Australian and New Zealand Journal of Psychiatry最新文献

Objective: Mental health disorders are concerningly high among young people, with one in five beginning in early childhood. This study examined developmental trajectories of internalising and externalising symptoms in young Australians and identified social determinants that best predict these psychiatric symptom trajectories.

Methods: Data from 5514 children in the Longitudinal Study of Australian Children were analysed. Group-based trajectory modelling identified symptom trajectories using Strengths and Difficulties Questionnaire scores across seven age-points. Multinomial logistic regression models examined associations between social determinants (guided by WHO Commission on Social Determinants of Health framework) and trajectory class membership.

Results: A total of 5501 children (2718 B-cohort; 2783 K-cohort) were included. Three distinct trajectories were identified for both internalising and externalising symptoms. For internalising symptoms, two groups maintained 'normal' levels, while one exhibited progressively worsening 'abnormal' levels. For externalising symptoms, two groups remained 'normal', while one exhibited persistent 'abnormal' levels despite declining. Key social determinants included socio-economic status, biological sex, maternal depression, hostile/angry parenting, partner violence, maternal smoking and social connections. Population Attributable Fractions suggest that reducing maternal depression, angry parenting and partner violence could prevent up to 40% of abnormal symptom trajectories, while higher socioeconomic position and maternal social connectedness may offer modest protection.

Conclusion: Nearly 10-15% of adolescents followed abnormal symptom trajectories from early childhood. Reducing maternal depression, angry parenting and partner violence, and enhancing maternal social connectedness could substantially prevent these trajectories. Addressing these social determinants through targeted policies aligned with the WHO-CSDH framework is essential for improving youth mental health.

People impacted by bipolar disorder are confronted by many unmet needs that contribute to the overall burden associated with the disorder. We do not have a good understanding of the underlying pathology of bipolar disorder, so we do not have biomarkers to accurately identify those who are at risk of developing the disorder. Delayed diagnosis is the norm, and it can take a decade or more for an individual to receive a diagnosis and to start appropriate treatment. We have evidence-based treatments such as lithium and psychosocial therapies; however, their availability and use are limited. We need a consolidated approach to advance indicated prevention and early intervention for bipolar disorder. In this viewpoint article, we describe these barriers in detail as well as introduce international and national work that is being done to progress the field. At the national level, we introduce the National Health and Medical Research Council Centre for Research Excellence in Bipolar Disorder. The Centre for Research Excellence in Bipolar Disorder comprises a multidisciplinary team of experts from Australia and internationally who are working together to develop a better understanding of opportunities for indicated prevention and early intervention as well as to improve interventions for those impacted by the disorder. Here we describe our research framework, stakeholder engagement activities and strategies for workforce development and capacity building. Ultimately by working together we will attempt to address many of issues faced by individuals impacted by bipolar disorder.

Background: Young people in out-of-home care experience complex mental health needs and may be prescribed psychotropic medications at a greater rate than those not living in care. The aim of this scoping review was to synthesise international literature to (1) understand the prevalence of psychotropic medication use among young people in out-of-home care and (2) identify the factors associated with a greater likelihood of prescribing and/or use.

Methods: This scoping review was conducted according to the Joanna Briggs Institute (JBI) methodological guidance. Five electronic databases were searched for relevant literature published from inception to September 2024. Synthesising the literature involved a mixed-method approach, utilising a proportional meta-analysis, narrative synthesis and content analysis.

Results: Sixty-one studies were eligible for inclusion. Meta-analysis calculated the pooled prevalence of any psychotropic medication as 42.16% (95% confidence interval [CI]: 31.76-52.93%). Pooled prevalence estimates for individual subclasses were 25.60% for stimulants (16.82-35.51%), 21.33% for antipsychotics (12.42-31.87%), 16.36% for antidepressants (10.35-23.42%), 8.57% for mood stabilisers (4.61-13.58%) and 2.24% for anxiolytics (1.12-3.72%). The most commonly examined predisposing factors suggested differences in prescribing practices associated with demographic characteristics such as age, sex and ethnicity.

Conclusions: Psychotropic medication management in out-of-home care is complex; however, further research on the international prescribing practices outside the United States is needed. Improved cross-system coordination, caregiver support, meaningful youth involvement and trauma-informed, person-centred approaches to mental health care in out-of-home care are essential to ensure safe, effective and equitable psychotropic medication use.

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.