Continuation or maintenance ECT for schizophrenia: A narrative review of case report data.

OBJECTIVE: This review aimed to address the limited evidence on the efficacy of continuation or maintenance electroconvulsive therapy (C/M-ECT) in schizophrenia, with a focus on international case reports and series due to the scarcity of randomised controlled trials. MATERIALS AND METHODS: Electronic database searches were conducted to identify case reports or series evaluating the efficacy of C/M-ECT in patients with schizophrenia or schizoaffective disorder. RESULTS: C/M-ECT treatment span varied from 3 months to 36 years (Median = 30 months; M = 43.9 months; SD = 63.0) and was effective in maintaining remission for most patients with schizophrenia in combination with antipsychotic medication. Reporting of adverse events including cognitive adverse effects was infrequent. CONCLUSIONS: Collation of case reports and series data indicated that C/M-ECT, when combined with antipsychotics, appears to be a safe and effective strategy for maintaining remission, even over several years. Caution is warranted due to the potential influence of publication bias.

Off-label prescribing of psychotropics in a psychiatric patient population in Australia.

BACKGROUND: This study aimed to investigate the practice of off-label prescribing in both in- and outpatient psychiatry practice. METHODS: One-hundred inpatient and 100 outpatient medical records from adult patients of an Australian psychiatry service from 2020 to 2021 were examined to determine the prevalence of off-label prescribing as defined by Therapeutic Goods Administration (TGA) indications, adherence to Royal Australian and New Zealand College of Psychiatrists (RANZCP) treatment guidelines, frequency of off-label prescription, and the quality of documentation and informed consent process. RESULTS: Most prescribing events in both in- and outpatient settings were either on-label or off-label but consistent with RANZCP guidelines. Patients with a schizoaffective disorder diagnosis or displaying aggression were most likely to receive off-label prescriptions. There was no significant difference between in- and outpatient groups in the quality of documentation or consent process. CONCLUSIONS: In general, off-label prescribing across groups was common, but many decisions were then in line with RANZCP recommendations. That there is a discrepancy between clinical and regulatory bodies has implications for how off-label status is decided.

The Somatomorphic Matrix-Female: More evidence for the validity of bidimensional figural rating scales for women.

Our study aimed to develop and provide a preliminary psychometric validation of the Somatomorphic Matrix-Female (SM-F), a new bidimensional female figural rating scale which can be used to gauge actual and desired levels of both body fat and muscularity in a consolidated measure, as well as providing an index of actual-desired body discrepancy based on these measures. Across two studies undergraduate women (n Study 1 = 481; n Study 2 = 391) completed the Eating Disorder Examination-Questionnaire, the Body Shape Questionnaire-34, and the Depression Anxiety Stress Scales-21 (Study 1) and the Drive for Thinness Scale and the Drive for Muscularity Scale (Study 2), as well as the SM-F. Overall, the SM-F demonstrated sound content, concurrent, and convergent validity for actual and desired body fat, actual and desired muscularity, and their respective discrepancy scores.

A retrospective matched case-control comparison of non-fatal hanging to non-fatal self-poisoning in a sample of Australian men and women.

OBJECTIVE: Our study examined the characteristics of individuals who survived attempted hanging and compared this group to a randomly selected comparison group of patients with non-fatal self-poisoning. METHOD: Non-fatal hanging cases were identified from case files from an Australian public hospital. They were matched by age, sex, and month of presentation with double the number of non-fatal self-poisoning cases. Patients were compared on demographic and clinical characteristics, as well as length of stay in hospital and discharge plan. RESULTS: Most non-fatal hanging patients were males with medium suicidal intent, and a significant proportion misused alcohol. In this group, women were more likely than men to have past psychiatric care, and men were more likely to misuse alcohol and stimulants. In comparison to the self-poisoning group, the non-fatal hanging group had higher suicidal intent but proportionally lower history of self-harm and psychiatric care, or benzodiazepine misuse. CONCLUSION: People who self-harm by hanging have higher suicidal intent, misuse alcohol more often, and are less likely to be in psychiatric care. They may benefit from a general community intervention, rather than one based upon interventions with people already in psychiatric care.

Visual Body Scale for Men (VBSM): Validation of a new figural rating scale to measure perceived-desired body discrepancy in men.

OBJECTIVES: This study examined the psychometric properties of the Visual Body Scale for Men (VBSM), a new figural rating scale designed as a measure of male perceived-ideal body discrepancy. METHODS: In Study 1, participants were 133 males who selected their perceived and desired bodies from the VBSM. Body composition, body dissatisfaction, eating disorder and depressive symptomatology were obtained. In Study 2, participants were 33 males who completed the VBSM and the Bodybuilder Image Grid (BIG). Study 2 aimed to compare the validity evidence of the VBSM to the BIG. RESULTS: Both VBSM-Body Fat (VBSM-BF) and VBSM-Muscularity (VBSM-M) demonstrated sound test-retest reliability, convergent, concurrent, and discriminant validity evidence. Additionally, the VBSM demonstrated better sensitivity for detecting body fat-related body image and dissatisfaction when compared to the BIG. CONCLUSION: The VBSM improves upon existing male figural rating scales in terms of image quality, includes both dimensions of a male body image, and demonstrates good psychometric properties.

Examining the impact of a group treatment using cognitive and social cognition remediation for young offenders: The justice health NSW school-link advantage pilot study.

AIM: Young offenders experience higher rates of neurodevelopmental and mental health disorders than the general population, and significant access barriers to health treatment. Treatment combining Cognitive Remediation Therapy (CRT) and Social Cognition Remediation Therapy (SCRT) has demonstrated benefits for functional improvements and social development. However, there is limited information regarding group treatment programs in custodial settings for young offenders. This pilot study explores the effectiveness and feasibility of a group treatment program for youth offenders with cognitive deficits and mental health concerns in youth detention. METHODS: The School-Link Advantage pilot study designed and tested a 10-week group treatment program combining CRT and SCRT for young offenders in custody. The closed groups incorporated interactive activities focussed on emotional recognition and regulation skills, optimizing executive functioning, understanding values, exploring belief systems, improving relationships, and safety planning. RESULTS: Of the 22 male participants recruited in an Australian Youth Justice Centre, 12 completed all aspects of the treatment program, reflecting a 54.5% completion rate in a typically challenging to engage population cohort. Results demonstrated significant improvements in the ability to store and retrieve information, recognize information, and control emotions. Planning and organizing skills also showed considerable development. CONCLUSIONS: This pilot study suggests that a combined CRT and SCRT group treatment program has the potential to effectively target cognitive challenges associated with mental health disorders in young offenders in custody. These promising outcomes suggest exploring randomized controlled trials with increased cultural sensitivity for diverse populations.

Examining the clinical effectiveness of continuation and maintenance electroconvulsive therapy in schizophrenia.

OBJECTIVE: There are few studies that examine the effectiveness of Continuation/Maintenance Electroconvulsive Therapy (C/M-ECT) in schizophrenia, despite the documented effectiveness of acute ECT treatment. We aimed to investigate the clinical effectiveness of C/M-ECT for in-patients with Schizophrenia in a naturalistic setting. We examined the medical records of 46 in-patients who were diagnosed with Schizophrenia and had received C/M-ECT belonging to non-acute extended care service in a public psychiatry hospital in Sydney, Australia. The focus of analysis was on 138 treatment cycles (71 acute only cycles and 67 acute-continuation/maintenance cycles) across 45 subjects. A linear mixed effects model was used to describe the change in clinical global impression-severity (CGI-S) over time 4 time points viz., pre-post acute and pre-post continuation/maintenance ECT. RESULTS: Acute-only cycles and acute-continuation/maintenance cycles had identical pre- (M = 5, C.I. = 4-6), post-cycle CGI-S scores, and identical CGI-S difference scores (M = 0, C.I. = -1 - 1). Broadly in each continuation/maintenance cycle, we observed an initial sharp decrease in CGI-S scores followed by a logarithmic increase in scores over time, with satisfactory CGI-S score maintenance observed for approximately 6 months. Bitemporal ECT influenced CGI-S across maintenance ECT (p < 0.05) indicating smaller declines in CGI-S scores over time. CONCLUSION: In schizophrenia, C/M ECT preserves effects on illness severity for at least upto 6 months following an acute course of ECT. Bitemporal ECT vis a vis other electrode positions differentiated clinical severity over time.

Integrating smartwatches in community mental health services for severe mental illness for detecting relapse and informing future intervention: A case series.

OBJECTIVE: This case series explored the integration of smartwatches in a community mental health service to support severe mental illness (SMI) management and intervention. We examined whether biometric data provided by smartwatches could help to predict relapse and inform treatment decisions. METHOD: Four Australian SMI outpatients of mixed diagnoses (age range = 19-24) were selected from a prior study. Clinicians accessed patients' biometric data (activity, sleep, heart rate, and electrodermal activity) through smartwatches. RESULTS: Changes in circadian rhythm and electrodermal activity preceded hospitalization in two cases. Additionally, smartwatch data was effectively used to guide targeted interventions, improving patient treatment outcomes. CONCLUSION: Integrating smartwatches in community mental health services offers promise as adjunct tools for SMI management. However, ethical considerations on data privacy and technology reliance require further evaluation. Additionally, as this is a small case series, randomized controlled trials with larger sample sizes are required to provide evidence for generalisability of results.

Exploration of height dissatisfaction, muscle dissatisfaction, body ideals, and eating disorder symptoms in men.

Objective: Height is a significant, yet under-studied dimension of body dissatisfaction in men. The present study examined the relationship between height dissatisfaction, height, muscle and fat dissatisfaction, body ideals, and eating disorder symptoms in men. Participants and methods: Participants were a sample of male undergraduate Australian students (N = 224) who were administered self-report measures of height, muscle, and fat dissatisfaction, eating disorder symptoms, and muscle and body fat body-ideals, and reported their height. Results: Results showed that height, muscle dissatisfaction, and desired muscularity were important for explaining height dissatisfaction. Additionally, although eating disorder symptoms did not uniquely predict height dissatisfaction, there were small positive correlations between height dissatisfaction and eating disorder symptoms. Conclusions: This study highlights the importance of height in male body dissatisfaction and its association with muscular dissatisfaction and desired muscularity, as well as the potential significance of height in male eating disorders.

Narcissus' belief about his body: Aspects of narcissism, body image, and eating disorder symptoms.

OBJECTIVE: Narcissism may play a role in shaping body image concerns. Here we examined the relationships between narcissism (i.e., agentic extraversion, antagonism, narcissistic neuroticism, leadership/authority, exhibitionism/entitlement) and body image concerns and disturbances (i.e., drive for thinness, drive for muscularity, eating disorder symptoms, body mass index, current/desired fat, and current/desired muscularity). METHODS: Mechanical Turk workers from the USA (N = 430; 64% male) completed the Narcissistic Admiration and Rivalry Questionnaire, the Hypersensitive Narcissism Scale, the Narcissistic Personality Inventory, the Drive for Muscularity Scale, the Drive for Thinness Scale, the Eating Disorder Examination Questionnaire-Short, and the Sex-Specific Somatomorphic Matrixes. RESULTS: All narcissistic factors were associated with a greater drive for thinness (except for leadership/authority) and for muscularity, more eating disorder symptoms, a greater desired body fat (except for leadership/authority), and a greater current muscularity. Greater agentic extraversion and exhibitionism/entitlement were associated with lower levels of current body fat, and greater antagonism was associated with a greater desired muscularity. DISCUSSION: Notably, individual differences in narcissism appeared to be important in understanding body image concerns, broadly speaking. We found that narcissism may be associated with body image concerns among both sexes differently, and especially that drive for thinness was more related to narcissism in men. Our results emphasize the importance of narcissism in formulating and treating body image-related disorders for both men and women. Ultimately, narcissistic features of personality may be risk factors for developing and perpetuating body image concerns, and therefore should be considered in assessment, formulation, diagnosis, and treatment of eating disorders.

Evidence of attentional bias toward body stimuli in men.

Over the past 30 years, attentional bias for body shape and weight content has been implicated in the precipitation and maintenance of body dissatisfaction and eating disorders. Although the existence of this bias toward body stimuli is well-established in female populations, it is comparatively understudied in men. This review aimed to examine the nature of this visual attentional bias toward male bodies in male samples across a range of different attentional paradigms, including eye-tracking, dot-probe, and the visual search task. Results were heterogenous, finding some evidence that men with higher body dissatisfaction and eating disorder symptoms demonstrated an attentional bias toward desirable bodies of other men, and undesirable features of their own bodies. These results suggest that schematic cognitive models of body dissatisfaction and eating disorders body may also be applicable to men, however more research is needed.

"The Sergeant wants to acupuncture me": a personal lens into the introduction of a traditional Eastern therapy to Indigenous Australians.

OBJECTIVE: This paper introduces a project established between the Emotional, Social Wellbeing Centre and the Goldfields Ngunytju Tjitji Pirni (Caring for Women and Children) and the Western Australia Police in Kalgoorlie, Western Australia. CONCLUSIONS: Members of the Indigenous community of Kalgoorlie have found benefit through consultation and treatment involving the use of acupuncture, dietary and lifestyle counselling. In addition, Indigenous persons have found benefit in an alternative means of accessing police services outside of a typical police environment.

The relationship between psychophysical body categorization performance and male body dissatisfaction.

The present study compared the predictive relationship between various psychophysical indices of body categorization performance (Point of Subjective Equivalence (PSE), Just Noticeable Difference (JND) and Reaction Time (RT)) and male body dissatisfaction (Male Body Attitudes Scale (MBAS)) and eating disorder symptoms (Eating disorders examination questionnaire (EDE-Q)), with performance on a validated figure rating scale (Visual Body Scale for Men (VBSM)). Body Mass Index, body fat percentage, and fat free mass index were also measured. PSE was not as sensitive in predicting body dissatisfaction and eating disorder symptoms as the VBSM. JND and average RT were found to be sensitive predictors of body dissatisfaction and eating disorder symptoms across the 82 male participants. JND proved to be a better indicator of weight concern than the VBSM-M. Whilst the body categorization task offers new insights into the way body images may be processed by males with different levels of body dissatisfaction, the VBSM and the conventional self-report measures are likely to be clinically more efficacious at measuring body dissatisfaction.

Female Body Dissatisfaction and Attentional Bias to Body Images Evaluated Using Visual Search.

One factor, believed to predict body dissatisfaction is an individual's propensity to attend to certain classes of human body image stimuli relative to other classes. These attentional biases have been evaluated using a range of paradigms, including dot-probe, eye-tracking and free view visual search, which have yielded a range of - often contradictory - findings. This study is the first to employ a classic compound visual search task to investigate the relationship between body dissatisfaction and attentional biases to images of underweight and with-overweight female bodies. Seventy-one undergraduate females, varying their degree of body dissatisfaction and Body Mass Index (BMI), searched for a horizontal or vertical target line among tilted lines. A separate female body image was presented within close proximity to each line. On average, faster search times were obtained when the target line was paired with a uniquely underweight or with-overweight body relative to neutral (average weight only) trials indicating that body weight-related images can effectively guide search. This congruent search effect was stronger for individuals with high eating restraint (a behavioral manifestation of body image disturbance) when search involved a uniquely underweight body. By contrast, individuals with high BMIs searched for lines more rapidly when paired with with-overweight rather than underweight bodies, than did individuals with lower BMIs. For incongruent trials - in which a unique body was paired with a distractor rather than the target - search times were indistinguishable from neutral trials, indicating that the deviant bodies neither compulsorily "captured" attention nor reduced participants' ability to disengage their attention from either underweight or with-overweight bodies. These results imply the existence of attentional strategies which reflect one's current body and goal-directed eating behaviors.

Stereoscopic Segmentation Cues Improve Visual Timing Performance in Spatiotemporally Cluttered Environments.

Recently, Cass and Van der Burg demonstrated that temporal order judgment (TOJ) precision could be profoundly impaired by the mere presence of dynamic visual clutter elsewhere in the visual field. This study examines whether presenting target and distractor objects in different depth planes might ameliorate this remote temporal camouflage (RTC) effect. TOJ thresholds were measured under static and dynamic (flickering) distractor conditions. In Experiment 1, targets were presented at zero, crossed, or uncrossed disparity, with distractors fixed at zero disparity. Thresholds were significantly elevated under dynamic compared with static contextual conditions, replicating the RTC effect. Crossed but not uncrossed disparity targets improved performance in dynamic distractor contexts, which otherwise produce substantial RTC. In Experiment 2, the assignment of disparity was reversed: targets fixed at zero disparity; distractors crossed, uncrossed, or zero. Under these conditions, thresholds improved significantly in the nonzero distractor disparity conditions. These results indicate that presenting target and distractor objects in different planes can significantly improve TOJ performance in dynamic conditions. In Experiment 3, targets were each presented with a different sign of disparity (e.g., one crossed and the other uncrossed), with no resulting performance benefits. Results suggest that disparity can be used to alleviate the performance-diminishing effects of RTC, but only if both targets constitute a single and unique disparity-defined surface.

Effect of Baseline Anxiety and Depression Symptoms on Selected Outcomes Following Pulmonary Rehabilitation.

PURPOSE: Anxiety and depression are prevalent comorbidities in people with chronic respiratory diseases (CRDs). This study sought to quantify the influence of varying degrees of anxiety and depression on functional performance and disease impact in a population with CRDs following pulmonary rehabilitation (PR) intervention. METHODS: The Hospital Anxiety and Depression Scale (HADS), the 6-Minute Walk Test (6MWT), and the Chronic Obstructive Pulmonary Disease Assessment Test (CAT) were assessed pre- and post-PR. Participants were categorized into 3 groups (None, Probable, and Present) based on their level of anxiety and depression. Functional performance and disease impact outcomes were compared pre- and post-PR. RESULTS: Patients consisted of a total of 134 program completers (72 males, 62 females; mean age = 67.8 years). Significant improvements in functional performance with regard to 6MWT scores were observed across all groups postintervention (P < .05). The Present group, in both the anxiety and depression domains, failed to reach a minimally clinically important difference postintervention. The Probable and Present groups achieved a significant improvement in CAT scores postintervention (P < .05). CONCLUSIONS: This study showed that symptoms of anxiety and depression in people with CRDs were significantly related to lower exercise tolerance levels and higher levels of disease impact. People with increased levels of anxiety and depression have the potential to significantly improve disease impact outcomes post-PR. The results demonstrated that the detection and treatment of anxiety and depression symptoms in people with CRDs are likely to be clinically important.

Schema modes in eating disorders compared to a community sample.

BACKGROUND: The aim of this study was to examine the association between eating disorders (ED) and schema modes, and identify which specific schema modes are associated with particular eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN) and other specified feeding or eating disorder (OSFED). METHODS: A total of forty seven women with eating disorders and 89 women from the community participated in this study. Eating disorder diagnosis was determined by a clinician treating the eating disorder and was confirmed on the basis of Body Mass Index (BMI) and the Eating Disorder Examination Questionnaire (EDE-Q). The Schema Mode Inventory (SMI) was used to explore the association between schema modes and eating disorder diagnostic status. RESULTS: A series t-tests revealed that when compared to the community sample, the ED group scored significantly higher on 10 out of 12 maladaptive schema modes, and significantly lower on both adaptive schema modes. A series of planned contrasts revealed that the AN, BN, and OSFED groups each scored significantly higher than the community sample group in the majority of maladaptive schema modes, with slight variations between groups. Further, AN, BN, and OSFED groups each scored significantly lower than the community sample group for the two SMI scores categorized as adaptive. All Cohen's d that reached significance ranged 0.55-2.24. CONCLUSIONS: The current study shows a tendency for females with eating disorders to rely on maladaptive schema modes more frequently, and more adaptive schema modes less frequently compared to a community sample. These findings provide initial empirical support for a schema mode model of eating disorders.