Finding help for OCD in Australia : development and evaluation of a clinician directory

Objective: People tend to live with obsessive-compulsive disorder (OCD) for many years before receiving evidence-based treatment. This delay is partly due to a lack of access to information about which healthcare providers offer evidence-based treatment for OCD. This information was not easily accessible online for people in Australia. Methods: In this study, we describe how an online directory of clinicians was developed and evaluated. We report on a needs analysis and survey of treatment-seeking histories among consumers and carers impacted by OCD. We describe the key features of the directory developed, and present survey feedback on its usability and utility. Results: The results validated the need for a directory specific to clinicians who offer evidence-based treatment for OCD, and that it meets essential usability standards. Areas for improvement and further developments were identified. Conclusion: This directory contributes to broader efforts invested to improve the treatment-seeking process for people living with OCD in Australia

Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure.

INTRODUCTION: The dural sheath surrounding the optic nerve communicates with the subarachnoid space, and distends when intracranial pressure is elevated. Magnetic resonance imaging (MRI) is often performed in patients at risk for raised intracranial pressure (ICP) and can be used to measure precisely the diameter of optic nerve and its sheath. The objective of this study was to assess the relationship between optic nerve sheath diameter (ONSD), as measured using MRI, and ICP. METHODS: We conducted a retrospective blinded analysis of brain MRI images in a prospective cohort of 38 patients requiring ICP monitoring after severe traumatic brain injury (TBI), and in 36 healthy volunteers. ONSD was measured on T2-weighted turbo spin-echo fat-suppressed sequence obtained at 3 Tesla MRI. ICP was measured invasively during the MRI scan via a parenchymal sensor in the TBI patients. RESULTS: Measurement of ONSD was possible in 95% of cases. The ONSD was significantly greater in TBI patients with raised ICP (>20 mmHg; 6.31 +/- 0.50 mm, 19 measures) than in those with ICP of 20 mmHg or less (5.29 +/- 0.48 mm, 26 measures; P < 0.0001) or in healthy volunteers (5.08 +/- 0.52 mm; P < 0.0001). There was a significant relationship between ONSD and ICP (r = 0.71, P < 0.0001). Enlarged ONSD was a robust predictor of raised ICP (area under the receiver operating characteristic curve = 0.94), with a best cut-off of 5.82 mm, corresponding to a negative predictive value of 92%, and to a value of 100% when ONSD was less than 5.30 mm. CONCLUSIONS: When brain MRI is indicated, ONSD measurement on images obtained using routine sequences can provide a quantitative estimate of the likelihood of significant intracranial hypertension

A call for prevention and early intervention in obsessive-compulsive disorder

Background: Evidence suggests that many people with obsessive-compulsive disorder (OCD) have subclinical symptoms years before the development of their disorder and that early treatment may reduce its severity. Aim: To explore prevention and early intervention strategies for OCD. Methods: A narrative literature review was conducted. Results: The literature in relation to the prevention of OCD is sparse. Genetic and environmental factors appear to be relevant to the aetiology of OCD, for example, the observation that hoarding symptoms and contamination/cleaning symptoms are more likely to also be present in first-degree relatives. Psychoeducation and the reduction of family accommodation, that is the act of parents, siblings or partners accommodating to the high-risk individual’s requests to comply with their compulsions, are promising areas for prevention and early intervention in high-risk groups. Tertiary prevention has also been limited by an inadequate number of trained clinicians to deliver evidence-based treatments. Conclusions: Much more research is needed in relation to the prevention of OCD. There is limited scope for primary prevention with respect to biological aetiological factors, but there is potential for strategies addressing environmental factors (eg, family factors). The effectiveness of psychoeducation for parents with OCD as a primary prevention strategy for OCD in their children requires scientific evaluation. Improving access to effective treatments for OCD would also improve tertiary prevention

Proxy‐reported sensory measures for children and adolescents with neurodevelopmental disorders: A systematic review

AIM: To determine the quality and utility of proxy‐reported sensory measures for children and adolescents with neurodevelopmental disorders (such as autism spectrum disorder, attention‐deficit/hyperactivity disorder, movement disorders, and intellectual disability). METHOD: We systematically searched 11 databases. We applied the updated Consensus‐based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist and criteria for good measurement properties to evaluate instrument development and psychometric properties. Findings were summarized using a COSMIN adaptation of Grading of Recommendations, Assessment, Development and Evaluations. RESULTS: From 11 databases, 6748 articles were screened. Ninety‐one full‐length articles were reviewed after removing excluded studies and manual searches conducted by two reviewers. Data were extracted for 12 measures from 20 articles. Of the 12 measures, only three provided sufficient data to evaluate content validity and psychometric measurement properties. The Participation and Sensory Environment Questionnaire‐Home (PSEQ‐H) was the only measure that satisfied moderate content validity and moderate‐to‐high quality for measurement properties. These properties included: structural validity, hypothesis testing for construct validity, internal consistency, reliability, and measurement error. INTERPRETATION: One measure, the PSEQ‐H, met eight criteria for good measurement properties. To facilitate evidence‐informed clinical decision‐making, all psychometric properties of all 12 sensory‐based, proxy‐reported measures were presented. The importance of consumer engagement in measure development and the need for ongoing evaluation of measures against contemporaneous standards is recommended

Paroxysmal sympathetic hyperactivity after acquired brain injury: a review of diagnostic criteria

Primary objective: To evaluate the development and usage of diagnostic criteria for paroxysmal sympathetic hyperactivity (PSH) following acquired brain injury (ABI), then comparatively analyse published criteria. Research design: Systematic literature review. Methods and procedures: Literature published in English language prior to 30 November 2008 was reviewed for dysautonomic syndromes following ABI, characterized by simultaneous paroxysmal autonomic hyperactivity and motor over-activity. Main outcome and results: Sixty papers presenting 349 cases of PSH were identified, with a further 21 papers providing additional information regarding the condition. Only 27 of these 81 papers (33%) utilized diagnostic criteria. There were nine novel or substantially modified diagnostic criteria sets, which were analysed further. Criteria showed strong agreement on core clinical features of PSH—heart rate (HR), blood pressure, respiratory rate, temperature, sweating, and motor hyperactivity. Most criteria sets utilized a polythetic diagnostic system and all but one indicated severity thresholds, e.g. HR >120 beats per minute. Two papers specified a minimum episode frequency and four papers required a minimum syndrome duration. Conclusions: Of necessity, diagnostic criteria have been developed ad hoc. The differences between criteria complicate both clinical diagnosis and the process of comparing research cohorts. These findings demarcate the need for a single set of PSH diagnostic criteria and provide the substrate for scientific consensus

Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure.

INTRODUCTION: The dural sheath surrounding the optic nerve communicates with the subarachnoid space, and distends when intracranial pressure is elevated. Magnetic resonance imaging (MRI) is often performed in patients at risk for raised intracranial pressure (ICP) and can be used to measure precisely the diameter of optic nerve and its sheath. The objective of this study was to assess the relationship between optic nerve sheath diameter (ONSD), as measured using MRI, and ICP. METHODS: We conducted a retrospective blinded analysis of brain MRI images in a prospective cohort of 38 patients requiring ICP monitoring after severe traumatic brain injury (TBI), and in 36 healthy volunteers. ONSD was measured on T2-weighted turbo spin-echo fat-suppressed sequence obtained at 3 Tesla MRI. ICP was measured invasively during the MRI scan via a parenchymal sensor in the TBI patients. RESULTS: Measurement of ONSD was possible in 95% of cases. The ONSD was significantly greater in TBI patients with raised ICP (>20 mmHg; 6.31 +/- 0.50 mm, 19 measures) than in those with ICP of 20 mmHg or less (5.29 +/- 0.48 mm, 26 measures; P < 0.0001) or in healthy volunteers (5.08 +/- 0.52 mm; P < 0.0001). There was a significant relationship between ONSD and ICP (r = 0.71, P < 0.0001). Enlarged ONSD was a robust predictor of raised ICP (area under the receiver operating characteristic curve = 0.94), with a best cut-off of 5.82 mm, corresponding to a negative predictive value of 92%, and to a value of 100% when ONSD was less than 5.30 mm. CONCLUSIONS: When brain MRI is indicated, ONSD measurement on images obtained using routine sequences can provide a quantitative estimate of the likelihood of significant intracranial hypertension

Diagnosing dysautonomia after acute traumatic brain injury : evidence for overresponsiveness to afferent stimuli

Objective: To differentiate between traumatic brain injury (TBI) subjects with normal and elevated autonomic activity by quantifying cardiac responsivity to nociceptive stimuli and to determine the utility of heart rate variability (HRV) and event-related heart rate changes in diagnosing dysautonomia. Design: Prospective cohort study. Setting: Intensive care unit in a tertiary metropolitan trauma center. Participants: Adults (N=27) with TBI recruited from 79 consecutive TBI admissions comprising 16 autonomically aroused and 11 control subjects matched by age, sex, and injury severity. Interventions: None. Main Outcome Measures: Immediate: pattern of autonomic changes indexed by HRV and event-related heart rate after nociceptive stimuli. Six months: length of stay, Glasgow Coma Scale, and Disability Rating Scale. Results: Heart rate changes (for both HRV and event-related heart rate) were associated with the diagnostic group and 6-month outcome when evaluated pre- and poststimulus but not when evaluated at rest. When assessed on day 7 postinjury, the comparison of HRV and heart rate parameters suggested an overresponsivity to nociceptive stimuli in dysautonomic subjects. These subjects showed a 2-fold increase in mean heart rate relative to subjects with sympathetic arousal of short duration (16% vs 8%), and a 6-fold increase over nonaroused control subjects. Data suggest that post-TBI sympathetic arousal is a spectrum disorder comprising, at one end, a short-duration syndrome and, at the other end, a dramatic, severe sympathetic and motor overactivity syndrome that continued for many months postinjury and associated with a significantly worse 6-month outcome. These findings suggest that it is not the presence of reactivity per se but rather the failure of processes to control for overreactivity that contributes to dysautonomic storming. Conclusions: This study provides empirical evidence that dysautonomic subjects show overresponsiveness to afferent stimuli. Findings from this study suggest an evidence-driven revision of diagnostic criteria and a simple clinical algorithm for the improved identification of cases