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Australas Psychiatry 2020 Jul 3:1039856220936152. Epub 2020 Jul 3.

Mental Health Services, Sydney Local Health District, Australia.

Objective: Increasing options for the delivery of community-based care may be one way to reduce inpatient bed pressures. This study set out to examine the effect of community-based step up/step down (SUSD) care on hospital usage for service users with multi-service usage.

Methods: A retrospective audit was undertaken of the medical records of all individuals admitted to a SUSD unit over a 2-year period, calculating inpatient bed days for the 12 months prior to, and the 12 months after, the SUSD admission. Read More

Australas Psychiatry 2020 Jul 3:1039856220936147. Epub 2020 Jul 3.

School of Medicine and Public Health, The University of Newcastle, Australia.

Objective: To assess rates of metabolic monitoring in patients prescribed antipsychotic medications in the psychiatric inpatient setting and the impact education can have regarding monitoring compliance.

Method: Two identical audits were undertaken at a NSW mental health inpatient service before and after a campaign designed to educate mental health workers about the importance of metabolic monitoring. Results from both audits were compared for statistically significant improvements in monitoring rates. Read More

Australas Psychiatry 2020 Jul 3:1039856220937646. Epub 2020 Jul 3.

Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia.

Objective: We reflect upon the processes of mental health administration in Australia with reference to George Orwell's novel, .

Conclusions: Mental healthcare in Australia is distorted by politicisation, spin and a refusal to acknowledge the reality of the current situation. These challenges for mental healthcare demonstrate some similarities with the Ministries of Truth and Plenty, which conversely performed as their opposites in Orwell's novel. Read More

Australas Psychiatry 2020 06;28(3):365

Australas Psychiatry 2020 Jun 29:1039856220936149. Epub 2020 Jun 29.

Child and Adolescent Psychiatry, South Eastern Sydney Local Health District, Australia.

Objectives: While mental illness has long been associated with states of heightened creativity, the intersection between psychiatry and art warrants further exploration. This paper seeks to examine some fundamental concerns common to both disciplines, highlighting the therapeutic potential of visual art within psychiatric practice.

Conclusions: Psychiatry and art are both concerned with the visual embodiment of abstract internal states, compelling us to deconstruct surface appearances in the pursuit of deeper meaning. Read More

Australas Psychiatry 2020 Jun 25:1039856220936140. Epub 2020 Jun 25.

Metro South Mental Health and Addiction Services, Australia.

There are challenges to conducting randomised controlled trials in psychotherapy. This article therefore discusses methodological advances in applying this design to the field. The application of evidence-based practice to psychotherapy means that people with psychological problems, clinicians, health services and any third-party payers can confidently choose from a range of effective treatments that are best suited to an individual's needs. Read More

Australas Psychiatry 2020 Jun 25:1039856220934317. Epub 2020 Jun 25.

Waikato Hospital, New Zealand.

Objective: Sodium valproate's teratogenicity has prompted increasing restriction in its use. It is still widely prescribed to women of childbearing age in New Zealand. To examine this problem, we audited the prescribing pattern of sodium valproate in a psychiatric inpatient unit in New Zealand. Read More

Australas Psychiatry 2020 Jun 25:1039856220934326. Epub 2020 Jun 25.

Department of Endocrinology & Diabetes, Alfred Hospital, Australia.

Objective: Guidelines stipulate that baseline prolactin be ordered prior to commencing antipsychotic treatment to facilitate investigation of any subsequent hyperprolactinaemic symptoms. The aim was to observe when and why prolactin levels are ordered for psychiatry inpatients commencing or continuing antipsychotics and how this alters clinical management.

Methods: Psychiatry inpatients admitted to the Alfred Hospital, Melbourne, Australia, in 2018 with the diagnoses of psychosis, schizophrenia, schizo-affective disorder or bipolar affective disorder were retrospectively analysed. Read More

Australas Psychiatry 2020 Jun 25:1039856220934313. Epub 2020 Jun 25.

Monash University, Australia.

Objective: Injudicious use of medical imaging may be associated with harm to patients and increased downstream healthcare costs. Guidance on the use of imaging in common psychiatric inpatient scenarios is inconsistent or absent. This paper explores three common clinical scenarios facing adult psychiatrists and provides guidance about the appropriate use of imaging. Read More

Australas Psychiatry 2020 Jun 25:1039856220928867. Epub 2020 Jun 25.

Waitemata District Health Board Research and Knowledge Centre, New Zealand; and Department of Psychological Medicine, University of Auckland, New Zealand.

Objectives: To understand the impact of 3-monthly treatment with paliperidone palmitate on patient management, including non-adherence and relapse, from a psychiatrist and nurse perspective for 73 patients enrolled in a patient familiarisation programme (PFP) in New Zealand.

Methods: An online questionnaire was sent to clinicians with at least 6 months of regular interaction with PFP patients. Questions addressed treatment effectiveness and patient management changes. Read More

Australas Psychiatry 2020 Jun 18:1039856220930672. Epub 2020 Jun 18.

PA-Southside Clinical Unit, School of Clinical Medicine, The University of Queensland, Australia.

Objective: To determine the mediating role of gratitude in the relationship between attachment styles and psychological well-being in students.

Method: We selected 200 students using randomised cluster sampling in the academic year 2016-2017. They completed the attachment style, psychological well-being and gratitude questionnaires. Read More

Australas Psychiatry 2020 Jun 17:1039856220933331. Epub 2020 Jun 17.

Australas Psychiatry 2020 Jun 17:1039856220933342. Epub 2020 Jun 17.

School of Psychological Sciences, University of Melbourne, Australia.

Objective: Psychiatrists are susceptible intermittently to use dehumanising terms in their clinical practice, which arguably harm patients and their families. Our goal is to shed light on this unwelcome phenomenon and to develop the means to combat it.

Method: We have examined journal articles, books on the history of psychiatry, and educational material devised for psychiatric patients, for evidence of what we have called 'pathogenic language'. Read More

Australas Psychiatry 2020 Jun 14:1039856220933128. Epub 2020 Jun 14.

School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Australia.

Objective: This article discusses the treatment that is actually provided by the Australian mental health system, arguing that the treatment provided constitutes purely psychiatric care in the sense that it is solely reliant on pharmaceuticals. This issue is framed in the context of an increasing mental health disease burden and the need to move to more holistic care in accordance with that advocated by Engel.

Conclusion: Thus, with the predictions of an increase in mental and substance use in the next 30 years, it is imperative to take measures to try to negate this increasing burden and associated costs. Read More

Australas Psychiatry 2020 06;28(3):251-252

Australian Defence Force Centre for Mental Health, HMAS Penguin, Australia.

Australas Psychiatry 2020 06;28(3):368-369

Australas Psychiatry 2020 06;28(3):367

Australas Psychiatry 2020 06;28(3):253

Deputy Editor, Australasian Psychiatry.

Australas Psychiatry 2020 Jun 11:1039856220928875. Epub 2020 Jun 11.

Metro South Addiction and Mental Health Service (MSAMHS), Australia.

Objective: Evaluation of a blended learning adaptation of the accreditation process for supervisors in the Royal Australian and New Zealand College of Psychiatrists' (RANZCP) Competency-Based Fellowship Program.

Method: The adaption of the accreditation process is described, and a mixed-methods approach was taken in its evaluation. Descriptive statistics are presented for participant responses to and engagement with interactive workshop elements. Read More

Australas Psychiatry 2020 Jun 8:1039856220924326. Epub 2020 Jun 8.

Queensland Health, Australia.

Objective: This paper reports the capabilities of mental health nurse (MHN) psychotherapists in Australia and their perceptions on how to best utilize their skills.

Method: An MHN is a registered nurse with recognized specialist qualifications in mental health nursing. One hundred and fifty three MHNs completed an online survey; 12 were interviewed. Read More

Australas Psychiatry 2020 Jun 4:1039856220930680. Epub 2020 Jun 4.

Australas Psychiatry 2020 Jun 4:1039856220928862. Epub 2020 Jun 4.

College of Medicine and Dentistry, James Cook University, Australia.

Objective: The primary aims were to compare the characteristics and health outcomes of consumers entering a regional mental health service compared with a city service.

Method: A retrospective audit was undertaken of consumers aged 18 and over from a regional town and city mental health service. Consumer demographics, diagnoses and outcomes were compared between the two services. Read More

Australas Psychiatry 2020 Jun 4:1039856220930676. Epub 2020 Jun 4.

Monash University, Australia.

Introduction: Contradictory social policies and attitudes about gender diversity raise questions about how we should understand the current status of the historical 'heterosexual' gender regime.

Conclusion: Drawing on the work of the feminist philosopher and psychoanalyst Luce Irigaray, this essay argues that sexual difference is the irreducible starting point for all meaning, sense, morality and affect. Read More

Australas Psychiatry 2020 Jun 2:1039856220928869. Epub 2020 Jun 2.

College of Science, Health, Engineering and Education, Murdoch University, Australia.

Objective: To explore the association between maternal depression and the screen and reading time experienced by their infants.

Methods: This study utilises data on 158 women and infants, collected within the Mercy Pregnancy and Emotional Wellbeing Study. Women less than 20 weeks gestation were diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Read More

Australas Psychiatry 2020 Jun 2:1039856220928871. Epub 2020 Jun 2.

Australas Psychiatry 2020 Jun 2:1039856220926940. Epub 2020 Jun 2.

Alfred Mental & Addiction Health, Alfred Health, Australia.

Objective: Patients admitted to mental health services may exhibit behaviours of concern (BOCs) such as aggression, self-harm, absconding and sexual harm. BOCs can lead to restrictive interventions, which have adverse effects on patients, carers and staff. This paper aims to explore the nature and outcome of BOCs within an adult inpatient mental health setting. Read More

Australas Psychiatry 2020 Jun 2:1039856220930675. Epub 2020 Jun 2.

Monash University, Melbourne, VIC, Australia; and Centre for Mental Health Education and Research at Delmont Private Hospital, Melbourne, VIC, Australia; & Private Psychiatrist, Melbourne, VIC, Australia.

Objective: This paper discusses issues arising from the rapid implementation of metropolitan telepsychiatry in private practice during the Covid-19 public health emergency.

Conclusions: The relatively rapid uptake of private practice metropolitan telepsychiatry may further increase flexibility of the options for appointments through ongoing broad telepsychiatry access after the Covid-19 crisis. Telepsychiatry can be used to facilitate the temporary provision of psychiatric care, and has benefits and risks, but is not a longer-term replacement for the interpersonal richness of face-to-face consultations. Read More

Australas Psychiatry 2020 Jun 2:1039856220928873. Epub 2020 Jun 2.

Translational Health Research Institute Western Sydney University, and Camden and Campbell town Hospitals, Australia.

Objective: To identify the age of onset of eating disorder behaviours (EDBs) and weight/shape overvaluation in a community sample and to evaluate the association between the age of onset and duration of EDBs with health related quality of life (HRQoL).

Method: Data were extracted from the 2008/2009 Health Omnibus Survey (HOS). In 2008, 3034 and in 2009, 3007 participants from a randomly selected sample of households in the Australian population were interviewed for current and age of onset of EDBs. Read More

Australas Psychiatry 2020 Jun 2:1039856220928865. Epub 2020 Jun 2.

Conjoint Lecturer, School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia.

Objective: The COVID-19 national emergency activates legislative powers that allow a proportional infringement upon individual liberties. We canvas the complex legal landscape governing mental health consumers in this climate, highlight ethical considerations in application of the law and offer a simple algorithm to navigate this space.

Conclusion: In times of emergency, it is crucial that we uphold the safeguards embodied within mental health legislation to prevent prejudicial treatment of mental health consumers. Read More

Australas Psychiatry 2020 May 29:1039856220928858. Epub 2020 May 29.

Sydney, NSW.

Australas Psychiatry 2020 May 29:1039856220928860. Epub 2020 May 29.

Royal Melbourne Hospital, Australia; and Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Australia.

Objective: The objective of this study was to determine if homeless men with psychosis in central Melbourne have spent a greater proportion of the past 12 months in homeless settings as compared with the same group 15 years previously.

Method: A 12-month accommodation history was collected from all men with psychosis assessed by a homeless outreach mental health team over a 12-month period commencing 2018 and compared with data from 2006.

Results: Between 2006 and 2018, the percentage of time spent homeless in the previous 12 months rose from 50% to 80% ( = 0. Read More

Australas Psychiatry 2020 May 29:1039856220917076. Epub 2020 May 29.

Institute of Contemporary Psychoanalysis, USA.

Objective: To explore a developmental understanding of childhood gender dysphoria and to compare it to the prevailing paradigm, gender-affirming care.

Conclusion: Viewing gender dysphoria through a contemporary developmental frame generates a different understanding of the nature of the phenomenon and its treatment and raises ethical questions about our current gender-affirming approach. Read More

Australas Psychiatry 2020 May 29:1039856220928863. Epub 2020 May 29.

Private Practice, Southport, Queensland, Australia.

Objective: To explore some of the emerging complexities in the management of childhood gender dysphoria.

Conclusion: The authors raise questions about the gender-affirmation approach and highlight concerns about informed consent and research ethics. Read More

Australas Psychiatry 2020 May 29:1039856220926941. Epub 2020 May 29.

Consultation-Liaisons Psychiatry, Royal Melbourne Hospital, Australia.

Objective: The objective of this study was to identify changes in patients referred to CLP at a typical inner urban teaching hospital over two decades in the context of increased hospital admissions.

Method: Multivariate analyses were conducted on data collected for all referrals to CLP at Royal Melbourne Hospital between 1998 and 2017. Analyses were conducted with reason for referral, current psychiatric contact, psychiatric diagnosis, discharge destination and follow up as dependent variables, and the year and annual hospital admissions as independent variables. Read More

Australas Psychiatry 2020 May 29:1039856220924324. Epub 2020 May 29.

Dunedin School of Medicine, University of Otago, New Zealand.

Objective: A significant number of men suffer from paternal postpartum depression (PPPD). This is detrimental to family and personal well-being. This study aims to report rates of PPPD in first-time fathers in New Zealand. Read More

Australas Psychiatry 2020 May 29:1039856220928866. Epub 2020 May 29.

Department of Psychological Medicine and Rehabilitation & Teaching Unit, University of Otago, New Zealand.

Objective: To remind the clinical and legal practitioner that anosognosia is a recognised facet of schizophrenia with implications for capacity assessment and for relating effectively with people who experience it.

Conclusions: The term anosognosia emphasises that, in schizophrenia, lack of capacity is the result of a neurological deficit. Under-appreciation of this may place that person at risk of a preventable harm. Read More

Australas Psychiatry 2020 May 29:1039856220928876. Epub 2020 May 29.

Metro South Addiction and Mental Health Service, Australia; and University of Queensland, School of Clinical Medicine, Australia.

Objectives: Assertive community treatment (ACT) teams are increasingly being adapted to suit the needs of consumers who have never experienced long-term institutional care yet struggle to retain community tenure and quality of life due to residual functional disabilities associated with severe mental illness. Support needs can be provided by the growing disability support sector but recovery-orientated rehabilitation services delivered by specialist rehabilitation clinicians are also required. The Mobile Intensive Rehabilitation Team (MIRT) within the Metro South Addiction and Mental Health Service has adapted the ACT model to deliver assertive outreach that aims to work collaboratively with the person and their chosen supports to improve their function and their sense of self-efficacy in illness self-management. Read More

Australas Psychiatry 2020 May 22:1039856220924319. Epub 2020 May 22.

Peninsula Health, Australia.

Objectives: Compulsory treatment in psychiatry is controversial and its use has been increasingly critiqued following the United Nations Convention on the Rights of Persons with Disabilities in 2006. This essay seeks to explore whether the restriction of personal liberty and autonomy that compulsory treatment requires can be justified on ethical or medical grounds.

Conclusions: Compulsory treatment is not without potential harms to the doctor-patient therapeutic relationship and patient engagement with mental health services. Read More

Australas Psychiatry 2020 May 22:1039856220924327. Epub 2020 May 22.

Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia.

Objective: We present reflections on student evaluation of teaching (SET) in the context of recent higher educational research that assesses SET, as well as concurrent and/or subsequent student performance.

Conclusions: In a sense, there is in-built cynicism in SET, with more favourable SET for easier assessment. There is emerging evidence that SET is inversely proportional to the performance of students in subsequent courses, i. Read More

Australas Psychiatry 2020 May 22:1039856220924315. Epub 2020 May 22.

Centre for Forensic Behavioural Science, Swinburne University of Technology, Australia.

Objective: A key challenge facing justice health service providers is addressing and treating the high rates of mental illness among offenders. It is well documented that rates of mental illness are substantially higher within prison populations compared to the general population. As such, the need to provide ongoing treatment to prisoners experiencing mental health issues is of fundamental importance. Read More

Australas Psychiatry 2020 May 22:1039856220924317. Epub 2020 May 22.

School of Medicine, Western Sydney University, Sydney, NSW.

Australas Psychiatry 2020 May 22:1039856220931327. Epub 2020 May 22.

Australas Psychiatry 2020 May 22:1039856220924321. Epub 2020 May 22.

Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Spain.

Objective: Borderline personality disorder (BPD) is a severe mental disorder characterized by emotional crises. To date, crisis interventions for BPD have been conducted via telephone calls and emergency units, which are associated with an extra amount of resources. The aim of this research was to test the usability and satisfaction with a psychotherapeutic mobile app for self-managing crises in BPD. Read More

Australas Psychiatry 2020 06 21;28(3):331-334. Epub 2020 May 21.

Orygen, Australia; and Center for Youth Mental Health, The University of Melbourne, Australia.

Objective: Face validity and the best available evidence strongly support the value of early intervention (EI) for psychotic disorders, and increasingly for other mental illnesses. Yet its value continues to be intensely criticised by some academics and doubted by many psychiatrists. This disconnect is examined through the lens of the 'clinician's illusion'. Read More

Australas Psychiatry 2020 May 19:1039856220926934. Epub 2020 May 19.

Australas Psychiatry 2020 May 19:1039856220901471. Epub 2020 May 19.

Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Australia.

Objective: The majority of people with gambling problems contact helplines when they are in crisis, hampering their capacity to explore suitable treatment options. To date, there has been limited research identifying the best way to support individuals to reduce distress and maximise further treatment-seeking. In this paper, we describe the development and piloting of the resulting six-step brief intervention. Read More

Australas Psychiatry 2020 06 12;28(3):364. Epub 2020 May 12.

Sydney, NSW.

Australas Psychiatry 2020 May 11:1039856220917074. Epub 2020 May 11.

The University of Melbourne, Australia.

Objective: The fentanyls have emerged as a significant public health threat in North America but much less so in Australia. We sought to identify reasons for this discrepancy and highlight harm reduction approaches that may mitigate a future Australian fentanyl epidemic.

Conclusions: Differences in drug use 'culture' and a supply of cheap high-quality methamphetamine in Australia may be reasons for the observed difference in fentanyl-related harm. Read More