Publications by authors named "James G Scott"

193 Publications

CoMET: a randomised controlled trial of co-commencement of metformin versus placebo as an adjunctive treatment to attenuate weight gain in patients with schizophrenia newly commenced on clozapine.

Ther Adv Psychopharmacol 2021 16;11:20451253211045248. Epub 2021 Oct 16.

Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.

Background: There is limited evidence on interventions to minimise weight gain at clozapine commencement. We compared the effect of adjunctive metformin placebo at clozapine initiation.

Methods: People with schizophrenia commencing on clozapine were randomised to either metformin or placebo for 24 weeks. The primary outcome was difference in the change of body weight. Secondary outcomes included comparative rates of weight gain of more than 5%, overall weight gain/loss, and differences in metabolic and psychosis outcomes.

Results: The study was closed prematurely in March 2020 due to COVID-19 restrictions. Ten participants were randomised to each of the metformin and placebo groups. Eight metformin group and five placebo group participants completed the trial and were included in the analysis. The study was insufficiently powered to detect difference between the metformin and placebo groups for the primary outcome of change in weight (0.09 kg vs 2.88 kg,  = 0.231). In terms of secondary outcomes, people in the metformin group were significantly less likely to gain >5% of their body weight (12.5% vs 80%,  = 0.015) and were more likely to lose weight (37.5% vs 0%  = 0.024) compared to placebo. There was no difference between the groups in terms of adverse drug reactions (ADRs).

Conclusion: While limited by the forced premature closure of the trial due to COVID19, the findings from this randomised controlled trial are promising. Clozapine and metformin co-commencement may be a promising treatment to prevent clozapine-associated weight gain, especially given the low rates of ADRs associated with metformin. This supports the consideration of use of metformin to prevent weight gain in people initiated on clozapine; however, further studies are needed to confirm this finding.

Trial Registration: ACTRN12617001547336.
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http://dx.doi.org/10.1177/20451253211045248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8521414PMC
October 2021

Association of Maternal Depressive Symptoms During the Perinatal Period With Oppositional Defiant Disorder in Children and Adolescents.

JAMA Netw Open 2021 Sep 1;4(9):e2125854. Epub 2021 Sep 1.

School of Population Health, Curtin University, Perth, Australia.

Importance: An association between perinatal maternal depression and risk of oppositional defiant disorder (ODD) in offspring has not been established. Identifying early determinants of ODD can help inform preventative intervention efforts.

Objective: To investigate the association between maternal perinatal depressive symptoms and the risk of ODD in offspring aged 7 to 15 years.

Design, Setting, And Participants: This population-based longitudinal birth cohort study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), in Bristol, UK. All pregnant women residents in Avon, UK, with expected delivery dates from April 1, 1991, to December 31, 1992, were invited to participate in the study. The study cohort ranged from approximately 8000 (at 7 years of age) to 4000 (at 15 years of age) mother-offspring pairs. Data were analyzed from November 2020 to July 2021.

Main Outcomes And Measures: Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) antenatally at 18 and 32 weeks of gestation and postnatally at 8 weeks and 8 months. This study primarily used a cutoff score of 12 or more on the EPDS to identify mothers with symptoms of depression, and the continuous EPDS scores were used to confirm the results of the main analyses. Offspring ODD at 7, 10, 13, and 15 years of age were diagnosed using the parent-reported Development and Well-Being Assessment.

Results: Of 7994 mother-offspring pairs for whom data were available on offspring ODD at 7 years, 4102 offspring (51.3%) were boys. The mean (SD) age of mothers was 28.6 (4.6) years. Maternal antenatal depressive symptoms (measured at 32 weeks of gestation) were associated with offspring ODD (adjusted odds ratio [AOR], 1.75; 95% CI, 1.33-2.31). Offspring of mothers with postpartum depressive symptoms at 8 weeks and 8 months were more than 2 times more likely to have a diagnosis of ODD over time (AOR at 8 weeks, 2.24 [95% CI, 1.74-2.90]; AOR at 8 months, 2.04 [95% CI, 1.55-2.68]), and maternal persistent depressive symptoms were associated with a 4-fold increased risk of offspring ODD (AOR, 3.59; 95% CI, 1.98-6.52).

Conclusions And Relevance: These findings suggest that perinatal depressive symptoms are associated with ODD in offspring and further support the need for early identification and management of prenatal and postnatal depression in women of childbearing age.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.25854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485171PMC
September 2021

Intervention programs designed to promote healthy romantic relationships in youth: A systematic review.

J Adolesc 2021 Oct 25;92:194-236. Epub 2021 Sep 25.

QIMR Berghofer Medical Research Institute, Herston, QLD, Australia; Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, QLD, Australia.

Introduction And Objectives: To conduct a systematic literature review of intervention programs designed to promote healthy romantic relationships in youth (aged 12-25 years). The focus was on universal interventions that have the potential to be effective and widely implemented.

Methods: We systematically searched PubMed, PsycINFO, Social Science Database, and Embase. Articles were included if they were a randomized controlled trial (RCT) or quasi-experimental study and reported on a universal intervention aimed at promoting healthy romantic relationship knowledge, attitudes, and behaviors among youth.

Results: The search strategy identified 27 studies (26,212 participants). Interventions were found to be effective for improving healthy romantic relationship knowledge in the target population. However, the findings were mixed for intervention effectiveness in changing relationship attitudes/beliefs, and there was limited evidence to support change across behavioral outcomes.

Conclusions: This review highlights the need for future research, including high quality RCTs with longer follow-up periods in a broad range of cultural and ethnic settings, to improve the generalisability of findings. Interventions for adolescents that improve knowledge and behavioral change relating to healthy romantic relationships have the potential to reduce mental and physical health problems during this phase of development.
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http://dx.doi.org/10.1016/j.adolescence.2021.08.008DOI Listing
October 2021

Gestational urinary tract infections and the risk of antenatal and postnatal depressive and anxiety symptoms: A longitudinal population-based study.

J Psychosom Res 2021 Nov 11;150:110600. Epub 2021 Sep 11.

School of Public Health, Curtin University, Perth, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, Australia.

Objective: Urinary tract infections (UTIs) are among the most common bacterial infections in pregnant women. This is the first longitudinal study investigating the association between gestational UTIs and the risk of maternal antenatal and postnatal depressive and anxiety symptoms.

Methods: Data were utilised from the Avon Longitudinal Study of Parents and Children (ALSPAC). Maternal depressive and anxiety symptoms during pregnancy and the postpartum period were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Crown-Crisp Experiential Index (CCEI), respectively. We used logistic regression analyses to examine the associations using the recommended EPDS and CCEI cut-off scores. We also ran sensitivity analyses and repeated the analyses with the continuous scores.

Results: More than 10,000 mothers had completed exposure and outcome measures during pregnancy and the postpartum period. After adjustments were made for a wide range of confounders, our findings showed that mothers with UTI during pregnancy were 1.72 (95% CI; 1.45-2.04) and 1.70 (95% CI: 1.44-1.99) times more likely to report antenatal depressive and anxiety symptoms compared with mothers without UTI, respectively. Mothers with UTI also had a 35% and a 28% higher risk of postnatal depressive symptoms at eight weeks and eight months, respectively, and the risk of postnatal anxiety was 55% higher in mothers who had UTI during pregnancy (aOR = 1.55; 95% CI, 1.26-1.91).

Conclusions: The present study found positive associations between UTI during pregnancy and antenatal and postnatal depressive and anxiety symptoms. Replication and further research determining the cause of these associations is warranted.
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http://dx.doi.org/10.1016/j.jpsychores.2021.110600DOI Listing
November 2021

Economic Evaluation of an Intervention Designed to Reduce Bullying in Australian Schools.

Appl Health Econ Health Policy 2021 Aug 9. Epub 2021 Aug 9.

School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.

Background: There is a shortage of information on the costs and benefits of anti-bullying programs implemented in Australia. Information on the costs and benefits of anti-bullying programs is vital to assist policy making regarding the adoption of these programs. The aim of this study was to estimate the changes to costs and health benefits of implementing the "Friendly Schools Friendly Families" (FSFF) anti-bullying intervention in Australia.

Methods: A societal perspective cost-effectiveness analysis was undertaken based on randomised controlled trial data for an anti-bullying intervention implemented in primary schools in Western Australia. The modelling strategy addressed changes to costs comprising intervention costs, less cost-savings, and then changes to health benefits measured by avoidable disability-adjusted life years (DALYs). Costs and health benefits were identified, measured, and valued in 2016 Australian dollars. Intermediate events modelled included anxiety disorders, depressive disorders, intentional self-harm, cost-savings accrued by educator time, and reduced productivity losses for carers associated with absenteeism. Uncertainty analysis and scenario analyses were also conducted.

Results: The prevalence of bullying victimisation was reduced by 18% by the Friendly Schools Friendly Families anti-bullying intervention. At a national level, this is expected to result in the avoidance of 9114 DALYs (95% CI 8770-9459) and cost-savings of A$120 million per year. The majority of cost-savings were associated with the reduction in mental healthcare. The model results demonstrated that the FSFF anti-bullying intervention is likely to be a cost-effective approach to reduce bullying in Australia, relative to a threshold of A$50,000 per DALY averted, with an ICER of A$1646.

Conclusions: The Friendly Schools Friendly Families anti-bullying intervention represents a good investment compared to usual activities for the management of child and adolescent bullying in Australia. The investment and implementation of evidence-based interventions that reduce bullying victimisation and bullying perpetration in schools could reduce the economic burden associated with common mental health disorders and thereby improve the health of many Australians.
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http://dx.doi.org/10.1007/s40258-021-00676-yDOI Listing
August 2021

Genetic association study of childhood aggression across raters, instruments, and age.

Transl Psychiatry 2021 07 30;11(1):413. Epub 2021 Jul 30.

Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Childhood aggressive behavior (AGG) has a substantial heritability of around 50%. Here we present a genome-wide association meta-analysis (GWAMA) of childhood AGG, in which all phenotype measures across childhood ages from multiple assessors were included. We analyzed phenotype assessments for a total of 328 935 observations from 87 485 children aged between 1.5 and 18 years, while accounting for sample overlap. We also meta-analyzed within subsets of the data, i.e., within rater, instrument and age. SNP-heritability for the overall meta-analysis (AGG) was 3.31% (SE = 0.0038). We found no genome-wide significant SNPs for AGG. The gene-based analysis returned three significant genes: ST3GAL3 (P = 1.6E-06), PCDH7 (P = 2.0E-06), and IPO13 (P = 2.5E-06). All three genes have previously been associated with educational traits. Polygenic scores based on our GWAMA significantly predicted aggression in a holdout sample of children (variance explained = 0.44%) and in retrospectively assessed childhood aggression (variance explained = 0.20%). Genetic correlations (r) among rater-specific assessment of AGG ranged from r = 0.46 between self- and teacher-assessment to r = 0.81 between mother- and teacher-assessment. We obtained moderate-to-strong rs with selected phenotypes from multiple domains, but hardly with any of the classical biomarkers thought to be associated with AGG. Significant genetic correlations were observed with most psychiatric and psychological traits (range [Formula: see text]: 0.19-1.00), except for obsessive-compulsive disorder. Aggression had a negative genetic correlation (r = ~-0.5) with cognitive traits and age at first birth. Aggression was strongly genetically correlated with smoking phenotypes (range [Formula: see text]: 0.46-0.60). The genetic correlations between aggression and psychiatric disorders were weaker for teacher-reported AGG than for mother- and self-reported AGG. The current GWAMA of childhood aggression provides a powerful tool to interrogate the rater-specific genetic etiology of AGG.
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http://dx.doi.org/10.1038/s41398-021-01480-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324785PMC
July 2021

Does the millennial generation of women experience more mental illness than their mothers?

BMC Psychiatry 2021 07 17;21(1):359. Epub 2021 Jul 17.

Mental Health Research Programme, QIMR Berghofer Medical Research Institute, Herston, Australia.

Background: There is concern that rates of mental disorders may be increasing although findings disagree. Using an innovative design with a daughter-mother data set we assess whether there has been a generational increase in lifetime ever rates of major depressive disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD) experienced prior to 30 years of age.

Methods: Pregnant women were recruited during 1981-1983 and administered the Composite International Diagnostic Interview (CIDI) at the 27-year follow-up (2008-11). Offspring were administered the CIDI at the 30-year follow-up (2010-2014). Comparisons for onset of diagnosis are restricted to daughter and mother dyads up to 30 years of age. To address recall bias, disorders were stratified into more (≥12 months duration) and less persistent episodes (< 12 months duration) for the purposes of comparison. Sensitivity analyses with inflation were used to account for possible maternal failure to differentially recall past episodes.

Results: When comparing life time ever diagnoses before 30 years, daughters had higher rates of persistent generalised anxiety disorder, and less persistent major depressive disorder, generalised anxiety disorder and PTSD.

Conclusions: In the context of conflicting findings concerning generational changes in mental disorders we find an increase in generational rates of persistent generalised anxiety disorders and a range of less persistent disorders. It is not clear whether this finding reflects actual changes in symptom levels over a generation or whether there has been a generational change in recognition of and willingness to report symptoms of mental illness.
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http://dx.doi.org/10.1186/s12888-021-03361-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285825PMC
July 2021

The association between birth by caesarean section at term and offspring cognitive and academic performance: A birth cohort study.

Aust N Z J Obstet Gynaecol 2021 Jul 5. Epub 2021 Jul 5.

Child and Youth Mental Health Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.

Background: Caesarean section (CS) is associated with an increased risk of adverse health outcomes for both mothers and offspring. The evidence for an association between CS and reduced offspring cognitive and academic performance has been inconsistent, with considerable limitations.

Aim: The aim of this study is to compare cognitive and academic performance in childhood and early adulthood in offspring delivered by CS with those delivered vaginally at term.

Materials And Methods: Data on 4327 mothers and offspring from a longitudinal birth cohort study were analysed. Offspring cognitive performance was measured by the Picture Peabody Vocabulary Test-Revised (PPVT-R) at ages five and 21 and the Raven's Standard Progressive Matrices at age 14. Academic achievement was assessed using the Wide Range Achievement Test at age 14.

Results: After adjustment for confounding factors, there was no statistically significant association between cognitive performance and offspring birth mode at age five (P = 0.11). The adjusted difference of mean scores at five years on the PPVT-R for elective CS birth compared to those born by vaginal delivery was -2.2 (95% confidence interval (CI) -4.3 to -0.2), whereas for emergency CS it was 0.0 (95% CI -2.0 to 2.0). There were no differences in cognitive or academic performance at ages 14 and 21.

Conclusion: Birth mode was not significantly associated with offspring cognitive or academic performance. Our study does not support concerns that CS is associated with a reduction in cognitive performance.
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http://dx.doi.org/10.1111/ajo.13403DOI Listing
July 2021

Psychosocial and lifestyle predictors of distress and well-being in people with mental illness during the COVID-19 pandemic.

Australas Psychiatry 2021 Jun 30:10398562211025040. Epub 2021 Jun 30.

QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.

Objectives: People with mental illness may be vulnerable to psychological distress and reduced well-being during the COVID-19 pandemic. The aim of this study was to assess psychosocial and lifestyle predictors of distress and well-being in people with mental illness during the pandemic.

Method: People with mental illness who participated in an exercise programme prior to the pandemic were invited to complete surveys about mental health and lifestyle corresponding to before and during the pandemic.

Results: Social support reduced, alcohol intake increased, and sleep quality and diet worsened during the pandemic, contributing to distress. Psychological distress was associated with the two or more mental illnesses, and negatively associated with having a physical disease. Better diet appeared to protect against increases in distress; loneliness hindered improvements in well-being.

Conclusions: Healthy lifestyle programmes designed to improve social connection may improve health for people with mental illnesses during and after the COVID-19 pandemic.
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http://dx.doi.org/10.1177/10398562211025040DOI Listing
June 2021

Cannabidiol for at risk for psychosis youth: A randomized controlled trial.

Early Interv Psychiatry 2021 Jun 30. Epub 2021 Jun 30.

Orygen, Melbourne, Australia.

Background: No biological treatment has been firmly established for the at-risk stage of psychotic disorder. In this study we aim to test if subthreshold psychotic symptoms can be effectively treated with cannabidiol (CBD), a non-psychoactive compound of the plant Cannabis sativa. The question has taken on increased importance in the wake of evidence questioning both the need and efficacy of specific pharmacological interventions in the ultra-high risk (UHR) for psychosis group.

Methods: Three-arm randomized controlled trial of 405 patients (135 per arm) aged 12-25 years who meet UHR for psychosis criteria. The study includes a 6-week lead-in phase during which 10% of UHR individuals are expected to experience symptom remission. Participants will receive CBD (per oral) at doses 600 or 1000 mg per day (fixed schedule) for 12 weeks. Participants in the third arm of the trial will receive matching placebo capsules. Primary outcome is severity of positive psychotic symptoms as measured by the Comprehensive Assessment of At-Risk Mental States at 12 weeks. We hypothesize that CBD will be significantly more effective than placebo in improving positive psychotic symptoms in UHR patients. All participants will also be followed up 6 months post baseline to evaluate if treatment effects are sustained.

Conclusion: This paper reports on the rationale and protocol of the Cannabidiol for At Risk for psychosis Youth (CanARY) study. This study will test CBD for the first time in the UHR phase of psychotic disorder.
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http://dx.doi.org/10.1111/eip.13182DOI Listing
June 2021

Monitoring of metabolic side-effects in children and adolescents prescribed antipsychotic medication: A systematic review.

Aust N Z J Psychiatry 2021 08 5;55(8):763-771. Epub 2021 May 5.

Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.

Objectives: Prescribing antipsychotic medications to children and adolescents with severe mental and developmental disorders is common; however, there is a lack of consensus on appropriate metabolic monitoring for this population. This review systematically evaluates studies examining metabolic monitoring of children and adolescents prescribed antipsychotic medication to understand the clinical practice of metabolic monitoring and identify opportunities to improve the safety of antipsychotic prescribing in this population.

Methods: A systematic search for original research on metabolic monitoring in children and adolescents prescribed antipsychotics was conducted in six databases (PubMed, EMBASE, PsycINFO, The Cochrane Library [Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CENTRAL], Cochrane Methodology Register and Web of Science [Science and Social Science Citation Index]) from inception to February 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were assessed for quality and findings summarised using narrative synthesis.

Results: Fifteen papers were identified. Studies agreed on the need for metabolic monitoring; however, there was a gap between guideline-recommended practice and clinical practice. Variable rates of baseline and subsequent monitoring were reported for both physical and biochemical parameters, with particularly low rates for monitoring requiring venesection. Younger age was also associated with lower monitoring rates. Implementation of quality improvement activities (new guidelines, staff education and checklists) improved monitoring rates although the measurement of biochemical parameters still occurred in only a minority of children.

Conclusion: Despite widespread awareness and concern regarding metabolic side-effects, monitoring occurred inconsistently and infrequently, particularly for biochemical parameters requiring venesection. Monitoring of anthropometric measures (weight, body mass index and waist circumference) with escalation to more laboratory testing where metabolic concerns are identified may improve monitoring. Minimising iatrogenic harm, through reduced antipsychotic prescription where possible, is a clinical priority in this population.
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http://dx.doi.org/10.1177/00048674211009620DOI Listing
August 2021

Concordance between adolescents and parents on the Strengths and Difficulties Questionnaire: Analysis of an Australian nationally representative sample.

Aust N Z J Psychiatry 2021 Apr 30:48674211009610. Epub 2021 Apr 30.

QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.

Objective: Differences between adolescent self-reported and parent-reported emotional and behavioural difficulties may influence psychiatric epidemiological research. This study examined concordance between adolescents and their parents about mental health symptoms using the Strengths and Difficulties Questionnaire.

Methods: The study comprised a randomly selected, nationally representative sample of adolescents aged 11-17 years who participated in the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing ( = 2967). Matched adolescent and parent responses across the five Strengths and Difficulties Questionnaire subscales (emotional problems, hyperactivity, peer problems, conduct problems and prosocial behaviour), as well as total difficulties and total impact scores were examined to estimate concordance. Concordance patterns were analysed by sex, after stratifying the sample by age group (younger adolescents: 11-14 years; older adolescents: 15-17 years).

Results: Concordance was 86.7% for total difficulties, 77.5% for total impact and ranged from 82.4% to 94.3% across the five Strengths and Difficulties Questionnaire subscales. There were no differences in concordance between sexes on the total difficulties score. Older females were more likely to disagree with their parents about emotional problems compared to males of the same age. Younger males were more likely to disagree with their parents compared to same-aged females about peer problems, hyperactivity, conduct problems and prosocial skills, as well as the impact of their problems. Older males were more likely to disagree with their parents about their prosocial skills compared to older females.

Conclusion: Overall, concordance between adolescents and parents on the Strengths and Difficulties Questionnaire was largely driven by the high proportion of respondents who reported having no problems. Discordance on a subscale increased as the prevalence of problems in a sex and age demographic subgroup increased. These findings highlight the need for a multi-informant approach to detect emotional and behavioural difficulties in adolescents, particularly when assessing the impact of symptoms, as this subscale had the lowest concordance.
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http://dx.doi.org/10.1177/00048674211009610DOI Listing
April 2021

Climate Change and Mental Health: A Scoping Review.

Int J Environ Res Public Health 2021 04 23;18(9). Epub 2021 Apr 23.

Queensland Centre for Mental Health Research, Queensland Health, Wacol, QLD 4076, Australia.

Climate change is negatively impacting the mental health of populations. This scoping review aims to assess the available literature related to climate change and mental health across the World Health Organisation's (WHO) five global research priorities for protecting human health from climate change. We conducted a scoping review to identify original research studies related to mental health and climate change using online academic databases. We assessed the quality of studies where appropriate assessment tools were available. We identified 120 original studies published between 2001 and 2020. Most studies were quantitative ( = 67), cross-sectional ( = 42), conducted in high-income countries ( = 87), and concerned with the first of the WHO global research priorities-assessing the mental health risks associated with climate change ( = 101). Several climate-related exposures, including heat, humidity, rainfall, drought, wildfires, and floods were associated with psychological distress, worsened mental health, and higher mortality among people with pre-existing mental health conditions, increased psychiatric hospitalisations, and heightened suicide rates. Few studies ( = 19) addressed the other four global research priorities of protecting health from climate change (effective interventions ( = 8); mitigation and adaptation ( = 7); improving decision-support ( = 3); and cost estimations ( = 1)). While climate change and mental health represents a rapidly growing area of research, it needs to accelerate and broaden in scope to respond with evidence-based mitigation and adaptation strategies.
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http://dx.doi.org/10.3390/ijerph18094486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122895PMC
April 2021

Predicting Child Maltreatment over the Early Life Course: A Prospective Study.

Child Psychiatry Hum Dev 2021 Mar 31. Epub 2021 Mar 31.

School of Criminology and Criminal Justice, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia.

A large number of early life exposures predict child maltreatment. Using data from a 30-year birth cohort study we examine 12 early life course risk factors of four types of self-reported childhood maltreatment recalled at the 30-year follow-up. Of the 7223 children in the sample at birth, 2425 responded to the Child Trauma Questionnaire at the 30-year follow-up. On adjusted analysis being a teenage mother predicts childhood physical and sexual abuse, as well as child neglect. More numerous maternal marital partner changes in the 5 years after the birth predict offspring experiences of emotional abuse, sexual abuse and childhood neglect. Policy responses should focus on the broad social context in which children are reared as the most effective approach to reducing the high level of childhood abuse and neglect.
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http://dx.doi.org/10.1007/s10578-021-01164-zDOI Listing
March 2021

Age of first alcohol intoxication and psychiatric disorders in young adulthood - A prospective birth cohort study.

Addict Behav 2021 07 11;118:106910. Epub 2021 Mar 11.

Department of Psychiatry, University of Turku, Turku, Finland; Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland.

Objective: Early onset of alcohol use is associated with an increased risk of substance use disorders (SUD), but few studies have examined associations with other psychiatric disorders. Our aim was to study the association between the age of first alcohol intoxication (AFI) and the risk of psychiatric disorders in a Finnish general population sample.

Methods: We utilized a prospective, general population-based study, the Northern Finland Birth Cohort 1986. In all, 6,290 15-16-year old adolescents answered questions on AFI and were followed up until the age of 33 years for psychiatric disorders (any psychiatric disorder, psychosis, SUD, mood disorders and anxiety disorders) by using nationwide register linkage data. Cox-regression analysis with Hazard Ratios (HR, with 95% confidence intervals (CI)) was used to assess the risk of psychiatric disorders associated with AFI.

Results: Statistically significant associations were observed between AFI and any psychiatric disorder, psychosis, SUDs, and mood disorders. After adjustments for other substance use, family structure, sex and parental psychiatric disorders, AFIs of 13-14 years and ≤12 years were associated with SUD (HR = 5.30; 95%CI 2.38-11.82 and HR = 6.49; 95%CI 2.51-16.80, respectively), while AFI ≤ 12 years was associated with any psychiatric disorder (HR = 1.59; 95%CI 1.26-2.02) and mood disorders (HR = 1.81; 95%CI 1.22-2.68). After further adjustments for Youth Self Report total scores, AFI ≤ 14 was associated with an increased risk of SUD and AFI ≤ 12 with an increased risk of any psychiatric disorder.

Conclusions: We found significant associations between the early age of first alcohol intoxication, later SUD and any psychiatric disorder in a general population sample. This further supports the need for preventive efforts to postpone the first instances of adolescent alcohol intoxication.
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http://dx.doi.org/10.1016/j.addbeh.2021.106910DOI Listing
July 2021

16Up: Outline of a Study Investigating Wellbeing and Information and Communication Technology Use in Adolescent Twins.

Twin Res Hum Genet 2020 12 29;23(6):345-357. Epub 2021 Jan 29.

Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.

The '16Up' study conducted at the QIMR Berghofer Medical Research Institute from January 2014 to December 2018 aimed to examine the physical and mental health of young Australian twins aged 16-18 years (N = 876; 371 twin pairs and 18 triplet sets). Measurements included online questionnaires covering physical and mental health as well as information and communication technology (ICT) use, actigraphy, sleep diaries and hair samples to determine cortisol concentrations. Study participants generally rated themselves as being in good physical (79%) and mental (73%) health and reported lower rates of psychological distress and exposure to alcohol, tobacco products or other substances than previously reported for this age group in the Australian population. Daily or near-daily online activity was almost universal among study participants, with no differences noted between males and females in terms of frequency or duration of internet access. Patterns of ICT use in this sample indicated that the respondents were more likely to use online information sources for researching physical health issues than for mental health or substance use issues, and that they generally reported partial levels of satisfaction with the mental health information they found online. This suggests that internet-based mental health resources can be readily accessed by adolescent Australians, and their computer literacy augurs well for future access to online health resources. In combination with other data collected as part of the ongoing Brisbane Longitudinal Twin Study, the 16Up project provides a valuable resource for the longitudinal investigation of genetic and environmental contributions to phenotypic variation in a variety of human traits.
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http://dx.doi.org/10.1017/thg.2020.83DOI Listing
December 2020

Demand for self-managed online telemedicine abortion in eight European countries during the COVID-19 pandemic: a regression discontinuity analysis.

BMJ Sex Reprod Health 2021 10 11;47(4):238-245. Epub 2021 Jan 11.

University of Cambridge, Cambridge, Cambridgeshire, UK.

Objectives: In most European countries, patients seeking medication abortion during the COVID-19 pandemic are still required to attend healthcare settings in person. We assessed whether demand for self-managed medication abortion provided by online telemedicine increased following the emergence of COVID-19.

Methods: We examined 3915 requests for self-managed abortion to online telemedicine service Women on Web (WoW) between 1 January 2019 and 1 June 2020. We used regression discontinuity to compare request rates in eight European countries before and after they implemented lockdown measures to slow COVID-19 transmission. We examined the prevalence of COVID-19 infection, the degree of government-provided economic support, the severity of lockdown travel restrictions and the medication abortion service provision model in countries with and without significant changes in requests.

Results: Five countries showed significant increases in requests to WoW, ranging from 28% in Northern Ireland (97 requests vs 75.8 expected requests, p=0.001) to 139% in Portugal (34 requests vs 14.2 expected requests, p<0.001). Two countries showed no significant change in requests, and one country, Great Britain, showed an 88% decrease in requests (1 request vs 8.1 expected requests, p<0.001). Among countries with significant increases in requests, abortion services are provided mainly in person in hospitals or abortion is unavailable and international travel was prohibited during lockdown. By contrast, Great Britain implemented a fully remote no-test telemedicine service.

Conclusion: These marked changes in requests for self-managed medication abortion during the COVID-19 pandemic demonstrate demand for remote models of care, which could be fulfilled by expanding access to medication abortion by telemedicine.
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http://dx.doi.org/10.1136/bmjsrh-2020-200880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802389PMC
October 2021

The association of birth by caesarean section and cognitive outcomes in offspring: a systematic review.

Soc Psychiatry Psychiatr Epidemiol 2021 Apr 3;56(4):533-545. Epub 2021 Jan 3.

QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, QLD, 4006, Australia.

Purpose: Studies have reported children born by caesarean section are more likely to have lower cognitive outcomes compared to those born by vaginal delivery. This paper reviews the literature examining caesarean birth and offspring cognitive outcomes.

Methods: A systematic search for observational studies or case-control studies that compared cognitive outcomes of people born by caesarean section with those born by vaginal delivery was conducted in six databases (Medline, PubMed, EMBASE, PsychInfo, CINAHL, Web of Science) from inception until December 2019 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were assessed for quality and a narrative synthesis was undertaken considering the evidence for a causal relationship according to the Bradford Hill Criteria.

Results: A total of seven studies were identified. Of these, four found a significant association between elective and emergency caesarean birth and reduction in offspring cognitive performance as measured by school performance or validated cognitive testing. Three studies found no association. There was variability in the quality of the studies, assessment of the reason for caesarean section (emergency vs elective), measurement of outcomes and adjustment for confounding factors.

Conclusion: The evidence of an association between CS birth and lower offspring cognitive functioning is inconsistent. Based on currently available data, there is no evidence that a causal association exists. To better examine this association, future studies should (a) distinguish elective and emergency caesareans, (b) adequately adjust for confounding variables and (c) have valid outcome measures of cognition.
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http://dx.doi.org/10.1007/s00127-020-02008-2DOI Listing
April 2021

Preferences of people with mental illness for engaging in exercise programs under COVID-19 restrictions.

Australas Psychiatry 2021 04 30;29(2):175-179. Epub 2020 Dec 30.

QIMR Berghofer Medical Research Institute, Australia.

Objectives: People with mental illness may be vulnerable to decline in mental health and reduced physical activity because of the COVID-19 pandemic and associated restrictions. The aim of this study was to inform the design of physical activity interventions for implementation under these conditions to improve/maintain well-being and physical activity in this population.

Methods: People with mental illness who had participated in a physical activity program prior to the pandemic were invited to complete a survey about the impact of COVID-19 on mental health and physical activity and their preferences for engaging in a physical activity program under pandemic-related restrictions.

Results: More than half the 59 respondents reported worse mental health and lower physical activity during the pandemic. The preferred format for a physical activity program was one-on-one exercise instruction in-person in a park. Program components endorsed as helpful included incentivization, provision of exercise equipment and fitness devices, and daily exercise programs. About a third of the participants reported limitations in using technology for a physical activity program.

Conclusions: In-person exercise support is preferred by people with mental illnesses during pandemic-related restrictions. Enablement strategies such as providing equipment and self-monitoring devices should be utilized; assistance may be needed to incorporate the use of technology in exercise programs.
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http://dx.doi.org/10.1177/1039856220975299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780068PMC
April 2021

Adjunctive Linn. (Mangosteen) Pericarp for Schizophrenia: A 24-Week Double-blind, Randomized, Placebo Controlled Efficacy Trial: Péricarpe d'appoint Garcinia mangostana Linn (mangoustan) pour la schizophrénie : un essai d'efficacité de 24 semaines, à double insu, randomisé et contrôlé par placebo.

Can J Psychiatry 2021 04 23;66(4):354-366. Epub 2020 Dec 23.

2104Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.

Objectives: Linn. ("mangosteen") pericarp contains bioactive compounds that may target biological pathways implicated in schizophrenia. We conducted a double-blind randomized placebo-controlled trial evaluating the efficacy of adjunctive mangosteen pericarp, compared to placebo, in the treatment of schizophrenia.

Methods: People diagnosed with schizophrenia or schizoaffective disorder (), recruited across 2 sites (Brisbane and Victoria, Australia), were randomized to receive 24 weeks of adjunctive mangosteen pericarp (1,000 mg/day) or matched placebo. The primary outcome measure was the Positive and Negative Symptom Scale total score. Secondary outcomes included positive and negative symptoms, general psychopathology, clinical global severity and improvement, participant reported overall improvement, depressive symptoms, functioning, quality of life, and safety data at 24 and 28 weeks (4 weeks postdiscontinuation). Data were collected from July 2016 to February 2019.

Results: Baseline assessments were conducted on 148 people (mangosteen = 74, placebo = 74); data analyses were conducted on 136 (92%) participants with postbaseline data. The treatment group had significantly higher symptom severity compared to placebo, and both groups significantly improved on all symptom, functioning, and quality of life measures over time. No between-group differences were found for the rate of change between baseline and 24 or 28 weeks.

Conclusion: Despite promising preclinical and clinical work, our results do not support mangosteen pericarp extract as an adjunctive treatment for schizophrenia or schizoaffective disorder.
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http://dx.doi.org/10.1177/0706743720982437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172349PMC
April 2021

Adjunctive Linn. (Mangosteen) Pericarp for Schizophrenia: A 24-Week Double-blind, Randomized, Placebo Controlled Efficacy Trial: Péricarpe d'appoint Garcinia mangostana Linn (mangoustan) pour la schizophrénie : un essai d'efficacité de 24 semaines, à double insu, randomisé et contrôlé par placebo.

Can J Psychiatry 2021 04 23;66(4):354-366. Epub 2020 Dec 23.

2104Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.

Objectives: Linn. ("mangosteen") pericarp contains bioactive compounds that may target biological pathways implicated in schizophrenia. We conducted a double-blind randomized placebo-controlled trial evaluating the efficacy of adjunctive mangosteen pericarp, compared to placebo, in the treatment of schizophrenia.

Methods: People diagnosed with schizophrenia or schizoaffective disorder (), recruited across 2 sites (Brisbane and Victoria, Australia), were randomized to receive 24 weeks of adjunctive mangosteen pericarp (1,000 mg/day) or matched placebo. The primary outcome measure was the Positive and Negative Symptom Scale total score. Secondary outcomes included positive and negative symptoms, general psychopathology, clinical global severity and improvement, participant reported overall improvement, depressive symptoms, functioning, quality of life, and safety data at 24 and 28 weeks (4 weeks postdiscontinuation). Data were collected from July 2016 to February 2019.

Results: Baseline assessments were conducted on 148 people (mangosteen = 74, placebo = 74); data analyses were conducted on 136 (92%) participants with postbaseline data. The treatment group had significantly higher symptom severity compared to placebo, and both groups significantly improved on all symptom, functioning, and quality of life measures over time. No between-group differences were found for the rate of change between baseline and 24 or 28 weeks.

Conclusion: Despite promising preclinical and clinical work, our results do not support mangosteen pericarp extract as an adjunctive treatment for schizophrenia or schizoaffective disorder.
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http://dx.doi.org/10.1177/0706743720982437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172349PMC
April 2021

Effect of Sodium Benzoate vs Placebo Among Individuals With Early Psychosis: A Randomized Clinical Trial.

JAMA Netw Open 2020 11 2;3(11):e2024335. Epub 2020 Nov 2.

Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia.

Importance: There is evidence that sodium benzoate (BZ) may be an effective adjunctive treatment for schizophrenia. The clinical efficacy of BZ has been investigated in chronic schizophrenia; however, the efficacy of this agent has not been studied in individuals with early psychosis.

Objective: To examine the clinical efficacy of the adjunctive use of BZ for symptoms in people with early psychosis.

Design, Setting, And Participants: Using a placebo-controlled double-masked parallel-group design, this randomized clinical trial was conducted from August 2015 to July 2018. Participants aged between 15 and 45 years experiencing early psychosis were enrolled from 5 major clinical sites in Queensland, Australia. Data analysis was conducted from October 2018 to February 2020.

Interventions: Participants were randomized 1:1 (50 participants in each group) to receive 500 mg of sodium benzoate twice daily or placebo for 12 weeks.

Main Outcomes And Measures: The primary efficacy outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 12 weeks. The key secondary efficacy measures were (1) the Clinical Global Impression score, (2) the Hamilton Depression Rating Scale for depression, (3) functioning as assessed by the clinician-rated Global Assessment of Function, and (4) the Assessment of Quality of Life Scale. The PANSS subscale scores and impact on selected amino acid concentrations were also assessed.

Results: The study comprised 100 participants with a mean (SD) age of 21.4 (4.1) years, of whom 73 (73%) were male individuals. The mean (SD) baseline PANSS score was 75.3 (15.4). We found no improvement in total PANSS score in the BZ group compared with the placebo group. The end result of least-squares mean difference (SE) for total PANSS was -1.2 (2.4) (P = .63). There were no differences in any subscales of the PANSS, any secondary measures, nor any amino acid concentrations. The dose of BZ was well tolerated without any clinically significant treatment-emergent adverse event differences between BZ and placebo groups.

Conclusions And Relevance: In this randomized clinical trial, there was no evidence that adjunctive use of 500 mg of BZ twice daily is an effective treatment for individuals with early psychosis.

Trial Registration: anzctr.org.au Identifier: ACTRN12615000187549.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.24335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656289PMC
November 2020

Muddying the waters? A false positive case of autoimmune psychosis.

Australas Psychiatry 2021 Jun 18;29(3):278-281. Epub 2020 Oct 18.

Metro North Mental Health Service, Herston, QLD, Australia.

Objective: To discuss challenges with the diagnosis of autoimmune psychosis (AP) in people with chronic psychotic disorders.

Method: We present a case of a 23-year-old man with an exacerbation of treatment-refractory psychosis after receiving intravenous immunoglobulin (IVIG) for suspected AP, diagnosed 4 years after the onset of psychosis. We highlight the diagnostic and management challenges in such cases.

Results: The diagnosis of AP in people with long-standing illness relies on the interpretation of non-specific clinical and laboratory findings in individuals with psychosocial problems and challenges of acceptance and adherence to complex medical investigations and treatments. Equivocal results from investigations undertaken without logical clinical reasoning can lead to inappropriate interventions that are costly and can cause iatrogenic harm.

Conclusion: Psychiatrists should restrict screening for antineuronal antibodies in people with chronic psychosis to those with higher risk features such as persistent treatment refractory symptoms with concurrent neurological signs and symptoms. Further research informing the clinical circumstances for antineuronal antibody testing is needed.
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http://dx.doi.org/10.1177/1039856220965041DOI Listing
June 2021

Social and Economic Costs of Attention-Deficit/Hyperactivity Disorder Across the Lifespan.

J Atten Disord 2020 Oct 13:1087054720961828. Epub 2020 Oct 13.

Murdoch Children's Research Institute, Parkville, VIC, Australia.

Objective: To determine the financial and non-financial costs of Attention-Deficit/Hyperactivity Disorder (ADHD) across the lifespan.

Method: The population costs of ADHD in Australia were estimated for the financial year 2018 to 2019 using a prevalence approach to cost estimation across all ages. Financial (healthcare, productivity, education and justice systems, and deadweight losses) and non-financial costs were measured (Disability Adjusted Life Years (DALYs)).

Results: The total social and economic cost of ADHD in 2018 to 2019 were US$12.76 billion (range US$8.40 billion to US$17.44 billion, with per person costs of US$15,664 per year). Productivity costs made up 81% of the total financial costs, followed by deadweight losses (11%), and health system costs (4%). Loss in terms of wellbeing was significant (US$5.31 billion).

Conclusion: There is a need to raise public awareness of the considerable socioeconomic impact and burden of ADHD in order to drive investment and policy decisions that improve identification and treatment of ADHD.
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http://dx.doi.org/10.1177/1087054720961828DOI Listing
October 2020

Social and Economic Costs of Attention-Deficit/Hyperactivity Disorder Across the Lifespan.

J Atten Disord 2020 Oct 13:1087054720961828. Epub 2020 Oct 13.

Murdoch Children's Research Institute, Parkville, VIC, Australia.

Objective: To determine the financial and non-financial costs of Attention-Deficit/Hyperactivity Disorder (ADHD) across the lifespan.

Method: The population costs of ADHD in Australia were estimated for the financial year 2018 to 2019 using a prevalence approach to cost estimation across all ages. Financial (healthcare, productivity, education and justice systems, and deadweight losses) and non-financial costs were measured (Disability Adjusted Life Years (DALYs)).

Results: The total social and economic cost of ADHD in 2018 to 2019 were US$12.76 billion (range US$8.40 billion to US$17.44 billion, with per person costs of US$15,664 per year). Productivity costs made up 81% of the total financial costs, followed by deadweight losses (11%), and health system costs (4%). Loss in terms of wellbeing was significant (US$5.31 billion).

Conclusion: There is a need to raise public awareness of the considerable socioeconomic impact and burden of ADHD in order to drive investment and policy decisions that improve identification and treatment of ADHD.
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http://dx.doi.org/10.1177/1087054720961828DOI Listing
October 2020

Agency notification and retrospective self-reports of childhood maltreatment in a 30-Year cohort: Estimating population prevalence from different data sources.

Child Abuse Negl 2020 11 1;109:104744. Epub 2020 Oct 1.

Clinical Psychological Science Department, Faculty of Psychology and Neuroscience, Maastricht University, Univesiteitssingel 40, 6229 ER, Maastrichts, Netherlands.

Background: There is little known about how two sources of child maltreatment reports correspond, specifically for emotional, physical, sexual abuse and emotional or physical neglect.

Objective: To compare agency and self-reports of child maltreatment and determine whether they are predicted by similar early life course adverse experiences. Participants Data are taken from a long running birth cohort study (Mater-University of Queensland Study of Pregnancy - MUSP). Mothers (N=7223) were recruited in 1981-83 and their children were followed-up 30 years later (2010-14). In 2000 data from the relevant child protection agency were accessed and linked to the survey data. Setting Consecutive women giving birth to a live singleton baby at a major obstetrical service in Brisbane, Australia were recruited and both mother and child were repeatedly follow-up over a 30 year period. Methods Birth cohort study with data linkage of child protection agency records and self-report survey data (using the Childhood Trauma Questionnaire - CTQ) of childhood maltreatment experiences. We compare reports of emotional, physical and sexual abuse and neglect using agency and self-reports (Cramer's V and kappa).

Results: Most children who are notified cases of maltreatment subsequently self-report they experienced little or no maltreatment in childhood. Most children who report experiencing severe maltreatment have not previously been notified to the protection agency. Teenage mothers have children who are notified 2.89 (1.52, 5.52) times, self-report 2.01 (1.31, 3.09) times and both notified and self-report 3.61 (2.26, 6.10) times more than their older comparison mothers.

Conclusions: Different methods of assessing maltreatment identify different subsets of those children who have experienced maltreatment.
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http://dx.doi.org/10.1016/j.chiabu.2020.104744DOI Listing
November 2020

Maternal hypertensive disorders during pregnancy and the trajectories of offspring emotional and behavioral problems: the ALSPAC birth cohort study.

Ann Epidemiol 2021 01 18;53:63-68.e1. Epub 2020 Sep 18.

Institute for Social Science Research, The University of Queensland, Brisbane, Australia; School of Public Health, Curtin University, Perth, Australia.

Purpose: This study examined the effect of hypertensive disorders during pregnancy on trajectories of emotional and behavioral problems in offspring.

Methods: We used data from the Avon Longitudinal Study of Parents and Children, a prospective birth cohort study in Avon, United Kingdom. A group-based trajectory modeling was used to identify the distinct trajectories of emotional and behavioral problems in children at four time points: at age 3.5, 6.75, 9, and 11 years. Multinomial logistic regression analyses were used to examine the association between hypertensive disorders during pregnancy and trajectories of emotional and behavioral problems.

Results: We identified four trajectories of offspring emotional and behavioral problems: normal (42.6%), borderline decreasing (40.6%), borderline stable (10.0%), and persistently elevated (6.8%). We found that children exposed to maternal pre-eclampsia were more likely to be in the persistently elevated symptom trajectory (OR = 2.72; 95% CI: 1.10-6.74) than in the normal trajectory group. We found no associations between maternal gestational hypertension and trajectories of offspring emotional and behavioral problems.

Conclusions: Maternal pre-eclampsia, but not gestational hypertension was associated with persistently elevated trajectory of offspring emotional and behavioral problems. Our findings highlight that the antenatal environment is important for children's behavioral and emotional development.
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http://dx.doi.org/10.1016/j.annepidem.2020.08.015DOI Listing
January 2021

The Patient Experience of Recovery Following Anti-NMDA Receptor Encephalitis: A Qualitative Content Analysis.

J Neuropsychiatry Clin Neurosci 2021 2;33(1):57-63. Epub 2020 Sep 2.

Metro South Addiction and Mental Health Services, Brisbane, Australia (McKeon, Parker, Warren);University of Queensland Centre for Clinical Research, Herston, Australia (McKeon, Scott); Child and Youth Mental Health Group, Queensland Centre for Mental Health Research, Wacol, Australia (McKeon, Scott); School of Medicine, University of Queensland, Herston, Australia (Parker, Warren); and Child and Youth Mental Health Group, Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston, Australia (McKeon, Scott).

Objective: The authors examined patients' perceptions of the factors affecting their recovery from anti--methyl-d-aspartate receptor (anti-NMDAR) encephalitis, which is a rare, severe immune-mediated neurological disorder.

Methods: Seven patients completed semistructured interviews exploring their experience of recovery. Participants were interviewed between 7 and 41 months after the initiation of treatment. Interviews were transcribed and subjected to qualitative content analysis.

Results: Facilitators of recovery included the presence of a support system and treatment-related factors. Barriers to recovery included perceived psychiatric stigma, insufficient illness education, and lifestyle disruptions to accommodate ongoing treatment. Adverse physical, psychological, and neurocognitive sequelae of anti-NMDAR encephalitis continued to affect participants' daily functioning. Most participants described strategies to manage neurocognitive deficits, fatigue, and anxiety.

Conclusions: Anti-NMDAR encephalitis contributes to persistent burden on patients, their families, and health services after the resolution of acute symptoms. Physical, psychological, and cognitive changes contribute to long-term disease morbidity. To optimize recovery and reduce disability, further attention must be directed toward illness education, reducing stigma, and role disruption. Longer-term disability support may benefit those who do not fully recover.
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http://dx.doi.org/10.1176/appi.neuropsych.20030049DOI Listing
September 2021

Reconceptualizing post-intensive care syndrome: Do we need to unpick our PICS?

Nurs Crit Care 2021 03 1;26(2):67-69. Epub 2020 Sep 1.

Metro North Mental Health Service, Brisbane, Australia.

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http://dx.doi.org/10.1111/nicc.12545DOI Listing
March 2021

A certificate in youth psychiatry: meeting the training needs of psychiatrists.

Australas Psychiatry 2021 02 28;29(1):97-100. Epub 2020 Jul 28.

QIMR Berghofer Medical Research Institute, Australia.

Objective: This paper provides the rationale for the development of sub-specialty training in youth psychiatry.

Method: Training needs for youth psychiatry are discussed and the opportunities provided by sub-specialisation in youth psychiatry are presented.

Results: The majority of mental disorders have their onset prior to 25 years. There has been substantial recent growth in services to meet the clinical needs of young people. The development of these services has exposed gaps in current training for psychiatrists, which varies considerably between child and adolescent, and adult psychiatry. Competencies acquired by psychiatrists in youth mental health are non-standardised, which may hinder optimal care.

Conclusions: Sub-specialty training in youth psychiatry is needed to meet workforce demands. The development of a certificate in youth psychiatry, by the RANZCP Section for Youth Mental Health, is underway. This will complement existing training and provide trainees and psychiatrists the opportunity to develop specialist skills in the provision of mental health care for young people negotiating the transition between adolescence and adulthood.
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http://dx.doi.org/10.1177/1039856220943015DOI Listing
February 2021
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