Mark A Huthwaite - Academia.edu (original) (raw)

Papers by Mark A Huthwaite

Research paper thumbnail of Hypnosedative prescribing in outpatient psychiatry

International Clinical Psychopharmacology, May 1, 2013

The objective of this study was to describe hypnosedative (HS) prescribing patterns in a typical ... more The objective of this study was to describe hypnosedative (HS) prescribing patterns in a typical sample of psychiatric outpatients. Prescription information was extracted from the clinical records of all current outpatients at two New Zealand public mental health centres. This included the type and duration of HS use and documentation of a clinical review of longstanding (>3 months) use, patient sex, age and ICD10 diagnoses. One-third of the patients (35.2%) were prescribed at least one HS; this was longstanding in two-thirds (69%). One in 10 had a coprescription of more than one HS drug. HS use was related to female sex and diagnosis, being more common among patients with nonpsychotic than psychotic disorders and very infrequent in patients on clozapine. In most longstanding cases, a clinical review had been documented. The logistic regression confirmed female sex, diagnosis and clozapine all as independent predictors of HS prescription. HS prescribing in psychiatric illness is more common than in the general population, often longstanding, with polypharmacy being common. The frequent use of antipsychotic drugs as HSs is of concern, given their side-effect profile. As there are risks involved with longstanding HS use, a better rationale for the role of medication in the management of sleep problems in psychiatric disorders is needed.

Research paper thumbnail of ‘Out of the frying pan’: the challenges of prescribing for insomnia in psychiatric patients

Australasian Psychiatry, Apr 2, 2014

Managing insomnia is a common challenge for psychiatrists and their patients. We have observed an... more Managing insomnia is a common challenge for psychiatrists and their patients. We have observed an increasing use of quetiapine as a hypnosedative. We conducted an audit with the aim of establishing the prescribing patterns of local general psychiatrists in New Zealand, comparing them with established guidelines and determining the extent of the prescribing of quetiapine as a hypnosedative. Participant psychiatrists were recruited from peer review groups. Each participant provided anonymised prescribing information from 10 patients and noted their intention when prescribing. Twenty-five clinicians (58% response rate) responded with prescriptions for 100 in-patients and 177 community mental health patients. 60% of in-patients and 62% of community patients were prescribed medications to aid with sleep. The most commonly prescribed medications were zopiclone, quetiapine and benzodiazepines. Prescribing adhered with the recommended guidelines for 20% of benzodiazepine and 35% of zopiclone prescriptions. Two thirds (60%) of the community prescriptions for quetiapine were primarily for hypnosedation. There is little concordance between guidelines for hypnosedative prescribing and the practices of general psychiatrists. Less zopiclone and fewer benzodiazepines were prescribed than in other studies, while more quetiapine was prescribed. The 'off-label' use of quetiapine and the duration of zopiclone and benzodiazepine use are discussed.

Research paper thumbnail of Lithium in drinking water

British Journal of Psychiatry, Feb 1, 2010

Research paper thumbnail of Colonic transit studies to measure gastrointestinal motility in antipsychotic treated patients

Research paper thumbnail of A pilot longitudinal sleep education intervention from early pregnancy and its effect on optimizing sleep and minimizing depressive symptoms

Sleep Health, Dec 1, 2020

Research paper thumbnail of The prevalence of symptoms of depression and anxiety, and the level of life stress and worry in New Zealand Māori and non-Māori women in late pregnancy

Australian and New Zealand Journal of Psychiatry, Jul 11, 2016

Objective: To describe the prevalence of symptoms of depression and anxiety, and the level of lif... more Objective: To describe the prevalence of symptoms of depression and anxiety, and the level of life stress and worry in late pregnancy for Māori and non-Māori women. Methods: In late pregnancy, women completed a questionnaire recording their prior history of mood disorders; self-reported current depressive symptoms (⩾13 on the Edinburgh Postnatal Depression Scale), current anxiety symptoms (⩾6 on the anxiety items from the Edinburgh Postnatal Depression Scale), significant life stress (⩾2 items on life stress scale) and dysfunctional worry (>12 on the Brief Measure of Worry Scale). Results: Data were obtained from 406 Māori women (mean age = 27.6 years, standard deviation=6.3 years) and 738 non-Māori women (mean age = 31.6 years, standard deviation=5.3 years). Depressive symptoms (22% vs 15%), anxiety symptoms (25% vs 20%), significant life stress (55% vs 30%) and a period of poor mood during the current pregnancy (18% vs 14%) were more prevalent for Māori than non-Maori women. Less than 50% of women who had experienced ⩾2 weeks of poor mood during the current pregnancy had sought help. Being young was an independent risk factor for depressive symptoms, significant life stress and dysfunctional worry. A prior history of depression was also consistently associated with a greater risk of negative affect in pregnancy. Conclusion: Antenatal mental health requires at least as much attention and resourcing as mental health in the postpartum period. Services need to specifically target Māori women, young women and women with a prior history of depression.

Research paper thumbnail of How well do medical students rate and communicate clinical empathy?

Medical Teacher, Sep 3, 2012

Research paper thumbnail of ‘Is it the crime of the century?’

International Clinical Psychopharmacology, Jul 1, 2015

Research paper thumbnail of Obesity in a forensic and rehabilitation psychiatric service: a missed opportunity?

Journal of forensic practice, Nov 13, 2017

PurposeThe purpose of this paper is to study weight changes during psychiatric hospitalization, s... more PurposeThe purpose of this paper is to study weight changes during psychiatric hospitalization, so as to identify “obesogenic” features in a mixed (forensic and rehabilitation) inpatient service.Design/methodology/approachAn observational study of psychiatric inpatients, gathering sociodemographic, clinical, weight, dietary and sleep information and an actigraphic assessment.FindingsA total of 51 patients, aged 19-68, 40 males, participated at a median of 13 months after their admission. When studied, only 6 percent had a healthy weight, 20 percent were overweight and three quarters (74 percent) were obese. The mean Body Mass Index (BMI) was 35.3 (SD: 8.1). At admission, only three patients (8.3 percent) had healthy BMIs and over the course of their hospital stay, 47 percent gained further weight. A high proportion was physically inactive and half slept more than nine hours a day. Participants received high calorie diets and half (53 percent) smoked cigarettes.Practical implicationsAlthough antipsychotic medication is known to cause weight gain, this should not be seen in isolation when attempting to explain psychiatric inpatient obesity. An inpatient admission is an opportunity to provide a healthier eating environment, health education and assertively promote less sedentary behavior and healthier sleep habits.Social implicationsObesity adds to the burden of this already significantly disadvantaged group of patients.Originality/valueThe results confirm earlier research showing that forensic and rehabilitation psychiatric inpatients as a group are obese, gain weight while in hospital and often smoke. The authors add data demonstrating that they are often physically inactive, sleep excessively and consume an unhealthy diet despite the provision of health focused interventions as an integral part of their inpatient program.

Research paper thumbnail of Long-term psychiatric inpatients’ perspectives on weight gain, body satisfaction, diet and physical activity: a mixed methods study

BMC Psychiatry, Sep 18, 2018

Research paper thumbnail of Prevalence of abnormal sleep duration and excessive daytime sleepiness in pregnancy and the role of socio-demographic factors: comparing pregnant women with women in the general population

Sleep Medicine, Dec 1, 2014

To compare the prevalence of self-reported abnormal sleep duration and excessive daytime sleepine... more To compare the prevalence of self-reported abnormal sleep duration and excessive daytime sleepiness in pregnancy among Māori (indigenous New Zealanders) and non-Māori women versus the general population, and to examine the influence of socio-demographic factors. Self-reported total sleep time (TST) in 24-hrs, Epworth Sleepiness Scale scores and socio-demographic information were obtained from nullipara and multipara women aged 20-46 yrs at 35-37 weeks pregnant (358 Māori and 717 non-Māori), and women in the general population (381 Māori and 577 non-Māori). After controlling for ethnicity, age, socio-economic status, and employment status, pregnant women average 30 min less TST than women in the general population. The distribution of TST was also greater in pregnant women, who were 3 times more likely to be short sleepers (≤6 h) and 1.9 times more likely to be long sleepers (>9 h). In addition, pregnant women were 1.8 times more likely to report excessive daytime sleepiness (EDS). Pregnant women >30 years of age experienced greater age-related declines in TST. Identifying as Māori, being unemployed, and working at night increased the likelihood of reporting abnormal sleep duration across all women population in this study. EDS also more likely occurred among Māori women and women who worked at night. Pregnancy increases the prevalence of abnormal sleep duration and EDS, which are also higher among Māori than non-Māori women and those who do night work. Health professionals responsible for the care of pregnant women need to be well-educated about the importance of sleep and discuss sleep issues with the women they care for.

Research paper thumbnail of Off label or on trend: a review of the use of quetiapine in New Zealand

Research paper thumbnail of Maternal sleep disturbances in late pregnancy and the association with emergency caesarean section: A prospective cohort study

Sleep Health, Feb 1, 2020

Research paper thumbnail of Teaching empathy to undergraduate medical students: Translation to practice

Focus on health professional education : a multi-disciplinary journal, Apr 14, 2016

Research paper thumbnail of Challenging some assumptions about empathy

The Clinical Teacher, Feb 2, 2017

Research paper thumbnail of The well-being of children of parents with a mental illness: the responsiveness of crisis mental health services in Wellington, New Zealand

Child & Family Social Work, Oct 9, 2014

Research paper thumbnail of Eye-Movement Desensitisation to Overcome Post-traumatic Stress Disorder

British Journal of Psychiatry, Jul 1, 1993

Research paper thumbnail of Infection-Associated Clozapine Toxicity

Clinical Schizophrenia & Related Psychoses, Oct 1, 2011

Research paper thumbnail of Hypnosedative access and risk of harm

PubMed, Nov 4, 2011

Aim: To review PHARMAC's decision, effective 1 September 2010, to remove the 1-month restriction ... more Aim: To review PHARMAC's decision, effective 1 September 2010, to remove the 1-month restriction on funded prescription of hypnotics and anxiolytics. Method: We consider the evidence for an association between access to these medicines and risk of harm. Results: Prescription volumes and reported harms have both increased over the last decade in New Zealand; available studies and clinical experience suggest a causal link. Preliminary data collected since PHARMAC's funding change suggest an exacerbation of the problem. Conclusion: The decision to relax funding restrictions on hypnosedatives is expected to increase drug-related harms in a sub-population of users. Improved pharmacovigilance could inform policy regarding these agents.

Research paper thumbnail of Madness at the movies: prioritised movies for self-directed learning by medical students

Australasian Psychiatry, Aug 17, 2014

Research paper thumbnail of Hypnosedative prescribing in outpatient psychiatry

International Clinical Psychopharmacology, May 1, 2013

The objective of this study was to describe hypnosedative (HS) prescribing patterns in a typical ... more The objective of this study was to describe hypnosedative (HS) prescribing patterns in a typical sample of psychiatric outpatients. Prescription information was extracted from the clinical records of all current outpatients at two New Zealand public mental health centres. This included the type and duration of HS use and documentation of a clinical review of longstanding (>3 months) use, patient sex, age and ICD10 diagnoses. One-third of the patients (35.2%) were prescribed at least one HS; this was longstanding in two-thirds (69%). One in 10 had a coprescription of more than one HS drug. HS use was related to female sex and diagnosis, being more common among patients with nonpsychotic than psychotic disorders and very infrequent in patients on clozapine. In most longstanding cases, a clinical review had been documented. The logistic regression confirmed female sex, diagnosis and clozapine all as independent predictors of HS prescription. HS prescribing in psychiatric illness is more common than in the general population, often longstanding, with polypharmacy being common. The frequent use of antipsychotic drugs as HSs is of concern, given their side-effect profile. As there are risks involved with longstanding HS use, a better rationale for the role of medication in the management of sleep problems in psychiatric disorders is needed.

Research paper thumbnail of ‘Out of the frying pan’: the challenges of prescribing for insomnia in psychiatric patients

Australasian Psychiatry, Apr 2, 2014

Managing insomnia is a common challenge for psychiatrists and their patients. We have observed an... more Managing insomnia is a common challenge for psychiatrists and their patients. We have observed an increasing use of quetiapine as a hypnosedative. We conducted an audit with the aim of establishing the prescribing patterns of local general psychiatrists in New Zealand, comparing them with established guidelines and determining the extent of the prescribing of quetiapine as a hypnosedative. Participant psychiatrists were recruited from peer review groups. Each participant provided anonymised prescribing information from 10 patients and noted their intention when prescribing. Twenty-five clinicians (58% response rate) responded with prescriptions for 100 in-patients and 177 community mental health patients. 60% of in-patients and 62% of community patients were prescribed medications to aid with sleep. The most commonly prescribed medications were zopiclone, quetiapine and benzodiazepines. Prescribing adhered with the recommended guidelines for 20% of benzodiazepine and 35% of zopiclone prescriptions. Two thirds (60%) of the community prescriptions for quetiapine were primarily for hypnosedation. There is little concordance between guidelines for hypnosedative prescribing and the practices of general psychiatrists. Less zopiclone and fewer benzodiazepines were prescribed than in other studies, while more quetiapine was prescribed. The 'off-label' use of quetiapine and the duration of zopiclone and benzodiazepine use are discussed.

Research paper thumbnail of Lithium in drinking water

British Journal of Psychiatry, Feb 1, 2010

Research paper thumbnail of Colonic transit studies to measure gastrointestinal motility in antipsychotic treated patients

Research paper thumbnail of A pilot longitudinal sleep education intervention from early pregnancy and its effect on optimizing sleep and minimizing depressive symptoms

Sleep Health, Dec 1, 2020

Research paper thumbnail of The prevalence of symptoms of depression and anxiety, and the level of life stress and worry in New Zealand Māori and non-Māori women in late pregnancy

Australian and New Zealand Journal of Psychiatry, Jul 11, 2016

Objective: To describe the prevalence of symptoms of depression and anxiety, and the level of lif... more Objective: To describe the prevalence of symptoms of depression and anxiety, and the level of life stress and worry in late pregnancy for Māori and non-Māori women. Methods: In late pregnancy, women completed a questionnaire recording their prior history of mood disorders; self-reported current depressive symptoms (⩾13 on the Edinburgh Postnatal Depression Scale), current anxiety symptoms (⩾6 on the anxiety items from the Edinburgh Postnatal Depression Scale), significant life stress (⩾2 items on life stress scale) and dysfunctional worry (>12 on the Brief Measure of Worry Scale). Results: Data were obtained from 406 Māori women (mean age = 27.6 years, standard deviation=6.3 years) and 738 non-Māori women (mean age = 31.6 years, standard deviation=5.3 years). Depressive symptoms (22% vs 15%), anxiety symptoms (25% vs 20%), significant life stress (55% vs 30%) and a period of poor mood during the current pregnancy (18% vs 14%) were more prevalent for Māori than non-Maori women. Less than 50% of women who had experienced ⩾2 weeks of poor mood during the current pregnancy had sought help. Being young was an independent risk factor for depressive symptoms, significant life stress and dysfunctional worry. A prior history of depression was also consistently associated with a greater risk of negative affect in pregnancy. Conclusion: Antenatal mental health requires at least as much attention and resourcing as mental health in the postpartum period. Services need to specifically target Māori women, young women and women with a prior history of depression.

Research paper thumbnail of How well do medical students rate and communicate clinical empathy?

Medical Teacher, Sep 3, 2012

Research paper thumbnail of ‘Is it the crime of the century?’

International Clinical Psychopharmacology, Jul 1, 2015

Research paper thumbnail of Obesity in a forensic and rehabilitation psychiatric service: a missed opportunity?

Journal of forensic practice, Nov 13, 2017

PurposeThe purpose of this paper is to study weight changes during psychiatric hospitalization, s... more PurposeThe purpose of this paper is to study weight changes during psychiatric hospitalization, so as to identify “obesogenic” features in a mixed (forensic and rehabilitation) inpatient service.Design/methodology/approachAn observational study of psychiatric inpatients, gathering sociodemographic, clinical, weight, dietary and sleep information and an actigraphic assessment.FindingsA total of 51 patients, aged 19-68, 40 males, participated at a median of 13 months after their admission. When studied, only 6 percent had a healthy weight, 20 percent were overweight and three quarters (74 percent) were obese. The mean Body Mass Index (BMI) was 35.3 (SD: 8.1). At admission, only three patients (8.3 percent) had healthy BMIs and over the course of their hospital stay, 47 percent gained further weight. A high proportion was physically inactive and half slept more than nine hours a day. Participants received high calorie diets and half (53 percent) smoked cigarettes.Practical implicationsAlthough antipsychotic medication is known to cause weight gain, this should not be seen in isolation when attempting to explain psychiatric inpatient obesity. An inpatient admission is an opportunity to provide a healthier eating environment, health education and assertively promote less sedentary behavior and healthier sleep habits.Social implicationsObesity adds to the burden of this already significantly disadvantaged group of patients.Originality/valueThe results confirm earlier research showing that forensic and rehabilitation psychiatric inpatients as a group are obese, gain weight while in hospital and often smoke. The authors add data demonstrating that they are often physically inactive, sleep excessively and consume an unhealthy diet despite the provision of health focused interventions as an integral part of their inpatient program.

Research paper thumbnail of Long-term psychiatric inpatients’ perspectives on weight gain, body satisfaction, diet and physical activity: a mixed methods study

BMC Psychiatry, Sep 18, 2018

Research paper thumbnail of Prevalence of abnormal sleep duration and excessive daytime sleepiness in pregnancy and the role of socio-demographic factors: comparing pregnant women with women in the general population

Sleep Medicine, Dec 1, 2014

To compare the prevalence of self-reported abnormal sleep duration and excessive daytime sleepine... more To compare the prevalence of self-reported abnormal sleep duration and excessive daytime sleepiness in pregnancy among Māori (indigenous New Zealanders) and non-Māori women versus the general population, and to examine the influence of socio-demographic factors. Self-reported total sleep time (TST) in 24-hrs, Epworth Sleepiness Scale scores and socio-demographic information were obtained from nullipara and multipara women aged 20-46 yrs at 35-37 weeks pregnant (358 Māori and 717 non-Māori), and women in the general population (381 Māori and 577 non-Māori). After controlling for ethnicity, age, socio-economic status, and employment status, pregnant women average 30 min less TST than women in the general population. The distribution of TST was also greater in pregnant women, who were 3 times more likely to be short sleepers (≤6 h) and 1.9 times more likely to be long sleepers (>9 h). In addition, pregnant women were 1.8 times more likely to report excessive daytime sleepiness (EDS). Pregnant women >30 years of age experienced greater age-related declines in TST. Identifying as Māori, being unemployed, and working at night increased the likelihood of reporting abnormal sleep duration across all women population in this study. EDS also more likely occurred among Māori women and women who worked at night. Pregnancy increases the prevalence of abnormal sleep duration and EDS, which are also higher among Māori than non-Māori women and those who do night work. Health professionals responsible for the care of pregnant women need to be well-educated about the importance of sleep and discuss sleep issues with the women they care for.

Research paper thumbnail of Off label or on trend: a review of the use of quetiapine in New Zealand

Research paper thumbnail of Maternal sleep disturbances in late pregnancy and the association with emergency caesarean section: A prospective cohort study

Sleep Health, Feb 1, 2020

Research paper thumbnail of Teaching empathy to undergraduate medical students: Translation to practice

Focus on health professional education : a multi-disciplinary journal, Apr 14, 2016

Research paper thumbnail of Challenging some assumptions about empathy

The Clinical Teacher, Feb 2, 2017

Research paper thumbnail of The well-being of children of parents with a mental illness: the responsiveness of crisis mental health services in Wellington, New Zealand

Child & Family Social Work, Oct 9, 2014

Research paper thumbnail of Eye-Movement Desensitisation to Overcome Post-traumatic Stress Disorder

British Journal of Psychiatry, Jul 1, 1993

Research paper thumbnail of Infection-Associated Clozapine Toxicity

Clinical Schizophrenia & Related Psychoses, Oct 1, 2011

Research paper thumbnail of Hypnosedative access and risk of harm

PubMed, Nov 4, 2011

Aim: To review PHARMAC's decision, effective 1 September 2010, to remove the 1-month restriction ... more Aim: To review PHARMAC's decision, effective 1 September 2010, to remove the 1-month restriction on funded prescription of hypnotics and anxiolytics. Method: We consider the evidence for an association between access to these medicines and risk of harm. Results: Prescription volumes and reported harms have both increased over the last decade in New Zealand; available studies and clinical experience suggest a causal link. Preliminary data collected since PHARMAC's funding change suggest an exacerbation of the problem. Conclusion: The decision to relax funding restrictions on hypnosedatives is expected to increase drug-related harms in a sub-population of users. Improved pharmacovigilance could inform policy regarding these agents.

Research paper thumbnail of Madness at the movies: prioritised movies for self-directed learning by medical students

Australasian Psychiatry, Aug 17, 2014