EMDR v. other psychological therapies for PTSD: a systematic review and individual participant data meta-analysis.

BACKGROUND: This systematic review and individual participant data meta-analysis (IPDMA) examined the overall effectiveness of eye movement desensitization and reprocessing (EMDR) in reducing posttraumatic stress disorder (PTSD) symptoms, achieving response and remission, and reducing treatment dropout among adults with PTSD compared to other psychological treatments. Additionally, we examined available participant-level moderators of the efficacy of EMDR. METHODS: This study included randomized controlled trials. Eligible studies were identified by a systematic search in PubMed, Embase, PsyclNFO, PTSDpubs, and CENTRAL. The target population was adults with above-threshold baseline PTSD symptoms. Trials were eligible if at least 70% of study participants had been diagnosed with PTSD using a structured clinical interview. Primary outcomes included PTSD symptom severity, treatment response, and PTSD remission. Treatment dropout was a secondary outcome. The systematic search retrieved 15 eligible randomized controlled trials (RCTs); 8 of these 15 were able to be included in this IPDMA (346 patients). Comparator treatments included relaxation therapy, emotional freedom technique, trauma-focused cognitive behavioral psychotherapies, and REM-desensitization. RESULTS: One-stage IPDMA found no significant difference between EMDR and other psychological treatments in reducing PTSD symptom severity (ß = -0.24), achieving response (ß = 0.86), attaining remission (ß = 1.05), or reducing treatment dropout rates (ß = -0.25). Moderator analyses found unemployed participants receiving EMDR had higher PTSD symptom severity at the post-test, and males were more likely to drop out of EMDR treatment than females. CONCLUSION: The current study found no significant difference between EMDR and other psychological treatments. We found some indication of the moderating effects of gender and employment status.

The 'Fit for Life' exercise programme: improving the physical health of people with a mental illness.

People with a mental illness have very poor physical health parameters when compared to the general population. This paper outlines an exercise programme developed to improve overall fitness and curb weight gain. Seventy-two mental health service inpatients completed the general or individualised gym exercise programme within 12 weeks. Baseline and end of course physical health parameters were recorded, along with test results on a number of fitness, strength and agility tasks. No statistically significant differences were found between average pre and post programme weight scores, and weight did not increase over time. Significant differences were found on strength and agility tasks, and a decrease was observed in average resting and post exercise heart rates. Average blood pressure did not change, but the number of baseline readings indicating hypertension reduced from 14 to 8 people. The exercise programme was successful in improving the physical capacity of the individuals who participated.

The physical health of Indigenous people with a mental illness in the Kimberley: is ongoing monitoring effective?

OBJECTIVE: The aim of this paper is to evaluate the effectiveness of ongoing physical health monitoring for Indigenous Australians with mental health issues in the Kimberley region of Western Australia. METHOD: This longitudinal, within-groups investigation assessed physical health parameters such as blood pressure and blood glucose levels at baseline and at 18 months for the same cohort. No standardised intervention was in place, but action was taken if results were found to be abnormal. RESULTS: Most measures of physical health remained stable, with mean lipid and fasting glucose levels remaining abnormal over the entire assessment period. Systolic blood pressure showed a significant improvement. CONCLUSIONS: More needs to be done to improve the physical health of Indigenous mental health patients - culturally appropriate and secure interventions incorporating holistic models of care are needed.

Amygdala Volumetric Change Following Psychotherapy for Posttraumatic Stress Disorder.

The authors investigated the impact of eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE) on the volumes of the amygdala and hippocampus, structures known to be important in fear conditioning, in 20 patients with posttraumatic stress disorder (PTSD). Patients were randomly allocated to either EMDR or PE. Volumes were assessed before and after treatment via magnetic resonance imaging (MRI). Both groups showed significant improvements in PTSD symptoms. Left amygdala mean volume increased significantly following EMDR treatment only. No significant volumetric changes were found for the hippocampus.

Screening for the metabolic syndrome in Australia: a national survey of psychiatrists' attitudes and reported practice in patients prescribed antipsychotic drugs.

OBJECTIVE: To investigate current reported psychiatric practice in relation to screening for the metabolic syndrome in patients prescribed antipsychotic drugs within Australia. METHOD: A postal survey of all Fellows of the Royal Australian and New Zealand College of Psychiatrists. A 28-item questionnaire inquired into different aspects of screening and monitoring for metabolic syndrome in patients on antipsychotic medication. RESULTS: Of 3123 questionnaires sent, 955 were returned. Of respondents, 55% had no established metabolic monitoring protocol or guidelines in their work place, with 13% saying they did not know what to monitor to detect metabolic syndrome. Altogether, 76% reported there was no reliable system in place to remind them when to monitor. Fewer than 50% of respondents routinely check weight, fasting glucose or lipids in their patients on antipsychotics and under than 30% checked blood pressure. Waist circumference was routinely checked in fewer than 7% of patients. Basic monitoring equipment was reported unavailable in more than 50% of clinical settings. However, more than 80% of respondents considered monitoring for metabolic syndrome to be their responsibility and 83% felt they had a medicolegal obligation in this respect. CONCLUSIONS: Routine screening for metabolic syndrome in patients on antipsychotic agents, by Australian psychiatrists, is inadequate. Interventions to improve screening rates need to be developed, implemented and evaluated.

Kimberley Indigenous mental health: An examination of metabolic syndrome risk factors.

OBJECTIVE: There is an increased risk of physical health comorbidities in people with a mental illness. This paper examines the metabolic syndrome parameters for the general population, indigenous Australians and people with a mental illness, and compares them to a sample of predominantly indigenous adults with mental health problems. DESIGN: A longitudinal (24 month) audit of patient medical records was conducted between February 2011 and March 2013. SETTING: The Kimberley Mental Health and Drug Service in Broome, Western Australia. PARTICIPANTS: Largely indigenous adults with a mental illness. Sample numbers increased from 56 at baseline (80% indigenous) to 136 at 18 months (70% indigenous). MAIN OUTCOME MEASURES: Waist circumference, blood pressure, fasting lipids, and fasting blood glucose. RESULTS: Preliminary assessment of the data indicates a high percentage of abnormalities at baseline and at the 18 month period on all four parameters, yet not all patients were assessed on a regular basis. CONCLUSIONS: Abnormalities in metabolic profiles consistent with the non-Indigenous mental health population were found. There are considerable challenges to implementing regular monitoring of physical and metabolic profiles of indigenous people in rural and remote communities.

Stigma towards mental illness among medical students in Australia and Ghana.

OBJECTIVE: Stigma towards mental illness has been found to impact adversely on medical students' attitudes towards psychiatry. This study aimed to assess the impact of stigma among final year students at the University of Science and Technology in Kumasi, Ghana, and the University of Western Australia. METHOD: A 28-item "Attitudes and stigma towards mental health" questionnaire was distributed to final year students at both universities. RESULTS: There was a significant difference in questionnaire scores, with Australian students showing more positive attitudes towards mental illness and lower levels of stigma compared with Ghanaian students. CONCLUSION: Stigmatization was expressed by Australian and Ghanaian students. A combination of medical school experiences and wider societal and cultural beliefs could be responsible for students' attitudes towards mental illness. Educators can develop locally relevant anti-stigma teaching resources throughout the psychiatry curriculum to improve students' attitudes towards psychiatry as a discipline and mental illness in general.

Here and Now Aboriginal Assessment: background, development and preliminary evaluation of a culturally appropriate screening tool.

OBJECTIVE: Assessment of Aboriginal social and emotional wellbeing (SEWB) is a complex and challenging task, in part due to a lack of suitable assessment tools. This paper reports the development and evaluation of a culturally appropriate screening tool called the Here and Now Aboriginal Assessment (HANAA). METHOD: The initial phase included development of a glossary of Aboriginal terms and concepts relating to SEWB. The glossary was used to identify 10 key HANAA domains, which included physical health, sleep, mood, suicide risk and self harm, substance use, memory, unusual experiences, functioning, life stressors and resilience. Evaluation of the HANAA included exploration of its cultural applicability, feasibility, reliability and validity. RESULTS: The HANAA was well accepted by study participants and easily implemented by assessors. Reliability was good, with inter-rater agreements between Aboriginal and non-Aboriginal assessors measured by Kappa statistics ranging from 0.5 to 1.0. There was also a good agreement between assessors and treating clinicians in identifying the main presenting problem and recommended course of action. CONCLUSION: The HANAA is a culturally appropriate and useful tool for the screening of SEWB among Aboriginal adults. It can also be used for teaching and training purposes of mental health and other professionals working with Aboriginal people.

The impact of lifestyle factors on the physical health of people with a mental illness: a brief review.

BACKGROUND: People with a mental illness are much more likely to experience poor physical health when compared to the general population, showing a higher propensity to develop the metabolic syndrome. Past focus has predominantly been upon individuals treated with antipsychotics, yet poor physical health is occurring across diagnoses. PURPOSE: The purpose of this paper is to draw attention to the major factors within the domain of lifestyle in order to support the need for more detailed and rigorous physical health assessment and ongoing monitoring for people with a mental illness. METHOD: This paper reviews existing evidence relating to lifestyle factors such as low exercise levels, poor diet and nutrition, high cholesterol levels, tobacco smoking and poor dental care, contributing to poor physical health such as a higher incidence of cardiovascular disease and type 2 diabetes. An integrative review was conducted from a multi-disciplinary search of online databases and journals, focusing upon mental illness and lifestyle issues predominant in the literature. RESULTS: The findings reviewed here suggest that greater attention should be paid to the physical health assessment and ongoing monitoring of all people with mental health disorders so that preventable illness does not result in higher levels of morbidity and mortality for this disadvantaged population. CONCLUSION: Early identification aids preventive interventions and assists clinicians and mental health staff to more effectively treat emergent physical health problems.

Assessing overweight and obesity across mental disorders: personality disorders at high risk.

PURPOSE: The aim of the present investigation is to assess the prevalence of obesity in people diagnosed as having a mental illness and to investigate differences between disorders. This adds to the paucity of research in this particular population of people and assists with preventative knowledge to obtain optimum physical health. METHODS: Data were collected for all 508 male and female inpatients (new and already existing) in a public mental health service centre in Western Australia between January and December 2008. Current weight for all patients and weight gain for some patients were calculated to obtain a body mass index (BMI) value, and diagnostic information was aligned to one of the six major categories of mental illness. RESULTS: The percentage of obese inpatients (30.3%) was much higher than that of the general population (21.4%), with females showing a higher propensity toward obesity than males. Most diagnostic categories had a mean BMI in the overweight range, whereas Personality Disorders had a mean BMI in the obese range (30.07). A gradual increase in weight over a 9-month time period can be seen in most patients who were assessed on more than one occasion. CONCLUSIONS: The proportion of obese people within the mental health system far exceeds that of the general population, with these people at a much greater risk of becoming obese. The highest level of obesity was found in people with a personality disorder rather than in people with psychosis. Further research is needed to ease out the mitigating factors behind weight gain occurring across disorders.

Neurotechnological solutions for post-traumatic stress disorder: A perspective review and concept proposal.

Post-traumatic stress disorder (PTSD) is an anxiety condition caused by exposure to severe trauma. It is characterised by nightmares, flashbacks, hyper-vigilance and avoidance behaviour. These all lead to impaired functioning reducing quality of life. PTSD affects 2-5% of the population globally. Most sufferers cannot access effective treatment, leading to impaired psychological functioning reducing quality of life. Eye movement desensitisation and reprocessing (EMDR) is a non-invasive brain stimulation treatment that has shown significant clinical effectiveness in PTSD. Another treatment modality, that is, trauma-focused cognitive behavioural therapy is also an effective intervention. However, both evidence-based treatments are significantly resource intensive as they need trained therapists to deliver them. A concept of a neuro-digital tool for development is proposed to put to clinical practice of delivering EMDR to improve availability, efficiency and effectiveness of treatment. The evidence in using new technologies to measure sleep, geolocation and conversational analysis of social media to report objective outcome measures is explored. If achieved, this can be fed back to users with data anonymously collated to evaluate and improve the tool. Coproduction would be at the heart of product development so that the tool is acceptable and accessible to people with the condition.

Obesity, cardiovascular disease and type 2 diabetes in people with a mental illness: a need for primary health care.

People with a mental illness show a growing incidence of obesity, and higher rates of metabolic syndrome when compared with the general population. This paper reviews research on obesity, cardiovascular disease and type 2 diabetes, with the aim of directing clinical attention towards the improvement of patient physical health. A systematic search of cross-discipline databases and journals provided peer-reviewed research for analysis, and national statistics allowed for the investigation of differences in rates of occurrence between people experiencing a mental illness and the general population. Treatment effects via psychotropic medications and lifestyle factors such as poor diet and low levels of exercise suggest that ongoing monitoring is necessary to prevent major physical disorders in people experiencing a mental illness. To aid clinicians, a comprehensive set of clinical guidelines have been developed for the physical assessment and ongoing monitoring of mental health patients.

Clinical guidelines for the physical care of mental health consumers: a comprehensive assessment and monitoring package for mental health and primary care clinicians.

OBJECTIVES: People with a mental illness are more likely to experience poor physical health as compared to the general population. Currently, Australian mental health patients experience a relatively low level of physical health appraisal, prompting the development of the Clinical guidelines for the physical care of mental health consumers assessment and monitoring package. METHOD: The Clinical guidelines package takes an holistic approach, with a focus on the key dimensions of medication effects, lifestyle, existing or developing physical disorders, alcohol and illicit drug use, and psychosocial factors. RESULTS: The package consists of a metabolic syndrome algorithm wall chart, a Clinician handbook, a Psychosocial assessment booklet, and a set of three screening forms. CONCLUSIONS: By taking a user-friendly, flexible, evidence-based approach, the resource can be used by all clinicians involved in the healthcare of people with a mental illness.

Fostering psychiatry in Ghana: the impact of a short review course through an international collaboration.

OBJECTIVE: The aim of the current study was to evaluate a short review course in psychiatry conducted at the Kwame Nkrumah University of Science and Technology medical school and any change in student interest in a career in psychiatry. METHOD: Students were asked to complete a general psychiatric knowledge questionnaire before and immediately after the course. They were also asked to rate their attitude toward psychiatry as a career. The same questionnaire was readministered 1 month later. RESULTS: The average results on the knowledge test pre-course was 52% (N=129) and post-course was 78% (N=122), constituting a 50% increase in knowledge for the average student. The proportion of students showing considerable interest in a psychiatric career increased from 19% pre-course to 32% post-course. At 1-month follow-up, the average result for the knowledge test was 76%, and considerable interest in psychiatry as a career was noted at 21%. CONCLUSION: Results indicate that the course significantly improved core psychiatric knowledge and that this improvement was retained after 1 month. An initial increase in interest in psychiatry as a career decreased almost to baseline at 1-month follow-up. Study limitations include the use of the same questionnaire at each stage knowledge was tested and the absence of a control group.

Complementary and alternative medicine in the treatment of anxiety and depression.

PURPOSE OF REVIEW: There is well documented evidence for the increasing widespread use of complementary and alternative medicine in the treatment of physical and psychiatric symptoms and disorders within Western populations. Here we provide a review of the recent literature on evidence for using such interventions in the treatment of anxiety and depression. RECENT FINDINGS: With regard to herbal treatments, kava is effective in reducing anxiety symptoms and St John's wort in treating mild to moderate depression. The association of kava with hepatotoxicity, however, is a significant concern. Promising data continue to emerge for the use of omega-3 fatty acids in managing depression. Evidence for the use of acupuncture in treating anxiety disorders is becoming stronger, although there is currently minimal empirical evidence for the use of aromatherapy or mindfulness-based meditation. SUMMARY: The evidence base for the efficacy of the majority of complementary and alternative interventions used to treat anxiety and depression remains poor. Recent systematic reviews all point to a significant lack of methodologically rigorous studies within the field. This lack of evidence does not diminish the popularity of such interventions within the general Western population.

Posttraumatic stress disorder and terrorism: 5 years after 9/11.

PURPOSE OF REVIEW: This article aims to review and summarize the recent literature investigating the relationship between posttraumatic stress disorder and terrorism. A particular focus is given to the studies related to the terrorist attacks on New York City and Washington, DC on 11 September 2001. The review aims to provide an update on an article published in this journal in the year following the September 11 attacks. RECENT FINDINGS: Elevated rates of posttraumatic stress disorder in the general population follow terrorist attacks but soon normalize, whereas directly exposed populations have higher rates and more persistent symptoms. An increased risk of posttraumatic stress disorder is associated with direct exposure, geographical proximity, female sex, low income, poor education, poor social supports and prior psychotropic drug use, and high-level media reporting of events (for vulnerable individuals). SUMMARY: An accumulating body of data exists on the relationship between posttraumatic stress disorder and terrorism in recent years. Caution needs to be exercised in drawing general conclusions as numerous variables need to be taken into account in addition to the socio-political context of the terrorist attacks. Having said this, a number of consistent findings are emphasized, not least the high degree of psychological resilience demonstrated across populations affected by terrorism.

Abnormal cortical asymmetry as a target for neuromodulation in neuropsychiatric disorders: A narrative review and concept proposal.

Recent advances in knowledge relating to the organization of neural circuitry in the human brain have increased understanding of disorders involving brain circuit asymmetry. These asymmetries, which can be measured and identified utilizing EEG and LORETA analysis techniques, may be a factor in mental disorders. New treatments involving non-invasive brain stimulation (NIBS), including trans-cranial magnetic stimulation, direct current stimulation and vagal nerve stimulation, have emerged in recent years. We propose that EEG identification of circuit asymmetry geometries can direct non-invasive brain stimulation more specifically for treatments of mental disorders. We describe as a narrative review new NIBS therapies that have been developed and delivered, and suggest that they are proving effective in certain patient groups. A brief narrative of influence of classical and operant conditioning of neurofeedback on EEG coherence, phase, abnormalities and Loreta's significance is provided. We also discuss the role of Heart rate variability and biofeedback in influencing EEG co-relates. Clinical evidence is at an early stage, but the basic science evidence and early case studies suggest that this may be a promising new modality for treating mental disorders and merits further research.

After the fire: the mental health consequences of fire disasters.

PURPOSE OF REVIEW: This article aims to summarize recent findings relating to the impact of fire disasters on the mental health of victims, responders, families and communities within the context of the existing literature. RECENT FINDINGS: Recent studies support previous findings that fire disasters are associated with a negative impact on the mental and physical health of victims, their families and professional and voluntary responders to the disasters. These effects can be delayed in onset and can persist over at least several years, although long-term follow-up studies over 20 years or more indicate that the psychological effects on victims are minimal relative to controls by this stage. SUMMARY: Fire disasters, like other natural or man-made disasters, can have significant mental health impact on individuals directly and indirectly affected and on communities caught up in the events.

Role of psychological trauma in the cause and treatment of anxiety and depressive disorders.

PURPOSE OF REVIEW: The role of traumatic events in the development of post-traumatic stress disorder is well established but their importance in the other anxiety disorders and in depression is less clear. We have reviewed recent publications in the medical literature which add to current knowledge regarding the possible causative role of trauma and the efficacy of trauma-focused treatments in these disorders. RECENT FINDINGS: A number of recent studies add further support to the notion that traumatic events increase vulnerability to a range of psychiatric disorders. Furthermore, pretrauma risk factors are shared across different anxiety and depressive disorders. Patients with partial rather than full post-traumatic stress disorder often have their post-traumatic symptoms subsumed within another anxiety or depressive diagnosis. There is very little data relating to trauma-focused treatment of disorders other than post-traumatic stress disorder. SUMMARY: There is increasing evidence that clinicians should be cognizant of the possible role of traumatic experience in the cause of patients with diagnoses other than post-traumatic stress disorder. There is, however, a paucity of data for the efficacy of trauma-focused psychological interventions for disorders other than post-traumatic stress disorder and further research is therefore needed.