Janice M McKenzie

University of Otago , Taieri, Otago Region, New Zealand

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Publications (42)145.35 Total impact

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    ABSTRACT: The literature on clinical characteristics associated with premature termination of treatment (PTT) is beset with conflicting and non-replicated findings. This study explores clinical characteristics potentially associated with PTT in a randomised controlled outpatient psychotherapy trial for anorexia nervosa (AN).
    European Eating Disorders Review 05/2014; Early view. · 1.38 Impact Factor
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    ABSTRACT: No previous studies have systematically assessed the psychological functioning of medical students following a major disaster.
    The New Zealand medical journal. 01/2014; 127(1398):54-66.
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    ABSTRACT: DSM-5 has dropped subtyping of bulimia nervosa (BN), opting to continue inclusion of the somewhat contentious diagnosis of BN-nonpurging subtype (BN-NP) within a broad BN category. Some contend however that BN-NP is more like binge eating disorder (BED) than BN-P. This study examines clinical characteristics, eating disorder symptomatology, and Axis I comorbidity in BN-NP, BN-P, and BED groups to establish whether BN-NP more closely resembles BN-P or BED. Women with BN-P (n = 29), BN-NP (n = 29), and BED (n = 54) were assessed at baseline in an outpatient psychotherapy trial for those with binge eating. Measures included the Structured Clinical Interviews for DSM-IV, Eating Disorder Examination, and Eating Disorder Inventory-2. The BN-NP subtype had BMIs between those with BN-P and BED. Both BN subtypes had higher Restraint and Drive for Thinness scores than BED. Body Dissatisfaction was highest in BN-NP and predicted BN-NP compared to BN-P. Higher Restraint and lower BMI predicted BN-NP relative to BED. BN-NP resembled BED with higher lifetime BMIs; and weight-loss clinic than eating disorder clinic attendances relative to the BN-P subtype. Psychiatric comorbidity was comparable except for higher lifetime cannabis use disorder in the BN-NP than BN-P subtype DISCUSSION: These results suggest that BN-NP sits between BN-P and BED however the high distress driving inappropriate compensatory behaviors in BN-P requires specialist eating disorder treatment. These results support retaining the BN-NP group within the BN category. Further research is needed to determine whether there are meaningful differences in outcome over follow-up. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013).
    International Journal of Eating Disorders 11/2013; 47(3). · 3.03 Impact Factor
  • 2013 International Conference on Eating Disorders; 05/2013
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    ABSTRACT: To evaluate the long-term efficacy of three psychotherapies for anorexia nervosa. Participants were women with broadly defined anorexia nervosa who had participated in a RCT comparing specialized psychotherapies (cognitive behavior therapy, CBT, and interpersonal psychotherapy, IPT) with a control condition (specialist supportive clinical management, SSCM), and attended long-term follow-up assessment (mean 6.7 years ± 1.2). Forty three of the original sample of 56 women participated in long-term follow-up assessment (77%). No significant differences were found on any pre-selected primary, secondary or tertiary outcome measures among the three psychotherapies at long-term follow-up assessment. Significantly different patterns of recovery were identified for the psychotherapies across time on the primary global outcome measure. Although SSCM was associated with a more rapid response than IPT, by follow-up all three treatments were indistinguishable. Potential implications for the timing of interventions to improve treatment response in anorexia nervosa are critically examined.
    International Journal of Eating Disorders 11/2011; 44(7):647-54. · 3.03 Impact Factor
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    ABSTRACT: The age at which a depressive episode is first experienced may be associated with particular individual and clinical characteristics. This study compares individual, clinical, and family characteristics across individuals who experienced their first major depressive episode when a child, teenager, or adult. Participants were 372 depressed outpatients who participated in 2 completed randomized trials for depression. The first compared fluoxetine and nortriptyline, whereas the second compared cognitive behavior therapy and interpersonal psychotherapy. Assessment across the studies included structured clinical interviews for Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I/II diagnoses and a range of self-report measures of symptoms, functioning, and childhood experiences. Participants with childhood- and teenage-onset depression had a greater number of comorbid Axis I diagnoses, were more likely to meet criteria for Avoidant and Paranoid personality disorder (PD), and were more likely to have attempted suicide than those with adult-onset depression. Those with teenage-onset depression were more likely to meet criteria for a PD than those with adult-onset depression. Participants with childhood- and teenage-onset depression reported lower perceptions of paternal care before the age of 16 years, compared to participants with adult-onset depression. Retrospective recall was used to classify individuals into childhood-, teenage-, and adult-onset groups and is subject to recall biases. The sample also consisted of treatment-seeking individuals. There were relatively few differences between teenage and childhood depression. Depressive episodes that begin in childhood or teenage years are associated with more comorbid diagnoses, a higher likelihood of Avoidant and Paranoid PD, a greater likelihood of attempted suicide, and poorer perceptions of paternal care. Compared to adult-onset depression, childhood-onset depression is associated with greater comorbidity.
    Comprehensive psychiatry 03/2011; 52(6):623-9. · 2.08 Impact Factor
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    ABSTRACT: This study examined patient predictors of response to interpersonal psychotherapy (IPT) and cognitive behaviour therapy (CBT). Participants were 177 adults with a primary diagnosis of major depressive disorder randomised to 16 weekly sessions of either IPT or CBT. Pre and post treatment depressive symptomatology was assessed by an independent clinician with the Montgomery Asberg Depression Rating Scale. General predictors of response were perceived logic of therapy, recurrent depression and childhood reasons for depression (r² =.21). Only one differential predictor of treatment response was identified. Increasing comorbid personality disorder symptoms was associated with decreases in response to IPT but not CBT. The results indicate that attention to specific pretreatment patient factors may enhance response to psychotherapy.
    Journal of Affective Disorders 02/2011; 128(3):252-61. · 3.76 Impact Factor
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    ABSTRACT: Cloninger's Temperament and Character Inventory (TCI) is a widely used measure of personality. Two scales of the TCI, harm avoidance (HA) and self directedness (SD), have been shown to be influenced by depressed mood. We examined how the seven TCI scales and their subscales are correlated with depression severity before and after treatment. We also examined whether changes in personality measures could be attributed to changes in depression severity. Two clinical samples of depressed out-patients were recruited for trials to examine predictors of treatment response to antidepressants (N=195) and psychotherapies (N=177). Assessment included the Montgomery-Asberg depression rating scales (MADRS), Hopkins Symptom Checklist (SCL-90) and TCI at baseline and after treatment. After treatment, in both samples, depression severity correlated significantly with HA and negatively with SD. Multiple regression analysis revealed that changes in SD and HA over treatment were related to improvement in depression. In the psychotherapy trial baseline MADRS scores correlated with low SD and high HA. The trial results are applicable to mild-moderately depressed out-patients. Depression severity influences the total scales and most of the subscale measures of HA and SD. Some personality traits, as measured by the TCI, were not impacted upon by mood. Clinically mood should be taken into account when assessing personality measures of negative affect using the TCI.
    Journal of Affective Disorders 04/2010; 126(1-2):140-6. · 3.76 Impact Factor
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    ABSTRACT: Numerous studies indicate rumination has a deleterious impact on the course of depressive symptoms. Very little is known about the factors that account for individual differences in the tendency to ruminate, particularly in clinical samples. The aim of this study was to examine the relationship between demographic factors, clinical characteristics of depression, personality and rumination in a clinical sample. Rumination was assessed with the Response Styles Questionnaire in 168 outpatients with a current diagnosis of major depression. Depression characteristics and personality were assessed with both structured clinical interviews and self-report measures. The results indicate that depression severity and personality predict rumination. Specifically, high initial depression severity, cluster B personality disorder symptoms and low self-directedness were significant predictors of rumination. There were no age or gender differences in the tendency to ruminate. Personality functioning appears to be an important dimension that may account for individual differences in the tendency to ruminate in depressed outpatients. Copyright © 2009 John Wiley & Sons, Ltd.
    Personality and Mental Health 11/2009; 3(4):275-283. · 1.10 Impact Factor
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    ABSTRACT: The Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) assesses eating disorder preoccupations, rituals, and symptom severity. This study examines the YBC-EDS in relation to eating disorder psychopathology, obsessionality, and impulsivity variables in women with anorexia nervosa (AN) and sensitivity of the YBC-EDS to change after psychotherapy. Participants were 56 women with "spectrum" AN (14.5 < BMI < 19). Variables examined in relation to the YBC-EDS were as follows: eating pathology, obsessionality (obsessive compulsive disorder and personality diagnoses, perfectionism), and impulsivity (borderline personality, impulsive traits, and behaviors). YBC-EDS scores were examined pre- and post-treatment. Eating Disorder Examination scores most strongly predicted the YBC-EDS. As expected, perfectionism was significantly associated, but so was impulsivity. YBC-EDS scores were significantly different in those with good versus poor global outcome after therapy. Unexpectedly, maximum lifetime BMI was correlated with the YBC-EDS. The YBC-EDS most strongly measured eating disorder severity and reflected change after psychotherapy for AN.
    International Journal of Eating Disorders 10/2008; 42(3):267-74. · 3.03 Impact Factor
  • European Psychiatry 04/2008; 23. · 3.21 Impact Factor
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    ABSTRACT: To compare the current sexual functioning of women in an intimate relationship with anorexia nervosa, with major depression, and in the postpartum period. Complete data were available for 76 women who reported being in an intimate relationship (anorexia = 10; depression = 24; postpartum = 42). Sexual functioning was assessed using the Social Adjustment Scale (Weissman and Bothwell, Arch Gen Psychiatry, 33, 1111-1115, 1976). Significant differences were found among groups for the frequency of sex (p =.03) and problems with sex (p < .001), but not for enjoyment of sex (p = .55). In the previous 2 weeks, women with anorexia nervosa or major depression were more likely to have had sex than postpartum women, but were also more likely to have had sexual problems than postpartum women. Most women with anorexia nervosa, women with major depression, and postpartum women reported enjoying sex. Women with anorexia nervosa and women with major depression who are in an intimate relationship report a similar profile of current sexual functioning that is different from postpartum women both in the frequency of sexual encounters and in reported problems with sex.
    International Journal of Eating Disorders 12/2007; 40(7):664-7. · 3.03 Impact Factor
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    ABSTRACT: Interpersonal psychotherapy and cognitive-behavioural therapy are widely accepted as effective treatments for major depression. There is little evidence on how personality disorder or personality traits affect treatment response. To determine whether personality disorder or traits have an adverse impact on treatment response to interpersonal psychotherapy or cognitive-behavioural therapy in people receiving out-patient treatment for depression. The study was a randomised trial in a university-based clinical research unit for out-patients with depression. Personality disorder did not adversely affect treatment response for patients with depression randomised to cognitive-behavioural therapy. Conversely, personality disorder did adversely affect treatment response for patients randomised to interpersonal psychotherapy. Despite the two therapies having comparable efficacy in patients with depression, response to interpersonal psychotherapy (but not cognitive-behavioural therapy) is affected by personality traits. This could suggest the two therapies are indicated for different patients or that they work by different mechanisms.
    The British Journal of Psychiatry 07/2007; 190(6):503-8. · 7.34 Impact Factor
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    ABSTRACT: Interpersonal psychotherapy and cognitive-behavioural therapy (CBT) are established as effective treatments for major depression. Controversy remains regarding their effectiveness for severe and melancholic depression. To compare the efficacy of interpersonal psychotherapy and CBT in people receiving out-patient treatment for depression and to explore response in severe depression (Montgomery-Asberg Depression Rating Scale (MADRS) score above 30), and in melancholic depression. Randomised clinical trial of 177 patients with a principal Axis I diagnosis of major depressive disorder receiving 16 weeks of therapy comprising 8-19 sessions. Primary outcome was improvement in MADRS score from baseline to end of treatment. There was no difference between the two psychotherapies in the sample as a whole, but CBT was more effective than interpersonal psychotherapy in severe depression, and the response was comparable with that for mild and moder-ate depression. Melancholia did not predict poor response to either psychotherapy. Both therapies are equally effective for depression but CBT may be preferred in severe depression.
    The British Journal of Psychiatry 07/2007; 190:496-502. · 7.34 Impact Factor
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    ABSTRACT: To evaluate the impact of childhood abuse and parental bonding on cortisol levels in depressed adults. Mean afternoon cortisol levels were measured in 192 depressed adult patients at the beginning of a treatment trial. Childhood experiences of physical and sexual abuse were ascertained by interview, and perceived parenting by self-report. Maternal affectionless control, childhood sexual and physical abuse were all associated with cortisol levels. Childhood experiences, especially maternal affectionless control, appear to be related to hypothalamic pituitary adrenal axis function in depressed adults.
    Australian and New Zealand Journal of Psychiatry 02/2007; 41(1):62-5. · 3.77 Impact Factor
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    ABSTRACT: This article presents the rationale for, and description of, a nonspecialized therapy for anorexia nervosa, called specialist supportive clinical management (SSCM). Clinical management and supportive psychotherapy models of treatment are outlined. SSCM is described, as it was delivered in a clinical trial of psychotherapies for adult women with anorexia nervosa. The primary focus of SSCM for anorexia nervosa is the resumption of normal eating and the restoration of weight. Therapy aims to maintain a therapeutic relationship that facilitates the return to normal eating, and to enable other life issues that may impact on the eating disorder to be addressed. Possible effective components of SSCM are discussed.
    International Journal of Eating Disorders 01/2007; 39(8):625-32. · 3.03 Impact Factor
  • International Conference on Eating Disorders: Eating disorders: complexity, progress and new directionsInternational Conference on Eating Disorders: Eating disorders: complexity, progress and new directions; 01/2007
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    ABSTRACT: Borderline personality disorder (BPD) is often co-morbid with major depression and may complicate its treatment. We were interested in differences in genetic and developmental risk factors between depressed patients with or without a co-morbid BPD. Out-patients with major depressive disorder were recruited for two treatment trials. Assessment of depressed patients included the assessment of personality disorders, developmental risk factors and DNA samples for genetic analyses. In each study there was a significant association between the 9-repeat allele of the dopamine transporter (DAT1) and BPD, with odds ratios (OR) > 3 and p < or = 0.02. This association remained significant when developmental risk factors for BPD (childhood abuse and neglect and borderline temperament) were also included in the analyses. The OR was even larger in the depressed patients aged > or = 35 years (OR 9.31, p = 0.005). This replicated association in depressed patients between the 9-repeat allele of DAT1 and BPD may provide clues to understanding the neurobiology of BPD. The finding that the association is larger in the older depressed patients, suggests that the 9-repeat allele may be associated with a poorer prognosis BPD, rather than a young adult limited variant of BPD.
    Psychological Medicine 07/2006; 36(6):807-13. · 5.43 Impact Factor
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    ABSTRACT: To examine whether the T allele of G protein beta3 (GNbeta3) is associated with self-mutilation in depressed patients. A history of self-mutilation was systematically inquired about when recruiting depressed patients for a long-term treatment trial. Risk factors such as borderline personality disorder and childhood abuse experiences were systematically assessed, and patients were genotyped for polymorphisms of GNbeta3. The T allele of GNbeta3, borderline personality disorder and childhood sexual abuse were all significantly associated with self-mutilation in depressed patients. These associations were significant in both univariate and multivariate analyses, and as predicted were stronger in young depressed patients than in depressed patients of all ages. If the association between the T allele of GNbeta3 and self-mutilation can be replicated, this may provide clues to understanding the neurobiology of self-mutilation.
    Australian and New Zealand Journal of Psychiatry 04/2006; 40(3):225-9. · 3.77 Impact Factor
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    ABSTRACT: Abstract An adaptation of the Collaborative Study Psychotherapy Rating Scale (CSPRS) was used to rate therapist adherence to three psychotherapies for anorexia nervosa. One audiotaped psychotherapy session from each of 30 patients was rated independently by two raters. Analysis of the psychometric properties of the instrument revealed good interrater agreement and high internal consistency. For all three therapies, therapists were rated as exhibiting significantly more behaviors appropriate to the therapy to which patients were randomized than the other two therapies, indicating very satisfactory adherence to therapy. The three therapies were clearly distinguishable by raters unaware of therapy condition using the modified CSPRS.
    Psychotherapy Research 07/2005; 15(3):339-44. · 1.75 Impact Factor

Publication Stats

945 Citations
145.35 Total Impact Points


  • 2003–2014
    • University of Otago
      • • Department of Psychological Medicine (Christchurch)
      • • Department of Psychological Medicine (Dunedin)
      • • Christchurch School of Medicine and Health Sciences
      Taieri, Otago Region, New Zealand
  • 1997–2007
    • Canterbury District Health Board
      • Clinical Research Unit
      Christchurch, Canterbury Region, New Zealand
  • 2004
    • University of Sydney
      Sydney, New South Wales, Australia
  • 2002
    • Virginia Commonwealth University
      • Department of Psychiatry
      Richmond, Virginia, United States