Australian and New Zealand Journal of Psychiatry最新文献

This is the first in a series of Position Papers from the Mental Health Australia General Clinical Trials Network (MAGNET) intended to promote the standard of mental health research in Australia. This paper focuses on improving the quality and safety of non-pharmacological trials with a mental health focus, which for the purpose of this paper, are those testing 'complex' behavioural interventions (including lifestyle or psychotherapy interventions) with clinical populations. This is timely after last year's update of the National Statement for Ethical Conduct in Human Research which is intended to provide extended guidance on assessing, mitigating and managing risk and the introduction of the Australian Commission on Safety & Quality in Healthcare's National Clinical Trials Governance Framework. However, what the implementation of these research policies means for behavioural trials in mental health, given their many nuances, is only being realised. This paper outlines historical issues in the conduct of behavioural trials in mental health (lack of consensus on the concept of harm; lack of governance and inconsistent data collection and/or trial procedures around harms). Next, we detail the methods for developing recommendations to aid triallists' monitoring and assessing safety during the conduct of behavioural mental health trials that evaluate lifestyle or psychotherapy interventions in clinical populations. Finally, we present a decision-making algorithm to support implementation. Ultimately, we intend to promote quality and safety of behavioural interventions in mental health, to better understand the risk/benefit profile of these treatments and to minimise unnecessary risk to participants and triallists.

The aim of this viewpoint paper is to consider different psychological transdiagnostic processes that can inform the development of effective early intervention approaches in youth mental health before threshold diagnosis is attained. A transdiagnostic process is defined as a mechanism which is present across different disorders and is either a risk or a maintaining factor for the disorder. We consulted the literature with respect to processes across depression, anxiety and eating disorders. We suggest 38 unique transdiagnostic psychological processes. Each were defined to make them suitable for stakeholder consultation (e.g. people with lived experience) in developing transdiagnostic processes (targets) for youth early interventions. We recommend that the definitions of these processes are further developed in consultation with stakeholders, and that systematic reviews are conducted to further identify psychological processes that can inform essential ingredients of interventions that can then be tested for clinical impact in early intervention with youth.

Background: The Growth and Empowerment Measure was developed by and for Aboriginal and Torres Strait Islander adults to measure social and emotional well-being and empowerment. This study aimed to co-design and validate a version of the Growth and Empowerment Measure with Aboriginal and Torres Strait Islander young people experiencing youth detention.

Method: 103 Aboriginal and Torres Strait Islander young people experiencing youth detention participated. Participants directed seven adaptations from the Growth and Empowerment Measure for adults to create a Growth and Empowerment Measure-Youth (GEM-Youth). 78 participants completed the GEM-Youth version 7 and 57 participants completed both the full GEM-Youth version 7 and the Kessler psychological distress scale (K10). Cronbach's alpha and inter-item correlations were calculated for two components of the GEM-Youth: how I feel about myself and thinking about my everyday life. Associations between K10 and GEM-Youth scores were quantified using Pearson's correlation.

Results: How I feel about myself questions had a mean inter-item correlation of (0.21) and good internal consistency (α = 0.80). Thinking about my everyday life questions had a mean inter-item correlation of 0.18 and internal consistency of α = 0.69. How I feel about myself showed a strong negative correlation (r(55) = -0.61, [95% confidence interval: -0.42, -0.75] p < 0.001) with K10. Thinking about my everyday life showed a moderate negative correlation with K10 (-0.31, [95% confidence interval: -0.05, -0.52] p = 0.02).

Implications: The GEM-Youth provides a culturally grounded and validated measure to assess social and emotional well-being and empowerment for Aboriginal and Torres Strait Islander young people in detention settings. This measure has therapeutic and research value that should be further refined and explored. Future research should adapt and validate this tool for use with other groups and settings.

Objective: Chronic diseases are a major challenge in Australia, contributing to disability, premature mortality, and a significant healthcare burden. This burden is intensified when depression, a common mental health issue, co-occurs with chronic diseases. This scoping review aimed to investigate the relationship between depression and comorbid chronic diseases, namely cardiovascular disease (CVD), diabetes, asthma, and chronic obstructive pulmonary disease (COPD) in the Australian population.

Methods: Following Joanna Briggs Institute (JBI) methodology, this scoping review searched for English-language articles published between January 2013 and December 2023. The review targeted studies examining depression and selected comorbid chronic diseases within the Australian population. Two independent reviewers conducted data screening and extraction, with results synthesised into tables and summarised narratively.

Results: The search yielded 31 quantitative studies, highlighting a high prevalence of depression co-occurring with chronic diseases. Key findings included the worsening of chronic disease severity by depression, compounded by gender and age disparities, and the impact of socioeconomic factors impairing the quality of life. The review also identified significant challenges in the provision of care, particularly in rural areas, emphasising the need for integrated care models, and enhanced healthcare training.

Conclusion: This review revealed critical research gaps in understanding the relationship between depression and chronic diseases, particularly regarding underrepresented groups such as younger adults and rural populations. It highlights the need for improved diagnostic criteria, treatment approaches, and professional training, advocating for targeted research and policy interventions to improve outcomes and quality of life for individuals with depression and selected comorbid chronic diseases.

Objective: Substance use and use disorders are elevated among people accessing mental health treatment, but the nature and patterns of use are unknown. The current study aimed to identify the prevalence of alcohol and other drug (AOD) use and problematic AOD use (i.e. hazardous, harmful, risky, misuse, abuse, dependence, disorder) in Australian mental health settings and conduct a meta-analysis of studies where sufficient data were available.

Method: A systematic review of all papers published up to July 2023 identified 59 eligible studies reporting the prevalence of substance use, problematic use, and use disorders among people accessing mental health treatment in Australia. Overall, 55 studies provided sufficient data for a meta-analysis for past year use and problematic use of any AOD overall, alcohol, cannabis, tobacco, stimulants/amphetamines, and opioids.

Results: Pooled prevalence estimates of past year use and problematic use among clients of mental health treatment settings varied (5%-58% and 7%-53%, respectively). Past year use and past year problematic use of tobacco were particularly prevalent (58% and 53%, respectively), as was cannabis (38% and 37%, respectively). Several key factors, including the type of mental health disorder, may explain some variation in prevalence estimates.

Conclusion: The presence of co-occurring and problematic AOD use should be expected among a considerable proportion of clients of mental health treatment settings, and are a significant concern that services must be prepared to address. As such, screening and assessment of AOD use and use disorders should be part of routine clinical care, and clinicians should be familiar with evidence-based management and treatment strategies, including those that address tobacco.

Introduction: Young-onset neurocognitive symptoms result from a heterogeneous group of neurological and psychiatric disorders which present a diagnostic challenge. To identify such factors, we analysed the Biomarkers in Younger-Onset Neurocognitive Disorders cohort, a study of individuals <65 years old presenting with neurocognitive symptoms for a diagnosis and who have undergone cognitive and biomarker analyses.

Methods: Sixty-five participants (median age at assessment of 56 years, 45% female) were recruited during their index presentation to the Royal Melbourne Hospital Neuropsychiatry Centre, a tertiary specialist service in Melbourne, Australia, and categorized as either early-onset Alzheimer's disease (n = 18), non-Alzheimer's disease neurodegeneration (n = 23) or primary psychiatric disorders (n = 24). Levels of neurofilament light chain, glial fibrillary acidic protein and phosphorylated-tau 181, apolipoprotein E genotype and late-onset Alzheimer's disease polygenic risk scores were determined. Information-theoretic model selection identified discriminatory factors.

Results: Neurofilament light chain, glial fibrillary acidic protein and phosphorylated-tau 181 levels were elevated in early-onset Alzheimer's disease compared with other diagnostic categories. A multi-omic model selection identified that a combination of cognitive and blood biomarkers, but not the polygenic risk score, discriminated between early-onset Alzheimer's disease and primary psychiatric disorders (area under the curve ⩾ 0.975, 95% confidence interval: 0.825-1.000). Phosphorylated-tau 181 alone significantly discriminated between early-onset Alzheimer's disease and non-Alzheimer's disease neurodegeneration causes (area under the curve = 0.950, 95% confidence interval: 0.877-1.00).

Discussion: Discriminating between early-onset Alzheimer's disease, non-Alzheimer's disease neurodegeneration and primary psychiatric disorders causes of young-onset neurocognitive symptoms is possible by combining cognitive profiles with blood biomarkers. These results support utilizing blood biomarkers for the work-up of young-onset neurocognitive symptoms and highlight the need for the development of a young-onset Alzheimer's disease-specific polygenic risk score.

Objective: To critically evaluate published and unpublished systematic reviews and meta-analyses on the safety and efficacy of methylenedioxymethamphetamine-assisted psychotherapy for post-traumatic stress disorder.

Methods: Six bibliometric databases and grey literature were searched from inception to 9 May 2024 for systematic reviews on the safety and efficacy of methylenedioxymethamphetamine (MDMA)-assisted psychotherapy compared to psychotherapy alone among adults with post-traumatic stress disorder. Quality assessment using the AMSTAR-2 tool was conducted independently by two investigators.

Results: Fourteen systematic reviews comprising 20 primary studies involving up to 353 participants were included. All reviews included studies of one-to-three sessions of 50-125 mg MDMA-assisted psychotherapy (some with supplemental dosage) compared to either 25-40 mg of MDMA or inactive placebo with psychotherapy. Four were deemed high quality. Meta-analyses reported substantial benefits of MDMA-assisted psychotherapy in improving post-traumatic stress disorder symptoms (standardised mean difference, 0.8-1.3), response rate (relative risk, 1.3-3.5) and remission rate (relative risk, 2.3-2.9) compared to psychotherapy alone. However, for reviews that assessed the certainty of evidence, the evidence was rated as low to very low certainty due to high risk of bias, indirectness and imprecision. There was moderate-quality evidence that MDMA-assisted psychotherapy was associated with an increased odd of transient adverse events. However, reviews noted reliance on spontaneous rather than systematic adverse event reporting, discrepancies between adverse events reported in published studies and clinical trial registries, and a lack of long-term safety data.

Conclusion: Four high-quality systematic reviews suggest low to very low certainty evidence for efficacy outcomes and moderate to very low quality evidence for safety outcomes.