Australian and New Zealand Journal of Psychiatry最新文献

The Early Psychosis Prevention and Intervention Centre model has significantly shaped early intervention strategies for psychotic disorders, setting a benchmark for effective care and influencing practices globally. The model's effectiveness has been demonstrated through various trials and systematic reviews, highlighting its benefits in symptomatic relief, functional improvement and reduced hospitalisation. This paper explores and proposes advancements to the current model of care for early psychosis, incorporating recent developments and emerging evidence in the field. We highlight several areas to further enhance the Early Psychosis Prevention and Intervention Centre model. This includes highlighting the importance of interventions to reduce duration of untreated psychosis, maximising pharmacological and cognitive interventions, incorporating digital technologies for real-time feedback and personalised care, and access to physical health interventions to prevent unwanted long-term physical outcomes. In addition, the growing role of trauma-informed care, and more recently, peer support, as well as approaches and interventions for culturally diverse and high-risk populations, underscores the need for more inclusive and tailored interventions. Future directions also need to concentrate especially on the long-term outcome, which are less favourable and equity of access to high-quality services. The development of national and international collaborative research platforms, including Australia's new clinical quality registry and clinical trials network, also represents a significant step forward in generating robust evidence and refining care models. We suggest that to further progress the early psychosis field a personalised, data-informed approach is needed and that we find ways to harness technological innovations and collaborative networks to enhance care and subsequent treatment outcomes.

Objective: The current Guidelines aim to provide evidence-based management recommendations for treatment of people living with schizophrenia in Australia and Aotearoa New Zealand.

Methods: The Australian and New Zealand Journal of Psychiatry (ANZJP) commissioned a panel of experts to establish these Guidelines. The existing literature was reviewed to address key health questions. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, and the strength of the recommendation was determined by the panel.

Results: The ANZJP GRADE Guidelines examined the current evidence base for a range of areas relevant to treatment for people with schizophrenia including: initial physical health assessment; pharmacological treatment; psychological and psychosocial interventions; family, whānau and carers; psychiatric comorbidities; physical health and lifestyle interventions; and special populations.

Conclusions: It is hoped that the current Guidelines provide useful recommendations in important aspects of care for people living with schizophrenia and their family, whānau and carers in Australia and Aotearoa New Zealand, both at the individual and systemic levels.

Objective: Cognitive difficulties are a core feature of psychotic disorders such as schizophrenia; however, the prevalence of cognitive impairment among Australians with schizophrenia is unclear. This review aimed to estimate the prevalence of cognitive impairment associated with schizophrenia in Australia and to describe methodological approaches to assessing cognition and defining cognitive impairment in the Australian schizophrenia research literature.

Methods: Systematic searches were conducted across MEDLINE Complete, APA PsycINFO, Embase and Scopus to identify studies reporting cognitive assessment outcomes among Australians diagnosed with schizophrenia or schizoaffective disorder. A particular focus was given to studies of naturalistic cohorts (those studied in real-world environments without manipulation or experimental intervention); however, clinical trial cohorts were also included. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and Synthesis Without Meta-analysis guidelines.

Results: Findings were synthesised from 198 studies comprising approximately 23,755 individuals. There was substantial heterogeneity in cognitive assessment approaches and definitions of cognitive impairment. Over 100 different cognitive tests and test batteries were used across the included studies. Only 11 studies described naturalistic cohorts, with reported prevalence estimates of cognitive impairment of between 14.5% and 90%. Given insufficient quantitative data and substantial methodological differences across studies, meta-analysis was not conducted.

Conclusion: Although a pooled prevalence estimate could not be calculated, cognitive impairment likely poses a substantial burden to Australians with schizophrenia. Reducing this burden requires a multifaceted approach, including improved access to cognitive assessments as part of routine clinical care, and improved availability of evidence-based cognition-focused treatment options.

Objective: To establish the effectiveness of specialist-delivered nutrition and exercise interventions on the physical health of people with severe mental illness.

Methods: An electronic database search was completed from earliest record to August 2024 using Scopus, Medline, EMBASE, PsycINFO, and CINAHL, using key nutritional, cardiometabolic and psychiatric terminology. Eligible studies were randomised and non-randomised controlled trials which included specialist-delivered interventions (dietitian and/or nutritionist or exercise professional) with people diagnosed with severe mental illness. Primary outcomes were cardiometabolic risk factors.

Results: Thirty-one studies were included: combined nutrition and exercise intervention (n = 12), nutrition intervention only (n = 9), and exercise intervention only (n = 10), with 23 contributing to the meta-analysis. Meta-analysis of combined nutrition and exercise interventions revealed positive-effects on body mass index (BMI) (Mean diff = -1.78 [95% confidence interval (CI) -2.97 to -0.59], p = 0.00) and waist circumference (Mean diff = -4.13 [95% CI -7.25 to -1.00] p = 0.01). In nutrition-only intervention studies, the meta-analysis revealed a positive-effect on systolic blood pressure (Mean diff = -6.14 [95% CI -12.02 to -0.26] p = 0.04). No significant impacts were tested for exercise-only interventions.

Conclusion: Specialist-delivered nutrition and exercise interventions are effective in improving weight, BMI and waist circumference status over the short to medium term in people diagnosed with severe mental illness. Exercise and nutrition programmes show promising effectiveness, and this research provides evidence to support the implementation as part of standard care of people diagnosed with severe mental illness.

Objective: The dual-factor model of mental health postulates a role for positive mental health, alongside mental illness, in determining mental health care needs. Informed by this model, the present study delineated profiles of social-emotional competencies and difficulties during middle childhood in a population-based sample of girls and boys and determined their association with adolescent mental disorder diagnoses.

Method: Latent profile analyses were conducted across five indices of social-emotional competency and four indices of psychopathology that were measured by questionnaire self-report among 13,349 girls and 13,488 boys at age ~11 years. The association of the profiles with adolescent presentations to hospital or ambulatory services (ages ~12-17 years) were determined using logistic regression.

Results: Analyses yielded five profiles in each sex: complete mental health (44% girls; 42% boys), average mental health (30%; 33%), internalising symptoms with poor relationship skills (9%; 7%), externalising symptoms with poor self-management (12%; 9%) and low mental health (5%; 10%). Profiles associated differentially with adolescent presentations with any mental disorder, externalising disorders, internalising disorders and self-harm/suicidal ideation, identified in linked health records. Greater odds of any and specific mental disorder diagnoses were characteristic of all profiles relative to average mental health (adjusted odds ratios [aOR]: 1.7-3.3) except complete mental health (aOR: 0.7-0.9), with different strengths of association according to profile.

Conclusion: Combining information on social-emotional competencies and psychopathology in middle childhood may help refine the provision of mental health promotion and early intervention to alleviate adolescent mental disorder.

Objective: While people experiencing severe mental illness have a greater prevalence of physical multimorbidity, data on incidence are largely limited to the onset of specific physical conditions. We assessed whether people with severe mental illness have increased incidence rates of physical multimorbidity compared to people with other psychiatric conditions.

Methods: This retrospective observational cohort study reported on a longitudinal psychiatric inpatient sample (2010-2024) in a metropolitan service in Brisbane, Australia. Within a subgroup of individuals with no pre-existing physical conditions, we compared individuals with and without a history of severe mental illness (schizophrenia-spectrum or bipolar disorder). With a denominator of person-years, we calculated the incidence of different thresholds of physical multimorbidity using adjusted Fine-Gray subdistribution hazard ratios.

Results: Among the 3310 individuals with severe mental illness, 298 developed physical multimorbidity (two chronic physical conditions) across 21893 person-years, compared to 52 among the 2850 individuals and 18,112 person-years in the comparison group. When adjusted for clinical and demographic covariates, people with severe mental illness had an increased risk of developing one (subdistribution hazard ratio = 3.36; 95% confidence interval = 2.79, 4.03), two (subdistribution hazard ratio = 4.06; 95% confidence interval = 3.02, 5.46), three (subdistribution hazard ratio = 5.36; 95% confidence interval = 3.35, 8.59), and four (subdistribution hazard ratio = 4.84; 95% confidence interval = 2.49, 9.40) chronic physical conditions. Except for malignancy and genitourinary disease, people with severe mental illness had increased incidence of chronic physical conditions in all other organ systems.

Conclusions: People with severe mental illness experienced greater incidence rates of multimorbidity at various thresholds, with a majority of organ systems affected. This highlights the need for holistic prevention and intervention strategies to curb the accumulation of physical multimorbidity.