Elizabeth Scott - Profile on Academia.edu (original) (raw)
Papers by Elizabeth Scott
Biological Psychiatry, 2018
, treatment resistance; personality: NEO-FFI, affective neuroscientific personality scale, ANPS) ... more , treatment resistance; personality: NEO-FFI, affective neuroscientific personality scale, ANPS) were assessed with student's t-test or X2 Test and with Spearmen's correlation coefficient. Non-responders/dropouts were analyzed with descriptive methods. Results: Strong responders did not differ in demographic or clinical characteristics from week responders. Response was not correlated with variables of severity, chronicity or treatment resistance but with a reduced CARE dimension (ANPS) (r¼-0.643, p¼ 0.007). Nonresponse/dropout was associated with intracranial bleeding (n¼1); methylphenidate abuse (n¼2), acute social stressors (n¼1), narcissistic personality disorder (n¼1). Conclusions: A high percentage of responders was found in this study. Typical predictors of response did not explain response status because this sample was highly selected and homogeneous. All patients were severely, chronically depressed and very treatment-resistant. Patients with melancholic or atypical depression, suffering from unipolar or bipolar disorder had a similar high chance of response to slMFB-DBS. Comorbidities (e.g. personality disorder, addiction) could be relevant factors in future studies but were excluded.
Medical Journal of Australia, 2001
To determine in pat ients attending qenerat pra ctice 1) the extent of comorbidity of mental d is... more To determine in pat ients attending qenerat pra ctice 1) the extent of comorbidity of mental d isorde rs and alcohol or othe r substance misuse , and consequent disability ; and 2) GPs' diagnosis and management of patients with comorbidity. Design an d se tting: Cross-sectional national audit of gene ral practices throughout Australia in 1998-1999. Parti cipan ts : 46 5 15 ambulatory ca re patients attending 386 GP s. Sc reen ing to ols : Prevalence of common mental disorde rs-12 items from the 34-item SP HERE se lf-report questionnaire and associated cla ss ificat ion system ; prevalence of alcohol o r other substance m isuse-two self-report screening questions, defining "probable " misuse (a positive response to both questions) and "possible" misuse (a positive response to one of the questions); disability-four items from the Brief Disability Questionna ire , and selfreported "days out of role" and "days in bed " in the past mon th; and rates of psychological diagnosis, treatment and referr al by G Ps , and GPs' rating of patients' psychological risk. Main o utcome measures : Comorbidity of mental disorders and alcohol or other substance misuse; disability; and cor rela tion with G Ps' diagnosis and management. Results : The sc reening questions revealed possible alc oho l or othe r substance misuse in 11% of patients (517 1/46515), and probable misuse in an additional 8% of patients (3593/46 515). Comorbidity of mental d isorde rs and substance misuse occu rred in 12% (5672/46 515) of patients. Patients with comorbidity (co mpared wi th those with alcohol or other substance misuse alone) were: more disabled-mean "days ou t of role in the last month". 8.4 (95% Cl , 7 .7-9.1) v 3 .6 (95% CI, 2.9-4 .3); at greate r psychological risk (as rated by GPs)-22 % v 7% , respectiv ely ; more frequently given psychological diagnoses by GPs-51% v 2 1%; more frequently trea ted for a psychological cond ition by GP s-47 % v 17%; and • more fre quently referred to men tal hea lth specialists by GP s-9% v 2% , Conclusio n: Comorbidily of men tal disorders and alcohol or othe r substance misuse is com mon in patients attending general practice , and results in considerable disability. Such patients receive inadequate attention (diagnosis and management) from GP s. G Ps identifyi ng one of these two ty pes of behaviour disorde r in a patient should ascertain wh ethe r the ot her type is also present.
Effects of mental health training and clinical audit on general practitioners' management of common mental disorders
Medical Journal of Australia, 2001
To evaluate the effects of a seminar-based training program and clinical practice audit on genera... more To evaluate the effects of a seminar-based training program and clinical practice audit on general practitioners' (GPs') knowledge and management of common mental disorders. Survey of GPs' knowledge before and after training, and clinical practice audit and re-audit after feedback. GP volunteers from around Australia in 1998-1999: 1008 completed the pre-training test, 190 the post-training test, 386 the first audit (33235 patients), and 157 of these the re-audit (13280 patients), with 57 undertaking both audit and training. Four-seminar, 12-hour training program focused on improving GPs' capacity to identify and manage patients with depression and anxiety; practice audit with patient- and practice-based feedback on diagnosis and treatment of common mental disorders. Scores on pre- and post-training knowledge tests; self-rated improvements in confidence in managing patients with mental disorders after training; rates of psychological diagnoses and treatment by GPs on first audit and re-audit. GPs' knowledge of pharmacological treatments and clinical management improved after the training program (P<0.001), and 97% of GPs reported increased confidence in their management skills. GPs who undertook training had higher diagnosis rates for common mental disorders in the first audit than those who did not undertake training (36% versus 29%; P<0.001), and their diagnosis rates increased over time (36% to 39%; P<0.01), while those of GPs who did not undertake training were unchanged. Similarly, GPs who undertook training provided more mental health treatments than those who did not (30% versus 27% in the first audit [P<0.001], and 31% versus 24% at reaudit [P<0.001]). They also place greater emphasis on use of nonpharmacological treatments (24% versus 21% at first audit [P<0.001], and 25% versus 19% at re-audit [P<0.001]). Clinical audits may heighten awareness of mental disorders, but, on their own, they do not improve mental health practice. A relatively brief but skills-based training program may contribute to better management of patients with common mental disorders by increasing GPs' confidence and competence.
BMJ Open, 2019
ObjectivesTo report the distribution and predictors of insulin resistance (IR) in young people pr... more ObjectivesTo report the distribution and predictors of insulin resistance (IR) in young people presenting to primary care-based mental health services.DesignCross-sectional.SettingHeadspace-linked clinics operated by the Brain and Mind Centre of the University of Sydney.Participants768 young people (66% female, mean age 19.7±3.5, range 12–30 years).Main outcome measuresIR was estimated using the updated homeostatic model assessment (HOMA2-IR). Height and weight were collected from direct measurement or self-report for body mass index (BMI).ResultsFor BMI, 20.6% of the cohort were overweight and 10.2% were obese. However, <1% had an abnormally high fasting blood glucose (>6.9 mmol/L). By contrast, 9.9% had a HOMA2-IR score >2.0 (suggesting development of IR) and 11.7% (n=90) had a score between 1.5 and 2. Further, there was a positive correlation between BMI and HOMA2-IR (r=0.44, p<0.001). Participants in the upper third of HOMA2-IR scores are characterised by younger age...
Frontiers in Neuroscience, 2017
Myo-inositol, a second messenger glucose isomer and glial marker, is potentiated by melatonin. In... more Myo-inositol, a second messenger glucose isomer and glial marker, is potentiated by melatonin. In addition to common abnormalities in melatonin regulation, depressive disorders have been associated with reduced myo-inositol in frontal structures. This study examined associations between myo-inositol in the anterior cingulate cortex and the timing of evening melatonin release. Forty young persons with unipolar depression were recruited from specialized mental health services (20.3 ± 3.8 years old). Healthy controls were recruited from the community (21.7 ± 2.6 years old). The timing of dim light melatonin onset (DLMO) was estimated using salivary melatonin sampling. Myo-inositol concentrations (MI/CrPCr ratio) in the anterior cingulate cortex were obtained using proton magnetic resonance spectroscopy. After controlling for age, sex, and CrPCr concentration the depression group had significantly lower MI/CrPCr ratios than healthy controls [F (4, 75) = 11.4, p = 0.001]. In the depression group, later DLMO correlated with lower MI/CrPCr ratio (r = −0.48, p = 0.014). These findings suggest that neurochemical changes in the frontal cortex are associated with circadian disruptions in young persons with depression.
European archives of psychiatry and clinical neuroscience, Jan 29, 2017
Fronto-limbic connectivity is compromised in mood disorders, as reflected by impairments in white... more 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, hippocampus), fornix, stria terminalis (ST) and uncinate fasciculus tracts. GSH concentration was measured in anterior cingulate cortex (ACC) and hippocampus (HIPP). Compared to controls, DEP showed significantly reduced FA in ST, where...
International journal of bipolar disorders, 2016
Circadian rhythm disturbances overlap with the symptoms of mood episodes and may trigger or prolo... more Circadian rhythm disturbances overlap with the symptoms of mood episodes and may trigger or prolong mood symptoms. There is limited research on the role of circadian disturbances in mood disorders in young people and/or first episode cases of unipolar and bipolar disorders. Actigraphy was undertaken for about 14 days in 63 post-pubertal individuals aged 13-25 years with a recent onset of a mood disorder meeting recognised diagnostic criteria. We examined associations between three easily interpretable markers of circadian rhythm activity (amplitude, acrophase and rhythmicity index) and demography and clinical characteristics. Then, circadian markers were compared between diagnostic groups, controlling for potential confounders. Longer duration of illness was correlated with reduced circadian rhythmicity and lower levels of activity over 24 h. A delay in the timing of maximum activity was associated with the level of manic but not depressive symptoms. The circadian rhythmicity index ...
The Lancet Psychiatry, 2015
Depression, schizophrenia, and bipolar disorder are three of the four most burdensome problems in... more Depression, schizophrenia, and bipolar disorder are three of the four most burdensome problems in people aged under 25 years. In psychosis and depression, psychological interventions are effective, low-risk, and high-benefit approaches for patients at high risk of first-episode or earlyonset disorders. We review the use of psychological interventions for early-stage bipolar disorder in patients aged 15-25 years. Because previous systematic reviews had struggled to identify information about this emerging sphere of research, we used evidence mapping to help us identify the extent, distribution, and methodological quality of evidence because the gold standard
International journal of bipolar disorders, 2013
Distress and/or dysfunction are well established as key reasons for help-seeking. We explore the ... more 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). Individuals 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 sample 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 signif...
BMC psychology, 2013
Clinical staging of mental disorders proposes that individuals can be assessed at various sub-syn... more Clinical staging of mental disorders proposes that individuals can be assessed at various sub-syndromal and later developed phases of illness. As an adjunctive rating, it may complement traditional diagnostic silo-based approaches. In this study, we sought to determine the relationships between clinical stage and neuropsychological profile in young persons presenting to youth-focused mental health services. Neuropsychological testing of 194 help-seeking young people (mean age 22.6 years, 52% female) and 50 healthy controls. Clinical staging rated 94 persons as having an 'attenuated syndrome' (stage 1b) and 100 with a discrete or persistent disorder (stage 2/3). The discrete disorder group (stage 2/3) showed the most impaired neuropsychological profile, with the earlier stage (1b) group showing an intermediate profile, compared to controls. Greatest impairments were seen in verbal memory and executive functioning. To address potential confounds created by 'diagnosis',...
The British journal of psychiatry : the journal of mental science, 2014
Between 30 and 60% of adults with unipolar or bipolar disorders exhibit impairments across multip... more Between 30 and 60% of adults with unipolar or bipolar disorders exhibit impairments across multiple domains. However, little is known about impaired functioning in youth with mood disorders. To examine the prevalence of objective, subjective and observer-rated disability in a large, representative sample of young people with a primary mood disorder. Individuals aged 16-25 years presenting to youth mental health services for the first time with a primary mood disorder participated in a systematic diagnostic and clinical assessment. Impairment was assessed using objective (unemployment or disability payments), observer- (Social and Occupational Functioning Assessment Scale; SOFAS) and self-rated measures (role functioning according to the Brief Disability Questionnaire). Of 1241 participants (83% unipolar; 56% female), at least 30% were functionally impaired on the objective, self-rated and/or observer-rated measures, with 16% impaired according to all three criteria. Even when curren...
BMJ open, Jan 23, 2014
Youth with mental health problems often have difficulties engaging in education and employment. I... more Youth with mental health problems often have difficulties engaging in education and employment. In Australia, youth mental health services have been widely established with a key aim of improving role functioning; however, there is little knowledge of those who are not engaged in employment, education or training (NEET) and the factors which may influence this. This study aimed to examine NEET status and its correlates in a sample of such youth. Cross-sectional data from a longitudinal cohort study. Between January 2011 and August 2012, young people presenting to one of the four primary mental health centres in Sydney or Melbourne were invited to participate. Young adults (N=696) aged between 15 and 25 years (M=19.0, SD=2.8), 68% female, 58% (n=404) attended headspace in Sydney. Individuals 'Not in any type of Education, Employment or Training' in the past month were categorised as NEET. Demographic, psychological and clinical factors alongside disability and functioning wer...
Translational Psychiatry, 2013
Schizophrenia Research, 2013
Previous research has suggested that psychotic symptoms are associated with impairments in social... more Previous research has suggested that psychotic symptoms are associated with impairments in social cognition. However, there is limited research evaluating this association in the context of younger patients with a broad range of mental health problems. In the present study, we evaluated social cognitive performance in 115 treatment-seeking participants who presented to a youth mental health service with affective or psychotic disturbances. Participants completed symptom severity measures, a social cognition task (the Reading the Mind in the Eyes Test (RMET)), and a standardised battery of neuropsychological tests. Analyses based on diagnostic groups showed that patients with psychotic illnesses (n = 23) showed impaired performance on the RMET compared to patients with primarily bipolar (n = 40) and depressive illnesses (n = 52). Performance on the RMET was negatively correlated with positive and negative psychotic symptoms, but not affective and anxiety symptoms. Performance on the RMET also was the strongest concurrent predictor of positive psychotic symptoms in a regression model that also included predicted intelligence, demographic variables, and neurocognition. RMET performance did not, however, predict negative symptoms above tests of sustained attention and verbal learning, nor was performance associated with any other symptoms of mental illness. Social cognitive impairments may provide a valuable marker for the presence of positive psychotic symptoms in young people with mental illness. Additionally, these impairments may have a role in the aetiology and maintenance of psychotic symptoms. Research is now needed to establish the nature of the relationship between social cognition and psychotic symptoms across different facets of social cognition. Research is also needed to investigate whether targeted social cognition treatments reduce risk for the development of positive psychotic symptoms.
Journal of the International Neuropsychological Society, 2011
Early stages of affective or psychotic disorders may be accompanied by neuropsychological changes... more Early stages of affective or psychotic disorders may be accompanied by neuropsychological changes that help to predict risk of developing more severe disorders. A comprehensive set of neuropsychological measures was collected in 109 help-seeking young people (16 to 30 years; 54 females), recently diagnosed with an affective or psychotic disorder and presenting with current depression. Hierarchical cluster analysis determined three clusters: one deemed to have a “poor memory” profile (n = 40); another with a “poor mental flexibility” profile (n = 38) and a third with widespread difficulties plus “impaired attention and memory” (n = 31). In general, the three clusters were comparable in demographic, functional and clinical factors suggesting some unique role for neurocognitive impairments. A discriminant function analysis confirmed that the clusters were best characterized by performance in “attentional” versus “learning/memory” measures. Furthermore, profiles of independent neuropsyc...
Journal of Psychiatric Research, 2013
Oxidative stress has recently been reported to assume a significant role in the pathophysiology o... more Oxidative stress has recently been reported to assume a significant role in the pathophysiology of bipolar disorder. Several studies have demonstrated the replenishment of glutathione (GSH) diminishes oxidative cellular damage and ameliorates depressive symptoms in this disorder. Whilst the mechanism by which GSH exerts any clinical effect is unknown it has been proposed that it involves the bolstering of antioxidant defences by increasing the bioavailability of GSH, which in turn reverses clinical symptoms of depression. Such a proposal is predicated on the implicit assumption that GSH is diminished in these patients prior to GSH supplementation. However hitherto no study has reported in vivo measures of GSH in patients with bipolar disorder. Using magnetic resonance spectroscopy we obtained in vivo measures of GSH in young people with bipolar disorder and contrasted these with matched healthy controls. Young people with bipolar disorder were found to have no diminution in baseline GSH concentration and, furthermore, no significant correlations were found between GSH and clinical scores of depression or mania. The results do not support the hypothesis that oxidative stress is involved in the primary pathophysiology of bipolar disorder.
Journal of Affective Disorders, 2011
Background: Although there is growing recognition that disability emerges early in the course of ... more Background: Although there is growing recognition that disability emerges early in the course of psychotic disorders, it is unclear whether young people with early stages of anxiety or affective disorders are similarly affected. This study examined patient self-reported disability in young people attending a designated early intervention service. Methods: Cross-sectional study comparing new headspace patients on self-reported measures of disability and distress (Kessler-10, Work and Social Adjustment Scale, and Brief Disability Questionnaire) with clinician-rated diagnosis and clinical stage. Results: Data from 330 participants with an average age of 16.8 years (50.0% male) was analysed and demonstrated high levels of psychological distress and disability in the overall group. Higher levels of self-reported psychological distress and disability were associated with affective disorder diagnosis and increased with advancing clinical stage. Female gender and younger age also predicted affective disorder diagnosis. Limitations: Clinician-rated participant disability was obtained via a single global measure (SOFAS) and not a systematic assessment. Additionally, data collected was cross-sectional and collected at intake only. Longitudinal assessment of clinical features and disability is required to map changes in disability over time. Conclusions: Surprisingly high levels of psychological distress and disability are apparent in young people presenting to early intervention services. Data suggests that distress and disability in those with anxiety is less than for affective disorder. Results also suggest that clinical staging approaches capture the increasing disability associated with illness progression. The obtained results highlight the need for interventions that specifically target disability, rather than just symptoms of mental health problems.
Journal of Affective Disorders, 2010
Background: Neuropsychological deficits in depression include difficulties with psychomotor speed... more Background: Neuropsychological deficits in depression include difficulties with psychomotor speed, executive functions and memory. Some of these changes persist despite antidepressant treatment. While research in other areas of psychiatry has shown cognitive training techniques to be effective, only one study has evaluated this approach in depression. Methods: Sixteen patients (mean age = 33.5 years) with a lifetime diagnosis of major depressive disorder were administered a standardised battery of neuropsychological tests and allocated to treatment (n = 8) or waitlist control (n = 8) conditions. The treatment consisted of 10-weeks of twice weekly cognitive training using the Neuropsychological Educational Approach to Remediation. All participants were reassessed after 10-weeks by interviewers blinded to group allocation. Results: Participants in the treatment condition demonstrated greater improvements on tests of memory encoding and memory retention than the waitlist control group. There were no observable benefits in terms of psychomotor speed or executive functions or in self-reported levels of disability. Affective symptoms also remained stable. Limitations: This study included a small sample of participants and treatment allocation was not randomised. Conclusions: Cognitive training in affective disorders improves memory performance. It may be an effective non-pharmacological treatment option for improving cognitive functions, which in turn, may improve psychosocial functioning and reduce disability. This study supports theories suggesting cognitive training may promote neuroplasticity.
Journal of Affective Disorders, 2009
Background: Depression in older adults is associated with neuropsychological dysfunction, fronto-... more Background: 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. Methods: 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. Results: 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. Limitations: This study was retrospective in nature, and did not include objective measures of sleep. Conclusions: 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.
Managing depression across the life cycle: new strategies for clinicians and their patients
Internal Medicine Journal, 2009
Depression is the leading cause of non-fatal disease burden in Australia. Recently, increasing pu... more 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.
Biological Psychiatry, 2018
, treatment resistance; personality: NEO-FFI, affective neuroscientific personality scale, ANPS) ... more , treatment resistance; personality: NEO-FFI, affective neuroscientific personality scale, ANPS) were assessed with student's t-test or X2 Test and with Spearmen's correlation coefficient. Non-responders/dropouts were analyzed with descriptive methods. Results: Strong responders did not differ in demographic or clinical characteristics from week responders. Response was not correlated with variables of severity, chronicity or treatment resistance but with a reduced CARE dimension (ANPS) (r¼-0.643, p¼ 0.007). Nonresponse/dropout was associated with intracranial bleeding (n¼1); methylphenidate abuse (n¼2), acute social stressors (n¼1), narcissistic personality disorder (n¼1). Conclusions: A high percentage of responders was found in this study. Typical predictors of response did not explain response status because this sample was highly selected and homogeneous. All patients were severely, chronically depressed and very treatment-resistant. Patients with melancholic or atypical depression, suffering from unipolar or bipolar disorder had a similar high chance of response to slMFB-DBS. Comorbidities (e.g. personality disorder, addiction) could be relevant factors in future studies but were excluded.
Medical Journal of Australia, 2001
To determine in pat ients attending qenerat pra ctice 1) the extent of comorbidity of mental d is... more To determine in pat ients attending qenerat pra ctice 1) the extent of comorbidity of mental d isorde rs and alcohol or othe r substance misuse , and consequent disability ; and 2) GPs' diagnosis and management of patients with comorbidity. Design an d se tting: Cross-sectional national audit of gene ral practices throughout Australia in 1998-1999. Parti cipan ts : 46 5 15 ambulatory ca re patients attending 386 GP s. Sc reen ing to ols : Prevalence of common mental disorde rs-12 items from the 34-item SP HERE se lf-report questionnaire and associated cla ss ificat ion system ; prevalence of alcohol o r other substance m isuse-two self-report screening questions, defining "probable " misuse (a positive response to both questions) and "possible" misuse (a positive response to one of the questions); disability-four items from the Brief Disability Questionna ire , and selfreported "days out of role" and "days in bed " in the past mon th; and rates of psychological diagnosis, treatment and referr al by G Ps , and GPs' rating of patients' psychological risk. Main o utcome measures : Comorbidity of mental disorders and alcohol or other substance misuse; disability; and cor rela tion with G Ps' diagnosis and management. Results : The sc reening questions revealed possible alc oho l or othe r substance misuse in 11% of patients (517 1/46515), and probable misuse in an additional 8% of patients (3593/46 515). Comorbidity of mental d isorde rs and substance misuse occu rred in 12% (5672/46 515) of patients. Patients with comorbidity (co mpared wi th those with alcohol or other substance misuse alone) were: more disabled-mean "days ou t of role in the last month". 8.4 (95% Cl , 7 .7-9.1) v 3 .6 (95% CI, 2.9-4 .3); at greate r psychological risk (as rated by GPs)-22 % v 7% , respectiv ely ; more frequently given psychological diagnoses by GPs-51% v 2 1%; more frequently trea ted for a psychological cond ition by GP s-47 % v 17%; and • more fre quently referred to men tal hea lth specialists by GP s-9% v 2% , Conclusio n: Comorbidily of men tal disorders and alcohol or othe r substance misuse is com mon in patients attending general practice , and results in considerable disability. Such patients receive inadequate attention (diagnosis and management) from GP s. G Ps identifyi ng one of these two ty pes of behaviour disorde r in a patient should ascertain wh ethe r the ot her type is also present.
Effects of mental health training and clinical audit on general practitioners' management of common mental disorders
Medical Journal of Australia, 2001
To evaluate the effects of a seminar-based training program and clinical practice audit on genera... more To evaluate the effects of a seminar-based training program and clinical practice audit on general practitioners' (GPs') knowledge and management of common mental disorders. Survey of GPs' knowledge before and after training, and clinical practice audit and re-audit after feedback. GP volunteers from around Australia in 1998-1999: 1008 completed the pre-training test, 190 the post-training test, 386 the first audit (33235 patients), and 157 of these the re-audit (13280 patients), with 57 undertaking both audit and training. Four-seminar, 12-hour training program focused on improving GPs' capacity to identify and manage patients with depression and anxiety; practice audit with patient- and practice-based feedback on diagnosis and treatment of common mental disorders. Scores on pre- and post-training knowledge tests; self-rated improvements in confidence in managing patients with mental disorders after training; rates of psychological diagnoses and treatment by GPs on first audit and re-audit. GPs' knowledge of pharmacological treatments and clinical management improved after the training program (P<0.001), and 97% of GPs reported increased confidence in their management skills. GPs who undertook training had higher diagnosis rates for common mental disorders in the first audit than those who did not undertake training (36% versus 29%; P<0.001), and their diagnosis rates increased over time (36% to 39%; P<0.01), while those of GPs who did not undertake training were unchanged. Similarly, GPs who undertook training provided more mental health treatments than those who did not (30% versus 27% in the first audit [P<0.001], and 31% versus 24% at reaudit [P<0.001]). They also place greater emphasis on use of nonpharmacological treatments (24% versus 21% at first audit [P<0.001], and 25% versus 19% at re-audit [P<0.001]). Clinical audits may heighten awareness of mental disorders, but, on their own, they do not improve mental health practice. A relatively brief but skills-based training program may contribute to better management of patients with common mental disorders by increasing GPs' confidence and competence.
BMJ Open, 2019
ObjectivesTo report the distribution and predictors of insulin resistance (IR) in young people pr... more ObjectivesTo report the distribution and predictors of insulin resistance (IR) in young people presenting to primary care-based mental health services.DesignCross-sectional.SettingHeadspace-linked clinics operated by the Brain and Mind Centre of the University of Sydney.Participants768 young people (66% female, mean age 19.7±3.5, range 12–30 years).Main outcome measuresIR was estimated using the updated homeostatic model assessment (HOMA2-IR). Height and weight were collected from direct measurement or self-report for body mass index (BMI).ResultsFor BMI, 20.6% of the cohort were overweight and 10.2% were obese. However, <1% had an abnormally high fasting blood glucose (>6.9 mmol/L). By contrast, 9.9% had a HOMA2-IR score >2.0 (suggesting development of IR) and 11.7% (n=90) had a score between 1.5 and 2. Further, there was a positive correlation between BMI and HOMA2-IR (r=0.44, p<0.001). Participants in the upper third of HOMA2-IR scores are characterised by younger age...
Frontiers in Neuroscience, 2017
Myo-inositol, a second messenger glucose isomer and glial marker, is potentiated by melatonin. In... more Myo-inositol, a second messenger glucose isomer and glial marker, is potentiated by melatonin. In addition to common abnormalities in melatonin regulation, depressive disorders have been associated with reduced myo-inositol in frontal structures. This study examined associations between myo-inositol in the anterior cingulate cortex and the timing of evening melatonin release. Forty young persons with unipolar depression were recruited from specialized mental health services (20.3 ± 3.8 years old). Healthy controls were recruited from the community (21.7 ± 2.6 years old). The timing of dim light melatonin onset (DLMO) was estimated using salivary melatonin sampling. Myo-inositol concentrations (MI/CrPCr ratio) in the anterior cingulate cortex were obtained using proton magnetic resonance spectroscopy. After controlling for age, sex, and CrPCr concentration the depression group had significantly lower MI/CrPCr ratios than healthy controls [F (4, 75) = 11.4, p = 0.001]. In the depression group, later DLMO correlated with lower MI/CrPCr ratio (r = −0.48, p = 0.014). These findings suggest that neurochemical changes in the frontal cortex are associated with circadian disruptions in young persons with depression.
European archives of psychiatry and clinical neuroscience, Jan 29, 2017
Fronto-limbic connectivity is compromised in mood disorders, as reflected by impairments in white... more 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, hippocampus), fornix, stria terminalis (ST) and uncinate fasciculus tracts. GSH concentration was measured in anterior cingulate cortex (ACC) and hippocampus (HIPP). Compared to controls, DEP showed significantly reduced FA in ST, where...
International journal of bipolar disorders, 2016
Circadian rhythm disturbances overlap with the symptoms of mood episodes and may trigger or prolo... more Circadian rhythm disturbances overlap with the symptoms of mood episodes and may trigger or prolong mood symptoms. There is limited research on the role of circadian disturbances in mood disorders in young people and/or first episode cases of unipolar and bipolar disorders. Actigraphy was undertaken for about 14 days in 63 post-pubertal individuals aged 13-25 years with a recent onset of a mood disorder meeting recognised diagnostic criteria. We examined associations between three easily interpretable markers of circadian rhythm activity (amplitude, acrophase and rhythmicity index) and demography and clinical characteristics. Then, circadian markers were compared between diagnostic groups, controlling for potential confounders. Longer duration of illness was correlated with reduced circadian rhythmicity and lower levels of activity over 24 h. A delay in the timing of maximum activity was associated with the level of manic but not depressive symptoms. The circadian rhythmicity index ...
The Lancet Psychiatry, 2015
Depression, schizophrenia, and bipolar disorder are three of the four most burdensome problems in... more Depression, schizophrenia, and bipolar disorder are three of the four most burdensome problems in people aged under 25 years. In psychosis and depression, psychological interventions are effective, low-risk, and high-benefit approaches for patients at high risk of first-episode or earlyonset disorders. We review the use of psychological interventions for early-stage bipolar disorder in patients aged 15-25 years. Because previous systematic reviews had struggled to identify information about this emerging sphere of research, we used evidence mapping to help us identify the extent, distribution, and methodological quality of evidence because the gold standard
International journal of bipolar disorders, 2013
Distress and/or dysfunction are well established as key reasons for help-seeking. We explore the ... more 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). Individuals 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 sample 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 signif...
BMC psychology, 2013
Clinical staging of mental disorders proposes that individuals can be assessed at various sub-syn... more Clinical staging of mental disorders proposes that individuals can be assessed at various sub-syndromal and later developed phases of illness. As an adjunctive rating, it may complement traditional diagnostic silo-based approaches. In this study, we sought to determine the relationships between clinical stage and neuropsychological profile in young persons presenting to youth-focused mental health services. Neuropsychological testing of 194 help-seeking young people (mean age 22.6 years, 52% female) and 50 healthy controls. Clinical staging rated 94 persons as having an 'attenuated syndrome' (stage 1b) and 100 with a discrete or persistent disorder (stage 2/3). The discrete disorder group (stage 2/3) showed the most impaired neuropsychological profile, with the earlier stage (1b) group showing an intermediate profile, compared to controls. Greatest impairments were seen in verbal memory and executive functioning. To address potential confounds created by 'diagnosis',...
The British journal of psychiatry : the journal of mental science, 2014
Between 30 and 60% of adults with unipolar or bipolar disorders exhibit impairments across multip... more Between 30 and 60% of adults with unipolar or bipolar disorders exhibit impairments across multiple domains. However, little is known about impaired functioning in youth with mood disorders. To examine the prevalence of objective, subjective and observer-rated disability in a large, representative sample of young people with a primary mood disorder. Individuals aged 16-25 years presenting to youth mental health services for the first time with a primary mood disorder participated in a systematic diagnostic and clinical assessment. Impairment was assessed using objective (unemployment or disability payments), observer- (Social and Occupational Functioning Assessment Scale; SOFAS) and self-rated measures (role functioning according to the Brief Disability Questionnaire). Of 1241 participants (83% unipolar; 56% female), at least 30% were functionally impaired on the objective, self-rated and/or observer-rated measures, with 16% impaired according to all three criteria. Even when curren...
BMJ open, Jan 23, 2014
Youth with mental health problems often have difficulties engaging in education and employment. I... more Youth with mental health problems often have difficulties engaging in education and employment. In Australia, youth mental health services have been widely established with a key aim of improving role functioning; however, there is little knowledge of those who are not engaged in employment, education or training (NEET) and the factors which may influence this. This study aimed to examine NEET status and its correlates in a sample of such youth. Cross-sectional data from a longitudinal cohort study. Between January 2011 and August 2012, young people presenting to one of the four primary mental health centres in Sydney or Melbourne were invited to participate. Young adults (N=696) aged between 15 and 25 years (M=19.0, SD=2.8), 68% female, 58% (n=404) attended headspace in Sydney. Individuals 'Not in any type of Education, Employment or Training' in the past month were categorised as NEET. Demographic, psychological and clinical factors alongside disability and functioning wer...
Translational Psychiatry, 2013
Schizophrenia Research, 2013
Previous research has suggested that psychotic symptoms are associated with impairments in social... more Previous research has suggested that psychotic symptoms are associated with impairments in social cognition. However, there is limited research evaluating this association in the context of younger patients with a broad range of mental health problems. In the present study, we evaluated social cognitive performance in 115 treatment-seeking participants who presented to a youth mental health service with affective or psychotic disturbances. Participants completed symptom severity measures, a social cognition task (the Reading the Mind in the Eyes Test (RMET)), and a standardised battery of neuropsychological tests. Analyses based on diagnostic groups showed that patients with psychotic illnesses (n = 23) showed impaired performance on the RMET compared to patients with primarily bipolar (n = 40) and depressive illnesses (n = 52). Performance on the RMET was negatively correlated with positive and negative psychotic symptoms, but not affective and anxiety symptoms. Performance on the RMET also was the strongest concurrent predictor of positive psychotic symptoms in a regression model that also included predicted intelligence, demographic variables, and neurocognition. RMET performance did not, however, predict negative symptoms above tests of sustained attention and verbal learning, nor was performance associated with any other symptoms of mental illness. Social cognitive impairments may provide a valuable marker for the presence of positive psychotic symptoms in young people with mental illness. Additionally, these impairments may have a role in the aetiology and maintenance of psychotic symptoms. Research is now needed to establish the nature of the relationship between social cognition and psychotic symptoms across different facets of social cognition. Research is also needed to investigate whether targeted social cognition treatments reduce risk for the development of positive psychotic symptoms.
Journal of the International Neuropsychological Society, 2011
Early stages of affective or psychotic disorders may be accompanied by neuropsychological changes... more Early stages of affective or psychotic disorders may be accompanied by neuropsychological changes that help to predict risk of developing more severe disorders. A comprehensive set of neuropsychological measures was collected in 109 help-seeking young people (16 to 30 years; 54 females), recently diagnosed with an affective or psychotic disorder and presenting with current depression. Hierarchical cluster analysis determined three clusters: one deemed to have a “poor memory” profile (n = 40); another with a “poor mental flexibility” profile (n = 38) and a third with widespread difficulties plus “impaired attention and memory” (n = 31). In general, the three clusters were comparable in demographic, functional and clinical factors suggesting some unique role for neurocognitive impairments. A discriminant function analysis confirmed that the clusters were best characterized by performance in “attentional” versus “learning/memory” measures. Furthermore, profiles of independent neuropsyc...
Journal of Psychiatric Research, 2013
Oxidative stress has recently been reported to assume a significant role in the pathophysiology o... more Oxidative stress has recently been reported to assume a significant role in the pathophysiology of bipolar disorder. Several studies have demonstrated the replenishment of glutathione (GSH) diminishes oxidative cellular damage and ameliorates depressive symptoms in this disorder. Whilst the mechanism by which GSH exerts any clinical effect is unknown it has been proposed that it involves the bolstering of antioxidant defences by increasing the bioavailability of GSH, which in turn reverses clinical symptoms of depression. Such a proposal is predicated on the implicit assumption that GSH is diminished in these patients prior to GSH supplementation. However hitherto no study has reported in vivo measures of GSH in patients with bipolar disorder. Using magnetic resonance spectroscopy we obtained in vivo measures of GSH in young people with bipolar disorder and contrasted these with matched healthy controls. Young people with bipolar disorder were found to have no diminution in baseline GSH concentration and, furthermore, no significant correlations were found between GSH and clinical scores of depression or mania. The results do not support the hypothesis that oxidative stress is involved in the primary pathophysiology of bipolar disorder.
Journal of Affective Disorders, 2011
Background: Although there is growing recognition that disability emerges early in the course of ... more Background: Although there is growing recognition that disability emerges early in the course of psychotic disorders, it is unclear whether young people with early stages of anxiety or affective disorders are similarly affected. This study examined patient self-reported disability in young people attending a designated early intervention service. Methods: Cross-sectional study comparing new headspace patients on self-reported measures of disability and distress (Kessler-10, Work and Social Adjustment Scale, and Brief Disability Questionnaire) with clinician-rated diagnosis and clinical stage. Results: Data from 330 participants with an average age of 16.8 years (50.0% male) was analysed and demonstrated high levels of psychological distress and disability in the overall group. Higher levels of self-reported psychological distress and disability were associated with affective disorder diagnosis and increased with advancing clinical stage. Female gender and younger age also predicted affective disorder diagnosis. Limitations: Clinician-rated participant disability was obtained via a single global measure (SOFAS) and not a systematic assessment. Additionally, data collected was cross-sectional and collected at intake only. Longitudinal assessment of clinical features and disability is required to map changes in disability over time. Conclusions: Surprisingly high levels of psychological distress and disability are apparent in young people presenting to early intervention services. Data suggests that distress and disability in those with anxiety is less than for affective disorder. Results also suggest that clinical staging approaches capture the increasing disability associated with illness progression. The obtained results highlight the need for interventions that specifically target disability, rather than just symptoms of mental health problems.
Journal of Affective Disorders, 2010
Background: Neuropsychological deficits in depression include difficulties with psychomotor speed... more Background: Neuropsychological deficits in depression include difficulties with psychomotor speed, executive functions and memory. Some of these changes persist despite antidepressant treatment. While research in other areas of psychiatry has shown cognitive training techniques to be effective, only one study has evaluated this approach in depression. Methods: Sixteen patients (mean age = 33.5 years) with a lifetime diagnosis of major depressive disorder were administered a standardised battery of neuropsychological tests and allocated to treatment (n = 8) or waitlist control (n = 8) conditions. The treatment consisted of 10-weeks of twice weekly cognitive training using the Neuropsychological Educational Approach to Remediation. All participants were reassessed after 10-weeks by interviewers blinded to group allocation. Results: Participants in the treatment condition demonstrated greater improvements on tests of memory encoding and memory retention than the waitlist control group. There were no observable benefits in terms of psychomotor speed or executive functions or in self-reported levels of disability. Affective symptoms also remained stable. Limitations: This study included a small sample of participants and treatment allocation was not randomised. Conclusions: Cognitive training in affective disorders improves memory performance. It may be an effective non-pharmacological treatment option for improving cognitive functions, which in turn, may improve psychosocial functioning and reduce disability. This study supports theories suggesting cognitive training may promote neuroplasticity.
Journal of Affective Disorders, 2009
Background: Depression in older adults is associated with neuropsychological dysfunction, fronto-... more Background: 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. Methods: 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. Results: 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. Limitations: This study was retrospective in nature, and did not include objective measures of sleep. Conclusions: 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.
Managing depression across the life cycle: new strategies for clinicians and their patients
Internal Medicine Journal, 2009
Depression is the leading cause of non-fatal disease burden in Australia. Recently, increasing pu... more 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.