Skilled yet lost? Challenges of international medical graduates in psychiatry: Australian perspective

Abstract of presentation at the 67th Annual National Conference of the Indian Psychiatric Society (ANCIPS 2015), at Hyderabad, India, 8-11 January 2015

Early Australian experience in the maintenance of schizophrenia management with 3-monthly paliperidone palmitate

Objectives: Real-world experience from a 6-month product familiarization programme (PFP) for 3-monthly paliperidone palmitate in schizophrenia maintenance treatment. Methods: Prescribers completed an online questionnaire for each patient at enrolment with further questions at second dose (re-supply) stage and a second survey of their overall experience at the end. Results: Ninety-four patients were enrolled and received a first dose and 23 received a second dose within the 6-month programme; 51.1% had been hospitalised for symptom relapse in the previous 2 years. Reasons for prescribing were convenience of 3-monthly dosing for patients (94.7%) and patient choice (54.6%). Prescribers followed-up at least once-monthly (69.6% cases) and indicated in 48.9% they would consider shared GP care. All patients were satisfied with symptom control and either maintained functioning or showed improvement. Clinicians felt confident with administration and identifying suitable patients and were all \u27satisfied\u27 or \u27somewhat satisfied\u27 with efficacy and tolerability. All felt patients\u27 treatment goals were either \u27met\u27 (81.3%) or \u27partly met\u27 (18.7%) and none reported dissatisfaction with relapse prevention. Conclusions: Convenient 3-monthly dosing was preferred by clinicians and patients, and symptoms were adequately managed. This has the potential to improve adherence and lead to better outcomes as patients only need four intramuscular doses per year

A systematic review of the quality of life of carers of children with cleft lip and/or plate

Caring for an infant or child requires a significant amount of time, energy and resources; this burden is further increased when the infant or child has a chronic condition or disability. Prior research has demonstrated that caregiving for a child with special needs impacts upon parents or carers mental health, well-being and quality of life. This article systematically reviews the literature pertaining to the impact of caring for a child with cleft lip and /or palate upon parental quality of life. A search of four databases was conducted with a number of key terms; the titles, abstracts and finally the whole article were read and assessed for relevance. Only articles written in English were included in the review. The results yielded four relevant articles; that displayed inconsistent results. The results of these articles are reviewed. It was evident that the construct of quality of life was narrowly operationalised in all four articles either being assessed as health-related quality of life or as the impact upon the family. Further all four studies emanated from the same country. The limitations are discussed with recommendations made for future research endeavours

Depletion of glutathione and enhanced lipid peroxidation in the CSF of acute psychotics following haloperidol administration

Haloperidol administration for 2 weeks results in significant reduction in the concentration of GSH in the CSF. Concomitantly, the levels of lipid peroxidation products increased as evidenced by increased malondialdehyde levels. The malondialdehyde levels in the CSF prior to haloparidol administration were not significantly higher than that seen in CSF from normal controls (data not shown) suggesting that increased oxidative stress did not exist in these patients prior to haloperidol administration. All the patients included in the present study were drug naive and hence the changes observed in the glutathione and malon6ialdehyde levels in the CSF were indeed mediated by haloperidol administration. The only other medication that was administered namely, anticholinergic drug, trihexyphenidyl is not known to cause any oxidative stress. The present study thus demonsuates that haloperidol administration results in significant oxidative stress. The generation of the oxidative stress is probably due to the increased turnover of dopemine caused by typical neuroleptics. Increased dopamine turnover is also observed in Parkinson's disease and the combination therapy consisting of antioxidant vitamin E and monoamine oxidase inhibitor, deprenyl has been shown to offer limited protection against the progression of the disease (Parkinson Disease Study Group 1989). In the present study, all the 15 patients exhibited extrapyramidal symptoms although the time of onset, the duration and the severity of the side effects differed between patients. On the presumption that the oxidative stress generated by haloperidel may cause extrapyramidal symptoms, the present study in humans taken together with the evidence provided in our earlier studies on rats (Shivakumar and Ravindranath 1992,1993) may justify experimental coadministration of antioxidanls (e.g., vitamin E) with typical neuroleptics like haloperidol to prevent the acute side effects

Preventing olanzapine-induced weight gain using betahistine: a study in a rat model with chronic olanzapine treatment

Olanzapine is the one of first line antipsychotic drug for schizophrenia and other serious mental illness. However, it is associated with troublesome metabolic side-effects, particularly body weight gain and obesity. The antagonistic affinity to histamine H1 receptors (H1R) of antipsychotic drugs has been identified as one of the main contributors to weight gain/obesity side-effects. Our previous study showed that a short term (2 weeks) combination treatment of betahistine (an H1R agonist and H3R antagonist) and olanzapine (O+B) reduced (−45%) body weight gain induced by olanzapine in drug-naïve rats. A key issue is that clinical patients suffering with schizophrenia, bipolar disease and other mental disorders often face chronic, even life-time, antipsychotic treatment, in which they have often had previous antipsychotic exposure. Therefore, we investigated the effects of chronic O+B co-treatment in controlling body weight in female rats with chronic and repeated exposure of olanzapine. The results showed that co-administration of olanzapine (3 mg/kg, t.i.d.) and betahistine (9.6 mg/kg, t.i.d.) significantly reduced (−51.4%) weight gain induced by olanzapine. Co-treatment of O+B also led to a decrease in feeding efficiency, liver and fat mass. Consistently, the olanzapine-only treatment increased hypothalamic H1R protein levels, as well as hypothalamic pAMPKα, AMPKα and NPY protein levels, while reducing the hypothalamic POMC, and UCP1 and PGC-1α protein levels in brown adipose tissue (BAT). The olanzapine induced changes in hypothalamic H1R, pAMPKα, BAT UCP1 and PGC-1α could be reversed by co-treatment of O+B. These results supported further clinical trials to test the effectiveness of co-treatment of O+B for controlling weight gain/obesity side-effects in schizophrenia with chronic antipsychotic treatment

Serious Mental Illness, Neighborhood Disadvantage, and Type 2 Diabetes Risk: A Systematic Review of the Literature

Aim of the Study: This review aims to systematically synthesize the body of literature examining the association between neighborhood socioeconomic disadvantage and serious mental illness (SMI)-type 2 diabetes (T2D) co-occurrence. Methods: We conducted an electronic search of four databases: PubMed, Scopus, Medline, and Web of Science. Studies were considered eligible if they were published in English, peer reviewed, quantitative, and focused on the association between neighborhood disadvantage and SMI-T2D comorbidity. Study conduct and reporting complied with PRISMA guidelines, and the protocol is made available at PROSPERO (CRD42017083483). Results: The one eligible study identified reported a higher burden of T2D in persons with SMI but provided only a tentative support for the association between neighborhood disadvantage and SMI-T2D co-occurrence. Conclusion: Research into neighborhood effects on SMI-T2D comorbidity is still in its infancy and the available evidence inconclusive. This points to an urgent need for attention to the knowledge gap in this important area of public health. Further research is needed to understand the health resource implications of the association between neighborhood deprivation and SMI-T2D comorbidity and the casual pathways linking them

Optical pathology of oral tissue: a Raman spectroscopy diagnostic method

Raman and fluorescence spectroscopy methods are being considered as techniques which could be complementary or even alternative to biopsy, and pathology and clinical assays in many medical applications. The present paper discusses the results of Raman spectral studies on oral tissues for optical pathology. It is shown that Raman spectra of oral tissues can be classified into spectra of normal and malignant sets and a model based on such a classification can be used to analyse oral tissue for detection of oral malignancy. Sensitivity and specificity calculated from 90 test spectra are better than 85 and 90 per cent respectively

Micropropagation and conservation of selected endangered anticancer medicinal plants from the Western Ghats of India

Globally, cancer is a constant battle which severely affects the human population. The major limitations of the anticancer drugs are the deleterious side effects on the quality of life. Plants play a vital role in curing many diseases with minimal or no side effects. Phytocompounds derived from various medicinal plants serve as the best source of drugs to treat cancer. The global demand for phytomedicines is mostly reached by the medicinal herbs from the tropical nations of the world even though many plant species are threatened with extinction. India is one of the mega diverse countries of the world due to its ecological habitats, latitudinal variation, and diverse climatic range. Western Ghats of India is one of the most important depositories of endemic herbs. It is found along the stretch of south western part of India and constitutes rain forest with more than 4000 diverse medicinal plant species. In recent times, many of these therapeutically valued herbs have become endangered and are being included under the red-listed plant category in this region. Due to a sharp rise in the demand for plant-based products, this rich collection is diminishing at an alarming rate that eventually triggered dangerous to biodiversity. Thus, conservation of the endangered medicinal plants has become a matter of importance. The conservation by using only in situ approaches may not be sufficient enough to safeguard such a huge bio-resource of endangered medicinal plants. Hence, the use of biotechnological methods would be vital to complement the ex vitro protection programs and help to reestablish endangered plant species. In this backdrop, the key tools of biotechnology that could assist plant conservation were developed in terms of in vitro regeneration, seed banking, DNA storage, pollen storage, germplasm storage, gene bank (field gene banking), tissue bank, and cryopreservation. In this chapter, an attempt has been made to critically review major endangered medicinal plants that possess anticancer compounds and their conservation aspects by integrating various biotechnological tool

Nucleic acid amplification tests in the diagnosis of tuberculous pleuritis: a systematic review and meta-analysis

BACKGROUND: Conventional tests for tuberculous pleuritis have several limitations. A variety of new, rapid tests such as nucleic acid amplification tests – including polymerase chain reaction – have been evaluated in recent times. We conducted a systematic review to determine the accuracy of nucleic acid amplification (NAA) tests in the diagnosis of tuberculous pleuritis. METHODS: A systematic review and meta-analysis of 38 English and Spanish articles (with 40 studies), identified via searches of six electronic databases, hand searching of selected journals, and contact with authors, experts, and test manufacturers. Sensitivity, specificity, and other measures of accuracy were pooled using random effects models. Summary receiver operating characteristic curves were used to summarize overall test performance. Heterogeneity in study results was formally explored using subgroup analyses. RESULTS: Of the 40 studies included, 26 used in-house ("home-brew") tests, and 14 used commercial tests. Commercial tests had a low overall sensitivity (0.62; 95% confidence interval [CI] 0.43, 0.77), and high specificity (0.98; 95% CI 0.96, 0.98). The positive and negative likelihood ratios for commercial tests were 25.4 (95% CI 16.2, 40.0) and 0.40 (95% CI 0.24, 0.67), respectively. All commercial tests had consistently high specificity estimates; the sensitivity estimates, however, were heterogeneous across studies. With the in-house tests, both sensitivity and specificity estimates were significantly heterogeneous. Clinically meaningful summary estimates could not be determined for in-house tests. CONCLUSIONS: Our results suggest that commercial NAA tests may have a potential role in confirming (ruling in) tuberculous pleuritis. However, these tests have low and variable sensitivity and, therefore, may not be useful in excluding (ruling out) the disease. NAA test results, therefore, cannot replace conventional tests; they need to be interpreted in parallel with clinical findings and results of conventional tests. The accuracy of in-house nucleic acid amplification tests is poorly defined because of heterogeneity in study results. The clinical applicability of in-house NAA tests remains unclear

Australian overview of best practices in recovery and rehabilitation services for people with Schizophrenia

Abstract of a presentation