Colonic transit studies to measure gastrointestinal motility in antipsychotic treated patients

This is the research protocol for an observational (cross-sectional) study investigating gastrointestinal motility in antipsychotic treated patients. Recruitment for this study will begin in 2014

Pathways to practice: overseas trained psychiatrists\u27 experiences of the processes involved in commencing professional practice in Australasia

Abstract Objective: There are significant shortages in the psychiatric workforce in Australasia, particularly in the rural and remote regions of Australia and New Zealand. In response to these shortages, mental health services have recruited large numbers of overseas trained psychiatrists (OTP). These are specialist psychiatrists, trained and recognised as such in other countries. Our objective was to ascertain how OTPs experience the processes of commencing professional practice in Australasia. Method: OTPs were surveyed to identify the pathways to obtaining specialist registration and College Fellowship in Australasia and to explore their experiences as they engaged in this process. Results: Although limited by a low response rate, the data does highlight a level of discontentment among those OTPs surveyed. The key issues identified related to the examination process, poor communication between different agencies (including the RANZCP), visa and residency related issues, medical board registration difficulties and notable differences between Australia and New Zealand. Conclusion: There is a negative perception among OTPs regarding the existing pathways to registration as specialist psychiatrists and the attainment of Fellowship. We submit that the RANZCP has a central and important role in resolving some of the underlying issues and supporting OTPs as vital and valued members of the workforce in Australia and New Zealand. Keywords: Australasia, experiences, overseas trained psychiatrists, RANZCP, workforc

Pathways to practice: overseas trained psychiatrists' experiences of the processes involved in commencing professional practice in Australasia

Objective: There are significant shortages in the psychiatric workforce in Australasia, particularly in the rural and remote regions of Australia and New Zealand. In response to these shortages, mental health services have recruited large numbers of overseas trained psychiatrists (OTP). These are specialist psychiatrists, trained and recognised as such in other countries. Our objective was to ascertain how OTPs experience the processes of commencing professional practice in Australasia

Colonic transit studies to measure gastrointestinal motility in antipsychotic treated patients

This is the research protocol for an observational (cross-sectional) study investigating gastrointestinal motility in antipsychotic treated patients. Recruitment for this study will begin in 2014

Long-term psychiatric inpatients’ perspectives on weight gain, body satisfaction, diet and physical activity: a mixed methods study

Abstract Background Obesity is a significant problem for people with serious mental illness. We aimed to consider body size from the perspective of long-stay psychiatric inpatients, focussing on: weight gain and its causes and impacts; diet and physical activity; and the perceived ability to make meaningful change in these domains. Method A mixed methods study with 51 long-term psychiatric forensic and rehabilitation inpatients using semi-structured interviews combined with biometric and demographic data. Results 94% of participants were overweight or obese (mean BMI 35.3, SD 8.1). They were concerned about their weight, with 75% of them attempting to lose weight. Qualitative responses indicated low personal effectiveness and self-stigmatisation. Participants viewed their weight gain as something ‘done to them’ through medication, hospitalisation and leave restrictions. A prevailing theme was that institutional constraints made it difficult to live a healthy life (just the way the system is). Many had an external locus of control, viewing weight loss as desirable but unachievable, inhibited by environmental factors and requiring a quantum of motivation they found hard to muster. Despite this, participants were thoughtful and interested, had sound ideas for weight loss, and wished to be engaged in a shared endeavour to achieve better health outcomes. Consulting people as experts on their experiences, preferences, and goals may help develop new solutions, remove unidentified barriers, and improve motivation. Conclusions The importance of an individualised, multifactorial approach in weight loss programmes for this group was clear. Patient-led ideas and co-design should be key principles in programme and environmental design

Clozapine-treated Patients Have Marked Gastrointestinal Hypomotility, the Probable Basis of Life-threatening Gastrointestinal Complications: A Cross Sectional Study

Background: Gastrointestinal side effects are particularly common with clozapine and occur with other antipsychotics, ranging from mild constipation to fatal bowel obstruction and/or ischemia. While this adverse-effect spectrum has been attributed to ‘gastrointestinal hypomotility’, gastrointestinal transit times in antipsychotic-treated patients have not previously been measured, making this mechanism speculative. Methods: Using standardized radiopaque marker (‘Metcalf’) methods we established colonic transit times of antipsychotic-treated psychiatric inpatients and compared them with population normative values. We analyzed results by antipsychotic type, antipsychotic dose equivalent, anticholinergic load, duration of treatment, gender, ethnicity, and age. Outcomes: For patients not prescribed clozapine, median colonic transit time was 23 h. For patients prescribed clozapine, median transit time was 104.5 h, over four times longer than those on other antipsychotics or normative values (p < 0.0001). Eighty percent of clozapine-treated patients had colonic hypomotility, compared with none of those prescribed other antipsychotics (olanzapine, risperidone, paliperidone aripiprazole, zuclopenthixol or haloperidol). In the clozapine group, right colon, left colon and rectosigmoid transit times were all markedly abnormal suggesting pan-colonic pathology. Hypomotility occurred irrespective of gender, age, ethnicity, or length of clozapine treatment. Transit times were positively correlated with clozapine plasma level (rho = 0.451, p = 0.045), but not with duration of treatment, total antipsychotic load or demographic factors. Interpretation: Clozapine, unlike the other antipsychotics examined, causes marked gastrointestinal hypomotility, as previously hypothesized. Pre-emptive laxative treatment is recommended when starting clozapine

Self-reported sleep in late pregnancy in relation to birth size and fetal distress:the E Moe, Māmā prospective cohort study

OBJECTIVES: To explore associations between features of sleep during pregnancy and adverse outcomes for the infant. SETTING: E Moe, Māmā is a cohort study in Aotearoa/New Zealand that investigates self-reported sleep and maternal health in late pregnancy and the postpartum period. PARTICIPANTS: Women (N=633; 194 Māori) reported detailed information on their sleep duration, quality, disturbances, disorders (snoring, breathing pauses, twitching legs, restless legs) and daytime sleepiness between 35 and 37 weeks gestation. OUTCOME MEASURES: Birthweight and fetal distress during labour were extracted from medical records. Associations between each sleep variable and small or large for gestational age (SGA/LGA) using customised birthweight centile or fetal distress were estimated using multinomial/logistic regression, controlling for potential confounders. Secondary analyses considered differences in associations between Māori and non-Māori women. RESULTS: There was some indication that breathing pauses (a measure of sleep apnoea) were associated with both SGA (OR 2.8, 95% CI 0.9 to 9.0, p=0.08) and LGA (OR 2.0, 95% CI 0.7 to 5.7, p=0.20), with the association for LGA being stronger when only pregnancy-onset breathing pauses were considered (OR 3.5, 95% CI 1.3 to 9.6, p=0.01). There was also some evidence that pregnancy-onset leg twitching (OR 3.3, 95% CI 1.1 to 10.0, p=0.03) and frequent sleep disturbance due to feeling too hot or too cold (OR 1.7, 95% CI 0.9 to 3.6, p=0.13) were associated with higher risk of fetal distress. Other sleep measures, including snoring, were not associated with SGA, LGA or fetal distress. Many of the associations we observed were considerably stronger in Māori compared with non-Māori women. CONCLUSIONS: We did not find evidence of previously reported associations between snoring and SGA. Our findings tentatively suggest that self-reported breathing pauses and leg twitching in late pregnancy are associated with infant outcomes, and highlight ethnic inequalities