Psychiatry - Research Publications

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    Effectiveness of Pharmacotherapy for Depression after Adult Traumatic Brain Injury: An Umbrella Review
    Hicks, A ; Clay, F ; James, A ; Hopwood, M ; Ponsford, J (TAYLOR & FRANCIS LTD, 2022-01-17)
    Symptoms of depression are common following traumatic brain injury (TBI), impacting survivors' ability to return to work, participate in leisure activities, and placing strain on relationships. Depression symptoms post TBI are often managed with pharmacotherapy, however, there is little research evidence to guide clinical practice. There have been a number of recent systematic reviews examining pharmacotherapy for post TBI depression. The aim of this umbrella review was to synthesize systematic reviews and meta-analyses of the effectiveness of pharmacotherapy for the management of post TBI depression in adults. Eligible reviews examined any pharmacotherapy against any comparators, for the treatment of depression in adults who had sustained TBI. Seven databases were searched, with additional searching of online journals, Research Gate, Google Scholar and the TRIP Medical Database to identify published and unpublished systematic reviews and meta-analyses in English up to May 2020. A systematic review of primary studies available between March 2018 and May 2020 was also conducted. Evidence quality was assessed using Joanna Briggs Institute Critical Appraisal Instruments. The results are presented as a narrative synthesis. Twenty-two systematic reviews were identified, of which ten reviews contained a meta-analysis. No new primary studies were identified in the systematic review. There was insufficient high quality and methodologically rigorous evidence to recommend prescribing any specific drug or drug class for post TBI depression. The findings do show, however, that depression post TBI is responsive to pharmacotherapy in at least some individuals. Recommendations for primary studies, systematic reviews and advice for prescribers is provided. Review Registration PROSPERO (CRD42020184915).
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    Psychotropic medication deprescribing in residential aged care facilities: An exploratory study of the knowledge and attitudes of family members of residents with dementia
    Lai, R ; Withiel, TD ; Angelone, M ; Redpath, C ; O'Connor, DW ; Plakiotis, C (WILEY, 2022-02-15)
    OBJECTIVES: General practitioners face many barriers to deprescribing psychotropic medications in people with dementia in nursing homes, including a lack of knowledge about their medication histories. This study explored the knowledge of family members about residents' medications and their willingness to support deprescribing. METHODS: Sixty-six family members of residents from seven residential aged care facilities participated in this cross-sectional study. Participation involved nomination of recognised medications, rating their effectiveness and rating level of support for deprescribing. RESULTS: Fifty-five per cent of medications were recognised by family members; significantly fewer psychotropics were recognised than non-psychotropic medications. Though rated as just as effective, support for deprescribing psychotropics was significantly higher. Most family members were agreeable to deprescribing with general practitioner support. CONCLUSIONS: Although there is a gap in family members' knowledge about psychotropic medications, overall they are supportive of deprescribing. Findings emphasise the need for psychoeducation among family members. Providing family members with a list of prescribed medications, specifying the type of and reason for prescription and side effects of each, is recommended to facilitate their advocacy for deprescribing on behalf of nursing home residents.
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    Brain Morphological Characteristics of Cognitive Subgroups of Schizophrenia-Spectrum Disorders and Bipolar Disorder: A Systematic Review with Narrative Synthesis
    Karantonis, JA ; Carruthers, SP ; Burdick, KE ; Pantelis, C ; Green, M ; Rossell, SL ; Hughes, ME ; Cropley, V ; Van Rheenen, TE (SPRINGER, 2022-02-22)
    Despite a growing body of research, there is yet to be a cohesive synthesis of studies examining differences in brain morphology according to patterns of cognitive function among both schizophrenia-spectrum disorder (SSD) and bipolar disorder (BD) individuals. We aimed to provide a systematic overview of the morphological differences-inclusive of grey and white matter volume, cortical thickness, and cortical surface area-between cognitive subgroups of these disorders and healthy controls, and between cognitive subgroups themselves. An initial search of PubMed and Scopus databases resulted in 1486 articles of which 20 met inclusion criteria and were reviewed in detail. The findings of this review do not provide strong evidence that cognitive subgroups of SSD or BD map to unique patterns of brain morphology. There is preliminary evidence to suggest that reductions in cortical thickness may be more strongly associated with cognitive impairment, whilst volumetric deficits may be largely tied to the presence of disease.
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    Effects of Intimate Partner Violence During COVID-19 and Pandemic-Related Stress on the Mental and Physical Health of Women Veterans.
    Iverson, KM ; Dardis, CM ; Cowlishaw, S ; Webermann, AR ; Shayani, DR ; Dichter, ME ; Mitchell, KS ; Mattocks, KM ; Gerber, MR ; Portnoy, GR (Springer Science and Business Media LLC, 2022-09)
    BACKGROUND: Little is known about women veterans' intimate partner violence (IPV) experiences during the COVID-19 pandemic or the impacts of pandemic-related stress on their mental and physical health. OBJECTIVES: To identify IPV experiences among women veterans prior to and during the pandemic, pandemic-related stressors, and examine their respective contributions to mental and physical health. DESIGN: National sample of women veterans drawn from a larger web-based longitudinal study. Relationships between recent IPV and pandemic-related stressors were tested with linear regressions, controlling for pre-pandemic IPV and mental and physical health symptoms, demographic, and military-related covariates. PARTICIPANTS: One hundred forty-two women veterans (Mage=58.8 years). MAIN MEASURES: We assessed IPV (CTS-2), PTSD (PCL-5), depression (CESD), anxiety (DASS-A), physical health (PHQ-15), and physical health-related quality of life (SF-12) prior to the pandemic (June 2016-December 2016/January 2017) and during the pandemic study period (March 2020-December 2020/January 2021). We assessed pandemic-related stressors (EPII) during the pandemic study period. KEY RESULTS: Over a third (38.7%) of participants experienced IPV during the pandemic study period (psychological: 35.9%, physical: 9.9%, sexual: 4.2%). Overall rates, frequency, and severity of IPV experience did not significantly differ between the pre-pandemic and pandemic study periods. Few participants tested positive for COVID-19 (4.2%); however, most participants reported experiencing pandemic-related stressors across life domains (e.g., social activities: 88%, physical health: 80.3%, emotional health: 68.3%). IPV during the pandemic and pandemic-related stressors were both associated with greater PTSD and depressive symptoms. Pandemic-related stressors were associated with worse anxiety and physical health symptoms. Neither IPV during the pandemic nor pandemic-related stressors were associated with physical health-related quality of life. CONCLUSIONS: IPV experiences during the pandemic were common among women veterans, as were pandemic-related stressors. Although IPV did not increase in the context of COVID-19, IPV experiences during the pandemic and pandemic-related stressors were linked with poorer mental and physical health.
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    The Impact of Posttraumatic Stress Disorder on Pharmacologic Intervention Outcomes for Adults With Bipolar Disorder: A Systematic Review
    Russell, SE ; Wrobel, AL ; Skvarc, D ; Kavanagh, BE ; Ashton, MM ; Dean, OM ; Berk, M ; Turner, A (OXFORD UNIV PRESS, 2022-08-29)
    BACKGROUND: There is a high prevalence of post-traumatic stress disorder (PTSD) co-occurring in people with bipolar disorder (BD). People with BD and PTSD may experience different outcomes and quality of life after pharmacological treatment than those with BD alone. This review systematically explores the impact of PTSD on pharmacological treatment outcomes for adults with BD. METHODS: A systematic search was completed up to November 25, 2021 using MEDLINE Complete, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials to identify randomised and non-randomised studies of pharmacological interventions for adults with BD that assessed for comorbid PTSD. The Newcastle-Ottowa Scale and Cochrane Risk of Bias tool were used for assessing the risk of bias. RESULTS: The search identified 5093 articles, and 62 full-text articles were reviewed. Two articles met inclusion criteria (N=438). One article was an observational study and the other a randomised comparative effectiveness trial. The observational study examined lithium response rates and found higher response rates in BD alone compared to BD+PTSD over four years. The randomised trial reported more severe symptoms in the BD+PTSD group than those with BD alone following 6 months of quetiapine treatment. There was no significant difference in the lithium treatment group at follow-up. CONCLUSIONS: Comorbid PTSD may impact quetiapine and lithium treatment response in those with BD. However, due to high risk of bias and low quality of evidence, these results are preliminary. Specific studies exploring comorbid BD and PTSD are required to inform pharmacotherapy selection and guidelines appropriately. (PROSPERO; CRD42020182540).
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    Can magnetic resonance imaging enhance the assessment of potential new treatments for cognitive impairment in mood disorders? A systematic review and position paper by the International Society for Bipolar Disorders Targeting Cognition Task Force.
    Miskowiak, KW ; Yalin, N ; Seeberg, I ; Burdick, KE ; Balanzá-Martínez, V ; Bonnin, CDM ; Bowie, CR ; Carvalho, AF ; Dols, A ; Douglas, K ; Gallagher, P ; Hasler, G ; Kessing, LV ; Lafer, B ; Lewandowski, KE ; López-Jaramillo, C ; Martinez-Aran, A ; McIntyre, RS ; Porter, RJ ; Purdon, SE ; Schaffer, A ; Sumiyoshi, T ; Torres, IJ ; Van Rheenen, TE ; Yatham, LN ; Young, AH ; Vieta, E ; Stokes, PRA (Wiley, 2022-09)
    BACKGROUND: Developing treatments for cognitive impairment is key to improving the functioning of people with mood disorders. Neuroimaging may assist in identifying brain-based efficacy markers. This systematic review and position paper by the International Society for Bipolar Disorders Targeting Cognition Task Force examines the evidence from neuroimaging studies of pro-cognitive interventions. METHODS: We included magnetic resonance imaging (MRI) studies of candidate interventions in people with mood disorders or healthy individuals, following the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis 2020 statement. Searches were conducted on PubMed/MEDLINE, PsycInfo, EMBASE, Cochrane Library, and Clinicaltrials.gov from inception to 30th April 2021. Two independent authors reviewed the studies using the National Heart, Lung, Blood Institutes of Health Quality Assessment Tool for Controlled Intervention Studies and the quality of neuroimaging methodology assessment checklist. RESULTS: We identified 26 studies (N = 702). Six investigated cognitive remediation or pharmacological treatments in mood disorders (N = 190). In healthy individuals, 14 studies investigated pharmacological interventions (N = 319), 2 cognitive training (N = 73) and 4 neuromodulatory treatments (N = 120). Methodologies were mostly rated as 'fair'. 77% of studies investigated effects with task-based fMRI. Findings varied but most consistently involved treatment-associated cognitive control network (CCN) activity increases with cognitive improvements, or CCN activity decreases with no cognitive change, and increased functional connectivity. In mood disorders, treatment-related default mode network suppression occurred. CONCLUSIONS: Modulation of CCN and DMN activity is a putative efficacy biomarker. Methodological recommendations are to pre-declare intended analyses and use task-based fMRI, paradigms probing the CCN, longitudinal assessments, mock scanning, and out-of-scanner tests.
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    Structural brain alterations associated with suicidal thoughts and behaviors in young people: results from 21 international studies from the ENIGMA Suicidal Thoughts and Behaviours consortium
    van Velzen, LS ; Dauvermann, MR ; Colic, L ; Villa, LM ; Savage, HS ; Toenders, YJ ; Zhu, AH ; Bright, JK ; Campos, A ; Salminen, LE ; Ambrogi, S ; Ayesa-Arriola, R ; Banaj, N ; Basgoze, Z ; Bauer, J ; Blair, K ; Blair, RJ ; Brosch, K ; Cheng, Y ; Colle, R ; Connolly, CG ; Corruble, E ; Couvy-Duchesne, B ; Crespo-Facorro, B ; Cullen, KR ; Dannlowski, U ; Davey, CG ; Dohm, K ; Fullerton, JM ; Gonul, AS ; Gotlib, IH ; Grotegerd, D ; Hahn, T ; Harrison, BJ ; He, M ; Hickie, IB ; Ho, TC ; Iorfino, F ; Jansen, A ; Jollant, F ; Kircher, T ; Klimes-Dougan, B ; Klug, M ; Leehr, EJ ; Lippard, ETC ; McLaughlin, KA ; Meinert, S ; Miller, AB ; Mitchell, PB ; Mwangi, B ; Nenadic, I ; Ojha, A ; Overs, BJ ; Pfarr, J-K ; Piras, F ; Ringwald, KG ; Roberts, G ; Romer, G ; Sanches, M ; Sheridan, MA ; Soares, JC ; Spalletta, G ; Stein, F ; Teresi, G ; Tordesillas-Gutierrez, D ; Uyar-Demir, A ; van der Wee, NJA ; van der Werff, SJ ; Vermeiren, RRJM ; Winter, A ; Wu, M-J ; Yang, TT ; Thompson, PM ; Renteria, ME ; Jahanshad, N ; Blumberg, HP ; Van Harmelen, A-L ; Schmaal, L (SPRINGERNATURE, 2022-09-07)
    Identifying brain alterations associated with suicidal thoughts and behaviors (STBs) in young people is critical to understanding their development and improving early intervention and prevention. The ENIGMA Suicidal Thoughts and Behaviours (ENIGMA-STB) consortium analyzed neuroimaging data harmonized across sites to examine brain morphology associated with STBs in youth. We performed analyses in three separate stages, in samples ranging from most to least homogeneous in terms of suicide assessment instrument and mental disorder. First, in a sample of 577 young people with mood disorders, in which STBs were assessed with the Columbia Suicide Severity Rating Scale (C-SSRS). Second, in a sample of young people with mood disorders, in which STB were assessed using different instruments, MRI metrics were compared among healthy controls without STBs (HC; N = 519), clinical controls with a mood disorder but without STBs (CC; N = 246) and young people with current suicidal ideation (N = 223). In separate analyses, MRI metrics were compared among HCs (N = 253), CCs (N = 217), and suicide attempters (N = 64). Third, in a larger transdiagnostic sample with various assessment instruments (HC = 606; CC = 419; Ideation = 289; HC = 253; CC = 432; Attempt=91). In the homogeneous C-SSRS sample, surface area of the frontal pole was lower in young people with mood disorders and a history of actual suicide attempts (N = 163) than those without a lifetime suicide attempt (N = 323; FDR-p = 0.035, Cohen's d = 0.34). No associations with suicidal ideation were found. When examining more heterogeneous samples, we did not observe significant associations. Lower frontal pole surface area may represent a vulnerability for a (non-interrupted and non-aborted) suicide attempt; however, more research is needed to understand the nature of its relationship to suicide risk.
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    Using photovoice to explore women's experiences of a women-only prevention and recovery care service in Australia
    Dixon, K ; Fossey, E ; Petrakis, M (WILEY, 2022-09-07)
    Women should be able to access mental health services that are safe, free from harassment and abuse. Yet, research indicates that women experiencing mental health issues are often not safe in mixed gender environments, and especially in inpatient settings. This qualitative study draws on a photo-elicitation method ('photovoice') and semi-structured interviews to explore women's experiences of a sub-acute women-only prevention and recovery care (PARC) service in Australia. Twelve women experiencing mental health issues were recruited via an aftercare peer support group for recent service participants. The women took photographs guided by the central question: 'What were your experiences of a women-only prevention and recovery care service?' They then shared these photographs with the researchers and each other, and described them in detail. Four key themes were identified by thematic analysis of the photovoice visual and narrative data: (a) Only women can understand what women go through; (b) I feel safer with no men around due to my history of trauma; (c) This environment feels safe, making it easier to talk and (d) Staff are accessible and make time for me to talk about difficult topics. Woven throughout the women's narratives was the expressed desire to feel safe and supported during the process of recovering. Aspects of service delivery that contributed to these feelings and facilitated shared support were also valued in this setting. These findings indicate that access to women-only services and peer support are not only valued by women experiencing mental health issues, but need to be more widely available to support their recovery. They also underline the importance of a trauma-informed approach for improving the gender sensitivity of services.
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    Networks of inflammation, depression, and cognition in aging males and females.
    Chalmers, RA ; Cervin, M ; Choo, C ; Baune, BT ; Trollor, JN ; Numbers, K ; Sachdev, PS ; Brodaty, H ; Kochan, NA ; Medvedev, ON (Springer Science and Business Media LLC, 2022-10)
    BACKGROUND: Prioritizing the maintenance of healthy cognitive aging and personalizing preventive interventions to enhance their effectiveness is crucial as the global population ages. Systemic inflammation and depression in older people have been associated with decreased levels of cognition but results have been inconsistent. AIMS: To explore the interactive network of inflammation, depression and cognition by sex in older people. METHODS: We used novel network analysis to explore the unique associations between inflammatory biomarkers, depression, cognition, and somatic, genetic, and lifestyle risk factors in an older (aged 70-90 years), non-demented, community-dwelling sample from the longitudinal Sydney Memory and Aging Study (N = 916) at baseline and at a two-year follow-up. RESULTS: The networks of biomarkers, depression, cognition, and relevant covariates were significantly different between males and females. A stable negative link between depression and cognition was found in females only; a stable positive association between biomarker interleukin-6 and depression was found in females only; and a stable positive association between biomarker interleukin-8 and alcohol was found in females only. For both males and females, a stable, positive relationship was found between the presence of APOE-ε4 gene and biomarker C-reactive protein; between education and cognition; and between biomarker interleukin-6 and all other biomarkers. CONCLUSIONS: These findings suggest different psychophysiological mechanisms underlie the interactive network of biomarkers, depression and cognition in males and females that should be considered when designing personalized preventive interventions to maintain cognitively healthy aging.