Showing papers in "Australian and New Zealand Journal of Psychiatry in 2013"

Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011

Abstract: Objective:This study examined longitudinal trends in the dispensing of psychotropic medications in Australia from January 2000 to December 2011.Method:Dispensing data for the major classes of psych...

Biomarkers in bipolar disorder: A positional paper from the International Society for Bipolar Disorders Biomarkers Task Force

Abstract: Although the etiology of bipolar disorder remains uncertain, multiple studies examining neuroimaging, peripheral markers and genetics have provided important insights into the pathophysiologic processes underlying bipolar disorder. Neuroimaging studies have consistently demonstrated loss of gray matter, as well as altered activation of subcortical, anterior temporal and ventral prefrontal regions in response to emotional stimuli in bipolar disorder. Genetics studies have identified several potential candidate genes associated with increased risk for developing bipolar disorder that involve circadian rhythm, neuronal development and calcium metabolism. Notably, several groups have found decreased levels of neurotrophic factors and increased pro-inflammatory cytokines and oxidative stress markers. Together these findings provide the background for the identification of potential biomarkers for vulnerability, disease expression and to help understand the course of illness and treatment response. In other areas of medicine, validated biomarkers now inform clinical decision-making. Although the findings reviewed herein hold promise, further research involving large collaborative studies is needed to validate these potential biomarkers prior to employing them for clinical purposes. Therefore, in this positional paper from the ISBD-BIONET (biomarkers network from the International Society for Bipolar Disorders), we will discuss our view of biomarkers for these three areas: neuroimaging, peripheral measurements and genetics; and conclude the paper with our position for the next steps in the search for biomarkers for bipolar disorder.

Is Internet addiction a useful concept

Abstract: Australian & New Zealand Journal of Psychiatry, 47(1) The Internet is utilised by hundreds of millions of people worldwide, with its numerous benefits only leading to an increase in the number of users. But there is a dark side to the Internet, and one of the negative consequences of the vast potentials of the Internet has been its excessive and uncontrollable use, often referred to as ‘Internet addiction’. Hardly a day passes without this phenomenon of the modern age being mentioned in the media. Over the past decade, Internet addiction and related behaviours have been attracting the attention of mental health researchers and clinicians, although this field is still in its infancy. In some Asian countries, such as South Korea, Internet addiction and similar problems are considered issues of public health significance. However, in such countries, competitive online video gaming is heavily promoted, blurring the boundary between ‘normal excessive’ and pathologically excessive use of the Internet and online video games. The very term ‘Internet addiction’ is controversial and the concept remains elusive. This article aims to examine some of the most important issues surrounding Internet addiction and to propose an alternative conceptualisation.

The association between problematic internet use and depression, suicidal ideation and bipolar disorder symptoms in Korean adolescents.

Abstract: Objective:This study used a sample of Korean adolescents to evaluate: (a) associations between problematic internet use and depression, bipolar disorder symptoms and suicidal ideation; and (b) whether mood disorders mediate the relationship between problematic internet use and suicidal ideation.Method:A total of 795 middle and high school students were recruited (538 girls; mean age, 13.87 ± 1.51 years). The Internet Addiction Proneness Scale for Youth–Short Form (KS-scale) was used to evaluate the presence and severity of problematic internet use. The frequencies of depression, suicidal ideation and probable bipolar disorder were compared between adolescents with and without internet addiction. The associations between the severity of problematic internet use and the severity of depressive symptoms, bipolar symptoms and suicidal ideation were also analyzed.Results:Seventy-five adolescents (9.4%) met the criteria for problematic internet use. The presence of problematic internet use was significantly asso...

Clinical features and axis I comorbidity of Australian adolescent pathological Internet and video game users

Abstract: Objectives:Although there is growing international recognition of pathological technology use (PTU) in adolescence, there has been a paucity of empirical research conducted in Australia. This study was designed to assess the clinical features of pathological video gaming (PVG) and pathological Internet use (PIU) in a normative Australian adolescent population. A secondary objective was to investigate the axis I comorbidities associated with PIU and video gaming.Method:A total of 1287 South Australian secondary school students aged 12–18 years were recruited. Participants were assessed using the PTU checklist, Revised Children’s Anxiety and Depression Scale, Social Anxiety Scale for Adolescents, revised UCLA Loneliness Scale, and Teenage Inventory of Social Skills. Adolescents who met the criteria for PVG or PIU or both were compared to normal adolescents in terms of axis I comorbidity.Results:The prevalence rates of PIU and PVG were 6.4% and 1.8%, respectively. A subgroup with co-occurring PIU and PVG was...

The future is in our hands: the role of mobile phones in the prevention and management of mental disorders.

Abstract: Australian & New Zealand Journal of Psychiatry, 47(2) Mobile phones lend themselves to mental health care. Widely used across ages, incomes and cultures, they are also personal, location independent, carried on the person, usually turned on, and often connected to the Internet. As such, they offer unique opportunities for accessing health information, monitoring progress, receiving personalised prompts and support, collecting ecologically valid data, and using self-management interventions when and where they are needed. Furthermore, entry barriers associated with other forms of technology are minimised, enhancing the potential to reach underserved populations. A small but rapidly growing literature supports their use in the prevention and management of mental health disorders. In this Viewpoint, I provide a brief overview of the current state of mobile mental health, a specialised section of the larger field of mHealth (health care delivered on mobile communication devices such as mobile phones, smartphones and tablets). I also discuss priorities for mobile mental health into the future.

Therapeutic effects of vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder.

Abstract: Objective:To compare the therapeutic effects of vitamin D3 plus fluoxetine and fluoxetine alone in patients with major depressive disorder.Methods:In the present double-blind, randomized, placebo-controlled trial, 42 patients with a diagnosis of major depressive disorder based on DSM-IV criteria were randomly assigned into two groups to receive daily either 1500 IU vitamin D3 plus 20 mg fluoxetine or fluoxetine alone for 8 weeks. Depression severity was assessed at 2-week intervals using the 24-item Hamilton Depression Rating Scale (HDRS) as a primary outcome measure and the 21-item Beck Depression Inventory (BDI) as a secondary outcome measure. Serum 25(OH) vitamin D was measured at baseline and after intervention.Results:Forty patients completed the trial. A two-way repeated-measures analysis of variance showed that depression severity based on HDRS and BDI decreased significantly after intervention, with a significant difference between the two groups. The vitamin D + fluoxetine combination was signifi...

Ketamine as a new treatment for depression: A review of its efficacy and adverse effects:

Abstract: Objective: Narrative review of the literature on the efficacy and safety of subanaesthetic doses of ketamine for the treatment of depression. Method: Medline and PubMed databases were searched up to October 2012 using appropriate keywords. Results: The studies consistently report substantial efficacy with high response and remission rates from 4 to 72 hours (averages 77% and 43%, respectively) from single doses, though not all patients respond to ketamine. Early relapse is common. While the usual procedure involves the administration of intravenous ketamine at a dose of 0.5 mg/kg over 40 minutes, some preliminary evidence suggests other dosing regimens and routes of administration may be useful or even better. Repeated doses and maintenance pharmacological treatments have been investigated in order to prolong the antidepressant effects, with only modest success. Conclusions: Current research on the antidepressant effects of ketamine has consistently shown rapid and substantial improvement in mood in the majority of patients. However, these effects have often been found to be short-lived. Future research should focus on identifying predictors of response (e.g. clinical, genetic, pharmacokinetic, environmental), examining different dosing regimens and routes of administration, and strategies to maintain the antidepressant response.

Systematic meta-analysis of individual selective serotonin reuptake inhibitor medications and congenital malformations.

Abstract: Context:It has been suggested that the commonly prescribed class of antidepressants selective serotonin reuptake inhibitors (SSRIs) are associated with birth defects. However, the teratogenic effec...

Pharmacotherapy of obsessive-compulsive disorder: evidence-based treatment and beyond.

Abstract: Background:Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder associated with a significant degree of functional disability and poor quality of life. Pharmacotherapy may have a subs...

Prevention of common mental disorders: What can we learn from those who have gone before and where do we go next?:

Abstract: ObjectivePrevention strategies have made a major contribution to the considerable successes in reductions in cardiovascular disease and cancer mortality seen in recent decades. However, in the fiel...

Effectiveness of psychoeducation for depression: A systematic review

Abstract: Objective:Pharmacological treatment is considered indispensable to major depressive disorder. In spite of this, a significant number of patients do not respond adequately to treatment based only on medication, presenting high relapse and recurrence rates. Therefore, psychosocial interventions, such as psychoeducation, have been increasingly recognized as an essential component in the treatment of depression, associated with pharmacological strategies. Thus, the aim of the present systematic review was to evaluate the effectiveness of psychoeducation for patients with unipolar depression, analyzing the evidence from the literature.Method:Searches were undertaken from April to October 2012 in LILACS, PsycINFO, PubMed, SCOPUS and ISI Web of Knowledge with keywords including ‘psychoeducation’, ‘psychoeducational intervention’ and ‘depression’, with no restriction regarding publishing dates.Results:Fifteen studies were included in the review, 13 of which evaluated the effectiveness of psychoeducation for patie...

The relationship between psychosocial functioning and resilience and negative symptoms in individuals at ultra-high risk for psychosis

Abstract: Objective:Decline in psychosocial functioning seems to be a core feature in schizophrenia across various phases of the disorder. Little is known about the relationship between psychosocial functioning and protective factors or psychopathologies in individuals in the prodrome phase of psychosis. We aimed to investigate whether psychosocial functioning is impaired in individuals in the putative prodromal phase of schizophrenia, and, if so, to identify factors associated with compromised psychosocial functioning.Method:Sixty participants at ultra-high risk (UHR) for psychosis and 47 healthy controls were recruited. All subjects were assessed in terms of psychosocial functioning using the Quality of Life Scale. A clinical assessment of psychopathology and protective factors, including resilience and coping style, was also conducted.Results:Psychosocial functioning in UHR participants was found to be compromised; this dysfunction was associated with negative symptoms, adaptive coping, and resilience. In additi...

Immune dysregulation and autoimmunity in bipolar disorder: Synthesis of the evidence and its clinical application.

Abstract: Objective:Increasing evidence suggests that inflammation and immune dysregulation play an important role in the pathogenesis of bipolar disorder. Because the brain can be affected by various autoim...

Cognitive remediation as a treatment for major depression: A rationale, review of evidence and recommendations for future research.

Abstract: Objective:There is considerable literature regarding the effectiveness of cognitive remediation (CR) in schizophrenia and in conditions such as stroke and traumatic brain injury. Patients with majo...

A controlled study of agoraphobia and the independent effect of virtual reality exposure therapy.

Abstract: Objectives:Past controlled clinical trials centred on virtual reality exposure therapy (VRET) for agoraphobia mostly used multicomponent therapy with success. However, the present paper aimed to evaluate the independent effect of VRET for agoraphobia.Methods:A controlled study involving 18 agoraphobic participants assigned to two groups: VRET only and VRET with cognitive therapy. Nine specific virtual environments were developed using an affordable game level editor.Results:Questionnaires, behavioural tests and physiological measures indicated a positive effect of VRET. Correlations supported the predictive value of presence towards treatment outcome. The addition of cognitive therapy did not provide significant additional benefit.Conclusions:Overall, the isolated effects of VRET did not seem to be significantly less than the effects of VRET combined with cognitive therapy. Future research should explore the use of other components in addition to cognitive therapy and VRET for agoraphobia as well as its p...

Internet-delivered cognitive behavioural therapy for depression: a feasibility open trial for older adults

Abstract: Background:Depression is an important health issue amongst older adults. Internet-delivered cognitive behaviour therapy (iCBT) may help to reduce barriers and improve access to treatment, but few studies have examined its use with older adults. The present study evaluated the efficacy, acceptability and feasibility of a brief iCBT program, the Managing Your Mood Program, to treat depression amongst adults aged 60 years and older.Method:Using an open trial design, 20 participants with elevated symptoms of depression (Patient Health Questionnaire 9-item (PHQ-9) total scores ≥ 10) received access to five educational lessons and homework summaries, additional resources, a moderated discussion forum and weekly telephone or email contact from a clinical psychologist. Eighty percent of the sample met diagnostic criteria for a major depressive episode at pre-treatment.Results:Completion rates and response rates were high, with 16/20 participants completing the five lessons within the 8 weeks, and post-treatment a...

Obsessive-compulsive personality disorder co-occurring with obsessive-compulsive disorder: Conceptual and clinical implications.

Abstract: Objectives:There are ongoing uncertainties in the relationship between obsessive–compulsive disorder (OCD) and obsessive–compulsive personality disorder (OCPD). This study aimed to test the proposition that OCPD may be a marker of severity of OCD by comparing groups of OCD individuals with and without OCPD on a number of variables.Method:A total of 148 adults with a principal diagnosis of OCD were administered the Mini International Neuropsychiatric Interview, Yale–Brown Obsessive–Compulsive Scale, Sheehan Disability Scale, Vancouver Obsessional Compulsive Inventory and Symptom Checklist 90-Revised. Participants with a DSM-IV diagnosis of OCPD were compared with those without OCPD.Results:Some 70 (47.3%) participants were diagnosed with OCPD. The groups of participants with and without OCPD did not differ significantly with respect to any of the demographic variables, clinician-rated severity of OCD, levels of disability and mean age of onset of OCD. All self-rated OCD symptom dimensions except for contam...

The role of inflammatory cytokines on the aetiopathogenesis of depression

Abstract: Objective:The primary focus of this review is to provide an overview of the role of inflammation in the development of depression. The article will describe how inflammatory cytokines contribute to depression via action on three major pathways in the brain: the neuroendocrine; neurotransmitter depletion; and neuroprogression pathways.Methods:An online literature search was carried out in July 2012. Original articles and reviews were selected if they discussed the role of inflammation on the development of depression.Results:There is a large body of current research on the role of inflammatory cytokines on the development of depression. Cytokines have been found to interact with different pathways in the brain, and may contribute to the development of depression. Cytokines cause hypercortisolaemia by dysregulation of the hypothalamic–pituitary–adrenal axis directly by activating it and indirectly by modifying glucocorticoid receptor sensitivity to cortisol leading to cortisol hypersecretion. Cytokines depl...

State of the e-mental health field in Australia: Where are we now?:

Abstract: Objective:E-mental health technologies are increasing rapidly, both in number and in utilisation by consumers, health systems and researchers. This review aimed to: (i) examine the features and scientific evidence for e-mental health programs; (ii) describe the growth in these programs in the past decade, and track the extent and quality of scientific research over time; and (iii) examine Australian and international contribution to the field.Method:Two types of e-mental health programs; ‘web interventions’ and mobile applications’; targeting depression, bipolar disorder, generalised anxiety disorder, social anxiety, panic disorder and general stress were included. Data were collected from the Beacon website (www.beacon.anu.edu.au; last updated July 2011). Features of each program and their supporting scientific evidence were coded.Results:In total, 62 web interventions and 11 mobile applications were identified. Half of these were developed in Australia. The majority of programs were aimed towards adults...

Mitochondrial modulators for bipolar disorder: a pathophysiologically informed paradigm for new drug development.

Abstract: Objectives:Bipolar patients frequently relapse within 12 months of their previous mood episode, even in the context of adequate treatment, suggesting that better continuation and maintenance treatments are needed. Based on recent research of the pathophysiology of bipolar disorder, we review the evidence for mitochondrial dysregulation and selected mitochondrial modulators (MM) as potential treatments.Methods:We reviewed the literature about mitochondrial dysfunction and potential MMs worthy of study that could improve the course of bipolar disorder, reduce subsyndromal symptoms, and prevent subsequent mood episodes.Results:MM treatment targets mitochondrial dysfunction, oxidative stress, altered brain energy metabolism and the dysregulation of multiple mitochondrial genes in patients with bipolar disorder. Several tolerable and readily available candidates include N-acetyl-cysteine (NAC), acetyl-L-carnitine (ALCAR), S-adenosylmethionine (SAMe), coenzyme Q10 (CoQ10), alpha-lipoic acid (ALA), creatine mono...

Should long-acting (depot) antipsychotics be used in early schizophrenia? A systematic review.

Abstract: Background:The relapse rate after a first episode of schizophrenia is high, often due to non-adherence with medication. Long-acting injections of antipsychotics (LAI) are used to promote adherence to medication.Objective:To review the literature on the use of LAIs in first-episode and early schizophrenia.Method:A systematic electronic search of all original data containing peer-reviewed studies published in English using EMBASE, MEDLINE, Cochrane and PsychINFO from the onset of records. Reference lists from retrieved articles were examined for further relevant studies.Results:Ten studies were identified: two cohort studies; three randomised controlled trials; and five open studies. These studies, although limited, demonstrated the effectiveness of LAI in early schizophrenia. Seven of the 10 studies had risperidone long-acting injection as the only LAI.Conclusion:LAIs may be useful in the treatment of early schizophrenia in terms of symptom control and relapse reduction, particularly if chosen by the patie...

A preliminary investigation on the efficacy of N-acetyl cysteine for mania or hypomania

Abstract: Objective:Oxidative imbalance has emerged as a treatment target in bipolar disorder. As very limited data are available on the clinical use of antioxidants for mania, we report here results from a ...

Issues for DSM-5: video-gaming disorder?

Abstract: Australian & New Zealand Journal of Psychiatry, 47(1) Internet addiction is a contentious disorder (Pies, 2009). To date, addiction researchers have questioned its construct validity (Shaffer et al., 2000); the precision of definitional criteria (Blaszczynski, 2008; Czincz and Hechanova, 2009); clinical formulation and overlap with other addictive disorders (Sim et al., 2012); aetiology and risk factors (Kuss and Griffiths, 2012); and, the quality of intervention studies (King et al., 2011, 2012). Vladan Starcevic’s insightful commentary (Starcevic, 2012) continues this line of critical analysis. Starcevic highlights in particular that there is no clear consensus as to whether internet addiction ‘exists’, given the variability in terminology, methodology and psychometric measurement used across studies. Recent developments in regard to the DSM-5 have significant bearing on this debate. On 1 May 2012, the DSM-5 Task Force and Work Groups proposed that internet use disorder, which refers primarily to maladaptive video-gaming (or ‘internet gaming’) behaviour, should be included in Section III of the DSM-5 as the subject of further empirical inquiry. The proposed DSM-5 category of internet use disorder was intended to provide greater clarity to the clinical formulation of internet-related disorders. However, we argue that, in practice, this diagnostic category may promote further confusion with its conflation of video-gaming and internet use for other purposes. The lack of a standard definition for internet-related disorders has led to conflicting accounts of the underlying pathology and its symptoms, and how it should be diagnosed or measured (Griffiths, 2008; Weinstein and Lejoyeux, 2010; Wood, 2008). Thus, while many researchers in the field have called for consensus on the criteria for internet-related disorders, they have meanwhile created their own distinct model of the disorder, often with an accompanying assessment tool. By our count, over a dozen assessment tools for problematic video-gaming have been used in research studies since the year 2000. Starcevic provides an example of this divergence in assessment in citing research by his colleagues on ‘problem video game use’ (PVGU) (Porter et al., 2010). He notes that PVGU criteria differ from prevailing models of ‘excessive’ and ‘pathological’ videogaming. Specifically, the PVGU concept does not refer to tolerance (i.e., the process whereby increasing amounts of video-game play are required to achieve the former moodmodifying effects). Starcevic argues that it is not clear whether tolerance is associated with video-gaming behaviour, and states that the research evidence is ‘equivocal’. To our knowledge, at least three widely used instruments of pathological video-gaming assess tolerance (i.e., Problem Videogame Playing Scale (Salguero and Moran, 2002), Game Addiction Scale (Lemmens et al., 2009), Online Game Addiction Scale for Adolescents (Wan and Chiou, 2006)). Therefore, divergent evidence on tolerance in video-gaming may be a reflection of the fact that differing assessment tools have been used across studies, some of which measure tolerance and some of which do not, rather than representing a true division in empirical findings. This again highlights the difficulty in comparing research findings when different definitions are employed, and thus the need for a standardised approach to classification of internet-related disorders. Another important theoretical issue raised by Starcevic is that internet addiction is a misnomer because it refers to an addiction to a ‘delivery mechanism’. In particular, he states:

Persistent sleep disturbance is associated with treatment response in adolescents with depression

Abstract: Background:Sleep disturbances are highly prevalent in adolescents with depressive disorders. To date there is limited evidence of the extent to which sleep disturbances are associated with treatment response in adolescents. This study aimed to examine the extent to which self-reported sleep disturbances are associated with treatment response in adolescents with depression.Method:Sleep data were gathered from a sample of 166 adolescents (aged 12–18 years) with a diagnosis of a DSM-IV depressive disorder who underwent 3 months of treatment (psychosocial and/or pharmacotherapy (sertraline)) in community-based research programs. The subjective report of sleep disturbance within depressive disorders was assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children at three time points: pre-treatment, post-treatment and 6-month follow-up.Results:Sixty-nine percent of participants had a sleep disturbance pre-treatment and approximately 75% of these participants had threshol...

Family psycho-education for people with schizophrenia and other psychotic disorders and their families:

Abstract: Australian & New Zealand Journal of Psychiatry, 47(6) Family psycho-education (FPE) is arguably the most researched psychosocial intervention for the treatment of psychosis with a robust evidence base with great potential to deliver improved outcomes for consumers and their families. Despite recommendation in treatment guidelines, available evidence suggests very limited availability of FPE and modest uptake in mental health settings even after targeted training and follow-up support. We argue that the emerging field of implementation science provides a framework for integrating existing knowledge about implementing FPE and identifying new opportunities for achieving practice change and realising the potential of FPE.

A review of social inclusion measures.

Abstract: Background:Social inclusion is crucial to mental health and well-being and is emphasised in Australia’s Fourth National Mental Health Plan. There is a recognition that a measure of social inclusion would complement the suite of outcome measures that is currently used in public sector mental health services. This paper is an initial scope of candidate measures of social inclusion and considers their suitability for this purpose.Methods:We identified potential measures through searches of PsycINFO and Medline and a more general Internet search. We extracted descriptive and evaluative information on each measure identified and compared this information with a set of eight criteria. The criteria related to the measure’s inclusion of four domains of social inclusion outlined in Australia’s Fourth National Mental Health Plan, its usability within the public mental health sector and its psychometric properties.Results:We identified 10 candidate measures of social inclusion: the Activity and Participation Questio...

Co-occurring mental disorder and intellectual disability in a large sample of Australian prisoners

Abstract: Objective:Prisoners with intellectual disability who have a coexisting mental health issue often have unmet health needs and are more likely to reoffend than those with intellectual disability alon...

The relationship between excessive daytime sleepiness and depressive and anxiety disorders in women.

Abstract: Objective:Excessive daytime sleepiness (EDS) is a common clinical symptom that affects women more than men. However, the association of excessive sleepiness with depressive and anxiety disorders in the broader population is unclear. The aim of this study was, therefore, to examine the association between excessive daytime sleepiness as measured by the Epworth Sleepiness Scale, and depressive and anxiety disorders in a population-based sample of women.Methods:Using the Structured Clinical Interview for DSM-IV Disorders (Non-Patient) (SCID-I/NP), 944 women aged 20–97 years (median 49 years, IQR 33–65 years) were assessed for depressive and anxiety disorders as part of the Geelong Osteoporosis Study. EDS was assessed using the Epworth Sleepiness Scale (ESS, cut-off > 10). Lifestyle factors were documented by self-report, height and weight were measured, and socioeconomic status categorised according to the Index of Relative Socio-Economic Advantage and Disadvantage.Results:Overall, 125 (13.2%) of the women w...

Gray matter abnormalities as brain structural vulnerability factors for bipolar disorder: A review of neuroimaging studies of individuals at high genetic risk for bipolar disorder.

Abstract: Objective:Cortical and subcortical gray matter abnormalities have been reported in individuals at high genetic risk for bipolar disorder, but the findings are inconsistent. The aim of this study wa...