Liza Edmonds

Familial Bipolar Disorder: Preliminary Results from the Otago Familial Bipolar Genetic Study

Objective: This paper outlines the methodologies used, and preliminary descriptive data collected, on a cohort of familial bipolar disorder (BPD) probands and first-degree relatives taking part in a descriptive and genetic study into familial BPD in New Zealand. Method: Fifity-five bipolar probands and 67 first-degree relatives were interviewed using the modified Diagnostic Interview for Genetic Studies (DIGS) and Family Interview for Genetic Studies (FIGS). Data was also collated from other sources. Blood samples were taken for DNA genomic analysis. Results: New Zealand families in which BPD segregates proved willing participants in this familial based genetic research. The methodologies used were acceptable. High rates of comorbidity were found in probands (27.3% met DSM-IV criteria for panic disorder/sub-threshold panic disorder; 12.7% for phobic disorder; 1.8% for obsessive-compulsive disorder; 9.1% for alcohol-related disorders and 7.3% for an eating disorder) and relatives (major depression 34.3%; panic disorder/sub-threshold panic disorder 12.0%; phobias 11.9% and alcohol-related disorders 11.9%). The polarity of index BPD illness was related to age of onset and frequency of comorbidity. Suicidal behaviour was common. Conclusions: Psychiatric genetic research in New Zealand families is highly feasible. Emerging trends in the familial transmission of BPD include high rates of comorbidity, illness patterns based on polarity of index episode and frequent suicidal behaviour. Such trends will be delineated further as numbers accrue, perhaps enabling identification of more homogenous phenotypic subgroups than currently produced by diagnostic schemes.

Assessing the Role of Drugs in Suicidal Ideation and Suicidality

The emergence of suicidal ideation and suicide-related behaviour in patients receiving drug treatment is of concern because of the overall burden of these conditions and the possible link with completed suicide. Observational studies have been useful in generating hypotheses of causality but are confounded by the association between various disease states and increased suicide-related behaviour and completed suicide. The demonstration of causality requires experimental studies, especially randomised controlled trials, and meta-analyses. Unfortunately, the lack of uniform requirements for defining, detecting and recording suicidal ideation, suicide-related behaviour and completed suicide creates difficulties in comparing studies.Nevertheless, there is evidence of an association between SSRIs and other newer antidepressant drugs and treatment-emergent suicidal ideation and suiciderelated behaviour in both children and adults; however, an increase in completed suicide as a result of treatment with SSRIs and other newer antidepressant drugs has not been demonstrated. Atomoxetine has also been associated with treatmentemergent suicidality, based on the results of a meta-analysis. Although similar associations have been proposed for some antiepileptic drugs, isotretinoin and interferon-α, they are yet to be supported by evidence from randomised controlled trials or meta-analyses.

Trends in Maori mental health in Otago

Objective: This paper outlines the methods used, and preliminary descriptive data collected, in a study on a cohort of Maori and non-Maori patients admitted to the inpatient psychiatric services in Otago between 1990 and 1992. Method: The notes of 42 Maori and 217 non-Maori first admissions to psychiatric inpatients were reviewed. Information concerning this admission was entered onto a database and analysed. Results: The Maori admission rate was 4 per 1000 compared with 1 per 1000 for non-Maori people. This was higher than expected based on Otago population figures. Rates of family psychiatric history did not differ between Maori and non-Maori. Although Maori were found to have higher rates of social welfare support and were more likely to have no academic qualifications the differences were not significant. The sources of referral for Maori admissions were more likely to be from the law, and Maori were more likely to have had prior psychiatric inpatient treatment. The most common diagnosis for Maori and non-Maori was depressive disorders, and suicidal behaviour was common. Conclusions: Maori are overrepresented among first psychiatric inpatient admissions in Otago. They appear to be a more disadvantaged group with respect to financial support, academic qualifications and other health problems. The most common diagnosis did not differ between Maori and non-Maori cohorts.

Career decisions: factors that influence the Māori doctor.

Māori have known health disparities that may be addressed through increasing the cultural competency of New Zealands medical workforce. There is a paucity of Māori health professionals choosing paediatrics or adult medicine as a career and the factors influencing their career decision are yet to be explored.

Perinatal arterial ischemic stroke in northern Queensland.

OBJECTIVES Our objective was to review the occurrence, presentation, and associated risk factors of stroke in infants at a tertiary neonatal intensive care unit. STUDY DESIGN Inpatient electronic records identified infants between March 2002 and March 2011 who had perinatal arterial ischemic stroke. RESULTS Ten infants had perinatal arterial ischemic stroke, 50% were outborn, 20% were indigenous, and mortality was 30%. Median birth weight was 2970 g (range 1699 to 3443 g), and median gestation was 36 weeks (range 32 to 41 weeks). Perinatal arterial ischemic stroke were left sided in three, right sided in three, and bilateral in four. Presentation included four with seizures, four with apnea/sepsis, one with thrombosis, and one without symptoms. In 4 of 10 cases reported in this series, there was a maternal history of gestational diabetes, although the incidence of gestational diabetes in Australia is only 4.5%. CONCLUSION The incidence of gestational diabetes mellitus in our cases appears to be very much higher than the average population. Larger studies are needed to determine if gestational diabetes mellitus is a risk factor for perinatal arterial ischemic stroke.

Congenital diaphragmatic hernia in Northern Queensland

To investigate the survival of non‐syndromic live born infants diagnosed in Northern Queensland with congenital diaphragmatic hernia (CDH).

Paracetamol treatment for patent ductus arteriosus: practice and attitudes in Australia and New Zealand

Abstract Aim: To describe the current clinical practices and attitudes of neonatologists towards paracetamol treatment of PDA in Australia (AU) and New Zealand (NZ). Method: A web-based survey of all neonatologists registered under the 2017 Australia New Zealand Neonatal Network (ANZNN) was conducted. Results: The response rate for the survey was 67%, (141/210). Of those respondents, 37% stated their unit had a written policy outlining how to treat patent ductus arteriosus (PDA). Of the written policies, 53% mentioned paracetamol treatment. The majority of the respondents (70%) have prescribed paracetamol for PDA closure. When comparing between countries, 79% of AU respondents had compared with 44% of NZ respondents. Successful ductal closure in the infants who received paracetamol was anecdotally reported by 61% of respondents. The main reasons for clinicians not prescribing paracetamol were due to preferential NSAID use (61%) and lack of evidence to indicate efficacy (49%). Conclusion: Many neonatologists in AU and NZ have prescribed paracetamol for PDA closure. However, considerable practice variations exist. The results from this study suggest there may be a role for paracetamol in the treatment of PDA, however, further research is required to clarify the optimal use and provide evidence of efficacy.

Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC), who then developed a supraventricular tachycardia (SVT). This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management.

A glowing 23-week gestation infant: A novel use of a Wee Sight transilluminator: Image of the Month

[Extract] A male, 600-g, 23-week gestation infant at 2 weeks of age had an acute episode of desaturation, increased oxygen requirement and a fall in mean blood pressure. At the time, he was ventilated on synchronised intermittent positive pressure mandatory ventilation. This picture was taken at this time using a transilluminator (Wee Sight Koninklijke Philips Electronics N.V., Groenewoudseweg, Eindhoven, the Netherlands). What is the diagnosis?

A glowing 23-week gestation infant: a novel use of a Wee Sight transilluminator. Tension pneumothorax.

[Extract] A male, 600-g, 23-week gestation infant at 2 weeks of age had an acute episode of desaturation, increased oxygen requirement and a fall in mean blood pressure. At the time, he was ventilated on synchronised intermittent positive pressure mandatory ventilation. This picture was taken at this time using a transilluminator (Wee Sight Koninklijke Philips Electronics N.V., Groenewoudseweg, Eindhoven, the Netherlands). What is the diagnosis?