ORCID Profile
0000-0003-3907-0324
Current Organisation
University of Sydney
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Publisher: American Medical Association (AMA)
Date: 02-2017
DOI: 10.1001/JAMAPSYCHIATRY.2016.3459
Abstract: Increased activity and energy alongside mood change are identified in the DSM-5 as cardinal symptoms of mania and hypomania. A wide range of existing research suggests that this revision may be valid, but systematic integration of the evidence has not been reported. The term activation is understood as emerging from underlying physiological change and having objective (observable motor activity) and related subjective (energy) levels. To systematically review studies of the clinical phenomenon of activation in bipolar disorder, to determine whether activation is statistically abnormal in bipolar disorder and demonstrably distinct from mood, and to identify any significant between- and within-in idual differences in the dynamics of activation. This systematic review of MEDLINE, PsycINFO, EMBASE, CINAHL, and PubMed databases from January 1, 1970, until September 30, 2016, identified 56 of a possible 3284 citations for (1) data-driven analyses of the dimensions and factor structure of mania and bipolar depression and (2) longitudinal studies reporting real-time objective monitoring or momentary assessment of daytime activity in in iduals with bipolar disorder compared with other clinical or healthy control s les. Hand search of reference lists, specialty journals, websites, published conference proceedings, and dissertation abstracts and contact with other researchers ensured inclusion of gray literature and additional analyses as well as raw data if appropriate. Quality assessment was perfomed using the National Institutes of Health quality assessment tool. A total of 56 studies met eligibility criteria for inclusion in the review including 29 analyses of the factor structure of bipolar disorder, 3 of activity data from experimental s ling or ecological momentary assessment, and 20 actigraphy and 4 laboratory-based studies. Synthesizing findings across the studies revealed that the most robust finding was that mean levels of activity are lower during euthymia and depression in patients with bipolar disorder compared with healthy controls and other comparison groups (11 studies). The 7 ecological and laboratory studies show less organized or predictable patterns of behavior and a relative lack of habituation among patients with bipolar disorders compared with others. Factor analytic studies provide fairly consistent evidence that mood and activation represent distinct dimensions of bipolar disorder. Ten studies that examined interin idual and intrain idual patterns of activity suggest that mania may be better characterized by differences in robustness, variability, predictability, or complexity of activation rather than mean levels of activity. Within the limitations of the data, this synthesis of available evidence broadly supports the elevation of activation as a criterion A symptom for bipolar disorder in DSM-5. Although the importance of activation in bipolar disorders has been acknowledged for more than a century, this review suggests that this critical construct is understudied and should be the topic of more systematic high-quality research.
Publisher: Informa UK Limited
Date: 03-05-2023
Publisher: JMIR Publications Inc.
Date: 12-2022
Abstract: s the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to an in idual’s risk of illness progression. The application of staging has been traditionally limited to trained clinicians, yet if digital technologies could be leveraged to apply clinical staging, then this could increase the scalability and utility of this model in services. he aim of this proof-of-concept study is to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. he cohort comprised 131 young people, aged between 16 to 25 years, who presented to youth mental health services in Australia for the first time between November 2018 to March 2021. Clinical stages (either stage 1a or stage 1b+) were allocated independently by expert psychiatrists and compared to the digital algorithm based on a multidimensional self-report questionnaire. f the 131 participants, the mean (SD) age was 20.3 (2.4) years and 94 (71.8%) were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the expert ratings with a substantial interrater agreement (κ=0.67, P .001). The algorithm demonstrated 90.8% (95% CI 85.6 – 95.2%, P=0.03) accuracy, 80.0% sensitivity, 92.8% specificity, and F1-score of 72.7%. Of the agreement, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, eight participants with lower levels of depressive mood (P .001) and anxiety (P .001) were rated lower (stage 1a) by the algorithm compared to the experts. his novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in early stages of common anxiety and depressive disorders. Between 11% and 27% of young people presenting for care may be suitable for low intensity online or brief interventions, creating additional clinical capacity to be directed towards those who are stage 1b+ for further assessment and intervention.
Publisher: JMIR Publications Inc.
Date: 27-03-2019
Abstract: opulations who do not speak English and currently reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers have weaker social support networks and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically- erse populations are limited. Having a Spanish version of the Mental Health eClinic (MHeC-S) would greatly benefit these students. sing participatory design (PD) methodologies with users (young people aged 16 to 30 years, supportive others and health professionals) the aims of this study were to: i) conduct workshops with users to co-design and culturally-adapt the MHeC ii) inform the development of the MHeC-S alpha prototype iii) perform usability testing of the MHeC-S alpha prototype iv) translate, culturally-adapt and face-validate the MHeC-S self-report assessment and v) collect information to inform its beta prototype. research and development (R& D) cycle included several iterative PD phases: co-design workshops knowledge translation language translation and cultural adaptation rapid prototyping and user testing of the MHeC-S alpha prototype. wo co-design workshops were held with 17 users (young people n=10, health professionals n=7). A total of 15 participated in the one-on-one user testing sessions (young people n=7, health professionals n=5, supportive others n=3). 225 source documents were collected and thematic analysis resulted in five main themes (help-seeking barriers, technology platform, functionality, content, user interface). A random s le of 106 source documents were analyzed by two independent raters revealing an ‘almost perfect’ agreement for the functionality (kappa=0.86 P .001) and content (kappa=0.92 P .001) and, a ‘substantial’ agreement for the user interface (kappa=0.785 P .001). In this random s le, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to get medical or psychological services and smartphones were the most used device to access the Internet. There was adequate acceptability of the prototype’s five main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system and personalized well-being plan. The data also revealed gaps in the current alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities and, a lack of Spanish language apps and etools as well as online mental health information was noted. hrough an iterative process of R& D, the MHeC-S was co-designed and culturally-adapted, developed and user-tested, as well as evaluated. By translating and culturally-adapting the MHeC to Spanish, we aimed to increase accessibility and availability of (e)mental health care to the developing world, and assist vulnerable populations that have migrated to English-speaking countries. he University of Sydney’s Human Research Ethics Committee approved the study Protocol No. 2014/689 and Protocol No. 2016/487
Publisher: SAGE Publications
Date: 28-05-2020
Publisher: JMIR Publications Inc.
Date: 03-03-2022
DOI: 10.2196/37679
Publisher: JMIR Publications Inc.
Date: 02-2018
Abstract: lobally there is increasing recognition that new strategies are required to reduce disability due to common mental health problems. As 75% of mental health and substance use disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, new and innovative technologies show promise in augmenting traditional clinic-based services. he aim of this study was to test new and innovative technologies to assess clinical stage in early intervention youth mental health services using a prototypic online system known as the Mental Health eClinic (MHeC). he online assessment within the MHeC was compared directly against traditional clinician assessment within 2 Sydney-based youth-specific mental health services (headspace C erdown and headspace C belltown). A total of 204 young people were recruited to the study. Eligible participants completed both face-to-face and online assessments, which were randomly allocated and counterbalanced at a 1-to-3 ratio. These assessments were (1) a traditional 45- to 60-minute headspace face-to-face assessment performed by a Youth Access Clinician and (2) an approximate 60-minute online assessment (including a self-report Web-based survey, immediate dashboard of results, and a video visit with a clinician). All assessments were completed within a 2-week timeframe from initial presentation. f the 72 participants who completed the study, 71% (51/72) were female and the mean age was 20.4 years (aged 16 to 25 years) 68% (49/72) of participants were recruited from headspace C erdown and the remaining 32% (23/72) from headspace C belltown. Interrater agreement of participants’ stage, as determined after face-to-face assessment or online assessment, demonstrated fair agreement (kappa=.39, P .001) with concordance in 68% of cases (49/72). Among the discordant cases, those who were allocated to a higher stage by online raters were more likely to report a past history of mental health disorders (P=.001), previous suicide planning (P=.002), and current cannabis misuse (P=.03) compared to those allocated to a lower stage. he MHeC presents a new and innovative method for determining key clinical service parameters. It has the potential to be adapted to varied settings in which young people are connected with traditional clinical services and assist in providing the right care at the right time.
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.JAD.2008.11.017
Abstract: Depression in older adults is associated with neuropsychological dysfunction, fronto-subcortical brain changes and sleep disturbance. Research suggests that adequate sleep is critical for many aspects of cognition including processing speed, verbal skills and memory. However, the association between sleep disturbance and neuropsychological functioning in depression has not been well evaluated. The current study therefore aimed to investigate these relationships. Forty-eight people (mean age=59.6, sd=8.2) meeting DSM-IV criteria for unipolar major depression were included for analysis. Neuropsychological assessment included assessment of processing speed, learning and memory, verbal fluency and executive functions. Early and late insomnia were defined by scores on the Hamilton Depression Rating Scale. While early insomnia was related to depression severity and poorer global cognition, late insomnia was associated with later age of depression onset, depression severity, and poorer scores on tests of verbal fluency and memory. The associations between cognition and late insomnia were not accounted for by depression severity or age of onset of disorder. This study was retrospective in nature, and did not include objective measures of sleep. This is the first known study to indicate that late insomnia in older people with major depression may be independently and aetiologically linked to neuropsychological performance, particularly verbal fluency and memory. It may also indicate underlying structural and neurochemical changes. Sleep and circadian disturbance may serve as a biomarker for ongoing cognitive decline and may be a potentially modifiable risk factor.
Publisher: Research Square Platform LLC
Date: 16-10-2023
Publisher: AMPCo
Date: 05-2014
DOI: 10.5694/MJA14.00145
Publisher: Elsevier BV
Date: 10-2023
Publisher: Wiley
Date: 28-03-2015
DOI: 10.1111/EIP.12133
Abstract: The Transitions Study was designed to establish a cohort of young people (12-25 years) seeking help for mental health problems, in order to longitudinally explore and refine a clinical staging model of the development and progression of mental disorders. This paper presents the baseline demographic and clinical characteristics of the cohort, particularly the nature and severity of psychopathology. All eligible young people attending one of four headspace clinical services were invited to participate, and completed a battery of self-report and interviewer-administered measures of psychopathology and functional impairment at baseline, which will be repeated at the annual follow up. Of 1615 eligible clients, 802 young people (66% women mean age = 18.3 years) consented to participate and completed baseline assessments (participation rate = 50%). The severity of mental health problems varied, with 51% meeting the criteria for probable caseness related to generalized anxiety, 45% presenting with moderate to severe depressive symptoms and over a third experiencing subthreshold psychotic symptomatology. Disordered eating (32%) and problematic tobacco (56%), cannabis (30%) and alcohol (38%) use also affected a significant proportion. Overall, 39% of the cohort were classed as being functionally impaired at baseline. The Transitions Study recruited a heterogeneous cohort at baseline in relation to the nature and severity of mental health problems and levels of functional impairment. The variation in clinical presentations within the cohort, from mild, through moderate to severe levels of psychopathology and impairment, increases the likelihood of the Transitions Study ultimately being able to achieve its aims of empirically testing a clinical staging model for mental disorders.
Publisher: JMIR Publications Inc.
Date: 25-07-2023
DOI: 10.2196/42993
Abstract: Highly personalized care is substantially improved by technology platforms that assess and track patient outcomes. However, evidence regarding how to successfully implement technology in real-world mental health settings is limited. This study aimed to naturalistically monitor how a health information technology (HIT) platform was used within 2 real-world mental health service settings to gain practical insights into how HIT can be implemented and sustained to improve mental health service delivery. An HIT (The Innowell Platform) was naturally implemented in 2 youth mental health services in Sydney, Australia. Web-based surveys (n=19) and implementation logs were used to investigate staff attitudes toward technology before and after implementation. Descriptive statistics were used to track staff attitudes over time, whereas qualitative thematic analysis was used to explore implementation log data to gain practical insights into useful implementation strategies in real-world settings. After the implementation, the staff were nearly 3 times more likely to agree that the HIT would improve care for their clients (3/12, 25% agreed before the implementation compared with 7/10, 70% after the implementation). Despite this, there was also an increase in the number of staff who disagreed that the HIT would improve care (from 1/12, 8% to 2/10, 20%). There was also decreased uncertainty (from 6/12, 50% to 3/10, 30%) about the willingness of the service to implement the technology for its intended purpose, with similar increases in the number of staff who agreed and disagreed with this statement. Staff were more likely to be uncertain about whether colleagues in my service are receptive to changes in clinical processes (not sure rose from 5/12, 42% to 7/10, 70%). They were also more likely to report that their service already provides the best mental health care (agreement rose from 7/12, 58% to 8/10, 80%). After the implementation, a greater proportion of participants reported that the HIT enabled shared or collaborative decision-making with young people (2/10, 20%, compared with 1/12, 8%), enabled clients to proactively work on their mental health care through digital technologies (3/10, 30%, compared with 2/12, 16%), and improved their response to suicidal risk (4/10, 40% compared with 3/12, 25%). This study raises important questions about why clinicians, who have the same training and support in using technology, develop more polarized opinions on its usefulness after implementation. It seems that the uptake of HIT is heavily influenced by a clinician’s underlying beliefs and attitudes toward clinical practice in general as well as the role of technology, rather than their knowledge or the ease of use of the HIT in question.
Publisher: SAGE Publications
Date: 06-1999
Publisher: Springer Science and Business Media LLC
Date: 14-12-2022
DOI: 10.1186/S12916-022-02666-W
Abstract: Clinical staging proposes that youth-onset mental disorders develop progressively, and that active treatment of earlier stages should prevent progression to more severe disorders. This retrospective cohort study examined the longitudinal relationships between clinical stages and multiple clinical and functional outcomes within the first 12 months of care. Demographic and clinical information of 2901 young people who accessed mental health care at age 12–25 years was collected at predetermined timepoints (baseline, 3 months, 6 months, 12 months). Initial clinical stage was used to define three fixed groups for analyses (stage 1a: ‘non-specific anxious or depressive symptoms’, 1b: ‘attenuated mood or psychotic syndromes’, 2+: ‘full-threshold mood or psychotic syndromes’). Logistic regression models, which controlled for age and follow-up time, were used to compare clinical and functional outcomes (role and social function, suicidal ideation, alcohol and substance misuse, physical health comorbidity, circadian disturbances) between staging groups within the initial 12 months of care. Of the entire cohort, 2093 young people aged 12–25 years were followed up at least once over the first 12 months of care, with 60.4% female and a baseline mean age of 18.16 years. Longitudinally, young people at stage 2+ were more likely to develop circadian disturbances (odds ratio [OR]=2.58 CI 1.60–4.17), compared with in iduals at stage 1b. Additionally, stage 1b in iduals were more likely to become disengaged from education/employment (OR=2.11, CI 1.36–3.28), develop suicidal ideations (OR=1.92 CI 1.30–2.84) and circadian disturbances (OR=1.94, CI 1.31–2.86), compared to stage 1a. By contrast, we found no relationship between clinical stage and the emergence of alcohol or substance misuse and physical comorbidity. The differential rates of emergence of poor clinical and functional outcomes between early versus late clinical stages support the clinical staging model's assumptions about illness trajectories for mood and psychotic syndromes. The greater risk of progression to poor outcomes in those who present with more severe syndromes may be used to guide specific intervention packages.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
DOI: 10.1097/PSY.0000000000000061
Abstract: Unexplained fatigue states are prevalent, with uncertain diagnostic boundaries. Patients with fatigue-related illnesses were investigated by questionnaire and a novel semistructured interview to identify discriminatory features. Cross-sectional s les of women from specialist practices with chronic fatigue syndrome (n = 20), postcancer fatigue (PCF n = 20), or major depression (n = 16) were recruited. Additionally, two longitudinal s les were studied: women with fatigue associated with acute infection who subsequently developed postinfective fatigue syndrome (n = 20) or recovered uneventfully (n = 21), and women undergoing adjuvant therapy for breast cancer experiencing treatment-related fatigue who subsequently developed PCF (n = 16) or recovered uneventfully (n = 16). Patients completed self-report questionnaires, and trained interviewers applied the Semi-structured Clinical Interview for Neurasthenia. The receiver operating characteristics curves of the interview were measured against clinician-designated diagnoses. Cluster analyses were performed to empirically partition participants by symptom characteristics. The interview had good internal consistency (Cronbach alpha "fatigue" = .83), and diagnostic sensitivity and specificity for chronic fatigue syndrome (100% and 83%) and major depression (100% and 72%), with reasonable parameters for PCF (72% and 58%). Empirical clustering by "fatigue" or "neurocognitive difficulties" items allocated most patients to one group, whereas "mood disturbance" items correctly classified patients with depression only. The Semi-structured Clinical Interview for Neurasthenia offers reliable diagnostic use in assessing fatigue-related conditions. The symptom domains of fatigue and neurocognitive difficulties are shared across medical and psychiatric boundaries, whereas symptoms of depression such as anhedonia are distinguishing.
Publisher: Cambridge University Press (CUP)
Date: 2023
Publisher: Cambridge University Press (CUP)
Date: 11-2001
DOI: 10.1017/S0033291701004731
Abstract: Background. Neuropsychiatric research needs to examine the relationships between aetiological, genotypic and clinical risk factors and behavioural phenotypes. These relationships can now be examined in older patients with depressive disorders. Methods. Key behavioural features, clinical and vascular risk factors and putative genotypes for late-onset neurodegenerative disorders and/or vascular disease were recorded in 78 older patients with depression (mean age = 54·9 years, S.D. = 14·1) and 22 healthy control subjects (mean age = 55·5 years, S.D. = 9·6). Results. Two or more vascular risks were more common in older patients (65% v. 26% of control subjects, P 0·01), and in patients with late-onset disorders (82% v. 57% in patients with early-onset disorders, P 0·05). Patients with late-onset depression had a higher prevalence of the homozygous or heterozygous forms of the C677T mutation of the methylenetetrahydrofolate reductase enzyme (MTHFR)(74% v. 48% in patients with early-onset disorders, P 0·05). In a multivariate model, only presence of the MTHFR gene mutation predicted late-onset depression (odds ratio = 3·8, 95% CI = 1·1–12·9). Neither apolipoprotein E epsilon 4 or epsilon 2 was associated with depression, late-onset depression, cognitive impairment, or psychomotor change. Patients with apolipoprotein E epsilon 4 were less likely to have psychotic forms of depression. Conclusions. Patients with late-onset depression had an increased rate of the C677T MTHFR gene mutation and other vascular risk factors. This suggests that a proportion of these patients may have genetically-determined and/or other vascular aetiologies. Patients at risk of these disorders may be assisted by currently-available preventative strategies.
Publisher: Elsevier BV
Date: 04-2005
DOI: 10.1016/J.JAD.2004.11.003
Abstract: While patients with depression have been shown to have a greater incidence of vascular risk factors and structural brain changes, any association with dietary co-factors is unclear. Forty-seven patients with major depression (mean age = 52.8 years, SD = 12.6) and 21 healthy volunteers (mean age = 54.7 years, SD = 9.1) underwent high-resolution magnetic resonance imaging scanning. T2-weighted films were scored for deep white matter (DWM), periventricular (PV), and subcortical (SC) hyperintensities. There was no difference in lesion severity between patients and control subjects. After controlling for age, vitamin B12 levels were predictive of DWM lesions in patients. DWM and SC lesions were associated with histories of hypertension and diabetes. A relatively small s le of patients were recruited from specialist services and the findings may not represent those observed in larger or community-based cohorts. In patients with major depression, vitamin B12 levels and histories of hypertension and/or diabetes are predictive of white matter lesions.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.JPSYCHIRES.2012.12.006
Abstract: Oxidative stress has recently been reported to assume a significant role in the pathophysiology of bipolar disorder. Several studies have demonstrated the replenishment of glutathione (GSH) diminishes oxidative cellular damage and ameliorates depressive symptoms in this disorder. Whilst the mechanism by which GSH exerts any clinical effect is unknown it has been proposed that it involves the bolstering of antioxidant defences by increasing the bioavailability of GSH, which in turn reverses clinical symptoms of depression. Such a proposal is predicated on the implicit assumption that GSH is diminished in these patients prior to GSH supplementation. However hitherto no study has reported in vivo measures of GSH in patients with bipolar disorder. Using magnetic resonance spectroscopy we obtained in vivo measures of GSH in young people with bipolar disorder and contrasted these with matched healthy controls. Young people with bipolar disorder were found to have no diminution in baseline GSH concentration and, furthermore, no significant correlations were found between GSH and clinical scores of depression or mania. The results do not support the hypothesis that oxidative stress is involved in the primary pathophysiology of bipolar disorder.
Publisher: SAGE Publications
Date: 15-11-2023
DOI: 10.1177/00048674221136037
Abstract: One in five people experience clinically relevant mental health problems before the age of 25 years. Furthermore, in Australia, one in seven children are reported to experience a mental health disorder. Consequently, there has been a steady increase in demand for mental health services for children and young people, and this has been compounded by the COVID-19 pandemic. Unfortunately, currently many children and young people with mental health difficulties are not accessing appropriate and/or timely care, with in iduals and families finding it increasingly difficult to access and navigate suitable services. In part, this is related to the fragmented and isolated manner in which child mental health services are operating. To address the current issues in access to appropriate child and adolescent mental health care in Australia, a novel Integrated Continuum of Connect and Care model is proposed to integrate relevant services along a tiered care pathway. The aim of this model is to facilitate timely access to mental health services that meet the specific needs of each child/young person and their family. This model will function within co-located service hubs that integrate health care through a comprehensive assessment followed by a link up to relevant services. The Integrated Continuum of Connect and Care has the potential to pave the way for unifying the fragmented child and youth mental health system in Australia.
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-025674
Abstract: To report the distribution and predictors of insulin resistance (IR) in young people presenting to primary care-based mental health services. Cross-sectional. Headspace-linked clinics operated by the Brain and Mind Centre of the University of Sydney. 768 young people (66% female, mean age 19.7±3.5, range 12–30 years). IR was estimated using the updated homeostatic model assessment (HOMA2-IR). Height and weight were collected from direct measurement or self-report for body mass index (BMI). For BMI, 20.6% of the cohort were overweight and 10.2% were obese. However, % had an abnormally high fasting blood glucose ( .9 mmol/L). By contrast, 9.9% had a HOMA2-IR score .0 (suggesting development of IR) and 11.7% (n=90) had a score between 1.5 and 2. Further, there was a positive correlation between BMI and HOMA2-IR (r=0.44, p .001). Participants in the upper third of HOMA2-IR scores are characterised by younger age, higher BMIs and depression as a primary diagnosis. HOMA2-IR was predicted by younger age (β=0.19, p .001) and higher BMI (β=0.49, p .001), together explaining 22% of the variance (F (2,361) =52.1, p .001). Emerging IR is evident in a significant subgroup of young people presenting to primary care-based mental health services. While the major modifiable risk factor is BMI, a large proportion of the variance is not accounted for by other demographic, clinical or treatment factors. Given the early emergence of IR, secondary prevention interventions may need to commence prior to the development of full-threshold or major mood or psychotic disorders.
Publisher: Public Library of Science (PLoS)
Date: 03-2013
Publisher: Wiley
Date: 16-07-2022
DOI: 10.1111/PCN.13440
Abstract: Patients with depression and bipolar disorder have previously been shown to have impaired white matter (WM) integrity compared with healthy controls. This study aimed to investigate potential sex differences that may provide further insight into the pathophysiology of these highly debilitating mood disorders. Participants aged 17 to 30 years (168 with depression [60% females], 107 with bipolar disorder [74% females], and 61 controls [64% females]) completed clinical assessment, self‐report measures, and a neuropsychological assessment battery. Participants also underwent magnetic resonance imaging from which diffusion tensor imaging data were collected among five fronto‐limbic WM tracts: cingulum bundle (cingulate gyrus and hippoc us subsections), fornix, stria terminalis, and the uncinate fasciculus. Mean fractional anisotropy (FA) scores were compared between groups using analyses of variance with sex and diagnosis as fixed factors. Among the nine WM tracts analyzed, one revealed a significant interaction between sex and diagnosis, controlling for age. Male patients with bipolar disorder had significantly lower FA scores in the fornix compared with the other groups. Furthermore, partial correlations revealed a significant positive association between FA scores for the fornix and psychomotor speed. Our findings suggest that males with bipolar disorder may be at increased risk of disruptions in WM integrity, especially in the fornix, which is thought to be responsible for a range of cognitive functions. More broadly, our findings suggest that sex differences may exist in WM integrity and thereby alter our understanding of the pathophysiology of mood disorders.
Publisher: Cambridge University Press (CUP)
Date: 10-04-2017
DOI: 10.1017/S0033291717000484
Abstract: Optimizing functional recovery in young in iduals with severe mental illness constitutes a major healthcare priority. The current study sought to quantify the cognitive and clinical factors underpinning academic and vocational engagement in a transdiagnostic and prospective youth mental health cohort. The primary outcome measure was ‘not in education, employment or training’ (‘NEET’) status. A clinical s le of psychiatric out-patients aged 15–25 years ( n = 163) was assessed at two time points, on average, 24 months apart. Functional status, and clinical and neuropsychological data were collected. Bayesian structural equation modelling was used to confirm the factor structure of predictors and cross-lagged effects at follow-up. In idually, NEET status, cognitive dysfunction and negative symptoms at baseline were predictive of NEET status at follow-up ( p 0.05). Baseline cognitive functioning was the only predictor of follow-up NEET status in the multivariate Bayesian model, while controlling for baseline NEET status. For every 1 s.d. deficit in cognition, the probability of being disengaged at follow-up increased by 40% (95% credible interval 19–58%). Baseline NEET status predicted poorer negative symptoms at follow-up ( β = 0.24, 95% credible interval 0.04–0.43). Disengagement with education, employment or training (i.e. being NEET) was reported in about one in four members of this cohort. The initial level of cognitive functioning was the strongest determinant of future NEET status, whereas being academically or vocationally engaged had an impact on future negative symptomatology. If replicated, these findings support the need to develop early interventions that target cognitive phenotypes transdiagnostically.
Publisher: Springer Science and Business Media LLC
Date: 12-11-2013
Publisher: Springer Science and Business Media LLC
Date: 28-04-2015
DOI: 10.1038/TP.2015.50
Abstract: Functional disability is the lead contributor to burden of mental illness. Cognitive deficits frequently limit functional recovery, although whether changes in cognition and disability are longitudinally associated in recent-onset in iduals remains unclear. Using a prospective, cohort design, 311 patients were recruited and assessed at baseline. One hundred and sixty-seven patients met eligibility criteria (M=21.5 years old, s.d.=4.8) and returned for follow-up (M=20.6 months later, s.d.=7.8). Two-hundred and thirty participants were included in the final analysis, comprising clinically stable patients with major depression ( n =71), bipolar disorder (BD n =61), schizophrenia-spectrum disorders ( n =35) and 63 healthy controls. Neuropsychological functioning and self-rated functional disability were examined using mixed-design, repeated-measures analysis, across diagnoses and cognitive clusters, covarying for relevant confounds. Clinical, neuropsychological and functional changes did not differ between diagnoses (all P .05). Three reliable neuropsychological subgroups emerged through cluster analysis, characterized by psychomotor slowing, improved sustained attention, and improved verbal memory. Controlling for diagnosis and changes in residual symptoms, clusters with improved neuropsychological functioning observed greater reductions in functional disability than the psychomotor slowing cluster, which instead demonstrated a worsening in disability ( P .01). Improved sustained attention was independently associated with greater likelihood of follow-up employment ( P .01). Diagnosis of BD uniquely predicted both follow-up employment and independent living. Neuropsychological course appears to be independently predictive of subjective and objective functional outcomes. Importantly, cognitive phenotypes may reflect distinct pathophysiologies shared across major psychiatric conditions, and be ideal targets for personalized early intervention.
Publisher: American Psychiatric Association Publishing
Date: 12-2002
DOI: 10.1176/APPI.AJP.159.12.2096
Abstract: The authors sought to determine whether caudate nucleus volumes or specific genotypes predict psychomotor slowing in older persons with depression. Forty-seven persons with depression (mean age=51.8 years, SD=12.4) and 20 healthy volunteers (mean age=56.1 years, SD=9.8) underwent clinical assessments, a neuropsychological test of psychomotor speed (part A of the Trail Making Test), high-resolution magnetic resonance imaging scans, and genotyping for the apolipoprotein E epsilon4 allele and a mutation of the methylenetetrahydrofolate reductase enzyme. Multivariate analyses revealed that psychomotor speed was uniquely predicted by age, a diagnosis of depression, right caudate nucleus volume, and mutation of the methylenetetrahydrofolate reductase enzyme. Psychomotor slowing, a key clinical and cognitive phenomenon in older persons with depression, is predicted by reduced caudate nucleus volumes and genetic determinants of homocysteine metabolism.
Publisher: Public Library of Science (PLoS)
Date: 21-04-2015
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.PSYCHRES.2019.05.003
Abstract: Neuropsychological assessments have provided the field of psychiatry with important information about patients. As an assessment tool, a neuropsychological battery can be useful in a clinical setting however, implementation as standard clinical care in an inpatient unit has not been extensively evaluated. A computerized cognitive battery was administered to 103 current young adult inpatients (19.2 ± 3.1 years 72% female) with affective disorder. Neurocognitive tasks included Verbal Recognition Memory (VRM), Attention Switching (AST), Paired Association Learning (PAL), and Rapid Visual Processing (RVP). Patients also completed a computerized self-report questionnaire evaluating subjective impressions of their cognition. Hierarchical cluster analysis determined three neurocognitive subgroups: cluster 1 (n = 17) showed a more impaired neurocognitive profile on three of the four variables compared to their peers in cluster 2 (n = 59), and cluster 3 (n = 27), who had the most impaired attentional shifting. Two of the four neurocognitive variables were significantly different between all three cluster groups (verbal learning and sustained attention). Overall group results showed an association between poorer sustained attention and increased suicidal ideation. These findings strengthen the idea that neurocognitive profiles may play an important role in better understanding the severity of illness in young inpatients with major psychiatric disorders.
Publisher: AMPCo
Date: 07-2001
DOI: 10.5694/J.1326-5377.2001.TB143785.X
Abstract: To determine the rate and predictors of unmet need for recognition of common mental disorders in Australian general practice. Cross-sectional national audit of general practices throughout Australia in 1998-1999. 46 515 ambulatory care patients attending 386 GPs. Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system prevalence of recognition of mental disorders by GPs--GPs reporting whether patients had depression, anxiety, mixed depression/anxiety, somatoform, or other psychological disorder predictors of unmet need for recognition of mental disorders--self-report questions about demography for patients and GPs, and about practice organisation for GPs. Reported recognition of psychological disorders by GPs actual prevalence of disorders and patient, GP and practice characteristics predicting the failure to recognise disorders. GPs did not recognise mental disorder in 56% (11922/21210) of patients. These comprised 46% (5134/11060) of patients in the higher level of mental disorders, and (in the second level of disorders) 58% (2906/5036) of patients with predominantly psychological symptoms, and 76% (3882/5114) of those with predominantly somatic symptoms. Patients more likely to have their need for psychological assessment met had the following characteristics: middle-aged (odds ratio [OR], 1.76 95% CI, 1.59-1.96), female (OR, 1.19 95% CI, 1.12-1.27), Australian-born (OR, 1.16 95% CI, 1.08-1.24), unemployed (OR, 1.75 95% CI, 1.64-1.89), single (OR, 1.52 95% CI, 1.41-1.61), presenting with mainly psychological symptoms (OR, 3.54 95% CI, 3.28-3.81), and presenting for psychological reasons (OR, 4.20 95% CI, 3.02-5.82). Characteristics of doctors associated with meeting patients' need for assessment were being aged over 35 years (OR, 1.51 95% CI, 1.09-2.08), having an interest in mental health (OR, 1.27 95% CI, 1.15-1.41), having had previous mental health training (OR, 1.29 95% CI, 1.15-1.45), being in part-time practice (OR, 1.23 95% CI, 1.09-1.39), seeing fewer than 100 patients per week (OR, 1.29 95% CI, 1.13-1.47), working in practices with fewer than 2000 patients (OR, 1.28 95% CI, 1.13-1.45) and working in regional centres (OR, 1.16 95% CI, 1.05-1.28). Unmet need for recognition of common mental disorders remains high. Predictors of unmet need include a somatic symptom profile and practitioner and organisational characteristics which impede the provision of high quality mental health services.
Publisher: Cambridge University Press (CUP)
Date: 19-12-2005
DOI: 10.1017/S0033291705006835
Abstract: Background. Implicit learning through motor sequencing tasks is sensitive to basal ganglia dysfunction. Consequently, it is ideally suited for testing elements of the frontostriatal model of major depression and performance can be related to key clinical, neuropsychological, vascular and biochemical data. Method. Twenty-one subjects with moderate to severe unipolar depression and 21 age-, sex- and education-matched controls were recruited. Clinical, vascular and biochemical data were recorded. Subjects were administered a battery of neuropsychological tests that assessed speed of processing, working memory, learning, memory, language, perceptual organization and executive functioning. Additionally, subjects were administered a motor sequencing implicit learning task. Implicit learning is assumed when reaction times improve during the sequenced condition as compared to the pseudo-random baseline condition. Results. The rate of implicit learning in persons with depression was only half that of control subjects (3·6% v . 7·3%). Lower rates of implicit learning in patients were associated with poorer performance on neuropsychological tests of visuomotor speed and mental flexibility, longer duration of depressive episode and severity of acute stress. In a small number of subjects, poorer performance was also related to past suicide attempt. Conclusions. Impaired implicit learning in persons with depression is consistent with frontostriatal dysfunction. Performance is related to some clinical characteristics and to neuropsychological functioning on tests of visuomotor speed and mental flexibility.
Publisher: Wiley
Date: 23-02-2023
DOI: 10.1111/BDI.13304
Abstract: Emerging evidence suggests a role of circadian dysrhythmia in the switch between “activation” states (i.e., objective motor activity and subjective energy) in bipolar I disorder. We examined the evidence with respect to four relevant questions: (1) Are natural or environmental exposures that can disrupt circadian rhythms also related to the switch into high‐/low‐activation states? (2) Are circadian dysrhythmias (e.g., altered rest/activity rhythms) associated with the switch into activation states in bipolar disorder? (3) Do interventions that affect the circadian system also affect activation states? (4) Are associations between circadian dysrhythmias and activation states influenced by other “third” factors? Factors that naturally or experimentally alter circadian rhythms (e.g., light exposure) have been shown to relate to activation states however future studies need to measure circadian rhythms contemporaneously with these natural/experimental factors. Actigraphic measures of circadian dysrhythmias are associated prospectively with the switch into high‐ or low‐activation states, and more studies are needed to establish the most relevant prognostic actigraphy metrics in bipolar disorder. Interventions that can affect the circadian system (e.g., light therapy, lithium) can also reduce the switch into high‐/low‐activation states. Whether circadian rhythms mediate these clinical effects is an unknown but valuable question. The influence of age, sex, and other confounders on these associations needs to be better characterised. Based on the reviewed evidence, our view is that circadian dysrhythmia is a plausible driver of transitions into high‐ and low‐activation states and deserves prioritisation in research in bipolar disorders.
Publisher: AMPCo
Date: 07-2001
DOI: 10.5694/J.1326-5377.2001.TB143789.X
Abstract: To evaluate the effects of a seminar-based training program and clinical practice audit on general practitioners' (GPs') knowledge and management of common mental disorders. Survey of GPs' knowledge before and after training, and clinical practice audit and re-audit after feedback. GP volunteers from around Australia in 1998-1999: 1008 completed the pre-training test, 190 the post-training test, 386 the first audit (33235 patients), and 157 of these the re-audit (13280 patients), with 57 undertaking both audit and training. Four-seminar, 12-hour training program focused on improving GPs' capacity to identify and manage patients with depression and anxiety practice audit with patient- and practice-based feedback on diagnosis and treatment of common mental disorders. Scores on pre- and post-training knowledge tests self-rated improvements in confidence in managing patients with mental disorders after training rates of psychological diagnoses and treatment by GPs on first audit and re-audit. GPs' knowledge of pharmacological treatments and clinical management improved after the training program (P<0.001), and 97% of GPs reported increased confidence in their management skills. GPs who undertook training had higher diagnosis rates for common mental disorders in the first audit than those who did not undertake training (36% versus 29% P<0.001), and their diagnosis rates increased over time (36% to 39% P<0.01), while those of GPs who did not undertake training were unchanged. Similarly, GPs who undertook training provided more mental health treatments than those who did not (30% versus 27% in the first audit [P<0.001], and 31% versus 24% at reaudit [P<0.001]). They also place greater emphasis on use of nonpharmacological treatments (24% versus 21% at first audit [P<0.001], and 25% versus 19% at re-audit [P<0.001]). Clinical audits may heighten awareness of mental disorders, but, on their own, they do not improve mental health practice. A relatively brief but skills-based training program may contribute to better management of patients with common mental disorders by increasing GPs' confidence and competence.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.SCHRES.2014.12.042
Abstract: Patients with schizophrenia are at increased risk of venous thromboembolism. The mechanisms underlying this association are poorly understood. We investigated whether there is a global hypercoagulable state in patients with schizophrenia utilising the overall haemostatic potential (OHP) assay which assesses overall coagulation potential (OCP), haemostatic potential (OHP) and fibrinolytic potential (OFP). Citrated plasma was collected for OHP assays from patients with schizophrenia on long-term antipsychotic treatment and compared with healthy age- and sex-matched controls. Time courses of fibrin formation and degradation were measured by spectrophotometry (absorption of 405nm) after the addition of tissue factor and tissue plasminogen activator to plasma. Ninety patients with schizophrenia (antipsychotic treatment-15.9±9.7years) and 30 controls were recruited. Patients with schizophrenia had higher rates of smoking and levels of inflammatory markers (high-sensitivity C-reactive protein and neutrophil-to-lymphocyte ratio) than controls. Whilst D-dimer, fibrinogen and platelet count did not differ between patients with schizophrenia and controls, the OCP (54.0±12.6 vs 45.9±9.1, p=0.002) and OHP (12.6±5.8 vs 7.2±3.7, p<0.001) were higher, and OFP was lower (76.6±9.8% vs 84.9±6.4%, p<0.001) in patients with schizophrenia, implying both a hypercoagulable and hypofibrinolytic state in these patients. Importantly, abnormalities in overall coagulation were independently predicted by levels of plasminogen-activator-inhibitor-1, fibrinogen, platelet count, inflammatory markers and plasma triglycerides, suggesting a multifactorial aetiology. Patients with schizophrenia have evidence of a global hypercoagulable and hypofibrinolytic state which may contribute to their increased risk of venous thromboembolism.
Publisher: BMJ
Date: 02-2014
Publisher: SAGE Publications
Date: 19-02-2019
Abstract: Neurocognitive assessment and feedback to a young adult inpatient. Computerised neurocognitive assessment and feedback. A collaborative process of personalised intervention. Personalised feedback in this setting can be employed as a management tool to identify and prioritise care.
Publisher: JMIR Publications Inc.
Date: 09-03-2022
DOI: 10.2196/33060
Abstract: Globally, there are fundamental shortcomings in mental health care systems, including restricted access, siloed services, interventions that are poorly matched to service users’ needs, underuse of personal outcome monitoring to track progress, exclusion of family and carers, and suboptimal experiences of care. Health information technologies (HITs) hold great potential to improve these aspects that underpin the enhanced quality of mental health care. Project Synergy aimed to co-design, implement, and evaluate novel HITs, as exemplified by the InnoWell Platform, to work with standard health care organizations. The goals were to deliver improved outcomes for specific populations under focus and support organizations to enact significant system-level reforms. Participating health care organizations included the following: Open Arms–Veterans & Families Counselling (in Sydney and Lismore, New South Wales [NSW]) NSW North Coast headspace centers for youth (Port Macquarie, Coffs Harbour, Grafton, Lismore, and Tweed Heads) the Butterfly Foundation’s National Helpline for eating disorders Kildare Road Medical Centre for enhanced primary care and Connect to Wellbeing North Coast NSW (administered by Neami National), for population-based intake and assessment. Service users, families and carers, health professionals, and administrators of services across Australia were actively engaged in the configuration of the InnoWell Platform to meet service needs, identify barriers to and facilitators of quality mental health care, and highlight potentially the best points in the service pathway to integrate the InnoWell Platform. The locally configured InnoWell Platform was then implemented within the respective services. A mixed methods approach, including surveys, semistructured interviews, and workshops, was used to evaluate the impact of the InnoWell Platform. A participatory systems modeling approach involving co-design with local stakeholders was also undertaken to simulate the likely impact of the platform in combination with other services being considered for implementation within the North Coast Primary Health Network to explore resulting impacts on mental health outcomes, including suicide prevention. Despite overwhelming support for integrating digital health solutions into mental health service settings and promising impacts of the platform simulated under idealized implementation conditions, our results emphasized that successful implementation is dependent on health professional and service readiness for change, leadership at the local service level, the appropriateness and responsiveness of the technology for the target end users, and, critically, funding models being available to support implementation. The key places of interoperability of digital solutions and a willingness to use technology to coordinate health care system use were also highlighted. Although the COVID-19 pandemic has resulted in the widespread acceptance of very basic digital health solutions, Project Synergy highlights the critical need to support equity of access to HITs, provide funding for digital infrastructure and digital mental health care, and actively promote the use of technology-enabled, coordinated systems of care.
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Abstract: Reducing suicidal behaviour is a major public health goal. Expanding access to care has been identified as a key strategy. In Australia, a national network of primary-care based services ( headspace ) has been established for young people with mental ill-health. This study determines the socio-demographic, psychopathological and illness-stage correlates of suicidal ideation in young persons attending headspace services. Suicidal ideation was recorded using the specific suicide item of the Hamilton Depression Rating Scale (HDRS) in a cohort of subjects aged 12-30 years (N = 494) attending headspace services. Of the 494 young persons assessed, 32% (158/494) had a positive response to any level of the HDRS suicide item, consisting of 16% (77/494) reporting that life was not worth living and a further 16% (81/494) reported thoughts of death or suicidal ideation. Young women (19% 94/494) were more likely to report any positive response as compared with young men (13% 64/494) [χ 2 (2,494) = 13.6, p .01]. Those with ‘attenuated syndromes’ reported positive responses at rates comparable to those with more established disorders (35% vs. 34% χ 2 (1,347) = 0.0, p = 0.87). However, more serious levels of suicidal ideation were more common in those with depressive disorders or later stages of illness. In multivariate analyses, the major predictors of the degree of suicidal ideation were increasing levels of clinician-rated depressive symptoms (beta = 0.595, p .001), general psychopathology (beta = 0.198, p .01), and self-reported distress (beta = 0.172, p .05). Feelings that life is not worth living, thoughts of death or suicidal ideation are common in young people seeking mental health care. These at-risk cognitions are evident before many of these in iduals develop severe or persistent mental disorders. Thoughts of death or suicidal ideation may well need to be a primary intervention target in these young people.
Publisher: Springer Science and Business Media LLC
Date: 05-08-2015
Publisher: SAGE Publications
Date: 09-2002
Publisher: Elsevier BV
Date: 12-1999
DOI: 10.1016/S0925-4927(99)00038-4
Abstract: Psychomotor slowing is a fundamental clinical feature of severe depression and is thought to reflect dysfunction within prefrontal-subcortical circuits. This study utilised a split-dose single photon emission computerised tomography (SPECT) scanning technique in association with a two-stage test of psychomotor speed. Twenty-five patients with primary depressive disorders were injected with technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) whilst performing each component of a two-stage psychomotor task. The first stage, 'simple reaction time' (RT) and the second stage, 'choice reaction time' (CRT), were each followed by 30-min SPECT scans. Regions of interest (ROIs) corresponding to the left and right neo-striatum (caudate-putamen) were drawn, and regional cerebral blood flow (rCBF) values were calculated. Importantly, the change in rCBF measure in the left neo-striatum was inversely correlated with RT (r = -0.48, P < 0.05). That is, the patients with the greatest psychomotor slowing initially showed the least increase in rCBF during the CRT condition. This effect was independent of age. The study demonstrates that a simple two-stage motor paradigm can be used to elicit rCBF correlates of psychomotor slowing in patients with primary depression. Such rCBF findings may implicate the neo-striatum in the neurobiology of major depression.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.PSYCHRES.2013.05.001
Abstract: For many young people, binge drinking is the most common form of alcohol misuse, particularly in those with a depressive disorder. Nonetheless, relatively little is known about the effects that the combination of depression and binge drinking has on neuropsychological outcomes. This study aimed to determine whether binge drinkers with depression show more pronounced neuropsychological dysfunction compared to their peers with depression alone or binge drinking alone. Neuropsychological testing was conducted on help-seeking young people (18-30 years) recently diagnosed with a depressive disorder and classified as either 'binge drinkers' (n=43) or 'non-bingers' (n=48). Two healthy control groups (i.e. binge drinkers, n=24 and non-bingers, n=21) were additionally recruited and also underwent the same testing. Qualitatively, binge-drinking patients with depression performed consistently below controls, depression alone, or binge drinking alone. In keeping with our hypotheses, visual learning and memory was significantly reduced in depressed binge drinkers, whereas mental flexibility was reduced at a trend level. There were no significant differences in neuropsychological performance in depressed alone or binge drinking alone in iduals compared to controls. The findings suggest that when treating young people with a depressive disorder, strategies targeting binge drinking may contribute to preventing potential neurobiological changes underlying poorer long-term clinical outcomes.
Publisher: Wiley
Date: 24-11-2016
DOI: 10.1111/BDI.12450
Abstract: Converging evidence identifies that the offspring of parents with bipolar disorder (BD), in iduals at clinical high risk of BD, and young people with recent onset BD may differ from other clinical cases or healthy controls in terms of sleep-wake profiles. However, it is possible that these differences may reflect current mental state, subtype of mood disorder, or familial traits. This study aimed to determine objective and subjective sleep-wake profiles in in iduals aged 15-25 years with a current major depressive episode, in relation to familial traits. Frequency matching was employed to ensure that each in idual with a confirmed family history of BD (FH+) could be compared to four controls who did not have a familial mood disorder (FH-). Pre-selected objective actigraphy and subjective Pittsburgh Sleep Quality Index (PSQI) ratings were compared using one-way analysis of variance (ANOVA) and applying the Benjamini-Hochberg (BH) correction for false discoveries. The s le comprised 60 in iduals with a mean age of 19 years. The FH+ (n=12) and FH- groups (n=48) differed on three key sleep parameters: mean sleep duration on week nights (P=.049), variability in waking after sleep onset (P=.038), and daily disturbances (PSQI dimension of sleep disturbance and daytime dysfunction P=.01). The sleep profiles we identified in this study, especially the daily disturbances phenotype, provide support for research into endophenotypes for BD. Also, the findings may offer the opportunity for more tailored, personalized interventions that target specific components of the sleep-wake cycle in in iduals with a family history of BD.
Publisher: AMPCo
Date: 07-2001
Publisher: Elsevier BV
Date: 02-1995
DOI: 10.1016/0006-3223(94)00174-2
Abstract: In 39 hospital inpatients with severe primary depressive disorders, we evaluated the relationships between subcortical hyperintensities on magnetic resonance imaging (MRI) and clinical features, neuropsychological impairment and response to standard therapies. Both white matter and gray nuclei lesions were associated with older age and the absence of a family history of affective disorder. White matter hyperintensities were also associated with onset of first affective episode after the age of 50 years and impaired psychomotor speed. Most importantly, the severity of white matter hyperintensities predicted a poorer response to treatment (r = -0.44, p < .01). Negative correlations of the same order were detected in those (n = 20) who received electroconvulsive therapy (r = -0.42, p = .06) and those (n = 19) who received pharmacotherapy alone (r = -.49, p < .05). This study provides preliminary evidence supporting the clinical and prognostic significance of extensive white matter hyperintensities in patients with severe depression.
Publisher: Wiley
Date: 28-11-2019
DOI: 10.1111/EIP.12757
Abstract: Clinical staging models offer a useful framework for understanding illness trajectories, where in iduals are located on a continuum of illness progression from stage 0 (at-risk but asymptomatic) to stage 4 (end-stage disease). Importantly, clinical staging allows investigation of risk factors for illness progression with the potential to target trans-diagnostic mechanisms at an early stage, especially in help-seeking youth who often present with sub-threshold syndromes. While depressive symptoms, rumination and sleep-wake disturbances may worsen syndrome outcomes, the role of these related phenomena has yet to be examined as risk factors for trans-diagnostic illness progression in at-risk youth. This study is a prospective follow-up of 248 in iduals aged 12 to 25 years presenting to headspace services with sub-threshold syndromes (stage 1) classified under the clinical staging model to determine transition to threshold syndromes (stage 2). Factor analysis of depression, rumination and sleep-wake patterns was used to identify key dimensions and any associations between factors and transition to stage 2 at follow-up. At 1 year, 9% of cases met criteria for stage 2 (n = 22). One of three identified factors, namely the factor reflecting the commonalities shared between rumination and sleep-wake disturbance, significantly differentiated cases that transitioned to stage 2 vs those that did not demonstrate transition. Items loading onto this factor, labelled Anergia, included depression severity and aspects of rumination and sleep-wake disturbance that were characterized as introceptive. Common dimensions between rumination and sleep-wake disturbance present a detectable trans-diagnostic marker of illness progression in youth, and may represent a target for early intervention.
Publisher: Wiley
Date: 16-01-2021
DOI: 10.1111/EIP.12910
Abstract: This study aimed to: (a) examine whether treatment-seeking young adults with social anxiety disorder (SAD) demonstrate similar degrees of distress, quality of life (QoL) and disability to those with other mental disorders and (b) investigate the impact of comorbidity, specific comorbid conditions and antidepressants use on distress, QoL and disability in treatment-seeking young adults with SAD. A cohort of treatment-seeking young adults (aged 16-45) diagnosed with SAD (N = 298) or other mental health disorders (N = 842 including depression, N = 349 bipolar, N = 141 psychosis, N = 173) completed self-report assessments of distress, QoL and disability. Young adults with SAD showed distress and disability of similar degree to those with most other mental disorders. Specifically, young adults with SAD reported significantly lower QoL than those with major depressive disorder or obsessive-compulsive disorder. Furthermore, young adults with SAD had the most difficulties in getting along with others and the second highest level of distress in comparison to other psychiatric groups. In comparison to antidepressants use, the presence of comorbidity showed a substantial negative influence on these health outcomes, particularly when presenting with comorbid depression or obsessive-compulsive disorder. Findings highlight significant impairments in young adults seeking treatment for SAD and the important moderating influence of comorbidity. This emphasizes the urgent need for effective management and treatment for its presentation and comorbidities in mental health services targeting young adults.
Publisher: Oxford University Press (OUP)
Date: 23-06-2015
Publisher: Elsevier BV
Date: 02-2021
Publisher: Frontiers Media SA
Date: 20-06-2017
Publisher: Cambridge University Press (CUP)
Date: 09-2013
DOI: 10.1016/J.EURPSY.2013.04.001
Abstract: This study evaluated the potential of circadian measures as early markers of mood disorders subtypes. Patients with bipolar disorders had significantly lower levels and later onset of melatonin secretion than those with unipolar depression. Furthermore, abnormal phase angles between sleep, melatonin and temperature were found in several patients.
Publisher: SAGE Publications
Date: 2009
DOI: 10.1080/10398560802657322
Abstract: Objective: Evidence suggests that quality mental health care is based on well-integrated multi-disciplinary care provided by a range of mental health, substance use, and general healthcare clinicians. There is a growing focus in Australia on providing this type of mental health care to young people, particularly those in the early stages of a major disorder. The development of such services has proceeded on the basis of limited service-based data and has also been impeded by current healthcare funding structures. Methods: This report outlines the service characteristics of three models: a traditional ‘fee for service’ model, a specialized youth mental health clinic, and a new headspace multi-disciplinary site in South Western Sydney. Results: Naturalistic data from these three services collected during their developmental phase indicate that each model is associated with differential demographic, illness and service organization characteristics. Conclusions: Compared with ‘fee-for-service’ type care, specialized youth models provide greater access to a broad range of multi-disciplinary clinicians.
Publisher: Elsevier BV
Date: 02-2007
DOI: 10.1016/J.JAD.2006.07.010
Abstract: Although the short allele of the serotonin transporter promoter polymorphism (5-HTT) has been linked to increased risk of major depression in early adult life, its relationships with late-life depression and to changes in subcortical nuclei remain unclear. 5-HTT genotypes (SS, SL, LL) were determined for 45 older persons with major depression (mean age=52.0, sd=12.8) and 16 healthy controls (mean age=55.8, sd=10.3). MRI-derived volumes of the amygdala, hippoc us, caudate and putamen were determined by reliable tracing techniques. In those with depression, the short allele of 5-HTT was associated with smaller caudate nucleus volumes. Although hippoc al and amygdala volumes were smaller in those with depression as compared with control subjects, 5-HTT gene status did not predict this reduction in size. The findings are limited by the number of clinical and control participants. Reduced caudate nucleus volume in older patients with major depression was associated with the short allele of the 5-HTT gene. This regional brain change may be a consequence of early developmental expression as well as later vascular or degenerative effects of this genotype.
Publisher: JMIR Publications Inc.
Date: 08-09-2023
DOI: 10.2196/45161
Publisher: Springer Science and Business Media LLC
Date: 17-07-2007
Publisher: SAGE Publications
Date: 19-07-2022
DOI: 10.1177/10398562221115607
Abstract: Youth with early-onset mood or psychotic disorders are occasionally prescribed metformin to manage cardiometabolic risk. This retrospective study explores the demographic, clinical and metabolic factors associated with metformin prescription youth with mood or psychotic disorders. Participants included 72 youth with mood or psychotic disorders from a young adult mental health inpatient unit, of which 18 (33%) were newly prescribed metformin, and 54 (66%) were not prescribed metformin. Demographic and clinical information were extracted from the patients’ medical files along with body mass index (BMI), fasting serum bloods and calculated updated homeostatic model of insulin resistance assessment (HOMA2-IR) scores to compare profiles between groups. Of those prescribed metformin, 83% were overweight or obese and 72% had elevated HOMA2-IR scores. Of those not receiving metformin treatment, 41% were overweight or obese and 22% had elevated HOMA2-IR scores. Youth prescribed metformin had significantly higher BMI, and elevated markers of insulin resistance, but did not differ to those not prescribed metformin on other demographic, clinical or metabolic factors. While metformin is prescribed to some youth with mood or psychotic disorders displaying markers of cardiometabolic disturbance, there is a need to develop clearer treatment guidelines for metformin in these youth.
Publisher: Cambridge University Press
Date: 31-07-2019
Publisher: Wiley
Date: 24-07-2015
DOI: 10.1111/EIP.12079
Abstract: An estimated 75% of mental disorders begin before the age of 24 and approximately 25% of 13-24-year-olds are affected by mental disorders at any one time. To better understand and ideally prevent the onset of post-pubertal mental disorders, a clinical staging model has been proposed that provides a longitudinal perspective of illness development. This heuristic model takes account of the differential effects of both genetic and environmental risk factors, as well as markers relevant to the stage of illness, course or prognosis. The aim of the Transitions Study is to test empirically the assumptions that underpin the clinical staging model. Additionally, it will permit investigation of a range of psychological, social and genetic markers in terms of their capacity to define current clinical stage or predict transition from less severe or enduring to more severe and persistent stages of mental disorder. This paper describes the study methodology, which involves a longitudinal cohort design implemented within four headspace youth mental health services in Australia. Participants are young people aged 12-25 years who have sought help at headspace and consented to complete a comprehensive assessment of clinical state and psychosocial risk factors. A total of 802 young people (66% female) completed baseline assessments. Annual follow-up assessments have commenced. The results of this study may have implications for the way mental disorders are diagnosed and treated, and progress our understanding of the pathophysiologies of complex mental disorders by identifying genetic or psychosocial markers of illness stage or progression.
Publisher: BMJ
Date: 12-2018
DOI: 10.1136/BMJOPEN-2018-022659
Abstract: We sought to determine the unique and shared contributions of clinical, neurocognitive and demographic factors to functional impairment in a large, transdiagnostic, clinical cohort of adolescents and young adults. Cross-sectional baseline data from a prospective, cohort study. Help-seeking youth referred from outpatient services were recruited to the Brain and Mind Youth Cohort (2008–2016) in Sydney, Australia. In total, 1003 outpatients were recruited, aged between 12 and 36 years (mean= 20.4 years, 54% female), with baseline diagnoses of affective, psychotic, developmental or behavioural disorders. Treatment as usual. Social and occupational functioning was used to index level of functional impairment. Structural equation modelling was used to examine associations between neurocognition, core clinical symptoms and alcohol and substance use, and clinician-rated and researcher-rated functional impairment. Moderator analyses were conducted to determine the potential influence of demographic and clinical factors (eg, medication exposure). Independent of diagnosis, we found that neurocognitive impairments, and depressive, anxiety and negative symptoms, were significantly associated with functioning. The association of neurocognition with social and occupational functioning remained significant even when constraining for age (15–25-year-olds only) or diagnosis (affective disorders only) in the final model. This study demonstrated that, in a clinically representative s le of youth, the key determinants of functioning may not be disorder specific. Further, evidence of neurocognitive dysfunction suggests that interventions that target cognition and functioning should not necessarily be reserved just for older adults with established illness.
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.JAD.2012.06.031
Abstract: To facilitate early intervention, there is a need to distinguish unipolar versus bipolar illness trajectories in adolescents and young adults with adult-type mood disorders. Detailed clinical and neuropsychological evaluation of 308 young persons (aged 12 to 30 years) with moderately severe unipolar and bipolar affective disorders. Almost 30% (90/308) of young people (mean age=19.4±4.4yr) presenting for care with affective disorders met criteria for a bipolar-type syndrome (26% with bipolar I). Subjects with bipolar- and unipolar-type syndromes were of similar age (19.8 vs. 19.2yr) and reported comparable ages of onset (14.5 vs. 14.3yr). Clinically, those subjects with unipolar and bipolar-type disorders reported similar levels of psychological distress, depressive symptoms, current role impairment, neuropsychological dysfunction and alcohol or other substance misuse. Subjects with unipolar disorders reported more social anxiety (p<0.01). Subjects with bipolar disorders were more likely to report a family history of bipolar (21% vs. 11% [χ(2)=4.0, p<.05]) or psychotic (19% vs. 9% [χ(2)=5.5, p<.05]), or substance misuse (35% vs. 23% [χ(2)=3.9, p<.05]), but not depressive (48% vs. 53% χ(2)=0.3, p=.582]) disorders. Young subjects with bipolar disorders were best discriminated by a family history of bipolar, psychotic or substance use disorders. Early in the course of illness, clinical features of depression, or neuropsychological function, do not readily differentiate the two illness trajectories.
Publisher: Springer Science and Business Media LLC
Date: 28-02-2023
DOI: 10.1007/S00127-022-02415-7
Abstract: Machine learning (ML) has shown promise in modelling future self-harm but is yet to be applied to key questions facing clinical services. In a cohort of young people accessing primary mental health care, this study aimed to establish (1) the performance of models predicting deliberate self-harm (DSH) compared to suicide attempt (SA), (2) the performance of models predicting new-onset or repeat behaviour, and (3) the relative importance of factors predicting these outcomes. 802 young people aged 12–25 years attending primary mental health services had detailed social and clinical assessments at baseline and 509 completed 12-month follow-up. Four ML algorithms, as well as logistic regression, were applied to build four distinct models. The mean performance of models predicting SA (AUC: 0.82) performed better than the models predicting DSH (AUC: 0.72), with mean positive predictive values (PPV) approximately twice that of the prevalence (SA prevalence 14%, PPV: 0.32, DSH prevalence 22%, PPV: 0.40). All ML models outperformed standard logistic regression. The most frequently selected variable in both models was a history of DSH via cutting. History of DSH and clinical symptoms of common mental disorders, rather than social and demographic factors, were the most important variables in modelling future behaviour. The performance of models predicting outcomes in key sub-cohorts, those with new-onset or repetition of DSH or SA during follow-up, was poor. These findings may indicate that the performance of models of future DSH or SA may depend on knowledge of the in idual’s recent history of either behaviour.
Publisher: Elsevier
Date: 2019
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.JAD.2022.03.007
Abstract: Actigraphy studies of in iduals with bipolar disorders (BD) suggest that illness progression may be associated with a range of progressive disruptions in 24-hour rest-activity rhythms (RAR). However, those longitudinal studies were undertaken in older adults with extended histories or illness and treatment rather than young people with emerging BD. To our knowledge, this is the first study to use network modelling to examine the statistical associations between clinical phenotypes of BD and different subsets of RAR markers. This study of adolescents and young adults (mean age 22 years 69% female) uses network modelling to examine which self-rated or actigraphic markers of RAR are more strongly associated with full threshold BD (referred to as Stage 2 N = 15) compared with BD-at risk syndromes (subthreshold presentations referred to as Stage 1 N = 25). Network analysis demonstrated that some RAR are associated with both stage of BD and a family history of BD (such as longer sleep duration and higher levels of daytime impairment). Markers of circadian rhythmicity indicated that regulation of this system is weaker in Stage 2 compared with Stage 1 of BD. The small subgroup s les may have undermined the ability to detect some associations between phenotypes and RAR. Network modelling may offer a useful strategy for visualizing and analysing patterns of association between RAR and clinical phenotypes defined by stage of illness, familial loading or symptom profile. This could prove useful in understanding the underlying pathophysiology of sleep-wake cycle and circadian rhythm disturbances in BD.
Publisher: Royal College of Psychiatrists
Date: 03-2005
Abstract: Hippoc al volume reduction has been reported inconsistently in people with major depression. To evaluate the interrelationships between hippoc al volumes, memory and key clinical, vascular and genetic risk factors. Totals of 66 people with depression and 20 control participants underwent magnetic resonance imaging and clinical assessment. Measures of depression severity, psychomotor retardation, verbal and visual memory and vascular and specific genetic risk factors were collected. Reduced hippoc al volumes occurred in older people with depression, those with both early-onset and late-onset disorders and those with the melancholic subtype. Reduced hippoc al volumes were associated with deficits in visual and verbal memory performance. Although reduced hippoc al volumes are most pronounced in late-onset depression, older people with early-onset disorders also display volume changes and memory loss. No clear vascular or genetic risk factors explain these findings. Hippoc al volume changes may explain how depression emerges as a risk factor to dementia.
Publisher: SAGE Publications
Date: 10-04-2023
DOI: 10.1177/10398562231167681
Abstract: This study utilised digital technology to assess the clinical needs of young people presenting for care at headspace centres across Australia. 1490 young people (12–25 years) who presented to one of 11 headspace services from four geographical locations (urban New South Wales, urban South Australia, regional New South Wales, and regional Queensland) completed a digital multidimensional assessment at initial presentation. Characteristics were compared between services and geographical locations. We identified major variation in the demographics, and the type and severity of needs across different services. In iduals from regional services were more likely to be younger, of Aboriginal and Torres Strait Islander origin, and present with psychotic-like symptoms and suicidality, while those in urban areas were more likely to have previously sought help and have problematic alcohol use. Further differences in age, distress, depressive symptoms, psychotic-like experiences, trauma, family history, alcohol use, education/employment engagement, and days out of role were identified between different urban sites. The variability between services provides insight into the heterogeneity of youth mental health populations which has implications for appropriate early intervention and prevention service provisions. We propose that integrating digital technologies has the potential to provide insights for smarter service planning and evaluation.
Publisher: Springer Science and Business Media LLC
Date: 20-01-2012
Publisher: Wiley
Date: 08-2010
DOI: 10.1111/J.1751-7893.2010.00194.X
Abstract: Early stages of severe mood disorders may be accompanied by neurocognitive changes. Specifically, deficits in verbal memory have been linked to depression in young people. This study examined whether young adults with unipolar compared with bipolar depression showed similar neurocognitive deficits. A total of 57 young adults (16-32 years) were assessed in this study. Twenty with unipolar and 20 with bipolar depression, all currently depressed, were compared with 17 healthy controls. Neuropsychological assessment included psychomotor speed, attention for routine mental operations, attentional switching, executive control and verbal learning and memory. Both unipolar and bipolar subjects showed significant impairments in verbal memory and attentional switching compared with controls. Both mood disorder groups showed no impairments in psychomotor speed, attention for routine mental operations and executive control. Effects size calculations show that the unipolar and bipolar groups do not differ from each other across a range of neurocognitive measures. Neurocognitive deficits in young adults with current depressive syndromes appear to differ from those typically seen in older patients. In early adulthood, both unipolar and bipolar depression may be distinguished by poor verbal memory, despite intact speed of processing, attention and executive functions. This study suggests that there is utility in neuropsychological testing for young adults in the early stages of severe mood disorders. In order to prevent neurobiological changes inherent to the disease, pharmacological and non-pharmacological interventions that target verbal memory deficits may be optimally delivered early in the disease course.
Publisher: BMJ
Date: 10-2023
Publisher: American Psychiatric Association Publishing
Date: 07-2014
DOI: 10.1176/APPI.PS.201300221
Abstract: Transformational reforms in mental health services are providing more young Australians who experience mental health problems with access to high-quality care. However, the current diagnostic approach has low utility in the early stages of illness, causing uncertainty among clinicians in regard to matching clients' needs with safe and effective interventions. The authors propose a clinical staging model that has the potential to better match illness stage to intervention. The model allows clinicians to provide more personalized and responsive care, especially to young people with attenuated syndromes (subthreshold disorders) who have a clear need for mental health care but who may not otherwise receive it. This approach can also assist clinicians in considering the potential trajectory of illness. Recent research using this framework has demonstrated the model's prospective utility. The authors describe application of the model in an early intervention youth mental health service in Australia.
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJOPEN-2020-038787
Abstract: Currently, the literature on personalised and measurement-based mental healthcare is inadequate with major gaps in the development and evaluation of 21st century service models. Clinical presentations of mental ill health in young people are heterogeneous, and clinical and functional outcomes are often suboptimal. Thus, treatments provided in a person-centred and responsive fashion are critical to meet the unique needs of young people and improve in idual outcomes. Personalised care also requires concurrent assessment of factors relating to outcomes and underlying neurobiology. This study builds on a completed feasibility study and will be the first to incorporate clinical, cognitive, circadian, metabolic and hormonal profiling with personalised and measurement-based care in a cohort of young people admitted to hospital. This prospective, transdiagnostic, observational study will be offered to all young people between the ages of 16 and 30 years admitted to the inpatient unit of the participating centre. In total, 400 participants will be recruited. On admission to hospital, young people will undergo clinical and diagnostic assessment, cognitive testing, self-report questionnaires, metabolic and hormonal data collection, and anthropomorphic measurements. Participants will wear an actigraphy watch for at least 1 week during admission to measure circadian patterns and sleep-wake cycles. A feedback session between clinician and participant will occur after clinical and other laboratory assessments to tailor in idual treatment plans, explain the ongoing process of measurement-based care, and provide participant and family education. Associations between cognitive impairments, disturbed sleep-wake behaviours, circadian rhythms, clinical symptoms and functional impairments will be evaluated to improve the understanding of parameters affecting clinical outcomes. This study protocol was approved by the Human Research Ethics Committees of the University of Sydney (HREC USYD 2015/867) and St Vincent’s Hospital (HREC SVH 17/045). This study will be published on completion in a peer-reviewed journal.
Publisher: Cambridge University Press (CUP)
Date: 09-1998
DOI: 10.1017/S0033291797006090
Abstract: The severe depressive disorders of late life are associated with high rates of medical morbidity and mortality, cognitive impairment, suicide, disability, complex treatment regimens, institutionalization and high costs to the community (Murphy, 1983 Murphy et al . 1988 Bruce & Leaf, 1989 NIH Consensus Development Panel, 1992 Alexopoulos et al . 1993 a , b Brodaty et al . 1993 Bruce et al . 1994 Forsell et al . 1994 Hickie et al . 1995 Blazer, 1996). Those disorders that are accompanied by cognitive impairment and/or concurrent medical morbidity have a particularly poor outcome (Bruce & Leaf, 1989 Alexopoulos et al . 1993 b Hickie et al . 1995, 1997 a ). Although psychosocial models of late-life depression place considerable importance on age-related psychological and social risk factors, those who survive into later life may actually be characterized by psychological resilience (Henderson, 1994 Blazer, 1997). Current aetiological research in late-life depression, therefore, places particular emphasis on the potential role of biological risk factors. The potential importance of vascular risk factors is receiving renewed attention and may provide opportunities for specific prevention and intervention strategies in high-risk populations. This emphasis on possible vascular risk factors, and the wider importance of vascular pathologies in late-life neuropsychiatric disorders, mirrors the emphasis of much earlier clinico-pathological studies (Binswanger, 1894 Alzheimer, 1895). The specific focus on the importance of small progressive changes within the subcortical white matter, as distinct from more discrete cortical infarcts (Olszewski, 1962), is now supported by the emerging neuroimaging literature and theoretical constructs in late-life depression (Krishnan, 1991, 1993 Hickie et al . 1996, 1997 b Krishnan et al . 1997).
Publisher: Springer Science and Business Media LLC
Date: 17-10-2013
Abstract: Distress and/or dysfunction are well established as key reasons for help-seeking. We explore the characteristics of groups defined by high or low distress or disability in young people with unipolar depression (UP) or bipolar disorder (BD). In iduals aged 12 to 25 years presenting to youth mental health services for the first time with a primary diagnosis of UP or BD were assessed using the Kessler Psychological Distress Scale (Kessler-10) and the Work and Social Adjustment Scale (WSAS). Four groups with high or low distress or impairment were defined (according to scores above or below the group medians for the Kessler-10 and WSAS). Multinomial logistic regression (MNLR) was used to examine how cases with high levels of distress and disability (reference group) differed from the other three groups. The s le comprised 1,746 cases (90% UP, 56% female) with a median age of 17.5 years. Median scores on the Kessler-10 and WSAS were both high (30 and 20, respectively) and were significantly inter-correlated ( r = 0.62) the high impairment/distress group was the largest sub-group (39% of cases). The MNLR analysis demonstrated that younger age was associated with lower impairment groups (irrespective of distress level), whilst male gender was associated with lower distress (irrespective of impairment). Compared to the low impairment/distress cases, the high impairment/distress group was significantly more likely to use cannabis and/or alcohol. Age, substance use and possibly gender are probably better predictors of distress/impairment sub-group than mood disorder sub-type in youth.
Publisher: Wiley
Date: 02-2009
DOI: 10.1111/J.1751-7893.2008.00102.X
Abstract: Early medical or behavioural intervention to slow cognitive decline might be a viable strategy for reducing disability and rates of institutional care in older persons. This paper details the published work supporting cross-sectional and longitudinal associations between vascular risk factors, depressive symptoms and progressive cognitive decline. Evidence for the beneficial effects of providing relevant interventions is assessed. Relevant published work from the areas of dementia research, 'vascular depression' and the cognitive benefits that might result from treating vascular risk factors, managing depression or promoting nutrition, cognitive or physical exercise was ascertained from electronic database searches and recent reviews of key areas. The existing published work does not provide many ex les of early intervention strategies that target vascular strategies or active treatment of depression to reduce the rate of cognitive decline. Most studies have major limitations including the evaluation of only single-risk-factor interventions, the observational designs and the inadequate measurement of cognition. An optimal early intervention strategy might be to target multiple risk factors within relevant experimental or health service frameworks. Early identification and multifaceted reduction of vascular risk factors, active management of depression, engagement in cognitive activity and physical exercise and promotion of better nutrition might together help to slow some forms of cognitive decline or progression to dementia. This health services approach now requires systematic evaluation.
Publisher: CMA Joule Inc.
Date: 11-2014
DOI: 10.1503/JPN.130280
Publisher: SAGE Publications
Date: 28-08-2023
DOI: 10.1177/00048674231195555
Abstract: To evaluate the potential impact of the recently announced ‘Safeguards’ initiative on mental health-related emergency department presentation rates for children and adolescents (0−17 years). This state-funded initiative aims to establish 25 Child and Adolescent Acute Response Teams across New South Wales. We estimated the effects of the ‘Safeguards’ initiative using a state-level dynamic model of child and adolescent acute mental health care. Potential reductions in total numbers of mental health-related emergency department presentations and re-presentations (i.e. presentations within 3 months of an initial presentation) were assessed via a series of simulation experiments in which we systematically varied the total number of Child and Adolescent Acute Response Teams and the mean duration of care per patient. Assuming a mean treatment duration of 6 weeks per patient, 25 Child and Adolescent Acute Response Teams are projected to reduce total numbers of mental health-related emergency department presentations and re-presentations over the period 2022–2031 by 15.0% (95% interval, 12.0−18.2%) and 31.7% (26.2−37.8%), respectively. Increasing the total number of Child and Adolescent Acute Response Teams above 25 has minimal additional impact on projected reductions in numbers of emergency department presentations and re-presentations, provided the mean duration of care is no more than 8 weeks. However, where the mean duration of care is greater than 4 weeks, a decrease in the number of Child and Adolescent Acute Response Teams below 25 reduces the potential effectiveness of the ‘Safeguards’ initiative significantly. Our simulation results indicate that full and timely implementation will be critical if the potentially substantial impact of the ‘Safeguards’ initiative on demand for hospital-based emergency mental health care is to be realised.
Publisher: Wiley
Date: 05-06-2013
DOI: 10.1111/J.1751-7893.2012.00366.X
Abstract: The study aims to apply clinical staging to young people who present for mental health care to describe the demographic features, patterns of psychological symptoms, disability correlates and clinical stages of those young people and to report longitudinal estimates of progression from less to more severe stages. The study uses cross-sectional and longitudinal assessments of young people managed in specialized youth clinics. On the basis of clinical records, subjects were assigned to a specific clinical 'stage' (i.e. 'help-seeking', 'attenuated syndrome', 'discrete disorder' or 'persistent or recurrent illness'). Young people (n = 209, mean age = 19.9 years (range = 12-30 years), 48% female) were selected from a broader cohort of n = 1483 subjects. Ten percent were assigned to the earliest 'help-seeking' stage, 54% to the 'attenuated syndrome' stage, 25% to the 'discrete disorder' stage and 11% to the later 'persistent or recurrent illness' stage. The interrater reliability of independent ratings at baseline was acceptable (κ = 0.71). Subjects assigned to the 'attenuated syndrome' stage reported symptom and disability scores that were similar to those assigned to later stages. Longitudinally (median = 48 weeks), transition to later clinical stages were 11% of the 'help-seeking', 19% of the 'attenuated syndrome' and 33% of the 'discrete disorder' groups. Among young people presenting for mental health care, most are clinically staged as having 'attenuated syndromes'. Despite access to specialized treatment, a significant number progress to more severe or persistent disorders.
Publisher: JMIR Publications Inc.
Date: 10-09-2018
DOI: 10.2196/JMIR.9966
Publisher: Public Library of Science (PLoS)
Date: 18-11-2014
Publisher: Public Library of Science (PLoS)
Date: 25-02-2014
Publisher: BMJ
Date: 02-2023
DOI: 10.1136/BMJOPEN-2022-064682
Abstract: Metformin is a medication likely to improve measures of cardiometabolic disturbance in young people with mental illness. Evidence also suggests metformin may improve depressive symptoms. This 52-week double-blind randomised control trial (RCT) aims to investigate the efficacy of metformin pharmacotherapy as an adjunct to a healthy lifestyle behavioural intervention in improving cardiometabolic outcomes, and depressive, anxiety and psychotic symptoms in youth with clinically diagnosed major mood syndromes. At least 266 young people aged 16–25 presenting for mental healthcare for major mood syndromes who are also at risk for poor cardiometabolic outcomes will be invited to participate in this study. All participants will engage in a 12-week sleep–wake, activity and metabolically focused behavioural intervention programme. As an adjunctive intervention, participants will receive either metformin (500–1000 mg) or placebo pharmacotherapy for 52 weeks. Participants will undergo a series of assessments including: (1) self-report and clinician-administered assessments (2) blood tests (3) anthropometric assessments (height, weight, waist circumference and blood pressure) and (4) actigraphy. Univariate and multivariate tests (generalised mixed-effects models) will be used to examine changes in primary and secondary outcomes (and associations with predetermined predictor variables). This study has been approved by the Sydney Local Health District Research Ethics and Governance Office (X22-0017). The results of this double-blind RCT will be disseminated into the scientific and broader community through peer-reviewed journals, conference presentations, social media and university websites. Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12619001559101p, 12 November 2019.
Publisher: AMPCo
Date: 07-2001
DOI: 10.5694/J.1326-5377.2001.TB143784.X
Abstract: To develop and validate a self-report screening tool for common mental disorders. Sequential development and validation studies in three cohorts of patients in general practice and one cohort of patients in a specialist psychiatry clinic. 1585 patients in general practice examined cross-sectionally and longitudinally 46515 patients attending 386 general practitioners nationwide 364 patients participating in a longitudinal study of psychiatric disorders in general practice and 522 patients attending a specialist psychiatry clinic. Performance of the 12 items from the 34-item SPHERE questionnaire against DSM-III-R and DSM-IV diagnoses of psychiatric disorder, self-reported Brief Disability Questionnaire findings, GPs' ratings of patients' needs for psychological care and degree of risk resulting from mental disorder, and patients' and GPs' reports of reasons for presentation. Six somatic and six psychological questions identify two levels (and three types) of mental disorder: patients reporting both characteristic psychological and somatic symptoms (Level 1, Type 1), and patients reporting either psychological symptoms (Level 2, Type 2) or somatic symptoms (Level 2, Type 3). This classification system predicts disability ratings (Level 1, 8.2 "days out of role in the last month" and Level 2, 4.1 and 5.4 "days out of role in the last month" for Types 2 and 3, respectively), rates of lifetime psychiatric diagnoses (Level 1, 63% and Level 2, 59% and 48%, respectively), both patients' and GPs' report of reasons for presentation, and doctors' ratings of risk as a result of mental disorder. There are important and differing sociodemographic correlates for the three types of mental disorders. A classification system based on the 12 items from the 34-item SPHERE questionnaire can be used to identify common mental disorders. This system has acceptable validity and reliability, and is suited specifically for general practice settings.
Publisher: JMIR Publications Inc.
Date: 28-05-2018
DOI: 10.2196/JMIR.9716
Publisher: JMIR Publications Inc.
Date: 25-09-2020
Abstract: he demand for mental health services is projected to rapidly increase as a direct and indirect result of the COVID-19 pandemic. Given that young people are disproportionately disadvantaged by mental illness and will face further challenges related to the COVID-19 pandemic, it is crucial to deliver appropriate mental health care to young people as early as possible. Integrating digital health solutions into mental health service delivery pathways has the potential to greatly increase efficiencies, enabling the provision of “right care, first time.” We propose an innovative digital health solution for demand management intended for use by primary youth mental health services, comprised of (1) a youth mental health model of care (ie, the Brain and Mind Centre Youth Model) and (2) a health information technology specifically designed to deliver this model of care (eg, the InnoWell Platform). We also propose an operational protocol of how this solution could be applied to primary youth mental health service delivery processes. By “flipping” the conventional service delivery models of majority in-clinic and minority web-delivered care to a model where web-delivered care is the default, this digital health solution offers a scalable way of delivering quality youth mental health care both in response to public health crises (such as the COVID-19 pandemic) and on an ongoing basis in the future.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-05-2012
Abstract: Prolonged and disabling fatigue is prevalent after cancer treatment, but the early natural history of cancer-related fatigue (CRF) has not been systematically examined to document consistent presence of symptoms. Hence, relationships to cancer, surgery, and adjuvant therapy are unclear. A prospective cohort study of women receiving adjuvant treatment for early-stage breast cancer was conducted. Women (n = 218) were enrolled after surgery and observed at end treatment and at 1, 3, 6, 9, and 12 months as well as 5 years. Structured interviews and self-report questionnaires were used to record physical and psychologic health as well as disability and health care utilization. Patients with CRF persisting for 6 months were assessed to exclude alternative medical and psychiatric causes of fatigue. Predictors of persistent fatigue, mood disturbance, and health care utilization were sought by logistic regression. The case rate for CRF was 24% (n = 51) postsurgery and 31% (n = 69) at end of treatment it became persistent in 11% (n = 24) at 6 months and 6% (n = 12) at 12 months. At each time point, approximately one third of the patients had comorbid mood disturbance. Persistent CRF was predicted by tumor size but not demographic, psychologic, surgical, or hematologic parameters. CRF was associated with significant disability and health care utilization. CRF is common but generally runs a self-limiting course. Much of the previously reported high rates of persistent CRF may be attributable to factors unrelated to the cancer or its treatment.
Publisher: JMIR Publications Inc.
Date: 10-2020
Abstract: ustralia’s mental health care system has long been fragmented and under-resourced, with services falling well short of demand. In response, the World Economic Forum has recently called for the rapid deployment of smarter, digitally enhanced health services to facilitate effective care coordination and address issues of demand. The University of Sydney’s Brain and Mind Centre (BMC) has developed an innovative digital health solution that incorporates 2 components: a highly personalized and measurement-based (data-driven) model of youth mental health care and a health information technology (HIT) registered on the Australian Register of Therapeutic Goods. Importantly, research into implementation of such solutions considers education and training of clinicians to be essential to adoption and optimization of use in standard clinical practice. The BMC’s Youth Mental Health and Technology Program has subsequently developed a comprehensive education and training program to accompany implementation of the digital health solution. his paper describes the protocol for an evaluation study to assess the effectiveness of the education and training program on the adoption and optimization of use of the digital health solution in service delivery. It also describes the proposed tools to assess the impact of training on knowledge and skills of mental health clinicians. he evaluation study will use the Kirkpatrick Evaluation Model as a framework with 4 levels of analysis: Reaction (to education and training), Learning (knowledge acquired), Behavior (practice change), and Results (client outcomes). Quantitative and qualitative data will be collected using a variety of tools, including evaluation forms, pre- and postknowledge questionnaires, skill development and behavior change scales, as well as a real-time clinical practice audit. his project is funded by philanthropic funding from Future Generation Global. Ethics approval has been granted via Sydney Local Health District’s Human Research Ethics Committee. At the time of this publication, clinicians and their services were being recruited to this study. The first results are expected to be submitted for publication in 2021. he education and training program teaches clinicians the necessary knowledge and skills to assess, monitor, and manage complex needs mood and psychotic syndromes and trajectories of youth mental ill-health using a HIT that facilitates a highly personalized and measurement-based model of care. The digital health solution may therefore guide clinicians to help young people recover low functioning associated with subthreshold diagnostic presentations and prevent progression to more serious mental ill-health. RR1-10.2196/24697
Publisher: Springer Science and Business Media LLC
Date: 08-02-2014
Publisher: AMPCo
Date: 07-2001
DOI: 10.5694/J.1326-5377.2001.TB143788.X
Abstract: To determine the variation in prevalence of common mental disorders and general practitioner (GP) responses across Australian general practices, and to identify practice characteristics that predict these rates. Cross-sectional national audit of general practices throughout Australia in 1998-1999. 46515 ambulatory care patients attending 386 GPs. Practice-based prevalence of mental disorders (based on patient-reported symptoms) and GP-reported rates of psychological diagnoses and treatment (median and range, excluding the upper and lower 10% of practices) practice characteristics (patient, doctor and organisational) that predict prevalences and rates, determined by multiple regression analysis. Even after omitting the upper and lower 10% of practices, there were large variations between practices in prevalence of common mental disorders (range, 39% to 59% of patients median, 48%), and substance misuse (range, 3%-13% median, 7%). There were also large variations between practices in rates at which GPs made psychological diagnoses in each practice (range, 12%-51% median, 27%), judged patients to be at risk to self or others (range, 6%-54% median, 23%), provided psychological treatments (range, 8%-41% median, 22%) and referred patients to specialist services (range, 1%-10% median, 4%). Practice-based rates of disorders and GP responses were predicted not only by sociodemographic characteristics of patients in each practice (eg, mean age or proportion of unemployed people), but also by doctor characteristics (eg, age and sex) and practice organisation characteristics (eg, urban versus regional or rural location). We identified patient, GP and practice characteristics that predict rates of mental disorder and treatments provided. These could be used to guide mental health service reform in general practice and assist with targeting relevant education and practice support programs.
Publisher: Public Library of Science (PLoS)
Date: 17-01-2019
Publisher: Cambridge University Press (CUP)
Date: 30-10-2022
DOI: 10.1017/S0033291720003840
Abstract: Predictors of new-onset bipolar disorder (BD) or psychotic disorder (PD) have been proposed on the basis of retrospective or prospective studies of ‘at-risk’ cohorts. Few studies have compared concurrently or longitudinally factors associated with the onset of BD or PDs in youth presenting to early intervention services. We aimed to identify clinical predictors of the onset of full-threshold (FT) BD or PD in this population. Multi-state Markov modelling was used to assess the relationships between baseline characteristics and the likelihood of the onset of FT BD or PD in youth (aged 12–30) presenting to mental health services. Of 2330 in iduals assessed longitudinally, 4.3% ( n = 100) met criteria for new-onset FT BD and 2.2% ( n = 51) met criteria for a new-onset FT PD. The emergence of FT BD was associated with older age, lower social and occupational functioning, mania-like experiences (MLE), suicide attempts, reduced incidence of physical illness, childhood-onset depression, and childhood-onset anxiety. The emergence of a PD was associated with older age, male sex, psychosis-like experiences (PLE), suicide attempts, stimulant use, and childhood-onset depression. Identifying risk factors for the onset of either BD or PDs in young people presenting to early intervention services is assisted not only by the increased focus on MLE and PLE, but also by recognising the predictive significance of poorer social function, childhood-onset anxiety and mood disorders, and suicide attempts prior to the time of entry to services. Secondary prevention may be enhanced by greater attention to those risk factors that are modifiable or shared by both illness trajectories.
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/BMJOPEN-2019-030985
Abstract: The Brain and Mind Centre (BMC) Optymise cohort assesses multiple clinical and functional domains longitudinally in young people presenting for mental health care and treatment. Longitudinal tracking of this cohort will allow investigation of the relationships between multiple outcome domains across the course of care. Subsets of Optymise have completed detailed neuropsychological and neurobiological assessments, permitting investigation of associations between these measures and longitudinal course. Young people (aged 12–30) presenting to clinics coordinated by the BMC were recruited to a research register (n=6743) progressively between June 2008 and July 2018. To date, 2767 in iduals have been included in Optymise based on the availability of at least one detailed clinical assessment. Trained researchers use a clinical research proforma to extract key data from clinical files to detail social and occupational functioning, clinical presentation, self-harm and suicidal thoughts and behaviours, alcohol and other substance use, physical health comorbidities, personal and family history of mental illness, and treatment utilisation at the following time points: baseline, 3, 6, 12, 24, 36, 48, and 60 months, and time last seen. There is moderate to substantial agreement between raters for data collected via the proforma. While wide variations in in idual illness course are clear, social and occupational outcomes suggest that the majority of cohort members show no improvement in functioning over time. Differential rates of longitudinal transition are reported between early and late stages of illness, with a number of baseline factors associated with these transitions. Furthermore, there are longitudinal associations between prior suicide attempts and inferior clinical and functional outcomes. Future reports will detail the longitudinal course of each outcome domain and examine multidirectional relationships between these domains both cross-sectionally and longitudinally, and explore in subsets the associations between detailed neurobiological measures and clinical, social and functional outcomes.
Publisher: Wiley
Date: 11-05-2020
DOI: 10.1002/WPS.20745
Publisher: Royal College of Psychiatrists
Date: 24-04-2023
DOI: 10.1192/BJO.2023.43
Abstract: Understanding premature mortality risk from suicide and other causes in youth mental health cohorts is essential for delivering effective clinical interventions and secondary prevention strategies. To establish premature mortality risk in young people accessing early intervention mental health services and identify predictors of mortality. State-wide data registers of emergency departments, hospital admissions and mortality were linked to the Brain and Mind Research Register, a longitudinal cohort of 7081 young people accessing early intervention care, between 2008 and 2020. Outcomes were mortality rates and age-standardised mortality ratios (SMR). Cox regression was used to identify predictors of all-cause mortality and deaths due to suicide or accident. There were 60 deaths (male 63.3%) during the study period, 25 (42%) due to suicide, 19 (32%) from accident or injury and eight (13.3%) where cause was under investigation. All-cause SMR was 2.0 (95% CI 1.6–2.6) but higher for males (5.3, 95% CI 3.8–7.0). The mortality rate from suicide and accidental deaths was 101.56 per 100 000 person-years. Poisoning, whether intentional or accidental, was the single greatest primary cause of death (26.7%). Prior emergency department presentation for poisoning (hazard ratio (HR) 4.40, 95% CI 2.13–9.09) and psychiatric admission (HR 4.01, 95% CI 1.81–8.88) were the strongest predictors of mortality. Premature mortality in young people accessing early intervention mental health services is greatly increased relative to population. Prior health service use and method of self-harm are useful predictors of future mortality. Enhanced care pathways following emergency department presentations should not be limited to those reporting suicidal ideation or intent.
Publisher: Elsevier
Date: 2018
Publisher: SAGE Publications
Date: 02-1997
DOI: 10.3109/00048679709073796
Abstract: Objective:To describe the rationale for investigating the dopaminergic system in patients with melancholia by applying molecular biological (notably, in situ hybridisation) and histopathological techniques in postmortem brain tissue. Method:Relevant advances in the functional neuroanatomy of frontostriatal circuits, as well as insights from clinical neuroimaging studies in primary and secondary depressive disorders, are presented. These are integrated with developments in the pharmacological and molecular characteristics of dopamine receptor subtypes and recognition of their selective anatomical distribution. Results:Converging data from the basic and clinical neurosciences suggest that the pathophysiology of depressive disorders characterised by psychomotor phenomena, such as melancholia, may involve dysregulation of dopaminergic mechanisms within complex frontostriatal circuits. Conclusions:The key feature of in situ hybridisation is its capacity to test for variations in the functional components of designated biochemical systems within highly specific anatomical regions. We utilise this approach, in combination with relevant histopathological techniques, to test the structural and functional integrity of the dopaminergic system within key fronto-striatal circuits in patients who had exhibited psychomotor phenomena. The same approach can also be used to study the integrity of other relevant biochemical systems, such as the serotoninergic and noradrenergic systems, in patients with other mood disorders.
Publisher: Springer Science and Business Media LLC
Date: 29-03-2018
DOI: 10.1007/S00406-017-0788-8
Abstract: Fronto-limbic connectivity is compromised in mood disorders, as reflected by impairments in white matter (WM) integrity revealed by diffusion tensor imaging. Although the underlying mechanisms remain unclear, disruption to normal myelination due to oxidative stress is thought to play a key role. We aimed to determine whether fronto-limbic WM integrity is compromised, and associated with in vivo antioxidant levels (indexed by glutathione GSH), in young adults with unipolar depression (DEP) and bipolar (BD) disorders. Ninety-four patients with DEP, 76 with BD and 59 healthy controls (18-30 years) underwent diffusion tensor and proton magnetic resonance spectroscopy imaging. Fractional anisotropy (FA) was calculated from the cingulum bundle (cingulate, hippoc us), fornix, stria terminalis (ST) and uncinate fasciculus tracts. GSH concentration was measured in anterior cingulate cortex (ACC) and hippoc us (HIPP). Compared to controls, DEP showed significantly reduced FA in ST, whereas BD did not significantly differ in FA across the five tracts. There were significant positive correlations between ST-FA and HIPP-GSH across groups. Regression analysis revealed that having DEP or BD and reduced HIPP-GSH were significantly associated with reduced ST-FA. Similarly, decreased ST-FA was associated with poorer neuropsychological performance in conjunction with having DEP. Our findings suggest a structural disconnectivity specific to the limbic region of young adults with DEP. Decreased WM integrity was associated with depleted levels of hippoc al GSH suggesting that this particular disruption may be linked to oxidative stress at early stages of illness. Young adults with BD do not have the same degree of impairment.
Publisher: BMJ
Date: 08-2022
DOI: 10.1136/BMJOPEN-2022-061734
Abstract: The aim of this study was to determine the prevalence of disordered eating in young people attending a headspace centre, an enhanced primary care centre providing early intervention services for mental health disorders for young people aged 12–25 years, in metropolitan Sydney. Cross-sectional assessment of disordered eating symptoms and behaviours. An enhanced primary care youth mental health service in inner urban Sydney, Australia. A sequential cohort of 530 young people aged 14–26 years presenting to headspace C erdown for support with mental health concerns. Participants completed a series of questionnaires online which included items assessing the presence of eating disorder symptoms and behaviours. Over one-third of young people aged 14–26 years presenting to headspace C erdown in a 22-month period reported symptoms of disordered eating. Of these, 32% endorsed overeating behaviours, 25% endorsed dietary restriction and 8% reported purging behaviours. In total, 44% reported engaging in one of more of these behaviours on a regular basis. Almost half reported experiencing significant shape and weight concerns. Eating disorder behaviours were particularly prevalent among female and gender- erse participants (48% of females and 46% of gender- erse participants compared with 35% of males) and overall scores across all of the eating disorder and body image items assessed were significantly higher for female participants compared with males. Disordered eating behaviours and symptoms are common among those presenting to youth mental health primary care services. Proactive screening for these behaviours presents opportunities for early detection and specific interventions. ACTRN12618001676202 Results.
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.SCHRES.2013.06.006
Abstract: Previous research has suggested that psychotic symptoms are associated with impairments in social cognition. However, there is limited research evaluating this association in the context of younger patients with a broad range of mental health problems. In the present study, we evaluated social cognitive performance in 115 treatment-seeking participants who presented to a youth mental health service with affective or psychotic disturbances. Participants completed symptom severity measures, a social cognition task (the Reading the Mind in the Eyes Test (RMET)), and a standardised battery of neuropsychological tests. Analyses based on diagnostic groups showed that patients with psychotic illnesses (n=23) showed impaired performance on the RMET compared to patients with primarily bipolar (n=40) and depressive illnesses (n=52). Performance on the RMET was negatively correlated with positive and negative psychotic symptoms, but not affective and anxiety symptoms. Performance on the RMET also was the strongest concurrent predictor of positive psychotic symptoms in a regression model that also included predicted intelligence, demographic variables, and neurocognition. RMET performance did not, however, predict negative symptoms above tests of sustained attention and verbal learning, nor was performance associated with any other symptoms of mental illness. Social cognitive impairments may provide a valuable marker for the presence of positive psychotic symptoms in young people with mental illness. Additionally, these impairments may have a role in the aetiology and maintenance of psychotic symptoms. Research is now needed to establish the nature of the relationship between social cognition and psychotic symptoms across different facets of social cognition. Research is also needed to investigate whether targeted social cognition treatments reduce risk for the development of positive psychotic symptoms.
Publisher: CSIRO Publishing
Date: 24-06-2021
DOI: 10.1071/AH20233
Abstract: This paper presents a case study of an innovative direct-to-consumer preclinic triage system designed to reduce predicted peak demand for Australian mental health services as a result of COVID-19 and its associated socioeconomic consequences by guiding Australians to the right mental health care first time. Our innovative, digital health solution comprises two components: (1) a highly personalised and measurement-based model of care (Brain and Mind Centre model of care) that considers both the heterogeneity of mental disorders and other underlying comorbidities, as well as clinical staging and (2) a health information technology (i.e. the InnoWell Platform). This digital health solution has been embedded as part of standard service delivery into a community-based intake service, thus resulting in a redesigned service model. The service model is currently being implemented as part of a pilot feasibility study, the marker of acceptability at the health professional and service level, and is now under active evaluation to determine its effect on outcomes for consumers, health professionals and the service. For the purposes of this paper, this model served as a prototype for the preclinic triage system that was conceptualised for national scalability at the primary health network level. When implemented at a national level, our direct-to-consumer preclinic triage system is expected to be an effective population health demand management strategy to address the rapidly emerging mental health demand crisis in Australia, and is aligned with the recent recommendation from the Productivity Commission to develop a sustainable national digital platform to facilitate the assessment and referral process to ensure access to mental health care matched to an in idual’s level of need. What is known about the topic? Although there is increased recognition of the mental health demand crisis in Australia as a result of the COVID-19 pandemic, little has been done to ‘flatten’ the curve. The Australian Government committed additional funding to support the Better Access Pandemic Support measure however, this approach to care fails to appreciate both the disparities in service availability across Australia and the gap fees that are prohibitive to some of those seeking help. Furthermore, the expansion of this program may only result in those in care remaining in care, thus further delaying access to those in need. What does this paper add? This paper describes a digital health solution, comprised of a highly personalised and measurement-based model of care coupled with a health information technology, that has been embedded as part of standard service delivery. Consumers seeking mental health care complete a multidimensional self-report assessment via the technology, the results of which are available in real-time and used to facilitate triage to pathways of care as indicated by the severity of the consumer’s illness and level of need to more effectively and efficiently allocate consumers to care. The redesigned service model is now under active evaluation to determine its effects on outcomes at consumer, health professional and service levels. What are the implications for practitioners? The redesigned local service model served as a prototype for our innovative direct-to-consumer preclinic triage system specifically designed to allocate consumers to self-management, ambulatory care or acute care based on clinical stage and level of need. It is our hypothesis that the preclinic triage system will be an effective population health demand management strategy. Importantly, the proposed preclinic triage system aligns with the recent recommendation from the Productivity Commission for the Australian Government to fund the development and sustained implementation of a digital platform to facilitate assessment and referral to evidence-based interventions matched to a consumer’s level of need.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.SCHRES.2015.06.005
Abstract: Schizophrenia is associated with significant impairments in both higher and lower order social cognitive performance and these impairments contribute to poor social functioning. People with schizophrenia report poor social functioning to be one of their greatest unmet treatment needs. Recent studies have suggested the potential of oxytocin as such a treatment, but mixed results render it uncertain what aspects of social cognition are improved by oxytocin and, subsequently, how oxytocin might best be applied as a therapeutic. The aim of this study was to determine whether a single dose of oxytocin improved higher-order and lower-order social cognition performance for patients with schizophrenia across a well-established battery of social cognition tests. Twenty-one male patients received both a single dose of oxytocin nasal spray (24IU) and a placebo, two weeks apart in a randomized within-subjects placebo controlled design. Following each administration, participants completed the social cognition tasks, as well as a test of general neurocognition. Results revealed that oxytocin particularly enhanced performance on higher order social cognition tasks, with no effects on general neurocognition. Results for in idual tasks showed most improvement on tests measuring appreciation of indirect hints and recognition of social faux pas. These results suggest that oxytocin, if combined to enhance social cognition learning, may be beneficial when targeted at higher order social cognition domains. This study also suggests that these higher order tasks, which assess social cognitive processing in a social communication context, may provide useful markers of response to oxytocin in schizophrenia.
Publisher: Wiley
Date: 17-02-2022
DOI: 10.5694/MJA2.51425
Publisher: Springer Science and Business Media LLC
Date: 09-10-2018
DOI: 10.1038/S41398-018-0255-Y
Abstract: Abnormalities in circadian rhythms have been reported in people with mood disorders, but these abnormalities are marked by considerable inter-in idual variability. This study aimed to identify pathophysiological subgroups on the basis of circadian markers and evaluate how these subgroups relate to psychiatric profiles. Thirty-five young adults (18–31 years old) receiving clinical care for unipolar depressive disorders and 15 healthy controls took part to this study. The Hamilton Rating Scale for Depression and the Young Mania rating scale were used to evaluate the severity of mood symptoms in participants with depressive disorders. All participant underwent ambulatory sleep monitoring with actigraphy for about 12 days before attending a laboratory-based chronobiological assessment which included repeated salivary s les to determine dim light melatonin onset (DLMO) and continuous core body temperature (CBT) monitoring using an ingestible temperature sensor. Cluster analyses were conducted across all participants to identify subgroups with consistent circadian timing profiles based on DLMO and the nocturnal minima of CBT. Two clusters were identified: ‘delayed’ and ‘conventional timing’ circadian phase. Descriptive analyses showed that the delayed cluster was characterised by abnormal time relationships between circadian phase markers and the sleep–wake cycle. Importantly, in iduals from the delayed cluster had worse depression severity ( t (28) = −2.7, p = 0.011) and hypomanic symptoms ( Z = −2.2, p = 0.041) than their peers with conventional circadian timing. These findings suggest that delayed and disorganised circadian rhythms may be linked to worse psychiatric profiles in young people with depressive disorders.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Elsevier BV
Date: 2021
Publisher: Wiley
Date: 22-01-2023
DOI: 10.1111/EIP.13381
Abstract: This retrospective cohort study aimed to identify the cardiometabolic characteristics, cross‐sectionally and longitudinally, associated with clinical stage in youth accessing early intervention mental health services. Cardiometabolic data we collected in 511 young people (aged 12–25 years at entry) receiving mental health care at the early intervention services in Sydney, Australia. The majority of young people ( N = 448, 87.67%) were classified in stage 1a or 1b at entry. At entry to care, there was no cross‐sectional relationship between clinical stage and age, gender, fasting insulin, fasting glucose, updated homeostatic model assessment for insulin resistance (HOMA2‐IR) score, BMI or waist circumference. Of the 111 (21.7%) young people initially classified at stage 1a (‘non‐specific symptoms’) and the 337 (65.9%) classified in stage 1b (‘attenuated syndromes’), 40 in iduals transitioned to stage 2+ (7.8%) (“full‐threshold disorders”) longitudinally. No cardiometabolic factors predicted clinical stage transitions. However, those with an increase in BMI over the course of care ( n = 54) were 1.46 (OR 95% CI: 1.02–2.17) times more likely to progress to stage 2+ at follow up. Whilst no relationships were found between demographic or cardiometabolic variables and clinical stage at entry to care, an increased BMI over time was associated with clinical stage transition longitudinally. Further longitudinal research is needed to understand the demographic, clinical, illness progression or treatment factors associated with changes in cardiometabolic status.
Publisher: Wiley
Date: 17-05-2023
DOI: 10.1111/HEX.13777
Abstract: Despite increasing support for stakeholder inclusion in research, there is limited evaluative research to guide safe (i.e., youth‐friendly) and meaningful (i.e., non‐tokenistic) partnerships with young people with lived experience of mental ill‐health in research. This paper describes a pilot evaluation and iterative design of a Youth Lived Experience Working Group (LEWG) protocol that was established by the Youth Mental Health and Technology team at The University of Sydney's Brain and Mind Centre, based on the results of two studies. Study one consisted of a pilot evaluation of the extent to which youth partners felt empowered to contribute, to qualitatively explore how LEWG processes could be improved. Youth partners completed online surveys, and results were shared over two LEWG meetings in 2021 to empower youth partners to collectively identify actions of positive change regarding LEWG processes. These meetings were audio‐recorded and transcripts were subsequently coded using thematic analysis. Study two assessed whether LEWG processes and proposed improvements were acceptable and feasible from the perspective of academic researchers via an online survey in 2022. Quantitative and qualitative data collected from nine youth partners and 42 academic researchers uncovered initial learnings regarding facilitators, motivators, and barriers to partnering with young people with lived experience in research. Implementing clear processes for youth partners and academic researchers on effective partnership strategies, providing training opportunities for youth partners to develop research skills, and providing regular updates on how youth partner contributions led to research outcomes were identified as key facilitators. This pilot study provides insight into a growing international field on how to optimise participatory processes so that researchers and young people with lived experience can be better supported and engaged to make meaningful contributions to mental health research. We argue that more transparency is needed around participatory research processes so that partnerships with young people with lived experience are not merely tokenistic. Our study has also been approved by and reflects the concepts and priorities of our youth lived experience partners and lived experience researchers, all of whom are authors of this paper.
Publisher: Wiley
Date: 12-2022
DOI: 10.1111/EIP.13260
Abstract: Young people with common mood disorders face the prospect of shortened life expectancy largely due to premature cardiovascular disease. Metabolic dysfunction is a risk factor for premature cardiovascular disease. There is an ongoing debate whether metabolic dysfunction can be simply explained by weight gain secondary to psychotropic medications or whether shared genetic vulnerability, intrinsic immune‐metabolic disturbances or other system perturbations (e.g. dysregulated sympathetic nervous system, circadian dysfunction) are more relevant determinants of premature cardiovascular disease. Thus, we aimed to investigate underlying drivers of metabolic dysfunction and premature cardiovascular disease in young people in the early phases of common mood disorders. We evaluated the relationships between insulin resistance (assessed by HOMA2‐IR) and body mass index (BMI), sex, diagnosis, medication, inflammatory markers and hormonal factors in 327 inpatients with emerging affective and major mood disorders admitted to the Young Adult Mental Health Unit, St Vincent's Private Hospital, Sydney. While HOMA2‐IR scores were positively associated with BMI ( r s = 0.465, p .001), they were also higher in those prescribed mood stabilizers ( p = .044) but were not associated with specific diagnoses, other medication types or the number of prescribed medications. Further, high‐sensitivity C‐reactive protein levels (but not thyroid‐stimulating hormone and ferritin levels) were positively associated with HOMA2‐IR ( r s = 0. 272, p .001) and BMI ( r s = . 409, p .001). In addition to BMI, other non‐specific markers of inflammation are associated with early metabolic dysfunction in young people with emerging affective and major mood disorders.
Publisher: Elsevier BV
Date: 09-1997
DOI: 10.1016/S0006-3223(96)00363-0
Abstract: Different studies have shown the prevalence of high level of social adjustment among English learners with hearing impairment. The objective of the present study was to investigate the effect of peer tutoring as a social adjustment intervention among English learners with hearing impairment in special primary schools in Enugu State, Nigeria. The area of the study was Enugu State. The study adopted a pre-test-post-test quasi experimental research design. The population of the study comprised 30 pupils with language hearing impairment. There was no s ling because the population size was small and manageable. The instrument for data collection was a social adjustment scale with reliability coefficient of 0.88. After the experiment, the experimental group were taught using peer tutoring teaching strategy while the control group were taught with conventional teaching method. Analysis of covariance was used to test the formulated hypotheses at 0.05 level of significance. Results showed that peer tutoring teaching strategy significantly increased social adjustment of pupils with language hearing impairment. Gender did not significantly influence social adjustment of pupils with language hearing impairment. The interaction effect of teaching strategies and gender on social adjustment of pupils with language hearing impairment was not significant. Peer tutoring can be used to alleviate social adjustment problem of pupils with language hearing impairment. The implications of the results for curriculum innovation were highlighted.
Publisher: BMJ
Date: 2013
Publisher: Springer Science and Business Media LLC
Date: 22-03-2013
Publisher: AMPCo
Date: 09-1999
DOI: 10.5694/J.1326-5377.1999.TB123667.X
Abstract: Clinical practice guidelines for psychiatry are now being developed, but important deficits in the evidence base are apparent. For many of the new treatments, clinical decisions can be idiosyncratic or based on limited knowledge. There is a need not only to perform properly constructed trials, but also to make immediate use of less rigorous forms of evidence, such as clinical practice surveys. An ex le is a recent survey of psychiatrists' use of antidepressant drugs. Such surveys are now part of a wider movement towards a more coordinated system of practice-based outcome assessment.
Publisher: JMIR Publications Inc.
Date: 27-09-2022
Abstract: ighly personalized care is substantially improved by technology platforms that assess and track patient outcomes. However, evidence regarding how to successfully implement technology in real-world mental health settings is limited. his study aimed to naturalistically monitor how a health information technology (HIT) platform was used within 2 real-world mental health service settings to gain practical insights into how HIT can be implemented and sustained to improve mental health service delivery. n HIT (The Innowell Platform) was naturally implemented in 2 youth mental health services in Sydney, Australia. Web-based surveys (n=19) and implementation logs were used to investigate staff attitudes toward technology before and after implementation. Descriptive statistics were used to track staff attitudes over time, whereas qualitative thematic analysis was used to explore implementation log data to gain practical insights into useful implementation strategies in real-world settings. fter the implementation, the staff were nearly 3 times more likely to agree that the HIT would i improve care for their clients /i (3/12, 25% agreed before the implementation compared with 7/10, 70% after the implementation). Despite this, there was also an increase in the number of staff who disagreed that the HIT would improve care (from 1/12, 8% to 2/10, 20%). There was also decreased uncertainty (from 6/12, 50% to 3/10, 30%) about the willingness of the service to i implement the technology for its intended purpose /i , with similar increases in the number of staff who agreed and disagreed with this statement. Staff were more likely to be uncertain about whether i colleagues in my service are receptive to changes in clinical processes /i ( i not sure /i rose from 5/12, 42% to 7/10, 70%). They were also more likely to report that their service i already provides the best mental health care /i (agreement rose from 7/12, 58% to 8/10, 80%). After the implementation, a greater proportion of participants reported that the HIT enabled shared or collaborative decision-making with young people (2/10, 20%, compared with 1/12, 8%), enabled clients to proactively work on their mental health care through digital technologies (3/10, 30%, compared with 2/12, 16%), and improved their response to suicidal risk (4/10, 40% compared with 3/12, 25%). his study raises important questions about why clinicians, who have the same training and support in using technology, develop more polarized opinions on its usefulness after implementation. It seems that the uptake of HIT is heavily influenced by a clinician’s underlying beliefs and attitudes toward clinical practice in general as well as the role of technology, rather than their knowledge or the ease of use of the HIT in question.
Publisher: Springer Science and Business Media LLC
Date: 09-09-2016
Publisher: AMPCo
Date: 07-2001
Publisher: Frontiers Media SA
Date: 27-08-2021
DOI: 10.3389/FPUBH.2021.621862
Abstract: Most mental disorders emerge before the age of 25 years and, if left untreated, have the potential to lead to considerable lifetime burden of disease. Many services struggle to manage high demand and have difficulty matching in iduals to timely interventions due to the heterogeneity of disorders. The technological implementation of clinical staging for youth mental health may assist the early detection and treatment of mental disorders. We describe the development of a theory-based automated protocol to facilitate the initial clinical staging process, its intended use, and strategies for protocol validation and refinement. The automated clinical staging protocol leverages the clinical validation and evidence base of the staging model to improve its standardization, scalability, and utility by deploying it using Health Information Technologies (HIT). Its use has the potential to enhance clinical decision-making and transform existing care pathways, but further validation and evaluation of the tool in real-world settings is needed.
Publisher: Royal College of Psychiatrists
Date: 22-02-2021
DOI: 10.1192/BJO.2021.14
Abstract: The schizophrenia polygenic risk score (SCZ-PRS) is an emerging tool in psychiatry. We aimed to evaluate the utility of SCZ-PRS in a young, transdiagnostic, clinical cohort. SCZ-PRSs were calculated for young people who presented to early-intervention youth mental health clinics, including 158 patients of European ancestry, 113 of whom had longitudinal outcome data. We examined associations between SCZ-PRS and diagnosis, clinical stage and functioning at initial assessment, and new-onset psychotic disorder, clinical stage transition and functional course over time in contact with services. Compared with a control group, patients had elevated PRSs for schizophrenia, bipolar disorder and depression, but not for any non-psychiatric phenotype (for ex le cardiovascular disease). Higher SCZ-PRSs were elevated in participants with psychotic, bipolar, depressive, anxiety and other disorders. At initial assessment, overall SCZ-PRSs were associated with psychotic disorder (odds ratio (OR) per s.d. increase in SCZ-PRS was 1.68, 95% CI 1.08–2.59, P = 0.020), but not assignment as clinical stage 2+ (i.e. discrete, persistent or recurrent disorder) (OR = 0.90, 95% CI 0.64–1.26, P = 0.53) or functioning ( R = 0.03, P = 0.76). Longitudinally, overall SCZ-PRSs were not significantly associated with new-onset psychotic disorder (OR = 0.84, 95% CI 0.34–2.03, P = 0.69), clinical stage transition (OR = 1.02, 95% CI 0.70–1.48, P = 0.92) or persistent functional impairment (OR = 0.84, 95% CI 0.52–1.38, P = 0.50). In this preliminary study, SCZ-PRSs were associated with psychotic disorder at initial assessment in a young, transdiagnostic, clinical cohort accessing early-intervention services. Larger clinical studies are needed to further evaluate the clinical utility of SCZ-PRSs, especially among in iduals with high SCZ-PRS burden.
Publisher: Wiley
Date: 11-2009
DOI: 10.1111/J.1445-5994.2009.02016.X
Abstract: Depression is the leading cause of non-fatal disease burden in Australia. Recently, increasing public recognition, together with the development of more integrated medical and psychological healthcare services has resulted in significant improvements. New pathophysiological models incorporate structural brain changes with established changes in neurotransmitter function. Further, recognition of predisposing factors and the salience of differential ages of onset have led to more pragmatic diagnostic systems. There is an ongoing need to promote early recognition, better information to inform treatment choices and more comprehensive treatment programmes that incorporate behavioural and lifestyle factors in addition to the wide range of pharmacological therapies that are now available.
Publisher: AMPCo
Date: 02-2002
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.PSYCHRES.2018.12.002
Abstract: The utility of key phenotypes of depression in predicting response to repetitive transcranial magnetic stimulation (rTMS), namely sleep-wake behaviour, cognition and illness chronicity, has been understudied and not been extended to young s les. This study aimed to determine whether sleep-wake disturbance, cognition or depression chronicity are associated with rTMS outcome in young depressed adults. Sixteen depressed young adults diagnosed with mood disorders (aged 18-29 years) completed this open-label study. Neuronavigationally targeted high-frequency rTMS was administered at 110% of motor threshold on the left dorsolateral prefrontal cortex for 20 sessions over 4 weeks. Clinical, sleep-wake and cognitive assessments were undertaken pre- and post-treatment. Repeated-measures and correlational analyses determined pre- and post-treatment changes and predictors of treatment outcome. rTMS significantly reduced depression and anxiety. Better cognitive flexibility, verbal learning, later age of onset and greater number of depressive episodes were associated with better treatment outcome. There were no other significant/trend-level associations. rTMS had no effect on sleep-wake or cognitive measures. We provide the first evidence for the utility of cognitive flexibility and verbal learning in predicting rTMS outcome in depressed young adults. This research provides preliminary support for rTMS as an early intervention for depression and supports the need for sham-controlled trials.
Publisher: Cambridge University Press (CUP)
Date: 04-01-2011
DOI: 10.1017/S1355617710001566
Abstract: Early stages of affective or psychotic disorders may be accompanied by neuropsychological changes that help to predict risk of developing more severe disorders. A comprehensive set of neuropsychological measures was collected in 109 help-seeking young people (16 to 30 years 54 females), recently diagnosed with an affective or psychotic disorder and presenting with current depression. Hierarchical cluster analysis determined three clusters: one deemed to have a “poor memory” profile ( n = 40) another with a “poor mental flexibility” profile ( n = 38) and a third with widespread difficulties plus “impaired attention and memory” ( n = 31). In general, the three clusters were comparable in demographic, functional and clinical factors suggesting some unique role for neurocognitive impairments. A discriminant function analysis confirmed that the clusters were best characterized by performance in “attentional” versus “learning/memory” measures. Furthermore, profiles of independent neuropsychological variables validated the original solution for two of the clusters, distinguishing all cluster-groups on an attentional measure. The findings of this study suggest that despite presenting with very similar levels of current depressive symptomatology, young help-seeking in iduals in the early stages of illness have underlying neuropsychological heterogeneity. Distinct neuropsychological profiling may help to predict later psychiatric outcomes and enhance in idually-tailored early intervention strategies. ( JINS , 2011, 17 , 267–276)
Publisher: BMJ
Date: 12-2014
Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.JAD.2009.06.028
Abstract: Neuropsychological deficits in depression include difficulties with psychomotor speed, executive functions and memory. Some of these changes persist despite antidepressant treatment. While research in other areas of psychiatry has shown cognitive training techniques to be effective, only one study has evaluated this approach in depression. Sixteen patients (mean age=33.5years) with a lifetime diagnosis of major depressive disorder were administered a standardised battery of neuropsychological tests and allocated to treatment (n=8) or waitlist control (n=8) conditions. The treatment consisted of 10-weeks of twice weekly cognitive training using the Neuropsychological Educational Approach to Remediation. All participants were re-assessed after 10-weeks by interviewers blinded to group allocation. Participants in the treatment condition demonstrated greater improvements on tests of memory encoding and memory retention than the waitlist control group. There were no observable benefits in terms of psychomotor speed or executive functions or in self-reported levels of disability. Affective symptoms also remained stable. This study included a small s le of participants and treatment allocation was not randomised. Cognitive training in affective disorders improves memory performance. It may be an effective non-pharmacological treatment option for improving cognitive functions, which in turn, may improve psychosocial functioning and reduce disability. This study supports theories suggesting cognitive training may promote neuroplasticity.
Publisher: Elsevier BV
Date: 12-2007
Publisher: Frontiers Media SA
Date: 23-08-2019
Publisher: Public Library of Science (PLoS)
Date: 19-03-2013
Publisher: Wiley
Date: 17-07-2022
DOI: 10.5694/MJA2.51653
Publisher: Springer Science and Business Media LLC
Date: 14-05-2013
Publisher: BMJ
Date: 27-03-2015
Publisher: JMIR Publications Inc.
Date: 02-08-2019
DOI: 10.2196/14127
Abstract: The Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help a online physical and mental health self-report assessment a results dashboard a booking and videoconferencing system and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers have weaker social support networks and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically erse populations are limited. Having a Spanish version (MHeC-S) of the Mental Health eClinic would greatly benefit these students. We used participatory design methodologies with users (young people aged 16-30 years, supportive others, and health professionals) to (1) conduct workshops with users to co-design and culturally adapt the MHeC (2) inform the development of the MHeC-S alpha prototype (3) test the usability of the MHeC-S alpha prototype (4) translate, culturally adapt, and face-validate the MHeC-S self-report assessment and (5) collect information to inform its beta prototype. A research and development cycle included several participatory design phases: co-design workshops knowledge translation language translation and cultural adaptation and rapid prototyping and user testing of the MHeC-S alpha prototype. We held 2 co-design workshops with 17 users (10 young people, 7 health professionals). A total of 15 participated in the one-on-one user testing sessions (7 young people, 5 health professionals, 3 supportive others). We collected 225 source documents, and thematic analysis resulted in 5 main themes (help-seeking barriers, technology platform, functionality, content, and user interface). A random s le of 106 source documents analyzed by 2 independent raters revealed almost perfect agreement for functionality (kappa=.86 P .001) and content (kappa=.92 P .001) and substantial agreement for the user interface (kappa=.785 P .001). In this random s le, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to getting medical or psychological services, and smartphones were the most-used device to access the internet. Acceptability was adequate for the prototype’s 5 main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system, and personalized well-being plan. The data also revealed gaps in the alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities. Spanish-language apps and e-tools, as well as online mental health information, were lacking. Through a research and development process, we co-designed and culturally adapted, developed and user tested, and evaluated the MHeC-S. By translating and culturally adapting the MHeC to Spanish, we aimed to increase accessibility and availability of e-mental health care in the developing world, and assist vulnerable populations that have migrated to English-speaking countries.
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJOPEN-2019-035379
Abstract: Mental disorders are a leading cause of long-term disability worldwide. Much of the burden of mental ill-health is mediated by early onset, comorbidities with physical health conditions and chronicity of the illnesses. This study aims to track the early period of mental disorders among young people presenting to Australian mental health services to facilitate more streamlined transdiagnostic processes, highly personalised and measurement-based care, secondary prevention and enhanced long-term outcomes. Recruitment to this large-scale, multisite, prospective, transdiagnostic, longitudinal clinical cohort study ( ‘ Youth Mental Health Tracker’) will be offered to all young people between the ages of 12 and 30 years presenting to participating services with proficiency in English and no history of intellectual disability. Young people will be tracked over 3 years with standardised assessments at baseline and 3, 6, 12, 24 and 36 months. Assessments will include self-report and clinician-administered measures, covering five key domains including: (1) social and occupational function (2) self-harm, suicidal thoughts and behaviour (3) alcohol or other substance misuse (4) physical health and (5) illness type, clinical stage and trajectory. Data collection will be facilitated by the use of health information technology. The data will be used to: (1) determine prospectively the course of multidimensional functional outcomes, based on the differential impact of demographics, medication, psychological interventions and other key potentially modifiable moderator variables and (2) map pathophysiological mechanisms and clinical illness trajectories to determine transition rates of young people to more severe illness forms. The study has been reviewed and approved by the Human Research Ethics Committee of the Sydney Local Health District (2019/ETH00469). All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals and scientific conference presentations.
Publisher: Wiley
Date: 07-2001
DOI: 10.5694/J.1326-5377.2001.TB143787.X
Abstract: To determine in patients attending general practice 1) the extent of comorbidity of mental disorders and alcohol or other substance misuse, and consequent disability and 2) GPs' diagnosis and management of patients with comorbidity. Cross-sectional national audit of general practices throughout Australia in 1998-1999. 46 515 ambulatory care patients attending 386 GPs. Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system prevalence of alcohol or other substance misuse--two self-report screening questions, defining "probable" misuse (a positive response to both questions) and "possible" misuse (a positive response to one of the questions) disability--four items from the Brief Disability Questionnaire, and self-reported "days out of role" and "days in bed" in the past month and rates of psychological diagnosis, treatment and referral by GPs, and GPs' rating of patients' psychological risk. Comorbidity of mental disorders and alcohol or other substance misuse disability and correlation with GPs' diagnosis and management. The screening questions revealed possible alcohol or other substance misuse in 11% of patients (5171/46515), and probable misuse in an additional 8% of patients (3593/46515). Comorbidity of mental disorders and substance misuse occurred in 12% (5672/46515) of patients. Patients with comorbidity (compared with those with alcohol or other substance misuse alone) were: more disabled--mean "days out of role in the last month", 8.4 (95% CI, 7.7-9.1) v 3.6 (95% CI, 2.9-4.3) at greater psychological risk (as rated by GPs)--22% v 7%, respectively more frequently given psychological diagnoses by GPs--51% v 21% more frequently treated for a psychological condition by GPs--47% v 17% and more frequently referred to mental health specialists by GPs--9% v 2%. Comorbidity of mental disorders and alcohol or other substance misuse is common in patients attending general practice, and results in considerable disability. Such patients receive inadequate attention (diagnosis and management) from GPs. GPs identifying one of these two types of behaviour disorder in a patient should ascertain whether the other type is also present.
Publisher: Public Library of Science (PLoS)
Date: 04-07-2013
Publisher: Royal College of Psychiatrists
Date: 11-2014
DOI: 10.1192/BJP.BP.113.134262
Abstract: Between 30 and 60% of adults with unipolar or bipolar disorders exhibit impairments across multiple domains. However, little is known about impaired functioning in youth with mood disorders. To examine the prevalence of objective, subjective and observer-rated disability in a large, representative s le of young people with a primary mood disorder. In iduals aged 16–25 years presenting to youth mental health services for the first time with a primary mood disorder participated in a systematic diagnostic and clinical assessment. Impairment was assessed using objective (unemployment or disability payments), observer- (Social and Occupational Functioning Assessment Scale SOFAS) and self-rated measures (role functioning according to the Brief Disability Questionnaire). Of 1241 participants (83% unipolar 56% female), at least 30% were functionally impaired on the objective, self-rated and/or observer-rated measures, with 16% impaired according to all three criteria. Even when current distress levels were taken into account, daily use of cannabis and/or nicotine were significantly associated with impairment, with odds ratios (OR) ranging from about 1.5 to 3.0. Comorbid anxiety disorders were related to lower SOFAS scores (OR = 2–5). Levels of disability were significant, even in those presenting for mental healthcare for the first time. Functional impairment did not differ between unipolar and bipolar cases, but some evidence suggested that females with bipolar disorder were particularly disabled. The prevalence of comorbid disorders (50%) and polysubstance use (28%) and their association with disability indicate that more meaningful indicators of mood episode outcomes should focus on functional rather than symptom-specific measures. The association between functioning and nicotine use requires further exploration.
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-054264
Abstract: Understanding the risk of premature death from suicide, accident and injury and other physical health conditions in people seeking healthcare for mental disorders is essential for delivering targeted clinical interventions and secondary prevention strategies. It is not clear whether morbidity and mortality outcomes in hospital-based adult cohorts are applicable to young people presenting to early-intervention services. The current data linkage project will establish the Brain and Mind Patient Research Register–Mortality and Morbidity (BPRR-M& M) database. The existing Brain and Mind Research Institute Patient Research Register (BPRR) is a cohort of 6743 young people who have accessed primary care-based early-intervention services subsets of the BPRR contain rich longitudinal clinical, neurobiological, social and functional data. The BPRR will be linked with the routinely collected health data from emergency department (ED), hospital admission and mortality databases in New South Wales from January 2010 to November 2020. Mortality will be the primary outcome of interest, while hospital presentations will be a secondary outcome. The established BPRR-M& M database will be used to establish mortality rates and rates of ED presentations and hospital admissions. Survival analysis will determine how time to death or hospital presentation varies by identified social, demographic and clinical variables. Bayesian modelling will be used to identify predictors of these morbidity and mortality outcomes. The study has been reviewed and approved by the human research ethics committee of the Sydney Local Health District (2019/ETH00469). All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals and scientific conference presentations.
Publisher: Public Library of Science (PLoS)
Date: 31-12-2020
DOI: 10.1371/JOURNAL.PONE.0243467
Abstract: A priority for health services is to reduce self-harm in young people. Predicting self-harm is challenging due to their rarity and complexity, however this does not preclude the utility of prediction models to improve decision-making regarding a service response in terms of more detailed assessments and/or intervention. The aim of this study was to predict self-harm within six-months after initial presentation. The study included 1962 young people (12–30 years) presenting to youth mental health services in Australia. Six machine learning algorithms were trained and tested with ten repeats of ten-fold cross-validation. The net benefit of these models were evaluated using decision curve analysis. Out of 1962 young people, 320 (16%) engaged in self-harm in the six months after first assessment and 1642 (84%) did not. The top 25% of young people as ranked by mean predicted probability accounted for 51.6% - 56.2% of all who engaged in self-harm. By the top 50%, this increased to 82.1%-84.4%. Models demonstrated fair overall prediction (AUROCs 0.744–0.755) and calibration which indicates that predicted probabilities were close to the true probabilities (brier scores 0.185–0.196). The net benefit of these models were positive and superior to the ‘treat everyone’ strategy. The strongest predictors were (in ranked order) a history of self-harm, age, social and occupational functioning, sex, bipolar disorder, psychosis-like experiences, treatment with antipsychotics, and a history of suicide ideation. Prediction models for self-harm may have utility to identify a large sub population who would benefit from further assessment and targeted (low intensity) interventions. Such models could enhance health service approaches to identify and reduce self-harm, a considerable source of distress, morbidity, ongoing health care utilisation and mortality.
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.JAD.2018.08.045
Abstract: There is growing evidence to support the need for personalised intervention in the early stages of a major psychiatric illness, as well as the clear delineation of subgroups in psychiatric disorders based on cognitive impairment. Affective disorders are often accompanied by neurocognitive deficits however a lack of research among young adult inpatients highlights the need to assess the utility of cognitive testing in this population. A computerised cognitive battery was administered to 50 current inpatient young adults (16-30 years 75% female) with an affective disorder. Patients also completed a computerised self-report questionnaire (to measure demographics and clinical features) that included items evaluating subjective impressions of their cognition. Hierarchical cluster analysis determined two neurocognitive subgroups: cluster 1 (n = 16) showed more severe impairments in sustained attention and memory as well as higher anxiety levels, compared to their peers in cluster 2 (n = 30) who showed the most impaired attentional switching. Across the s le, poor sustained attention was significantly correlated with higher levels of current anxiety and depressive symptoms, whereas poor verbal memory was significantly associated with increased psychological distress. This study has a relatively small s le size (due to it being a pilot/feasibility study). Furthermore, future studies should aim to assess inpatient s les compared to community care s les, as well as healthy controls, on a larger scale. The findings suggest neurocognitive profiles are important in understanding phenotypes within young people with severe affective disorders. With clear subgroups based on cognitive impairment being demonstrated, the clinical utility and use of new and emerging technologies is warranted in such inpatients facilities. This pilot/feasibility study has strengthened the utility of cognitive screening as standard clinical care in an inpatient unit.
Publisher: Elsevier BV
Date: 06-2015
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.JAD.2010.10.052
Abstract: Although there is growing recognition that disability emerges early in the course of psychotic disorders, it is unclear whether young people with early stages of anxiety or affective disorders are similarly affected. This study examined patient self-reported disability in young people attending a designated early intervention service. Cross-sectional study comparing new headspace patients on self-reported measures of disability and distress (Kessler-10, Work and Social Adjustment Scale, and Brief Disability Questionnaire) with clinician-rated diagnosis and clinical stage. Data from 330 participants with an average age of 16.8 years (50.0% male) was analysed and demonstrated high levels of psychological distress and disability in the overall group. Higher levels of self-reported psychological distress and disability were associated with affective disorder diagnosis and increased with advancing clinical stage. Female gender and younger age also predicted affective disorder diagnosis. Clinician-rated participant disability was obtained via a single global measure (SOFAS) and not a systematic assessment. Additionally, data collected was cross-sectional and collected at intake only. Longitudinal assessment of clinical features and disability is required to map changes in disability over time. Surprisingly high levels of psychological distress and disability are apparent in young people presenting to early intervention services. Data suggests that distress and disability in those with anxiety is less than for affective disorder. Results also suggest that clinical staging approaches capture the increasing disability associated with illness progression. The obtained results highlight the need for interventions that specifically target disability, rather than just symptoms of mental health problems.
Publisher: JMIR Publications Inc.
Date: 26-08-2021
Abstract: lobally, there are fundamental shortcomings in mental health care systems, including restricted access, siloed services, interventions that are poorly matched to service users’ needs, underuse of personal outcome monitoring to track progress, exclusion of family and carers, and suboptimal experiences of care. Health information technologies (HITs) hold great potential to improve these aspects that underpin the enhanced quality of mental health care. roject Synergy aimed to co-design, implement, and evaluate novel HITs, as exemplified by the InnoWell Platform, to work with standard health care organizations. The goals were to deliver improved outcomes for specific populations under focus and support organizations to enact significant system-level reforms. articipating health care organizations included the following: Open Arms–Veterans & Families Counselling (in Sydney and Lismore, New South Wales [NSW]) NSW North Coast headspace centers for youth (Port Macquarie, Coffs Harbour, Grafton, Lismore, and Tweed Heads) the Butterfly Foundation’s National Helpline for eating disorders Kildare Road Medical Centre for enhanced primary care and Connect to Wellbeing North Coast NSW (administered by Neami National), for population-based intake and assessment. Service users, families and carers, health professionals, and administrators of services across Australia were actively engaged in the configuration of the InnoWell Platform to meet service needs, identify barriers to and facilitators of quality mental health care, and highlight potentially the best points in the service pathway to integrate the InnoWell Platform. The locally configured InnoWell Platform was then implemented within the respective services. A mixed methods approach, including surveys, semistructured interviews, and workshops, was used to evaluate the impact of the InnoWell Platform. A participatory systems modeling approach involving co-design with local stakeholders was also undertaken to simulate the likely impact of the platform in combination with other services being considered for implementation within the North Coast Primary Health Network to explore resulting impacts on mental health outcomes, including suicide prevention. espite overwhelming support for integrating digital health solutions into mental health service settings and promising impacts of the platform simulated under idealized implementation conditions, our results emphasized that successful implementation is dependent on health professional and service readiness for change, leadership at the local service level, the appropriateness and responsiveness of the technology for the target end users, and, critically, funding models being available to support implementation. The key places of interoperability of digital solutions and a willingness to use technology to coordinate health care system use were also highlighted. lthough the COVID-19 pandemic has resulted in the widespread acceptance of very basic digital health solutions, Project Synergy highlights the critical need to support equity of access to HITs, provide funding for digital infrastructure and digital mental health care, and actively promote the use of technology-enabled, coordinated systems of care.
Publisher: Springer Science and Business Media LLC
Date: 13-01-2016
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.PSYCHRES.2016.06.025
Abstract: This study investigated the relative contribution of psychiatric symptoms and psychotropic medications on the sleep-wake cycle. Actigraphy and clinical assessments (Brief Psychiatric Rating Scale) were conducted in 146 youths with anxiety, depression or bipolar disorders. Independently of medications, mania symptoms were predictive of lower circadian litude and rhythmicity. Independently of diagnosis and symptoms severity: i) antipsychotics were related to longer sleep period and duration, ii) serotonin-norepinephrine reuptake inhibitors to longer sleep period, and iii) agomelatine to earlier sleep onset. Manic symptoms and different subclasses of medications may have independent influences on the sleep-wake cycle of young people with mental disorders.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.PSCYCHRESNS.2007.01.006
Abstract: [corrected] Selected structural and functional neuroimaging correlates of psychomotor slowing were examined [corrected] in older persons with depression. Clinical, neuropsychological, magnetic resonance imaging (MRI) and single photon emission computerized tomography (SPECT) data were obtained for 32 persons with depression (mean age=55.5) and 17 controls (mean age = 55.4). Psychomotor slowing was measured by simple (SRT) and choice (CRT) reaction times. White matter lesions (WMLs) were visually rated and caudate nucleus regional cerebral blood flow (rCBF) was obtained through the co-registration of MRI and SPECT data. Two SPECT scans were performed (corresponding to the SRT and CRT tasks) and a percentage change score in rCBF (%rCBF) due to the increasing complexity of the second task was calculated. Persons with depression and controls did not differ with respect to %rCBF or frequency of WMLs. In persons with depression, reduced %rCBF was associated with slower CRT. For all subjects, WMLs predicted 14% of the variance in %rCBF. Although CRT was predicted by a combination of older age, WMLs and %rCBF, the diagnosis of depression still predicted a further 25% of the variance. Reduced %rCBF is associated with demonstrable psychomotor slowing and presence of WMLs. While psychomotor slowing is determined in part by subcortical changes, other cortical and illness-dependent factors are likely to be relevant.
Publisher: Elsevier BV
Date: 02-2021
Publisher: CMA Joule Inc.
Date: 2015
DOI: 10.1503/JPN.130247
Publisher: JMIR Publications Inc.
Date: 18-12-2022
Abstract: s the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to an in idual’s risk of illness progression. The application of staging has been traditionally limited to trained clinicians, yet if digital technologies could be leveraged to apply clinical staging, then this could increase the scalability and utility of this model in services.` he aim of this study is to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. he cohort comprised 131 young people, aged between 16 to 25 years, who presented to youth mental health services in Australia for the first time between November 2018 to March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm’s allocation based on a multidimensional self-report questionnaire. f the 131 participants, the mean (SD) age was 20.3 (2.4) years and 94 (71.8%) were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the expert ratings with a substantial interrater agreement (κ=0.67, P .001). The algorithm demonstrated an accuracy of 90.8% (95% CI 85.6 – 95.2%, P=0.03), sensitivity of 80.0%, specificity of 92.8%, and F1-score of 72.7%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to eight participants compared to the experts. These in iduals had significantly milder symptoms of depressive mood (P .001) and anxiety symptoms (P .001) compared to those with concordant stage 1b+ ratings. his novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may be benefit from low-intensity, online or brief interventions. Finding of this study suggests the possibility of redirecting clinical capacity to focus on in iduals in stage 1b+ for further assessment and intervention. >
Publisher: Royal College of Psychiatrists
Date: 09-2023
DOI: 10.1192/BJO.2023.521
Publisher: Wiley
Date: 30-05-2016
DOI: 10.1111/JSR.12413
Abstract: Mood disorders are characterized by disabling symptoms and cognitive difficulties which may vary in intensity throughout the course of the illness. Sleep-wake cycles and circadian rhythms influence emotional regulation and cognitive functions. However, the relationships between the sleep-wake disturbances experienced commonly by people with mood disorders and the longitudinal changes in their clinical and cognitive profile are not well characterized. This study investigated associations between initial sleep-wake patterns and longitudinal changes in mood symptoms and cognitive functions in 50 young people (aged 13-33 years) with depression or bipolar disorder. Data were based on actigraphy monitoring conducted over approximately 2 weeks and clinical and neuropsychological assessment. As part of a longitudinal cohort study, these assessments were repeated after a mean follow-up interval of 18.9 months. No significant differences in longitudinal clinical changes were found between the participants with depression and those with bipolar disorder. Lower sleep efficiency was predictive of longitudinal worsening in manic symptoms (P = 0.007). Shorter total sleep time (P = 0.043) and poorer circadian rhythmicity (P = 0.045) were predictive of worsening in verbal memory. These findings suggest that some sleep-wake and circadian disturbances in young people with mood disorders may be associated with less favourable longitudinal outcomes, notably for subsequent manic symptoms and memory difficulties.
Publisher: AMPCo
Date: 05-2014
DOI: 10.5694/MJA14.00123
Publisher: BMJ
Date: 03-2018
DOI: 10.1136/BMJOPEN-2017-020678
Abstract: Mental disorders typically emerge during adolescence and young adulthood and put young people at risk for prolonged socioeconomic difficulties. This study describes the longitudinal course of social and occupational functioning of young people attending primary care-based, early intervention services. A longitudinal study of young people receiving mental healthcare. Data were collected between January 2005 and August 2017 from a designated primary care-based mental health service. 554 young people (54% women) aged 12–32 years. A systematic medical file audit collected clinical and functional information at predetermined time intervals (ie, 3 months to 5+ years) using a clinical pro forma. Group-based trajectory modelling (GBTM) was used to identify distinct trajectories of social and occupational functioning over time (median number of observations per person=4 median follow-up time=23 months). Between first clinical contact and time last seen, 15% of young people had reliably deteriorated, 23% improved and 62% did not demonstrate substantive change in function. Of the whole cohort, 69% had functional scores less than 70 at time last seen, indicative of ongoing and substantive impairment. GBTM identified six distinct functional trajectories whereby over 60% had moderate-to-serious functional impairment at entry and remained chronically impaired over time 7% entered with serious impairment and deteriorated further a quarter were mildly impaired at entry and functionally recovered and only a small minority (4%) presented with serious impairments and functionally improved over time. Not being in education, employment or training, previous hospitalisation and a younger age at baseline emerged as significant predictors of these functional trajectories. Young people with emerging mental disorders have significant functional impairment at presentation for care, and for the majority, it persists over the course of clinical care. In addition to providing clinical care earlier in the course of illness, these data suggest that more sophisticated and more intensive in idual-level and organisational strategies may be required to achieve significant and sustained functional improvements.
Publisher: Springer Science and Business Media LLC
Date: 23-04-2013
DOI: 10.1038/TP.2013.25
Publisher: American Medical Association (AMA)
Date: 11-2019
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.JAD.2018.06.032
Abstract: Mental disorders and suicidal thoughts and behaviours are common in help-seeking youth. Few studies report the longitudinal associations between these phenomena and clinical and functional outcomes. This study examined whether prior suicide attempts predict poorer outcomes in mental health service attendees. Clinical and functional data from 1143 in iduals (aged 12-30) attending a primary care-based mental health service in Australia were collected over 3-60 months (median = 21 months). Odds ratios (OR) with 95% confidence intervals for the effect of a prior suicide attempt on follow-up outcomes were estimated (adjusted for confounders). Prior suicide attempts were common (n = 164 14%) and prospectively associated with suicidal thoughts (OR = 1.71), suicide attempts (OR = 2.59), self-harm (OR = 1.71), an increased likelihood of being diagnosed with bipolar disorder (OR = 2.99), and the onset of an alcohol/substance use disorder (OR = 2.87). Over the course of care, no suicide attempts were reported in 1052 (92%) in iduals, but 25 (2%) had recurrent attempts, and 66 (6%) had new onset of an attempt. New onset was associated with being female and previous suicidal ideation or self-harm recurrent attempts were associated with being older and comorbid alcohol/substance use disorder. The cohort includes only in iduals who remained in clinical contact, and the consistency of their documentation varied (across clinicians and over time). Young people with prior suicide attempts are vulnerable to ongoing suicidal behaviours, and poorer clinical and functional outcomes. More intensive management strategies may be needed to directly address these behaviours and the long-term risks they confer. These behaviours also emerge over the course of care among those with no previous history, which has important implications for active service-level strategies that target these behaviours for all of those who present to such services.
Publisher: American Psychiatric Association Publishing
Date: 06-2021
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.JPSYCHIRES.2017.07.007
Abstract: While disturbances of the sleep-wake cycle are common in people with affective disorders, the characteristics of these disturbances differ greatly between in iduals. This heterogeneity is likely to reflect multiple underlying pathophysiologies, with different perturbations in circadian systems contributing to the variation in sleep-wake cycle disturbances. Such disturbances may be particularly relevant in adolescents and young adults with affective disorders as circadian rhythms undergo considerable change during this key developmental period. This study aimed to identify profiles of sleep-wake disturbance in young people with affective disorders and investigate associations with biological circadian rhythms. Fifty young people with affective disorders and 19 control participants (aged 16-31 years) underwent actigraphy monitoring for approximately two weeks to derive sleep-wake cycle parameters, and completed an in-laboratory assessment including evening dim-light saliva collection for melatonin assay and overnight continuous core body temperature measurement. Cluster analysis based on sleep-wake cycle parameters identified three distinct patient groups, characterised by 'delayed sleep-wake', 'disrupted sleep', and 'long sleep' respectively. The 'delayed sleep-wake' group had both delayed melatonin onset and core temperature nadir whereas the other two cluster groups did not differ from controls on these circadian markers. The three groups did not differ on clinical characteristics. These results provide evidence that only some types of sleep-wake disturbance in young people with affective disorders are associated with fundamental circadian perturbations. Consequently, interventions targeting endogenous circadian rhythms to promote a phase shift may be particularly relevant in youth with affective disorders presenting with delayed sleep-wake cycles.
Publisher: Springer Science and Business Media LLC
Date: 17-04-2013
Publisher: JMIR Publications Inc.
Date: 02-03-2022
Abstract: his is a corrigendum.
Publisher: JMIR Publications Inc.
Date: 14-06-2021
DOI: 10.2196/24697
Abstract: Australia’s mental health care system has long been fragmented and under-resourced, with services falling well short of demand. In response, the World Economic Forum has recently called for the rapid deployment of smarter, digitally enhanced health services to facilitate effective care coordination and address issues of demand. The University of Sydney’s Brain and Mind Centre (BMC) has developed an innovative digital health solution that incorporates 2 components: a highly personalized and measurement-based (data-driven) model of youth mental health care and a health information technology (HIT) registered on the Australian Register of Therapeutic Goods. Importantly, research into implementation of such solutions considers education and training of clinicians to be essential to adoption and optimization of use in standard clinical practice. The BMC’s Youth Mental Health and Technology Program has subsequently developed a comprehensive education and training program to accompany implementation of the digital health solution. This paper describes the protocol for an evaluation study to assess the effectiveness of the education and training program on the adoption and optimization of use of the digital health solution in service delivery. It also describes the proposed tools to assess the impact of training on knowledge and skills of mental health clinicians. The evaluation study will use the Kirkpatrick Evaluation Model as a framework with 4 levels of analysis: Reaction (to education and training), Learning (knowledge acquired), Behavior (practice change), and Results (client outcomes). Quantitative and qualitative data will be collected using a variety of tools, including evaluation forms, pre- and postknowledge questionnaires, skill development and behavior change scales, as well as a real-time clinical practice audit. This project is funded by philanthropic funding from Future Generation Global. Ethics approval has been granted via Sydney Local Health District’s Human Research Ethics Committee. At the time of this publication, clinicians and their services were being recruited to this study. The first results are expected to be submitted for publication in 2021. The education and training program teaches clinicians the necessary knowledge and skills to assess, monitor, and manage complex needs mood and psychotic syndromes and trajectories of youth mental ill-health using a HIT that facilitates a highly personalized and measurement-based model of care. The digital health solution may therefore guide clinicians to help young people recover low functioning associated with subthreshold diagnostic presentations and prevent progression to more serious mental ill-health. PRR1-10.2196/24697
Publisher: AMPCo
Date: 11-2019
DOI: 10.5694/MJA2.50383
Abstract: Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change. Consequently, the effects of adolescent-onset mood and psychotic syndromes can have long term consequences. A key clinical challenge for youth mental health is to develop and test new systems that align with current evidence for comorbid presentations and underlying neurobiology, and are useful for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. Our highly personalised and measurement-based care model includes three core concepts: ▶ A multidimensional assessment and outcomes framework that includes: social and occupational function self-harm, suicidal thoughts and behaviour alcohol or other substance misuse physical health and illness trajectory. ▶ Clinical stage. ▶ Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on proposed pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). The model explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within this highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care as well as utilisation of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality, mental health care for young people. CHAPTER 1: MULTIDIMENSIONAL OUTCOMES IN YOUTH MENTAL HEALTH CARE: WHAT MATTERS AND WHY?: Mood and psychotic syndromes present one of the most serious public health challenges that we face in the 21st century. Factors including prevalence, age of onset, and chronicity contribute to substantial burden and secondary risks such as alcohol or other substance misuse. Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change thus, effects can have long term consequences. We propose five key domains which make up a multidimensional outcomes framework that aims to address the specific needs of young people presenting to health services with emerging mental illness. These include social and occupational function self-harm, suicidal thoughts and behaviours alcohol or other substance misuse physical health and illness type, stage and trajectory. Impairment and concurrent morbidity are well established in young people by the time they present for mental health care. Despite this, services and health professionals tend to focus on only one aspect of the presentation - illness type, stage and trajectory - and are often at odds with the preferences of young people and their families. There is a need to address the disconnect between mental health, physical health and social services and interventions, to ensure that youth mental health care focuses on the outcomes that matter to young people. CHAPTER 2: COMBINING CLINICAL STAGE AND PATHOPHYSIOLOGICAL MECHANISMS TO UNDERSTAND ILLNESS TRAJECTORIES IN YOUNG PEOPLE WITH EMERGING MOOD AND PSYCHOTIC SYNDROMES: Traditional diagnostic classification systems for mental disorders map poorly onto the early stages of illness experienced by young people, and purport categorical distinctions that are not readily supported by research into genetic, environmental and neurobiological risk factors. Consequently, a key clinical challenge in youth mental health is to develop and test new classification systems that align with current evidence on comorbid presentations, are consistent with current understanding of underlying neurobiology, and provide utility for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. This chapter outlines a transdiagnostic framework for classifying common adolescent-onset mood and psychotic syndromes, combining two independent but complementary dimensions: clinical staging, and three proposed pathophysiological mechanisms. Clinical staging reflects the progression of mental disorders and is in line with the concept used in general medicine, where more advanced stages are associated with a poorer prognosis and a need for more intensive interventions with a higher risk-to-benefit ratio. The three proposed pathophysiological mechanisms are neurodevelopmental abnormalities, hyperarousal and circadian dysfunction, which, over time, have illness trajectories (or pathways) to psychosis, anxious depression and bipolar spectrum disorders, respectively. The transdiagnostic framework has been evaluated in young people presenting to youth mental health clinics of the University of Sydney's Brain and Mind Centre, alongside a range of clinical and objective measures. Our research to date provides support for this framework, and we are now exploring its application to the development of more personalised models of care. CHAPTER 3: A COMPREHENSIVE ASSESSMENT FRAMEWORK FOR YOUTH MENTAL HEALTH: GUIDING HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE USING MULTIDIMENSIONAL AND OBJECTIVE MEASURES: There is an urgent need for improved care for young people with mental health problems, in particular those with subthreshold mental disorders that are not sufficiently severe to meet traditional diagnostic criteria. New comprehensive assessment frameworks are needed to capture the biopsychosocial profile of a young person to drive highly personalised and measurement-based mental health care. We present a range of multidimensional measures involving five key domains: social and occupational function self-harm, suicidal thoughts and behaviours alcohol or other substance misuse physical health and illness type, stage and trajectory. Objective measures include: neuropsychological function sleep-wake behaviours and circadian rhythms metabolic and immune markers and brain structure and function. The recommended multidimensional measures facilitate the development of a comprehensive clinical picture. The objective measures help to further develop informative and novel insights into underlying pathophysiological mechanisms and illness trajectories to guide personalised care plans. A panel of specific multidimensional and objective measures are recommended as standard clinical practice, while others are recommended secondarily to provide deeper insights with the aim of revealing alternative clinical paths for targeted interventions and treatments matched to the clinical stage and proposed pathophysiological mechanisms of the young person. CHAPTER 4: PERSONALISING CARE OPTIONS IN YOUTH MENTAL HEALTH: USING MULTIDIMENSIONAL ASSESSMENT, CLINICAL STAGE, PATHOPHYSIOLOGICAL MECHANISMS, AND INDIVIDUAL ILLNESS TRAJECTORIES TO GUIDE TREATMENT SELECTION: New models of mental health care for young people require that interventions be matched to illness type, clinical stage, underlying pathophysiological mechanisms and in idual illness trajectories. Narrow syndrome-focused classifications often direct clinical attention away from other key factors such as functional impairment, self-harm and suicidality, alcohol or other substance misuse, and poor physical health. By contrast, we outline a treatment selection guide for early intervention for adolescent-onset mood and psychotic syndromes (ie, active treatments and indicated and more specific secondary prevention strategies). This guide is based on experiences with the Brain and Mind Centre's highly personalised and measurement-based care model to manage youth mental health. The model incorporates three complementary core concepts: ▶A multidimensional assessment and outcomes framework including: social and occupational function self-harm, suicidal thoughts and behaviours alcohol or other substance misuse physical health and illness trajectory. ▶Clinical stage. ▶Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on three underlying pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). These core concepts are not mutually exclusive and together may facilitate improved outcomes through a clinical stage-appropriate and transdiagnostic framework that helps guide decisions regarding the provision of appropriate and effective care options. Given its emphasis on adolescent-onset mood and psychotic syndromes, the Brain and Mind Centre's model of care also respects a fundamental developmental perspective - categorising childhood problems (eg, anxiety and neurodevelopmental difficulties) as risk factors and respecting the fact that young people are in a period of major biological and social transition. Based on these factors, a range of social, psychological and pharmacological interventions are recommended, with an emphasis on balancing the personal benefit-to-cost ratio. CHAPTER 5: A SERVICE DELIVERY MODEL TO SUPPORT HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE IN YOUTH MENTAL HEALTH: Over the past decade, we have seen a growing focus on creating mental health service delivery models that better meet the unique needs of young Australians. Recent policy directives from the Australian Government recommend the adoption of stepped-care services to improve the appropriateness of care, determined by severity of need. Here, we propose that a highly personalised approach enhances stepped-care models by incorporating clinical staging and a young person's current and multidimensional needs. It explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within a highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care and use of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality of, mental health care for young people.
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Frontiers Media SA
Date: 11-12-2018
Publisher: JMIR Publications Inc.
Date: 22-12-2017
Abstract: ach year, many young Australians aged between 16 and 25 years experience a mental health disorder, yet only a small proportion access services and even fewer receive timely and evidence-based treatments. Today, with ever-increasing access to the Internet and use of technology, the potential to provide all young people with access (24 hours a day, 7 days a week) to the support they require to improve their mental health and well-being is promising. he aim of this study was to use participatory design (PD) as research methodologies with end users (young people aged between 16 and 25 years and youth health professionals) and our research team to develop the Mental Health eClinic (a Web-based mental health clinic) to improve timely access to, and better quality, mental health care for young people across Australia. research and development (R& D) cycle for the codesign and build of the Mental Health eClinic included several iterative PD phases: PD workshops translation of knowledge and ideas generated during workshops to produce mockups of webpages either as hand-drawn sketches or as wireframes (simple layout of a webpage before visual design and content is added) rapid prototyping and one-on-one consultations with end users to assess the usability of the alpha build of the Mental Health eClinic. our PD workshops were held with 28 end users (young people n=18, youth health professionals n=10) and our research team (n=8). Each PD workshop was followed by a knowledge translation session. At the conclusion of this cycle, the alpha prototype was built, and one round of one-on-one end user consultation sessions was conducted (n=6 all new participants, young people n=4, youth health professionals n=2). The R& D cycle revealed the importance of five key components for the Mental Health eClinic: a home page with a visible triage system for those requiring urgent help a comprehensive online physical and mental health assessment a detailed dashboard of results a booking and videoconferencing system to enable video visits and the generation of a personalized well-being plan that includes links to evidence-based, and health professional–recommended, apps and etools. he Mental Health eClinic provides health promotion, triage protocols, screening, assessment, a video visit system, the development of personalized well-being plans, and self-directed mental health support for young people. It presents a technologically advanced and clinically efficient system that can be adapted to suit a variety of settings in which there is an opportunity to connect with young people. This will enable all young people, and especially those currently not able or willing to connect with face-to-face services, to receive best practice clinical services by breaking down traditional barriers to care and making health care more personalized, accessible, affordable, and available.
Publisher: Wiley
Date: 12-06-2012
DOI: 10.1111/J.1751-7893.2012.00364.X
Abstract: Although the use of illness-staging models in clinical medicine has proved particularly useful, the concept has not been widely applied in mental health. Here, we apply a clinical staging framework to a population of help-seeking young people presenting with social anxiety. The goal was to provide a detailed description of common clinical stage of those presenting for treatment of social anxiety, and to delineate the associations between symptom type, severity and clinical stage. The results of a structured clinical interview along with background clinical information formed the basis for consensus-derived decisions regarding clinical stage. Subjects also completed self-report measures to assess anxiety and depressive symptoms. Comparisons were conducted largely between those subjects who were considered to have reached a critical clinical threshold for discrete or progressive disorders (i.e., those staged at two and beyond) and those with 'attenuated syndromes' (stage 1b - 69% of subjects). One hundred forty-three subjects (63% male, mean age = 22.1 years) were clinically assessed prior to entry into active treatment programmes. Subjects assigned to stage two or above reported more psychological distress, higher depression scores and more alcohol use. However, these subjects did not report more severe anxiety symptoms. A higher incidence of substance misuse was a significant feature of those in later clinical stages. The study suggests that those who present with social anxiety are characterized by a broad range of symptom severity, with a small, though significant proportion representing in iduals whose mental health problems have already progressed to a stage characterized by greater co-morbidity and risk of chronicity. Our data specifically suggest that depressive symptoms and substance abuse/dependence may differentiate those in earlier and later clinical stages.
Publisher: AMPCo
Date: 02-2012
DOI: 10.5694/MJA11.10481
Abstract: To assess the extent to which youth-specific, mental health care centres engage young people (12-25 years of age) in treatment, and to report the degree of psychological distress, and the diagnostic type, stage of illness, and psychosocial and vocational impairment evident in these young people. Standardised clinical and self-report assessments of consecutive presentations at two youth-specific centres from October 2007 to December 2009. Both sites are operated by the Brain and Mind Research Institute in Sydney, Australia, as part of headspace: the National Youth Mental Health Foundation mental health care service. Of 1260 young people assessed, 53% were male, and the mean (SD) age was 18.1 (3.9) years. Over 40% of the young people were self-referred, or their assessment was arranged by family or friends, or by other social agencies 30% of young people were referred from other primary health providers. Almost 70% reported high or very high levels of psychological distress. More than 60% of subjects reported having 2 or more days "unable to function" within the past month, and clinicians rated over 50% as having at least moderate difficulty in social/occupational functioning. Importantly, 25% of subjects were receiving income support. Two-thirds of subjects were rated as being at the early stage of an illness, and almost half were diagnosed with anxiety or depressive syndromes. Targeted youth-specific mental health services, based in primary care settings, are able to engage young Australians, particularly young men, in treatment. Many of these young people report established patterns of psychosocial and vocational impairment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-1998
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.JAD.2012.06.006
Abstract: Circadian disturbances may play a key role in the pathogenesis of some forms of mood disorders. Despite marked changes in circadian rhythms during the normal course of adolescence and young adulthood, less is known about changes in the 24-h sleep-wake cycle in young persons with mood disorders. Seventy-five young participants with mood disorders (unipolar: n=46, 20.1 ± 4.7 years old bipolar I or II: n=29, 23.2 ± 4.3) and 20 healthy participants (24.8 ± 2.5 years old) underwent actigraphy monitoring during a depressive phase over seven consecutive days and nights. Sleep phase delay was defined as mean sleep onset ≥ 1:30 am and/or sleep offset ≥ 1 0:00 am. A delayed sleep phase was found in 62% of participants with bipolar disorders when depressed, compared with 30% of those with unipolar depression (χ(2)=6.0, p=0.014) and 10% of control participants (χ(2)=11.2, p<0.001). Sleep offset times were significantly later in subjects with mood disorders compared to the control group, and later in those with bipolar as compared with unipolar disorders (all p ≤ 0.043). This study was cross-sectional and the depressed groups were somewhat younger compared to the healthy controls. Longitudinal studies are required to determine the predictive significance of these findings. Young patients with mood disorders, especially those with bipolar disorders, are particularly likely to have a delayed sleep phase. Therapies focused on advancing sleep phase may be of specific benefit to these young persons.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.PNPBP.2018.08.032
Abstract: Diffusion tensor imaging (DTI) has been utilized to index white matter (WM) integrity in the major psychiatric disorders. However, the findings within and across such disorders have been mixed. Given this, transdiagnostic s ling with data-driven statistical approaches may lead to new and better insights about the clinical and functional factors associated with WM abnormalities. Thus, we undertook a cross-sectional DTI study of 401 young adult (18-30 years old) outpatients with a major psychiatric (depressive, bipolar, psychotic, or anxiety) disorder and 61 healthy controls. Participants also completed self-report questionnaires and underwent neuropsychological assessment. Fractional anisotropy (FA) as well as axial (AD) and radial (RD) diffusivity was determined via a whole brain voxel-wise approach (tract-based spatial statistics). Hierarchical cluster analysis was performed on FA scores in patients only, obtained from 20 major WM tracts (that is, association, projection and commissural fibers). The three cluster groups derived were distinguished by having consistently increased or decreased FA scores across all tracts. Compared to controls, the largest cluster (N = 177) showed significantly increased FA in 55% of tracts, the second cluster (N = 169) demonstrated decreased FA (in 90% of tracts) and the final cluster (N = 55) exhibited the most increased FA (in 95% of tracts). Importantly, the distribution of primary diagnosis did not significantly differ among the three clusters. Furthermore, the clusters showed comparable functional, clinical and neuropsychological measures, with the exception of alcohol use, medication status and verbal fluency. Overall, this study provides evidence that among young adults with a major psychiatric disorder there are subgroups with either abnormally high or low FA and that either pattern is associated with suboptimal functioning. Importantly, these neuroimaging-based subgroups appear despite diagnostic and clinical factors, suggesting differential treatment strategies are warranted.
Publisher: AMPCo
Date: 07-2001
DOI: 10.5694/J.1326-5377.2001.TB143786.X
Abstract: To determine the rates and predictors of treatments for patients with common mental disorders in Australian general practice. Cross-sectional national audit of general practices throughout Australia in 1998-1999. 46 515 ambulatory care patients attending 386 GPs. Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system pharmacological and non-pharmacological treatment provided, as reported by the GPs--questions relating to treatments provided predictors of treatments--self-report questions about demography for patients and GPs, and about practice organisation for GPs. GPs' reported provision of pharmacological and nonpharmacological treatments and patient, GP and practice characteristics predicting treatment provision. There were complete data on treatment for 39 983 patients. 27% (10752) of all patients received some form of intervention 21% (8304) received non-pharmacological and 12% (4765) received pharmacological treatments. Non-pharmacological treatments were mostly non-specific counselling and support (83% 6892/8304). Among the 10303 patients with the most severe level of psychological disorders, only 50% (5152) received any intervention (38% [3872] received non-pharmacological and 27% [2766] pharmacological treatments). Evidence-based treatments were provided to only 12% (4961) of all patients (and only 27% [2802] of the 10303 with the most severe disorders). Although the newer antidepressant agents were commonly prescribed, older medications (mainly tricyclic antidepressants) were prescribed to older (OR, 1.29 95% CI, 1.07-1.56), less educated (OR, 1.41 95% CI, 1.12-1.79) and female (OR, 1.44 95% CI, 1.23-1.70) patients. Among the 8304 patients receiving non-pharmacological treatments, specific (evidence-based) treatments were provided to only 17% (1412) these patients were typically middle-aged (OR, 2.94 95% CI, 2.32-3.73) and the providing GPs were typically not in full-time practice (OR, 3.34 95% CI, 2.56-4.17). Practitioners largely provide non-specific, non-pharmacological interventions for patients with common mental disorders. Even among those with the most severe disorders, only a minority receive pharmacological or specific evidence-based non-pharmacological treatments.
Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2020-044731
Abstract: Approximately 75% of major mental illness occurs before the age of 25 years. Despite this, our capacity to provide effective, early and personalised interventions is limited by insufficient evidence for characterising early-stage, and less specific, presentations of major mental disorders in youth populations. This article describes the protocol for setting up a large-scale database that will collect longitudinal, prospective data that incorporate clinical, social and occupational function, neuropsychological, circadian, metabolic, family history and genetic metrics. By collecting data in a research-purposed, standardised manner, the ‘Neurobiology Youth Follow-up Study’ should improve identification, characterisation and profiling of youth attending mental healthcare, to better inform diagnosis and treatment at critical time points. The overall goal is enhanced long-term clinical and functional outcomes. This longitudinal clinical cohort study will invite participation from youth (12–30 years) who seek help for mental health-related issues at an early intervention service (headspace C erdown) and linked services. Participants will be prospectively tracked over 3 years with a series of standardised multimodal assessments at baseline, 6, 12, 24 and 36 months. Evaluations will include: (1) clinician-administered and self-report assessments determining clinical stage, pathophysiological pathways to illness, diagnosis, symptomatology, social and occupational function (2) neuropsychological profile (3) sleep–wake patterns and circadian rhythms (4) metabolic markers and (5) genetics. These data will be used to: (1) model the impact of demographic, phenomenological and treatment variables, on clinical and functional outcomes (2) map neurobiological profiles and changes onto a transdiagnostic clinical stage and pathophysiological mechanisms framework. This study protocol has been approved by the Human Research Ethics Committee of the Sydney Local Health District (2020/ETH01272, protocol V.1.3, 14 October 2020). Research findings will be disseminated through peer-reviewed journals and presentations at scientific conferences and to user and advocacy groups. Participant data will be de-identified.
Publisher: SAGE Publications
Date: 10-1998
Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2020-044977
Abstract: Worsened cardiometabolic profiles in youth with mental ill health have been associated with a number of modifiable lifestyle risk factors. It is becoming increasingly evident that clinical interventions need to be multimodal in focus to improve mental health symptoms and the physical health symptoms in this already at-risk cohort. This 12-week pilot clinical trial examines the efficacy, feasibility and acceptability of an adjunctive online psychoeducation programme for improving cardiometabolic risk parameters and affective symptoms in a transdiagnostic s le of at least 44 young people aged 16–25 years presenting for mental healthcare for mood and/or psychotic syndromes (including anxiety, depression, bipolar disorder and psychosis). In iduals will be invited to participate in a pilot clinical trial for a structured online psychoeducation programme incorporating nutritional, physical activity, sleep–wake and healthy lifestyle information, delivered fortnightly over six online modules. Participants will undergo a series of assessments including: (1) self-report and clinician administered assessments determining mental health symptomatology (2) fasting blood tests to assess cardiometabolic markers (fasting insulin, fasting glucose and blood lipids) (3) anthropometric assessments (height, weight, waist circumference and blood pressure) and (4) sleep–wake behaviours and circadian rhythm assessments. Changes in scores for all cardiometabolic and affective measures will be assessed via paired s les t-tests, and correlations between change scores will be assessed via Pearson’s or Spearman’s correlations. Feasibility will be assessed via completion rates, and the acceptability of the programme will be assessed via programme satisfaction measures. This pilot clinical trial has been approved by the Sydney Local Health District Research Ethics and Governance Office (X20-0228 & 2020/ETH01201). The results of this pilot clinical trial will be disseminated into the scientific and broader community through peer-reviewed journals, conference presentations, social media and university websites. Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12620000772943, Date 28 August 2020.
Publisher: AMPCo
Date: 06-2012
DOI: 10.5694/MJA12.10634
Publisher: Wiley
Date: 29-04-2016
DOI: 10.1111/EIP.12143
Abstract: To determine if disturbed sleep-wake cycle patterns in young people with evolving mental disorder are associated with stages of illness. The sleep-wake cycle was monitored using actigraphy across 4 to 22 days. Participants (21 healthy controls and 154 persons seeking help for mental health problems) were aged between 12 and 30 years. Those persons seeking mental health care were categorized as having mild symptoms (stage 1a), an 'attenuated syndrome' (stage 1b) or an 'established mental disorder' (stage 2+). The proportions of in iduals with a delayed weekdays sleep schedule increased progressively across illness stages: 9.5% of controls, 11.1% of stage 1a, 25.6% of stage 1b, and 50.0% of stage 2+ (χ(2) (3 d.f.) = 18.4, P < 0.001). A similar pattern was found for weekends (χ(2) (3 d.f.) = 7.6, P = 0.048). Compared with controls, stage 1b participants had later sleep onset on weekends (P = 0.015), and participants at stages 1b and 2+ had later sleep offset on both weekdays and weekends (P < 0.020). Compared with controls, all participants with mental disorders had more wake after sleep onset (P < 0.029) and those at stages 1a and 2+ had lower sleep efficiency (P < 0.040). Older age, medicated status and later weekdays sleep offset were found to be the three strongest correlates of later versus earlier clinical stages. In relation to clinical staging of common mental disorders in young people, the extent of delayed sleep phase is associated with more severe or persistent phases of illness.
Publisher: Springer Science and Business Media LLC
Date: 21-01-2020
DOI: 10.1038/S41398-020-0726-9
Abstract: Neurocognitive impairment is commonly associated with functional disability in established depressive, bipolar and psychotic disorders. However, little is known about the longer-term functional implications of these impairments in early phase transdiagnostic cohorts. We aimed to examine associations between neurocognition and functioning at baseline and over time. We used mixed effects models to investigate associations between neurocognitive test scores and longitudinal social and occupational functioning (“Social and Occupational Functioning Assessment Scale”) at 1–7 timepoints over five-years in 767 in iduals accessing youth mental health services. Analyses were adjusted for age, sex, premorbid IQ, and symptom severity. Lower baseline functioning was associated with male sex (coefficient −3.78, 95% CI −5.22 to −2.34 p 0.001), poorer verbal memory (coefficient 0.90, 95% CI 0.42 to 1.38, p 0.001), more severe depressive (coefficient −0.28, 95% CI −0.41 to −0.15, p 0.001), negative (coefficient −0.49, 95% CI −0.74 to −0.25, p 0.001), and positive symptoms (coefficient −0.25, 95% CI −0.41 to −0.09, p = 0.002) and lower premorbid IQ (coefficient 0.13, 95% CI 0.07 to 0.19, p 0.001). The rate of change in functioning over time varied among patients depending on their sex (male coefficient 0.73, 95% CI 0.49 to 0.98, p 0.001) and baseline level of cognitive flexibility (coefficient 0.14, 95% CI 0.06 to 0.22, p 0.001), such that patients with the lowest scores had the least improvement in functioning. Impaired cognitive flexibility is common and may represent a meaningful and transdiagnostic target for cognitive remediation in youth mental health settings. Future studies should pilot cognitive remediation targeting cognitive flexibility while monitoring changes in functioning.
Publisher: Springer Science and Business Media LLC
Date: 29-05-2012
DOI: 10.1038/TP.2012.47
Publisher: SAGE Publications
Date: 09-2002
Publisher: JMIR Publications Inc.
Date: 15-12-2020
DOI: 10.2196/24578
Abstract: The demand for mental health services is projected to rapidly increase as a direct and indirect result of the COVID-19 pandemic. Given that young people are disproportionately disadvantaged by mental illness and will face further challenges related to the COVID-19 pandemic, it is crucial to deliver appropriate mental health care to young people as early as possible. Integrating digital health solutions into mental health service delivery pathways has the potential to greatly increase efficiencies, enabling the provision of “right care, first time.” We propose an innovative digital health solution for demand management intended for use by primary youth mental health services, comprised of (1) a youth mental health model of care (ie, the Brain and Mind Centre Youth Model) and (2) a health information technology specifically designed to deliver this model of care (eg, the InnoWell Platform). We also propose an operational protocol of how this solution could be applied to primary youth mental health service delivery processes. By “flipping” the conventional service delivery models of majority in-clinic and minority web-delivered care to a model where web-delivered care is the default, this digital health solution offers a scalable way of delivering quality youth mental health care both in response to public health crises (such as the COVID-19 pandemic) and on an ongoing basis in the future.
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2021-056298
Abstract: Sleep-wake and circadian disturbance is a key feature of mood disorders with a potential causal role and particular relevance to young people. Brexpiprazole is a second-generation antipsychotic medication with demonstrated efficacy as an adjunct to antidepressant treatment for major depressive disorder (MDD) in adults, with preliminary evidence suggesting greater effectiveness in subgroups of depressed patients with sleep disturbances. This clinical trial aims to evaluate the relationships between changes in sleep-wake and circadian parameters and changes in depressive symptoms following adjunctive brexpiprazole treatment in young adults with MDD and sleep-wake disturbance. This study is designed as a 16 week (8 weeks active treatment, 8 weeks follow-up) mechanistic, open-label, single-arm, phase IV clinical trial and aims to recruit 50 young people aged 18–30 with MDD and sleep-wake cycle disturbance through an early intervention youth mental health clinic in Sydney, Australia. At baseline, participants will undergo multidimensional outcome assessment and subsequently receive 8 weeks of open-label treatment with brexpiprazole as adjunctive to their stable psychotropic medication. Following 4 weeks of treatment, clinical and self-report measures will be repeated. Ambulatory sleep-wake monitoring will be conducted continuously for the duration of treatment. After 8 weeks of treatment, all multidimensional outcome assessments will be repeated. Follow-up visits will be conducted 4 and 8 weeks after trial completion (including sleep-wake, clinical and self-report assessments). Circadian rhythm biomarkers including salivary melatonin, cortisol and core body temperature will be collected during an in-lab assessment. Additionally, metabolic, inflammatory and genetic risk markers will be collected at baseline and after 8 weeks of treatment. This trial protocol has been approved by the Human Research Ethics Committee of the Sydney Local Health District (X19-0417 and 2019/ETH12986, Protocol Version 1–3, dated 25 February 2021). The results of this study, in deidentified form, will be disseminated through publication in peer-reviewed journals, scholarly book chapters, presentation at conferences and publication in conference proceedings. ACTRN12619001456145.
Publisher: Royal College of Psychiatrists
Date: 03-2016
DOI: 10.1192/BJO.2020.12
Abstract: Neurocognitive impairments robustly predict functional outcome. However, heterogeneity in neurocognition is common within diagnostic groups, and data-driven analyses reveal homogeneous neurocognitive subgroups cutting across diagnostic boundaries. To determine whether data-driven neurocognitive subgroups of young people with emerging mental disorders are associated with 3-year functional course. Model-based cluster analysis was applied to neurocognitive test scores across nine domains from 629 young people accessing mental health clinics. Cluster groups were compared on demographic, clinical and substance-use measures. Mixed-effects models explored associations between cluster-group membership and socio-occupational functioning (using the Social and Occupational Functioning Assessment Scale) over 3 years, adjusted for gender, premorbid IQ, level of education, depressive, positive, negative and manic symptoms, and diagnosis of a primary psychotic disorder. Cluster analysis of neurocognitive test scores derived three subgroups described as ‘normal range’ ( n = 243, 38.6%), ‘intermediate impairment’ ( n = 252, 40.1%), and ‘global impairment’ ( n = 134, 21.3%). The major mental disorder categories (depressive, anxiety, bipolar, psychotic and other) were represented in each neurocognitive subgroup. The global impairment subgroup had lower functioning for 3 years of follow-up however, neither the global impairment ( B = 0.26, 95% CI −0.67 to 1.20 P = 0.581) or intermediate impairment ( B = 0.46, 95% CI −0.26 to 1.19 P = 0.211) subgroups differed from the normal range subgroup in their rate of change in functioning over time. Neurocognitive impairment may follow a continuum of severity across the major syndrome-based mental disorders, with data-driven neurocognitive subgroups predictive of functional course. Of note, the global impairment subgroup had longstanding functional impairment despite continuing engagement with clinical services.
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2023
End Date: 12-2027
Amount: $5,000,000.00
Funder: Australian Research Council
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