Pub Date : 2019-11-27DOI: 10.1177/0004867419889408
G. Parker, C. Loo
{"title":"Temporal effects of bitemporal electroconvulsive therapy","authors":"G. Parker, C. Loo","doi":"10.1177/0004867419889408","DOIUrl":"https://doi.org/10.1177/0004867419889408","url":null,"abstract":"","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":"11 1","pages":"433 - 434"},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88201655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-22DOI: 10.1177/0004867419888575
Sally E Meikle, Paul Liknaitzky, S. Rossell, M. Ross, N. Strauss, N. Thomas, G. Murray, Martin L Williams, D. Castle
In the quest for new treatment options for depression, attention is being paid to the potential role of psychedelic drugs. Psilocybin is of particular interest given its mechanism of action, its benefits in early trials and its relatively low side effects burden. This viewpoint outlines a number of key issues that remain to be elucidated about its potential use in the clinical environment, including clarification of the profile of people most likely to benefit and those who might experience adverse effects, longer-term outcomes and the role of psychotherapeutic input alongside the drug itself. There are also opportunities to understand better, the neurobiology underpinning its effects.
{"title":"Psilocybin-assisted therapy for depression: How do we advance the field?","authors":"Sally E Meikle, Paul Liknaitzky, S. Rossell, M. Ross, N. Strauss, N. Thomas, G. Murray, Martin L Williams, D. Castle","doi":"10.1177/0004867419888575","DOIUrl":"https://doi.org/10.1177/0004867419888575","url":null,"abstract":"In the quest for new treatment options for depression, attention is being paid to the potential role of psychedelic drugs. Psilocybin is of particular interest given its mechanism of action, its benefits in early trials and its relatively low side effects burden. This viewpoint outlines a number of key issues that remain to be elucidated about its potential use in the clinical environment, including clarification of the profile of people most likely to benefit and those who might experience adverse effects, longer-term outcomes and the role of psychotherapeutic input alongside the drug itself. There are also opportunities to understand better, the neurobiology underpinning its effects.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":"21 1","pages":"225 - 231"},"PeriodicalIF":0.0,"publicationDate":"2019-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90228959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-21DOI: 10.1177/0004867419888576
J. Rosenblat, P. Kurdyak, F. Cosci, M. Berk, M. Maes, A. Brunoni, Madeline Li, G. Rodin, R. McIntyre, A. Carvalho
Background: Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. Methods: Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. Results: Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug–drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. Limitations: Non-systematic review of the literature. Conclusion: Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.
{"title":"Depression in the medically ill","authors":"J. Rosenblat, P. Kurdyak, F. Cosci, M. Berk, M. Maes, A. Brunoni, Madeline Li, G. Rodin, R. McIntyre, A. Carvalho","doi":"10.1177/0004867419888576","DOIUrl":"https://doi.org/10.1177/0004867419888576","url":null,"abstract":"Background: Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. Methods: Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. Results: Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug–drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. Limitations: Non-systematic review of the literature. Conclusion: Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":"18 1","pages":"346 - 366"},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85287208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-21DOI: 10.1177/0004867419888297
J. Pirkis, D. Currier, L. Too, Marc Bryant, Sara Bartlett, M. Sinyor, M. Spittal
Objective: This study assessed the extent to which local reporting of Robin Williams’ suicide (on 11 August 2014) was associated with suicide in Australia. It followed several studies in the United States which showed that there were significant increases in suicide following media reports of Williams’ death and that those media reports were less than optimal in terms of adherence to best-practice guidelines. In a previous study, we demonstrated that Australian media reports of Williams’ suicide were largely adherent with our Mindframe guidelines on responsible reporting of suicide, so we speculated that there would be no increase in suicide following the reporting of Williams’ suicide in Australia. Method: We extracted data on Australian suicides from the National Coroners Information System for the period 2001 to 2016. We conducted interrupted time series regression analyses to determine whether there were changes in suicides in the 5-month period immediately following Williams’ suicide. Results: Our hypothesis that there would be no increase in suicides in Australia following Williams’ highly publicised suicide was not supported. There was an 11% increase in suicides in the 5-month period following Williams’ death, largely accounted for by men aged 30–64 and by people who died by hanging (the method Williams used). Conclusion: It may be that Australians were exposed to reports that contravened safe reporting recommendations, particularly via overseas media or social media, and/or that some Australian reports may have had unhelpful overarching narratives, despite largely adhering to the Mindframe guidelines. The Mindframe guidelines constitute international best practice but consideration should be given to whether certain recommendations within them should be further reinforced and whether more nuanced information about how stories should be framed could be provided. Future revision and augmentation of the Mindframe guidelines should, as always, involve media professionals.
{"title":"Suicides in Australia following media reports of the death of Robin Williams","authors":"J. Pirkis, D. Currier, L. Too, Marc Bryant, Sara Bartlett, M. Sinyor, M. Spittal","doi":"10.1177/0004867419888297","DOIUrl":"https://doi.org/10.1177/0004867419888297","url":null,"abstract":"Objective: This study assessed the extent to which local reporting of Robin Williams’ suicide (on 11 August 2014) was associated with suicide in Australia. It followed several studies in the United States which showed that there were significant increases in suicide following media reports of Williams’ death and that those media reports were less than optimal in terms of adherence to best-practice guidelines. In a previous study, we demonstrated that Australian media reports of Williams’ suicide were largely adherent with our Mindframe guidelines on responsible reporting of suicide, so we speculated that there would be no increase in suicide following the reporting of Williams’ suicide in Australia. Method: We extracted data on Australian suicides from the National Coroners Information System for the period 2001 to 2016. We conducted interrupted time series regression analyses to determine whether there were changes in suicides in the 5-month period immediately following Williams’ suicide. Results: Our hypothesis that there would be no increase in suicides in Australia following Williams’ highly publicised suicide was not supported. There was an 11% increase in suicides in the 5-month period following Williams’ death, largely accounted for by men aged 30–64 and by people who died by hanging (the method Williams used). Conclusion: It may be that Australians were exposed to reports that contravened safe reporting recommendations, particularly via overseas media or social media, and/or that some Australian reports may have had unhelpful overarching narratives, despite largely adhering to the Mindframe guidelines. The Mindframe guidelines constitute international best practice but consideration should be given to whether certain recommendations within them should be further reinforced and whether more nuanced information about how stories should be framed could be provided. Future revision and augmentation of the Mindframe guidelines should, as always, involve media professionals.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":"1 1","pages":"104 - 99"},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74664743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-21DOI: 10.1177/0004867419888289
R. Burns, P. Butterworth, Dimity A. Crisp
Objective: Describing the long-term mental health of Australians is limited as many reports rely on cross-sectional studies which fail to account for within-person changes and age-related developmental processes which may bias estimates which ignore these phenomena. We examined the 17-year trajectories of mental health in 27,519 Australian adults. Methods: Household panel data of 27,519 participants aged 18 years and over from the Household, Income and Labour Dynamics in Australia Survey provided at least one observation of mental health over a 17-year period from 2001. On average, participants reported 7.6 observations. Mental Health was assessed annually using the Short-Form Health Survey-36 mental health scale. Results: Over time, there were only very small changes in mental health and only for the youngest and oldest adults. Over time, there was consistent evidence for better metal health with increasing age, although for the very old, there appear to be substantial declines. These patterns were consistent between sex. In line with an existing literature, males reported better mental health over life span, although the declines of mental health in very-late-life are particularly pronounced for males. Conclusion: Decline in mental health was only reported by the youngest and oldest respondents, and was notable only in the last 4–5 years. However, the magnitude of the decline was small and further follow-up will be needed to determine whether this is a trend of substantive declining mental health for these specific age cohorts. In contrast, the more consistent finding is that there has been no substantive change in the level of mental health in Australia over the last 17 years. Analysis of the mental health trajectories of baseline age-cohorts confirmed that age differences are consistent over time.
{"title":"Age, sex and period estimates of Australia’s mental health over the last 17 years","authors":"R. Burns, P. Butterworth, Dimity A. Crisp","doi":"10.1177/0004867419888289","DOIUrl":"https://doi.org/10.1177/0004867419888289","url":null,"abstract":"Objective: Describing the long-term mental health of Australians is limited as many reports rely on cross-sectional studies which fail to account for within-person changes and age-related developmental processes which may bias estimates which ignore these phenomena. We examined the 17-year trajectories of mental health in 27,519 Australian adults. Methods: Household panel data of 27,519 participants aged 18 years and over from the Household, Income and Labour Dynamics in Australia Survey provided at least one observation of mental health over a 17-year period from 2001. On average, participants reported 7.6 observations. Mental Health was assessed annually using the Short-Form Health Survey-36 mental health scale. Results: Over time, there were only very small changes in mental health and only for the youngest and oldest adults. Over time, there was consistent evidence for better metal health with increasing age, although for the very old, there appear to be substantial declines. These patterns were consistent between sex. In line with an existing literature, males reported better mental health over life span, although the declines of mental health in very-late-life are particularly pronounced for males. Conclusion: Decline in mental health was only reported by the youngest and oldest respondents, and was notable only in the last 4–5 years. However, the magnitude of the decline was small and further follow-up will be needed to determine whether this is a trend of substantive declining mental health for these specific age cohorts. In contrast, the more consistent finding is that there has been no substantive change in the level of mental health in Australia over the last 17 years. Analysis of the mental health trajectories of baseline age-cohorts confirmed that age differences are consistent over time.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":"107 3 1","pages":"602 - 608"},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89696889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-21DOI: 10.1177/0004867419889147
S. Allison, T. Bastiampillai, J. Looi, D. Copolov
There has been debate in Australian & New Zealand Journal of Psychiatry (ANZJP) about the required numbers of psychiatric beds in Australia (Allison et al., 2019; Benjamin et al., 2018). While debate has focused on acute beds, Australia also has relatively few hospital based adult non-acute beds (10 per 100,000 persons, according to the Australian Institute of Health and Welfare: www.aihw.gov.au/reports-data/ health-welfare-services/mentalhealth-services/overview). In contrast, the World Health Organisation (www. who.int/mental_health/evidence/atlas/ menta l_hea l th_at las_2017/en/ ) reports that high-income countries have 31 beds per 100,000 in standalone mental health hospitals, while Europe has 34 per 100,000. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Faulty of Adult Psychiatry endorsed a major submission from 48 psychiatrists to the Royal Commission into Victoria’s Mental Health System, which recommends increasing the state’s hospital based adult non-acute beds from 3 per 100,000 to around New South Wales’ (NSW’s) level of 14 per 100,000 – with new beds in university-linked ‘Mental Health Rehabilitation Centres’ that would ‘facilitate much needed research on treatment-resistant psychiatric conditions, and on optimal psychosocial practices in rehabilitation psychiatry’ (The Adult Psychiatry Imperative: https://s3.apsoutheast-2.amazonaws.com/hdp. a u . p r o d . a p p . v i c r c v m h s . files/2915/6765/3776/The_Adult_Psy chiatry_Imperative.pdf). Hospital based non-acute care is designed to reduce the adverse outcomes associated with chronic treatment-resistant illness (Sisti et al., 2015).
《澳大利亚和新西兰精神病学杂志》(ANZJP)一直在争论澳大利亚所需的精神科病床数量(Allison等人，2019;Benjamin et al.， 2018)。虽然辩论的重点是急症床位，但澳大利亚医院的成人非急症床位也相对较少(根据澳大利亚健康和福利研究所的数据，每10万人中有10张床位:www.aihw.gov.au/reports-data/健康福利服务/精神健康服务/概览)。相比之下，世界卫生组织(World Health organization)who.int/mental_health/evidence/atlas/ mental_heal th_at las_2017/ zh /)报告称，高收入国家的独立精神卫生医院每10万人中有31张床位，而欧洲每10万人中有34张床位。澳大利亚和新西兰皇家精神科医学院(RANZCP)成人精神病学缺陷认可了48名精神科医生向维多利亚精神健康系统皇家委员会提交的一份重要报告。该报告建议将该州医院的成人非急性床位从每10万人3张增加到新南威尔士州(NSW)的水平，即每10万人14张，并在与大学有联系的“精神健康康复中心”提供新床位，这将“促进对治疗困难的精神疾病的急需研究，以及康复精神病学的最佳社会心理实践”(成人精神病学当务之急:https://s3.apsoutheast-2.amazonaws.com/hdp)。A u。P。A p p。V I c c c V m h。文件/ 2915/6765/3776 The_Adult_Psy chiatry_Imperative.pdf)。基于医院的非急性护理旨在减少与慢性治疗难治性疾病相关的不良后果(Sisti et al.， 2015)。
{"title":"Pareto’s law of the vital few: Patient requirements for hospital based non-acute care","authors":"S. Allison, T. Bastiampillai, J. Looi, D. Copolov","doi":"10.1177/0004867419889147","DOIUrl":"https://doi.org/10.1177/0004867419889147","url":null,"abstract":"There has been debate in Australian & New Zealand Journal of Psychiatry (ANZJP) about the required numbers of psychiatric beds in Australia (Allison et al., 2019; Benjamin et al., 2018). While debate has focused on acute beds, Australia also has relatively few hospital based adult non-acute beds (10 per 100,000 persons, according to the Australian Institute of Health and Welfare: www.aihw.gov.au/reports-data/ health-welfare-services/mentalhealth-services/overview). In contrast, the World Health Organisation (www. who.int/mental_health/evidence/atlas/ menta l_hea l th_at las_2017/en/ ) reports that high-income countries have 31 beds per 100,000 in standalone mental health hospitals, while Europe has 34 per 100,000. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Faulty of Adult Psychiatry endorsed a major submission from 48 psychiatrists to the Royal Commission into Victoria’s Mental Health System, which recommends increasing the state’s hospital based adult non-acute beds from 3 per 100,000 to around New South Wales’ (NSW’s) level of 14 per 100,000 – with new beds in university-linked ‘Mental Health Rehabilitation Centres’ that would ‘facilitate much needed research on treatment-resistant psychiatric conditions, and on optimal psychosocial practices in rehabilitation psychiatry’ (The Adult Psychiatry Imperative: https://s3.apsoutheast-2.amazonaws.com/hdp. a u . p r o d . a p p . v i c r c v m h s . files/2915/6765/3776/The_Adult_Psy chiatry_Imperative.pdf). Hospital based non-acute care is designed to reduce the adverse outcomes associated with chronic treatment-resistant illness (Sisti et al., 2015).","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":"11 1","pages":"205 - 206"},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89417390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-18DOI: 10.1177/0004867419889153
R. Porter
Australian & New Zealand Journal of Psychiatry, 53(12) Given the complexity of mental health conditions and apparent lack of progress in improving the prevalence of these at a population level, it is easy to become negative about progress in psychiatric treatment. Indeed, some have argued in recent years that despite increased development and provision of treatment, the prevalence of common mental disorders has increased, or at least not decreased (Mulder et al., 2017). This month in ANZJP, not only is this argument refuted, but several authors present new ideas and paradigms for improvements in the treatment of important mental health conditions, which give considerable cause for optimism. Regarding the prevalence of mental disorders, Furukawa and Kessler (this issue) argue cogently that this situation is not as negative as it might appear. First, they argue that years lived with disability due to mental health disorders may not have increased, when figures are adjusted for age and population. Second, they argue that prevalence in psychiatric epidemiological studies may not always be an accurate reflection of the situation, being influenced significantly by participation rates and the readiness of participants to admit to symptoms of depression, which may have changed significantly over time. Third, they argue that while rates of mental disorder may not have altered, they may, however, be better controlled by current treatments, resulting in an improved quality of life for sufferers. This then sets the scene for several papers in this month’s issue that discuss exciting new paradigms for the treatment of common mental health conditions. Anorexia nervosa is a condition which is particularly difficult to treat and Phillipou et al. (this issue) point out that compared with other mental health conditions, relatively modest advances in treatment have been made. These authors argue that although the biopsychosocial model has frequently been applied to anorexia nervosa, the biological aspects of the disorder have been relatively under researched resulting in a paucity of neurobiological therapies. They note that most of the neurobiological therapies employed are used to treat comorbidity with other conditions. They also emphasise the importance of interactions between different aspects of the biopsychosocial model. For example, they point to the interaction between the gut/brain axis and the behavioural aspects of what is ingested. In a condition in which therapeutic nihilism may easily emerge, this erudite paper that concludes with a plea to fund truly multidisciplinary initiatives to help to provide individualised treatment for anorexia nervosa signals a positive future. In their model, reference to the importance of the gut/brain axis draws the attention of readers to the relationship between the gut microbiome, the ‘leaky brain’ and mental health – an area that is of increasing interest and reviewed in detail recently in this journal (Morris et al.
澳大利亚和新西兰精神病学杂志，53(12)鉴于精神健康状况的复杂性，以及在改善人口水平上的患病率方面明显缺乏进展，人们很容易对精神病学治疗的进展持消极态度。事实上，近年来一些人认为，尽管发展和提供了更多的治疗，但常见精神障碍的患病率有所增加，或者至少没有减少(Mulder等人，2017)。本月的《澳新早报》不仅驳斥了这一论点，而且几位作者提出了改善重要精神健康状况治疗的新想法和新范式，这给了我们相当大的乐观理由。关于精神疾病的流行，Furukawa和Kessler(本期)很有说服力地认为，这种情况并不像看起来那么消极。首先，他们认为，当数据根据年龄和人口进行调整时，由于精神健康障碍而残疾的年数可能没有增加。其次，他们认为，精神病学流行病学研究中的患病率可能并不总是准确反映情况，这在很大程度上受到参与率和参与者承认抑郁症状的准备程度的影响，这可能随着时间的推移而发生重大变化。第三，他们认为，虽然精神障碍的发病率可能没有改变，但目前的治疗方法可能会更好地控制它们，从而提高患者的生活质量。这为本月的几篇论文奠定了基础，这些论文讨论了治疗常见精神健康状况的令人兴奋的新范式。神经性厌食症是一种特别难以治疗的疾病，Phillipou等人(本期)指出，与其他精神健康疾病相比，神经性厌食症的治疗进展相对温和。这些作者认为，尽管生物心理社会模型经常被应用于神经性厌食症，但这种疾病的生物学方面的研究相对较少，导致神经生物学治疗的缺乏。他们指出，大多数采用的神经生物学疗法都是用于治疗与其他疾病的共病。他们还强调了生物心理社会模型的不同方面之间相互作用的重要性。例如，他们指出肠道/大脑轴与摄入的行为方面之间的相互作用。在治疗虚无主义很容易出现的情况下，这篇博学多才的论文以呼吁资助真正的多学科倡议来帮助提供神经性厌食症的个性化治疗来结束，这标志着一个积极的未来。在他们的模型中，提到肠道/大脑轴的重要性，引起了读者对肠道微生物群、“漏脑”和心理健康之间关系的关注——这一领域越来越受关注，最近在本杂志上进行了详细综述(Morris et al.， 2018)。这也是McGovern等人(本期)的一篇优秀综述的主题，该综述研究了血清素再摄取抑制剂对肠道微生物群的可能影响。基于有关选择性5 -羟色胺再摄取抑制剂(SSRIs)的药代动力学和胃肠道转运特性及其原位抗菌作用的文献，作者得出结论，在常规剂量下每天至少4小时，SSRIs可能在肠道中发挥显着的抗菌作用。这篇综述提出了关于SSRIs可能的作用机制和通过影响肠道微生物群的可能途径的重要问题。作者认为，这不仅对SSRIs的作用机制有影响，而且对理解其他治疗方法的效果也有影响，这些治疗方法可能通过对肠道微生物组的影响来改善抑郁症的结果。近年来，另一个引起越来越多兴趣的情绪障碍研究领域是认知功能障碍的作用。这通常是情绪障碍的一个重要特征，会对身体机能产生重大影响。因此，认知补救的使用已经被广泛研究，特别是在精神分裂症中，现在已经开始在情绪障碍的研究中发挥作用(Porter et al.， 2013)。本月心理健康状况的新治疗模式:是重新燃起热情的时候了?
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Pub Date : 2019-11-18DOI: 10.1177/0004867419887792
J. Russell
Anorexia nervosa remains vexing to treat with the illness having a decadeslong trajectory in most patients, even those in whom intervention has been early. Despite the severe, enduring and often relapsing course, 75% or more ultimately do recover. Mortality rate from the illness, high though it is, has been reduced with better medical salvage and management of the longterm complications but suicide rate increases after 15 years of illness particularly in the context of substance abuse and socioeconomic disadvantage. Neuroprogression has been mooted but thus far has not been satisfactorily distinguished from the effects of continuing brain starvation (Russell et al., 2019). Anorexia nervosa bears some resemblance to other serious mental illnesses where a substantial number of sufferers remain symptomatic with cognitive and social decline despite what Phillipou et al. (2019) describe rather naively as ‘effective evidencebased treatments’. Genetic studies have shown an overlap between schizophrenia, mood disorders and anorexia nervosa. Autistic social deficits and cognitive rigidity may be premorbid in anorexia nervosa but are exacerbated by weight loss and serve to lock the sufferer into a self-perpetuating vicious cycle. The prospect of eventual full recovery, however, sets anorexia nervosa apart from other serious mental illnesses (Russell et al., 2019). Of course, effective biological treatment for anorexia nervosa does exist – namely refeeding or nutritional rehabilitation. This can bring about complete resolution of physical, endocrine and psychological symptoms, as documented from the earliest descriptions of the condition. However, it is not always easy to effect (or to complete), often unacceptable to patients and even their families who may see it as persecutory. Maintaining the improved state of nourishment is another challenge, with the patient often unable or unwilling to continue with the behavioural changes. Shifting the patient’s mind-set around this and correcting the system of perverse reward in a lasting way continue to be extraordinarily difficult despite involvement of family and friends as cotherapists and numerous proven psychological treatments. These have been informed by the role of diverse factors such as temperament, traits, emotional skills, trauma and distorted body image in aetiogenesis and perpetuation (Keiser et al., 2016; Russell et al., 2019). The main source of difficulty psychologically is that patients with anorexia nervosa with few exceptions differ from patients with most other mental or physical illnesses in that they are unwilling to relinquish their symptoms (i.e. emaciation and engagement in nourishment controlling behaviours) as these seem to assuage a pervasively low sense of self-worth and lack of agency. This reluctance underpins the egosyntonicity, dishonesty and treatment sabotage so frustrating to carers and clinicians (Russell et al., 2019). Patients for their part often feel hopeless to change. Ps
神经性厌食症的治疗仍然令人烦恼，因为这种疾病在大多数患者身上都有几十年的发展轨迹，即使是那些早期干预的患者。尽管病程严重、持久且经常复发，但75%或更多的患者最终会康复。这种疾病的死亡率虽然很高，但随着更好的医疗救助和对长期并发症的管理，死亡率已经降低，但自杀率在患病15年后上升，特别是在滥用药物和社会经济劣势的情况下。神经进展已被提出，但到目前为止还没有令人满意地将其与持续脑饥饿的影响区分开来(Russell et al.， 2019)。神经性厌食症与其他严重的精神疾病有一些相似之处，尽管Phillipou等人(2019)相当天真地将其描述为“有效的循证治疗”，但仍有大量患者出现认知和社交能力下降的症状。基因研究表明，精神分裂症、情绪障碍和神经性厌食症之间存在重叠。自闭症患者的社交缺陷和认知僵化可能在神经性厌食症发病前就有，但体重减轻会加重，并使患者陷入自我延续的恶性循环。然而，最终完全康复的前景将神经性厌食症与其他严重的精神疾病区分开来(Russell et al.， 2019)。当然，神经性厌食症的有效生物治疗是存在的——即重新进食或营养康复。这可以带来身体、内分泌和心理症状的完全解决，从最早的病情描述记录。然而，它并不总是那么容易实现(或完成)，患者甚至他们的家人往往无法接受，他们可能认为这是一种迫害。维持改善的营养状态是另一个挑战，患者往往不能或不愿继续改变行为。尽管有家人和朋友作为共同治疗师的参与，以及许多经过验证的心理治疗方法，但要改变患者的思维模式，并以一种持久的方式纠正错误的奖励系统，仍然是非常困难的。这些都是由不同因素的作用所决定的，如气质、特质、情感技能、创伤和扭曲的身体形象在病因发生和延续中的作用(Keiser等人，2016;Russell et al.， 2019)。心理上困难的主要来源是神经性厌食症患者与大多数其他精神或身体疾病患者的不同之处在于，他们不愿意放弃自己的症状(即消瘦和参与营养控制行为)，因为这些症状似乎缓解了普遍存在的低自我价值感和缺乏能动性。这种不情愿助长了自我同心化、不诚实和治疗破坏，这让护理人员和临床医生感到沮丧(Russell等人，2019)。对病人来说，他们常常觉得改变是无望的。精神药物已被证明可以减轻准精神病和强迫症状，并促进体重增加。焦虑和抑郁是长期脑饥饿(如果不是发病前)的后果，即使在饥饿的大脑中疗效较低，也可能对针对这些症状的药物有反应(Russell等人，2019)。然而，可以说，食物是治疗神经性厌食症的灵丹妙药——只要能说服病人吃就好了!已经证明了许多潜在可逆的神经生物学现象，包括白质和灰质的丧失，脑代谢物的变化，连通性的改变(Phillipou等人，2019)以及内源性大麻素和催产素失调的继发奖励过程，其中已经证明了潜在的治疗益处(Brockmeyer等人，2018;Russell et al.， 2019)。神经调节已显示出治疗前景(Brockmeyer等人，2018)，而在身体的另一端，评论887792 ANP ANZJP通信
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Pub Date : 2019-11-16DOI: 10.1177/0004867419887794
R. Porter, M. Inder, Katie M. Douglas, S. Moor, J. Carter, C. Frampton, M. Crowe
Objective: To examine the effects of 18 months of intensive stabilisation with medication management and Interpersonal and Social Rhythm Therapy or Non-specific Supportive Clinical Management on cognitive function in young people with bipolar disorder. Determinants of change in cognitive function over the 18 months of the trial were also examined. Method: Patients aged 15–36 years with Bipolar I Disorder, Bipolar II Disorder and Bipolar Not Otherwise Specified were recruited. From a battery of cognitive tests, change scores for pre-defined domains of cognitive function were created based on performance at baseline and follow-up. Change was compared between the two therapy groups. Regression analysis was used to determine the impact of a range of clinical variables on change in cognitive performance between baseline and follow-up. Results: One hundred participants were randomised to Interpersonal and Social Rhythm Therapy (n = 49) or Non-specific Supportive Clinical Management (n = 51). Seventy-eight patients underwent cognitive testing at baseline and 18 months. Across both groups, there were significant improvements in a Global Cognitive Composite score, Executive Function and Psychomotor Speed domains from baseline to 18 months. Lower scores at baseline on all domains were associated with greater improvement over 18 months. Overall, there was no difference between therapies in change in cognitive function, either in a global composite score or change in domains. Conclusion: While there was no difference between therapy groups, intensive stabilisation with psychological therapy was associated with improved cognitive function, particularly in those patients with poorer cognitive function at baseline. However, this was not compared with treatment as usual so cannot be attributed necessarily to the therapies.
{"title":"Improvement in cognitive function in young people with bipolar disorder: Results from participants in an 18-month randomised controlled trial of adjunctive psychotherapy","authors":"R. Porter, M. Inder, Katie M. Douglas, S. Moor, J. Carter, C. Frampton, M. Crowe","doi":"10.1177/0004867419887794","DOIUrl":"https://doi.org/10.1177/0004867419887794","url":null,"abstract":"Objective: To examine the effects of 18 months of intensive stabilisation with medication management and Interpersonal and Social Rhythm Therapy or Non-specific Supportive Clinical Management on cognitive function in young people with bipolar disorder. Determinants of change in cognitive function over the 18 months of the trial were also examined. Method: Patients aged 15–36 years with Bipolar I Disorder, Bipolar II Disorder and Bipolar Not Otherwise Specified were recruited. From a battery of cognitive tests, change scores for pre-defined domains of cognitive function were created based on performance at baseline and follow-up. Change was compared between the two therapy groups. Regression analysis was used to determine the impact of a range of clinical variables on change in cognitive performance between baseline and follow-up. Results: One hundred participants were randomised to Interpersonal and Social Rhythm Therapy (n = 49) or Non-specific Supportive Clinical Management (n = 51). Seventy-eight patients underwent cognitive testing at baseline and 18 months. Across both groups, there were significant improvements in a Global Cognitive Composite score, Executive Function and Psychomotor Speed domains from baseline to 18 months. Lower scores at baseline on all domains were associated with greater improvement over 18 months. Overall, there was no difference between therapies in change in cognitive function, either in a global composite score or change in domains. Conclusion: While there was no difference between therapy groups, intensive stabilisation with psychological therapy was associated with improved cognitive function, particularly in those patients with poorer cognitive function at baseline. However, this was not compared with treatment as usual so cannot be attributed necessarily to the therapies.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":"26 1","pages":"272 - 281"},"PeriodicalIF":0.0,"publicationDate":"2019-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90074894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-16DOI: 10.1177/0004867419885443
Xiaoman Liu, Siew-Kee Low, J. Atkins, J. Wu, W. Reay, Heath M. Cairns, Melissa J. Green, U. Schall, A. Jablensky, B. Mowry, P. Michie, S. Catts, F. Henskens, C. Pantelis, C. Loughland, A. Boddy, P. Tooney, R. Scott, V. Carr, M. Cairns
Objectives: Large-scale genetic analysis of common variation in schizophrenia has been a powerful approach to understanding this complex but highly heritable psychotic disorder. To further investigate loci, genes and pathways associated more specifically in the well-characterized Australian Schizophrenia Research Bank cohort, we applied genome-wide single-nucleotide polymorphism analysis in these three annotation categories. Methods: We performed a case–control genome-wide association study in 429 schizophrenia samples and 255 controls. Post-genome-wide association study analyses were then integrated with genomic annotations to explore the enrichment of variation at the gene and pathway level. We also examine candidate single-nucleotide polymorphisms with potential function within expression quantitative trait loci and investigate overall enrichment of variation within tissue-specific functional regulatory domains of the genome. Results: The strongest finding (p = 2.01 × 10−6, odds ratio = 1.82, 95% confidence interval = [1.42, 2.33]) in genome-wide association study was with rs10252923 at 7q21.13, downstream of FZD1 (frizzled class receptor 1). While this did not stand alone after correction, the involvement of FZD1 was supported by gene-based analysis, which exceeded the threshold for genome-wide significance (p = 2.78 × 10−6). Conclusion: The identification of FZD1, as an independent association signal at the gene level, supports the hypothesis that the Wnt signalling pathway is altered in the pathogenesis of schizophrenia and may be an important target for therapeutic development.
{"title":"Wnt receptor gene FZD1 was associated with schizophrenia in genome-wide SNP analysis of the Australian Schizophrenia Research Bank cohort","authors":"Xiaoman Liu, Siew-Kee Low, J. Atkins, J. Wu, W. Reay, Heath M. Cairns, Melissa J. Green, U. Schall, A. Jablensky, B. Mowry, P. Michie, S. Catts, F. Henskens, C. Pantelis, C. Loughland, A. Boddy, P. Tooney, R. Scott, V. Carr, M. Cairns","doi":"10.1177/0004867419885443","DOIUrl":"https://doi.org/10.1177/0004867419885443","url":null,"abstract":"Objectives: Large-scale genetic analysis of common variation in schizophrenia has been a powerful approach to understanding this complex but highly heritable psychotic disorder. To further investigate loci, genes and pathways associated more specifically in the well-characterized Australian Schizophrenia Research Bank cohort, we applied genome-wide single-nucleotide polymorphism analysis in these three annotation categories. Methods: We performed a case–control genome-wide association study in 429 schizophrenia samples and 255 controls. Post-genome-wide association study analyses were then integrated with genomic annotations to explore the enrichment of variation at the gene and pathway level. We also examine candidate single-nucleotide polymorphisms with potential function within expression quantitative trait loci and investigate overall enrichment of variation within tissue-specific functional regulatory domains of the genome. Results: The strongest finding (p = 2.01 × 10−6, odds ratio = 1.82, 95% confidence interval = [1.42, 2.33]) in genome-wide association study was with rs10252923 at 7q21.13, downstream of FZD1 (frizzled class receptor 1). While this did not stand alone after correction, the involvement of FZD1 was supported by gene-based analysis, which exceeded the threshold for genome-wide significance (p = 2.78 × 10−6). Conclusion: The identification of FZD1, as an independent association signal at the gene level, supports the hypothesis that the Wnt signalling pathway is altered in the pathogenesis of schizophrenia and may be an important target for therapeutic development.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":"23 1","pages":"902 - 908"},"PeriodicalIF":0.0,"publicationDate":"2019-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82471515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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