A Prospective Cohort Study Of Mortality, Abstinence, Criminality And Psychiatric Comorbidity
Funder
National Health and Medical Research Council
Funding Amount
$419,500.00
Summary
Over 70 000 Australians are dependent on heroin. Heroin dependence is remarkably persistent and is, in many cases, a lifelong condition. Long term treatment outcome and abstinence from heroin among this group are poor. Mortality among heroin users is high, with heroin users dying at a rate 13 times that of peers. Despite the extent of the problem, the natural history of heroin users has not yet been studied in Australia. The current study will be the first Australian study of the natural history ....Over 70 000 Australians are dependent on heroin. Heroin dependence is remarkably persistent and is, in many cases, a lifelong condition. Long term treatment outcome and abstinence from heroin among this group are poor. Mortality among heroin users is high, with heroin users dying at a rate 13 times that of peers. Despite the extent of the problem, the natural history of heroin users has not yet been studied in Australia. The current study will be the first Australian study of the natural history of heroin users. The study will follow up a large cohort of heroin users over a three year period. Estimates will be obtained of mortality rates, abstinence rates, criminal careers, and psychiatric problems among heroin users. It will also examine factors that predict abstinence, mortality, criminality and levels of psychopathology, and determine the health costs associated with heroin use careers. The study will provide essential data on how heroin use progresses, and on what factors predict a better outcome for heroin users.Read moreRead less
Efficacy Of Treatment For Resistant Command Hallucinations.
Funder
National Health and Medical Research Council
Funding Amount
$343,875.00
Summary
Auditory hallucinations (AHs), often described as voices, are a common symptom of schizophrenia and psychoses. Command hallucinations (CHs) are a type of AH in which the voice heard by the patient commands him or her to perform a particular action. The nature of the directive may vary from inconsequential actions to commands to harm the patient or others. There is widespread public concern about the danger individuals with schizophrenia or related disorders pose to themselves and to the communit ....Auditory hallucinations (AHs), often described as voices, are a common symptom of schizophrenia and psychoses. Command hallucinations (CHs) are a type of AH in which the voice heard by the patient commands him or her to perform a particular action. The nature of the directive may vary from inconsequential actions to commands to harm the patient or others. There is widespread public concern about the danger individuals with schizophrenia or related disorders pose to themselves and to the community. There is firm evidence pointing to the important role that CHs play in propelling psychotic individuals into serious and damaging actions. We have found, however, that most individuals who comply with dangerous CHs do so, not because they are angry, violent, antisocial or wish to cause harm, but because they feel powerless to resist. Though CHs are one of the most disturbing symptoms of psychosis, standard treatment has proved to be of limited benefit. This study will evaluate the effectiveness of Treatment of Resistant Command Hallucinations (TORCH), an innovative treatment for CHs. TORCH is an extension of an existing treatment for psychosis that we previously developed. TORCH aims to reduce the distress, worry and harmful or self-defeating behaviour associated with CHs by arming the patient with effective strategies that will enhance resistance and reduce compliance. The project has clear implications for improved clinical and therapeutic management of CHs with major public health, clinical and forensic repercussions. The consequences of being formally assessed as being at risk of acting violently result in the potential for substantial restrictions on the freedom of the individual. The availability of TORCH may prompt a less restrictive management of individuals at risk of dangerous behaviour and promote a more optimistic attitude amongst clinicians. Relatives and carers also stand to benefit through reduction in perplexing and fear-inducing behaviours.Read moreRead less
A Prospective Study Of The Psychiatric & Medical Characteristics Of Post-infective Fatigue & Chronic Fatigue Syndrome.
Funder
National Health and Medical Research Council
Funding Amount
$500,000.00
Summary
This project forms the central component of a larger set of studies which investigate competing psychiatric, immunological and infective models of the causes of a number of chronic fatigue syndromes, including post-infective fatigue. The study takes place in western NSW where certain viral illnesses (Glandular Fever, Ross River Virus) and a non-viral infection (QF) are common and have been associated with prolonged fatigue states. The study follows patients from laboratory-documented infections ....This project forms the central component of a larger set of studies which investigate competing psychiatric, immunological and infective models of the causes of a number of chronic fatigue syndromes, including post-infective fatigue. The study takes place in western NSW where certain viral illnesses (Glandular Fever, Ross River Virus) and a non-viral infection (QF) are common and have been associated with prolonged fatigue states. The study follows patients from laboratory-documented infections with appropriate infective, immunological and psychological measures throughout the course of their acute illness, the early recovery period and for the next 12 months. These patients are compared with people who present to their doctor with other forms of medically-unexplained fatigue. Very few previous studies have used an appropriate prospective design and followed patients with documented illness from the onset through to the development of specific forms of chronic fatigue. Further, the study is unique in terms of the range of viral and non-viral agents being investigated. It relies on the combined psychiatric, immunological and infective disease expertise of a group of researchers with an international reputation for the successful completion of such multidisciplinary projects. The initial phase of the study has demonstrated that the research team has the capacity to complete this project. Initial results have already demonstrated the potential roles of psychological and immunological factors in causing some cases of prolonged fatigue. Further, the initial results indicate that two key symptom sets (fatigue, psychological distress) can be adequately measured during the recovery phase and are predicted by differing psychological factors. The study will result in the identification of different psychiatric risk factors to chronic fatigue, assist development of clear diagnostic guidelines for post-infective fatigue and guide relevant aetiological and treatment research.Read moreRead less
A Prospective Study Investigating Implications Of Bioactive Lipids For Diagnosis And Treatment Of Schizophrenia
Funder
National Health and Medical Research Council
Funding Amount
$324,480.00
Summary
This study will investigate the role of fatty acids (lipids) in schizophrenia. Studies in blood cells and in the brains of patients with schizophrenia have shown that these lipids and related products are altered in schizophrenia. We are now able to measure separate lipid metabolites in the living human brain using a technique called magnetic resonance spectroscopy. Until recently it was only possible to assess lipid metabolites as a group, limiting interpretation. Thanks to a newly available im ....This study will investigate the role of fatty acids (lipids) in schizophrenia. Studies in blood cells and in the brains of patients with schizophrenia have shown that these lipids and related products are altered in schizophrenia. We are now able to measure separate lipid metabolites in the living human brain using a technique called magnetic resonance spectroscopy. Until recently it was only possible to assess lipid metabolites as a group, limiting interpretation. Thanks to a newly available imaging system at the Brain Imaging Research Institute and a new analysis technique, we will be able to measure single lipid metabolites in the living human brain. Simultaneously we will also measure lipids and related enzymes in red blood cells that are responsible for the regulation of these lipids. Preliminary data has shown that there is a strong correlation between these two measures. Furthermore we will investigate the genes that are responsible for the production of these enzymes. By repeating the same tests after 12 weeks we hope to understand how the newer antipsychotic drugs act. Two easy clinical tests (a skin and breath test) will help us to implement the findings in daily clinical practice (diagnostic markers for patients at risk) . With such a multi-level approach we hope to contribute to a new understanding of the origins of schizophrenia going beyond the traditional concepts. The findings might also have direct implications for treatment. Preliminary results are very promising but also contradictory. Therefore it is even more important to carefully investigate the role of these lipids in schizophrenia.Read moreRead less
Estrogen - A Potential New Treatment For Women & Men With Schizophrenia
Funder
National Health and Medical Research Council
Funding Amount
$227,545.00
Summary
Estrogen - the major female hormone, has been shown in animal studies to decrease the two main brain chemicals (dopamine and serotonin) that are implicated in causing schizophrenia. The effect of estrogen in the brain is similar to current antipsychotic drugs. We have carried out a study that showed that when we gave 12 young women with schizophrenia 100 micrograms of estrogen in a skin patch form plus standard antipsychotic drug treament they recovered more quickly than 12 young women who recei ....Estrogen - the major female hormone, has been shown in animal studies to decrease the two main brain chemicals (dopamine and serotonin) that are implicated in causing schizophrenia. The effect of estrogen in the brain is similar to current antipsychotic drugs. We have carried out a study that showed that when we gave 12 young women with schizophrenia 100 micrograms of estrogen in a skin patch form plus standard antipsychotic drug treament they recovered more quickly than 12 young women who received standard antipsychotic drug treatment only. 100mcg is a safe dose of estrogen. In this proposal we want to expand and clarify the pilot study resutls by conducting a 28 day trial in a total of 60 women with schizophrenia. 30 women would receive 100 mcg skin patch estrogen plus antipsychotic medication and 30 women would receive antipsychotic medicationly only. We also tested the value of adding a very small dose of oral estrogen to antipsychotic drug treatment in five men with schizophrenia and found that they made a better recovery compared to five men who received standard antipsychotic drugs only. We trialled the use of estrogen for seven days in men, but this may not have been long enough to examine the real impact of estrogen treatment in men. In this proposal we want to conduct a 14 day trial in a total of 60 men with schizophrenia. 30 men would receive 2mg of oral estrogen plus antipsychotic drug treatment and their results would be compared with 30 men who received standard antipsychotic drug treatment plus a placebo tablet identical in appearance to estrogen. For 14 days, this low dose of estrogen is very safe. Potentially estrogen may be a useful addition to the current standard treatment of schizophrenia. It may decrease the duration of acute illness and in women it may have a role in preventing relapses of schizophrenia as well as improving the general health of women with schizophrenia.Read moreRead less
The Effect Of High-dose Vitamin-D Supplementation On Mental Health In A Randomised, Controlled Trial Of 1500 Older Women
Funder
National Health and Medical Research Council
Funding Amount
$81,965.00
Summary
Vitamin D is commonly deficient in Western populations, more so in the winter months and in the elderly. A link between depression and vitamin D insufficiency may exist. This study aims to see if vitamin-D supplementation is a practical health intervention for depressive symptoms and may define a public health strategy. In this study participants receive a dose of vitamin D3 or placebo annually for three years. Self-rated psychiatric assessments are administered.
A Double-blind Placebo Controlled Trial Of Transcranial Magnetic Stimulation In The Treatment Of Depression.
Funder
National Health and Medical Research Council
Funding Amount
$366,775.00
Summary
Depression is a severe and often disabling illness that occurs frequently in the general population. Depression is a treatable illness and the majority of patients will respond to anti-depressant medication, a form of psychotherapy or a combination of these. However, a significant percentage of patients with depression fail to respond to these therapies and currently require electroconvulsive therapy (ECT). This entails the complications and costs of multiple anaesthetics, memory impairment and ....Depression is a severe and often disabling illness that occurs frequently in the general population. Depression is a treatable illness and the majority of patients will respond to anti-depressant medication, a form of psychotherapy or a combination of these. However, a significant percentage of patients with depression fail to respond to these therapies and currently require electroconvulsive therapy (ECT). This entails the complications and costs of multiple anaesthetics, memory impairment and substantial social stigma. Transcranial magnetic stimulation is being researched as a potential alternative for these patients. It is administered to patients who are awake and alert and appears to have fewer side effects. TMS uses the unique properties of a magnetic field to produce or disrupt electrical activity in superficial areas of the brain, targeted to the areas thought to be involved in the cause of depression. Our research study will compare the two most promising types of TMS with an inactive or placebo condition. This is important to establish that the effects of TMS arise from the actual stimulation and to investigate whether one of two types of TMS administered is superior. We will administer this treatment for between 2 and 4 weeks and assess the response. We anticipate that our research will contribute to the development of TMS as a treatment methodology for this important patient group. It is crucial that a new treatment be thoroughly evaluated prior to wide dissemination of it in clinical practice. We will help define the effectiveness of this treatment and the most appropriate way in which it can be administered.Read moreRead less
A Double-blind Controlled Trial Of RTMS In The Treatment Of Bipolar Depression
Funder
National Health and Medical Research Council
Funding Amount
$401,605.00
Summary
Bipolar affective disorder (BPAD) is a serious mental illness of substantive impact but there has been relatively sparse investigation of treatments for it. One of the only substantially new treatments developed for depression in recent years has been rTMS. Repetitive TMS has been evaluated in over 30 trials conducted, but no substantive trials have explored its use in bipolar depression. We propose to do this, conducting a large scale clinical trial.
Selective Estrogen Receptor Modulators (SERMs) A Potential Treatment For Psychotic Symptoms Of Schizophrenia?
Funder
National Health and Medical Research Council
Funding Amount
$701,276.00
Summary
Schizophrenia is a serious disease with increasing social and economic costs. We need new treatments to improve the life and functioning of people with schizophrenia. We have published studies showing that estrogen is potentially a new treatment for schizophrenia. New brain estrogens called Selective Estrogen Receptor Modulators have fewer side-effects than standard estrogen. We will conduct a controlled clinical trial of a SERM in 180 postmenopausal women with schizophrenia.
An Investigation Of The Aetiology Of Eating Disorders: Interactions Between Genes And Environmental Risk Factors.
Funder
National Health and Medical Research Council
Funding Amount
$225,000.00
Summary
Eating disorders, along with substance abuse, carry the highest risk of premature death, from both natural and unnatural causes, out of 27 mental disorder categories. Eating disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder, affect about 6% of Australian women. Despite increased levels of research into the aetiology of eating disorders over the last 20 years, little knowledge exists as to which risk factors cause women to attempt weight loss to the point of increa ....Eating disorders, along with substance abuse, carry the highest risk of premature death, from both natural and unnatural causes, out of 27 mental disorder categories. Eating disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder, affect about 6% of Australian women. Despite increased levels of research into the aetiology of eating disorders over the last 20 years, little knowledge exists as to which risk factors cause women to attempt weight loss to the point of increasing their risk of premature mortality. A review of twin studies in eating disorders concludes that there is increasing evidence to suggest that genetic factors play a role in the development of eating disorders. In addition, a recent series of studies, examining risk factors before the age of eating disorder onset, have found the following events to specifically predict the development of an eating disorder as opposed to another psychiatric condition: negative self-evaluation, parental alcoholism, low parental contact and high parental expectations, critical comments about weight, shape or eating during childhood, and childhood obesity. To date, no studies have attempted to integrate the findings from twin studies with the findings from early risk factor studies. Specifically, the ways in which genes interact with the environment to increase the chances of genetic vulnerability to an eating disorder being expressed have not been examined. The proposed project seeks to investigate precisely these interactions between genes and the environment, by examining a large number of female twins, aged 29-37. An enhanced understanding of how genes interact with the environment to either increase the chances that a woman will develop an eating disorder, or alternatively to protect a woman from developing an eating disorder, will benefit our understanding of how to target prevention and treatment strategies.Read moreRead less