Orygen Youth Health Research Articles

M21. THE STEP TRIAL: A SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMISED TRIAL (SMART) OF INTERVENTIONS FOR PATIENTS AT ULTRA-HIGH RISK OF PSYCHOSIS - STUDY RATIONALE, DESIGN AND BASELINE DATA

BackgroundAlthough approximately twenty randomised controlled trials have now been conducted with young people identified as being at high clinical risk of psychotic disorder, it remains unclear what the optimal type and sequence of treatments are for this clinical population. There has also been increased focus on clinical outcomes other than transition to psychotic disorder, such as psychosocial functioning, persistent attenuated psychotic symptoms and non-psychotic disorders. At Orygen, we are currently conducting a trial of a sequence of interventions consisting of two psychosocial therapies (support and problem solving [SPS] and cognitive-behavioural case management [CBCM]) and antidepressant medication. The primary outcome of the study is functional outcome after 6 months. This presentation will outline the background, rationale, design, recruitment and retention data and preliminary baseline results.MethodsSTEP is a sequential multiple assignment randomised trial (SMART) of treatments for young people (12–25 year olds) who meet ultra high risk for psychosis (UHR) criteria. Participants were recruited from primary (headspace) and secondary/tertiary (Orygen Youth Health) mental health services in Melbourne, Australia. The trial consists of three steps: Step 1: SPS (1.5 months); Step 2: SPS vs Cognitive Behavioural Case Management (4.5 months); Step 3: Cognitive Behavioural Case Management + Antidepressant Medication vs Cognitive Behavioural Case Management + Placebo (6 months). Patients who do not respond by the end of each step graduate to the next step in treatment. Responders are randomised to SPS or monitoring. Treatment response is based a combination of reduced attenuated psychotic symptoms, rated using the Comprehensive Assessment of At-Risk Mental States (CAARMS), and functional improvement (Social and Occupational Functioning Assessment Scale [SOFAS]) at the end of the treatment step. A ‘fast fail’ option is built into Step 3, whereby patients who deteriorate or have not responded 3 months into Step 3 are offered a choice of continuing existing treatment or commencing omega-3 fatty acids or low-dose antipsychotic medication. The intervention is for 12 months, with follow up at 18 and 24 months. A pilot study using the same design is currently being conducted at The University of California Davis.ResultsRecruitment has recently completed, with 342 patients recruited over a 2.4 year period, representing the largest UHR treatment study conducted to date. Preliminary results indicate an 8% response rate to Step 1 and a 23% response rate to Step 2. Discontinuation rates are 15% (step 1), 43% (step 2), 32% (step 3), primarily due to participants being lost to follow up or not wanting to start medication. The current transition to psychosis rate is 10.2%. Baseline clinical data are currently being analysed and will be presented at the conference.DiscussionPreliminary results indicate high non-response rates following SPS and moderate non-response rates following extended SPS or CBCM, possibly partly due to the stringent definition of response, which required substantial and persistent improvement in both attenuated psychotic symptoms and functioning. Discontinuation rates are low to moderate, reflecting the complexity and severity of this clinical population. The recruitment and retention data show that it is possible to conduct large-scale and complex stepped care trials with this high risk population in a primary mental health care setting (headspace services). Outcomes will inform the most effective type and sequence of treatments for improving psychosocial functioning, symptoms and reducing risk of developing psychotic disorder in this group, as well as identify predictors of treatment response.

Physical health assistance in early recovery of psychosis: Study protocol for a randomized controlled trial.

Young people with psychotic disorders have poorer physical health compared to their healthy peers, a state compounded by the metabolic side-effects of antipsychotic medications. To address this, Orygen Youth Health has introduced physical health services including exercise physiologists and dieticians. These services are typically coordinated by the case manager and doctor. It is not yet known whether a treating team member dedicated to physical health will improve engagement, adherence and outcomes with these services. Hence, the protocol is presented here for a trial to evaluate the effect of including a physical health nurse in the care of young people with first-episode psychosis. This will be a single-blind randomized controlled trial that includes 15- to 24-year-olds with first-episode psychosis who have just commenced (within 30 days) antipsychotic medication. The primary outcome will be the event of clinically significant weight gain (≥7% body weight). Participants will be assigned either a physical health nurse in their treating team (in addition to the case manager and doctor) for a 12-week period, or treatment as usual (case manager and doctor). Research assessments will be conducted at baseline, 12 and 26 weeks. Activity trackers worn by participants for the study's duration will measure sleep and physical activity. The present study will determine whether a physical health nurse will facilitate participants in attending and engaging in physical health interventions and whether this will be associated with physical health improvements or the prevention of worsening physical health.

Incidence of treated first episode psychosis from an Australian early intervention service and its association with neighbourhood characteristics

ObjectivesPsychotic disorder incidence varies geographically and is associated with neighbourhood characteristics, including social deprivation, population density, unemployment, social capital or social fragmentation. Yet it is not known whether these findings are applicable to Australia's unique geography. This study aimed to determine whether the incidence of first episode psychosis (FEP) varies according to neighbourhood characteristics in an Australian cohort. MethodThis study included all young people, aged 15 to 24, with an FEP who attended Orygen Youth Health in Melbourne, from a geographically defined catchment area encompassing Northern and Western Melbourne, over a 44-month period. Neighbourhood demographic data was collected from the 2011 Australian National Census. Negative binomial regression was used to determine incidence rate ratios controlled for age, sex and migrant status. ResultsA total of 747 young people had an FEP during the 44-month study period and 722 were included in this study. Of these, 58.0% were males and 67.9% had a non-affective psychotic disorder; the mean age of the cohort was 19.1 years. The incidence of FEP in young people aged 15 to 24 in the catchment area was 123.2 per 100,000 person-years. There was a higher incidence of FEP in neighbourhoods of greatest social deprivation (IRR = 1.65, CI = 1.06–2.51, p = .02), highest unemployment (IRR = 1.56, CI = 1.04–2.35, p = .03) and above average social fragmentation (IRR = 1.42, CI = 1.02–1.97, p = .04), when controlled for age, sex and migrant status. ConclusionsThis study highlights variation in psychotic disorder incidence and the need for this disparity to be reflected in appropriate resource allocation.

Prevalence and predictors of restrictive interventions in a youth-specific mental health inpatient unit.

The use of restrictive interventions is one of the most controversial practices in medicine. They are utilized in an inpatient setting to manage agitated or aggressive behaviour or to ensure that an individual receives the necessary treatments. However, restrictive interventions remove autonomy and adverse events can be associated with their practice. Youth-specific inpatient units (IPUs) are now being established and it is imperative that the use of restrictive interventions is reduced. In order to inform and facilitate prevention and reduction strategies, this study aimed to determine the prevalence and determinants of restrictive interventions (restraint, seclusion and medication without consent) in a youth specialist mental health IPU. This study was set at a 16-bed youth specialist acute IPU of Orygen Youth Health, a specialist youth mental health service that provides inpatient care for those aged 18 to 25 years within a catchment area of west and north-western regions of Melbourne, Australia. A retrospective file audit was conducted of all the admissions to the unit from 01 January 2015 to 30 June 2015. Over the 6-month study period, 159 young people were admitted and this accounted for 188 admissions. Over half (54.3%) of admissions were involuntary and restrictive intervention were used in 17.6% of admissions. Specifically, 15.7% (N = 25) of young people experienced restraint, 10.1% (N = 16) were secluded, and 8.1% (N = 12) experienced medication without consent. Absent insight and involuntary status on admission were associated with restrictive interventions. As youth mental health services develop, interventions aimed at reducing restrictive interventions are needed.

Transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder: current perspectives.

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neurostimulation technique receiving increasing attention in the treatment of different psychiatric disorders. Evidence for rTMS use in obsessive–compulsive disorder (OCD) is accumulating and informing further developments in the neurostimulation field, the latest being deep transcranial magnetic stimulation (dTMS). dTMS allows direct stimulation of deeper subcortical structures and larger brain volume than conventional rTMS. Underlying neurobiological mechanisms related to transcranial magnetic stimulation are still under evaluation, but appear to offer a novel “third” way of addressing symptoms via localized electrical stimulation compared to pharmacotherapy and psychotherapy approaches. This systematic review focuses on the effects of rTMS and dTMS stimulation on different brain targets in OCD. Brain areas included are the dorsolateral prefrontal cortex, supplementary motor area, orbitofrontal cortex/medial prefrontal cortex, and anterior cingulate cortex (ACC). Improved understanding of the therapeutic effects of rTMS in OCD will support fine-tuning of the method and help determine how we can best optimize the approach via rTMS or dTMS to achieve clinically relevant results.

Clozapine use in early psychosis

BackgroundThe superior efficacy of clozapine in treatment resistant schizophrenia has been clearly demonstrated, yet there are often delays in the commencement of clozapine. In this study, we aimed to determine; the proportion of young people with a first episode of psychosis (FEP) who would be considered eligible for clozapine treatment, the theoretical delay in commencing clozapine and to compare the outcomes of those treated with clozapine to those who were eligible but not treated with clozapine. MethodsThis study was conducted at Orygen Youth Health (OYH), a youth mental health service for young people aged 15–24. All clients who were treated at the Early Psychosis Prevention and Intervention Centre (EPPIC) clinic between 01.01.2011 and 31.12.2013 were included. Results544 young people presented with a FEP in the study period and 9.4% (N = 51) subsequently fulfilled criteria for treatment-resistant schizophrenia. Of these individuals, thirty (58.8%) were commenced on clozapine, in addition to a further eleven. The median delay to the commencement of clozapine was 42 weeks (I.Q.R. = 7.5–64). Of those commenced on clozapine, 76.6% achieved remission of positive psychotic symptoms and 50% were in employment or education by the time of discharge or transfer to the adult mental health services. The rate of discontinuation of clozapine was 24.4% and 60.0% of discontinuations were due to cardiac complications and the remainder were due to non-compliance. ConclusionsThese findings suggest that early intervention for psychosis services have a crucial role in ensuring timely initiation of clozapine in individuals with a diagnosis of treatment-resistant schizophrenia.

Multimodal Approach May Improve Ability to Predict Transition to Psychosis

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessMultimodal Approach May Improve Ability to Predict Transition to PsychosisNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:17 Nov 2016https://doi.org/10.1176/appi.pn.2016.11a6AbstractThirty percent of people classified at ultra-high risk of psychosis experience a transition, but simple clinical assessments can raise the predictive value to 70 percent.Despite best efforts to identify patients at greatest risk of developing psychosis, studies suggest that some 70 percent of people identified as ultra-high risk (UHR) for psychosis never develop a psychotic disorder.A study published in September in Translational Psychiatry suggests that using a multimodal diagnostic approach that combines a person’s historical risk factors (such as family history of psychosis), clinical assessments (such as Positive and Negative Syndrome Scale), and blood biomarkers (including measures of oxidative stress and fatty acids) may be able to better predict UHR patients most likely to develop psychosis.Researchers have been searching for ways to improve their ability to identify individuals at risk of developing psychosis since UHR criteria were first introduced in the 1990s. A patient is considered to be UHR if he or she experiences one or more of the following: attenuated positive symptoms (APS); positive symptoms at full psychotic intensity for brief, limited periods known as brief intermittent psychotic symptoms (BLIPS); and a combination of genetic risk accompanied by functional decline, known as genetic risk and deterioration (GRD). “Currently, all patients in the ultra-high-risk group are considered to have a similar chance of a future psychotic episode,” said Scott Clark, Ph.D., M.B.B.S., a clinical investigator of psychiatry at the University of Adelaide in Australia.But as a meta-analysis published earlier this year in JAMA Psychiatry suggests, current UHR criteria may fail to fully capture the heterogeneity of the group and each subgroup may carry different levels of risk. The meta-analysis, which compiled 33 studies including over 4,000 individuals, found that the presence of BLIPS conferred a higher psychosis risk than the other groups, whereas GRD by itself conferred no greater risk than someone not designated UHR. “What we need is a more reliable—and flexible—method of prediction to tailor care appropriately for the people who need it most,” Clark said. Clark led a multinational team that developed a staged diagnostic tool that combines basic bedside clinical assessments with a person’s risk history and their plasma concentrations of the fatty acids omega-3 and nervonic acid (both critical for healthy brain function). In a retrospective assessment of 40 UHR individuals (who were enrolled in the placebo group of a year-long trial examining of the effect of omega-3 fatty acid supplementation on psychosis risk), this new approach demonstrated greatly improved accuracy.Of the 40 patients tested, the multimodal diagnosis identified eight of the 11 people who transitioned to psychosis within the year while also finding one false positive among the 29 patients who did not transition. This yielded a sensitivity of 73 percent, a specificity of 96 percent, and overall accuracy of about 70 percent.The model was also able to classify 77 percent of patients as low or high risk using only the historical and clinical information.“A staged approach to risk assessment would then be the most efficient, using fatty-acid markers only when the probability following history and clinical assessment is between 0.1 and 0.9, that is, 23 percent of participants in the current study,” the authors wrote. “Extending this staged approach, resource-intensive neuroimaging or electrophysiology could be reserved for cases that remain at intermediate risk based on clinical and blood biomarker assessments.”In addition, because the model was designed to be flexible, other diagnostic tools in development, such as visual tests or language processing software, could one day be incorporated to provide a more comprehensive patient stratification and increase the accuracy of the model even further. Clark said his group now plans to team up with Orygen Youth Health in Melbourne, Australia, to test this model in an independent population of at-risk individuals, and if those results are positive, he is hopeful that he and colleagues will be able to initiate a large, prospective clinical trial.Clark’s study was supported by the James and Diana Ramsay Foundation. ■“Prediction of Transition From Ultra-High Risk to First-Episode Psychosis Using a Probabilistic Model Combining History, ClinicalAssess-ment, and Fatty-Acid Biomarker” can be accessed here. ISSUES NewArchived

Integrating family work into the treatment of young people with severe and complex depression: a developmentally focused model.

Although models of family intervention are clearly articulated in the child and early adolescent literature, there is less clarity regarding family intervention approaches in later adolescence and emerging adulthood. This study provides the rationale and intervention framework for a developmentally sensitive model of time-limited family work in the outpatient treatment of complex youth depression (15-25 years). Derived from current practice in the Youth Mood Clinic (YMC) at Orygen Youth Health, Melbourne, a stepped model of family intervention is discussed. YMC aims to provide comprehensive orientation, assessment and education to all families. For some, a family-based intervention, delivered either by the treating team or through the integration of a specialist family worker, offers an important adjunct in supporting the recovery of the young person. Developmental phases and challenges experienced by the young person with respect to family/caregiver involvement are discussed in the context of two case studies. A developmentally sensitive model is presented with particular attention to the developmental needs and preferences of young people. Formal evaluation of this model is required. Evaluation perspectives should include young people, caregivers, the broader family system (i.e. siblings) and the treating team (i.e. case manager, doctor and family worker) incorporating outcome measurement. Such work determines how best to apply a time-limited family-based intervention approach in strengthening family/caregiver relationships as part of the young person's recovery from severe and complex depression.

Family peer support work in an early intervention youth mental health service

This paper describes the evolution of a family peer support programme in an early intervention service in Melbourne, Australia. In response to policy directions from Federal and State governments calling for carer participation in public mental health services, and feedback from the families of young people at Orygen Youth Health, the 'Families Helping Families' project was developed. The positive acceptance by families of this innovative programme also warrants further exploration. The programme has overcome many organizational hurdles associated with specifically trained and employed family carers working alongside professional mental health clinicians. This article describes the change processes involved in implementing this programme and documents preliminary expressions of the benefits of family peer support. The contribution of lived experience in treatment and consumer care plans needs rigorous research and evaluation.

A Qualitative Study of the Prodrome to First-Episode Major Depressive Disorder in Adolescents

Background: Currently, we lack a clear picture of the evolution of major depressive disorder (MDD) in adolescents. The period of disturbance preceding MDD can be conceptualised as the prodrome. The aim of the study was to explore the prodrome of first-episode MDD retrospectively in a group of help-seeking adolescents using qualitative methodologies. Sampling and Methods: Consecutively referred adolescents (15-18 years of age) with first-episode MDD were recruited for this study from Orygen Youth Health, Melbourne, Vic., Australia. After using quantitative methodologies to confirm the index episode of MDD and measure the extent of recovery, the prodrome was investigated in depth using qualitative techniques. Results: Twenty-nine adolescents (20 females and 9 males) and 7 informants (6 mothers and 1 grandmother) participated. All 29 participants had a prodrome of varying lengths (between 6 days and 4 years). The most noticeable symptoms initially were perplexity and confusion and, thereafter, sadness and irritability. A common pattern was a reduction in their ability to fulfil their role accompanied by guilt, self-blame and reduced self-esteem. Around half of the participants had increased thoughts of suicide and increased anxiety. There were gender differences in the patterns of symptoms noticed, with males more commonly noticing a change in how they related to the world and females more commonly noticing a change in the way that they related to others. All informants noticed a prodrome of varying lengths; in 2 cases longer, in 2 cases shorter and in 3 cases around the same time period as that noticed by the participant. The changes most commonly noticed by informants were sadness, upset, irritability and reduced self-esteem. The symptoms were fewer in number and sometimes varied from those noticed by the adolescents themselves. Conclusions: Whilst we recognise that this study is vulnerable to autobiographical bias, we took all reasonable measures to minimise this. Symptoms not included in the diagnostic criteria for depression were the earliest changes noticed by the adolescents themselves and are, therefore, potentially important in informing prevention strategies, as is the finding that there are gender differences in the patterns of changes noticed. In addition, parents may provide an additional avenue to help seeking.

Borderline personality pathology in young people at ultra high risk of developing a psychotic disorder

The association between borderline personality disorder and the ultra high risk (UHR) for psychosis state is unclear. The following study aimed to investigate the type of attenuated psychotic symptoms and prevalence of borderline personality pathology in a sample of UHR young people. Additionally, the study aimed to explore whether borderline personality pathology influenced the transition rate to psychosis. Medical records from Orygen Youth Health between 2007 and 2009 were examined. There were 180 patients who met UHR criteria and were included for analysis. Most patients were females (62.8%) and age ranged from 15 to 24 years. A quarter (25.2%) of UHR patients endorsed items consistent with borderline personality pathology. UHR patients with borderline personality pathology experienced a range of attenuated psychotic symptoms and could not be statistically differentiated from UHR patients with less significant or without borderline personality pathology. Borderline personality pathology did not increase or decrease the risk of developing a psychotic disorder. The absence of depression was the only predictor of psychosis. Many UHR patients present with concurrent borderline personality features. The psychotic experiences reported by UHR patients with borderline personality features were not limited to paranoid ideation, supporting the idea that borderline personality disorder may include a wider range of psychotic symptoms than previously thought. It is further possible that the psychotic symptoms experienced in this group could also be indicative of an emerging psychotic disorder.

The predictive validity of bipolar at-risk (prodromal) criteria in help-seeking adolescents and young adults: a prospective study.

There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria. This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive individuals and a matched group of individuals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM-IV manic symptoms for more than four days, in line with the DSM-IV definition of hypomania/mania. A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non-BAR group [χ(2) (1) = 5.38, p = 0.020]. Four out of these five converters had a DSM-IV diagnosis of bipolar I or bipolar II disorder. These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods.

Getting mental health reform back on track: a leadership challenge for the new Australian Government

Medical Journal of AustraliaVolume 200, Issue 8 p. 445-448 Perspective Getting mental health reform back on track: a leadership challenge for the new Australian Government Ian B Hickie AM, MD, FRANZCP, FASSA, Corresponding Author Ian B Hickie AM, MD, FRANZCP, FASSA Professor of Psychiatry and Executive Director [email protected] Brain & Mind Research Institute, University of Sydney, Sydney, NSW.Correspondence: [email protected]Search for more papers by this authorPatrick D McGorry MD, PhD, FRANZCP, Patrick D McGorry MD, PhD, FRANZCP Executive Director; and Professor of Youth Mental Health and Director Orygen Youth Health Research Centre, Melbourne, VIC. Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC.Search for more papers by this authorTracey A Davenport BA(Hons), eMBA, Tracey A Davenport BA(Hons), eMBA Research Affiliate Brain & Mind Research Institute, University of Sydney, Sydney, NSW.Search for more papers by this authorSebastian P Rosenberg BA, MPubAdmin, Sebastian P Rosenberg BA, MPubAdmin Senior Lecturer (Mental Health Policy) Brain & Mind Research Institute, University of Sydney, Sydney, NSW.Search for more papers by this authorJohn A Mendoza BEd, GradDipHlthProm, John A Mendoza BEd, GradDipHlthProm Adjunct Associate Professor; and Director Brain & Mind Research Institute, University of Sydney, Sydney, NSW. ConNetica Consulting, Caloundra, QLD.Search for more papers by this authorJane M Burns PhD, Jane M Burns PhD Founder and CEO; and VicHealth Senior Research Fellow Young and Well Cooperative Research Centre, Melbourne, VIC. Orygen Youth Health Research Centre, Melbourne, VIC.Search for more papers by this authorJonathan Nicholas BA(Hons), MPH, Jonathan Nicholas BA(Hons), MPH CEO Inspire Foundation (Australia), Sydney, NSW.Search for more papers by this authorHelen Christensen MPsych, PhD, FASSA, Helen Christensen MPsych, PhD, FASSA Professor and Executive Director Black Dog Institute, University of New South Wales, Sydney, NSW.Search for more papers by this author Ian B Hickie AM, MD, FRANZCP, FASSA, Corresponding Author Ian B Hickie AM, MD, FRANZCP, FASSA Professor of Psychiatry and Executive Director [email protected] Brain & Mind Research Institute, University of Sydney, Sydney, NSW.Correspondence: [email protected]Search for more papers by this authorPatrick D McGorry MD, PhD, FRANZCP, Patrick D McGorry MD, PhD, FRANZCP Executive Director; and Professor of Youth Mental Health and Director Orygen Youth Health Research Centre, Melbourne, VIC. Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC.Search for more papers by this authorTracey A Davenport BA(Hons), eMBA, Tracey A Davenport BA(Hons), eMBA Research Affiliate Brain & Mind Research Institute, University of Sydney, Sydney, NSW.Search for more papers by this authorSebastian P Rosenberg BA, MPubAdmin, Sebastian P Rosenberg BA, MPubAdmin Senior Lecturer (Mental Health Policy) Brain & Mind Research Institute, University of Sydney, Sydney, NSW.Search for more papers by this authorJohn A Mendoza BEd, GradDipHlthProm, John A Mendoza BEd, GradDipHlthProm Adjunct Associate Professor; and Director Brain & Mind Research Institute, University of Sydney, Sydney, NSW. ConNetica Consulting, Caloundra, QLD.Search for more papers by this authorJane M Burns PhD, Jane M Burns PhD Founder and CEO; and VicHealth Senior Research Fellow Young and Well Cooperative Research Centre, Melbourne, VIC. Orygen Youth Health Research Centre, Melbourne, VIC.Search for more papers by this authorJonathan Nicholas BA(Hons), MPH, Jonathan Nicholas BA(Hons), MPH CEO Inspire Foundation (Australia), Sydney, NSW.Search for more papers by this authorHelen Christensen MPsych, PhD, FASSA, Helen Christensen MPsych, PhD, FASSA Professor and Executive Director Black Dog Institute, University of New South Wales, Sydney, NSW.Search for more papers by this author First published: 05 May 2014 https://doi.org/10.5694/mja13.11207Citations: 15Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume200, Issue8Psychiatry issueMay 2014Pages 445-448 RelatedInformation

Development of practice principles for the management of ongoing suicidal ideation in young people diagnosed with major depressive disorder.

Objectives:There is a lack of clear guidance regarding the management of ongoing suicidality in young people experiencing major depressive disorder. This study utilised an expert consensus approach in identifying practice principles to complement relevant clinical guidelines for the treatment of major depressive disorder in young people. The study also sought to outline a broad treatment framework for clinical intervention with young people experiencing ongoing suicidal ideation.Methods:In-depth focus groups were undertaken with a specialist multidisciplinary clinical team (the Youth Mood Clinic at Orygen Youth Health Clinical Program, Melbourne) working with young people aged 15–25 years experiencing ongoing suicidal ideation. Each focus group was audio recorded and transcribed verbatim using orthographic conventions. Principles of grounded theory and thematic analysis were used to analyse and code the resultant data.Results:The identified codes were subsequently synthesised into eight practice principles reflecting engagement and consistency of care, ongoing risk assessment and documentation, individualised crisis planning, engaging systems of support, engendering hopefulness, development of adaptive coping, management of acute risk, and consultation and supervision.Conclusions:The identified practice principles provide a broad management framework, and may assist to improve treatment consistency and clinical management of young people experiencing ongoing suicidal ideation. The practice principles may be of use to health professionals working within a team-based setting involved in the provision of care, even if peripherally, to young people with ongoing suicidal ideation. Findings address the lack of treatment consistency and shared terminology and may provide containment and guidance to multidisciplinary clinicians working with this at-risk group.

Change and stasis in sexual health and relationships: comparisons between the First and Second Australian Studies of Health and Relationships.

School of Psychology, Pevensey 1, University of Sussex, Falmer BN1 9QH, UK. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia. Sydney School of Public Health, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW 2006, Australia. Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia. Centre for Youth Mental Health, University of Melbourne, Orygen Youth Health Research Centre, 35 Poplar Road, Parkville, Vic. 3052, Australia. Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, NSW 2006, Australia. Kirby Institute, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia. Deceased. Corresponding author. Email: rd48@sussex.ac.uk

Outdoor adventure camps for people with mental illness

The aim of the study was to evaluate a novel outdoor adventure camping program for individuals with mental illness. The program was developed by YMCA Victoria in partnership with Sport and Recreation Victoria, and mental health service agencies. Orygen Youth Health Research Centre conducted the program evaluation. One hundred and eight individuals from mental health services across Victoria participated in 12 camps. Five camps targeted young people between the ages of 18 and 25 years. Seven camps were run for adults 26 years and older. Participants were assessed at baseline, end of camp, and four weeks following the camp in terms of self-esteem, mastery, and social connectedness. Quality of life was assessed at baseline and four weeks post-camp. Participants demonstrated significant improvements in mastery, self-esteem and social connectedness from baseline to end of the camp; however, these improvements were not sustained by the four-week follow-up. We have demonstrated that utilizing the expertise of mental health services and a community recreation provider can benefit individuals experiencing mental illness. More research is required with respect to how to sustain these benefits over the longer term.

Redeeming diagnosis in psychiatry: timing versus specificity

Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia (P McGorry MD); Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, European Graduate School of Neuroscience, Maastricht University, Maastricht, Netherlands (J van Os MD); and King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK (J van Os)

Not all first‐episode psychosis is the same: preliminary evidence of greater basic self‐disturbance in schizophrenia spectrum cases

Disturbance in the basic sense of self has previously been found to characterize schizophrenia spectrum disorders and to predict onset of psychosis in the ultra-high-risk population. The current study examined basic self-disturbance in a first-episode psychosis (FEP) population. We hypothesized that basic self-disturbance would be more prominent in cases with a schizophrenia spectrum disorder compared to those with other psychoses. Sixteen FEP patients from Orygen Youth Health, Melbourne, were recruited to the study. Participants were assessed using the Examination of Anomalous Self-Experience and the Structured Clinical Interview for DSM-IV. Basic self-disturbance scores were significantly higher in patients with a schizophrenia spectrum diagnosis (n = 8) compared to patients with other psychotic diagnoses (n = 8). The findings are consistent with previous work indicating that the disturbance of the basic sense of self is more characteristic of schizophrenia spectrum psychosis than other psychoses. This may have implications for early diagnosis, clinical formulation and intervention.

Moderated Online Social Therapy for Recovery From Early Psychosis

Moderated Online Social Therapy for Recovery From Early Psychosis

Outdoor adventure for young people with a mental illness

The study aims to evaluate the efficacy of an Outdoor Adventure Group (OAG) for young people with a mental illness. It was hypothesized that participating in OAG would result in an increase in self-esteem, sense of mastery and social connectedness, compared with those who attended other Psychosocial Recovery Group Program groups based at Orygen Youth Health. In addition, those in the OAG would show an improved performance of personal goals. Twenty-one youths (aged 15 to 25) participated in the OAG and 12 participated in other Psychosocial Recovery Group Program groups and served as the comparison group. Pre- and post-evaluation measures included (i) Rosenberg Self Esteem Scale; (ii) Mastery Scale; (iii) Social Connectedness Scale; and (iv) personal goals for attending the OAG, rated 1-10 on current performance. The groups were based at Orygen Youth Health, Melbourne, Australia and run over an 8 to 10-week period. Participants of the OAG experienced an improvement in self-esteem (P = 0.001) and mastery (P = 0.001); these changes were not observed in the controls. There were a total of 80 personal goals for the OAG, with an average of 3.81 per person, and performance significantly improved in 66 (82.5%) goals. There were 10 categories of goals; the most common goals were related to self-improvement and social skills development. Increased self-esteem and mastery, and achievement of personal goals gained through the OAG, may facilitate, or be a precursor to, a young person's psychosocial recovery.