Publications by authors named "Lisa Hahn"

24 Publications

  • Page 1 of 1

Accelerated theta burst stimulation for the treatment of depression: A randomised controlled trial.

Brain Stimul 2021 Jul 29;14(5):1095-1105. Epub 2021 Jul 29.

Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia.

Introduction: Theta burst pattern repetitive transcranial magnetic stimulation (TBS) is increasingly applied to treat depression. TBS's brevity is well-suited to application in accelerated schedules. Sizeable trials of accelerated TBS are lacking; and optimal TBS parameters such as stimulation intensity are not established.

Methods: We conducted a three arm, single blind, randomised, controlled, multi-site trial comparing accelerated bilateral TBS applied at 80 % or 120 % of the resting motor threshold and left unilateral 10 Hz rTMS. 300 patients with treatment-resistant depression (TRD) were recruited. TBS arms applied 20 bilateral prefrontal TBS sessions over 10 days, while the rTMS arm applied 20 daily sessions of 10 Hz rTMS to the left prefrontal cortex over 4 weeks. Primary outcome was depression treatment response at week 4.

Results: The overall treatment response rate was 43.7 % and the remission rate was 28.2 %. There were no significant differences for response (p = 0.180) or remission (p = 0.316) across the three groups. Response rates between accelerated bilateral TBS applied at sub- and supra-threshold intensities were not significantly different (p = 0.319). Linear mixed model analysis showed a significant effect of time (p < 0.01), but not rTMS type (p = 0.680).

Conclusion: This is the largest accelerated bilateral TBS study to date and provides evidence that it is effective and safe in treating TRD. The accelerated application of TBS was not associated with more rapid antidepressant effects. Bilateral sequential TBS did not have superior antidepressant effect to unilateral 10 Hz rTMS. There was no significant difference in antidepressant efficacy between sub- and supra-threshold accelerated bilateral TBS.
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http://dx.doi.org/10.1016/j.brs.2021.07.018DOI Listing
July 2021

Participatory Action Research-Dadirri-Ganma, using Yarning: methodology co-design with Aboriginal community members.

Int J Equity Health 2021 07 12;20(1):160. Epub 2021 Jul 12.

Adelaide Nursing School, The University of Adelaide, South Australia, Adelaide, Australia.

Background: Appropriate choice of research design is essential to rightly understand the research problem and derive optimal solutions. The Comorbidity Action in the North project sought to better meet the needs of local people affected by drug, alcohol and mental health comorbidity. The aim of the study focused on the needs of Aboriginal peoples and on developing a truly representative research process. A methodology evolved that best suited working with members of a marginalised Aboriginal community. This paper discusses the process of co-design of a Western methodology (participatory action research) in conjunction with the Indigenous methodologies Dadirri and Ganma. This co-design enabled an international PhD student to work respectfully with Aboriginal community members and Elders, health professionals and consumers, and non-Indigenous service providers in a drug and alcohol and mental health comorbidity project in Adelaide, South Australia.

Methods: The PhD student, Aboriginal Elder mentor, Aboriginal Working Party, and supervisors (the research team) sought to co-design a methodology and applied it to address the following challenges: the PhD student was an international student with no existing relationship with local Aboriginal community members; many Aboriginal people deeply distrust Western research due to past poor practices and a lack of implementation of findings into practice; Aboriginal people often remain unheard, unacknowledged and unrecognised in research projects; drug and alcohol and mental health comorbidity experiences are often distressing for Aboriginal community members and their families; attempts to access comorbidity care often result in limited or no access; and Aboriginal community members experience acts of racism and discrimination as health professionals and consumers of health and support services. The research team considered deeply how knowledge is shared, interpreted, owned and controlled, by whom and how, within research, co-morbidity care and community settings. The PhD student was supported to co-design a methodology that was equitable, democratic, liberating and life-enhancing, with real potential to develop feasible solutions.

Results: The resulting combined Participatory Action Research (PAR)-Dadirri-Ganma methodology sought to create a bridge across Western and Aboriginal knowledges, understanding and experiences. Foundation pillars of this bridge were mentoring of the PhD student by senior Elders, who explained and demonstrated the critical importance of Yarning (consulting) and Indigenous methodologies of Dadirri (deep listening) and Ganma (two-way knowledge sharing), and discussions among all involved about the principles of Western PAR.

Conclusions: Concepts within this paper are shared from the perspective of the PhD student with the permission and support of local Elders and Working Group members. The intention is to share what was learned for the benefit of other students, research projects and community members who are beginning a similar journey.
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http://dx.doi.org/10.1186/s12939-021-01493-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8274049PMC
July 2021

Examining early structural and functional brain alterations in postpartum depression through multimodal neuroimaging.

Sci Rep 2021 Jun 30;11(1):13551. Epub 2021 Jun 30.

Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany.

Postpartum depression (PPD) affects approximately 1 in 10 women after childbirth. A thorough understanding of a preexisting vulnerability to PPD will likely aid the early detection and treatment of PPD. Using a within-sample association, the study examined whether the brain's structural and functional alterations predict the onset of depression. 157 euthymic postpartum women were subjected to a multimodal MRI scan within the first 6 days of childbirth and were followed up for 12 weeks. Based on a clinical interview 12 weeks postpartum, participants were classified as mentally healthy or having either PPD or adjustment disorder (AD). Voxel-based morphometry and resting-state functional connectivity comparisons were performed between the three groups. 13.4% of women in our study developed PPD (n = 21) and 12.1% (n = 19) adjustment disorder (AD). The risk factors for PPD were a psychiatric history and the experience and severity of baby blues and the history of premenstrual syndrome. Despite the different risk profiles, no differences between the PPD, AD and control group were apparent based on structural and functional neuroimaging data immediately after childbirth. At 12 weeks postpartum, a significant association was observed between Integrated Local Correlation (LCor) and the Edinburgh Postnatal Depression Score (EPDS). Our findings do not support the notion that the brain's structural and resting-state functional alterations, if present, can be used as an early biomarker of PPD or AD. However, effects may become apparent if continuous measures of symptom severity are chosen.
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http://dx.doi.org/10.1038/s41598-021-92882-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245412PMC
June 2021

Ageing with psychosis - Fifty and beyond.

Aust N Z J Psychiatry 2021 Apr 27:48674211009619. Epub 2021 Apr 27.

The University of Melbourne, Department of Psychiatry Melbourne, VIC, Australia.

Objective: While there is considerable current emphasis on youth and early psychosis, relatively little is known about the lives of people who live with psychotic disorders into middle age and beyond. We investigated social functioning, physical health status, substance use and psychiatric symptom profile in people with psychotic disorders aged between 50 and 65 years.

Methods: Data were collected as part of the Survey of High Impact Psychosis, a population-based survey of Australians aged 18-65 years with a psychotic disorder. We compared those aged 50-65 years ( = 347) with those aged 18-49 years ( = 1478) across a range of measures.

Results: The older group contained more women and more people with affective psychoses compared to the younger group. They were also more likely to have had a later onset and a chronic course of illness. The older group were more likely to have negative symptoms but less likely to exhibit positive symptoms; they also had lower current cognition, compared to the younger group. Compared to the younger group, the older group were more likely to be divorced/separated, to be living alone and to be unemployed. They had substantially lower lifetime use of alcohol and illicit substances, but rates of obesity, metabolic syndrome and diabetes mellitus were higher.

Conclusion: Our findings suggest that the characteristics of people with psychosis change significantly as they progress into the middle age and beyond. A better understanding of these differences is important in informing targeted treatment strategies for older people living with psychosis.
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http://dx.doi.org/10.1177/00048674211009619DOI Listing
April 2021

A comparison of 15 minute vs 30 minute repetitive transcranial magnetic stimulation sessions for treatment resistant depression - are longer treatment sessions more effective?

J Affect Disord 2021 03 7;282:974-978. Epub 2021 Jan 7.

The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services; Discipline of Psychiatry, University of Adelaide; Northern Adelaide Local Health Network, Adelaide, SA, Australia. Electronic address:

Background: Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe and effective treatment for treatment resistant depression (TRD). The number of patients able to be treated with rTMS is determined by the availability of the machine and staff. If treatment delivered in a shorter time were just as effective as longer treatments, then more patients could be treated with the same resources.

Method: This naturalistic study investigated 145 first-time patients treated with 15 minute (900 pulses) or 30 minute (1800 pulses) RLF rTMS for TRD 3 days/week for 6 weeks. Response and remission rates for the two groups were compared. We investigated whether longer right unilateral low (1Hz) frequency (RLF) repetitive transcranial magnetic stimulation (rTMS) treatment sessions are more effective than shorter sessions in achieving response and remission for treatment resistant depression (TRD).

Results: The duration of rTMS treatment sessions had no effect on treatment outcomes over the course of 6 weeks. The group treated with 15 minute rTMS sessions showed a partial response rate of 28.2%, a response rate of 11.5% and remission rate of 21.8%, which did not differ significantly from patients receiving 30 minute sessions who had a partial response rate of 25.4%, response rate of 17.9% and remission rate of 22.4%.

Limitations: Participants were not randomized and the inclusion criteria were broad and reflected the nature of patients seen in routine practice.

Conclusions: Fifteen minute rTMS sessions 3 days/week for 6 weeks were as effective as 30 minute sessions, providing a pragmatic advantage for shorter treatments.
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http://dx.doi.org/10.1016/j.jad.2021.01.009DOI Listing
March 2021

Early identification of postpartum depression using demographic, clinical, and digital phenotyping.

Transl Psychiatry 2021 02 11;11(1):121. Epub 2021 Feb 11.

Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany.

Postpartum depression (PPD) and adjustment disorder (AD) affect up to 25% of women after childbirth. However, there are no accurate screening tools for either disorder to identify at-risk mothers and enable them to benefit from early intervention. Combinations of anamnestic, clinical, and remote assessments were evaluated for an early and accurate identification of PPD and AD. Two cohorts of mothers giving birth were included in the study (N = 308 and N = 193). At baseline, participants underwent a detailed sociodemographic-anamnestic and clinical interview. Remote assessments were collected over 12 weeks comprising mood and stress levels as well as depression and attachment scores. At 12 weeks postpartum, an experienced clinician assigned the participants to three distinct groups: women with PPD, women with AD, and healthy controls (HC). Combinations of these assessments were assessed for an early an accurate detection of PPD and AD in the first cohort and, after pre-registration, validated in a prospective second cohort. Combinations of postnatal depression, attachment (for AD) and mood scores at week 3 achieved balanced accuracies of 93 and 79% for differentiation of PPD and AD from HC in the validation cohort and balanced accuracies of 87 and 91% in the first cohort. Differentiation between AD and PPD, with a balanced accuracy of 73% was possible at week 6 based on mood levels only with a balanced accuracy of 73% in the validation cohort and a balanced accuracy of 76% in the first cohort. Combinations of in clinic and remote self-assessments allow for early and accurate detection of PPD and AD as early as three weeks postpartum, enabling early intervention to the benefit of both mothers and children.
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http://dx.doi.org/10.1038/s41398-021-01245-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878890PMC
February 2021

A qualitative study of medication adherence amongst people with schizophrenia.

Arch Psychiatr Nurs 2020 08 6;34(4):194-199. Epub 2020 Jun 6.

The University of Adelaide, North Terrace, Adelaide 5005, SA, Australia; Ramsay Health Care (SA) Mental Health, 33 Park Terrace, Gilberton, Adelaide 5081, SA, Australia; Northern Adelaide Local Health Network, Haydown Road, Elizabeth Vale, Adelaide 5112, SA, Australia. Electronic address:

Non-adherence to antipsychotic medication is common among people with schizophrenia, and is associated with an increased risk of relapse. It is important to develop strategies to enhance medication adherence. Few qualitative studies have been undertaken to understand the consumer's perspective. The voice of people who are prescribed these medications is therefore missing from the research literature. Reasons for non-adherence were investigated by directly engaging with consumers and exploring their attitudes, beliefs and experiences concerning antipsychotic medications. Qualitative, semi- structured, one-to-one interviews were conducted with 25 community-dwelling people with schizophrenia from metropolitan Adelaide, Australia. Interviews were audio-recorded, transcribed and analysed, guided by a grounded theory approach. Codes identified in open coding were grouped into categories, reflective of the different aspects of consumers' attitudes and experiences with medication. Interviews continued until there was saturation of themes. Consumer-related factors, medication-related factors and service-related factors were reported to influence adherence behavior. These included poor insight, unpleasant medication side effects, inadequate efficacy and poor therapeutic alliance. Lessons gained during periods of non-adherence were the motivator for future adherence; such as worsening of symptoms if medication was not taken. Potential implications of future adherence described by Interviewees include greater involvement of peer workers, as they were considered to work more effectively with consumers to encourage adherence. Peer workers had more credibility than other service providers due to their lived experience. Multiple factors were identified that impact on antipsychotic medication adherence, providing opportunities for interventions and improvements in services that would enhance adherence.
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http://dx.doi.org/10.1016/j.apnu.2020.06.002DOI Listing
August 2020

Parental history of diabetes mellitus has additive risk of metabolic syndrome in patients treated with clozapine.

Asian J Psychiatr 2020 Apr 11;50:101939. Epub 2020 Feb 11.

Psychiatry Department, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, PR China. Electronic address:

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http://dx.doi.org/10.1016/j.ajp.2020.101939DOI Listing
April 2020

Weight Change after Striatal/Capsule Deep Brain Stimulation Relates to Connectivity to the Bed Nucleus of the Stria Terminalis and Hypothalamus.

Brain Sci 2019 Oct 3;9(10). Epub 2019 Oct 3.

Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Medical faculty, 50937 Cologne, Germany.

Weight changes are insufficiently understood adverse events of deep brain stimulation. In this context, exploring neural networks of weight control may inform novel treatment strategies for weight-related disorders. In this study, we investigated weight changes after deep brain stimulation of the ventral striatum/ventral capsule and to what extent changes are associated with connectivity to feeding-related networks. We retrospectively analyzed 25 patients undergoing deep brain stimulation for obsessive-compulsive disorder or substance dependency. Weight changes were assessed preoperatively and six to twelve months after surgery and then matched with individual stimulation sites and stimulation-dependent functional connectivity to a priori defined regions of interest that are involved in food intake. We observed a significant weight gain after six to twelve months of continuous stimulation. Weight increases were associated with medial/apical localization of stimulation sites and with connectivity to hypothalamic areas and the bed nucleus. Thus, deep brain stimulation of the ventral striatum/ventral capsule influences weight depending on localization and connectivity of stimulation sites. Bearing in mind the significance of weight-related disorders, we advocate further prospective studies investigating the neuroanatomical and neuropsychological underpinnings of food intake and their neuromodulatory therapeutic potential.
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http://dx.doi.org/10.3390/brainsci9100264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826646PMC
October 2019

Efficacy of repetitive transcranial magnetic stimulation in the treatment of depression with comorbid anxiety disorders.

J Affect Disord 2019 06 30;252:435-439. Epub 2019 Mar 30.

The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, South Australia, Australia; Discipline of Psychiatry, School of Medicine, The University of Adelaide, South Australia, Australia; Northern Adelaide Local Health Network, South Australia, Australia. Electronic address:

Background: The presence of comorbid anxiety is generally associated with poorer treatment outcomes in people with depression. Repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective for treatment resistant depression, but there has been little research examining rTMS in depressed patients with comorbid anxiety disorders. This study aimed to investigate the efficacy of rTMS in patients with treatment resistant Major Depressive Disorder (MDD) and comorbid anxiety disorders.

Methods: This study included 248 patients with treatment resistant MDD who were treated with rTMS. Of these, 172 patients had one or more comorbid anxiety disorders, so their outcomes were compared with patients who did not have comorbid anxiety.

Results: Patients both with and without comorbid anxiety disorders showed improvement in depression ratings after rTMS treatment, with no significant difference in remission rates between groups. In those with comorbid anxiety disorders, 23.3% met criteria for remission and 39.5% met response criteria. For each anxiety disorder diagnosis, there was a significant reduction in HAM-A, HAM-D21, MADRS and ZUNG scores (p = <0.001 for all).

Limitations: This was not a sham-controlled study, so placebo response rates are not known. Patients were referred by private psychiatrists so are not representative of all patients with depression.

Conclusion: Our study indicates that rTMS is an effective treatment for Major Depressive Disorder in people who have comorbid anxiety disorders.
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http://dx.doi.org/10.1016/j.jad.2019.03.085DOI Listing
June 2019

Ultraviolet patterns of flowers revealed in polymer replica - caused by surface architecture.

Beilstein J Nanotechnol 2019 13;10:459-466. Epub 2019 Feb 13.

Nees Institute for Biodiversity of Plants, University of Bonn, Venusbergweg 22, D-53115 Bonn, Germany.

Angiosperms and their pollinators are adapted in a close co-evolution. For both the plants and pollinators, the functioning of the visual signaling system is highly relevant for survival. As the frequency range of visual perception in many insects extends into the ultraviolet (UV) region, UV-patterns of plants play an important role in the flower-pollinator interaction. It is well known that many flowers contain UV-absorbing pigments in their petal cells, which are localized in vacuoles. However, the contribution of the petal surface microarchitecture to UV-reflection remains uncertain. The correlation between the surface structure and its reflective properties is also relevant for biomimetic applications, for example, in the field of photovoltaics. Based on previous work, we selected three model species with distinct UV-patterns to explore the possible contribution of the surface architecture to the UV-signaling. Using a replication technique, we transferred the petal surface structure onto a transparent polymer. Upon illumination with UV-light, we observed structural-based patterns in the replicas that were surprisingly comparable to those of the original petals. For the first time, this experiment has shown that the parameters of the surface structure lead to an enhancement in the amount of absorbed UV-radiation. Spectrophotometric measurements revealed up to 50% less reflection in the UV-absorbing regions than in the UV-reflecting areas. A comparative characterization of the micromorphology of the UV-reflecting and UV-absorbing areas showed that, in principle, a hierarchical surface structure results in more absorption. Therefore, the results of our experiments demonstrate the structural-based amplification of UV-reflection and provide a starting point for the design of bioinspired antireflective and respectively strongly absorbing surfaces.
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http://dx.doi.org/10.3762/bjnano.10.45DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404398PMC
February 2019

A new scoring system for increasing the sensitivity of the MMSE.

Z Gerontol Geriatr 2020 Mar 25;53(2):156-162. Epub 2019 Feb 25.

Department of Neurology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Background: The mini mental state examination (MMSE) has been criticized for its lack of sensitivity, especially in mild cases of dementia. There have been several attempts to increase the sensitivity by adding or deleting items, which never became accepted in clinical practice.

Objective: In the current study a new scoring system for improving the sensitivity of the MMSE is proposed, which preserves the original items and the total score of 30 points. Instead of changing the number of items or the total score of 30 points, the weighting of the different items in the total score of 30 points was changed.

Material And Methods: Neuropsychological test data of 765 patients were retrospectively included in the study to determine the difficulty of each MMSE item. Multiple scoring systems for the MMSE were developed by inclusion of the item difficulty and clinical relevance. The sensitivity of the new scoring system was compared to the original scoring system by using the DemTect as an established measure.

Results: The results showed that an increase of 24.3% in sensitivity was statistically significant. Within the mild cognitive impairment subgroup, the sensitivity of the new scoring system was twice as high in comparison to the original MMSE and within the dementia group the sensitivity was increased by 8.2%.

Conclusion: A new scoring system with a higher sensitivity than the original MMSE was developed, which can easily be administered in clinical practice because it preserves all items and the total score of 30 points.
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http://dx.doi.org/10.1007/s00391-019-01516-4DOI Listing
March 2020

'Having a mentor helped me with difficult times': a trainee-run mentoring project.

Australas Psychiatry 2019 Jun 17;27(3):230-233. Epub 2019 Jan 17.

Psychiatrist, Northern Adelaide Local Health Network, Adelaide, SA, and; Discipline of Psychiatry, Adelaide Medical School, Adelaide, SA, and; Ramsay Health Care Mental Health, Adelaide, SA, Australia.

Objective: A mentoring programme was established in South Australia in 2014 by psychiatry trainees, with the goal of reducing stress and burnout amongst first-year trainees. All first-year trainees are offered the opportunity to have a senior trainee as a mentor. This article describes the mentoring programme, presents feedback from participants and identifies areas for further development.

Method: The majority (72/76) of first-year trainees entering psychiatry training in South Australia from 2014-2018 were allocated a mentor. Surveys were sent out in 2014, 2015 and 2017. Twenty of 42 (48%) mentors and 17 of 42 (40%) of mentees completed a 10-item questionnaire, with free text responses.

Results: Mentee feedback was mostly positive, reporting that mentors offered them reassurance and support. The most common challenges were advice about training, managing work-life balance and issues with supervision. The main barrier to the mentoring programme was lack of time to meet. Mentors identified that they would have liked more training in mentoring.

Conclusion: The trainee mentoring programme has been a useful initiative. As consultant psychiatrists are likely to provide mentoring for more junior colleagues, the authors propose that training in mentoring should be part of the Royal Australian and New Zealand College of Psychiatrists education programme.
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http://dx.doi.org/10.1177/1039856218822735DOI Listing
June 2019

Does rTMS reduce depressive symptoms in young people who have not responded to antidepressants?

Early Interv Psychiatry 2019 10 10;13(5):1129-1135. Epub 2018 Oct 10.

Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.

Aim: Depression is common in young people, and there is a need for safe, effective treatments. This study examined the efficacy of repetitive transcranial magnetic stimulation in a sample of young people aged 17 to 25 years.

Methods: This retrospective study included 15 people aged 17 to 25 years referred by their private psychiatrists affiliated with Ramsay Health Care, South Australia Mental Health Services. All patients met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for treatment-resistant Major Depressive Disorder. Eleven patients received right unilateral treatment and four patients received bilateral treatment. Patients were assessed at baseline and after treatment.

Results: There was a significant improvement on the Hamilton Rating Scale for Depression (t(14) = 4.71, P < 0.0001); Montgomery-Åsperg Depression Rating Scale (t(14) = 3.96, P < 0.01) and the Zung Self-Rating Depression Scale (t(14) = 4.13, P < 0.01). There was no difference in response by gender or age. The response rates in these young people did not differ significantly from those of adults aged 25 to 82 years.

Conclusion: This open label, naturalistic study suggests that repetitive transcranial magnetic stimulation is an effective treatment in young adults who have treatment-resistant depression. Randomized sham-controlled studies are needed to further investigate the efficacy of this treatment in this age group.
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http://dx.doi.org/10.1111/eip.12743DOI Listing
October 2019

Body height loss characterizes camptocormia in Parkinson's disease.

J Neural Transm (Vienna) 2018 10 7;125(10):1473-1480. Epub 2018 Aug 7.

Department of Neurology and Clinical Neurophysiology, Centre for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing, Parzivalplatz 4, 80804, Munich, Germany.

Axial deformities such as camptocormia or Pisa syndrome in people with Parkinson's disease (PwP) are poorly understood. The scarcity of information may result from the shortage of reliable and responsive evaluation instruments. We evaluated the body height loss (BHL) as a new measure for PwP with axial deformities. 50 PwP with axial deformity defined by an UPDRS item 28 value of at least 2 were included in this mono-center study. We measured body height while lying supine and after 1 min of standing, providing a percentage value of BHL, and compared this measure to other clinical variables. BHL depended on the Hoehn and Yahr clinical stage and correlated with clinical scales for function and mobility, but not with timely measures of the axial disorder such as age at diagnosis or duration of disease. ANOVA showed that only lumbar flexion explained the variability of BHL (F = 21.0, p < 0.0001), but not kyphosis (F = 0.4, p = 0.74) or lateroflexion (F = 0.6, p = 0.6). Re-test reliability of BHL was good with к = 0.76 (p < 0.0001). BHL resulted from the lumbar spine and the hip joint and not from the thoracic spine or lateroflexion. This observation conforms to the concept of upper-type and lower-type camptocormia with only the latter leading to a BHL. The assessment of the BHL is shown to be a well defined, easy to perform, and reliable measure for the clinical evaluation of lower-type camptocormia.
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http://dx.doi.org/10.1007/s00702-018-1912-2DOI Listing
October 2018

Shorter telomere length in people with schizophrenia who live alone?

Schizophr Res 2018 09 28;199:422-423. Epub 2018 Feb 28.

Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Ramsay Health Care Mental Health, SA, Australia.

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http://dx.doi.org/10.1016/j.schres.2018.02.039DOI Listing
September 2018

Shorter telomere length in people with schizophrenia: A preliminary study from Australia.

Schizophr Res 2017 12 9;190:46-51. Epub 2017 Mar 9.

Nutrigenomics & DNA Damage Diagnostics, CSIRO Health and Biosecurity, Adelaide, SA, Australia.

Schizophrenia is a complex mental illness affecting the normal functioning of the brain, interfering with the ability to think, feel and act. It can be conceptualised as a syndrome of accelerated ageing, with early onset of cardiovascular disease and high rates of premature mortality. Telomere attrition increases with oxidative stress and is considered a biomarker of ageing. Previous studies have assessed abnormalities in telomere length in schizophrenia, but the results are inconsistent. The present study used a case-control design to assess whether people with schizophrenia have shortened telomeres, indicative of accelerated ageing. Subjects were all male, aged 25-35years, living in the same urban region of Adelaide, South Australia. Telomere length was measured using a quantitative real-time polymerase chain reaction (PCR) method. We found significantly shorter telomeres in people with schizophrenia relative to healthy controls. This is the first study to show telomere attrition among people with schizophrenia in Australia. Shorter telomere length may indicate the common pathways that schizophrenia shares with other neuropsychiatric and neurodevelopmental disorders associated with increased cellular senescence. Further well-controlled larger studies in people with schizophrenia are required to fully understand (i) the role of variables that have the potential to modulate telomere length such as use of antipsychotic drugs, medical conditions, parental age, smoking, alcohol abuse and use of illicit drugs; (ii) effective treatments to slow telomere erosion and (iii) mechanisms responsible for accelerating and reducing telomere damage.
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http://dx.doi.org/10.1016/j.schres.2017.03.007DOI Listing
December 2017

The role of arterial elasticity and cardiovascular peripheral resistance as clinically relevant indices of health status in people with psychosis.

Schizophr Res 2017 06 6;184:88-95. Epub 2016 Dec 6.

Discipline of Psychiatry, School of Medicine, University of Adelaide Ramsay Health Care, Mental Health Services, Northern Adelaide Local Health Network, Adelaide, SA, Australia. Electronic address:

Objective: Hypertension is one of the most important risk factors for cardiovascular disease (CVD). Systolic and diastolic blood pressure (BP) are higher in people with psychosis compared to the general population, but there is little research into measures of the elasticity of the arterial wall (pulse pressure; PP) and peripheral resistance (mean arterial pressure; MAP). PP and MAP can provide an additional perspective on the functioning of the circulatory system. This study investigated PP and MAP in people with psychosis, using factors known to be related to PP and MAP in the general population.

Method: Participants included 1421 people aged 18-64years, from the second Australian national survey of psychosis, untreated with antihypertensive medication. We tested the interaction and main effects between age and gender on PP, MAP, systolic BP and diastolic BP. Odds ratios were calculated in people exceeding the at-risk thresholds for PP and MAP. Multiple linear regression was used to test whether factors associated with at-risk PP and MAP in the general population were similarly associated in the psychosis population.

Results: The interaction effect between age and gender on PP, MAP, systolic BP and diastolic BP was not statistically significant. Variables that retained significance in the regression model in explaining higher PP and MAP were: male gender, higher age, and having a family history of hypertension.

Conclusion: Clinicians monitoring and treating CV risk in this population need to ensure that they have recorded whether there is a family history of hypertension, and should be especially, more vigilant in men and in older patients.
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http://dx.doi.org/10.1016/j.schres.2016.11.046DOI Listing
June 2017

Counting up the risks: How common are risk factors for morbidity and mortality in young people with psychosis?

Early Interv Psychiatry 2018 12 17;12(6):1045-1051. Epub 2016 Nov 17.

Discipline of Psychiatry, School of Medicine, University of Adelaide Ramsay Health Care, Mental Health Services Northern Adelaide Local Health Network, Adelaide, Southern Australia, Australia.

Background: This study examined the prevalence of risk factors for cardiovascular (CV)-related morbidity and mortality in young people with psychosis aged 18 to 24 years.

Methods: The study included 132 people aged 18 to 24 years who participated in the 2010 second Australian national survey of people living with psychosis. The 2009 World Health Organisation (WHO) Global Health Risks report was used as a framework to determine which specific risk factors were present in each in these young people. The risk factors assessed in this study were smoking, alcohol use, hypertension, overweight/obesity, physical inactivity, high blood glucose, high cholesterol and poor diet. Each risk factor was defined according to WHO criteria. A count of the total number of risk factors present for each participant was determined. Data for male and female participants were compared.

Results: Young men had an average of 2.9 (SD 1.2) risk factors. Young women had an average of 2.4 (SD 1.2) risk factors. The most common risk factors were low fruit and vegetable intake (77.9%), cigarette smoking (67.7%), overweight/obesity (55%) and physical inactivity (39.8%). There were no significant differences between men and women in the number of risk factors present, or the prevalence of individual risk factors.

Conclusion: This study demonstrated that many of the risk factors that ultimately contribute to disability and premature death are present at an early age in people with psychosis. Preventive measures need to be an integral component of early intervention services for this client population to avert progression to serious CV morbidity and early mortality.
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http://dx.doi.org/10.1111/eip.12406DOI Listing
December 2018

The value of counting WHO-defined cardiovascular risk factors for death and disability in a national sample of adults with psychosis.

Schizophr Res 2017 04 22;182:13-18. Epub 2016 Sep 22.

Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia; Ramsay Health Care, Mental Health Services, Northern Adelaide Local Health Network, Adelaide, SA, Australia; Northern Adelaide Local Area Health Network, Adelaide, SA, Australia. Electronic address:

Objective: This study explored the prevalence and associations of eight WHO-defined CVD risk factors for death and disability in people with psychosis.

Method: The study included 1156 people aged 18-64years, diagnosed with psychosis. The 2009 World Health Organisation (WHO) Global Health Risks Report was used as a framework to determine the prevalence and number of eight key risk factors for cardiovascular disease (CVD) in men and women with psychosis. Differences in the number and type of risk factors by age and gender were investigated. Multi-predictor analysis was performed to identify associations between demographic factors, psychiatric diagnosis and accumulative CVD risk factors.

Results: Women had fewer CVD risk factors than men. The number of risk factors significantly decreased in association with single marital status, current employment and significantly increased with earning a higher income. People aged 35-49years and 50-64years had an average of 4 risk factors (SD 1.38 and 1.30); people aged 18-34years had an average of 3 risk factors (SD 1.30). Mean risk factors were higher in the middle age and older age groups (35-49years and 50-64years) compared with the younger age group (18-34years) (p<0.0001). Overweight/obesity, hypertension, high blood glucose/diabetes and high cholesterol were significantly more prevalent in older men and women.

Conclusion: People with psychosis have a high prevalence of individual and aggregate CVD risks. These were more common in men and rose with age, implying the necessity of close clinical monitoring. The most common risk factors should be targeted by lifestyle interventions.
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http://dx.doi.org/10.1016/j.schres.2016.09.028DOI Listing
April 2017

Psychosis and cardiovascular disease: is diet the missing link?

Schizophr Res 2015 Feb 2;161(2-3):465-70. Epub 2015 Jan 2.

Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Northern Adelaide Local Area Health Network, Australia; Ramsay Health Care (SA) Mental Health Services, South Australia, Australia.

Objective: To explore the diets of people living with psychotic disorders, and to compare their dietary composition to the general population.

Method: 184 people with psychotic disorders in Adelaide, South Australia completed a food frequency questionnaire. Physical information and mental health status were collected. Outcome measures included energy and macronutrient intake; fish, sodium, fruit and vegetable intake; micro-nutrient intake; body mass index; waist circumference; and diagnoses of diabetes and hypertension. The RDI of nutrients was derived from Australian Government publications. Comparison dietary data was obtained from surveys carried out by the Australian Bureau of Statistics.

Results: The majority of participants were overweight or obese (78%) and 77.5% met the criteria for at-risk waist circumference; and 58% of participants consumed salt and saturated fat in excess of the RDI. Most did not achieve the RDI for fruits and vegetables (97.8%), fibre (88.6%), fish (61.4%), magnesium (73.4%) or folate (86.4%). Women with psychosis had significantly higher intakes of vitamins and minerals compared to women in the general population. Men and women with psychosis consumed more daily total fat, saturated fat and sodium compared to adults in the Australian population, but lower fibre and vitamin E than their male and female counterparts.

Conclusion: People with psychosis, especially women, report poor dietary choices including increased energy and fat intake, heightening their risk for cardiovascular disease. Women with psychosis report higher intake of vitamins and minerals than women in the general population. Whilst dietary intake contributes to obesity in psychosis, other factors including antipsychotic agents, decreased physical activity and smoking add to the cardiovascular risk.
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http://dx.doi.org/10.1016/j.schres.2014.12.012DOI Listing
February 2015

Inadequate fruit and vegetable intake in people with psychosis.

Aust N Z J Psychiatry 2014 Nov 8;48(11):1025-35. Epub 2014 Oct 8.

School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, Australia.

Objective: The objective of this study was to identify factors associated with poor dietary intake (less than four servings of fruit and vegetables daily) in a large nationally representative sample of adults with psychotic disorders.

Methods: The sample comprised 1286 adults aged 18-64 years who took part in the second Australian national survey of psychosis. Dietary information was obtained using a standardised questionnaire; all participants provided fasting blood samples. Variables that may be related to diet and nutritional intake were investigated; these included demographics, physical health outcomes, physical activity, substance use, symptom severity and financial difficulty. Dietary status was explored by sex, age and body mass index using univariate analyses, while a multivariate analysis was performed to identify predictors of low nutritional intake.

Results: Approximately 74% of participants ate less than four servings of fruit and vegetables daily. This was associated with a lower body mass index (p<0.05), lower levels of physical activity (p<0.05), sedentary behaviour (p<0.05), substance use (p<0.001), more negative symptoms (p<0.05), eating less frequently (p<0.001), consuming whole fat milk compared to low fat milk (p<0.05), adding salt to food (p<0.05) and financial difficulty (p<0.05). Male sex and younger age (18-34 years) were also associated with lower fruit and vegetable intake (p<0.001). A multivariate regression analysis showed that current smoking (p<0.001) and alcohol (p<0.01) and cannabis abuse (p<0.05) were risk factors for lower fruit and vegetable intake.

Conclusion: The findings suggest that poor diet in people with psychosis, as reflected by less than four servings of fruit and vegetables daily, is accompanied by other unhealthy behaviours, which has important implications for the development of effective interventions. Importantly, current smoking is a significant predictor of dietary inadequacy.
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http://dx.doi.org/10.1177/0004867414553950DOI Listing
November 2014

Determinants of high rates of smoking among people with psychosis living in a socially disadvantaged region in South Australia.

Aust N Z J Psychiatry 2014 Jan 5;48(1):70-9. Epub 2013 Jun 5.

1Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, Australia.

Objective: This study aimed to identify factors associated with the high rates of smoking amongst people with psychosis living in a disadvantaged region in Adelaide, South Australia.

Methods: Data were collected from 402 people with psychosis, aged 18-64 years, who lived in the northern suburbs of Adelaide. This area is disadvantaged on many measures of socioeconomic well-being and people living in this region have higher rates of smoking compared to the general Australian population. We hypothesised that whilst tobacco use by people with psychosis living in this region was primarily associated with mental illness, factors related to social disadvantage also contributed to the high rates of smoking.

Results: Approximately 74% of men and 71% of women with psychotic disorders living in the northern suburbs of Adelaide were current smokers. Factors such as unemployment, lower levels of education and receiving government welfare, factors known to be associated with smoking in the general population, were more prevalent in the northern region. Smokers with psychosis were less likely to participate in recreational programs and physical activity, and more likely to use illicit substances and be a victim of crime. They had poorer health and financial outcomes than non-smokers. There were some gender differences: for men with psychosis, employment and having a post-school qualification decreased the risk of smoking while cannabis use increased the risk; for women with psychosis, a diagnosis of alcohol abuse/dependence, using cannabis and being sedentary were risk factors for smoking, while attending recreational programs reduced this risk.

Conclusion: Smoking rates were strikingly high in both men and women, and particularly high in women when compared with previous research. Our study shows that the risk of smoking is increased by factors related to the social disadvantage of living in the northern Adelaide region. Smoking cessation interventions for people with mental illness should take into account the social context, and also address relevant comorbidities such as drug and alcohol disorders.
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http://dx.doi.org/10.1177/0004867413491158DOI Listing
January 2014
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