搜索结果：Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists

BackgroundSomatization is a psychological process leading to the experience of somatic symptoms in response to psychosocial factors. Variations in sampling, nosology and instrumentation have contributed to uncertainty about the prevalence of the diagnosis of somatization disorder(s). We estimated the pooled prevalence of relevant classifications of somatization syndromes in unselected and selected adult primary care populations.MethodsWe searched electronic databases from 1946 to 2022 and selected all papers in adult primary care populations reporting prevalence of any somatization syndrome. A series of random effects meta-analyses calculated pooled estimates of prevalence. Primary outcomes were any somatoform disorder, individual somatization syndrome, and PHQ-15 derived 'diagnosis'. Secondary outcomes were somatization syndromes by clinician diagnosis, classification system, diagnostic instrument and gender.ResultsIn unselected primary care populations the pooled mean prevalence was: Somatoform disorder 16.3%; individual somatization syndrome 7.7%; and PHQ-15 any severity 18.7%. Meta-regressions showed modification by diagnostic instrument but no effect of decade or geographical location. Selected populations generally had higher prevalence estimates for equivalent diagnoses.ConclusionsSomatization syndromes in primary care are common, affecting more than one in 10 patients. Recent classification systems may represent a substantial widening in conceptualisation of somatization syndromes, especially for somatization disorder and so future studies will be needed to compare prevalence estimates.

ObjectiveClozapine is effective, but is associated with cardiometabolic disease burden. The cardiometabolic health of Indigenous Australians taking clozapine is unclear. This study aimed to determine the cardiometabolic health state and management of Indigenous and non-Indigenous clozapine patients over 1 year.MethodsA retrospective cross-sectional observational study using clinical data from a regional clozapine clinic. We calculated QRisk3 cardiovascular disease (CVD) risk scores and the prevalence of diabetes, hypertension and metabolic syndrome (MES). Cardiometabolic monitoring and management were also analysed. Findings were compared between Indigenous and non-Indigenous patients.ResultsOverall, 76 patients were included (35.5% Indigenous). Ninety-seven percent had complete metabolic monitoring data for MES. Prevalences of diabetes (22.3%), hypertension (42.1%), and MES (68.4%) were high. Indigenous patients had significantly higher levels of diabetes, CVD risk and reduced high-density lipoprotein (HDL). The majority (84.2%) of patients received lifestyle advice. Follow-up with allied health services and communication with general practicioners (GPs) was limited. Indigenous patients were significantly more likely to receive pharmacological treatments.ConclusionsA high cardiometabolic disease burden was observed, which was significantly greater in Indigenous patients. All received excellent cardiometabolic monitoring, but lifestyle interventions were underutilised. Clear treatment guidelines and better integration of monitoring and management are required.

ObjectivesThis survey evaluated psychiatry trainees' attitudes toward conceptual and philosophical issues in psychiatry practice, research and training.MethodsA 20-item Likert questionnaire was administered to 156 psychiatry trainees (53 UK, 103 US) via Webropol (UK) and REDCap (US). The survey assessed demographics, familiarity with conceptual and philosophical issues, attitudes toward its importance, confidence in three domains of conceptual competence, and views on specific philosophical issues. Descriptive statistics and Mann-Whitney U tests were used to analyze UK and US responses. Free-text responses provided qualitative data.ResultsMost trainees (82% research, 92% practice) recognized the importance of conceptual and philosophical issues in psychiatry, with 96% supporting their inclusion in training, but only 28% felt their current training had adequately prepared them. Trainees were 'somewhat confident' in recognizing conceptual assumptions implicit in psychiatric work but felt less confident that they possessed the requisite philosophical vocabulary and ability to critically evaluate philosophical issues. Regarding specific philosophical positions, responses revealed a strong endorsement of explanatory pluralism and a rejection of naturalist definitions of mental disorder.ConclusionTrainees viewed conceptual skills as important but felt unprepared by current training programs. This article advocates for the integration of 'conceptual competence' in psychiatric education.

ObjectiveTo evaluate confidence levels of junior doctors working in the paediatric emergency department (ED) in the assessment and management of acute mental health presentations.MethodsThis cross-sectional study invited 89 eligible junior doctors in an Australian paediatric ED to complete an online survey. Information about clinical experience was collected, and self-report confidence levels assessed using 5-point Likert scale. Descriptive statistics and comparative analysis were conducted using the Mann-Whitney U test.Results28 participants responded to the survey. Participants indicated feeling less confident in domains of assessment and management such as managing acute agitation, having knowing of referral pathways and support services compared to other domains. Confidence levels did not significantly differ based on training level or prior experience. Suggestions for future training included scenario-based learning, clinical simulation, education on referral pathways and acute behavioural disturbance.ConclusionsThis study reveals generally low confidence levels of junior doctors in assessment and management of acute mental health presentations to the paediatric ED. Confidence levels did not significantly differ between groups based on clinical experience and varied across domains of assessment and management. The study highlights a need for further training to address the current skills and knowledge gap in this area.

BackgroundADHD is a common neurodevelopmental disorder. Stimulants are the gold standard treatment resulting in measurable improvements in associated functional impairment. However, people with a history of comorbid anorexia nervosa (AN), an illness characterised by restricted intake and malnutrition, find it challenging to access stimulant treatment. In our clinical experience, amidst a scarce safety-profile for this population, stimulants are ceased or withheld due to concerns about appetite suppression, weight loss, and cardiac risks. We responded to the paucity of literature by reviewing the cases of people with ADHD and a history of AN who have received stimulant-treatment.MethodWe reviewed the medical records and personal experiences of six community patients with ADHD and a history of AN, to assess the safety and acceptability of stimulants.ResultsSide-effects included appetite suppression and stimulant induced weight loss. This did not appear to exacerbate AN-pathology. Patients experienced subjective improvement in ADHD pathology, attenuation of the negative impacts of ADHD on AN, and subjective improvements in anxiety, depression, and suicidality.ConclusionThese preliminary findings indicate safety and acceptability for the careful use of stimulants in people with ADHD and a history of AN and paves the way for larger studies to demonstrate clinical benefit.

Medical journals are fundamental institutions that champion free speech and scientific enquiry, for the betterment of healthcare of patients, health professions, and society. Psychiatry draws upon and overlaps with a range of fields including ethics, the law, social science, philosophy, and politics, amongst others. Psychiatric science and the art of practice encompass many controversial domains that impact upon the health of the people the profession cares for. It is increasingly challenging to facilitate open spaces for free speech and enquiry in the context of ascendant authoritarianism in government, the academy, medical organisations, and broader society. Fortunately, there are important guideposts drawn from twentieth century and recent history that enable recognition of and democratic action to curtail authoritarianism and empower free speech and scientific enquiry.

ObjectiveTo investigate the role of telehealth in youth psychiatry during and after the pandemic in Australia.MethodsWe analysed Medicare Benefits Schedule (MBS) item number data for psychiatry services provided to patients aged 0-24 years, from 2017 to 2022. We analysed total services (in-person and telehealth) from 2017 to 2022, determining provision before and during the pandemic. We also analysed changes to use of each modality during the pandemic. Finally, we calculated the use of each modality in 2022, when COVID-19 restrictions had eased.ResultsYouth psychiatry service provision steadily increased prior to the pandemic (2017-2019). Larger increases were seen during the pandemic, with 15.3% increase between 2019 and 2020, and 9.7% increase between 2020 and 2021. After the introduction of telepsychiatry MBS item numbers, in-person services decreased from 71.3% to 63% between 2020 and 2022. Video-telepsychiatry increased from 15.7% to 26.4% between 2020 and 2022, and telephone-telepsychiatry decreased from 13% to 10.6%. In 2022, most consultations were in-person, but video-telepsychiatry was higher than ever despite fewer COVID-19 restrictions.ConclusionsTelepsychiatry was well-received by young people during the pandemic and should remain an option to improve access to youth psychiatry in post-pandemic times.

ObjectiveDespite recent efforts to promote rural training opportunities, little is known about contemporary trainees' experiences. The study aimed to explore the experiences of stage one psychiatry trainees in rural Australia, focussing on development across CanMEDs competencies.MethodTwelve RANZCP trainees who completed stage one training in rural settings across Australia were recruited. The study used a qualitative, phenomenological approach. Data were collected through semi-structured interviews, which were analysed through thematic analysis.ResultsData revealed three primary themes. First, the interconnectedness of rural communities created an expanded sense of professional identity. Second, resource scarcity represented a duality of challenges and opportunities, which framed the development of generalist competencies. Third, progression through training highlighted challenges related to supervision and trainees' approach to their learning.ConclusionRural psychiatry training presents a unique interplay of challenges and opportunities that shape trainee development across multiple competency domains, providing a rich platform for professional education and growth. Our results may inform current efforts to enhance the quality of rural psychiatry training.

BackgroundDelirium is a common neuropsychiatric syndrome associated with significant morbidity and healthcare burden. Consultation-liaison psychiatry (CLP) is frequently involved in delirium management, though evidence regarding outcomes of CLP referral remains limited.MethodsThis retrospective case-control study examined delirium outcomes over 6 months. Delirium patients referred to CLP were matched by age and gender with those not referred to CLP. Outcomes included length-of-stay (LoS), psychotropics prescribed (PP), mechanical restraint (MR), and Code Greys (CG). Within-group comparisons before and after CLP were also conducted.ResultsOf 1365 delirium cases, 20 CLP referrals were found and matched with 20 controls. The CLP group had a significantly longer LoS than controls (median 20.5 vs 9, p = .024). More psychotropics were prescribed for the CLP group than for the control group (median 1 vs 0.5, p = .33). Mechanical restraint occurred only in the CLP group, while CG rates were similar. The CLP involvement was associated with a non-significant increase in PP, alongside reductions in MR and CG.ConclusionsThe CLP involvement in delirium was associated with longer LoS and higher PP, likely reflecting referral of more complex cases. Modest reductions in MR and CG were observed. Larger prospective studies are required to clarify the impact of CLP on delirium outcomes.

BackgroundVitamin D is a neuroactive hormone involved in brain development and immune regulation. It may influence psychiatric symptoms, particularly depression and schizophrenia.ObjectiveTo examine the association between vitamin D levels and the symptoms of depression and schizophrenia.MethodsThe PRISMA guidelines were followed in this systematic review. A literature search was conducted in PubMed, Web of Science, Google Scholar, and Cochrane Library to identify studies published between 2014 and 2025. The studies included case-control, cohort, cross-sectional, and interventional designs that evaluated the levels of vitamin D and psychiatric symptoms in individuals with depression or schizophrenia. The risk of bias was evaluated.ResultsEleven studies met our inclusion criteria. From these results, it can be observed that there is a link between vitamin D deficiency and increased symptom severity in depression and schizophrenia. Lower vitamin D levels are related to higher severity scores of symptoms and inflammatory and neurotrophic biomarkers. However, three studies have reported no significant relationship.ConclusionThis systematic review highlights a potential association wherein vitamin D deficiency may contribute to the pathophysiology or severity of both depression and schizophrenia.

ObjectiveThis study analysed antipsychotic prescribing patterns at discharge from an acute Tasmanian MHIU, and evaluated prescribing practice alignment with RANZCP clinical practice guidelines (CPG) for schizophrenia and BPAD.MethodsDescriptive cross-sectional analysis of discharge prescriptions was conducted for 202 patients extracted from routinely collected data. Diagnoses, prescribed antipsychotics, and doses (converted to olanzapine equivalents) were reviewed. Polypharmacy, as well as the use of depot and PRN doses, were also analysed.ResultsOverall, 66% of patients were prescribed antipsychotics at discharge, with 33% of this group receiving polypharmacy. Schizophrenia was the most common indication (35%), followed by off-label prescriptions (34%) and mood disorders (20%). Quetiapine IR and olanzapine were the most prescribed, with high rates of off-label use and polypharmacy. In around 10% of patients, doses exceeded 20 mg/day olanzapine equivalents. Depot formulations were prescribed to 24% of patients, with aripiprazole being most common. Schizophrenia spectrum diagnoses were significantly associated with polypharmacy.ConclusionsThis study highlights high rates of antipsychotic off-label prescribing and polypharmacy. The findings underscore the need for individualized prescribing, enhanced monitoring, and regular medication reviews. They also raise questions about the applicability of CPGs. Further research should investigate factors influencing off-label prescribing and strategies for safer prescribing.

Purpose of researchDescribe prescribing patterns in Australian Vietnam veterans, identify CYP2C19-metabolised medications using established pharmacogenetic (PGx) resources, characterise CYP2C19 profiles of veterans and assess the potential clinical impact of these medications.Major findingsAmong 283 veterans with CYP2C19 profiles, 256 reported current medications use, with a mean prescribed medication of 5.4. Of these, 89 veterans (34.7%) were prescribed at least one medication with CYP2C19 PGx recommendation. Notably, 52 veterans (58.4%) had CYP2C19 profiles that may be at risk of therapeutic failure or adverse effects. Prescribed medications also included six CYP2C19 inhibitors and one inducer, with potential to induce phenoconversion and impact drug metabolism.ConclusionVeterans experienced high levels of polypharmacy and frequently carried CYP2C19 phenotypes associated with increased risk of therapeutic failure or adverse effects. The presence of CYP2C19 inhibitors and inducers raises the potential for phenoconversion, where CYP2C19 profiles may be placed at risk. Given their similarities to the broader older population, these findings suggest that both groups may benefit from pre-emptive PGx testing. Furthermore, ongoing monitoring of drug-gene and drug-drug interactions remains essential to optimise medication safety and efficacy in these high-risk individuals.

AimThe experience of conducting an unsuccessful pilot trial of behavioural activation (BA) to improve depressive symptoms in young clients with early or emerging psychosis is reported on. We aimed to identify barriers and enablers to inform the conduct of future trials with this client group.MethodsClinicians completed BA training with the aim of delivering this to suitable clients. Feasibility outcomes were calculated as proportions of feasibility targets. The various stages of the pilot randomised trial were examined, informed by interviews with five young people with early or emerging psychosis and four clinicians. Interviews were content analysed.ResultsClient recruitment and retention targets were not met, with proportions of 10% and 50%, respectively. Barriers included 'clinician self-efficacy in recruitment', 'staff turnover', the 'fragility of young people's engagement with the service', and 'workload incurred from study involvement'. The enablers were 'clients' and clinicians' perceived potential to contribute to new evidence', 'the clinician-client relationship', and 'opportunities to provide feedback to the research team'.ConclusionsRecommendations for future similar studies include pre-trial stakeholder consultation; offering multiple cycles of training; support to grow clinician confidence for recruitment; accounting for increased workload; and ongoing service-research team meetings to identify solutions to emerging issues.

ObjectiveTo examine the risks and benefits associated with tapering and ceasing antipsychotic medication after treatment for psychotic illness.MethodNarrative synthesis of major guidelines and meta-analyses, landmark trials and recent randomised controlled trials (RCTs).Results(1) Maintenance is consistently protective against relapse and associated harms in the first 1 to 2 years of illness. (2) Some evidence suggests long-term functional benefits from reduction in dose or medication discontinuation, but findings are inconsistent and of low certainty. (3) Relapse after abrupt cessation is common, often within 3 months, possibly due to dopaminergic super-sensitivity. (4) Hyperbolic tapering, with slow and progressively smaller dose reductions, may reduce withdrawal effects and relapse risk. Clinical features associated with safer tapering included sustained remission, insight, absence of substance use, strong social support and access to rapid review.ConclusionDeprescribing is not universally safe, but a structured, gradual and reversible approach is consistent with ethical and patient-centred treatment, and in a small proportion of patients is not followed by relapse. Clinicians should emphasise shared decision-making, hyperbolic tapering and robust relapse-prevention strategies.

ObjectiveThis study investigated the perspectives of multidisciplinary staff regarding consultation-liaison psychiatry (CLP) services in Australian public hospitals.MethodA cross-sectional survey was distributed to CLP service providers (CLP staff and managers) and non-CLP hospital staff (allied health professionals, peer workers, and medical staff from Victoria and Tasmania). The survey assessed perceptions of response times, satisfaction, and areas for improvement in bed-based CLP service provision. Open-ended responses were analysed thematically.ResultsA total of 222 staff from diverse disciplines and settings participated. Most participants (65%) reported that patients were reviewed within an acceptable timeframe, and 90% were at least moderately satisfied with CLP performance. Frequently endorsed areas for improvement were enhanced communication, increased resource allocation (staff, skill-mix, outpatient clinics), development of referral guidelines, and greater integration with medical teams. Non-CLP staff expressed frustrations with barriers to service delivery, particularly limited telephone access and medical clearance hurdles. Multiple CLP respondents believed that CLP's role continues to be poorly understood by non-psychiatry staff. They also called for digitally integrated workflows to improve efficiency.ConclusionThis study highlights the essential role of CLP services in Australian public hospitals and identifies workforce, leadership, and infrastructure improvements as key priorities for enhancing service quality.

ObjectiveThe Australian Institute of Health and Welfare regularly reports on specialised mental health facilities. Data are available from 1992 to 2022 on public mental health hospital and residential mental health service beds, as well as supported housing and staffing of specialised mental healthcare facilities. We provide a clinical commentary on these reports, reflecting upon the implications for psychiatric practice and patient care.ConclusionsThere are overall trends in public specialised mental health bed numbers. There were substantial declines in public mental health beds that slowed around 2000 and subsequently plateaued in 2015-16 in most jurisdictions with two exceptions, South Australia and the ACT. By contrast, residential mental health service beds increased from 1999 onwards, though since 2015 there have been declines for the ACT, Victoria and Tasmania. For supported housing, most states and territories showed declines in the reported levels since 2002, although there were increases in the Northern Territory, South Australia and Western Australia. From 2009 supported housing rates were relatively stable, with declines in all states and territories from 2015 onwards.

AimHealth service usage for eating disorders (EDs) has increased substantially; however, many tertiary hospitals lack resources for specialist ED services. Evidence-based guidelines outline ED management approaches for acute medical stabilisation in non-specialised services, including protocols for care across key disciplines (psychiatry, medicine and dietetics). The study aim was to evaluate collaboration of care within an Australian tertiary hospital following an eating disorder Inpatient Access and Treatment Pathway (IATP).MethodsThis retrospective cohort study reviewed 40 patients admitted with an ED diagnosis pre- (2019) and post- (2022) implementation of the IATP. The electronic medical record was utilised to gather patient demographics and health outcomes, and organisation of care (multidisciplinary team meetings, discharge planning).ResultsFollowing the implementation of the IATP, there was a 40% (p = .01) increase in appropriate discharge planning, classified as ED service referral or suitable community dietetic, medical and psychology follow-up. There was a significant increase in the Care Adherence Score (p = .004) which quantified organisation of care, utilising four key dichotomous variables. There was also a significant an increase in starting energy prescription (5900 KJ vs 4480 KJ, p = .046).ConclusionsA local IATP supported a significant increase in multidisciplinary collaboration and care adherence, appropriate discharge planning and starting energy provision.

ObjectiveThis study explores prevalence and risk factors of problematic internet behaviours (PIBs) among youth who attended an emergency department (ED) for mental health (MH) concerns.MethodThis is a retrospective cross-sectional study of 237 patients aged 12-25 years who attended ED. Using a modified emergency department media use screener (mEDMUS) questionnaire and ED data, this study examined the association of socio-demographic and clinical predictors with PIB by applying bivariate and multiple logistic regression analysis.ResultsED presentation was related to PIB in 21.1% of participants. Female participants, those from culturally and linguistically diverse backgrounds, and individuals without a history of trauma were more likely to present with PIB. Multiple logistic regression analyses revealed that four internet-related behaviours (expressing aggression online, sending harmful content to others, deleting one's social media account, or accessing unhealthy ways of weight loss) were predictive of visits to the ED for MH concerns associated with online behaviours.ConclusionsThe findings of this study will help clinical services and policy makers gain a better understanding of young people's PIB in relation to their psychiatric symptoms. Future intervention studies should aim to broaden data collection techniques with long-term follow-ups, to explore how these online risk factors influence their everyday lives.

ObjectiveThere are relatively few papers addressing the challenges faced in the care of people with Borderline Personality Disorder in healthcare systems. We therefore present a clinical perspective on multidisciplinary team management of Borderline Personality Disorder.ConclusionsBorderline Personality Disorder has historically attracted significant stigma, partly due to negative, inaccurate beliefs regarding prognosis. Unique challenges may be encountered treating this condition, which, if not appropriately recognised and managed, contribute to and perpetuate stigma and poor outcomes. Potential challenges that may arise for multidisciplinary team care include splitting of teams, negative emotional contagion, fragmentation of care, patient re-traumatisation, frequent admissions, medicalisation, and de-medicalisation of Borderline Personality Disorder. We describe these challenges to facilitate multidisciplinary team discussions that promote greater awareness and better management for the benefit of patients and clinicians.