North Metropolitan Health Service Mental Health

Clinical Research Centre

Annual Report 2012

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Contents CRC Objectives .......................................................................................................................... 2

2012 CRC Staff ........................................................................................................................... 3

2012 CRC Research Associates ............................................................................................... 4

Acting Director’s Report ............................................................................................................ 5

2012 CRC Operational Structure .............................................................................................. 6

2012 Research Projects ............................................................................................................. 7

CRC Research Associates ...................................................................................................... 15

2012 Publications ..................................................................................................................... 18

2012 Conference Presentations .............................................................................................. 22

2012 Clinical and Community Engagement ........................................................................... 24

Contact Details ......................................................................................................................... 26

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CRC Objectives

The Clinical Research Centre (CRC) was formally initiated in 2012, and is based at Gascoyne House, Graylands Health Campus. It carries out a wide range of mental health research projects, translational research and clinical audits for North Metropolitan Health Service (NMHS) Mental Health.

CRC comprises a number of clinical research and academic staff that conduct high quality mental health research. Research projects conducted at CRC contribute to improvements in the clinical management and outcomes for people with mental illness, and towards the reform of service delivery within WA. This work is underpinned by a coordinated approach to research that has the highest national and international scientific standing which also aligns with statewide clinical priorities.

The specific objectives of CRC are as follows:

• Carry out high quality multidisciplinary research with clinical relevance for people with mental illness, clinical management and service delivery

• Foster a research program that is aligned with clinical priorities that works towards better health outcomes

• Provide advice and support relating to research design, research analyses, research results, research and ethics governance and informed consent and the conduct of research undertaken as part of NMHS Mental Health and statewide services.

• Be actively involved in NMHS Mental Health and statewide planning regarding clinical interventions, clinical management and service delivery

• Strengthen partnerships with consumers, carers and NGOs in developing research projects and protocols

• Undertake collaborative research with universities, clinical, research, health and other services and the community

• Conduct supervision and research training to students and other mental health professionals

• Participate in resource and information sharing with other NMHS Mental Health and statewide services to support the learning culture

Two sub-units also currently operate within the Clinical Research Centre:

• The Clinical Applications Unit works with local clinicians and uses local research findings to develop care coordination packages for mental health patients with complex health care needs.

• The Service Analysis Unit provides advanced statistical analysis to enhance mental health operational effectiveness and outputs. It undertakes data collection and analysis to benefit local and statewide projects.

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2012 CRC Staff

Andrew, Steve SAU - Project Officer

Badcock, Johanna Clinical Psychologist

Bahri Lorraine Administrative Assistant

Blackwell, Bridget CAU - Research Assistant

Bose, Avijit Neurophysiology Technologist

Davison, Sophie CAU - Research Psychiatrist

Dragović, Milan Senior Scientist - Neuropsychiatry

Faulkner, Deb CAU - Project Officer (maternity leave)

Harrison Carole CAU - Senior Research Nurse

Hauck, Yvonne CAU - Research Consultant

Howell, Sarah Coordinator of Clinical Research

Martyr, Philippa Communications Officer

Mondinos, Nick IT Support

Morar, Bharti Laboratory Research Officer

Morgan Vera Operational Epidemiologist

Murphy, Elaine Senior Research Nurse

Naik, Neepa CAU - Project Officer

Price, Greg Senior Scientist - Electrophysiology

Richards, Neilson SAU - Senior Information Analyst

Rock, Daniel Co-Director, CCRN Research & Director CAU

Vohma, Vaike SAU - Senior Information Analyst

Waters, Flavie Senior Research Fellow

Zota, Camelia Governance Project Officer, NMHS MH

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2012 CRC Research Associates Name Affiliation Collaborating with Term expires

Dr Brian Power Rockingham General Hospital

Nikos Stefanis, Milan Dragović

March 2015

Dr Thinh Nguyen Rockingham General Hospital

Yvonne Hauck, Milan Dragović, Jo Badcock

March 2015

Dr Alexander John Bentley Health Service

Padmaja Ramankutty, Milan Dragović

March 2015

Professor Sergio Starkstein

School of Psychiatry and Clinical Neurosciences, UWA

Milan Dragović March 2015

Professor Nikos Stefanis

National and Kapodistrian University of Athens Medical School, Greece

Milan Dragović March 2015

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Acting Director’s Report

I have now completed 10 months as Acting Director of the Clinical Research Centre, while Clinical Professor Daniel Rock has been acting in the position of Deputy Area Executive Director, NMHS MH.

This period has been a challenging time for the new Clinical Research Centre. In 2011, NMHS MH began discussions with the Centre for Clinical Research in Neuropsychiatry (CCRN) about possible future research directions. As a result, CCRN became a separate research unit, operating under UWA’s aegis and continuing its program of research into the endophenotypes of schizophrenia. NMHS MH staff (now the ‘Clinical Research Unit’), the Clinical Applications Unit (CAU, 2008) and the newly-developed Service Analysis Unit (SAU) and Neurophysiology Unit (NPU) were then brought under the umbrella of a new ‘Clinical Research Centre’ operating at Gascoyne House, Graylands Hospital.

This means that CRC is well-placed and well-equipped to carry out its brief of assisting NMHS MH with a wide range of mental health research projects, including the translational research and clinical audits already undertaken successfully by the Clinical Applications Unit. CRC will also be actively assisting NMHS MH with its ongoing clinical reform and improvements in the clinical management of people with mental illness.

Drawing on the combined experience of its research staff, CRC’s work is underpinned by a coordinated approach to research that is also aligned with NMHS MH and statewide clinical priorities. We also hope to be an essential part of building up a learning culture in NMHS MH through our continuing collaboration with universities, clinicians, health services and the wider community, and through our workshops and other training delivery.

CRC staff are already actively involved in an impressive range of projects across NMHS MH and statewide. These include nursing, physical health care, diagnostics, workplace evaluation, clinical audits, educational package development, electrophysiology, and improving access to services. We look forward to a productive engagement with mental health services that focuses on improving outcomes for all our service users.

Dr Milan Dragović

Acting Director, CRC

May 2013

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2012 CRC Operational Structure

NMHS MH Deputy Executive Director

NMHS MH Executive Director

Health Informatics Committee

Director CRC

Clinical Research Centre

Service Analysis

Unit

Clinical Applications

Unit

Neuro-physiology

Unit

2 x Senior Information Analyst

1 x Project Officer

1 x Senior Research Nurse

1 x Research Psychiatrist

1 x Prof. (UWA, Pop Health)

2 x Senior Research Nurse

1 x Clinical Psychologist

2 x Senior Scientist

1 x Communications Officer

1 x Research Officer

1 x Laboratory Technician

1 x Admin Assistant

1 x Senior Scientist – Neurophysiology

1 x Neurophysiology Technician

1 x Scientific System Officer

1 x Prof. (UWA, Pharmacology )

Clinical Research

Unit

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2012 Research Projects

Action identification and the mechanisms of obsessive-compulsive disorder Obsessive compulsive disorder involves impairment in the flexible control of actions; current treatments aim to change recurrent action tendencies. The goal of this research was to determine whether subclinical compulsive checkers show similar difficulties in action processing, indicating a pathway of risk for the disorder. The findings showed that subclinical checkers habitually attend to “why” actions are performed, and their consequences, rather than the mechanics of actions (i.e. “how” they are performed). This effect is independent from the cognitive bias of overestimating threat that is also implicated in the onset of OCD. These findings may help to refine early interventions for compulsive checking. Project Status: COMPLETE (E Jamnadass awarded First Class Honours) Project Staff: CI Jo Badcock, Murray Maybery, Esha Jamnadass. ATT activity analysis The aim of this analysis was to determine the time and duration of after hours emergency jobs and on the basis of results further validate current processes and identify gaps in service delivery. Project Status: ONGOING Project Staff: Milan Dragović, Denise Bromwell, Leanne Sultan, Sandy Tait Better health in the Rehabilitation Clinical Stream Wellness depends on recognising and supporting what are called the ‘pillars of health’. These include good physical health, restorative sleep, and psychosocial functions. Clinical audits have been conducted in the Rehabilitation Clinical Stream of Graylands Hospital. These have focused on examining specific domains of enquiry: (i) sleep quality, (ii) executive functions, (iii) fatigue, and (iv) functional impairments. This evidence-base continues to be used to plan interventions and better services. Project Status: ONGOING Project Staff: CI Flavie Waters, CI Daniel Rock CECAT & RAS Clinical Service Redesign Project To map the whole of service functions required to support the operations of the CECAT and RAS State wide Services. To then provide a Clinical Redesign framework for both services for structural change to ensure future sustainability in meeting the growth of clinical needs within the recognised workforce limitations. To help establish workable partnership models for CECAT and RAS to engage in future service delivery. The outcomes of the project will impact on the daily operations in identifying opportunities for the most efficient and effective use of staffing resources, clinical programming and partnerships to support the priority business of the CECAT and RAS State wide Services. The Project Team will work collaboratively to undertake the functional review and redesign project on behalf of CECAT and RAS. Recommendations will then be provided for service changes including the implementation process of these. Project Status: ONGOING Project Staff: Elaine Murphy, Danita Walsh, RAS Manager. Sponsor: Milan Dragović

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Cognitive mechanisms of auditory hallucinations Aims: 1) to improve evidence-based practice in the assessment and treatment of auditory hallucination and 2) to provide advanced research training for clinical and neuropsychological graduates. The specific goal of this research is to improve understanding of the cognitive, biological and emotional processes underlying the onset, maintenance and/or recurrence of auditory hallucinations. This research targets the experience of auditory hallucinations in patients with psychosis and the experience of "hearing voices" in the general community. Portions of this research are conducted as part of an international collaboration: The Neurophysiology of auditory hallucinations. Project Status: ONGOING [S Chhabra awarded PhD in 2012 and is now working full-time as clinical psychologist in NMHS MH] Project Staff: CI Jo Badcock, Murray Maybery, Saruchi Chhabra

CVD-related mortality in a Western Australian psychiatric cohort 1950-1959 The focus of the project is the introduction of first generation antipsychotics into psychiatric hospitals of WA and whether this impacted on the rate of CVD deaths in this cohort. To access archival material, create new linked data sets and publish results thus providing a historical context to CVD-related mortality in a WA psychiatric population – in association with next study. Project Status: ONGOING Project Staff: Carole Harrison, Philippa Martyr, Daniel Rock

Diagnostic Criteria for Depression in Alzheimer’s Disease Specific criteria to diagnose depression in AD are still to be validated. This study was conducted to validate a set of diagnostic criteria for major depression in AD. Participants were recruited from consecutive referrals to a Memory Clinic of a tertiary hospital. Participants: A consecutive series of 971 outpatients with probable AD. Main Outcome Measure: Clusters of patients with or without major depression as determined with LCA. Results: A LCA demonstrated three clusters that were considered to represent major depression, minor depression, and no depression. All nine Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression were significantly associated with the major depression cluster. Although a diagnosis of generalized anxiety disorder (GAD) and apathy were also associated with the major depression cluster, irritability was not. Conclusions: The DSM-IV criteria for major depression should be used unmodified to diagnose depression in AD. Future studies should determine whether GAD should be included as an additional diagnostic criterion. Project Status: COMPLETED Project Staff: CI Sergio Starkstein, Milan Dragović

Diagnostic criteria for depression in Parkinson’s disease The main aim of our study was to validate depressive symptoms using latent cluster analysis (LCA) for use as diagnostic criteria for major depression in PD. We examined a consecutive series of 259 patients with PD admitted to two movement disorders clinics for regular follow-ups. We found that all nine DSM-IV diagnostic criteria for major depression identified a patient class (severe depression group) with high statistical significance. LCA also demonstrated a patient class with minimal depressive symptoms (no depression group), and a third patient class with intermediate depressive symptoms (moderate depression). Anxiety and apathy were both

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significant comorbid conditions of moderate and severe depression. Taken together, our findings validate the use of the DSM-IV criteria for major depression for use in clinical practice and research in PD and suggest that anxiety may be included as an additional diagnostic criterion. structured assessments for depression, anxiety and apathy Project Status: COMPLETED Project Staff: CI Sergio Starkstein, Milan Dragović

Evaluation of HWA Clinical Supervision Support Project As a Health Workforce Australia initiative associated with the Clinical Training Project (increasing undergrad nursing students in NMHS MH), education sessions re: clinical support of students in the clinical area have been conducted in 2012; all NMHS MH nursing staff were required to attend. Post-evaluation is now due. Consultative advice for this project has been provided by Carole who will advice and oversee the project. Project Status: ONGOING Project Staff: Carole Harrison, Rosemary Hoffman, Adrian Redknap, Ann Hobson

Evaluation of Individual Support and Development Program in Nursing Project Enhance the provision of education and graduate support systems for new graduate nurses in the mental health setting (a recruitment and retention strategy). Evaluation will allow for development of a support framework for beginning practitioners in mental health nursing for NMHS MH. Project Status: ONGOING Project Staff: Carole Harrison, Robina Redknap

Executive Office and Statewide Services Administrative Services Redesign ProjectTo map administrative functions required to support the operations of the NMHS MH Executive office and Statewide Services as a pilot project and first phase of a functional review of all NMHS MH administrative services with the aim of ensuring alignment of administrative resources with priority business requirements. Project Status: ONGOING Project Staff: Milan Dragović, Helen Kristianopulos (Executive Sponsor: Patrick Marwick) Family/Carer Partnership and Education Strategy A responsive partnership between mental health services and carers/families is recognised as pivotal in improving the outcomes of people with mental illness. A multidisciplinary Carer Partnership and Education team was formed in November 2012, led by Associate Professor Flavie Waters. The team's broad objective is to develop clinical pathways to enable better engagement between clinicians and carers/families. The four key priorities that have been identified are to: (i) improve families/carers’ access to information and resources, (ii) develop clinical pathways and support tools for mental health clinicians, (iii) increase families/carers participations and collaborations, and (iv) measure and report on progress. Project Status: ONGOING Project Staff: Flavie Waters, Daniel Rock, Kerry Hawkins, Philippa Martyr, Milan Dragović Forensic services audit We supported Statewide Forensic Service in gathering data about all their inpatients on a census date. This included data about symptoms, diagnosis, clinical, health and social need,

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executive functioning, social functioning, risk and security needs using validated instruments. The instruments were chosen as they yield meaningful data at an individual and group level. The aim is to describe the clinical, social and security needs of mentally disordered offenders admitted to the Statewide service; to use cluster analytic techniques to identify groups of patients who have similar characteristics; and to explore the relationship between the different variables. It is hoped this will yield useful information in planning services and interventions for mentally disordered offenders in WA. We are analysing the data on the patients surveyed. Project Status: ONGOING Project Staff: CI Sophie Davison

Graylands History Project To research the history of Claremont-Graylands Hospital and produce published work which is historically sound, contextualised, and inclusive of staff and patients. To create new data sets and access archival material, government records, and top collect new oral history. A special focus of the project is the changing demographics of the patient population, which includes a critical examination of physical health, age, ethnicities and psychiatric diagnoses. Project Status: COMPLETED Project Staff: Philippa Martyr

Incidence of CVD and the distribution of risk factors for CVD among people with psychosis in Western Australia 1970-2011 Cardiovascular disease (CVD) is reported to be the leading cause of death for both males and females in Australia. High levels of medical co-morbidity (e.g. diabetes mellitus) and excess mortality have long been documented in people with serious mental illness. Life style related CVD-risk factors such as smoking prevalence, higher BMI and sedentary lifestyle in association with side effects of antipsychotic medication (weight gain, dyslipidemia etc) impact significantly on this cohort. The life expectancy of patients with schizophrenia is between two and three decades shorter than that of the general population, in large part due to CVD. Using linked data from core data sets (MHIS, HMDS, Mortality) to determine rates of CVD incidence, CVD interventions and mortality in people suffering psychosis in WA. This will allow health services in WA to better understand the CVD-risk in its treatment population, assist in health promotion, therapeutic care planning and management of co-morbid medical disorders etc. Project Status: ONGOING Project Staff: Carole Harrison, Vera Morgan, Milan Dragović, Daniel Rock, Assen Jablensky

Mental Health and Substance Misuse Needs of WA Reception Prisoners The aim of the project is to determine the nature and extent of mental health and substance misuse problems in WA reception prisoners and to look at their clinical and social needs. We plan to produce high-quality data that will help in the planning of services in prison and in the community for people with mental disorders who offend. Project Status: ONGOING Project Staff: CI Sophie Davison, Bridget Blackwell

Mental Health Nursing Professional Practice Enhancement Strategy Project A key component of reducing the possibility of adverse outcomes is risk management. From a North Metropolitan Area Health Service-Mental Health (NMAHS-MH) nursing perspective, there is a key requirement to provide documentary evidence that practice issues as identified in

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coroner’s recommendations, complaints, observation of practice and audits are being addressed and risk managed appropriately. Specific documentation and associated processes will be developed for implementation across programmes for NMHS-MH. Project Status: SUSPENDED (due to temporary secondment) Project Staff: Carole Harrison, Rosemary Hoffman

Mental Health Professional Online Development NMHS MH Project Control MHPOD is a web based elearning platform aimed specifically at Mental Health practitioners in a variety of professional groups including nurses, occupational therapists, psychologists and psychiatrists. A phased introduction is planned, first targeting staff in their first two years of practice, followed by the wider workforce and finally NGOs and other relevant parties. MHPOD is being deployed across Australia with other states at varying degrees of implementation and readiness. Implementation in WA has been separated into a WACHS deployment programme and a combined North/South Metro deployment. Project Status: ONGOING Project Staff: Carole Harrison, Jeff Burge, Ann Steele, Heath Greville, Frank Mackie

Midwives’ Knowledge, Attitudes and Perception of their Perinatal Mental Health Learning Needs Department of Nursing and Midwifery Education and Research (DNAMER) staff are working in collaboration with the Department of Psychological Medicine, the Mother-Baby Unit, WA Perinatal Mental Health Unit and CRC to develop professional development sessions to better address the perinatal mental health learning needs of midwives caring for childbearing women. The purpose of this project is to gain information around: attitudes toward caring for women with different mental health issues; which mental health issues are most challenging for midwives; what topics would midwives want more information about; and the preferred format for delivery of this information. Project Status: ONGOING Project Staff: Yvonne Hauck, Janice Butt, Jo Badcock, Milan Dragović, Pam Whittaker Nursing and Midwifery Doctor of Health Science Reference and Curriculum Development Group - ECU ECU has developed a higher degree course which focuses on leadership skills in health and will assist in driving the workforce agenda into the future. Representatives from industry were nominated from all areas of health to provide input into the development of the course and ensure the content covers the challenges faced by the Health industry. Provide prospective research topic ideas for inclusion in course. Project Status: COMPLETED Project Staff: Carole Harrison (NMHS MH Industry Rep)

On-call Project Project Status: ONGOING Project Staff: John Ellis, Rosemary Hoffman, Tamara Rouen, Colleen Wood, Leon Ou, Milan Dragović

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Overtime Project Project Status: COMPLETED Project Staff: John Ellis, Rosemary Hoffman, Robina Redknap, Gary Wallace, Colleen Wood, Leon Ou, Milan Dragović

Promoting Mental Health Nursing as a sustainable career option Mental Health Nursing has an ageing workforce and as well there is a critical shortage of nursing staff in mental health facilities across the whole of Australia and more specifically Western Australia. In addition to these concerns it is apparent that Mental Health Nursing is not the preferred career choice for many graduate nurses. Challenges with recruitment and retention are currently being experienced by NMHS MH which suggests that the existing workforce is simply not sustainable. The project aims to investigate recruitment and retention strategies of graduate nurses into Mental Health; Inform recommendations for the further development of support systems for graduate nurses and for improving professional development for existing nurses Project Status: ONGOING Project Staff: Carole Harrison, Yvonne Hauck, Rosemary Hoffman

rTMS in depression Repetitive Transcranial Magnetic Stimulation in the treatment of depression: This study prospectively evaluated the antidepressant efficacy of rTMS in a double-blind active controlled trial, replicating the NIH study in a group of treatment-resistant patients. Stimulus parameters are determined from comparable studies, reflecting current best practice, as well as investigating improvement to these parameters. This modification involves linking TMS parameters to the individuals electrophysiological activity. Project Status: COMPLETED Project Staff: Greg Price, Joseph Lee, Avijit Bose

Sleep disorders in people with mental illness There are significant gaps in our understanding of sleep problems in people with severe mental disorders. This program of clinical research is driven by four facts: (i) sleep disorders are ubiquitous in mental disorders, (ii) sleep problems have significant impact on health and functioning, (iii) people with mental illness have unequal access to diagnosis and treatment of sleep disorders, and (iv) much of the screening and intervention can be done with in-house resources. Three audits have been conducted that have examined the prevalence of sleep disorders in psychosis, and their relationship to medications and functioning. Screening for sleep disorders in affected individuals remains available as a free service. Novel interventions specifically addressed for insomnia in individuals with psychosis are currently being developed and evaluated. Project Status: ONGOING Project Staff: CI Flavie Waters, CI Daniel Rock Social perception of left-handers Social tolerance towards left-handed people is commonly accepted in the 21st century, though not universal. However, at the level of social cognition a subtle bias against this visible minority group may not have disappeared. To investigate this possibility, we adopted the theoretical framework of the Stereotype Content Model (SCM) whereby two fundamental dimensions

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(warm and competence) are sufficient to explain group differences in stereotype content. We examined how a large sample of students (N=300) perceived nine social groups (seven with various physical, social or mental handicaps and the two target groups of left- and right-handers), and four 'anchor' groups comprising educated, pensioners, drug addicts and rich people) which are considered as prototypical in terms of the SCM. Project Status: COMPLETED Project Staff: CI Milan Dragović, AI Johanna Badcock

Stigma and mental illness This is an interconnected series of projects examining the many faces of stigma associated with mental illness. The specific aims are: 1) to provide a better understanding of the nature, extent and mechanisms of stigma associated with mental illness using advanced techniques from psychological science, 2) to investigate new methods for challenging and changing the stereotypes, prejudice and discrimination directed towards people with mental illness, 3) undertake targeted research on specific populations (e.g. children, mental health professionals, in-patients in psychiatric services) and specific types of mental illness (autism, schizophrenia) and 4) to offer advanced research training for clinical psychology graduates. Projects Study 1. Does contact decrease or ironically increase the negative stereotype of schizophrenia. Project Status: ONGOING Project Staff: CI Jo Badcock, Milan Dragović Study 2. Stereotypes of autism in the Australian community Project Status: ONGOING Project Staff: CI Jo Badcock, Milan Dragović

Visual processing in individuals with Autism Spectrum Disorders Aims: 1) to advance our understanding of atypical (often superior) visual processing in autism and autism-related traits, 2) to develop a new, improved tool for the assessment of visual performance in these groups, and 3) to provide advanced research training for clinical/neuropsychology graduates. Project Status: ONGOING Project Staff: CI David Badcock, Murray Maybery, CI Jo Badcock, Hayley Mighall

WAFSS: EEG endophenotype Investigating the EEG state basis of electrophysiological endophenotypes as identified in the WAFSS study. Project Status: ONGOING Project Staff: Greg Price

WAFSS: Electrophysiology Electrophysiology WAFSS: The aim of this research is to identify genes contributing to the risk of schizophrenia by studying cognitive and personality traits (i.e. stable features) that are correlated with schizophrenia, regardless of symptom state. This approach, referred as endophenotype strategy, has been adopted because the genetic structure of these stable traits may be more amenable to genetic analysis than that of schizophrenia as a highly complex disorder, and easier to identify. Project Status: ONGOING

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Project Staff: Assen Jablensky, Nikos Stefanis, Johanna Badcock, Milan Dragović, Greg Price

Women’s Health Survey (Sexual and Reproductive Health Needs of Women with Serious Mental Illness) The original objective of this survey was to obtain baseline health data on Western Australian women of childbearing age (18 to 50 years) attending North Metropolitan community mental health services (2011). The study has been extended to South Metropolitan community mental health services (2012). This project is a collaboration between the Clinical Applications Unit, King Edward Memorial Hospital and WA Sexual Health Services. Project Status: ONGOING Project Staff: Yvonne Hauck, Thinh Nguyen, Daniel Rock, Jacquie Frayne, Suzanne Allen, Deb Faulkner, Maria Garefalakis

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CRC Research Associates

Dr Brian Power

I am working collaboratively within the Australian United States Scandinavian Imaging Exchange, and our work focusses on the development of clinical neuroimaging biomarkers suitable for diagnosis and monitoring of disease progression and treatment in neurodegenerative disorders with neuropsychiatric manifestations. My focus is understanding the structural basis of cognitive, emotional, motor and behavioural dysfunction in neurodegenerative disease through correlation of clinical features with thalamic morphology.

I am currently developing a protocol for manual segmentation of the thalamus on T1-weighted MRI scans in normal human controls, using ANALYZE 11.0 software, and will ascertain intra- and inter-rater reliability. I will then conduct morphometric analysis of the thalamus in a number of neurodegenerative conditions (starting with a PSP and FTD cohorts). A variety of statistical methods will be utilised, including multivariate analysis of co-variance to assess the significance of any differences in bilateral thalamic volume between disease and control groups, and ROC analysis to determine group membership based on bilateral thalamic volumes, and P/M ratio, for instance.

As I am a full-time clinician with limited time to dedicate to my research, the support offered by CRC with the statistical methodology in my studies is invaluable. I would hope that CRC continues to support the research endeavours of clinicians, and also extend support to psychiatric trainees with a strong research interest, in order to foster the development of future academic clinicians in Western Australia.

Dr Thinh Nguyen

I have been working with Yvonne Hauck, Deb Faulkner and Danny Rock for a number of years, to examine the obstetric and neonatal outcomes of pregnant women with SMI who delivered through the KEMH Childbirth and Mental Illness (CAMI) clinic. Yvonne and I have recently completed the Sexual and Reproductive Health survey of women between 18-50 who attended metropolitan community mental health clinics. I have received invaluable consultative support on research methodology and research direction, as well as statistical analysis for these projects. I have found CRC services to be accessible and encouraging and collaborative and aim to continue my association in my new role with the School of Psychiatry and Clinical Neurosciences.

Professor Alexander John

John Milne Centre, which is a treatment and rehabilitation in-patient service for patients with severe mental illness residing within South Metropolitan areas has been involved in a number of research projects with Clinical Research Centre, NMHS-MH in 2012. This collaboration was established and strengthened by Professor Alexander P John, Consultant Psychiatrist, John Milne Centre and Dr Milan Dragovic, A/ Director CRC.

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The following research projects have been established as part of the collaboration in 2012 and are currently ongoing.

• Prevalence and nature of antipsychotic polypharmacy among adult inpatients of an Australian mental health service (expected time of completion – August 2013)

Even though the practice of antipsychotic polypharmacy (APP) has little evidence base and is not recommended by treatment guidelines, it is common in clinical practice. This study will evaluate the prevalence and factors associated with APP among psychiatry in-patients. A better understanding of the phenomenon of APP should assist with developing interventions to reduce prevalence of APP in public mental health services.

• Prevalence and nature of cognitive deficits in patients with schizophrenia admitted to a medium stay treatment and rehabilitation unit

Cognitive deficits are core symptoms of schizophrenia and are robust predictors of outcome of psychosocial interventions and community functioning. Unfortunately, among psychosocial rehabilitation services in Australia, little attention has been focussed on assessing severity and nature of cognitive deficits, providing interventions for cognitive deficits, and measuring the efficacy of these interventions to ameliorate the cognitive deficits. This study will evaluate the nature and severity of cognitive deficits and its relationship with functioning and symptoms and effectiveness of interventions in patients with schizophrenia. This is a retrospective “real world” study evaluating the outcome measures collected as part of clinical practice at John Milne Centre.

CRC has been providing valuable statistical consultancy for both the above studies and in spite of his busy schedule the CRC Director has been readily available for consultancy. These studies are ongoing and the continued collaboration with CRC would be a major determinant of the success of the projects. I look forward to be involved in further substantial clinically relevant collaborative projects with CRC.

Dr Sergio Starkstein

CRC’s help in 2012 was instrumental to complete statistical analysis for several papers that were published in prestigious psychiatric and neurological journals. CRC was also proactive in our research projects sponsored by the Michael J Fox Foundation for Parkinson’s Disease and by the NHMRC. I hope we will continue to work in close interaction with the CRC in a variety of research projects. The synergy between the CRC and the Neuropsychiatry laboratory at Fremantle Hospital has been instrumental to our obtaining important research funds and publishing the results of our studies.

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Professor Nikos Stefanis

In my 2 ½ years in Western Australia I was able to forge some remarkable research partnerships, facilitated by my collaborative work with CRC. This includes my role as Professor at the School of Psychiatry and Clinical Neurosciences UWA, my work as Consultant Psychiatrist, First Episode Psychosis (FEP) team, Joondalup Community Mental Health, and my work with the Early Intervention in Psychosis Alliance (EIPA) on behalf of Early Intervention in Psychosis Services within North and South Metropolitan Health Services - Mental Health. I was a founder–partner of the EU-GEI project, and am continuing to work closely with Professor Jim van Os at Maastricht University, Netherlands (EU-GEI project leader). Now that I have returned to take up my academic position in Greece, I look forward to continuing these productive collaborations with CRC as we continue to explore the gene-environment interaction in the development of psychosis.

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2012 Publications

Books and book chapters Albrecht M, Graham K, Martin-Iverson M, Waters F (2012) The rubber-hand illusion: Manipulating our sense of body experience. In A E Cavanna, A Nani (eds) Consciousness: States, Mechanisms and Disorders, Nova Science Pub Inc: 159-185 Badcock, JC Hugdahl K. (2012). Examining the continuum model of auditory hallucinations: A review of cognitive mechanisms In: J.D. Blom and I.E.C. Sommer (eds.), Hallucinations: Research and Practice, Chapter 24. Springer Science + Business Media, LLC. Martyr P. Beyond 'Beyond Reason': images of people with mental disabilities in Australian film since the 1970s. In: Lawrence Rubin (ed) Mental Illness in Popular Media: Essays on the Representation of Disorders, North Carolina: McFarland, 2012: 238-255 Refereed journal articles Almeida RA, Dickinson JE, Maybery MT, Badcock JC, Badcock DR (2012) Visual search targeting either local or global perceptual processes differs as a function of autistic-like traits in the typically developing population. J Autism Dev Disord. 2012 Oct 9. [Epub ahead of print] Badcock JC, Hugdahl K (2012) Cognitive mechanisms of auditory verbal hallucinations in psychotic and non-psychotic groups. Neurosci Biobehav Rev. 2012 Jan;36(1):431-8. doi: 10.1016/j.neubiorev.2011.07.010. Epub 2011 Aug 2. Review. Chhabra S, Badcock JC, Maybery MT, Leung D (2012) Voice identity discrimination in schizophrenia. Neuropsychologia. 2012 Oct;50(12):2730-5. doi: 10.1016/j.neuropsychologia.2012.08.006. Epub 2012 Aug 14. Chhabra S, Badcock JC, Maybery MT (2012) Memory binding in clinical and non-clinical psychotic experiences: How does the continuum model fare? Cogn Neuropsychiatry. 2012 Oct 16. [Epub ahead of print] Davison S, Janca A (2012) Personality disorder and criminal behaviour: what is the nature of the relationship? Curr Opin Psychiatry. 2012 Jan;25(1):39-45. doi: 10.1097/YCO.0b013e32834d18f0. Girschik J, Fritschi L, Heyworth J, Waters F (2012) Validation of self-reported sleep against actigraphy. J Epidemiol. 2012 Sep 5;22(5):462-8. Epub 2012 Jul 28. Green MJ, Cairns MJ, Wu J, Dragović M, Jablensky A, Tooney PA, Scott RJ, Carr VJ (2012) Genome-wide supported variant MIR137 and severe negative symptoms predict membership of an impaired cognitive subtype of schizophrenia. Mol Psychiatry. 2012 Jun 26. doi: 10.1038/mp.2012.84. [Epub ahead of print]

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Jablensky A, Angelicheva D, Donohoe GJ, Cruickshank M, Azmanov DN, Morris DW, McRae A, Weickert CS, Carter KW, Chandler D, Alexandrov B, Usheva A, Morar B, Verbrugghe PL, Filipovska A, Rackham O, Bishop AR, Rasmussen KØ, Dragović M, Cooper M, Phillips M, Badcock J, Bramon-Bosch E, Almeida OP, Flicker L, Gill M, Corvin A, MacGregor S, Kalaydjieva L (2012) Promoter polymorphisms in two overlapping 6p25 genes implicate mitochondrial proteins in cognitive deficit in schizophrenia. Mol Psychiatry. 2012 Dec;17(12):1328-39. doi: 10.1038/mp.2011.129. Epub 2011 Oct 4. Larøi F, Sommer IE, Blom JD, Fernyhough C, Ffytche DH, Hugdahl K, Johns LC, McCarthy-Jones S, Preti A, Raballo A, Slotema CW, Stephane M, Waters F (2012) The characteristic features of auditory verbal hallucinations in clinical and nonclinical groups: state-of-the-art overview and future directions. Schizophr Bull. 2012 Jun;38(4):724-33. doi: 10.1093/schbul/sbs061. Epub 2012 Apr 12. Review. Levy F, Young D, Bennett K, Martin N, Hay D (2012) Comorbid ADHD and mental health disorders: are these children more likely to develop reading disorders? ADHD Attention Deficit and Hyperactivity Disorders, November 2012, 10.1007/s12402-012-0093-3 Henderson A, Martyr P (2012) Too little, too late: mental health nursing education in Western Australia, 1958-1994. International Journal of Mental Health Nursing doi: 10.1111/j.1447-0349.2012.00861.x Milenkovic S, Dragović M (2012) Modification of the Edinburgh Handedness Inventory: A replication study. Laterality. 2012 Jul 2. [Epub ahead of print] Power B, Dragović M, Rock D (2012) Brief screening for executive dysfunction in schizophrenia in a rehabilitation hospital. J Neuropsychiatry Clin Neurosci. 2012 Spring;24(2):215-22. doi: 10.1176/appi.neuropsych.11060145. Power B, Dragović M, Rock D (2012) Clusters according to patient need in a long-stay inpatient population with schizophrenia: does executive dysfunction underpin needs-directed care? Soc Psychiatry Psychiatr Epidemiol. 2012 Sep 9. [Epub ahead of print] Power B, Dragović M, Jablensky A, Stefanis NC (2012) Does accumulating exposure to illicit drugs bring forward the age at onset in schizophrenia? Aust N Z J Psychiatry. 2013 Jan;47(1):51-8. doi: 10.1177/0004867412461957. Epub 2012 Oct 5. Power B, Williams H, Shymko G (2012) The difficulties of diagnosing clozapine myocarditis: damned if you do, damned if you don't. Australas Psychiatry. 2012 Apr;20(2):165-6. doi: 10.1177/1039856211432482. No abstract available. Power B, Trivedi D, Samuel M (2012) What psychiatrists should know about sporadic Creutzfeldt-Jakob disease. Australas Psychiatry. 2012 Feb;20(1):61-6. doi: 10.1177/1039856211430145. Epub 2012 Jan 5. Verbrugghe P, Bouwer S, Wiltshire S, Carter K, Chandler D, Cooper M, Morar B, Razif MF, Henders A, Badcock JC, Dragović M, Carr V, Almeida OP, Flicker L, Montgomery G, Jablensky A, Kalaydjieva L (2012) Impact of the Reelin signaling cascade (ligands-receptors-

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adaptor complex) on cognition in schizophrenia. Am J Med Genet B Neuropsychiatr Genet. 2012 Jun;159B(4):392-404. doi: 10.1002/ajmg.b.32042. Epub 2012 Mar 14. Waters F, Aleman A, Fernyhough C, Allen P (2012) Report on the inaugural meeting of the International Consortium on Hallucination Research: a clinical and research update and 16 consensus-set goals for future research. Schizophr Bull. 2012 Mar;38(2):258-62. doi: 10.1093/schbul/sbr181. Epub 2012 Jan 5. Waters F, Allen P, Aleman A, Fernyhough C, Woodward TS, Badcock JC, Barkus E, Johns L, Varese F, Menon M, Vercammen A, Larøi F(2012) Auditory hallucinations in schizophrenia and nonschizophrenia populations: a review and integrated model of cognitive mechanisms. Schizophr Bull. 2012 Jun;38(4):683-93. doi: 10.1093/schbul/sbs045. Epub 2012 Mar 23. Review. Waters F, Faulkner D, Naik N, Rock D(2012) Effects of polypharmacy on sleep in psychiatric inpatients. Schizophr Res. 2012 Aug;139(1-3):225-8. doi: 10.1016/j.schres.2012.05.013. Epub 2012 Jun 1. Waters F, Hanken K, Rock D(2012) Sleep-disordered breathing in schizophrenia: An audit. Schizophr Res. 2013 Feb;143(2-3):393-4. doi: 10.1016/j.schres.2012.11.034. Epub 2012 Dec 28. Waters F, Manoach D (2012) Sleep dysfunctions in schizophrenia: A practical review. Open Journal of Psychiatry, 2(4A) 384-392 Waters F(2012) Multidisciplinary approaches to understanding auditory hallucinations in schizophrenia and nonschizophrenia populations: the International Consortium on Hallucination Research. Schizophr Bull. 2012 Jun;38(4):693-4. doi: 10.1093/schbul/sbs070. Epub 2012 Jul 25.

Research associate publications Antypa N, Mandelli L, Nearchou FA, Vaiopoulos C, Stefanis CN, Serretti A, Stefanis NC(2012) The 3111T/C polymorphism interacts with stressful life events to influence patterns of sleep in females. Chronobiol Int. 2012 Aug;29(7):891-7. doi: 10.3109/07420528.2012.699380. Hatzimanolis A, Smyrnis N, Avramopoulos D, Stefanis CN, Evdokimidis I, Stefanis NC(2012) Bipolar disorder ANK3 risk variant effect on sustained attention is replicated in a large healthy population. Psychiatr Genet. 2012 Aug;22(4):210-3. doi: 10.1097/YPG.0b013e328353ae79. Mandelli L, Antypa N, Nearchou FA, Vaiopoulos C, Stefanis CN, Serretti A, Stefanis NC(2012) The role of serotonergic genes and environmental stress on the development of depressive symptoms and neuroticism. J Affect Disord. 2012 Dec 15;142(1-3):82-9. doi: 10.1016/j.jad.2012.03.047. Epub 2012 Aug 4. Morgan VA, F. Morgan, G. Valuri, A. Ferrante, D. Castle and A. Jablensky A. (2012) Whole-of-population study of the prevalence and patterns of criminal offending in people with

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schizophrenia and other mental illness. Psychological Medicine / FirstView Article / December 2012, pp 1-12 DOI: 10.1017/S0033291712002887, Published online: 13 December 2012 Pentaraki AD, Stefanis NC, Stahl D, Theleritis C, Toulopoulou T, Roukas D, Kaliora SC, Chatzimanolis I, Smyrnis N, Russell T, Kravariti E, Murray RM (2012) Theory of Mind as a potential trait marker of schizophrenia: a family study. Cogn Neuropsychiatry. 2012;17(1):64-89. doi: 10.1080/13546805.2011.568289. Epub 2011 Jun 15. Stefanis NC, Hatzimanolis A, Avramopoulos D, Smyrnis N, Evdokimidis I, Stefanis CN, Weinberger DR, Straub RE(2012) Variation in Psychosis Gene ZNF804A Is Associated With a Refined Schizotypy Phenotype but Not Neurocognitive Performance in a Large Young Male Population. Schizophr Bull. 2012 Nov 15. [Epub ahead of print] Theleritis C, Vitoratou S, Smyrnis N, Evdokimidis I, Constantinidis T, Stefanis NC(2012) Neurological soft signs and psychometrically identified schizotypy in a sample of young conscripts. Psychiatry Res. 2012 Jul 30;198(2):241-7. doi: 10.1016/j.psychres.2012.03.007. Epub 2012 Apr 14.

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2012 Conference Presentations

Badcock J, Dragović M. Mapping mental illness stereotypes in Australia. Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012 (oral) Badcock J. Cognitive mechanisms of auditory hallucinations: some new perspectives. University of Newcastle, 18 October 2012 (invited talk) Chhabra S, Badcock J, Maybery M, Leung D. Vocal Identity Processing in Clinical and Non-clinical Hallucinators. Experimental Psychology Conference, Sydney 2012 (poster) Chhabra S, Badcock J, Maybery M, Leung D. Voice Identity Discrimination in Schizophrenia. Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012 (oral) Clark V, Baker A, Badcock J, Todd J. The Effects of Nicotine on Visual Spatial Working Memory in People with Schizophrenia. Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012 (oral) Davison S, Blackwell B. The Mental Health Needs of WA Reception Prisoners – Pilot Study Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012 Downie J, Graham K, Waters F, Martin-Iverson M. Dexamphetamine effects on body representation constructs in the projected hand illusion. Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012 Graham K, Martin-Iverson M, Jablensky A, Badcock J, Dragović M, Holmes N, Waters F. Self-recognition in first-rank (passivity) symptoms of schizophrenia, as assessed with the rubber-hand illusion. Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012 Mellor A, Olaith M, Waters F, Bucks R. Changes in sleep across the lifespan and the relationship with depression. Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012 (Best Poster Award) Mellor A, Waters F, Bucks R. Sleep and cognition across the lifespan: A questionnaire study. Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012 Naik N, Faulkner D, Rock D, Waters F. Fatigue in psychiatric inpatients. Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012 Naik N, Faulkner D, Rock D, Waters F. Pain complaints in in psychiatric patients. Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012 Price G, Bose A. Applications at the boundaries of EEG in clinical research. 34th Annual Association of Neurophysiological Technologists of Australia Inc (ANTA) Conference, Perth, 2012.

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Price G. System identification of the EEG transformation due to TMS pulses: a novel method for a synchronous brain computer interface (BCI). 2012 Spring Congress on Engineering and Technology, Xian, China, 2012. Spaapen D, Waters F, Bucks R. The Emotion Regulation Questionnaire: Development and validation of the ERP-9 in two community samples. Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012 Waters F, Naik N, Faulkner D, Rock D. The co-morbidity of fatigue and sleep in psychiatric inpatients. Australasian Society for Psychiatric Research (ASPR), Fremantle, December 2012

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2012 Clinical and Community Engagement

Badcock J. Member, Honours Marking Panel, School of Psychology, November 2012 Badcock J. Member, Advisory and Liaison Committee, DPsych training programme, School of Psychology, UWA Badcock J. Guest Associate Editor, Frontiers in Human Neuroscience Badcock J. Member, NH&MRC Research Translation Faculty Badcock J. Member, NH&MRC Centres of Research Excellence (Clinical) - Peer Review Panel Badcock J. Executive member, Schizophrenia Research Institute: Cognition and Connectivity Panel Badcock J. Deputy Board Member, Psychologists Registration Board, WA Badcock J. Journal reviewing: Human Brain Mapping Badcock J. Journal reviewing: Personality and Individual Differences Badcock J. Journal reviewing: Frontiers in Human Neuroscience Badcock J. Conference organisation: ASPR 2012 - Member, Scientific Committee Davison S. Chair, Forensic Faculty RANZCP – WA Branch

Davison S. Convenor, 2014 RANZCP Perth Congress

Davison S. Consultant Psychiatrist, Bandyup Women's Prison, Statewide Forensic Mental Health Service

Davison S. ‘Use of HCR-20 clinical risk assessment of violence’, DCS/clinicians training, ongoing

Harrison C. Member, Doctor of Health Science Reference Group, School of Nursing and Midwifery, Edith Cowan University

Harrison C. Presenter, ‘Mental Health Nursing as a Sustainable Career Option’, Education and Research Centre Open Day, 7 February 2013

Martyr P. Presenter, ‘Researching your family history in the Mental Health Services,’ Family History Society of Rockingham & Districts Inc, 3 March 2012 Martyr P. Presenter, ‘Researching your family history in the Mental Health Services,’ South Metropolitan Area Health Services, 21 March 2012 Martyr P. Presenter, ‘Sex, strikes and scandals: the history of mental health nursing unionism in Western Australia’, NMHS MH Senior Nurses Forum, 28 June 2012

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Martyr P. Presenter, ‘Researching your family history in the Mental Health Services,’ WA Genealogical Society (WAGS), 22 July 2012 Martyr P. Presenter, ‘Researching your family history in the Mental Health Services,’ National Family History Week, Heathcote Museum, 4 August 2012 Martyr P. Presenter, ‘History of mental health nursing in WA’, NMHS MH EN/RN Professional Development Day, 9 August 2012

Martyr P. Joint book reviews editor, Health and History Martyr P. Presenter, Mental Health Museum of WA, Inc - monthly tours and community education; nursing student rotations as required (1 hour; by pre-arrangement) and other tours:

• 16 May: Queens Park Seniors Group • 13 June: Challenger TAFE • 18 July: Challenger TAFE • 18 September: Challenger TAFE • 27 September: ECU • 29 October: Polytechnic West • 31 October: ECU • 1 November: NDA • 7 November: ECU • 14 November: Central TAFE • 21 November: Central TAFE • 22 November: NDA • 23 November: Challenger TAFE • 28 November: Challenger TAFE

Martyr P. Lecturer, 4 x sessional lectures, School of Medicine and Pharmacology, UWA, Pharmacology 1101 'Drugs That Changed the World' Murphy E. Member, Graylands Emergency Preparedness Committee Murphy E. Member, NMHS-MH Emergency Preparedness Committee Waters F. Organiser and Convenor, Australasian Society for Psychiatric Research conference, Fremantle, December 2012 Waters F. Scientific Board member, Human Research Ethics Committee (North Metropolitan Health Service – Mental Health) (2012- onwards) Waters F. WA Representative, Australasian Society for Psychiatric Research 2012-2014

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Contact Details LOCATION / COURIER ADDRESS East Wing, Gascoyne House Graylands Health Campus, Brockway Road Mt Claremont WA 6010

POSTAL ADDRESS Private Bag No 1 Claremont Western Australia 6910

TELEPHONE (+61) 08 9347 6429

FAX (+61) 08 9384 5128

EMAIL Lorraine.Bahri@health.wa.gov.au

WEBSITE http://www.nmahsmh.health.wa.gov.au/services/statewide_crc.cfm Gascoyne House – Map Location

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© Department of Health 2013