Australasian Psychiatry

Research has repeatedly failed to account for the high suicide rate post-discharge from a psychiatric hospital. It is apparent that research in this field largely focuses on simple categorical variables and fails to consider inpatient experiences of their admission and treatment.

Empirically investigating how the treatment experience itself can contribute to post-discharge adverse outcomes is required. Failure to broaden our investigation into causes of post-discharge suicide will hamper our efforts in addressing this devastating issue.

To evaluate confidence levels of junior doctors working in the paediatric emergency department (ED) in the assessment and management of acute mental health presentations.

This cross-sectional study invited 89 eligible junior doctors in an Australian paediatric ED to complete an online survey. Information about clinical experience was collected, and self-report confidence levels assessed using 5-point Likert scale. Descriptive statistics and comparative analysis were conducted using the Mann–Whitney U test.

28 participants responded to the survey. Participants indicated feeling less confident in domains of assessment and management such as managing acute agitation, having knowing of referral pathways and support services compared to other domains. Confidence levels did not significantly differ based on training level or prior experience. Suggestions for future training included scenario-based learning, clinical simulation, education on referral pathways and acute behavioural disturbance.

This study reveals generally low confidence levels of junior doctors in assessment and management of acute mental health presentations to the paediatric ED. Confidence levels did not significantly differ between groups based on clinical experience and varied across domains of assessment and management. The study highlights a need for further training to address the current skills and knowledge gap in this area.

Consultation liaison psychiatry (CLP) is a subspeciality of psychiatry that integrates mental health care into non-psychiatric departments of a general hospital. The Mackay Hospital and Health Service (MHHS) commenced CLP services in 2016, with referrals increasing annually. However, literature describing and evaluating regional CLP services remains scarce.

This study aimed to evaluate referrer satisfaction with the MHHS CLP service through a staff satisfaction survey, and to inform service improvement and development planning.

A 14-question survey, based on the Service Model for CLP in Victoria, was distributed to relevant hospital departments from May to September 2022. The survey assessed users’ backgrounds, reasons for referrals, service awareness, efficiency, satisfaction, and included open feedback.

Diagnostic clarification, medication review, and risk assessment were the primary reasons for referral. The service’s consultationliaison aspects and response times were highly rated. Positive feedback centred on access and communication while suggested improvement highlighted outpatient care and education opportunities.

There is a strong perceived need and high satisfaction with the local CLP service, which provides quality and efficient care. Implementing suggested improvements will require input and resources from key stakeholders.

Methamphetamine dependence is associated with psychological distress (stress, anxiety, and depression). Insomnia is common in this population, yet its association with distress remains underexplored. This study examined the relationship between insomnia severity and psychological distress in treatment-seeking individuals with methamphetamine dependence.

This is a secondary cross-sectional analysis of baseline data from 152 participants enrolled in a randomised controlled trial of lisdexamfetamine versus placebo for methamphetamine dependence. Insomnia severity was assessed using the Insomnia Severity Index (ISI), and distress was measured via the Depression Anxiety and Stress Scale (DASS-21). Associations were analysed using Spearman’s correlations and regression models adjusted for demographics, methamphetamine use, concomitant medication, and co-occurring distress.

Insomnia severity showed moderate correlations with depression, anxiety, stress, and total distress (ρ = 0.46–0.59, p < .001). In adjusted models, insomnia remained associated with distress: each 1-point ISI increase related to a 2.1–2.5% rise in DASS-21 depression and stress scores (β = 0.021–0.025, p = .003–.007), and a 6.5% increase in total scores (β = 0.063, p < .001); the association with anxiety was attenuated.

Our study identified insomnia as an independent correlate of psychological distress in treatment-seeking individuals with methamphetamine dependence. Findings underscore sleep problems’ relevance and support further research into sleep-focused interventions.

This study examined stimulant and medicinal cannabis prescribing in individuals before and after referral to an early psychosis (EP) service in Queensland, Australia.

A retrospective review of 220 consecutive EP referrals (2019–2023) was conducted, extracting data on stimulant and medicinal cannabis prescriptions from clinical records. Longitudinal prescribing patterns were analysed, with descriptive comparisons of Δ9-tetrahydrocannabinol (THC) concentrations in medicinal cannabis prescriptions before and after the onset of psychosis.

Prior to referral, 4.5% of patients were prescribed stimulants and 3.2% medicinal cannabis, with most having a history of substance use. After a psychotic episode, 3.2 % were prescribed stimulants and 6.8% were prescribed medicinal cannabis, with mean THC concentrations higher after the onset of a psychotic illness (31.4% vs 16.9%). Over 70% of those prescribed stimulants and 60% prescribed medicinal cannabis after experiencing a psychotic episode had further contact with mental health services due to concerns about a deterioration in mental state where these medications were thought to be a contributory factor.

It is of concern that THC concentrations were higher in prescriptions made post-EP discharge. Enhanced safeguards are required to mitigate risks and reliably identify patients where such prescription would be contraindicated.

Clozapine is effective, but is associated with cardiometabolic disease burden. The cardiometabolic health of Indigenous Australians taking clozapine is unclear. This study aimed to determine the cardiometabolic health state and management of Indigenous and non-Indigenous clozapine patients over 1 year.

A retrospective cross-sectional observational study using clinical data from a regional clozapine clinic. We calculated QRisk3 cardiovascular disease (CVD) risk scores and the prevalence of diabetes, hypertension and metabolic syndrome (MES). Cardiometabolic monitoring and management were also analysed. Findings were compared between Indigenous and non-Indigenous patients.

Overall, 76 patients were included (35.5% Indigenous). Ninety-seven percent had complete metabolic monitoring data for MES. Prevalences of diabetes (22.3%), hypertension (42.1%), and MES (68.4%) were high. Indigenous patients had significantly higher levels of diabetes, CVD risk and reduced high-density lipoprotein (HDL). The majority (84.2%) of patients received lifestyle advice. Follow-up with allied health services and communication with general practicioners (GPs) was limited. Indigenous patients were significantly more likely to receive pharmacological treatments.

A high cardiometabolic disease burden was observed, which was significantly greater in Indigenous patients. All received excellent cardiometabolic monitoring, but lifestyle interventions were underutilised. Clear treatment guidelines and better integration of monitoring and management are required.

To describe the need for specialised women’s mental health services and the development of Australia’s first women’s mental health hospital service in the 21st century.

Women in Australia experience a high level of violence and trauma. Compounding their past experiences with sexual violence, Australian and United States data indicate that a significant percentage of inpatients experience sexual violence during a psychiatric admission. Despite many reviews of mental health service provision, co-gendered wards, with noted incidents of assault against women inpatients, continue to be the usual mode of service in both the public and private healthcare sectors in Australia. Inpatient and community therapeutic programmes have not met the special needs of women. The establishment of Australia’s first women-only mental health hospital at Cabrini Health in 2021 demonstrates the feasibility and value of a specialised, trauma-focused and holistic model of care. These developments highlight the urgent need for broader service reform to ensure safe inpatient facilities and gender-focused therapeutic programs for women.

Describe prescribing patterns in Australian Vietnam veterans, identify CYP2C19-metabolised medications using established pharmacogenetic (PGx) resources, characterise CYP2C19 profiles of veterans and assess the potential clinical impact of these medications.

Among 283 veterans with CYP2C19 profiles, 256 reported current medications use, with a mean prescribed medication of 5.4. Of these, 89 veterans (34.7%) were prescribed at least one medication with CYP2C19 PGx recommendation. Notably, 52 veterans (58.4%) had CYP2C19 profiles that may be at risk of therapeutic failure or adverse effects. Prescribed medications also included six CYP2C19 inhibitors and one inducer, with potential to induce phenoconversion and impact drug metabolism.

Veterans experienced high levels of polypharmacy and frequently carried CYP2C19 phenotypes associated with increased risk of therapeutic failure or adverse effects. The presence of CYP2C19 inhibitors and inducers raises the potential for phenoconversion, where CYP2C19 profiles may be placed at risk. Given their similarities to the broader older population, these findings suggest that both groups may benefit from pre-emptive PGx testing. Furthermore, ongoing monitoring of drug–gene and drug–drug interactions remains essential to optimise medication safety and efficacy in these high-risk individuals.

The most common psychiatric disorders in adolescents are anxiety and mood disorders. Often, anxiety itself is a prelude to depression and irritability is an antecedent to both. Thus, irritability likely heralds the onset of mental illness in adolescents, especially those disorders with a bias in gender prevalence. Consequently, it is necessary to examine irritability to obtain a comprehensive understanding of this phenomenon. Further, factoring gender into these examinations may provide insights into its nature and the role it putatively plays in the development of anxiety, depression and suicide in adolescence. Presently, efforts for early intervention look to identifying established disorders early in their course; however, by detecting symptoms that are precursors it may be possible to shift the focus of health practice and policy.

Viewing irritability through a lens of gender during adolescence may yield key insights that inform our understanding of how disorders and outcomes that have a bias in gender prevalence emerge. By considering the divergent experiences of puberty, and factoring these into our mechanistic understanding of irritability, pathways for future systematic examinations become clearer.

To describe the clinical features and outcomes of persons aged 60 years and over admitted to Darlinghurst Reception House between 1868 and 1900, and to compare their outcomes and use of alcohol with those under the age of 60.

Data were extracted from the medical case books and admission and discharge registers of Darlinghurst Reception House at the New South Wales State Archives.

There were 12,745 admissions of which 911 (7.1%) were aged 60 years and over. The majority had cognitive symptoms (54%), followed by behavioural issues (32.3%) and psychosis (19.6%). Alcohol was implicated in 129 cases (14.2%), less than in admissions aged under 60 (22.5%). Dementia was diagnosed in over 50%. Most (n = 721, 79.1%) were transferred to a hospital for the insane, 178 (19.5%) were discharged (38.2% alcohol-related) and 12 (1.3%) died. These outcomes were worse than for those aged under 60 in whom 28.8% were discharged (57.9% alcohol-related) and 0.7% died.

Older people were regularly admitted to Darlinghurst Reception House for mainly cognitive disorders that usually resulted in transfer to a hospital for the insane. Alcohol was less frequently implicated than in younger people.