Dr Jean Hollis, MBBS (Hons), FRANZCP, FPOA, MPhil

Supervisor: Professor Tim Lambert
Associate Supervisor: Professor David Le Couteur

Coenzyme Q10 receives and donates electrons in the mitochondrial electron transport chain. In addition to the role in energy production, coenzyme Q10 reduces inflammation and is a lipophilic antioxidant. It binds to the mitochondrial permeability transition pore and is a cofactor for uncoupling proteins. The latter proteins dissipate the mitochondrial proton gradient without the production of ATP, thereby providing a mechanism to reduce radical oxygen species production at times of cellular stress.

In randomised, placebo-controlled trials, coenzyme Q10 has been found to reduce significantly blood pressure in hypertensive individuals and to reduce the frequency and severity of migraines in migraineurs. There is some evidence that coenzyme Q10 supplementation improves pancreatic beta-islet performance, outcomes in congestive cardiac failure and may prevent the development of atheroma.

Those with chronic psychotic disorders and chronic mood disorders have an increased risk of developing the metabolic syndrome and cardiovascular disease. Some preliminary studies in those with depression have demonstrated low serum and white blood cell coenzyme Q10 levels. Some psychotropic medications and HMG-CoA reductase inhibitors (statins) are associated with lower coenzyme Q10 levels.

The present study will assess coenzyme Q10 levels in those with chronic psychotic disorders and chronic mood disorders. Demographic data, current medication, psychiatric and medical history, and metabolic risk factors will be ascertained. Mood and other mental state features will be elicited using validated scales. Coenzyme Q10 levels will be established in age and gender matched control subjects. This study will form part of my doctoral thesis.

Hypersalivation and drooling are common presentations in patients with schizophrenia treated with clozapine. The researchers aim to explore the mental health prescribers management of hypersalivation and drooling through a survey questionnaire. The researchers will also be testing the effect of Atropine mouth wash when used for the treatment of clozapine induced hypersalivation or drooling.

Researcher is Omar Mubaslat, Mental Health and Medicines Information pharmacist at Royal Prince Alfred Hospital
Research supervisor is Professor Tim Lambert, Professor and Head of Psychiatry | Sydney Medical School – Concord

The project is a six week health literacy intervention for people aged 18-65 living with a psychotic illness. The intervention is run once a week for 45 minutes in a group setting and teaches people with a psychotic illness about the cardiometabolic health conditions that are associated with a psychotic illness, such as high blood pressure, high cholesterol, diabetes and metabolic syndrome.

The cardiometabolic health literacy education program is targeted at people living with a diagnosed psychotic illness. The educational program is designed to encourage participants to understand the cardiometabolic health conditions that are associated with a psychotic illness. The education program aims to inform people with a psychotic illness about a variety of cardiometabolic health conditions such as, high blood pressure, type II diabetes, high cholesterol and metabolic syndrome. In this study we aim to: 1) Educate people diagnosed with a psychotic illness about cardiometabolic health conditions that are highly prevalent in patients that have a diagnosed psychotic illness; 2) Improve health literacy in patients with a psychotic illness; and 3) Support and empower patients with a psychotic illness to make informed decisions about their health care in regards to their cardiometabolic health.

Researcher: Philippa Boss
Supervisor: Prof Tim Lambert

Aim:
Establish the feasibility and utility of a single channel nasal transducer (Flow Wizard see Figure 1) as a screening tool for Obstructive Sleep Apnoea (OSA) in a mentally ill (psychotic), predominantly schizophrenia inpatient population. This will measure the airflow recordings of patients while asleep.

Figure 1. Flow Wizard

BACKGROUND:
Obstructive sleep apnoea (OSA) is an established and public health problem in the normal population. Obesity (particularly central), is by far the major risk factor for OSA, with more than half the prevalence of moderate to severe OSA related to excess body weight (1-4).
There is increasing concern that patients living with severe psychotic mental illness (SMI) such as schizophrenia have a particularly high risk of developing OSA (5) (6) (7) (8). Central obesity is 1.5 – 2 times higher in comparison to the normal population and other less severe mental health populations. (9) (10, 11).
There is almost a thirty-year differential gap in mortality between those with SMI and the normal population (12). This differential mortality gap is predicted to increase if those with SMI continue not to share in improved community health care (13). OSA is recognized as an additional risk for all-cause mortality if undiagnosed and untreated in patients with SMI (5). Consequently, the role of OSA as a cardiovascular risk factor and its role in obesity, metabolic syndrome and diabetes driving premature death in those with SMI such as schizophrenia demands attention.
Currently there is a paucity of studies examining OSA in schizophrenia and those few available show rates differing greatly from each other (7). In particular, there are no studies that describe well- tolerated simple objective screening tools for OSA . Tools with a subjective component have been found to be unreliable in populations without psychiatric disturbance as they do not predict or correlate well with objective findings (14). If tools with a subjective component are unreliable of OSA prediction in normal populations, it can be reasoned that such tools would highly unreliable in those with SMI.

OSA, medication side effects and psychiatric illness can all disturb sleep; cause daytime sleepiness, cognitive impairment and irritability (5). In those with SMI who are at risk of OSA, there is great difficulty determining what percentage of daytime sleepiness, cognitive impairment and irritability is specific to OSA. Therefore, a validated objective screening tool would be most beneficial in this population.
A study using a single-channel nasal pressure transducer device (Flow Wizard) is currently under way to establish whether this assessment tool can be used to assess for significant OSA within this patient group.

1. Seidell JC. Waist circumference and waist/hip ratio in relation to all-cause mortality, cancer and sleep apnea. European Journal of Clinical Nutrition. 2010;64:3541.
2. Ravesloot MJL, Van Maanen JP, Hilgevoord AAJ, Van Wagensveld BA, de Vries N. Obstructive Sleep Apnea is Underrecognized in Patients Undergoing Bariatric Surgery. A tailor made approach to obstructive sleep apnea. 2012;23:79.
3. Gasa M, Salord N, Fortuna AM et al. Obstructive sleep apnoea and metabolic impairment in severe obesity. … Respiratory Journal. 2011;38:1089-1097.
4. McNicholas WT, Bonsigore MR. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J. 2007;29:156-178.
5. Alam A, Chengappa KNR. Obstructive sleep apnoea and schizophrenia: a primer for psychiatrists. Acta Neuropsychiatrica. 2011;23:201-209.
6. Alam A, Chengappa KNR, Ghinassi F. Screening for obstructive sleep apnea among individuals with severe mentaL ILLNESS AT A PRIMARY CARE CLINIC. General Hospital Psychiatry. 2012;34
7. Kalucy MJ, Grunstein R, Lambert T, Glozier N. Obstructive sleep apnoea and schizophrenia–A research agenda. Sleep medicine reviews. 2013
8. Winkelman JW. Schizophrenia, obesity, and obstructive sleep apnea. The Journal of clinical psychiatry. 2001;62:8-11.
9. Allison DB, Newcomer JW, Dunn AL et al. Obesity among those with mental disorders: a National Institute of Mental Health meeting report. American journal of preventive medicine. 2009;36:341-350.
10. Fountoulakis KN, Siamouli M, Panagiotidis P et al. Obesity and smoking in patients with schizophrenia and normal controls: a case-control study. Psychiatry research. 2010;176:13-16.
11. American Diabetes Association American Psychiatric Association. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes care. 2004;27
12. O’Connor N, Hunt GE, O’Hara-Aarons M et al. The Sydney Mental Health Client Mortality Audit: what does it tell us and what are we to do? Australasian Psychiatry. 2014
13. McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiologic Reviews. 2008;30:67-76.
14. Sharwood LN, Elkington J, Stevenson M et al. Assessing sleepiness and sleep disorders in Australian long-distance commercial vehicle drivers: self-report versus an “at home” monitoring device. Sleep. 2012;35:469.

Researcher: Ms Bronwyn Siviour (MPhil student – Sydney University)
Supervisor: Prof Tim Lambert
Co-supervisor: Prof Ron Grunstein, (Woolcock Institute of Medical Research)

Atheer’s PhD research involves exploring quality use of medicines in the area of mental health. This includes the patterns of psychotropic medicines use in tertiary and community settings and how this relates to health outcomes and patient safety. The issue of Poly-Antipsychotics Prescribing (PAP), its determinants and effects (including cardio-metabolic side effects) are the main focus in this research project.

Researcher: Atheer Nassir, PhD candidate, University of Sydney
Supervisor: Professor Andrew McLachlan
Co-supervisor: Professor Tim Lambert

Impact of a health literacy intervention on cardiometabolic health, knowledge and access to medical care, in people living with a psychotic illness: a feasibility study undertaken in three different NSW Mental Health Service settings.

Introduction
The cardiometabolic health literacy education program is targeted at people living with a diagnosed psychotic illness. The educational program is designed to encourage participants to understand the cardiometabolic health conditions that are associated with a psychotic illness. The education program aims to inform people with a psychotic illness about a variety of cardiometabolic health conditions such as, high blood pressure, type II diabetes, high cholesterol and metabolic syndrome. In this study we aim to: 1) Educate people diagnosed with a psychotic illness about cardiometabolic health conditions that are highly prevalent in patients that have a diagnosed psychotic illness; 2) Improve health literacy in patients with a psychotic illness; 3) Support and empower patients with a psychotic illness to make informed decisions about their health care in regards to their cardiometabolic health; 4) The HELP study will implement a 6 week health literacy education program for people living with a psychotic disorder; and 5) The HELP study will develop and implement a GP physical health check-up prompt card for people living with a psychotic disorder.

Study Population
Study participants will be recruited from the Croydon, Marrickville and Canterbury Community Mental Health Centres in the Sydney Local Health District. Study participants will also be recruited from the Kirkbride Unit and the Broughton Unit at the Concord Centre for Mental Health. Participants will also be recruited from Schizophrenia Fellowship of NSW Inc. (SFNSW) Day to Day Living (D2DL) sites at Parramatta (Frangipani House) and Chatswood (Hercules House). People with a diagnosed psychotic disorder aged 18-65 are eligible to participate in the HELP study. Each education session will be delivered in a group format, consisting of 8-12 participants. The groups will consist of female and male participants, however, if the study investigator sees that females are becoming intimidated, embarrassed or self-conscious by having males in the group session, the group will be split into two groups so that the health concerns of both genders are respected, as participants may become self-conscious when they discuss issues around weight gain and lifestyle behaviours. We aim to recruit 160 participants to the study. 20 participants will be recruited from the Kirkbride Unit and the Broughton Unit at the Concord Centre for Mental Health. 40 participants will be recruited from the Croydon, Marrickville and Canterbury Community Mental Health Centres. 20 participants will be recruited from the SFNSW D2DL programs at Parramatta (Frangipani House) and Chatswood (Hercules House). We aim to run nine to ten intervention groups of 8-12 (n = 80) participants, to fulfil the total study recruitment number of 160 participants. We will run 2-3 intervention groups at each of the research sites, these include the Kirkbride Unit and Broughton Unit, the SLHD Community Mental Health Centres (Croydon, Marrickville and Canterbury) and the SFNSW D2DL program sites in Parramatta (Frangipani House) and Chatswood (Hercules House).

Researcher: Mrs Philippa Boss, Higher Degree Research Candidate, University of Sydney
Supervisor: Professor Tim Lambert, University of Sydney
Co-supervisor: Dr Nicola Reavley, University of Melbourne

There is a clear recognition of the link between severe mental illness (SMI) like schizophrenia, poor physical health, and the disproportionate rate of premature morbidity and mortality in people with a diagnosed psychotic illness. This health inequality is attributed to a number of factors including the enduring deficiency of quality physical health care through cardiometabolic screening and management.

This study aims to investigate the barriers to the referral of patients with a diagnosed psychotic illness for cardiometabolic care from an integrated and specialist clinic using a survey questionnaire. This study will also describe the relationship between clinician characteristics and the barriers to the referral of patients for cardiometabolic care.

Researcher: Dianne Latta
Supervisor: Professor Tim Lambert, University of Sydney