Gin S Malhi

Gin S Malhi
The University of Sydney · Discipline of Psychiatry

MB.ChB. B.Sc.(Hons). FRCPsych., FRANZCP., MD.

About

821
Publications
157,899
Reads
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25,147
Citations
Introduction
EDITOR - Australian & New Zealand Journal of Psychiatry; Bipolar Disorders. RESEARCH - Mood & Anxiety Disorders; Suicide & the effects of Lithium; Neuroimaging. FUNDING - NHMRC Program Grant; American Foundation for Suicide Prevention; Australian Rotary Health; Ramsay Research & Teaching Fund; SPARK Sydney; SMS Foundation. DIRECTOR - CADE Clinic; CADE Lithium Clinic (CliC). ROYAL NORTH SHORE HOSPITAL - Head & Department Chair. SYDNEY MEDICAL SCHOOL - Distinguished Professor.
Additional affiliations
October 2006 - present
The University of Sydney
Position
  • Professor of Psychiatry
October 2006 - present
Royal North Shore Hospital
Position
  • Professor (Full) Head of Department

Publications

Publications (821)
Article
The use of randomized clinical trials, in particular placebo-controlled trials, for drug approval, is the subject of long-standing debate in the scientific community and beyond. This study offers consensus recommendations from clinical and academic experts to guide the selection of clinical trial design in psychiatry. Forty-one highly cited clinica...
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Full-text available
An increased prevalence of duplicated Heschl’s gyrus (HG) has been repeatedly demonstrated in various stages of schizophrenia as a potential neurodevelopmental marker, but it remains unknown whether other neuropsychiatric disorders also exhibit this macroscopic brain feature. The present magnetic resonance imaging study aimed to examine the disease...
Article
Objective: There is often a shortfall in recovery following treatment for an episode of bipolar disorder (BD). Exploration of participant's experience provides vital information to enhance statistical outcomes for novel therapy trials. This study used mixed-methods to explore participants' experience of a trial testing N -acetyl cysteine (NAC) and...
Article
Objective To rebut the claims made in an opinion piece by Anaf and colleagues regarding the recommendations for psychotherapy within the 2020 RANZCP Mood Disorders Clinical Practice Guidelines (CPG). Conclusions The CPG attaches importance to psychological interventions and recommends their administration as first-line in the treatment of depressi...
Article
Distinguishing the symptoms of antidepressant withdrawal from those of relapse is a complex issue that has an impact on a significant number of clinicians and patients. This commentary expands on several important points made by Horowitz & Taylor in their examination of this critically under-researched area and illustrates the relationships between...
Article
Psychotic episodes occur in a substantial proportion of patients suffering from major mood disorders (both unipolar and bipolar) at some point in their lives. The nature of these episodes is less well understood than the more common, non-psychotic periods of illness and hence their management is also less sophisticated. This is a concern because th...
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Background A significant proportion of patients with major depressive disorder are resistant to antidepressant medication and psychological treatments. A core symptom of treatment-resistant depression (TRD) is anhedonia, or the inability to feel pleasure, which has been attributed to disrupted habenula function – a component of the reward network....
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Torture has profound psychological and physiological consequences for survivors. While some brain structures and functions appear altered in torture survivors, it is unclear how torture exposure influences functional connectivity within and between core intrinsic brain networks. In this study, 37 torture survivors (TS) and 62 non-torture survivors...
Article
Objective This study aimed to explore effects of adjunctive minocycline treatment on inflammatory and neurogenesis markers in major depressive disorder (MDD). Methods Serum samples were collected from a randomised, placebo-controlled 12-week clinical trial of minocycline (200mg/day, added to treatment as usual) for adults ( n =71) experiencing MDD...
Article
With advances in technology being applied to the detection and diagnosis of medical disorders we consider the potential role of such innovations in improving the management of mental health, in particular depression.
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Background The relationship between irritability as a subjective experience and the behavioural indicators typically used to measure the construct are not known. Its links to mood, and contextual relationships, vary with age and are yet to be thoroughly examined. Aims First, to interrogate the relationship between the subjective experience of irri...
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Bipolar disorder (BD) is commonly misdiagnosed as major depressive disorder (MDD). This is understandable, as depression often precedes mania and is otherwise indistinguishable in both. It is therefore imperative to identify neural mechanisms that can differentiate the two disorders. Interrogating resting brain neural activity may reveal core disti...
Article
Objectives The 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) guidelines provided clinicians with pragmatic treatment recommendations for bipolar disorder (BD). While these guidelines included commentary on how mixed features may direct treatment selection, specific recommendati...
Article
Background: Glutamergic system dysfunction has been implicated in the pathophysiology of bipolar depression. This is an update of the 2015 Cochrane Review for the use of glutamate receptor modulators for depression in bipolar disorder. Objectives: 1. To assess the effects of ketamine and other glutamate receptor modulators in alleviating the acu...
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Full-text available
Social attachment systems are disrupted for refugees through trauma and forced displacement. This study tested how the attachment system mitigates neural responses to threat in refugees with PTSD. Refugees with PTSD (N=28) and refugee trauma-exposed controls (N=22) viewed threat-related stimuli primed by attachment cues during fMRI. We examined gro...
Article
The prospect of staging psychiatric disorders has been a source of ongoing controversy since the idea was first proposed in the early 1990s, based on the staging models used for cancer. More recently, several staging models have been proposed for bipolar disorder, however as yet there is no consensus as to which model (or composite) is best, and th...
Article
This perspective piece is a detailed analysis of the critique by Gordon Parker of the mood disorders clinical practice guidelines (MDcpg ²⁰²⁰ ), in which he claims that bipolar II disorder has been ‘banished’ despite its formal status in current taxonomies. In this article, I defend the reasoning used by the Committee to adopt a dimensional model f...
Article
Feeling irritable is a common experience, both in health and disease. In the context of psychiatric illnesses, it is a transdiagnostic phenomenon that features across all ages, and often causes significant distress and impairment. In mood disorders, irritability is near ubiquitous and plays a central role in diagnosis and yet, despite its prevalenc...
Article
Background Bipolar Disorder (BD) is commonly misdiagnosed as Major Depressive Disorder (MDD) because depression declares onset and is common to both; making it imperative to identify neural mechanisms that can differentiate the two disorders clinically. Interrogating the resting brain may reveal core distinguishing abnormalities in its framework an...
Article
The efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression is disputed. This is partly because, to date, insufficient good-quality studies have been conducted, and a definitive clinical profile for which rTMS is best suited is yet to be determined. However, another equally important reason for questioning the...
Article
The validity of Paediatric bipolar disorder (PBD) as a clinical diagnosis is at the centre of an ongoing controversy. The diagnostic difficulties of PBD and its clinical ramifications exemplify some of the broader tensions within psychiatry between phenomenological and biological schemas, and the challenges we face in marrying the two to meaningful...
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Full-text available
Although trauma-focused cognitive behavioural therapy (TF-CBT) is the frontline treatment for posttraumatic stress disorder (PTSD), up to one half of patients do not respond optimally to this treatment. Inhibitory functions are important for successful management of PTSD, yet there is a dearth of knowledge regarding the extent to which neural mecha...
Article
This article is a detailed response to the criticisms levelled by the authors of an accompanying viewpoint, which claims that the positioning of repetitive transcranial magnetic stimulation (rTMS) in the 2020 Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines for the management mood disorders (MDcpg ²⁰²⁰...
Article
Background: Bipolar disorder (BD) is associated with elevated rates of eating disorders (EDs), but the nature and impact of specific ED features are unclear. Aims: This study sought to identify which ED features are common in BD, and whether these relate to quality of life (QoL) impairment and body mass index (BMI). Method: A clinical sample of 73...
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Full-text available
Irritability is a transdiagnostic phenomenon that, despite its ubiquity and significant impact, is poorly conceptualised, defined and measured. As it lacks specificity, efforts to examine irritability in adults by using a diagnostic category perspective have been hamstrung. Therefore, using a Research Domain Criteria (RDoC) approach to examine irri...
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Objectives To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. Methods Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were suppleme...
Article
Background Up to 40% of patients with Bipolar Disorder (BD) are initially diagnosed as having Major Depressive Disorder (MDD) and emotional lability is a key aspect of both sets of mood disorders. However, it remains unknown whether differences in the regulation of emotions through cognitive reappraisal may serve to distinguish BD and MDD. Therefor...
Article
Objectives To provide a succinct, clinically useful summary of the management of major depression, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg²⁰²⁰). Methods To develop the MDcpg²⁰²⁰, the mood disorders committee conducted an extensive review of the available lit...
Article
Objectives To provide a succinct, clinically useful summary of the management of bipolar disorder, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg²⁰²⁰). Methods To develop the MDcpg²⁰²⁰, the mood disorders committee conducted an extensive review of the available lit...
Article
Background Major depressive disorder is a common, recurrent, disabling and costly disorder that is often severe and/or chronic, and for which non-remission on guideline concordant first-line antidepressant treatment is the norm. A sizeable percentage of patients diagnosed with MDD do not achieve full remission after receiving antidepressant treatme...
Article
Bipolar disorders are a complex group of severe and chronic disorders that includes bipolar I disorder, defined by the presence of a syndromal, manic episode, and bipolar II disorder, defined by the presence of a syndromal, hypomanic episode and a major depressive episode. Bipolar disorders substantially reduce psychosocial functioning and are asso...
Article
Background : Irritability is a common symptom in youth that is thought to be predictive of mood disorders. Its effects on mood are likely to be age-dependent, with direct and indirect mediators. We assessed age-related effects and mediators of irritability in adolescent girls with subthreshold depressive and manic symptoms. Methods : We analysed t...
Article
It has recently been argued that a unidimensional approach to mood disorders, focusing predominantly on emotions is too narrow to capture the full spectrum of symptoms of affective disorders, and that additional symptom domains of activity and cognition are at least equally important – possibly even more so1. This ‘ACE’ (Activity, Cognition and Emo...
Article
Background Randomized controlled clinical trials that have investigated minocycline as an adjunctive treatment for major depressive disorder have proved promising. Data from two studies were pooled to evaluate more definitively whether the addition of minocycline to standard treatment for major depressive disorder leads to an improvement of depress...
Article
Identifying early clinical phenotypes that may be indicative of an emerging psychiatric condition has been a major focus of public health and medicine, and to this end, extensive effort has been expended to develop clinical staging models of disease. ‘Staging’ an illness requires a number of conditions to be met. First, it needs to be inherently “s...
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Full-text available
Background Although trauma‐focused cognitive behavioral therapy (TF‐CBT) is the frontline treatment for posttraumatic stress disorder (PTSD), at least one‐third of patients are treatment nonresponders. This study aimed to identify neural markers of treatment response, specifically the prediction of remission of specific PTSD symptoms. Methods This...
Article
The current study aimed to identify alterations in brain activation and connectivity related to memory suppression in posttraumatic stress disorder (PTSD) using the Think/No-Think paradigm during functional magnetic resonance imaging (fMRI). Reduced activation in the parahippocampal cortex during No-Think vs. Baseline trials was found in participan...
Article
Objective Torture adversely influences emotional functioning, but the neurophysiological mechanisms underpinning its impact are unknown. This study examined how torture exposure affects the neural substrates of interpersonal threat and reward processing. Methods Male refugees with ( N = 31) and without ( N = 27) torture exposure completed a clinic...
Article
Objective The aims of this study were to evaluate changes in inflammatory and oxidative stress levels following treatment with N-acetylcysteine (NAC) or mitochondrial-enhancing agents (CT), and to assess the how these changes may predict and/or moderate clinical outcomes primarily the Montgomery-Åsberg Depression Rating Scale (MADRS). Methods This...
Article
Objective: Rates of suicidality are higher in military than comparable civilian populations. The period of transition from regular military service may be a time of particular vulnerability. In order to best inform early intervention and prevention strategies, we sought to investigate the childhood determinants (trauma and disorder) of self-report...