Australian and New Zealand Journal of Psychiatry最新文献

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.

Purpose: The aim of the present study was to undertake a retrospective analysis of national data on psychostimulant prescription for attention-deficit hyperactivity disorder for youths aged 5 to 17 years in Australia for the period 2003 to 2022.

Method: An area-based national data set (including number of individuals and total dispensing) was used to analyse: (1) total prescription patterns over the period; (2) geographical variation in prescription by state/territory; and (3) socioeconomic variation of prescriptions by postcode.

Findings: Four major findings were observed over the period: (1) prescriptions per thousand rose sixfold; (2) variance of standardised prescription levels by state and territory are narrowing around the national average; (3) standardised prescription levels vary by socioeconomics of postcode but variance is narrowing around the national average; and (4) the highest socioeconomic decile has lifted from the lowest standardised prescription ratio to the highest between census years 2006 to 2021.

Conclusions: Standardised prescription levels in Australia are narrowing around the national average. Findings for both individual prescriptions and total dispensing are similar, providing little evidence for large quantum of drug use. Youth from lower socioeconomic regions are slightly more likely to be prescribed medication. Youth from the highest socioeconomic decile are now much more likely to be prescribed medication. The was an increase in prescription levels across the first 2 years of COVID-19. The drivers behind these changes are worthy of further research.

Background: Clozapine is the most effective therapy for treatment-resistant schizophrenia, yet adverse drug reactions (ADRs) limit its use. The concurrent ADR burden in outpatients and its relation to psychotropic polypharmacy, tobacco smoking and measured clozapine exposure has not been well characterised.

Method: We conducted a retrospective, cross-sectional review of medical records for 360 adults receiving maintenance clozapine at a dedicated outpatient clinic. Adverse drug reactions (ADRs) were ascertained using a standardised patient checklist alongside clinical measures. We used multivariate logistic regression to estimate the association between antipsychotic polypharmacy and the presence of ADRs, and negative binomial regression to quantify its association with ADR burden. We conducted a log-linear model to evaluate dose-concentration compensation in tobacco smokers.

Results: At the clinic visit, 89.6% had ⩾1 symptomatic ADR. The most prevalent were metabolic syndrome (71.8%), hypersalivation (64.7%) and tachycardia (61.2%). Antipsychotic augmentation (51.4%) was independently associated with ADRs (adjusted odds ratios [aOR] = 3.38, 95% confidence interval [CI] = 1.41-8.06) and a 28% higher ADR count per person (incidence-rate ratio [IRR] = 1.28, 95% CI = 1.11-1.48). Smokers received higher doses yet had lower plasma concentrations, suggesting incomplete dose compensation for CYP1A2 induction and had higher odds of antipsychotic augmentation (odds ratio [OR] = 2.50, 95% CI = 1.53-4.10).

Conclusion: In maintenance clozapine care, persistent ADRs were common and were more frequent in patients receiving antipsychotic augmentation. Smokers were under-exposed to clozapine and were more likely to receive antipsychotic augmentation. Services should implement structured ADR surveillance and prioritise therapeutic drug monitoring-guided dose optimisation, particularly in smokers, before considering antipsychotic augmentation.

Objective: The Neuropsychiatry Unit Cognitive Assessment is a valid and reliable screening tool used in detecting cognitive deficits in a range of neurological and psychiatric conditions. We aimed to develop abbreviated versions of the Neuropsychiatry Unit Cognitive Assessment tool using retrospective data, and to assess their psychometric performance in distinguishing between healthy cognition and dementia.

Methods: Healthy controls (n = 132, 41%) and those with dementia (n = 191, 59%) were randomised into a 'training' cohort (n = 226, 70%) for the development and a 'testing' cohort (n = 97, 30%) for validation of the short-form versions. Receiver-operating characteristic curves were first computed for each of the 24 original Neuropsychiatry Unit Cognitive Assessment items. Items were ranked according to area under the curve values to create five-, 10- and 15-item short-form versions, which were subsequently validated.

Results: The psychometric properties of the Neuropsychiatry Unit Cognitive Assessment short-form versions were comparable with the original, with all maintaining high convergent validity and reliability. Of the three versions, the 10-item version strikes the ideal balance of breadth and brevity. With a cut-off score of 42/54, the 10-item version generated similar sensitivity, specificity and predictive values for dementia as the original Neuropsychiatry Unit Cognitive Assessment, with a sensitivity of 0.98, specificity of 0.95, and positive and negative predictive values of 0.97.

Conclusions: The 10-item Neuropsychiatry Unit Cognitive Assessment has strengths in its shorter administration time, of approximately 10 minutes, high reliability and validity, and retention of items from each cognitive domain from the original Neuropsychiatry Unit Cognitive Assessment. Future research may involve testing these short forms in non-tertiary settings, across dementia subtypes and in non-dementia groups.

Background: Diversionary approaches seek to address criminal legal system involvement among people with psychosis and other mental illness. There is limited evidence examining health characteristics of people with psychosis in Australian criminal legal systems and how these vary with court outcomes, including diversion.

Methods: We conducted a data-linkage study of 21,229 adults hospitalised with psychosis in New South Wales (June 2001 to December 2019) with a subsequent offence finalised in the New South Wales Local Court. We described psychosis types, co-occurring conditions and prior health service use and examined their associations with court outcome (diversion vs conviction) using logistic regression, adjusting for sociodemographic and legal factors.

Results: A total of 70.8% of participants had a schizophrenia spectrum disorder (substance-induced psychosis 22.6%; affective psychosis 6.6%). Co-occurring conditions were common (lifetime substance-related harm 84.8%; personality disorder 41.3%; neurodevelopmental disorder 17.5%; physical condition 25.6%), and 76.3% used mental health services in the year before the index offence. Affective and substance-induced psychoses were negatively associated with diversion vs schizophrenia spectrum disorders (adjusted odds ratios = 0.64 [95% confidence interval = 0.54-0.74] and 0.29 [95% confidence interval = 0.26-0.33], respectively). Duration of psychosis admissions and past-year mental health service use were positively associated with diversion, while in those with schizophrenia spectrum disorders, lifetime substance-related harm was negatively associated.

Conclusion: Court defendants with psychosis have a complex health profile. Although people with schizophrenia spectrum disorders are more likely to be diverted than those with other psychosis types, substance use may inhibit diversion. Health and criminal legal system collaboration is needed to facilitate diversion and treatment for this group.

Objective: To identify the barriers accessing health (including mental health) services by Indigenous people in Victoria, Australia, and putative solutions, through yarns with 44 members of the Victorian Aboriginal community.

Methods: This paper systematically explores grassroots barriers and potential solutions for Indigenous young people to engage and use health (including mental health) services. Elder-governed yarns were conducted via Zoom with 44 representative Victorian Aboriginal Elders, Healers, Senior and Junior people involved in the health and wellbeing of the Victorian Aboriginal community. These yarns were analyzed through an innovative, constructivist, multi-perspectival discursive grounded theory method.

Results: Five pre-eminent themes emerged: the socio-economic barriers to services, the ongoing effects of colonization, disconnection and isolation from community and Country, pressures in society of living in two worlds and lack of cultural safety and racism. Detailed and rich day-to-day barriers and possible grassroots solutions were proffered.

Conclusions: The analyzed yarns provide important detail about everyday barriers Indigenous peoples face in healthcare services and potential ways forward to improve the situation for Indigenous young people and their kinship networks. This paper can help shape future policy and its implementation. In particular, Aboriginal Community Controlled Health Organizations running traditional Indigenous healing programmes alongside Western health management, ensuring formal processes predominate and are monitored for their day-to-day effectiveness.

Objective: The prevalence of common mental disorders (CMDs, depression/anxiety) among Australian adolescents is increasing. Evidence is needed to inform how prevention efforts can be focused for greatest impact. This study used a compartmental model to estimate how investments could be optimally allocated across interventions to prevent CMDs in adolescents, and the corresponding health and economic benefits.

Methods: The Australian 0- to 19-year-old population was disaggregated by age (0-9, 10-14, 15-19), sex (male, female) and CMD experience (never, currently, previously). Twelve prevention interventions were included following targeted reviews. The model was calibrated to Australian population survey data and included sociodemographic risk factors from the literature that were relevant for included interventions (bullying, financial stress, poor school connectedness, racial discrimination, child maltreatment). An optimisation estimated how an additional AUD$50 million-AUD$1 billion per annum over 2024-2050 could be allocated across interventions to maximise the number of adolescents turning 20 without a lifetime experience of CMD.

Results: The benefit-cost ratios of interventions varied widely depending on whether they impacted CMDs directly or indirectly by reducing a risk factor, and also whether CMD was their primary purpose or not (e.g. poverty interventions). Optimally investing AUD$50 million-AUD$1 billion p.a. over 2024-2050 could lead to 144,577-791,277 fewer adolescents experiencing a CMD by age 20 (AUD$5064-AUD$18,507/lifetime CMD experience averted), with lower bound benefit-cost ratios ranging from 5.0 to 19.2. Optimally, budget allocations should include combinations of interventions targeting different age groups, sub-populations and risk factors.

Conclusions: Investing in evidence-based prevention interventions for adolescent mental health is likely to have a favourable return-on-investment.

Each year in Australia, tens of thousands of people living with mental illness die from preventable physical health conditions. Australia is yet to meet its 2008 commitment to provide equal healthcare for people with disabilities (Article 25, United Nations Convention on the Rights of Persons with Disabilities). In May 2024, a national forum of 240 delegates called for urgent action to address the life expectancy gap for people living with mental illness. This article presents perspectives of forum delegates about: (1) where we need to be, (2) critical reform elements and (3) foundational components to address this health inequity. Attendees overwhelmingly expressed the need for lived experience leadership and human rights to underpin the health system. Foundational components included respectful and inclusive practices, co-learning and co-production, a strong and integrated lived experience workforce, strategic support for reform, and societal shifts in values. Recommendations for government, advocacy bodies, services and individuals were provided, including conducting analyses of mental health legislation to align with Article 25 of the United Nations Convention on the Rights of Persons with Disabilities; establishing strategic lived experience leadership positions; providing workforce training on the increased risk of premature death and human rights approaches to improving healthcare equity; and taking every opportunity to advocate for physical health equality for people with mental illness. Urgent public health action is needed to incentivise and instil accountability for change, ensuring that reform efforts add power to the voices of those most impacted by mental illness and the services designed to support them.