Australian and New Zealand Journal of Psychiatry最新文献

Psychotropic pharmacogenetics (PGx) offers significant potential advancements in psychiatric care by optimising medication selection and dosing based on genetic factors. This perspective article highlights the clinical utility, health economic implications and implementation challenges of psychotropic PGx, proposing that its broader implementation could enhance patient outcomes and reduce healthcare costs. Landmark studies show that PGx-guided care results in fewer adverse drug reactions and improved medication efficacy, with substantial cost savings compared to traditional prescribing methods. However, implementation barriers persist, particularly in Australia, where knowledge gaps, limited clinical guidelines and funding constraints hinder adoption. Despite challenges such as industry bias and limited data on non-antidepressant psychotropics, robust clinical and economic evidence supports the expanded use of psychotropic PGx, with emerging combinatorial approaches offering promise for future psychiatric treatment.

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.

Background: The diagnosis and management of autism spectrum disorder is an important clinical issue for psychiatrists. However, there is a lack of research and resources to recognise this condition in older people. This condition is important to detect and diagnose because it is associated with high incidence of psychiatric comorbidity. The diagnosis helps clinicians understand the additional needs of these patients and helps families understand their additional difficulties. This paper aims to identify the studies that have been conducted on autism in the eldest and the approaches to detect and diagnose this.

Method: A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews guidelines. Searches were performed on five databases where search terms were based on (1) Autism, (2) Aged/Elderly and (3) Diagnosis. Two authors independently assessed the results with discrepancies resolved by a third reviewer. Quality was assessed using Mixed Method Quality Assessment Tool in included systematic reviews, randomised control trials, case-control studies, cohort studies, case series and case reports.

Results: The review identified 4 diagnostic tools, and 19 screening tools available for use in the elderly. However, most of these tools were not validated in studies focusing on older people and most included a small number of older people in their sample.

Conclusion: Given Australia's ageing population, and resultant increasing demands on healthcare services, this is an important topic to inform future research and clinical practice. More research is required to validate or create diagnostic and screening tools specifically for older people.

Objective: Art therapy offers a predominantly non-verbal form of creative self-expression for people experiencing mental health issues. This systematic review aims to investigate the effectiveness and acceptability of art therapy for children and adolescents experiencing acute or severe mental health conditions.

Methods: Following PRISMA guidelines, five electronic databases were searched (Embase, MEDLINE, Web of Science Core Collection, PsychINFO, CINAHL) using the search terms ('art therap*' OR 'art psychotherap*') AND ('child*' OR 'adolescen*' OR 'youth' OR 'young' OR 'teen*'). Study quality was assessed based on methodological rigour, and narrative synthesis of findings was undertaken.

Results: Of 3529 identified articles, 90 (23 original research papers and 67 case studies) met criteria. Art therapy delivery method, dose and intervention duration varied across studies. Nonetheless, synthesis of the 23 original research studies indicated high acceptability. Randomised control trials demonstrated effectiveness in reducing the severity of symptoms of post-traumatic stress disorder, depression and suicidal ideation. Quasi-experimental, cohort and cross-sectional studies also showed reductions in anxiety symptoms and improvements in emotion regulation, self-awareness, distress tolerance, confidence, communication and self-expression across various mental health conditions.

Conclusion: Art therapy is an effective and acceptable treatment for young people experiencing acute or severe mental health conditions, with a preponderance of evidence for post-traumatic stress disorder. Effectiveness across conditions, settings and art therapy intervention type suggests the capacity of art therapy to adapt to needs of young people. Enhanced access to art therapy for young people navigating acute distress will support the provision of engaging and effective mental health treatments.

Objective: The objective was to examine response rates, types of callers and their probability of being answered, prevalence of at-risk callers, and to calculate national call rates.

Methods: Data on all calls to the Danish, national telephone helpline for suicide prevention during July 2019 to December 2022 were analysed. A measure of unique calls was developed to account for repeat calls not being answered. We examined the probability of calls being answered by caller types using logistic regression and calculated national call rates for individuals aged ⩾15 years.

Results: Overall, 526,533 calls were made by 31,317 individuals, and 131,621 unique calls were identified, of which 48.9% were answered. First-time callers (95.1%) accounted for 5.7% of calls. We found that 0.1% of callers accounted for 61.8% of all calls. This group of daily callers (>1000 calls each year) consisted of 8-12 unique callers and was more likely to be answered (odds ratio = 24, 95% confidence interval = [23, 25] vs first-time callers), often hung up (49.1% vs first-time callers: 4.4%), and received 33.0% of the total counselling time. The yearly national call and caller rates were 893 calls and 212 unique callers per 100,000 inhabitants, respectively.

Conclusions: Correcting for repeated unanswered calls provided an informative estimate of the response rate. The call distribution was highly skewed; a small group of daily callers accounted for most calls and were more likely to be answered. These callers frequently hung up before a conversation was initiated. National call rates facilitate cross-country comparisons.

Background: Australia has a high mental illness burden, especially among young women. It is known that people in urban areas, with more education and higher incomes are more likely to use Better Access services (mental health treatment plans and psychological treatments), while those in rural areas, or with lower education or incomes, disproportionately use antidepressants. During the COVID-19 period, the Australian government increased access to mental health care. Our aim was to investigate how rurality, education level and perceived ability to manage with income influenced young women's use of mental health treatment plans, psychological treatments and antidepressants separately or in various combinations (2019-2022).

Methods: Survey and linked administrative data from 7642 women from the Australian Longitudinal Study on Women's Health were used. Relative risk ratios and 95% confidence intervals for associations between sociodemographic factors and use of mental health treatment plans and treatments were estimated using multinomial logistic regression.

Results: Women in rural/remote areas (vs metropolitan areas) were less likely to have a mental health treatment plan (with/without antidepressants), difficulty managing with available income (vs not too bad/easy) was associated with having a mental health treatment plan and using antidepressants. High school-educated women (vs university-educated) were more likely to use antidepressants only (relative risk ratio = 1.60; 95% confidence interval = [1.24, 2.07]). Among women with mental health treatment plans (n = 3525), those in rural/remote areas (relative risk ratio = 2.00; 95% confidence interval = [1.13, 3.53]) and women not university-educated were more likely to use antidepressants without psychological treatment.

Conclusion: Sociodemographically disadvantaged young women disproportionately used antidepressants without Better Access services. Evidence-based interventions to reduce these inequities should be a priority.