Australian and New Zealand Journal of Psychiatry最新文献

One of the key concerns of recent national mental health policy has been to lift the rate of population access to mental health services.

Ketamine has emerged as a rapid-acting intervention for treatment-resistant psychiatric disorders, generating both enthusiasm and unease. While evidence demonstrates robust antidepressant, anxiolytic and anti-suicidal effects, ketamine also carries risks, including dissociation, dependence and uncertain long-term safety. Its reputation as a recreational drug further complicates clinical adoption, fostering stigma and regulatory caution. In this article, we consider ketamine's psychiatric use through the lens of medical ethics, structured around the principles of autonomy, beneficence, non-maleficence and justice. We argue that while ketamine should be embraced as a legitimate psychiatric therapy, its application must be grounded in rigorous ethical practice, supported by regulation and research, and shielded from both undue dismissal and premature over-promotion.

Objectives: Data from a longitudinal national cohort study was used to test associations between young caregiving and self-harming and suicidal behaviours.

Methods: We used data from Waves 6-8 (2014-2018) of the Longitudinal Study of Australian Children to assess the effect of 'core' caregiving activities (e.g. personal care, assistance moving around) on suicidal and self-harming behaviours. Care activities at 16-17 years were classified as core caregiving, non-core caregiving and no caregiving. Five self-harming and suicidal measures, collected at age 18/19 years, were used to form two outcomes: thoughts (of self-harm or suicide, or plan to suicide) and behaviours (self-harm, suicide attempt), operationalised as binary variables. Analyses were carried out using augmented inverse probability treatment weighting, adjusting for potential confounders, on complete case data.

Results: Core caregiving was associated with higher levels of suicidal and self-harming behaviours compared no caregiving, with an average treatment effect (ATE) of 0.07 (95% confidence interval [CI] = 0.02, 0.12), equating to a risk ratio of 1.86 (95% CI = [1.21, 2.45]). The ATE of core caregiving on thoughts of suicide or self-harm (compared to non-caregiving) was 0.05 (95% CI = [-0.00, 0.11]), equating to a risk ratio of 1.26 (95% CI = [0.97, 1.56]). There was no evidence of an association between non-core care and any outcomes tested. Sensitivity analyses confirmed main findings.

Discussion: Core caregiving is associated with elevated risks of self-harm among young carers, underlining the crucial need to better identify and support young carers to mitigate these adverse outcomes.

Objective: People with different psychiatric diagnoses use certain suicide methods more frequently. These findings could have implications for reducing suicide. Therefore, the aim of this study was to assess associations between three severe mental illnesses (SMIs) and suicide methods, while adjusting for other confounding factors that could influence choice of suicide methods.

Methods: We used information on all individuals dying by suicide in Queensland, Australia, from 1989 to 2021. Methods were compared to hanging, strangulation and suffocation for people with three different SMIs with adjusted risk ratios in multinomial logistic regression models.

Results: People with psychotic disorders were over three times more likely to jump from a high place, jump or lie before a moving object, or use a sharp object. They were also more than twice as likely to use explosive material or smoke, fire and flames; or drowning and submersion and 60% more likely to use crashing of a motor vehicle. Poisoning by drugs was around 50% higher in those with psychotic disorders or depression. No other methods were substantially elevated relative to hanging, strangulation and suffocation (HSS). People with bipolar and depression had a lower risk ratios (RR) for several suicide methods.

Conclusion: People with psychotic disorders were the most likely to use diverse methods and would benefit the most from means restriction interventions. Trialling interventions to ensure that people with psychotic disorders can avoid situations where they could use these methods may reduce suicides in this group. Further analysis of what drugs people with depression and bipolar might use is needed.

Objective: To describe Australian trends in poisoning exposures to attention deficit hyperactivity disorder medication reported to the New South Wales Poisons Information Centre over a 10-year period.

Methods: This is a large retrospective case series of human exposures to the following medications used for attention deficit hyperactivity disorder: atomoxetine, clonidine, dexamphetamine, guanfacine, lisdexamfetamine and methylphenidate. We extracted exposures from the New South Wales Poisons Information Centre database from 2014 to 2023. Exposures are reported per 100,000 population, data obtained from the Australian Bureau of Statistics. Dispensing data was obtained from the public Pharmaceutical Benefits Scheme Report.

Results: There were 17,299 exposures reported to New South Wales Poisons Information Centre during this period. Exposure rates increased by 16.5% (95% confidence interval: 15-18%) annually. Groups with some of the greatest annual increases were female adolescents 20.4% (95% confidence interval: 16-25.4%) and children 18.5% (95% confidence interval: 14.7-22.8%). Over half of exposures (9657) were referred into hospital or were in hospital at the time of the call to New South Wales Poisons Information Centre. Sixty percent (10,427) of exposures were unintentional. There was a strong positive correlation between exposures and number of prescriptions, R² = 0.94, significant F = 4.5 × 10^-6.

Conclusion: Exposures to attention deficit hyperactivity disorder medications present a growing public health issue. Rates have risen annually over the past decade, and the majority require medical attention, placing strain on healthcare resources. There are notable differences in exposure patterns among affected age groups. This highlights the need for targeted preventive measures focused on both quality use of the medication being prescribed as well as considering the circumstances and safety of the individual and household.

Australia's reclassification of psilocybin as a Schedule 8 substance for treatment-resistant depression represents a significant shift in psychiatric policy. While this regulatory change positions Australia as a global leader in psychedelic medicine, its implementation has revealed substantial challenges. This article critically examines the regulatory, ethical and operational complexities surrounding the provision of psilocybin-assisted therapy in clinical practice. Key issues include limited prescriber access, absence of Australian Register of Therapeutic Goods-listed products, lack of standardised training pathways and significant cost barriers. Ethical considerations such as informed consent, cultural safety and therapeutic fidelity are also discussed, particularly in the context of trauma-informed care. This article proposes a series of structural recommendations to support safe and equitable deployment, including national training accreditation and fidelity monitoring tools. In addition, to maximise the efficacy of psilocybin-assisted therapy, we recommend that research explores the potential of neurobiologically informed stratification models to assist with treatment recommendations. These recommendations aim to enhance clinical integrity through evidence-based patient selection, improved safety, and to ensure that emerging psychedelic treatments are integrated responsibly within Australia's mental health system. By addressing these foundational gaps, Australia can move beyond regulatory novelty ensuring the therapeutic potential of these products is realised in a manner which is scientifically sound and upholds the integrity of psychiatric practice.

Objective: This study aimed to examine the association of trauma exposure and shame on the clinical presentation of individuals experiencing psychosis (including suicidal behaviours).

Methods: A retrospective audit of clinical data collected over a 4-year period from a tertiary psychosis service was conducted. All individuals accessing the service had experience of psychosis.

Findings: Data from 201 individuals who completed assessments between 2020 and 2024 were analysed. Exposure to trauma was high, with all reporting experience of at least one traumatic event. Trauma related to psychosis symptoms (64.0%) and treatment experiences following psychosis (57.0%) were particularly prevalent. Exposure to lifespan trauma was positively related to the number of lifetime suicide attempts, r(90) = 0.22, p = 0.038. Higher levels of shame were associated with an increased frequency of current suicide ideation, External shame: (r(51)= 0.46, p < 0.001); Internal shame: (r(50) = 0.45, p < 0.001).

Conclusions: These findings highlight different, though related, associations between suicidal behaviours with trauma exposure and shame. While trauma is associated with suicidal behaviours, shame is correlated with suicidal ideation, raising implications for assessment and intervention. Future work could examine whether suicide ideation in this group is influenced by psychological interventions that target shame.