Australian & New Zealand Journal of Psychiatry最新文献

{"title":"Temporal effects of bitemporal electroconvulsive therapy","authors":"G. Parker, C. Loo","doi":"10.1177/0004867419889408","DOIUrl":"https://doi.org/10.1177/0004867419889408","url":null,"abstract":"","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88201655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psilocybin-assisted therapy for depression: How do we advance the field?","authors":"Sally E Meikle, Paul Liknaitzky, S. Rossell, M. Ross, N. Strauss, N. Thomas, G. Murray, Martin L Williams, D. Castle","doi":"10.1177/0004867419888575","DOIUrl":"https://doi.org/10.1177/0004867419888575","url":null,"abstract":"In the quest for new treatment options for depression, attention is being paid to the potential role of psychedelic drugs. Psilocybin is of particular interest given its mechanism of action, its benefits in early trials and its relatively low side effects burden. This viewpoint outlines a number of key issues that remain to be elucidated about its potential use in the clinical environment, including clarification of the profile of people most likely to benefit and those who might experience adverse effects, longer-term outcomes and the role of psychotherapeutic input alongside the drug itself. There are also opportunities to understand better, the neurobiology underpinning its effects.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90228959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression in the medically ill","authors":"J. Rosenblat, P. Kurdyak, F. Cosci, M. Berk, M. Maes, A. Brunoni, Madeline Li, G. Rodin, R. McIntyre, A. Carvalho","doi":"10.1177/0004867419888576","DOIUrl":"https://doi.org/10.1177/0004867419888576","url":null,"abstract":"Background: Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. Methods: Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. Results: Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug–drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. Limitations: Non-systematic review of the literature. Conclusion: Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85287208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicides in Australia following media reports of the death of Robin Williams","authors":"J. Pirkis, D. Currier, L. Too, Marc Bryant, Sara Bartlett, M. Sinyor, M. Spittal","doi":"10.1177/0004867419888297","DOIUrl":"https://doi.org/10.1177/0004867419888297","url":null,"abstract":"Objective: This study assessed the extent to which local reporting of Robin Williams’ suicide (on 11 August 2014) was associated with suicide in Australia. It followed several studies in the United States which showed that there were significant increases in suicide following media reports of Williams’ death and that those media reports were less than optimal in terms of adherence to best-practice guidelines. In a previous study, we demonstrated that Australian media reports of Williams’ suicide were largely adherent with our Mindframe guidelines on responsible reporting of suicide, so we speculated that there would be no increase in suicide following the reporting of Williams’ suicide in Australia. Method: We extracted data on Australian suicides from the National Coroners Information System for the period 2001 to 2016. We conducted interrupted time series regression analyses to determine whether there were changes in suicides in the 5-month period immediately following Williams’ suicide. Results: Our hypothesis that there would be no increase in suicides in Australia following Williams’ highly publicised suicide was not supported. There was an 11% increase in suicides in the 5-month period following Williams’ death, largely accounted for by men aged 30–64 and by people who died by hanging (the method Williams used). Conclusion: It may be that Australians were exposed to reports that contravened safe reporting recommendations, particularly via overseas media or social media, and/or that some Australian reports may have had unhelpful overarching narratives, despite largely adhering to the Mindframe guidelines. The Mindframe guidelines constitute international best practice but consideration should be given to whether certain recommendations within them should be further reinforced and whether more nuanced information about how stories should be framed could be provided. Future revision and augmentation of the Mindframe guidelines should, as always, involve media professionals.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74664743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age, sex and period estimates of Australia’s mental health over the last 17 years","authors":"R. Burns, P. Butterworth, Dimity A. Crisp","doi":"10.1177/0004867419888289","DOIUrl":"https://doi.org/10.1177/0004867419888289","url":null,"abstract":"Objective: Describing the long-term mental health of Australians is limited as many reports rely on cross-sectional studies which fail to account for within-person changes and age-related developmental processes which may bias estimates which ignore these phenomena. We examined the 17-year trajectories of mental health in 27,519 Australian adults. Methods: Household panel data of 27,519 participants aged 18 years and over from the Household, Income and Labour Dynamics in Australia Survey provided at least one observation of mental health over a 17-year period from 2001. On average, participants reported 7.6 observations. Mental Health was assessed annually using the Short-Form Health Survey-36 mental health scale. Results: Over time, there were only very small changes in mental health and only for the youngest and oldest adults. Over time, there was consistent evidence for better metal health with increasing age, although for the very old, there appear to be substantial declines. These patterns were consistent between sex. In line with an existing literature, males reported better mental health over life span, although the declines of mental health in very-late-life are particularly pronounced for males. Conclusion: Decline in mental health was only reported by the youngest and oldest respondents, and was notable only in the last 4–5 years. However, the magnitude of the decline was small and further follow-up will be needed to determine whether this is a trend of substantive declining mental health for these specific age cohorts. In contrast, the more consistent finding is that there has been no substantive change in the level of mental health in Australia over the last 17 years. Analysis of the mental health trajectories of baseline age-cohorts confirmed that age differences are consistent over time.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89696889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pareto’s law of the vital few: Patient requirements for hospital based non-acute care","authors":"S. Allison, T. Bastiampillai, J. Looi, D. Copolov","doi":"10.1177/0004867419889147","DOIUrl":"https://doi.org/10.1177/0004867419889147","url":null,"abstract":"There has been debate in Australian & New Zealand Journal of Psychiatry (ANZJP) about the required numbers of psychiatric beds in Australia (Allison et al., 2019; Benjamin et al., 2018). While debate has focused on acute beds, Australia also has relatively few hospital based adult non-acute beds (10 per 100,000 persons, according to the Australian Institute of Health and Welfare: www.aihw.gov.au/reports-data/ health-welfare-services/mentalhealth-services/overview). In contrast, the World Health Organisation (www. who.int/mental_health/evidence/atlas/ menta l_hea l th_at las_2017/en/ ) reports that high-income countries have 31 beds per 100,000 in standalone mental health hospitals, while Europe has 34 per 100,000. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Faulty of Adult Psychiatry endorsed a major submission from 48 psychiatrists to the Royal Commission into Victoria’s Mental Health System, which recommends increasing the state’s hospital based adult non-acute beds from 3 per 100,000 to around New South Wales’ (NSW’s) level of 14 per 100,000 – with new beds in university-linked ‘Mental Health Rehabilitation Centres’ that would ‘facilitate much needed research on treatment-resistant psychiatric conditions, and on optimal psychosocial practices in rehabilitation psychiatry’ (The Adult Psychiatry Imperative: https://s3.apsoutheast-2.amazonaws.com/hdp. a u . p r o d . a p p . v i c r c v m h s . files/2915/6765/3776/The_Adult_Psy chiatry_Imperative.pdf). Hospital based non-acute care is designed to reduce the adverse outcomes associated with chronic treatment-resistant illness (Sisti et al., 2015).","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89417390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New treatment paradigms for mental health conditions: A time for renewed enthusiasm?","authors":"R. Porter","doi":"10.1177/0004867419889153","DOIUrl":"https://doi.org/10.1177/0004867419889153","url":null,"abstract":"Australian & New Zealand Journal of Psychiatry, 53(12) Given the complexity of mental health conditions and apparent lack of progress in improving the prevalence of these at a population level, it is easy to become negative about progress in psychiatric treatment. Indeed, some have argued in recent years that despite increased development and provision of treatment, the prevalence of common mental disorders has increased, or at least not decreased (Mulder et al., 2017). This month in ANZJP, not only is this argument refuted, but several authors present new ideas and paradigms for improvements in the treatment of important mental health conditions, which give considerable cause for optimism. Regarding the prevalence of mental disorders, Furukawa and Kessler (this issue) argue cogently that this situation is not as negative as it might appear. First, they argue that years lived with disability due to mental health disorders may not have increased, when figures are adjusted for age and population. Second, they argue that prevalence in psychiatric epidemiological studies may not always be an accurate reflection of the situation, being influenced significantly by participation rates and the readiness of participants to admit to symptoms of depression, which may have changed significantly over time. Third, they argue that while rates of mental disorder may not have altered, they may, however, be better controlled by current treatments, resulting in an improved quality of life for sufferers. This then sets the scene for several papers in this month’s issue that discuss exciting new paradigms for the treatment of common mental health conditions. Anorexia nervosa is a condition which is particularly difficult to treat and Phillipou et al. (this issue) point out that compared with other mental health conditions, relatively modest advances in treatment have been made. These authors argue that although the biopsychosocial model has frequently been applied to anorexia nervosa, the biological aspects of the disorder have been relatively under researched resulting in a paucity of neurobiological therapies. They note that most of the neurobiological therapies employed are used to treat comorbidity with other conditions. They also emphasise the importance of interactions between different aspects of the biopsychosocial model. For example, they point to the interaction between the gut/brain axis and the behavioural aspects of what is ingested. In a condition in which therapeutic nihilism may easily emerge, this erudite paper that concludes with a plea to fund truly multidisciplinary initiatives to help to provide individualised treatment for anorexia nervosa signals a positive future. In their model, reference to the importance of the gut/brain axis draws the attention of readers to the relationship between the gut microbiome, the ‘leaky brain’ and mental health – an area that is of increasing interest and reviewed in detail recently in this journal (Morris et al.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86698940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A biopsychosocial proposal to progress the field of anorexia nervosa","authors":"J. Russell","doi":"10.1177/0004867419887792","DOIUrl":"https://doi.org/10.1177/0004867419887792","url":null,"abstract":"Anorexia nervosa remains vexing to treat with the illness having a decadeslong trajectory in most patients, even those in whom intervention has been early. Despite the severe, enduring and often relapsing course, 75% or more ultimately do recover. Mortality rate from the illness, high though it is, has been reduced with better medical salvage and management of the longterm complications but suicide rate increases after 15 years of illness particularly in the context of substance abuse and socioeconomic disadvantage. Neuroprogression has been mooted but thus far has not been satisfactorily distinguished from the effects of continuing brain starvation (Russell et al., 2019). Anorexia nervosa bears some resemblance to other serious mental illnesses where a substantial number of sufferers remain symptomatic with cognitive and social decline despite what Phillipou et al. (2019) describe rather naively as ‘effective evidencebased treatments’. Genetic studies have shown an overlap between schizophrenia, mood disorders and anorexia nervosa. Autistic social deficits and cognitive rigidity may be premorbid in anorexia nervosa but are exacerbated by weight loss and serve to lock the sufferer into a self-perpetuating vicious cycle. The prospect of eventual full recovery, however, sets anorexia nervosa apart from other serious mental illnesses (Russell et al., 2019). Of course, effective biological treatment for anorexia nervosa does exist – namely refeeding or nutritional rehabilitation. This can bring about complete resolution of physical, endocrine and psychological symptoms, as documented from the earliest descriptions of the condition. However, it is not always easy to effect (or to complete), often unacceptable to patients and even their families who may see it as persecutory. Maintaining the improved state of nourishment is another challenge, with the patient often unable or unwilling to continue with the behavioural changes. Shifting the patient’s mind-set around this and correcting the system of perverse reward in a lasting way continue to be extraordinarily difficult despite involvement of family and friends as cotherapists and numerous proven psychological treatments. These have been informed by the role of diverse factors such as temperament, traits, emotional skills, trauma and distorted body image in aetiogenesis and perpetuation (Keiser et al., 2016; Russell et al., 2019). The main source of difficulty psychologically is that patients with anorexia nervosa with few exceptions differ from patients with most other mental or physical illnesses in that they are unwilling to relinquish their symptoms (i.e. emaciation and engagement in nourishment controlling behaviours) as these seem to assuage a pervasively low sense of self-worth and lack of agency. This reluctance underpins the egosyntonicity, dishonesty and treatment sabotage so frustrating to carers and clinicians (Russell et al., 2019). Patients for their part often feel hopeless to change. Ps","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86219997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement in cognitive function in young people with bipolar disorder: Results from participants in an 18-month randomised controlled trial of adjunctive psychotherapy","authors":"R. Porter, M. Inder, Katie M. Douglas, S. Moor, J. Carter, C. Frampton, M. Crowe","doi":"10.1177/0004867419887794","DOIUrl":"https://doi.org/10.1177/0004867419887794","url":null,"abstract":"Objective: To examine the effects of 18 months of intensive stabilisation with medication management and Interpersonal and Social Rhythm Therapy or Non-specific Supportive Clinical Management on cognitive function in young people with bipolar disorder. Determinants of change in cognitive function over the 18 months of the trial were also examined. Method: Patients aged 15–36 years with Bipolar I Disorder, Bipolar II Disorder and Bipolar Not Otherwise Specified were recruited. From a battery of cognitive tests, change scores for pre-defined domains of cognitive function were created based on performance at baseline and follow-up. Change was compared between the two therapy groups. Regression analysis was used to determine the impact of a range of clinical variables on change in cognitive performance between baseline and follow-up. Results: One hundred participants were randomised to Interpersonal and Social Rhythm Therapy (n = 49) or Non-specific Supportive Clinical Management (n = 51). Seventy-eight patients underwent cognitive testing at baseline and 18 months. Across both groups, there were significant improvements in a Global Cognitive Composite score, Executive Function and Psychomotor Speed domains from baseline to 18 months. Lower scores at baseline on all domains were associated with greater improvement over 18 months. Overall, there was no difference between therapies in change in cognitive function, either in a global composite score or change in domains. Conclusion: While there was no difference between therapy groups, intensive stabilisation with psychological therapy was associated with improved cognitive function, particularly in those patients with poorer cognitive function at baseline. However, this was not compared with treatment as usual so cannot be attributed necessarily to the therapies.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90074894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wnt receptor gene FZD1 was associated with schizophrenia in genome-wide SNP analysis of the Australian Schizophrenia Research Bank cohort","authors":"Xiaoman Liu, Siew-Kee Low, J. Atkins, J. Wu, W. Reay, Heath M. Cairns, Melissa J. Green, U. Schall, A. Jablensky, B. Mowry, P. Michie, S. Catts, F. Henskens, C. Pantelis, C. Loughland, A. Boddy, P. Tooney, R. Scott, V. Carr, M. Cairns","doi":"10.1177/0004867419885443","DOIUrl":"https://doi.org/10.1177/0004867419885443","url":null,"abstract":"Objectives: Large-scale genetic analysis of common variation in schizophrenia has been a powerful approach to understanding this complex but highly heritable psychotic disorder. To further investigate loci, genes and pathways associated more specifically in the well-characterized Australian Schizophrenia Research Bank cohort, we applied genome-wide single-nucleotide polymorphism analysis in these three annotation categories. Methods: We performed a case–control genome-wide association study in 429 schizophrenia samples and 255 controls. Post-genome-wide association study analyses were then integrated with genomic annotations to explore the enrichment of variation at the gene and pathway level. We also examine candidate single-nucleotide polymorphisms with potential function within expression quantitative trait loci and investigate overall enrichment of variation within tissue-specific functional regulatory domains of the genome. Results: The strongest finding (p = 2.01 × 10−6, odds ratio = 1.82, 95% confidence interval = [1.42, 2.33]) in genome-wide association study was with rs10252923 at 7q21.13, downstream of FZD1 (frizzled class receptor 1). While this did not stand alone after correction, the involvement of FZD1 was supported by gene-based analysis, which exceeded the threshold for genome-wide significance (p = 2.78 × 10−6). Conclusion: The identification of FZD1, as an independent association signal at the gene level, supports the hypothesis that the Wnt signalling pathway is altered in the pathogenesis of schizophrenia and may be an important target for therapeutic development.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82471515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}