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Randwick, Australia

Large M.,Kiloh Center | Large M.,University of New South Wales | Ryan C.,University of Sydney | Walsh G.,Kiloh Center | And 2 more authors.
Australasian Psychiatry | Year: 2014

Objective and Method: To consider the possibility that adverse aspects of psychiatric hospitalisation may precipitate suicide contributing significantly to the increased rate of suicide among inpatients, given little has been published about this. Results and Conclusions: It is likely that psychiatric hospitalisation itself contributes to some inpatient suicides. This has significant implications for the delivery of inpatient psychiatric care. © The Royal Australian and New Zealand College of Psychiatrists 2013. Source


Sparks A.,University of New South Wales | Sparks A.,Black Dog Institute | McDonald S.,University of New South Wales | Lino B.,University of New South Wales | And 5 more authors.
Schizophrenia Research | Year: 2010

Social and occupational functioning difficulties are a characteristic feature of schizophrenia, and a growing body of evidence suggests that deficits in social cognition contribute significantly to these functional impairments. The present study sought to investigate whether the association between social cognition and social functioning in schizophrenia would be mediated by self-reported levels of empathy. Thirty outpatients with a diagnosis of schizophrenia or schizoaffective disorder, and twenty-five healthy controls completed a well-validated facial affect processing task (Ekman 60-faces facial task from the Facial Expressions of Emotion - Stimuli and Tests; FEEST), The Awareness of Social Inference Test (TASIT; to assess emotion perception and complex social cognitive skills such as the detection of sarcasm and deceit, from realistic social exchanges), and measures of self-reported empathy and social functioning. Participants with schizophrenia performed more poorly than controls in identifying emotional states from both FEEST and TASIT stimuli, and were impaired in their ability to comprehend counterfactual information in social exchanges, including sarcasm and lies, on the TASIT. Impairment in the comprehension of sarcasm was associated with higher empathic personal distress, and lower recreational functioning. Impairment in the identification of the emotions of others was found to be associated with lower satisfaction and lower empathic fantasy. However, empathy could not be explored as a mediator of associations between social cognition and functional outcome, due to lack of common associations with functional outcome measures. These findings have implications for the remediation of specific social cognitive deficits with respect to improving functional outcomes in schizophrenia. © 2010 Elsevier B.V. Source


Mullin K.,Kiloh Center | Gupta P.,Kiloh Center | Compton M.T.,George Washington University | Nielssen O.,University of New South Wales | And 5 more authors.
Australian and New Zealand Journal of Psychiatry | Year: 2012

Objective: To assess the extent to which ceasing the use of cannabis or other substances reduces the symptoms and social disability associated with psychotic illness. Methods: The electronic databases CINAHL, EMBASE, MEDLINE and PsycINFO were searched for peer-reviewed publications in English that report data about the characteristics of current and former substance-using patients diagnosed with psychotic illnesses. The searches yielded 328 articles, of which 23 studies met the inclusion criteria. Four key outcome variables; positive symptoms, negative symptoms, ratings of depression and global function, and five other measures of outcome that were reported in five or more studies were examined using meta-analysis. Results: Current substance-using patients were significantly younger than former substance-using patients (standardised mean difference (SMD) = 0.38), but did not differ in age at onset of psychosis, sex, level of education or marital status. Current substance users had higher scores on rating scales of positive symptoms (SMD = 0.29) and depression (SMD = 0.36), and lower scores on global function (SMD = 0.26) when compared with former substance users. There was a significant improvement in the ratings of positive symptoms, mood and global function among patients who stopped using substances during the first episode of psychosis, while improvements in the symptoms of patients with a more established psychotic illness did not reach statistical significance. Conclusion: The results suggest that substance use contributes to both the symptoms and the burden of disability experienced by patients with psychosis. Patients in the early stages of psychotic illness should be informed about the benefits of giving up substances earlier, rather than later in the illness. Psychiatric services should regard the treatment of substance use as an integral part of the treatment of psychotic disorders. © The Royal Australian and New Zealand College of Psychiatrists 2012. Source


Large M.,University of New South Wales | Large M.,Kiloh Center | Mullin K.,Kiloh Center | Gupta P.,Kiloh Center | And 2 more authors.
Australian and New Zealand Journal of Psychiatry | Year: 2014

Objective: To compare the symptoms and social function of patients with psychosis and current substance use to those with psychosis and no history of substance use. Method: The databases EMBASE, MEDLINE and PsycINFO were searched for peer-reviewed publications in English that reported the characteristics of patients with psychotic illness who were current substance users and those who had never used substances. The searches yielded 22 articles that met the inclusion criteria. Meta-analysis was used to compare four key outcome variables: positive symptoms, negative symptoms, depression and social function - and three secondary outcomes: violence, self-harm and hospital admissions. Results: Current substance-using patients were significantly younger than non-substance-using patients and were more likely to be male, but did not differ in age at onset of psychosis or in their level of education. Current substance users had higher ratings of positive symptoms and were more likely to have a history of violence. Older studies reported a stronger association between current substance use and positive symptoms than more recently published studies. Current substance users did not differ from non-users on measurements of negative symptoms, depressive symptoms, social function, self-harm, or the number of hospital admissions. Conclusion: Current substance users with psychosis may have more severe positive symptoms than patients who have never used substances, but this result should be interpreted with caution because of demographic differences between substance users and non-substance users. © The Royal Australian and New Zealand College of Psychiatrists 2014. Source


Gupta P.,Kiloh Center | Mullin K.,Kiloh Center | Nielssen O.,University of New South Wales | Nielssen O.,University of Sydney | And 3 more authors.
Australian and New Zealand Journal of Psychiatry | Year: 2013

Objective: To compare the symptoms and function of patients with psychosis who have ceased using substances to those who have psychosis but do not have a history of substance use. Method: The databases EMBASE, MEDLINE and PsycINFO were searched for peer-reviewed publications in English reporting the characteristics of patients with psychotic illness who had stopped using substances and those who had never used substances. The searches yielded 20 articles that met the inclusion criteria. Four key outcome variables - positive symptoms, negative symptoms, depression and global function - and four other outcome measures reported in five or more studies were examined using meta-analysis. Results: Former substance-using patients were significantly younger than non-substance-using patients and were more likely to be male, but did not differ in age at onset of psychosis or in their level of education. There were no significant differences between former substance users and non-substance users in ratings of positive symptoms, negative symptoms, depression or global function. Among first-episode patients there was a trend towards former substance users having less severe depressive symptoms than non-substance users. In contrast, among non-first-episode patients, former substance users had significantly more depressive symptoms than non-substance users. In studies rated as being of higher quality, former substance users had significantly less severe positive symptoms than non-substance users. Conclusion: The absence of significant differences between the two groups suggests that a history of substance use is not a poor prognostic indicator for patients who are able to stop using substances. © 2013 The Royal Australian and New Zealand College of Psychiatrists. Source

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