Monash Alfred Psychiatry Research Center rc

Melbourne, Australia

Monash Alfred Psychiatry Research Center rc

Melbourne, Australia
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Kulkarni J.,Monash Alfred Psychiatry Research Center rc
Australasian Psychiatry | Year: 2017

Objective: To consider the use of the diagnostic category ‘complex posttraumatic stress disorder’ (c-PTSD) as detailed in the forthcoming ICD-11 classification system as a less stigmatising, more clinically useful term, instead of the current DSM-5 defined condition of ‘borderline personality disorder’ (BPD). Conclusions: Trauma, in its broadest definition, plays a key role in the development of both c-PTSD and BPD. Given this current lack of differentiation between these conditions, and the high stigma faced by people with BPD, it seems reasonable to consider using the diagnostic term ‘complex posttraumatic stress disorder’ to decrease stigma and provide a trauma-informed approach for BPD patients. © 2017, © The Royal Australian and New Zealand College of Psychiatrists 2017.


Batty R.,Swinburne University of Technology | Batty R.,Monash Alfred Psychiatry Research Center rc | Batty R.,RMIT University | Francis A.,RMIT University | And 8 more authors.
Psychiatry Research | Year: 2015

Verbal fluency in patients with psychosis following traumatic brain injury (PFTBI) has been reported as comparable to healthy participants. This finding is counterintuitive given the prominent fluency impairments demonstrated post-traumatic brain injury (TBI) and in psychotic disorders, e.g. schizophrenia. We investigated phonemic (executive) fluency (3 letters: 'F' 'A' and 'S'), and semantic fluency (1 category: fruits and/or vegetables) in four matched groups; PFTBI (. N=10), TBI (. N=10), schizophrenia (. N=23), and healthy controls (. N=23). Words produced (minus perseverations and errors), and clustering and switching scores were compared for the two fluency types across the groups. The results confirmed that PFTBI patients do show impaired fluency, aligned with existing evidence in TBI and schizophrenia. PFTBI patients produced the least amount of words on the phonemic fluency ('A') trial and total score, and demonstrated reduced switching on both phonemic and semantic tasks. No significant differences in clustering performance were found. Importantly, the pattern of results suggested that PFTBI patients share deficits with their brain-injured (primarily executive), and psychotic (executive and semantic), counterparts, and that these are exacerbated by their dual-diagnosis. These findings add to a very limited literature by providing novel evidence of the nature of fluency impairments in dually-diagnosed PFTBI. © 2015 Elsevier Ireland Ltd.


Rossell S.L.,Swinburne University of Technology | Rossell S.L.,Monash Alfred Psychiatry Research Center rc | Rossell S.L.,Mental Health Research Institute of Victoria | Rossell S.L.,University of Melbourne | And 8 more authors.
Schizophrenia Research | Year: 2014

Facial affect processing (FAP) deficits in schizophrenia (SZ) and bipolar disorder (BD) have been widely reported; although effect sizes vary across studies, and there are limited direct comparisons of the two groups. Further, there is debate as to the influence of both psychotic and mood symptoms on FAP. This study aimed to address these limitations by recruiting groups of psychosis patients with either a diagnosis of SZ or BD and comparing them to healthy controls (HC) on a well validated battery of four FAP subtests: affect discrimination, name affect, select affect and match affect. Overall, both groups performed more poorly than controls in terms of accuracy. In SZ, this was largely driven by impairments on three of the four subtests. The BD patients showed impaired performance specifically on the match affect subtest, a task that had a high cognitive load. FAP performance in the psychosis patients was correlated with severity of positive symptoms and mania. This study confirmed that FAP deficits are a consistent finding in SZ that occur independent of task specific methodology; whilst FAP deficits in BD are more subtle. Further work in this group is needed to replicate these results. © 2014 Elsevier B.V.


Van Rheenen T.E.,Swinburne University of Technology | Van Rheenen T.E.,Monash Alfred Psychiatry research Center rc | Rossell S.L.,Swinburne University of Technology | Rossell S.L.,Monash Alfred Psychiatry research Center rc
Journal of the International Neuropsychological Society | Year: 2014

The ability to integrate information from different sensory channels is a vital process that serves to facilitate perceptual decoding in times of unimodal ambiguity. Despite its relevance to psychosocial functioning, multimodal integration of emotional information across facial and prosodic modes has not been addressed in bipolar disorder (BD). In light of this paucity of research we investigated multimodal processing in a BD cohort using a focused attention paradigm. Fifty BD patients and 52 healthy controls completed a task assessing the cross-modal influence of emotional prosody on facial emotion recognition across congruent and incongruent facial and prosodic conditions, where attention was directed to the facial channel. There were no differences in multi-modal integration between groups at the level of accuracy, but differences were evident at the level of response time; emotional prosody biased facial recognition latencies in the control group only, where a fourfold increase in response times was evident between congruent and incongruent conditions relative to patients. The results of this study indicate that the automatic process of integrating multimodal information from facial and prosodic sensory channels is delayed in BD. Given that interpersonal communication usually occurs in real time, these results have implications for social functioning in the disorder. Copyright © INS.Published by Cambridge University Press, 2014.


Batty R.,Swinburne University of Technology | Batty R.,Monash Alfred Psychiatry Research Center rc | Batty R.,RMIT University | Batty R.,Brain and Psychological science Research Center | And 8 more authors.
Journal of Clinical and Experimental Neuropsychology | Year: 2015

Introduction: Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent, and often do not reflect the deficits demonstrated in patients with traumatic brain injury (TBI) or SCZ. We sought to determine the extent of executive dysfunction in PFTBI relative to three comparison cohorts. Method: Measures of executive function were administered to dually diagnosed patients with PFTBI (n = 10) including tests of mental inhibition and switching, processing speed, and attention: the Stroop Task, Trail Making Test (TMT), and the Attention subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Demographically comparable patients with TBI (n = 10), SCZ (n = 23), and healthy controls (n = 23) underwent an identical battery. Results: Significant executive dysfunction was evident in patients with PFTBI on all measures. Relative to all three comparison cohorts patients with PFTBI performed most poorly. Conclusions: These data present novel evidence of substantially impaired executive function across four task types in PFTBI and suggest that TBI and psychosis have an additive influence on executive function deficits. Treatment programs requiring substantial executive engagement are not suitable for patients dually diagnosed with PFTBI. © 2015 Taylor & Francis.


Van Rheenen T.E.,Swinburne University of Technology | Van Rheenen T.E.,Monash University | Van Rheenen T.E.,Monash Alfred Psychiatry Research Center rc | Rossell S.L.,Swinburne University of Technology | Rossell S.L.,Monash University
Journal of Affective Disorders | Year: 2014

Background People with bipolar disorder (BD) experience significant psychosocial impairment. Understandings of the nature and causes of such impairment is limited by the lack of research exploring the extent to which subjectively reported functioning should be valued as an indicator of objective dysfunction, or examining the relative influence of neurocognition, social cognition and emotion regulation on these important, but different aspects of psychosocial functioning in the context of mania and depression symptoms. This study aimed to address this paucity of research by conducting a comprehensive investigation of psychosocial functioning in a well characterised group of BD patients. Methods Fifty-one BD patients were compared to 52 healthy controls on objectively and subjectively assessed psychosocial outcomes. Relationships between current mood symptoms, psychosocial function and neurocognitive, social cognitive and emotion regulation measures were also examined in the patient group. Results Patients had significantly worse scores on the global objective and subjective functioning measures relative to controls. In the patient group, although these scores were correlated, regression analyses showed that variance in each of the measures was explained by different predictors. Depressive symptomatology was the most important predictor of global subjective functioning, and neurocognition had a concurrent and important influence with depressive symptoms on objective psychosocial function. Emotion regulation also had an indirect effect on psychosocial functioning via its influence on depressive symptomatology. Limitations As this study was cross-sectional in nature, we are unable to draw precise conclusions regarding contributing pathways involved in psychosocial functioning in BD. Conclusions These results suggest that patients' own evaluations of their subjective functioning represent important indicators of the extent to which their observable function is impaired. They also highlight the importance of incorporating cognitive and emotion regulation assessments into clinical practice when working to reduce psychosocial dysfunction with patients diagnosed with BD. © 2014 Elsevier B.V. All rights reserved.


Van Rheenen T.E.,Swinburne University of Technology | Van Rheenen T.E.,Monash Alfred Psychiatry Research Center rc | Rossell S.L.,Swinburne University of Technology | Rossell S.L.,Monash Alfred Psychiatry Research Center rc
Journal of Affective Disorders | Year: 2013

Background This paper reports the performance of DSM-IV-TR diagnosed bipolar disorder (BD) patients on a well-recognised measure of theory of mind (ToM) that commonly elicits group-related differences in schizophrenia research. Methods Forty-nine BD patients and 49 age and gender matched controls completed Langdon and Coltheart (1999) Picture Sequencing Task. Results Relative to controls, patients with BD performed significantly worse on the ToM relevant false-belief stories of the picture sequencing task, but not on the control stories requiring social script knowledge, executive control or an understanding of causal connexions. There were no differences in the ToM performance of symptomatic versus euthymic patients or those categorised as having BD I or BD II. Limitations As sub group sizes were small, data suggesting a trait-like deficit in ToM should be interpreted with caution. Conclusions The results support previous evidence of ToM impairment in BD and indicate a potential endophenotypic overlap in the phenomenology of both schizophrenia and BD. © 2013 Elsevier B.V.


Andrews S.C.,Monash University | Hoy K.E.,Monash University | Enticott P.G.,Monash University | Daskalakis Z.J.,University of Toronto | And 2 more authors.
Brain Stimulation | Year: 2011

Background: Transcranial direct current stimulation (tDCS), applied to the left dorsolateral prefrontal cortex (DLPFC) has been found to improve working memory (WM) performance in both healthy and clinical participants. However, whether this effect can be enhanced by cognitive activity undertaken during tDCS has not yet been explored. Objective: This study aimed to explore whether tDCS applied to the left DLPFC during the persistent performance of one WM task would improve performance on a subsequent WM task, to a greater extent than either tDCS or cognitive activity alone. Methods: Ten healthy participants took part in three counterbalanced conditions. The conditions involved 10 minutes of either anodal tDCS while completing an n-back task, anodal tDCS while at rest, or sham tDCS while completing an n-back task. The n-back that was used in this study was a computer-based letter WM task that involved 5 minutes of two-back, followed by 5 minutes of three-back. Digit span forward and backward was administered immediately before and after each treatment, and performance change (pre- to posttreatment) calculated and compared across conditions. The digit span tasks involved a series of numbers being read to the participant, and the participant was required to repeat them back, either in the same order (Digits forward) or in the reverse order (Digits backward). Results: tDCS applied during completion of the n-back task was found to result in greater improvement in performance on digit span forward, compared with tDCS applied while at rest and sham tDCS during the n-back task. This finding was not evident with digit span backward. Conclusions: These results indicate that there may be potential for the use of adjunctive cognitive remediation techniques to enhance the effects of tDCS. However, further research needs to be undertaken in this area to replicate and extend this finding. © 2011 Elsevier Inc.

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