Medicine & Health

Publication Search Results

Now showing 1 - 10 of 38
  • (2008) Large, M.; Nielssen, O.; Slade, T.; Harris, A.
    Journal Article
    Aim: The aim of this study was to investigate the demographic, illness and methodological factors associated with mean and median duration of untreated psychosis (DUP). Methods: A systematic review and meta-analysis of the published studies of DUP and an examination of available DUP distributions. Results: DUP was longer in samples with a higher proportion of patients with schizophrenia and was shorter in samples that included affective psychosis. Sex, age, and the methods of measuring the onset and end-point of DUP and the type of service in which the studies were performed did not contribute to the heterogeneity of the mean or median DUP values. Mean DUP is significantly prolonged by a small number of patients, and the median DUP is a poor indicator of the rate at which patients present. Conclusions: The DUP of patients with affective and non-affective psychosis should be examined separately in order to make measures of DUP more meaningful and comparable, and DUP should be reported using more comprehensive measures. We suggest a method of reporting DUP based on the rate of presentation of first-episode psychosis patients rather than the length of DUP.

  • (2009) Nielssen, O.; Large, M.; Westmore, B.; Lackersteen, S.
    Journal Article
    Objective: To examine the circumstances of homicides of children in New South Wales from 1991 to 2005. Design and setting: Retrospective analysis of all identified child homicides in NSW from 1991 to 2005, based on data on offenders and victims obtained from crime statistics, documents located by systematic searches of legal databases and media reports, and medicolegal reports of offenders who committed child homicides during psychotic illness. Main outcome measures: Demographic characteristics of homicides and a history of prior psychiatric treatment among offenders with psychosis. Results: We located documents describing 165 homicides by 157 offenders. Fifty-nine deaths were a consequence of child abuse, including those of five children who died from methadone overdoses. Both the offenders and the victims in fatal child abuse were significantly younger than in other forms of child homicide. The courts found that 27 child homicides had been committed by 26 offenders during the acute phase of psychotic illness, and 15 of these offenders had never been treated with antipsychotic medication. Conclusions: Earlier identification and treatment of psychotic illness in mothers, and changes in the way methadone is provided to opiate-dependent parents, might result in a small overall reduction in the number of child deaths. More lives could be saved by measures that reduce the incidence of child abuse, including the prohibition of corporal punishment of children.

  • (2008) Large, M.; Nielssen, O.
    Journal Article
    Background: Recent studies of homicide during psychotic illness have shown that the risk of homicide is greatest during the first episode of psychosis. It is also possible that the proportion of patients who commit homicide before they receive effective treatment may be associated with the length of time they were unwell. We aimed to establish whether there was an association between the average duration of untreated psychosis and the proportion of homicides committed during the first episode of psychosis in the same countries. Methods: Systematic searches of published studies of homicide in psychosis and the duration of untreated psychosis were conducted. The results were combined to examine the relationship between the reported delay in receiving treatment and the proportion of homicides committed before initial treatment. Results: We found 16 studies that reported the proportion of psychotic patients who committed homicide prior to treatment. The proportion of first episode patients ranged from 13% to 76%. We were able to match 13 of those studies with DUP studies from the same country. Longer average DUP was associated with a higher proportion of patients who committed homicide prior to receiving treatment. Conclusions: The possibility that the proportion of patients who commit homicide before receiving treatment may be related to the average treatment delay in the region that the homicide occurs needs to be examined using a case controlled design. If this finding were confirmed, then any measure that reduced the delay in treating emerging psychosis would save lives.

  • (2001) Large, M.; Nielssen, O.
    Journal Article
    Objective: The objective of this audit was to examine whether the content of medico-legal reports regarding psychiatric injury following motor vehicle accidents was influenced by the role of the report writers. Method: The audit consisted of a retrospective review, using a novel rating scale, of archived documents from 559 consecutively examined insurance claims following motor vehicle accidents in New South Wales. Results: Treating practitioners wrote less complete reports than experts representing the plaintiff or defendant. Treating practitioners and plaintiffs' experts were more likely to diagnose posttraumatic stress disorder (PTSD) and depression, while defendants' experts were more likely to find no psychiatric disorder. Limitations of the study were that it was retrospective and examined report writing between 1989 and 1994. The completeness, rather than quality, of the medico-legal reports was measured. Conclusion: Further training and quality assurance procedures may improve medico-legal report writing. Reform of the rules regulating the content of experts' reports may reduce the extent to which the role of the report writer influences their opinion.

  • (2007) Barnett, M.; Hayes, R.; Large, M.; Nielssen, O.
    Journal Article
    Overview of ethical, legal, professional and legal practice management issues in relation to mentally ill clients - psychological and safety issues - lawyers' ethical duties - strategies for dealing effectively with mentally disabled clients.

  • (2008) Large, M.; Babidge, N.; Andrews, D.; Storey, P.; Nielssen, O.
    Journal Article
    Major self-mutilation (MSM) is a rare but catastrophic complication of severe mental illness. Most people who inflict MSM have a psychotic disorder, usually a schizophrenia spectrum psychosis. It is not known when in the course of psychotic illness, MSM is most likely to occur. In this study, the proportion of patients in first episode of psychosis (FEP) was assessed using the results of a systematic review of published case reports. Histories of patients who had removed an eye or a testicle, severed their penis, or amputated a portion of a limb and were diagnosed with a schizophrenia spectrum psychosis were included. A psychotic illness was documented in 143 of 189 cases (75.6%) of MSM, of whom 119 of 143 (83.2%) were diagnosed with a schizophrenia spectrum psychosis. The treatment status of a schizophrenia spectrum psychosis could be ascertained in 101 of the case reports, of which 54 were in the FEP (53.5%, 95% confidence interval = 43.7%-63.2%). Patients who inflict MSM in FEP exhibited similar symptoms to those who inflict MSM later in their illness. Acute psychosis, in particular first-episode schizophrenia, appears to be the major cause of MSM. Although MSM is extremely uncommon, earlier treatment of psychotic illness may reduce the incidence of MSM.

  • (1997) Nielssen, O.; Buhrich, N.; Finlay-Jones, R.
    Journal Article
    Objective: Intravenous sedation of involuntary psychiatric patients is practised in almost all hospitals in New South Wales. Despite its widespread use, little has been published about the medications used or their safety and efficacy. The present study reports the frequency and reasons for intravenous sedation, the medications used, and the incidence of adverse effects. Method: Eighteen of 21 acute psychiatric admission units in the State were reviewed. The medical records of a random sample of 495 patients admitted involuntarily during 1990 were examined and information from the progress notes, drug charts and physical observations was recorded and subjected to statistical analysis. Results: Of the 495 patients, 132 (27%) were intravenously sedated. Eighty-six per cent (86%) of patients received a combination of haloperidol or diazepam, usually 20 mg of each drug. The threat of violence was the most significant patient characteristic predicting the use of intravenous sedation. Patients with mania or intoxication were relatively more likely to be intravenously sedated than other diagnostic categories. Patients admitted via accident and emergency departments and those admitted to teaching and metropolitan general hospitals compared to rural and large psychiatric hospitals were significantly more likely to receive intravenous sedation. The most common complications of intravenous sedation were dystonia (37%), hypotension (8%) and confusion (5%). The incidence of phlebitis and other extrapyramidal side-effects was probably under-reported. Conclusion: About one in four involuntary psychiatric patients receive intravenous sedation in NSW. Intravenous sedation is more likely when patients are admitted through accident and emergency departments to teaching or metropolitan hospitals, and pose a threat of violence. Intravenous sedation was shown to be a safe procedure given certain precautions.

  • (2006) Riddell, S.; Nielssen, O.; Butler, T.; Christie, M.; Starmer, G.
    Journal Article
    The study used data from a survey of the mental health of prisoners to examine possible links between amphetamine use, psychiatric disorder and the alleged offences for which the inmate was received to NSW prisons. Ethical approval was obtained to examine data from inmates received to NSW prisons in 2001. Prisoners had been interviewed using the CIDI-auto and several other structured questionnaires, using methodology similar to the National Mental Health Survey. Data analysis was carried out in the form of chi-square frequency tables and logistic regression. About a third of the inmates received to NSW prisons during the study period had been using amphetamines in the 12-month period before their arrest. The charges were more likely to be for robbery or property crimes (χ2 = 22.185, p = .014). Amphetamine users had more admissions to psychiatric hospitals (χ2 = 13.740, p < .001) than non-users and were more likely to report symptoms of psychotic illness (χ2 = 16.252, p <.001). The combination of amphetamine use and the reported presence of psychotic symptoms was associated with violent offending (OR = 1.86, p = .017). The results show that the charges laid against amphetamine users were similar to those for heroin users, but they suffered more psychiatric disorder. Those reporting psychotic symptoms were more likely to have allegedly committed violent offences.

  • (2008) Large, M.; Farooq, S.; Nielssen, O.; Slade, T.
    Journal Article
    Background: The duration of untreated psychosis (DUP), the period between the first onset of psychotic symptoms and treatment, has an important influence on the outcome of schizophrenia. Aims: To compare the published studies of DUP in low- and middle-income (LAMI) countries with the DUP of high-income countries, and examine a possible association between DUP and per capita income. Method: We used six search strategies to locate studies of the DUP from LAMI countries published between January 1975 and January 2008. We then examined the relationship between DUP and measures of economic activity, which was assessed using the LAMI classification of countries and gross domestic product (GDP) purchasing power parity. Results: The average mean DUP in studies from LAMI countries was 125.0 weeks compared with 63.4 weeks in studies from high-income countries (P=0.012). Within the studies from LAMI countries, mean DUP fell by 6 weeks for every $1000 of GDP purchasing power parity. Conclusions: There appears to be an inverse relationship between income and DUP in LAMI countries. The cost of treatment is an impediment to care and subsidised antipsychotic medication would improve the access to treatment and the outcome of psychotic illness in LAMI countries.

  • (2008) Large, M.; Nielssen, O.; Lackersteen, S.
    Journal Article
    Introduction: Mental health laws limiting involuntary admission to psychiatric hospitals to those assessed to be dangerous or at risk of harm to themselves or others (obligatory dangerousness criteria, ODC) have been introduced in almost every jurisdiction in the United States of America. Some mentally ill patients, who might have been admitted for treatment under previous laws, but who were not admitted because they were not considered 'dangerous', could subsequently have committed suicide. In order to investigate whether or not suicide rates increased after the introduction of ODC, we examined suicide statistics from 48 states and the District of Columbia. Methods: We aligned suicide statistics according to the year in which ODC were introduced in each jurisdiction. We then examined suicide rates in the 15 years before and after the introduction of ODC and trends in national and state suicide rates between 1960 and 1990. Meta-analysis was used to examine differences in suicide rates in the year immediately before and in the year immediately after the introduction of ODC. Results: Between 1968 and 1977, the decade in which ODC were introduced in the majority of jurisdictions, national suicide rates increased from under 11 per 100,000 per annum to over 12.5 per 100,000 per annum. The increase in many jurisdictions occurred in the years immediately before the introduction of ODC. The introduction of ODC was associated with a non-significant increase in suicide rates in the 49 jurisdictions. There was a significant increase in suicide rates after the introduction of ODC in the 19 jurisdictions that introduced ODC prior to 1976. Conclusions: The introduction of ODC might have contributed to increased suicide rates prior to 1976. However, a simpler explanation for the finding is that national suicide rates were rising for other reasons in the same period. We did not find an increase in suicide rates in the jurisdictions where ODC mental health laws were introduced after 1976. Hence, the findings of this study do not support the conclusion that ODC laws have a measurable impact on suicide rates.