Australasian Psychiatry最新文献

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.

ObjectiveMajor mental illness can be associated with violent or aggressive behaviour. Electroconvulsive therapy (ECT) plays a role in managing violence in clinical practice, but there is limited evidence in the literature demonstrating its efficacy. This systematic literature review therefore sought to highlight the available data on ECT and violence in patients with major mental illness.MethodA search of MEDLINE, Embase, and PsycInfo identified 10 relevant papers. The studies were predominantly retrospective and analysed small study populations of participants with psychotic disorders, as well as one study looking at affective disorders, who had received ECT.ResultsAll studies found a reduction in violence following ECT, although there was substantial variation in methodology and outcome measures. Of the five papers using clear quantitative measures, four noted a statistically significant improvement in violence and the fifth demonstrated a non-statistically significant improvement. The remaining papers respectively demonstrated an improvement in general psychopathology, an overall reduction in assaultive behaviour, and a reduction in the use of restraint.ConclusionAlthough it is difficult for this review to draw definitive conclusions due to the low quality and heterogeneity of studies included, ECT may play a role in reducing violence in patients with severe mental illness.

AimEvidence supporting an outpatient initiation model for clozapine is lacking and would add to prescriber, service and consumer confidence in the safety and benefits of this approach. Our study aims to determine whether outpatient initiation and titration of clozapine is feasible, safe and cost-effective in Australia.MethodsWe retrospectively identified 27 consumers aged 18-65 admitted to our service between 2007 and 2019 for day initiation and outpatient titration of clozapine. We collected demographic and clinical data from medical records including diagnosis, adverse drug reactions, hospitalisations and adherence. We compared costs over the initial fortnight of initiating clozapine through our outpatient model versus an inpatient admission for schizophrenia of equivalent duration using local standardised costing data.ResultsWe demonstrated that the cost differential between our model for clozapine initiation in the outpatient setting versus an inpatient admission was $24421.96 per patient over the first fortnight. Adherence, side effects and safety, including access to hospitalisation as needed, were comparable to prior studies.ConclusionsClozapine initiation in an outpatient setting is likely to produce significant cost savings whilst being feasible and safe. There were no appreciable effects on treatment adherence or adverse drug reactions. Limitations include a small sample size and retrospective methodology.

This article explores how psychiatry can meaningfully advance equity by focussing on equality of opportunity over equality of outcomes. It examines the risks of growing politicisation and inappropriate implementation of Diversity, Equity and Inclusion (DEI) initiatives, proposing that merit and fairness are best preserved by addressing systemic barriers without compromising standards. Using examples from Indigenous health leadership and gender equity, it highlights practical strategies such as balancing formal expertise with lived experience and supporting mentoring and flexible work arrangements. It concludes by outlining emerging initiatives that expand access and autonomy, demonstrating how opportunity-based approaches can deliver sustainable and noticeable improvements.

ObjectiveGlobal estimates indicate that the highest suicide rate (adjusted for age) has been observed in high-income countries. In Australia, Tasmania had the second highest suicide rate adjusted for age after the Northern Territory in 2023. Preventing suicide is a global imperative, with comprehensive sustainable strategies essential in suicide prevention. To support the successful implementation of a suicide prevention strategy, the quality and effectiveness of the interventions delivered should be continually monitored and evaluated. To assist with the evaluation, an evaluation framework is anticipated. In this article we describe the processes employed in the development and implementation of an evaluation framework designed for the Tasmanian Suicide Prevention Strategy 2023-2027 Implementation Plan One.ConclusionThe evaluation of Implementation Plan One examined fulfilment of stipulated processes involved in suicide prevention in Tasmania. The evaluation was undertaken as per the approach outlined in the evaluation framework. Based on our experience, a framework can provide the structure for objectively evaluating delivery and compliance with objectives and activities of a suicide prevention strategy. Therefore, an evaluation framework should be considered a key component of every suicide prevention strategy.