Philip Boyce

The Edinburgh Postnatal Depression Scale: Validation for an Australian Sample:

One hundred and three post-partum women completed the Edinburgh Postnatal Depression Scale (EPDS) and were interviewed using the Diagnostic Interview Schedule. A cut-off score of 12.5 on the Edinburgh Postnatal Depression Scale identified all nine women who reached criteria for major depression. At this threshold the sensitivity (the percentage of true “cases’ identified) of the EPDS was 100%, its specificity (the percentage of true “non-cases’ identified as such) 95.7% and its positive predictive value (the percentage of all those tested as positive who were correctly identified as such) 69.2%. Although this study supported the validity of the EPDS, a replication of this study on a larger sample is suggested.

Evidence of a genetic contribution to functional bowel disorder.

Objective:Anecdotally, functional bowel disorders (FBD) such as the irritable bowel syndrome appears to cluster in some families, but no studies have investigated the heritability of FBD. We aimed to investigate the influence of heritable factors in FBD.Methods:Same sex twin pairs enrolled in the Australian Twin Registry completed a structured interview that included questions related to symptoms consistent with FBD: abdominal pain, diarrhea, constipation, excessive gas or bloating, and nausea. Reasons for the occurrence of each symptom, including their physicians’ diagnoses, were recorded. Lisrel 7.16 software was used to fit genetic models following standard procedures.Results:Of the 686 individual twins from same-sex pairs, 33 (4.8%) had one or more symptoms diagnosed by a medical practitioner as functional bowel disorder. Complete data on this symptom scale was available for 186 monozygotic and 157 same sex dizygotic twin pairs. A model in which 56.9% (95% CI: 40.6–75.9%) of the variance was attributed to additive genetic variance, with the remaining 43.1% attributed to the individuals unique environment, closely fitted the data (χ2= 0.01, df = 4, p= 1.0).Conclusion:Our results suggest that a substantial proportion of the liability for FBD may be under genetic control. Whether this liability is related to the disorder itself or to other potential predisposing factors requires clarification.

Epidemiology and Health Care Seeking in the Functional GI Disorders: A Population-Based Study

OBJECTIVES:Functional GI disorders (FGIDs) are common in clinical practice, but little is known about the epidemiology of these disorders in the general population. We aimed to determine the prevalence, association with psychological morbidity, and health care seeking behavior of FGIDs in the population.METHODS:A random sample of subjects (n = 4500) aged ≥18 yr and representative of the Australian population were mailed a validated questionnaire. For these subjects we measured all Rome I GI symptoms and physician visits over the past 12 months, as well as neuroticism, anxiety, depression, and somatic distress.RESULTS:The response rate for the study was 72%. The prevalence of any FGID was 34.6%, and 62.1% of these subjects had consulted a physician. There was considerable overlap of the FGIDs (19.2% had more than two disorders). Independent predictors for an FGID diagnosis were neuroticism, somatic distress, anxiety, bowel habit disturbance, abdominal pain frequency, and increasing age. However, psychological morbidity did not independently discriminate between consulters and nonconsulters with an FGID.CONCLUSIONS:More than one third of the general population have one or more FGIDs. There seems to be a modest link between psychological morbidity and FGIDs, although other unknown factors seem to be more important in explaining health care seeking for these disorders.

Development of a Scale to Measure Interpersonal Sensitivity

We describe the development of a self-report measure (the Interpersonal Sensitivity Measure or IPSM). The IPSM generates a total score as well as five sub-scale scores: interpersonal awareness, need for approval, separation anxiety, timidity and fragile inner-self. Its reliability is demonstrated by high internal consistency in two separate groups, and by stability in scores over time in a non-clinical group. Studies of a clinical group of depressives showed change in scale scores following improvement in the depressive state, suggesting some sensitivity of the measure to mood state. The IPSM appears related to measures of neuroticism and to low self-esteem but not to a modified concept of neuroticism, emotional arousability. The constructs contributing to interpersonal sensitivity and their relevance to depression are considered. Some preliminary findings of higher scores in depressives compared to non-depressives are reported.

Irritable bowel syndrome according to varying diagnostic criteria : Are the new Rome II criteria unnecessarily restrictive for research and practice?

OBJECTIVES:It has been suggested that the variation in the prevalence of irritable bowel syndrome (IBS) may be due to the application of different diagnostic criteria. New criteria for IBS have been proposed (Rome II). It is unknown whether persons meeting different criteria for IBS have similar psychological and symptom features. The aim of this study was to measure the prevalence of IBS according to Manning and Rome definitions of IBS and to evaluate the clinical and psychological differences between diagnostic categories.METHODS:A total of 4500 randomly selected subjects, with equal numbers of male and female subjects aged ≥18 yr and representative of the Australian population, took part in this study. Subjects were mailed a questionnaire (response rate, 72%). Characteristics measured were gastrointestinal symptoms over the past 12 months, neuroticism and extroversion (Eysenck Personality Questionnaire), anxiety and depression (Delusions-Symptoms-States Inventory), mental and physical functioning (SF-12), and somatic distress (Sphere).RESULTS:The prevalence for IBS according to Manning, Rome I, and Rome II was 4.4% (95% confidence interval [CI] = 3.5–5.1%), 6.9% (CI 6.0–7.8%), and 13.6% (CI 12.3–14.8%), respectively. Only 12 persons with Rome I did not also meet Rome II criteria; 196 persons with Manning criteria did not meet Rome II cut-offs. Having IBS regardless of which criteria were used was significantly associated with psychological morbidity, but psychological factors were not important in discriminating between diagnostic categories. However, pain and bowel habit severity independently discriminated between diagnostic groups.CONCLUSIONS:IBS is a relatively common disorder in the community. The new Rome II criteria may be unnecessarily restrictive in practice.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Objectives: To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. Methods: Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. Results: The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. Conclusions: The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Mood Disorders Committee: Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. International expert advisors: Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O’Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. Australian and New Zealand expert advisors: Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O’Connor, Dr Nick O’Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.

Response inhibition deficits in obsessive–compulsive disorder

Difficulty inhibiting irrelevant information may play a central role in the aetiology of obsessive-compulsive disorder (OCD). The aim of the present study was to determine whether OCD subjects (n=20) exhibit deficits in behavioural and cognitive inhibition compared with a clinical control group diagnosed with panic disorder (n=20). All subjects were administered a Go/Nogo task (a measure of behavioural inhibition) and a Stroop test (a measure of cognitive inhibition). OCD subjects made more commission errors on the Go/Nogo task, and they made more errors and displayed longer reaction times on the interference trial of the Stroop task. Trends towards correlations were observed between OCD severity scores and Stroop reaction time, where the more severe the OCD symptoms the faster was the response. No correlations between clinical symptomatology or subject demographics and the Go/Nogo task were observed. It was demonstrated that OCD subjects exhibit deficits in behavioural and cognitive inhibition, which together may underlie the repetitive symptomatic behaviours of the disorder, such as compulsions and obsessions.

Obstetric risk factors for postnatal depression in urban and rural community samples

Objective: The objective of this study was to examine obstetric risk factors for postnatal depression in an urban and rural community sample, with concurrent consideration of personality, psychiatric history and recent life events. Methods: This was a prospective study with women planning to give birth in one of the four participating hospitals recruited antenatally. Obstetric information was obtained from the New South Wales Midwives Data Collection, completed shortly after delivery. Personality, psychiatric history and life-events information were obtained from a questionnaire, administered within 1 week postpartum. Depression status was assessed at 8 weeks postpartum using the Edinburgh Postnatal Depression Scale. Results: Complete data were obtained from 490 women. Several non-obstetric risk factors for the development of postnatal depression at 8 weeks postpartum were reported including: sociodemographic (up to technical college level education, rented housing, receiving a pension/benefit), personality (those who described themselves as either nervy, shy/selfconscious, obsessional, angry or a worrier), psychiatric history (familial history of mental illness, personal history of depression or anxiety or a history of depression in the participants mother) and recent life-events (major health problem, arguments with partner and friends/relatives). None of the obstetric variables were significantly associated with increased risk for postnatal depression, but several showed marginally significant increases (multiparous women, antepartum haemorrhage, forceps and caesarean section deliveries). Conclusions: The results emphasize the importance of psychosocial risk factors for postnatal depression and suggest that most obstetric factors during pregnancy and birth do not significantly increase risk for this depression. Early identification of potential risk for postnatal depression should include assessment of sociodemography, personality, psychiatric history and recent life events, as well as past and present obstetric factors.

The impact of functional gastrointestinal disorders on quality of life

OBJECTIVE:The impact of functional gastrointestinal disorders (FGIDs) on quality of life is unknown. We aimed to evaluate whether FGIDs impair quality of life in terms of mental and physical functioning in patients and nonpatients.METHODS:A random sample of 4500 subjects, representative of the Australian population, were mailed a questionnaire on gastrointestinal symptoms in the past 12 months. Quality of life was assessed using the valid SF-12, in which the lower the scores, the greater the impairment of quality of life. The response rate was 72%.RESULTS:Among those fulfilling Rome I criteria for a diagnosis of a FGID (n = 1006) versus those not having a FGID (n = 1904) (healthy controls), there was a significant association with impaired mental (43.9 vs 48.1) and physical (47.7 vs 51.6) functioning. Mental functioning (43.3 vs 44.9) and physical functioning (46.0 vs 50.5) was significantly more impaired in patients versus nonpatients with a FGID. Furthermore, nonpatients with a FGID had more impaired mental and physical functioning than healthy controls.CONCLUSION:FGIDs impair quality of life, particularly in those that consult for health care.

A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome

OBJECTIVES:Psychological treatments are considered to be useful in the irritable bowel syndrome (IBS), although the evidence is based on small, often flawed trials. Although cognitive behavior therapy (CBT) and relaxation therapy have both been promising, we hypothesized that CBT would be superior to relaxation and standard care alone in IBS patients. The objective of this study was to test this assumption by comparing the effects of cognitive behavior therapy with relaxation therapy and routine clinical care alone in individuals with IBS.METHODS:Patients (n = 105) with Rome I criteria for IBS were recruited from advertisement (n = 51) and outpatient clinics (n = 54); those patients with resistant IBS were not included. A randomized controlled trial with three arms (standard care for all groups plus either CBT or relaxation) for 8 wk was conducted, which applied blinded outcome assessments using validated measures with 1 yr of follow-up. The primary outcome for this study was bowel symptom severity.RESULTS:Of 105 patients at the commencement of treatment, the mean bowel symptom frequency score for the whole sample was 21.1 and at the end of treatment had fallen to 18.1; this persisted at the 52-wk follow-up, with a significant linear trend for scores to change over time (F= 39.57 p < 0.001). However, there were no significant differences among the three treatment conditions. Significant changes over time were found for physical functioning (F= 4.37, p < 0.001), pain (F= 3.12, p < 0.05), general health (F= 2.71, p < 0.05), vitality (F= 2.94, p < 0.05), and the social functioning scales on the Medical Outcomes Study Short Form 36 (F= 4.08, p < 0.05); however, all three arms showed similar improvement. There were significant reductions in anxiety, depression, and locus of control scales, but no significant differences among the treatment groups were detected.CONCLUSION:Cognitive behavior and relaxation therapy seem not to be superior to standard care alone in IBS.