Browsing by Author "Leathem J"
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- ItemAre emotional regulation strategies able to be taught to people with an intellectual disability?(International Association of Forensic Mental Health Services, 2013) de Terte ID; McWilliams J; Leathem J
- ItemCognitive assessment during a course of electroconvulsive therapy - A national questionnaire survey of current practice in Aotearoa, New Zealand(1/07/2014) Thornton A; Leathem J; Flett RObjective: To shed light on current practice regarding cognitive assessment during electroconvulsive therapy (ECT) across Aotearoa. Design/Participants: 24 medical professionals representing all ECT administering district health boards responded to an electronic questionnaire. Results: 73.7% assess cognitive function at least once during a course of ECT. 27.3% assess at baseline, at least once during the course and again post-treatment. Assessments are primarily conducted by nurses (38.8%), psychiatrists (22.2%) and psychologists (22.2%). 66% of respondents reported cognitive assessment was not conducted frequently or thoroughly enough in their workplace due to a lack of time, resources and sensitive tests. Conclusion: Respondents recognised assessing cognitive change during a course of ECT was important, though large variations in the nature, frequency and length of assessments existed. Future research should focus on the development of a sensitive screening measure tailored for use with patients receiving ECT to help overcome the current restrictions to cognitive assessment.
- ItemDevelopmental and epileptic encephalopathy: Personal utility of a genetic diagnosis for families(Wiley Periodicals LLC on behalf of International League Against Epilepsy, 2021-03) Jeffrey JS; Leathem J; King C; Mefford HC; Ross K; Sadleir LGObjectives Identifying genetic pathogenic variants improves clinical outcomes for children with developmental and epileptic encephalopathy (DEE) by directing therapy and enabling accurate reproductive and prognostic information for families. We aimed to explore the additional personal utility of receiving a genetic diagnosis for families. Methods Semi-structured interviews were conducted with fifteen families of children with a DEE who had received a genetic diagnosis. The interviews stimulated discussion focusing on the impact of receiving a genetic diagnosis for the family. Interview transcripts were analyzed using the six-step systematic process of interpretative phenomenological analysis (IPA). Results Three key themes were identified: “Importance of the label,” “Relief to end the diagnostic journey,” and “Factors that influence personal utility.” Families reported that receiving a genetic label improved their knowledge about the likely trajectory of the DEE, increased their hope for the future, and helped them communicate with others. The relief of finally having an answer for the cause of their child's DEE alleviated parental guilt and self-blame as well as helped families to process their grief and move forward. Delay in receipt of a genetic diagnosis diluted its psychological impact. Significance To date, the factors associated with the personal utility of a genetic diagnosis for DEEs have been under appreciated. This study demonstrates that identifying a genetic diagnosis for a child's DEE can be a psychological turning point for families. A genetic result has the potential to set these families on an adaptive path toward better quality of life through increased understanding, social connection, and support. Early access to genetic testing is important as it not only increases clinical utility, but also increases personal utility with early mitigation of family stress, trauma, and negative experiences.
- ItemDiagnostic processes and disclosure: A survey of practitioners diagnosing cognitive impairment(New Zealand Psychological Society, 2014-07) McKinlay A; Leathem J; Merrick PThe literature reports widespread variation in practitioners’ disclosure of a dementia diagnosis, though it is currently unclear what factors influence this difference in practice. 57 New Zealand based practitioners completed an online questionnaire relating to how they reach a diagnosis of cognitive impairment and under what circumstances (if any) a diagnosis might be withheld from a client. The findings indicate that a diagnosis of cognitive impairment is never completely withheld by practitioners. All qualitative responses were analysed using conventional content analysis. Practitioners noted more positive consequences associated with disclosing a diagnosis to their clients, suggesting that providing a diagnosis is perceived by practitioners as helpful for people experiencing cognitive impairment. This study adds to the field of ethics and diagnostic disclosure in that it highlights what specific factors are considered when a practitioner chooses how to relay a cognitive impairment diagnosis to their client. Such considerations include when disclosure conflicts with the clients wishes, lack of insight, and the presence of other illnesses. Ongoing research on the subject of disclosure is needed as the number of adults who will experience cognitive impairment is predicted to rise.
- ItemMonitoring cognitive function during ECT: Current New Zealand practice(The New Zealand Psychological Society, 2013) Thornton A; Leathem J; Flett RObjective: To determine current practice regarding cognitive assessment during electroconvulsive therapy among ECT treating professionals across New Zealand. Design/Participants: A questionnaire sent to 45 professionals resulted in a response rate of 35.5% from 12 district health boards across New Zealand. Results: Most assess cognitive function at least once during a course of ECT. A third assess at baseline, at least once during and then after the course. Assessments are being conducted by people from various professions. Over two thirds said that a lack of time, resources and sensitive tests were restricting more frequent and thorough cognitive assessments. Conclusion: Respondents recognise that assessing cognitive functioning during a course of ECT is important, though large variations in the nature, frequency and length of the assessments exist. Future research should develop a standardised, sensitive, inexpensive screening measure tailored for use with patients receiving ECT to help overcome the current restrictions to cognitive assessment.
- ItemPesticide exposure in New Zealand school-aged children: Urinary concentrations of biomarkers and assessment of determinants(Elsevier Ltd, 2022-05) Li Y; Wang X; Feary McKenzie J; 't Mannetje A; Cheng S; He C; Leathem J; Pearce N; Sunyer J; Eskenazi B; Yeh R; Aylward LL; Donovan G; Mueller JF; Douwes JThis study aimed to assess pesticide exposure and its determinants in children aged 5-14 years. Urine samples (n = 953) were collected from 501 participating children living in urban areas (participant n = 300), rural areas but not on a farm (n = 76), and living on a farm (n = 125). The majority provided two samples, one in the high and one in the low spraying season. Information on diet, lifestyle, and demographic factors was collected by questionnaire. Urine was analysed for 20 pesticide biomarkers by GC-MS/MS and LC-MS/MS. Nine analytes were detected in > 80% of samples, including six organophosphate insecticide metabolites (DMP, DMTP, DEP, DETP, TCPy, PNP), two pyrethroid insecticide metabolites (3-PBA, trans-DCCA), and one herbicide (2,4-D). The highest concentration was measured for TCPy (median 13 μg/g creatinine), a metabolite of chlorpyrifos and triclopyr, followed by DMP (11 μg/g) and DMTP (3.7 μg/g). Urine metabolite levels were generally similar or low compared to those reported for other countries, while relatively high for TCPy and pyrethroid metabolites. Living on a farm was associated with higher TCPy levels during the high spray season. Living in rural areas, dog ownership and in-home pest control were associated with higher levels of pyrethroid metabolites. Urinary concentrations of several pesticide metabolites were higher during the low spraying season, possibly due to consumption of imported fruits and vegetables. Organic fruit consumption was not associated with lower urine concentrations, but consumption of organic food other than fruit or vegetables was associated with lower concentrations of TCPy in the high spray season. In conclusion, compared to other countries such as the U.S., New Zealand children had relatively high exposures to chlorpyrifos/triclopyr and pyrethroids. Factors associated with exposure included age, season, area of residence, diet, in-home pest control, and pets.
- ItemThe effects of docosahexaenoic acid supplementation on cognition and well-being in mild cognitive impairment: A 12-month randomised controlled trial(John Wiley and Sons, Ltd, 2022-05) Mengelberg A; Leathem J; Podd J; Hill S; Conlon COBJECTIVES: Several recent clinical trials have shown that docosahexaenoic acid (DHA) supplements have a significant effect on cognition in cognitively impaired older adults. This randomised controlled trial aimed to investigate the cognitive effects of a DHA fish oil supplement in older adults with mild cognitive impairment, and to examine the moderating effect of the apolipoprotein E (APOE) ɛ4 allele on cognition and well-being. METHODS/DESIGN: Seventy-two older adults between the ages of 60 and 90 from New Zealand were given a DHA supplement equivalent to 1491 mg DHA + 351 mg eicosapentaenoic acid per day or a placebo for a period of 12 months. Outcome measures included cognition, wellbeing and self-rated quality of life as well as height, weight, blood pressure and APOE genotyping. RESULTS: The final analysis (n = 60) found no evidence of a treatment effect on cognitive measures, although did find a treatment effect on systolic blood pressure (p = 0.03, ƞ2 = 0.08), and a treatment interaction for APOE ɛ4 carriers on depression (p = 0.04, ƞ2 = 0.07) and anxiety (p = 0.02, ƞ2 = 0.09) scores in favour of the DHA supplement. CONCLUSIONS: Despite no effect on cognition, the positive result in APOE ɛ4 carriers on depression and anxiety scores and on systolic blood pressure justifies further DHA trials. It may be a prudent step going forward for more studies to replicate the design elements (dose, duration and cognitive measures) of previous DHA trials to help understand why not all older adults appear to benefit from taking a fish oil supplement.
- ItemThe use of brief screening instruments for age-related cognitive impairment in New Zealand(New Zealand Psychological Society, 2012) Strauss H-M; Leathem J; Humphries S; Podd J; Fitzgerald, JThis study aimed to determine which measures are most commonly used to screen for age-related cognitive impairment in New Zealand, to describe how and why they are used, determine the factors clinicians deem most important in the selection of a particular screen and their levels of training and expertise in using particular screens. A web survey was completed by geriatricians, neurologists, psychiatrists, and psychologists (N=82). Cognitive screening measures were selected for the survey based on previous research. According to the sample, the most frequently used screen was the Mini-Mental State Exam (MMSE), followed by the Clock Drawing Test (CDT) and Addenbrooke's Cognitive Examination Revised (ACE-R). Cognitive screening fulfilled a variety of functions in clinical practice and was widely used, especially in services for older people, however formal training was limited. Availability, reliability and validity, and brevity (respectively) were the most important factors clinicians considered when selecting a screening instrument. Respondent comments agreed with current literature that the MMSE is inadequate as a screening instrument for cognitive impairment, and this was reflected in the comments of respondents on the survey questionnaire, yet this was still the most commonly used measure in New Zealand.
