Australian & New Zealand Journal of Psychiatry最新文献

{"title":"The institute for urban indigenous health: The role of psychiatry in reducing health inequality","authors":"S. Suetani, Leshay Chong, Randall Frazer, C. Nelson, Lyle R. Turner, Marianna Serghi, A. Carson, H. Whiteford","doi":"10.1177/00048674221103481","DOIUrl":"https://doi.org/10.1177/00048674221103481","url":null,"abstract":"the BiOC model, underpinned by an Indigenous practice framework and a partnership with a tertiary hospital, was able to close the gap against several perinatal health measures.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86698258","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":"Combinatorial panel with endophenotypes from multilevel information of diffusion tensor imaging and lipid profile as predictors for depression","authors":"Juan Liu, Zhuang Liu, Yan-ge Wei, Yanbo Zhang, F. Womer, Duan Jia, Shengnan Wei, Feng Wu, Ling-tao Kong, Xiaowei Jiang, Luheng Zhang, Yanqing Tang, Xizhe Zhang, Fei Wang","doi":"10.1177/00048674211031477","DOIUrl":"https://doi.org/10.1177/00048674211031477","url":null,"abstract":"Objective: Clinical heterogeneity in major depressive disorder likely reflects the range of etiology and contributing factors in the disorder, such as genetic risk. Identification of more refined subgroups based on biomarkers such as white matter integrity and lipid-related metabolites could facilitate precision medicine in major depressive disorder. Methods: A total of 148 participants (15 genetic high-risk participants, 57 patients with first-episode major depressive disorder and 76 healthy controls) underwent diffusion tensor imaging and plasma lipid profiling. Alterations in white matter integrity and lipid metabolites were identified in genetic high-risk participants and patients with first-episode major depressive disorder. Then, shared alterations between genetic high-risk and first-episode major depressive disorder were used to develop an imaging x metabolite diagnostic panel for genetically based major depressive disorder via factor analysis and logistic regression. A fivefold cross-validation test was performed to evaluate the diagnostic panel. Results: Alterations of white matter integrity in corona radiata, superior longitudinal fasciculus and the body of corpus callosum and dysregulated unsaturated fatty acid metabolism were identified in both genetic high-risk participants and patients with first-episode major depressive disorder. An imaging x metabolite diagnostic panel, consisting of measures for white matter integrity and unsaturated fatty acid metabolism, was identified that achieved an area under the receiver operating characteristic curve of 0.86 and had a significantly higher diagnostic performance than that using either measure alone. And cross-validation confirmed the adequate reliability and accuracy of the diagnostic panel. Conclusion: Combining white matter integrity in corpus callosum, superior longitudinal fasciculus and corona radiata, and unsaturated fatty acid profile may improve the identification of genetically based endophenotypes in major depressive disorder to advance precision medicine strategies.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82072774","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":"What works for whom when treating major depression with psychotherapy?","authors":"G. Murray, E. Bell, Darryl L Bassett, P. Boyce, R. Bryant, P. Hazell, M. Hopwood, B. Lyndon, R. Mulder, R. Porter, Ajeet B. Singh, G. Malhi","doi":"10.1177/00048674221100425","DOIUrl":"https://doi.org/10.1177/00048674221100425","url":null,"abstract":"Australian & New Zealand Journal of Psychiatry, 56(9) career level have been women, and this significantly decreases to 3/40 (7.5%) at senior research level. An important consideration in gaining a deeper understanding of the systemic barriers underpinning this disparity is how career disruption and relative-toopportunity frameworks are applied in these award and grant schemes. We are not aware of a framework or guidelines supporting such considerations within the RANZCP and argue that this is urgently needed. On a positive note, Suetani et al. report that in 2021, the RANZCP established the Clinical Academic Psychiatry Steering Committee to ‘consult and advise the next generation of academic-psychiatrists’. We are hope ful that this Steering Committee is representative and consultative in its activities; inclusive in diversity across gender, academic level, colour and indigenous representation; and seeking cross-specialty and state, territory and binational perspectives. In summary, we reiterate Suetani et al.’s (2022) call for more data regarding the psychiatry research workforce, the need for greater clarity in the outcomes of research training efforts and finally, a national effort required to promote, implement and sustain the training of psychiatrist researchers.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88662002","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":"Clinical recommendations for the care of people with treatment-refractory obsessive-compulsive disorder when undergoing deep brain stimulation","authors":"Nicola Acevedo, D. Castle, Clare Groves, P. Bosanac, P. Mosley, S. Rossell","doi":"10.1177/00048674221100947","DOIUrl":"https://doi.org/10.1177/00048674221100947","url":null,"abstract":"Deep brain stimulation is an emerging therapy for treatment-refractory obsessive-compulsive disorder patients. Yet, accessibility is limited, treatment protocols are heterogeneous and there is no guideline or consensus on the best practices. Here, we combine evidence from scientific investigations, expert opinions and our clinical expertise to propose several clinical recommendations from the pre-operative, surgical and post-operative phases of deep brain stimulation care for treatment-refractory obsessive-compulsive disorder patients. A person-centered and biopsychosocial approach is adopted. Briefly, we discuss clinical characteristics associated with response, the use of improved educational materials, an evaluative consent process, comprehensive programming by an expert clinician, a more global assessment of treatment efficacy, multi-disciplinary adjunct psychotherapy and the importance of peer support programs. Furthermore, where gaps are identified, future research suggestions are made, including connectome surgical targeting, scientific evaluation of hardware models and health economic data. In addition, we encourage collaborative groups of data and knowledge sharing by way of a clinical registry and a peer group of programming clinicians. We aim to commence a discussion on the determinants of deep brain stimulation efficacy for treatment-refractory obsessive-compulsive disorder patients, a rare and severe patient group, and contribute to more standardized and evidence-based practices.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74207862","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":"Inequity in psychiatry cannot be addressed without first embracing intersectionality","authors":"Zoë E. Kristensen","doi":"10.1177/00048674221098632","DOIUrl":"https://doi.org/10.1177/00048674221098632","url":null,"abstract":"","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82562282","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":"The need to take a trauma history in the acute psychiatry inpatient setting","authors":"Laurann Gilbertson, J. Kulkarni","doi":"10.1177/00048674221097037","DOIUrl":"https://doi.org/10.1177/00048674221097037","url":null,"abstract":"Australian & New Zealand Journal of Psychiatry, 56(8) wayside. By instead accepting these issues as interconnected and embracing intersectionality by empowering and including these voices, we can find a solution which addresses the underlying issues once and for all. Our alternative is to spend decades repeating the process turn-wise providing half-measures to each marginalised group within our college.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74156388","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":"Clomipramine as an alternative to selective serotonin reuptake inhibitors for patients at haemorrhagic risk","authors":"Reuben White, M. Papadopoulos, P. Tibrewal","doi":"10.1177/00048674221096617","DOIUrl":"https://doi.org/10.1177/00048674221096617","url":null,"abstract":"Selective serotonin reuptake inhibitors (SSRIs) can cause haemorrhage secondary to decreased platelet aggregation thus limiting pharmacological treatment options in Obsessive-compulsive disorder (OCD) patients with bleeding tendency (Laporte et al., 2017). We report a case where Clomipramine was better tolerated than SSRIs in a patient with recurrent epistaxis and recommend it as an alternative to SSRIs in patients susceptible to haemorrhagic complications. EL is a 59-year-old male, with a 15-year history of schizophrenia stable on Paliperidone 3 monthly depot and a 10-year history of OCD that responded well to Fluvoxamine but was selfceased due to recurrent epistaxis. In February 2021, EL was admitted to an acute psychiatric inpatient ward with obsessive ruminations about past social interactions where he would ‘replay conversations’ in his mind incessantly. The associated anxiety led to reduced self-care, isolation and disengagement with community mental health services. The psychotic symptoms were not dominant. EL was commenced on Sertraline 25 mg and titrated to 50 mg, but subsequently experienced recurrent episodes of severe epistaxis, which resolved with cessation. Naranjo Adverse Drug Reaction Probability Scale was applied to Sertraline and in retrospect to Fluvoxamine (Naranjo et al., 1981). The SSRIs scored 7 and 8, respectively, indicating probable adverse drug reaction (ADR). Further exploration of the aetiology of his epistaxis also revealed a nasal septal defect and Polycythemia Rubra Vera (PCV) for which he was commenced on Aspirin 100 mg/day and Hydroxyurea 1000 mg mane. PCV increases the risk of thrombosis and haemorrhage and Aspirin increases the risk of bleeding. Subsequent treatment with an SSRI would have further increased this risk. We therefore initiated a trial of Clomipramine which has a theoretical advantage over SSRIs of increased platelet aggregation (Alvarez et al., 1999). Clomipramine was gradually uptitrated to 175 mg/day with no further epistaxis during the admission. EL’s OCD symptoms improved with his Yale-Brown Obsessive Compulsive Scale score reducing from 22 at admission to 14 at discharge. He exhibited improved selfcare, social interactions and mood. Clomipramine is a third-line pharmacological treatment for OCD. Like SSRIs it can also increase the risk of haemorrhage via decreased platelet aggregation However, unlike SSRIs, Clomipramine is distinctly a 5-HT2 receptor antagonist which is proposed to lead to compensatory up-regulation of 5-HT2 receptors promoting platelet aggregation (Alvarez et al., 1999). It is possible that this mechanism helped prevent epistaxis in EL and led to better clinical outcome. To our knowledge, this is the first report comparing clomipramine and SSRIs in patients with haemorrhagic complications and provides the clinicians a safer alternative in such cases.","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74126187","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":"Interventional psychiatry: Why an umbrella term is useful?","authors":"A. Pouchon, M. Polosan, C. Dondé","doi":"10.1177/00048674221096616","DOIUrl":"https://doi.org/10.1177/00048674221096616","url":null,"abstract":"The term ‘interventional psychiatry’ was coined for the first time in 2014 to describe the growing field of psychiatry based on neuroscience-informed brain modulation devices (Williams et al., 2014). Since then, new interventional treatments have emerged and have been the subject of a large amount of encouraging published and ongoing trials. Some of these treatments were subsequently approved by the US Food and Drug Administration, the European Medicines Agency for Europe and the French Haute Autorité de Santé. Transcranial focused ultrasound stimulation, botulinum toxin injection devices, subcutaneous implants for prolonged psychotropic drugs delivery, infusion and intranasal therapies (Ketamine, Brexanolone) are among the most innovative interventional techniques that have been developed in the last few years. A growing use and demand for interventional approaches in clinical practice has led to individualization and labeling of ‘Interventional Psychiatry Centers’ in many countries, including the United States, Canada, Australia, Germany and Switzerland. Hereby, we strongly support the development and implementation of the ‘Interventional Psychiatry’ label for units that offer a range of services and expertise about these treatment options. We posit that the use of this umbrella term will lead to two following advances. First is stigma and misinformation reduction around interventional approaches with a special focus on neuromodulation techniques. Despite safe and ethical practice frameworks, these techniques continue to be stigmatized resulting in restriction and reduced accessibility. As an example, the name of electroconvulsive therapy has been demonstrated as having itself an impact on both its acceptability and effectiveness (Andrade and Thyagarajan, 2007). System atization of the ‘Interventional Psychiatry’ label would better meet the challenges of the underutilization of interventional – stigmatized – techniques by moving closer to the general, less-stigmatized, framework of interventional medicine. This is likely to improve the credibility and acceptability of interventional approaches in the eyes of patients, caregivers and health workers. Second, the use of interventional psychiatry umbrella term might lead to harmonized improvement of interventional psychiatric practice to a level of innovation and excellence that is recognized internationally. In this perspective, specialty tracks in interventional psychiatry including both neuroscience didactics and hands-on experiences must be generalized within residency curricula. Currently, most psychiatrists who use interventional techniques are trained in a very inconsistent manner. Few programs exist, but to our knowledge, such training is not mandatory to practice this subspecialty. Generalizing these programs will facilitate the identification of highly specialized practitioners, the implementations and visibility of specific Intervention Psychiatry Units and resources, and promote better ","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90586595","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":"Monitoring of cutaneous manifestations of lithium treatment in mental health inpatients","authors":"Charlotte Cox, M. George","doi":"10.1177/00048674221089566","DOIUrl":"https://doi.org/10.1177/00048674221089566","url":null,"abstract":"","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74153130","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":"Reviving academic psychiatry in Australia and New Zealand","authors":"S. Suetani, S. Every-Palmer, M. Galbally, M. Berk, Neeraj S. Gill, D. Siskind","doi":"10.1177/00048674221091927","DOIUrl":"https://doi.org/10.1177/00048674221091927","url":null,"abstract":"Australian & New Zealand Journal of Psychiatry, 56(5) Fostering the next generation of academic psychiatrists is crucial to maintaining our leading role in providing evidence-based care for the patients we serve. Embedding academic psychiatry into clinical services ensures the development of cutting edge clinical evidence and rapid translation into clinical practice, thus improving clinical outcomes (Burke et al., 2018). There is much to be loved about a career in academic psychiatry: self-determinism in terms of time and following interests; opportunities to teach and mentor; being able to influence policy and practice; connecting and collaborating with colleagues; asking difficult questions and sometimes finding answers; and long-term job satisfaction. It is often said that clinicians burn out but academics never retire – this may in turn improve recruitment and retention, especially in the public mental health sector. Despite these benefits, fewer psychiatrists are taking this career pathway, and those that do face significant challenges. Husain (2021) has argued that there is a genuine existential threat to clinical scientists who are ‘under pressure either to voluntarily seek extinction or to evolve into a set of desktop scientists who don’t run experimental studies but rather analyse big data’. Husain worried that such a shift away from experimental studies would have significant deleterious consequences for discovery science (Husain, 2021). In the United States, while the current COVID-19 pandemic has highlighted the critical importance of clinical scientists, it has also brought the decline of this workforce due to constraints on reimbursement, time and funding into stark relief – the percentage of physicians engaged in research has declined from 4.75% in the 1980s to 1.5% today (Utz et al., 2022). In New Zealand and Australia, we do not have far to look for inspiration in academic psychiatry. John Cade was a psychiatrist who discovered lithium in a kitchen at Bundoora Repatriation Mental Hospital in Melbourne. Mason Durie is a leader of Māori health and research world-renowned for the promotion of Indigenous knowledge. Beverley Raphael’s mentorship inspired a generation of academic psychiatrists, demonstrating the importance of creating a stimulating and supportive environment to help grow a culture of lifelong learning. So how can we build and grow the next generation of clinical academics? Utz et al. (2022) proposed the multipronged strategy of: (1) providing an immersive research experience for medical trainees (e.g. funding for a gap year in research laboratory), (2) lowering financial barriers to academic careers, (3) restoring the educators and mentors in clinical science and (4) building a leak-free physician-scientist network. These approaches are in keeping with the call by Scott Henderson et al. (2015) from Australia and Richard Porter from New Zealand, along with 19 other senior academic psychiatrists across Australasia, for u","PeriodicalId":8576,"journal":{"name":"Australian & New Zealand Journal of Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84069752","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}