Australasian Psychiatry最新文献

Defining rurality matters in healthcare. Evidence supports the singularity of the rural experience and its detrimental impact on health outcomes and, specifically, on mental health. Yet, no internationally accepted definition of 'rural' exists. In Aotearoa New Zealand, the Geographical Classification for Health (GCH) has set out to describe rurality in terms of health outcomes from a primary health lens, using distance and population density to better understand and address health inequities between geographical areas. Adopted in the latest national health strategy, the GCH has limitations specifically in the context of considering new approaches to overcoming the historical shortage of a psychiatry workforce in areas beyond large metropolitan centres. As Aotearoa New Zealand implements the RANZCP's Rural Psychiatry Roadmap, contextual sensitivity will be key, with lessons learnt from Australian experiences critical in ensuring effective and efficient changes are made to improve workforce distribution through training systems. Careful consideration of the GCH when implementing the Roadmap, underpinned by a nuanced definition of rurality, will help the RANZCP fulfil its social contract with all communities across Aotearoa New Zealand and Australia, including those that face geographical challenges.

ObjectiveTo identify longitudinal changes in the number and demographics of amphetamine type stimulant (ATS)-related admissions to a rural hospital, in comparison with findings from 2008-2013 and national trends.MethodA retrospective quantitative epidemiological study of patients admitted to Albany Health Campus from 2018 to 2023 with an International Classification of Diseases-10 (ICD-10) code related to ATS. Age, gender, Indigenous status, and ATS-related ICD-10 code were compared over time, including repeat admissions. Substance used, ward, and comorbidities were observed.ResultsOne hundred and seventy-nine admissions with an ATS-related primary diagnosis were identified, and a further 549 admissions with an ATS-related additional diagnosis. The mean age was 34.1, 55.9% were female, and 46.9% were Aboriginal. Repeat admissions accounted for 53.6% of total events. The most common ATS-related diagnosis code was F15.1 (harmful use) followed by F15.5 (psychotic disorder). Most admissions involved methamphetamine use and were to the mental health unit. Fifty-three percent had at least one comorbidity.ConclusionBoth overall and repeat ATS-related admissions to Albany Health Campus have increased since the last decade. There is a growing proportion of female and older patients, and Aboriginal people are overrepresented. Many patients have comorbidities further complicating their hospitalisations.

ObjectiveThe COVID-19 pandemic accelerated telepsychiatry use in New Zealand. This study aimed to survey New Zealand psychiatrists and trainees' perception of their telepsychiatry competencies; the importance of these competencies when providing a culturally responsive telepsychiatry service; and to ascertain if the competency items converged to dimensions developed from a previous qualitative study.MethodsNew Zealand psychiatrists and trainees completed an anonymised online questionnaire comprising 20 competency statements. Participants rated each statement on a scale from 0 (low level competence/importance) to 100 (high level competence/importance): (1) How competent do you believe you are? (2) How important is this competency when providing a culturally responsive telepsychiatry service? A principal components factor analysis with Varimax Rotation was conducted on the importance ratings.ResultsEighty-six participants (47.7% female) participated. The factor analysis revealed four new domains: Cultural Safety, Infrastructure and Technology, Professional Development and Ethics, and Clinical Practice. These new domains explained 64.9% of the total variance. Their internal consistencies were acceptable (alpha≥0.70) except for self-rated competence in the Clinical Practice domain (alpha = 0.68).ConclusionThis competency framework could be used to develop educational curricula and training resources to improve culturally responsive telepsychiatry practice in Aotearoa.

ObjectiveThe northern suburbs of Adelaide, South Australia, are characterised by marked socio-economic disadvantage. Through private practice agreements, psychiatrists employed by this region's public health service accept referrals from General Practitioners (GPs) to undertake Medicare-Benefits-Scheme Item 291 Psychiatric Assessments (MBS-291s). This study reports the clinical characteristics of people in this region who received an assessment under this initiative.MethodData was collected from 169 consumers aged 18-65 years, who attended MBS-291s with one psychiatrist between 2017 and 2021. Data included demographics, diagnoses, comorbidities, management challenges, engagement with other services, and the psychiatrist's recommendations.ResultsOf 169 consumers, 32% were aged 18-25. Mood (37%) and trauma-related (36%) disorders predominated. Psychiatric comorbidity was common (37% had ≥2 diagnoses). Adverse experiences were reported by 92%, including psychological abuse (60%) and suicidality (51%). Medication recommendations were provided in 99% of cases, alongside psychotherapy (75%), referrals to other services (88%), and lifestyle recommendations (70%).ConclusionsThis study highlights the complex clinical and psychosocial characteristics of those referred for MBS-291s in the northern suburbs of Adelaide, South Australia. We discuss the range of specialist recommendations and comment on the value and sustainability of providing these assessments in the Australian healthcare context.

ObjectivesTo review the available evidence, key deliberations, and potential influences behind the Pharmaceutical Benefits Advisory Committee's (PBAC's) conditional recommendation for esketamine to be listed on the Pharmaceutical Benefits Scheme (PBS).ConclusionsThis paper forms part 2 of the esketamine story in Australia-its handling by the Therapeutic Goods Administration (TGA) and, subsequently, the PBAC. Currently available high-quality evidence does not support esketamine as an effective treatment for depression beyond 1-2 weeks. The available data suggests potential for serious acute harms, including suicide. There is insufficient data regarding long-term harms, but data from animal and recreational settings is extremely concerning. Financial costs are estimated to be substantial. Despite these issues, in December 2024, the PBAC made a conditional recommendation for esketamine to be listed on the PBS. This paper explores the evidence, key deliberations and potential influences behind the PBAC's decision on esketamine and revisits related issues concerning the TGA.

ObjectiveThis article provides psychiatry registrars with a structured approach to selecting an appropriate patient for the Royal Australian and New Zealand College of Psychiatrists Psychotherapy Written Case summative assessment.ConclusionsThoughtful patient selection is crucial to achieving both a positive clinical outcome and a meaningful therapeutic experience for both patient and registrar. This article presents a structured framework based on Maslow's Hierarchy of Needs to guide patient selection, enhancing the likelihood of a successful psychotherapeutic process.

ObjectiveWhile physical symptoms are not uncommonly reported by those experiencing burnout, the syndrome is essentially defined by a set of psychological symptoms. We therefore undertook a study to quantify physical symptoms associated with a burnout syndrome.MethodA sample of self-diagnosed individuals with burnout were requested to complete data on representative physical symptoms (i.e. headaches, cardiovascular symptoms and falls), illness course variables (i.e. increased rate of infections, being ill more often and taking longer to recover from sickness) as well as being hospitalised as a consequence.ResultsIn a refined sample of 317 respondents assigned to a 'burning out' stage and 509 to a 'burnt out phase', only headaches had a higher prevalence in the first group. Prevalence rates of all symptoms and of compromised health were high while 10% of the combined group reported that their condition had led to them being hospitalised.ConclusionsCompromised physical functioning would appear to be common in those experiencing a burnout syndrome, and awareness of such a consequence should assist clinical diagnosis of such a condition and might warrant physical symptoms being listed in diagnostic criteria sets as secondary features.

BackgroundAripiprazole is a partial dopamine agonist antipsychotic used for schizophrenia and bipolar disorder. Where most antipsychotics increase prolactin, aripiprazole, due to its novel action, lowers prolactin levels. This novel action can also suppress lactation.AimThe aim of this study was to understand the rates of breastfeeding (exclusive or supplemented) while on aripiprazole.MethodsUsing a retrospective, chart review, electronic prescribing reports were used to identify when aripiprazole was prescribed in maternity units in six hospital sites in Queensland, Australia. Electronic charts were then used to identify cases of breastfeeding whilst on aripiprazole. Rates of breastfeeding were compared to a general population.FindingsThirty-four cases of breastfeeding whilst on aripiprazole were identified. Twenty-three (73.5%) ceased breastfeeding by the last midwife appointment. Eight (23.5%) were supplementing breastfeeding with artificial feeds. Only one mother was able to exclusively breastfeed. The effect may be dose related.ConclusionThis study further supports the current case reports in the literature and suggests that women taking aripiprazole appear to have very low rates of exclusive breastfeeding. This effect appears to be dose related.

ObjectiveThis perspective critically examines the impact of capitalism on Australian mental healthcare employing Bronfenbrenner's ecological theory. By analysing systemic challenges across macro-, meso-, and micro-levels, the paper reveals how marketisation prioritises profit over patient welfare. The perspective also highlights solution-based attempts of the Royal Australian and New Zealand College of Psychiatry to address the current crisis.ConclusionThe paper concludes by proposing strategies to restore justice, equity, and continuity in mental healthcare through reinvestment in public services, strengthened governance, workforce support, and a rights-based, socially integrated model of care.