Australasian Psychiatry最新文献

Current ethnicity categorization practices in Aotearoa New Zealand's health system may perpetuate health inequities. Prioritized ethnicity data obscures social realities and fails to capture mixed ethnic identity complexity. Waikato Hospital admission and regional suicide data reveal significant health outcome variations within ethnic groups, particularly among Māori populations. Those identifying solely as Māori show higher hospital admission rates and suicide risk compared to mixed Māori-European identity individuals. Collapsing diverse ethnic categories masks important disparities and leads to inappropriate resource allocation. Mental health services require sophisticated approaches to ethnicity data that recognize cultural identity complexity and enable targeted interventions.

ObjectiveThe number of individuals presenting with a mental health crisis in Australia has been steadily increasing. This review aims to identify what crisis intervention services are available in Australia for consumers experiencing a mental health crisis without an underlying severe psychiatric illness, and to explore the experiences of consumers utilizing these services.MethodUsing PRISMA methodology, we conducted a review of four databases (Ovid Medline, PsycINFO, Web of Science, and Scopus) for articles relating to lived experience of consumers in Australian crisis intervention services. Inclusion and exclusion criteria were applied, and relevant articles assessed.ResultsEleven articles met the inclusion criteria. Identified crisis services included emergency departments, emergency services, crisis helplines, and community centres. Persistent themes included negative attitudes from staff, discordance around what constitutes a mental health crisis warranting presentation, long wait times, and the role of these services in providing non-clinical emotional support rather than medical interventions.ConclusionThis review identified clear discrepancies in consumer experiences between services, with specific aspects of care consistently linked to either positive or negative experiences. Improving staff communication and addressing judgemental attitudes may improve experiences. System reform would be better guided by further research into why consumers engage with specific crisis services.

ObjectiveThis study aimed to identify factors associated with venous thromboembolism (VTE) diagnosis in psychiatric inpatients in Saskatoon, Saskatchewan, Canada.MethodsWe conducted a retrospective case-control chart review of patients admitted to the Dube Centre for Mental Health from January 2007 to December 2021. Cases were individuals aged 18 years and older who received anticoagulation for VTE treatment. Controls were randomly selected, with case-to-control ratio 1:4, from patients with a discharge diagnosis not including VTE. Data were analyzed using descriptive analysis, univariate, followed by multivariable logistic regression analysis to identify factors associated with VTE diagnosis.ResultsA total of 32 VTE and 159 non-VTE patients were included. The mean age of VTE patients was 52 years (standard deviation [SD] = 19.7), 65.6% were female, and 65.6% had no previous VTE. Comorbidities including cancer (adjusted odds ratio [AOR] = 51.83; p = .004), cardiovascular conditions (AOR = 7.83; p = .01), and insomnia (AOR = 88.79; p = .01); psychiatric-specific interventions such as electroconvulsive therapy (AOR = 21.10; p < .001) and mechanical restraints (AOR = 12.65; p = .004); and acute medical diagnoses (AOR = 8.56; p = .01) were independently associated with developing VTE.ConclusionsPsychiatric inpatients have unique factors that increase the likelihood of developing VTE. Further research with a larger sample size and multicenter design is needed.

BackgroundThe first author is a third-year trainee with Queensland Centre of Excellence for Intellectual Disability and Autism Health (QCEIDAH). This perspective stemmed from the experience of working at QCEIDAH and reflecting during supervision on the complexity and confusion that arose being 'within and without' - quote from F. Scott Fitzgerald's 1925 novel, 'The Great Gatsby', depicting the narrator's coming of age.ObjectiveTo explore and outline the perspective of a registrar working in a state-wide intellectual and developmental disability consultation service.MethodThe utility of various psychiatric frameworks within a complex consultation service is discussed, including biopsychosocial model, psychodynamic model, and systems framework.ConclusionTo be 'within and without' not only describes the physical state of being inside a room with the patient in a time-limited consultation service but also mirrors the complexity of stepping into the various system of the patient including their families, support workers, NDIS coordinator, and other health providers in a variety of physical, metaphorical, and metatheatrical sense. This presentation highlights the challenge of a trainee working in a space with high expectations from a variety of systems in a field which lacks the clarity and framework to easily achieve this.

For people with mental illnesses that impair reality testing, such as psychosis, severe depression and bipolar disorder, Artificial Intelligence (AI) Large-Language Models (LLMs) may represent threats to mental health. LLMs are unable to detect delusional beliefs, may encourage and validate delusions and cognitive distortions, miss opportunities to reinforce reality-based thinking, and exacerbate risks of self-harm and harm to others. Psychiatrists need to understand these risks of LLMs for people with severe mental illnesses, and educate patients and carers on avoiding these potential harms. Risk assessments need to be informed by an awareness of the inputs that patients receive from LLMs.

ObjectiveGood Psychiatric Management (GPM) is a structured, evidence-based approach for treating borderline personality disorder (BPD). In this study, we aimed to explore the experiences of using GPM within a multidisciplinary mental health team and to identify factors that promote or impede its implementation and practice.MethodsThe study design was informed by interpretive description methodology. Semi-structured, in-person interviews were conducted with staff based at an assertive community outreach service (ACOS) trained in GPM. Interviews were audio-recorded, transcribed and coded by reflexive thematic analysis.ResultsFrom eleven participants of social work, community support work, nursing, psychology, occupational therapy and managerial backgrounds, we identified three main themes: (1) GPM as complementary to practitioners' values, (2) GPM as empowerment to deliver treatment confidently and consistently and (3) leadership as instrumental for the implementation of a new model.ConclusionsImplementing GPM as a shared model of care has value for health professionals by improving confidence and skills in working with people with BPD and increasing team cohesion. Effective leadership facilitates the introduction of an empirically supported evidence-based model of care, even when there are system constraints. Further research is needed to evaluate the use of GPM in general healthcare settings.

IntroductionPeople with eating disorders (ED) are at a high risk for suicidal ideation (SI), and evidence suggests that psychiatric comorbidities play an important role in this association. The objective of this study was to investigate the relationships between SI in binge-eating spectrum conditions (BESC includes binge-eating disorder (BED), bulimia nervosa (BN), and recurrent binge-eating behavior (RBE)) in a representative sample from Rio de Janeiro, Brazil.MethodsIn-house interviews were conducted with 2297 adults. SI was assessed by the PHQ-9. BESC were screened using the QEWP-5 and confirmed at a clinical interview. Valid instruments evaluated psychiatric comorbidities, and logistic regression was used to estimate associations between SI and BESC.ResultsIndividuals with BESC had higher rates of SI (BED (39.6%), BN (40.8%), RBE (26.5%)) compared to those in the general population (7.5%) (p < .0001). There was a higher odds ratio for SI in BED (OR 7.1, 95% CI 2.3-21.7), BN (OR 7.3, 95% CI 1.9-27.0), and RBE (OR 4.0, 95% CI 2.1-7.7). However, when adjusted for depressive symptoms, the observed differences were no longer statistically significant.ConclusionA high prevalence of SI was found in individuals with BESC. Furthermore, this maybe an indirect effect of comorbid depressive symptoms.