Depression: Walter G

Malhi GS, Adams D, Porter R, Wignall A, Lampe L, O'Connor N, Paton M, Newton LA, Walter G, Taylor A, Berk M, Mulder RT, Anonymous00017, Anonymous00018, Anonymous00019. · CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, University of Sydney, NSW, Australia. · Acta Psychiatr Scand Suppl. · Pubmed #19356154 No free full text.

Abstract: OBJECTIVE: To provide clinically relevant evidence-based recommendations for the management of depression in adults that are informative, easy to assimilate and facilitate clinical decision making. METHOD: A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. The recommendations then underwent consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives. RESULTS: The clinical practice recommendations for depression (Depression CPR) summarize evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative. CONCLUSION: These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of depression. Further, the novel style and practical approach should promote uptake and implementation.

Horsfall J, Cleary M, Hunt GE, Walter G. · Research Unit, Sydney South West Area Health Service, Concord Centre for Mental Health, Concord Hospital, New South Wales 2139, Australia. · Harv Rev Psychiatry. · Pubmed #19205964 No free full text.

Abstract: Considerable research documents the health consequences of psychosis and co-occurring substance use disorders. Results of randomized controlled trials assessing the effectiveness of psychosocial interventions for persons with dual diagnoses are equivocal but encouraging. Many studies are hampered by small, heterogeneous samples, high attrition rates, short follow-up periods, and unclear description of treatment components. The treatments available for this group of patients (which can be tailored to individual needs) include motivational interviewing, cognitive-behavioral therapy, contingency management, relapse prevention, case management, and skills training. Regardless of whether services follow integrated or parallel models, they should be well coordinated, take a team approach, be multidisciplinary, have specialist-trained personnel (including 24-hour access), include a range of program types, and provide for long-term follow-up. Interventions for substance reduction may need to be further developed and adapted for people with serious mental illnesses. Further quality trials in this area will contribute to the growing body of data of effective interventions.

Lyndon B, Rowe L, Fraser A, Efron D, Walter G, Wilson I, Newman L, Silove N, Anonymous00361, Anonymous00362, Anonymous00363. · No affiliation provided · Aust Fam Physician. · Pubmed #16184211 links to  free full text

This publication has no abstract.

Walter G, Tormos JM, Israel JA, Pascual-Leone A. · Department of Psychological Medicine, University of Sydney, Australia. · J Child Adolesc Psychopharmacol. · Pubmed #11322748 No free full text.

Abstract: There are no published data about transcranial magnetic stimulation (TMS) as a treatment for psychiatric disorders in young persons. The aim of this article is to collate available information about TMS in this population. Information was sought, by placing a message on the TMS Listserver, from investigators who had used TMS in patients 18 years of age or younger. Only one group reported experience in this area; it had treated seven patients, ages 16-18 years. Three patients had unipolar depression, three had schizophrenia, and one had bipolar disorder. Five of the seven patients had improved by the conclusion of the TMS course. Adverse events were reported in one patient. Further studies are needed first to investigate systematically the safety of TMS in children and adolescents and second to examine its potential therapeutic effects in this population.

Cleary M, Hunt GE, Matheson S, Walter G. · Faculty of Nursing and Midwifery, University of Sydney, Australia. · Arch Psychiatr Nurs. · Pubmed #19026926 No free full text.

Abstract: The influence of substance use on patient's needs and caregiving consequences has received insufficient research attention. We sought to determine whether patients with comorbid substance use have higher levels of need, anxiety, depression, and caregiving consequences than those of patients who do not use substances. A total of 520 patients participated, and those who used substances (n = 216) reported higher levels of unmet needs, anxiety, and caregiving consequences than did patients who did not use substances. Carers of patients who used substances also reported higher anxiety and more caregiving consequences. Very few patients were actively involved in treatment programs to reduce their substance use.

Soh NL, Touyz S, Dobbins TA, Clarke S, Kohn MR, Lee EL, Leow V, Ung KE, Walter G. · Child and Adolescent Mental Health Services, Northern Sydney Central Coast Area Health Service, New South Wales, Australia. · Eur Eat Disord Rev. · Pubmed #18683904 No free full text.

Abstract: OBJECTIVE: To investigate the relationship between skinfold thickness and body mass index (BMI) in North European Caucasian and East Asian young women with and without anorexia nervosa (AN) in two countries. METHOD: Height, weight and skinfold thicknesses were assessed in 137 young women with and without AN, in Australia and Singapore. The relationship between BMI and the sum of triceps, biceps, subscapular and iliac crest skinfolds was analysed with clinical status, ethnicity, age and country of residence as covariates. RESULTS: For the same BMI, women with AN had significantly smaller sums of skinfolds than women without AN. East Asian women both with and without AN had significantly greater skinfold sums than their North European Caucasian counterparts after adjusting for BMI. CONCLUSION: Lower BMI goals may be appropriate when managing AN patients of East Asian ancestry and the weight for height diagnostic criterion should be reconsidered for this group.

Maloney D, Jones J, Walter G, Davenport R. · Thomas Walker Hospital ('Rivendell') Child, Adolescent and Family Mental Health Services, Sydney, NSW, Australia. · Australas Psychiatry. · Pubmed #18202934 No free full text.

Abstract: OBJECTIVE: The aim of this paper was to evaluate the reach and impact of the New South Wales' School-Link initiative. METHOD: Postal surveys, focus groups and interviews were conducted. RESULTS: School-Link has established a strong partnership between health and education, raised the awareness of child and adolescent mental health problems and contributed in the areas of prevention and early intervention. CONCLUSIONS: Building on the momentum and the foundations that have been established is the next challenge for this initiative.

Nash L, Daly M, Johnson M, Walter G, Walton M, Willcock S, Coulston C, van Ekert E, Tennant C. · Department of Psychological Medicine, Royal North Shore Hospital, St Leonards, Australia. · Aust N Z J Psychiatry. · Pubmed #17924245 No free full text.

Abstract: OBJECTIVE: To describe the differences in psychological morbidity between Australian general practitioners (GPs) who have experienced a medico-legal matter and those who have not. METHODS: A total of 1,499 GPs were initially invited to participate in the study. Two hundred and sixty requested not to participate, with 1,239 subsequently being sent a survey. There were 566 respondents (45.7% response rate to survey). There were two sources of data. First, a cross-sectional survey sought demographic information, personality traits via the Eysenck Personality Questionnaire (EPQ), history of a medico-legal matter with any medical defence organization, and measures of psychological morbidity, including the General Health Questionnaire (GHQ), Sheehan Disability Scale (SDS), and Alcohol Use Disorders Identification Test. Second, information was extracted from the United Medical Protection database on medico-legal matters. RESULTS: Fifty-nine per cent of respondents to the survey reported ever having a medico-legal matter, with 13% having a current medico-legal matter. Those with a current matter reported increased levels of disability (in work, social or family life) and higher prevalence of psychiatric morbidity (45% vs 27% GHQ 'case identification' rates), compared to those with no current matter. Those respondents with a history of past medico-legal matters reported increased levels of disability (SDS) and depression subscores (GHQ). Male respondents drank significantly more alcohol than female respondents, and male respondents with current or past medico-legal matters had significantly higher levels of alcohol use than male respondents with no experience of medico-legal matters. CONCLUSIONS: Doctors who have current and past medico-legal matters have a higher level of psychological morbidity. The study design was unable to distinguish cause or effect. A longitudinal study is planned to investigate this. The findings have significant implications for medical training, doctor support systems and medical insurance groups.

McShane G, Mihalich M, Walter G, Rey J. · St Joseph's College, Hunters Hill, NSW, Australia. · Australas Psychiatry. · Pubmed #16734650 No free full text.

Abstract: OBJECTIVES: To evaluate the outcome of adolescents with unipolar, bipolar and psychotic disorders admitted to a specialist child and adolescent mental health service in order to inform and enhance service delivery. METHODS: Young people treated over a 2 year period at the Rivendell Unit, Sydney, Australia, were identified. Information was gathered from the medical records, mailed questionnaires and follow-up telephone interviews. RESULTS: Of 114 patients eligible for inclusion in the study, outcome information was available for 85 (75%). After 3 years, there was improvement in mood and general level of functioning for all diagnostic groupings. Overall, suicidal thought, self-harm and suicide attempts were not significantly reduced at follow up and relapse rates were high. Patients with bipolar disorder seemed to have a better response to treatment than other diagnostic groups on general functioning, education and employment. CONCLUSIONS: The findings confirm the seriousness and adverse psychosocial consequences of psychotic, unipolar and bipolar mood disorders in this age group, highlighting the need for consistent and systematic follow up of young people after treatment.

Loo C, McFarquhar T, Walter G. · School of Psychiatry, University of New South Wales, Australia. · Australas Psychiatry. · Pubmed #16630205 No free full text.

Abstract: OBJECTIVE: There are few safe and effective biological treatments for major depression in adolescents. We aimed to report the use of repetitive transcranial magnetic stimulation (rTMS) as a treatment for adolescents with this condition. METHODS: The first two subjects in a double-blind, sham-controlled trial of rTMS that is evaluating the efficacy and safety of rTMS in depressed adolescents are described. Clinical response was assessed at baseline and at the end of each week. The following scales were used: Montgomery-Asberg Depression Rating Scale, Clinical Global Impression-Severity Scale, Beck Depression Inventory and Centre for Epidemiological Studies - Depression - Child Scale. A battery of cognitive tests was also used at several intervals to measure potential change in neuropsychological functioning. RESULTS: Random allocation of both subjects was to active treatment. Both subjects improved to a clinically significant degree with rTMS treatment and reported no adverse effects. Neuropsychological testing did not demonstrate any deterioration in the domains of functioning tested. CONCLUSIONS: Repetitive transcranial magnetic stimulation shows early promise as a treatment for major depression in adolescents. Well-designed, sham-controlled studies are now indicated to test the efficacy and safety of rTMS in these patients.

Walter G, Rey JM. · Thomas Walker Hospital ("Rivendell"), Child and Adolescent Mental Health Services, Central Sydney Area Health Service and Department of Psychological Medicine, University of Sydney, Sydney, New South Wales, Australia. · J ECT. · Pubmed #12792456 No free full text.

Abstract: OBJECTIVE: To investigate whether there were changes in the practice and outcome of electroconvulsive therapy (ECT) in adolescents in a whole population over a decade. METHOD: All persons younger than 19 years who received ECT in the state of New South Wales, Australia, in the period from 1990 to 1999 were identified. Detailed information about diagnosis, treatment and outcome were then obtained. RESULTS: Seventy-two patients aged 14-18 years underwent a total of 84 courses of ECT (1.53/100,000 adolescents were treated with ECT per year). In 1996 to 1999 compared with 1990 to 1995, there was an increase in ECT among females hospitalized involuntarily, EEG monitoring, stimulus dosing, bilateral ECT, and use of thiopentone. Overall, mood disorders derived most benefit from ECT while comorbid personality disorder predicted poorer short term outcome. Side effects were minor and transient. CONCLUSIONS: The changes in ECT practice are consistent with changes in ECT practice generally over the survey period. The overall data on effectiveness and safety further support the treatment's use in young people.

Rey JM, Grayson D, Mojarrad T, Walter G. · Department of Psychological Medicine, University of Sydney, Australia. · Aust N Z J Psychiatry. · Pubmed #11982545 No free full text.

Abstract: OBJECTIVE: Because major depression in adolescents often goes undiagnosed, it is useful to establish whether clinicians' rates of making this diagnosis in a specialist adolescent mental health service change when a self-rating depression scale is routinely administered. METHOD: A retrospective, naturalistic study examining the rate of diagnosis of major depression in a mental health service between 1993 and 1997. The intervention was the administration of the Center for Epidemiological Studies Depression Scale (CES-D)prior to initial assessment from September 1995 onwards. The proportion of clinical diagnoses of DSM-III-R or DSM-IV major depression was the outcome measure. Age, gender, ratings of depression and other confounding variables were used to control for changes in patient population over time. RESULTS: One thousand three hundred and ten adolescents aged 12 to 17 years assessed between 1993 and 1997 were included. After taking into account potential confounders, diagnosis of major depression was 2.8 times (95% confidence interval 1.8, 4.3) as likely when the CES-D was in use. Increase was more marked when adolescents were more disturbed overall. There was no evidence suggesting this was due to changes in diagnostic practices or in the patient population. CONCLUSION: Availability to clinicians of a self-rating depression scale completed prior to assessment was associated with an increase in the frequency of diagnosis of depression in a specialist mental health service for adolescents.

Ghaziuddin N, Kaza M, Ghazi N, King C, Walter G, Rey JM. · Division of Child Adolescent Psychiatry, University of Michigan, Ann Arbor 48109-0390, USA. · J ECT. · Pubmed #11417921 No free full text.

Abstract: OBJECTIVE: To estimate knowledge, experience, and attitudes towards the use of electroconvulsive treatment in minors (patients < 18 years of age), among child and adolescent psychiatrists and psychologists. METHOD: 1,600 questionnaires were mailed to a group of child and adolescent psychiatrists and psychologists. RESULT: There were 625 (39%) respondents. 329 (53.8%) of the respondents stated that they possessed minimal knowledge about the use of ECT in children and adolescents. Lack of confidence in providing a second opinion was common and reported by 75%. Compared with those with minimal knowledge, respondents with advanced knowledge reported a higher perception of safety and efficacy. The majority (70%) of the respondents regarded ECT as a treatment of last resort. CONCLUSION: Many child and adolescent psychiatrists and psychologists have very little knowledge, training, or experience in this treatment. They seem to be ill equipped to appropriately consider or advise patients and families about ECT. Clinical and research implications of these findings are discussed.

Walter G, Martin J, Kirkby K, Pridmore S. · Child and Adolescent Mental Health Services, Central Sydney Area Health Service, Australia. · Aust N Z J Psychiatry. · Pubmed #11270457 No free full text.

Abstract: OBJECTIVE: To examine the experience, knowledge and attitudes of recipients of transcranial magnetic stimulation (TMS) regarding the treatment. There have been no studies of patient views about TMS. METHOD: A 60-item survey was administered by telephone to persons with depressive illness who received TMS at Royal Hobart Hospital, Tasmania. RESULTS: Forty-eight patients were interviewed. About two-thirds also had a history of treatment with electroconvulsive therapy (ECT). Experience and opinions about TMS were generally very positive. Almost three-quarters of interviewees believed TMS had been helpful. The vast majority rated TMS as more acceptable than having, or the prospect of having, ECT. The majority would have TMS again and would recommend it to others. CONCLUSIONS: The mostly favourable experiences and attitudes reported by interviewees will be reassuring to patients, their families and treating health professionals when TMS is being considered.