Papers by Mark A Huthwaite
Hypnosedative prescribing in outpatient psychiatry
International Clinical Psychopharmacology, May 1, 2013
The objective of this study was to describe hypnosedative (HS) prescribing patterns in a typical ... more The objective of this study was to describe hypnosedative (HS) prescribing patterns in a typical sample of psychiatric outpatients. Prescription information was extracted from the clinical records of all current outpatients at two New Zealand public mental health centres. This included the type and duration of HS use and documentation of a clinical review of longstanding (>3 months) use, patient sex, age and ICD10 diagnoses. One-third of the patients (35.2%) were prescribed at least one HS; this was longstanding in two-thirds (69%). One in 10 had a coprescription of more than one HS drug. HS use was related to female sex and diagnosis, being more common among patients with nonpsychotic than psychotic disorders and very infrequent in patients on clozapine. In most longstanding cases, a clinical review had been documented. The logistic regression confirmed female sex, diagnosis and clozapine all as independent predictors of HS prescription. HS prescribing in psychiatric illness is more common than in the general population, often longstanding, with polypharmacy being common. The frequent use of antipsychotic drugs as HSs is of concern, given their side-effect profile. As there are risks involved with longstanding HS use, a better rationale for the role of medication in the management of sleep problems in psychiatric disorders is needed.
‘Out of the frying pan’: the challenges of prescribing for insomnia in psychiatric patients
Australasian Psychiatry, Apr 2, 2014
Managing insomnia is a common challenge for psychiatrists and their patients. We have observed an... more Managing insomnia is a common challenge for psychiatrists and their patients. We have observed an increasing use of quetiapine as a hypnosedative. We conducted an audit with the aim of establishing the prescribing patterns of local general psychiatrists in New Zealand, comparing them with established guidelines and determining the extent of the prescribing of quetiapine as a hypnosedative. Participant psychiatrists were recruited from peer review groups. Each participant provided anonymised prescribing information from 10 patients and noted their intention when prescribing. Twenty-five clinicians (58% response rate) responded with prescriptions for 100 in-patients and 177 community mental health patients. 60% of in-patients and 62% of community patients were prescribed medications to aid with sleep. The most commonly prescribed medications were zopiclone, quetiapine and benzodiazepines. Prescribing adhered with the recommended guidelines for 20% of benzodiazepine and 35% of zopiclone prescriptions. Two thirds (60%) of the community prescriptions for quetiapine were primarily for hypnosedation. There is little concordance between guidelines for hypnosedative prescribing and the practices of general psychiatrists. Less zopiclone and fewer benzodiazepines were prescribed than in other studies, while more quetiapine was prescribed. The 'off-label' use of quetiapine and the duration of zopiclone and benzodiazepine use are discussed.
British Journal of Psychiatry, Feb 1, 2010
This is a observational (cross sectional) study investigating gastrointestinal hypomotility cause... more This is a observational (cross sectional) study investigating gastrointestinal hypomotility caused by antispychotic medication, an important adverse effect spectrum that has caused considerable morbidity and mortality amongst antipsychotic-treated patients.
Sleep Health, Dec 1, 2020
Investigate the efficacy of a pilot longitudinal sleep education program for optimizing sleep and... more Investigate the efficacy of a pilot longitudinal sleep education program for optimizing sleep and minimizing depressive symptoms in nulliparous pregnant women. Design: Early and longitudinal sleep education intervention pilot study. Setting: Community-based convenience sample of New Zealand women. Participants: 15 nulliparous women who were involved in a pilot of a longitudinal sleep education intervention during pregnancy (N = 15) were compared to a comparison group (n = 76) from another observational study with the same time points. Groups were matched on depression history and parity. Intervention: A longitudinal sleep education program was developed. Women in the intervention group participated in three individualized and trimester specific education sessions designed to increase sleep knowledge and improve sleep practices. The comparison group received no sleep education. Measurements: Self-reports of depressive symptoms and five dimensions of sleep (duration, quality, continuity, latency, daytime sleepiness) were compared between groups using linear mixed model analysis of variance. Results: At the conclusion of the intervention, the intervention group had fewer depressive symptoms with none experiencing clinically significant depressive symptoms, while 21% of the comparison group were considered to have clinically significant depressive symptoms. The intervention group also had better sleep quality, sleep initiation and sleep continuity than the comparison group at late pregnancy. Conclusions: Findings suggest that a longitudinal sleep education intervention commencing early in pregnancy may be effective in optimizing sleep and minimizing depressive symptoms for nulliparous women with a history of depression. Further investigation of sleep education interventions to improve maternal mental health in pregnancy and postnatally is warranted.
The prevalence of symptoms of depression and anxiety, and the level of life stress and worry in New Zealand Māori and non-Māori women in late pregnancy
Australian and New Zealand Journal of Psychiatry, Jul 11, 2016
Objective: To describe the prevalence of symptoms of depression and anxiety, and the level of lif... more Objective: To describe the prevalence of symptoms of depression and anxiety, and the level of life stress and worry in late pregnancy for Māori and non-Māori women. Methods: In late pregnancy, women completed a questionnaire recording their prior history of mood disorders; self-reported current depressive symptoms (⩾13 on the Edinburgh Postnatal Depression Scale), current anxiety symptoms (⩾6 on the anxiety items from the Edinburgh Postnatal Depression Scale), significant life stress (⩾2 items on life stress scale) and dysfunctional worry (>12 on the Brief Measure of Worry Scale). Results: Data were obtained from 406 Māori women (mean age = 27.6 years, standard deviation=6.3 years) and 738 non-Māori women (mean age = 31.6 years, standard deviation=5.3 years). Depressive symptoms (22% vs 15%), anxiety symptoms (25% vs 20%), significant life stress (55% vs 30%) and a period of poor mood during the current pregnancy (18% vs 14%) were more prevalent for Māori than non-Maori women. Less than 50% of women who had experienced ⩾2 weeks of poor mood during the current pregnancy had sought help. Being young was an independent risk factor for depressive symptoms, significant life stress and dysfunctional worry. A prior history of depression was also consistently associated with a greater risk of negative affect in pregnancy. Conclusion: Antenatal mental health requires at least as much attention and resourcing as mental health in the postpartum period. Services need to specifically target Māori women, young women and women with a prior history of depression.
Medical Teacher, Sep 3, 2012
Background: This article presents findings from a prospective, longitudinal cohort educational st... more Background: This article presents findings from a prospective, longitudinal cohort educational study investigating empathy communication in clinical consultations. It reports on changes in students' self-report empathy during medical undergraduate training, investigates how well peers can assess student competence in motivational interviewing/brief interventions (MI/BI) skills and explores the relationship between students' self-report empathy and peer-or tutor-assessments of competence. Methods: 72 medical students completed the Jefferson Scale of Physician Empathy at three time points: at the beginning of their fifth year medical training (Time 1), after a specific MI/BI training session during their fifth year medical training (Time 2) and 1 year later during a revision session in year 6. Competence in BI/MI consultation was assessed using the validated tool Behaviour Change Counselling Index. Results: A significant decline in medical students' empathy scores was observed from year 5 to year 6, consistent with international findings. Peer assessments and tutor ratings of competence in MI/BI skills performance were moderately correlated, but peer assessments were negatively correlated with medical students' self-rated empathy. Senior medical students who self-rated as more empathic received lower competence evaluations of MI/BI skills from their peers. Interventions to further investigate teaching and learning of empathy are discussed.
International Clinical Psychopharmacology, Jul 1, 2015
Given the longstanding controversy about hypnosedative use, we aimed to investigate the attitudes... more Given the longstanding controversy about hypnosedative use, we aimed to investigate the attitudes of prescribing psychiatrists and service users towards long-term use of hypnosedative medication, and their perceptions of barriers to evidence-based nonmedication alternatives. Qualitative data from focus groups in Aotearoa/NZ were analysed thematically. A novel research design involved a service user researcher contributing throughout the research design and process. Service users and psychiatrists met to discuss each other's views, initially separately, and subsequently together. Analysis of the data identified four key themes: the challenge, for both parties, of sleep disturbance among service users with mental health problems; the conceptual and ethical conflicts for service users and psychiatrists in managing this challenge; the significant barriers to service users accessing evidencebased nonmedication alternatives; and the initial sense of disempowerment, shared by both service users and psychiatrists, which was transformed during the research process. Our results raise questions about the relevance of the existing guidelines for this group of service users, highlight the resource and time pressures that discourage participants from embarking on withdrawal regimes and education programmes on alternatives, highlight the lack of knowledge about alternatives and reflect the complex interaction between sleep and mental health problems, which poses a significant dilemma for service users and psychiatrists.
Obesity in a forensic and rehabilitation psychiatric service: a missed opportunity?
Journal of forensic practice, Nov 13, 2017
PurposeThe purpose of this paper is to study weight changes during psychiatric hospitalization, s... more PurposeThe purpose of this paper is to study weight changes during psychiatric hospitalization, so as to identify “obesogenic” features in a mixed (forensic and rehabilitation) inpatient service.Design/methodology/approachAn observational study of psychiatric inpatients, gathering sociodemographic, clinical, weight, dietary and sleep information and an actigraphic assessment.FindingsA total of 51 patients, aged 19-68, 40 males, participated at a median of 13 months after their admission. When studied, only 6 percent had a healthy weight, 20 percent were overweight and three quarters (74 percent) were obese. The mean Body Mass Index (BMI) was 35.3 (SD: 8.1). At admission, only three patients (8.3 percent) had healthy BMIs and over the course of their hospital stay, 47 percent gained further weight. A high proportion was physically inactive and half slept more than nine hours a day. Participants received high calorie diets and half (53 percent) smoked cigarettes.Practical implicationsAlthough antipsychotic medication is known to cause weight gain, this should not be seen in isolation when attempting to explain psychiatric inpatient obesity. An inpatient admission is an opportunity to provide a healthier eating environment, health education and assertively promote less sedentary behavior and healthier sleep habits.Social implicationsObesity adds to the burden of this already significantly disadvantaged group of patients.Originality/valueThe results confirm earlier research showing that forensic and rehabilitation psychiatric inpatients as a group are obese, gain weight while in hospital and often smoke. The authors add data demonstrating that they are often physically inactive, sleep excessively and consume an unhealthy diet despite the provision of health focused interventions as an integral part of their inpatient program.
BMC Psychiatry, Sep 18, 2018
Background: Obesity is a significant problem for people with serious mental illness. We aimed to ... more Background: Obesity is a significant problem for people with serious mental illness. We aimed to consider body size from the perspective of long-stay psychiatric inpatients, focussing on: weight gain and its causes and impacts; diet and physical activity; and the perceived ability to make meaningful change in these domains. Method: A mixed methods study with 51 long-term psychiatric forensic and rehabilitation inpatients using semistructured interviews combined with biometric and demographic data. Results: 94% of participants were overweight or obese (mean BMI 35.3, SD 8.1). They were concerned about their weight, with 75% of them attempting to lose weight. Qualitative responses indicated low personal effectiveness and self-stigmatisation. Participants viewed their weight gain as something 'done to them' through medication, hospitalisation and leave restrictions. A prevailing theme was that institutional constraints made it difficult to live a healthy life (just the way the system is). Many had an external locus of control, viewing weight loss as desirable but unachievable, inhibited by environmental factors and requiring a quantum of motivation they found hard to muster. Despite this, participants were thoughtful and interested, had sound ideas for weight loss, and wished to be engaged in a shared endeavour to achieve better health outcomes. Consulting people as experts on their experiences, preferences, and goals may help develop new solutions, remove unidentified barriers, and improve motivation. Conclusions: The importance of an individualised, multifactorial approach in weight loss programmes for this group was clear. Patient-led ideas and co-design should be key principles in programme and environmental design.
Prevalence of abnormal sleep duration and excessive daytime sleepiness in pregnancy and the role of socio-demographic factors: comparing pregnant women with women in the general population
Sleep Medicine, Dec 1, 2014
To compare the prevalence of self-reported abnormal sleep duration and excessive daytime sleepine... more To compare the prevalence of self-reported abnormal sleep duration and excessive daytime sleepiness in pregnancy among Māori (indigenous New Zealanders) and non-Māori women versus the general population, and to examine the influence of socio-demographic factors. Self-reported total sleep time (TST) in 24-hrs, Epworth Sleepiness Scale scores and socio-demographic information were obtained from nullipara and multipara women aged 20-46 yrs at 35-37 weeks pregnant (358 Māori and 717 non-Māori), and women in the general population (381 Māori and 577 non-Māori). After controlling for ethnicity, age, socio-economic status, and employment status, pregnant women average 30 min less TST than women in the general population. The distribution of TST was also greater in pregnant women, who were 3 times more likely to be short sleepers (≤6 h) and 1.9 times more likely to be long sleepers (>9 h). In addition, pregnant women were 1.8 times more likely to report excessive daytime sleepiness (EDS). Pregnant women >30 years of age experienced greater age-related declines in TST. Identifying as Māori, being unemployed, and working at night increased the likelihood of reporting abnormal sleep duration across all women population in this study. EDS also more likely occurred among Māori women and women who worked at night. Pregnancy increases the prevalence of abnormal sleep duration and EDS, which are also higher among Māori than non-Māori women and those who do night work. Health professionals responsible for the care of pregnant women need to be well-educated about the importance of sleep and discuss sleep issues with the women they care for.
Off label or on trend: a review of the use of quetiapine in New Zealand
PubMed, May 4, 2018
Sleep Health, Feb 1, 2020
To investigate the association between measures of sleep quality, sleep duration and sleep disord... more To investigate the association between measures of sleep quality, sleep duration and sleep disorder symptoms in late pregnancy and likelihood of emergency caesarean section. Design: Population-based prospective cohort study Setting: New Zealand Participants: 310 M aori (Indigenous New Zealanders) and 629 non-M aori women Measurements: Multivariable logistic regression models were used to investigate the association between type of delivery (emergency caesarean section vs. spontaneous vaginal delivery) and self-reported sleep duration, sleep quality and sleep-related symptoms, (e.g. snoring, breathing pauses during sleep, legs twitching/jerking) in the third trimester of pregnancy. Models were adjusted by ethnicity (ref¼non-M aori), age (ref¼16e19 y), parity (ref¼nulliparous), clinical indicators (any vs. none), area deprivation (ref¼least deprived quintile), BMI and for some models smoking. Results: Women who reported poor quality sleep as measured by the General Sleep Disturbance Scale in later pregnancy had almost twice the odds of delivering via emergency caesarean than women with good sleep quality (OR¼1.98, 95% CI 1.18e3.31). Reporting current breathing pauses during sleep (OR¼3.27, 95% CI 1.38e7.74) or current snoring (OR¼1.65, 95% CI 1.00e2.72) were also independently associated with a higher likelihood of an emergency caesarean. Short sleep duration and leg twitching/jerking were not independently associated with emergency caesarean section in this study. Conclusions: Supporting healthy sleep during pregnancy could be a novel intervention to reduce the risks associated with emergency caesarean section. Research on the effectiveness of sleep interventions for reducing caesarean section risk is required.
Focus on health professional education : a multi-disciplinary journal, Apr 14, 2016
Introduction: Clinical empathy is the cornerstone of a good patient-clinician relationship. is st... more Introduction: Clinical empathy is the cornerstone of a good patient-clinician relationship. is study aims to examine the impact of an empathy teaching innovation (ETI) on empathic communication in medical students, which was introduced in a new medical curriculum and incorporates clinical skills and patient contacts from students' rst-year study. Method: A cluster randomised controlled trial (RCT) collected data on medical students' self-reported empathy using the Je erson Scale of Physician Empathy (JSPE), simulated patients' ratings of each student using the Je erson Scale of Patient Perception of Physician Empathy (JSPPPE) and students' performance in an objective structured clinical examination (OSCE). Half of the medical students (n = 39) received the ETI and the other half (n = 40) acted as the control group. e ETI is a 1-hour actor-led empathy workshop focusing on "being-in-role" and how to "walk a mile in the patient's shoes", previously shown to improve medical students' empathy scores. Results: e medical students who received the ETI were rated as more empathetic by the simulated patients, with statistically signi cant correlations between patients' perception of empathy and the consultation performance for the intervention group, but not for the control group. However, the ETI did not signi cantly enhance student self-reported empathy. Conclusions: is study presents the ETI as a short intervention tool for improving medical students' portrayal of clinical empathy, as perceived by simulated patients. Findings raise interesting questions for medical educationalists regarding the use of simulated (or actual) patients' reports on empathy.
The Clinical Teacher, Feb 2, 2017
Background: In New Zealand little nursing or medical curricula time, if any, is specifically devo... more Background: In New Zealand little nursing or medical curricula time, if any, is specifically devoted to the enhancement of empathy. If being empathic is important in the context of patient care, it is a quality that is already present in students or is learned by students during their practicum in the company of experienced clinicians. This study aimed to compare self-reported empathy ratings between different groups of medical students and one cohort of nursing students
Child & Family Social Work, Oct 9, 2014
British Journal of Psychiatry, Jul 1, 1993
Relationships between CSF levels of endorphins and monamine metabolites in chronic pain patients.... more Relationships between CSF levels of endorphins and monamine metabolites in chronic pain patients. Psychopharmaco!ogia, 67, 139â€" 142. BASBAUM, A. 1. & FIELDS, H. L. (1984) Endogenous pain control systems:brainstem,spinal pathwaysand endorphin circuitry.
Clinical Schizophrenia & Related Psychoses, Oct 1, 2011
Three case vignettes are presented documenting the rise in serum clozapine that occurred at a tim... more Three case vignettes are presented documenting the rise in serum clozapine that occurred at a time of acute infection in these patients. The literature on this phenomenon is scant. The physiological processes that occur in the acute phase of the inflammatory response are summarized and provide an explanation of how clozapine levels may rise in response to infection. The risk of clozapine toxicity occurring in association with infections is highlighted.
Hypnosedative access and risk of harm
PubMed, Nov 4, 2011
Aim: To review PHARMAC's decision, effective 1 September 2010, to remove the 1-month restriction ... more Aim: To review PHARMAC's decision, effective 1 September 2010, to remove the 1-month restriction on funded prescription of hypnotics and anxiolytics. Method: We consider the evidence for an association between access to these medicines and risk of harm. Results: Prescription volumes and reported harms have both increased over the last decade in New Zealand; available studies and clinical experience suggest a causal link. Preliminary data collected since PHARMAC's funding change suggest an exacerbation of the problem. Conclusion: The decision to relax funding restrictions on hypnosedatives is expected to increase drug-related harms in a sub-population of users. Improved pharmacovigilance could inform policy regarding these agents.
Australasian Psychiatry, Aug 17, 2014
RT avera ge score (/10) Collective ranking by the authors (1=best) Description / comments Rachel ... more RT avera ge score (/10) Collective ranking by the authors (1=best) Description / comments Rachel Getting Married (2008) 7.5 7 This movie deals with drug dependency and recovery (the main character participates in a 12-step programme). Various forms of both family support and family dysfunction (e.g., the detached mother) are shown. At times the level of narcissism by the main character is quite markedso a narcissitic personality disorder is also a possible additional diagnosis.
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Papers by Mark A Huthwaite