Australasian Psychiatry最新文献

ObjectiveTo assess the compliance of Victorian designated mental health services (DMHS) with mental health and wellbeing principles under section 30 of the Mental Health and Wellbeing Act 2022 (Vic).MethodAn audit of 19 Victorian DMHS' annual reports to assess compliance with a duty to report actions on one or more mental health and wellbeing principles (principles) within the last year.Results16 of 19 (84.2%) of designated mental health services breached their duty to report on how they complied with one or more principles within the last year. The three compliant services provided varied responses to this duty.ConclusionsThe vast majority of Victorian DMHS have failed to comply with a minimum reporting requirement under the MHWA. This data suggests that imprecise legislative drafting, an inadequate commissioning and regulatory framework as well as under-enforcement by the Mental Health and Wellbeing Commission may have contributed to non-compliance. Further research may examine how regulatory oversight agencies can ensure greater compliance with human rights and the MHWA.

BackgroundGiven the robust association of cognitive deficits (CD) with community functioning in people with schizophrenia and the inconsistent findings from the limited research on CD among people with treatment-resistant schizophrenia (TRS), we evaluated the neurocognitive functions of patients with TRS.MethodsWe retrospectively collated data on cognition and selected demographic and clinical variables of 181 patients with TRS and 59 with treatment-responsive schizophrenia (non-TRS) admitted to a psychiatric rehabilitation facility from 2010 to 2019. The Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate cognitive function. Multivariate analysis was utilised to compare the BACS scores of the two groups.ResultsTRS patients had more severe CD than non-TRS patients, with the BACS composite score (p = .003), verbal memory and learning (p = .003), working memory (p = .043), and psychomotor speed (p = .004) significantly worse in the TRS group. There was no significant difference in the BACS scores between the 60% of the TRS patients who were treated with clozapine and the TRS patients (40%) treated with other antipsychotics.ConclusionCD are more severe among patients with TRS than in non-TRS cohorts. The pathophysiology of CD among people with TRS and efficacy of interventions to ameliorate CD among this cohort warrant greater scrutiny.

ObjectiveMajor depressive disorder (MDD) is a highly prevalent debilitating mental health disorder with a lifetime risk of 11-15% in Australia. The most effective treatment for severe depression is electroconvulsive therapy (ECT), but it is associated with high relapse rates. This review aimed to investigate non-ECT interventions for preventing relapse of MDD after an effective acute course of ECT.MethodThe search covered electronic databases, specifically PubMed, PsycINFO and Embase, and clinical trials registered with clinicaltrials.gov and Cochrane Register of controlled trials up to 1 June 2022. Medical Subject Headings and key words used in the search were 'electroconvulsive therapy', 'depressive disorder', 'continuation', 'maintenance', 'prevention', 'prophylaxis', 'relapse' and 'recurrence'.ResultsA total of fifteen articles were included in the review. Interventions investigated by the studies were lithium, lithium + nortriptyline, escitalopram, imipramine, phenelzine, amitriptyline, venlafaxine and cognitive behavioural therapy (CBT).ConclusionsLithium was investigated the most, demonstrating good outcomes either as monotherapy or combination therapy with nortriptyline or venlafaxine. Imipramine, phenelzine, amitriptyline and CBT demonstrated encouraging results, while escitalopram failed to show a favourable outcome. Clinicians aiming to reduce the risk of relapse after an effective acute course of ECT could consider lithium, nortriptyline, venlafaxine and CBT.

ObjectiveCommunity-Initiated Care (CIC) leverages existing community roles to support mental health, such as teachers supporting youth within their natural environments (e.g., schools). One such model, "Education as mental health therapy" (Ed-MH), first emerged when 19 teachers in a 2018 pilot study in Darjeeling, India were given a choice within protocol to deliver care via traditional 1-on-1 sessions, micro-doses fitted into teacher workflows, or some combination; of the 536 techniques teachers chose in 2018, 80% fit into their teaching workflow, supporting the potential emergence of Ed-MH as a novel CIC modality only teachers could deliver.MethodsUsing post-hoc qualitative content analysis, we explored in a 2019 pilot study in Darjeeling whether new teachers' choices (n = 9) across their care for children (n = 17) similarly supported Ed-MH's potential emergence.ResultsOf the 154 techniques used, 82% fit into their teaching duties, consistent with 2018 findings.ConclusionWith 2019 findings supporting Ed-MH as a novel modality uniquely deliverable by teachers, illustrating a practical CIC approach, this model addresses social/environmental factors impacting child well-being, potentially offering an alternative to traditional treatment paradigms.

IntroductionCaring contact SMS text messages were designed as a brief suicide prevention intervention to support service users (tangata whaiora) after suicidal behaviour. The aim of this exploratory research was to evaluate responses to receiving a series of caring contact messages via SMS, culturally tailored to a New Zealand context.MethodParticipants presenting to an Emergency Department after suicidal behaviour were sent a series of seven SMS text messages. In this qualitative study, participants were interviewed by phone to evaluate their experiences of receiving SMS. Individual interviews were audio-recorded and transcribed. Reflexive thematic analysis was performed in three cycles of coding.ResultsThree themes were identified: connection to the caring essence of text messages, strengthening of self-agency by the message series, and cultural dimensions that support healing, including use of te reo Māori (Māori language).ConclusionSMS is acceptable as a means to reach and connect with people after an episode of suicidal behaviour. Tailoring messages to an individual's culture and context can potentially enhance their therapeutic value. Further research is recommended to evaluate upscaling through automated delivery, the use of apps, and use of language via SMS.

BackgroundAntibiomania, whereby an antibiotic induces a manic/hypomanic episode in those with or without a pre-existing bipolar condition, is a little-known phenomenon, diagnostically elusive, may be more prevalent than recognised and thus warrants the current overview.MethodRepresentative studies and clinical observations are noted.ResultsSeveral mechanistic issues are considered but with a weighting to the antibiotic causing gut dysbiosis and so activating gut-brain axis pathways that may induce manic/hypomanic episodes.ConclusionFuture studies should seek to determine the prevalence of antibiomania and whether differing antibiotics effect differential risks, while clinicians identifying such a potential linkage in a patient who has developed a first episode or recurrence of a manic/hypomanic episode should consider nuanced pre-emptive and management strategies in such instances.

ObjectiveThe objective is to reflect on my own lived experience to affirm the importance of hope in fuelling personal growth after an experience of mental illness. My personal testimony describes mental illness ultimately as a blessing as it precludes a humbling and exquisite transformation and healing process. Secondly, to provide a narrative review of the ways hope may spread through mental health systems, identifying peer support as a current example. Finally, to illustrate the importance of people with lived experience leading research in mental health as it may guide the field to areas of greatest impact.ConclusionsA narrative of lived experience testimony of mental illness and subsequent transformation can inspire hope and sustained growth in individuals and communities. One of the most important drivers of profound healing comes in the form of hope. Currently, peer support workers employed in mental health systems embrace companionship with the people accessing services while simultaneously growing to sounder mental health together through hopeful, healing relationships. Lived experience leadership in research also continues to grow and drives specific and unique insights into grant, protocol, and policy development.