David Crompton

Deep brain stimulation for obsessive–compulsive disorder: a systematic review and meta-analysis

BACKGROUND Deep brain stimulation (DBS) is increasingly being applied to psychiatric conditions such as obsessive-compulsive disorder (OCD), major depression and anorexia nervosa. Double-blind, randomized controlled trials (RCTs) of active versus sham treatment have been limited to small numbers. We therefore undertook a systematic review and meta-analysis of the effectiveness of DBS in psychiatric conditions to maximize study power. METHOD We conducted a systematic literature search for double-blind, RCTs of active versus sham treatment using Pubmed/Medline and EMBASE up to April 2013. Where possible, we combined results from studies in a meta-analysis. We assessed differences in final values between the active and sham treatments for parallel-group studies and compared changes from baseline score for cross-over designs. RESULTS Inclusion criteria were met by five studies, all of which were of OCD. Forty-four subjects provided data for the meta-analysis. The main outcome was a reduction in obsessive symptoms as measured by the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patients on active, as opposed to sham, treatment had a significantly lower mean score [mean difference (MD) -8.93, 95% confidence interval (CI) -13.35 to -5.76, p < 0.001], representing partial remission. However, one-third of patients experienced significant adverse effects (n = 16). There were no differences between the two groups in terms of other outcomes. CONCLUSIONS DBS may show promise for treatment-resistant OCD but there are insufficient randomized controlled data for other psychiatric conditions. DBS remains an experimental treatment in adults for severe, medically refractory conditions until further data are available.

A retrospective quasi-experimental study of a community crisis house for patients with severe and persistent mental illness

Objective: There is increasing international evidence that crisis houses can reduce the time spent in acute psychiatric inpatient units for patients with severe and persistent mental illness, at a lower cost and in an environment preferable to patients. We evaluated the Alternatives to Hospitalisation (AtH) program, a crisis house operating in outer suburban Brisbane. Methods: One hundred and ninety-three AtH patients were compared to 371 matched controls admitted to a peer hospital district acute psychiatric unit. Hospitalisations, demographics and illness acuity were compared one year before and after an acute index episode of residential care involving hospital and/or AtH. Hospital bed-days during the index episode were compared between AtH participants and controls. The cost of bed-days averted was compared to the cost of providing the AtH program. Results: AtH participants spent 5.35 fewer days in hospital during the index episode than controls, after adjustment for illness acuity, living conditions, marital status and emergency department (ED) presentations. Per patient cost of averted psychiatric inpatient bed-days,

The Effects of Tai Chi in Centrally Obese Adults with Depression Symptoms

5948.22, was higher than the per patient cost of providing AtH,

The importance of safety, agency and control during involuntary mental health admissions

3071.44. AtH participants had higher levels of illness acuity, ED presentations and acute psychiatric admissions than controls in the year after the index episode. Conclusions: For acutely unwell, stably housed patients, able to be managed outside of a secure facility, a crisis house program can reduce acute psychiatric bed-days, providing a cost saving for mental health services.

The language we use – the effect of writing mental health care plans in the first person

This study examined the effects of Tai Chi, a low-impact mind-body movement therapy, on severity of depression, anxiety, and stress symptoms in centrally obese people with elevated depression symptoms. In total, 213 participants were randomized to a 24-week Tai Chi intervention program or a wait-list control group. Assessments were conducted at baseline and 12 and 24 weeks. Outcomes were severity of depression, anxiety, and stress symptoms, leg strength, central obesity, and other measures of metabolic symptom. There were statistically significant between-group differences in favor of the Tai Chi group in depression (mean difference = −5.6 units, P < 0.001), anxiety (−2.3 units, P < 0.01), and stress (−3.6 units, P < 0.001) symptom scores and leg strength (1.1 units, P < 0.001) at 12 weeks. These changes were further improved or maintained in the Tai Chi group relative to the control group during the second 12 weeks of follow-up. Tai Chi appears to be beneficial for reducing severity of depression, anxiety, and stress and leg strength in centrally obese people with depression symptoms. More studies with longer follow-up are needed to confirm the findings. This trial is registered with ACTRN12613000010796.

General practitioner management of chronic diseases in adults with severe mental illness: a community intervention trial

Abstract Background: Constructs such as personal recovery, patient engagement and consumer involvement are central in mental health care delivery. These approaches emphasise the importance of empowerment and choice. Aims: Under some circumstances Involuntary Treatment Orders (ITO) allow a person to be treated for a mental illness without their consent. This study explores the tensions between the principles of empowerment and control and involuntary treatment. Methods: Twenty-five involuntary inpatients of a major teaching hospital were interviewed about their experiences of being placed under an ITO. The interviews were analysed thematically. Results: Being able to have some sense of agency and re-asserting personal control are critical components of an involuntary mental health admission. Participants wanted information about their treatment, the ITO process and their environment. They also spoke about the importance of a space where they felt safe from themselves and others to make sense of the experience. Conclusions: This study suggests that for coercive treatment to aid, rather than disrupt recovery, treatment services need to focus on: the provision of rights; the creation of a sense of safety; establishing supportive relationships; carrying hope and finding ways to foster a strong sense of agency and empowerment.

Australian overseas trained psychiatrists' perspective of up-skilling programme

Objective: This study describes the impact of Motivational Aftercare Planning (MAP) – an intervention to increase consumer/clinician collaboration on the content of mental health recovery plans. The intervention focussed on enhancing existing discharge processes in psychiatric inpatient wards and supporting nursing staff in using motivational interviewing techniques to facilitate the completion of these plans. Methods: We conducted a qualitative thematic content analysis of the recovery plans completed throughout the study (n = 110). Chi-squared tests were then used to compare the occurrence of themes and content identified in recovery plans pre and post the intervention (n = 55). Results: The thematic content of the recovery plans shifted in focus following the intervention, with a change from third to first person language. Those completed prior to the intervention generally mentioned: decreasing symptoms of mental illness; acceptance of the illness; achieving clinical stability; risk management and treatment compliance. The recovery plans completed after the intervention focussed on: general wellness; participate in meaningful activities; community life; social roles and connections with others. Conclusions: This study demonstrated that a simple time-limited, facilitated intervention resulted in a change of thematic content in recovery plans. The use of these plans and its effect on care planning will need further evaluation.

Metformin prescription in psychiatry

Objective The aim of the present study was to assess the effects of a community intervention aimed at general practitioners (GPs) by comparing Medicare claims data from patients with severe mental illness (SMI) of GPs exposed to the intervention and controls that were not. Methods A comparison was made of primary care consultation and pathology data of people with SMI from intervention and control areas. Negative binomial regression models were used to compare the frequency and length of GP consultations, as well as the number and type of pathology examinations. Results Records of 103 people from intervention area and 98 controls were obtained. Intervention and control areas were not different at baseline in terms of age and claims data, but females had higher consultation rates. After adjusting for gender, people from intervention areas had more GP consultations, especially long consultations (adjusted incidence rate ratio 1.56; 95% confidence interval 1.28-1.91). They also had more pathology screening for chronic diseases, in accordance with implemented guideline recommendations. These benefits persisted after the end of the intervention. Conclusion These findings suggest that the ACTIVATE program aimed at training GPs to screen and better manage chronic diseases in adults with SMI had a positive effect up to 6 months after the trial, with demonstrated desired changes in medical management practices by GPs in the intervention area during that time. What is known about the topic? People with an SMI have higher mortality and poorer physical health than the general population. What does this paper add? The community intervention had a significant and sustained effect, with demonstrated desired changes in screening and medical management by GPs for adults with SMI in the intervention area. What are the implications for practitioners? GPs are ideally placed to assist in the prevention and better management of health conditions, thereby reducing avoidable illness and deaths in vulnerable populations, such as adults with SMI. Ongoing professional training and dissemination of clinical guidelines are critical for raising awareness about the physical and oral health care needs of people with SMI.

A capability framework to develop leadership for evidence-informed therapies in publicly-funded mental health services

Purpose – The purpose of this paper is to report research findings on the perspectives of overseas trained psychiatrists (OTPs) on the “The Overseas Trained Specialist Up-Skilling Programme” (OTSUP), initiated in Queensland, Australia to assist OTPs to prepare for the Royal Australian and New Zealand College of Psychiatrist (RANZCP) Fellowship examination. Ascertaining and utilisation of OTPs views about the programme will enable improvements to be made to the programme and better implementation. Design/methodology/approach – An exploratory qualitative design was utilised for the study in order to provide insights on the quality and effectiveness of the OTSUP. Findings – Centred around two main themes. The first theme included participants knowledge about the up-skilling programme with its subthemes of “finding out about the programme”; “perceived aims of the programme”; and “educational events supporting the programme”. The second theme revolved around participants’ perceived benefits of the up-skilli...

Mental health services planning for G20 summit in Brisbane and assessment of impact

We thank Smith et al. for the publication of a metformin prescribing tool1 for people with severe mental disorders (SMD). The importance of physical health in people with SMD is now well recognised.2 Even though there is evidence to suggest that the rate of screening people with SMD for metabolic issues in Australia outperforms the international average, the rate of intervention still lags behind that of identification,3 with physical ill health among those with SMD often under-diagnosed.4 A practical tool to facilitate secondary prevention by limiting antipsychotic associated weight gain is of clear relevance to psychiatry.