Australasian Psychiatry最新文献

Objectives: To review the challenges to developing and sustaining the Pacific mental health workforce for future planning.

Conclusion: Emerging from a colonial mental health service and training paradigm, contemporary Pacific Island Countries and Territories confront significant workforce education and training challenges that require solutions relevant to regional circumstances.

The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines on mood disorders recommend psychotherapy as foundational care for patients with acute depression with minimal discussion of any potential adverse effects. Randomised controlled trial evidence on psychotherapy adverse effects is limited. This is problematic because clinicians must balance the benefits of treatment against the harms, and clinical decisions become skewed without data on adverse effects. We suggest that clinical practice guidelines should be more guarded about recommending psychotherapy and add consensus statements on adverse effects for informed consent and clinical decision-making.

Objective: Recent guidelines suggest that the overall quantity and duration of antidepressant prescriptions should be reduced. In this paper, we comment on the evidence both for and against this view.

Methods: We critically review the arguments proposed by proponents of antidepressant deprescribing in the context of the evidence-base for the treatment of depression.

Results: Proponents of deprescribing do not address the substantive issues of whether inappropriate prescribing has been demonstrated, and when prescribing is needed. Their arguments for deprescribing are rebutted in this context.

Conclusions: Whether or not to deprescribe antidepressant medication needs to take into consideration the risk-benefit profile of the decision, the responsibility for which needs to be shared and based on the context of the patient's depression, their preferences, experiences and perspectives.

Objective: In this perspective, we investigate how the Royal Australian and New Zealand College of Psychiatrists' (RANZCP) position statement on psychotherapy takes the potential for adverse effects into account.

Conclusions: Psychotherapy has two critical outcomes - efficacy and adverse effects. Evidence-based psychotherapy is significantly more effective than care-as-usual for about one in 10 psychotherapy patients. However, a similar proportion also reports adverse effects. Despite this, the RANZCP position statement on psychotherapy focuses on efficacy with minimal discussion of the adverse effects. This is an oversight because psychiatrists have legal and ethical obligations to consider the adverse effects as well as the benefits of any treatment. We therefore reflect on the RANZCP's six recommendations in light of the adverse effects of psychotherapy.

Introduction: Creating Futures initiative has established a network of mental health professionals, researchers, and community members from the Pacific Island Nations (PIN), Australia, and New Zealand to address the growing challenges of mental health conditions compounded by the climate change crisis. The enormous amount of work done in Global Mental Health can be particularly helpful to improve population-level mental health. However, translation of this evidence base into practice poses several challenges.

Objective: This perspective paper discusses the role of local culture and health systems context in determining the feasibility and acceptability of implementing and scaling up evidence-based interventions designed in an American-European context. The paper also advocates development (and evaluation) of mental health interventions in the PIN communities particularly and Global South generally and exporting these interventions to the rest of the world.

Conclusions: COVID-19 crisis underlined the role of global cooperation as well as national level 'self-reliance'. In this post COVID-19 world, it will be desirable for the mental health community to cooperate and collaborate to scale up evidence-based interventions through rigorous contextualization and at the same time main-stream mental health interventions developed in the Global South by incorporating them in the Global Mental Health discourse.