Australasian Psychiatry最新文献

ObjectiveTo present the perspective of professionals working in the field of transcranial magnetic stimulation (TMS) regarding the regulations which impact the availability of government subsidisation via Australian Medicare Benefits Schedule Item Number rebates to patients with major depressive disorder (MDD) who are seeking TMS treatment.ConclusionsWe argue that three regulations should be withdrawn: (1) that patients who received TMS prior to 1 November 2021 are ineligible for TMS rebates after 1 November 2021; (2) that every person is subject to a limit of 50 TMS treatments in a lifetime; and (3) that rebates are not available for maintenance TMS. We also conclude that consideration should be given to the provision of rebates for TMS treatments when it is delivered as a first-line treatment for MDD.

ObjectiveMoral distress occurs when we know what the right thing to do is in accordance with our ethical principles and values, but institutional or other constraints make this difficult¹. As psychiatrists and psychiatry trainees, we are asked to assume responsibilities and balance competing obligations to our patients, organisations, and the public. I offer a first-person narrative of the moral distress experienced by a prison psychiatrist. I hope it resonates with other psychiatrists and psychiatry trainees dedicated to addressing the moral challenges in mental health and inspires those to harness the moral courage to improve the broken systems in which we work.ConclusionsForensic psychiatrists who practice in the carceral system, a low resourced and punitive environment, encounter unique structural and institutional constraints on their moral judgement. These include the inequivalence of care, coercive practices, role conflicts, hierarchical power structures, and punitive laws. Such constraints on our moral agency invoke a complicity of wrongdoing and generate feelings of powerlessness where our moral intuitions are not heard or taken seriously. Moral distress is not unique to forensic psychiatry, but the sub-speciality is exemplary of the concept and offers fertile learning opportunities for other areas of psychiatric practice.

ObjectiveTo assist mental health clinicians to develop a biopsychosocial formulation for children and adolescents with gender distress.ConclusionsVarious biological, psychological, and social factors, developmental disorders and adverse experiences, may contribute to a child claiming a trans identity. Factors relevant to the individual child or adolescent should be encapsulated in a formulation to guide therapeutic approaches.

ObjectiveUse of seclusion (in particular inequitable use) continues in mental health services in many countries, despite evidence against it and substantial endeavour to reduce or eliminate it. Aotearoa New Zealand's national quality improvement agency Te Tāhū Hauora Health Quality & Safety Commission has since 2018 led a project to eliminate use of seclusion in mental health inpatient units.MethodThe 'Zero Seclusion: Safety and dignity for all' project co-designed a bicultural change package and implemented it nationwide in a formative collaborative with clinical teams, consumers, families, and whānau. Outcome measures included seclusion rates, duration, and average number of episodes, by ethnicity, with a focus on equity.ResultsFrom a baseline mean of 6.4% of mental health service consumers secluded monthly in the 12 months to September 2019, the mean rate of seclusion reduced to 4.3% by June 2024. The seclusion rate of Māori mental health service consumers fell from 9.9% to 6.0%, and of non-Māori/non-Pacific consumers from 4.0% to 2.3%.ConclusionReduction and elimination of seclusion, especially its inequitable use with indigenous populations, is possible. True co-design, strong leadership, partnership with indigenous populations and those most affected, and an embrace of robust measurement were critical to these good results.

BackgroundDespite a limited evidence base to inform clinicians, Australia has adopted a national approach in rescheduling psilocybin and MDMA as clinical therapies for treatment-resistant depression (TRD) and post-traumatic stress disorder (PTSD), respectively.PurposeThis paper explores clinical research domains warranting further investigation through outlining the reflections of a clinical-academic psychiatrist involved in psychedelic trial work.ResultsEight domains were found to warrant further research investigation including: efficacy, safety (including combining with psychotropics), psychotherapy models, psychological support, therapeutic touch, set/setting and examination of naturalistic data.ConclusionsThe clinical availability of psychedelic-assisted therapy (PAT) gives greater impetus for careful research studies, informing treatment and improving patient outcomes.

ObjectivePeople with schizophrenia are at increased risk of metabolic syndrome (MetS), contributing to excess morbidity and mortality. This study examined MetS monitoring rates and prevalence in people with schizophrenia receiving public mental health care in Queensland.MethodsData from the Consumer Integrated Mental Health and Addiction Application (CIMHA) were extracted for individuals aged 18-64 with a schizophrenia diagnosis. MetS was determined using International Diabetes Federation criteria.ResultsOf 5802 individuals, 16.0% had sufficient data to determine MetS status. Among those with complete data, MetS prevalence was 53.2%. MetS was significantly more common in regional than metropolitan areas. Blood pressure and BMI were recorded for most patients (≥74%), but biochemical indices (fasting glucose, HDL, triglycerides) were recorded in only 26.4%-35.5%.ConclusionsMetS is highly prevalent in schizophrenia, yet routine monitoring is incomplete, particularly for biochemical markers. Strengthening data integration across healthcare systems and ensuring access to evidence-based interventions for MetS management, particularly in regional areas, is critical to addressing this major health disparity.

ObjectiveDeliberate self-harm (DSH) is a complex event with multitude of contributing factors. The emergency department has an essential role as first point of contact with patients who present with DSH. We aimed to determine the pattern of DSH presenting in emergency department of a tertiary care hospital in Pakistan.MethodFollowing ethical approval, data including demographics, methods, reasons, and intent were collected for 6 months (January-June 2022) and analyzed using SPSS-26.Results485 cases (53.2% males) with mean age of 29 years (SD ± 13.16), were included. More than half (55.4%) were married with urban predominance (81.9%). One-fourth of patients were housewives. The most frequent DSH method was ingestion of a poisonous substance (95.1%), followed by firearms (1.2%). Among ingested substances, intake of wheat pills (23.1%), corrosives/acid (11.5%), and bleach (10.3%) was frequent. Immediate triggers for DSH included family conflicts (16.3%), intent to put pressure on family (17.7%), financial reasons (11.3%), and to get out of a situation (7.2%). Twenty-two percent (106) people had an intent to die. There were almost three presentations of DSH per day.ConclusionIngestion of poisonous substances, due to easy availability, highlights ongoing gaps that the policymakers can address to reduce the burden of DSH in Pakistan.