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Aims: Community treatment orders have been introduced in many jurisdictions with increasing use over time. We conducted a rapid umbrella review to synthesise the quantitative and qualitative evidence from systematic reviews and/or meta-analyses of their potential harms and benefits. Methods: A systematic search of Medline, PubMed, Embase and PsycINFO for relevant systematic reviews and/or meta-analyses. Where available, participants on community treatment orders were compared with controls receiving voluntary psychiatric treatment. This review is registered with PROSPERO (CRD42023398767) and the Open Science Framework (https://osf.io/zeq35). Results: In all, 17 publications from 14 studies met the inclusion criteria. Quantitative synthesis of data from different systematic reviews was not possible. There were mixed findings on the effects of community treatment orders on health service use, and clinical, psychosocial or forensic outcomes. Whereas uncontrolled evidence suggested benefits, results were more equivocal from controlled studies and randomised controlled trials showed no effect. Any changes in health service use took several years to become apparent. There was evidence that better targeting of community treatment order use led to improved outcomes. Although there were other benefits, such as in mortality, findings were mostly rated as suggestive using predetermined and standardised criteria. Qualitative findings suggested that family members and clinicians were generally positive about the effect of community treatment orders but those subjected to them were more ambivalent. Any possible harms were under-researched, particularly in quantitative designs. Conclusions: The evidence for the benefits of community treatment orders remains inconclusive. At the very least, use should be better targeted to people most likely to benefit. More quantitative research on harms is indicated. [ABSTRACT FROM AUTHOR]

Introduction: People with pre-existing mental health conditions may have been disproportionally impacted by the COVID-19 pandemic and associated public health restrictions. In this study, we compared psychological outcomes, experiences and sources of stress over the pandemic lockdown in New Zealanders with and without a previous diagnosis of mental illness. Methods: Two online surveys were conducted in New Zealand over the level 4 lockdown in April 2020 measuring psychological distress, anxiety, well-being, suicidality, alcohol use and subjective experiences. They included 3389 participants, of whom 18.4% reported having been previously diagnosed with a mental illness. Results: During the lockdown, people previously diagnosed with a mental illness had about twice the risk of reporting moderate-high levels of psychological distress (K10 ⩾ 12), at least moderate levels of anxiety (GAD-7 ⩾ 10) and poor well-being (WHO-5 ⩽ 12). They reported increased alcohol use and were about four times as likely to have experienced suicidal thoughts with 3% reporting having made a suicide attempt over the lockdown period. They reported less satisfaction with, and poorer relationships with people in their 'bubble', reduced social contacts and greater loneliness. They also reported higher levels of health and financial concerns. Conclusion: During the COVID-19 lockdown in New Zealand, people with a previous diagnosis of a mental illness were at increased risk of detrimental psychological outcomes. This highlights the importance of recognising this and the challenges people face in pandemics. [ABSTRACT FROM AUTHOR]

Objective: The Health of the Nation Outcome Scales was developed as an overall measure of mental health, applicable to the complete range of psychiatric disorders. Meanwhile, it is a benchmark tool for service providers and is also used for the allocation of costs and funding. The ability of the Health of the Nation Outcome Scales to assess and differentiate the severity of psychiatric disorders is largely unknown, as it is the interpretation of a change in score. We aim to establish Health of the Nation Outcome Scales cut-off and benchmark values for severity and improvement – respectively change, using equipercentile linking to the Clinical Global Impression scales. Methods: In a clinical sample of 30,616 individuals with a psychiatric disorder, we used a multivariate regression analysis to determine the correlation between the scales and possible confounders. We used an equipercentile linking analysis of the Clinical Global Impressions severity scale with the Health of the Nation Outcome Scales sum score to establish cut-off values for severity. The linking of the Health of the Nation Outcome Scales sum score difference and the percentage of change to the Clinical Global Impression improvement scale determined benchmark values for change (i.e. improvement or deterioration). Results: The Health of the Nation Outcome Scales and Clinical Global Impression scales showed a Spearman correlation of 0.38 (p < 0.000). Clinical Global Impression–Severity: 'borderline-ill' corresponded to Health of the Nation Outcome Scales score 3–5; 'mildly ill' to 6–10; 'moderately ill' to 11–16; 'markedly ill' to 17–25; 'severely ill' to 26–35; and 'extremely ill' to a score ⩾36. The Spearman correlation between the percentage change of the Health of the Nation Outcome Scales was 0.39 (p > 0.000); Clinical Global Impression–Improvement: 'minimally improved' corresponded to Health of the Nation Outcome Scales reduction of 4 points or 9%; 'much-improved' to 12 points or 48%; 'very-much-improved' to ⩾20 points or ⩾90%. Clinical Global Impression–Improvement: 'minimally worse' corresponded to an increase of 6 points or 25%; 'much-worse' to 12 points or 54%; and finally, 'very-much-worse' to >18 points or ⩾82%. Conclusion: Our results allow for the comparison of severity and response to treatment of patients with a psychiatric disorder, independent of diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Adverse childhood experiences are linked to the development of a number of psychiatric illnesses in adulthood. Our study examined the pattern of adverse childhood experiences and their relation to the age of onset of major psychiatric conditions in individuals from families that had ⩾2 first-degree relatives with major psychiatric conditions (multiplex families), identified as part of an ongoing longitudinal study. Methods: Our sample consisted of 509 individuals from 215 families. Of these, 268 were affected, i.e., diagnosed with bipolar disorder (n = 61), obsessive–compulsive disorder (n = 58), schizophrenia (n = 52), substance dependence (n = 59) or co-occurring diagnoses (n = 38), while 241 were at-risk first-degree relatives who were either unaffected (n = 210) or had other depressive or anxiety disorders (n = 31). All individuals were evaluated using the Adverse Childhood Experiences – International Questionnaire and total adverse childhood experiences exposure and severity scores were calculated. Results: It was seen that affected males, as a group, had the greatest adverse childhood experiences exposure and severity scores in our sample. A Cox mixed effects model fit by gender revealed that a higher total adverse childhood experiences severity score was associated with significantly increased risk for an earlier age of onset of psychiatric diagnoses in males. A similar model that evaluated the interaction of diagnosis revealed an earlier age of onset in obsessive–compulsive disorder and substance dependence, but not in schizophrenia and bipolar disorder. Conclusion: Our study indicates that adverse childhood experiences were associated with an earlier onset of major psychiatric conditions in men and individuals diagnosed with obsessive–compulsive disorder and substance dependence. Ongoing longitudinal assessments in first-degree relatives from these families are expected to identify mechanisms underlying this relationship. [ABSTRACT FROM AUTHOR]

Background: Hospital-treated deliberate self-poisoning is common, with a median patient age of around 33 years. Clinicians are less familiar with assessing older adults with self-poisoning and little is known about their specific clinical requirements. Objective: To identify clinically important factors in the older-age population by comparing older adults (65+ years) with middle-aged adults (45–64 years) during an index episode of hospital-treated deliberate self-poisoning. Methods: A prospective, longitudinal, cohort study of people presenting to a regional referral centre for deliberate self-poisoning (Calvary Mater Newcastle, Australia) over a 10-year period (2003–2013). We compared older-aged adults with middle-aged adults on demographic, toxicological and psychiatric variables and modelled independent predictors of referral for psychiatric hospitalisation on discharge with logistic regression. Results: There were (n = 157) older-aged and (n = 925) middle-aged adults. The older-aged group was similar to the middle-aged group in several ways: proportion living alone, reporting suicidal ideation/planning, prescribed antidepressant and antipsychotic drugs, and with a psychiatric diagnosis. However, the older-aged group were also different in several ways: greater proportion with cognitive impairment, higher medical morbidity, longer length of stay, and greater prescription and ingestion of benzodiazepines in the deliberate self-poisoning event. Older age was not a predictor of referral for psychiatric hospitalisation in the multivariate model. Conclusion: Older-aged patients treated for deliberate self-poisoning have a range of clinical needs including ones that are both similar to and different from middle-aged patients. Individual clinical assessment to identify these needs should be followed by targeted interventions, including reduced exposure to benzodiazepines. [ABSTRACT FROM AUTHOR]

Objectives: Although the prevalence and mental health consequences of childhood maltreatment among adolescents have been studied widely, there are few data addressing these issues in Asian lower middle–income countries. Here, we assessed the prevalence and types of childhood maltreatment and, for the first time, examined their association with current mental health problems in Indian adolescents with a history of child work. Methods: One hundred and thirty-two adolescents (12–18 years; 114 males, 18 females) with a history of child work were interviewed using the Child Maltreatment, Conventional Crime, and Witnessing and Indirect Victimisation modules of the Juvenile Victimization Questionnaire. Potential psychiatric diagnoses and current emotional and behavioural problems were assessed using the culturally adapted Hindi versions of the Youth's Inventory–4R and the Strengths and Difficulties Questionnaire, respectively. Results: A large proportion of the sample reported childhood abuse or neglect (83.36%), direct or indirect victimisation (100%) and experienced symptoms of one or more psychiatric disorders (83.33%). Of the most common maltreatment types, physical abuse was present for 72.73% (extra-familial 56.25%, intra-familial 42.71%), emotional abuse for 47.7% (extra-familial 74.6%, intra-familial 12.9%), general neglect for 17.4% and unsafe home for 45.5% of the adolescents. All these maltreatment types were associated with poor mental health, with emotional abuse showing the strongest and wide-ranging impact. Conclusions: Indian adolescents with a history of child work are at an extremely high risk of extra-familial physical and emotional abuse as well as victimisation. They also experience a range of psychiatric symptoms, especially if they suffered emotional abuse. There is an urgent need for routine mental health screening and to consider emotional abuse in all current and future top-down and bottom-up approaches to address childhood maltreatment, as well as in potential interventions to ameliorate its adverse effects on mental health and well-being, of child and adolescent workers. [ABSTRACT FROM AUTHOR]

The authors explore the idea of staging psychiatric disorders for better diagnosis and treatment. It notes on the staging being used in diagnosing cancer. It cites the overlapping problems in relation to staging of psychiatric disorders such as phenomenal problem, coupling problem and trajectory of change problem.

Objective: Ketamine may reduce suicidal ideation in treatment-resistant depression. But it is not known how quickly this occurs and how long it persists. We undertook a systematic review and meta-analysis to determine the short- and long-term effectiveness of ketamine for suicidality. Method: CENTRAL, EMBASE, Medline, and PsycINFO were searched until 12 December 2018. Randomised controlled trials of ketamine or esketamine reporting data on suicidal ideation, self-harm, attempted or completed suicide in adults diagnosed with any psychiatric disorder were included. Two reviewers independently extracted data, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Standardised mean difference was used for continuous outcomes. Results: Twenty-five reports from 15 independent trials, with a total of 572 participants diagnosed with predominately affective disorders, were included. The evidence was rated moderate to low. In most trials, ketamine was administered at 0.5 mg/kg via a single intravenous infusion over a 30- to 45-minute period. Only a single trial of intranasal esketamine was identified. At 4 hours post-infusion, treatment with ketamine was associated with a significant reduction in suicidal ideation scores (standardised mean difference = −0.51, 95% confidence interval = [−1.00, −0.03]), which persisted until 72 hours post-infusion (time points between 12 and 24 hours: standardised mean difference = −0.63, 95% confidence interval = [−0.99, −0.26]; between 24 and 72 hours: standardised mean difference = −0.57, 95% confidence interval = [−0.99, −0.14]), but not thereafter. However, there was marked heterogeneity of results. In a single trial of esketamine, marginal effects on suicidal ideation were observed. In terms of actual suicidal behaviour, there were virtually no data on effects of ketamine or esketamine. Conclusion: A single infusion of ketamine may have a short-term (up to 72 hours) beneficial impact on suicidal thoughts. While confirmation of these results in further trials is needed, they suggest possible use of ketamine to treat acute suicidality. Means of sustaining any anti-suicidal effect need to be found. [ABSTRACT FROM AUTHOR]

Objective: Neurofilament light has shown promise as a biomarker for diagnosis, staging and prognosis in a wide range of neurological and neurodegenerative disorders. This study explored the utility of cerebrospinal fluid neurofilament light in distinguishing primary psychiatric disorders from neurodegenerative and neurological disorders, a common diagnostic dilemma for psychiatrists and neurologists. Methods: This cross-sectional retrospective pilot study assessed cerebrospinal fluid neurofilament light on patients referred to a tertiary neuropsychiatry service from 2009 to 2017 for diagnostic assessment of neuropsychiatric and neurocognitive symptoms, where a neurodegenerative disorder was a differential diagnosis, who received lumbar punctures as part of a comprehensive workup. The most recent gold-standard clinical consensus diagnosis was categorised into psychiatric disorder or neurodegenerative or neurological disorder. Data from healthy controls were available for comparison. Data extraction and diagnostic categorisation was blinded to neurofilament light results. Results: A total of 129 participants were included: 77 neurodegenerative or neurological disorder (mean age 57 years, including Alzheimer's dementia, frontotemporal dementia), 31 psychiatric disorder (mean age 51 years, including schizophrenia, major depressive disorder) and 21 healthy controls (mean age 66 years). Neurofilament light was significantly higher in neurodegenerative or neurological disorder (M = 3560 pg/mL, 95% confidence intervals = [2918, 4601]) compared to psychiatric disorder (M = 949 pg/mL, 95% confidence intervals = [830, 1108]) and controls (M = 1036 pg/mL, 95% confidence intervals = [908, 1165]). Neurofilament light distinguished neurodegenerative or neurological disorder from psychiatric disorder with an area under the curve of 0.94 (95% confidence intervals = [0.89, 0.98]); a cut-off of 1332 pg/mL was associated with 87% sensitivity and 90% specificity. Conclusion: Cerebrospinal fluid neurofilament light shows promise as a diagnostic test to assist with the often challenging diagnostic dilemma of distinguishing psychiatric disorders from neurodegenerative and neurological disorders. Further studies are warranted to replicate and expand on these findings, including on plasma neurofilament light. [ABSTRACT FROM AUTHOR]

Objective: The current international trend is to create large datasets with existing data and/or deposit newly collected data into repositories accessible to the scientific community. These practices lead to more efficient data sharing, better detection of small effects, modelling of confounders, establishment of sample generalizability and identification of differences between any given disorders. In Australia, to facilitate such data-sharing and collaborative opportunities, the Neurobiology in Youth Mental Health Partnership was created. This initiative brings together specialised researchers from around Australia to work towards a better understanding of the cross-diagnostic neurobiology of youth mental health and the translation of this knowledge into clinical practice. One of the mandates of the partnership was to develop a protocol for harmonised prospective collection of data across research centres in the field of youth mental health in order to create large datasets. Methods: Four key research modalities were identified: clinical assessments, brain imaging, neurocognitive assessment and collection of blood samples. This paper presents the consensus set of assessments/data collection that has been selected by experts in each domain. Conclusion: The use of this core set of data will facilitate the pooling of psychopathological and neurobiological data into large datasets allowing researchers to tackle important questions requiring very large numbers. The aspiration of this transdiagnostic approach is a better understanding of the mechanisms underlying mental illnesses. [ABSTRACT FROM AUTHOR]

Objectives: Schizophrenia is a serious and chronic mental illness known to have broad ranging impacts for individuals across the lifespan, yet research on the disease in older adults is sparse. This study provides a profile of the sociodemographic, environmental and diagnostic characteristics of older community residents with schizophrenia using a national database. Methods: A cross-sectional sample of individuals who underwent community needs assessment using the standardised Home Care International Residential Assessment Instrument between 1 September 2012 and 31 January 2016 was utilised. Sociodemographic, diagnostic, and social and environmental variables were measured for individuals with a diagnosis of schizophrenia and compared to those without a diagnosis of schizophrenia. Statistical investigations employed bivariable and multivariable logistic regression models. Results: A total sample of 71,859 was eligible and 517 (0.7%) had a diagnosis of schizophrenia. The majority of the sociodemographic variables were statistically associated with schizophrenia in the adjusted analysis, except for ethnicity (p = 0.35). Nearly all the measured social and environmental variables were adversely associated with having a diagnosis of schizophrenia, such as living in squalid conditions (adjusted odds ratio = 2.16; 95% confidence interval = [1.42, 3.28]). Participants with schizophrenia were significantly more likely to be diagnosed with all assessed psychiatric comorbidities (p < 0.001) and diabetes mellitus (p = 0.002), whereas coronary heart disease (p = 0.001) and other physical comorbidities (p = 0.001) were found at significantly lower rates. Conclusion: The profile of schizophrenia found here suggests some subtle differences in the demographic profile and distribution of medical comorbidities in the older population with schizophrenia. The results also suggest that this group continues to experience social disadvantage into old age. This requires the attention of policy-makers to ensure that services are tailored to the high social needs of these individuals. [ABSTRACT FROM AUTHOR]

Objective: People with severe mental illness have similar cancer incidence, but higher mortality than the general population. Participation in cancer screening may be a contributing factor but existing studies are conflicting. The aim of this study was to investigate the frequency of colorectal, prostate and cervical cancer screening among people with and without severe mental illness in Australia, who have access to universal health care. Methods: We followed three cohorts using de-identified data from a random 10% sample of people registered for Australia's universal health care system: those aged 50–69 years (n = 760,058) for colorectal cancer screening; women aged 18–69 years (n = 918,140) for cervical cancer screening and men aged 50–69 years (n = 380,238) for prostate cancer screening. We used Poisson regression to estimate incidence rate ratios and 95% confidence intervals for the association between severe mental illness and rates of faecal occult blood testing, pap smears and prostate-specific antigen testing. Results: Having severe mental illness was associated with a 17% reduction in rates of pap smear (incidence rate ratio = 0.83, 95% confidence interval: 0.82–0.84) and prostate-specific antigen testing (incidence rate ratio = 0.83, 95% confidence interval: 0.81–0.85), compared to the general population. By contrast, incidence rates of faecal occult blood testing were only lower in people with severe mental illness among the participants who visited their general practitioner less than an average of five times per year (incidence rate ratio = 0.83, 95% confidence interval = [0.73, 0.94]). Conclusion: Our results suggest that differences in screening frequency may explain some of the mismatch between cancer incidence and mortality in people with severe mental illness and indicate that action is required to improve preventive screening in this very disadvantaged group. [ABSTRACT FROM AUTHOR]

Objective: We examined associations between developmental vulnerability profiles determined at the age of 5 years and subsequent childhood mental illness between ages 6 and 13 years in an Australian population cohort. Methods: Intergenerational records from New South Wales (NSW) Government Departments of Health and Child Protection spanning pre-birth to 13 years of age were linked with the 2009 Australian Early Development Census records for 86,668 children. Mental illness indices for children were extracted from health records between 2009 and 2016 (child's age of 6–13 years). Associations between mental disorder diagnoses and membership of early childhood risk groups, including those with established 'special needs' (3777, 4.3%) at school entry, or putative risk classes delineated via latent class analysis of Australian Early Development Census subdomains – referred to as 'pervasive risk' (N = 3479; 4.0%), 'misconduct risk' (N = 5773; 6.7%) or 'mild generalised risk' (N = 9542; 11%) – were estimated using multinomial logistic regression, relative to children showing 'no risk' (N = 64,097; 74%). Poisson regression models estimated the relative risk of a greater number of days recorded with mental health service contacts among children in each Australian Early Development Census risk group. Adjusted models included child's sex, socioeconomic disadvantage, child protection contacts and parental mental illness as covariates. Results: The crude odds of any mental disorder among children aged 6–13 years was increased approximately threefold in children showing pervasive risk or misconduct risk profiles at the age of 5 years, and approximately sevenfold in children with special needs, relative to children showing no risk; patterns of association largely remained after adjusting for covariates. Children with special needs and the misconduct risk class used mental health services over a greater number of days than the no risk class. Conclusion: Patterns of early childhood developmental vulnerability are associated with subsequent onset of mental disorders and have the potential to inform interventions to mitigate the risk for mental disorders in later childhood and adolescence. [ABSTRACT FROM AUTHOR]

Objective: Worldwide, little information is available about the extent to which children with mental disorders in the general population receive treatment from health professionals that meets minimal clinical practice guidelines. This study identifies the percentage of 6–17 year olds with mental disorders in the 2013–2014 Australian national survey of mental health who had sufficient contact with health professionals during the 18 months after the survey to have received treatment meeting criteria for minimally adequate treatment (MAT). It also identifies factors associated with children having this level of contact with health professionals. Method: Mental disorders were identified using the Diagnostic Interview Schedule for Children Version IV completed by parents. Health professional attendances and psychotropic medications dispensed were identified from linked national Medicare Benefits Schedule and Pharmaceutical Benefits Scheme records. Results: Only 11.6% (95% confidence interval [CI] [9.1, 14.8]) of children with disorders (n = 517) had sufficient contact to achieve study criteria for MAT. Furthermore, among children with mental disorders who had severe functional impairment and whose parents perceived that their child needed help (n = 146), 20.2% (95% CI [14.3, 27.9]) had contact sufficient for MAT, 46.0% (95% CI [37.8, 54.4]) had contact that did not achieve MAT criteria and 33.8% (95% CI [26.1, 42.3]) had no contact with health professionals. In multivariable regression, children with moderate or severe functional impairment were more likely to have had sufficient contact to meet MAT criteria. Conclusion: During the 18 months after being identified with a mental disorder, only a small percentage of children have enough contact with health professionals to allow provision of MAT. This may be contributing to the unchanging high prevalence of childhood mental disorders. [ABSTRACT FROM AUTHOR]

Objective: This study intended to classify subtypes of Korean adolescents with suicidal ideation based on mental health problems and to explore the relationship between such subtypes and individual-, school- and community-level factors. Method: Data from high school freshmen who participated in the 2013 school-based mental health screening test and data about school and community variables obtained from public sources were combined and analyzed. A multilevel latent profile analysis using mental health issues as class indicators that included several predictors was conducted. Results: Three latent profiles were identified: Group 1 (6.5%) had high scores for both the internalizing and externalizing problems; Group 2 (40.2%) had high scores for internalizing problems, such as depression and mood related symptoms; and Group 3 (53.3%) had lower scores for all mental health problems compared to Groups 1 and 2. Gender, peer conflict, family conflict and academic problems were significant predictors at the individual level; school dropout rate was a significant school-level variable; and percent of youth in the total population, availability of mental health services, number of social welfare facilities and percentage of the total budget devoted to education/welfare were significant community-level variables. Conclusion: The present findings suggest that adolescents with suicidal ideation can be classified into several distinct subtypes based on mental health problems. These profiles and their associated covariates will aid in the establishment of youth suicide prevention policies. [ABSTRACT FROM AUTHOR]

The author talks about the psychiatric practice and the potential future developments in it. Topics discussed include the lack of reach to general population by psychiatrists, where a large section of the population goes untreated; increasing numbers of the diagnosis of posttraumatic stress disorder (PTSD) and attention-deficit hyperactivity disorder (ADHD); and the need for better government policies on mental health services.

Objective: Amphetamine use and availability have increased in Australia and there are concerns that this has led to more frequent hospital admissions with amphetamine-related psychosis. This study examines whether amphetamine-related admissions to mental health units are more common at times of greater amphetamine availability. Methods: We conducted an ecological study using aggregate crime and health service data for NSW, Australia, from January 2000 to March 2015. Amphetamine-related criminal incidents (arrests or cautions for possession or use) were used as an indirect measure of amphetamine availability. Semiparametric time series analysis was used to compare monthly arrest rates to monthly hospitalisation rates for (1) amphetamine abuse or dependence, (2) amphetamine-related psychosis and (3) any psychosis. Results: Amphetamine-related admissions to NSW mental health units have increased four- to fivefold since 2009 and comprised approximately 10% of all admissions to these units in early 2015. There was a significant association between arrests and amphetamine-related admissions. After adjustment for seasonal variation, this effect demonstrated a time lag of 1–2 months. There was no relationship between amphetamine arrests and overall admissions for psychosis. Conclusion: Greater amphetamine availability significantly predicts admissions for amphetamine use disorders and amphetamine-related psychosis. Better treatment strategies are needed to break the nexus between drug availability and drug-related harm. [ABSTRACT FROM AUTHOR]

The article discusses advancements in psychiatry. Topics include the development of scientific knowledge, clinical services and health outcomes with the use of scientific resources, and tools; the growth of the industry with the advancement of digital tools, and medical and technological innovations.

The article offers information related to debate on the gaming disorder (GD) with logic, evidence and consensus. Topics include the need for conceptual clarity and strong evidence in this growing field of GD; distorting a simple proposition and then making this the target of criticism; and supporting GD as a diagnostic category in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) and "International Classification of Diseases" (ICD) classification systems.

The article discusses the debate regarding the impact of Better Access scheme to the population's mental health in Australia. Topics mention including the appropriateness in using the prevalence of psychological distress and suicide rate, necessary evaluation of programmes and testing in pilot trials before national dissemination.

An editorial is presented on the contemporary human rights framework of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) along with its implications for economic, social and cultural rights and involuntary treatment of people with mental disabilities. Topics include the history of the framework, various mental health laws challenged by the organisation due to their treatment for people with disabilities, and the ethical issues of mental health.

Objective: We evaluated the psychiatric comorbidities in adults who were diagnosed with Diagnostic and Statistical Manual of Mental disorders, 5th edition attention-deficit/hyperactivity disorder as a function of recalled symptom onset before and after the age of 7 years and whether the childhood attention-deficit/hyperactivity disorder symptoms were associated with psychiatric comorbidities. Method: In all, 214 adults who were diagnosed with Diagnostic and Statistical Manual of Mental disorders, 5th edition attention-deficit/hyperactivity disorder and 174 non-attention-deficit/hyperactivity disorder controls (aged 17–40 years) received psychiatric interviews to confirm their previous and current attention-deficit/hyperactivity disorder status and other psychiatric diagnoses. Demographics and risks of lifetime psychiatric disorders were compared among three groups: (1) attention-deficit/hyperactivity disorder, onset <7 years (early-onset); (2) attention-deficit/hyperactivity disorder, onset between 7 and 12 years (late-onset) and (3) non-attention-deficit/hyperactivity disorder controls. We also tested the effects of attention-deficit/hyperactivity disorder symptoms on the risk of later psychiatric comorbidities by Cox regression analyses. Results: Regardless of the age of onset, attention-deficit/hyperactivity disorder was significantly associated with a wide range of psychiatric comorbidities. There were similar comorbid patterns between early- and late-onset attention-deficit/hyperactivity disorder. Regardless of attention-deficit/hyperactivity disorder diagnosis, increased severity of attention-deficit/hyperactivity disorder symptoms was associated with higher risks of oppositional defiant disorder, conduct disorder, dysthymia and sleep disorder but not major depression, which was associated with the attention-deficit/hyperactivity disorder diagnosis. Conclusion: Our findings suggest that elevating the threshold of age of onset to 12 years in Diagnostic and Statistical Manual of Mental disorders, 5th edition would not over-diagnose attention-deficit/hyperactivity disorder in the adult population. Recalled childhood attention-deficit/hyperactivity disorder symptom severity was correlated with conduct disorder, oppositional defiant disorder, dysthymia and sleep disorders. [ABSTRACT FROM AUTHOR]

Objectives: In accordance with consolidated clinical practice, Diagnostic and Statistical Manual of Mental Disorders, 5th edition suggests a key role of collateral information in the evaluation of retrospective childhood attention-deficit/hyperactivity disorder symptoms in adults despite poor evidence supporting its use. This study aims to assess the incremental value of collateral information on the presence of childhood attention-deficit/hyperactivity disorder symptoms when evaluating adults with attention-deficit/hyperactivity disorder. Methods: Adult patients with attention-deficit/hyperactivity disorder (n = 449) and non-attention-deficit/hyperactivity disorder subjects (n = 143) underwent an extensive clinical assessment based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. For patients, retrospective collateral information regarding childhood attention-deficit/hyperactivity disorder was obtained and used to sort them into two groups: agreement (n = 277) and disagreement (n = 172) between self- and collateral reports. We compared demographic, clinical and response to treatment profiles among groups to test the relevance of collateral information on the specific issue of childhood attention-deficit/hyperactivity disorder symptoms. Results: Both attention-deficit/hyperactivity disorder groups had higher rates of several comorbidities (oppositional defiant, conduct, substance use and bipolar disorders; all p < 0.001) and impairments than controls. Disagreement between self- and collateral reports on childhood attention-deficit/hyperactivity disorder symptoms occurred in 38% of patients. Overall, attention-deficit/hyperactivity disorder disagreement and agreement groups had similar profiles in response to treatment and comorbidity, and the few differences detected in impairment measures were of small magnitude (Eta2 < 0.05). Conclusion: Although collateral report has an important role for diagnosing attention-deficit/hyperactivity disorder in children, it has no incremental value in the evaluation of childhood attention-deficit/hyperactivity disorder symptoms in adults with a self-reported history of attention-deficit/hyperactivity disorder assessed in clinical settings. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discussess publications of the perodical including mental health in the workplace, classification of eating disorders, and psychiatry research.

The article focuses on the syndromal diagnosis of neuropsychiatric disorders. Topics dicussed include aetiology, pathophysiology and endophenotypes associated with neuropsychiatric disorders; clinical evolution of the relationship of neuropsychiatric diagnosis with spatio-temporal course; and role of diagnostic thinking in addressing the same.

The article focuses on the role of staging psychiatric disorders to guide decisions regarding management and clinical outcomes. Topics discussed include the definition of staging in psychiatry, issues in clinical practice that are considered not enough in defining the stage four of psychiatric disorders' course, and the use of transdiagnostic approach to staging psychiatric disorders.

Objective: The main risk of serious harm at major public figure gatherings comes not from terrorists or criminal activity but from fixated persons, many of whom have a serious mental illness. This paper reviews a collaborative mental healthpolice diversionary model for assessing and managing mentally ill individuals who attend major events because of their fixation on a dignitary or some idiosyncratic cause. Method: We examine the role of a multidisciplinary fixated threat assessment service during the pre-operational, operational and post-operational phases of major events in Queensland in 2014, including the G20 World Leaders' Summit. The benefits and challenges of this unique approach are reviewed. Results: The royal visit and G20 Finance Ministers' Meeting presented opportunities for the Queensland Fixated Threat Assessment Centre to develop and refine its approach to assessing and managing the threat posed by fixated persons at such events. Based on this experience, we also developed a typology to assist in the assessment of mentally ill people who present at public figure gatherings. In the week prior to the G20 Summit, six fixated people required hospitalisation for acute psychosis. A further 18 cases were identified during the event, one of whom was an involuntary patient whose leave from hospital was revoked as a consequence of his concerning behaviour at one of the G20 venues. There were no other admissions to hospital during the event, but in the remaining cases, where indicated, follow-up was arranged through the treating mental health service or general practitioner. There were no disruptive incidents involving fixated individuals during the G20. Conclusion: This novel diversionary model for assessing and intervening with concerning, fixated persons at major events proved effective in mitigating the risk posed by these individuals. It also highlighted the need for police, security and mental health services to consider the fixated in major event planning, for the safety of the event, the public and vulnerable mentally ill, fixated persons. [ABSTRACT FROM AUTHOR]

The article presents a study on the patterns of attention deficit in youths diagnosed with bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD). It mentions the use of a research framework from the Research Domain Criteria (RDoC) project, results of the Conners' Continuous Performance Test (CPT II), formation of cluster groups within the control, BD, ADHD and BD+ADHD groups and the differences among the cluster groups across various variables, one is sustained attention.

The article presents research which assessed the efficiency of screening children age four to five to determine those who might have teacher-reported mental health issues at the age of six to seven. Topics covered include accuracy of data gathered from parents and information from the Longitudinal Study of Australian Children (LSAC). Also mentioned is the importance of targeted interventions to lessen the prevalence of mental health issues in children.

The authors discuss potential benefits of the Australian government healthcare program, the National Disability Insurance Scheme (NDIS), to the mental health sector. They acknowledge established goals of the NDIS for the public and the inclusion of psychiatric disability in its coverage. They also explore the possible implementation of self-directed support for the mental health services industry and the involvement of carer organizations, consumers, and stakeholders in the NDIS.

The article discusses research which investigated profiles of patients with mental health and substance use disorders. The study used data from the 2007 Australian National Survey of Mental Health and Wellbeing to explore characteristics of patients belonging to three age groups. Aside from types and rates of disorder, the factors compared include the suicide tendencies of patients, the presence of co-occurring disorders, distress levels, and social support being received.

The article informs on DSM-5 which is the fifth edition of the American Psychiatric Association's (APA) diagnostic and statistical manual of mental disorders. It explains that the first section of the manual includes guidance for using the manual, introduction, and a cautionary note. It also informs that the manual contains several international conferences conducted by the World Health Organization (WHO), American Psychiatric Association (APA), and National Institute of Health (NIH).

The article discusses a study to evaluate the mental health correlates of anger in the general population using data collected as part of the 2007 Australian National Survey of Mental Health and Wellbeing. The study found a range of mood, anxiety disorders like major depressive disorder, bipolar disorder, anxiety disorder, post-traumatic stress disorder, and alcohol/drug use disorders to be independently associated with symptoms of anger after controlling for demographics and comorbidity.

The article discusses a study that examined correlates of stimulant use disorder in a large Australian population sample. It compared the characteristics of users who have disorders from those who do not, and described the patterns of help-seeking and service use in people with disorders. The results found association with high rates of comorbidity and harm. The study recommends treatment that involves addressing substance use disorders and mood and anxiety disorders.

The article discusses a study examining conceptual confusions in the foundation of psychiatric diagnosis from some important critical viewpoints illustrated by Ludwig Wittgenstein. It discusses that Diagnostic terms by Wittgenstein has no core phenomenon, and that the concept of diagnosis cannot be located in or explained by a mental process. It suggests that identification of the cardinal diagnoses in psychiatry with a fixed phenomenological picture or underlying explanatory mental process.

The author offers his opinion on psychiatric diagnoses of young Australians. Many times personal sufferings are misdiagnosed as mental sickness; few weeks of significant distress attract the diag­nosis of depression which is unjustified. Psychiatrists should offer help to youngsters by providing a positive therapeutic relationship and enhancing understanding. He opines that psychiatrist should provide a safe environment in which patients can come to terms with their needs.

Background: The concept of staging of disease in psychiatry has developed over the past years. A neglected component of this model pertains to people in the advanced stages of a mental illness, who remain symptomatic and functionally impaired despite treatment. These patients are often high service utilizers, receiving complex multimodal treatments where the balance of risk and benefit shifts perceptibly. In this paper, we argue the need to adopt ‘palliative’ models of care for some individuals, and consider changing the therapeutic goals to follow care pathways similar to those used in other chronic and refractory medical illnesses.Method: Data was sourced by a literature search using Medline and a hand search of scientific journals. Relevant articles were selected.Results: Clinical staging can help us better define subgroups of patients who will benefit from different goals and treatment. In the most advanced stage group, we find patients with persistent symptoms and treatment resistance. In these situations, it may be preferable to follow some of the principles of palliative care, which include the setting of attainable goals, reduction of side-effects, limited symptom control, targeting identified psychological and social problems, and attempting to attain the best quality of life for these patients and their families.Conclusions: It is in the interest of those in the advanced phases of a disorder that clinicians acknowledge the limitations of treatment and actively attempt to plan treatment utilizing alternate models. It is essential to be clear that such approaches do not equate to the abandonment of care, but rather to the reconceptualizing of feasible and personalized treatment goals, a rebalancing of the risks and benefits of intervention, the management of illness behaviour, and the approaches that allow the patient to live gainfully within their limitations. [ABSTRACT FROM PUBLISHER]

Objective: The aim of this study was to present scoring rules for predicting DSM-IV mental illness in the previous 12 months using the Kessler Psychological Distress Scale in the Australian population.Method: The method described in Kessler et al. [1] was closely followed using data from the 2007 Australian Survey of Mental Health and Wellbeing. A series of 93 nested logistic regression models were generated and compared to estimate the predicted probabilities of mental illness for each survey respondent using scores on the Kessler Psychological Distress Scale. The best model was selected using information theoretic criteria. Concordance between the predicted probabilities of mental illness generated by the best models with DSM-IV defined mental illness, assessed using the Composite International Diagnostic Interview, was determined using receiver operating characteristic analysis.Results: The best fitting models were found to contain the quadratic form of the Kessler Psychological Distress Scale (both 6 item and 10 item versions). Age was found to be significant in the model predicting mood, anxiety, and substance use with serious impairment using the 6 item version whilst age and gender was found to be significant in the model for the 10 item version. The concordance between the predicted probabilities of mood, anxiety, and substance use with serious impairment generated from the best models and DSM-IV mood, anxiety, and substance use with serious impairment was within an acceptable level for both versions. Results were similar when predicting DSM-IV mood, anxiety, and substance use without seriousness indicators and DSM-IV anxiety and depression. The performance of predicted probabilities was then examined in various sub-populations of the Australian population.Conclusions: Using a logistic regression model, the Kessler Psychological Distress Scale can be used to generate predicted probabilities of mental illness with an acceptable level of agreement in Australian-based population studies where it is not feasible to conduct a comprehensive assessment. [ABSTRACT FROM PUBLISHER]

Background: Australia's Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative involves a series of Medicare Benefits Schedule (MBS) item numbers which offer a rebate for selected services delivered by eligible clinicians. There has been considerable debate about the appropriateness and effectiveness of Better Access, much of which has been based on limited evidence. The current paper contributes to this debate by presenting the findings of a study which profiled the clinical and treatment characteristics of Better Access patients and examined the outcomes of their care. Method: We approached a stratified random sample of providers who had billed for at least 100 occasions of service under the Better Access item numbers in 2008 (509 clinical psychologists, 640 registered psychologists, 1280 GPs) and invited them to participate. Those who agreed were asked to recruit 5-10 Better Access patients according to a specific protocol. We collected data that enabled us to profile providers, patients and sessions. We also collected pre- and post-treatment patient outcome data, using the Kessler-10 (K-10) and the Depression Anxiety Stress Scales (DASS-21). Results: In total, 883 patients were recruited into the study (289 by 41 clinical psychologists, 317 by 49 registered psychologists and 277 by 39 GPs). More than 90% of participating patients had diagnoses of depression and/or anxiety (compared with 13% of the general population). More than 80% were experiencing high or very high levels of psychological distress (compared with 10% of the general population). Around half of all participating patients had no previous history of mental health care. Patients experienced statistically significant improvements in average K-10 and DASS-21 scores from pre- to post-treatment. Conclusions: The findings suggest that Better Access is playing an important part in meeting the community's previously unmet need for mental health care. [ABSTRACT FROM AUTHOR]

Objective: To present Australian normative data on the ten-item Kessler Psychological Distress Scale (K10). Method: Analysis of cross-sectional data from the 2007 Australian National Survey of Mental Health and Wellbeing, a nationally representative household survey of 8841 adults. Mean K10 scores and K10 scores at selected percentiles of the K10 score distribution are presented by sex, age, the presence of mental disorders and the presence of physical conditions. Stratum-specific likelihood ratios were computed to help clinicians and researchers calculate predicted probabilities of mental disorder given scores on the K10. Results: Scores on the K10 were generally higher in women compared to men, in people with a mental disorder compared to without a mental disorder and in people with affective disorders compared to people with substance use disorders. The SSLRs were informative in ruling in a diagnosis of mental disorder, particularly at the high or very high end of the psychological distress spectrum. Conclusions: These data may be helpful for clinicians and researchers alike in understanding the likelihood of mental disorder in a given individual or sample. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of current psychiatric disorders and unmet needs in a sample of police cell detainees in Victoria. Method: A cross-sectional descriptive study was conducted, including data linkage with the Victoria Police database and the Victorian Psychiatric Case Register. In Melbourne, Australia, 150 detainees were recruited from two busy metropolitan police stations. Outcome measures included estimated rates of psychiatric disorders, using the Structured Clinical Interview for DSM-IV-TR, and individual needs, using the Camberwell Assessment of Need - Forensic Version. Results: One quarter (n = 32, 25.4%) of detainees had a prior admission to a psychiatric hospital, and three quarters met current criteria for a diagnosable mental disorder. The most common disorders were substance dependence (n = 81, 54%) and mood disorders (n = 60, 40%). A third met diagnostic criteria for both a mental illness and a substance use disorder. The odds of being classified with mood (OR = 10.1), anxiety (OR = 2.2), psychotic (OR = 15.4) and substance use disorders (OR = 26.3) were all significantly higher in the current sample as compared with the general population. Detainees with a mental illness identified significantly more needs and significantly more unmet needs (e.g. psychological distress) than those who did not rate as having a current mental illness. Conclusions: There remains a pressing need to evaluate standardized screening tools for mental illnesses in police cells to provide timely access to assessment and treatment services. The need for functional interagency collaborations are highlighted and discussed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine patterns of service utilization in the public mental health service in the Australian state of Victoria. Lifetime contact with the public mental health system will be used to approximate lifetime prevalence for schizophrenia in the community. Method: A case-linkage design joined a statewide psychiatric register with a random sample of community members drawn from a statewide electoral roll (n = 4830). In cases where individuals had been in contact with public mental health services, their full contact history was extracted. Results: Members of the community come into contact with public mental health services for a variety of reasons, including those beyond the scope of psychiatric diagnosis and treatment, with 23% of those who made contact not receiving a psychiatric diagnosis and/or ongoing treatment. Although only 0.7% of the sample had a lifetime diagnosis of schizophrenia, these persons accounted for a significant proportion of public mental health service use. Schizophrenia-spectrum disorders were particularly prevalent among psychiatric crisis and extended care and supervision services. Conclusions: The Australian public mental health system has undergone significant reform in recent years. As a result, there has been a shift towards community-based care and a marked reduction in inpatient facilities. The public mental health system is a service that primarily serves those with a psychotic illness, thereby dictating that persons with so-called high-prevalence disorders, including affective and/or substance use disorders, seek psychiatric treatment elsewhere. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present exploratory study was to determine the predictors of aggression and restraint in children admitted to a child psychiatric inpatient unit in Melbourne, Australia. Method: A retrospective review of incident report forms over a 12 month period at the State Wide Child Inpatient Unit (SWCIU) was conducted. These report forms were based upon 41 children aged 5–12 years, who had various psychiatric diagnoses including conduct disorder, attention-deficit–hyperactivity disorder and anxiety disorders. Results: A total of 70 children were admitted to the SWCIU during the audit period. Forty-one children aged 5–12 engaged in 235 violent incidents. A high-risk assessment and disruptive behaviour disorder were associated with aggressive behaviour and restraint. Disruptive behaviour disorder also predicted more serious episodes of aggression. Conclusions: There are readily identifiable patient factors that predict aggression and the need for restraint in child inpatient units. [ABSTRACT FROM AUTHOR]

The author reflects on the differences between the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB) and the 2003-2004 New Zealand Mental Health Survey (NZMHS). She says that the 2007 Australian NSMHWB focused on ICD-10 diagnoses, while the NZMHS concentrated on DSM-IV diagnoses. She stresses that the response rate in the 2007 Australian NSMHWB was 60.0%, while in the NZMHS was 70.3%. She adds that the countries have nearly 40% of adult population who have mental disorder.

Objective: To provide a description of the methods and key findings of the 2007 Australian National Survey of Mental Health and Wellbeing. Method: A national face-to-face household survey of 8841 (60% response rate) community residents aged between 16 and 85 years was carried out using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Diagnoses were made according to ICD-10. Key findings include the prevalence of mental disorder, sex and age distributions of mental disorders, severity of mental disorders, comorbidity among mental disorders, and the extent of disability and health service use associated with mental disorders. Results: The prevalence of any lifetime mental disorder was 45.5%. The prevalence of any 12 month mental disorder was 20.0%, with anxiety disorders (14.4%) the most common class of mental disorder followed by affective disorders (6.2%) and substance use disorders (5.1%). Mental disorders, particularly affective disorders, were disabling. One in four people (25.4%) with 12 month mental disorders had more than one class of mental disorder. One-third (34.9%) of people with a mental disorder used health services for mental health problems in the 12 months prior to the interview. Conclusions: Mental disorders are common in Australia. Many people have more than one class of mental disorder. Mental disorders are associated with substantial disability, yet many people with mental disorders do not seek help for their mental health problems. [ABSTRACT FROM AUTHOR]

Objectives: It has been previously argued that the methodology used by the Composite International Diagnostic Interview version 2.1 to assess the substance-induced and general medical condition exclusion criteria are inadequate. As a result prevalence estimates generated from epidemiological studies using this interview may be underestimated. The purpose of the current study was to examine the substance-induced and general medical condition exclusion criteria in the Australian National Survey for Mental Health and Well-being and determine the impact that they have on prevalence estimates of the common mental disorders. Method: Data from the 1997 Australian National Survey of Mental Health and Well-being were analysed. Frequencies were generated as an indication of how many respondents believed that their psychiatric symptoms were always due to a substance or general medical condition. New DSM-IV prevalence estimates were calculated ignoring the application of the substance-induced and general medical condition exclusion criteria and compared to standard DSM-IV prevalence estimates. Results: The effect of the substance-induced and general medical condition exclusion criteria on final prevalence rates were minimal, with approximately a 0.1% increase when the exclusions were ignored. This equates to a relative difference ranging from no difference for generalized anxiety disorder to an increase of 12% of the base prevalence estimate for agoraphobia. Conclusions: In surveys that use the Composite International Diagnostic Interview version 2.1 the substance-induced and general medical condition exclusion criteria have a minor impact on determining final case definition in the majority of mental disorders. [ABSTRACT FROM AUTHOR]

Objective: A study on the incidence of suicide in the train system and a description of main characteristics of victims and attempters was commissioned by Queensland Rail in response to an apparent increase of suicide phenomena and their consequences. Methods: Two sources of data were used for the analyses: the Queensland Suicide Register (QSR) and the Queensland Rail Incident Surveillance Information System (ISIS). Data on suicide were cross-checked on the two systems for the years 1990-2004. ISIS provided information on cases of attempted suicide for the period 1993-2206. Results: One hundred and sixty-one train suicide victims were identified. Globally, they represented 2% of all cases of suicide in Queensland. During the examined period no significant changes in trends of suicide through that method were found. Of all suicide cases, 59 (36.6%) included victims aged 15-24years. The ratio of male:female was 4:1, equal to the sex distribution of suicide with all methods in Queensland. Positive blood alcohol content was found in nearly 50% of young people and in 29.8% of the total sample. A psychiatric diagnosis was documented in 40.4% of all train suicide victims. Only 18 suicide attempters were identified through the ISIS database; of them, 15 were male and three were female, with a gender ratio similar to that of suicide victims. Conclusions: This study involved the largest dataset ever published in Australia on this topic. In Queensland, train suicides presented a stable trend during 1990-2004. Subjects of very young age (15-24) seem to be particularly exposed to this method; in this age group one in two individuals had positive blood alcohol content. [ABSTRACT FROM AUTHOR]