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Arya D.,Mental Health Service | Arya D.,University of Newcastle
Australasian Psychiatry

Objective: Current legislative provisions for compulsory treatment of people with mental illness allow decisions to treat people under compulsion to be made on the basis of presence of a mental illness or mental disorder without consideration of whether the patient has the capacity to make decisions that are in his/her best interest. Issues of autonomy, equity, justice and beneficence in relation to treatment of people with mental illness are explored to determine decision-making rules that should be applied for compulsory mental health treatment. Conclusions: It is proposed that assessment of the capacity of the individual to make decisions in his/her best interest, rather than presence of diagnosable mental illness, should be the key consideration for compulsory mental health treatment. © 2013 The Royal Australian and New Zealand College of Psychiatrists. Source

Soble J.R.,University of Illinois at Urbana - Champaign | Spanierman L.B.,McGill University | Fitzgerald Smith J.,Mental Health Service
Journal of Clinical and Experimental Neuropsychology

This study examined the neuropsychological performance of 125 outpatient Operation Enduring Freedom/Operation Iraqi Freedom combat veterans with posttraumatic stress disorder (PTSD) and nonacute mild traumatic brain injury (TBI) (n = 66) and PTSD (n = 59) across multiple cognitive domains to determine whether mild TBI results in greater impairment among those with PTSD. Profile analyses revealed that veterans with PTSD and mild TBI did not differ significantly from those with just PTSD across domains, suggesting that comorbid mild TBI does not result in an additive effect. A norms-based comparison also revealed that neither group demonstrated impaired performance on any of the objective neuropsychological measures examined. However, both groups endorsed moderately elevated symptoms of depression and anxiety, indicating that comorbid psychopathology may contribute to subjective cognitive complaints. © 2013 Copyright Taylor and Francis Group, LLC. Source

Das C.,University of Arkansas for Medical Sciences | Mendez G.,Arizona State University | Jagasia S.,University of Arkansas for Medical Sciences | Jagasia S.,Georgetown University | Labbate L.A.,Mental Health Service
Annals of Clinical Psychiatry

BACKGROUND: Weight gain in schizophrenia, particularly secondary to second-generation antipsychotic (SGA) use, is a common adverse effect and often is associated with significant physical and psychological morbidity. METHODS: We performed a critical literature review of all controlled clinical trials for pharmacologic and/or behavioral management of SGA-induced weight gain in schizophrenia patients by searching PubMed and Google Scholar. A meta-analysis was performed to estimate and compare weight changes for various medications and behavioral interventions. RESULTS: Sample sizes generally were small. Clinical trials were 6 weeks to 1 year, and weight loss was modest with any treatment. Although several adjunctive pharmacologic treatments showed no weight loss, sibutramine, metformin, and topiramate showed some benefit. Amantadine and orlistat were somewhat less effective and had lower rates of tolerability. Among the behavioral therapies, nutritional counseling combined with exercise showed the most benefit. Behavioral therapies, although modest, showed the most consistent benefits compared with controls. CONCLUSIONS: Scheduled pharmacologic treatment to prevent weight gain or promote weight loss in schizophrenia patients on SGA therapy is limited based on current studies. Switching antipsychotic agents has not been established as a long-term solution. Additional long-term studies are required to influence clinical practice. Source

Carlyle D.A.,Mental Health Service
Community Practitioner

This paper highlights resilience as a key concept when working with young children to improve their emotional wellbeing and reduce anxieties. Supporting children aged 4-7 years with anxiety is a significant area of advancement in terms of therapeutic approaches over the last decade. This paper outlines one such approach that was implemented within a Tier 2 Community Child and Adolescent Mental Health Service (CAMHS) within the northern region of England to determine whether findings from Australian studies could be replicated in the UK. A pilot study was undertaken with a group of young children aged 4-7 years old with symptoms of anxiety. All of the children had been referred to the service because of anxiety related issues, such as social phobia, generalised anxiety disorder and obsessive-compulsive disorder. They received a group intervention, FUN FRIENDS, over a period of 12 weeks. By enabling the children to become more self-sufficient this allowed greater emotional and social skills development. All the children demonstrated improved anxiety scores post intervention, as measured by the Spence Child Anxiety Scale. Source

Ahnallen C.G.,Mental Health Service | Ahnallen C.G.,Harvard University | Bidwell L.C.,Brown University | Tidey J.W.,Brown University
Nicotine and Tobacco Research

Introduction: Beneficial effects of nicotine on cognitive functioning may contribute to the markedly high rates of smoking among people with schizophrenia. A reduction in the nicotine content of cigarettes to non-addictive levels is being considered as a regulatory strategy for reducing tobacco dependence in the United States. We examined whether switching to very low nicotine content (VLNC) cigarettes impairs cognitive functioning in smokers with and without schizophrenia, andwhether nicotine replacement reverses these effects. Methods: Smokers with schizophrenia (SS, n = 29) and control smokers matched on smoking rate but without psychiatric illness (CS, n = 28) smoked usual-brand cigarettes, VLNC cigarettes while wearing 2 placebo patches (PLA), or VLNC cigarettes while wearing 2 nicotine patches totaling 42mg (NIC) for 5hr, and then completed computerized assessments of visual sustained attention, motor speed, visual working memory, processing speed, inhibitory control, and response variability. Results: Across conditions, SS were slower than CS in tasks of motor speed and visual working memory, and had poorer target detectability on a visual sustained attention task. Across groups, functioning in domains of visual sustained attention, inhibitory control, processing speed, and response variability was impaired in the VLNC + PLA condition relative to the usual-brand and VLNC + NIC conditions. Conclusions: Dramatically reducing the nicotine content of cigarettes may impair cognitive functioning in heavy smokers with and without schizophrenia, but the use of nicotine replacement while smoking VLNC cigarettes may preserve cognitive functioning in these smokers. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. Source

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