Alfred Psychiatry Research Centre (APRC)

Study Staff:

Bipolar Affective Disorder (BPAD) and schizoaffective disorder are mood disorders characterised by either an alternation, or a combination of depression and mania. The person may also experience symptoms of psychosis. The most common treatment for these disorders is a group of medications known as conventional mood stabilisers (lithium, sodium valproate and carbamazepine). Atypical antipsychotic medications, such as olanzapine, are increasingly prescribed in the treatment of patients with these disorders. To date, no study has assessed the true clinical use (i.e. not a randomised clinical trial) of atypical antipsychotics in the long-term treatment of bipolar or schizoaffective disorder. There is also a paucity of information on the long-term treatment and outcome of these disorders.

The Alfred Psychiatry Research Centre (APRC) is conducting an observational study that will follow up over 200 people who experience symptoms of BPAD or Schizoaffective Disorder at 3 monthly intervals, for a period of two years. This study will provide information about the course and experience of these disorders, the use and effectiveness of the treatments involved, and the social and economic impact of these disorders. This observational study will include measures of symptoms (both mania and depression), severity, frequency and duration of episodes, quality of life, functional status, treatment and adherence to treatment, and health care service use and costs.

The APRC completed recruitment for the study in December 2005, and are hopeful that the participant visits will be complete by December 2007.

The staff at APRC would like to thank all of the participants involved for their invaluable contribution to the study.

Schizophrenia Care and Assessment Program (SCAP)

Investigators:

The SCAP study is a prospective, non-randomised, observational study designed to evaluate the relationship between usual medical care as delivered in various health systems and the clinical, humanistic, and economic outcomes of care. A global study, SCAP is following more than 2700 people with schizophrenia over a 3-year period (2400 people at six sites in the United States, and 350 people at this one site in Australia). SCAP collects a wide range of information including, the types of care patients receive, from whom, at what cost, and with what effect. More specifically, SCAP aims to examine factors that predict the costs, outcomes and cost-effectiveness of a wide range of interventions including drug therapies.

The Schizophrenia Care and Assessment Program (SCAP) was commenced at the Dandenong Psychiatry Research Centre. Clients were recruited from the catchment area of the Dandenong Area Mental Health Service and while the study is no longer in the recruitment phase, follow-up is continuing.

Recruitment for the project began in December 1997 and finished in June 2000. Male or female patients 18 years or older who fulfilled the criteria for schizophrenia, schizophreniform, or schizoaffective disorder, as defined by DSM-IV, were included provided they were able to give informed consent and were able to understand and communicate in English sufficiently well to participate in the interviews.

Follow-up assessments are completed at six-monthly intervals. At each visit, the SCAP Health Questionnaire, an instrument designed to measure a broad range of outcome domains is completed. Ratings of psychopathology, quality of life and extra-pyramidal side effects are conducted annually, using a combination of objective and subjective measures.

At this time there are approximately 150 people still ongoing in the project, with the final assessments due to be completed in June 2003. Data is constantly being released and prepared for publication.

Neuropsychological functioning and quality of life in people with schizophrenia enrolled in the Schizophrenia Care and Assessment Program (SCAP)

Investigators:

Objectives

There is a paucity of research into the relationship between neuropsychological functioning and quality of life in people with schizophrenia. Therefore, in an exploratory fashion, the current study will examine the relationship between neuropsychological functioning, and objective and subjective measures of quality of life in people with schizophrenia. Furthermore, this study will examine the relationship between psychopathology and neuropsychological functioning as well as examine the comparative efficacy of atypical and typical antipsychotic medications on neuropsychological functioning in people with schizophrenia.

Methodology

This study is part of a bigger project, namely the Schizophrenia Care and Assessment Program (SCAP). The SCAP project aims to improve the quality of mental health care for people with schizophrenia by observing patients with the disorder worldwide over a three-year period. The examination of neuropsychological functioning is unique to the Australian site of the SCAP project.

To date, 93 participants from the Australian site of the SCAP study, with a diagnosis of schizophrenia, have participated in the current study. All participants are administered a comprehensive neuropsychological test battery as well as clinical test instruments.

Results

There is a significant relationship between quality of life measures and neuropsychological functioning in people with schizophrenia. Furthermore, there is a significant relationship between psychopathology and neuropsychological functioning in people with schizophrenia.

Discussion

Both the presence of psychopathology and cognitive deficits can be devastating and debilitating. This research demonstrates the importance of interventions aimed at alleviating or reducing the impact of these symptoms, in order to increase a person's quality of life.

Suicide and Problem Gambling – A Community Partnership Strategy for Problem Gamblers

Investigators:

Ms. Judy Chow-Fairhall
Mr Anthony de Castella
Ms Nadya Kouzma
Dr Yitz Hollander
Ms Suellen Butler
Mr David Watkins

Recent clinical studies have reported elevated levels of suicidality in pathological gamblers ranging between 17% to 80% for suicidal ideation (Leiseur & Bloom, 1990; Horodecki, 1992; Schwatz & Libndner, 1992) and 4% to 23% for attempts (Blaszczynski & Marfels, 2002; Frank, Lester & Wexker, 1991; Schwatz & Lindner, 1992; Sullivan, 1994; & Thompson 1998). Recent media reports linking suicide to excessive gambling losses have also drawn further community attention to this major public health issue. Given the available literature, and the large number of people who present to the Emergency Department (ED) of the Alfred Hospital with suicidal ideation, intent, or attempt, it is expected that a significant percentage (4% to 12%) of this population will experience problem gambling (PG).

Over the next 12 months, this study will investigate the prevalence of PG in people who present at ED with suicidal attempt/ideation and are seen by the Crisis Assessment & Treatment Service or Psychiatric Triage Service. Through an in-depth interview and utilising a variety of relevant research instruments, it will also examine the extent and consequences of PG in these people. The study will incorporate a screening and risk assessment protocol for PG into an existing health risk screening process used by The Alfred CATT/Triage service and will also develop and deliver a short-term intervention strategy for people identified with PG.

It is anticipated that this will help to place PG within a public health perspective and to view problem gambling behaviour along a health-related continuum, taking into consideration risk, resiliency, and protective factors that can influence the development of gambling related problems. In turn this will help to create awareness and promote the inclusion of problem gambling screening in mental health assessment amongst health professionals that work in the acute and crisis mental health areas and strengthen relationships and develop a working protocol between the various services, (ED, CATT/Triage, and Problem Gambling services), which interface with people experiencing PG.