Ian Hickie

Using participatory design methodologies to co-design and culturally adapt the Spanish version of the Mental Health eClinic (Preprint)

Publisher: JMIR Publications Inc.

Date: 27-03-2019

DOI: 10.2196/PREPRINTS.14127

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

The course of neuropsychological functioning in young people with attenuated vs discrete mental disorders

Publisher: Wiley

Date: 08-11-2019

DOI: 10.1111/EIP.12499

Abstract: Clinical staging of mental disorders is designed to facilitate the selection of stage-appropriate interventions, early in the course of illness. Neuropsychological performance, particularly at early stages of mental disorder, is a strong predictor of medium-term functional outcomes. Despite this, the longitudinal examination of neuropsychological profiles in early stages of illness is poorly researched. Thus, we examined baseline and longitudinal neuropsychological profiles of young patients with attenuated syndromes vs those with discrete disorders. Neuropsychological testing of 497 help-seeking young people (21.2 ± 3 years 56% female). Clinical staging, assigned separately from testing, rated 262 in iduals as "attenuated syndrome" (stage 1b) and 235 as "discrete" or "persistent" disorder (stage 2+). Follow-up testing was undertaken in 170 in iduals (54% at stage 1b) after 19.8 ± 9 months (range: 3 to 51 months). At baseline, attenuated and discrete ersistent disorders significantly differed in 4 of the 9 neuropsychological measures (verbal learning, verbal memory, visual memory and set shifting). Despite this, both groups showed similar improvement in neuropsychological functioning at follow-up, particularly in processing speed, sustained attention and visual memory. Longitudinal improvement in cognition corresponded with increases in socio-occupational functioning. The degree of baseline neuropsychological dysfunction discriminates those with attenuated syndromes from those with a discrete ersistent disorder. Furthermore, improvement in neuropsychological functioning corresponded with improvement in clinical and functional status, despite stage of illness. This suggests that neuropsychological functioning remains relatively stable in young people with a mental illness and may be a critical window for intervention.

Economic rationality in youth with emerging mood disorders

Publisher: American Psychological Association (APA)

Date: 09-2020

DOI: 10.1037/NPE0000129

The Impact of Technology-Enabled Care Coordination in a Complex Mental Health System: A Local System Dynamics Model

Publisher: JMIR Publications Inc.

Date: 30-06-2021

DOI: 10.2196/25331

Abstract: Prior to the COVID-19 pandemic, major shortcomings in the way mental health care systems were organized were impairing the delivery of effective care. The mental health impacts of the pandemic, the recession, and the resulting social dislocation will depend on the extent to which care systems will become overwhelmed and on the strategic investments made across the system to effectively respond. This study aimed to explore the impact of strengthening the mental health system through technology-enabled care coordination on mental health and suicide outcomes. A system dynamics model for the regional population catchment of North Coast New South Wales, Australia, was developed that incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and suicidal behavior. The model reproduced historic time series data across a range of outcomes and was used to evaluate the relative impact of a set of scenarios on attempted suicide (ie, self-harm hospitalizations), suicide deaths, mental health–related emergency department (ED) presentations, and psychological distress over the period from 2021 to 2030. These scenarios include (1) business as usual, (2) increase in service capacity growth rate by 20%, (3) standard telehealth, and (4) technology-enabled care coordination. Each scenario was tested using both pre– and post–COVID-19 social and economic conditions. Technology-enabled care coordination was forecast to deliver a reduction in self-harm hospitalizations and suicide deaths by 6.71% (95% interval 5.63%-7.87%), mental health–related ED presentations by 10.33% (95% interval 8.58%-12.19%), and the prevalence of high psychological distress by 1.76 percentage points (95% interval 1.35-2.32 percentage points). Scenario testing demonstrated that increasing service capacity growth rate by 20% or standard telehealth had substantially lower impacts. This pattern of results was replicated under post–COVID-19 conditions with technology-enabled care coordination being the only tested scenario, which was forecast to reduce the negative impact of the pandemic on mental health and suicide. The use of technology-enabled care coordination is likely to improve mental health and suicide outcomes. The substantially lower effectiveness of targeting in idual components of the mental health system (ie, increasing service capacity growth rate by 20% or standard telehealth) reiterates that strengthening the whole system has the greatest impact on patient outcomes. Investments into more of the same types of programs and services alone will not be enough to improve outcomes instead, new models of care and the digital infrastructure to support them and their integration are needed.

CHRONIC FATIGUE SYNDROME - CURRENT PERSPECTIVES ON EVALUATION AND MANAGEMENT

Publisher: AMPCo

Date: 09-1995

DOI: 10.5694/J.1326-5377.1995.TB124601.X

Abstract: To describe clinical and laboratory guidelines for assessment and management of patients presenting with chronic fatigue syndrome (CFS). Relevant international consensus diagnostic criteria and research literature on the epidemiology, pathophysiology, concurrent medical and psychological disturbance and clinical management of CFS. Medical and psychiatric morbidity should be carefully assessed and actively treated, while unnecessary laboratory investigations and extravagant treatment regimens should be avoided. No single infective agent has been demonstrated as the cause of CFS, and immunopathological hypotheses remain speculative. The aetiological role of psychological factors is debated, but they do predict prolonged illness. The rate of spontaneous recovery appears to be high. Effective clinical management requires a multidisciplinary approach, with consideration of the medical, psychological and social factors influencing recovery.

Fatigue in selected primary care settings: Sociodemographic and psychiatric correlates

Publisher: AMPCo

Date: 05-1996

DOI: 10.5694/J.1326-5377.1996.TB122199.X

Abstract: To determine the prevalence and sociodemographic and psychiatric correlates of prolonged fatigue syndromes among patients in primary care. Prospective questionnaire survey. Adults over 18 years attending three general practices in metropolitan Sydney and one on the Central Coast, north of Sydney. Of 1593 patients, 25% had prolonged fatigue, while 37% had psychological disorder. Of the patients with fatigue, 70% had both fatigue and psychological disorder, while 30% had fatigue only. The factors associated with prolonged fatigue were concurrent psychological disorder, female gender, lower socioeconomic status and fewer total years of education. Patients with fatigue were more likely to have a current depressive disorder. Prolonged fatigue/neurasthenia syndromes are common in Australian primary care settings, and are commonly associated with current depressive disorders. Such syndromes, however, do not fit readily into current international psychiatric classification systems.

Fronto-striatal correlates of impaired implicit sequence learning in major depression: An fMRI study

Publisher: Elsevier BV

Date: 09-2010

DOI: 10.1016/J.JAD.2010.02.114

Abstract: Neural network models of major depression (MD) suggest that the striatum is involved in the pathophysiology and is linked to key cognitive and clinical features. However, functional imaging studies have largely assessed the prefrontal cortex and have utilised emotional paradigms. This study sought to probe the integrity of fronto-striatal circuits using functional magnetic resonance imaging (fMRI) in conjunction with a theoretically-driven motor sequencing implicit learning (IL) task. Nineteen patients with MD (mean age=56.1 years, sd=9.8) and 20 control participants (mean age=50.6 years, sd=11.9) participated. A blocked fMRI paradigm was used in association with a motor sequencing task which included an IL and random sequence (baseline) condition. Although the study was hypothesis driven, within and between groups whole-brain analysis was used to examine fMRI patterns in the IL compared to BL condition. While both groups activated the striatum, there was no significant difference between patients and controls in striatal activation. Instead, control subjects showed significantly greater activity in the middle frontal gyrus whereas the patients exhibited greater activity in the superior temporal gyrus and cerebellum. Most patients were receiving antidepressant medication when assessed. An event-related fMRI design would have enabled more fine-grained temporal analysis of IL related activation. IL deficits in MD are not due primarily to striatal dysfunction. IL performance may depend on more specific sub-components of the striatum or a more distributed neural network involving frontal, temporal and cerebellar regions.

Predictors of Cancer Worry in Unaffected Women from High Risk Breast Cancer Families: Risk Perception is not the Primary Issue

Publisher: Wiley

Date: 09-09-2007

DOI: 10.1007/S10897-007-9105-4

Abstract: Some women at increased familial risk of breast cancer experience elevated levels of cancer-specific worry, which can possibly act as a barrier to screening, and may be a significant factor in decisions regarding risk-reducing surgery. The aim of this study was to comprehensively examine predictors of cancer-specific worry in high risk women and to test a model which proposes that perceived breast cancer risk mediates the impact of other factors on worry. 1,437 unaffected women from high risk breast cancer families completed questionnaires and interviews. Path analysis was used to test the model of potential predictors of cancer worry, including familial, personal and psychological variables, mediated via perceived cancer risk. Levels of cancer-specific worry were generally low despite an average perceived risk of 50.3%. The goodness-of-fit of the proposed model was poor, explaining only 9% of the variance for perceived risk and 10% of the variance for cancer specific worry. An alternative model of a direct relationship between all of the predictor variables and cancer worry, explained 24% of the variation in cancer worry. General anxiety, perceived risk, the stressful impact of recent cancer related events, a relative risk greater than 10, being closer in age to the youngest breast cancer diagnosis in family, and knowledge of personal mutation status, all independently contributed to cancer worry. Addressing general affective responses, experiences of recent cancer related events, in addition to education about personal risk, should be considered in counselling women with elevated cancer worry. Risk perception appears to act independently of other factors in its formulation and impact on cancer worry. Further research on the way in which women come to perceive their risk is indicated.

Augmenting online mental health support services

Publisher: IGI Global

Date: 2016

DOI: 10.4018/978-1-5225-0778-9.CH013

Abstract: The Internet allows mental health organisations to provide services to more people via new models of care. Amongst these, online support groups are becoming increasingly popular. This model of mental health service provision includes moderators who read posts, recognise those that need attention and provide support via online responses. However, as these groups become more popular they risk becoming more difficult to manage due to the sheer volume of posts. This challenge can be addressed through computational linguistics techniques. This chapter reports on work with a mental health organisation on three components to help scale up the number of people they can support. The design aims to go beyond helping end-users and explores how design can support the wellbeing of the moderators themselves. The design of the three components is discussed: 1) A triage component automatically detects posts that need a prompt response. 2) An intervention generator (IG) generates a draft response for the moderator to use, for ex le a positive psychology intervention. These two can help in the management of a discussion forum, supporting positive behaviours, not just dealing in situations of distress. 3) A component for synchronous support through an augmented chat system.

Transdiagnostic Clinical Staging for Childhood Mental Health: An Adjunctive Tool for Classifying Internalizing and Externalizing Syndromes that Emerge in Children Aged 5–11 Years

Publisher: Springer Science and Business Media LLC

Date: 22-05-2022

DOI: 10.1007/S10567-022-00399-Z

Abstract: Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.

An age-based comparison of chronic pain clinic patients

Publisher: Wiley

Date: 2001

DOI: 10.1002/GPS.366

Abstract: The aim of this study was to compare demographic, illness and personality characteristics, and formal rates of mental disorder between younger ( or= 65 years) patients attending a chronic pain clinic. Patients with non-malignant pain of > 6 months' duration attending a specialist outpatient clinic were given a structured medical and psychiatric interview, and completed self-report questionnaires assessing disability, personality style and attitudes to illness. Fifty patients (26 of whom were older) participated in the study. None of the older patients had experienced the onset of chronic pain before the age of 50 years. Although current and lifetime major depression were common in both groups, there was no specific association between age and depression. The younger group was more likely to have been injured prior to the onset of pain and to be seeking financial compensation, reported more physical and social disability, and was more likely to be preoccupied with somatic discomfort. The younger group was also more likely to be rated as displaying impulsive personality traits and the older group anxious traits, although there was no difference in neuroticism scores. Despite a greater level of multiple medical morbidity and longer duration of pain, older patients with chronic pain were not more likely to suffer from concurrent depression, were less disabled and less somatically preoccupied than younger patients. There were sufficient differences in illness and psychological characteristics to suggest that the older patients represented an aetiologically distinct sub-group, rather than patients with chronic pain of early onset who have simply grown old. Finally, the utility of DSM-IV defined somatoform disorders, in particular pain disorder, is discussed. A model which integrates medical and psychological mechanisms is needed for clinical use.

Subcortical brain structure and suicidal behaviour in major depressive disorder: a meta-analysis from the ENIGMA-MDD working group

Publisher: Springer Science and Business Media LLC

Date: 02-05-2017

DOI: 10.1038/TP.2017.84

Greater male than female variability in regional brain structure across the lifespan

Publisher: Cold Spring Harbor Laboratory

Date: 17-02-2020

DOI: 10.1101/2020.02.17.952010

Abstract: For many traits, males show greater variability than females, with possible implications for understanding sex differences in health and disease. Here, the ENIGMA (Enhancing Neuro Imaging Genetics through Meta-Analysis) Consortium presents the largest-ever mega-analysis of sex differences in variability of brain structure, based on international data spanning nine decades of life. Subcortical volumes, cortical surface area and cortical thickness were assessed in MRI data of 16,683 healthy in iduals 1-90 years old (47% females). We observed significant patterns of greater male than female between-subject variance for all subcortical volumetric measures, all cortical surface area measures, and 60% of cortical thickness measures. This pattern was stable across the lifespan for 50% of the subcortical structures, 70% of the regional area measures, and nearly all regions for thickness. Our findings that these sex differences are present in childhood implicate early life genetic or gene-environment interaction mechanisms. The findings highlight the importance of in idual differences within the sexes, that may underpin sex-specific vulnerability to disorders.

Adolescents and young adults who are not in employment, education, or training

Publisher: BMJ

Date: 18-09-2013

DOI: 10.1136/BMJ.F5270

The Australian Genetics of Depression Study: new risk loci and dissecting heterogeneity between subtypes

Publisher: Elsevier BV

Date: 08-2021

DOI: 10.1016/J.BIOPSYCH.2021.10.021

Abstract: Major depressive disorder (MDD) is a common and highly heterogeneous psychiatric disorder, but little is known about the genetic characterization of this heterogeneity. Understanding the genetic etiology of MDD can be challenging because large s le sizes are needed for gene discovery-often achieved with a trade-off in the depth of phenotyping. The Australian Genetics of Depression Study is the largest stand-alone depression cohort with both genetic data and in-depth phenotyping and comprises a total of 15,792 participants of European ancestry, 92% of whom met diagnostic criteria for MDD. We leveraged the unique nature of this cohort to conduct a meta-analysis with the largest publicly available depression genome-wide association study to date and subsequently used polygenic scores to investigate genetic heterogeneity across various clinical subtypes of MDD. We increased the number of known genome-wide significant variants associated with depression from 103 to 126 and found evidence of association of novel genes implicated in neuronal development. We found that a polygenic score for depression explained 5.7% of variance in MDD liability in our s le. Finally, we found strong support for genetic heterogeneity in depression with differential associations of multiple psychiatric and comorbid traits with age of onset, longitudinal course, and various subtypes of MDD. Until now, this degree of detailed phenotyping in such a large s le of MDD cases has not been possible. Along with the discovery of novel loci, we provide support for differential pathways to illness models that recognize the overlap with other common psychiatric disorders as well as pathophysiological differences.

Genetic and Environmental Causes of Individual Differences in Borderline Personality Disorder Features and Loneliness are Partially Shared.

Publisher: Cambridge University Press (CUP)

Date: 08-2020

DOI: 10.1017/THG.2020.62

Abstract: Loneliness is related to mental and somatic health outcomes, including borderline personality disorder. Here, we analyze the sources of variation that are responsible for the relationship between borderline personality features (including four dimensions, affective instability, identity disturbance, negative relationships, self-harm and a total score) and loneliness. Using genetically informative data from two large nonclinical s les of adult twin pairs from Australia and the Netherlands ( N = 11,329), we estimate the phenotypic, genetic and environmental correlations between self-reported borderline personality features and loneliness. In idual differences in borderline personality and loneliness were best explained by additive genetic factors with heritability estimates h 2 = 41% for the borderline personality total score and h 2 = 36% for loneliness, with the remaining variation explained by environmental influences that were not shared by twins from the same pair. Genetic and environmental factors influencing borderline personality (total score and four subscales separately) were also partial causes of loneliness. The correlation between loneliness and the borderline personality total score was r ph = .51. The genetic correlation was estimated at r g = .64 and the environmental correlation at r e = .40. Our study suggests common etiological factors in loneliness and borderline personality features.

Late-onset depression: Genetic, vascular and clinical contributions

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.

Discussing the impact of first onset psychosis programs on public sector health services

Publisher: SAGE Publications

Date: 08-1998

DOI: 10.3109/10398569809084834

How to tackle a giant: Creating a genuine evaluation of the Better Access Program

Publisher: SAGE Publications

Date: 12-2010

DOI: 10.3109/10398562.2010.525642

Abstract: Objective: This paper proposes a framework for a systematic evaluation of the Better Access Program, the largest single component of mental health reform announced under the Council of Australian Governments National Action Plan on Mental Health 2006–11. Method: The article explores the genesis of the Program and considers extant data sets and information available with which to establish the impact of the Program on consumers and service providers. Results: There are useful data available in Australia from which to derive pre- and post-implementation analysis about the impact of the Better Access Program. There is doubt as to whether these data form part of the Federal Government's current approach to evaluation of the Program. Conclusions: Anything less than a genuine and comprehensive evaluation will leave Australia unable to assess the real impact of the Better Access Program. The merit of further expenditure in the vital area of primary mental health care will be in doubt as a consequence.

Impaired causal awareness and associated cortical–basal ganglia structural changes in youth psychiatric disorders

Publisher: Elsevier BV

Date: 02-2016

DOI: 10.1016/J.NICL.2016.06.017

Neuropsychological and Socio-Occupational Functioning in Young Psychiatric Outpatients: A Longitudinal Investigation

Publisher: Public Library of Science (PLoS)

Date: 03-2013

DOI: 10.1371/JOURNAL.PONE.0058176

Evidence that complement and coagulation proteins are mediating the clinical response to omega-3 fatty acids: A mass spectrometry-based investigation in subjects at clinical high-risk for psychosis

Publisher: Springer Science and Business Media LLC

Date: 28-10-2022

DOI: 10.1038/S41398-022-02217-0

Abstract: Preliminary evidence indicates beneficial effects of omega-3 polyunsaturated fatty acids (PUFAs) in early psychosis. The present study investigates the molecular mechanism of omega-3 PUFA-associated therapeutic effects in clinical high-risk (CHR) participants. Plasma s les of 126 CHR psychosis participants at baseline and 6-months follow-up were included. Plasma protein levels were quantified using mass spectrometry and erythrocyte omega-3 PUFA levels were quantified using gas chromatography. We examined the relationship between change in polyunsaturated PUFAs (between baseline and 6-month follow-up) and follow-up plasma proteins. Using mediation analysis, we investigated whether plasma proteins mediated the relationship between change in omega-3 PUFAs and clinical outcomes. A 6-months change in omega-3 PUFAs was associated with 24 plasma proteins at follow-up. Pathway analysis revealed the complement and coagulation pathway as the main biological pathway to be associated with change in omega-3 PUFAs. Moreover, complement and coagulation pathway proteins significantly mediated the relationship between change in omega-3 PUFAs and clinical outcome at follow-up. The inflammatory protein complement C5 and protein S100A9 negatively mediated the relationship between change in omega-3 PUFAs and positive symptom severity, while C5 positively mediated the relationship between change in omega-3 and functional outcome. The relationship between change in omega-3 PUFAs and cognition was positively mediated through coagulation factor V and complement protein C1QB. Our findings provide evidence for a longitudinal association of omega-3 PUFAs with complement and coagulation protein changes in the blood. Further, the results suggest that an increase in omega-3 PUFAs decreases symptom severity and improves cognition in the CHR state through modulating effects of complement and coagulation proteins.

Implementing 21st century end-to-end and technology-enhanced care for young people

Publisher: Wiley

Date: 11-01-2022

DOI: 10.1002/WPS.20928

Risk factors for eating disorders: findings from a rapid review

Publisher: Springer Science and Business Media LLC

Date: 17-01-2023

DOI: 10.1186/S40337-022-00717-4

Abstract: Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders. The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021–2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper. A total of 284 studies were included. The findings were ided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms. Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for in iduals.

Prevention and early intervention in eating disorders: findings from a rapid review

Publisher: Springer Science and Business Media LLC

Date: 10-03-2023

DOI: 10.1186/S40337-023-00758-3

Abstract: Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs. This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review. In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist. Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or erse groups, where a more targeted approach may be necessary.

The Addition of Fish Oil to Cognitive Behavioral Case Management for Youth Depression: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Clinical Trial

Publisher: Elsevier BV

Date: 06-2023

DOI: 10.1016/J.BIOPSYCH.2023.06.015

Early intervention for depressive disorders in young people: the opportunity and the (lack of) evidence

Publisher: AMPCo

Date: 10-2007

DOI: 10.5694/J.1326-5377.2007.TB01329.X

Abstract: Young people experiencing their first onset of depression are a group at risk of relapse and recurrence to whom early intervention and prevention efforts should be targeted. Despite the argument for a significant research effort addressing these issues, the evidence regarding optimal intervention strategies for first episodes is lacking. Cognitive behaviour therapy is an effective approach to treatment and relapse prevention among depressed adolescents, and is likely to be an important component of any evidenced-based approach to early intervention. Antidepressants are not recommended as first-line treatment for most first episodes of depression. The role that they may play in patients with severe depression, or those who do not respond to psychological therapies, requires further evaluation. Given the high prevalence of depressive disorders, and the significant burden of disease they represent within our community, early intervention in depressive disorders is a critical research agenda for the future.

Relationship Between Polyunsaturated Fatty Acids and Psychopathology in the NEURAPRO Clinical Trial

Publisher: Frontiers Media SA

Date: 06-06-2019

DOI: 10.3389/FPSYT.2019.00393

Neuropsychological profile according to the clinical stage of young persons presenting for mental health care

Publisher: Springer Science and Business Media LLC

Date: 14-05-2013

DOI: 10.1186/2050-7283-1-8

Cohort profile: the Australian genetics of depression study.

Publisher: BMJ

Date: 05-2020

DOI: 10.1136/BMJOPEN-2019-032580

Abstract: Depression is the most common psychiatric disorder and the largest contributor to global disability. The Australian Genetics of Depression study was established to recruit a large cohort of in iduals who have been diagnosed with depression at some point in their lifetime. The purpose of establishing this cohort is to investigate genetic and environmental risk factors for depression and response to commonly prescribed antidepressants. A total of 20 689 participants were recruited through the Australian Department of Human Services and a media c aign, 75% of whom were female. The average age of participants was 43 years±15 years. Participants completed an online questionnaire that consisted of a compulsory module that assessed self-reported psychiatric history, clinical depression using the Composite Interview Diagnostic Interview Short Form and experiences of using commonly prescribed antidepressants. Further voluntary modules assessed a wide range of traits of relevance to psychopathology. Participants who reported they were willing to provide a DNA s le (75%) were sent a saliva kit in the mail. 95% of participants reported being given a diagnosis of depression by a medical practitioner and 88% met the criteria for a lifetime depressive episode. 68% of the s le report having been diagnosed with another psychiatric disorder in addition to depression. In line with findings from clinical trials, only 33% of the s le report responding well to the first antidepressant they were prescribed. A number of analyses to investigate the genetic architecture of depression and common comorbidities will be conducted. The cohort will contribute to the global effort to identify genetic variants that increase risk to depression. Furthermore, a thorough investigation of genetic and psychosocial predictors of antidepressant response and side effects is planned.

Non-melancholic depression: the contribution of personality, anxiety and life events to subclassification

Publisher: Cambridge University Press (CUP)

Date: 09-1998

DOI: 10.1017/S0033291798007107

Abstract: Background. We sought to develop a clinically useful subtyping system for the non-melancholic depressive disorders, and here we assess one weighted to central aetiological factors. Methods. We studied 185 patients meeting DSM-III-R and/or clinical criteria for non-melancholic depression. Data were obtained by self-report, interview of patients and from corroborative witnesses. We developed a set of variables for class definition, assessing: ( i ) ‘P’, disordered personality as a vulnerability factor ( ii ) ‘A’, meeting criteria for a lifetime anxiety disorder or positive on probe questions about trait anxiety characteristics, so assessing anxiety as a vulnerability factor and ( iii ) ‘L’, psychiatrist and consensually-rated life event stress prior to depression onset. Results. A latent class analysis generated a four-class solution for the P–A–L variables. Life event stressors had similar item probabilities across all four classes, and did not influence the four-class ‘P–A’ solution when deleted from the analysis, suggesting that life event stress may act more as a general provoking agent, rather than constituting any distinct ‘reactive’ or ‘situational’ depression class. Three classes generated clinically meaningful groupings, reflecting varying contributions of anxiety and disordered personality functioning, and with evidence of differential outcome over the following 12 months. Conclusions: We suggest that a refined aetiologically-weighted model may assist definition of the non-melancholic depressive disorders, and provide the logic for exploring the comparative utility of differing treatments to identified vulnerability-based classes.

Body Image Distress and Its Associations From an International Sample of Men and Women Across the Adult Life Span: Web-Based Survey Study

Publisher: JMIR Publications Inc.

Date: 04-11-2021

DOI: 10.2196/25329

Abstract: Previous research on body image distress mainly relied on s les that were small, generally homogeneous in age or sex, often limited to one geographical region, and were characterized by a lack of comprehensive analysis of multiple psychosocial domains. The research presented in this paper extends the international literature using the results of the web-based Global Health and Wellbeing Survey 2015. The survey included a large s le of both men and women aged ≥16 years from Australia, Canada, New Zealand, the United Kingdom, or the United States. The main objectives of this study are to examine body image distress across the adult life span (≥16 years) and sex and assess the association between body image distress and various psychosocial risk and protective factors. Data were extracted from the Global Health and Wellbeing Survey 2015, a web-based international self-report survey with 10,765 respondents, and compared with previous web-based surveys conducted in 2009 and 2012. The body image distress of young Australians (aged 16-25 years) significantly rose by 33% from 2009 to 2015. In 2015, 75.19% (961/1278) of 16- to 25-year-old adults reported body image distress worldwide, and a decline in body image distress was noted with increasing age. More women reported higher levels of body image distress than men (1953/3338, 58.51% vs 853/2175, 39.22%). Sex, age, current dieting status, perception of weight, psychological distress, alcohol and other substance misuse, and well-being significantly explained 24% of the variance in body image distress in a linear regression (F15,4966=105.8 P .001). This study demonstrates the significant interplay between body image distress and psychosocial factors across age and sex.

The Impact of the Organisation of Mental Health Services on the Quality of Assessment Provided to Older Patients with Depression

Publisher: SAGE Publications

Date: 10-2000

DOI: 10.1080/J.1440-1614.2000.00805.X

Abstract: Objective: The objective of this study was to examine the impact of the organisation of mental health services on the quality of medical and psychiatric assessment provided to patients with depression over 50 years of age. Method: A retrospective clinical audit of 99 patients with primary depressive disorders who were over 50 years of age was used. These patients were assessed initially by specialised psychogeriatric outpatient and community services (44%), community-based adult mental health services (35%) or an inpatient service (21%). At 2–3 years follow up, clinical outcomes were rated by treating physicians and included current depression status, cognitive and medical status, course of illness since initial assessment and current living circumstances. Results: Patients who were assessed by the community-based adult mental health service received the least comprehensive assessment. Although these patients were more likely to be living independently, they tended to have the poorest depression outcome. Patients who were assessed by the specialised or inpatient services received more comprehensive initial assessment and better coordinated long-term care. Although these patients had more medical and cognitive comorbidity they had better overall depression outcomes. Conclusions: Within a service system that determines access according to an arbitrary age of onset, patients with depression receive the best assessment from specialised psychogeriatric services. However, patients with an early age of onset, more chronic disorders and poor outcomes are treated largely within community-based adult services. Psychiatric services need to ensure that all older patients with depression receive appropriate biomedical and psychosocial assessment, as well as continuity of medical and psychological treatment.

Piloting the ‘Youth Early-intervention Study’ (‘YES’): Preliminary functional outcomes of a randomized controlled trial targeting social participation and physical well-being in young people with emerging mental disorders

Publisher: Elsevier BV

Date: 02-2021

DOI: 10.1016/J.JAD.2020.10.070

Predictors of Chronic Fatigue Syndrome and Mood Disturbance After Acute Infection

Publisher: Frontiers Media SA

Date: 25-07-2022

DOI: 10.3389/FNEUR.2022.935442

Abstract: Prospective cohort studies following in iduals from acute infections have documented a prevalent post-infective fatigue state meeting diagnostic criteria for chronic fatigue syndrome (CFS) – that is, a post-infective fatigue syndrome (PIFS). The Dubbo Infection Outcomes Study (DIOS) was a prospective cohort following in iduals from acute infection with Epstein-Barr virus (EBV), Ross River virus (RRV), or Q fever through to assessment of caseness for CFS designated by physician and psychiatrist assessments at 6 months. Previous studies in DIOS have revealed that functional genetic polymorphisms in both immunological (pro- and anti-inflammatory cytokines) and neurological (the purinergic receptor, P2X7) genes are associated with both the severity of the acute infection and subsequent prolonged illness. Principal components analysis was applied to self-report data from DIOS to describe the severity and course of both the overall illness and concurrent mood disturbance. Associations between demographics and acute infection characteristics, with prolonged illness course as well as the PIFS outcome were examined using multivariable statistics. Genetic haplotype-driven functional variations in the neuropeptide Y (NPY) gene previously shown to be associated with brain responses to stress, and to trait anxiety were also examined as predictors. The s le included 484 subjects (51% female, median age 32, IQR 19–44), of whom 90 (19%) met diagnostic criteria for CFS at 6 months. Participants with greater overall illness severity and concurrent mood disturbance in the acute illness had a more prolonged illness severity (HR = 0.39, 95% CI: 0.34–0.46, p & 0.001) and mood disturbance (HR = 0.36, 95% CI: 0.30–0.42, p & 0.001), respectively. Baseline illness severity and RRV infection were associated with delayed recovery. Female gender and mood disturbance in the acute illness were associated with prolonged mood disturbance. Logistic regression showed that the odds of an in idual being diagnosed with PIFS increased with greater baseline illness severity (OR = 2.24, 95% CI: 1.71–2.94, p & 0.001). There was no association between the NPY haplotypes with overall illness severity or mood disturbance either during the acute illness phase or with prolonged illness ( p & 0.05). Severe acute infective illnesses predicted prolonged illness, prolonged mood disturbance and PIFS. These factors may facilitate early intervention to manage both PIFS and mood disturbances.

Longitudinal associations between mismatch negativity and disability in early schizophrenia- and affective-spectrum disorders

Publisher: Elsevier BV

Date: 10-2013

DOI: 10.1016/J.PNPBP.2013.07.002

Abstract: Impaired mismatch negativity (MMN) is a robust finding in schizophrenia and, more recently, similar impairments have been reported in other psychotic- and affective-disorders (including at early stages of illness). Although cross-sectional studies have been numerous, there are few longitudinal studies that have explored the predictive value of this event-related potential in relation to clinical/functional outcomes. This study assessed changes in MMN (and the concomitant P3a) litude over time and aimed to determine the longitudinal relationship between MMN/P3a and functional outcomes in patients recruited during the early stage of a schizophrenia- or affective-spectrum disorder. Sixty young patients with schizophrenia- and affective-spectrum disorders and 30 healthy controls underwent clinical, neuropsychological and neurophysiological assessment at baseline. Thirty-one patients returned for clinical and neuropsychological follow-up 12-30months later, with 28 of these patients also repeating neurophysiological assessment. On both occasions, MMN/P3a was elicited using a two-tone passive auditory paradigm with duration deviants. Compared with controls, patients showed significantly impaired temporal MMN litudes and trend-level deficits in central MMN/P3a litudes at baseline. There were no significant differences for MMN measures between the diagnostic groups, whilst the schizophrenia-spectrum group showed reduced P3a litudes compared to those with affective-spectrum disorders. For those patients who returned for follow-up, reduced temporal MMN litude at baseline was significantly associated with greater levels of occupational disability, and showed trend-level associations with general and social disability at follow-up. Paired t-tests revealed that MMN litudes recorded at the central-midline site were significantly reduced in patients over time. Interestingly, those patients who did not return for follow-up showed reduced frontal MMN and fronto-central P3a litudes compared to their peers who did return for repeat assessment. This study provides some evidence of the predictive utility of MMN at the early stages of schizophrenia- and affective-spectrum disorders and demonstrated that MMN impairments in such patients may worsen over time. Specifically, we found that young patients with the most impaired MMN litudes at baseline showed the most severe levels of disability at follow-up. Furthermore, in the subset of patients with repeat neurophysiological testing, central MMN was further impaired suggestive of neurodegenerative effects. MMN may serve as a neurophysiological biomarker to more accurately predict functional outcomes and prognosis, particularly at the early stages of illness.

Genetic effects on the cerebellar role in working memory: Same brain, different genesα

Publisher: Elsevier BV

Date: 02-2014

DOI: 10.1016/J.NEUROIMAGE.2013.10.006

Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study

Publisher: JMIR Publications Inc.

Date: 08-09-2023

DOI: 10.2196/45161

Reduced temporal mismatch negativity in late-life depression: An event-related potential index of cognitive deficit and functional disability?

Publisher: Elsevier BV

Date: 04-2012

DOI: 10.1016/J.JAD.2011.12.028

Abstract: Depression in older people has been consistently linked with a variety of neurobiological brain changes. One measure of preattentive auditory processing, the mismatch negativity (MMN), has not been previously examined in late-life depression. This study examined MMN elicited by duration deviant stimuli in older people with lifetime depression, and explored its relationship with neuropsychological functioning and disability. Twenty-two older health-seeking patients (mean age=65.2 years) with lifetime major depressive disorder and twelve age and sex-matched control participants (mean age=64.6 years) completed detailed clinical and neuropsychological assessments and the WHO-DAS as a measure of disability. MMN litudes were elicited using a two-tone passive auditory oddball paradigm and measured at frontal (Fz), central (Cz) and temporal (left and right mastoid: M1 and M2, respectively) sites. Patients with depression demonstrated reduced mean MMN litude at temporal (M1, t=3.1, p<0.01 M2, t=3.8, p<0.01), but not fronto-central sites. Reduced temporal MMN litudes did not relate to depressive symptom severity, but were associated with reduced semantic fluency and greater self-rated functional disability. The contribution of depressive symptom 'state' and medications on MMN need to be considered. Reduced mean litudes of mastoid MMN in older patients with lifetime depression may reflect underlying brain changes. This preattentive marker relates to neuropsychological probes of frontotemporal circuits, and importantly, is associated with disability. Longitudinal analysis of MMN in this group will determine its predictive utility as a biomarker for ongoing cognitive decline and illness chronicity.

The Utility of Clinical Staging in Youth Mental Health Settings: Neurobiological and Longitudinal Data from Sydney-Based Studies of Transdiagnostic Cohorts

Publisher: Cambridge University Press

Date: 31-07-2019

DOI: 10.1017/9781139839518.005

Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution

Publisher: Springer Science and Business Media LLC

Date: 12-2003

DOI: 10.1186/1472-6963-3-25

Clinical Staging and Its Potential to Enhance Mental Health Care

Publisher: Cambridge University Press

Date: 07-2019

DOI: 10.1017/9781139839518.002

The treatment of chronic fatigue syndrome: Science and speculation

Publisher: Elsevier BV

Date: 06-1994

DOI: 10.1016/0002-9343(94)90095-7

Abstract: The chronic fatigue syndrome (CFS) is a heterogeneous disorder characterized by fatigue, neuropsychiatric symptoms, and various other somatic complaints. Treatment studies to date reflect both the ersity of medical disciplines involved in the management of patients with CFS and the multiple pathophysiologic mechanisms proposed. There have been few attempts to study integrated treatment programs, and although several controlled studies have been reported, no treatment has been shown clearly to result in long-term benefit in the majority of patients. Good clinical care integrating medical and psychologic concepts, together with symptomatic management, may prevent significant secondary impairment in the majority of patients. Future treatment studies should examine differential response rates for possible subtypes of the disorder (eg, documented viral onset, concurrent clinical depression), evaluate the extent of any synergistic effects between therapies (ie, medical and psychologic), and employ a wide range of biologic and psychologic parameters as markers of treatment response.

The Potential of Health Information Technologies to Transform Mental Health Care for Young People in Low-and Middle-Income Countries

Publisher: Springer International Publishing

Date: 2021

DOI: 10.1007/978-3-030-57296-9_128

A network analysis of rest-activity rhythms in young people with emerging bipolar disorders

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.

Early and late onset depression in old age: Different aetiologies, same phenomenology

Publisher: Elsevier BV

Date: 10-2001

DOI: 10.1016/S0165-0327(00)00317-7

Abstract: Phenomenological differences between older patients with early onset (EO onset of first major depressive episode before 60 years) and late onset (LO) depression have been inconsistent but, if real, may reflect differences in aetiology. We aimed to compare aetiological factors, phenomenology and cognitive function in older patients with depression by age of onset. Subjects were all patients > or =60 years old (n=73) from 407 consecutive attenders to a Mood Disorders Unit, diagnosed with DSM-III-R Major Depressive Episode, at or close to the nadir of their episode. Putative risk factors were assessed by structured interview. Psychological morbidity and depressive symptoms were assessed by the 21-item Hamilton Rating Scale for Depression, CORE rating of psychomotor disturbance, Newcastle Endogeneity Scale, Zung Depression Scale and General Health Questionnaire. Cognition was assessed by tests of memory, attention, executive function and motor speed. Personality abnormalities, a family history of psychiatric illness and dysfunctional past maternal relationships were significantly more common in EO depression. The two age of onset groups were essentially similar in terms of depressive sub-type and severity, phenomenology, history of previous episode, and in neuropsychological performance. Use of self-report data, moderate s le size, s le not age-matched, tertiary referral patients. EO and LO depression are similar phenotypically, but differ aetiologically. The pursuit of mechanisms which predispose depressive episodes may be heuristically more valuable than further investigation of in idual depressive features in distinguishing early from late onset depression.

Clinical staging for mental disorders: A new development in diagnostic practice in mental health: Matching the timing and intensity of interventions to the specific needs of patients

Publisher: AMPCo

Date: 05-2013

DOI: 10.5694/MJA13.10431

EMPOWERED trial: protocol for a randomised control trial of digitally supported, highly personalised and measurement-based care to improve functional outcomes in young people with mood disorders

Publisher: BMJ

Date: 10-2023

DOI: 10.1136/BMJOPEN-2023-072082

A behavioral approach based on reconstructing the sleep-wake cycle

Publisher: Elsevier BV

Date: 09-1999

DOI: 10.1016/S1077-7229(99)80065-0

The reply

Publisher: Elsevier BV

Date: 10-1991

DOI: 10.1016/0002-9343(91)90171-S

Distress and disability in young adults presenting to clinical services with mood disorders

Publisher: Springer Science and Business Media LLC

Date: 17-10-2013

DOI: 10.1186/2194-7511-1-23

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.

Potential Genetic Overlap Between Insomnia and Sleep Symptoms in Major Depressive Disorder: A Polygenic Risk Score Analysis

Publisher: Frontiers Media SA

Date: 03-12-2021

DOI: 10.3389/FPSYT.2021.734077

Abstract: Background: The prevalence of insomnia and hypersomnia in depressed in iduals is substantially higher than that found in the general population. Unfortunately, these concurrent sleep problems can have profound effects on the disease course. Although the full biology of sleep remains to be elucidated, a recent genome-wide association (GWAS) of insomnia, and other sleep traits in over 1 million in iduals was recently published and provides many promising hits for genetics of insomnia in a population-based s le. Methods: Using data from the largest available GWAS of insomnia and other sleep traits, we sought to test if sleep variable PRS scores derived from population-based studies predicted sleep variables in s les of depressed cases [Psychiatric Genomics Consortium - Major Depressive Disorder subjects (PGC MDD)]. A leave-one-out analysis was performed to determine the effects that each in idual study had on our results. Results: The only significant finding was for insomnia, where p -value threshold, p = 0.05 was associated with insomnia in our PGC MDD s le ( R 2 = 1.75 −3 , p = 0.006). Conclusion: Our results reveal that & % of variance is explained by the variants that cover the two significant p -value thresholds, which is in line with the fact that depression and insomnia are both polygenic disorders. To the best of our knowledge, this is the first study to investigate genetic overlap between the general population and a depression s le for insomnia, which has important treatment implications, such as leading to novel drug targets in future research efforts.

16Up: Outline of a Study Investigating Wellbeing and Information and Communication Technology Use in Adolescent Twins.

Publisher: Cambridge University Press (CUP)

Date: 12-2020

DOI: 10.1017/THG.2020.83

Abstract: The ‘16Up’ study conducted at the QIMR Berghofer Medical Research Institute from January 2014 to December 2018 aimed to examine the physical and mental health of young Australian twins aged 16−18 years ( N = 876 371 twin pairs and 18 triplet sets). Measurements included online questionnaires covering physical and mental health as well as information and communication technology (ICT) use, actigraphy, sleep diaries and hair s les to determine cortisol concentrations. Study participants generally rated themselves as being in good physical (79%) and mental (73%) health and reported lower rates of psychological distress and exposure to alcohol, tobacco products or other substances than previously reported for this age group in the Australian population. Daily or near-daily online activity was almost universal among study participants, with no differences noted between males and females in terms of frequency or duration of internet access. Patterns of ICT use in this s le indicated that the respondents were more likely to use online information sources for researching physical health issues than for mental health or substance use issues, and that they generally reported partial levels of satisfaction with the mental health information they found online. This suggests that internet-based mental health resources can be readily accessed by adolescent Australians, and their computer literacy augurs well for future access to online health resources. In combination with other data collected as part of the ongoing Brisbane Longitudinal Twin Study, the 16Up project provides a valuable resource for the longitudinal investigation of genetic and environmental contributions to phenotypic variation in a variety of human traits.

Is depression overdiagnosed? No

Publisher: BMJ

Date: 16-08-2007

DOI: 10.1136/BMJ.39268.497350.AD

Dynamic modelling of the impact of community-based acute mental health services for children and adolescents

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.

Cytokine Polymorphisms Have a Synergistic Effect on Severity of the Acute Sickness Response to Infection

Publisher: Oxford University Press (OUP)

Date: 12-2008

DOI: 10.1086/592967

Abstract: Functional polymorphisms in immune response genes are increasingly recognized as important contributors to the marked in idual differences in susceptibility to and outcomes of infectious disease. The acute sickness response is a stereotypical set of illness manifestations mediated by the proinflammatory cytokines induced by many different pathogens. The genetic determinants of severity of the acute sickness response have not previously been explored. We examined the impact of functional polymorphisms in cytokine genes with critical roles in the early immune response (tumor necrosis factor-alpha, interleukin-6, interleukin-10, and interferon-gamma) on the severity and duration of illness following acute infection with Epstein-Barr virus, Coxiella burnetii (the causative agent of Q fever), or Ross River virus. We found that the interferon-gamma +874T/A and the interleukin-10 -592C/A polymorphisms significantly affected illness severity, cytokine protein levels, and the duration of illness. These cytokine genotypes acted in synergy to potentiate their influence on disease outcomes. These findings suggest that genetically determined variations in the intensity of the inflammatory response underpin the severity of the acute sickness response and predict the recovery time across varied infections.

The brisbane longitudinal twin study: Pathways to cannabis use, abuse, and dependence project - Current status, preliminary results, and future directions

Publisher: Cambridge University Press (CUP)

Date: 28-11-2013

DOI: 10.1017/THG.2012.111

Abstract: We describe the data being collected from the Brisbane Longitudinal Twin Study in Australia as part of the US National Institute on Drug Abuse (NIDA)-funded project, Pathways to Cannabis Use, Abuse and Dependence. The history, recruitment, assessment, and retention of twin families in this project are described in detail, along with preliminary findings and plans for future research. The goal of this NIDA project is to make a significant contribution to the discovery of quantitative trait loci influencing cannabis use disorders. Although the focus is cannabis use, abuse, and dependence in young adults, measures of comorbid illicit drug use disorders are also being collected. In addition, a variety of internalizing and externalizing disorders are being assessed, funded by support from the Australian National Health and Medical Research Council. Because these same twins have participated in numerous twin studies since 1992, future plans will include linking different phenotypes to investigate relationships between drug use, psychiatric disorders, and psychological phenotypes within cross-sectional and longitudinal or developmental frameworks.

Applying clinical staging to young people who present for mental health care

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.

Deficits in episodic memory retrieval reveal impaired default mode network connectivity in amnestic mild cognitive impairment

Publisher: Elsevier BV

Date: 2014

DOI: 10.1016/J.NICL.2014.02.010

Sleep-wake cycle in young and older persons with a lifetime history of mood disorders

Publisher: Public Library of Science (PLoS)

Date: 25-02-2014

DOI: 10.1371/JOURNAL.PONE.0087763

Reducing off-label prescribing in psychiatry

Publisher: AMPCo

Date: 02-2014

DOI: 10.5694/MJA14.00050

Nineteen and Up study (19Up): Understanding pathways to mental health disorders in young Australian twins

Publisher: BMJ

Date: 03-2018

DOI: 10.1136/BMJOPEN-2017-018959

Abstract: The Nineteen and Up study (19Up) assessed a range of mental health and behavioural problems and associated risk factors in a genetically informative Australian cohort of young adult twins and their non-twin siblings. As such, 19Up enables detailed investigation of genetic and environmental pathways to mental illness and substance misuse within the Brisbane Longitudinal Twin S le (BLTS). Twins and their non-twin siblings from Queensland, Australia mostly from European ancestry. Data were collected between 2009 and 2016 on 2773 participants (age range 18–38, 57.8% female, 372 complete monozygotic pairs, 493 dizygotic pairs, 640 non-twin siblings, 403 singleton twins). A structured clinical assessment (Composite International Diagnostic Interview) was used to collect lifetime prevalence of diagnostic statistical manual (4th edition) (DSM-IV) diagnoses of major depressive disorder, (hypo)mania, social anxiety, cannabis use disorder, alcohol use disorder, panic disorder and psychotic symptoms. Here, we further describe the comorbidities and ages of onset for these mental disorders. Notably, two-thirds of the s le reported one or more lifetime mental disorder. In addition, the 19Up study assessed general health, drug use, work activity, education level, personality, migraine/headaches, suicidal thoughts, attention deficit hyperactivity disorder (ADHD) symptomatology, sleep–wake patterns, romantic preferences, friendships, familial environment, stress, anorexia and bulimia as well as baldness, acne, asthma, endometriosis, joint flexibility and internet use. The overlap with previous waves of the BLTS means that 84% of the 19Up participants are genotyped, 36% imaged using multimodal MRI and most have been assessed for psychological symptoms at up to four time points. Furthermore, IQ is available for 57%, parental report of ADHD symptomatology for 100% and electroencephalography for 30%. The 19Up study complements a phenotypically rich, longitudinal collection of environmental and psychological risk factors. Future publications will explore hypotheses related to disease onset and development across the waves of the cohort. A follow-up study at 25+years is ongoing.

The impact of gender on early ill-health retirement in people with heart disease and depression

Publisher: SAGE Publications

Date: 05-01-2012

DOI: 10.1177/0004867411427807

Abstract: Objective: Depression and heart disease are major causes of early ill-health retirement. The effect of comorbid depression on the award of ill-health retirement in those with heart disease is unclear, however, and may differ by gender. Given the deleterious effects of ill-health retirement, identifying at-risk groups is important for guiding targeted interventions. Method: We retrospectively analysed baseline data of 20,655 participants from the 45 and Up Study (New South Wales, Australia), who had fully retired between the ages of 45 and 64. We examined the associations of depression and heart disease with ill-health retirement and then adjusted for the presence of common confounders. We then restricted the s le to the 1165 in iduals with heart disease prior to retirement, to determine the impact of comorbid depression on IHR and analysed whether there was a differential impact by gender. Results: In the complete s le, 3836 out of 20,655 (18.6%) of the participants retired early due to ill health. Prior heart disease and depression were both independently and strongly associated with ill-health retirement. Those who retired due to ill health were also more likely to be men, less educated, report greater physical disability and were younger at retirement. Among the 1165 for whom heart disease predated any form of retirement, 40% retired due to ill health. Comorbid depression prior to ill-health retirement was strongly associated with an increased risk of this IHR in women (odds ratio = 2.85 95% confidence interval = 1.20–6.77, p = 0.01), but not in men (interaction term, p = 0.045). Conclusions: Ill-health retirement is common in those with heart disease. Women appear to be particularly susceptible to the effects of comorbid depression. Given the policy emphasis on reducing the number of people leaving the workforce early, women with early heart disease may represent a particular group in whom interventions designed to detect and treat comorbid depression should be targeted.

Transforming Cultures to Enable Stage-Related Care of Mental Ill-Health: A Youth Mental Health Challenge

Publisher: Cambridge University Press

Date: 31-07-2019

DOI: 10.1017/9781139839518.013

Intranasal arginine vasopressin enhances the encoding of happy and angry faces in humans.

Publisher: Elsevier BV

Date: 06-2010

DOI: 10.1016/J.BIOPSYCH.2010.03.014

Abstract: Arginine vasopressin (AVP) has a complex but crucial role in social behavior. In nonhuman mammals it facilitates social recognition and bonding while also promoting defensive, aggressive, and territorial behaviors. There has been little research in humans exploring its effect on social cognition, including the encoding of social memories. In a double-blind, randomized, placebo-controlled, between-subject design, we administered AVP (20 IU) or a placebo intranasally to 48 healthy human male volunteers and then presented 54 happy, angry, or neutral human faces. Participants returned the following day to make "remember", "know", or "new" judgments for a mix of 108 new and previously seen faces. Participants who were administered AVP were more likely to make know judgments for previously seen happy and angry faces in comparison with neutral human faces. Arginine vasopressin did not influence judgments for faces that had not been presented previously. Administration of AVP to male humans enhances the encoding of both happy and angry social information to make this more memorable. Results suggest that AVP could facilitate both bonding and aggressive related behaviors in humans by enhancing the encoding of positive and negative social cues within everyday interactions.

PET imaging of putative microglial activation in individuals at ultra-high risk for psychosis, recently diagnosed and chronically ill with schizophrenia

Publisher: Springer Science and Business Media LLC

Date: 29-08-2017

DOI: 10.1038/TP.2017.193

The relationship between distress and the development of a primary immune response to a novel antigen

Publisher: Elsevier BV

Date: 2004

DOI: 10.1016/S0889-1591(03)00107-7

Abstract: Forty-five medical students were recruited to examine the effects of distress on the development of an immune response to the novel antigen, keyhole limpet hemocyanin (KLH). The subjects' level of distress was manipulated by immunizing them either at the time of an important viva voce examination (n=22) or during examination-free term time (n=23). This manipulation increased variance amongst the subjects, but the emphasis in this research was on in idual distress as a predictor of immune function. In the group as a whole, the likelihood of developing DTH skin responses to KLH was reduced in the more distressed subjects (r=-.45 p=.002), independently of a number of behavioral (e.g., sleep disturbance) and demographic (e.g., sex) variables. Proliferation of T cells against KLH in vitro and the development of anti-KLH IgG antibodies were not related to levels of distress. Thus, cellular, rather than humoral, immune responses in vivo appear susceptible to the influence of distress. This immunization model provides the opportunity to further dissect the basis of these stress-immune pathways.

Familial aggregation and heritability of the melancholic and atypical subtypes of depression

Publisher: Elsevier BV

Date: 11-2016

DOI: 10.1016/J.JAD.2016.06.040

Abstract: The heterogeneity of mood disorders has been a challenge to our understanding of their underlying biologic and genetic pathways. This report examines the specificity of the familial aggregation of atypical and melancholic subtypes of depression and their clinical correlates in a large community based family study of affective spectrum disorders. The s le includes 457 probands and their directly interviewed adult first degree relatives from the National Institute of Mental Health (NIMH) Family Study of Affective Spectrum Disorder. Depression subtypes were based on best estimate diagnoses using information from semi-structured diagnostic interviews by experienced clinical interviews and multiple family history reports. Atypical depression in probands was significantly associated with the atypical subtype of depression in relatives (OR 1.75 [95%CI 1.02-3.02], p=0.04), independent of proband and relative comorbid disorders. Melancholic depression in probands was not associated with melancholic depression in relatives (OR 1.25 [95%CI 0.62-2.55], p=.53). The familial heritability of the atypical subtype was 0.46 (95%CI 0.21-0.71), whereas that of the melancholic subtype was 0.33 (95%CI 0.21-0.45). Melancholic depression was associated with greater severity in terms of treatment, global functioning, suicide attempts, comorbid disorders, and an earlier age at onset of depression. The subs le of interviewed relatives necessary to assess specific subtypes of depression reduced the power to detect the specificity of mood disorder subtypes. The results indicate that the atypical subtype should be incorporated in future treatment, genetic and other etiologic studies of major depression. Findings further suggest that melancholic subtype may be an indicator of clinical severity of depression.

The effect of oxytocin nasal spray on social interaction deficits observed in young children with autism: a randomized clinical crossover trial

Publisher: Springer Science and Business Media LLC

Date: 27-10-2016

DOI: 10.1038/MP.2015.162

Nick Martin and the Genetics of Depression: Sample Size, Sample Size, Sample Size

Publisher: Cambridge University Press (CUP)

Date: 04-2020

DOI: 10.1017/THG.2020.13

Abstract: Nick Martin is a pioneer in recognizing the need for large s le size to study the complex, heterogeneous and polygenic disorders of common mental disorders. In the predigital era, questionnaires were mailed to thousands of twin pairs around Australia. Always quick to adopt new technology, Nick’s studies progressed to phone interviews and then online. Moreover, Nick was early to recognize the value of collecting DNA s les. As genotyping technologies improved over the years, these twin and family cohorts were used for linkage, candidate gene and genome-wide association studies. These cohorts have underpinned many analyses to disentangle the complex web of genetic and lifestyle factors associated with mental health. With characteristic foresight, Nick is chief investigator of our Australian Genetics of Depression Study, which has recruited 16,000 people with self-reported depression (plus DNA s les) over a time frame of a few months — analyses are currently ongoing. The mantra of s le size, s le size, s le size has guided Nick’s research over the last 30 years and continues to do so.

Psychological morbidity in women at increased risk of developing breast cancer: A controlled study

Publisher: Wiley

Date: 2005

DOI: 10.1002/PON.835

Abstract: There has been an ongoing debate in the literature on the extent to which women with a family history of breast cancer are at risk of psychological morbidity. This study compares psychological morbidity in 557 women participating in a large Australian registry of high-risk breast cancer families (kConFab) with 2 age and education matched s les, 1494 general practitioner attendees and 158 members of a twin registry. Participants completed the Somatic and Psychological Health Report (SPHERE). There were no significant differences between the three groups on psychological distress (F(2, 670) = 1.77, p = 0.17). Unsurprisingly, GP attendees reported more symptoms of somatic distress than the kConFab group (t411 = 2.89, p = 0.004) there were no differences between the twins and the kConFab group on somatic distress (t174 = 0.40, p = 0.687). Clinically significant anxiety/depression, a combination of psychological and somatic distress, therefore was significantly higher in GP attendees (28%) than the kConFab and twin s les (both 20%). These results refute the hypothesis that women with a family history of breast cancer are at greater psychological risk.

The internet as a setting for mental health service utilisation by young people

Publisher: AMPCo

Date: 06-2010

DOI: 10.5694/J.1326-5377.2010.TB03688.X

Abstract: To explore patterns of internet use by young people in Australia and assess the usefulness of online resources for mental health problems, exploring functionality that may be relevant in the development of online mental health services. Cross-sectional survey of a nationally representative s le of young people (2000 randomly selected participants aged 12-25 years), via telephone interview, conducted in January-March 2008. Patterns of internet use including type of use, social networking, sources of information about mental health, alcohol or other substance use problems and levels of satisfaction with the information, and type of information accessed via websites. Young people reported using the internet to connect with other young people (76.9% 1464/1905) and to seek information about a mental health problem, regardless of whether they had a problem themselves (38.8% 735/1894). Twenty per cent of young people (398/1990) had personally experienced a mental health problem in the previous 5 years when these people were asked about sources of information used for this problem, 30.8% (70/227) reported searching the internet. Patterns of internet use and types of resources used differed by age and sex. Our findings suggest that technology is important in the everyday lives of young people, and online mental health services that encompass promotion and prevention activities should include a variety of resources that appeal to all ages and both sexes, such as "question and answer" forums and email.

Accuracy of self-reported sleep parameters compared with actigraphy in young people with mental ill-health

Publisher: Elsevier BV

Date: 09-2015

DOI: 10.1016/J.SLEH.2015.07.006

Abstract: Validation of self-report assessment of habitual sleep duration and onset time in young people with mental ill-health. Validation s le. Specialized early intervention centers for young people in Sydney, Australia. One hundred and forty-six young people with mental ill-health. N/A. Self-reported habitual sleep duration and onset time were compared against at least 7 days of actigraphy monitoring. Average bias in and calibration of subjective measures were assessed, along with correlation of subjective and objective measures. Differences by age, sex, mental-disorder type, and reported insomnia were also explored. On average, subjective estimates of sleep were unbiased. Overall, each additional hour of objective habitual sleep duration predicted 41 minutes more subjective habitual sleep duration, and each hour later objective habitual sleep onset occurred predicted a 43-minute later subjective habitual sleep onset. There were subgroup differences: subjective habitual sleep duration in self-reported insomnia was shorter than objective duration by 30 minutes (SD = 119), on average. Calibration of habitual sleep duration was worse for those with mood disorders than with other primary diagnoses (t = -2.39, P = .018). Correlation between subjective and objective measures was strong for sleep onset time (Á = .667, P < .001) and moderate for sleep duration (r = .332, P < .001). For the mood disorder group, subjective and objective sleep durations were uncorrelated. Self-reports seem valid for large-scale studies of habitual sleep duration and onset in help-seeking young people, but assessment of habitual sleep duration requires objective measures where in idual accuracy is important.

Twenty-Five and Up (25Up) Study: A New Wave of the Brisbane Longitudinal Twin Study

Publisher: Cambridge University Press (CUP)

Date: 06-2019

DOI: 10.1017/THG.2019.27

Abstract: The aim of the 25 and Up (25Up) study was to assess a wide range of psychological and behavioral risk factors behind mental illness in a large cohort of Australian twins and their non-twin siblings. Participants had already been studied longitudinally from the age of 12 and most recently in the 19Up study (mean age = 26.1 years, SD = 4.1, range = 20–39). This subsequent wave follows up these twins several years later in life (mean age = 29.7 years, SD = 2.2, range = 22–44). The resulting data set enables additional detailed investigations of genetic pathways underlying psychiatric illnesses in the Brisbane Longitudinal Twin Study (BLTS). Data were collected between 2016 and 2018 from 2540 twins and their non-twin siblings (59% female, including 341 monozygotic complete twin-pairs, 415 dizygotic complete pairs and 1028 non-twin siblings and singletons). Participants were from South-East Queensland, Australia, and the s le was of predominantly European ancestry. The 25Up study collected information on 20 different mental disorders, including depression, anxiety, substance use, psychosis, bipolar and attention-deficit hyper-activity disorder, as well as general demographic information such as occupation, education level, number of children, self-perceived IQ and household environment. In this article, we describe the prevalence, comorbidities and age of onset for all 20 examined disorders. The 25Up study also assessed general and physical health, including physical activity, sleep patterns, eating behaviors, baldness, acne, migraines and allergies, as well as psychosocial items such as suicidality, perceived stress, loneliness, aggression, sleep–wake cycle, sexual identity and preferences, technology and internet use, traumatic life events, gambling and cyberbullying. In addition, 25Up assessed female health traits such as morning sickness, breastfeeding and endometriosis. Furthermore, given that the 25Up study is an extension of previous BLTS studies, 86% of participants have already been genotyped. This rich resource will enable the assessment of epidemiological risk factors, as well as the heritability and genetic correlations of mental conditions.

Innovative preclinic triage system to guide Australians to the right mental health care first time

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.

PSYCHOIMMUNE NETWORKS IN HEALTH AND DISEASE - PROCEEDINGS OF THE 3RD INTERNATIONAL SCIENTIFIC MEETING OF THE AUSTRALIAN-BEHAVIORAL-IMMUNOLOGY-GROUP - SYDNEY, AUSTRALIA - 1-3-APRIL-1993 - INTRODUCTION

Publisher: Elsevier BV

Date: 08-1995

DOI: 10.1016/0192-0561(95)90000-4

Meta-analysis of neurocognition in young psychosis patients with current cannabis use

Publisher: Elsevier BV

Date: 04-2018

DOI: 10.1016/J.JPSYCHIRES.2018.01.010

Abstract: Adult psychosis patients (i.e. over the age of 25 years) who are also lifetime cannabis users (CANN±) appear to exhibit superior cognition compared to never-using patients (CANN-). The objective of this meta-analysis was to evaluate the cognitive differences between CANN- and patients who currently use cannabis (CANN+) (i.e. during the CANN± patients' cannabis-using stage). Specifically, focusing on young patients under the age of 25 years, the typical stage of both psychosis- and cannabis-onset. Of the 308 studies identified through database searches and secondary referencing, 14 compared neurocognition of CANN+ and CANN- in young people with psychotic disorders (mean age between 15 and 45 years). Effect sizes were extracted using neurocognitive test performance between CANN+ and CANN- and random effects modelling was conducted on pooled ES and moderator analyses. CANN+ performed worse on several cognitive domains (i.e. premorbid IQ, current IQ, verbal learning, verbal working memory, motor inhibition) compared to CANN-. The association between age and performance in CANN+ cognition was varied, with older age predictive of worse performance in processing speed, sustained attention, verbal memory, and better performance in verbal learning and very fluency. Of note, CANN+ outperformed CANN- in tests of conceptual set-shifting. These results are consistent with previous findings indicating that CANN+ demonstrate poorer neurocognition than CANN- and that this is exacerbated with increasing age. Our findings demonstrate significant cognitive differences between patients with CANN+ versus CANN- even at early-onset psychosis, which could suggest a different underlying mechanism towards psychosis for cannabis users.

Napping in older people 'at risk' of dementia: Relationships with depression, cognition, medical burden and sleep quality

Publisher: Wiley

Date: 21-06-2015

DOI: 10.1111/JSR.12313

Abstract: Sleep disturbance is prevalent in older adults, particularly so in those at a greater risk of dementia. However, so far the clinical, medical and neuropsychological correlates of daytime sleep have not been examined. The aims of this study were to investigate the characteristics and effects of napping using actigraphy in older people, particularly in those 'at risk' of dementia. The study used actigraphy and sleep diaries to measure napping habits in 133 older adults 'at risk' of dementia (mean age = 65.5 years, SD = 8.4 years), who also underwent comprehensive medical, psychiatric and neuropsychological assessment. When defined by actigraphy, napping was present in 83.5% (111/133) of participants however, duration and timing varied significantly among subjects. Nappers had significantly greater medical burden and body mass index, and higher rates of mild cognitive impairment. Longer and more frequent naps were associated with poorer cognitive functioning, as well as higher levels of depressive symptoms, while the timing of naps was associated with poorer nocturnal sleep quality (i.e. sleep latency and wake after sleep onset). This study highlights that in older adults 'at risk' of dementia, napping is associated with underlying neurobiological changes such as depression and cognition. Napping characteristics should be more routinely monitored in older in iduals to elucidate their relationship with psychological and cognitive outcomes.

Associations between the CADM2 gene, substance use, risky sexual behavior, and self‐control: A phenome‐wide association study

Publisher: Wiley

Date: 18-02-2021

DOI: 10.1111/ADB.13015

Abstract: Risky behaviors, such as substance use and unprotected sex, are associated with various physical and mental health problems. Recent genome‐wide association studies indicated that variation in the cell adhesion molecule 2 ( CADM2 ) gene plays a role in risky behaviors and self‐control. In this phenome‐wide scan for risky behavior, it was tested if underlying common vulnerability could be (partly) explained by pleiotropic effects of this gene and how large the effects were. Single nucleotide polymorphism (SNP)‐level and gene‐level association tests within four s les (25 and Up, Spit for Science, Netherlands Twin Register, and UK Biobank and meta‐analyses over all s les (combined s le of 362,018 participants) were conducted to test associations between CADM2 , substance‐ and sex‐related risk behaviors, and various measures related to self‐control. We found significant associations between the CADM2 gene, various risky behaviors, and different measures of self‐control. The largest effect sizes were found for cannabis use, sensation seeking, and disinhibition. Effect sizes ranged from 0.01% to 0.26% for single top SNPs and from 0.07% to 3.02% for independent top SNPs together, with sufficient power observed only in the larger s les and meta‐analyses. In the largest cohort, we found indications that risk‐taking proneness mediated the association between CADM2 and latent factors for lifetime smoking and regular alcohol use. This study extends earlier findings that CADM2 plays a role in risky behaviors and self‐control. It also provides insight into gene‐level effect sizes and demonstrates the feasibility of testing mediation. These findings present a good starting point for investigating biological etiological pathways underlying risky behaviors.

Delayed preattentional functioning in early psychosis patients with cannabis use

Publisher: Springer Science and Business Media LLC

Date: 09-03-2012

DOI: 10.1007/S00213-012-2676-2

Abstract: Cannabis use is prevalent among the early psychosis (EP) population. The event-related potentials, mismatch negativity (MMN) and P3a are reduced in EP. Cannabinoids have been shown to modulate N-methyl-D-aspartate receptors which are involved in MMN generation. This study is the first to investigate the effects of cannabis use on MMN/P3a in EP. EP was defined as a history of psychosis or psychotic symptoms with no progression to date to chronic schizophrenia. Twenty-two EP patients with cannabis use (EP + CANN), 22 non-cannabis-using EP patients (EP-CANN) and 21 healthy controls participated in this study. MMN/P3a was elicited using a two-tone, auditory paradigm with 8% duration deviants. As expected, EP-CANN showed marked reductions in MMN/P3a litudes compared to controls. However, EP + CANN showed evidence of a different pattern of neurophysiological expression of MMN/P3a compared to non-using patients, most notably in terms of delayed frontal MMN/P3a latencies. This study provides further evidence that MMN/P3a deficits are present during early psychosis and suggests that this biomarker may have utility in differentiating substance- from non-substance-related psychoses.

A CATECHOLAMINE MODEL OF FATIGUE

Publisher: Royal College of Psychiatrists

Date: 08-1994

DOI: 10.1192/BJP.165.2.275

A consensus statement for safety monitoring guidelines of treatments for major depressive disorder

Publisher: SAGE Publications

Date: 09-2011

DOI: 10.3109/00048674.2011.595686

Abstract: Objective: This paper aims to present an overview of screening and safety considerations for the treatment of clinical depressive disorders and make recommendations for safety monitoring. Method: Data were sourced by a literature search using MEDLINE and a manual search of scientific journals to identify relevant articles. Draft guidelines were prepared and serially revised in an iterative manner until all co-authors gave final approval of content. Results: Screening and monitoring can detect medical causes of depression. Specific adverse effects associated with antidepressant treatments may be reduced or identified earlier by baseline screening and agent-specific monitoring after commencing treatment. Conclusion: The adoption of safety monitoring guidelines when treating clinical depression is likely to improve overall physical health status and treatment outcome. It is important to implement these guidelines in the routine management of clinical depression.

Heart Rate Variability in Children With Autism Spectrum Disorder and Associations With Medication and Symptom Severity

Publisher: Wiley

Date: 22-11-2021

DOI: 10.1002/AUR.2437

Letters to the Editor

Publisher: SAGE Publications

Date: 03-1987

DOI: 10.1080/00048678709160906

Schizophrenia polygenic risk scores in youth mental health: preliminary associations with diagnosis, clinical stage and functioning

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.

Managing depression across the life cycle: new strategies for clinicians and their patients

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.

Preliminary results from the Australian Genetics of Bipolar Disorder Study: A nation-wide cohort

Publisher: SAGE Publications

Date: 09-2023

DOI: 10.1177/00048674231195571

Sleep disturbance in mild cognitive impairment is associated with alterations in the brain’s default mode network.

Publisher: American Psychological Association (APA)

Date: 06-2016

DOI: 10.1037/BNE0000137

Abstract: This study aimed to identify default mode network (DMN) functional connectivity deficits in patients with mild cognitive impairment (MCI) and sleep disturbance, relative to those with MCI and no sleep disturbance. A control group was included to aid in identifying DMN changes specific to MCI. A cross-sectional, single-center study was performed at the Brain and Mind Research Centre in Sydney, Australia. Participants (95 adults over the age of 65: 38 controls and 57 meeting criteria for MCI) underwent resting-state functional MRI along with comprehensive neuropsychological, medical, and psychiatric assessment. Self-report data were collected including sleep quality assessment via the Pittsburgh Sleep Quality Index. A total score of greater than 5 on the Pittsburgh Sleep Quality Index was used to signify the presence of significant sleep disturbance, as per commonly used methodology. Using this criterion, 53% (n = 30) of our MCI group were classified as sleep-disturbed. Whereas the total group of MCI subjects and controls demonstrated no significant differences, sleep-disturbed MCIs demonstrated increased connectivity between temporal and parietal regions, and decreased connectivity between the prefrontal cortex and the temporoparietal junction relative to sleep-disturbed controls. Relative to those MCIs without sleep disturbance, sleep-disturbed MCI participants demonstrated significantly diminished DMN connectivity between temporal and parietal regions, a finding that was particularly pronounced in amnestic MCI. Sleep disturbance in MCI is associated with distinct alterations in DMN functional connectivity in brain regions underpinning salient memory and sleep systems. Future studies may build on these results via experimental manipulation and objective measurement of sleep. (PsycINFO Database Record

Modelling change in neurocognition, symptoms and functioning in young people with emerging mental disorders

Publisher: Elsevier BV

Date: 12-2020

DOI: 10.1016/J.JPSYCHIRES.2020.08.028

Effect of apomorphine on motor and cognitive function in melancholic patients: a preliminary report

Publisher: Elsevier BV

Date: 12-2000

DOI: 10.1016/S0165-1781(00)00222-5

Abstract: Given the many clinical parallels between melancholia and disorders associated with impaired dopaminergic function such as Parkinson's Disease (PD), it has been hypothesised that major depressive disorder, and in particular the psychomotor features of melancholic depression, may also be associated with a hypodopaminergic state. If this is the case, then the use of a dopamine agonist might lead to reversal of both the cognitive and motor impairments seen in these patients. A double-blind, placebo-controlled cross-over design was used to test the effect of apomorphine on motor and cognitive function in seven melancholic subjects (as defined by the CORE instrument) and five control subjects. The testing battery included the following items: finger tapping, rapid alternating movements, verbal fluency, Rey Auditory Verbal Learning Task, digit symbol substitution task and simple and complex reaction times. The independent t-test, after covarying for age, revealed significant impairment in melancholic subjects for the walking task and digit symbol substitution at baseline. Results of the ANCOVA revealed no impact of time or drug condition, either alone or in combination, upon task performance in either group whether assessed separately or jointly. Results of a MANCOVA revealed that apomorphine impaired performance on some cognitive tasks, and that this was seen to a lesser extent in melancholics than control subjects. There was no evidence that the dopamine agonist apomorphine improved cognitive or motor function in subjects with strictly defined melancholia, suggesting that psychomotor retardation is not associated with a hypodopaminergic state. Our conclusions, however, were limited by small s le size minimal baseline task impairment in depressed compared to control subjects mild sedation in many subjects during task performance and lack of serum apomorphine levels.

PSYCHOMOTOR DISTURBANCE IN DEPRESSION - DEFINING THE CONSTRUCTS

Publisher: Elsevier BV

Date: 04-1993

DOI: 10.1016/0165-0327(93)90049-P

Abstract: Four hundred and thirteen depressed patients were rated on eighteen signs of psychomotor disturbance, and the data examined by factor analyses. A three-factor solution was favoured. In addition to 'retardation' and 'agitation' dimensions (whose derived factor scores suggested independence of those two dimensions), a third 'non-interactive' dimension was evident--with derived factor scores correlating significantly with both the retardation and agitation dimensions. Thus, a 'trunk and branch' analogy was suggested for construing psychomotor disturbance, with a truncal 'psychic' component arborising into retardation and agitation 'motoric' expressions. Higher scores on all three factors were significantly linked with features weighted more to the melancholic 'type' of depression.

Psychomotor slowing in older patients with major depression: Relationships with blood flow in the caudate nucleus and white matter lesions (vol 155, pg 211, 2007)

Publisher: Elsevier BV

Date: 12-2007

DOI: 10.1016/J.PSCYCHRESNS.2007.08.001

A transdiagnostic examination of anxiety and stress on executive function outcomes in disorders with social impairment

Publisher: Elsevier BV

Date: 02-2021

DOI: 10.1016/J.JAD.2020.11.089

Predictors of placebo response in pharmacological and dietary supplement treatment trials in pediatric autism spectru disorder: A meta-analysis

Publisher: Springer Science and Business Media LLC

Date: 22-09-2015

DOI: 10.1038/TP.2015.143

Abstract: Large placebo responses in many clinical trials limit our capacity to identify effective therapeutics. Although it is often assumed that core behaviors in children with autism spectrum disorders (ASDs) rarely remit spontaneously, there has been limited investigation of the size of the placebo response in relevant clinical trials. These trials also rely on caregiver and clinical observer reports as outcome measures. The objectives of this meta-analysis are to identify the pooled placebo response and the predictors of placebo response in pharmacological and dietary supplement treatment trials for participants with a diagnosis of ASD. Randomized controlled trials (RCTs) in pediatric ASD, conducted between 1980 and August 2014, were identified through a search of Medline, EMBASE, Web of Science, Cochrane Database of Systematic Reviews and clinicaltrials.gov. RCTs of at least 14 days duration, comparing the treatment response for an oral active agent and placebo using at least one of the common outcome measures, were included. Analysis of 25 data sets (1315 participants) revealed a moderate effect size for overall placebo response (Hedges’ g =0.45, 95% confidence interval (0.34–0.56), P .001). Five factors were associated with an increase in response to placebo, namely: an increased response to the active intervention outcome ratings by clinicians (as compared with caregivers) trials of pharmacological and adjunctive interventions and trials located in Iran. There is a clear need for the identification of objective measures of change in clinical trials for ASD, such as evaluation of biological activity or markers, and for consideration of how best to deal with placebo response effects in trial design and analyses.

Are there any differences between bipolar and unipolar melancholia?

Publisher: Elsevier BV

Date: 06-1992

DOI: 10.1016/0165-0327(92)90072-E

Abstract: Although it is now more than 30 years since Leohard originally proposed the distinction between bipolar and monopolar (unipolar) forms of affective disorder, there have been relatively few studies which have investigated clinical features which may differentiate the depressed phase of bipolar disorder from unipolar depression. In this study we examined the value of a new scale for rating depressive mental state signs (the 'core' score system), and a large series of symptoms and risk factors, in distinguishing between 27 age and sex-matched pairs of bipolar and unipolar patients diagnosed as melancholic on several diagnostic criteria. In general, we found a marked similarity between the groups on clinical features of the depressive episode when allowance was made for multiple tests. Bipolar patients, however, had shorter episodes of depression and were less likely to demonstrate 'slowed movements' than unipolar subjects. There were also consistent trends on other items for psychomotor retardation to be less common and agitation to be more likely in the bipolar patients. At the least, these findings suggest that the widely-held belief that bipolar depressed patients typically have psychomotor retardation is not as clear-cut as has been previously described.

Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value

Publisher: Royal College of Psychiatrists

Date: 31-01-2019

DOI: 10.1192/BJO.2018.88

Abstract: The expression of suicidal ideation is considered to be an important warning sign for suicide. However, the predictive properties of suicidal ideation as a test of later suicide are unclear. To assess the strength of the association between suicidal ideation and later suicide measured by odds ratio (OR), sensitivity, specificity and positive predictive value (PPV). We located English-language studies indexed in PubMed that reported the expression or non-expression of suicidal ideation among people who later died by suicide or did not. A random effects meta-analysis was used to assess the pooled OR, sensitivity, specificity and PPV of suicidal ideation for later suicide among groups of people from psychiatric and non-psychiatric settings. There was a moderately strong but highly heterogeneous association between suicidal ideation and later suicide ( n = 71, OR = 3.41, 95% CI 2.59–4.49, 95% prediction interval 0.42–28.1, I 2 = 89.4, Q -value = 661, d.f.( Q ) = 70, P ≤0.001). Studies conducted in primary care and other non-psychiatric settings had similar pooled odds to studies of current and former psychiatric patients (OR = 3.86 v. OR = 3.23, P = 0.7). The pooled sensitivity of suicidal ideation for later suicide was 41% (95% CI 35–48) and the pooled specificity was 86% (95% CI 76–92), with high between-study heterogeneity. Studies of suicidal ideation expressed by current and former psychiatric patients had a significantly higher pooled sensitivity (46% v. 22%) and lower pooled specificity (81% v. 96%) than studies conducted in non-psychiatric settings. The PPV among non-psychiatric cohorts (0.3%, 95% CI 0.1%–0.5%) was significantly lower ( Q -value = 35.6, P 0.001) than among psychiatric s les (3.9%, 95% CI 2.2–6.6). Estimates of the extent of the association between suicidal ideation and later suicide are limited by unexplained between-study heterogeneity. The utility of suicidal ideation as a test for later suicide is limited by a modest sensitivity and low PPV. M.M.L. and C.J.R. have provided expert evidence in civil, criminal and coronial matters. I.B.H. has been a Commissioner in Australia's National Mental Health Commission since 2012. He is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC) University of Sydney. The BMC operates an early-intervention youth services at C erdown under contract to Headspace. I.B.H. has previously led community-based and pharmaceutical industry-supported (Wyeth, Eli Lily, Servier, Pfizer, AstraZeneca) projects focused on the identification and better management of anxiety and depression. He is a Board Member of Psychosis Australia Trust and a member of Veterans Mental Health Clinical Reference group. He was a member of the Medical Advisory Panel for Medibank Private until October 2017. He is the Chief Scientific Advisor to, and an equity shareholder in, InnoWell. InnoWell has been formed by the University of Sydney and PricewaterhouseCoopers to administer the $30 M Australian Government Funded Project Synergy. Project Synergy is a 3-year programme for the transformation of mental health services through the use of innovative technologies.

Right external globus pallidus changes are associated with altered causal awareness in youth with depression

Publisher: Springer Science and Business Media LLC

Date: 06-10-2015

DOI: 10.1038/TP.2015.148

Abstract: Cognitive impairment is a functionally disabling feature of depression contributing to maladaptive decision-making, a loss of behavioral control and an increased disease burden. The ability to calculate the causal efficacy of ones actions in achieving specific goals is critical to normal decision-making and, in this study, we combined voxel-based morphometry (VBM), shape analysis and diffusion tensor tractography to investigate the relationship between cortical–basal ganglia structural integrity and such causal awareness in 43 young subjects with depression and 21 demographically similar healthy controls. Volumetric analysis determined a relationship between right pallidal size and sensitivity to the causal status of specific actions. More specifically, shape analysis identified dorsolateral surface vertices where an inward location was correlated with reduced levels of causal awareness. Probabilistic tractography revealed that affected parts of the pallidum were primarily connected with the striatum, dorsal thalamus and hippoc us. VBM did not reveal any whole-brain gray matter regions that correlated with causal awareness. We conclude that volumetric reduction within the indirect pathway involving the right dorsolateral pallidum is associated with reduced awareness of the causal efficacy of goal-directed actions in young depressed in iduals. This causal awareness task allows for the identification of a functionally and biologically relevant subgroup to which more targeted cognitive interventions could be applied, potentially enhancing the long-term outcomes for these in iduals.

Health correlates of insomnia symptoms and comorbid mental disorders in a nationally representative sample of US adolescents

Publisher: Oxford University Press (OUP)

Date: 02-2015

DOI: 10.5665/SLEEP.4396

Heart rate variability is associated with emotion recognition: Direct evidence for a relationship between the autonomic nervous system and social cognition

Publisher: Elsevier BV

Date: 11-2012

DOI: 10.1016/J.IJPSYCHO.2012.08.012

Abstract: It is well established that heart rate variability (HRV) plays an important role in social communication. Polyvagal theory suggests that HRV may provide a sensitive marker of one's ability to respond and recognize social cues. The aim of the present study was to directly test this hypothesis. Resting-state HRV was collected and performance on the Reading the Mind in the Eyes Test was assessed in 65 volunteers. HRV was positively associated with performance on this emotion recognition task confirming our hypothesis and these findings were retained after controlling for a variety of confounding variables known to influence HRV - sex, BMI, smoking habits, physical activity levels, depression, anxiety, and stress. Our data suggests that increased HRV may provide a novel marker of one's ability to recognize emotions in humans. Implications for understanding the biological basis of emotion recognition, and social impairment in humans are discussed.

Summary of Guideline for the Treatment of Depression

Publisher: SAGE Publications

Date: 03-2003

DOI: 10.1046/J.1440-1665.2003.00530.X

Abstract: Depression is common, serious and treatable. The Australian and New Zealand Clinical Practice Guideline for the Treatment of Depression by Specialist Services provides evidence-based treatment guidance across the spectrum of depressive disorders and delineates where specialist treatment and primary care management is indicated. The present summary version covers the key contents of the guideline. It includes assessment, treatment and general management issues by category type and severity of depressive disorder. Algorithms of first-line and subsequent treatment choices are provided for: (i) mild depression without complications (ii) moderately severe depression (including with comorbid anxiety) and dysthymia (iii) uncomplicated, melancholic or atypical depression (iv) moderately severe depression with comorbid substance abuse (v) moderate to severe depression with physical disorders (vi) severe depression with melancholia (vii) recurrent depression or failure to respond to a preferred first-line treatment and (viii) psychotic depression, and severe depression with risk of suicide. Continuing and maintenance treatments for recurrent depression are discussed. Emerging evidence of the equal value of cognitive behaviour therapy (CBT) and interpersonal psychotherapy (IPT) to pharmacological treatments for some depression is discussed, and the need to ensure that they are provided by suitably trained practitioners. Indications for hospitalization and electroconvulsive therapy (ECT) are also provided.

Case-finding instruments may help identify depression in primary care

Publisher: BMJ

Date: 05-2003

DOI: 10.1136/EBMH.6.2.63

Attitudes to prophylactic surgery and chemoprevention in Australian women at increased risk for breast cancer

Publisher: Mary Ann Liebert Inc

Date: 10-2003

DOI: 10.1089/154099903322447738

Abstract: Because of the uncertain efficacy of breast cancer screening in women at increased risk of developing breast cancer, bilateral prophylactic oophorectomy and mastectomy are considered management options for high-risk women. Data on the attitudes to prophylactic strategies of high-risk women who have not attended specialist clinics are needed to ascertain the need for patient education and provide the basis for planning of support services. Three hundred seventy-one women unaffected by cancer and with unknown mutation status from families with a dominantly inherited susceptibility to breast cancer, recruited through a large Australian population-based, epidemiological study, were assessed using a mailed self-administered questionnaire with validated measures of psychological outcome. Sixteen percent of women reported considering prophylactic mastectomy, and 1% had already had the procedure. Among women with a family history of breast/ovarian cancer, 33% had considered and 5% had already had a prophylactic oophorectomy. Twenty-three percent of women reported considering taking tamoxifen if it were shown to prevent breast cancer. Consideration of prophylactic oophorectomy (OR = 1.51 for a 10% change in perceived risk, 95% CI 1.14-1.99, p = 0.0045) and tamoxifen (OR = 1.14 for a 10% change in perceived risk, 95% CI 1.002-1.30, p = 0.047) were positively associated with perceived cancer risk. Attitudes to prophylactic surgery and psychological distress levels in high-risk women participating in an epidemiological study appear to be comparable to those of women attending familial cancer clinics and indicate that women attending high-risk clinics may be representative of the larger population of women at increased risk.

GENETIC RISK FOR DEPRESSION AND TREATMENT RESPONSE IN THE AUSTRALIAN GENETICS OF DEPRESSION STUDY

Publisher: Elsevier BV

Date: 10-2019

DOI: 10.1016/J.EURONEURO.2019.07.109

Psychosocial risk factors for coronary heart disease a consensus statement from the national heart foundation of Australia

Publisher: AMPCo

Date: 08-2013

DOI: 10.5694/MJA13.10440

Abstract: In 2003, the National Heart Foundation of Australia published a position statement on psychosocial risk factors and coronary heart disease (CHD). This consensus statement provides an updated review of the literature on psychosocial stressors, including chronic stressors (in particular, work stress), acute in idual stressors and acute population stressors, to guide health professionals based on current evidence. It complements a separate updated statement on depression and CHD. Perceived chronic job strain and shift work are associated with a small absolute increased risk of developing CHD, but there is limited evidence regarding their effect on the prognosis of CHD. Evidence regarding a relationship between CHD and job (in)security, job satisfaction, working hours, effort-reward imbalance and job loss is inconclusive. Expert consensus is that workplace programs aimed at weight loss, exercise and other standard cardiovascular risk factors may have positive outcomes for these risk factors, but no evidence is available regarding the effect of such programs on the development of CHD. Social isolation after myocardial infarction (MI) is associated with an adverse prognosis. Expert consensus is that although measures to reduce social isolation are likely to produce positive psychosocial effects, it is unclear whether this would also improve CHD outcomes. Acute emotional stress may trigger MI or takotsubo ("stress") cardiomyopathy, but the absolute increase in transient risk from an in idual stressor is low. Psychosocial stressors have an impact on CHD, but clinical significance and prevention require further study. Awareness of the potential for increased cardiovascular risk among populations exposed to natural disasters and other conditions of extreme stress may be useful for emergency services response planning. Wider public access to defibrillators should be available where large populations gather, such as sporting venues and airports, and as part of the response to natural and other disasters.

INTERRATER RELIABILITY OF A REFINED INDEX OF MELANCHOLIA - THE CORE SYSTEM

Publisher: Elsevier BV

Date: 03-1993

DOI: 10.1016/0165-0327(93)90003-3

Abstract: We report an inter-rater reliability study of the modified 18-item, sign-based CORE index of melancholia, undertaken on 205 ratings of 35 patients by five clinical research psychiatrists. Inter-rater agreement about the presence or absence of in idual items was slight to moderate when examined by the kappa coefficient, but moderate to high when examined by the intraclass correlation statistic. For total CORE scores, perhaps the most important application of the index of melancholia, high levels of intraclass correlation coefficients (ranging 0.79 to 0.90 across the varying rater dyads) were established. When a single cut-off score (of 7/8) was used to allocate patients to either a 'melancholic' or 'non-melancholic' class, only moderate agreement was established between raters in such 'class' assignments--a limitation which can be redressed by imposing a 'probable ossible melancholia' band of scores.

Aberrant Gaze Patterns in Social Anxiety Disorder: An Eye Movement Assessment during Public Speaking

Publisher: SAGE Publications

Date: 08-2016

DOI: 10.5127/JEP.040313

Abstract: Social anxiety disorder is maintained by biased attentional processing, which may encompass biases in the component engagement, disengagement, and avoidance attentional processes. However, few studies have directly examined whether such biases occur during social-evaluative conditions characteristically feared in social anxiety. The current study presents a novel approach for the assessment of attentional bias. Clinically socially anxious (n = 27) and control (n = 29) participants were required to give a speech in front of a pre-recorded audience displaying emotional social gestures while eye movement was recorded. Socially anxious in iduals avoided attending to positive and threatening stimuli. At the onset of an emotional gesture, control participants were additionally faster to orient towards positive, relative to threatening gestures, while this bias was absent in socially anxious participants. The findings suggest that during conditions of social-evaluative stress, social anxiety is characterized by the attentional avoidance of emotional stimuli, and the absence of an engagement bias favouring positive stimuli.

Informing the Future of Integrated Digital and Clinical Mental Health Care: Synthesis of the Outcomes From Project Synergy (Preprint)

Publisher: JMIR Publications Inc.

Date: 26-08-2021

DOI: 10.2196/PREPRINTS.33060

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.

Qualitative and quantitative analyses of a ‘lock and key’ hypothesis of depression

Publisher: Cambridge University Press (CUP)

Date: 11-1998

DOI: 10.1017/S0033291798007387

Abstract: Background. We examine a ‘lock and key’ (‘L–K’) hypothesis to depression which posits that early adverse experiences establish locks that are activated by keys mirroring the earlier adverse experience to induce depression. Methods. Two-hundred and seventy clinically depressed patients were examined with open-ended and pre-coded interview questions to ascertain both early adverse experiences and precipitating life events. Qualitative and quantitative data analyses examined for any associations between developmental ‘locks’ and precipitating ‘keys’. Results. Qualitative assessment suggested ‘L–K’ links in almost one-third of the s le, and ex les are provided. While quantitative analyses indicated significant associations between several identical ‘lock’ and ‘key’ constructs, evidence of specificity was rare. When in idual ‘locks’ and ‘keys’ were consolidated into three higher-order constructs, variable models were suggested, including a non-specific link, a specific link and absence of any link. ‘L–K’ links appeared more likely in those with ‘non-melancholic’ ( versus ‘melancholic’) depression, with the seemingly greater relevance to ‘reactive’ ( versus ‘neurotic’) depression in the quantitative analyses inviting speculation that that ‘disorder’ may be more a reaction to a salient rather than a severe stressor. Conclusions. This exploratory study suggests that early adverse experiences may variably establish specific and non-specific patterns of vulnerability to having depression triggered by exposure to salient mirroring life event stressors.

Fifty years of medical specialisation: From foundation to fragmentation

Publisher: AMPCo

Date: 2001

DOI: 10.5694/J.1326-5377.2001.TB143146.X

Abstract: The past 50 years of medicine have been dominated by revolutions in biological sciences and clinical therapeutics. No less dramatic have been changes in our healthcare systems, with medical specialisation playing a leading role. The middle of the century saw the rapid development of the teaching hospital as the centre of professional education, collegiate identity, medical specialisation and clinical research. By contrast, the past 20 years have seen dramatic shifts in response to the demands of a more erse community.

Experience with treatment services for people with bipolar disorder

Publisher: AMPCo

Date: 10-2004

DOI: 10.5694/J.1326-5377.2004.TB06353.X

Abstract: To describe the experiences of people with bipolar disorder with primary care and specialist mental health services. Focus groups and indepth interviews were conducted in seven Australian capital cities between July 2002 and April 2003. Thematic analyses were conducted using the QSR NUD*IST software package for qualitative data. Forty-nine people with bipolar disorder participated in the focus groups and four participated in the interviews. Thematic analyses highlighted eight key themes. Most notably, respondents identified a lack of awareness and understanding about bipolar disorder within the Australian community, which contributed to apparent delays in seeking medical assessment. The burden of illness was exacerbated by difficulties experienced with obtaining an accurate diagnosis and optimal treatment. The healthcare system responses were described as inadequate and included inappropriate crisis management, difficulties accessing hospital care, inappropriate exclusion of carers and families from management decisions, and frequent discontinuities of medical and psychological care. People with extensive experience of bipolar disorder report barriers to optimal care because of lack of community understanding and healthcare system shortcomings. These barriers exacerbate the social, interpersonal and economic costs of this illness.

Neurocognitive functioning predicts suicidal behaviour in young people with affective disorders

Publisher: Elsevier BV

Date: 02-2021

DOI: 10.1016/J.JAD.2020.11.077

A prospective cohort study of fatigue after adjuvant therapy for breast cancer: Association with hematologic, endocrine, and immune parameters

Publisher: American Society of Clinical Oncology (ASCO)

Date: 20-05-2008

DOI: 10.1200/JCO.2008.26.15_SUPPL.9596

Reviving the diagnosis of neurasthenia

Publisher: Cambridge University Press (CUP)

Date: 09-1997

DOI: 10.1017/S0033291797004893

Abstract: The Gram-positive strain R79

Familial aggregation of anxiety disorder subtypes and anxious temperament in the NIMH Family Study of Affective Spectrum Disorders

Publisher: Elsevier BV

Date: 02-2021

DOI: 10.1016/J.JAD.2020.11.070

Assessment of Bidirectional Relationships Between Physical Activity and Depression Among Adults

Publisher: American Medical Association (AMA)

Date: 04-2019

DOI: 10.1001/JAMAPSYCHIATRY.2018.4175

Abstract: Increasing evidence shows that physical activity is associated with reduced risk for depression, pointing to a potential modifiable target for prevention. However, the causality and direction of this association are not clear physical activity may protect against depression, and/or depression may result in decreased physical activity. To examine bidirectional relationships between physical activity and depression using a genetically informed method for assessing potential causal inference. This 2-s le mendelian randomization (MR) used independent top genetic variants associated with 2 physical activity phenotypes—self-reported (n = 377 234) and objective accelerometer-based (n = 91 084)—and with major depressive disorder (MDD) (n = 143 265) as genetic instruments from the largest available, nonoverlapping genome-wide association studies (GWAS). GWAS were previously conducted in erse observational cohorts, including the UK Biobank (for physical activity) and participating studies in the Psychiatric Genomics Consortium (for MDD) among adults of European ancestry. Mendelian randomization estimates from each genetic instrument were combined using inverse variance weighted meta-analysis, with alternate methods (eg, weighted median, MR Egger, MR–Pleiotropy Residual Sum and Outlier [PRESSO]) and multiple sensitivity analyses to assess horizontal pleiotropy and remove outliers. Data were analyzed from May 10 through July 31, 2018. MDD and physical activity. GWAS summary data were available for a combined s le size of 611 583 adult participants. Mendelian randomization evidence suggested a protective relationship between accelerometer-based activity and MDD (odds ratio [OR], 0.74 for MDD per 1-SD increase in mean acceleration 95% CI, 0.59-0.92 P = .006). In contrast, there was no statistically significant relationship between MDD and accelerometer-based activity (β = −0.08 in mean acceleration per MDD vs control status 95% CI, −0.47 to 0.32 P = .70). Furthermore, there was no significant relationship between self-reported activity and MDD (OR, 1.28 for MDD per 1-SD increase in metabolic-equivalent minutes of reported moderate-to-vigorous activity 95% CI, 0.57-3.37 P = .48), or between MDD and self-reported activity (β = 0.02 per MDD in standardized metabolic-equivalent minutes of reported moderate-to-vigorous activity per MDD vs control status 95% CI, −0.008 to 0.05 P = .15). Using genetic instruments identified from large-scale GWAS, robust evidence supports a protective relationship between objectively assessed—but not self-reported—physical activity and the risk for MDD. Findings point to the importance of objective measurement of physical activity in epidemiologic studies of mental health and support the hypothesis that enhancing physical activity may be an effective prevention strategy for depression.

LIPOPOLYSACCHARIDE-STIMULATED INTERLEUKIN-10 RELEASE FROM NEONATAL SPINAL CORD MICROGLIA IS POTENTIATED BY GLUTAMATE

Publisher: Elsevier BV

Date: 02-2011

DOI: 10.1016/J.NEUROSCIENCE.2010.10.080

Abstract: Interleukin-10 (IL-10) is a cytokine with important endogenous and therapeutic anti-inflammatory effects. Given this, it is of interest to investigate factors that modulate IL-10 levels in the central nervous system. IL-10 is released after lipopolysaccharide (LPS) stimulation of microglia. Microglia also express functional glutamate receptors and in inflammatory conditions are exposed to increased levels of glutamate. The aim of this research, then, is to investigate whether glutamate can modulate lipopolysaccharide stimulation of IL-10 release from neonatal rat spinal cord microglia. Enzyme-linked immunosorbent assays (ELISAs) were used to quantify IL-10 release from cultured neonatal spinal cord microglia and reverse transcriptase-polymerase chain reaction (RT-PCR) was used to measure IL-10 mRNA expression. Glutamate (1 mM) significantly increased LPS (1 μg/ml)-stimulated IL-10 release from microglia by 172% (EC(50) of 103 μM) and significantly upregulated IL-10 mRNA levels. Glutamate potentiated LPS-stimulated IL-10 release by binding all subtypes of glutamate receptor. These results show that glutamate substantially increases the release of an anti-inflammatory cytokine from neonatal spinal cord microglia activated by a high concentration of LPS.

Parcellating cognitive heterogeneity in early psychosis-spectrum illnesses: A cluster analysis

Publisher: Elsevier BV

Date: 12-2018

DOI: 10.1016/J.SCHRES.2018.06.060

Abstract: Cognitive impairment is argued to represent a core feature of psychosis-spectrum illnesses. However, within-diagnosis heterogeneity is common, and risk factors for poor cognition remain to be examined after statistically accounting for heterogeneity. Accordingly, we used a data-driven technique (cluster analysis) to empirically-derive cognitive clusters across diagnoses and examined whether concurrent substance use or a history of a neurodevelopmental/behavioral disorder differed between clusters. Data from 135 young help-seekers (aged 12-30 years) with a psychosis-spectrum illness were retrospectively analyzed. Ward's hierarchical cluster analysis classified three cognitive clusters characterized by: (1) normal-range (2) mixed and (3) grossly-impaired performance. Despite mostly comparable clinical and demographic measures, cluster 1 had superior socio-occupational functioning and the highest estimated premorbid IQ, followed sequentially by clusters 2 and 3. Proportions of cannabis and hetamine users did not differ significantly across clusters, nor did rates of patients with a neurodevelopmental/behavioral disorder history. Cluster 3 was however comprised of fewer 'risky' drinkers, possibly reflecting reduced opportunity for social drinking associated with cognitive impairment. Estimated premorbid IQ predicted cluster membership (2 vs. 1 & 3 vs. 1), as did clinician-rated socio-occupational functioning and 'not being enrolled in school or tertiary education' (3 vs. 1). Our results suggest that concurrent substance use and history of a neurodevelopmental/behavioral disorder do not adequately explain cluster-level cognitive variance in this s le. Future work should integrate neurobiological measures associated with cognition (e.g. white matter integrity) to discern whether clusters reflect neurobiological subtypes better representative of pathophysiology than present symptom-based classifications.

National mental health reform: less talk, more action

Publisher: AMPCo

Date: 02-2009

DOI: 10.5694/J.1326-5377.2009.TB02346.X

Abstract: The Council of Australian Governments revitalised national mental health reform in 2006. Unfortunately, evidence-based models of collaborative care have not yet been supported. Previous attempts at national reform have lacked a strategic vision. We continue to rely on arrangements that are fragmented between different levels of government, poorly resourced community services, and an embattled public hospital sector. Our persisting unwillingness to record or publicly report key measures of health, social or economic outcomes undermines community confidence in the mental health system. Six priority areas for urgent national action are proposed and linked to key measures of improved health system performance. In Australia, we recognise special groups (such as war veterans) and organise and fund services to meet their specific health needs. Such systems could be readily adapted to meet the needs of people with psychosis.

Sleep-wake profiles and circadian rhythms of core temperature and melatonin in young people with affective disorders

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.

Brain structural correlates of insomnia severity in major depressive disorder: Results from the ENIGMA-MDD consortium

Publisher: Elsevier BV

Date: 2019

DOI: 10.1016/J.EURONEURO.2019.01.076

Correction: Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study (Preprint)

Publisher: JMIR Publications Inc.

Date: 02-03-2022

DOI: 10.2196/PREPRINTS.37679

Abstract: his is a corrigendum.

Supporting Clinicians to Use Technology to Deliver Highly Personalized and Measurement-Based Mental Health Care to Young People: Protocol for an Evaluation Study

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

Neurocognitive disturbances associated with acute infectious mononucleosis, Ross River fever and Q fever: A preliminary investigation of inflammatory and genetic correlates

Publisher: Elsevier BV

Date: 02-2014

DOI: 10.1016/J.BBI.2013.11.002

Abstract: Disturbances in neurocognitive performance are a core feature of the acute sickness response to infection however the underlying mechanisms remain unclear. The current study used a computerised battery to assess neurocognitive functioning in subjects enrolled in the Dubbo Infection Outcomes Study (n=107) - a prospective cohort of subjects followed from documented acute infection with Epstein Barr virus, Ross River virus, or Coxiella burnetii until recovery. Subjects were assessed when ill, and a subset again after complete recovery. Associations between sickness-related cognitive disturbances and single nucleotide polymorphisms (SNPs) in cytokine (interleukin [IL]-6, IL-10, tumor necrosis factor-α and interferon-γ) and neurobehavioral genes (serotonin transporter and catechol-O-methyltransferase) were explored. During acute infection, subjects exhibited slower matching-to-s le responses (p=0.03), poorer working memory capacity (p=0.014), mental planning (p=0.045), and dual attention task performance (p=0.02), and required longer to complete discordant Stroop trials (p=0.01) compared to recovery. Objective impairments correlated significantly with self-reported symptoms (p<0.05) as well as levels of the inflammation marker, C-reactive protein (p=0.001). Linear regression analysis identified an association between neurocognitive disturbance during acute illness and functional polymorphisms in inflammatory cytokine genes. Specifically, the high cytokine producing G allele of the IL-6-174G/C SNP was associated with poorer neurocognitive performance when subjects were ill (p=0.027). These findings confirm that acute infection impacts on neurocognitive performance, manifesting as slowed responses and impaired performance on complex tasks requiring higher-order functioning which has important real-world implications. The data provide the first preliminary evidence for a role of a genetic predisposition to more intense inflammatory responses in objective neurocognitive disturbances during acute infections. These associations require replication in a larger s le size.

An App That Incorporates Gamification, Mini-Games, and Social Connection to Improve Men's Mental Health and Well-Being (MindMax): Participatory Design Process (Preprint)

Publisher: JMIR Publications Inc.

Date: 17-05-2018

DOI: 10.2196/PREPRINTS.11068

Abstract: en have different mental health needs as compared with women, and women make up the primary audience of most digital mental health interventions. An Australian football-themed (specifically Australian Football League, AFL) app named MindMax incorporating psychoeducation, gamification, mini-games, and social connection was developed in an effort to address this issue. he aim of this study was to identify the best way to structure and present MindMax, an app that aims to deliver psychoeducational modules, and create a Web-based community centering on well-being, AFL, and video games for men aged 16 to 35 years who are interested in AFL or video games. e conducted 6 participatory design (PD) workshops with people aged 16 to 35 years in 3 cities in Australia, to identify the best way to present MindMax, and contracted a digital development agency to develop MindMax. We then iteratively tested MindMax prototypes with 15 user experience testing interviews across 3 separate time points: 2 before app launch and 1 after app launch. total of 40 in iduals (25 male and 15 female) participated in the PD workshops, and a total of 15 in iduals (10 male and 5 female) participated in user experience interviews. Broadly, participants expressed a preference for activities requiring active engagement that practiced useful skills. They were also sensitive to how content was presented and wanted the ability to customize their own app experience. Although participants agreed that social motivations were important for engagement with an app, they recommended not to mimic existing social networks. n basing itself strongly within the AFL subculture and by incorporating gamification as well as mini-games, MindMax aimed to tackle mental health help-seeking barriers for people who enjoy AFL or video games, with a particular emphasis on men, and to provide psychoeducation on strategies to increase mental health and well-being. If MindMax is successful, this would indicate that generalizing this approach to other traditional sporting codes and even competitive video gaming leagues (esports) would be fruitful.

Pre-emptive psychiatric treatments: pipe dream or a realistic outcome of clinical staging models?

Publisher: OMICS Publishing Group

Date: 08-2012

DOI: 10.2217/NPY.12.32

Oxytocin Treatment, Circuitry, and Autism: A Critical Review of the Literature Placing Oxytocin into the Autism Context

Publisher: Elsevier BV

Date: 02-2016

DOI: 10.1016/J.BIOPSYCH.2015.06.028

Abstract: Observed impairment in reciprocal social interaction is a diagnostic hallmark of autism spectrum disorders. There is no effective medical treatment for these problems. Psychological treatments remain costly, time intensive, and developmentally sensitive for efficacy. In this review, we explore the potential of oxytocin-based therapies for social impairments in autism. Evidence shows that acute oxytocin administration improves numerous markers critical to the social circuitry underlying social deficits in autism. Oxytocin may optimize these circuits and enhance reward, motivation, and learning to improve therapeutic outcomes. Despite this, the current evidence of therapeutic benefit from extended oxytocin treatment remains very limited. We highlight complexity in crossing from the laboratory to the autism clinical setting in evaluation of this therapeutic. We discuss a clinical trial approach that provides optimal opportunity for therapeutic response by using personalized methods that better target specific circuitry to define who will obtain benefit, at what stage of development, and the optimal delivery approach for circuitry manipulation. For the autism field, the therapeutic challenges will be resolved by a range of treatment strategies, including greater focus on specific interventions, such as oxytocin, that have a strong basis in the fundamental neurobiology of social behavior. More sophisticated and targeted clinical trials utilizing such approaches are now required, placing oxytocin into the autism context.

Clinical staging model applied to young people presenting with social anxiety

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.

Sexting, Web-Based Risks, and Safety in Two Representative National Samples of Young Australians: Prevalence, Perspectives, and Predictors

Publisher: JMIR Publications Inc.

Date: 17-06-2019

DOI: 10.2196/13338

Abstract: The rapid uptake of information and communication technology (ICT) over the past decade—particularly the smartphone—has coincided with large increases in sexting. All previous Australian studies examining the prevalence of sexting activities in young people have relied on convenience or self-selected s les. Concurrently, there have been recent calls to undertake more in-depth research on the relationship between mental health problems, suicidal thoughts and behaviors, and sexting. How sexters (including those who receive, send, and two-way sext) and nonsexters apply ICT safety skills warrants further research. This study aimed to extend the Australian sexting literature by measuring (1) changes in the frequency of young people’s sexting activities from 2012 to 2014 (2) young people’s beliefs about sexting (3) association of demographics, mental health and well-being items, and internet use with sexting and (4) the relationship between sexting and ICT safety skills. Computer-assisted telephone interviewing using random digit dialing was used in two Young and Well National Surveys conducted in 2012 and 2014. The participants included representative and random s les of 1400 young people aged 16 to 25 years. From 2012 to 2014, two-way sexting (2012: 521/1369, 38.06% 2014: 591/1400, 42.21% P=.03) and receiving sexts (2012: 375/1369, 27.39% 2014: 433/1400, 30.93% P .001) increased significantly, not sexting (2012: 438/1369, 31.99% 2014: 356/1400, 25.43% P .001) reduced significantly, whereas sending sexts (2012: n=35/1369, 2.56% 2014: n=20/1400, 1.43% P .05) did not significantly change. In addition, two-way sexting and sending sexts were found to be associated with demographics (male, second language, and being in a relationship), mental health and well-being items (suicidal thoughts and behaviors and body image concerns), and ICT risks (cyberbullying others and late-night internet use). Receiving sexts was significantly associated with demographics (being male and not living with parents or guardians) and ICT risks (being cyberbullied and late-night internet use). Contrary to nonsexters, Pearson correlations demonstrated that all sexting groups (two-way, sending, and receiving) had a negative relationship with endorsing the ICT safety items relating to being careful when using the Web and not giving out personal details. Our research demonstrates that most young Australians are sexting or exposed to sexting in some capacity. Sexting is associated with some negative health and well-being outcomes—specifically, sending sexts is linked to suicidal thoughts and behaviors, body image issues, and ICT safety risks, including cyberbullying and late-night internet use. Those who do sext are less likely to engage in many preventative ICT safety behaviors. How the community works in partnership with young people to address this needs to be a multifaceted approach, where sexting is positioned within a wider proactive conversation about gender, culture, psychosocial health, and respecting and caring for each other when on the Web.

Should the legal age for buying alcohol be raised to 21 years?

Publisher: AMPCo

Date: 06-2014

DOI: 10.5694/MJA13.10465

Epidemiology of eating disorders: population, prevalence, disease burden and quality of life informing public policy in Australia—a rapid review

Publisher: Springer Science and Business Media LLC

Date: 15-02-2023

DOI: 10.1186/S40337-023-00738-7

Abstract: Understanding of the epidemiology and health burden of eating disorders has progressed significantly in the last 2 decades. It was considered one of seven key areas to inform the Australian Government commissioned National Eating Disorder Research and Translation Strategy 2021–2031, as emerging research had highlighted a rise in eating disorder prevalence and worsening burden-of-illness. The aim of this review was to better understand the global epidemiology and impact of eating disorders to inform policy decision-making. Using a systematic Rapid Review methodology, ScienceDirect, PubMed and Medline (Ovid) were searched for peer-reviewed studies published between 2009 and 2021. Clear inclusion criteria were developed in consultation with experts in the field. Purposive s ling of literature was conducted, which predominately focused on higher-level evidence (meta-analyses, systematic reviews, and large epidemiological studies), synthesised, and narratively analysed. 135 studies were deemed eligible for inclusion in this review (N = 1324). Prevalence estimates varied. Global Lifetime prevalence of any eating disorder ranged from 0.74 to 2.2% in males, and 2.58–8.4% in females. Australian 3-month point-prevalence of broadly defined disorders was around 16% in females. Eating disorders appeared more prevalent in young people and adolescents, particularly females (in Australia: eating disorders ~ 22.2% disordered eating ~ 25.7%). Limited evidence was found on sex, sexuality and gender erse (LGBTQI +) in iduals, particularly males, who had a six-fold increase in prevalence compared to the general male population, with increased illness impact. Similarly, limited evidence on First Australian’s (Aboriginal and Torres Strait Islander) suggests prevalence rates similar to non-Indigenous Australians. No prevalence studies were identified specifically assessing culturally and linguistically erse populations. Global disease burden of any eating disorder was 43.4 age-standardised disability-adjusted-life-years per 100,000 increasing by 9.4% between 2007 and 2017. Australian’s total economic cost was estimated at $84 billion from years-of-life lost due to disability and death, and annual lost earnings ~ $1.646 billion.” There is no doubt that eating disorder prevalence and impact are on the rise, particularly in at-risk and understudied populations. Much of the evidence came from female-only s les, and Western, high-income countries which more readily have access to specialised services. Future research should examine more representative s les. There is an urgent need for more refined epidemiological methods to better understand these complex illnesses over time, to guide health policy and development-of-care.

Cognitive impairment with and without depression history: An analysis of white matter microstructure

Publisher: CMA Joule Inc.

Date: 03-2014

DOI: 10.1503/JPN.130079

Privacy Practices of Health Information Technologies: Privacy Policy Risk Assessment Study and Proposed Guidelines (Preprint)

Publisher: JMIR Publications Inc.

Date: 07-12-2020

DOI: 10.2196/PREPRINTS.26317

Abstract: long with the proliferation of health information technologies (HITs), there is a growing need to understand the potential privacy risks associated with using such tools. Although privacy policies are designed to inform consumers, such policies have consistently been found to be confusing and lack transparency. his study aims to present consumer preferences for accessing privacy information develop and apply a privacy policy risk assessment tool to assess whether existing HITs meet the recommended privacy policy standards and propose guidelines to assist health professionals and service providers with understanding the privacy risks associated with HITs, so that they can confidently promote their safe use as a part of care. n phase 1, participatory design workshops were conducted with young people who were attending a participating i headspace /i center, their supportive others, and health professionals and service providers from the centers. The findings were knowledge translated to determine participant preferences for the presentation and availability of privacy information and the functionality required to support its delivery. Phase 2 included the development of the 23-item privacy policy risk assessment tool, which incorporated material from international privacy literature and standards. This tool was then used to assess the privacy policies of 34 apps and e-tools. In phase 3, privacy guidelines, which were derived from learnings from a collaborative consultation process with key stakeholders, were developed to assist health professionals and service providers with understanding the privacy risks associated with incorporating HITs as a part of clinical care. hen considering the use of HITs, the participatory design workshop participants indicated that they wanted privacy information to be easily accessible, transparent, and user-friendly to enable them to clearly understand what personal and health information will be collected and how these data will be shared and stored. The privacy policy review revealed consistently poor readability and transparency, which limited the utility of these documents as a source of information. Therefore, to enable informed consent, the privacy guidelines provided ensure that health professionals and consumers are fully aware of the potential for privacy risks in using HITs to support health and well-being. lack of transparency in privacy policies has the potential to undermine consumers’ ability to trust that the necessary measures are in place to secure and protect the privacy of their personal and health information, thus precluding their willingness to engage with HITs. The application of the privacy guidelines will improve the confidence of health professionals and service providers in the privacy of consumer data, thus enabling them to recommend HITs to provide or support care. >

HANDBOOK OF AFFECTIVE-DISORDERS - PAYKEL,ES

Publisher: Cambridge University Press (CUP)

Date: 11-1994

DOI: 10.1017/S0033291700029135

Do delivery routes of intranasally administered oxytocin account for observed effects on social cognition and behavior? A two-level model

Publisher: Elsevier BV

Date: 02-2015

DOI: 10.1016/J.NEUBIOREV.2014.12.011

Abstract: Accumulating evidence demonstrates the important role of oxytocin (OT) in the modulation of social cognition and behavior. This has led many to suggest that the intranasal administration of OT may benefit psychiatric disorders characterized by social dysfunction, such as autism spectrum disorders and schizophrenia. Here, we review nasal anatomy and OT pathways to central and peripheral destinations, along with the impact of OT delivery to these destinations on social behavior and cognition. The primary goal of this review is to describe how these identified pathways may contribute to mechanisms of OT action on social cognition and behavior (that is, modulation of social information processing, anxiolytic effects, increases in approach-behaviors). We propose a two-level model involving three pathways to account for responses observed in both social cognition and behavior after intranasal OT administration and suggest avenues for future research to advance this research field.

Treatment guidelines for depression in the Asia Pacific region: a review of current developments

Publisher: SAGE Publications

Date: 27-08-2004

DOI: 10.1111/J.1039-8562.2004.02100.X-I1

Cytokine aberrations in autism spectrum disorder: a systematic review and meta-analysis

Publisher: Springer Science and Business Media LLC

Date: 17-06-2014

DOI: 10.1038/MP.2014.59

Abstract: The role of non-diagnostic features in the pathophysiology of autism spectrum disorders (ASDs) is unclear. Increasing evidence suggests immune system alterations in ASD may be implicated in the severity of behavioral impairment and other developmental outcomes. The primary objective of this meta-analysis was to investigate if there is a characteristic abnormal cytokine profile in ASD compared with healthy controls (HCs). We identified relevant studies following a search of MEDLINE, EMBASE, PsycINFO, Web of Knowledge and Scopus. A meta-analysis was performed on studies comparing plasma and serum concentrations of cytokines in unmedicated participants with ASD and HCs. Results were reported according to PRISMA statement. Seventeen studies with a total s le size of 743 participants with ASD and 592 HC were included in the analysis. Nineteen cytokines were assessed. Concentrations of interleukin (IL)-1beta (P<0.001), IL-6 (P=0.03), IL-8 (P=0.04), interferon-gamma (P=0.02), eotaxin (P=0.01) and monocyte chemotactic protein-1 (P<0.05) were significantly higher in the participants with ASD compared with the HC group, while concentrations of transforming growth factor-β1 were significantly lower (P<0.001). There were no significant differences between ASD participants and controls for the other 12 cytokines analyzed. The findings of our meta-analysis identified significantly altered concentrations of cytokines in ASD compared to HCs, strengthening evidence of an abnormal cytokine profile in ASD where inflammatory signals dominate.

Genetic diversity fuels gene discovery for tobacco and alcohol use

Publisher: Springer Science and Business Media LLC

Date: 07-12-2022

DOI: 10.1038/S41586-022-05477-4

Abstract: Tobacco and alcohol use are heritable behaviours associated with 15% and 5.3% of worldwide deaths, respectively, due largely to broad increased risk for disease and injury 1–4 . These substances are used across the globe, yet genome-wide association studies have focused largely on in iduals of European ancestries 5 . Here we leveraged global genetic ersity across 3.4 million in iduals from four major clines of global ancestry (approximately 21% non-European) to power the discovery and fine-mapping of genomic loci associated with tobacco and alcohol use, to inform function of these loci via ancestry-aware transcriptome-wide association studies, and to evaluate the genetic architecture and predictive power of polygenic risk within and across populations. We found that increases in s le size and genetic ersity improved locus identification and fine-mapping resolution, and that a large majority of the 3,823 associated variants (from 2,143 loci) showed consistent effect sizes across ancestry dimensions. However, polygenic risk scores developed in one ancestry performed poorly in others, highlighting the continued need to increase s le sizes of erse ancestries to realize any potential benefit of polygenic prediction.

Understanding genetic risk factors for common side effects of antidepressant medications

Publisher: Cold Spring Harbor Laboratory

Date: 16-07-2021

DOI: 10.1101/2021.07.12.21260397

Abstract: Major depression is one of the most disabling health conditions internationally. In recent years, new generation antidepressant medicines have become very widely prescribed. While these medicines are efficacious, side effects are common and frequently result in discontinuation of treatment. Compared with specific pharmacological properties of the different medications, the relevance of in idual vulnerability is understudied. We used data from the Australian Genetics of Depression Study to gain insights into the aetiology and genetic risk factors to antidepressant side effects. As expected, the most commonly reported longer-term side effects were reduced sexual function and weight gain. Importantly, participants reporting a specific side effect for one antidepressant were more likely to report the same side effect for other antidepressants, suggesting the presence of shared in idual or pharmacological factors. Depression Polygenic Risk Scores (PRS) were associated with side effects that overlapped with depressive symptoms, including suicidality and anxiety. Body Mass Index PRS were strongly associated with weight gain from all medications. PRS for headaches were associated with headaches from sertraline. Insomnia PRS showed some evidence of predicting insomnia from amitriptyline and escitalopram. Our results suggest a set of common factors underlying the risk for antidepressant side effects. These factors seem to be, at least in part, explained by genetic liability related to depression severity and the nature of the side effect. Future studies on the genetic aetiology of side effects will enable insights into their underlying mechanisms and the possibility of risk stratification and prophylaxis strategies.

Enhancing memory in late-life depression: The effects of a combined psychoeducation and cognitive training program

Publisher: Elsevier BV

Date: 03-2011

DOI: 10.1097/JGP.0B013E3181DBA587

The value of early intervention in creating the new mental health system: Response to Allison et al

Publisher: SAGE Publications

Date: 28-05-2020

DOI: 10.1177/0004867420925169

Does sleep disturbance mediate neuropsychological functioning in older people with depression?

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.

Prevalence and Correlates of Prolonged Fatigue in a U.S. Sample of Adolescents

Publisher: American Psychiatric Association Publishing

Date: 05-2013

DOI: 10.1176/APPI.AJP.2012.12040454

Abstract: Prolonged fatigue in adolescents has a major impact on social functioning and school attendance. In adults, prolonged fatigue substantially overlaps with mood and anxiety disorders. Extending the data to adolescents, the authors studied the prevalence and correlates of fatigue in a representative U.S. s le. The participants were 10,123 adolescents ages 13-18 years from the National Comorbidity Survey Adolescent Supplement. They were interviewed about prolonged fatigue, defined as extreme fatigue with at least one associated symptom (pains, dizziness, headache, sleep disturbance, inability to relax, irritability) that does not resolve by resting or relaxing and lasting at least 3 months. The prevalence of prolonged fatigue was 3.0% (SE=0.3), with 1.4% (SE=0.2) for prolonged fatigue only and 1.6% (SE=0.2) for prolonged fatigue concomitant with a depressive or anxiety disorder. Nearly 60% of the adolescents with prolonged fatigue only had severe or very severe disability, and their rates of poor physical and mental health were comparable to those of adolescents with mood or anxiety disorders only. Adolescents with prolonged fatigue and comorbid mood or anxiety disorders had significantly greater disability, poorer mental health, and more health service use than those with either condition alone. These findings suggest that prolonged fatigue is associated with disability and is an important clinical entity independent of mood and anxiety disorders in adolescents. Persistent fatigue with a comorbid mood or anxiety state is related to even more functional impairment, suggesting that prolonged fatigue may reflect greater severity of mood and anxiety disorders in adolescents.

Specific mental health disorders: Depressive and anxiety disorders

Publisher: Elsevier

Date: 2008

DOI: 10.1016/B978-012373960-5.00048-4

Participatory Design of an Activities-Based Collective Mentoring Program in After-School Care Settings: Connect, Promote, and Protect Program (Preprint)

Publisher: JMIR Publications Inc.

Date: 09-09-2020

DOI: 10.2196/PREPRINTS.22822

Abstract: ut of school hours care (OSHC) services provide a unique opportunity to deliver early intervention programs to enhance primary school–aged children’s social, emotional, physical, and cognitive well-being however, such programs are currently lacking. his study aims to address the lack of well-being programs for children accessing OSHC services in the research literature by using participatory design (PD) to collaboratively develop and test an OSHC well-being program—the connect, promote, and protect program (CP3). he study employed methods of PD, user (acceptance) testing, and iterative knowledge translation to develop a novel well-being program framework—CP3—with key stakeholders (eg, children, OSHC staff, volunteers, families, clinicians, educators, and researchers). Thematic techniques were used to interpret and translate the qualitative information obtained during the research and design cycles. he co-design process generated the CP3 model, which comprises a group-based mentoring approach to facilitate enhanced activities in OSHC settings. Activities are underpinned by 4 key principles of program delivery: build well-being and resilience, broaden horizons, inspire and engage, and connect communities. o our knowledge, the CP3 program is the first co-designed well-being program developed specifically for OSHC services. This co-design process is key to ensuring local community needs—particularly those of young people accessing OSHC—are met and that these in iduals are meaningfully and actively involved in all stages of the research and design process, from conception to implementation, evaluation, and continuous improvement. >

Measuring outcomes in patients with depression or anxiety: An essential part of clinical practice

Publisher: AMPCo

Date: 08-2002

DOI: 10.5694/J.1326-5377.2002.TB04734.X

Short Sleep Duration in Prevalent and Persistent Psychological Distress in Young Adults: The DRIVE Study

Publisher: Oxford University Press (OUP)

Date: 09-2010

DOI: 10.1093/SLEEP/33.9.1139

Contrast Effects and Sex Influence Maternal and Self-Report Dimensional Measures of Attention-Deficit Hyperactivity Disorder

Publisher: Springer Science and Business Media LLC

Date: 24-08-2015

DOI: 10.1007/S10519-014-9670-X

Abstract: The heritability of attention-deficit/hyperactivity disorder (ADHD) is higher for children than adults. This may be due to increasing importance of environment in symptom variation, measurement inaccuracy when two raters report behavior of a twin-pair, a contrast effect resulting from parental comparison of siblings and/or dimensionality of measures. We examine rater contrast and sex effects in ADHD subtypes using a dimensional scale and compare the aetiology of self, versus maternal-report. Data were collected using the Strengths and Weaknesses of ADHD and Normal Behaviour Scale (SWAN): maternal-report for 3,223 twins and siblings (mean age 21.2, SD = 6.3) and self-report for 1,617 twins and siblings (mean age 25.5, SD = 3.2). Contrast effects and magnitude of genetic and environmental contributions to variance of ADHD phenotypes (inattention, hyperactivity-impulsivity, combined behaviours) were examined using structural equation modeling. Contrast effects were evident for maternal-report hyperactivity-impulsivity (b = -0.04) and self-report inattention (-0.09) and combined ADHD (-0.08). Dominant genetic effects were shared by raters for inattention, hyperactivity-impulsivity and combined ADHD. Broad-sense heritability was equal across sex for maternal-report inattention, hyperactivity-impulsivity and combined ADHD (0.72, 0.83, 0.80). Heritability for corresponding subtypes in self-reported data were best represented by sex (0.46, 0.30, 0.39 for males 0.69, 0.41, 0.65 for females). Heritability difference between maternal and self-report ADHD was due to greater variance of male specific environment in self-report data. Self-reported ADHD differed across sex by magnitude of specific environment and genetic effects.

Oxytocin selectively moderates negative cognitive appraisals in high trait anxious males

Publisher: Elsevier BV

Date: 12-2012

DOI: 10.1016/J.PSYNEUEN.2012.04.018

Abstract: The mammalian neuropeptide oxytocin has well-characterized effects in facilitating prosocial and affiliative behavior. Additionally, oxytocin decreases physiological and behavioral responses to social stress. In the present study we investigated the effects of oxytocin on cognitive appraisals after a naturalistic social stress task in healthy male students. In a randomized, double-blind, placebo-controlled trial, 48 participants self-administered either an oxytocin or placebo nasal spray and, following a wait period, completed an impromptu speech task. Eye gaze to a pre-recorded video of an audience displayed during the task was simultaneously collected. After the speech, participants completed questionnaires assessing negative cognitive beliefs about speech performance. Whilst there was no overall effect of oxytocin compared to placebo on either eye gaze or questionnaire measures, there were significant positive correlations between trait levels of anxiety and negative self-appraisals following the speech. Exploratory analyses revealed that whilst higher trait anxiety was associated with increasingly poorer perceptions of speech performance in the placebo group, this relationship was not found in participants administered oxytocin. These results provide preliminary evidence to suggest that oxytocin may reduce negative cognitive self-appraisals in high trait anxious males. It adds to a growing body of evidence that oxytocin seems to attenuate negative cognitive responses to stress in anxious in iduals.

Developing Culturally Appropriate Content for a Child-Rearing App to Support Young Children’s Socioemotional and Cognitive Development in Afghanistan: Co-Design Study

Publisher: JMIR Publications Inc.

Date: 23-08-2023

DOI: 10.2196/44267

Abstract: Optimal child-rearing practices can help mitigate the consequences of detrimental social determinants of health in early childhood. Given the ubiquity of personal digital technologies worldwide, the direct delivery of evidence-based information about early childhood development holds great promise. However, to make the content of these novel systems effective, it is crucial to incorporate place-based cultural beliefs, traditions, circumstances, and value systems of end users. This paper describes the iterative approach used to develop the Thrive by Five child-rearing app in collaboration with Afghan parents, caregivers (eg, grandparents, aunts, and nannies), and subject matter experts (SMEs). We outline how co-design methodologies informed the development and cultural contextualization of content to meet the specific needs of Afghan parents and the content was tested and refined in collaboration with key Afghan stakeholders. The preliminary content was developed based on a comprehensive literature review of the historical and sociocultural contexts in Afghanistan, including factors that influence child-rearing practices and early childhood development. After an initial review and refinement based on feedback from SMEs, this content was populated into a beta app for testing. Overall, 8 co-design workshops were conducted in July and August 2021 and February 2022 with 39 Afghan parents and caregivers and 6 SMEs to collect their feedback on the app and its content. The workshops were audio recorded and transcribed detailed field notes were taken by 2 scribes. A theoretical thematic analysis using semantic codes was conducted to inform the refinement of existing content and development of new content to fulfill the needs identified by participants. The following 4 primary themes were identified: child-rearing in the Afghan sociocultural context, safety concerns, emotion and behavior management, and physical health and nutrition. Overall, participants agreed that the app had the potential to deliver valuable information to Afghan parents however, owing to the volatility in the country, participants recommended including more activities that could be safely done indoors, as mothers and children are required to spend most of their time at home. Additionally, restrictions on public engagement in music required the removal of activities referencing singing that might be performed outside the home. Further, activities to help parents reduce their children’s screen time, promote empathy, manage emotions, regulate behavior, and improve physical health and nutrition were requested. Direct engagement with Afghan parents, caregivers, and SMEs through co-design workshops enabled the development and refinement of evidence-based, localized, and contextually relevant child-rearing activities promoting healthy social, emotional, and cognitive development during the first 5 years of children’s lives. Importantly, the content was adapted for the ongoing conflict in Afghanistan with the aim of empowering Afghan parents and caregivers to support their children’s developmental potential despite the security concerns and situational stressors.

Normative Modeling of Brain Morphometry Across the Lifespan using CentileBrain: Algorithm Benchmarking and Model Optimization

Publisher: Cold Spring Harbor Laboratory

Date: 31-01-2023

DOI: 10.1101/2023.01.30.523509

Distress and sleep quality in young amphetamine-type stimulant users with an affective or psychotic illness

Publisher: Elsevier BV

Date: 04-2018

DOI: 10.1016/J.PSYCHRES.2018.02.033

Abstract: Misuse of hetamine-type stimulant (ATS) drugs may disrupt key neurodevelopmental processes in young people and confer protracted neurocognitive and psychopathological harm. ATS users with a co-occurring psychiatric illness are typically excluded from research, reducing generalisability of findings. Accordingly, we conducted a cross-sectional examination of key clinical, sleep, socio-occupational and neurocognitive measures in current, past and never users of ATS drugs who were accessing a youth mental health service (headspace) for affective- or psychotic-spectrum illnesses. Contrary to hypotheses, groups did not differ in psychotic symptomology, socio-occupational functioning or neurocognitive performance. Current ATS users were however significantly more distressed and reported poorer subjective sleep quality and greater subjective sleep disturbances than never users, with a trend toward greater depressive symptomology in current users. Regression analyses revealed that depressive symptoms, daily ATS use and socio-occupational functioning predicted distress, and depressive symptoms and distress predicted subjective sleep quality. Our findings suggest that distress and poor sleep quality reflect a particular pathophysiology among ATS-using patients, which may negatively impact treatment engagement. Delineating the factors that disrupt social and neurobiological development in young people (such as substance use) warrants further investigation, including longitudinal study.

Heart rate variability predicts alcohol craving in alcohol dependent outpatients: Further evidence for HRV as a psychophysiological marker of self-regulation

Publisher: Elsevier BV

Date: 09-2013

DOI: 10.1016/J.DRUGALCDEP.2013.02.025

Abstract: Past research has highlighted an important role of the autonomic nervous system in alcohol dependence and capacity for self-regulation. While previous studies have examined alcohol dependent inpatients, it remains unclear whether resting-state HRV, a potential psychophysiological marker of ones capacity for self-regulation, is related to craving in patients who currently consume alcohol. Thus, the aim of the present study was to determine whether HRV predicts alcohol craving in dependent in iduals in the community. Resting-state HRV and alcohol craving, as indexed by the obsessive compulsive drinking scale, were assessed in 26 alcohol dependent outpatients. Results supported hypotheses indicating that HRV accounts for an additional 12.1% of the variance in craving after controlling for age, anxiety and levels of alcohol consumption. Here we show for the first time that resting-state HRV predicts craving in alcohol dependent outpatients. Results provide important new evidence for a role of the autonomic nervous system in the maintenance of dependence disorders.

Neuropsychological and functional outcomes in recent-onset major depression, bipolar disorder and schizophrenia-spectrum disorders: A longitudinal cohort study

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.

Caudate nucleus volumes and genetic determinants of homocysteine metabolism in the prediction of psychomotor speed in older persons with depression

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.

Validation of a brief tool to assess and monitor suicidal ideation: The Youth Suicide Ideation Screen (YSIS-3)

Publisher: Elsevier BV

Date: 12-2021

DOI: 10.1016/J.JAD.2021.08.053

Social inclusion, intersectionality, and profiles of vulnerable groups of young people seeking mental health support

Publisher: Springer Science and Business Media LLC

Date: 06-06-2021

DOI: 10.1007/S00127-021-02123-8

Abstract: headspace centres provide enhanced primary mental healthcare for young people. A priority is to provide services for all young people irrespective of a range of social disadvantages or social exclusion. The aims of this study were to: (i) delineate extent of social inclusion across domains of housing, studying/employment, functioning, alcohol, and other drug use and (ii) map profiles of young people deemed vulnerable to experiencing additional barriers to accessing services based on their social inclusion domains (e.g., those living in unstable housing, not in employment/education, and/or experiencing intersecting or multiple forms of disadvantage or difficulties), including detailing their clinical characteristics. Young people were recruited from five headspace centres. Data relevant to social inclusion were examined. Multivariate logistic regression models were used to determine overlap between vulnerable groups, functional, social, clinical, and behavioural factors. 1107 young people participated, aged 12-25 years (M = 18.1 years, SD = 3.3), most living in stable housing (96.5%) and engaged in studying/employment (84.8%). Specific vulnerabilities were evident in young people with NEET status (15.2%) in unstable accommodation (3.5%) of culturally erse backgrounds (CALD) (12.2%) living in regional areas (36.1%) and identifying as lesbian, gay, bisexual, transgender, intersex, queer/questioning, and asexual plus (LGBTIQA+ 28.2%). Higher levels of distress, substance use, functional impairment, and lower social support were reported by those who were NEET and/or in unstable housing. LGBTIQA+ status was associated with high distress, depressive symptoms, and suicidal ideation. Most participants reported good social support, stable housing, and engagement in work or education. Those deemed vulnerable were likely to experience social exclusion across multiple domains and reported more mental health problems. The co-occurrence of mental ill-health and social exclusion highlights the importance of integrated mental healthcare.

NHMRC funding of mental health research

Publisher: AMPCo

Date: 10-2016

DOI: 10.5694/MJA16.00179

Sympathetic activity in major depressive disorder: Identifying those at increased cardiac risk?

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 10-2007

DOI: 10.1097/HJH.0B013E32829BAAE7

A Preliminary Survey of Undergraduate Education on Depression in Medical Schools in the Asia Pacific Region

Publisher: SAGE Publications

Date: 10-2004

DOI: 10.1080/J.1039-8562.2004.02101.X-2

Dynamic networks of psychological symptoms, impairment, substance use, and social support: The evolution of psychopathology among emerging adults

Publisher: Royal College of Psychiatrists

Date: 2022

DOI: 10.1192/J.EURPSY.2022.23

Abstract: Subthreshold/attenuated syndromes are established precursors of full-threshold mood and psychotic disorders. Less is known about the in idual symptoms that may precede the development of subthreshold syndromes and associated social/functional outcomes among emerging adults. We modeled two dynamic Bayesian networks (DBN) to investigate associations among self-rated phenomenology and personal/lifestyle factors (role impairment, low social support, and alcohol and substance use) across the 19Up and 25Up waves of the Brisbane Longitudinal Twin Study. We examined whether symptoms and personal/lifestyle factors at 19Up were associated with (a) themselves or different items at 25Up, and (b) onset of a depression-like, hypo-manic-like, or psychotic-like subthreshold syndrome (STS) at 25Up. The first DBN identified 11 items that when endorsed at 19Up were more likely to be reendorsed at 25Up (e.g., hypersomnia, impaired concentration, impaired sleep quality) and seven items that when endorsed at 19Up were associated with different items being endorsed at 25Up (e.g., earlier fatigue and later role impairment earlier anergia and later somatic pain). In the second DBN, no arcs met our a priori threshold for inclusion. In an exploratory model with no threshold, items at 19Up were associated with progression to an STS at 25Up (with lower statistical confidence) the top five arcs were: feeling threatened by others and a later psychotic-like STS increased activity and a later hypo-manic-like STS and anergia, impaired sleep quality, and/or hypersomnia and a later depression-like STS. These probabilistic models identify symptoms and personal/lifestyle factors that might prove useful targets for indicated preventative strategies.

The psychological impact of September 11 terrorism on Australian inpatients

Publisher: SAGE Publications

Date: 09-2004

DOI: 10.1111/J.1039-8562.2004.02098.X

Associations Between Depression and Anxiety Symptoms and Retinal Vessel Caliber in Adolescents and Young Adults

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 11-2014

DOI: 10.1097/PSY.0000000000000117

Youth mental health: we know where we are and we can now say where we need to go next

Publisher: Wiley

Date: 06-01-2011

DOI: 10.1111/J.1751-7893.2010.00243.X

Abstract: To provide an overview of the state of knowledge relevant to the development of youth-specific mental health initiatives. A selective review of data, particularly from Australian community and health service studies, that are relevant to the decisions faced by those who fund and organize health services internationally. It is possible to reach consensus on key issues such as the current state of evidence, myths that need to be challenged, areas of genuine uncertainty, priorities for future reform, and five and ten year goals and targets. There is considerable convergence of evidence from epidemiology, clinical and basic neuroscience, population health and health service evaluation that supports an urgent new investment in development and evaluation of youth mental health initiatives.

Genetic comorbidity between major depression and cardio‐metabolic traits, stratified by age at onset of major depression

Publisher: Wiley

Date: 18-07-2020

DOI: 10.1002/AJMG.B.32807

Transitions Study of predictors of illness progression in young people with mental ill health: study methodology

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.

Clinical, neurocognitive and demographic factors associated with functional impairment in the Australian Brain and Mind Youth Cohort Study (2008-2016)

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.

An Uncertainty Visual Analytics Framework for fMRI Functional Connectivity

Publisher: Springer Science and Business Media LLC

Date: 11-08-2019

DOI: 10.1007/S12021-018-9395-8

Abstract: Analysis and interpretation of functional magnetic resonance imaging (fMRI) has been used to characterise many neuronal diseases, such as schizophrenia, bipolar disorder and Alzheimer's disease. Functional connectivity networks (FCNs) are widely used because they greatly reduce the amount of data that needs to be interpreted and they provide a common network structure that can be directly compared. However, FCNs contain a range of data uncertainties stemming from inherent limitations, e.g. during acquisition, as well as the loss of voxel-level data, and the use of thresholding in data abstraction. Additionally, human uncertainties arise during interpretation due to the complexity in understanding the data. While existing FCN visual analytics tools have begun to mitigate the human ambiguities, reducing the impact of data limitations is an open problem. In this paper, we propose a novel visual analytics framework with three linked, purpose-designed components to evoke deeper interpretation of the fMRI data: (i) an enhanced FCN abstraction (ii) a temporal signal viewer and (iii) the anatomical context. Each component has been specifically designed with novel visual cues and interaction to expose the impact of uncertainties on the data. We augment this with two methods designed for comparing subjects, by using a small multiples and a marker approach. We demonstrate the enhancements enabled by our framework on three case studies of common research scenarios, using clinical schizophrenia data, which highlight the value in interpreting fMRI FCN data with an awareness of the uncertainties. Finally, we discuss our framework in the context of fMRI visual analytics and the extensibility of our approach.

Heart rate variability during social interactions in children with and without psychopathology: a meta-analysis

Publisher: Wiley

Date: 18-03-2014

DOI: 10.1111/JCPP.12226

Abstract: The inability to regulate autonomic activity during social interactions is believed to contribute to social and emotional dysregulation in children. Research has employed heart rate variability (HRV) during both socially engaging and socially disengaging dyadic tasks between children and adults to assess this. We conducted a meta-analysis including evidence from 18 studies comprising 1,544 children who were categorized as either healthy or at risk/diagnosed with psychopathology. Within these groups, we assessed the impact of social engagement and disengagement tasks on HRV. Results showed that social engagement tasks left HRV unaltered to a baseline. Social disengagement, however, was associated with decreases in HRV. In a task that included disengagement and then engagement, HRV was reduced during disengagement but was then restored during the reunion phase (engagement). Children at risk or with a diagnosis for psychopathology, however, failed to show any change in HRV during dyadic social interaction tasks. This was despite a social stressor, the Trier Social Stress Test, causing significantly reduced HRV in both groups. This meta-analysis provides support to suggest HRV may provide a worthwhile context specific marker for the effective regulation of dyadic social interactions in children.

Characterising variability in youth mental health service populations: A detailed and scalable approach using digital technology

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.

Building the social, economic, legal, and health-care foundations for Contributing Lives and Thriving Communities

Publisher: Elsevier BV

Date: 02-2020

DOI: 10.1016/S2215-0366(19)30378-5

Days out of role and somatic, anxious-depressive, hypo-manic, and psychotic-like symptom dimensions in a community sample of young adults

Publisher: Springer Science and Business Media LLC

Date: 13-05-2021

DOI: 10.1038/S41398-021-01390-Y

Abstract: Improving our understanding of the causes of functional impairment in young people is a major global challenge. Here, we investigated the relationships between self-reported days out of role and the total quantity and different patterns of self-reported somatic, anxious-depressive, psychotic-like, and hypomanic symptoms in a community-based cohort of young adults. We examined self-ratings of 23 symptoms ranging across the four dimensions and days out of role in young adult twins and non-twin siblings participating in the “19Up” wave of the Brisbane Longitudinal Twin Study. Adjusted prevalence ratios (APR) and 95% confidence intervals (95% CI) quantified associations between impairment and different symptom patterns. Three in idual symptoms showed significant associations with days out of role, with the largest association for impaired concentration. When impairment was assessed according to each symptom dimension, there was a clear stepwise relationship between the total number of somatic symptoms and the likelihood of impairment, while in iduals reporting ≥4 anxious-depressive symptoms or five hypomanic symptoms had greater likelihood of reporting days out of role. Furthermore, there was a stepwise relationship between the total number of undifferentiated symptoms and the likelihood of reporting days out of role. There was some suggestion of differences in the magnitude and significance of associations when the cohort was stratified according to sex, but not for age or twin status. Our findings reinforce the development of early intervention mental health frameworks and, if confirmed, support the need to consider interventions for subthreshold and/or undifferentiated syndromes for reducing disability among young people.

Brain structural correlates of insomnia severity in 1053 individuals with major depressive disorder: results from the ENIGMA MDD Working Group

Publisher: Springer Science and Business Media LLC

Date: 08-12-2020

DOI: 10.1038/S41398-020-01109-5

Abstract: It has been difficult to find robust brain structural correlates of the overall severity of major depressive disorder (MDD). We hypothesized that specific symptoms may better reveal correlates and investigated this for the severity of insomnia, both a key symptom and a modifiable major risk factor of MDD. Cortical thickness, surface area and subcortical volumes were assessed from T1-weighted brain magnetic resonance imaging (MRI) scans of 1053 MDD patients (age range 13-79 years) from 15 cohorts within the ENIGMA MDD Working Group. Insomnia severity was measured by summing the insomnia items of the Hamilton Depression Rating Scale (HDRS). Symptom specificity was evaluated with correlates of overall depression severity. Disease specificity was evaluated in two independent s les comprising 2108 healthy controls, and in 260 clinical controls with bipolar disorder. Results showed that MDD patients with more severe insomnia had a smaller cortical surface area, mostly driven by the right insula, left inferior frontal gyrus pars triangularis, left frontal pole, right superior parietal cortex, right medial orbitofrontal cortex, and right supramarginal gyrus. Associations were specific for insomnia severity, and were not found for overall depression severity. Associations were also specific to MDD healthy controls and clinical controls showed differential insomnia severity association profiles. The findings indicate that MDD patients with more severe insomnia show smaller surfaces in several frontoparietal cortical areas. While explained variance remains small, symptom-specific associations could bring us closer to clues on underlying biological phenomena of MDD.

Identification and Management of Depression in Australian Primary Care and Access to Specialist Mental Health Care

Publisher: American Psychiatric Association Publishing

Date: 12-2012

DOI: 10.1176/APPI.PS.201200017

Abstract: The authors evaluated management of illness, including access to specialist mental health care, among people identified by general practitioners as clinically depressed. Australian primary care practitioners recruited in 2009 completed case reports and collected self-report assessments from five to seven consecutively presenting patients whom they identified as having clinical depression. Among 735 patients with clinical depression, 55% met criteria for major depressive syndrome, 86% reported clinically significant sleep disturbance, and 47% had been depressed for more than 12 months. Most (77%) were prescribed antidepressants, and 30% were prescribed anxiolytics or hypnotics. Patients under shared care with specialist mental health care providers (42%) had more severe, chronic, and recurrent conditions but no demographic advantages. Depressed patients of general practitioners often had chronic, recurrent, and moderately to severely disabling conditions, but fewer than half received specialist care. Access to specialist care, however, appeared to be based on clinical need, with little inequity in sociodemographic characteristics observed.

Protocol for a young adult mental health (Uspace) cohort: personalising multidimensional care in young people admitted to hospital

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.

Risky alcohol use predicts temporal mismatch negativity impairments in young people with bipolar disorder

Publisher: Elsevier BV

Date: 05-2014

DOI: 10.1016/J.BIOPSYCHO.2014.02.013

Abstract: Alcohol misuse in bipolar disorder (BD) has a negative impact on illness progression. The NMDA/glutamatergic system is implicated in BD pathophysiology and is critically involved in the effects of alcohol on the brain. Mismatch negativity (MMN) is purported to reflect NMDA receptor output, providing a measure for investigating this association. Forty-two patients and 34 controls (16-30 years) were split into low and high-risk drinkers (based on the Alcohol Use Disorders Identification Test) and underwent a two-tone passive auditory oddball, duration deviant MMN paradigm. Multiple regression models revealed risky drinking and BD diagnosis were predictors of impaired temporal MMN. Potentially reflecting an additive effect of alcohol on a perturbed NMDA/glutamatergic system in BD, these findings highlight alcohol as both a modifiable risk factor of neurobiological impairments and as a potential confounder in MMN studies. Given the increasing use of glutamatergic agents for BD treatment, this finding is important clinically.

Novel melatonin-based therapies: potential advances in the treatment of major depression

Publisher: Elsevier BV

Date: 08-2011

DOI: 10.1016/S0140-6736(11)60095-0

White matter tractography in early psychosis: Clinical and neurocognitive associations

Publisher: CMA Joule Inc.

Date: 11-2014

DOI: 10.1503/JPN.130280

Identification of common genetic risk variants for autism spectrum disorder

Publisher: Springer Science and Business Media LLC

Date: 25-02-2019

DOI: 10.1038/S41588-019-0344-8

Intravenous Immunoglobulin is Ineffective in the Treatment of Patients with Chronic Fatigue Syndrome

Publisher: Elsevier BV

Date: 07-1997

DOI: 10.1016/S0002-9343(97)90045-0

Abstract: To determine whether the reported therapeutic benefit of intravenous immunoglobulin in patients with chronic fatigue syndrome (CFS) is dose dependent. Ninety-nine adult patients, who fulfilled diagnostic criteria for CFS, participated in this double-blind, randomized, and placebo-controlled trial. Patients received intravenous infusions with either a placebo solution (1% albumin) or one of three doses of immunoglobulin (0.5, 1, or 2 g/kg) on a monthly basis for 3 months, followed by a treatment-free follow-up period of 3 months. Outcome was assessed by changes in a series of self-reported measures (quality-of-life visual analog scales, standardized diaries of daily activities, the profile of mood states questionnaire) and the Karnofsky performance scale. Cell-mediated immunity was evaluated by T-cell subset analysis and delayed-type hypersensitivity (DTH) skin testing. No dose of intravenous immunoglobulin was associated with a specific therapeutic benefit. Adverse reactions, typically constitutional symptoms, were reported by 70% to 80% of patients, with no relationship to immunoglobulin treatment. Intravenous immunoglobulin cannot be recommended as a therapy for the treatment of CFS. A better understanding of the pathophysiology of this disorder is needed before effective treatment can be developed.

Short association fibres of the insula-temporoparietal junction in early psychosis: A diffusion tensor imaging study

Publisher: Public Library of Science (PLoS)

Date: 18-11-2014

DOI: 10.1371/JOURNAL.PONE.0112842

Perceived dysfunctional intimate relationships: a specific association with the non-melancholic depressive subtype

Publisher: Elsevier BV

Date: 06-1990

DOI: 10.1016/0165-0327(90)90014-Y

Abstract: Associations between perceptions of dysfunctional current intimate relationships and subtypes of depressive disorders were quantified in a s le of 136 patients, using the Intimate Bond Measure (IBM). Deficient care was two to three times more likely to be reported by patients with non-melancholic disorders than by matched subjects, but was no more likely to be reported by patients with melancholic disorders, suggesting a risk factor selective for depressive type. Patients who reported markedly deficient care in childhood were more likely to report very poor current intimate relationships. For the remaining patients, however, no evidence of continuity between a dysfunctional parental relationship and a current dysfunctional intimate relationship was found.

A systematic review and meta-analysis of sleep and circadian rhythms disturbances in individuals at high-risk of developing or with early onset of bipolar disorders

Publisher: Elsevier BV

Date: 04-2022

DOI: 10.1016/J.NEUBIOREV.2022.104585

Recommendations for the standardisation of oxytocin nasal administration and guidelines for its reporting in human research

Publisher: Elsevier BV

Date: 05-2013

DOI: 10.1016/J.PSYNEUEN.2012.11.019

Abstract: A series of studies have reported on the salubrious effects of oxytocin nasal spray on social cognition and behavior in humans, across physiology (e.g., eye gaze, heart rate variability), social cognition (e.g., attention, memory, and appraisal), and behavior (e.g., trust, generosity). Findings suggest the potential of oxytocin nasal spray as a treatment for various psychopathologies, including autism and schizophrenia. There are, however, increasing reports of variability of response to oxytocin nasal spray between experiments and in iduals. In this review, we provide a summary of factors that influence transmucosal nasal drug delivery, deposition, and their impact on bioavailability. These include variations in anatomy and resultant airflow dynamic, vascularisation, status of blood vessels, mode of spray application, gallenic formulation (including presence of uptake enhancers, control release formulation), and amount and method of administration. These key variables are generally poorly described and controlled in scientific reports, in spite of their potential to alter the course of treatment outcome studies. Based on this review, it should be of no surprise that differences emerge across in iduals and experiments when nasal drug delivery methods are employed. We present recommendations for researchers to use when developing and administering the spray, and guidelines for reporting on peptide nasal spray studies in humans. We hope that these recommendations assist in establishing a scientific standard that can improve the rigor and subsequent reliability of reported effects of oxytocin nasal spray in humans.

Intranasal Oxytocin Improves Emotion Recognition for Youth with Autism Spectrum Disorders

Publisher: Elsevier BV

Date: 04-2010

DOI: 10.1016/J.BIOPSYCH.2009.09.020

Abstract: A diagnostic hallmark of autism spectrum disorders is a qualitative impairment in social communication and interaction. Deficits in the ability to recognize the emotions of others are believed to contribute to this. There is currently no effective treatment for these problems. In a double-blind, randomized, placebo-controlled, crossover design, we administered oxytocin nasal spray (18 or 24 IU) or a placebo to 16 male youth aged 12 to 19 who were diagnosed with Autistic or Asperger's Disorder. Participants then completed the Reading the Mind in the Eyes Task, a widely used and reliable test of emotion recognition. In comparison with placebo, oxytocin administration improved performance on the Reading the Mind in the Eyes Task. This effect was also shown when analysis was restricted to the younger participants aged 12 to 15 who received the lower dose. This study provides the first evidence that oxytocin nasal spray improves emotion recognition in young people diagnosed with autism spectrum disorders. Findings suggest the potential of earlier intervention and further evaluation of oxytocin nasal spray as a treatment to improve social communication and interaction in young people with autism spectrum disorders.

Transdiagnostic clinical staging in youth mental health: a first international consensus statement

Publisher: Wiley

Date: 11-05-2020

DOI: 10.1002/WPS.20745

Moderate alcohol intake is related to increased heart rate variability in young adults: Implications for health and well-being

Publisher: Wiley

Date: 14-08-2013

DOI: 10.1111/PSYP.12134

Abstract: Epidemiological literature indicates that the relationship between alcohol consumption and health outcomes reflects a J-shaped curve such that moderate alcohol consumption confers a protective effect in comparison to abstinence, while heavy consumption is associated with poorer health. While heart rate variability (HRV) may underpin the relationship between drinking and poor health in heavy drinkers, it is unclear whether HRV is increased in moderate, habitual drinkers relative to nonhabitual drinkers. HRV and drinking habits were assessed in 47 volunteers. Results supported hypotheses suggesting that moderate, habitual drinking increases HRV. Although not supported by a significant interaction between drinking group and sex, planned follow-up analysis also revealed that these findings may be specific to males. Regardless, results highlight HRV as a candidate mechanism for the findings reported in the epidemiological literature.

The impact of strengthening mental health services to prevent suicidal behaviour

Publisher: SAGE Publications

Date: 12-12-2019

DOI: 10.1177/0004867418817381

Abstract: Successive suicide prevention frameworks and action plans in Australia and internationally have called for improvements to mental health services and enhancement of workforce capacity. However, there is debate regarding the priorities for resource allocation and the optimal combination of mental health services to best prevent suicidal behaviour. This study investigates the potential impacts of service capacity improvements on the incidence of suicidal behaviour in the Australian context. A system dynamics model was developed to investigate the optimal combination of (1) secondary (acute) mental health service capacity, (2) non-secondary (non-acute) mental health service capacity and (3) resources to re-engage those lost to services on the incidence of suicidal behaviour over the period 2018–2028 for the Greater Western Sydney (Australia) population catchment. The model captured population and behavioural dynamics and mental health service referral pathways and was validated using population survey and administrative data, evidence syntheses and an expert stakeholder group. Findings suggest that 28% of attempted suicide and 29% of suicides could be averted over the forecast period based on a combination of increases in (1) hospital staffing (with training in trauma-informed care), (2) non-secondary health service capacity, (3) expansion of mental health assessment capacity and (4) re-engagement of at least 45% of in iduals lost to services. Reduction in the number of available psychiatric beds by 15% had no substantial impact on the incidence of attempted suicide and suicide over the forecast period. This study suggests that more than one-quarter of suicides and attempted suicides in the Greater Western Sydney population catchment could potentially be averted with a combination of increases to hospital staffing and non-secondary (non-acute) mental health care. Reductions in tertiary care services (e.g. psychiatric hospital beds) in combination with these increases would not adversely affect subsequent incidence of suicidal behaviour.

Better Outcomes or Better Access - which was better for mental health care?

Publisher: AMPCo

Date: 12-2012

DOI: 10.5694/MJA12.11247

Evidence for separate inheritance of mania and depression challenges current concepts of bipolar mood disorder

Publisher: Springer Science and Business Media LLC

Date: 24-12-2014

DOI: 10.1038/MP.2013.173

A Dynamic Approach to Economic Priority Setting to Invest in Youth Mental Health and Guide Local Implementation: Economic Protocol for Eight System Dynamics Policy Models

Publisher: Frontiers Media SA

Date: 29-04-2022

DOI: 10.3389/FPSYT.2022.835201

Abstract: Mental illness costs the world economy over US2.5 Bn each year, including premature mortality, morbidity, and productivity losses. Multisector approaches are required to address the systemic drivers of mental health and ensure adequate service provision. There is an important role for economics to support priority setting, identify best value investments and inform optimal implementation. Mental health can be defined as a complex dynamic system where decision makers are challenged to prospectively manage the system over time. This protocol describes the approach to equip eight system dynamics (SD) models across Australia to support priority setting and guide portfolio investment decisions, tailored to local implementation context. As part of a multidisciplinary team, three interlinked protocols are developed (i) the participatory process to codesign the models with local stakeholders and identify interventions for implementation, (ii) the technical protocol to develop the SD models to simulate the dynamics of the local population, drivers of mental health, the service system and clinical outcomes, and (iii) the economic protocol to detail how the SD models will be equipped to undertake a suite of economic analysis, incorporating health and societal perspectives. Models will estimate the cost of mental illness, inclusive of service costs (health and other sectors, where necessary), quality-adjusted life years (QALYs) lost, productivity costs and carer costs. To assess the value of investing (disinvesting) in interventions, economic analysis will include return-on-investment, cost-utility, cost benefit, and budget impact to inform affordability. Economic metrics are expected to be dynamic, conditional upon changing population demographics, service system capacities and the mix of interventions when synergetic or antagonistic interactions. To support priority setting, a portfolio approach will identify best value combinations of interventions, relative to a defined budget(s). User friendly dashboards will guide decision makers to use the SD models to inform resource allocation and generate business cases for funding. Equipping SD models to undertake economic analysis is intended to support local priority setting and help optimise implementation regarding the best value mix of investments, timing and scale. The objectives are to improve allocative efficiency, increase mental health and economic productivity.

Polymorphisms in Toll-like receptors-2 and -4 are not associated with disease manifestations in acute Q fever

Publisher: Springer Science and Business Media LLC

Date: 03-01-2024

DOI: 10.1038/SJ.GENE.6364428

Abstract: Coxiella burnetii is a macrophage-tropic, Gram-negative organism, which causes acute Q fever infection in humans. This zoonotic infection causes illness ranging from asymptomatic seroconversion to severe and protracted disease featuring hepatitis and pneumonia. Interactions between C. burnetii lipopolysaccharide (LPS) and host Toll-like receptors (TLR)-2 and -4 have been implicated in pathogen recognition, phagocytosis and signaling responses. Nonconservative single nucleotide polymorphisms in the coding regions of TLR-2 (Arg677Trp and Arg753Gln) and TLR-4 (Asp299Gly) have been found to correlate with mycobacterial infections and Gram-negative sepsis respectively. Associations between the TLR-2 and -4 polymorphisms, illness characteristics and immune response parameters were examined in subjects with acute Q fever (n=85) and comparison subjects with viral infections (n=162). No correlation was demonstrated between these polymorphisms and susceptibility to Q fever, illness severity or illness course.

Adolescent-Onset Depressive Disorders and Inflammation

Publisher: Elsevier

Date: 2018

DOI: 10.1016/B978-0-12-811073-7.00024-6

Depressive psychomotor disturbance, cortisol, and dexamethasone

Publisher: Elsevier BV

Date: 11-1996

DOI: 10.1016/0006-3223(95)00635-4

Abstract: We examine the dexamethasone suppression test as a biological correlate of melancholia as defined by the CORE system, a scale for rating objective signs of psychomotor disturbance. Postdexamethasone cortisol concentrations and rates of nonsuppression were higher in CORE, Newcastle, and DSM-III-R defined melancholic groups. These differences, however, were no longer significant after partialling out the combined effects of age, dexamethasone, and basal cortisol concentrations. There was a significant correlation between the CORE (but not the Newcastle) scale and 8:00 AM postdexamethasone cortisol levels, which persisted after partialling out those same three covariates. Dexamethasone concentrations themselves were lower in CORE- and Newcastle-defined melancholics, though these were no longer significant after covarying for cortisol concentrations. Dexamethasone levels were also significantly inversely correlated with CORE and Newcastle scales. A significant correlation between CORE (but not Newcastle) scores and dexamethasone levels at 4:00 PM persisted after partialling out the effects of age and cortisol. These findings indicate an intriguing relationship between the CORE system as a dimensional construct for rating psychomotor disturbance, and both postdexamethasone cortisol and dexamethasone concentrations.

Examining the prevalence of disordered eating in a cohort of young Australians presenting for mental health care at a headspace centre: results from a cross-sectional clinical survey study

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.

Measurement of EBV-IgG anti-VCA avidity aids the early and reliable diagnosis of primary EBV infection

Publisher: Wiley

Date: 02-06-2003

DOI: 10.1002/JMV.10439

Abstract: Current serological methods for the diagnosis of Epstein-Barr virus (EBV) infection still differentiate poorly between primary infection and reactivation. This is particularly true when IgG and IgM antibodies are present simultaneously and only a single serum s le is provided for analysis. The demonstration of the IgG avidity state has the potential to distinguish recent from past or reactivated infection. An analysis of the kinetics of avidity maturation of anti-VCA antibodies in primary EBV infection was undertaken with longitudinally collected sets of sera from 28 well-characterised EBV cases and in sera from 35 cases with previous EBV infection and recent primary infection due to HIV, CMV, or hepatitis A. Antibodies directed against the viral capsid antigen (VCA) and Epstein-Barr nuclear antigen (EBNA-1) were sought, using a commercial enzyme immunoassay (EIA). In parallel with standard IgG anti-VCA detection, serum was incubated with 8 M urea to disrupt low-avidity complexes to allow calculation of the percentage avidity. In cases with primary EBV infection, the mean avidity rose from 54% at 6 weeks to 82% by 28 weeks after the onset of symptoms, but remained lower than that of the control sera (96%). The addition of the avidity measurement improved the sensitivity of IgG and IgM anti-VCA testing in diagnosis of primary EBV infection from 93% to 100%. The specificity of IgM anti-VCA testing alone was poor, with 14 of 35 cases (49%) demonstrating false-positive results, but it improved to 97% by the demonstration of high-avidity IgG anti-VCA. The combination of negative IgG anti-EBNA and low-avidity IgG anti-VCA had a sensitivity and specificity of 100%. The routine addition of IgG anti-VCA avidity estimation to diagnostic EBV serology is recommended.

A single dose of oxytocin nasal spray improves higher-order social cognition in schizophrenia

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.

A preliminary study of aged care facility staff indicates limitations in awareness of the link between depression and physical morbidity

Publisher: Springer Science and Business Media LLC

Date: 09-04-2013

DOI: 10.1186/1471-2318-13-30

S136. A NOVEL APPROACH FOR DEVELOPING PREDICTION MODEL OF TRANSITION TO PSYCHOSIS: DYNAMIC PREDICTION USING JOINT MODELLING

Publisher: Oxford University Press (OUP)

Date: 04-2018

DOI: 10.1093/SCHBUL/SBY018.923

Dysregulation of objectively assessed 24-hour motor activity patterns as a potential marker for bipolar I disorder: results of a community-based family study

Publisher: Springer Science and Business Media LLC

Date: 22-08-2017

DOI: 10.1038/TP.2017.136

Abstract: There has been a growing number of studies that have employed actigraphy to investigate differences in motor activity in mood disorders. In general, these studies have shown that people with bipolar disorders (BPDs) tend to exhibit greater variability and less daytime motor activity than controls. The goal of this study was to examine whether patterns of motor activity differ in euthymic in iduals across the full range of mood disorder subtypes (Bipolar I (BPI), Bipolar II (BPII) and major depression (MDD)) compared with unaffected controls in a community-based family study of mood spectrum disorders. Minute-to-minute activity counts derived from actigraphy were collected over a 2-week period for each participant. Prospective assessments of the level, timing and day-to-day variability of physical activity measures were compared across diagnostic groups after controlling for a comprehensive list of potential confounding factors. After adjusting for the effects of age, sex, body mass index (BMI) and medication use, the BPI group had lower median activity intensity levels across the second half of the day and greater variability in the afternoon compared with controls. Those with a history of BPII had increased variability during the night time compared with controls, indicating poorer sleep quality. No differences were found in the average intensity, variability or timing of activity in comparisons between other mood disorder subgroups and controls. Findings confirm evidence from previous studies that BPI may be a manifestation of a rhythm disturbance that is most prominent during the second half of the day. The present study is the largest study to date that included the full range of mood disorder subgroups in a nonclinical s le that increases the generalizability of our findings to the general community. The manifestations of activity patterns outside of acute episodes add to the accumulating evidence that dysregulation of patterns of activity may constitute a potential biomarker for BPD.

Response to: ‘Prolonged Fatigue, Anxiety and Depression: Exploring Relationships in a Primary Care Sample’

Publisher: SAGE Publications

Date: 08-2000

DOI: 10.1080/J.1440-1614.2000.0766A.X

Cross-sectional and longitudinal associations between cardiometabolic measures and clinical stage in young people accessing early intervention mental health services

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.

A phenome-wide association and Mendelian Randomisation study of polygenic risk for depression in UK Biobank

Publisher: Springer Science and Business Media LLC

Date: 08-05-2020

DOI: 10.1038/S41467-020-16022-0

Abstract: Depression is a leading cause of worldwide disability but there remains considerable uncertainty regarding its neural and behavioural associations. Here, using non-overlapping Psychiatric Genomics Consortium (PGC) datasets as a reference, we estimate polygenic risk scores for depression (depression-PRS) in a discovery ( N = 10,674) and replication ( N = 11,214) imaging s le from UK Biobank. We report 77 traits that are significantly associated with depression-PRS, in both discovery and replication analyses. Mendelian Randomisation analysis supports a potential causal effect of liability to depression on brain white matter microstructure ( β : 0.125 to 0.868, p FDR 0.043). Several behavioural traits are also associated with depression-PRS ( β : 0.014 to 0.180, p FDR : 0.049 to 1.28 × 10 −14 ) and we find a significant and positive interaction between depression-PRS and adverse environmental exposures on mental health outcomes. This study reveals replicable associations between depression-PRS and white matter microstructure. Our results indicate that white matter microstructure differences may be a causal consequence of liability to depression.

Evaluating the quality and safety of health-related apps and e-tools: Adapting the Mobile App Rating Scale and developing a quality assurance protocol

Publisher: Elsevier BV

Date: 04-2021

DOI: 10.1016/J.INVENT.2021.100379

Immunological and psychological dysfunction in patients receiving immunotherapy for chronic fatigue syndrome

Publisher: SAGE Publications

Date: 06-1992

DOI: 10.3109/00048679209072034

Mental health: build predictive models to steer policy

Publisher: Springer Science and Business Media LLC

Date: 26-09-2021

DOI: 10.1038/D41586-021-02581-9

Right Care, First Time: Developing a Theory-Based Automated Protocol to Help Clinically Stage Young People Based on Severity and Persistence of Mental Illness

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.

Conclusions about the assessment and management of common mental disorders in Australian general practice

Publisher: AMPCo

Date: 07-2001

DOI: 10.5694/J.1326-5377.2001.TB143791.X

Clinical symptoms predict concurrent social and global functioning in an early psychosis sample

Publisher: Wiley

Date: 02-12-2018

DOI: 10.1111/EIP.12295

Abstract: Although well established in chronic schizophrenia, the key determinants of functioning remain unknown during the early phase of a psychotic disorder. The aim of this study was to comprehensively examine the social cognitive, basic neurocognitive and clinical predictors of concurrent social functioning and global functioning in an early psychosis s le. This study examined the relationship between social cognition, basic neurocognition and clinical symptoms with concurrent functioning in 51 early psychosis in iduals. Assessments included a range of self-report, observational and clinician-rated measures of cognitive, symptom severity and functioning domains. Results revealed a significant association between self-reported social function and lower levels of both social interaction anxiety and negative psychotic symptoms. A significant association was also observed between lower levels of negative psychotic symptoms and observed social functioning. Lastly, results demonstrated a significant association between reduced negative psychotic symptoms and clinician-rated global functioning. Clinical domains such as negative symptoms and social interaction anxiety significantly contribute to an optimal model predicting outcome during the early phase of a psychotic disorder. These clinical features may also provide useful markers of an in idual's capacity for social participation. Clinical implications include the need for early targeted intervention to address social anxiety and negative psychotic symptoms to facilitate optimum patient outcome.

Providing psychological treatments in general practice: how will it work?

Publisher: AMPCo

Date: 07-2003

DOI: 10.5694/J.1326-5377.2003.TB05411.X

Abstract: Provision of "Focussed Psychological Strategies" by general practitioners is one component of the recent Better Outcomes in Mental Health Care (BOiMHC) initiative. The BOiMHC initiative requires GPs to undertake minimum training requirements before they may provide services under the new Medicare Benefits Schedule item number. We argue that GPs need further training and ongoing clinical interaction with mental health specialists (beyond the minimum training requirements) for refinement of psychological skills. Research focusing on GP training and how GPs interact with specialist services in the provision of psychological treatments is urgently required.

Specificity of interpersonal sensitivity to non-melancholic depression

Publisher: Elsevier BV

Date: 02-1993

DOI: 10.1016/0165-0327(93)90082-U

Abstract: Scores of 69 remitted depressed patients were compared to control subjects on the Interpersonal Sensitivity Measure (IPSM). The patients were categorised into melancholic and non-melancholic sub-groups according to DSM-III criteria. Differences between the depressives and controls were detected but were principally the result of high IPSM scores being returned by the non-melancholic depressives. Melancholic depressives did not differ from the controls in their IPSM scores, supporting the proposition that this depressive sub-type is not associated with a vulnerable personality style.

Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

Publisher: Springer Science and Business Media LLC

Date: 05-09-2022

DOI: 10.1186/S40337-022-00654-2

Abstract: Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders. This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised. A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED. This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.

Screening for depression in general practice and related medical settings

Publisher: AMPCo

Date: 10-2002

DOI: 10.5694/J.1326-5377.2002.TB04869.X

Abstract: To determine if screening in general practice and related medical settings improves management and clinical outcomes in people with depression. The Medline (1966-2002), EMBASE (1980-2002) and PsycINFO (1966-2002) databases were searched. These were supplemented by searching the Cochrane databases (to 2002) performing additional specific searches on Medline, EMBASE and PsycINFO scrutinising reference lists of selected articles and querying experts. Inclusion criteria were: review of prospective studies with a primary focus of depression screening in general practice settings review of studies of healthy populations or people with known depression publication in a peer-reviewed journal and written in English. Eleven reviews that satisfied these criteria were assessed for quality using the Oxman and Guyatt Index. Four reviews met the criterion of a score of five or more. One author tabulated relevant material (including number and type of studies, outcomes/endpoints, measures of association/statistical results, and findings) from the four key reviews. A second author independently checked the accuracy of this extracted material. Brief self-report instruments have acceptable psychometric properties and are practical for use in general practice settings. Screening increases the recognition and diagnosis of depression and, when integrated with a commitment to provide coordinated and prompt follow-up of diagnosis and treatment, clinical outcomes are improved. Although controversial, the evidence is now in favour of the appropriate use of screening tools in primary care.

Research to Clinical Practice—Youth seeking mental health information online and its impact on the first steps in the patient journey

Publisher: Wiley

Date: 27-12-2021

DOI: 10.1111/ACPS.13390

Abstract: Online searches about anxiety and depression are recorded every 3–5 s. As such, information and communication technologies (ICT) have enormous potential to enable or impair help‐seeking and patient‐professional interactions. Youth studies indicate that ICT searches are undertaken before initial mental health consultations, but no publications have considered how this online activity affects the first steps of the patient journey in youth mental health settings. State‐of‐the‐art review using an iterative, evidence mapping approach to identify key literature and expert consensus to synthesize and prioritise clinical and research issues. Adolescents and young adults are more likely to seek health advice via online search engines or social media platforms than from a health professional. Young people not only search user‐generated content and social media to obtain advice and support from online communities but increasingly contribute personal information online. A major clinical challenge is to raise professional awareness of the likely impact of this activity on mental health consultations. Potential strategies range from modifying the structure of clinical consultations to ensure young people are able to disclose ICT activities related to mental health, through to the development and implementation of ‘internet prescriptions’ and a youth‐focused ‘toolkit’.

Technology-Enabled Solutions for Australian Mental Health Services Reform: Impact Evaluation (Preprint)

Publisher: JMIR Publications Inc.

Date: 18-03-2020

DOI: 10.2196/PREPRINTS.18759

Abstract: ealth information technologies (HITs) are becoming increasingly recognized for their potential to provide innovative solutions to improve the delivery of mental health services and drive system reforms for better outcomes. his paper describes the baseline results of a study designed to systematically monitor and evaluate the impact of implementing an HIT, namely the InnoWell Platform, into Australian mental health services to facilitate the iterative refinement of the HIT and the service model in which it is embedded to meet the needs of consumers and their supportive others as well as health professionals and service providers. ata were collected via web-based surveys, semistructured interviews, and a workshop with staff from the mental health services implementing the InnoWell Platform to systematically monitor and evaluate its impact. Descriptive statistics, Fisher exact tests, and a reliability analysis were used to characterize the findings from the web-based surveys, including variability in the results between the services. Semistructured interviews were coded using a thematic analysis, and workshop data were coded using a basic content analysis. aseline data were collected from the staff of 3 primary youth mental health services (n=18), a counseling service for veterans and their families (n=23), and a helpline for consumers affected by eating disorders and negative body image issues (n=6). As reported via web-based surveys, staff members across the services consistently i agreed /i or i strongly agreed /i that there was benefit associated with using technology as part of their work (38/47, 81%) and that the InnoWell Platform had the potential to improve outcomes for consumers (27/45, 60%) however, there was less certainty as to whether their consumers’ capability to use technology aligned with how the InnoWell Platform would be used as part of their mental health care (11/45, 24% of the participants i strongly disagreed /i or i disagreed /i 15/45, 33% were i neutral /i and 19/45, 42% i strongly agreed /i or i agreed /i ). During the semistructured interviews (n=3) and workshop, participants consistently indicated that the InnoWell Platform was appropriate for their respective services however, they questioned whether the services’ respective consumers had the digital literacy required to use the technology. Additional potential barriers to implementation included health professionals’ digital literacy and service readiness for change. espite agreement among participants that HITs have the potential to result in improved outcomes for consumers and services, service readiness for change (eg, existing technology infrastructure and the digital literacy of staff and consumers) was noted to potentially impact the success of implementation, with less than half (20/45, 44%) of the participants indicating that their service was ready to implement new technologies to enhance mental health care. Furthermore, participants reported mixed opinions as to whether it was their responsibility to recommend technology as part of standard care.

Optimizing Strategies for Improving Mental Health in Victoria, Australia during the COVID-19 Era: A System Dynamics Modelling Study

Publisher: MDPI AG

Date: 26-05-2022

DOI: 10.3390/IJERPH19116470

Abstract: The ongoing COVID-19 pandemic has impacted the mental health of populations and highlighted the limitations of mental health care systems. As the trajectory of the pandemic and the economic recovery are still uncertain, decision tools are needed to help evaluate the best interventions to improve mental health outcomes. We developed a system dynamics model that captures causal relationships among population, demographics, post-secondary education, health services, COVID-19 impact, and mental health outcomes. The study was conducted in the Australian state of Victoria. The model was calibrated using historical data and was stratified by age group and by geographic remoteness. Findings demonstrate that the most effective intervention combination includes economic, social, and health sector initiatives. Assertive post-suicide attempt care is the most impactful health sector intervention, but delaying implementation reduces the potency of its impact. Some evidence-based interventions, such as population-wide community awareness c aigns, are projected to worsen mental health outcomes when implemented on their own. Systems modelling offers a powerful decision-support tool to test alternative strategies for improving mental health outcomes in the Victorian context.

Mild Cognitive Impairment Subtypes in Older People with Depressive Symptoms: Relationship with Clinical Variables and Hippocampal Change

Publisher: SAGE Publications

Date: 10-03-2015

DOI: 10.1177/0891988715573535

Abstract: To examine the rates and clinical characteristics of mild cognitive impairment (MCI) in older people with depressive symptoms and to determine the relative contribution of hippoc al volume and MCI to memory change. One hundred and fifty-two participants with lifetime Major Depression and remitted or mild symptoms and 28 healthy controls underwent psychiatric and neuropsychological assessments. Magnetic resonance imaging was also conducted in a subset of the patients (n = 81) and healthy controls (n = 18). MCI was diagnosed in 75.7% of the patients and was associated with increasing age, medical burden, vascular risk factors, later age of depression onset and smaller hippoc i. Multiple regression showed that both hippoc al volume and MCI diagnosis mediate memory performance in depression. MCI occurs in older adults with a history of depression and is not simply due to symptom severity. Memory change is linked to underlying hippoc al atrophy in this patient group.

Reducing youth suicide: systems modelling and simulation to guide targeted investments across the determinants

Publisher: Springer Science and Business Media LLC

Date: 12-03-2021

DOI: 10.1186/S12916-021-01935-4

Abstract: Reducing suicidal behaviour (SB) is a critical public health issue globally. The complex interplay of social determinants, service system factors, population demographics, and behavioural dynamics makes it extraordinarily difficult for decision makers to determine the nature and balance of investments required to have the greatest impacts on SB. Real-world experimentation to establish the optimal targeting, timing, scale, frequency, and intensity of investments required across the determinants is unfeasible. Therefore, this study harnesses systems modelling and simulation to guide population-level decision making that represent best strategic allocation of limited resources. Using a participatory approach, and informed by a range of national, state, and local datasets, a system dynamics model was developed, tested, and validated for a regional population catchment. The model incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and SB. Intervention scenarios were investigated to forecast their impact on SB over a 20-year period. A combination of social connectedness programs, technology-enabled coordinated care, post-attempt assertive aftercare, reductions in childhood adversity, and increasing youth employment projected the greatest impacts on SB, particularly in a youth population, reducing self-harm hospitalisations (suicide attempts) by 28.5% (95% interval 26.3–30.8%) and suicide deaths by 29.3% (95% interval 27.1–31.5%). Introducing additional interventions beyond the best performing suite of interventions produced only marginal improvement in population level impacts, highlighting that ‘more is not necessarily better.’ Results indicate that targeted investments in addressing the social determinants and in mental health services provides the best opportunity to reduce SB and suicide. Systems modelling and simulation offers a robust approach to leveraging best available research, data, and expert knowledge in a way that helps decision makers respond to the unique characteristics and drivers of SB in their catchments and more effectively focus limited health resources.

Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review

Publisher: JMIR Publications Inc.

Date: 26-06-2019

DOI: 10.2196/13717

Abstract: There is little research on the application of gamification to mental health and well-being. Furthermore, usage of gamification-related terminology is inconsistent. Current applications of gamification for health and well-being have also been critiqued for adopting a behaviorist approach that relies on positive reinforcement and extrinsic motivators. This study aimed to analyze current applications of gamification for mental health and well-being by answering 3 research questions (RQs). RQ1: which gamification elements are most commonly applied to apps and technologies for improving mental health and well-being? RQ2: which mental health and well-being domains are most commonly targeted by these gamified apps and technologies? RQ3: what reasons do researchers give for applying gamification to these apps and technologies? A systematic review of the literature was conducted to answer these questions. We searched ACM Digital Library, CINAHL, Cochrane Library, EMBASE, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying papers published between the years 2013 and 2018. To answer RQ1 and RQ2, papers were coded for gamification elements and mental health and well-being domains according to existing taxonomies in the game studies and medical literature. During the coding process, it was necessary to adapt our coding frame and revise these taxonomies. Thematic analysis was conducted to answer RQ3. The search and screening process identified 70 qualifying papers that collectively reported on 50 apps and technologies. The most commonly observed gamification elements were levels or progress feedback, points or scoring, rewards or prizes, narrative or theme, personalization, and customization the least commonly observed elements were artificial assistance, unlockable content, social cooperation, exploratory or open-world approach, artificial challenge, and randomness. The most commonly observed mental health and well-being domains were anxiety disorders and well-being, whereas the least commonly observed domains were conduct disorder and bipolar disorders. Researchers’ justification for applying gamification to improving mental health and well-being was coded in 59% (41/70) of the papers and was broadly ided into 2 themes: (1) promoting engagement and (2) enhancing an intervention’s intended effects. Our findings suggest that the current application of gamification to apps and technologies for improving mental health and well-being does not align with the trend of positive reinforcement critiqued in the greater health and well-being literature. We also observed overlap between the most commonly used gamification techniques and existing behavior change frameworks. Results also suggest that the application of gamification is not driven by health behavior change theory, and that many researchers may treat gamification as a black box without consideration for its underlying mechanisms. We call for the inclusion of more comprehensive and explicit descriptions of how gamification is applied and the standardization of applied games terminology within and across fields.

Informing the development of Australia’s National Eating Disorders Research and Translation Strategy: a rapid review methodology

Publisher: Springer Science and Business Media LLC

Date: 04-03-2022

DOI: 10.1186/S40337-022-00556-3

Abstract: Eating disorders (EDs) are highly complex mental illnesses associated with significant medical complications. There are currently knowledge gaps in research relating to the epidemiology, aetiology, treatment, burden, and outcomes of eating disorders. To clearly identify and begin addressing the major deficits in the scientific, medical, and clinical understanding of these mental illnesses, the Australian Government Department of Health in 2019 funded the InsideOut Institute (IOI) to develop the Australian Eating Disorder Research and Translation Strategy, the primary aim of which was to identify priorities and targets for building research capacity and outputs. A series of rapid reviews (RR) were conducted to map the current state of knowledge, identify evidence gaps, and inform development of the national research strategy. Published peer-reviewed literature on DSM-5 listed EDs, across eight knowledge domains was reviewed: (1) population, prevalence, disease burden, Quality of Life in Western developed countries (2) risk factors (3) co-occurring conditions and medical complications (4) screening and diagnosis (5) prevention and early intervention (6) psychotherapies and relapse prevention (7) models of care (8) pharmacotherapies, alternative and adjunctive therapies and (9) outcomes (including mortality). While RRs are systematic in nature, they are distinct from systematic reviews in their aim to gather evidence in a timely manner to support decision-making on urgent or high-priority health concerns at the national level. Three medical science databases were searched as the primary source of literature for the RRs: Science Direct, PubMed and OVID (Medline). The search was completed on 31st May 2021 (spanning January 2009–May 2021). At writing, a total of 1,320 articles met eligibility criteria and were included in the final review. For each RR, the evidence has been organised to review the knowledge area and identify gaps for further research and investment. The series of RRs (published separately within the current series) are designed to support the development of research and translation practice in the field of EDs. They highlight areas for investment and investigation, and provide researchers, service planners and providers, and research funders rapid access to quality current evidence, which has been synthesised and organised to assist decision-making.

Validation of the InnoWell Platform: Protocol for a Clinical Trial

Publisher: JMIR Publications Inc.

Date: 31-05-2019

DOI: 10.2196/13955

Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial

Publisher: Elsevier BV

Date: 04-2016

DOI: 10.1016/S2215-0366(15)00536-2

Gambling and the Role of Resilience in an International Online Sample of Current and Ex-serving Military Personnel as Compared to the General Population

Publisher: Springer Science and Business Media LLC

Date: 16-10-2019

DOI: 10.1007/S10899-019-09900-W

Abstract: Compared to the general population, military personnel are particularly vulnerable to developing gambling problems. The present study examined the presentation of gambling-including gambling frequency, personal thoughts on reducing gambling and recommendations from others to reduce gambling-across these populations. Additionally, the study measured the association between gambling and various psychosocial risk and protective factors-including psychological distress, suicidal ideation, external encouragement to reduce substance use, days out of role, personal wellbeing, resilience, social support and intimate bonds. Data was extracted from the Global Health & Wellbeing Survey, an online self-report survey conducted in Australia, Canada, New Zealand, the United Kingdom and the United States. Of the 10,765 eligible respondents, 394 were military veterans and 337 were active military personnel. Consistent with previous research, a higher proportion of gambling behaviours were observed in both current and ex-serving military s les, compared to the general population. To varying degrees, significant associations were found between the different gambling items and all psychosocial risk and protective factors in the general population s le. However, the military s le yielded only one significant association between gambling frequency and the protective factor 'resilience'. A post hoc stepwise linear regression analysis demonstrated the possible mediating role resilience plays between gambling frequency and other psychosocial risk (psychological distress, and suicidal thoughts and behaviour) and protective factors (personal wellbeing) for the military s le. Given the findings, it is recommended that routine screening tools identifying problem gambling are used within the military, and subsequent resilience focused interventions are offered to at risk personnel.

Somatic distress syndromes in later life: the need for paradigm change

Publisher: Cambridge University Press (CUP)

Date: 05-2001

DOI: 10.1017/S003329170100383X

Abstract: Somatic distress syndromes, which include somatoform disorders and syndromes of chronic fatigue such as neurasthenia but not somatic presentations of anxiety and depression, are one of the common expressions of distress in primary care (Ormel et al . 1994) and general hospital settings (Hemert et al . 1993). They are of considerable importance cross-culturally (Ono et al . 1999), and often lie at the interface of psychiatry and medicine (Hickie, 1999). They are associated with significant disability (Ormel et al . 1994 Andrews, 2000) and health-care utilization (Escobar et al . 1991).

A review of the legislative mechanisms available to protect the social participation rights of people with depression in the Asia Pacific region

Publisher: SAGE Publications

Date: 10-2004

DOI: 10.1080/J.1039-8562.2004.02102.X-2

Structural brain alterations in major depression: findings from the ENIGMA Major Depressive Disorder Working Group

Publisher: Elsevier BV

Date: 09-2015

DOI: 10.1016/S0924-977X(15)30517-4

Chronic fatigue syndrome Role of psychological factors overemphasised

Publisher: BMJ

Date: 14-05-1994

DOI: 10.1136/BMJ.308.6939.1297

Evaluation of the Usability and Acceptability of the InnoWell Platform as Rated by Older Adults: Survey Study

Publisher: JMIR Publications Inc.

Date: 21-04-2021

DOI: 10.2196/25928

Abstract: As the global population ages, there is increased interest in developing strategies to promote health and well-being in later life, thus enabling continued productivity, social engagement, and independence. As older adults use technologies with greater frequency, proficiency, and confidence, health information technologies (HITs) now hold considerable potential as a means to enable broader access to tools and services for the purposes of screening, treatment, monitoring, and ongoing maintenance of health for this group. The InnoWell Platform is a digital tool co-designed with lived experience to facilitate better outcomes by enabling access to a comprehensive multidimensional assessment, the results of which are provided in real time to enable consumers to make informed decisions about clinical and nonclinical care options independently or in collaboration with a health professional. This study aims to evaluate the usability and acceptability of a prototype of the InnoWell Platform, co-designed and configured with and for older adults, using self-report surveys. Participants were adults 50 years and older who were invited to engage with the InnoWell Platform naturalistically (ie, at their own discretion) for a period of 90 days. In addition, they completed short web-based surveys at baseline regarding their background, health, and mental well-being. After 90 days, participants were asked to complete the System Usability Scale to evaluate the usability and acceptability of the prototyped InnoWell Platform, with the aim of informing the iterative redesign and development of this digital tool before implementation within a health service setting. A total of 19 participants consented to participate in the study however, only the data from the 16 participants (mean age 62.8 years, SD 7.5 range 50-72) who completed at least part of the survey at 90 days were included in the analyses. Participants generally reported low levels of psychological distress and good mental well-being. In relation to the InnoWell Platform, the usability scores were suboptimal. Although the InnoWell Platform was noted to be easy to use, participants had difficulty identifying the relevance of the tool for their personal circumstances. Ease of use, the comprehensive nature of the assessment tools, and the ability to track progress over time were favored features of the InnoWell Platform, whereas the need for greater personalization and improved mobile functionality were cited as areas for improvement. HITs such as the InnoWell Platform have tremendous potential to improve access to cost-effective and low-intensity interventions at scale to improve and maintain mental health and well-being in later life. However, to promote adoption of and continued engagement with such tools, it is essential that these HITs are personalized and relevant for older adult end users, accounting for differences in background, clinical profiles, and levels of need.

The NEURAPRO Biomarker Analysis: Long-Chain Omega-3 Fatty Acids Improve 6-Month and 12-Month Outcomes in Youth at Ultra-High Risk for Psychosis

Publisher: Elsevier BV

Date: 2019

DOI: 10.2139/SSRN.3393730

Discovery of 95 PTSD loci provides insight into genetic architecture and neurobiology of trauma and stress-related disorders

Publisher: Cold Spring Harbor Laboratory

Date: 02-09-2023

DOI: 10.1101/2023.08.31.23294915

Measuring, Modeling, and Forecasting the Mental Wealth of Nations

Publisher: Frontiers Media SA

Date: 28-07-2022

DOI: 10.3389/FPUBH.2022.879183

Abstract: The COVID-19 pandemic has exposed the deep links and fragility of economic, health and social systems. Discussions of reconstruction include renewed interest in moving beyond GDP and recognizing “human capital”, “brain capital”, “mental capital”, and “wellbeing” as assets fundamental to economic reimagining, productivity, and prosperity. This paper describes how the conceptualization of Mental Wealth provides an important framing for measuring and shaping social and economic renewal to underpin healthy, productive, resilient, and thriving communities. We propose a transdisciplinary application of systems modeling to forecast a nation's Mental Wealth and understand the extent to which policy-mediated changes in economic, social, and health sectors could enhance collective mental health and wellbeing, social cohesion, and national prosperity. Specifically, simulation will allow comparison of the projected impacts of a range of cross-sector strategies (education sector, mental health system, labor market, and macroeconomic reforms) on GDP and national Mental Wealth, and provide decision support capability for future investments and actions to foster Mental Wealth. Finally, this paper introduces the Mental Wealth Initiative that is harnessing complex systems science to examine the interrelationships between social, commercial, and structural determinants of mental health and wellbeing, and working to empirically challenge the notion that fostering universal social prosperity is at odds with economic and commercial interests.

The Sleep Or Mood Novel Adjunctive therapy (SOMNA) trial: a study protocol for a randomised controlled trial evaluating an internet-delivered cognitive behavioural therapy program for insomnia on outc

Publisher: Springer Science and Business Media LLC

Date: 05-02-2015

DOI: 10.1186/S12888-015-0397-X

Lifetime prevalence and correlates of perinatal depression in a case-cohort study of depression

Publisher: BMJ

Date: 07-2022

DOI: 10.1136/BMJOPEN-2021-059300

Abstract: This study sought to evaluate the prevalence, timing of onset and duration of symptoms of depression in the perinatal period (PND) in women with depression, according to whether they had a history of depression prior to their first perinatal period. We further sought to identify biopsychosocial correlates of perinatal symptoms in women with depression. The Australian Genetics of Depression Study is an online case cohort study of the aetiology of depression. For a range of variables, women with depression who report significant perinatal depressive symptoms were compared with women with lifetime depression who did not experience perinatal symptoms. In a large s le of parous women with major depressive disorder (n=7182), we identified two subgroups of PND cases with and without prior depression history (n=2261 n=878, respectively). The primary outcome measure was a positive screen for PND on the lifetime version of the Edinburgh Postnatal Depression Scale. Descriptive measures reported lifetime prevalence, timing of onset and duration of PND symptoms. There were no secondary outcome measures. The prevalence of PND among parous women was 70%. The majority of women reported at least one perinatal episode with symptoms both antenatally and postnatally. Of women who experienced depression prior to first pregnancy, PND cases were significantly more likely to report more episodes of depression (OR=1.15 per additional depression episode, 95% CI 1.13 to 1.17, p .001), non-European ancestry (OR 1.5, 95% CI 1.0 to 2.1, p=0.03), severe nausea during pregnancy (OR 1.3, 95% CI 1.1 to 1.6, p=0.006) and emotional abuse (OR 1.4, 95% CI 1.1 to 1.7, p=0.005). The majority of parous women with lifetime depression in this study experienced PND, associated with more complex, severe depression. Results highlight the importance of perinatal assessments of depressive symptoms, particularly for women with a history of depression or childhood adverse experiences.

Structural brain correlates of obstructive sleep apnoea in older adults at risk for dementia

Publisher: European Respiratory Society (ERS)

Date: 07-2018

DOI: 10.1183/13993003.00740-2018

Abstract: This study aimed to investigate associations between obstructive sleep apnoea (OSA) and cortical thickness in older adults with subjective and objective cognitive difficulties, who are considered “at-risk” for dementia. 83 middle-aged to older adults (51–88 years) underwent neuropsychological testing, polysomnography assessment of OSA and a structural magnetic resonance imaging brain scan. A principal components analysis was performed on OSA measures. Cortical thickness and subcortical volumes were compared to extracted components of “oxygen desaturation” and “sleep disturbance”. Oxygen desaturation was significantly related to reduced cortical thickness in the bilateral temporal lobes (left: r=−0.44, p .001 right: r=−0.39, p=0.003). Conversely, sleep disturbance was associated with increased thickness in the right postcentral gyrus (r=0.48, p .001), pericalcarine (r=0.50, p=0.005) and pars opercularis (r=0.46, p=0.009) and increased volume of the hippoc us and amygdala. Decreased thickness in the bilateral temporal regions was associated with reduced verbal encoding (r=0.28, p=0.010). Given the clinical significance of this s le in terms of dementia prevention, these changes in grey matter reveal how OSA might contribute to neurodegenerative processes in older adults.

Recommendations for Designing Health Information Technologies for Mental Health Drawn From Self-Determination Theory and Co-design With Culturally Diverse Populations: Template Analysis

Publisher: JMIR Publications Inc.

Date: 10-02-2021

DOI: 10.2196/23502

Abstract: Culturally erse populations (including Aboriginal and Torres Strait Islander people, people of erse genders and sexualities, and culturally and linguistically erse people) in nonurban areas face compounded barriers to accessing mental health care. Health information technologies (HITs) show promising potential to overcome these barriers. This study aims to identify how best to improve a mental health and well-being HIT for culturally erse Australians in nonurban areas. We conducted 10 co-design workshops (N=105 participants) in primary youth mental health services across predominantly nonurban areas of Australia and conducted template analysis on the workshop outputs. Owing to local (including service) demographics, the workshop participants naturalistically reflected culturally erse groups. We identified 4 main themes: control, usability, affirmation, and health service delivery factors. The first 3 themes overlap with the 3 basic needs postulated by self-determination theory (autonomy, competence, and relatedness) and describe participant recommendations on how to design an HIT. The final theme includes barriers to adopting HITs for mental health care and how HITs can be used to support care coordination and delivery. Hence, it describes participant recommendations on how to use an HIT. Although culturally erse groups have specific concerns, their expressed needs fall broadly within the relatively universal design principles identified in this study. The findings of this study provide further support for applying self-determination theory to the design of HITs and reflect the tension in designing technologies for complex problems that overlap multiple medical, regulatory, and social domains, such as mental health care. Finally, we synthesize the identified themes into general recommendations for designing HITs for mental health and provide concrete ex les of design features recommended by participants.

The effect of 12-wk ω-3 fatty acid supplementation on in vivo thalamus glutathione concentration in patients at risk for major depression

Publisher: Elsevier BV

Date: 10-2015

DOI: 10.1016/J.NUT.2015.04.019

Abstract: As life expectancy increases, the need to prevent major health disorders is clear. Depressive symptoms are common in older adults and are associated with cognitive decline and greater risk for transitioning to major depression. Oxidative stress may be implicated in the pathophysiology of major depression and can be measured in vivo using proton magnetic resonance spectroscopy via the neurometabolite glutathione (GSH). Evidence suggests ω-3 fatty acid (FA) supplementation may prevent depression and directly affect GSH concentration. The aim of this study was to examine the effect of ω-3 FA supplementation on in vivo GSH concentration in older adults at risk for depression. Fifty-one older adults at risk for depression were randomized to receive either four 1000-mg ω-3 FA supplements daily (containing eicosapentaenoic acid 1200 mg plus docosahexaenoic acid 800 mg) or placebo (four 1000-mg paraffin oil placebo capsules daily) for 12 wk. Participants underwent magnetic resonance spectroscopy, as well as medical, neuropsychological, and self-report assessments at baseline and after 12 wk of supplementation. GSH was measured in the thalamus and calculated as a ratio to creatine. Depressive symptoms were measured using the Patient Health Questionnaire. Compared with the group given the ω-3 FA supplements, the placebo group had greater change in the GSH-to-creatine ratio in the thalamus (t = 2.00 P = 0.049) after the 12 wk intervention. This increase was in turn associated with a worsening of depressive symptoms (r = 0.43 P = 0.043). Depressive symptom severity in older adults appears to be associated with increased brain levels of GSH, a key marker of oxidative stress. Importantly, ω-3 FA supplementation may attenuate oxidative stress mechanisms, thereby offering benefits for depression prevention.

National mental health reform: less talk, more action

Publisher: AMPCo

Date: 03-2009

DOI: 10.5694/J.1326-5377.2009.TB02440.X

From Basic Science to Clinical Application of Polygenic Risk Scores

Publisher: American Medical Association (AMA)

Date: 2021

DOI: 10.1001/JAMAPSYCHIATRY.2020.3049

Abstract: Polygenic risk scores (PRS) are predictors of the genetic susceptibilities of in iduals to diseases. All in iduals have DNA risk variants for all common diseases, but genetic susceptibility differences between people reflect the cumulative burden of these. Polygenic risk scores for an in idual are calculated as weighted counts of thousands of risk variants that they carry, where the risk variants and their weights have been identified in genome-wide association studies. Here, we review the underlying basic science of PRS, providing a foundation for understanding the potential clinical utility and limitations of PRS. Polygenic risk scores can be calculated for a wide range of diseases from a saliva or blood s le using genotyping technologies that are inexpensive. While genotyping only needs to be done once for each in idual in their lifetime, the PRS can be recalculated as identification of risk variants improves. On their own, PRS will never be able to establish or definitively predict future diagnoses of common complex conditions because genetic factors only contribute part of the risk, and PRS will only ever capture part of the genetic contributions. Nonetheless, just as clinical medicine uses a multitude of other predictive measures, PRS either on their own or as part of multivariable predictive algorithms could play a role. Utility of PRS in clinical medicine and ethical issues related to their use should be evaluated in the context of realistic expectations of what PRS can and cannot deliver. For different diseases, PRS could have utility in community settings (stratification to better triage people into established screening programs) or could contribute to clinical decision-making for those presenting with symptoms but where formal diagnosis is unclear. In principle, PRS could contribute to treatment choices, but more data are needed to allow development of PRS in this context.

Does genotype mask the relationship between psychological factors and immune function?

Publisher: Elsevier BV

Date: 03-2005

DOI: 10.1016/J.BBI.2004.06.005

Abstract: This paper examined the interaction between genetic influences of the polymorphic human leukocyte antigens (DRB1 and DQB1) and psychological distress on the development of cellular immunity to the novel antigen, keyhole limpet hemocyanin (KLH). Participants (n = 227) were immunized with KLH and the development of cutaneous delayed-type hypersensitivity (DTH) against KLH was examined 3 weeks later. Distress was assessed using the Profile of Mood States. DNA was typed for the serologically defined DRB1 and DQB1 antigens. There was a significant correlation between distress at immunization and the development of DTH skin test responses to KLH (n = 214, r = .24, p = .003). HLA DQ2 was weakly associated with a decreased likelihood of developing a cutaneous delayed-type hypersensitivity response against KLH (odds ratio [OR] = 1.6 confidence interval [CI] 0.9-2.7). HLA DQ5 was weakly associated with an increased likelihood of responding to the antigen (OR=0.6 CI=0.3-1.0). The correlation between distress and immune function in HLA DQ2 negative in iduals was .34 (n = 136, p = .00) and in HLA DQ2 positive in iduals it was .06 (n = 74, p =. 64). For HLA DQ5 negative in iduals the correlation was .26 (n = 140, p = .00) and for HLA DQ5 positive in iduals it was .22 (n = 70, p = .07). These results suggest that the distress/immune relationship in genetically susceptible or protected in iduals may be underestimated in psychoneuroimmunology research.

Two Sides of the Same Coin: Cannabis Dependence and Mental Health Problems in Help-Seeking Adolescent and Young Adult Outpatients

Publisher: Springer Science and Business Media LLC

Date: 28-03-2012

DOI: 10.1007/S11469-012-9378-1

Could Polygenic Risk Scores Be Useful in Psychiatry?

Publisher: American Medical Association (AMA)

Date: 02-2021

DOI: 10.1001/JAMAPSYCHIATRY.2020.3042

Abstract: Polygenic risk scores (PRS) are predictors of the genetic susceptibility to diseases, calculated for in iduals as weighted counts of thousands of risk variants in which the risk variants and their weights have been identified in genome-wide association studies. Polygenic risk scores show promise in aiding clinical decision-making in many areas of medical practice. This review evaluates the potential use of PRS in psychiatry. On their own, PRS will never be able to establish or definitively predict a diagnosis of common complex conditions (eg, mental health disorders), because genetic factors only contribute part of the risk and PRS will only ever capture part of the genetic contribution. Combining PRS with other risk factors has potential to improve outcome prediction and aid clinical decision-making (eg, determining follow-up options for in iduals seeking help who are at clinical risk of future illness). Prognostication of adverse physical health outcomes or response to treatment in clinical populations are of great interest for psychiatric practice, but data from larger s les are needed to develop and evaluate PRS. Polygenic risk scores will contribute to risk assessment in clinical psychiatry as it evolves to combine information from molecular, clinical, and lifestyle metrics. The genome-wide genotype data needed to calculate PRS are inexpensive to generate and could become available to psychiatrists as a by-product of practices in other medical specialties. The utility of PRS in clinical psychiatry, as well as ethical issues associated with their use, should be evaluated in the context of realistic expectations of what PRS can and cannot deliver. Clinical psychiatry has lagged behind other fields of health care in its use of new technologies and routine clinical data for research. Now is the time to catch up.

Comparison of Self-Reported Telephone Interviewing and Web-Based Survey Responses: Findings From the Second Australian Young and Well National Survey

Publisher: JMIR Publications Inc.

Date: 26-09-2017

DOI: 10.2196/MENTAL.8222

Abstract: Web-based self-report surveying has increased in popularity, as it can rapidly yield large s les at a low cost. Despite this increase in popularity, in the area of youth mental health, there is a distinct lack of research comparing the results of Web-based self-report surveys with the more traditional and widely accepted computer-assisted telephone interviewing (CATI). The Second Australian Young and Well National Survey 2014 sought to compare differences in respondent response patterns using matched items on CATI versus a Web-based self-report survey. The aim of this study was to examine whether responses varied as a result of item sensitivity, that is, the item’s susceptibility to exaggeration on underreporting and to assess whether certain subgroups demonstrated this effect to a greater extent. A subs le of young people aged 16 to 25 years (N=101), recruited through the Second Australian Young and Well National Survey 2014, completed the identical items on two occasions: via CATI and via Web-based self-report survey. Respondents also rated perceived item sensitivity. When comparing CATI with the Web-based self-report survey, a Wilcoxon signed-rank analysis showed that respondents answered 14 of the 42 matched items in a significantly different way. Significant variation in responses (CATI vs Web-based) was more frequent if the item was also rated by the respondents as highly sensitive in nature. Specifically, 63% (5/8) of the high sensitivity items, 43% (3/7) of the neutral sensitivity items, and 0% (0/4) of the low sensitivity items were answered in a significantly different manner by respondents when comparing their matched CATI and Web-based question responses. The items that were perceived as highly sensitive by respondents and demonstrated response variability included the following: sexting activities, body image concerns, experience of diagnosis, and suicidal ideation. For high sensitivity items, a regression analysis showed respondents who were male (beta=−.19, P=.048) or who were not in employment, education, or training (NEET beta=−.32, P=.001) were significantly more likely to provide different responses on matched items when responding in the CATI as compared with the Web-based self-report survey. The Web-based self-report survey, however, demonstrated some evidence of avidity and attrition bias. Compared with CATI, Web-based self-report surveys are highly cost-effective and had higher rates of self-disclosure on sensitive items, particularly for respondents who identify as male and NEET. A drawback to Web-based surveying methodologies, however, includes the limited control over avidity bias and the greater incidence of attrition bias. These findings have important implications for further development of survey methods in the area of health and well-being, especially when considering research topics (in this case diagnosis, suicidal ideation, sexting, and body image) and groups that are being recruited (young people, males, and NEET).

Association of anterior cingulate glutathione with sleep apnea in older adults at-risk for dementia

Publisher: Oxford University Press (OUP)

Date: 04-2016

DOI: 10.5665/SLEEP.5650

The Ultra-High-Risk for psychosis groups: Evidence to maintain the status quo

Publisher: Elsevier BV

Date: 05-2018

DOI: 10.1016/J.SCHRES.2017.09.003

Abstract: In iduals are considered Ultra-High-Risk (UHR) for psychosis if they meet a set of standardised criteria including presumed genetic vulnerability (Trait), or a recent history of Attenuated Psychotic Symptoms (APS) or Brief Limited Intermittent Psychotic Symptoms (BLIPS). Recent calls to revise these criteria have arisen from evidence that Trait, APS and BLIPS groups may transition to psychosis at different rates. Concurrently, it has become clear that the UHR status confers clinical risk beyond transition to psychosis. Specifically, most UHR in iduals will not develop psychosis, but will experience high rates of non-psychotic disorders, persistent APS and poor long-term functional outcomes. Rather than focus on transition, the present study investigated whether UHR groups differ in their broader clinical risk profile by examining baseline clinical characteristics and long-term outcomes other than transition to psychosis. Four UHR groups were defined: Trait-only, APS-only, Trait+APS, and any BLIPS. Participants (N=702) were recruited upon entry to early intervention services and followed-up over a period of up to 13years (mean=4.53, SD=3.84). The groups evidenced similar symptom severity (SANS for negative symptoms, BPRS for positive and depression/anxiety symptoms) and psychosocial functioning (SOFAS, GAF, QLS) at baseline and follow-up as well as similar prevalence of non-psychotic disorders at follow-up. Our findings demonstrate that UHR groups evidence a similar clinical risk profile when we expand this beyond transition to psychosis, and consequently support maintaining the existing UHR criteria.

Australia's Better Access initiative: still awaiting serious evaluation?

Publisher: SAGE Publications

Date: 10-2011

DOI: 10.3109/00048674.2011.610744

A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies

Publisher: JMIR Publications Inc.

Date: 05-08-2011

DOI: 10.2196/JMIR.1772

Responding to the Australian experience of depression

Publisher: Wiley

Date: 05-2002

DOI: 10.5694/J.1326-5377.2002.TB04505.X

Unemployment and underemployment are causes of suicide

Publisher: American Association for the Advancement of Science (AAAS)

Date: 12-07-2023

DOI: 10.1126/SCIADV.ADG3758

Abstract: Epidemiological studies indicate that labor underutilization and suicide are associated, yet it remains unclear whether this association is causal. We applied convergent cross mapping to test for causal effects of unemployment and underemployment on suicidal behavior, using monthly data on labor underutilization and suicide rates in Australia for the period 2004–2016. Our analyses provide evidence that rates of unemployment and underemployment were significant drivers of suicide mortality in Australia over the 13-year study period. Predictive modeling indicates that 19.9% of the ~32,000 suicides reported between 2004 and 2016 resulted directly from labor underutilization, including 3295 suicides attributable to unemployment and 3131 suicides attributable to underemployment. We conclude that economic policies prioritizing full employment should be considered integral to any comprehensive national suicide prevention strategy.

Ambulatory sleep-wake patterns and variability in young people with emerging mental disorders

Publisher: CMA Joule Inc.

Date: 2015

DOI: 10.1503/JPN.130247

An approach to managing depression in general practice

Publisher: AMPCo

Date: 07-2000

DOI: 10.5694/J.1326-5377.2000.TB139255.X

Abstract: Detection of depression in primary care can be enhanced by use of self-report assessment forms. With the new classes of antidepressants, there is the opportunity to choose specific drug classes for different types of depressive disorders. Depression is frequently a relapsing illness. Treatment goals should include long term reduction of vulnerability factors. An active therapeutic partnership can be facilitated by providing accurate detailed information early in the course of the illness. Behavioural therapies, which focus on modification of the sleep-wake cycle, activity planning and reduction of substance abuse, are essential. Structured problem solving is the most accessible form of cognitive intervention that general practitioners can readily provide. More complex cognitive therapies are usually provided by mental health professionals or general practitioners with extensive training.

Time to implement national mental health reform

Publisher: AMPCo

Date: 06-2015

DOI: 10.5694/MJA15.00490

Reduced Heart Rate Variability in Social Anxiety Disorder: Associations with Gender and Symptom Severity

Publisher: Public Library of Science (PLoS)

Date: 30-07-2013

DOI: 10.1371/JOURNAL.PONE.0070468

More age-care staff report helping care recipients following a brief depression awareness raising intervention

Publisher: Springer Science and Business Media LLC

Date: 05-04-2013

DOI: 10.1186/1472-6955-12-10

Increasing general practitioner skills with patients with serious mental illness

Publisher: CSIRO Publishing

Date: 1997

DOI: 10.1071/AH970055A

Abstract: This report describes a clinical training program designed to increase generalpractitioner involvement with a public mental health service. The program involvedone half-day clinical session per week and one two-hour formal training seminar permonth, over a six-month period. Prior to training, participants demonstrated major clinical and theoretical skill deficits when assessing patients with serious mental illnesses. While specific knowledge of psychiatry increased by the end of the training program, little change in clinical interview skills was evident. Current initiatives toenhance general practitioner involvement in mental health care may be h ered if these skill deficits are not directly addressed in relevant shared care programs.

Cytokine levels and associations with symptom severity in male and female children with autism spectrum disorder

Publisher: Springer Science and Business Media LLC

Date: 12-2017

DOI: 10.1186/S13229-017-0176-2

Making better choices about mental health investment: The case for urgent reform of Australia's Better Access Program

Publisher: SAGE Publications

Date: 31-07-2019

DOI: 10.1177/0004867419865335

Abstract: To explore the impact of proposed expansion of Australia’s Better Access Program and alternatives. Australia’s Better Access Program, which costs taxpayers AUD28 million every week, is once again the focus of national political and professional scrutiny. The current Medicare Review calls for a massive expansion. This article reviews its history and context. It challenges the recommendations made by the Review. It also provides three scenarios which model the proposed expansion, with significant implications for consumers, the workforce and taxpayers. The capacity for continued growth of the Program is demonstrated. At the same time. There has been recent evidence suggesting the impact of the programme on key mental health indicators in Australia has been negligible, while also perpetuating social, economic and geographic inequities. While advocacy for increased mental health expenditure is easy, active reform of existing patterns of service is hard. Nonetheless, this article suggests that it is timely to reconsider the structure and scale of this AUD1.5 billion annual investment, which has the potential to grow to up to AUD10 billion per year over the next decade. In our view, it is possible to make the programme fit for purpose in the 21st century. Specifically, the principal focus could be shifted to better support the interdisciplinary, team-based care that responds to the needs of people with more complex mental health problems. An increased role for incorporation of digital technologies alongside clinical services is part of the mix. The combination of changes suggested would suggest that the programme could be rebranded as ‘Better Access and Quality’. This shift in the primary focus of the clinical programme away from brief interventions for those with lower needs to more sustained interventions with those with greater impairment requires new service models, as well as new regionally based health care systems. In addition, we propose specific outcomes that can be measured regionally, and collated nationally, to properly evaluate the impact of the programme and drive systemic quality improvement.

Modified CBT for social anxiety and social functioning in young adults with autism spectrum disorder

Publisher: Springer Science and Business Media LLC

Date: 08-02-2021

DOI: 10.1186/S13229-021-00418-W

Abstract: There is a strong research imperative to investigate effective treatment options for adolescents and adults with autism spectrum disorder (ASD). Elevated social anxiety, difficulties with social functioning and poor mental health have all been identified as core treatment targets for this group. While theoretical models posit a strong bidirectionality between social anxiety and ASD social functioning deficits, few interventions have targeted both domains concurrently. Of the two group interventions previously conducted with adolescents and adults with ASD, significant results have only been observed in either social anxiety or social functioning, and have not generalised to changes in overall mood. The aim of this study was to evaluate the potential benefit, tolerability and acceptability of a group cognitive-behaviour therapy (CBT) intervention in young adults with ASD. Primary treatment outcomes were social anxiety symptoms and social functioning difficulties secondary outcomes were self-reported mood and overall distress. Ten groups of participants completed an eight-week, modified group CBT intervention targeting both social anxiety and social functioning, that included social skills training, exposure tasks and behavioural experiment components. Seventy-eight adolescents and young adults with ASD, without intellectual impairment, aged between 16 and 38 ( M = 22.77 SD = 5.31), were recruited from the community, Headspace centres and the Autism Clinic for Translational Research at the Brain and Mind Centre, University of Sydney. Outcomes (social anxiety, social functioning and mood) were measured pre- and post-intervention via self-report questionnaires (administered either online or through the return of hard-copy booklets), and participants were invited to provide anonymous feedback on the intervention (at the mid-point and end of the intervention). Participants demonstrated statistically significant improvements on all outcome measures in response to the intervention. Specifically, social anxiety symptoms decreased ( p .001), and specific subdomains of social functioning improved post-intervention, particularly in social motivation ( p = .032) and restricted interests and repetitive behaviours ( p = .025). Self-reported symptom improvements also generalised to mood (depression, anxiety and stress p .05). All improvements demonstrated small effect sizes. Participant feedback was positive and indicated strong satisfaction with the program. The absence of a control group and follow-up measures, reliance on self-report instruments as outcome measures and the exclusion of those with intellectual disability represent significant limitations to this study. These findings indicate that a group CBT intervention appears to be a beneficial intervention for self-reported social anxiety, social functioning and overall mental health in adolescents and young adults with ASD. The stand-alone nature of the intervention combined with positive participant feedback indicates it was well tolerated, has potential clinical utility and warrants further study in a randomised-controlled, follow-up design.

Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies

Publisher: JMIR Publications Inc.

Date: 08-02-2020

DOI: 10.2196/15914

Abstract: Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). This study involved the utilization of a research and development (R& D) cycle including 4 iterative phases: co-design workshops knowledge translation tailoring to language, culture, and place (or context) and one-on-one user-testing sessions. A total of 2 co-design workshops were held with 18 users—young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions—young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup chat geolocation and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. The application of an R& D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R& D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C—a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.

Polygenic Risk Scores Derived from Varying Definitions of Depression and Risk of Depression

Publisher: American Medical Association (AMA)

Date: 10-2021

DOI: 10.1001/JAMAPSYCHIATRY.2021.1988

Outcomes focused service delivery: developing an academic-management partnership

Publisher: SAGE Publications

Date: 06-1998

DOI: 10.3109/00048679809065524

Abstract: Objective: Current mental health policies emphasise the need for services to be integrated and to develop outcomes-based evaluation systems. An overview of the challenges faced by service managers and clinical academics who develop the appropriate financial, personnel and academic infrastructure for these tasks is presented. Method: By drawing on experiences within the St George Service and references to other services, we propose a model for a successful partnership between the academic and management components of a district service. Results: Major logistic impediments to the development of a partnership are identified, although the long-term scientific and service delivery benefits are highlighted. Key areas within both academic practice and managerial approaches requiring transformation are discussed. Conclusions: A successful long-term partnership between management and an academic department within a district service may provide the opportunity for rapid progress in population-based service evaluation and health outcomes research.

Basic symptoms in young people at ultra-high risk of psychosis: Association with clinical characteristics and outcomes

Publisher: Elsevier BV

Date: 02-2020

DOI: 10.1016/J.SCHRES.2019.11.047

Abstract: There has been limited research into the predictive value of basic symptoms and their relationship with other psychopathology in patients identified using the 'ultra high risk' (UHR) for psychosis approach. The current study investigated whether basic symptoms, specifically cognitive disturbances (COGDIS), were associated with a greater risk of transition to psychotic disorder and persistent attenuated psychotic symptoms (APS) at medium term follow-up (mean = 3.4 years) in UHR patients, as well as with general psychopathology at baseline. The s le included 304 UHR participants (mean age = 19.12 years) involved in an international multicenter trial of omega-3 fatty acids. UHR in iduals who also met the COGDIS criteria (basic symptoms risk criteria) did not have a greater risk of transition than those who met the UHR criteria alone. However, meeting COGDIS risk criteria was associated with a greater likelihood of meeting the UHR attenuated psychotic symptoms risk group (i.e., having persistent attenuated psychotic symptoms) at 12-month follow-up (odds ratio = 1.85 95% CI = 1.03, 3.32). Greater severity of cognitive basic symptoms was also independently associated with more severe general psychopathology at study entry. The findings do not support the notion that combined risk identification approaches (UHR and basic symptoms) aid in the identification of in iduals at greatest risk of psychosis, although this interpretation is limited by the modest transition to psychosis rate (13%) and the time of follow up. However, the findings indicate that basic symptoms may be a clinically useful marker of more severe general psychopathology in UHR groups and risk for persistent attenuated psychotic symptoms.

INTERPERSONAL SENSITIVITY AND THE ONE-YEAR OUTCOME OF A DEPRESSIVE EPISODE

Publisher: SAGE Publications

Date: 06-1992

DOI: 10.3109/00048679209072022

Abstract: Previous studies have demonstrated that abnormalities of personality can contribute to a poor prognosis following a depressive episode. In this study the relevance of a specific personality trait, interpersonal sensitivity, to poor outcome was examined. One hundred and eleven depressives completed the Interpersonal Sensitivity Measure (IPSM) twenty weeks after a baseline assessment. High scores on the IPSM were associated with a poor outcome at one year following the baseline assessment, judged according to whether they had remitted clinically or not and by the degree of change in depression severity measured using the Hamilton and Zung Depression Rating Scales. The relevance of this personality trait to the course and treatment of depression is discussed.

Comorbid chronic pain and depression: shared risk factors and differential antidepressant effectiveness

Publisher: Frontiers Media SA

Date: 12-04-2021

DOI: 10.3389/FPSYT.2021.643609

Abstract: The bidirectional relationship between depression and chronic pain is well-recognized, but their clinical management remains challenging. Here we characterize the shared risk factors and outcomes for their comorbidity in the Australian Genetics of Depression cohort study ( N = 13,839). Participants completed online questionnaires about chronic pain, psychiatric symptoms, comorbidities, treatment response and general health. Logistic regression models were used to examine the relationship between chronic pain and clinical and demographic factors. Cumulative linked logistic regressions assessed the effect of chronic pain on treatment response for 10 different antidepressants. Chronic pain was associated with an increased risk of depression (OR = 1.86 [1.37–2.54]), recent suicide attempt (OR = 1.88 [1.14–3.09]), higher use of tobacco (OR = 1.05 [1.02–1.09]) and misuse of painkillers (e.g., opioids OR = 1.31 [1.06–1.62]). Participants with comorbid chronic pain and depression reported fewer functional benefits from antidepressant use and lower benefits from sertraline (OR = 0.75 [0.68–0.83]), escitalopram (OR = 0.75 [0.67–0.85]) and venlafaxine (OR = 0.78 [0.68–0.88]) when compared to participants without chronic pain. Furthermore, participants taking sertraline (OR = 0.45 [0.30–0.67]), escitalopram (OR = 0.45 [0.27–0.74]) and citalopram (OR = 0.32 [0.15–0.67]) specifically for chronic pain (among other indications) reported lower benefits compared to other participants taking these same medications but not for chronic pain. These findings reveal novel insights into the complex relationship between chronic pain and depression. Treatment response analyses indicate differential effectiveness between particular antidepressants and poorer functional outcomes for these comorbid conditions. Further examination is warranted in targeted interventional clinical trials, which also include neuroimaging genetics and pharmacogenomics protocols. This work will advance the delineation of disease risk indicators and novel aetiological pathways for therapeutic intervention in comorbid pain and depression as well as other psychiatric comorbidities.

The prognostic significance of attenuated psychotic symptoms in help-seeking youth

Publisher: Elsevier BV

Date: 2020

DOI: 10.1016/J.SCHRES.2019.10.016

Abstract: Recent findings suggest that attenuated psychotic symptoms (APS) might serve as a risk factor for general mental health impairment in help-seeking youth. The current study was designed to test this possibility by examining the prognostic significance of APS in a large cohort of help-seeking youth not selected for psychosis risk. 465 youth aged 12-25 referred to general youth mental health services were grouped as either APS + or APS- based on whether or not they met 'ultra high risk' for psychosis APS risk criteria as assessed using the Comprehensive Assessment of At Risk Mental States (CAARMS). They completed clinical assessments at baseline and at 12-month follow-up, measuring a range of psychopathology (depression, anxiety, eating disorders, general psychological distress, substance abuse) and psychosocial functioning. APS + had significantly poorer outcomes at 12-months on a range of clinical variables, even after adjusting for baseline scores and amount of treatment received. However, the APS + group showed greater improvement in functioning at follow-up compared to APS-. Attenuated psychotic symptoms are a prognostic indicator of persistent transdiagnostic mental health problems and reduced response to treatment in help-seeking youth over the short term. Hence, it is critical to screen and assess attenuated psychotic symptoms at the primary and secondary mental health services level, especially given that these subclinical symptoms are rarely voluntarily reported.

The Genetic and Environmental Contributions to Internet Use and Associations with Psychopathology: A Twin Study

Publisher: Cambridge University Press (CUP)

Date: 23-12-2016

DOI: 10.1017/THG.2015.91

Abstract: Excessive internet use has been linked to psychopathology. Therefore, understanding the genetic and environmental risks underpinning internet use and their relation to psychopathology is important. This study aims to explore the genetic and environmental etiology of internet use measures and their associations with internalizing disorders and substance use disorders. The s le included 2,059 monozygotic (MZ) and dizygotic (DZ) young adult twins from the Brisbane Longitudinal Twin Study (BLTS). Younger participants reported more frequent internet use, while women were more likely to use the internet for interpersonal communication. Familial aggregation in ‘frequency of internet use’ was entirely explained by additive genetic factors accounting for 41% of the variance. Familial aggregation in ‘frequency of use after 11 pm’, ‘using the internet to contact peers’, and ‘using the internet primarily to access social networking sites’ was attributable to varying combinations of additive genetic and shared environmental factors. In terms of psychopathology, there were no significant associations between internet use measures and major depression (MD), but there were positive significant associations between ‘frequency of internet use’ and ‘frequency of use after 11 pm’ with social phobia (SP). ‘Using the internet to contact peers’ was positively associated with alcohol abuse, whereas ‘using the internet to contact peers’ and ‘using the internet primarily to access social networking sites’ were negatively associated with cannabis use disorders and nicotine symptoms. In idual differences in internet use can be attributable to varying degrees of genetic and environmental risks. Despite some significant associations of small effect, variation in internet use appears mostly unrelated to psychopathology.

Effects of adjunctive brexpiprazole on sleep-wake and circadian parameters in youth with depressive disorders: study protocol for a clinical trial

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.

NEURAPRO‐E study protocol: a multicentre randomized controlled trial of omega‐3 fatty acids and cognitive‐behavioural case management for patients at ultra high risk of schizophrenia and other psychot

Publisher: Wiley

Date: 16-08-2015

DOI: 10.1111/EIP.12260

Abstract: Recent research has indicated that preventative intervention is likely to benefit patients 'at-risk' for psychosis, both in terms of symptom reduction and delay or prevention of onset of threshold psychotic disorder. The strong preliminary results for the effectiveness of omega-3 polyunsaturated fatty acids (PUFAs), coupled with the falling transition rate in ultra high-risk (UHR) s les, mean that further study of such benign, potentially neuroprotective interventions is clinically and ethically required. Employing a multicentre approach, enabling a large s le size, this study will provide important information with regard to the use of omega-3 PUFAs in the UHR group. This trial is a 6-month, double-blind, randomized placebo-controlled trial of 1.4 g day This is the protocol of the NeuraproE study. Utilizing a large s le, results from this study will be important in informing indicated prevention strategies for schizophrenia and other psychotic disorders, which may be the strongest avenue for reducing the burden, stigmatization, disability and economic consequences of these disorders.

Erratum to: A prospective cohort study of depression course, functional disability, and NEET status in help-seeking young adults

Publisher: Springer Science and Business Media LLC

Date: 07-02-2017

DOI: 10.1007/S00127-017-1336-6

No Alterations of Brain Structural Asymmetry in Major Depressive Disorder: An ENIGMA Consortium Analysis

Publisher: American Psychiatric Association Publishing

Date: 12-2019

DOI: 10.1176/APPI.AJP.2019.18101144

Abstract: Asymmetry is a subtle but pervasive aspect of the human brain, and it may be altered in several psychiatric conditions. MRI studies have shown subtle differences of brain anatomy between people with major depressive disorder and healthy control subjects, but few studies have specifically examined brain anatomical asymmetry in relation to this disorder, and results from those studies have remained inconclusive. At the functional level, some electroencephalography studies have indicated left fronto-cortical hypoactivity and right parietal hypoactivity in depressive disorders, so aspects of lateralized anatomy may also be affected. The authors used pooled in idual-level data from data sets collected around the world to investigate differences in laterality in measures of cortical thickness, cortical surface area, and subcortical volume between in iduals with major depression and healthy control subjects. The authors investigated differences in the laterality of thickness and surface area measures of 34 cerebral cortical regions in 2,256 in iduals with major depression and 3,504 control subjects from 31 separate data sets, and they investigated volume asymmetries of eight subcortical structures in 2,540 in iduals with major depression and 4,230 control subjects from 32 data sets. T The largest effect size (Cohen's d) of major depression diagnosis was 0.085 for the thickness asymmetry of the superior temporal cortex, which was not significant after adjustment for multiple testing. Asymmetry measures were not significantly associated with medication use, acute compared with remitted status, first episode compared with recurrent status, or age at onset. Altered brain macro-anatomical asymmetry may be of little relevance to major depression etiology in most cases.

The Brain and Mind Research Institute: A Unique Campus for the Integration of Clinical and Basic Neurosciences in Australia

Publisher: SAGE Publications

Date: 2008

DOI: 10.1080/10398560802005100

Abstract: Objective: The aim of this paper is to describe the conceptual and practical development of the Brain and Mind Research Institute (BMRI) at the University of Sydney. Method: The key conceptual framework of the BMRI is reviewed and contrasted with other biomedical institutes. The major timelines for appointment of key personnel, development of infrastructure and implementation of clinical capacities are presented. Results: The BMRI has developed over 15000 square metres of designated basic research and clinical space. This is thanks to major investments by the University of Sydney, the Australian and NSW governments and the wider community. Conclusion: Amelioration of the burden of disease due to disorders of the brain and mind may result from a conceptual and practical move away from the traditional emphasis on single disorders or narrow research platforms.

Validation of the InnoWell Platform: a clinical trial protocol (Preprint)

Publisher: JMIR Publications Inc.

Date: 07-03-2019

DOI: 10.2196/PREPRINTS.13955

Abstract: ew electronic health technologies are being rapidly developed to improve the delivery of mental health care for both health professionals and consumers as well as to better support self-management of care. he objective of this paper is to describe the research protocol for a naturalistic prospective clinical trial wherein all consumers presenting for care to a traditional face-to-face or online mental health service utilising the InnoWell Platform as part of their standard clinical care will be offered the opportunity to use the platform. he web-based platform is a configurable and customisable digital tool that assists in the assessment, monitoring and management of mental ill health and maintenance of wellbeing. It does this by collecting, storing, analysing, and reporting health information back to the person and their clinicians to enable transformation to person-centred care. The clinical trial will be conducted with in iduals aged two years and older presenting to participating services for care, including persons from the Veteran community, Aboriginal and Torres Strait Islander peoples, people from culturally and linguistically erse backgrounds, the LGBTI community, and those from broader education and workforce sectors as well as persons with disabilities, lived-experience of comorbidity, complex disorders, and/ or suicidality. roject Synergy was funded in June of 2017 and data collection began in November of 2018 in a youth mental health service. At the time of this publication, 4 additional services have also begun recruitment including 2 youth mental health services, a Veteran’s service and a national eating disorders tele-web service. The first results are expected to be submitted in mid-2019 for publication. his clinical trial will promote access to comprehensive, high-quality mental health care in order to improve outcomes for consumers and health professionals. The data collected will be used to validate a clinical staging algorithm designed to match consumers with the right level of care and to reduce the rate of suicidal thoughts and behaviours and suicide by suggesting pathways to care that are appropriate for the identified level of need while simultaneously enabling a timely service response. ustralian New Zealand Clinical Trial Registry ACTRN12618001676202

Comments on 'Cognitive remediation improves memory and psychosocial functioning in first-episode psychiatric out-patients': A reply

Publisher: Cambridge University Press (CUP)

Date: 31-10-2014

DOI: 10.1017/S0033291713002687

Hormonal Responses to Fenfluramine in Depressive Subtypes

Publisher: Royal College of Psychiatrists

Date: 10-1990

DOI: 10.1192/BJP.157.4.551

Abstract: In order to study putative differences in central neurotransmitter function in depressive subtypes, serum Cortisol and prolactin responses to the putative serotonin agonist fenfluramine were examined in 30 subjects with major depression. Patients with endogenous depression (melancholia) as defined by each of ICD–9, DSM–III, RDC and Newcastle scale demonstrated a reduced prolactin response to 60 mg oral fenfluramine when compared with non-endogenous subjects. This was independent of either prolactin or Cortisol baseline levels, and indicates that there are differences in brain neurotransmitter function in the endogenous and non-endogenous subtypes of depression. Basal prolactin levels were reduced in bipolar compared with unipolar subjects, and delusional compared with non-delusional patients, although there were no differences in the prolactin responses to fenfluramine between these subgroups. Basal Cortisol levels and Cortisol response to fenfluramine did not distinguish between any of the subtypes.

Australian mental health reform: Time for real outcomes

Publisher: AMPCo

Date: 04-2005

DOI: 10.5694/J.1326-5377.2005.TB06759.X

Abstract: After 12 years of national mental health reform, major service gaps and poor experiences of care are common. The mental health community reports little progress in implementing its key priorities, such as expanded early-intervention programs, comanagement of people with mental health problems and related alcohol or substance misuse, and widening of the spectrum of acute care settings. We propose new national targets for reducing the social and economic costs of poor mental health these include increased access to effective care, reduced suicide rates and improved rates of return to full social and economic participation. We detail specific service reforms designed to maximise the chance of achieving these targets, and prioritise youth health and integrated primary care programs. New independent and national reporting systems on the progress of mental health reform are urgently required.

General practitioners' response to depression and anxiety in the Australian community: A preliminary analysis

Publisher: AMPCo

Date: 10-2004

DOI: 10.5694/J.1326-5377.2004.TB06349.X

Moving beyond stepped care to staged care using a novel, technology-enabled care model for youth mental health

Publisher: AMPCo

Date: 11-2019

DOI: 10.5694/MJA2.50379

Diabetes, psychotic disorders and antipsychotic therapy: a consensus statement

Publisher: AMPCo

Date: 03-2005

DOI: 10.5694/J.1326-5377.2005.TB06713.X

Electroconvulsive therapy-induced persistent retrograde amnesia: Could it be minimised by ketamine or other pharmacological approaches?

Publisher: Elsevier BV

Date: 10-2010

DOI: 10.1016/J.JAD.2009.11.018

Abstract: Certain pharmacological agents administered during electroconvulsive therapy may have the potential to prevent persistent retrograde amnesia induced during electroconvulsive therapy. This review examines mechanisms for electroconvulsive therapy-induced retrograde amnesia, and evaluates the suitability of the anaesthetic ketamine for preventing this amnestic outcome. A review of human studies, animal models and theoretical models in light of memory dysfunction following electroconvulsive therapy was conducted. MEDLINE was searched from 1950 to April 2009 using the MeSH terms "electroconvulsive therapy", "memory", "memory short term", "memory disorders", "excitatory amino acid antagonists", and "ketamine". PREMEDLINE was searched using the terms "electroconvulsive therapy", "amnesia" and "ketamine". Additional keyword and reference list searches were performed. No language, date constraints or article type constraints were used. Disruption of long term potentiation as a mechanism for electroconvulsive therapy-induced retrograde amnesia is well supported. Based on this putative mechanism, an N-methyl-D-aspartate receptor antagonist would appear suitable for preventing the retrograde amnesia. Available evidence in animals and humans supports the prediction that ketamine, an anaesthetic agent and N-methyl-D-aspartate receptor antagonist, could effectively prevent electroconvulsive therapy-induced persistent retrograde amnesia. Whilst there are concerns about the use of ketamine with electroconvulsive therapy, such as possible psychotomimetic effects, on balance this anaesthetic agent may improve or hasten clinical response to electroconvulsive therapy. A clinical trial is warranted to determine if ketamine anaesthesia during electroconvulsive therapy can lessen persistent retrograde amnesia and improve therapeutic response. Electroconvulsive therapy with ketamine anaesthesia may provide effective antidepressant action with minimal side effects.

Lessons from a mood disorders unit

Publisher: SAGE Publications

Date: 06-1993

DOI: 10.1080/00048679309075774

Abstract: Specialist treatment centres, such as the Mood Disorders Unit (MDU) at Prince Henry Hospital, Sydney, have developed in response to the high prevalence of mood disorders and their frequent persistence and treatment resistance. The MDU's assessment and treatment of patients from state-wide catchment area and its teaching and research effectiveness are reviewed. Of 479 patients assessed between 1985 and 1989, there were 304 with primary depressive disorders, of whom 154 were followed up by clinical assessment at 52 weeks and 231 by telephone interview at 3 1/2 years. At intake, 59% were tertiary referral patients and 88% were from outside the local area. Two-thirds were recovered 3 1/2 years later, despite the disorders having been generally severe and protracted. Treatment modality was associated primarily with diagnosis, but also with age and somewhat with the patient's personality and consultant psychiatrists' preferences. No consistent predictors of outcome were discerned. Specialist tertiary referral centres, such as the MDU, contribute significantly to treatment success, especially of difficult cases, and enrich teaching and research.

O8.8. NEUROCOGNITION IN ULTRA-HIGHRISK INDIVIDUALS AND RELATIONSHIP TO TRANSITION TO PSYCHOSIS, DEPRESSIVE DISORDER, AND FUNCTIONING: FINDINGS FROM THE NEURAPRO TRIAL

Publisher: Oxford University Press (OUP)

Date: 04-2018

DOI: 10.1093/SCHBUL/SBY015.244

National health reform: it's time for a decision

Publisher: AMPCo

Date: 10-2009

DOI: 10.5694/J.1326-5377.2009.TB02844.X

Abstract: A national system financed and governed by the Australian Government would open up access to the widest range of health services.

Circadian profiles in young people during the early stages of affective disorder (vol 2, e123, 2012)

Publisher: Springer Science and Business Media LLC

Date: 15-01-2013

DOI: 10.1038/TP.2012.127

Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 14-02-2019

DOI: 10.2196/PREPRINTS.13717

Abstract: here is little research on the application of gamification to mental health and well-being. Furthermore, usage of gamification-related terminology is inconsistent. Current applications of gamification for health and well-being have also been critiqued for adopting a behaviorist approach that relies on positive reinforcement and extrinsic motivators. his study aimed to analyze current applications of gamification for mental health and well-being by answering 3 research questions (RQs). RQ1: which gamification elements are most commonly applied to apps and technologies for improving mental health and well-being? RQ2: which mental health and well-being domains are most commonly targeted by these gamified apps and technologies? RQ3: what reasons do researchers give for applying gamification to these apps and technologies? A systematic review of the literature was conducted to answer these questions. e searched ACM Digital Library, CINAHL, Cochrane Library, EMBASE, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying papers published between the years 2013 and 2018. To answer RQ1 and RQ2, papers were coded for gamification elements and mental health and well-being domains according to existing taxonomies in the game studies and medical literature. During the coding process, it was necessary to adapt our coding frame and revise these taxonomies. Thematic analysis was conducted to answer RQ3. he search and screening process identified 70 qualifying papers that collectively reported on 50 apps and technologies. The most commonly observed gamification elements were levels or progress feedback, points or scoring, rewards or prizes, narrative or theme, personalization, and customization the least commonly observed elements were artificial assistance, unlockable content, social cooperation, exploratory or open-world approach, artificial challenge, and randomness. The most commonly observed mental health and well-being domains were anxiety disorders and well-being, whereas the least commonly observed domains were conduct disorder and bipolar disorders. Researchers’ justification for applying gamification to improving mental health and well-being was coded in 59% (41/70) of the papers and was broadly ided into 2 themes: (1) promoting engagement and (2) enhancing an intervention’s intended effects. ur findings suggest that the current application of gamification to apps and technologies for improving mental health and well-being does not align with the trend of positive reinforcement critiqued in the greater health and well-being literature. We also observed overlap between the most commonly used gamification techniques and existing behavior change frameworks. Results also suggest that the application of gamification is not driven by health behavior change theory, and that many researchers may treat gamification as a black box without consideration for its underlying mechanisms. We call for the inclusion of more comprehensive and explicit descriptions of how gamification is applied and the standardization of applied games terminology within and across fields.

The neglect of somatoform disorders by old age psychiatry: Some explanations and suggestions for future research

Publisher: Wiley

Date: 2003

DOI: 10.1002/GPS.925

Abstract: The somatoform disorders have long been ignored by old age psychiatry. The main aim of this paper is to identify and examine possible reasons for this neglect. A selective review of the general literature on somatoform disorders. Significant conceptual, diagnostic and classificatory problems have impeded the consideration of somatoform disorders in older people. There is a perception that somatoform disorders are infrequent and have not been validated as independent clinical disorders. However, we present evidence that the more broadly defined somatoform disorders are common in all age groups in primary care and meet criteria for the determination of clinical validity. General difficulties in the assessment of psychiatric disorders in primary care, the setting in which somatoform disorders are most common, are compounded by a lack of support from old age psychiatry services. Effective psychological therapies may not be readily available to sufferers. There is a need for change in the conceptualisation and nosology of the somatoform disorders. The formulation of age appropriate diagnostic criteria and presentations is a prerequisite for determining the clinical validity of these disorders in older people. This can be followed by study of their frequency, associated risk factors and treatment. A system of education that enhances the management of these disorders within primary care and old age psychiatry services is needed.

T9. CROSS-SECTIONAL ASSOCIATION OF MEMBRANE FATTY ACID COMPOSITION AND PSYCHOPATHOLOGY IN THE NEURAPRO-E STUDY

Publisher: Oxford University Press (OUP)

Date: 04-2018

DOI: 10.1093/SCHBUL/SBY016.285

Pathways to depression by age 16 years: Examining trajectories for self-reported psychological and somatic phenotypes across adolescence

Publisher: Elsevier BV

Date: 04-2018

DOI: 10.1016/J.JAD.2017.12.007

Abstract: Sex differences in rates of depression emerge during adolescence. However, it is unclear whether symptom patterns and trajectories differ significantly according to gender in youth. Barriers to research include the fact that most self-report tools are weighted towards psychological rather than somatic symptoms. Data were collected on symptoms of depression in about 1800 in iduals at ages 12, 14 and 16 years. Odds ratios and 95% confidence intervals were used to examine the trajectory of psychological and somatic phenotypes and self-reported depression caseness over time. At age 12, 24% of participants met criteria for self-reported depression caseness. Although there was only a small incremental increase in the prevalence over time (about 5%), 57% of participants met criteria for self-reported depression caseness at least once. Generic symptoms at age 12 were associated with depression longitudinally, although early transition to caseness was reported in females only. Categorization as a psychological phenotype at age 12 predicted depression at age 14 and/or 16 years, especially in females. The somatic phenotype was more common in males, but showed a weaker association with self-reported depression caseness over time. Depression was assessed by self-report only 30% of participants had ratings for age 12, 14 and 16. Although sub-threshold psychological and somatic syndromes often co-occur in cases of self-reported depression in adolescence, longitudinally they may represent independent symptom trajectories. However, it is important to remember that self-reported depression is indicative of, but not confirmation of a depressive episode that meets diagnostic criteria.

Heritable DNA methylation marks associated with susceptibility to breast cancer

Publisher: Springer Science and Business Media LLC

Date: 28-02-2018

DOI: 10.1038/S41467-018-03058-6

Abstract: Mendelian-like inheritance of germline DNA methylation in cancer susceptibility genes has been previously reported. We aimed to scan the genome for heritable methylation marks associated with breast cancer susceptibility by studying 25 Australian multiple-case breast cancer families. Here we report genome-wide DNA methylation measured in 210 peripheral blood DNA s les provided by family members using the Infinium HumanMethylation450. We develop and apply a new statistical method to identify heritable methylation marks based on complex segregation analysis. We estimate carrier probabilities for the 1000 most heritable methylation marks based on family structure, and we use Cox proportional hazards survival analysis to identify 24 methylation marks with corresponding carrier probabilities significantly associated with breast cancer. We replicate an association with breast cancer risk for four of the 24 marks using an independent nested case–control study. Here, we report a novel approach for identifying heritable DNA methylation marks associated with breast cancer risk.

Distinct Loci in the CHRNA5/CHRNA3/CHRNB4 Gene Cluster Are Associated With Onset of Regular Smoking

Publisher: Wiley

Date: 11-2013

DOI: 10.1002/GEPI.21760

Evaluation of the Usability and Acceptability of the InnoWell Platform as Rated by Older Adults: Survey Study (Preprint)

Publisher: JMIR Publications Inc.

Date: 20-11-2020

DOI: 10.2196/PREPRINTS.25928

Abstract: s the global population ages, there is increased interest in developing strategies to promote health and well-being in later life, thus enabling continued productivity, social engagement, and independence. As older adults use technologies with greater frequency, proficiency, and confidence, health information technologies (HITs) now hold considerable potential as a means to enable broader access to tools and services for the purposes of screening, treatment, monitoring, and ongoing maintenance of health for this group. The InnoWell Platform is a digital tool co-designed with lived experience to facilitate better outcomes by enabling access to a comprehensive multidimensional assessment, the results of which are provided in real time to enable consumers to make informed decisions about clinical and nonclinical care options independently or in collaboration with a health professional. his study aims to evaluate the usability and acceptability of a prototype of the InnoWell Platform, co-designed and configured with and for older adults, using self-report surveys. articipants were adults 50 years and older who were invited to engage with the InnoWell Platform naturalistically (ie, at their own discretion) for a period of 90 days. In addition, they completed short web-based surveys at baseline regarding their background, health, and mental well-being. After 90 days, participants were asked to complete the System Usability Scale to evaluate the usability and acceptability of the prototyped InnoWell Platform, with the aim of informing the iterative redesign and development of this digital tool before implementation within a health service setting. total of 19 participants consented to participate in the study however, only the data from the 16 participants (mean age 62.8 years, SD 7.5 range 50-72) who completed at least part of the survey at 90 days were included in the analyses. Participants generally reported low levels of psychological distress and good mental well-being. In relation to the InnoWell Platform, the usability scores were suboptimal. Although the InnoWell Platform was noted to be easy to use, participants had difficulty identifying the relevance of the tool for their personal circumstances. Ease of use, the comprehensive nature of the assessment tools, and the ability to track progress over time were favored features of the InnoWell Platform, whereas the need for greater personalization and improved mobile functionality were cited as areas for improvement. ITs such as the InnoWell Platform have tremendous potential to improve access to cost-effective and low-intensity interventions at scale to improve and maintain mental health and well-being in later life. However, to promote adoption of and continued engagement with such tools, it is essential that these HITs are personalized and relevant for older adult end users, accounting for differences in background, clinical profiles, and levels of need.

Circadian rhythm and sleep alterations in older people with lifetime depression: A case-control study

Publisher: Springer Science and Business Media LLC

Date: 29-04-2020

DOI: 10.1186/S12888-020-02606-Z

Abstract: Depression is common in older people and is associated with underlying brain change increasing the risk of dementia. Sleep disturbance is frequently reported by those with lifetime depression, however whether circadian misalignment also exists is unclear. We aimed to examine circadian rhythms and sleep associations in older patients with and without lifetime depression. Thirty-four older people meeting DSM-IV criteria for lifetime major depression (mean age = 63.9 years), and 30 healthy controls (mean age = 65.7 years) were recruited. Participants underwent 2-weeks of actigraphy followed by a 3-night protocol including dim light melatonin onset (DLMO) assessment and overnight polysomnography (PSG) for sleep architecture. DLMO and phase angle of entrainment were computed. Compared to controls, participants with depression had a significantly longer phase angle of entrainment (6.82 h ± 1.45 vs. 5.87 h ± 1.60, p = 0.02, Cohens-d = 0.62). A small to moderate yet non-significant difference in DLMO times, with earlier DLMO (34 ± 27 min) observed in depression (20:36 ± 1:48 vs. 21:10 ± 1:48, p = 0.22, Cohens-d = 0.32). In iduals with depression had longer sleep latency and latency to rapid eye movement sleep than controls (all p 0.05). Circadian advancement and alterations to the timing of sleep and REM onset are evident in older people with lifetime major depression, despite having only mild residual symptoms. Further research examining the prognostic significance of these changes is warranted as well as chronotherapeutic treatment studies.

Improved prediction of chronological age from DNA methylation limits it as a biomarker of ageing

Publisher: Cold Spring Harbor Laboratory

Date: 23-05-2018

DOI: 10.1101/327890

Abstract: DNA methylation is associated with age. The deviation of age predicted from DNA methylation from actual age has been proposed as a biomarker for ageing. However, a better prediction of chronological age implies less opportunity for biological age. Here we used 13,661 s les (from blood and saliva) in the age range of 2 to 104 years from 14 cohorts measured on Illumina HumanMethylation450/EPIC arrays to perform prediction analyses. We show that increasing the s le size achieves a smaller prediction error and higher correlations in test datasets. We demonstrate that smaller prediction errors provide a limit to how much variation in biological ageing can be captured by methylation and provide evidence that age predictors from small s les are prone to confounding by cell composition. Our predictor shows a similar or better performance in non-blood tissues including saliva, endometrium, breast, liver, adipose and muscle, compared with Horvath’s across-tissue age predictor.

Guidelines for youth depression: time to incorporate new perspectives

Publisher: AMPCo

Date: 11-2010

DOI: 10.5694/J.1326-5377.2010.TB04053.X

The genetics of the mood disorder spectrum: genome-wide association analyses of over 185,000 cases and 439,000 controls

Publisher: Cold Spring Harbor Laboratory

Date: 03-08-2018

DOI: 10.1101/383331

Abstract: Mood disorders (including major depressive disorder and bipolar disorder) affect 10-20% of the population. They range from brief, mild episodes to severe, incapacitating conditions that markedly impact lives. Despite their diagnostic distinction, multiple approaches have shown considerable sharing of risk factors across the mood disorders. To clarify their shared molecular genetic basis, and to highlight disorder-specific associations, we meta-analysed data from the latest Psychiatric Genomics Consortium (PGC) genome-wide association studies of major depression (including data from 23andMe) and bipolar disorder, and an additional major depressive disorder cohort from UK Biobank (total: 185,285 cases, 439,741 controls non-overlapping N = 609,424). Seventy-three loci reached genome-wide significance in the meta-analysis, including 15 that are novel for mood disorders. More genome-wide significant loci from the PGC analysis of major depression than bipolar disorder reached genome-wide significance. Genetic correlations revealed that type 2 bipolar disorder correlates strongly with recurrent and single episode major depressive disorder. Systems biology analyses highlight both similarities and differences between the mood disorders, particularly in the mouse brain cell types implicated by the expression patterns of associated genes. The mood disorders also differ in their genetic correlation with educational attainment – positive in bipolar disorder but negative in major depressive disorder. The mood disorders share several genetic associations, and can be combined effectively to increase variant discovery. However, we demonstrate several differences between these disorders. Analysing subtypes of major depressive disorder and bipolar disorder provides evidence for a genetic mood disorders spectrum.

Developing neurocognitive standard clinical care: A study of young adult inpatients

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.

Recommendations for Designing Health Information Technologies for Mental Health Drawn From Self-Determination Theory and Co-design With Culturally Diverse Populations: Template Analysis

Publisher: JMIR Publications Inc.

Date: 14-08-2021

DOI: 10.2196/PREPRINTS.23502

Abstract: ulturally erse populations (including Aboriginal and Torres Strait Islander people, people of erse genders and sexualities, and culturally and linguistically erse people) in nonurban areas face compounded barriers to accessing mental health care. Health information technologies (HITs) show promising potential to overcome these barriers. his study aims to identify how best to improve a mental health and well-being HIT for culturally erse Australians in nonurban areas. e conducted 10 co-design workshops (N=105 participants) in primary youth mental health services across predominantly nonurban areas of Australia and conducted template analysis on the workshop outputs. Owing to local (including service) demographics, the workshop participants naturalistically reflected culturally erse groups. e identified 4 main themes: control, usability, affirmation, and health service delivery factors. The first 3 themes overlap with the 3 basic needs postulated by self-determination theory (autonomy, competence, and relatedness) and describe participant recommendations on how to i design /i an HIT. The final theme includes barriers to adopting HITs for mental health care and how HITs can be used to support care coordination and delivery. Hence, it describes participant recommendations on how to i use /i an HIT. lthough culturally erse groups have specific concerns, their expressed needs fall broadly within the relatively universal design principles identified in this study. The findings of this study provide further support for applying self-determination theory to the design of HITs and reflect the tension in designing technologies for complex problems that overlap multiple medical, regulatory, and social domains, such as mental health care. Finally, we synthesize the identified themes into general recommendations for designing HITs for mental health and provide concrete ex les of design features recommended by participants. >

Efficacy and Effectiveness of Universal School-Based Wellbeing Interventions in Australia: A Systematic Review

Publisher: MDPI AG

Date: 02-08-2023

DOI: 10.3390/IJERPH20156508

Autism, Early Psychosis, and Social Anxiety Disorder: a transdiagnostic examination of executive function cognitive circuitry and contribution to disability

Publisher: Springer Science and Business Media LLC

Date: 24-09-2018

DOI: 10.1038/S41398-018-0193-8

Abstract: The disability burden in clinical cohorts with social impairment is significant, leading to poor functional outcomes. Some of this impairment has been linked to executive dysfunction. In this study, a transdiagnostic approach was taken to identify executive function (EF) processes in young adults that may underpin social impairment and to evaluate their contribution to disability. Comparisons were made between three prominent disorders that are characterized by social impairments, Autism Spectrum Disorder (ASD), Early Psychosis (EP) and Social Anxiety Disorder (SAD), as well as a neurotypically developing group (TYP). We examined whether overall disability could be predicted by neuropsychological and self-report assessments of EF. Our study showed that ASD participants demonstrated impaired performance on most domains of EF compared to the TYP group (mental flexibility, sustained attention and fluency) while the EP group showed impairment on sustained attention and attentional shifting. The SAD participants showed EF impairment on self-report ratings, even though their objective performance was intact. Self-reports of EF explained a significant percentage (17%) of disability in addition to the variance explained by other predictors, and this was particularly important for ASD. This is the first study to compare EF measures across clinical groups of social impairment and suggests unique cognitive-circuitry that underpins disability within groups. Impairments in EF were broad in ASD and predicted disability, EP impairments were specific to attentional processes and SAD impairments likely relate to negative self-monitoring. Self-report, as opposed to performance-based EF, provided best capacity to predict disability. These findings contribute to transdiagnostic circuitry models and intervention strategies.

Production of pro-inflammatory cytokines correlates with the symptoms of acute sickness behaviour in humans

Publisher: Cambridge University Press (CUP)

Date: 10-2004

DOI: 10.1017/S0033291704001953

Abstract: Background. Elaboration of the concept of cytokine-induced sickness behaviour in recent years has opened new avenues for understanding brain involvement in sickness and recovery processes. Additionally, this has led to much speculation about the role of the immune system in neuropsychiatric syndromes, including depression and chronic fatigue. However, few studies have examined this phenomenon as it naturally occurs in sick humans, and none has attempted to document the quantitative relationships between cytokine levels and non-specific symptoms. The aim of this research was to examine human sickness behaviour and its immunological correlates in documented Epstein–Barr virus (EBV), Q fever or Ross River virus (RRV) infections. Method. We studied two separate s les. The first consisted of 21 patients with acute Q fever. The second included 48 patients with acute RRV or EBV infection. Psychological and somatic symptom profiles were derived from self-report measures completed at enrolment. Quantification of pro-inflammatory cytokines [interleukin (IL)-1β and IL-6] in sera and supernatants of peripheral blood mononuclear cell (PBMC) cultures was undertaken by specific ELISAs. Results. Levels of IL-1β and IL-6 spontaneously released from PBMC cultures were consistently correlated with reported manifestations of acute sickness behaviour including fever, malaise, pain, fatigue, mood and poor concentration. Conclusions. IL-1β and IL-6 produced as part of the host response represent sensitive markers of sickness behaviour in humans with acute infection. Further work is needed to systematically characterize the spectrum and natural history of sickness behaviour in humans and to elucidate its biological basis.

Distress, quality of life and disability in treatment-seeking young adults with social anxiety disorder

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.

Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies (Preprint)

Publisher: JMIR Publications Inc.

Date: 09-2019

DOI: 10.2196/PREPRINTS.15914

Abstract: ealth information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. sing participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). his study involved the utilization of a research and development (R& D) cycle including 4 iterative phases: co-design workshops knowledge translation tailoring to language, culture, and place (or context) and one-on-one user-testing sessions. total of 2 co-design workshops were held with 18 users—young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions—young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup chat geolocation and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. he application of an R& D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R& D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C—a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.

A Double-Blind Randomized Controlled Trial of Oxytocin Nasal Spray and Social Cognition Training for Young People with Early Psychosis

Publisher: Oxford University Press (OUP)

Date: 23-06-2015

DOI: 10.1093/SCHBUL/SBU094

Elderly care recipients’ perceptions of treatment helpfulness for depression and the relationship with help-seeking

Publisher: Informa UK Limited

Date: 2015

DOI: 10.2147/CIA.S70086

Paying the price - out-of-pocket payments for mental health care in Australia

Publisher: CSIRO Publishing

Date: 27-10-2022

DOI: 10.1071/AH22154

Abstract: Objective This study set out to present data on out-of-pocket payments for Medicare mental health services provided by general practitioners (GP), psychiatrists, clinical psychologists and other psychologists, to explore how much is spent on out-of-pocket payments for mental health if any trends could be seen and what variations exist across regions. Methods We performed secondary analysis of publicly available data on Medicare-subsidised GP, allied health and specialist health care across Australia. We merged and interrogated data covering the period 2013–19 and 2019–21 to create a data set covering eight full years of Medicare mental health services, arranged by profession and by region. Results Out-of-pocket payments for mental health care in Australia have been rising consistently over the period 2013–21, at a considerably faster rate than overall expenditure on mental health care. There is wide variation in out-of-pocket payments depending on where you live. Conclusions The impact of out-of-pocket payments on community access to mental health care is growing. This has implications, especially in poorer communities, for access to care. This should be an important consideration taken as the Australian Government considers next steps in national mental health reform, including the Better Access Program, currently under evaluation.

Effect of sertraline on symptoms and survival in patients with advanced cancer, but without major depression: a placebo-controlled double-blind randomised trial

Publisher: Elsevier BV

Date: 07-2007

DOI: 10.1016/S1470-2045(07)70148-1

Actigraphic and melatonin alignment in older adults with varying dementia risk

Publisher: Informa UK Limited

Date: 21-11-2023

DOI: 10.1080/07420528.2022.2144744

Abstract: Circadian rhythms alter with ageing and may be aetiologically linked to neurodegeneration. This study explored the association between clinical markers and 1) dim light melatonin onset (DLMO) time and 2) phase angle derived from sleep midpoint, in older adults with varying dementia risks. Participants completed 14 days of actigraphy followed by in-lab measurement of salivary melatonin, from which DLMO time and phase angle were computed. Eighty participants (age = 65.5, SD = 9.6), 44 males (55%), MMSE (28.6, SD = 1.5) were included in the analysis. Sex (t = 2.15, p = .04), sleep onset (r = 0.49, p < .001) and midpoint (r = 0.44, p < .001) also correlated with DLMO time. Multiple linear regression showed chronotype, average actigraphy-derived light exposure during the DLMO window (window 2 h prior to DLMO to 2 h post), early biological day (6-10 h post DLMO time) and late biological day (10-14 h post DLMO time) were predictive of DLMO time (adjusted R

Greater male than female variability in regional brain structure across the lifespan

Publisher: Wiley

Date: 12-10-2020

DOI: 10.1002/HBM.25204

Abstract: For many traits, males show greater variability than females, with possible implications for understanding sex differences in health and disease. Here, the ENIGMA (Enhancing Neuro Imaging Genetics through Meta‐Analysis) Consortium presents the largest‐ever mega‐analysis of sex differences in variability of brain structure, based on international data spanning nine decades of life. Subcortical volumes, cortical surface area and cortical thickness were assessed in MRI data of 16,683 healthy in iduals 1‐90 years old (47% females). We observed significant patterns of greater male than female between‐subject variance for all subcortical volumetric measures, all cortical surface area measures, and 60% of cortical thickness measures. This pattern was stable across the lifespan for 50% of the subcortical structures, 70% of the regional area measures, and nearly all regions for thickness. Our findings that these sex differences are present in childhood implicate early life genetic or gene‐environment interaction mechanisms. The findings highlight the importance of in idual differences within the sexes, that may underpin sex‐specific vulnerability to disorders.

Exploring the perspectives of people whose lives have been affected by depression

Publisher: Wiley

Date: 05-2002

DOI: 10.5694/J.1326-5377.2002.TB04507.X

Abstract: To describe the experiences of people whose lives have been affected by depression. Thematic review of data collected from 21 community meetings (1529 people, providing 911 evaluation forms) and nine focus groups (69 in iduals) held nationally, and written feedback and website-based interactions with beyondblue: the national depression initiative between April and December 2001. Barriers to social participation experienced by people whose lives have been affected by depression, and their interactions with the healthcare system. The key theme was the experience of stigma, which was evident in healthcare settings and in barriers to social participation, particularly regarding employment. Inadequacies of primary care and specialist treatment systems were highlighted. Particular emphasis was placed on limited access to high-quality primary care and non-pharmacological care. The stigmatising attitudes of many healthcare providers were notable. Within society, lack of access to knowledge and self-care or mutual support services was evident. Lack of support both from and for people in caring roles was also emphasised. People with depression are subject to many of the same attitudes, inadequate healthcare and social barriers reported by people with psychotic disorders. Consumers and carers prioritise certain notions of illness, recovery and quality of healthcare, and expect healthcare providers to respond to these concerns.

Project Synergy: co-designing technology-enabled solutions for Australian mental health services reform

Publisher: AMPCo

Date: 10-2019

DOI: 10.5694/MJA2.50349

Abstract: Project Synergy aims to test the potential of new and emerging technologies to enhance the quality of mental health care provided by traditional face-to-face services. Specifically, it seeks to ensure that consumers get the right care, first time (delivery of effective mental health care early in the course of illness). Using co-design with affected in iduals, Project Synergy has built, implemented and evaluated an online platform to assist the assessment, feedback, management and monitoring of people with mental disorders. It also promotes the maintenance of wellbeing by collating health and social information from consumers, their supportive others and health professionals. This information is reported back openly to consumers and their service providers to promote genuine collaborative care. The online platform does not provide stand-alone medical or health advice, risk assessment, clinical diagnosis or treatment instead, it supports users to decide what may be suitable care options. Using an iterative cycle of research and development, the first four studies of Project Synergy (2014-2016) involved the development of different types of online prototypes for young people (i) attending university (ii) in three disadvantaged communities in New South Wales (iii) at risk of suicide and (iv) attending five headspace centres. These contributed valuable information concerning the co-design, build, user testing and evaluation of prototypes, as well as staff experiences during development and service quality improvements following implementation. Through ongoing research and development (2017-2020), these prototypes underpin one online platform that aims to support better multidimensional mental health outcomes for consumers more efficient, effective and appropriate use of health professional knowledge and clinical skills and quality improvements in mental health service delivery.

A meta-analysis of neuropsychological functioning in first-episode bipolar disorders

Publisher: Elsevier BV

Date: 10-2014

DOI: 10.1016/J.JPSYCHIRES.2014.06.019

Abstract: Broad neuropsychological deficits have been consistently demonstrated in well-established bipolar disorder. The aim of the current study was to systematically review neuropsychological studies in first-episode bipolar disorders to determine the breadth, extent and predictors of cognitive dysfunction at this early stage of illness through meta-analytic procedures. Electronic databases were searched for studies published between January 1980 and December 2013. Twelve studies met eligibility criteria (N = 341, mean age = 28.2 years), and pooled effect sizes (ES) were calculated across eight cognitive domains. Moderator analyses were conducted to identify predictors of between-study heterogeneity. Controlling for known confounds, medium to large deficits (ES ≥ 0.5) in psychomotor speed, attention and working memory, and cognitive flexibility were identified, whereas smaller deficits (ES 0.20-0.49) were found in the domains of verbal learning and memory, attentional switching, and verbal fluency. A medium to large deficit in response inhibition was only detected in non-euthymic cases. Visual learning and memory functioning was not significantly worse in cases compared with controls. Overall, first-episode bipolar disorders are associated with widespread cognitive dysfunction. Since euthymia was not associated with superior cognitive performance in most domains, these results indicate that even in the earliest stages of disease, cognitive deficits are not mood-state dependent. The current findings have important implications for whether cognitive impairments represent neurodevelopmental or neurodegenerative processes. Future studies need to more clearly characterise the presence of psychotic features, and the nature and number of previous mood episodes.

Correction: Genome-wide gene-environment analyses of major depressive disorder and reported lifetime traumatic experiences in UK Biobank

Publisher: Springer Science and Business Media LLC

Date: 18-05-2020

DOI: 10.1038/S41380-020-0779-4

Genetic risk for chronic pain is associated with lower antidepressant effectiveness: converging evidence for a depression subtype

Publisher: SAGE Publications

Date: 16-07-2021

DOI: 10.1177/00048674211031491

Abstract: Chronic pain and depression are highly comorbid and difficult-to-treat disorders. We previously showed this comorbidity is associated with higher depression severity, lower antidepressant treatment effectiveness and poorer prognosis in the Australian Genetics of Depression Study. The current study aimed to assess whether a genetic liability to chronic pain is associated with antidepressant effectiveness over and above the effect of genetic factors for depression in a s le of 12,863 Australian Genetics of Depression Study participants. Polygenic risk scores were calculated using summary statistics from genome-wide association studies of multisite chronic pain and major depression. Cumulative linked regressions were employed to assess the association between polygenic risk scores and antidepressant treatment effectiveness across 10 different medications. Mixed-effects logistic regressions showed that in idual genetic propensity for chronic pain, but not major depression, was significantly associated with patient-reported chronic pain (Pain PRS OR = 1.17 [1.12, 1.22] MD PRS OR = 1.01 [0.98, 1.06]). Significant associations were also found between lower antidepressant effectiveness and genetic risk for chronic pain or for major depression. However, a fully adjusted model showed the effect of Pain PRS (adjOR = 0.93 [0.90, 0.96]) was independent of MD PRS (adjOR = 0.96 [0.93, 0.99]). Sensitivity analyses were performed to assess the robustness of these results. After adjusting for depression severity measures (i.e. age of onset number of depressive episodes interval between age at study participation and at depression onset), the associations between Pain PRS and patient-reported chronic pain with lower antidepressant effectiveness remained significant (0.95 [0.92, 0.98] and 0.84 [0.78, 0.90], respectively). These results suggest genetic risk for chronic pain accounted for poorer antidepressant effectiveness, independent of the genetic risk for major depression. Our results, along with independent converging evidence from other studies, point towards a difficult-to-treat depression subtype characterised by comorbid chronic pain. This finding warrants further investigation into the implications for biologically based nosology frameworks in pain medicine and psychiatry.

Evidence into practice: the mental health hurdle is high

Publisher: AMPCo

Date: 06-2006

DOI: 10.5694/J.1326-5377.2006.TB00375.X

Abstract: Guidelines for GPs need to tackle the tough issues.

In reply

Publisher: Wiley

Date: 09-2014

DOI: 10.5694/MJA14.00841

Positive Relationships Between Public Awareness Activity and Recognition of the Impacts of Depression in Australia

Publisher: SAGE Publications

Date: 2006

DOI: 10.1080/J.1440-1614.2006.01742.X

Abstract: Objective: This report records the level of exposure to depression-related information across the Australian community and explores associations with recognition of depression and relevant sociodemographic factors. Method: A cross-sectional telephone survey was conducted with a representative community s le. Participants consisted of 3200 respondents (400 respondents across each Australian State/Territory). Results: Sixty-five point four per cent (n=2089/3193) of respondents indicated that they or someone close to them had experienced depression, of whom 18.7% (n=391/2089) reported a personal experience of this illness. Various measures of recent exposure to depression-related information were high with 69.0% (n=2207/3200) reporting that they had seen, read or heard something in the media in the last 12 months. Recognition of beyondblue: the national depression initiativewas also surprisingly high (61.9%, 1982/3200). Those with greater understanding that depression is common and debilitating were more likely to recall recent media stories, spontaneously recall relevant organizations such as beyondblue, to have had direct or family experiences, to be younger and to have achieved higher levels of education. Depression, however, is rarely mentioned (1.3%, 47/3720) as a major general health as distinct from a mental health problem. Conclusion: The active promotion of depression-related material to the community appears to have contributed to recognition of the commonality and impacts of this illness. Although depression is commonly recognized as a mental health problem, it is not yet considered a major general health problem. Further, like many public health c aigns, those initially reached appear more likely to be female, younger, better educated and residing in metropolitan areas.

The role of new technologies in monitoring the evolution of psychopathology and providing measurement‐based care in young people

Publisher: Wiley

Date: 10-01-2020

DOI: 10.1002/WPS.20697

Sampling bias in an internet treatment trial for depression

Publisher: Springer Science and Business Media LLC

Date: 23-10-2012

DOI: 10.1038/TP.2012.100

A Mental Wealth perspective: crossing disciplines to understand the value of collective mental and social assets in the post-COVID-19 era

Publisher: Springer Science and Business Media LLC

Date: 12-12-2022

DOI: 10.1186/S13033-022-00568-1

Abstract: A reconceptualised global strategy is key as nations begin to shift from crisis management to medium- and long-term planning to rebuild and strengthen their economic, social and public health systems. Efforts towards measuring, modelling, and forecasting Mental Wealth could serve as the catalyst for this reconceptualization. The Mental Wealth approach builds systemic resilience through investments which promote collective cognitive and emotional wellbeing. This paper presents the theoretical foundations for Mental Wealth. It presents, for the first time, literature across the disciplines of health and social sciences, economics, business, and humanities to underpin the development of an operational metric of Mental Wealth. An approach which embeds social and psychological dimensions of prosperity, alongside the economic, is needed to inform the effective allocation of investments in the post-pandemic world. The authors advocate for a transdisciplinary framework of Mental Wealth to be applied in innovating population-level policy interventions to address the growing challenges brought on by COVID-19. Mental Wealth highlights the value generated by the deployment of collective mental assets and supporting social infrastructure. In order to inform this position, a review of the literature on the concepts underpinning Mental Wealth is presented, limitations of current measurement tools of mental and social resources are evaluated, and a framework for development of a Mental Wealth metric is proposed. There are challenges in developing an operational Mental Wealth metric. The breadth of conceptual foundations to be considered is extensive, and there may be a lack of agreement on the appropriate tools for its measurement. While variability across current measurement approaches in social resources, wellbeing and mental assets contributes to the difficulty creating a holistic and generic metric, these variations are now clearer. The operationalisation of the Mental Wealth metric will require comprehensive mapping of the elements to be included against the data available.

User Experience Co-Design of a Mobile Application to Support Childrearing in Low- and Middle-Income Countries

Publisher: IOS Press

Date: 22-06-2023

DOI: 10.3233/SHTI230377

Abstract: The widespread adoption of mobile phones and increasing mobile connectivity globally create opportunities to access remote and disadvantaged populations. Mobile health interventions in low- and middle-income countries have substantial reach and potential to promote the socio-emotional and cognitive development of children. This study presents co-design workshop findings relating to the user experience of a mobile application – Thrive by Five – which intends to promote healthy early childhood development globally, particularly in low- and middle-income countries. Here, findings from workshops conducted in 11 countries in Asia, Africa, and Oceania are presented. Key feedback on the mobile application user experience indicated several necessary changes, such as simplifying and localising the language, incorporating short videos or animations, adding more bright colours and illustrations, and making numerous improvements and additions to the app features and functionality. The findings contribute to advancing mobile health, context-sensitive technologies, user experience design, and low-resource setting technology co-design.

Is there an independent somatic symptom dimension in older people?

Publisher: Elsevier BV

Date: 08-2006

DOI: 10.1016/J.JPSYCHORES.2006.01.012

Abstract: In explaining the dimensions underlying nonpsychotic symptom reporting, traditional psychiatric paradigm has advocated a hierarchical model in which somatic symptoms are subsumed within two correlated psychological dimensions. A more recent alternate view is that somatic symptoms may be clearly separated from typical anxiety and depression symptoms if somatic symptoms are adequately recorded. The main aim of this study is to determine whether discrete somatic dimension(s) could be derived in older people. Exploratory factor analysis was used to determine the factor structure underlying the responses of 10662 ambulatory primary care patients, aged 60 years and over, who completed the 34-item SPHERE (Somatic and Psychological HEalth REport) questionnaire of somatic and psychological symptoms. In addition, weighted factor scores were compared according to whether there was a physical or psychological reason for presentation to a doctor. A clinically interpretable four-factor solution, consisting of mood, cognitive, musculoskeletal, and fatigue symptoms, was derived. When factor analysis was repeated by gender, the only difference was that mood, cognitive, and pain-fatigue factors were derived in males. In the overall s le, all factor scores were higher in patients with a purely psychological reason for presentation. Somatic symptoms could be measured independently of psychological symptoms in the current s le of older primary care patients.

Late-onset depressive disorders: a preventable variant of cerebrovascular disease?

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).

DEPRESSIVE TYPE AND STATE EFFECTS ON PERSONALITY MEASURES

Publisher: Wiley

Date: 02-1990

DOI: 10.1111/J.1600-0447.1990.TB06478.X

Abstract: We examine the hypothesis that the effect of mood state on personality questionnaire scores is more a function of diagnosis than of depression severity. Sixteen endogenous and 83 neurotic depressives completed a battery of personality questionnaires at a baseline assessment and again 20 weeks later. Scores on the personality measures changed significantly. Endogenous depressives were found to have more pronounced changes on measures of dependence and timidity, but when change in mood state was partialed out only one of the dependence measures and timidity remained significant. Thus the hypothesis only received partial support--change in mood state appears to be the major factor in elevating personality questionnaire scores.

Age and depression

Publisher: Elsevier BV

Date: 11-1991

DOI: 10.1016/0165-0327(91)90026-O

Abstract: The interaction of age and depression was investigated by comparing differences between elderly (greater than or equal to 60 years old) and younger consecutive in- and out-patient referrals to a tertiary referral mood disorders unit. Older patients with unipolar major depressive episode were more likely to be psychotic and agitated regardless of depressive subtype and less likely to have personality inadequacies or a family history of affective disorder. In this s le, elderly depressives' rating of diagnosis, severity, endogeneity and social impairment were similar, irrespective of age of first onset of depression, but a positive family history and personality abnormalities were less likely in late-onset depressives.

Circuits for social learning: A unified model and application to Autism Spectrum Disorder

Publisher: Elsevier BV

Date: 12-2019

DOI: 10.1016/J.NEUBIOREV.2019.09.034

Outcomes for frail very old patients in theICUare remarkably good

Publisher: AMPCo

Date: 16-09-2019

DOI: 10.5694/MJA2.50343

The “uberisation” of mental health care: a welcome global phenomenon?

Publisher: AMPCo

Date: 10-2019

DOI: 10.5694/MJA2.50342

Recognition and treatment of depression

Publisher: Springer Science and Business Media LLC

Date: 20-11-2009

DOI: 10.1007/S00127-008-0471-5

Abstract: Depression is a major public health problem in both China and Australia. To improve services, we need to ensure health professionals have an appropriate understanding of depression and its treatments. This study compares the level of awareness of depression between Chinese and Australian medical students. The International Depression Literacy Survey assessing the public health impact, recognition and treatment of depression was completed by pre-psychiatric training medical students in China (n = 220) and Australia (n = 177). Chinese students were far less likely to consider mental health conditions and depression as major public health problems (P < 0.001). Depression symptom recognition was similar with four of the top five symptoms of depression the same in both groups of students. Chinese students were more likely to consider some psychological symptoms such as "thinking life is not worth living", but less likely to consider somatic features such as "sleep disturbance" as typical for people with depression. Chinese students were more likely to claim that they would seek help from mental health professionals if experiencing depression whilst Australian students were more likely to seek help from a general or family doctor. Chinese medical students recognise depression similarly to Australian students but do not consider it a major public health problem. These results challenge the stereotype that depression is characterised by somatic symptoms in China. Increasing awareness of the public health impact of depression should be incorporated into the medical curriculum in China.

Practitioner-supported delivery of internet-based cognitive behaviour therapy: Evaluation of the feasibility of conducting a cluster randomised trial

Publisher: AMPCo

Date: 06-2010

DOI: 10.5694/J.1326-5377.2010.TB03690.X

Erratum: A Neuroethics Framework for the Australian Brain Initiative (Neuron (2019) 101(3) (365–369), (S0896627319300054), (10.1016/j.neuron.2019.01.004))

Publisher: Elsevier BV

Date: 2020

DOI: 10.1016/J.NEURON.2019.12.019

Perinatal depression is associated with a higher polygenic risk for major depressive disorder than non-perinatal depression

Publisher: Hindawi Limited

Date: 05-01-2022

DOI: 10.1002/DA.23232

Abstract: Distinctions between major depressive disorder (MDD) and perinatal depression (PND) reflect varying views of PND, from a unique etiological subtype of MDD to an MDD episode that happens to coincide with childbirth. This case-control study investigated genetic differences between PND and MDD outside the perinatal period (non-perinatal depression or NPD). We conducted a genome-wide association study using PND cases (Edinburgh Postnatal Depression Scale score ≥ 13) from the Australian Genetics of Depression Study 2018 data (n = 3804) and screened controls (n = 6134). Results of gene-set enrichment analysis were compared with those of women with non-PND. For six psychiatric disorders/traits, genetic correlations with PND were evaluated, and logistic regression analysis reported polygenic score (PGS) association with both PND and NPD. Genes differentially expressed in ovarian tissue were significantly enriched (stdBeta = 0.07, p = 3.3e-04), but were not found to be associated with NPD. The genetic correlation between PND and MDD was 0.93 (SE = 0.07 p = 3.5e-38). Compared with controls, PGS for MDD are higher for PND cases (odds ratio [OR] = 1.8, confidence interval [CI] = [1.7-1.8], p = 9.5e-140) than for NPD cases (OR = 1.6, CI = [1.5-1.7], p = 1.2e-49). Highest risk is for those reporting both antenatal and postnatal depression, irrespective of prior MDD history. PND has a high genetic overlap with MDD, but points of distinction focus on differential expression in ovarian tissue and higher MDD PGS, particularly for women experiencing both antenatal and postpartum PND.

Cancer-Related Fatigue in Women With Breast Cancer: Outcomes of a 5-Year Prospective Cohort Study

Publisher: American Society of Clinical Oncology (ASCO)

Date: 20-05-2012

DOI: 10.1200/JCO.2011.34.6148

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.

MMN/P3a deficits in first episode psychosis: Comparing schizophrenia-spectrum and affective-spectrum subgroups

Publisher: Elsevier BV

Date: 08-2011

DOI: 10.1016/J.SCHRES.2011.03.025

Abstract: Reduced mismatch negativity (MMN) and P3a litudes are neurophysiological biomarkers for schizophrenia that index deviance detection and the orienting response, respectively. First-episode psychosis (FEP) patients show reduced litudes of the 'MMN/P3a complex', but it is unclear whether this occurs across the FEP spectrum. Fifty-three young people (17-36 years) were assessed: 17 FEP affective-spectrum (bipolar disorder with psychotic features and major depressive disorder with psychotic features), 18 FEP schizophrenia-spectrum (schizophrenia, schizoaffective disorder, and schizophreniform disorder), and 18 healthy controls. MMN/P3a was acquired during a two-tone, auditory paradigm with 8% duration deviants. Clinical, psychosocial and neuropsychological assessments were also undertaken. FEP schizophrenia- and FEP affective-spectrum showed significantly reduced fronto-central MMN and central P3a litudes compared to controls. FEP subgroups also showed significantly poorer cognitive and psychosocial functioning. The combined FEP s le showed significant correlations between fronto-central MMN litudes and cognitive measures. FEP schizophrenia-spectrum and FEP affective-spectrum were similarly impaired in two biomarkers for schizophrenia. FEP subgroups showed impairments in fronto-central MMN consistent with chronic patients. Similarly, both subgroups showed reductions in P3a although the affective subgroup showed an 'intermediate' frontal response. These findings suggest that FEP patients with both affective and schizophrenia spectrum diagnoses share common neurobiological disturbances in deviance detection/orienting processes in the early phase of illness.

Delayed sleep onset in depressed young people

Publisher: Springer Science and Business Media LLC

Date: 08-02-2014

DOI: 10.1186/1471-244X-14-33

Variability and predictors of mental disorder rates and medical practitioner responses across Australian general practices

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.

Stakeholder perspectives on evidence for digital mental health interventions: Implications for accreditation systems

Publisher: SAGE Publications

Date: 2019

DOI: 10.1177/2055207619878069

Abstract: Digital mental health interventions can be effective for treating mental health problems, but uptake by consumers and clinicians is not optimal. The lack of an accreditation pathway for digital mental health interventions is a barrier to their uptake among clinicians and consumers. However, there are a number of factors that may contribute to whether a digital intervention is suitable for recommendation to the public. The aim of this study was to identify the types of evidence that would support the accreditation of digital interventions. An expert workshop was convened, including researcher, clinician, consumer (people with lived experience of a mental health condition) and policymaker representatives. Existing methods for assessing the evidence for digital mental health interventions were discussed by the stakeholders present at the workshop. Empirical evidence from randomised controlled trials was identified as a key component for evaluating digital interventions. However, information on the safety of users, data security, user ratings, and fidelity to clinical guidelines, along with data from routine care including adherence, engagement and clinical outcomes, were also identified as important considerations when evaluating an intervention. There are considerable challenges in weighing the evidence for a digital mental health intervention. Empirical evidence should be the cornerstone of any accreditation system to identify appropriate digital mental health interventions. However, robust accreditation systems should also account for program and user safety, user engagement and experience, and fidelity to clinical treatment guidelines.

Federal and State Cooperation Necessary but Not Sufficient for Effective Regional Mental Health Systems: Insights From Systems Modelling and Simulation

Publisher: Research Square Platform LLC

Date: 15-04-2021

DOI: 10.21203/RS.3.RS-409804/V1

Subcortical volumetric differences between clinical stages of young people with affective and psychotic disorders

Publisher: Elsevier BV

Date: 2018

DOI: 10.1016/J.PSCYCHRESNS.2017.11.015

Abstract: The aim of this study was to investigate differences in subcortical and hippoc al volumes between healthy controls, young people at an early stage of affective and psychotic disorders and those in more advanced stages, to identify markers associated with functional outcomes and illness severity. Young people presenting to youth mental health services with admixtures of depressive, manic and psychotic symptoms (n = 141), and healthy counterparts (n = 49), aged 18-25 were recruited. Participants underwent magnetic resonance imaging, clinical assessments and were rated as to their current clinical stage. Eighty-four patients were classified at the attenuated syndrome stage (Stage 1b) and 57 were classified as having discrete and persistent disorders (Stage 2+). Automated segmentation was performed using NeuroQuant® to determine volumes of subcortical and hippoc us structures which were compared between groups and correlated with clinical and functional outcomes. Compared to healthy controls, Stage 2+ patients showed significantly reduced right amygdala volumes. Whereas Stage 1b patients showed significantly reduced left caudate volumes compared to healthy controls. Smaller left caudate volume correlated with greater psychological distress and impaired functioning. This study shows a clinical application for an automated program to identify and track subcortical changes evident in young people with emerging psychopathology.

Australian and New Zealand clinical practice guidelines for the treatment of depression

Publisher: SAGE Publications

Date: 06-2004

DOI: 10.1080/J.1440-1614.2004.01377.X

Using accountability for mental health to drive reform summary

Publisher: AMPCo

Date: 10-2015

DOI: 10.5694/MJA15.00447

Abstract: Greatly enhanced accountability can drive mental health reform. As extant approaches are ineffective, we propose a new approach. Australia spends around $7.6 billion on mental health services annually, but is anybody getting better? Effective accountability for mental health can reduce variation in care and increase effective service provision. Despite 20 years of rhetoric, Australia's approach to accountability in mental health is overly focused on fulfilling governmental reporting requirements rather than using data to drive reform. The existing system is both fragmented and outcome blind. Australia has failed to develop useful local and regional approaches to benchmarking in mental health. New approaches must address this gap and better reflect the experience of care felt by consumers and carers, as well as by service providers. There are important social priorities in mental health that must be assessed. We provide a brief overview of the existing system and propose a new, modest but achievable set of indicators by which to monitor the progress of national mental health reform. These indicators should form part of a new, system-wide process of continuous quality improvement in mental health care and suicide prevention.

Federal and state cooperation necessary but not sufficient for effective regional mental health systems: insights from systems modelling and simulation

Publisher: Springer Science and Business Media LLC

Date: 27-05-2021

DOI: 10.1038/S41598-021-90762-X

Abstract: For more than a decade, suicide rates in Australia have shown no improvement despite significant investment in reforms to support regionally driven initiatives. Further recommended reforms by the Productivity Commission call for Federal and State and Territory Government funding for mental health to be pooled and new Regional Commissioning Authorities established to take responsibility for efficient and effective allocation of ‘taxpayer money.’ This study explores the sufficiency of this recommendation in preventing ongoing policy resistance. A system dynamics model of pathways between psychological distress, the mental health care system, suicidal behaviour and their drivers was developed, tested, and validated for a large, geographically erse region of New South Wales the Hunter New England and Central Coast Primary Health Network (PHN). Multi-objective optimisation was used to explore potential discordance in the best-performing programs and initiatives (simulated from 2021 to 2031) across mental health outcomes between the two state-governed Local Health Districts (LHDs) and the federally governed PHN. Impacts on suicide deaths, mental health-related emergency department presentations, and service disengagement were explored. A combination of family psychoeducation, post-attempt aftercare, and safety planning, and social connectedness programs minimises the number of suicides across the PHN and in the Hunter New England LHD (13.5% reduction 95% interval, 12.3–14.9%), and performs well in the Central Coast LHD (14.8% reduction, 13.5–16.3%), suggesting that aligned strategic decision making between the PHN and LHDs would deliver substantial impacts on suicide. Results also highlighted a marked trade-off between minimising suicide deaths versus minimising service disengagement. This is explained in part by the additional demand placed on services of intensive suicide prevention programs leading to increases in service disengagement as wait times for specialist community based mental health services and dissatisfaction with quality of care increases. Competing priorities between the PHN and LHDs (each seeking to optimise the different outcomes they are responsible for) can undermine the optimal impact of investments for suicide prevention. Systems modelling provides essential regional decision analysis infrastructure to facilitate coordinated federal and state investments for optimal impacts.

Fatigue as related to anxiety and depression in a community-based sample of twins aged over 50

Publisher: Springer Science and Business Media LLC

Date: 03-1999

DOI: 10.1007/S001270050116

Abstract: Measures of fatigue, anxiety and depression were administered in self-report questionnaire format to a community-based s le of 2703 Australian twins aged over 50. Factor analysis indicated that a two-factor solution was appropriate and demonstrated a clear separation between fatigue-related items and questionnaire items relating to anxiety and depression. Highly congruent factor structures were derived for male and female subjects.

Building a ‘National Coalition for People with Depression’

Publisher: SAGE Publications

Date: 06-2000

DOI: 10.1046/J.1440-1665.2000.00251.X

Sex-Dependent Shared and Nonshared Genetic Architecture Across Mood and Psychotic Disorders

Publisher: Elsevier BV

Date: 2022

DOI: 10.1016/J.BIOPSYCH.2021.02.972

In vivo imaging of oxidative stress and fronto-limbic white matter integrity in young adults with 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.

The role of rumination in illness trajectories in youth: Linking trans-diagnostic processes with clinical staging models

Publisher: Cambridge University Press (CUP)

Date: 29-06-2016

DOI: 10.1017/S0033291716001392

Abstract: Research in developmental psychopathology and clinical staging models has increasingly sought to identify trans-diagnostic biomarkers or neurocognitive deficits that may play a role in the onset and trajectory of mental disorders and could represent modifiable treatment targets. Less attention has been directed at the potential role of cognitive-emotional regulation processes such as ruminative response style. Maladaptive rumination (toxic brooding) is a known mediator of the association between gender and internalizing disorders in adolescents and is increased in in iduals with a history of early adversity. Furthermore, rumination shows moderate levels of genetic heritability and is linked to abnormalities in neural networks associated with emotional regulation and executive functioning. This review explores the potential role of rumination in exacerbating the symptoms of alcohol and substance misuse, and bipolar and psychotic disorders during the peak age range for illness onset. Evidence shows that rumination not only lifies levels of distress and suicidal ideation, but also extends physiological responses to stress, which may partly explain the high prevalence of physical and mental co-morbidity in youth presenting to mental health services. In summary, the normative developmental trajectory of rumination and its role in the evolution of mental disorders and physical illness demonstrates that rumination presents a detectable, modifiable trans-diagnostic risk factor in youth.

Head motion and Inattention/Hyperactivity share common genetic influences: Implications for fMRI studies of ADHD

Publisher: Public Library of Science (PLoS)

Date: 08-01-2016

DOI: 10.1371/JOURNAL.PONE.0146271

TAKING CHRONIC FATIGUE SYNDROME SERIOUSLY

Publisher: American Psychiatric Association Publishing

Date: 12-1992

DOI: 10.1176/AJP.149.12.1753A

Technology-Enabled Reform in a Nontraditional Mental Health Service for Eating Disorders: Participatory Design Study

Publisher: JMIR Publications Inc.

Date: 16-02-2021

DOI: 10.2196/19532

Abstract: The recent Australian National Agenda for Eating Disorders highlights the role technology can play in improving accessibility and service development through web-based prevention, early access pathways, self-help, and recovery assistance. However, engagement with the eating disorders community to co-design, build, and evaluate these much-needed technology solutions through participatory design processes has been lacking and, until recently, underresourced. This study aims to customize and configure a technology solution for a nontraditional (web-based, phone, email) mental health service that provides support for eating disorders and body image issues through the use of participatory design processes. Participants were recruited chiefly through the Butterfly National Helpline 1800 ED HOPE (Butterfly’s National Helpline), an Australian-wide helpline supporting anyone concerned by an eating disorder or body image issue. Participants included in iduals with lived experience of eating disorders and body image issues, their supportive others (such as family, health professionals, support workers), and staff of the Butterfly Foundation. Participants took part in participatory design workshops, running up to four hours, which were held nationally in urban and regional locations. The workshop agenda followed an established process of discovery, evaluation, and prototyping. Workshop activities included open and prompted discussion, reviewing working prototypes, creating descriptive artifacts, and developing user journeys. Workshop artifacts were used in a knowledge translation process, which identified key learnings to inform user journeys, user personas, and the customization and configuration of the InnoWell Platform for Butterfly’s National Helpline. Further, key themes were identified using thematic techniques and coded in NVivo 12 software. Six participatory design workshops were held, of which 45 participants took part. Participants highlighted that there is a critical need to address some of the barriers to care, particularly in regional and rural areas. The workshops highlighted seven overarching qualitative themes: identified barriers to care within the current system need for people to be able to access the right care anywhere, anytime recommendations for the technological solution (ie, InnoWell Platform features and functionality) need for communication, coordination, and integration of a technological solution embedded in Butterfly’s National Helpline need to consider engagement and tone within the technological solution identified challenges and areas to consider when implementing a technological solution in the Helpline and potential outcomes of the technological solution embedded in the Helpline relating to system and service reform. Ultimately, this technology solution should ensure that the right care is provided to in iduals the first time. Our findings highlight the value of actively engaging stakeholders in participatory design processes for the customization and configuration of new technologies. End users can highlight the critical areas of need, which can be used as a catalyst for reform through the implementation of these technologies in nontraditional services.

Social and occupational outcomes for young people who attend early intervention mental health services

Publisher: Wiley

Date: 17-02-2022

DOI: 10.5694/MJA2.51425

Participatory Methods for Systems Modeling of Youth Mental Health: Implementation Protocol

Publisher: JMIR Publications Inc.

Date: 07-02-2022

DOI: 10.2196/32988

Abstract: Despite significant investment, mental health issues remain a leading cause of death among young people globally. Sophisticated decision analysis methods are needed to better understand the dynamic and multisector drivers of youth mental health. System modeling can help explore complex issues such as youth mental health and inform strategies to effectively respond to local needs and achieve lasting improvements. The advantages of engaging stakeholders in model development processes have long been recognized however, the methods for doing so are often not well-described. This paper aims to describe the participatory procedures that will be used to support systems modeling for national multisite implementation. The Right Care, First Time, Where You Live research program will focus on regional youth mental health applications of systems modeling in 8 different sites across Australia. The participatory model development approach involves an iterative process of engaging with a range of participants, including people with lived experience of mental health issues. Their knowledge of the local systems, pathways, and drivers is combined with the academic literature and data to populate the models and validate their structure. The process centers around 3 workshops where participants interact and actively engage in group model-building activities to define, refine, and validate the systems models. This paper provides a detailed blueprint for the implementation of this process for mental health applications. The participatory modeling methods described in this paper will be implemented at 2 sites per year from 2022 to 2025. The 8 selected sites have been chosen to capture variations in important factors, including determinants of mental health issues and access to services. Site engagement commenced in August 2021, and the first modeling workshops are scheduled to commence in February 2022. Mental health system decision makers require tools to help navigate complex environments and leverage interdisciplinary problem-solving. Systems modeling can mobilize data from erse sources to explore a range of scenarios, including the impact of interventions in different combinations and contexts. Involving stakeholders in the model development process ensures that the model findings are context-relevant and fit-for-purpose to inform decision-making. PRR1-10.2196/32988

Real-time Mobile Monitoring of the Dynamic Associations Among Motor Activity, Energy, Mood, and Sleep in Adults With Bipolar Disorder

Publisher: American Medical Association (AMA)

Date: 02-2019

DOI: 10.1001/JAMAPSYCHIATRY.2018.3546

Emotion Recognition in Mild Cognitive Impairment: Relationship to Psychosocial Disability and Caregiver Burden

Publisher: SAGE Publications

Date: 10-06-2013

DOI: 10.1177/0891988713491832

Abstract: Impaired emotion recognition in dementia is associated with increased patient agitation, behavior management difficulties, and caregiver burden. Emerging evidence supports the presence of very early emotion recognition difficulties in mild cognitive impairment (MCI) however, the relationship between these impairments and psychosocial measures is not yet explored. Emotion recognition abilities of 27 patients with nonamnestic MCI (naMCI), 29 patients with amnestic MCI (aMCI), and 22 control participants were assessed. Self-report measures assessed patient functional disability, while informants rated the degree of burden they experienced. Difficulties in recognizing anger was evident in the amnestic subtype. Although both the patient groups reported greater social functioning disability, compared with the controls, a relationship between social dysfunction and anger recognition was evident only for patients with naMCI. A significant association was found between burden and anger recognition in patients with aMCI. Impaired emotion recognition abilities impact MCI subtypes differentially. Interventions targeted at patients with MCI, and caregivers are warranted.

Effect of oral appliance therapy on neurobehavioral functioning in obstructive sleep apnea: a randomized controlled trial.

Publisher: American Academy of Sleep Medicine (AASM)

Date: 15-10-2005

DOI: 10.5664/JCSM.26365

Childhood adversity impacts on brain subcortical structures relevant to depression

Publisher: Elsevier BV

Date: 03-2017

DOI: 10.1016/J.JPSYCHIRES.2016.11.010

Association between polygenic risk for tobacco or alcohol consumption and liability to licit and illicit substance use in young Australian adults

Publisher: Elsevier BV

Date: 04-2019

DOI: 10.1016/J.DRUGALCDEP.2019.01.015

Abstract: Co-morbid substance use is very common. Despite a historical focus using genetic epidemiology to investigate comorbid substance use and misuse, few studies have examined substance-substance associations using polygenic risk score (PRS) methods. Using summary statistics from the largest substance use GWAS to date (258,797- 632,802 subjects), GWAS and Sequencing Consortium of Alcohol and Nicotine use (GSCAN), we constructed PRSs for smoking initiation (PRS-SI), age of initiation of regular smoking (PRS-AI), cigarettes per day (PRS-CPD), smoking cessation (PRS-SC), and drinks per week (PRS-DPW). We then estimated the fixed effect of in idual PRSs on 22 lifetime substance use and substance use disorder phenotypes collected in an independent s le of 2463 young Australian adults using genetic restricted maximal likelihood (GREML) in Genome-wide Complex Trait Analysis (GCTA), separately in females, males and both sexes together. After accounting for multiple testing, PRS-SI significantly explained variation in the risk of cocaine (0.67%), hetamine (1.54%), hallucinogens (0.72%), ecstasy (1.66%) and cannabis initiation (0.97%), as well as DSM-5 alcohol use disorder (0.72%). PRS-DPW explained 0.75%, 0.59% and 0.90% of the variation of cocaine, hetamine and ecstasy initiation respectively. None of the 22 phenotypes including emergent classes of substance use were significantly predicted by PRS-AI, PRS-CPD, and PRS-SC. To our knowledge, this is the first study to report significant genetic overlap between the polygenic risks for smoking initiation and alcohol consumption and the risk of initiating major classes of illicit substances. PRSs constructed from large discovery GWASs allows the detection of novel genetic associations.

Clinical staging: a heuristic model for psychiatry and youth mental health

Publisher: AMPCo

Date: 10-2007

DOI: 10.5694/J.1326-5377.2007.TB01335.X

Abstract: Diagnosis in psychiatry continues to struggle to fulfil its key purposes, namely to guide treatment and to predict outcome. A clinical staging model, widely used in clinical medicine, could improve the utility of diagnosis in psychiatry, especially in young people with emerging disorders. Clinical staging has immediate potential to improve the logic and timing of interventions in psychiatry, as it does in many complex and potentially serious medical disorders. Interventions could be evaluated in terms of their ability to prevent or delay progression from earlier to later stages of a disorder, and selected by consumers and clinicians on the basis of clear-cut risk-benefit criteria. This would ensure that, as treatments are offered earlier, they remain safe, acceptable and affordable, and potentially more effective. Biological variables and a range of candidate risk and protective factors could be studied within and across stages, and their role, specificity and centrality in risk, onset and progression of disorders clarified. In this way, a clinicopathological framework could be progressively constructed. Clinical staging, with restructuring across and within diagnostic boundaries and explicit operational criteria for extent and progression of disorder, should be actively explored in psychiatry as a heuristic strategy for developing and evaluating earlier, safer, and more effective clinical interventions, and for clarifying the biological basis of psychiatric disorders. Young people with emerging mental and substance use disorders could be the main beneficiaries.

Fatigue and psychiatric disorder: different or the same?

Publisher: Cambridge University Press (CUP)

Date: 05-2995

DOI: 10.1017/S0033291799008697

Abstract: Background. Fatigue and psychiatric symptoms are common in the community, but their association and outcome are sparsely studied. Method. A total of 1177 patients were recruited from UK primary care on attending their general practitioner. Fatigue and psychiatric disorder was measured at three time points with the 12-item General Health Questionnaire and the 11-item Fatigue Questionnaire. Results. Total scores for fatigue and psychiatric disorder did not differ between the three time points and were closely correlated ( r around 0·6). The association between non-co-morbid (‘pure’) fatigue and developing psychiatric disorder 6 months later was the same as that for being well and subsequent psychiatric disorder. Similarly, having non-co-morbid psychiatric disorder did not predict having fatigue any more than being well 6 months previously. Between 13 and 15% suffered from non-co-morbid fatigue at each time point and 2·5% suffered from fatigue at two time points 6 months apart. Less than 1% of patients suffered from non-co-morbid fatigue at all three time points. Conclusions. The data are consistent with the existence of ‘pure’ independent fatigue state. However, this state is unstable and the majority (about three-quarters) of patients become well or a case of psychiatric disorder over 6 months. A persistent, independent fatigue state lasting for 6 months can be identified in the primary-care setting, but it is uncommon – of the order of 2·5%. Non-co-morbid (pure) fatigue did not predict subsequent psychiatric disorder.

SPHERE: A national depression project (multiple letters)

Publisher: AMPCo

Date: 02-2002

DOI: 10.5694/J.1326-5377.2002.TB04364.X

Sleep-wake, cognitive and clinical correlates of treatment outcome with repetitive transcranial magnetic stimulation for young adults with depression

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.

Determinants of well-being and their interconnections in Australian general practitioners: a qualitative study

Publisher: BMJ

Date: 07-2022

DOI: 10.1136/BMJOPEN-2021-058616

Abstract: The well-being of doctors is recognised as a major priority in healthcare, yet there is little research on how general practitioners (GPs) keep well. We aimed to address this gap by applying a positive psychology lens, and exploring what determines GPs’ well-being, as opposed to burnout and mental ill health, in Australia. Semi-structured qualitative interviews. From March to September 2021, we interviewed GPs working in numerous settings, using snowball and purposive s ling to expand recruitment across Australia. 20 GPs participated in idually via Zoom. A semi-structured interview-guide provided a framework to explore well-being from a personal, organisational and systemic perspective. Recordings were transcribed verbatim, and inductive thematic analysis was performed. Eleven female and nine male GPs with erse experience, from urban and rural settings were interviewed (mean 32 min). Determinants of well-being were underpinned by GPs’ sense of identity. This was strongly influenced by GPs seeing themselves as a distinct but often undervalued profession working in small organisations within a broader health system. Both personal finances, and funding structures emerged as important moderators of the interconnections between these themes. Enablers of well-being were mainly identified at a personal and practice level, whereas systemic determinants were consistently seen as barriers to well-being. A complex balancing act between all determinants of well-being was evidenced. GPs were able to identify targets for in idual and practice level interventions to improve well-being, many of which have not been evaluated. However, few systemic aspects were suggested as being able to promote well-being, but rather seen as barriers, limiting how to develop systemic interventions to enhance well-being. Finances need to be a major consideration to prioritise, promote and support GP well-being, and a sustainable primary care workforce.

Missing in action: the right to the highest attainable standard of mental health care

Publisher: Springer Science and Business Media LLC

Date: 11-06-2022

DOI: 10.1186/S13033-022-00537-8

Abstract: The right to the highest attainable standard of mental health remains a distant goal worldwide. The Report of the UN Special Rapporteur on the right of all people to enjoyment of the highest attainable standard of physical and mental health pleaded the urgent need for governments to act through appropriate laws and policies. We argue that Australia is in breach of international obligations, with inadequate access to mental health services, inconsistent mental health legislation across jurisdictions and ongoing structural (systematic) and in idual discrimination. Inadequate access to mental health services is a worldwide phenomenon. Australia has committed to international law obligations under the Convention on the Rights of Persons with Disabilities (CRPD) to ‘promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disability, with respect to their inherent dignity’. This includes people with mental health impairment and this convention includes the right to ‘the highest attainable standard of mental health’. Under the Australian Constitution, ratification of this convention enables the national government to pass laws to implement the convention obligations, and such national laws would prevail over any inconsistent state (or territory) laws governing mental health service provision. The authors argue that enabling positive rights through legislation and legally binding mental health service standards may facilitate enhanced accountability and enforcement of such rights. These steps may support critical key stakeholders to improve the standards of mental health service provision supported by the implementation of international obligations, thereby accelerating mental health system reform. Improved legislation would encourage better governance and the evolution of better services, making mental health care more accessible, without structural or in idual discrimination, enabling all people to enjoy the highest attainable standard of health.

Social and occupational outcomes for young people who attend early intervention mental health services: a longitudinal study

Publisher: Wiley

Date: 17-07-2022

DOI: 10.5694/MJA2.51653

Sleep disturbance relates to neuropsychological functioning in late-life depression

Publisher: Elsevier BV

Date: 07-2011

DOI: 10.1016/J.JAD.2011.02.027

Abstract: Sleep-wake disturbance in older people is a risk factor for depression onset and recurrence. The aim of this study was to determine if objective sleep-wake disturbance in late-life depression relates to neuropsychological functioning. Forty-four older patients with a lifetime history of major depression and 22 control participants underwent psychiatric, medical and neuropsychological assessments. Participants completed self-report sleep measures, sleep diaries and wore wrist actigraphy for two weeks. Outcome measures included sleep latency, the number and duration of nocturnal awakenings and the overall sleep efficiency. Patients with depression had a greater duration of nocturnal awakenings and poorer sleep efficiency, in comparison to control participants. Sleep disturbance in patients was associated with greater depression severity and later ages of depression onset. It also related to poorer psychomotor speed, poorer verbal and visual learning, poorer semantic fluency as well as poorer performance on tests of executive functioning. These relationships largely remained significant after controlling for depression and estimated apnoea severity. This s le had only mild levels of depression severity and results require replication in patients with moderate to severe depression. The inclusion of polysomnography and circadian markers would be useful to delineate the specific features of sleep-wake disturbance that are critical to cognitive performance. Sleep-wake disturbance in older patients with depression is related to neuropsychological functioning and to later ages of illness onset. This study suggests that common neurobiological changes may underpin these disease features, which may, in turn, warrant early identification and management.

Sleep and Biological Rhythms in Mania

Publisher: Elsevier

Date: 2015

DOI: 10.1016/B978-0-12-417188-6.00014-1

Clinical staging in psychiatry: a cross-cutting model of diagnosis with heuristic and practical value

Publisher: Royal College of Psychiatrists

Date: 04-2013

DOI: 10.1192/BJP.BP.112.110858

Abstract: Staging models are used routinely in general medicine for potentially serious or chronic physical disorders such as diabetes, arthritis and cancers, describing the links between biomarkers, clinical phenotypes and disease extension, and promoting a personalised or stratified medicine approach to treatment planning. Clinical staging involves a detailed description of where an in idual exists on a continuum of disorder progression from stage 0 (an at-risk or latency stage) through to stage IV (late or end-stage disease). The approach is popular owing to its clinical utility and is increasingly being applied in psychiatry. The concept offers an informed approach to research and the active promotion of indicated prevention and early intervention strategies. We suggest that for young persons with emerging bipolar disorder, such transdiagnostic staging models could provide a framework that better reflects the developmental psychopathology and matches the complex longitudinal inter-relationships between subsyndromal and syndromal mood, psychotic and other disorders.

Corrigendum: Relationship Between Polyunsaturated Fatty Acids and Psychopathology in the NEURAPRO Clinical Trial

Publisher: Frontiers Media SA

Date: 10-06-2020

DOI: 10.3389/FPSYT.2020.00514

Preliminary evidence of mitochondrial dysfunction associated with post-infective fatigue after acute infection with Epstein Barr Virus

Publisher: Springer Science and Business Media LLC

Date: 31-01-2006

DOI: 10.1186/1471-2334-6-15

Abstract: Acute infectious diseases are typically accompanied by non-specific symptoms including fever, malaise, irritability and somnolence that usually resolve on recovery. However, in some in iduals these symptoms persist in what is commonly termed post-infective fatigue. The objective of this pilot study was to determine the gene expression correlates of post-infective fatigue following acute Epstein Barr virus (EBV) infection. We followed 5 people with acute mononucleosis who developed post-infective fatigue of more than 6 months duration and 5 HLA-matched control subjects who recovered within 3 months. Subjects had peripheral blood mononuclear cell (PBMC) s les collected at varying time points including at diagnosis, then every 2 weeks for 3 months, then every 3 months for a year. Total RNA was extracted from the PBMC s les and hybridized to microarrays spotted with 3,800 oligonucleotides. Those who developed post-infective fatigue had gene expression profiles indicative of an altered host response during acute mononucleosis compared to those who recovered uneventfully. Several genes including ISG20 (interferon stimulated gene), DNAJB2 (DnaJ [Hsp40] homolog and CD99), CDK8 (cyclin-dependent kinase 8), E2F2 (E2F transcription factor 2), CDK8 (cyclin-dependent kinase 8), and ACTN2 (actinin, alpha 2), known to be regulated during EBV infection, were differentially expressed in post-infective fatigue cases. Several of the differentially expressed genes affect mitochondrial functions including fatty acid metabolism and the cell cycle. These preliminary data provide insights into alterations in gene transcripts associated with the varied clinical outcomes from acute infectious mononucleosis.

What is Chronic Fatigue Syndrome? Heterogeneity Within an International Multicentre Study

Publisher: SAGE Publications

Date: 08-2001

DOI: 10.1046/J.1440-1614.2001.00888.X

Abstract: Objective: We sought to compare the characteristics of patients presenting with chronic fatigue (CF) and related syndromes in eight international centres and to subclassify these subjects based on symptom profiles. The validity of the subclasses was then tested against clinical data. Method: Subjects with a clinical diagnosis of CF completed a 119-item self-report questionnaire to provide clinical symptom data and other information such as illness course and functional impairment. Subclasses were generated using a principal components-like analysis followed by latent profile analysis (LPA). Results: 744 subjects returned complete data sets (mean age 40.8 years, mean length of illness 7.9 years, female to male ratio 3:1). Overall, the subjects had a high rate of reporting typical CF symptoms (fatigue, neuropsychological dysfunction, sleep disturbance). Using LPA, two subclasses were generated. Class one (68% s le) was characterized by: younger age, lower female to male ratio shorter episode duration less premorbid, current and familial psychiatric morbidity and, less functional disability. Class two subjects (32%) had features more consistent with a somatoform illness. There was substantial variation in subclass prevalences between the study centres (Class two range 6–48%). Conclusions: Criteria-based approaches to the diagnosis of CF and related syndromes do not select a homogeneous patient group. While substratification of patients is essential for further aetiological and treatment research, the basis for allocating such subcategories remains controversial.

GROWTH-HORMONE AND OTHER HORMONAL RESPONSES TO CLONIDINE IN MELANCHOLIC AND NONMELANCHOLIC DEPRESSED SUBJECTS AND CONTROLS

Publisher: Elsevier BV

Date: 05-1991

DOI: 10.1016/0165-1781(91)90074-Y

Abstract: To study putative differences in central neurotransmitter function in depressive subtypes, growth hormone, adrenocorticotropic hormone (ACTH), cortisol, and prolactin responses to the alpha 2-noradrenergic receptor agonist clonidine (1.3 micrograms/kg i.v.) were examined in 26 subjects with major depression, 13 of whom had melancholia. The responses of 10 of these endogenous/melancholic subjects were compared with those of 10 controls who were matched to the patients on age, sex, and menopausal status. In 15 of the depressed subjects, prolactin and cortisol responses to the putative serotonergic agonist fenfluramine were also examined to test for associations between these challenges. There were no significant differences in any of the responses between melancholic and nonmelancholic depressive subgroups after controlling for age and sex. With the exception of a greater reduction in ACTH in the endogenous/melancholic subjects, there were also no significant differences in hormonal responses between these patients and controls. There was, however, a significantly greater reduction in systolic blood pressure in the control subjects. There were no significant correlations between the responses to clonidine and fenfluramine. The findings suggest that clonidine at a dosage of 1.3 micrograms/kg is neither able to differentiate reliably between depressive subtypes nor to differentiate reliably between depressed and control subjects.

Genetic Influences on Individual Differences in Longitudinal Changes in Global and Subcortical Brain Volumes: Results of the ENIGMA Plasticity Working Group

Publisher: Wiley

Date: 05-06-2017

DOI: 10.1002/HBM.23672

Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs

Publisher: Springer Science and Business Media LLC

Date: 11-08-2202

DOI: 10.1038/NG.2711

Premature mortality in early-intervention mental health services: a data linkage study protocol to examine mortality and morbidity outcomes in a cohort of help-seeking young people

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.

Genetic and Environmental Contributions to Functional Connectivity Architecture of the Human Brain

Publisher: Oxford University Press (OUP)

Date: 18-02-2016

DOI: 10.1093/CERCOR/BHW027

A systematic review and meta-analysis of proton magnetic resonance spectroscopy and mismatch negativity in bipolar disorder

Publisher: Elsevier BV

Date: 11-2013

DOI: 10.1016/J.EURONEURO.2013.07.007

Abstract: Aberrant glutamate neurotransmission has been implicated in the pathophysiology of bipolar disorder with accumulating evidence from imaging, post-mortem and pathology studies. Studies investigating in vivo changes to the glutamatergic system have not been as consistent and warrant clarification. Studies utilizing proton-magnetic resonance spectroscopy ((1)H-MRS) have reported increased levels of combined glutamate and glutamine ("Glx"), which have been linked to impairments in N-methyl-d-aspartate (NMDA) receptor function. Similarly, neurophysiological studies utilising mismatch negativity (MMN) as an index of NMDA receptor function, have reported impairments in bipolar disorder. Here, we provide a systematic review of the literature in regards to the concentration of Glx and the magnitude of MMN in bipolar disorder. Separate meta-analyses revealed that bipolar disorder was associated with increased Glx concentration and decreased MMN-both measured frontally. The current findings corroborate previous evidence indicating that bipolar disorder is characterized by a perturbed frontal glutamate system. These observed changes in bipolar disorder might manifest as impairments in neuronal-glial interactions that lead to disrupted neuronal output and ultimately result in the characteristic neurocognitive sequelae associated with this disorder.

Genetic comorbidity between major depression and cardio-metabolic disease, stratified by age at onset of major depression

Publisher: Cold Spring Harbor Laboratory

Date: 24-05-2019

DOI: 10.1101/645077

Abstract: It’s imperative to understand the specific and shared aetiologies of major depression and cardio-metabolic disease, as both traits are frequently comorbid and each represents a major burden to society. This study examined whether there is a genetic association between major depression and cardio-metabolic traits and if this association is stratified by age at onset for major depression. Polygenic risk scores analysis and linkage disequilibrium score regression was performed to examine whether differences in shared genetic aetiology exist between depression case control status (N cases = 40,940, N controls = 67,532), earlier (N = 15,844), and later onset depression (N = 15,800) with body mass index, coronary artery disease, stroke, and type 2 diabetes in eleven data sets from the Psychiatric Genomics Consortium, Generation Scotland, and UK Biobank. All cardio-metabolic polygenic risk scores were associated with depression status. Significant genetic correlations were found between depression and body mass index, coronary artery disease, and type 2 diabetes. Higher polygenic risk for body mass index, coronary artery disease and type 2 diabetes was associated with both early and later onset depression, while higher polygenic risk for stroke was associated with later onset depression only. Significant genetic correlations were found between body mass index and later onset depression, and between coronary artery disease and both early and late onset depression. The phenotypic associations between major depression and cardio-metabolic traits may partly reflect their overlapping genetic aetiology irrespective of the age depression first presents.

CAN THE CHRONIC FATIGUE SYNDROME BE DEFINED BY DISTINCT CLINICAL-FEATURES

Publisher: Cambridge University Press (CUP)

Date: 09-1995

DOI: 10.1017/S0033291700037417

Abstract: To determine whether patients diagnosed as having chronic fatigue syndrome (CFS) constitute a clinically homogeneous class, multivariate statistical analyses were used to derive symptom patterns and potential patient subclasses in 565 patients. The notion that patients currently diagnosed as having CFS constitute a single homogeneous class was rejected. An alternative set of clinical subgroups was derived. The validity of these subgroups was assessed by sociodemographic, psychiatric, immunological and illness behaviour variables. A two-class statistical solution was considered most coherent, with patients from the smaller class (27% of the s le) having clinical characteristics suggestive of somatoform disorders. The larger class (73% of s le) presented a more limited combination of fatigue and neuropsychological symptoms, and only moderate disability but remained heterogeneous clinically. The two patient groups differed with regard to duration of illness, spontaneous recovery, severity of current psychological morbidity, utilization of medical services and CD8 T cell subset counts. The distribution of symptoms among patients was not unimodal, supporting the notion that differences between the proposed subclasses were not due simply to differences in symptom severity. This study demonstrated clinical heterogeneity among patients currently diagnosed as CFS, suggesting aetiological heterogeneity. In the absence of discriminative clinical features, current consensus criteria do not necessarily reduce the heterogeneity of patients recruited to CFS research studies.

Machine Learning for Differential Diagnosis Between Clinical Conditions With Social Difficulty: Autism Spectrum Disorder, Early Psychosis, and Social Anxiety Disorder

Publisher: Frontiers Media SA

Date: 19-06-2020

DOI: 10.3389/FPSYT.2020.00545

Adjunctive Internet-delivered cognitive behavioural therapy for insomnia in men with depression: A randomised controlled trial

Publisher: SAGE Publications

Date: 07-09-2018

DOI: 10.1177/0004867418797432

Abstract: Internet-delivered cognitive behavioural therapy for insomnia is efficacious for insomnia, and post hoc analyses suggest mood improvements. We undertook the first clinical trial evaluating the efficacy of Internet-delivered cognitive behavioural therapy for insomnia on depressive symptoms as an adjunct to guideline-based treatment of depressive disorders. Older men undergoing psychiatrist-coordinated treatment for major depressive disorder or dysthymia and who had significant insomnia symptoms were randomised to either adjunctive Internet-delivered cognitive behavioural therapy for insomnia (Sleep Healthy Using The Internet) or online sleep psychoeducation. The primary outcome was change in depressive symptoms (Centre for Epidemiological Studies Depression scale) from baseline to week 12 (post intervention). Secondary outcomes were insomnia and anxiety symptoms. In all, 87 men were randomised (Internet-delivered cognitive behavioural therapy for insomnia = 45 psychoeducation = 42). The mean observed Centre for Epidemiological Studies Depression scale changes by week 12 were 8.2 (standard deviation = 11.5) and 3.9 (standard deviation = 12.8) for Internet-delivered cognitive behavioural therapy for insomnia and psychoeducation, respectively. The adjunctive effect size of 0.35 in favour of Sleep Healthy Using The Internet programme was not statistically significant (group × time difference in the Mixed effect Model Repeat Measurement analysis difference 4.3 95% confidence interval = [−1.2, 9.8] p = 0.15). There was a statistically significant effect on insomnia symptoms (group × time p = 0.02, difference 2.7 95% confidence interval = [0.2, 5.3] effect size = 0.62). There were no differences in insomnia or depression at 6 months or differential effects on anxiety at any time point. There were no reported adverse trial-related events in the intervention arm. Adjunctive Internet-delivered cognitive behavioural therapy for insomnia for older men being treated for depression can improve insomnia in the short term, without apparent harm. The short-term depressive symptom effect size in this pilot trial was comparable to other adjunctive interventions and may warrant a larger, definitive trial.

Patterns of emergency department presentations for a youth mental health cohort: data-linkage cohort study

Publisher: Royal College of Psychiatrists

Date: 09-2023

DOI: 10.1192/BJO.2023.521

Possibilities for the prevention and treatment of cognitive impairment and dementia

Publisher: Royal College of Psychiatrists

Date: 05-2007

DOI: 10.1192/BJP.BP.106.033407

Abstract: The human brain has a remarkable capacity for plasticity, but does it have the capacity for repair and/or regeneration? On the basis of controversial new evidence we speculate that the answer may be ‘yes', and suggest that clinicians should therefore approach cognitive impairment and dementia with a new, cautious optimism.

Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: A longitudinal study

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.

Primary care psychiatry is not specialist psychiatry in general practice - Reply

Publisher: AMPCo

Date: 07-1999

DOI: 10.5694/J.1326-5377.1999.TB123553.X

Short- and long-term impact of receiving genetic mutation results in women at increased risk for hereditary breast cancer

Publisher: Wiley

Date: 09-03-2004

DOI: 10.1023/B:JOGC.0000018822.56297.A6

Abstract: Forty-seven unaffected women from high-risk breast cancer families who had received results for hereditary breast/ovarian predisposition genes between 1 month and 5 years ago were interviewed regarding their experiences. Women responded to open-ended questions. The initial emotional turmoil reported by most was generally short lived. However, the impact of genetic testing went beyond the in idual to the extended family and social context, particularly in the short-term. A common theme was the difficulty associated with ulging a result to family members, who were also adjusting to their own result. The majority of carriers reported advantages that were both physical (options for surveillance programs and prophylactic surgery) and emotional (reduced uncertainty, increased awareness of options and knowledge about risk, preparation time). Most carriers reported no change in lifestyle although some reported discovering their mutation status as a positive life-changing experience. Implications for genetic counseling and further research are discussed.

Prior suicide attempts predict worse clinical and functional outcomes in young people attending a mental health service

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.

1098 IMPROVEMENTS IN SUBJECTIVE SLEEP AND DEPRESSION ALONG THE COURSE OF ADJUNCTIVE PHOTOTHERAPY

Publisher: Oxford University Press (OUP)

Date: 28-04-2017

DOI: 10.1093/SLEEPJ/ZSX050.1097

Unique genetic and environmental determinants of prolonged fatigue: a twin study

Publisher: Cambridge University Press (CUP)

Date: 03-1999

DOI: 10.1017/S0033291798007934

Abstract: Background. Prolonged fatigue syndromes have been proposed as prevalent and disabling forms of distress that occur independently of conventional notions of anxiety and depression. Methods. To investigate the genetic and environmental antecedents of common forms of psychological and somatic distress, we measured fatigue, anxiety, depression and psychological distress in 1004 normal adult twin pairs (533 monozygotic (MZ), 471 dizygotic (DZ)) over 50 years of age. Results. Familial aggregation of psychological distress, anxiety and fatigue appeared to be due largely to additive genetic factors (MZ[ratio ]DZ ratios of 2·12–2·69). The phenotypic correlations between the psychological measures (distress, anxiety and depression) were moderate (0·67–0·79) and higher than that between fatigue and psychological distress (0·38). Multivariate genetic modelling revealed a common genetic factor contributing to the development of all the observed phenotypes (though most strongly for the psychological forms), a second independent genetic factor also influenced anxiety and depression and a third independent genetic factor made a major contribution to fatigue alone. In total, 44% (95% CI 25–60%) of the genetic variance for fatigue was not shared by the other forms of distress. Similarly, the environmental factor determining psychological distress made negligible contributions to fatigue, which was underpinned largely by its own independent environmental factor. Conclusion. This study supports the aetiological independence of prolonged fatigue and, therefore, argues strongly for its inclusion in classification systems in psychiatry.

CORRESPONDENCE

Publisher: SAGE Publications

Date: 27-08-2004

DOI: 10.1111/J.1039-8562.2004.02103.X

Estimating the Mental Wealth of nations: valuing social production and investment

Publisher: Springer Science and Business Media LLC

Date: 18-04-2023

DOI: 10.1038/S44220-023-00044-W

Moderator Assistant: A Natural Language Generation-Based Intervention to Support Mental Health via Social Media

Publisher: Informa UK Limited

Date: 02-10-2015

DOI: 10.1080/15228835.2015.1105768

Perspectives of young people on depression: awareness, experiences, attitudes and treatment preferences

Publisher: Wiley

Date: 11-2007

DOI: 10.1111/J.1751-7893.2007.00042.X

Abstract: Ascertaining current knowledge and attitudes towards depression among young people is vital for developing c aigns promoting community awareness and early intervention. Cross-sectional computer-assisted telephone interviews of persons aged 18-90 years were conducted by beyondblue in Australia in 2002 and 2004/05. Items assessed consideration of depression as a major general health or mental health problem, knowledge about prevalence of depression, usual age of onset for depression or anxiety and treatment preferences. The surveys included 2003 and 3200 persons, respectively, with 285 and 400 aged between 18 and 25 years. Depression was not recognized by young persons as a major general health problem (1-2% of responses), but was the most frequently named mental health problem (37-42%). Younger persons were more likely than older persons to see depression as the major mental health problem, placing less emphasis on alcohol and other drug problems. They preferred first to seek help from family or friends (61-65%) and try non-pharmacological treatments. Although understanding of the helpfulness of several evidence-based treatments was good, many younger respondents still considered non-evidence-based treatments to be helpful. A quarter of subjects believed antidepressant medications were harmful and that alcohol use may be helpful. Although knowledge about depression was good, young people do not recognize depression as a major general health problem and remain reluctant to use professional services. These attitudes represent significant barriers to seeking treatment early in the course of common mental health problems.

Emotional Processing, P50 Sensory Gating, and Social Functioning in Bipolar Disorder

Publisher: SAGE Publications

Date: 13-05-2015

DOI: 10.1177/1550059414523417

Abstract: Emotional processing has been reported to effect sensory gating as measured by the event-related potential known as P50. Because both P50 and emotional processing are dysfunctional in bipolar disorder (BD), we sought to investigate the impact that concurrent emotional processing has on sensory gating in this psychiatric population. P50 was recorded using a paired-click paradigm. Peak-to-peak litudes for stimulus 1 (S1) and stimulus 2 (S2) were acquired during the presentation of disgust and neutral faces to young adults with BD (n = 19) and controls (n = 20). Social functioning and quality-of-life self-reported measures were also obtained. The BD group had significantly larger P50 litudes elicited by the S2-disgust response compared with controls, but no significant difference in overall P50 sensory gating was found between the groups. There were also no differences between groups in S1-disgust or in either of the neutral P50 litudes. The BD group showed significant associations between sensory gating to disgust and measures of social functioning. Importantly, BD showed impaired filtering of auditory information when paired with an emotionally salient image. Thus, it appears that patients with the greatest impairment in sensory gating also have the most difficulty engaging in social situations.

Suicidal Thoughts and Behaviors and Their Associations With Transitional Life Events in Men and Women: Findings From an International Web-Based Sample (Preprint)

Publisher: JMIR Publications Inc.

Date: 23-02-2020

DOI: 10.2196/PREPRINTS.18383

Abstract: lthough numerous studies have demonstrated sex differences in the prevalence of suicidal thoughts and behaviors (STB), there is a clear lack of research examining the similarities and differences between men and women in terms of the relationship between STB, transitional life events, and the coping strategies employed after experiencing such events when they are perceived as stressful. his study aims to examine the differences between men’s and women’s experiences of STB, sociodemographic predictors of STB, and how coping responses after experiencing a stressful transitional life event predict STB. web-based self-report survey was used to assess the health and well-being of a voluntary community-based s le of men and women aged 16 years and older, living in Australia, Canada, New Zealand, the United Kingdom, and the United States, who were recruited using web-based social media promotion and snowballing. n total, 10,765 eligible web-based respondents participated. Compared with men, a significantly greater proportion of women reported STB ( i P /i & .001) and endorsed experiencing a transitional life event as stressful ( i P /i & .001). However, there were no gender differences in reporting that the transitional life event or events was stressful for those who also reported STB. Significant sociodemographic adjusted risk factors of STB included younger age identifying as a sexual minority lower subjective social connectedness lower subjective intimate bonds experiencing a stressful transitional life event in the past 12 months living alone (women only) not being in employment, education, or training (women only) suddenly or unexpectedly losing a job (men only) and experiencing a relationship breakdown (men only). Protective factors included starting a new job, retiring, having a language background other than English, and becoming a parent for the first time (men only). The results relating to coping after experiencing a self-reported stressful transitional life event in the past 12 months found that regardless of sex, respondents who reported STB compared with those who did not were less likely to engage in activities that promote social connections, such as talking about their feelings ( i P& /i .001). Coping strategies significantly explained 19.0% of the STB variance for men ( i F /i sub ,1027 /sub =14.64 i P /i & .001) and 22.0% for women ( i F /i sub ,1977 /sub =36.45 i P /i & .001). his research highlights multiple risk factors for STB, one of which includes experiencing at least one stressful transitional life event in the past 12 months. When in iduals are experiencing such events, support from services and the community alike should consider using sex-specific or targeted strategies, as this research indicates that compared with women, more men i do nothing /i when experiencing stress after a transitional life event and may be waiting until they experience STB to engage with their social networks for support.

Effect of interventions for the well-being, satisfaction and flourishing of general practitioners - A systematic review

Publisher: BMJ

Date: 08-2021

DOI: 10.1136/BMJOPEN-2020-046599

Abstract: Clinician well-being has been recognised as an important pillar of healthcare. However, research mainly addresses mitigating the negative aspects of stress or burnout, rather than enabling positive aspects. With the added strain of a pandemic, identifying how best to maintain and support the well-being, satisfaction and flourishing of general practitioners (GPs) is now more important than ever. Systematic review. We searched MEDLINE, PsycINFO, Embase, CINAHL and Scopus from 2000 to 2020. Intervention studies with more than 50% GPs in the s le evaluating self-reported well-being, satisfaction and related positive outcomes were included. The Cochrane Risk of Bias 2 tool was applied. We retrieved 14 792 records, 94 studies underwent full-text review. We included 19 studies in total. Six randomised controlled trials, three non-randomised, controlled trials, eight non-controlled studies of in idual or organisational interventions with a total of 1141 participants. There were two quasi-experimental articles evaluating health system policy change. Quantitative and qualitative positive outcomes were extracted and analysed. In idual mindfulness interventions were the most common (k=9) with medium to large within-group (0.37–1.05) and between-group (0.5–1.5) effect sizes for mindfulness outcomes, and small-to-medium effect sizes for other positive outcomes including resilience, compassion and empathy. Studies assessing other intervention foci or other positive outcomes (including well-being, satisfaction) were of limited size and quality. There is remarkably little evidence on how to improve GPs well-being beyond using mindfulness interventions, particularly for interventions addressing organisational or system factors. This was further undermined by inconsistent reporting, and overall high risk of bias. We need to conduct research in this space with the same rigour with which we approach clinical intervention studies in patients. CRD42020164699. Dr Diana Naehrig is funded through the Raymond Seidler PhD scholarship.

A data-driven transdiagnostic analysis of white matter integrity in young adults with major psychiatric disorders

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.

Making activity-based funding work for mental health

Publisher: CSIRO Publishing

Date: 2013

DOI: 10.1071/AH13002

Abstract: The implementation of activity-based funding (ABF) in mental health from 1 July 2013 has significant risks and benefits. It is critical that the process of implementation is consistent with Australia’s cherished goal of establishing a genuine and effective model of community-based mental health care. The infrastructure to support the application of ABF to mental health is currently weak and requires considerable development. States and territories are struggling to meet existing demand for largely hospital-based acute mental health care. There is a risk that valuable ABF-driven Commonwealth growth funds may be used to prop up these systems rather than drive the emergence of new models of community-based care. Some of these new models exist now and this article provides a short description. The aim is to help the Independent Hospital Pricing Authority better understand the landscape of mental health into which it now seeks to deploy ABF.

A clinical trials agenda for testing interventions in earlier stages of psychotic disorders

Publisher: AMPCo

Date: 02-2009

DOI: 10.5694/J.1326-5377.2009.TB02372.X

Abstract: A fundamental shift in the design of clinical trials for psychotic disorders is desirable and feasible. Priority should be placed on evaluation of the efficacy of interventions targeting different phases of illness. A range of traditional therapeutic approaches needs to be augmented by an increased emphasis on the potential benefits of informational, e-health, behavioural and neuroprotective strategies. A new national clinical trials platform, based on headspace, the National Youth Mental Health Foundation, is outlined. It provides the opportunity for conducting large multisite clinical trials in young people with emerging major mental disorders.

Disability, functioning, and quality of life among treatment-seeking young autistic adults and its relation to depression, anxiety, and stress

Publisher: SAGE Publications

Date: 17-01-2019

DOI: 10.1177/1362361318823925

Abstract: In this study, we consecutively recruited treatment-seeking young autistic adults without intellectual impairment aged 16–30 years who presented to a mental health service and evaluated general health (distress, quality of life, and disability), functioning (work loss days and social functioning), and mood symptoms (depression, anxiety, and stress) in those diagnosed with autism spectrum disorder ( n = 96). This group was compared to young adults presenting to the same service with primary mental health disorders (depression, n = 343 bipolar, n = 132 psychosis, n = 166 and anxiety, n = 303). This study also investigated the influence of mood symptoms on general health and functioning in the autism spectrum disorder group. Young autistic adults reported significant general health and functioning impairments that were of similar degree to those presenting with primary mental health disorders. Interestingly, the autistic group also reported similarly high levels of mood symptoms to those with primary depressive and anxiety disorders. In the autistic group, depressive symptoms were strongly associated with distress, quality of life, and work loss days, while stress symptoms were strongly associated with disability. This study highlights further research, and mental health services are required specifically targeting young autistic adults to address their significant unmet needs.

Complex genetic and environmental relationships between psychological distress, fatigue and immune functioning: a twin study

Publisher: Cambridge University Press (CUP)

Date: 03-1999

DOI: 10.1017/S0033291798007922

Abstract: Background. Although there is considerable support for adverse relationships between states of psychological and somatic distress and immune response, there is little evidence in humans of the relative contribution of genetic and environmental factors. Methods. This study utilized a twin methodology to examine the interplay between psychological distress, fatigue and immune function. We recorded a number of measures of distress, including conventional depression and anxiety as well as the somatic symptom of prolonged fatigue, and immune responsiveness (by delayed-type hypersensitivity skin response) in 124 normal adult twin pairs (79 monozygotic, 45 dizygotic). Results. While there were strong genetic influences on the psychological distress and fatigue factors (only some of which are common to both), familial aggregation of immune responsiveness arose mainly from environmental factors shared by both members of a twin pair. Phenotypic correlations between psychological and immune measures were negligible, but multivariate genetic modelling revealed that these masked larger genetic and environmental correlations of opposite sign. Negative environmental effects of psychological distress and fatigue on immune responsiveness were countered by a positive genetic relationship between psychological distress and immune function. Conclusions. Our study suggests that current psychoneuroimmunological hypotheses in humans need to be modified to place increasing importance on the in idual's genotype. In this cohort immune responsiveness varied in response to a complex interplay of genetic and environmental factors. Additionally, although psychological distress and fatigue had some shared genetic determinants, independent genetic and environmental risk factors for fatigue were also identified.

Activation in Bipolar Disorders

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.

Dynamic modelling of chronotype and hypo/manic and depressive symptoms in young people with emerging mental disorders

Publisher: Informa UK Limited

Date: 03-05-2023

DOI: 10.1080/07420528.2023.2203241

Clinical and cognitive correlates of structural hippocampal change in at-risk older adults

Publisher: SAGE Publications

Date: 05-11-2014

DOI: 10.1177/0891988713509137

Abstract: With estimates of dementia expected to rise over the coming decades, there is interest in understanding the factors associated with promoting neuroprotection and limiting neurodegeneration. In this study, we examined the change in the volume of the hippoc us over a 2-month period in 34 older people “at risk” of cognitive decline (mean age = 66.8 years, 38% male). Factors that were examined included cognitive reserve, neuropsychological functioning, depression as well as a lifestyle (cognitive training) intervention. The results showed that over a 2-month period, increases in hippoc al size were associated with having higher premorbid intellect, greater occupational attainment, superior memory, and higher levels of functioning. Conversely, depression and disability were associated with decreases in hippoc al volume. Cognitive training was not associated with changes in hippoc al volume. These findings suggest that factors associated with cognitive reserve, cognition and depression may play an integral pathophysiological role in determining hippoc al volumes in “at-risk” older adults.

SUB-TYPING DEPRESSION .3. DEVELOPMENT OF A CLINICAL ALGORITHM FOR MELANCHOLIA AND COMPARISON WITH OTHER DIAGNOSTIC MEASURES

Publisher: Cambridge University Press (CUP)

Date: 07-1995

DOI: 10.1017/S003329170003508X

Abstract: We describe the development of a clinical algorithm to differentiate melancholic from non-melancholic depression, using refined sets of ‘endogeneity’ symptoms together with clinician-rated CORE scores assessing psychomotor disturbance. Assignment by the empirically developed algorithm is contrasted with assignment by DSM-III-R and with several other melancholia subtyping indices. Both the numbers of ‘melancholies’ assigned by the several systems and their capacity to distinguish ‘melancholics’ on clinical, demographic and a biological index test (the DST) varied across the systems with the algorithm being as ‘successful’ as several systems that include inter-episode and treatment response variables. Analyses provide information on the criteria set developed for DSM-IV definition of ‘melancholia’.

Were the budgetary reforms to the better access to mental health care initiative appropriate? - No

Publisher: AMPCo

Date: 06-2011

DOI: 10.5694/J.1326-5377.2011.TB03112.X

Abstract: Mental health policy expert Sebastian Rosenberg and psychiatrist Ian Hickie want more change.

Epidemiology of depression in the Asia Pacific region

Publisher: SAGE Publications

Date: 27-08-2004

DOI: 10.1111/J.1039-8562.2004.02097.X-I1

The severity of the pathogen-induced acute sickness response is affected by polymorphisms in genes of the NLRP3 inflammasome pathway

Publisher: Elsevier BV

Date: 03-2021

DOI: 10.1016/J.BBI.2021.01.005

PROPOFOL AS AN ANESTHETIC AGENT FOR ECT - EFFECT ON OUTCOME AND LENGTH OF COURSE

Publisher: SAGE Publications

Date: 06-1991

DOI: 10.3109/00048679109077742

Abstract: Recent reports of reduced seizure duration with ECT under propofol anaesthesia have led to concerns that propofol may diminish the efficacy of this treatment. To investigate the effect of propofol on the response to ECT, we reviewed records of 66 patients with primary depression treated with ECT, 37 of whom had been assessed prospectively with pre- and post-ECT Hamilton and Zung depression severity ratings. Despite demonstrating that the in idual seizure duration was significantly reduced with propofol compared to thiopentone we found no evidence of reduced ECT efficacy with propofol. Courses under propofol anaesthesia were on an average two treatments longer than with thiopentone. Although this difference was not statistically significant this may have been due to a type II error. These results suggest that it is premature to abandon the use of this new anaesthetic agent in ECT without controlled prospective outcome studies.

Comorbid chronic pain and depression: Shared risk factors and differential antidepressant effectiveness

Publisher: Cold Spring Harbor Laboratory

Date: 24-05-2020

DOI: 10.1101/2020.05.23.20110841

Abstract: The bidirectional relationship between depression and chronic pain is well recognized, but their clinical management remains challenging. Here we characterize the shared risk factors and outcomes for their comorbidity in the Australian Genetics of Depression cohort study (N=13,839). Participants completed online questionnaires about chronic pain, psychiatric symptoms, comorbidities, treatment response and general health. Logistic regression models were used to examine the relationship between chronic pain and clinical and demographic factors. Cumulative linked logistic regressions assessed the effect of chronic pain on treatment response for ten different antidepressants. Chronic pain was associated with an increased risk of depression (OR=1.86 [1.37–2.54]), recent suicide attempt (OR=1.88[1.14–3.09]), higher use of tobacco (OR=1.05 [1.02–1.09]) and misuse of painkillers (e.g., opioids OR=1.31 [1.06–1.62]). Participants with comorbid chronic pain and depression reported fewer functional benefits from antidepressant use and lower benefits from sertraline (OR=0.75[0.68–0.83]), escitalopram (OR=0.75[0.67–0.85]) and venlafaxine (OR=0.78[0.68–0.88]) when compared to participants without chronic pain. Furthermore, participants taking sertraline (OR=0.45[0.30–0.67]), escitalopram (OR=0.45[0.27–0.74]) and citalopram (OR=0.32[0.15–0.67]) specifically for chronic pain (among other indications) reported lower benefits compared to other participants taking these same medications but not for chronic pain. These findings reveal novel insights into the complex relationship between chronic pain and depression. Treatment response analyses indicate differential effectiveness between particular antidepressants and poorer functional outcomes for these comorbid conditions. Further examination is warranted in targeted interventional clinical trials, which also include neuroimaging genetics and pharmacogenomics protocols. This work will advance the delineation of disease risk indicators and novel aetiological pathways for therapeutic intervention in comorbid pain and depression as well as other psychiatric comorbidities.

The Polarization of Clinician and Service Staff Perspectives After the Use of Health Information Technology in Youth Mental Health Services: Implementation and Evaluation Study

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.

Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study

Publisher: BMJ

Date: 09-2006

DOI: 10.1136/BMJ.38933.585764.AE

eHealth Tools That Assess and Track Health and Well-being in Children and Young People: Systematic Review

Publisher: JMIR Publications Inc.

Date: 12-05-2022

DOI: 10.2196/26015

Abstract: eHealth tools that assess and track health outcomes in children or young people are an emerging type of technology that has the potential to reform health service delivery and facilitate integrated, interdisciplinary care. The aim of this review is to summarize eHealth tools that have assessed and tracked health in children or young people to provide greater clarity around the populations and settings in which they have been used, characteristics of digital devices (eg, health domains, respondents, presence of tracking, and connection to care), primary outcomes, and risks and challenges of implementation. A search was conducted in PsycINFO, PubMed or MEDLINE, and Embase in April 2020. Studies were included if they evaluated a digital device whose primary purpose was to assess and track health, focused on children or young people (birth to the age of 24 years), reported original research, and were published in peer-reviewed journals in English. A total of 39 papers were included in this review. The s le sizes ranged from 7 to 149,329 participants (median 163, mean 5155). More studies were conducted in urban (18/39, 46%) regions than in rural (3/39, 8%) regions or a combination of urban and rural areas (8/39, 21%). Devices were implemented in three main settings: outpatient health clinics (12/39, 31%), hospitals (14/39, 36%), community outreach (10/39, 26%), or a combination of these settings (3/39, 8%). Mental and general health were the most common health domains assessed, with a single study assessing multiple health domains. Just under half of the devices tracked children’s health over time (16/39, 41%), and two-thirds (25/39, 64%) connected children or young people to clinical care. It was more common for information to be collected from a single informant (ie, the child or young person, trained health worker, clinician, and parent or caregiver) than from multiple informants. The health of children or young people was assessed as a primary or secondary outcome in 36% (14/39) of studies however, only 3% (1/39) of studies assessed whether using the digital tool improved the health of users. Most papers reported early phase research (formative or process evaluations), with fewer outcome evaluations and only 3 randomized controlled trials. Identified challenges or risks were related to accessibility, clinical utility and safety, uptake, data quality, user interface or design aspects of the device, language proficiency or literacy, sociocultural barriers, and privacy or confidentiality concerns ways to address these barriers were not thoroughly explored. eHealth tools that assess and track health in children or young people have the potential to enhance health service delivery however, a strong evidence base validating the clinical utility, efficacy, and safety of tools is lacking, and more thorough investigation is needed to address the risks and challenges of using these emerging technologies in clinical care. At present, there is greater potential for the tools to facilitate multi-informant, multidomain assessments and longitudinally track health over time and room for further implementation in rural or remote regions and community settings around the world.

Diabetes, psychotic disorders and antipsychotic therapy: A consensus statement

Publisher: Wiley

Date: 11-2004

DOI: 10.5694/J.1326-5377.2004.TB06443.X

Potential genetic overlap between insomnia and sleep symptoms in major depressive disorder: A polygenic risk score analysis (vol 12, 734077, 2021)

Publisher: Frontiers Media SA

Date: 04-08-2022

DOI: 10.3389/FPSYT.2022.893816

Characterization and prediction of clinical pathways of vulnerability to psychosis through graph signal processing

Publisher: eLife Sciences Publications, Ltd

Date: 27-09-2021

DOI: 10.7554/ELIFE.59811

Abstract: Causal interactions between specific psychiatric symptoms could contribute to the heterogenous clinical trajectories observed in early psychopathology. Current diagnostic approaches merge clinical manifestations that co-occur across subjects and could significantly hinder our understanding of clinical pathways connecting in idual symptoms. Network analysis techniques have emerged as alternative approaches that could help shed light on the complex dynamics of early psychopathology. The present study attempts to address the two main limitations that have in our opinion hindered the application of network approaches in the clinical setting. Firstly, we show that a multi-layer network analysis approach, can move beyond a static view of psychopathology, by providing an intuitive characterization of the role of specific symptoms in contributing to clinical trajectories over time. Secondly, we show that a Graph-Signal-Processing approach, can exploit knowledge of longitudinal interactions between symptoms, to predict clinical trajectories at the level of the in idual. We test our approaches in two independent s les of in iduals with genetic and clinical vulnerability for developing psychosis. Novel network approaches can allow to embrace the dynamic complexity of early psychopathology and help pave the way towards a more a personalized approach to clinical care.