Publications
Date: 02-07-2015
Abstract: Existing guidelines suggest that collaboration between general practitioners and mental health services may improve the physical health of people with serious mental illness. This study investigated the extent of general practitioner involvement in a community mental health centre and examined whether the presence of a documented general practitioner in the patient’s medical records was associated with markers of better health outcomes. The medical records of current patients were audited, including those receiving medical care and case management and those only receiving medical care. The demographic and diagnostic information, evidence of metabolic screening, blood test results, and medications of patients with a recorded general practitioner were compared with those of patients with no recorded general practitioner. Ninety-eight of 191 (51%) of patients had details of a general practitioner documented in their medical records. There were no significant differences in rates of metabolic screening between the two groups. Those with a general practitioner had more medical diagnoses and were taking a greater number of psychiatric medications. Although the medical comorbidities of serious mental illness are becoming increasingly recognised, our findings suggest the need for ongoing and coordinated efforts by policymakers, general practitioners, mental health services and patients to ensure the health and longevity of people with serious mental illness.
Effectiveness of a brief lifestyle intervention targeting mental health staff: Analysis of physical fitness and activity in the Keeping Our Staff in Mind study
Publisher: BMJ
Date: 07-2020
DOI: 10.1136/BMJSEM-2020-000761
Abstract: People with mental illness die on average 15 years less than the general population, primarily to cardiometabolic disease. Lifestyle interventions are effective in reducing cardiometabolic risk but are not routinely provided to mental health consumers. Lifestyle interventions targeting mental health staff may be beneficial in changing culture surrounding physical health and subsequently improving consumer outcomes. This study examines exercise and fitness outcomes of a targeted lifestyle intervention directed at Australian mental health staff. A pragmatic single-arm intervention study was conducted within an Australian public mental health service. Mental health staff were provided a five-session in idualised lifestyle intervention (incorporating exercise and nutritional counselling) over 5 weeks. Two waves of the programme were delivered between 2015 and 2016. This paper examines the exercise and fitness outcomes of the second wave of the study. Participants were assessed at baseline and at a 16-week follow-up. The primary exercise outcome was a measurement of cardiorespiratory fitness. Secondary outcomes included self-reported physical activity and a measurement of handgrip strength. A total of 106 staff participated in this component of the study. Cardiorespiratory fitness increased significantly from baseline to follow-up (p .001). Significant improvements to physical activity occurred with decreases in sedentary time (p .0005) and increases in moderate-to-vigorous physical activity (p .005). Lifestyle interventions incorporating exercise counselling may improve the physical health of mental health staff. Such strategies may be effective in improving culture surrounding physical health and/or increasing the effectiveness of lifestyle interventions targeting mental health consumers.
Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times - Children and Adolescents
Publisher: Elsevier BV
Date: 02-2022
Confidence levels of exercise physiology and dietetic students’ pre- and post-practicum within mental health facilities
Publisher: Emerald
Date: 20-08-2021
DOI: 10.1108/JMHTEP-12-2020-0086
Abstract: This paper aims to examine student exercise physiologists (EPs) and student dietitians’ confidence regarding working with people with severe mental illness (SMI) pre- and post-practicum in a mental health service. This single-arm, quality improvement project included students completing practicum within a lifestyle programme embedded in mental health services. Student EPs completed 100 h of practicum across 15 weeks as part requirement for their Bachelor of Exercise Physiology degree and student dietitians completed six weeks full-time (40 h/week) for the part requirement of their Master of Nutrition and Dietetics. Students completed the Dietetic Confidence Scale (terminology was adapted for student EPs) pre- and post-practicum. In total, 27 student EPs and 13 student dietitians completed placement and returned pre- and post-practicum questionnaires. Pre-practicum confidence scores were 90.8 ± 17.1 and 86.9 ± 18.9 out of a possible 140 points for student EPs and student dietitians, respectively. Confidence scores increased substantially post-practicum for both student EPs [mean difference (MD) = 29.3 ± 18.8, p 0.001, d = 1.56] and dietitian students (MD = 26.1 ± 15.9, p = 0.002, d = 1.64). There were significant improvements in confidence across all domains of the confidence questionnaire for both EPs and dietitian students. There is a research gap in understanding the confidence levels of student EPs’ and student dietitians’ when working with people with mental illness and the impact that undertaking a practicum in a mental health setting may play. To the best of the authors’ knowledge, this is the first study to explore student EP and student dietitian confidence in working with people with SMI pre- and post-practicum in a mental health setting.
Acute tranquilisation in young people with first-episode psychosis: Let's start low, go slow
Publisher: SAGE Publications
Date: 18-07-2016
Is Obesity in Young People With Psychosis a Foregone Conclusion? Markedly Excessive Energy Intake Is Evident Soon After Antipsychotic Initiation.
Publisher: Frontiers Media SA
Date: 24-12-2018
Implementing evidence-based physical activity interventions for people with mental illness: An Australian perspective
Publisher: SAGE Publications
Date: 02-07-2016
Abstract: Physical activity (PA) and exercise is increasingly being recognised as an efficacious component of treatment for various mental disorders. The association between PA and cardiometabolic disease is well established, as is the strong link between mental illness, sedentary behaviour and poor cardiometabolic health. Ex les of successful integration of clinical PA programs within mental health treatment facilities are increasing. The aim of this review was to summarise the evidence regarding PA and mental illness, and to present ex les of clinical exercise programs within Australian mental health facilities. A narrative synthesis of systematic reviews and clinical trials was conducted. Evidence supporting the inclusion of PA programs as an adjunct to treatment for various conditions was presented including depression, schizophrenia, anxiety disorders, post-traumatic stress disorder and substance abuse. In light of the available evidence, the inclusion of clinical PA programs within mental health treatment, facilitated by dedicated clinicians (exercise physiologists / physiotherapists) was justified. PA is a feasible, effective and acceptable adjunct to usual care for a variety of mental disorders. There is a clear need for greater investment in initiatives aiming to increase PA among people experiencing mental illness, given the benefits to both mental and physical health outcomes.
Electrophysiological, cognitive and clinical profiles of at-risk mental state: The longitudinal minds in transition (MinT) study
Publisher: Public Library of Science (PLoS)
Date: 10-02-2017
Breast screening participation and degree of spread of invasive breast cancer at diagnosis in mental health service users, a population linkage study
Publisher: Wiley
Date: 26-08-2023
DOI: 10.1002/CNCR.35002
Abstract: Women living with mental health conditions may not have shared in improvements in breast cancer screening and care. No studies have directly examined the link between reduced screening participation and breast cancer spread in women using mental health (MH) services. Population‐wide linkage of a population cancer register, BreastScreen register, and mental health service data set in women aged 50 to 74 years in New South Wales, Australia, from 2008 to 2017. Incident invasive breast cancers were identified. Predictors of degree of spread (local, regional, metastatic) at diagnosis were examined using partial proportional odds regression, adjusting for age, socioeconomic status, rurality, and patterns of screening participation. A total of 29 966 incident cancers were identified and included 686 (2.4%) in women with MH service before cancer diagnoses. More than half of MH service users had regional or metastatic spread at diagnosis (adjusted odds ratio, 1.63 95% CI, 1.41‐1.89). MH service users had lower screening participation however, advanced cancer was more common even when adjusting for screening status (adjusted odds ratio, 1.53 95% CI, 1.32‐1.77). Advanced cancer was more common in women with severe or persistent MH conditions. Low screening participation rates explain only small part of the risk of more advanced breast cancer in women who use MH services. More study is needed to understand possible mechanisms contributing to more advanced breast cancer in women living with MH conditions. Health systems need strategies to ensure that women living with MH conditions enjoy population gains in breast cancer outcomes.
Editorial: Keeping the Body in Mind: Scientific Effort in Advocating the Best Outcomes for People Living With Severe Mental Illness
Publisher: Frontiers Media SA
Date: 03-01-2022
Changing health workforce attitudes to promote improved physical health in mental health service users: Keeping our Staff in Mind (KoSiM)
Publisher: Wiley
Date: 28-01-2020
DOI: 10.1002/HPJA.320
Abstract: People living with mental illness die on average 15 years earlier than the general population, primarily due to preventable and premature cardiovascular disease. Lifestyle interventions can be effective in reducing cardiovascular risk, yet mental health services do not routinely provide targeted lifestyle interventions. Exposing mental health staff to lifestyle interventions prior to targeting patients may be critical to changing culture and improving patient outcomes. This study aimed to improve the physical health of mental health staff through a targeted lifestyle intervention. A pragmatic single-arm intervention study was conducted in a public mental health service, including inpatient and community settings, in Sydney, Australia. Participants in this study were n = 212 clinical and non-clinical staff. A five-session in idualised lifestyle intervention (delivered over 5 weeks) incorporating physical activity and nutritional counselling was delivered by multidisciplinary teams. Participants were assessed at baseline, following the intervention, and at follow-up (mean = 16.7 weeks). The primary outcome was the barriers, attitudes, knowledge and confidence regarding screening, promoting and intervening to improve physical health outcomes of patients (M-BACK questionnaire). Secondary outcomes included anthropometric measures, cardiorespiratory fitness, sedentary time and nutritional intake. Repeated measures ANCOVAs were performed. A total of 212 staff (79% female) participated in this study. M-BACK total score significantly increased from baseline to follow-up (P < .001). Waist circumference, sedentary time and total energy intake all significantly decreased (all P's < .001) and cardiorespiratory fitness significantly increased (P < .001). A brief lifestyle intervention for staff of a public mental health service may increase the capability of the participants to improve their own physical health. SO WHAT?: Improving staff health may be an important strategy in improving the uptake and/or the effectiveness of lifestyle interventions targeting mental health service users.
Physical activity interventions: An essential component in recovery from mental illness
Publisher: BMJ
Date: 18-12-2015
Targeted Intervention to Reduce Smoking among People with Severe Mental Illness: Implementation of a Smoking Cessation Intervention in an Inpatient Mental Health Setting
Publisher: MDPI AG
Date: 24-04-2020
Abstract: Background and Objectives: Smoking and smoking-related harms are highly prevalent among people with severe mental illness. Targeted smoking cessation programs are much needed in this population. This pilot study aimed to assess the effectiveness of implementing smoking cessation system change interventions within an acute inpatient mental health unit. Materials and Methods: Design: Pre-post intervention study. System change interventions for smoking cessation were delivered over a three-month period (05 March 2018–04 June 2018) on an acute inpatient mental health unit. Participants (n = 214) were all in iduals receiving care as inpatients during the three-month intervention. Outcomes assessed pre- and post-intervention were: (i) recording of patient smoking status in medical notes, (ii) number of inpatients offered smoking cessation medication, and iii) number of violent incidents reported. Results: Recording of smoking status significantly increased from 1.9% to 11.4% (X2 = 14.80 p ≤ 0.001). The proportion of inpatients offered smoking cessation treatment significantly increased from 11.0% to 26.8% (X2 = 16.01 p ≤ 0.001). The number of violent incidents decreased by half, which was not statistically significant. Conclusion: Evidence-based smoking cessation interventions can be successfully implemented on an inpatient mental health unit. Modest gains were made in routine screening for smoking and in smoking cessation treatment prescription. Future studies should prioritize effective participatory collaboration with staff to optimize effectiveness of interventions and should include additional strategies such as brief intervention training and smoking cessation treatments such as varenicline and buproprion in addition to nicotine replacement therapy (NRT).
Individual Dietetic Consultations in First Episode Psychosis: A Novel Intervention to Reduce Cardiometabolic Risk
Publisher: Springer Science and Business Media LLC
Date: 19-12-2015
DOI: 10.1007/S10597-014-9787-7
Abstract: In idual dietetic consultations were trialled in a community-based first-episode psychosis program. Participants received eight in idualised dietetic consultations, plus weekly shopping tours and cooking groups. The outcome measure was waist circumference (WC). In total, 30 patients commenced the program. An intention-to-treat analysis revealed, a statistically significant reduction in WC (mean=2.1±5.4 cm, t=2.1, df=29, p=0.04). Similar results were found for the 14 participants who attended all eight sessions (mean WC reduction=2.9±4.7 cm, t=2.3, df=13, p=0.04). Dietetic consultations were feasible and effective in reducing WC, and could enhance programs to reduce cardiometabolic risk in youth with psychosis using lifestyle interventions.
Metabolic abnormalities in an early psychosis service: A retrospective, naturalistic cross-sectional study
Publisher: Wiley
Date: 07-04-2011
DOI: 10.1111/J.1751-7893.2011.00262.X
Abstract: There is an increasing recognition of the impact of weight gain on the development of metabolic abnormalities in young people receiving atypical antipsychotic drugs for first-episode psychosis. This study examined the prevalence of such abnormalities in a specialist early-intervention community mental health team. A retrospective case record audit of 85 patients 16-27 years old attending the Early Psychosis Service between October 2006 and June 2008, who had at least one metabolic measure defined as: weight, body mass index (BMI), waist circumference, blood pressure, and fasting blood glucose and lipids. Metabolic syndrome identified by the International Diabetes Federation (IDF) criteria. Fifty-five percent of males and 42% of females were overweight or obese at a median treatment duration of 8 months. Duration of antipsychotic therapy was associated with higher BMI (r = 0.28, P < 0.01). More than 40% of the total s le had high waist circumference. Of the 64 subjects with complete metabolic data, eight (12.5%) met full IDF criteria for metabolic syndrome, and another 21 (32.8%) had either increased waist with one metabolic abnormality or normal waist and two metabolic abnormalities. Over a third of young patients being treated for their first episode of psychosis either had metabolic syndrome or showed metabolic abnormalities. Treatment duration related to higher BMI and greater prevalence of metabolic syndrome. Detection of metabolic complications after treatment instigation in patients with first-episode psychosis will permit early intervention with lifestyle or drug interventions in those at risk of significant physical health morbidity.
The effects of antipsychotic switching on diabetes in chronic schizophrenia
Publisher: Wiley
Date: 16-02-2014
DOI: 10.1111/DME.12359
Abstract: People with severe mental illness have a 20-year life-expectancy shortfall. The majority of antipsychotic medications are associated with obesity and heightened diabetes risk. People with severe mental illness less frequently achieve benchmarked diabetes care, often attributed to poor adherence, lower clinical attendance and documented medical biases in treatment. This case is presented to highlight the profound effect medication change can have on diabetes control. A 56-year-old man with a 42-year history of schizophrenia had required clozapine treatment for the preceding 14 years. Type 2 diabetes and obesity occurred within 4 years of clozapine instigation. Glycaemic control had been continuously poor, despite frequent contact with diabetes services and multiple medications, including insulin at a dose exceeding 200 IU daily. Request for consideration of antipsychotic review and close interaction with the psychiatry team was initiated at the diabetes outpatient clinic. A gradual medication switch from clozapine to aripiprazole was associated with a reduction in HbA(1c) from 80 to 50 mmol/mol (9.5 to 6.7%) over 4 months, associated with a weight loss of 10 kg. Over the ensuing 2 years, the improvement in HbA(1c) has endured, with total weight loss of 13 kg and halving of insulin requirements. This case illustrates the benefits of engagement between endocrinologists and psychiatrists to achieve the shared goal of improved physical health in severe mental illness. Greater interdisciplinary collaboration will help bridge the life-expectancy gap in severe mental illness and may assist in preventing disabling diabetes complications in this vulnerable patient group.
Quality prescribing in early psychosis: key pharmacotherapy principles
Publisher: SAGE Publications
Date: 08-11-2022
DOI: 10.1177/10398562211054656
Abstract: To present a practical, easy-to-implement clinical framework designed to support evidence-based quality prescribing for people with early psychosis. Identification and explanation of key principles relating to evidence-based pharmacotherapy for people with early psychosis. These were derived from the literature, practice guidelines and clinical experience. Key principles include (1) medication choice informed by adverse effects (2) metabolic monitoring at baseline and at regular intervals (3) comprehensive and regular medication risk–benefit assessment and psychoeducation (4) early consideration of long-acting injectable formulations (preferably driven by informed patient choice) (5) identification and treatment of comorbid mood disorders and (6) early consideration of clozapine when treatment refractory criteria are met. Current prescribing practices do not align with the well-established evidence for quality pharmacotherapy in early psychosis. Adopting evidence-based prescribing practices for people with early psychosis will improve outcomes.
Implementing an Exercise Physiology Clinic for Consumers Within a Community Mental Health Service: A Real-World Evaluation
Publisher: Frontiers Media SA
Date: 24-11-2021
DOI: 10.3389/FPSYT.2021.791125
Abstract: Background: Physical activity significantly improves mental illness symptoms and physical health for people living with mental illness. Mental health services do not routinely provide their consumers with access to exercise professionals for physical activity engagement. Barriers exist to integrating physical activity as part of standard care including staff culture, finance, and resources. This study examines the feasibility of newly established exercise physiology clinic within a mental health service in Sydney, Australia. Methods: A single site, open trial was conducted in a community centre within a large mental health district. A meeting room was converted into a part-time exercise physiology clinic where in idualised physical activity interventions were delivered by an accredited exercise physiologist. Outcome measures including BMI, cardiovascular fitness, and self-reported physical activity were collected. Results: A total of 84 mental health consumers (17% of eligible consumers within the mental health service) participated in the clinic on average for one exercise session weekly. Moderate-to-vigorous physical activity significantly increased and sedentary time significantly decreased ( p & 0.001). Conclusions: Exercise physiology clinics are feasible within mental health services and should be incorporated as part of standard care.
Lifestyle interventions to reduce premature mortality in schizophrenia
Publisher: Elsevier BV
Date: 07-2017
The clinical significance of serial creatine phosphokinase estimations in acute Ward admissions
Publisher: SAGE Publications
Date: 09-1994
DOI: 10.3109/00048679409075873
Abstract: The aim of the study was to assess the effects of a number of physical factors on serial total creatine phosphokinase (CK) levels within the first few days of admission to an acute psychiatric ward. Patients (n=17) who received parenteral injections within 48 hours of admission were compared with those (n=30) who did not, looking at factors such as method of admission, alcohol use, presence of restraint and serial CK estimations. Those receiving injections had significantly raised CK levels over the first few days post-admission these levels tended to normalise over 72 hours of admission. A small number of the patients who were given intramuscular injections demonstrated CK levels of over 1000 U/L. It is suggested that where CK levels are elevated, NMS should be excluded on clinical grounds. CK levels should return to normal over the next 72 hours (in the absence of NMS) if there are no further intramuscular injections.
Detection and intervention in emerging youth mental health issues: Outcomes from the first year of the
CASPAR
service
Publisher: Wiley
Date: 03-04-2020
DOI: 10.1111/EIP.12956
Breast cancer screening participation in women using mental health services in NSW, Australia: a population study
Publisher: Springer Science and Business Media LLC
Date: 12-06-2023
DOI: 10.1007/S00127-023-02509-W
Abstract: Population screening programs have contributed to reduced breast cancer mortality, but disadvantaged or vulnerable groups may not have shared these improvements. In North American and European studies, women living with mental health conditions have reduced breast screening rates. There are no current Australasian data to support health system planning and improvement strategies. The New South Wales (NSW) BreastScreen program offers free screening to NSW women aged 50–74. We compared 2-year breast screening rates for mental health service users ( n = 33,951) and other NSW women ( n = 1,051,495) in this target age range, after standardisation for age, socioeconomic status and region of residence. Mental health service contacts were identified through linkage to hospital and community mental health data. Only 30.3% of mental health service users participated in breast screening, compared with 52.7% of other NSW women (crude incidence rate ratio 0.57, 95% CI 0.56–0.59). Standardisation for age, socioeconomic disadvantage or rural residence did not alter this screening gap. Around 7000 fewer women received screening than would be expected from comparable population rates. Screening gaps were largest in women over 60 and in socioeconomically advantaged areas. Women with severe or persistent mental illness had slightly higher screening rates than other mental health service users. Low breast cancer screening participation rates for NSW mental health service users suggest significant risk of later detection, possibly leading to more extensive treatment and premature mortality. Focussed strategies are needed to support greater breast screening participation for NSW women who use mental health services.
Potentially preventable hospitalisations for physical health conditions in community mental health service users: A population-wide linkage study
Publisher: Cambridge University Press (CUP)
Date: 2021
DOI: 10.1017/S204579602100007X
Abstract: Mental health (MH) service users have increased prevalence of chronic physical conditions such as cardio-respiratory diseases and diabetes. Potentially Preventable Hospitalisations (PPH) for physical health conditions are an indicator of health service access, integration and effectiveness, and are elevated in long term studies of people with MH conditions. We aimed to examine whether PPH rates were elevated in MH service users over a 12-month follow-up period more suitable for routine health indicator reporting. We also examined whether MH service users had increased PPH rates at a younger age, potentially reflecting the younger onset of chronic physical conditions. A population-wide data linkage in New South Wales (NSW), Australia, population 7.8 million. PPH rates in 178 009 people using community MH services in 2016–2017 were compared to population rates. Primary outcomes were crude and age- and disadvantage-standardised annual PPH episode rate (episodes per 100 000 population), PPH day rate (hospital days per 100 000) and adjusted incidence rate ratios (AIRR). MH service users had higher rates of PPH admission (AIRR 3.6, 95% CI 3.5–3.6) and a larger number of hospital days (AIRR 5.2, 95% CI 5.2–5.3) than other NSW residents due to increased likelihood of admission, more admissions per person and longer length of stay. Increases were greatest for vaccine-preventable conditions (AIRR 4.7, 95% CI 4.5–5.0), and chronic conditions (AIRR 3.7, 95% CI 3.6–3.7). The highest number of admissions and relative risks were for respiratory and metabolic conditions, including chronic obstructive airways disease (AIRR 5.8, 95% CI 5.5–6.0) and diabetic complications (AIRR 5.4, 95% CI 5.1–5.8). One-quarter of excess potentially preventable bed days in MH service users were due to vaccine-related conditions, including vaccine-preventable respiratory illness. Age-related increases in risk occurred earlier in MH service users, particularly for chronic and vaccine-preventable conditions. PPH rates in MH service users aged 20–29 were similar to population rates of people aged 60 and over. These substantial differences were not explained by socio-economic disadvantage. PPHs for physical health conditions are substantially increased in people with MH conditions. Short term (12-month) PPH rates may be a useful lead indicator of increased physical morbidity and less accessible, integrated or effective health care. High hospitalisation rates for vaccine-preventable respiratory infections and hepatitis underline the importance of vaccination in MH service users and suggests potential benefits of prioritising this group for COVID-19 vaccination.
Efficacy of metformin for prevention of weight gain in psychiatric populations: A review
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2012
A nutrition intervention is effective in improving dietary components linked to cardiometabolic risk in youth with first-episode psychosis
Publisher: Cambridge University Press (CUP)
Date: 04-04-2016
DOI: 10.1017/S0007114516001033
Abstract: Severe mental illness is characterised by a 20-year mortality gap due to cardiometabolic disease. Poor diet in those with severe mental illness is an important and modifiable risk factor. The present study aimed to (i) examine baseline nutritional intake in youth with first-episode psychosis (FEP), (ii) evaluate the feasibility and acceptability of nutritional intervention early in FEP and (iii) to evaluate the effectiveness of early dietary intervention on key nutritional end points. Participants were recruited over a 12-month period from a community-based programme specifically targeting young people aged 15–25 years with newly diagnosed FEP. In idual dietetic consultations and practical group sessions were offered as part of a broader lifestyle programme. Dietary assessments were conducted before and at the end of the 12-week intervention. Participants exceeded recommended energy and Na intakes at baseline. Retention within the nutrition intervention was 67 %, consistent with other interventions offered to FEP clients. There was a 47 % reduction in discretionary food intake (−94 g/d, P ·001) and reductions in daily energy (−24 %, P ·001) and Na (−26 %, P ·001) intakes. Diet quality significantly improved, and the mean change was 3·6 (95 % CI 0·2, 6·9, P ·05), although this finding was not significant after Bonferroni’s correction. Increased vegetable intake was the main factor contributing to improved diet quality. Nutrition intervention delivered shortly after initiation of antipsychotic medication is feasible, acceptable and effective in youth with FEP. Strategies to prevent weight gain and metabolic decline will contribute to prevent premature cardiometabolic disease in this vulnerable population.
Considering metformin in cardiometabolic protection in psychosis
Publisher: Wiley
Date: 16-07-2012
Keeping our staff in mind: Dietary results of a lifestyle intervention targeting mental health staff
Publisher: Wiley
Date: 15-08-2021
DOI: 10.1002/HPJA.377
Abstract: 1) Describe the dietary intake of mental health staff within South Eastern Sydney Local Health District and 2) Evaluate the impact of an in idualised staff lifestyle program on the following nutrition parameters (i) energy, (ii) core food groups and (iii) discretionary foods. This was a pragmatic single‐arm intervention study, conducted for all staff working in a public mental health service, in Sydney, Australia. A five‐session in idualised lifestyle intervention delivered over 5 weeks incorporated nutritional counselling delivered by a dietitian. Participants were assessed at baseline, following the intervention, and at follow‐up using diet history to assess dietary intake. Eighty‐eight staff completed the dietary intervention and follow‐up. An intake of core food groups significantly below national recommendations was reported for total vegetables (−1.75 ± 0.14 serves, P .001), fruit (−0.29 ± 0.11 serves, P = .01), grains (−1.25 ± 0.20 serves, P .001) and dairy servings (−1.00 ± 1.08 serves, P .001), and protein‐based foods were significantly above national recommendations (0.2 ± 0.09 serves, P = .03). At completion of the program, energy from discretionary foods was reduced by 460 kJ (95% CI −635 to −285, P .001), and the serves of total vegetables (0.91 serves, 95% CI 0.59‐1.22, P .001) and dairy (0.31 serves, 95% CI 0.11‐0.50, P .001) were increased significantly. A workplace‐based well‐being program for staff working in the mental health setting coincided with dietary improvements. Mental health staff can act as positive role models for clients to promote developing positive physical health behaviours.
Tobacco use before, at, and after first-episode psychosis: A systematic meta-analysis
Publisher: Physicians Postgraduate Press, Inc
Date: 15-04-2012
DOI: 10.4088/JCP.11R07222
Modifiable cardiometabolic risk factors in youth with at-risk mental states: A cross-sectional pilot study
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.PSYCHRES.2017.08.034
Abstract: Young people experiencing psychotic illness engage in low amounts of physical activity have poor fitness levels and poor sleep quality. This study aimed to determine the prevalence of these modifiable cardiometabolic risk factors among in iduals with at-risk mental states (ARMS), who are at increased risk of developing psychosis. A cross-sectional study was conducted in a community-based youth mental health service. Thirty participants (23%♀, 21.3 ± 1.7 years old) were recruited, 10 with ARMS, 10 with first-episode psychosis (FEP) and 10 healthy volunteers. Physical activity levels were assessed using self-report and objective measures. Aerobic capacity, upper body strength, hamstring flexibility, forearm grip strength and core endurance were assessed. Sleep quality, depression and anxiety were measured by self-report questionnaire. The ARMS group did not differ significantly on anthropometric measures from FEP or healthy volunteers. They engaged in significantly less physical activity (p < 0.05) and had poorer sleep quality (p < 0.05) than healthy volunteers. Our results are consistent with other studies that found that youth with ARMS are at greater cardiometabolic risk. Interventions aimed at improving these modifiable risk factors may assist with preventing the decline in physical health associated with the development of psychiatric illness.
Cardio-metabolic risk in individuals prescribed long-acting injectable antipsychotic medication
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.PSYCHRES.2019.112606
Abstract: People living with severe mental illness (SMI) experience significant physical health co-morbidity. Few studies have focused on physical health outcomes for those prescribed long-acting injectable (LAI) antipsychotics. This observational cross-sectional study aimed to assess the prevalence of metabolic syndrome (MetS) and other cardio-metabolic risk factors in a large cohort prescribed LAI and managed by community mental health services. For participants with elevated cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. Of the 301 eligible participants, many met the full criteria for MetS (44%) and its components. Cardio-metabolic risk factors were largely under- or un-treated. Smoking rates were very high (62%) along with reported high rates of physical inactivity and poor dietary intake. The vast majority (89%) reported seeing their general practitioner in the preceding twelve months. In iduals prescribed LAI have a very high prevalence of MetS and potentially modifiable risk factors for cardiovascular disease. Routine monitoring accompanied by evidence-based treatment of cardiometabolic abnormalities which contribute to significant morbidity, disability and premature death should be prioritised. Better collaboration between mental health services and primary care providers should be pursued to optimise the delivery of effective physical health care to in iduals living with SMI.
The heart of the matter: Cardiometabolic care in youth with psychosis
Publisher: Wiley
Date: 06-01-2012
DOI: 10.1111/J.1751-7893.2011.00315.X
Abstract: Weight gain, obesity and metabolic disturbances in youth with psychosis are significant contributors to the health burden of people with psychosis, with a two- to threefold increase in rates compared with the general population and a 20% reduction in life expectancy. Several studies have now described cardiometabolic benefits of a range of interventions, including a structured diet and exercise programmes and metformin for patients receiving antipsychotic medications. Despite the development of Australian consensus guidelines and screening algorithms to detect such metabolic abnormalities, there is a lack of guidelines for clinicians to determine appropriate, timely, targeted prevention and intervention to manage these complications in the youth population. The Bondi Early Psychosis Programme targets young people (aged 15-25 years) experiencing their first episode of psychosis. This service has developed a model of metabolic screening and a treatment algorithm to provide clinicians with recommendations for targeted interventions. Positive Cardiometabolic Health: an early intervention framework for patients on psychotropic medication describes a method for early detection, prevention and intervention strategies targeting antipsychotic-induced metabolic abnormalities and cardiovascular risk factors. Although further research is required, there is sufficient evidence to support early intervention and prevention strategies to improve physical health outcomes in young people with first-episode psychosis.
Improving the cardiometabolic health of people with psychosis: A protocol for a randomised controlled trial of the Physical Health Nurse Consultant service
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.CCT.2018.09.001
Abstract: Over 690,000 Australians experience psychosis annually, significantly impacting cardiometabolic illness and healthcare costs. Current models of care are fragmented and a critical implementation gap exists regarding the delivery of coordinated physical healthcare for Australians with psychosis. To describe a trial implementing a Physical Health Nurse Consultant (PHNC) role to coordinate physical health care in a community mental health setting. In this 24-month, 2-group randomised controlled trial, 160 adults with psychosis will be randomised to usual care, or to the PHNC in addition to usual care. Using the Positive Cardiometabolic Health treatment framework and working in collaborative partnerships with consumers (consumer-led co-design), the PHNC will provide care coordination including referral to appropriate programmes or services based on the treatment framework, with the consumer. Burden of Disease risk factors will be collected according to Australian Bureau of Statistics' National Health Survey guidelines. Consumer experience will be assessed using the 'Access', 'Acceptability' and 'Shared Decision Making' dimensions of the Patient Experiences in Primary Healthcare Survey. Cost-effectiveness will be modelled from Burden of Disease data using the Assessing Cost Effectiveness Prevention methodology. Data collection of two years duration will commence in late 2018. Preliminary findings are expected in December 2019. Primary outcomes will be the effect of the PHNC role on physical healthcare in community-based adults with psychosis. The PHNC is an innovative approach to physical health care for adults with psychosis which aims to meet the physical health needs of consumers by addressing barriers to physical health care.
Premature mortality and schizophrenia - The need to heal right from the start
Publisher: American Medical Association (AMA)
Date: 05-2016
Dietary intake, food addiction and nutrition knowledge in young people with mental illness
Publisher: Wiley
Date: 27-06-2020
Abstract: The aim of this study was to comprehensively assess dietary intake, nutrition knowledge and food addiction in young people with mental illness. This was a three-arm cross-sectional study of 16-25-year-olds attending community mental health services who met criteria for: (i) first-episode psychosis (FEP), (ii) ultra-high risk for psychosis (UHR) or (iii) depression/anxiety. Participants self-completed three validated questionnaires: (i) Australian Eating Survey, (ii) General Nutrition Knowledge Questionnaire-Revised and (iii) Yale Food Addiction Score Questionnaire. Thirty participants (mean age 19.7 ± 2.5 years) completed the study (10 per study arm) 43% of the energy intake was obtained from energy-dense, non-nutritious foods, higher than the recommended upper limit (<15%) and the levels reported in the general population (35%). Mean diet quality score was 33.5 ± 11.8 of 73. Mean food addiction symptom score was 3.3 ± 3.7. Prevalence of food addiction was 37%. Nutrition knowledge was lower in the FEP and UHR participants than the depression/anxiety group (48.2 ± 13.8 and 49.5 ± 8.2 of 88 respectively) however, this difference was not statistically significant. Unhealthy dietary intake was observed in the early stages of mental illness, likely seeding future poor physical health. Further research is needed on the role of food addiction in this population, including effective intervention techniques.
The effectiveness of the Keeping the Body in Mind Xtend pilot lifestyle program on dietary intake in first-episode psychosis: Two-year outcomes
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.ORCP.2019.02.003
Abstract: Severe mental illness is characterised by a 15-year mortality gap driven by cardiometabolic disease. Antipsychotic treatment leads to increased appetite and rapid weight gain. The 12-week lifestyle pilot intervention improved dietary intake and prevented antipsychotic-induced weight gain. Here we report two-year outcomes. Participants were exposed to an extended program. Weight and waist circumference were measured, and food frequency questionnaire completed. Diet quality was higher, and discretionary food intake was 40% lower, at two-years compared to baseline. Weight and waist-circumference did not increase. This pilot study demonstrated sustained effectiveness of a dietetic intervention in youth with first-episode psychosis with improvements in diet quality and no increase in weight secondary to antipsychotic medication initiation.
Is early separation anxiety a risk factor for adult panic disorder?: A critical review
Publisher: Elsevier BV
Date: 05-1996
DOI: 10.1016/S0010-440X(96)90033-4
Abstract: Heightened levels of early separation anxiety (SA) have long been linked to the risk of adult panic disorder (PD), suggesting that the two types of anxiety arise from a common diathesis--a proposition that has considerably influenced the classification of the anxiety disorders. However, the SA-PD link remains contentious, with some recent studies failing to confirm that putative association. All published research studies investigating the relationship of early SA to PD and/or other anxiety disorders were reviewed. Taken as a whole, the evidence provides support for the SA-PD hypothesis, although the specificity of that relationship needs further clarification. Problems of s le selection, retrospective measurement of early SA and comorbid diagnoses limit the certainty with which inferences can be drawn from existing data. Nevertheless, a recent community-based study provides additional support for the SA-PD hypothesis. Possible developmental pathways linking SA to PD are considered. One possibility that has not received adequate research attention is that early SA disorder (SAD) may persist into adulthood, rendering the sufferer vulnerable to panic and other anxiety symptoms when confronted with salient life stressors. We conclude that it is premature to reject the SA hypothesis of PD. Only well-designed longitudinal studies can map the complex developmental pathways linking early and later manifestations of morbid anxiety.
Keeping the body in mind: A qualitative analysis of the experiences of people experiencing first-episode psychosis participating in a lifestyle intervention programme
Publisher: Wiley
Date: 15-12-2020
DOI: 10.1111/INM.12683
Abstract: The life expectancy gap experienced by people living with severe mental illness is primarily a result of cardiometabolic disease that is often exacerbated by side effects of antipsychotic medication. Commencement of atypical antipsychotic medication is commonly associated with weight gain. The Keeping the Body in Mind programme has demonstrated that early intervention with lifestyle activities can attenuate this weight gain and potentially improve long-term health outcomes. The aim of this study was to explore the experiences of young people who participated in the Keeping the Body in Mind programme, a targeted lifestyle intervention programme. A qualitative approach was used employing a semi-structured interview format. The interview schedule included questions related to four topics: aspects of the programmes that were useful, attributes of staff members that influenced the programme, changes in attitudes towards their own physical health, and suggestions for programme improvements. Interviews were recorded with duration ranging from 40 to 65 min. Thematic analysis was used to detect and assemble codes. These were then synthesized and classified into themes. Eleven participants were interviewed (seven males), aged between 18 and 25 years. Thematic analysis revealed four main themes: the role of physical health in mental health recovery the importance of staff interactions the value of peer interaction and graduation to a sustainable healthy lifestyle. Study participants reported that they valued the programme for both their physical health and mental health recovery.
Don't ignore the skeleton in the psychiatric closet
Publisher: SAGE Publications
Date: 29-09-2016
Stepping up early treatment for help-seeking youth with at-risk mental states: Feasibility and acceptability of a real-world exercise program
Publisher: Wiley
Date: 18-09-2020
DOI: 10.1111/EIP.12871
Abstract: Youth with at-risk mental states (ARMS) have low levels of physical activity (PA), reduced fitness levels and experience poor sleep quality. These lifestyle factors exacerbate mental health symptoms and increase cardiometabolic disease risk. PA interventions can help prevent this decline in physical health whilst reducing mental health symptom severity. Whether PA interventions are feasible and acceptable amongst youth with ARMS is unclear. This study evaluated the feasibility and acceptability of headspace Active, a pragmatic PA program offered to 14 to 25 year olds with ARMS. The 12-week exercise physiologist-led intervention was conducted in adjunct to usual care. Feasibility was determined by number of referrals, attendance, engagement in exercise sessions and dropout from the intervention. Acceptability was assessed by a 10-item questionnaire. Secondary outcomes included anthropometry, cardiorespiratory fitness and strength. Subjective PA levels, symptoms of depression and anxiety, sleep, motivation and quality of life were also assessed. Within 12 months, 77% of referrals completed the 12-week intervention (n = 20), with six dropouts. Of the 20 "completers", 95% attended at least five sessions over the 12-week intervention. Participants found the program highly acceptable (mean = 41.2/50 on the 10-item acceptability questionnaire) and experienced significant improvements in PA, strength, motivation, depressive symptoms and sleep quality post-intervention. No changes in anthropometry were observed. Results suggest headspace Active was feasible and acceptable and was associated with improvements in physical and mental health outcomes among ARMS youth. Given the potential scalability of this real-world PA program to other youth mental health settings, these data have implications for best practice implementation of PA interventions for in iduals with emerging mental illness.
Bridging the gap from evidence to policy and practice: Reducing the progression to metabolic syndrome for children and adolescents on antipsychotic medication
Publisher: SAGE Publications
Date: 09-10-2013
Abstract: For children and adolescents, the adverse effects from antipsychotic medicines exaggerate the already considerable burden of having a serious mental illness. Many of these young people face a future not only limited by stigmatizing psychiatric illness but also a life restricted and shortened by physical ill-health, particularly cardiovascular disease and type-2 diabetes. This review focuses on bridging the current gap between available evidence and practice guidelines and policies. Following an extensive literature search, key papers focusing on the evidence of the nature and occurrence of metabolic morbidity in children and adolescents following the use of antipsychotic medication were included. There is growing evidence to suggest that some of the key antecedents of metabolic syndrome occur soon after diagnosis and initiation of antipsychotic medication, and they accumulate over time. While guidelines and policies around the monitoring of metabolic syndrome in children and adolescents with mental illness receiving antipsychotic medication are limited, an opportunity lies in altering the trajectory towards cardiovascular disease and type-2 diabetes by early recognition and intervention to reduce cardiometabolic risk rather than waiting until disease end-points are reached later in life.
Meta‐analysis of natural, unnatural and cause‐specific mortality rates following discharge from in‐patient psychiatric facilities
Publisher: Wiley
Date: 10-08-2019
DOI: 10.1111/ACPS.13073
Abstract: People discharged from in-patient psychiatric facilities have highly elevated rates of suicide, and there is increasing concern about natural mortality among the seriously mentally ill. A meta-analysis of English-language, peer-reviewed longitudinal studies of mortality among patients discharged from in-patient psychiatric facilities was conducted using papers published in MEDLINE, PsycINFO or EMBASE (from 1 January 1960 to 1 April 2018) located using the terms ((suicid*).ti AND (hospital OR discharg* OR inpatient OR in-patient OR admit*)).ab and ((mortality OR outcome* OR death*) AND (psych* OR mental*)).ti AND (admit* OR admis* OR hospital* OR inpatient* OR in-patient* OR discharg*).ab. Pooled mortality rates for aggregated natural and unnatural causes, and the specific causes of suicide, accident, homicide, vascular, neoplastic, respiratory, gastrointestinal, infectious and metabolic death were calculated using a random-effects meta-analytic model. Between-study heterogeneity was investigated using subgroup analysis and metaregression. The pooled natural death rate of 1128 per 100 000 person-years exceeded the pooled unnatural deaths of 479 per 100 000 person-year among studies with varying periods of follow-up. Natural deaths significantly exceeded unnatural deaths among studies with a mean follow-up of longer than 2 years, and vascular deaths exceeded suicide deaths among studies with mean period of follow-up of 5 years or longer. Suicide may be the largest single cause of death in the short term after discharge from in-patient psychiatric facilities but vascular disease is the major cause of mortality in the medium- and long-term.
Evaluating an individualized lifestyle and life skills intervention to prevent antipsychotic-induced weight gain in first-episode psychosis
Publisher: Wiley
Date: 26-02-2016
DOI: 10.1111/EIP.12230
Abstract: Initiating antipsychotic medication frequently induces rapid, clinically significant weight gain. We aimed to evaluate the effectiveness of a lifestyle and life skills intervention, delivered within 4 weeks of antipsychotic medication initiation, in attenuating weight gain in youth aged 14-25 years with first-episode psychosis (FEP). We undertook a prospective, controlled study in two early psychosis community services. Intervention participants (n = 16) received a 12-week in idualized intervention delivered by specialist clinical staff (nurse, dietician and exercise physiologist) and youth peer wellness coaches, in addition to standard care. A comparison group was recruited from a similar service and received standard care (n = 12). The intervention group experienced significantly less weight gain at 12 weeks compared to standard care (1.8 kg, 95% CI -0.4 to 2.8 vs. 7.8 kg, 4.8-10.7, P < 0.001). Thirteen per cent (2/16) of the intervention group experienced clinically significant weight gain (greater than 7% of baseline weight), while 75% (9/12) of the standard care group experienced this level of weight gain. Similar positive effects of the intervention were observed for waist circumference. A lifestyle and life skills intervention delivered as part of standard care attenuated antipsychotic-induced weight gain in young people with FEP. The intervention was acceptable to the young people referred to the service. Such interventions may prevent the seeding of future disease risk and in the long-term help reduce the life expectancy gap for people living with serious mental illness.
Ethical considerations in the management of asylum seekers on hunger strike
Publisher: American Medical Association (AMA)
Date: 07-08-1996
Cardiometabolic health in young people with psychosis
Publisher: Elsevier BV
Date: 12-2014
Serum testosterone levels are related to cognitive function in men with schizophrenia
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.PSYNEUEN.2013.02.007
Abstract: Sex steroids such as oestrogen and testosterone are potent neurodevelopmental hormones that also play a role in neuromodulation and neuroprotection of the mature brain. Sex steroid hormones may also be involved in the pathophysiology of schizophrenia as reduced circulating sex steroid levels and changes in brain sex steroid receptors are found in people with schizophrenia compared to controls. In men with schizophrenia, recent studies have documented an inverse correlation between serum testosterone and negative symptoms. Our study sought to confirm whether men with schizophrenia had lower levels of testosterone relative to controls and to determine whether lower testosterone levels were related to higher symptom severity and impaired cognition. Circulating serum hormone levels (testosterone, oestrogen, and prolactin), cognitive function and symptoms were assessed in 29 chronically ill men with schizophrenia or schizoaffective disorder. Twenty healthy men were recruited as a comparison group. A series of regression analyses were performed to determine the extent to which circulating sex steroid hormone levels predict cognition and symptoms in men with schizophrenia. We did not find a significant difference in serum testosterone levels between groups. However, circulating testosterone levels significantly predicted performance on verbal memory, processing speed, and working memory in men with schizophrenia. With the exception of an effect of oestrogen on verbal memory, circulating sex steroid levels did not predict cognitive function in healthy men. Testosterone levels were not related to positive or negative symptom severity, but testosterone influenced excitement/hostility levels in our schizophrenia s le. The results suggest that circulating sex steroids may modulate cognitive deficits associated with schizophrenia.
Disambiguating ventral striatum fMRI-related bold signal during reward prediction in schizophrenia
Publisher: Springer Science and Business Media LLC
Date: 28-06-2011
DOI: 10.1038/MP.2011.75
Separation anxiety in adulthood: A phenomenological investigation
Publisher: Elsevier BV
Date: 09-1997
DOI: 10.1016/S0010-440X(97)90060-2
Abstract: Separation anxiety disorder is well recognized as a juvenile psychiatric disorder, but it appears to be rarely diagnosed in adulthood. Drawing on our clinical impressions and a review of the relevant literature, we sought to investigate whether separation anxiety symptoms could be identified in adulthood. Forty-four subjects recruited by a media c aign were administered a semistructured interview and a self-report checklist for adult separation anxiety (ASA) symptoms, as well as the Separation Anxiety Symptom Inventory (SASI), a retrospective measure of early separation anxiety symptoms. Diagnoses of major depressive disorder (MDD), panic disorder (PD), agoraphobia (Ag), and dependent personality disorder were made using the SCID-P and SCID-II. Thirty-six subjects met criteria for a putative diagnosis of ASA based on a global clinical rating and/or endorsement of DSM-IV-derived criteria. Although most subjects dated the separation anxiety symptoms to their juvenile years, it was notable that one third reported the first onset of separation anxiety symptoms in adulthood. Although comorbid lifetime anxiety or depressive disorders were common, the majority of subjects reported that the separation anxiety symptoms predated other axis I disorders. Only six subjects (17%) were diagnosed with dependent personality disorder. Although limited by the method of s ling, this preliminary study suggests the need to examine more systematically whether a form of separation anxiety disorder may occur in adulthood.
Vaccine-preventable hospitalisations in adult mental health service users: a population study
Publisher: Cambridge University Press (CUP)
Date: 05-04-2023
DOI: 10.1017/S0033291723000776
Abstract: Vaccine-preventable conditions cause preventable illness and may increase mortality in people living with mental illness. We examined how risks of hospitalisation for a wide range of vaccine-preventable conditions varied by age and sex among mental health (MH) service users. Linked population data from New South Wales (NSW), Australia were used to identify vaccine-preventable hospitalisations (VPH) for 19 conditions from 2015 to 2020. Adult MH service users ( n = 418 915) were compared to other NSW residents using incidence rates standardised for age, sex and socioeconomic status. Secondary analyses examined admissions for COVID-19 to September 2021. We identified 94 180 VPH of which 41% were influenza, 33% hepatitis B and 10% herpes zoster. MH service users had more VPH admissions [adjusted incidence rate ratio (aIRR) 3.2, 95% CI 3.1–3.3]. Relative risks were highest for hepatitis (aIRR 4.4, 95% CI 4.3–4.6), but elevated for all conditions including COVID-19 (aIRR 2.0, 95% CI 1.9–2.2). MH service users had a mean age of 9 years younger than other NSW residents at first VPH admission, with the largest age gap for vaccine-preventable pneumonias (11–13 years younger). The highest relative risk of VPH was among MH service users aged 45–65. MH service users have increased risk of hospitalisation for many vaccine-preventable conditions. This may be due to reduced vaccination rates, more severe illness requiring hospitalisation, greater exposure to infectious conditions or other factors. People living with mental illness should be prioritised in vaccination strategies.
The collaborative outcomes study on health and functioning during infection times in adults (COH-FIT-Adults): Design and methods of an international online survey targeting physical and mental health
Publisher: Elsevier BV
Date: 02-2201
Adjunctive nutrients in first-episode psychosis: A systematic review of efficacy, tolerability and neurobiological mechanisms
Publisher: Wiley
Date: 21-03-2018
DOI: 10.1111/EIP.12544
2-year follow-up: Still keeping the body in mind.
Publisher: SAGE Publications
Date: 23-01-2018
Developing an Evidence-Based Specialist Nursing Role to Improve the Physical Health Care of People with Mental Illness
Publisher: Informa UK Limited
Date: 09-05-2019
DOI: 10.1080/01612840.2019.1584655
Abstract: The substantial physical health disadvantage experienced by people diagnosed with mental illness is now identified in a growing body of research evidence. The recent promulgation of improved physical health care as a goal of contemporary Australian Mental Health Policy should provide impetus for initiatives and strategies to address this inequity. To date increased knowledge of the problem has not resulted in obvious and sustained changes. The aim of this article is to introduce the role of the Physical Health Nurse Consultant as a potential strategy. The potential contribution and value of this role is considered by reviewing the evidence from the perspective of multiple stakeholders and considering the suitability of nursing to meet the complex needs involved in improving physical health. The requirement for a multi-faceted and comprehensive evaluation is also articulated. A robust, prospective and long-term evaluation plan includes physical health measures, changes in health behaviours, cost-benefit analysis and consumer acceptability to ensure the intervention is effective in the long term. This thorough approach is essential to provide the level of evidence required to facilitate changes at the practice and policy levels. The specialist nursing role presented in this article, subject to the comprehensive evaluation proposed, could become an integral component of a comprehensive approach to addressing physical health inequities in people with mental illness.
Observation to action: Progressive implementation of lifestyle interventions to improve physical health outcomes in a community-based early psychosis treatment program
Publisher: SAGE Publications
Date: 23-06-2014
Hospital service utilisation of people previously hospitalised with different subtypes of psychotic disorder: A record linkage study
Publisher: SAGE Publications
Date: 03-08-2022
DOI: 10.1177/00048674221115642
Abstract: Little research has examined the physical and mental comorbidities, and health service use patterns, of people diagnosed with psychotic disorder subtypes other than schizophrenia spectrum disorders. This study aims to examine the physical and mental comorbidities, and subsequent hospital service use patterns, of in iduals previously hospitalised with various psychotic disorder subtypes using linked health service data. We included in iduals hospitalised with a psychotic disorder in New South Wales, Australia, between 1 July 2002 and 31 December 2014 (N = 63,110). We examined the demographic profile of the cohort and rates of subsequent acute hospital care and ambulatory mental health service use. We compared the rates of subsequent hospital admissions, emergency department presentations and ambulatory mental health treatment days of people hospitalised with different psychotic disorder subtypes to people hospitalised with schizophrenia spectrum disorders using Poisson regression. People most recently hospitalised with mood/affective disorders and psychotic symptoms had a higher rate of subsequent hospital admissions than those most recently hospitalised with schizophrenia spectrum and delusional disorders (adjusted incident rate ratio = 1.06 95% confidence interval = [1.02, 1.10]), while people most recently hospitalised with drug-induced and other organic (adjusted incident rate ratio = 1.19 95% confidence interval = [1.12, 1.27]) and acute psychotic disorders (adjusted incident rate ratio = 1.10 95% confidence interval = [1.03, 1.18]) had more subsequent emergency department presentations than those most recently hospitalised with schizophrenia spectrum and delusional disorders. All three groups had fewer subsequent mental health ambulatory days than those most recently hospitalised with schizophrenia spectrum and delusional disorders (adjusted incident rate ratios = 0.85–0.91). The health profiles and subsequent hospital service use patterns of people previously hospitalised with different psychotic disorder subtypes are heterogeneous, and research is needed to develop targeted health policies to meet their specific health needs.
The health service contact patterns of people with psychotic and non-psychotic forms of severe mental illness in New South Wales, Australia: A record-linkage study
Publisher: SAGE Publications
Date: 13-07-2022
DOI: 10.1177/00048674211031483
Abstract: To describe and compare the health profiles and health service use of people hospitalised with severe mental illness, with and without psychotic symptoms. We conducted a historical cohort study using linked administrative datasets, including data on public hospital admissions, emergency department presentations and ambulatory mental health service contacts in New South Wales, Australia. The study cohort comprised 169,306 in iduals aged 12 years and over who were hospitalised at least once with a mental health diagnosis between 1 July 2002 and 31 December 2014. Of these, 63,110 had a recorded psychotic illness and 106,196 did not. Outcome measures were rates of hospital, emergency department and mental health ambulatory service utilisation, analysed using Poisson regression. People with psychotic illnesses had higher rates of hospital admission (adjusted incidence rate ratio (IRR) 1.26 95% confidence interval [1.23, 1.30]), emergency department presentation (adjusted IRR 1.17 95% confidence interval [1.13, 1.20]) and ambulatory mental health treatment days (adjusted IRR 2.90 95% confidence interval [2.82, 2.98]) than people without psychotic illnesses. The higher rate of hospitalisation among people with psychotic illnesses was driven by mental health admissions while people with psychosis had over twice the rate of mental health admissions, people with other severe mental illnesses without psychosis (e.g. mood/affective, anxiety and personality disorders) had higher rates of physical health admissions, including for circulatory, musculoskeletal, genitourinary and respiratory disorders. Factors that predicted greater health service utilisation included psychosis, intellectual disability, greater medical comorbidity and previous hospitalisation. Findings from this study support the need for (a) the development of processes to support the physical health of people with severe mental illness, including those without psychosis (b) a focus in mental health policy and service provision on people with complex support needs, and (c) improved implementation and testing of integrated models of care to improve health outcomes for all people experiencing severe mental illness.
Progress towards parity: Improving the physical health of long-term psychiatric inpatients
Publisher: SAGE Publications
Date: 15-08-2014
The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness
Publisher: Elsevier BV
Date: 08-2019
Aerobic exercise capacity: An important correlate of psychosocial function in first episode psychosis
Publisher: Wiley
Date: 10-10-2015
DOI: 10.1111/ACPS.12350
Continuities of separation anxiety from early life onto adulthood
Publisher: Elsevier BV
Date: 2000
DOI: 10.1016/S0887-6185(99)00029-8
Abstract: The study investigates whether a putative diagnosis of separation anxiety disorder can be identified in adulthood and whether there are continuities between juvenile and adult forms of the disorder. Seventy patients with conventional adult diagnoses of panic disorder and generalized anxiety disorder attending an anxiety clinic were administered an interview and checklist to assess separation anxiety (SA) symptoms in adulthood. Memories of early SA were assessed using the Separation Anxiety Symptom Inventory (SASI). A subs le (n = 31) was used to calibrate the checklist against assignment to a category of adult separation anxiety disorder (ASAD) based on the structured interview. In an expanded s le (n = 70), patients assigned to the ASAD category returned statistically higher scores on the SASI, with the severity of juvenile SA symptoms accounting for 33% of the variance of adult SA scores (p < .001). Assignment of subjects to the putative ASAD category was not associated with any conventional adult anxiety diagnosis and symptoms of SA appeared to predate the onset of the other anxiety disorders. One possible explanation for the data is that, in some in iduals, early onset separation anxiety disorder may persist into adulthood, but the symptoms may either be overlooked or, alternatively, obscured by secondary features such as panic.
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Related Funding Activities
Improving The Cardiometabolic Health Of People With Psychosis: The Physical Health Nurse Consultant Service
Start Date: 2018
End Date: 2021
Funder: National Health and Medical Research Council
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