8 results on '"Myles, Nicholas"'
Search Results
2. The age at onset of psychosis and tobacco use: a systematic meta-analysis
- Author
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Myles, Nicholas, Newall, Hannah, Compton, Michael T., Curtis, Jackie, Nielssen, Olav, and Large, Matthew
- Published
- 2012
- Full Text
- View/download PDF
3. Systematic review and meta-analysis of rates of clozapine-associated myocarditis and cardiomyopathy.
- Author
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Siskind, Dan, Sidhu, Ashneet, Cross, John, Chua, Yee-Tat, Myles, Nicholas, Cohen, Dan, and Kisely, Steve
- Subjects
DRUG therapy for schizophrenia ,MORTALITY risk factors ,CLOZAPINE ,CONFIDENCE intervals ,DIABETES ,DRUG side effects ,MEDICAL information storage & retrieval systems ,PSYCHOLOGY information storage & retrieval systems ,MEDLINE ,META-analysis ,CARDIOMYOPATHIES ,ONLINE information services ,RISK assessment ,SYSTEMATIC reviews ,COMORBIDITY ,METABOLIC syndrome ,DISEASE incidence ,DISEASE risk factors - Abstract
Background: Clozapine is the most effective medication for treatment refractory schizophrenia, but is associated with cardiac adverse drug reactions. Myocarditis and cardiomyopathy are the most serious cardiac adverse drug reactions although reported rates of these conditions vary in the literature. We systematically reviewed and meta-analysed the event rates, the absolute death rates and case fatality rates of myocarditis and cardiomyopathy associated with clozapine. Methods: PubMed, EMBASE and PsycINFO were searched for studies that reported on the incidence of cardiomyopathy or myocarditis in people exposed to clozapine. Data were meta-analysed using a random effects model, with subgroup analysis on study size, time frame, region, quality, retrospective vs prospective, and diagnostic criteria of myocarditis or cardiomyopathy. Results: 28 studies of 258,961 people exposed to clozapine were included. The event rate of myocarditis was 0.007 (95% confidence interval [CI] = [0.003, 0.016]), absolute death rate was 0.0004 (95% CI = [0.0002, 0.0009]) and case fatality rate was 0.127 (95% CI = [0.034, 0.377]). The cardiomyopathy event rate was 0.006 (95% CI = [0.002, 0.023]), absolute death rate was 0.0003 (95% CI = [0.0001, 0.0012]) and case fatality rate was 0.078 (95% CI = [0.018, 0.285]). Few included studies provided information on criteria for diagnosis of myocarditis and cardiomyopathy. Event rates of cardiomyopathy and myocarditis were higher in Australia. Conclusion: Clarity of diagnostic criteria for myocarditis remains a challenge. Observation bias may, in part, influence higher reported rates in Australia. Monitoring for myocarditis is warranted in the first 4 weeks, and treatment of comorbid metabolic syndrome and diabetes may reduce the risk of cardiomyopathy. The risks of myocarditis and cardiomyopathy are low and should not present a barrier to people with treatment refractory schizophrenia being offered a monitored trial of clozapine. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
4. A meta-analysis of controlled studies comparing the association between clozapine and other antipsychotic medications and the development of neutropenia.
- Author
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Myles, Nicholas, Myles, Hannah, Xia, Shelley, Large, Matthew, Bird, Robert, Galletly, Cherrie, Kisely, Steve, and Siskind, Dan
- Subjects
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NEUTROPENIA , *ANTIPSYCHOTIC agents , *CLOZAPINE , *CONFIDENCE intervals , *MEDICAL information storage & retrieval systems , *PSYCHOLOGY information storage & retrieval systems , *MEDLINE , *META-analysis , *NEUTROPHILS , *SYSTEMATIC reviews , *DATA analysis , *EFFECT sizes (Statistics) , *SEVERITY of illness index , *DISEASE risk factors - Abstract
Background: In most countries, clozapine can only be prescribed with regular monitoring of white blood cell counts because of concerns that clozapine has a stronger association with neutropenia than other antipsychotics. However, this has not been previously demonstrated conclusively with meta-analysis of controlled studies. Methods: The aim of this study was to assess the strength of the association between clozapine and neutropenia when compared to other antipsychotic medications by a meta-analysis of controlled studies. An electronic search of Medline (1948–2018), PsycINFO (1967–2018) and Embase (1947–2018) using search terms (clozapine OR clopine OR clozaril OR zaponex) AND (neutropenia OR agranulocytosis) was undertaken. Random-effects meta-analysis using Mantel–Haenszel risk ratio was used to assess the strength of the effect size. Results: We located 20 studies that reported rates of neutropenia associated with clozapine and other antipsychotic medications. The risk ratio was not significantly increased in clozapine-exposed groups compared to exposure to other antipsychotic medications (Mantel–Haenszel risk ratio = 1.45, 95% confidence interval = [0.87, 2.42]). This also applied to severe neutropenia (absolute neutrophil count < 500 per µL) when compared to other antipsychotics (Mantel–Haenszel risk ratio = 1.65, 95% confidence interval = [0.58, 4.71]). The relative risk of neutropenia associated with clozapine exposure was not significantly associated with any individual antipsychotic medication. Conclusion: Data from controlled trials do not support the belief that clozapine has a stronger association with neutropenia than other antipsychotic medications. This implies that either all antipsychotic drugs should be subjected to haematological monitoring or monitoring isolated to clozapine is not justified. [ABSTRACT FROM AUTHOR]
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- 2019
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5. Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time.
- Author
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Large, Matthew, Kaneson, Muthusamy, Myles, Nicholas, Myles, Hannah, Gunaratne, Pramudie, and Ryan, Christopher
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PSYCHOTHERAPY patients ,SUICIDE risk factors ,MEDICAL care ,CATEGORIZATION (Psychology) ,COHORT analysis ,META-analysis - Abstract
Objective: It is widely assumed that the clinical care of psychiatric patients can be guided by estimates of suicide risk and by using patient characteristics to define a group of high-risk patients. However, the statistical strength and reliability of suicide risk categorization is unknown. Our objective was to investigate the odds of suicide in high-risk compared to lower-risk categories and the suicide rates in high-risk and lower-risk groups. Method: We located longitudinal cohort studies where psychiatric patients or people who had made suicide attempts were stratified into high-risk and lower-risk groups for suicide with suicide mortality as the outcome by searching for peer reviewed publications indexed in PubMed or PsychINFO. Electronic searches were supplemented by hand searching of included studies and relevant review articles. Two authors independently extracted data regarding effect size, study population and study design from 53 samples of risk-assessed patients reported in 37 studies. Results: The pooled odds of suicide among high-risk patients compared to lower-risk patients calculated by random effects meta-analysis was of 4.84 (95% Confidence Interval (CI) 3.79–6.20). Between-study heterogeneity was very high (I
2 = 93.3). There was no evidence that more recent studies had greater statistical strength than older studies. Over an average follow up period of 63 months the proportion of suicides among the high-risk patients was 5.5% and was 0.9% among lower-risk patients. The meta-analytically derived sensitivity and specificity of a high-risk categorization were 56% and 79% respectively. There was evidence of publication bias in favour of studies that inflated the pooled odds of suicide in high-risk patients. Conclusions: The strength of suicide risk categorizations based on the presence of multiple risk factors does not greatly exceed the association between individual suicide risk factors and suicide. A statistically strong and reliable method to usefully distinguish patients with a high-risk of suicide remains elusive. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
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6. Obstructive sleep apnea and schizophrenia: A systematic review to inform clinical practice.
- Author
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Myles, Hannah, Myles, Nicholas, Antic, Nick A., Adams, Robert, Chandratilleke, Madhu, Liu, Dennis, Mercer, Jeremy, Vakulin, Andrew, Vincent, Andrew, Wittert, Gary, and Galletly, Cherrie
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HYPNAGOGIA , *META-analysis , *SLEEP apnea syndromes , *SCHIZOPHRENIA , *PSYCHOSES , *SCHIZOPHRENIA treatment , *SLEEP apnea syndrome treatment , *SYSTEMATIC reviews , *DISEASE complications - Abstract
Background: Risk factors for obstructive sleep apnea (OSA) are common in people with schizophrenia. Identification and treatment of OSA may improve physical health in this population; however there are no guidelines to inform screening and management.Objectives: Systematic review to determine, in people with schizophrenia and related disorders: the prevalence of OSA; the prevalence of OSA compared to general population controls; the physical and psychiatric correlates of OSA, associations between antipsychotic medications and OSA; the impact of treatment of OSA on psychiatric and physical health; and the diagnostic validity of OSA screening tools.Data Sources: Medline, EMBASE, ISI Web of Science and PsycINFO electronic databases. Cohort, case-control and cross-sectional studies and RCTs reporting on prevalence of OSA in subjects with schizophrenia and related disorders were reviewed.Results: The prevalence of OSA varied between 1.6% and 52%. The prevalence of OSA was similar between people with schizophrenia and population controls in two studies. Diagnosis of OSA was associated with larger neck circumference, BMI>25, male sex and age>50years. There were no data on physical or psychiatric outcomes following treatment of OSA. The diagnostic utility of OSA screening tools had not been investigated.Conclusion: OSA may be prevalent and potentially under-recognized in people with schizophrenia. Further research is required to determine utility of OSA screening tools, the relationships between antipsychotic medications and OSA and any benefits of treating OSA. We propose a strategy for the identification of OSA in people with schizophrenia and related disorders. [ABSTRACT FROM AUTHOR]- Published
- 2016
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7. Systematic meta-analysis of individual selective serotonin reuptake inhibitor medications and congenital malformations.
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Myles, Nicholas, Newall, Hannah, Ward, Harvey, and Large, Matthew
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CINAHL database , *CONFIDENCE intervals , *EPIDEMIOLOGY , *MEDICAL information storage & retrieval systems , *PSYCHOLOGY information storage & retrieval systems , *MEDLINE , *META-analysis , *SEROTONIN uptake inhibitors , *SYSTEMATIC reviews , *DATA analysis , *DRUG-induced abnormalities - Abstract
The article offers information on a study conducted by the authors related to the association between antidepressants selective serotonin reuptake inhibitors (SSRIs) and malformations in heart of infants, whose mothers take these antidepressants. It states that paroxetine and fluoxetine caused malformations in infants. It highlights that citalopram and sertraline did not cause much problem in infants.
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- 2013
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8. Tobacco Use Before, At, and After First-Episode Psychosis: A Systematic Meta-Analysis.
- Author
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Myles, Nicholas, Newall, Hannah D., Curtis, Jackie, Nielssen, Olav, Shiers, David, and Large, Matthew
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META-analysis ,TOBACCO use ,PSYCHOSES ,MEDICAL research evaluation ,SUBSTANCE abuse ,PATIENTS - Abstract
The article presents a meta-analysis of the interval between tobacco use initiation and first-episode psychosis, the prevalence and course of tobacco use during early psychosis. Data including the age at tobacco use initiation, psychosis onset, and the proportion of the general population that used tobacco are cited to have been extracted from several studies. First-episode psychosis patients are described to have been found to have smoked for years prior to onset of psychosis.
- Published
- 2012
- Full Text
- View/download PDF
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