Enduring themes across journal issues

Sometimes themes endure across multiple issues of the journal, indicating their importance for the field. In the current issue, we see this for three diverse topics: effects of bullying on mental health, physical health of people with psychotic disorders and the role of lithium as a treatment.

Concerning bullying, Scott et al. (2014) suggested that ‘bullying in schools is arguably the most important aetiological factor for mental illness that could be systemically targeted at a population level’. Two articles in the current issue, based on Australian national surveys of adolescents, provide dramatic support for this position (Ford et al., this issue; Thomas et al., this issue). Taken together, these studies show that bullying is common in Australian adolescents and that it has medium-to-large associations with a range of mental health problems and with suicide attempts. Ford et al. (this issue) estimated that ‘a 20% reduction in bullying could be associated with a 11.4% reduction in the proportion of adolescents who self-harm, an 11.2% reduction in suicidal ideation, 11.8% in suicidal planning and 10.4% reduction in suicidal attempts’. These are substantial public health impacts and underline what could be achieved in this area. Given the recent support in Australia for a major effort to reduce suicide through a ‘systems approach’ (Krysinska et al., 2016), interventions to reduce bullying should arguably be an important component.

The second enduring theme is the appalling physical health of people with psychotic disorders, which has been amply demonstrated world-wide. This has been a major focus of the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines on schizophrenia (Galletly et al., 2016) and its expert consensus statement on the physical health of people with psychotic disorders (Lambert et al., 2017), as well as a number of past commentaries in the journal. In the current issue, the theme continues, with evidence from the Survey of High Impact Psychosis that close to half of Australian adults with a psychotic disorder have suboptimal vitamin D status (Suetani et al., this issue). The authors advise that

given the substantial burden of physical co-morbidities and high prevalence of suboptimal vitamin D status in this population, combined with the vitamin D supplement being simple, safe and cheap, we suggest that clinicians should remain mindful of vitamin D status of people with psychotic disorders, and encourage the use of appropriate vitamin D supplements where indicated.

A third enduring theme is lithium as a treatment. This was the topic of an article by John Cade in the very first year of the journal and continues to generate interest and debate, with a number of relevant contributions in the current issue, both specifically on lithium and more generally on the concept of ‘mood stabilizer’. Zivanovic (this issue) reviews the evidence for the effectiveness of lithium, laments its declining use and argues that lithium ‘should once again become the first-line treatment for bipolar disorders’. In commenting on this article, Gitlin (this issue) not only acknowledges the efficacy of lithium but also notes its limitations as a treatment, including the risks involved.

Finally, this month’s issue continues the tradition of publishing letters reporting clinicians’ observations of the effects of interventions on their patients. This is an important tradition, as knowledge of the benefits and harms of psychiatric treatments have evolved from the initial astute observations of clinicians, with Cade’s seminal observations on lithium being a prime example.