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Objective: The co-occurrence of type 2 diabetes and psychosis is an important form of medical comorbidity within individuals, but no large-scale study has evaluated comorbidity within families. The aim of this study was to determine whether there is evidence for familial comorbidity between type 2 diabetes and psychosis. Method: Data were analysed from an observational study of a nationally representative sample of 1642 people with psychosis who were in contact with psychiatric services at the time of survey (The 2010 Australian National Survey of Psychosis). Participants were aged 18–64 years and met World Health Organization’s International Classification of Diseases, 10th Revision diagnostic criteria for a psychotic disorder (857 with schizophrenia, 319 with bipolar disorder with psychotic features, 293 with schizoaffective disorder, 81 with depressive psychosis and 92 with delusional disorder or other non-organic psychoses). Logistic regression was used to estimate the association between a family history of diabetes and a family history of schizophrenia. Results: A positive family history of diabetes was associated with a positive family history of schizophrenia in those with a psychotic disorder (odds ratio = 1.35, p = 0.01, adjusted for age and gender). The association was different in those with an affective versus non-affective psychosis (odds ratio = 0.613, p = 0.019, adjusted for age and gender) and was significant only in those with a non-affective psychosis, specifically schizophrenia (odds ratio = 1.58, p = 0.005, adjusted for age and sex). Adjustment for demographic factors in those with schizophrenia slightly strengthened the association (odds ratio = 1.74, p = 0.001, adjusted for age, gender, diagnosis, ethnicity, education, employment, income and marital status). Conclusion: Elevated risk for type 2 diabetes in people with schizophrenia is not simply a consequence of antipsychotic medication; type 2 diabetes and schizophrenia share familial risk factors. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. Method: Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. Results: The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. Conclusion: In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Little is known about community mental health service use prior to offending. Aim This study aimed to investigate the 1-year community mental health service use by adult offenders (18-44 years) prior to their first ever criminal sentence in Western Australia. Methods Administrative mental health service data were compared between all offenders (n = 23,755) commencing their first ever criminal sentence in Western Australia during 1985-1994 and a matched community group of 21,977 non-offenders. Results Just over 8% of offenders had used mental health services prior to sentence compared with 1% of non-offenders. After adjusting for age, offenders were more likely to have used these services than non-offenders in all gender-race groups, but the effect was strongest for non-Indigenous women, who were over 12 times more likely to have used such services, and weakest among Indigenous men, who were about twice as likely to have used them as their non-offending peers. Service use for substance use disorder, the most common diagnosis, was about one and a half times more prevalent among Indigenous than non-Indigenous offenders, regardless of gender. For non-Indigenous offenders, prevalence of any mental health service contact was higher for violent than non-violent offenders, irrespective of gender. Service use was no different between offenders receiving custodial or non-custodial sentences in all gender-race groups. Conclusion The higher likelihood of mental health service use by offenders in the year prior to their first ever sentence than by non-offenders suggests that, insofar as the disorder was relevant to offending, there were some opportunities for preventive measures during that time. Differential service use according to gender and Indigenous/non-Indigenous status is of concern. It would be important to understand more about this apparently unequal service access, not least because Indigenous populations tend to be over-represented in prison. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated mental health services utilisation based on the results of the 2010 Australian national survey of psychosis. It reports the design and administration of the survey, the random selection of interview participants on topics including substance use, psychopathology, and education, and the diagnostic assessment performed. Various factors that determine mental health services utilisation are outlined including inpatient admissions and home visits.

The article presents a comparison of first and second national survey of psychosis in Australia regarding the costs of psychosis in 2000 and 2010. Topics discussed include minimum difference between the average annual costs of psychosis between the two surveys, the cost difference obtained due to changes in resource which added upto 3,183 Australian dollars per person in the second survey and several tables related to the costs of psychosis for individuals.

The article discusses a study which estimated from societal and government perspectives the annual costs of psychosis in Australia for 2010 and assessed whether average costs per person differ by principal service provider at time of census. Results show that the average annual costs of psychosis are estimated at 77,297 Australian dollars per affected individual. It concluded that the costs of psychosis are broad ranging and very high.

The article discusses a study that aims to examine the prevalence of prior and current mental health disorders in parents of infants born in Western Australia (WA) between 1990 and 2005. The study analyzed trends in the disorders over the period, and highlighted an increase in prevalence of parents with a prior history of mental health disorders in WA. The study concluded that mental health workers can identify mental illness and work with such families to offer early intervention.

Background: Recent evidence points to partially shared genetics of neuropsychiatric disorders.Aims: We examined risk of intellectual disability and other neuropsychiatric outcomes in 3174 children of mothers with schizophrenia, bipolar disorder or unipolar major depression compared with 3129 children of unaffected mothers.Method: We used record linkage across Western Australian population-based registers. The contribution of obstetric factors to risk of intellectual disability was assessed.Results: Children were at significantly increased risk of intellectual disability with odds ratios (ORs) of 3.2 (95% CI 1.8-5.7), 3.1 (95% CI 1.9-4.9) and 2.9 (95% CI 1.8-4.7) in the maternal schizophrenia, bipolar disorder and unipolar depression groups respectively. Multivariate analysis suggests familial and obstetric factors may contribute independently to the risk. Although summated labour/delivery complications (OR = 1.4, 95% CI 1.0-2.0) just failed to reach significance, neonatal encephalopathy (OR = 7.7, 95% CI 3.0-20.2) and fetal distress (OR = 1.8, 95% CI 1.1-2.7) were independent significant predictors. Rates of rare syndromes in children of mothers with mental disorder were well above population rates. Risk of pervasive developmental disorders, including autism, was significantly elevated for children of mothers with bipolar disorder. Risk of epilepsy was doubled for children of mothers with unipolar depression.Conclusions: Our findings provide epidemiological support for clustering of neuropsychiatric disorders. Further larger epidemiological studies are warranted. [ABSTRACT FROM AUTHOR]

A population-based record linkage case cohort of 239,995 births, to 119,214 women, born in Western Australia from 1980 to 2001 inclusive, was used to measure the recording of selected indicators of maternal health (current and prior) during pregnancy. We compared records of women with singleton pregnancies with that in twin pregnancies Mothers of first- and second-born singletons (n = 117,647) were compared with women with a first-born singleton followed by twins (n = 1,567). Binary indicators were used to calculate population prevalence of medical conditions, pregnancy complications and birth outcomes. Infant outcomes included stillbirth, low birthweight, preterm birth and birth defects. Women with twins were significantly older and taller, with similar rates of medical conditions and pregnancy complications during first singleton pregnancies compared with women with two consecutive singletons. However, during their second pregnancy, women with twins had significantly higher rates of essential hypertension, pre-eclampsia, threatened abortion, premature rupture of the membranes and ante partum hemorrhage with abruption than women with singletons. For both groups, maternal conditions in the first pregnancy were underreported in the second pregnancy, including diabetes, epilepsy, asthma, chronic renal dysfunction and essential hypertension. At the second birth, twins were 3 times more likely to be stillborn, 17 times more likely to be low birthweight and 4 times more likely to be delivered preterm compared with singletons. This research demonstrates the importance for epidemiologists and others, of having access to a complete maternal medical history for analyses of risks associated with maternal, infant and childhood morbidity. [ABSTRACT FROM AUTHOR]

The article presents a research related to the impact of schizophrenia on social organization and urbanicity in Australia. It states that schizophrenia is the most common of the psychotic disorders and is characterized by fundamental distortions of thought, perception and emotional response. The aim of the study was to identify the influence or area residence on arrest and on recorded diagnoses of schizophrenia. Furthermore, the study takes advantage of prior record linkage between two population-based registers, the Western Australian Mental Health Information System and the Western Australian Arrestee Database.

Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, a recently reported autoimmune disorder, can be mistakenly diagnosed as a psychotic disorder, especially schizophrenia, as patients can present with prominent psychotic symptoms, in particular persecutory ideation, hallucinations and disturbed speech. In this study we used machine learning of the clinical data in a large cohort of persons with a positive psychosis history to ascertain whether we could predict NMDAR-positive cases, and which variables most accurately distinguished between NMDAR-positive and -negative cases. Methods: SHIP collected nationally representative data from 1825 individuals with a psychotic illness. Plasma samples were available for n=472. To investigate the prevalence of NMDAR autoantibodies a recombinant indirect immunofluorescence test was performed (EuroImmun AG, Lübeck, Germany), with NMDAR transfected human embryonic kidney (HEK) 293 cells quantified using NIS Elements software. NMDAR-positive cases were estimated. Gradient boosting machine learning (the data were randomly split: 60% for initial ascertainment and 40% for validation) was subsequently performed using the clinical data available: 120 variables in total across various domains of sociodemographic, medical history, psychiatric diagnosis and current psychiatric symptoms. Only the variables found to have significant (or near significant) association with being NMDAR-positive were used to develop rules for identifying cases. Results: There were 38 NMDAR-positive cases. They were more likely to be associated with a schizophrenia /schizoaffective and a depressive psychosis diagnosis, and less likely to be associated with a bipolar diagnosis, than antibody-negative cases. They were also more likely to be associated with a single episode with good recovery, and with anxiety symptoms and dizziness in the prior 12 months (which included light headedness, feeling faint and unsteady). For the present state symptoms, restricted affect was more likely to be present whereas poverty of speech was rare. Initial insomnia and a medical history that included epilepsy were not present for any of the NMDAR-positive cases. The machine learning algorithm was able to successfully classify 94% of cases to the correct antibody group. Discussion: In this significant Australian epidemiological cohort, we have identified key clinical features associated with anti-NMDAR encephalitis, including diagnosis, and symptoms and clinical course. The novel and insightful analyses afforded by using machine learning should be replicated in other samples to confirm the important clinical findings reported in the current work. [ABSTRACT FROM AUTHOR]

Este estudio determinó la incidencia de complicaciones durante el embarazo, y el parto y las características neonatales de los hijos de mujeres con esquizofrenia, trastorno bipolar o depresión mayor en una cohorte de base poblacional. Método: Basándose en un enlace entre registros (record linkage) de pacientes psiquiátricos y en datos obstétricos recopilados prospectivamente, el estudio comprendió a mujeres con esquizofrenia o trastornos afectivos mayores que habían dado a luz a 3. 174 niños entre 1980 y 1992 en Australia Occidental. Se seleccionó, de forma aleatorizada, una muestra de control de 3. 129 hijos de mujeres sin diagnóstico psiquiátrico entre todas las mujeres que habían dado a luz entre 1980 y 1992. Las complicaciones fueron puntuadas con la escala de McNeil-Sjostram. Se calcularon las razones de probabilidad para determinadas incidencias del proceso de procreación. Resultados: Los pacientes con trastornos esquizofrenico o afectivo tenían mayor riesgo de complicaciones durante el embarazo, el parto y el período neonatal, incluyendo problemas placentarios, hemorragias preparto y sufrimiento fetal. Las mujeres con esquizofrenia tenían una probabilidad significativamente mayor de presentar un desprendimiento prematuro de la placenta, dar a luz a hijos con un peso y un índice de crecimiento situados en el percentil más bajo de la población o tener hijos con alteraciones congénitas cardiovasculares. Las complicaciones neonatales tenían una probabilidad significativamente mayor de presentarse en invierno; el bajo peso de nacimiento alcanzó los valores máximos en primavera. Otras complicaciones, diferentes del bajo peso y de las alteraciones congénitas, fueron más frecuentes en los embarazos que siguieron a una enfermedad psiquiátrica que en los embarazos que precedieron al diagnóstico. Conclusiones: Aunque la predisposición genética y las interacciones genético ambientales pueden explicar algunas de las complicaciones, los factores de riesgo maternos y los factores biológicos y comportamentales que acompañan a una enfermedad mental grave son los principales factores determinantes del aumento de la patología de la procreación en esta cohorte. Las oportunas intervenciones prenatales y posnatales deberían reducir el riesgo en estos grupos vulnerables. [ABSTRACT FROM PUBLISHER]

Background A range of adversities have been implicated as risks for schizophrenia. Adversities often cluster, with synergistic impact, which may vary by age of exposure. We expand on current understanding, and propose a method for ranking combinations of adversities associated with risk of schizophrenia, to derive a risk prediction measure. Methods We used prospectively collected data for 430,000 children born 1980–2001 in Western Australia, and their parents. Follow up continued until 2015 using linked State registers, identifying 1,620 children with schizophrenia. Five domains of adversity exposure to age 10 were considered. Using Cox modeling of a 40% training data subset, we categorised adversity exposure by associated rates of schizophrenia. Firstly, for each domain separately, numerous constructs of adversity exposure were screened for independent association with schizophrenia. Those with p < =0.2 were combined, using augmented backwards elimination, to define a minimal domain set of jointly associated constructs. Combination was summarised as the linear predictor corresponding to the optimum Cox model. Secondly, these domain summaries were combined with each other to form a global Cox model, predictive of association with schizophrenia. Harrell's Concordance was calculated using a 30% assessment sample which did not overlap with our training sample. Prognostic categories were defined and tested. Results Harrell's Concordance was 0.655. Dose response was observed. Conclusions Our scale combines many adversity measures into a single construct. It displays dose response and predicts association considerably above chance. Key messages EAS-SZ allows a range of adversity exposure profiles to be ranked according to association with schizophrenia. [ABSTRACT FROM AUTHOR]

Background: General population data show that cannabis use by younger people has been declining but increasing in older adults and overall, the gap between men and women appears to be narrowing. Despite rates of past-year cannabis use by people with a psychotic disorder being much higher than that of the general population, little has been documented about sex and age differences in patterns of cannabis use over time by people with a psychotic disorder. Methods: To better understand trends in cannabis use by people with a psychotic illness, we examined sex and age differences in rates of past-year cannabis use using nationally representative data from two cross-sectional Australian national surveys of psychosis (1997, 2010). We then compared our findings to comparable general population data collected in the Australian National Drug Strategy Household Survey (1998, 2010). Results: Prevalence of past-year cannabis use by people with psychotic illness dropped significantly from 38.2% to 33.7%. Both sexes showed a decline in use. The steeper decline in use by men aged 18–29 years (70.2% to 47.8%) contributed to a narrowing of the sex gap. Conversely, use by men aged 55–64 increased from 4.8% to 18.8%. In comparison, general population data showed a similar pattern of change across sex and age groups including a steeper decline in use by men aged 18–29 years, but only a very modest increase in use from 3% to 5%, by men aged 55 and over. Discussion: Despite declining rates of past-year cannabis use in people with a psychotic illness, rates remain more than double that of the general population. Traditionally, men were more likely to use cannabis than women, but convergence in rates in younger people shows this is changing. Furthermore, cannabis use is not restricted to young people. Increasing use of cannabis by older men will place additional demands on drug and alcohol services. [ABSTRACT FROM AUTHOR]

Evidence about the association between maternal mental health disorders and stillbirth and infant mortality is limited and conflicting. We aimed to examine whether maternal prenatal mental health disorders are associated with stillbirth and/or infant mortality. MEDLINE, Embase, PsycINFO, and Scopus were searched for studies examining the association of any maternal prenatal (occurring before or during pregnancy) mental health disorder(s) and stillbirth or infant mortality. A random-effects meta-analysis was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). The between-study heterogeneity was quantified using the I2 statistic. Subgroup analyses were performed to identify the source of heterogeneity. Of 4487 records identified, 28 met our inclusion criteria with 27 contributing to the meta-analyses. Over 60% of studies examined stillbirth and 54% of them evaluated neonatal or infant mortality. Thirteen studies investigated the association between maternal depression and anxiety and stillbirth/infant mortality, pooled OR, 1.42 (95% CI, 1.16–1.73; I2, 76.7%). Another 13 studies evaluated the association between severe maternal mental illness and stillbirth/infant mortality, pooled OR, 1.47 (95% CI, 1.28–1.68; I2, 62.3%). We found similar results for the association of any maternal mental health disorders and stillbirth/infant mortality (OR, 1.59; 95% CI, 1.43–1.77) and in subgroup analyses according to types of fetal/infant mortality. We found no significant evidence of publication bias. Maternal prenatal mental health disorders appear to be associated with a moderate increase in the risk of stillbirth and infant mortality, although the mechanisms are unclear. Efforts to prevent and treat these disorders may reduce the scale of stillbirth/infant deaths. [ABSTRACT FROM AUTHOR]