Australasian Psychiatry最新文献

Aims: To identify clinical and other factors associated with the use of electroconvulsive therapy (ECT) in New South Wales for the period 1944-1949 and to compare with contemporaneous practice.

Method: Annual reports of the Inspector-General of Mental Hospitals in NSW (1944/45 to 1948/49) were examined.

Main findings: Seven hospitals reported a total of 8964 courses of treatment during the period. Demographically, 60.6% of patients who received ECT were female, and rural hospitals reported 13.6% of courses. ECT was as likely to be given for non-affective psychoses (37.7%), as for affective psychoses (35.0%). ECT was also administered for confusional states and non-psychotic disorders. Better outcomes were observed for depression, anxiety and confusional states than non-affective psychoses. Recovery rates declined over the study period. Mortality was <1%.

Conclusions: The clinical indications for ECT in the mid-twentieth century in NSW were much broader than currently. There has been no change in the sex ratio of patients administered ECT or reported mortality.

Objectives: To examine trends in access to mental healthcare by old and very old people since the commencement of Australia's Better Access Initiative in 2006.

Methods: Descriptive analysis of changes in access by people aged 75-84 and over 85 using data analysed and published by the AIHW.

Results: Since the introduction of Better Access, rates of access to specialist inpatient and community mental healthcare have reduced for those aged 75 years and older. The reduction is greatest for those aged 85 and over; with a 21% fall in community care access, 54% fall in inpatient access, and Medicare-funded psychologists and clinical psychologists access failing to rise above 1%. Rates of admissions by those 85 and older to inpatient care without specialised mental healthcare have increased by 92%, with emergency department presentations with mental health problems increasing by 33% since 2014-2015.

Conclusions: The oldest people in Australia have missed most benefits from mental healthcare reforms. The contribution of these changes to high rates of mental illness on entering residential aged care, persistent high suicide rates in older men, and increased use of emergency departments and general hospital beds demands further inquiry and action.

Objective: Psychological morbidity is common among patients with breast cancer. The present study aimed to find the relationship between modifiable determinants, that is, perceived social support (PSS) and mental adjustment to cancer (reflecting coping) with depression in patients with breast cancer.

Methods: A total of 76 adult patients with breast cancer undergoing treatment at a tertiary care hospital were recruited in this cross-sectional study. Patients were diagnosed for depression as per ICD-10 criteria. Hamilton Depression Rating Scale was used for assessing the severity of depression. PSS and coping style were assessed using the Multidimensional Scale for Perceived Social Support and Mini-Mental Adjustment to Cancer scale. We analyzed the data using Fisher exact test, Mann-Whitney U test, Spearman's correlation, logistic regression, and mediation analysis.

Results: 26.3% patients had depression. The logistic regression showed that PSS is a significant predictor of the occurrence of depression in patients with breast cancer (OR = 0.793, 95% CI: 0.634-0.992). The mediation analysis showed that hopelessness-helplessness (a maladaptive subscale) mediates the effects of PSS on depression.

Conclusion: The effect of PSS on the occurrence of depression is mediated through maladaptive coping (hopelessness-helplessness). Accessing these factors can provide an important avenue for psychological intervention in breast cancer patients.

Objective: Eating disorders were previously considered less common in rural/regional areas. However, emerging research suggests that eating disorders may be more prevalent in these populations than initially recognized. We aimed to describe demographic/clinical characteristics of metropolitan compared to rural/regional inpatients during psychiatric inpatient eating disorder treatment at the Eating Disorders Unit (EDU), Austin Health in Melbourne, Australia.

Methods: Retrospective review of patient files was undertaken for inpatients aged 18-65 years who resided within the Body Image & Eating Disorders Treatment & Recovery Service (BETRS) catchment area and were admitted to EDU between 01/01/21 and 30/10/23.

Results: Regional/rural patients were on average 2.7 years older and first diagnosed 3.5 years later compared to metropolitan inpatients. These groups showed otherwise similar characteristics in relation to psychiatric/medical history.

Conclusion: Available and accessible speciality eating disorders services in rural and regional areas are needed for early detection, prevention, and multidisciplinary management.

Objective: To stimulate discussion on how the RANZCP can contribute more constructively to the debate over Australia's immigration policies.

Conclusions: Updated in March 2024, RANZCP Position Statement 46, titled: 'The provision of mental health services for asylum seekers and refugees', continues the College's advocacy for a compassionate stance towards asylum seekers and refugees on the grounds of preventing or improving their mental health. College statements over the last decade have raised concerns about policies that are designed to deter boat arrivals; and recently, have endorsed the High Court's NZYQ decision to mandate community release of detained non-Australian citizens deemed to have failed 'the character test' under the Migration Act 1958 (Cth). The College appears to have avoided addressing public concern about how a high asylum seeker and refugee inflow may impact community cohesion and prosperity. RANZCP's reputation will be enhanced by ensuring more extensive explication of reasoning and rebuttal of counter arguments for the position it has taken on this complex political issue.

Objective: The first-hand expertise of people with lived experience has gained prominence in the provision of mental health services over the last 20 years. Unfortunately, due to ongoing stigma, there appears to be an ongoing belief that people with lived experience and mental health professionals are two separate entities. Research suggests otherwise, with a significant proportion of mental health professionals having their own experience of mental crisis or mental illness. Indeed, there are numerous prominent figures, littered through the history of psychiatry, all with lived experience of trauma or mental illness which shaped their contributions to the field. The history and prevalence of lived experience among our clinicians and the benefits brought by their expertise will be discussed in this article.

Conclusions: Research demonstrates that acknowledging clinicians' own lived experience has significant benefits in mental health care and outcomes. Perhaps a little more acceptance of our own 'wounded healers' is the first step to truly incorporating the wisdom of those with personal lived experience into our mental health services.

Objective: Women face considerable barriers in pursuing careers in academic psychiatry.

Methods: A group of Australian and New Zealand academic women psychiatrists convened in September 2022 to identify and propose solutions to increase opportunities for women in academic psychiatry.

Results: Limiting factors were identified in pathways to academia including financial support, engagement and coordination between academia and clinical services, and flexible working conditions. Gender biases and the risk of burnout were additional and fundamental barriers. Potential solutions include offering advanced training certificates to enable trainees to commence a PhD and Fellowship contemporaneously; improved financial support; expanding opportunities for research involvement; establishing mentoring opportunities and communities of practice; and strategies to enhance safety at work and redress gender bias and imbalance in academia.

Conclusions: Support for women in research careers will decrease gender disparity in academic psychiatry and may decrease problematic gender bias in research. Fellows and trainees, the RANZCP, universities, research institutes, governments, industry and health services should collaborate to develop and implement policies supporting changes in working conditions and training. Facilitating the entry and retention of women to careers in academic psychiatry requires mentoring and development of a community of practice to provide and enable support, role modelling, and inspiration.