Australian & New Zealand Journal of Psychiatry

Neurocognitive ability and mood have often been discussed as contributing mechanisms to the severe psychosocial dysfunction experienced in bipolar disorder (BD). In contrast, there has been little discussion on the contribution of social cognition or emotion regulation. This paper aims to assert a potential role for these constructs in psychosocial functioning in BD, with an overarching goal to highlight the necessary importance of considering them in future research examining psychosocial outcomes in the disorder.

This paper provides a theoretical synthesis of available and indirect evidence for an influence of (1) social cognition and (2) emotion regulation on psychosocial functioning; it acknowledges important clinical questions that need addressing, and discusses how current research might be translated to improve the treatment of psychosocial dysfunction in BD.

Given their assumed roles in facilitating social interactions and modulating behaviours, it is certainly plausible that abnormalities in social cognition and emotion regulation are detrimental to psychosocial functioning. Currently, there is only minimal direct evidence examining their influence, although existing BD studies are preliminarily supportive of relationships between these constructs.

There are reasonable theoretical grounds, supported by indirect and preliminary evidence, to suggest that social cognition and emotion regulation may be important in the prediction of psychosocial outcome in BD. However, this proposition is limited by the paucity of empirical research directly examining this matter.

There is growing evidence that anhedonia is a commonly experienced symptom among substance-using populations. This systematic review synthesises findings across a range of substances to address questions regarding the time course of anhedonia, how anhedonia relates to other symptoms of substance dependence and whether it is similarly prevalent across all addictive drugs.

A literature search was conducted on PubMed, PsycINFO and MEDLINE, yielding 32 studies that used self-report measures of anhedonia among participants with a history of a substance abuse, dependence or long-term daily use of addictive substances.

Findings from these studies indicate that anhedonia (1) is elevated in samples dependent on a range of substances; (2) typically appears as a consequence of substance abuse or dependence, and diminishes with abstinence; and (3) predicts increased drug cravings and the likelihood of relapse in those attempting abstinence.

The common experience of anhedonia in substance-dependent populations, and its relationship to relapse, emphasises the importance of developing therapeutic interventions that specifically target anhedonia in the treatment of all substance use disorders.

The co-prescription of multiple antipsychotic drugs continues to increase despite a lack of evidence supporting this practice. The purpose of this study was to quantify and describe recent trends of antipsychotic polypharmacy in Korean schizophrenic inpatients by comparing prescribed medications between the years of 2005 and 2010.

We reviewed comprehensive medication profiles of schizophrenic patients discharged from a university psychiatric hospital in 2005 (n=194) or 2010 (n=201). Antipsychotic polypharmacy was defined as the concurrent receipt of two or more chemically distinct antipsychotics for at least 14 days. High antipsychotic dose was defined as a prescribed daily dose to defined daily dose ratio of greater than 1.5.

Antipsychotic polypharmacy increased between 2005 (37.1%) and 2010 (48.3%, p=0.025). The most frequently used drug within combinations of antipsychotics was haloperidol in 2005 (51.4%) and quetiapine in 2010 (48.5%). Overall, no changes were observed between 2005 and 2010 in the rate of prescribing high-dose antipsychotics. High-dose antipsychotic monotherapy decreased across years (from 30.4 to 18.4%), but high-dose antipsychotic polypharmacy increased (from 34.0 to 45.3%). Regression analysis revealed that antipsychotic polypharmacy was strongly associated with high doses of prescribed antipsychotics (odds ratio=18.60, p<0.001).

The practice of prescribing multiple antipsychotics to patients with schizophrenia is increasing, and high-dose antipsychotic drugs are more likely to be prescribed in combination than in isolation. The reasons for this pattern of prescription and its impact warrants further study.

The aim of this study was to develop scales to assess mental health literacy relating to affective disorders, anxiety disorders and schizophrenia/psychosis.

Scales were created to assess mental health literacy in relation to depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia and post-traumatic stress disorder using data from a survey of 1536 health professionals (general practitioners, clinical psychologists and psychiatrists), assessing recognition of these disorders and beliefs about the helpfulness of interventions. This was done by using the consensus of experts about the helpfulness and harmfulness of treatments for each disorder as a criterion. Data from a general population survey of 6019 Australians aged ≥ 15 was used to examine associations between scale scores, exposure to mental disorders and sociodemographic variables, to assess scale validity.

Those with a close friend or family member with a mental disorder had significantly higher mean scores on all mental health literacy scales, providing support for scale validity. Personal experience of the problem and working with people with a similar problem was linked to higher scores on some scales. Male sex, a lower level of education and age > 60 were linked to lower levels of mental health literacy. Higher scores were also linked to a greater belief that people with mental disorders are sick rather than weak.

The scales developed in this study allow for the assessment of mental health literacy in relation to depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia and PTSD. Those with exposure to mental disorders had higher scores on the scales, and analyses of the links between scale scores and sociodemographic variables of age, gender and level of education were in line with those seen in other studies, providing support for scale validity.

This study aimed to identify factors associated with the high rates of smoking amongst people with psychosis living in a disadvantaged region in Adelaide, South Australia.

Data were collected from 402 people with psychosis, aged 18–64 years, who lived in the northern suburbs of Adelaide. This area is disadvantaged on many measures of socioeconomic well-being and people living in this region have higher rates of smoking compared to the general Australian population. We hypothesised that whilst tobacco use by people with psychosis living in this region was primarily associated with mental illness, factors related to social disadvantage also contributed to the high rates of smoking.

Approximately 74% of men and 71% of women with psychotic disorders living in the northern suburbs of Adelaide were current smokers. Factors such as unemployment, lower levels of education and receiving government welfare, factors known to be associated with smoking in the general population, were more prevalent in the northern region. Smokers with psychosis were less likely to participate in recreational programs and physical activity, and more likely to use illicit substances and be a victim of crime. They had poorer health and financial outcomes than non-smokers. There were some gender differences: for men with psychosis, employment and having a post-school qualification decreased the risk of smoking while cannabis use increased the risk; for women with psychosis, a diagnosis of alcohol abuse/dependence, using cannabis and being sedentary were risk factors for smoking, while attending recreational programs reduced this risk.

Smoking rates were strikingly high in both men and women, and particularly high in women when compared with previous research. Our study shows that the risk of smoking is increased by factors related to the social disadvantage of living in the northern Adelaide region. Smoking cessation interventions for people with mental illness should take into account the social context, and also address relevant comorbidities such as drug and alcohol disorders.

To describe PTSD symptom persistence and resolution, including the potential phenomenon of late-onset PTSD, in children and adolescents 18 months after a cyclone disaster; and to investigate factors that predict longer-term symptom outcome.

71 children and 191 adolescents who were screened three months after a Category 5 Cyclone were re-screened 18 months post-disaster. Child-report measures included the PTSD Reaction Index, measures of event exposure and social connectedness.

Approximately 1-in-5 children and 1-in-12 adolescents endorsed cyclone-related PTSD symptoms at the moderate to severe level 18 months post-disaster. Of these approximately one-half (44.8%) of children were in the ‘high-persister’ group at 18-month follow-up. Persistence of low symptoms was very common (97.6%) and late-onset PTSD was a rare phenomenon. This pattern was similar in adolescents: 25.0% were in the ‘high-persister’ group and few students experienced late-onset PTSD. In multivariate analysis, only initial severe to very severe PTSD category made a significant independent contribution to explaining persisting moderate to severe PTSD symptoms in primary school students (ORadj=8.33, 95% CI=1.45-47.84). There was a trend for a similar result in secondary students.

A child or adolescent with few PTSD symptoms three months post-disaster is likely to remain so unless a further traumatic event occurs. However, if symptomatic at three months, there is approximately a 30-45% chance that the child or adolescent will still be symptomatic 18 months after the disaster. Given the high rate of students in the ‘resolver’ group, initial posttraumatic symptoms are a necessary but not sufficient condition for predicting chronic symptomatology. Other targets for predictive modelling include initial threat perception and high and low social connectedness.