Australian and New Zealand Journal of Psychiatry最新文献

{"title":"Health characteristics and court diversion among adults with psychosis in the New South Wales Local Court: A data-linkage study.","authors":"Erin Spike, Tony Butler, Preeyaporn Srasuebkul, Julian Trollor, Grant Sara, David Greenberg, Azar Kariminia","doi":"10.1177/00048674251405145","DOIUrl":"10.1177/00048674251405145","url":null,"abstract":"<p><strong>Background: </strong>Diversionary approaches seek to address criminal legal system involvement among people with psychosis and other mental illness. There is limited evidence examining health characteristics of people with psychosis in Australian criminal legal systems and how these vary with court outcomes, including diversion.</p><p><strong>Methods: </strong>We conducted a data-linkage study of 21,229 adults hospitalised with psychosis in New South Wales (June 2001 to December 2019) with a subsequent offence finalised in the New South Wales Local Court. We described psychosis types, co-occurring conditions and prior health service use and examined their associations with court outcome (diversion vs conviction) using logistic regression, adjusting for sociodemographic and legal factors.</p><p><strong>Results: </strong>A total of 70.8% of participants had a schizophrenia spectrum disorder (substance-induced psychosis 22.6%; affective psychosis 6.6%). Co-occurring conditions were common (lifetime substance-related harm 84.8%; personality disorder 41.3%; neurodevelopmental disorder 17.5%; physical condition 25.6%), and 76.3% used mental health services in the year before the index offence. Affective and substance-induced psychoses were negatively associated with diversion vs schizophrenia spectrum disorders (adjusted odds ratios = 0.64 [95% confidence interval = 0.54-0.74] and 0.29 [95% confidence interval = 0.26-0.33], respectively). Duration of psychosis admissions and past-year mental health service use were positively associated with diversion, while in those with schizophrenia spectrum disorders, lifetime substance-related harm was negatively associated.</p><p><strong>Conclusion: </strong>Court defendants with psychosis have a complex health profile. Although people with schizophrenia spectrum disorders are more likely to be diverted than those with other psychosis types, substance use may inhibit diversion. Health and criminal legal system collaboration is needed to facilitate diversion and treatment for this group.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"765-779"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autism spectrum disorder in older people: A scoping review of the screening and diagnostic tools available for diagnosis.","authors":"Annabelle Chalk, Andre Bauer, Niall Higgins, Isaac Tranter, Megan Nitz","doi":"10.1177/00048674251374475","DOIUrl":"10.1177/00048674251374475","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis and management of autism spectrum disorder is an important clinical issue for psychiatrists. However, there is a lack of research and resources to recognise this condition in older people. This condition is important to detect and diagnose because it is associated with high incidence of psychiatric comorbidity. The diagnosis helps clinicians understand the additional needs of these patients and helps families understand their additional difficulties. This paper aims to identify the studies that have been conducted on autism in the eldest and the approaches to detect and diagnose this.</p><p><strong>Method: </strong>A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews guidelines. Searches were performed on five databases where search terms were based on (1) Autism, (2) Aged/Elderly and (3) Diagnosis. Two authors independently assessed the results with discrepancies resolved by a third reviewer. Quality was assessed using Mixed Method Quality Assessment Tool in included systematic reviews, randomised control trials, case-control studies, cohort studies, case series and case reports.</p><p><strong>Results: </strong>The review identified 4 diagnostic tools, and 19 screening tools available for use in the elderly. However, most of these tools were not validated in studies focusing on older people and most included a small number of older people in their sample.</p><p><strong>Conclusion: </strong>Given Australia's ageing population, and resultant increasing demands on healthcare services, this is an important topic to inform future research and clinical practice. More research is required to validate or create diagnostic and screening tools specifically for older people.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"729-746"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Involuntary treatment for substance use disorders in Victoria - An audit of people treated under the Severe Substance Dependence Treatment Act from 2011 to 2023.","authors":"Tom English, Adam Pastor, Greta Moon, Sara Vogrin, Yvonne Bonomo","doi":"10.1177/00048674261438065","DOIUrl":"10.1177/00048674261438065","url":null,"abstract":"<p><strong>Objective: </strong>Characteristics and outcomes of all patients treated involuntarily under Victoria's Severe Substance Dependence Treatment Act 2010 between 2011 and 2023 were described. Predictors of outcomes 6 months after the end of the Severe Substance Dependence Treatment Act 2010 treatment period were examined.</p><p><strong>Method: </strong>All admissions under the Severe Substance Dependence Treatment Act 2010 from when the programme began in January 2011 to December 2023 were audited. Data were analysed using descriptive statistics and univariate logistic regression.</p><p><strong>Results: </strong>There were 70 admissions for 60 patients. 58% were male, and 5% were Aboriginal and Torres Strait Islander people. Alcohol was a substance of concern for 91%, 43% had liver disease and 78% had additional psychiatric diagnoses. Six months after the end of treatment, 15% were deceased and 48% of patients had returned to their previous level of substance use. 27.6% were either using less or abstinent at 6 months which was predicted by reduced use or abstinence at 1 month (OR = 70, 95% CI = [11.5, 424.8], <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>This study suggests that brief involuntary treatment is associated with meaningful improvements in substance use outcomes for a minority of patients. If reduced substance use is achieved early following involuntary admission, it is likely to be sustained. No other clear predictor of outcome emerged in this cohort. In the absence of a control group, it is not possible to attribute these results to treatment under the Severe Substance Dependence Treatment Act 2010. Larger cohorts are required to determine variables that can be used to predict outcomes and enable judicious use of involuntary treatment for substance use disorders.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"792-802"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic complexity and comorbidity: Implications for identification, outcomes, health care and involuntary treatment.","authors":"Steve Kisely","doi":"10.1177/00048674261462366","DOIUrl":"10.1177/00048674261462366","url":null,"abstract":"","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"713-714"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148343785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autism spectrum disorder trends for children and adults in New Zealand: A longitudinal examination of three national databases.","authors":"Ben Beaglehole, Gordon Lu, Chris Frampton","doi":"10.1177/00048674261472427","DOIUrl":"https://doi.org/10.1177/00048674261472427","url":null,"abstract":"<p><strong>Background: </strong>Autism spectrum disorder rates are rising internationally, although most studies only report prevalence rates for children, with limited data available for adults. We were interested in whether a similar trend is present in New Zealand and wished to report autism spectrum disorder data for adults.</p><p><strong>Method: </strong>We analysed three large national databases to report population-adjusted rates of autism spectrum disorder in New Zealand between 2009 and 2023. Rates were analysed according to child (<18 years) and adult (18 years and over) populations, as well as by gender and ethnicity. The frequency of newly identified cases in the databases was also reported.</p><p><strong>Results: </strong>Autism spectrum disorder prevalence and the frequency of newly identified cases increased threefold during the study period. By 2023, the rate of autism spectrum disorder diagnoses in the New Zealand population was 1.3% for children and 0.14% for adults. Autism spectrum disorder was more common among males and in more deprived areas. Māori rates of autism spectrum disorder were lower than non-Māori rates in 2009 but increased nearly fivefold, and this finding reversed by 2023.</p><p><strong>Conclusion: </strong>Autism spectrum disorder is becoming more common in New Zealand. The increase occurred for child and adult populations and shows no sign of abating. Healthcare and disability services should prepare for increased demand by people with autism spectrum disorder through enhanced education, service planning, and additional resources.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261472427"},"PeriodicalIF":4.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding '<i>Australian and New Zealand Journal of Psychiatry</i> Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines for the management of schizophrenia'.","authors":"Subramanian Purushothaman, Uday Kolur, Sarangan Ketheesan, Bhargavaraman Parthasarathy, Anne Stark, Vinit Sawhney, Stephen Parker","doi":"10.1177/00048674261470984","DOIUrl":"https://doi.org/10.1177/00048674261470984","url":null,"abstract":"","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261470984"},"PeriodicalIF":4.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenge of improving assessment and treatment for attention-deficit/hyperactivity disorder in Australia.","authors":"Benjamin Johnson, Stephen Parker, Richard Xu, Rachel Simmons, Wayne Hall","doi":"10.1177/00048674261465180","DOIUrl":"https://doi.org/10.1177/00048674261465180","url":null,"abstract":"<p><p>Australia's mental health system is under increasing pressure as demand for the assessment and treatment of attention-deficit/hyperactivity disorder grows. Many people face long wait times, high out-of-pocket costs and limited specialist capacity. This encourages faster assessments, increasing the risk of misdiagnosis and avoidable downstream demand. The policy response has been to improve access and relieve specialist bottlenecks by expanding the role of general practitioners. Assessment for attention-deficit/hyperactivity disorder requires time-intensive clinical evaluation, including careful consideration of developmental history, collateral information and differential diagnoses. Making an attention-deficit/hyperactivity disorder diagnosis in adulthood adds complexity given the need for retrospective assessment to support childhood onset, limitations in the availability of collateral information and the impact of life events on executive functioning. Without dedicated time and training, general practitioners may struggle to maintain consistent diagnostic quality and appropriate prescribing at scale. There is already limited delivery of guideline-recommended multimodal care for Australians experiencing attention-deficit/hyperactivity disorder. Medications reduce core symptoms for many people, but sustained functional improvement typically requires psychoeducation, skill-based therapies, coaching and family, school or workplace interventions. Reform should pursue both access and quality by clarifying guideline advice for difficult adult diagnoses, introducing higher Medicare rebates for longer assessment appointments, linking any general practitioner role expansion to structured training and shared-care support, and funding scalable multimodal attention-deficit/hyperactivity disorder care through multidisciplinary clinics, group-based programmes, workforce upskilling, and national digital psychoeducation and self-management supports.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261465180"},"PeriodicalIF":4.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a place for non-invasive brain stimulation in the treatment of schizophrenia?","authors":"Paul B Fitzgerald","doi":"10.1177/00048674261470630","DOIUrl":"https://doi.org/10.1177/00048674261470630","url":null,"abstract":"<p><p>The management of patients with schizophrenia is a complex undertaking informed by a diverse evidence base addressing pharmacological, psychosocial and physical therapies. The journal has recently published a clinical guideline, using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, to assess the evidence for the effectiveness of a range of treatments, providing a valuable guide to practice and service planning. However, the guideline process did not assess the evidence for forms of non-invasive brain stimulation such as repetitive transcranial magnetic stimulation. Repetitive transcranial magnetic stimulation methods, especially, have been evaluated in studies conducted over 25 years, addressing symptoms experienced by patients with treatment-resistant schizophrenia. Many of these methods have been the subject of recent systematic reviews, meta-analyses and network meta-analyses, including some involving more than 30 studies and well over 1000 patients. Despite the heterogeneity of the literature (including variation in stimulation protocols, sham methods and follow-up), its extent and the conclusions of the studies conducted to date make a clear case that these approaches warrant meaningful consideration, including GRADE appraisal. This evidence is strongest for the use of stimulation of the left temporoparietal junction to reduce treatment-resistant auditory hallucinations, and prefrontal stimulation to modulate negative symptoms, both substantial clinical problems. These new approaches warrant meaningful consideration, alongside those supported in the recently published guidelines.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261470630"},"PeriodicalIF":4.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of clozapine-resistant schizophrenia.","authors":"John Lally, Siobhan Gee, Caroline Hynes-Ryan, Korinne Northwood, Dolores Keating, Shuichi Suetani, Dan Siskind, Brian O'Donoghue","doi":"10.1177/00048674261462755","DOIUrl":"https://doi.org/10.1177/00048674261462755","url":null,"abstract":"<p><p>The ANZJP 2026 schizophrenia guideline appropriately emphasises the importance of identifying treatment-resistant schizophrenia and the timely initiation of clozapine. However, despite clear guidance on when to commence clozapine, there remains comparatively limited direction regarding the systematic assessment and management of individuals who show an inadequate response to clozapine, commonly termed clozapine-resistant schizophrenia. The absence of consistent, operationalised guidance contributes to variability in clinical practice and uncertainty regarding optimal management strategies. In this perspective article, we summarise practical, evidence-informed recommendations to assist clinicians in the assessment and management of clozapine-resistant schizophrenia. Current evidence supports the early use of clozapine once treatment-resistant schizophrenia is established, with delayed clozapine use associated with poorer outcomes. In individuals with persistent symptoms despite clozapine treatment, systematic assessment is required to exclude pseudoresistance, including non-adherence, drug interactions, altered metabolism, and subtherapeutic plasma clozapine concentrations. Therapeutic drug monitoring is therefore a core component of care. Optimisation of clozapine should prioritise individualised adjustment of plasma concentrations guided by clinical response, adverse effects, and tolerability, rather than reliance on fixed concentration thresholds alone. Where an adequate trial of optimised clozapine has failed, augmentation strategies may be considered, with preference given to interventions supported by meta-analytic findings and real-world effectiveness data, while recognising the modest and inconsistent benefits observed across studies. Augmentation trials should be time-limited, systematically evaluated and if no meaningful improvement occurs, should be discontinued rather than continued indefinitely. Despite decades of research, no augmentation strategy has demonstrated consistent efficacy in clozapine-resistant schizophrenia. Future research should prioritise adequately powered, placebo-controlled trials and standardised definitions of treatment-resistant schizophrenia and clozapine-resistant schizophrenia to enable clearer treatment algorithms and more reliable clinical pathways for this patient group.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261462755"},"PeriodicalIF":4.1,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding 'The future of psychiatry: Reclaiming relevance in an era of technological and systemic transformation'.","authors":"Christopher Gale, Paul Glue, Yoram Barak","doi":"10.1177/00048674261465198","DOIUrl":"https://doi.org/10.1177/00048674261465198","url":null,"abstract":"","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261465198"},"PeriodicalIF":4.1,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}