Emma Black

A systematic review of randomized trials for the treatment of burning mouth syndrome

OBJECTIVES Burning mouth syndrome (BMS) is characterized by burning of the oral mucosa in the absence of underlying dental or medical causes. The results of previous systematic reviews have generally been equivocal. However, findings for most interventions are based on searches of 5-10years ago. This study therefore updates previous searches of randomized controlled trials (RCTs) for pain as assessed by Visual Analogue Scales (VAS). Secondary outcomes included quality of life, mood, taste and salivary flow. METHODS A search of MEDLINE and Embase up to 2016. RESULTS 24 RCTs were identified. Meta-analyses were impossible because of wide variations in study method and quality. The commonest interventions were alpha-lipoic acid (ALA) (8 comparisons), capsaicin or an analogue (4 comparisons), clonazepam (3 comparisons) and psychotherapy (2 comparisons). ALA and capsaicin led to significantly greater improvements in VAS (4 studies each), as did clonazepam (all 3 studies), at up to two month follow-up. However, capsaicin led to prominent dyspepsia. Psychotherapy significantly improved outcomes in one study at two and 12month follow-up. Catauma and tongue-protectors also showed promise (one study each). There were no significant differences in any of the secondary outcomes except in the one study of tongue protectors. CONCLUSIONS At least in some studies and for some outcomes, ALA, clonazepam, capsaicin and psychotherapy may show modest benefit in the first two months. However, these conclusions are limited by generally short follow-up periods, high study variability and low participant numbers. Further RCTs with follow-up of at least 12months are indicated.

A systematic review: Identifying the prevalence rates of psychiatric disorder in Australia’s Indigenous populations

Objective: This review aimed to draw on published literature to identify the prevalence rates of psychiatric disorders in Australia’s Indigenous populations, Aboriginal and Torres Strait Islander peoples. Method: A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) model was conducted using the following electronic databases: PubMed, Scopus, Web of Science, MEDLINE, PsycINFO, PsycARTICLES, and Informit Indigenous and Health Collections. Studies were included for analysis if they were empirical quantitative studies reporting prevalence rates for any psychiatric disorder in Indigenous people. Results: Of the 1584 papers extracted by the search strategy, 17 articles met the eligibility criteria and were reviewed in detail. Methodology, sampling strategy and study design varied greatly across these 17 studies. Prevalence rates varied by disorder and are as follows: major depressive disorder (4.3–51%); mood disorders (7.7–43.1%); post-traumatic stress disorder (14.2–55.2%); anxiety disorders (17.2–58.6%); substance dependence (5.9%–66.2%); alcohol dependence (21.4–55.4%); and psychotic disorders (1.68–25%). While the number of studies on community-based Indigenous populations was limited, available evidence suggested that prevalence rates are higher in prison populations compared with community-based studies. Conclusions: It was identified that there is limited evidence on the occurrence of psychiatric disorders for Indigenous people in the general community. More research in this area is essential to provide accurate and reliable estimates and to provide a baseline for evaluating the effectiveness of programs aimed at reducing the high mental health burden experienced by Indigenous Australians. Future research needs to ensure that standardised and validated methods are used to accurately estimate the prevalence of psychiatric disorders among Indigenous Australians.

Predicting impulsive self-injurious behavior in a sample of adult women

Abstract Different types of self-injury have been classified as reflecting impulsive and compulsive characteristics (article by Simeon and Favazza [Self-injurious Behaviors: Assessment and Treatment {pp 1–28}. Washington, DC: American Psychiatric Publishing, Inc, 2001]). The current research used a prospective design to evaluate whether there is a progression between these different types of self-injurious behaviors (SIB) over time. Support was found for a progression from compulsive SIB (including hair pulling, nail-biting, skin picking, scratching, and preventing wounds from healing) to impulsive SIB (including cutting, burning, carving, pin sticking, and punching) in a group of adult women (N = 106). Other factors hypothesized to be linked to this outcome were disordered eating, age, and personality facets of impulsivity (specifically, urgency and lack of perseverance). Of these variables, only urgency positively predicted impulsive SIB at the study’s conclusion. These findings are discussed, limitations of the study are noted, and directions for future research are outlined.

Homeless youth: Barriers and facilitators for service referrals

Young people who are homeless and experiencing mental health issues are reluctant to use relevant services for numerous reasons. Youth are also at risk of disengaging from services at times of referral to additional or alternative services. This study aimed to identify barriers and facilitators for inter-service referrals for homeless youth with mental health issues who have already engaged with a service. Qualitative, semi-structured interviews were conducted with homeless youth (n = 10), homelessness support workers (n = 10), and mental health clinicians (n = 10). Barriers included: resource shortages; programs or services having inflexible entry criteria; complexity of service systems; homeless youth feeling devalued; and a lack of communication between services, for example, abrupt referrals with no follow up. Referral facilitators included: services providers offering friendly and client-centred support; supported referrals; awareness of other services; and collaboration between services. Relationships with service providers and inter-service collaboration appeared essential for successful referrals for homeless youth. These facilitating factors may be undermined by sector separation and siloing, as well as resource shortages in both the homelessness and mental health sectors. Service transitions may be conceptualised as a genuine service outcome for homeless youth, and as a basis for successful future service provision.

Characteristics of non-suicidal self-injury in women accessing internet help sites

Background This article aimed to examine and compare the frequency of occurrence of a broad range of non-suicidal self-injury (NSSI) behaviours in an international sample of women. Methods Female participants with NSSI (n = 464) were recruited via a range of websites and completed a questionnaire examining 17 different types of NSSI types and their frequency, severity, and duration. Results Prevalent acts were cutting, scratching, and word carving; cutting and scratching occurred frequently, whilst word carving most often occurred as a single episode. Analyses revealed significant differences between Australian and U.S. participants, with U.S. participants having significantly higher rates of cutting, wound interference, carving, scratching, and sharp object sticking. Participants also reported on other self-harm methods not assessed by the questionnaire. Conclusions Word carving may be qualitatively different from other forms of NSSI. More severe NSSI methods (e.g., bone breaking) are less prevalent than less dangerous methods (e.g., scratching). Participants considered a range of indirectly harmful or suicidal behaviours as self-injury contrary to researcher or clinician understanding. Finally, there may be cultural differences in relation to NSSI between countries where such behaviours are common, although further research is required to determine this. Language: en

A systematic review: non-suicidal self-injury in Australia and New Zealand's Indigenous populations

Objective To undertake a systematic review of non‐suicidal self‐injury (NSSI) prevalence, patterns, functions, and behavioural correlates for the Indigenous populations of Australia (Aboriginal and Torres Strait Islanders) and New Zealand (NZ; Maori). Method We searched the following electronic databases: PubMed, MedLine, Scopus, Web of Science, ScienceDirect, PsycInfo, and PsycArticles, CINAHL, and the Informit Health and Indigenous Peoples collections. Studies were included for review if they were published within the last 25 years and reported on NSSI in Australia and NZs Indigenous populations. Results Seven studies were included, six of which came from Australia. The prevalence of NSSI in Australia ranged from 0.9% up to 22.50%; statistics varied by the different samples, types of prevalence, and relationship to alcohol. Several studies found that Aboriginal and Torres Strait Islander peoples had higher rates of NSSI than other Australians, but that this was not significantly higher. Two studies indicated that NSSI was linked to alcohol use, incarceration, and a younger age. The one NZ study was of injury and not specifically NSSI. Conclusions Findings are limited due to a small pool of literature. Cultural variations in NSSI presentation should be considered when working with Indigenous populations. Further research is required to help determine what cultural variations may exist.

Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study

Objective To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists’ diagnoses. Design Cross-sectional study July 2014–November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). Setting Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales. Participants Indigenous Australian adults. Outcome measures Cultural acceptability of SCID-I interviews, standardised rates of CMD, comorbid CMD and concordance with psychiatrist diagnoses. Results Participants reported that the SCID-I interviews were generally culturally acceptable. Standardised rates (95% CI) of current mood, anxiety, substance use and any mental disorder were 16.2% (12.2% to 20.2%), 29.2% (24.2% to 34.1%), 12.4% (8.8% to 16.1%) and 42.2% (38.8% to 47.7%), respectively—6.7-fold, 3.8-fold, 6.9-fold and 4.2-fold higher, respectively, than those of the Australian population. Differences between this Indigenous cohort and the Australian population were less marked for 12-month (2.4-fold) and lifetime prevalence (1.3-fold). Comorbid mental disorder was threefold to fourfold higher. In subgroups living on traditional lands in Indigenous reserves and in remote areas, the rate was half that of those living in mainstream communities. Moderate-to-good concordance with psychiatrist diagnoses was found. Conclusions The prevalence of current CMD in this Indigenous population is substantially higher than previous estimates. The lower relative rates of non-current disorders are consistent with underdiagnosis of previous events. The lower rates among Reserve and remote area residents point to the importance of Indigenous peoples’ connection to their traditional lands and culture, and a potentially important protective factor. A larger study with random sampling is required to determine the population prevalence of CMD in Indigenous Australians.

The Cultural Validity of Diagnostic Psychiatric Measures for Indigenous Australians: Indigenous cultural validation

Objective There is limited research available regarding the prevalence rates of psychiatric illness in Indigenous Australians, and the available literature varies widely in terms of methods and findings. Culturally valid and appropriate tools are needed to ensure accurate outcomes. The purpose of this review is to examine the methods used to diagnose psychiatric disorders in Indigenous Australians and identify whether these are culturally appropriate or valid. Method A systematic search of available literature was undertaken in electronic databases (PubMed, Scopus, PsycInfo, PsycArticles, Web of Science, Medline, and Informit Health Indigenous Australians Peoples Collections). Narrative synthesis was used to analyse the data obtained, with a quantitative evaluations of study quality and cultural validity. Results Twelve articles were included for review. Six studies were of diagnostic tools and none had been validated for use with Indigenous Australians. Another six used practitioner assessment. Some studies indirectly referenced cultural competence on behalf of the practitioner, but again on the whole this was lacking. Conclusions Further validation of the use of diagnostic instruments in Indigenous Australians is needed so that the prevalence of psychiatric disorders in this population can be accurately determined. In addition, practitioners working with Indigenous Australians should have some training in cultural awareness or competence, and consider the cultural appropriateness of diagnostic tools when applied to this population.

Mood and anxiety disorders in Australia and New Zealand's indigenous populations: A systematic review and meta-analysis.

The Indigenous populations of Australia and New Zealand are considered at higher risk of mood and anxiety disorders but many studies do not include direct comparisons with similar non-Indigenous controls. We conducted a systematic search of relevant electronic databases, as well as snowballing and targeted searches of the grey literature. Studies were included for meta-analysis if they compared rates of mood and anxiety disorders between Indigenous and non-Indigenous Australians or Maori. Seven Australian and 10 NZ studies were included. Overall, Indigenous people in both countries did not have significantly higher rates of disorder. However, in terms of specific disorders, there were differences in risk by gender, country (Australia or NZ), disorder type, and prevalence (current, 12-month or lifetime). For instance, Indigenous Australians and Maori both had significantly lower rates of simple phobias (current prevalence) and Maori participants had significantly lower rates of both lifetime simple phobia and generalised anxiety disorders. By contrast, Indigenous Australians had significantly higher rates of bipolar affective disorder and social phobia (current prevalence). Generalisations regarding the risk of psychiatric disorders in Indigenous people cannot therefore be made as this varies by several factors. These include disorder type, sociodemographic factors, Indigenous origin and study method.

PSYCHIATRIC MORBIDITY IN INDIGENOUS PEOPLES FROM AUSTRALIA AND THE AMERICAS: UNEXPECTED FINDINGS FROM A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Problem drinking is a worldwide concern and is often a comorbid health problem for psychiatric illness. With the rising trend in e-mental health interventions, the advancement of smartphone technology has ushered in an era where smartphone applications can be used for behavioural intervention in problem drinking. Objectives: The aim of the study is to contribute towards the development of a novel smartphone application for use with problem drinkers based on behavioural modification principles. Methods: Seven postgraduate students in the School of Health Professions at Murdoch University were interviewed about the use of a novel smartphone application for behavioural intervention with problem drinking and the interview transcripts were subjected to thematic analysis. Findings: Themes that emerged include: accessibility, milestones and commitment. Conclusions: These findings shed light on the development of a novel e-mental health intervention for problem drinking. The implications for clients from diverse cultures and various age groups are discussed.Background: The last 10 years has seen considerable progress in relation to seclusion data development and reduction initiatives in Australia. Part of the success has been the use of a standardized definition and national collection of data for benchmarking and quality improvement. The National Seclusion and Restraint Reduction Project has encouraged services and individuals to reconsider their practices, and there has been a flurry of activity at local, state and national levels. Objectives: This paper describes that journey presents data from the national collection and looks at the future intentions of the Project. Findings: The acute mental health units have progressively reduced their use of seclusion in the last 6 years from 13.8 episodes per 1000 bed days in 2009–2010 to 8.0 in 2013–2014. Despite this, an average of 5% of people admitted to specialized services still experience an episode of seclusion, and there are considerable variations across sites and age ranges. There have also been some remarkable successes, particularly when consumers have been actively involved in the response. Conclusions: The call for ‘recovery’ challenges us to think about many other forms of restrictive practice. We are at various stages in the development of national measures of physical and mechanical restraints, continuing involuntary treatment and acute injectable medications. As seclusion once was, much of this has been considered necessary for safety or to get a good outcome. Is this true and what does the future hold?