Causes

The human population of New Zealand is about one-fifth of Australia’s. It would be reassuring to know that their contribution to medicine is roughly proportionate and complementary. For information about disease as free as possible from distortion, there is no equal in epidemiology to following a population sample prospectively over many years, but this is a demanding investment. New Zealand has been running two such cohorts, in Christchurch and Dunedin. This month, Boden et al. (this issue) report from the former what happens in adulthood to those who abused alcohol in their adolescence. They find two quite different outcomes, an observation of great significance for prevention. But that is not all: this finding adds most usefully to our understanding of pathogenesis. It suggests yet once more that a proportion of the population carries a common vulnerability to a wide range of disorders, the so-called p-factor (Caspi and Moffitt, 2018). In the field of prevention, which remains so challenging for psychiatry, the burden of suicide has come to command close attention and significant funding. So far, no conspicuous success has been achieved globally. Readers may therefore be attracted to a novel approach developed by a quite remarkable consortium of minds, some from outside medicine or behavioural science (Atkinson et al., this issue). Their aim is to use systems modelling and simulation to guide our administrative leaders towards interventions with some chance of reducing both completed suicide and further hospital admissions for self-harm. They used information from four very disparate sources to identify what interventions are likely to carry the greatest impact. Their Figures 2 and 3 are nothing less than arresting, not least for the most unexpected finding about the contribution predicted for general practitioners (GPs). In short, these authors are offering a method to identify what is likely to reduce both suicide and self-harm, what will do little and even what may be deleterious.

The rate at which self-harm and suicidal thoughts in Indigenous Australians present to our hospitals is no longer just alarming. How to assess these deeply troubled individuals in a way that is culturally responsive is far from clear. Clumsy interaction reduces the chances of further help-seeking. Leckning et al. (this issue) have gone to admirable lengths to help health professionals do better when carrying out a psychosocial assessment of Indigenous Australians presenting to hospital with self-harm or thoughts of suicide. The diverse panel of experienced personnel they consulted were unanimous that standardised methods are to be avoided at all costs. Instead, discretion and flexibility are paramount. Readers seeking guidance on how to acquire a better style need to look closely at their synthesis of what the experts have advised. To this writer, how best to conduct the assessment remains obscure, but that may be the reality.

A universe away in South Korea, Park et al. (this issue) tell us that people with Alzheimer’s disease may have their brains partly restored by injections of stem cells from their own bone marrow. They claim this from their work on 25 transgenic mice used as an animal model of this form of dementia. The mice were given injections of their own bone marrow stem cells, which were presumed to cross the blood–brain barrier. A decrease was subsequently observed in β-amyloid deposition but also a functional improvement in memory performance. Note that it is not revealed what changes took place in other mouse tissues, besides cortex. Here, we have advanced molecular medicine carrying some prospects of effective treatment where there is at present so little to offer. In further search for the elusive, in another of humankind’s worst diseases, Liu et al. (this issue) in Australia have used Genome-Wide Association Studies (GWAS), but also functional genomics, to identify genes conferring risk for schizophrenia. Using the Australian Schizophrenia Research Bank cohort, they examined 6.4 million single nucleotide polymorphisms (SNPs) in 429 patients and 255 controls, hoping to achieve a higher resolution analysis than has been possible before.They did find one signal, albeit with a modest odds ratio of 1.82. The usefulness of their finding may be that the associated gene is for a receptor, which in turn leads to a possible therapeutic application.

While cognitive side effects of ECT are universally recognised, they are probably rarely measured, and even more rarely monitored over time.Martin et al. (this issue) advise that routine monitoring can bring about better patient outcomes by dosing adjustments and spacing of treatments. But what instrument should one use, when considering pressure on staff time and tolerability for very unwell patients? They have reviewed the available instruments and identified the Montreal Cognitive Assessment as particularly attractive, with some useful alternatives.

When patients are admitted to acute psychiatric units, this is seen as a good opportunity to have them stop smoking tobacco, which the majority do. There has been some success in this initiative, but what actually happens to people probably varies greatly. How is their smoking status assessed on admission and are all smokers offered a smoking cessation intervention? Plever et al. (this issue) have examined just that over a 2-year period in Queensland inpatient units. Happily, they found that practice was indeed improving, albeit slowly and the possible reasons are unclear. One should note that offering help to stop smoking varied from 3% to 100% across Mental Health Services. Here is a source of encouragement to do better in this indisputably worthwhile intervention.

Australia and New Zealand have endured exceptional adversity in recent times. It would be surprising if ferocious bushfires, earthquakes, terrorist attacks, Covid-19, self-isolation and unemployment have not adversely affected mental health at the population level. What the epidemiological changes really are, their symptom type, distribution, duration and consequent help-seeking will become apparent in the months ahead. In admirably restrained language, Looi et al. (this issue) go further. They say the media are making things worse. Exposure to the constant reports should be limited and the media should adopt guidelines akin to those for reporting suicide. Our readers may want to give some thought to Looi et al.’s idea that the media have made the impact of adverse events even worse. Meanwhile, we may be comforted that residents of countries such as the People’s Republic of China are protected by the State from receiving harmful information.