Australasian Psychiatry最新文献

Objective: Since the release of ChatGPT, popular demand has driven the use of social chatbots as pseudo-AI psychotherapists. With time, it is inevitable that these technologies will be deployed in some form as dedicated psychotherapy interventions. Here, we attempt to forecast the implications for psychotherapy including the unique benefits to distributive justice as well as concerns for the quality of the therapy and its societal impact.

Conclusion: An AI psychotherapist (APT) has the potential to provide engaging clinical interactions given its capacity for highly realistic interaction as well as its high level cognitive and emotional capabilities. Moreover, it can potentially address financial and workforce limitations on access to therapy. However, an APT may cause significant iatrogenic harm if released without adequate quality control and oversight by trained psychotherapists. If not appropriately designed and regulated, APTs have potential to mislead and reinforce maladaptive coping behaviours. Given societal drivers and possible benefits, these technologies will inevitably be deployed; thus, it is incumbent upon us as a professional body to consider their regulation.

Objective: To study outcomes for patients after they are discharged from Community treatment orders (CTO) including rate of relapse, median time to relapse and to identify the risk factors associated with relapse.

Method: The study population included patients discharged from CTO from July 2017 to December 2021, managed by a major metropolitan* case management team (CMT). The data were collected from electronic medical records (EMR). Descriptive analysis was conducted to study the sample characteristics. Logistic regression using univariate and multivariate analysis was performed to examine the associations between factors related to relapse.

Results: A total of 128 patients were studied. The relapse rate was 27.4% with median time to relapse of 72 days. Poor insight, poor treatment compliance, duration of CTO and number of CMT contacts were significantly associated with relapse while substance use, psychiatric comorbidities and psychosocial factors were not.

Conclusions: The findings suggest that people who relapsed had poor insight and poor medication adherence, had CTO for a longer period and had frequent contact from CMT even after discharge from CTO.

Objective: To introduce the World Federation for Mental Health (WFMH) viewpoint on the Pacific Island countries' mental health capacity building.

Conclusion: Multi-agency collaboration guided by a nuanced understanding of the local context can enable a public health model of mental health service delivery in the Pacific Island countries.

Objective: Many Aboriginal and Torres Strait Islander Australians are dismayed by the rejection of the 2023 Voice Referendum and its amplification of social divisions. This article considers a recent article in Australasian Psychiatry in which matters of motivation, process and outcome are raised that provides the scaffolding to explore these issues.

Conclusions: The breakdown of bipartisan political support and subsequent politicisation of the Referendum process resulted in claims regarding the reasons for and consequences of the Referendum that were not consistent with the process leading to the Uluru Statement. The outcome has been socially divisive and a cause of significant distress for many Aboriginal and Torres Strait Islander Australians, the majority of whom voted in support of the Voice.

Objectives: This 'Realist Review' aimed to investigate the factors associated with length of stay and outcomes of medium secure care to help inform the development of a local secure care pathway.

Method: The searches generated a total of 1570 entries across multiple search engines. Following removal of duplicates, application of inclusion/exclusion criteria and selection of articles, a total of 18 were reviewed in detail, including a further five articles obtained from references and the explored grey literature.

Results: Several issues influenced not only admission to medium secure units, but also the outcomes. Many articles were retrospective studies relying on administrative data. The realist synthesis provides contextual data to inform program development.

Conclusions: The existing literature, though variable in quality, was limited by the varied jurisdictions and contexts. However it may be useful to inform care pathways for the optimal use of medium secure beds.

Objectives: To understand the key descriptors of the Top End Mental Health Service, Northern Territory's, perinatal mental health consultation service (PMHCS).

Method: A retrospective cross-sectional review of all referrals to the PMHCS in the 12 months period 1 January to 31 December 2021 inclusive was undertaken. The study was descriptive in nature.

Results: From January 2021 to December 2021, there were 266 women referred to the service. There was a large proportion of Aboriginal and Torres Strait Islanders. Mean age was 28.8 (SD = 6.04) years. A statistically significant difference was identified between the average age of the Aboriginal and Torres Strait Islander women (n = 53, M = 24.6 years, SD = 6.31) which was significantly less than Caucasian women (n = 161, M = 29.4037, SD = 4.982) and women of other cultural backgrounds (n = 52, M = 31.154, SD = 6.792), p < .00,001. Sixty two percent of patients managed had a history of trauma with significantly more service contact.

Conclusion: This data gives insight into a unique population group. It also highlights the impact that trauma has on patient care and management.

Objective: Promoting holistic health and wellbeing is a shared conversation, or talanoa, requiring collaboration between individuals, their families and wider communities. This paper will explore various community-based initiatives privileging Pacific epistemologies and ontologies that promote and provide accessible resources improving mental health literacies.

Method: Three specific initiatives are discussed in this paper; Mental Health Talanoa (MHT), Open Worksheet and Wellbeing Talanoa. These provide a platform to understand practical ways to support Pacific peoples in various contexts.

Results: The MHT project offers a nuanced understanding of symptomatology related to common mental disorders amongst Pacific peoples, a nuanced understanding of the barriers and enablers to health literacies and help seeking behaviour, and a series of infographics, including the Pacific Mental Health Lexicons (PIMHL). The Open Worksheet is a dynamic tool underpinned by a dialogical and relationally driven way to understanding individual and familial narratives. The Wellbeing Talanoa supports a communally orientated opportunity to enhance a sense of connection to self and others whilst therapeutically reviewing social and welfare needs and solutions.

Conclusion: Developing and implemented Pacific approaches that are grounded in Pacific values and practices can lead to enhanced help seeking behaviour, engagement, service retention and provision.