Shae-Leigh C Vella

The measurement of burden of care in serious mental illness: A qualitative review

Objective: Caring for someone with serious mental illness such as schizophrenia or bipolar disorder can result in considerable consequences for the caregiver. Carers often experience a range of negative emotions, impacts upon their physical and mental health, as well as financial strain. Resultant from these impacts, carers utilise medical services at a higher rate than their non-caregiving counterparts. Further, these consequences of caregiving can also impact upon the patient, resulting in an increase in psychopathology and relapse. Although the notion of burden has been studied for approximately 60 years, many flaws and inadequacies remain; most notably, a lack of agreement on the definition of the construct along with the poor psychometric properties of the burden assessment instruments. Method: This article reviews and evaluates the measures of burden of care that have been utilised with carers of people with a serious mental illness. A systematic search was conducted and all articles that had measured burden of care in schizophrenia or bipolar disorder in the database PUBMED were reviewed to ascertain the measure utilised. Results: Ten different measures were subsequently identified and eight were reviewed; two were excluded on the basis that they had only been utilised once. Conclusions: It was apparent that many of the measures lacked a strong theoretical basis and sound psychometric properties. Further, some of the measures lacked utility, feasibility and specificity. The article concludes with recommendations for future research.

Reason for clozapine cessation

Pai NB, Vella SC. Reason for clozapine cessation.

Are there different neural mechanisms responsible for three stages of weight gain development in anti-psychotic therapy: Temporally based hypothesis

Weight gain as a result of atypical anti-psychotic treatment is a common issue with different atypical anti-psychotic treatments causing differing magnitudes of weight gain. Although differing amounts of weight gain result from different atypical agents little is known about the temporal course of weight gain in anti-psychotic treatment. Specifically is the time course of weight gain comparable across different agents. Therefore this article reviews the temporal course of weight gain for three common atypical anti-psychotics namely; clozapine, olanzapine and risperidone. It is evident that all three of these agents exhibit similar although at distinct magnitudes temporal courses of weight gain. That is an initial rapid increase from baseline to 3 months (stage 1), a steady increase from 3 months to 18 months (stage 2) and a plateau after this point (stage 3) with continued anti-psychotic treatment. It is postulated that each of these stages of weight gain result from distinct neural mechanisms. The hypothesized neural correlates for each stage of weight gain are reviewed and discussed. The article concludes with recommendations for future research.

Augmentation of clozapine with another pharmacological agent: treatment for refractory schizophrenia in the ‘real world’

Pai NB, Laidlaw M, Vella S‐C. Augmentation of clozapine with another pharmacological agent: treatment for refractory schizophrenia (SZ) in the ‘real world’.

Is food addiction a valid phenomenon through the lens of the DSM-5?

Australian & New Zealand Journal of Psychiatry, 48(3) Recent literature has seen a rise in interest in the phenomenon of food addiction. Nolan (2013) highlighted that Medline has had a sevenfold increase in the number of papers indexed by the term food addiction since 2008. However, a lack of consensus regarding the entity of food addiction and whether it constitutes a ‘true’ and valid addiction pervades. Clearly the ideology of food addiction and its accompanying nosological status (if such a status should exist) has vast implications. Especially in the context of the current global epidemic of overweight and obesity with its associated health, psychological, economic and social consequences, as logically food addiction would be a significant aetiological factor fuelling this epidemic (Lindberg, et al., 2011). This viewpoint seeks to briefly highlight the debate regarding whether food addiction is a ‘true’ and valid addiction, through the lens of the recently released DSM-5 (American Psychiatric Association, 2013). Firstly, the status of food addiction as a ‘true’ addiction in relation to the DSM-5 generally will be discussed, before moving on to a discussion of food addiction in relation to the nosology of substance use.

A pilot study of mental health and quality-of-life of caregivers of children with cleft lip/palate in India.

Background: There has been insufficient and contradictory research to date on the impacts of caring for a child with cleft lip/palate. Therefore this pilot study sought to investigate the mental health and quality of life of primary caregivers of children with cleft lip/palate. Materials and Methods: Seventy-nine primary caregivers of children with cleft lip/palate awaiting a surgical procedure in India completed questionnaires to measure their mental health, quality of life, and demographic variables. Results: The results indicated that half of the sample suffered from poor mental health and a reduced quality of life. Overall perceptions of quality of life were significantly associated with the age of the child requiring care and the contact hours per day spent with the child. Conclusion: It is apparent that caregivers for this population do suffer from a reduced quality of life and poorer mental health. This is especially relevant for older caregivers and those with greater caring responsibilities.

The importance of primary care psychiatry: an Australian perspective with global implications

This paper provides a review of the importance of primary care psychiatry within an Australian context. The aims of this review are: (1) to emphasize the integral role of mental health in overall health and well-being, (2) to elucidate the factors that make the provision of primary care psychiatry essential, and (3) to review the impact of the Australian government’s mental health policy initiatives on the mental health of the Australian population as well as on the practice of primary care psychiatry. From this review, it is evident that the discipline of psychiatry is integral to the overall health of the community. Furthermore, it is apparent that primary care psychiatry has a large and pivotal role to play in the prevention, treatment, and early detection of mental disorders in Australia and worldwide. The article concludes with some simple, actionable recommendations for the practice of primary care psychiatry.

A narrative review of potential treatment strategies for food addiction

The concept of food addiction (FA) remains controversial with research being in the nascent stages; FA like any addiction can have a devastating impact on the lives of those afflicted. There exists a clinical need for treatment strategies for those affected. This article reviews potential treatment strategies for FA. The treatment strategies target four core behaviours of the addiction phenotype specifically craving through the opioid system, impulsivity as a personality trait, compulsivity through the serotonergic system and lastly motivation through the dopaminergic system. A range of pharmacological and psychological interventions are reviewed. Future research should seek to test and validate the proposed clinical treatment strategies.

Can one spring back from psychosis? The role of resilience in serious mental illness

Australian & New Zealand Journal of Psychiatry, 52(11) range. On physical examination, the patient demonstrated gegenhalten, staring, immobility and catalepsy. The pathological grasp reflex was not present. The patient commenced 0.5 mg lorazepam twice daily and was reviewed 4 weeks later. He had not experienced further ‘slow motion’ episodes and single word expressive communication had returned. His mobility had been restored to include walking unaided and dancing. He was again able to finish meals independently without prompting. His fine motor skills (reaching, grasping, holding, transferring and manipulating) were again intact. He was still slowed in his movements with minimal blinking. Escitalopram was reduced to 10 mg once daily. The vitamin supplements were ceased. The lorazepam 0.5 mg twice daily was continued. In hindsight, this patient displayed many of the physical features of catatonia (Kaufmann et al., 2017), and these were mistaken for psychological features of major depressive disorder. The heterogeneous course of catatonia and its intermittent recurrence can be easily mistaken for mood disorders, psychotic disorders, an exacerbation of stereotypies arising from developmental disorders or medication-induced movement disorders. This case highlights the unique expertise psychiatry can bring to diagnostic problems in patients with autism. It emphasises the ongoing need for basic clinical data in catatonia and the development of enhanced catatonia instruments for use in developmental disability (Sienaert et al., 2011). The new Diagnostic and Statistical Manual of Mental Disorders (5th Ed.; DSM-5) diagnostic criteria for catatonia serve to advance its disentanglement from schizophrenia, further enumerate the conditions in which catatonia is expressed and will encourage more clinical and basic research on this condition.

The clinical assessment of impulsivity

The term impulsivity is often used to describe behavior that is both spontaneous and detrimental. Impulsivity is multidimensional and derives from personality, general psychopathology as well as specific mental disorders. Thus, the construct of impulsivity is important as it is associated with numerous mental disorders as well as socially deviant behaviors ranging from behaviors targeted towards others such as aggression, to behaviors targeted toward oneself, for example, self-harm and suicide. As a clinical construct impulsivity is highly predictive of poor prognosis thus further emphasizing its clinical relevance. Therefore, the need exists for impulsivity to be clinically assessed and this assessment should take place at the same time as the assessment of risk. As risk and impulsivity are interrelated and interact. Although there are existing self-report rating scales for trait-based impulsivity, a dearth exists in regards to assessment of impulsivity in clinical practice that is focused and pragmatic. Thus, a pragmatic rubric to guide the individualized assessment of impulsivity in a clinical population is proposed. The quadrants espoused will assist both with the formulation of questions and categorization of responses to determine the most appropriate interventions for the client.