Australasian Psychiatry最新文献

ObjectivesThere is limited research on entry to aged residential care (ARC) in people living with young-onset dementia (YOD). Most people with YOD eventually require ARC, often in facilities designed for older adults. This study aimed to investigate the time to ARC admission in a previously identified YOD cohort and their health outcomes before and after ARC admission.Methods60 YOD participants (diagnosed in Waikato, New Zealand between 2014 and 2016) were retrospectively followed over a median of 5.4 years, using routinely collected health data (interRAI and mortality data). Survival analysis assessed the ARC admissions time, considering age, gender, ethnicity, and dementia type. McNemar's/McNemar-Bowker tests were conducted to compare health outcomes before and after ARC admission.Results32 participants required ARC, with a median admission time of 4.5 years post-diagnosis. No significant effects were detected for age at diagnosis, gender, ethnicity (Māori vs non-Māori), or dementia type (Alzheimer's vs non-Alzheimer's disease) on ARC admission time. Significant health improvements were observed post-admission regarding health stability (CHESS), smoking, physical activity, and hospitalisations.ConclusionsWell-being improvements after ARC admission are encouraging and align with the New Zealand Aged Care Association (NZACA) report. However, the small sample size warrants further research to confirm these findings.

Since its founding in 1946, the Royal Australian and New Zealand College of Psychiatrists has grown from a volunteer association representing the interests of a small group of doctors focused on clinical concerns, to a large corporation representing thousands of psychiatrists with hundreds of staff operating in a complex regulatory environment. Growing dissatisfaction of college members can be attributed to prioritisation of the risk-averse corporate ethics of large organisations over the patient-focused clinical ethics of small professional groups. This is illustrated by an example of the risk-aversion demonstrated by bloviation in response to member questions to avoid accountability for college decisions.

Purpose of researchDescribe prescribing patterns in Australian Vietnam veterans, identify CYP2C19-metabolised medications using established pharmacogenetic (PGx) resources, characterise CYP2C19 profiles of veterans and assess the potential clinical impact of these medications.Major findingsAmong 283 veterans with CYP2C19 profiles, 256 reported current medications use, with a mean prescribed medication of 5.4. Of these, 89 veterans (34.7%) were prescribed at least one medication with CYP2C19 PGx recommendation. Notably, 52 veterans (58.4%) had CYP2C19 profiles that may be at risk of therapeutic failure or adverse effects. Prescribed medications also included six CYP2C19 inhibitors and one inducer, with potential to induce phenoconversion and impact drug metabolism.ConclusionVeterans experienced high levels of polypharmacy and frequently carried CYP2C19 phenotypes associated with increased risk of therapeutic failure or adverse effects. The presence of CYP2C19 inhibitors and inducers raises the potential for phenoconversion, where CYP2C19 profiles may be placed at risk. Given their similarities to the broader older population, these findings suggest that both groups may benefit from pre-emptive PGx testing. Furthermore, ongoing monitoring of drug-gene and drug-drug interactions remains essential to optimise medication safety and efficacy in these high-risk individuals.

ObjectiveClozapine is effective, but is associated with cardiometabolic disease burden. The cardiometabolic health of Indigenous Australians taking clozapine is unclear. This study aimed to determine the cardiometabolic health state and management of Indigenous and non-Indigenous clozapine patients over 1 year.MethodsA retrospective cross-sectional observational study using clinical data from a regional clozapine clinic. We calculated QRisk3 cardiovascular disease (CVD) risk scores and the prevalence of diabetes, hypertension and metabolic syndrome (MES). Cardiometabolic monitoring and management were also analysed. Findings were compared between Indigenous and non-Indigenous patients.ResultsOverall, 76 patients were included (35.5% Indigenous). Ninety-seven percent had complete metabolic monitoring data for MES. Prevalences of diabetes (22.3%), hypertension (42.1%), and MES (68.4%) were high. Indigenous patients had significantly higher levels of diabetes, CVD risk and reduced high-density lipoprotein (HDL). The majority (84.2%) of patients received lifestyle advice. Follow-up with allied health services and communication with general practicioners (GPs) was limited. Indigenous patients were significantly more likely to receive pharmacological treatments.ConclusionsA high cardiometabolic disease burden was observed, which was significantly greater in Indigenous patients. All received excellent cardiometabolic monitoring, but lifestyle interventions were underutilised. Clear treatment guidelines and better integration of monitoring and management are required.

ObjectiveTo describe the need for specialised women's mental health services and the development of Australia's first women's mental health hospital service in the 21st century.ConclusionWomen in Australia experience a high level of violence and trauma. Compounding their past experiences with sexual violence, Australian and United States data indicate that a significant percentage of inpatients experience sexual violence during a psychiatric admission. Despite many reviews of mental health service provision, co-gendered wards, with noted incidents of assault against women inpatients, continue to be the usual mode of service in both the public and private healthcare sectors in Australia. Inpatient and community therapeutic programmes have not met the special needs of women. The establishment of Australia's first women-only mental health hospital at Cabrini Health in 2021 demonstrates the feasibility and value of a specialised, trauma-focused and holistic model of care. These developments highlight the urgent need for broader service reform to ensure safe inpatient facilities and gender-focused therapeutic programs for women.

IntroductionConsultation liaison psychiatry (CLP) is a subspeciality of psychiatry that integrates mental health care into non-psychiatric departments of a general hospital. The Mackay Hospital and Health Service (MHHS) commenced CLP services in 2016, with referrals increasing annually. However, literature describing and evaluating regional CLP services remains scarce.AimThis study aimed to evaluate referrer satisfaction with the MHHS CLP service through a staff satisfaction survey, and to inform service improvement and development planning.MethodsA 14-question survey, based on the Service Model for CLP in Victoria, was distributed to relevant hospital departments from May to September 2022. The survey assessed users' backgrounds, reasons for referrals, service awareness, efficiency, satisfaction, and included open feedback.ResultsDiagnostic clarification, medication review, and risk assessment were the primary reasons for referral. The service's consultationliaison aspects and response times were highly rated. Positive feedback centred on access and communication while suggested improvement highlighted outpatient care and education opportunities.ConclusionThere is a strong perceived need and high satisfaction with the local CLP service, which provides quality and efficient care. Implementing suggested improvements will require input and resources from key stakeholders.

ObjectivesTo examine identified needs of 'very old' people accessing Australian and New Zealand specialist mental health services and consider service delivery implications.MethodExamination of Australian and New Zealand routine outcome measure data from admissions to specialist mental health services. Comparison of data for over 16,500 admissions of people aged 85 years or over with people aged 65-84 years.ResultsThose aged over 85 have higher total HoNOS65+ scores, driven by raised impairment and social problem subscales, without reduction in symptom subscales. Increased problems were identified in aggression/agitation, cognitive impairment, physical health and activities of daily living items but reduced prevalence of substance related problems. Whilst magnitudes vary, trends are consistent across countries, and across ambulatory and inpatient settings. On admission to Australian inpatient settings, very old age is associated with >30% of people requiring nursing assistance (measured by RUG-ADL), although <10% required two-person assistance on any domain.ConclusionsVery old age at admission to mental healthcare is associated with increasing complexity and nursing support needs, without reduced psychiatric symptoms. This requires consideration in models of care and staff capabilities. The very old with greatest aged-related support needs may be excluded from specialist inpatient care.