Australian & New Zealand Journal of Psychiatry

Aggression is a persistent clinical challenge, particularly prevalent in individuals with psychotic disorders. This systematic review aimed to compile current non-restrictive clinical interventions for aggression management in this population and identify those supported by a high level of evidence.

A systematic literature search was conducted across Scopus/Elsevier/ClinicalKey/Embase, PubMed, Cochrane Library and CINAHL from 27 March to 10 May 2024. The review included randomized controlled trials (RCTs), non-randomized controlled trials and pre–post studies without a control group. From an initial pool of 575 records, 17 studies met the inclusion criteria for evidence assessment.

The 17 included studies comprised 15 RCTs, 1 non-randomized controlled trial and 1 pre–post study. Eleven studies demonstrated that the tested interventions were effective for aggression management, with evidence levels rated as high to moderate. Interventions were categorized into six groups: risk assessment (n = 2), cognitive skills improvement interventions (n = 2), social skills improvement interventions (n = 1), environmental management (n = 1), staff training (n = 3) and multicomponent interventions (n = 8). The findings underscore the necessity of multicomponent, holistic approaches over single-dimensional strategies.

The review confirms the benefits of cognitive and social interventions and reinforces the effectiveness of staff de-escalation training. The positive results for sleep hygiene and therapeutic environment interventions support their integration into multidimensional aggression management protocols. Future research should employ larger RCTs to assess long-term sustainability, identify patient subgroups most likely to benefit from specific interventions and evaluate cost-effectiveness. This review is registered with PROSPERO (CRD42024579465).

People with psychotic disorders face significant functional impairments, high levels of disability, multimorbidity and physical health challenges. Despite unique health benefits, resistance training remains underexplored in this population and rarely implemented in real-world mental health settings.

This randomised controlled trial comparing resistance training with aerobic interval training in people with psychotic disorders accessing psychiatric rehabilitation. Supervised exercise sessions by exercise physiologists were conducted 3 times per week over 8 weeks. Primary outcomes were feasibility, acceptability and adverse events. Secondary outcomes were psychiatric symptoms, global and physical functioning and the effect of randomisation to exercise type on participation rates.

In total, 54 participants (median age 31 years, 71.6% male, 75% diagnosed with schizophrenia/schizoaffective disorder, 55.5% with ⩾3 health conditions) were enrolled. Resistance training met predetermined feasibility and acceptability thresholds and showed comparable results to aerobic interval training with no significant exercise-related adverse events. Within-group analysis revealed significant increases in muscle strength following resistance training. Post-intervention, resistance training participants reported more total weekly minutes of physical activity compared to aerobic interval training, though no other significant between-group differences were observed. Randomisation to exercise type did not influence participation.

In conclusion, resistance training was feasible and acceptable to people with psychotic disorders, with no serious adverse events and comparable to aerobic interval training. Resistance training was successfully implemented in rehabilitation settings with promising improvements in muscle strength and self-reported physical activity. In future, larger longer-term trials comparing resistance training with aerobic interval training, and in comparison with other psychosocial therapies are warranted. Further exploration of participant preference for exercise type on outcomes is recommended.

This study aimed to examine the association of trauma exposure and shame on the clinical presentation of individuals experiencing psychosis (including suicidal behaviours).

A retrospective audit of clinical data collected over a 4-year period from a tertiary psychosis service was conducted. All individuals accessing the service had experience of psychosis.

Data from 201 individuals who completed assessments between 2020 and 2024 were analysed. Exposure to trauma was high, with all reporting experience of at least one traumatic event. Trauma related to psychosis symptoms (64.0%) and treatment experiences following psychosis (57.0%) were particularly prevalent. Exposure to lifespan trauma was positively related to the number of lifetime suicide attempts, r(90) = 0.22, p = 0.038. Higher levels of shame were associated with an increased frequency of current suicide ideation, External shame: (r(51)= 0.46, p < 0.001); Internal shame: (r(50) = 0.45, p < 0.001).

These findings highlight different, though related, associations between suicidal behaviours with trauma exposure and shame. While trauma is associated with suicidal behaviours, shame is correlated with suicidal ideation, raising implications for assessment and intervention. Future work could examine whether suicide ideation in this group is influenced by psychological interventions that target shame.

While people experiencing severe mental illness have a greater prevalence of physical multimorbidity, data on incidence are largely limited to the onset of specific physical conditions. We assessed whether people with severe mental illness have increased incidence rates of physical multimorbidity compared to people with other psychiatric conditions.

This retrospective observational cohort study reported on a longitudinal psychiatric inpatient sample (2010–2024) in a metropolitan service in Brisbane, Australia. Within a subgroup of individuals with no pre-existing physical conditions, we compared individuals with and without a history of severe mental illness (schizophrenia-spectrum or bipolar disorder). With a denominator of person-years, we calculated the incidence of different thresholds of physical multimorbidity using adjusted Fine-Gray subdistribution hazard ratios.

Among the 3310 individuals with severe mental illness, 298 developed physical multimorbidity (two chronic physical conditions) across 21893 person-years, compared to 52 among the 2850 individuals and 18,112 person-years in the comparison group. When adjusted for clinical and demographic covariates, people with severe mental illness had an increased risk of developing one (subdistribution hazard ratio = 3.36; 95% confidence interval = 2.79, 4.03), two (subdistribution hazard ratio = 4.06; 95% confidence interval = 3.02, 5.46), three (subdistribution hazard ratio = 5.36; 95% confidence interval = 3.35, 8.59), and four (subdistribution hazard ratio = 4.84; 95% confidence interval = 2.49, 9.40) chronic physical conditions. Except for malignancy and genitourinary disease, people with severe mental illness had increased incidence of chronic physical conditions in all other organ systems.

People with severe mental illness experienced greater incidence rates of multimorbidity at various thresholds, with a majority of organ systems affected. This highlights the need for holistic prevention and intervention strategies to curb the accumulation of physical multimorbidity.

Initial presentations of psychosis require a thorough physical health assessment to identify comorbidities, establish treatment safety and exclude organic causes of psychosis. Despite clinical consensus that these assessments are essential, global guidelines are variable and outdated. This work aimed to synthesise current evidence to inform updated recommendations for physical assessments in psychosis, balancing thorough investigation with practical applicability.

A scoping review of physical health disorders associated with psychosis was conducted using PubMed, Embase and CINAHL. Separately, a systematic review of international guidelines from 2000 to 2025 was performed, extracting physical health assessment recommendations for schizophrenia spectrum disorders. A narrative analysis evaluated the clinical utility of identified investigations.

Eighty-four physical health disorders with potential psychotic presentations were identified, mostly rare and typically associated with other neurological or systemic features. There was significant heterogeneity in investigations advised by the 25 identified guidelines, outside of the common consideration for metabolic screening. The majority of guidelines considered investigations for both the exclusion of organic causes of psychosis and identifying a physical health baseline or comorbidity. There was limited consistency around recommendations for neuroimaging or autoimmune screening. Clinical assessment remains central to determining appropriate investigations.

Global inconsistency in assessment recommendations reflects the complexity of distinguishing organic psychoses from primary psychiatric disorders. Structured yet individualised assessments, informed by symptomatology and risk factors, are essential. A staged, context-sensitive approach is proposed to optimise diagnostic accuracy and avoid unnecessary testing. Updated, evidence-informed guidelines are critical for improving care for people with psychosis.

Poor oral health is a common, but overlooked, issue among people with serious mental ill-health who experience higher rates of dental caries and periodontal disease, leading to increased hospital admissions. Despite its preventability, oral health remains largely absent from Australian mental healthcare policy and service delivery.

This two-phase study (1) systematically reviewed oral health integration within Australian oral and mental health policy and competitive funding mechanisms; and (2) qualitatively explored the experiences and prioritising of oral health care by individuals with serious mental ill-health, carers and healthcare professionals.

Findings indicated that oral health is rarely prioritised in mental health policy and that it receives only 0.22% of health research funding. Eighteen participants, including health practitioners and individuals with lived experience, were interviewed. Participants described oral health as being largely ignored, personal experiences of inadequate care, financial and psychological barriers to care and systemic neglect. Recommendations for change were identified, including a need for trauma-informed, holistic approaches to care that address social determinants and promote oral health within mental health services.

Poor oral health significantly, and negatively, impacts both quality of life and hospital admissions for people with serious mental ill-health, yet remains overlooked in mental health care. Holistic, interdisciplinary approaches – integrating oral health into psychiatric assessments, education and policy – are essential. Early intervention, public health messaging, trauma-informed training and personalised care may improve outcomes. Co-produced interventions and equitable access to services are critical to reducing oral health disparities and enhancing well-being for individuals living with serious mental ill-health.