Australasian Psychiatry最新文献

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.

ObjectiveVoluntary assisted dying (VAD) in Australia and New Zealand is reserved for terminally ill individuals experiencing unbearable suffering. This study investigated the knowledge and views of Australian and New Zealand psychiatrists and trainees on VAD, including for mental illnesses, and whether these knowledge and views differ between psychiatrists and trainees.MethodsParticipants completed an online survey consisting of 18 questions between March and June 2024. The survey was distributed via various Royal Australian and New Zealand College of Psychiatrists newsletters and through snowballing.ResultsOne hundred and sixty-four psychiatrists and sixty-five trainees were included. Psychiatrists tended to be more confident in their knowledge of VAD, less willing to be involved with VAD and more conservative in their views of VAD than trainees: 26.8% of psychiatrists and 10.8% of trainees strongly agreed that the criteria for VAD will progressively broaden (p < .047).ConclusionDifferences in experience may explain some of these distinctions; however, other factors are likely to have been influential in explaining these differences. Given the increasingly liberalised and autonomous social landscape, Australian and New Zealand psychiatry should prepare themselves for the ethical question of VAD for mental illnesses that will inevitably arise.

ObjectiveThis study examined stimulant and medicinal cannabis prescribing in individuals before and after referral to an early psychosis (EP) service in Queensland, Australia.MethodsA retrospective review of 220 consecutive EP referrals (2019-2023) was conducted, extracting data on stimulant and medicinal cannabis prescriptions from clinical records. Longitudinal prescribing patterns were analysed, with descriptive comparisons of Δ9-tetrahydrocannabinol (THC) concentrations in medicinal cannabis prescriptions before and after the onset of psychosis.ResultsPrior to referral, 4.5% of patients were prescribed stimulants and 3.2% medicinal cannabis, with most having a history of substance use. After a psychotic episode, 3.2 % were prescribed stimulants and 6.8% were prescribed medicinal cannabis, with mean THC concentrations higher after the onset of a psychotic illness (31.4% vs 16.9%). Over 70% of those prescribed stimulants and 60% prescribed medicinal cannabis after experiencing a psychotic episode had further contact with mental health services due to concerns about a deterioration in mental state where these medications were thought to be a contributory factor.ConclusionsIt is of concern that THC concentrations were higher in prescriptions made post-EP discharge. Enhanced safeguards are required to mitigate risks and reliably identify patients where such prescription would be contraindicated.

ObjectiveTo examine psychiatry's cardinal diagnoses as historical concepts that reflect the time and place of their origins not their factual status. Schizophrenia is the exemplar.ProcessKraepelin on dementia praecox and Bleuler and Schneider on schizophrenias are examined, including Kraepelin's late unsuccessful attempt to recant his earlier argument.ConclusionDiagnoses start as speculative aggregations of phenomena peculiar to their time and place. They have been reified as timeless, universal disease processes. Kraepelin made a late radical recanting of his concept yet schizophrenia became the symbol of 20^th century psychiatry. Diagnoses like schizophrenia are historical artefacts that deserve their place in psychiatry's history but do not define present problems. They should have been honoured and superseded.

ObjectivesThis study examined the prevalence of major depressive disorder (MDD) and associated factors among children and adolescents aged 10-16 years attending a Pediatric Psychology and Psychiatry Department in Vietnam.MethodsA cross-sectional study was conducted from February to June 2025. Patients aged 10-16 years were recruited and assessed via structured interviews with caregivers for sociodemographic information, childhood trauma, and parent-child relationship. Depression was diagnosed using DSM-5-TR criteria.ResultsAmong 199 eligible participants, 26.6% were diagnosed with MDD. In the multivariable model, female gender (AOR = 10.3, 95% CI: 2.8-38.0, p < .001), emotional neglect (AOR = 9.9, 95% CI: 3.4-28.7, p < .001), physical neglect (AOR = 6.1, 95% CI: 2.2-17.0, p < .001), physical abuse (AOR = 4.4, 95% CI: 1.3-15.5, p = .020), and sexual abuse (AOR = 7.3, 95% CI: 1.3-15.5, p = .004) were independently associated with MDD. Household economic status and parent-child relationship were not significant after adjustment.ConclusionOver one-quarter of children and adolescents seeking psychiatric care met diagnostic criteria for MDD, with risk shaped by family environment and adverse childhood experiences. These findings highlight the need for screening of at-risk subgroups and targeted interventions addressing family functioning and trauma history.

ObjectivesThere is evidence that people with severe mental illness (SMI) are more likely to be diagnosed at a later stage and die earlier from colorectal cancer (CRC). The purpose of this study is to understand the barriers to effective CRC diagnosis and treatment for this group.MethodsFive people (four people diagnosed with CRC and SMI and one carer for a person in this group) participated in interviews about their experience of CRC diagnosis and treatment. Interviews were analysed using NVivo to identify key themes.ResultsWe identified four key themes: diagnostic overshadowing, fear, practical access and interpersonal partnerships.ConclusionsParticipants in this study were less likely to have their healthcare needs met because of discrimination and unmet needs associated with their diagnosis of SMI. This is not a new finding - many other mental and physical health researchers have identified this problem. But this study enables people who have lived through the challenge of this experience to share their perspective. Consequently, we recommend that future research focus on practical strategies to minimise discrimination among health professionals and policymakers and identify solutions to address the disproportionate barriers people diagnosed with SMI encounter regarding CRC testing.

IntroductionMethamphetamine dependence is associated with psychological distress (stress, anxiety, and depression). Insomnia is common in this population, yet its association with distress remains underexplored. This study examined the relationship between insomnia severity and psychological distress in treatment-seeking individuals with methamphetamine dependence.MethodsThis is a secondary cross-sectional analysis of baseline data from 152 participants enrolled in a randomised controlled trial of lisdexamfetamine versus placebo for methamphetamine dependence. Insomnia severity was assessed using the Insomnia Severity Index (ISI), and distress was measured via the Depression Anxiety and Stress Scale (DASS-21). Associations were analysed using Spearman's correlations and regression models adjusted for demographics, methamphetamine use, concomitant medication, and co-occurring distress.ResultsInsomnia severity showed moderate correlations with depression, anxiety, stress, and total distress (ρ = 0.46-0.59, p < .001). In adjusted models, insomnia remained associated with distress: each 1-point ISI increase related to a 2.1-2.5% rise in DASS-21 depression and stress scores (β = 0.021-0.025, p = .003-.007), and a 6.5% increase in total scores (β = 0.063, p < .001); the association with anxiety was attenuated.ConclusionsOur study identified insomnia as an independent correlate of psychological distress in treatment-seeking individuals with methamphetamine dependence. Findings underscore sleep problems' relevance and support further research into sleep-focused interventions.

Brief User-Controlled Admission (BUCA) refers to a set of crisis interventions in which the traditional gatekeeping role of the physician is bypassed, allowing service users to independently decide when to access short-term inpatient care through a pre-negotiated agreement. Examples include Brief Admission by self-referral, Patient-Initiated Brief Admission, Patient-Controlled Admission, and Self-Referral to Inpatient Treatment. The structured agreement promotes predictability and collaboration, enabling the user to assume control over their care. BUCA has been studied in adults and adolescents with severe mental distress at risk for escalation of symptoms, self-harm or suicide. Users report high satisfaction, describing the agreement as a source of psychological safety, dignity, and proactive crisis management. Staff experience strengthened therapeutic alliances and role shifts from gatekeeping to collaboration. Families experience relief, though they may need information and support adapting to the user-led structure. BUCA has been associated with increased functioning in daily life, and lower healthcare costs, particularly among users with high service utilization. While earlier studies have suggested potential reductions in inpatient care, studies including controls have not proven significant effects. Representing a shift towards user-led care, BUCA offers a scalable and potentially cost-effective model aligned with current mental health reform priorities.

ObjectiveThis study aimed to analyse the differences in Emergency Departments (EDs) length of stay (LOS) for mental health (MH) presentations between older patients (aged 65 and above) and younger adults, identifying factors contributing to longer stays.MethodsA retrospective data analysis of MH patients presenting to MHEDs in three Brisbane hospitals between May 2018 and May 2019 was conducted. We dichotomised LOS around the 75th quartile (20 h), given the skewness of the data. Patients remaining in MHED for longer than 20 h were considered as a prolonged length of stay (PLOS).ResultsOlder patients constituted 4.5% (n = 423) of the 9452 MH presentations. They were significantly more likely to experience PLOS (p < .0001). Awaiting admission had an 11-fold increased risk of PLOS (Adjusted OR 9.69-12.48, 95% CI). Additionally, alcohol and drug-related cases were prone to PLOS (p < .0001), though these factors did not explain the extended stays in the elderly.ConclusionOlder MH patients had a significantly longer LOS in MHED compared to younger adults. Neither waiting for admission nor substance-related issues fully accounted for this discrepancy. Further research is needed to explore other potential contributing factors to PLOS, for example, medical comorbidities, psychosocial issues, and systemic-related delays in elderly MH care.

This article explores the perspectives and experiences of trainee, trainee-adjacent and early career psychiatrists who are attempting a clinical academic career. Collective views are grouped under five themes - Fostering Agency, Barriers and Setbacks, Mentors and Self Care, Saying Yes to Serendipity, and Stability and Time. Recommendations for those at an individual, clinical service, and College level are considered.