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Corstens D.,RIAGG Maastricht | Longden E.,University of Leeds | McCarthy-Jones S.,Macquarie University | McCarthy-Jones S.,Durham University | And 3 more authors.
Schizophrenia Bulletin | Year: 2014

The international Hearing Voices Movement (HVM) is a prominent mental health service-user/survivor movement that promotes the needs and perspectives of experts by experience in the phenomenon of hearing voices (auditory verbal hallucinations). The main tenet of the HVM is the notion that hearing voices is a meaningful human experience, and in this article, we discuss the historical growth and influence of the HVM before considering the implications of its values for research and practice in relation to voice-hearing. Among other recommendations, we suggest that the involvement of voice-hearers in research and a greater use of narrative and qualitative approaches are essential. Challenges for implementing user-led research are identified, and avenues for future developments are discussed. © 2014 The Author.


McCarthy-Jones S.,Macquarie University | Trauer T.,Monash University | Trauer T.,University of Melbourne | Trauer T.,St Vincents Hospital | And 5 more authors.
Schizophrenia Bulletin | Year: 2014

A comprehensive understanding of the phenomenology of auditory hallucinations (AHs) is essential for developing accurate models of their causes. Yet, only 1 detailed study of the phenomenology of AHs with a sample size of N ≥ 100 has been published. The potential for overreliance on these findings, coupled with a lack of phenomenological research into many aspects of AHs relevant to contemporary neurocognitive models and the proposed (but largely untested) existence of AH subtypes, necessitates further research in this area. We undertook the most comprehensive phenomenological study of AHs to date in a psychiatric population (N = 199; 81% people diagnosed with schizophrenia), using a structured interview schedule. Previous phenomenological findings were only partially replicated. New findings included that 39% of participants reported that their voices seemed in some way to be replays of memories of previous conversations they had experienced; 45% reported that the general theme or content of what the voices said was always the same; and 55% said new voices had the same content/theme as previous voices. Cluster analysis, by variable, suggested the existence of 4 AH subtypes. We propose that there are likely to be different neurocognitive processes underpinning these experiences, necessitating revised AH models. © 2012 The Author.


Tucker R.,La Trobe University | Farhall J.,La Trobe University | Thomas N.,Swinburne University of Technology | Thomas N.,Monash Alfred Psychiatry Research Center | And 3 more authors.
Frontiers in Human Neuroscience | Year: 2013

Research on auditory verbal hallucinations (AVHs) indicates that AVH schizophrenia patients show greater abnormalities on tasks requiring recognition of affective prosody (AP) than non-AVH patients. Detecting AP requires accurate perception of manipulations in pitch, amplitude and duration. Schizophrenia patients with AVHs also experience difficulty detecting these acoustic manipulations; with a number of theorists speculating that difficulties in pitch, amplitude and duration discrimination underlie AP abnormalities. This study examined whether both AP and these aspects of auditory processing are also impaired in first degree relatives of persons with AVHs. It also examined whether pitch, amplitude and duration discrimination were related to AP, and to hallucination proneness. Unaffected relatives of AVH schizophrenia patients (N = 19) and matched healthy controls (N = 33) were compared using tone discrimination tasks, an AP task, and clinical measures. Relatives were slower at identifying emotions on the AP task (p = 0.002), with secondary analysis showing this was especially so for happy (p = 0.014) and neutral (p = 0.001) sentences. There was a significant interaction effect for pitch between tone deviation level and group (p = 0.019), and relatives performed worse than controls on amplitude discrimination and duration discrimination. AP performance for happy and neutral sentences was significantly correlated with amplitude perception. Lastly, AVH proneness in the entire sample was significantly correlated with pitch discrimination (r = 0.44) and pitch perception was shown to predict AVH proneness in the sample (p = 0.005). These results suggest basic impairments in auditory processing are present in relatives of AVH patients; they potentially underlie processing speed in AP tasks, and predict AVH proneness. This indicates auditory processing deficits may be a core feature of AVHs in schizophrenia, and are worthy of further study as a potential endophenotype for AVHs. © 2013 Tucker, Farhall, Thomas, Groot and Rossell.


Mccarthy-Jones S.,Macquarie University | Mccarthy-Jones S.,Durham University | Thomas N.,Swinburne University of Technology | Thomas N.,Monash Alfred Psychiatry Research Center | And 12 more authors.
Schizophrenia Bulletin | Year: 2014

The phenomenological diversity of auditory verbal hallucinations (AVH) is not currently accounted for by any model based around a single mechanism. This has led to the proposal that there may be distinct AVH subtypes, which each possess unique (as well as shared) underpinning mechanisms. This could have important implications both for research design and clinical interventions because different subtypes may be responsive to different types of treatment. This article explores how AVH subtypes may be identified at the levels of phenomenology, cognition, neurology, etiology, treatment response, diagnosis, and voice hearer's own interpretations. Five subtypes are proposed; hypervigilance, autobiographical memory (subdivided into dissociative and nondissociative), inner speech (subdivided into obsessional, own thought, and novel), epileptic and deafferentation. We suggest other facets of AVH, including negative content and form (eg, commands), may be best treated as dimensional constructs that vary across subtypes. After considering the limitations and challenges of AVH subtyping, we highlight future research directions, including the need for a subtype assessment tool. © 2014 The Author.


Fitzgerald P.B.,Monash Alfred Psychiatry Research Center | Hoy K.E.,Monash Alfred Psychiatry Research Center | Singh A.,University of Vic | Gunewardene R.,Mosman Private Hospital | And 4 more authors.
International Journal of Neuropsychopharmacology | Year: 2013

Repetitive transcranial magnetic stimulation treatment (rTMS) is an effective treatment for depression but the optimal methods of administration have yet to be determined. Recent studies have produced conflicting results as to whether unilateral rTMS is more or less effective than sequentially applied bilateral rTMS. To address this we conducted a trial comparing sequential bilateral rTMS to right-sided unilateral rTMS using a priming protocol. Patients with treatment-resistant depression (n = 179) were enrolled in a two-Arm randomized controlled trial across a 4-wk time period. The primary outcome assessment was the Hamilton Depression Rating Scale. Overall, there was a substantial response rate of >50% (and a 40% remission rate); however, there were no significant differences in clinical response between the two treatment groups. rTMS was well tolerated with a very low discontinuation rate. There was no relationship between response in the current trial and previous response, or non-response, to electroconvulsive therapy. We found no significant differences in clinical response between sequential bilateral rTMS and right-sided unilateral rTMS applied with a priming protocol. The results of this study do not support superior efficacy of bilateral rTMS and instead suggest that other approaches should be explored to increase treatment efficacy. © © CINP 2013Â.


Fitzgerald P.B.,Monash University | Fitzgerald P.B.,Monash Alfred Psychiatry Research Center | Hoy K.,Monash University | Gunewardene R.,Mosman Private Hospital | And 4 more authors.
Psychological Medicine | Year: 2011

Background Although several studies have reported that repetitive transcranial magnetic stimulation (rTMS) treatment has demonstrable efficacy in patients with depression, the parameters needed to optimize therapeutic efficacy remain unclear. To this end we determined the efficacy of low-frequency right rTMS to the dorsolateral prefrontal cortex (DLPFC) compared to two forms of bilateral rTMS to the DLPFC: (1) sequential low-frequency right-sided followed by high-frequency left-sided rTMS and (2) sequential low-frequency rTMS to both hemispheres.Method A total of 219 patients with treatment-resistant depression (TRD) were randomized to a 4-week course of rTMS applied with one of the three treatment conditions. Outcomes were assessed with standard rating scales.Results Overall, slightly more than 50% of the patients achieved clinical response criteria. There was no substantial difference in response between the unilateral and bilateral treatment groups. Successful response to rTMS was predicted by a greater degree of baseline depression severity.Conclusions There is no substantial difference in efficacy between unilateral right-sided rTMS and the two forms of bilateral rTMS assessed in the study. Furthermore, our results call into question the specificity between frequency and laterality and rTMS response. © 2010 Cambridge University Press.


Naim-Feil J.,Monash Alfred Psychiatry Research Center | Naim-Feil J.,Monash University | Zangen A.,Ben - Gurion University of the Negev
Handbook of Clinical Neurology | Year: 2013

Drug and alcohol addiction is a debilitating disorder characterized by persistent drug-seeking behaviors despite negative physiological, medical, or social consequences. Neurobiological models of addiction propose that the reinforcing effects of addictive drugs are associated with altered neurotransmission within the reward 'mesocorticolimbic' circuitry in the brain. Immense efforts are therefore designed to target the mesocorticolimbic circuitry in attenuating drug dependence and addiction-related behaviors. Yet, to date, most addiction treatments have demonstrated only limited success in reducing addiction-related behaviors. Accumulating and compelling evidence suggests that novel nonsurgical brain stimulation techniques, such as transcranial magnetic stimulation and transcranial direct current stimulation, could serve as promising tools for indexing altered neurotransmission associated with repetitive drug use, and moreover, may hold therapeutic potential for the treatment of drug dependence and addiction-related behaviors. This chapter reviews and discusses the current and potential applications of such techniques in the study and treatment of addiction; we focus on a number of common drugs of abuse, including nicotine, alcohol, cocaine, cannabis, and ecstasy. © 2013 Elsevier B.V.


Whitecross F.,Alfred Psychiatry | Seeary A.,Alfred Psychiatry | Lee S.,Monash Alfred Psychiatry Research Center
International Journal of Mental Health Nursing | Year: 2013

Despite the accumulation of evidence demonstrating patients' accounts of trauma associated with seclusion, the use of evidence-based post-seclusion debriefing is not apparent in the published work. This study aimed to identify the impacts seclusion has on an individual using the Impact of Events - Revised (IES-R), a standardized and widely used measure of trauma symptoms, and measure the effectiveness of a post-seclusion counselling intervention in mitigating the experience of seclusion-related trauma and reducing time spent in seclusion. The study design involved a comparison of the seclusion-related trauma and time in seclusion that was experienced by consenting patients managed on the two inpatient wards of Alfred Psychiatry. To investigate the efficacy of post-seclusion counselling to reduce event-related trauma as well as the use of seclusion, a brief single-session intervention was piloted comparing outcomes for patients treated on a ward implementing semistructured post-seclusion counselling and patients treated on a ward continuing with post-seclusion support as usual. A total of 31 patients consented to participate, with approximately 47% reporting trauma symptoms consistent with 'probable post-traumatic stress disorder' (IES-R total score, >33), although there was no difference in trauma experience between groups. Significantly fewer hours were spent in seclusion for patients treated on the ward piloting the post-seclusion counselling intervention. Findings, therefore, highlight not only the potential for significant trauma stemming from a seclusion event, but also the capacity for the implementation of such interventions as post-seclusion counselling to raise awareness of the need to minimize time spent in seclusion for patients. © 2013 Australian College of Mental Health Nurses Inc.


Hoy K.E.,Monash Alfred Psychiatry Research Center | Enticott P.G.,Monash Alfred Psychiatry Research Center | Daskalakis Z.J.,University of Toronto | Fitzgerald P.B.,Monash Alfred Psychiatry Research Center
Brain Stimulation | Year: 2010

Background One of the few novel treatments developed for major depression in recent years has been repetitive transcranial magnetic stimulation (rTMS). Despite mostly promising results, 50-60% of patients do not respond to rTMS. Therefore, it is important to investigate ways of enhancing the effectiveness of this treatment. To date, attempting to enhance the mood effects of rTMS via behavioral means has not been investigated. One such intervention involves concurrent exposure to affective stimuli that have been shown to result in activation of brain regions associated with emotion. This pilot study of ten participants investigates such an intervention. Objectives The aim of this pilot study was to investigate whether exposing participants to affective stimuli while they were receiving 5 Hz rTMS resulted in greater mood change compared with rTMS or affective stimuli alone. Methods Ten healthy male and female participants were exposed to affective stimuli while receiving rTMS. All participants took part in three counterbalanced conditions conducted a week apart in which they received rTMS (active or sham) delivered to the left dorsolateral prefrontal cortex (DLPFC) combined with affective stimuli (positive or neutral). To measure the impact of the dual intervention visual analogue mood scales and an affective go no go task were conducted pre- and post intervention for each session. Results There was no effect of any rTMS condition on performances on the affective go no go task, or on any of the visual analogue scales. The current data do not provide support for the use of affective stimuli during rTMS. Methodological limitations that may have contributed to the lack of significant findings are discussed. © 2010 Elsevier Inc. All rights reserved.


Kulkarni J.,Monash Alfred Psychiatry Research Center | Reeve-Parker K.,Janssen Cilag Australia
Australasian Psychiatry | Year: 2015

Objectives: The Adherence in Schizophrenia (ADHES) initiative aimed to assess physicians' perspectives about treatment adherence in people with schizophrenia, and assess strategies to improve adherence. Methods: Between March and April 2012, a 20-question survey was delivered to Australian psychiatrists (n = 3400). These anonymous surveys were returned by mail. The survey asked about the demographics of participating psychiatrists and the respondents' perceptions of different factors that affect the adherence of people with schizophrenia to their treatment with antipsychotic medications. Adherence was defined by the proportion of prescribed doses taken: non-adherence, if < 30%; partial-adherence, 30%-90%; and adherent, > 90%. Data were reported descriptively and were not weighted. Results: Respondent psychiatrists (n = 406; response rate 12%) reported that one-half (51%) of people with schizophrenia were either non-adherent (20%) or only partially adherent (31%). This was despite most (72%) psychiatrists' reporting that they assessed adherence to medication at every visit. The main reported reasons for medication discontinuation were: lack of insight (45%), drug or alcohol abuse (3%), or side effects (29%). The preferred strategies for improving adherence were switching to or adding a long-acting antipsychotic (40%), or simplifying the medication regimen (30%). Conclusions: Lack of adherence to antipsychotic medication remains a problem. More proactive management is required, to improve adherence and long-term outcomes. © The Royal Australian and New Zealand College of Psychiatrists 2015.

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