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Using Multivariate Statistics

/pdf/practice-guideline-for-the-treatment-of-patients-with-major-ofberaz3o1.pdf

PRACTICE GUIDELINE FOR THE Treatment of Patients With Major Depressive Disorder

https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(16)30030-X.pdf

Suicide prevention strategies revisited: 10-year systematic review

Diagnostic and Statistical Manual of Mental Disorders(DSM)-5による分類と診断 (特集 周産期メンタルヘルス : 妊婦の不安とどう立ち向かうか)

Schizophrenia, “just the facts” 4. Clinical features and conceptualization

Background Compulsory community treatment orders (CTOs) are controversial because they enforce psychiatric treatment of patients in the community. It is important to know which patients benefit from compulsory treatment to better inform CTO use. Aims To examine the effect of a range of diagnoses on outcomes associated with CTOs to determine whether there are specific outcome signatures for CTOs according to diagnosis. Method New Zealand's Ministry of Health databases provided demographic, service use and medication-dispensing data for all individuals placed on a CTO between 2009 and 2018. We used a hierarchical approach to categorise individuals according to diagnosis. Admission rates, admission days per year, community care and medication dispensing were analysed according to diagnosis and CTO status. Results In total, 14 726 patients were placed on a CTO over the 10-year period between 1 January 2009 and 31 December 2018. For psychotic disorders, CTOs were associated with reduced admission frequency and duration. However, the opposite occurred for dementia disorders, bipolar disorders, major depressive disorder and personality disorders. Higher rates of medications, including depot antipsychotic medications, were dispensed on CTOs for all diagnostic groups. Conclusions CTOs were associated with reduced admission frequency and admission days per year for patients with psychotic disorders, whereas the opposite occurred for other diagnostic groups. Rather than seeking to establish whether CTOs are effective, we suggest that there are specific outcome signatures associated with CTOs for different disorders and knowledge of these can improve understanding and clinical practice in this area.

/pdf/impact-of-diagnosis-on-outcomes-for-compulsory-treatment-1cjxkrpc.pdf

Impact of diagnosis on outcomes for compulsory treatment orders in New Zealand

Background This study examined the association between methamphetamine use and psychotic symptoms in a New Zealand general population birth cohort (n = 1265 at birth). Methods At age 18, 21, 25, 30, and 35, participants reported on their methamphetamine use and psychotic symptoms in the period since the previous interview. Generalized estimating equations modelled the association between methamphetamine use and psychotic symptoms (percentage reporting any symptom, and number of symptoms per participant). Confounding factors included childhood individual characteristics, family socioeconomic circumstances and family functioning. Long term effects of methamphetamine use on psychotic symptoms were assessed by comparing the incidence of psychotic symptoms at age 30-35 for those with and without a history of methamphetamine use prior to age 30. Results After adjusting for confounding factors and time-varying covariate factors including concurrent cannabis use, methamphetamine use was associated with a modest increase in psychosis risk over five waves of data (adjusted odds ratio (OR) 1.33, 95% confidence interval (CI) 1.03-1.72 for the percentage measure; and IRR 1.24, 95% CI 1.02-1.50 for the symptom count measure). The increased risk of psychotic symptoms was concentrated among participants who had used at least weekly at any point (adjusted OR 2.85, 95% CI 1.21-6.69). Use of methamphetamine less than weekly was not associated with increased psychosis risk. We found no evidence for a persistent vulnerability to psychosis in the absence of continuing methamphetamine use. Conclusion Methamphetamine use is associated with increased risk of psychotic symptoms in the general population. Increased risk is chiefly confined to people who ever used regularly (at least weekly), and recently.

Methamphetamine use and psychotic symptoms: findings from a New Zealand longitudinal birth cohort.

Traditional teaching in psychiatry does little to address recovery concepts. The aim of this study was to evaluate the incorporation of a recovery-focused teaching program for medical students in psychiatry. Recovery, as understood by medical students who had participated in a recovery-focused teaching program, was assessed by thematic analysis of recovery-focused assessment reflections. Six major themes emerged from the recovery reflections from final year medical students are as follows: (1) recovery as a person-centered approach, (2) the need for social integration, (3) non-diagnostic framing of mental illness, (4) tensions between the medical model and personal recovery, (5) a patient’s willingness to engage with mental health services, and (6) the development of a positive sense of self. A recovery teaching program was associated with students expressing knowledge of recovery principles and positive attitudes towards people with experience of mental illness. Psychiatric placements for medical students may benefit from a recovery focus.

What Do Final Year Medical Students Understand by the Concept of Recovery? A Descriptive Qualitative Study.

ISSPD: Past, Present, and Future.

Background Thereisconflictingevidenceabouttheinfluenceofpersonalitydisorderonoutcomeindepressivedisorders.Aims Meta-analysisofstudiesinwhichacategoricalassessmentofpersonalitydisorderornopersonalitydisorderwasmadeinpeoplewithdepressivedisorders,andcategoricaloutcome (recovered/notandcategoricaloutcome(recovered/notrecovered) also determined.MMetethodhod Systematicelectronicsearchoftheliteratureforrelevantpublications.Handsearchesof JournalofAffectiveDisorders andrecentreviews,withsubsequentmeta-analysisofselectedststuuddiieess..RReesusulltsts Comorbidpersonalitydisorderwithdepressionwasassociatedwithadoublingoftheriskofapooroutcomefordepressioncomparedwithnopersonalitydisorder (randomeffectspersonalitydisorder(randomeffectsmomoddeellOORR ¼2.18,95%CI1.70^2.80),arobustfindingmaintainedwithonlyHamilton-typedepressioncriteriaatHamilton-type depressioncriteria atoutcome(OR¼2.20,95%CI1.61^3.01).Alltreatmentsapartfromelectroconvulsivetherapy (ECT) showedthispooroutcome,andtheECTgroupwassmall.Conclusions Combineddepressionandpersonalitydisorderisassociatedwithapooreroutcomethandepressionalone.Declarationof interest PP..TT..ananddTT..JJ..belongtoaUKMedicalResearchCouncilCooperative Group (Mencog) evaluatingmentalhealthinterventions. P.T. is Editorofthe BritishJournalofPsychiatryBritish Journalof Psychiatrybuthadnopartintheevaluationofthispaper.nopartinthe evaluationofthispaper.

Giles Newton-Howes

Papers

Impact of diagnosis on outcomes for compulsory treatment orders in New Zealand

Methamphetamine use and psychotic symptoms: findings from a New Zealand longitudinal birth cohort.

What Do Final Year Medical Students Understand by the Concept of Recovery? A Descriptive Qualitative Study.

ISSPD: Past, Present, and Future.

meta-analysis of published studies Personality disorder and the outcome of depression: