Australian and New Zealand Journal of Psychiatry最新文献

We reviewed Australian mental health legislation to determine what obligations it places on psychiatrists to facilitate second opinions for compulsory patients who request them. Only four jurisdictions-Australian Capital Territory, Queensland, Victoria, and Western Australia-have legislated for 'patient-initiated' second opinions. Within these four regimes, there is variation in important aspects of the second opinion process, and there is a general absence of direction given to the second opinion providers. Based on research showing the variability of second opinion provision under New Zealand mental health legislation, we argue that this absence is likely to result in significant variation in the quality and depth of second opinions provided in Australia. We argue that New South Wales, the Northern Territory, South Australia, and Tasmania should consider formal provision for patient-initiated second opinions in their mental health legislation. We believe that such legislation ought to be aware of the barriers patients may face in accessing second opinions, and avoid exacerbating these barriers as Queensland's legislation appears to. Also, we argue that research on current practice in Australia should be conducted to better understand the effects of legislation on second opinions, and to help determine what amounts to best practice.

Objective: Studies using proton magnetic resonance spectroscopy reveal substantial inconsistencies in the levels of brain glutamate, glutamine and glutamate + glutamine across schizophrenia spectrum disorders. This systematic review employs qualitative and quantitative methods to analyse the patterns and relationships between glutamatergic metabolites, schizophrenia spectrum disorders and brain regions.

Methods: A literature search was conducted using various databases with keywords including glutamate, glutamine, schizophrenia, psychosis and proton magnetic resonance spectroscopy. Inclusion criteria were limited to case-control studies that reported glutamatergic metabolite levels in adult patients with a schizophrenia spectrum disorder diagnosis - i.e. first-episode psychosis, schizophrenia, treatment-resistant schizophrenia and/or ultra-treatment-resistant schizophrenia - using proton magnetic resonance spectroscopy at 3 T or above. Pooled study data were synthesized and analysed.

Results: A total of 92 studies met the inclusion criteria, including 2721 healthy controls and 2822 schizophrenia spectrum disorder participants. Glu levels were higher in the basal ganglia, frontal cortex and medial prefrontal of first-episode psychosis participants, contrasting overall lower levels in schizophrenia participants. For Gln, strong differences in metabolite levels were evident in the basal ganglia, dorsolateral prefrontal cortex and frontal cortex, with first-episode psychosis showing significantly higher levels in the basal ganglia. In glutamate + glutamine, higher metabolite levels were found across schizophrenia spectrum disorder groups, particularly in the basal ganglia and dorsolateral prefrontal cortex of treatment-resistant schizophrenia participants. Significant relationships were found between metabolite levels and medication status, clinical measures and methodological variables.

Conclusion: The review highlights abnormal glutamatergic metabolite levels throughout schizophrenia spectrum disorders and in specific brain regions. The review underscores the importance of standardized future research assessing glutamatergic metabolites using proton magnetic resonance spectroscopy due to considerable literature heterogeneity.

Introduction: The trauma most commonly associated with the military is combat-related trauma. It is increasingly recognised that childhood sexual and physical abuse and military sexual assault may influence or exacerbate posttraumatic stress disorder (PTSD) when military members are exposed to combat.

Aims: The study aimed to determine whether a history of childhood sexual and physical abuse would increase the likelihood of military sexual assault (MSA) and determine whether a history of sexual abuse (childhood or military) impacted the incidence and severity of post-trauma sequelae compared to veterans without this history.

Method: A retrospective correlational analysis was performed on baseline data collected from clinical case records of a cohort of 134 Australian veterans with PTSD who had attended an outpatient Military Service Trauma Recovery Day Programme between October 2020 and May 2022.

Results: Almost half (48.5%) of veterans reported a history of abuse. Prevalence rates of military sexual abuse, child sexual abuse and child physical abuse were 14.9%, 13.4% and 23.1% respectively. The relationship between those who experienced childhood abuse and those who experienced military sexual abuse was not significant. No significant differences were observed between those who experienced any sexual abuse and those who did not on intake scores of psychological symptoms.

Conclusion: This is the first Australian study to investigate the prevalence of childhood abuse and military sexual abuse and its impact on PTSD and associated psychopathology in a sample of veterans seeking mental health treatment. No additional risks of experiencing military sexual assault were found for those who had survived childhood sexual abuse.

Background: Complex psychosis is associated with high social and economic costs. The key skills and attributes needed by mental health professionals to provide optimal clinical care to people experiencing complex psychosis have not previously been defined. A framework detailing these skills and attributes is needed to support the identification of training needs for those working with this population.

Methods: A modified online Delphi method was used to reach consensus on the skills and attributes essential for mental health professionals to deliver optimal clinical care to people experiencing complex psychosis. Participants were international healthcare professionals and academic researchers who self-identified as experts in complex psychosis. Participants were asked to rate their level of agreement with each item on a five-point Likert-type scale and to provide comments. Qualitative feedback was used to modify existing, or create new, items for subsequent rounds.

Results: 64 responses were received across three Delphi rounds. 167 items reached consensus and were endorsed (132 in Round 1, 31 in Round 2 and 4 in Round 3). Median score range for endorsed items was 4.5/5, with 88.6% scoring 5/5. All 167 endorsed items were included in the framework, categorised into 14 overarching domains.

Conclusion: Multiple skills and attributes were identified as being core components required in the delivery of optimal care by mental health professionals to people experiencing complex psychosis. The resulting framework provides a benchmark for training and skill development of mental health clinicians at both individual and team levels to optimise effective working with this high-needs population.

Introduction: A disproportionate number of mental health presentations to emergency services are made by frequent presenters. No current consensus definition of a frequent presenter exists. Using a statewide population-based ambulance database, this study (i) applied previous statistical methods to determine thresholds for frequent presenters, (ii) explored characteristics of the identified frequent presenter groups compared to non-frequent presenters and (iii) assessed the reliability of these methods in predicting continued frequent presenter status over time.

Methods: Statistical methods utilised in previous studies to identify frequent presenters were applied to all ambulance attendances for mental health symptoms, self-harm and alcohol and other drug issues between 1 January 2017 and 31 December 2020 in Victoria, Australia. Differences in characteristics between identified frequent and non-frequent presenter groups were determined by logistic regression analysis. The consistency of agreement of frequent presenter status over time was assessed using intraclass correlation coefficients.

Results: Thresholds for frequent presenters ranged from a mean of 5 to 39 attendances per calendar year, with groups differing in size, service use and characteristics. Compared to non-frequent presenters, frequent presenters had greater odds of being female, presenting with self-harm, experiencing social disadvantage or housing issues, involving police co-attendance and being transported to hospital. All frequent presenter definitions had poor reliability in predicting ongoing frequent presentations over time.

Conclusion: A range of methods can define frequent presenters according to thresholds of yearly service use. Reasons for identifying frequent presenters may influence the method chosen. Future studies should explore definitions that capture the dynamic nature of presentations by this group.

Objective: Youth suicidality prevalence continues to rise alongside hot weather severity. Links between these two variables are underexplored. We examined associations between daily temperature and emergency department suicidality presentations by young people. We assessed these associations for five regions covering New South Wales as determined by 'climate zone' and analysed for heatwave effects as well as based on demographic subgroups.

Methods: Daily emergency department presentations for suicidality by people aged 12-24 years across New South Wales, Australia, during warmer months (November to March) from 2012 to 2019 were examined in relation to daily mean temperature and heatwaves (⩾3 consecutive days ⩾ 95th percentile of long-term daily mean temperature) and by climate zone, using a generalised additive model with negative binomial distribution. Risks for age- and sex-based subgroups were also calculated.

Results: New South Wales youth suicidality presentation rates were significantly higher on hotter days. For every 1°C rise above average daily mean temperature, youth suicidality presentations to New South Wales emergency departments increased by 1.3%. Heatwaves did not increase presentation rates beyond single-day daily mean temperature effects. These findings were predominantly replicated across climate zones and demographic subgroups, though the association between suicidality and ambient temperature was weaker in coastal regions including Eastern Sydney.

Conclusion: There is a positive linear association between ambient temperature and youth suicidality presentations to emergency departments. Risks are increased on single hot days, not only during heatwaves. Public health, broader societal approaches to heat and health system planning should consider impacts on youth suicidality of predicted increases in hot weather severity and frequency.

Background: Military service is historically a male-dominated occupation, as such, the majority of research examining the development of mental disorder in Australian Defence Force members has had primarily male samples. While there have been mixed findings internationally regarding sex differences in rates of mental disorder and subthreshold symptoms among military personnel, across studies, the evidence tends to suggest that female military members are at least as likely as males to experience subthreshold mental health symptoms and have similar or higher rates of posttraumatic stress disorder despite the differences in roles during service. What is less understood is the impact of sex differences in symptom emergence over time and in predictors of clinical disorder.

Method: The sample included a longitudinal cohort of Australian Defence Force members (N = 8497) surveyed at Time 1 (2010) and followed up at Time 2 (2015) on measures of anger, self-perceived resilience, trauma exposure, deployment exposure, suicidality, help-seeking, relationship satisfaction and mental health disorder symptoms. Outcomes included Subthreshold Disorder (above the optimal screening cut-off on the 10-item Kessler distress scale or posttraumatic stress disorder checklist) and Probable Disorder (above the epidemiological cut-off on the 10-item Kessler distress scale or posttraumatic stress disorder checklist).

Results: Results found that while lifetime trauma exposure remained the strongest predictor of later probable disorder emergence among both males and females, for females specifically, self-reported resilience was also a significant protective factor. In contrast, being in a significant relationship at Time 1 was a protective factor against the development of subthreshold disorder in males.

Conclusion: For the first time, sex differences in mental health symptom emergence over time have been explored in a large Australian cohort of military members. The capacity to adapt and bounce back after adversity emerged as a proactive factor against poor mental health for females in the military and could be addressed as part of routine skills training. Social support from significant relationship was particularly important for males' mental health, suggesting that maintaining positive relationships and supporting military spouses and partners are critical for males' mental health.