Lake-Hui Quek

Advanced dental disease in people with severe mental illness: systematic review and meta-analysis

BACKGROUND Psychiatric patients have increased comorbid physical illness. There is less information concerning dental disease in this population in spite of risk factors including diet and psychotropic side-effects (such as xerostomia). Aims To compare the oral health of people with severe mental illness with that of the general population. METHOD A systematic search for studies from the past 20 years was conducted using Medline, PsycINFO, Embase and article bibliographies. Papers were independently assessed. The primary outcome was total tooth loss (edentulousness), the end-stage of both untreated caries and periodontal disease. We also assessed dental decay through standardised measures: the mean number of decayed, missing and filled teeth (DMFT) or surfaces (DMFS). For studies lacking a control group we used controls of similar ages from a community survey within 10 years of the study. RESULTS We identified 21 papers of which 14 had sufficient data (n = 2784 psychiatric patients) and suitable controls (n = 31 084) for a random effects meta-analysis. People with severe mental illness had 3.4 times the odds of having lost all their teeth than the general community (95% CI 1.6-7.2). They also had significantly higher scores for DMFT (mean difference 6.2, 95% CI 0.6-11.8) and DMFS (mean difference 14.6, 95% CI 4.1-25.1). Fluoridated water reduced the gap in oral health between psychiatric patients and the general population. CONCLUSIONS Psychiatric patients have not shared in the improving oral health of the general population. Management should include oral health assessment using standard checklists that can be completed by non-dental personnel. Interventions include oral hygiene and management of xerostomia.

Concurrent and Simultaneous Polydrug Use: Latent Class Analysis of an Australian Nationally Representative Sample of Young Adults

Background: Alcohol use and illicit drug use peak during young adulthood (around 18–29 years of age), but comparatively little is known about polydrug use in nationally representative samples of young adults. Drawing on a nationally representative cross-sectional survey (Australian National Drug Strategy Household Survey), this study examines polydrug use patterns and associated psychosocial risk factors among young adults (n = 3,333; age 19–29). Method: The use of a broad range of licit and illicit drugs were examined, including alcohol, tobacco, cannabis, cocaine, hallucinogens, ecstasy, ketamine, GHB, inhalants, steroids, barbiturates, meth/amphetamines, heroin, methadone/buprenorphine, other opiates, painkillers, and tranquilizers/sleeping pills. Latent class analysis was employed to identify patterns of polydrug use. Results: Polydrug use in this sample was best described using a 5-class solution. The majority of young adults predominantly used alcohol only (52.3%), alcohol and tobacco (34.18%). The other classes were cannabis, ecstasy, and licit drug use (9.4%), cannabis, amphetamine derivative, and licit drug use (2.8%), and sedative and alcohol use (1.3%). Young adult males with low education and/or high income were most at risk of polydrug use. Conclusion: Almost half of young adults reported polydrug use, highlighting the importance of post-high school screening for key risk factors and polydrug use profiles, and the delivery of early intervention strategies targeting illicit drugs.

The topography of multiple drug use among adolescent Australians: findings from the National Drug Strategy Household Survey.

INTRODUCTION AND AIMS Despite evidence that many Australian adolescents have considerable experience with various drug types, little is known about the extent to which adolescents use multiple substances. The aim of this study was to examine the degree of clustering of drug types within individuals, and the extent to which demographic and psychosocial predictors are related to cluster membership. DESIGN AND METHOD A sample of 1402 adolescents aged 12-17 years were extracted from the Australian 2007 National Drug Strategy Household Survey. Extracted data included lifetime use of 10 substances, gender, psychological distress, physical health, perceived peer substance use, socioeconomic disadvantage, and regionality. Latent class analysis was used to determine clusters, and multinomial logistic regression employed to examine predictors of cluster membership. RESULT There were 3 latent classes. The great majority (79.6%) of adolescents used alcohol only, 18.3% were limited range multidrug users (encompassing alcohol, tobacco, and marijuana), and 2% were extended range multidrug users. Perceived peer drug use and psychological distress predicted limited and extended multiple drug use. Psychological distress was a more significant predictor of extended multidrug use compared to limited multidrug use. DISCUSSION AND CONCLUSION In the Australian school-based prevention setting, a very strong focus on alcohol use and the linkages between alcohol, tobacco and marijuana are warranted. Psychological distress may be an important target for screening and early intervention for adolescents who use multiple drugs.

Co‐Occurring Anger in Young People With Asperger's Syndrome

OBJECTIVES The co-occurrence of anger in young people with Aspergers syndrome (AS) has received little attention despite aggression, agitation, and tantrums frequently being identified as issues of concern in this population. The present study investigated the occurrence of anger in young people with AS and explores its relationship with anxiety and depression. METHOD Sixty-two young people (12-23 years old) diagnosed with AS were assessed using the Beck Anger Inventory for Youth, Spence Childrens Anxiety Scale, and Reynolds Adolescent Depression Scale. RESULTS Among young people with AS who participated in this study, 41% of participants reported clinically significant levels of anger (17%), anxiety (25.8%) and/or depression (11.5%). Anger, anxiety, and depression were positively correlated with each other. Depression, however, was the only significant predictor of anger. CONCLUSION Anger is commonly experienced by young people with AS and is correlated with anxiety and depression. These findings suggest that the emotional and behavioral presentation of anger could serve as a cue for further assessment, and facilitate earlier identification and intervention for anger, as well as other mental health problems.

Effect of the increase in "alcopops" tax on alcohol-related harms in young people: a controlled interrupted time series.

Objective: To measure alcohol‐related harms to the health of young people presenting to emergency departments (EDs) of Gold Coast public hospitals before and after the increase in the federal government “alcopops” tax in 2008.

Craving as a predictor of treatment outcomes in heavy drinkers with comorbid depressed mood

Alcohol and depression comorbidity is high and is associated with poorer outcomes following treatment. The ability to predict likely treatment response would be advantageous for treatment planning. Craving has been widely studied as a potential predictor, but has performed inconsistently. The effect of comorbid depression on cravings predictive performance however, has been largely neglected, despite demonstrated associations between negative affect and craving. The current study examined the performance of craving, measured pre-treatment using the Obsessive subscale of the Obsessive Compulsive Drinking Scale, in predicting 18-week and 12-month post-treatment alcohol use outcomes in a sample of depressed drinkers. Data for the current study were collected during a randomized controlled trial (Baker, Kavanagh, Kay-Lambkin, Hunt, Lewin, Carr, & Connolly, 2010) comparing treatments for comorbid alcohol and depression. A subset of 260 participants from that trial with a Timeline Followback measure of alcohol consumption was analyzed. Pre-treatment craving was a significant predictor of average weekly alcohol consumption at 18 weeks and of frequency of alcohol binges at 18 weeks and 12 months, but pre-treatment depressive mood was not predictive, and effects of Baseline craving were independent of depressive mood. Results suggest a greater ongoing risk from craving than from depressive mood at Baseline.

Multiple drug use in adolescents and young adults

Issue: Harmful use of alcohol is a leading cause of disease burden for young Australians. Little is known about the context of adolescent alcohol initiation and the development of harmful patterns of consumption. This research reports descriptive baseline data from a national Australian longitudinal cohort. Approach: Parent-child dyads were recruited nationally via NSW, Tasmanian and WA secondary schools. During 2010/11, 1929 parent–child dyads completed baseline surveys. Measures include: alcohol use and harms; rules; parental style and monitoring; family relationships, confl ict and relations; peer substance use and approval; and delinquency. Key Findings: Sixty-eight percent of adolescents (M = 12.5 yrs) had tried alcohol. Parent factors including frequency and quantity of alcohol consumption (÷2 (3, N=1880) = 79.27, P < 0.00005; ÷2 (3, N=1879) = 63.75, P < 0.00005), drinking alcohol in the presence of their child (÷2 (3, N=1879) = 81.63, P < 0.00005) and younger age of alcohol initiation (÷2 (1, N=1785) = 20.13, P < 0.00005) were associated with adolescent alcohol initiation. Children with higher levels of rule breaking and aggressive behaviour (÷2 (1, N=1903) = 44.43, P < 0.0005; ÷2 (1, N=1893) = 13.40, P = 0.0003), who were male (÷2 (1, N=1904) = 6.72, P = 0.0095) and who had at least some friends who had tried alcohol (÷2 (3, N=1896) = 506.94, P < 0.00005) and who approved of drinking alcohol (÷2 (2, N=1903) = 91.21, P < 0.00005) were more likely to have tried alcohol themselves. Implications: To address current levels of binge drinking and long term harms from alcohol, it is essential to understand the context of early-adolescent alcohol use and how harmful trajectories may develop. Conclusion: Future analyses of this cohort will provide insight into the impact of contextual factors on adolescent alcohol use and inform public health policy and prevention.

A latent class analysis of polydrug use in treatment-seeking cannabis users: the role of social cognitive mechanisms

Abstract presented at the Australasian Professional Society on Alcohol and other Drugs Conference 2013, 24-27 November 2013, Brisbane, Australiapresented at the Australasian Professional Society on Alcohol and other Drugs Conference 2013, 24-27 November 2013, Brisbane, AustraliaAbstract presented at the Australasian Professional Society on Alcohol and other Drugs Conference 2013, 24-27 November 2013, Brisbane, AustraliaAbstract presented at the Australasian Professional Society on Alcohol and other Drugs Conference 2013, 24-27 November 2013, Brisbane, AustraliaAbstract presented at the Australasian Professional Society on Alcohol and other Drugs Conference 2013, 24-27 November 2013, Brisbane, Australia

Symposium - Using a dynamic approach to address a dynamic problems: new developments in the treatment of alcohol use

Introduction and Aims: High rates of cannabis use and dependence are significant issues in remote Indigenous communities. We have previously shown extremely high rates of cannabis use, dependence and adverse mental health impacts in Arnhem Land. This study reports the first data on cannabis use and its mental health impacts in Cape York. Design and Methods: We interviewed over 300 Aboriginal people aged 16–40 years in three remote Cape York communities. Data was gathered on rates of cannabis use, mental health impacts including dependence and withdrawal, and reasons for quitting. Results: One in two individuals interviewed was using cannabis, with most using cannabis daily or weekly. Approximately 70% reported cannabis dependence. Encouragingly, more than 70% of current users were considering quitting/cutting down or had made previous attempts. In current users, seeking or starting employment was the most common motivation for wanting to quit, whilst former users quit primarily for family reasons. Users reported negative mental health impacts of cannabis. One in four reported ‘stressing out’ when cannabis was unavailable, suggesting withdrawal. Anger/ irritability, paranoia, auditory hallucinations, thoughts of suicide/ self-harm and memory impairment were reported in up to 10% of users. Discussion and Conclusions: Rates of use and dependence are much higher than national rates (4.9% of males and 2.2% of females nationally used cannabis in the past week, 21% exhibiting dependence), and are similar to Northern Territory rates. One in four Aboriginal users in remote communities may be suffering mental ill health. Interventions should enhance quit support and employment opportunities and strengthen families.Introduction and Aims: Wastewater analysis has become a useful technique for monitoring illicit drug use in communities. Findings have been reported from different countries in Europe and North America. We applied this technique to gauge the illicit drug consumption in an urban catchment from South East Queensland, Australia. Design and Methods: The sampling campaigns were conducted in 2009 (21st November – 2nd December) and 2010 (19th – 25th November). We collected daily composite wastewater samples from the inlet of the sewage treatment plant using continuous flow-proportional sampling. Ten illicit drug residues (parent compounds and key metabolites) in the samples were measured using liquid chromatography coupled to tandem mass spectrometer. Results: Seven compounds were quantified in all the samples. Our data indicated higher drug consumption on weekends. Cannabis was the highest used drug in both sampling periods. Compared to the first sampling campaign which indicated that cocaine and methamphetamine use exceeded ecstasy usage, the second sampling campaign suggested the use of methamphetamine exceeded that of ecstasy which in turn exceeded cocaine use. Discussion and Conclusions: The observed weekly trend of drug use in our study is in agreement with findings in other studies. The variation between two sampling periods in the prevalence of drug use may relate to the availability and prices of the drugs on markets. The cocaine use we estimated in 2009 was much greater than estimations obtained through the national household survey [1], implying under- reporting of cocaine use in surveys. Future work is underway to tackle methodological challenges for more accurate estimation.