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Recent years have seen escalating media, public and scientific interest in psychedelic medicine. Australia and New Zealand have been late to this research; however, in the past 2 years, rapid developments suggest that this is changing. Here, we argue for the need to critically review existing evidence in this field to guide future directions. We focus on (±)3,4-methylenedioxymethamphetamine-assisted psychotherapy for post-traumatic stress disorder, currently the most advanced area of clinical psychedelic research. Food and Drug Administration approval of this approach is likely in 2023, based on a series of promising findings. We provide a detailed overview of Phase 2 and 3 studies published to date. We identify several concerns related to this body of evidence, including methodological/design limitations and broader factors – such as robust involvement of advocacy groups in research and reliance on non-government financing leading to simplistic public messaging – that compound the methodological issues identified. We propose steps for future improvement, including the need for large, high-quality, independent efficacy trials with design enhancements, effectiveness trials and for researchers to consider their own engagement with media and public messaging around these modalities. We argue that, notwithstanding promising findings to date, rigorous and dispassionate science is needed to move the field forward and safeguard the welfare of participants. [ABSTRACT FROM AUTHOR]

Objectives: We argue that mental health-related concepts have become degraded within professional circles and in the wider community. We identify three trends: concept creep, the rise of broad umbrella concepts (e.g. distress and trauma), and the conflation of mental health with well-being, which marginalises serious mental illness. We speculate on the causes of these trends, including cultural shifts towards greater sensitivity to harm and the rise of wellness industries. Contributing factors within psychiatry include overdiagnosis, dimensional models and transdiagnostic perspectives. Conclusions: These trends may lead to inflated demands on services from those at the milder end of the psychopathological spectrum. We set out seven measures that mental health professionals can take to resist trends towards broad concepts of mental illness and limit some of their adverse consequences. [ABSTRACT FROM AUTHOR]

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Objective: Clinical psychologists are practitioners with expertise in mental health, who apply advanced psychological theory and knowledge to their practice in order to assess and treat complex psychological disorders. Given their robust specialised mental health training, clinical psychology is an integral component of the Australian mental health workforce, but is under-utilised. Recent reviews have identified significant problems with Australia's mental health system, including unequal access to clinical psychology services and fragmentation of service delivery, including convoluted pathways to care.Conclusions: Clinical psychology is well placed to contribute meaningfully to public mental health services (PMHS). We describe what clinical psychologists currently contribute to team-based care in PMHS, how we could further contribute and the barriers to making more extensive contributions. We identify significant historical and organisational factors that have limited the contribution made by clinical psychologists and provide suggestions for cultural change to PMHS. [ABSTRACT FROM AUTHOR]

Aims: Social inclusion is increasingly understood to have positive and beneficial implications for the mental health outcomes of people with severe mental illness. The concept is plagued by definitional inconsistencies and a lack of consensus regarding what it means to be socially included, in particular for groups most vulnerable to social exclusion, such as people with mental illness. The aim of this study was to obtain a consensus regarding the key contributors to social inclusion from the perspective of people with and without a lived experience of mental illness (consumers of mental health services, carers, and general community members). Methods: Delphi methodology was employed to reach consensus agreement. The Delphi questionnaire was based on a previous review of the literature and consisted of 147 items categorized into 13 domains. It was presented to participants over three rounds. Participants (N = 104) were recruited into three groups (32 consumers, 32 carers of people with a mental illness, and 40 members of the general community – neither consumers nor carers). Retention of participants from Round 1 to Round 3 was 79.8%. Results: Similarities and differences were observed between the groups. A number of items were very strongly endorsed as key contributors to social inclusion, relating to social participation, social supports, housing, neighbourhood, community involvement, employment and education, health and well-being and service utilization. Conclusion: Findings supported previous work, indicating the importance of having a strong sense of connection with others as well as the importance of safe and stable housing, support services and personal motivation and hope. We obtained a well-rounded perspective among groups regarding the key contributors to social inclusion, with a particular relevance to people living with mental illness. This perspective has significant clinical and research utility. [ABSTRACT FROM AUTHOR]

Objective: We aimed to describe the prevalence and age distribution of personality disorders and their comorbidity with other psychiatric disorders in an age-stratified sample of Australian women aged ⩾25 years. Methods: Individual personality disorders (paranoid, schizoid, schizotypal, histrionic, narcissistic, borderline, antisocial, avoidant, dependent, obsessive-compulsive), lifetime mood, anxiety, eating and substance misuse disorders were diagnosed utilising validated semi-structured clinical interviews (Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition and Structured Clinical Interview for DSM-IV Axis II Personality Disorders). The prevalence of personality disorders and Clusters were determined from the study population (n = 768), and standardised to the Australian population using the 2011 Australian Bureau of Statistics census data. Prevalence by age and the association with mood, anxiety, eating and substance misuse disorders was also examined. Results: The overall prevalence of personality disorders in women was 21.8% (95% confidence interval [CI]: 18.7, 24.9). Cluster C personality disorders (17.5%, 95% CI: 16.0, 18.9) were more common than Cluster A (5.3%, 95% CI: 3.5, 7.0) and Cluster B personality disorders (3.2%, 95% CI: 1.8, 4.6). Of the individual personality disorders, obsessive-compulsive (10.3%, 95% CI: 8.0, 12.6), avoidant (9.3%, 95% CI: 7.1, 11.5), paranoid (3.9%, 95% CI: 3.1, 4.7) and borderline (2.7%, 95% CI: 1.4, 4.0) were among the most prevalent. The prevalence of other personality disorders was low (⩽1.7%). Being younger (25–34 years) was predictive of having any personality disorder (odds ratio: 2.36, 95% CI: 1.18, 4.74), as was being middle-aged (odds ratio: 2.41, 95% CI: 1.23, 4.72). Among the strongest predictors of having any personality disorder was having a lifetime history of psychiatric disorders (odds ratio: 4.29, 95% CI: 2.90, 6.33). Mood and anxiety disorders were the most common comorbid lifetime psychiatric disorders. Conclusions: Approximately one in five women was identified with a personality disorder, emphasising that personality disorders are relatively common in the population. A more thorough understanding of the distribution of personality disorders and psychiatric comorbidity in the general population is crucial to assist allocation of health care resources to individuals living with these disorders. [ABSTRACT FROM AUTHOR]

Objectives: Delusional infestation may present as a primary disorder or secondary to another disorder (e.g. schizophrenia). In this report we focus on the issue of inadequacies in mental state examinations leading to diagnostic uncertainty.Methods: Case studies were identified for this review through searching the academic databases MedLine, PSYCInfo and PubMed. We developed a template that contained 36 headings and independently examined each case study report. Our percentage agreement for the first 42 case studies we reviewed was 91%.Results: We identified diagnostic uncertainty due to inadequacies in the reporting of mental state examinations.Conclusions: Clinicians need to provide mental state information to an adequate standard that would allow confirmation of a diagnosis of delusions of infestation or exclude other possibilities. [ABSTRACT FROM AUTHOR]

The article presents the authors' views on delusions of infestation. Delusions of infestation is a delusional disorder in which individuals incorrectly believe that they are infested by parasites or insects. Topics include the aetiology of the condition, its symptoms, and why insects is the focus of infestation delusions.

Objective: To investigate the relationship between childhood trauma, post-traumatic stress symptoms due to the experience of childhood trauma, and post-traumatic stress symptoms due to the experience of psychosis.Method: The current study assessed childhood trauma and post-traumatic stress disorder (PTSD) symptoms as a result of both childhood trauma and psychosis using the Impact of Events Scale - Revised, in a group of 36 people with first-episode psychosis.Results: Reported rates of clinical level post-psychotic PTSD symptoms, childhood trauma and childhood trauma-related clinical level PTSD symptoms were 47% (95% CI 31–64%), 64% (95% CI 48–80%) and 39% (95% CI 23–55%), respectively. Reporting childhood trauma increased the risk of developing post-psychosis PTSD 27-fold (95% CI 2.96–253.80, p = 0.01). Having childhood trauma-related PTSD increased the risk of developing post-psychosis PTSD 20-fold (95% CI 3.38–123.25, p = 0.01). These risks were not explained by illness factors such as duration of untreated psychosis, age of onset or severity of psychotic symptoms. Those without post-psychotic PTSD symptoms at clinical levels were unlikely to report childhood trauma (6%; 95% CI 3–8%).Conclusions: These results suggest the cognitive, social and biological consequences of childhood trauma can prevent effective recovery from the trauma of acute first-episode psychosis resulting in post-psychotic PTSD. Treatment strategies for post-psychotic PTSD must address childhood trauma and related PTSD. [ABSTRACT FROM PUBLISHER]

The authors reflect on the assessment of the Better Access scheme, which was sponsored by the Commonwealth Department of Health and Aging. The authors remark that because of poor methodology, there are numerous questions which were not answered by Better Access's evaluation. Meanwhile, the authors mention the editorial of Tony Jorm which points out that the scheme has been more expensive compared to what was expected.

Objective: The aim of the present study was to compare the effectiveness of specialized team-based early intervention for borderline personality disorder (BPD) with treatment as usual. Method: In a quasi-experimental design, 32 outpatients who received historical treatment as usual (H-TAU) were compared with 78 participants from a recently published randomized controlled trial of cognitive analytic therapy (CAT; n = 41) versus manualized good clinical care (GCC; n = 37), conducted in a specialized early intervention service for BPD (the Helping Young People Early (HYPE) programme). All participants were 15-18-year-old outpatients who fulfilled 2-9 DSM-IV BPD criteria. It was predicted that, compared with H-TAU, HYPE + GCC and HYPE + CAT would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24months. Results: At 24month follow up: (i) HYPE + CAT had lower standardized levels of, and a significantly faster standardized rate of improvement in, internalizing and externalizing psychopathology, compared with H-TAU; and (ii) HYPE + GCC had lower standardized levels of internalizing psychopathology and a faster rate of improvement in global functioning than H-TAU. HYPE + CAT yielded the greatest median improvement on the four continuous outcome measures over 24months. No adverse effects were shown with any of the treatments. Conclusions: Specialized early intervention for subsyndromal or full-syndrome BPD is more effective than TAU, with HYPE + CAT being the most effective intervention. Reform of existing services using the HYPE model might yield substantial improvements in patient outcomes. [ABSTRACT FROM AUTHOR]

Estimating the racial and ethnic proportions within the driving population at risk of being stopped by the police is the most serious methodological threat to the viability of racial profiling research. Most strategies are externally based on the residential population, field observations of drivers, and, more recently, accident records. Using data collected in 2001 by the Wichita (Kansas) Police Department, the authors construct an internal benchmark and are able to identify the officers (at the individual level) that are actually stopping substantially higher proportions of racial minorities when compared to their similarly situated peers. Recommendations for developing an internal benchmarking strategy are included. [ABSTRACT FROM AUTHOR]

Objective: In Australia the prevalence of mental health problems does not vary by gender, but help-seeking and service utilization do. The aim of the present study was to examine a number of attitudinal factors that may influence help-seeking for mental health problems. Method: A cross-sectional community survey was conducted with a sample of 579 rural residents (57.9% female), who completed self-report measures assessing stoicism, alexithymia, perceived and personal stigma and the various facets of the personality trait of openness to experience. Results: Men scored higher on measures of stoicism and personal stigma associated with mental health problems than women, and compared to women had lower scores on the facets of openness to experience. Conclusions: Higher rates of help-seeking for mental health problems by women may be due to lower levels of stoicism and personal stigma related to mental health problems in women compared to men. [ABSTRACT FROM AUTHOR]

Objective: To examine the level and type of service utilisation by rural residents for mental health problems, and to explore the influence of level of need, sociodemographic factors and town size on such service use. Method: This was a cross-sectional, community-based study. Subjects were recruited from three locales in rural north-west Victoria: a large regional centre, towns of 5,000-20,000 population and towns of <5,000 population. Three hundred and ninety-one individuals (54% females) participated. A logistic regression analysis was used to investigate which factors (i.e. need, sociodemographic and town size) predicted lifetime help-seeking for emotional or mental problems from formal health providers in the study sample. Results: Factors that predicted having ever sought help from a formal health provider for emotional or mental health problems were: a lifetime and/or current psychiatric disorder, being female, being separated, divorced or widowed, and living in medium sized towns (population 5,000-20,000). Conclusions: While traditionally known predictors of help-seeking, i.e need and gender, were associated with help seeking in this study, help seeking for mental health problems was also more common amongst individuals living in medium sized rural towns than those living in a large regional city. Possible explanations include availability, accessibility and organisation of services, and individual and/or community attitudes towards help seeking. [ABSTRACT FROM AUTHOR]

Objective: While there are now effective interventions for the symptoms of psychosis and schizophrenia, treatment for the functional domains of these illnesses has received less attention. A key area affected by psychotic illness is vocational functioning. This area is currently of interest to clinicians, policy-makers, politicians and patients. This paper reviews several forms of vocational intervention practised over the years and highlights the issues around adopting an early intervention approach towards vocational rehabilitation. The paper has four aims: first, to consider some of the consequences of unemployment for those with psychotic illnesses; second, to review methods that have been used to address unemployment among the mentally ill; third, to highlight the importance of vocational development at a developmentally appropriate life stage; and finally, to consider the application of evidence-based vocational rehabilitation to those with first-episode psychosis. Method: An initial broad literature search was conducted using PsychInfo and Medline databases. Further narrower searches were conducted electronically where indicated. Finally, some articles were sourced through manual searches of relevant journals. Results: People with psychotic illness have a high rate of unemployment at the outset of their illness which tends to worsen over time. This is complicated by systemic factors such as the structure of the welfare system. Approaches for assisting people with mental illness return to work have evolved over the history of psychiatry. There now exists an evidence-based method of intervention. To date this has not been trialled in a systematic way with people in the early stages of psychotic illness. Conclusions: There is cause for cautious optimism in the vocational recovery of people with psychotic illnesses. Limited evidence exists that the individual placement and support approach developed with chronic populations is very effective in early episode patients. There are a number of challenges to implementing vocational intervention in first-episode psychosis. Overcoming these obstacles will require the cooperation of clinicians, those with illness, policy-makers and politicians. However, the potential economic, health and personal gains, as well as current and future research should provide sufficient motivation to overcome these barriers. [ABSTRACT FROM AUTHOR]

Objective: To examine the role of stoicism, self-efficacy and perceived stigma in predicting help-seeking by rural residents, for mental health problems. Method: A cross-sectional community survey was conducted with a sample of 467 rural residents (58% female), who completed self-report questionnaires assessing current levels of symptomatology, disability, perceived stigma, self-efficacy, stoicism, attitudes towards and experience of seeking help for psychological problems. Results: Overall, 27.6% (n = 129) of respondents had sought help from a general practitioner and/or mental health professional for psychological problems or a mental health issue. More women than men reported having sought such help. Lifetime help-seeking for a psychological problem or mental health issue was positively associated with higher levels of distress and lower levels of stoicism and, to a lesser extent, lower levels of self-efficacy. Conclusions: Efforts to improve help-seeking by rural residents for mental health problems should focus on understanding and addressing attitudes, such as stoicism which act as barriers to help-seeking. [ABSTRACT FROM AUTHOR]

Diagnosis in psychiatry increasingly struggles to fulfil its key purposes, namely, to guide treatment and to predict outcome. The clinical staging model, widely used in clinical medicine yet virtually ignored in psychiatry, is proposed as a more refined form of diagnosis which could restore the utility of diagnosis, promote early intervention and also make more sense of the confusing array of biological research findings in psychiatry by organizing data into a coherent clinicopathological framework. A selective review of key papers in clinical medicine and psychiatry which describe clinical and clinicopathological staging, and a range of related issues. Clinical staging has immediate potential to improve the logic and timing of interventions in psychiatry just as it does in many complex and potentially serious medical disorders. Interventions could be evaluated in terms of their ability to prevent or delay progression from earlier to later stages of disorder, and they could be selected on clear-cut risk/benefit criteria. Biological variables and a range of candidate risk factors could be studied within and across stages, and their role, specificity and centrality in risk, onset and progression of disorder could be greatly clarified. A clinicopathological framework could be progressively constructed. Clinical staging with a restructure across and within diagnostic boundaries with the explicit operationalization of criteria for extent and progression of disorder should be actively explored in psychiatry as a heuristic strategy for the development and evaluation of earlier, safer, and more effective clinical interventions, and for clarifying the biological basis of psychiatric disorders. [ABSTRACT FROM AUTHOR]

Objective : To examine the role of perceived stigma and attitudes to seeking care in predicting help-seeking from a general practitioner (GP) for mental health problems. Method : A cross-sectional survey in 2002 with self-report questionnaires assessing current levels of symptomatology, disability, attitudes towards mental illness, knowledge of prevalence and causes of mental illness, contact with mental illness and help-seeking behaviour and preferences and attitudes toward seeking professional psychological help. Results : No significant relationship was found between symptom measures and measures of disability and help-seeking. Variables positively associated with general attitudes to seeking professional psychological help were: lower perceived stigma, and biological rather than person-based causal attributions for schizophrenia. Willingness to discuss mental health issues with a GP was predicted by the perceived helpfulness of the GP and by no other variable. Conclusions : Causal attributions and perceived stigma rather than participants' levels of symptomatology and disability influence attitudes to help-seeking for mental health issues. Efforts to improve attitudes to help-seeking should focus on reducing stigma and improving mental health literacy regarding the causes of disorders. Australian and New Zealand Journal of Psychiatry 2005; 39:514–521 [ABSTRACT FROM AUTHOR]

The absence of an agreed definition of ‘rural’ limits the utility of existing research into a possible relationship between rurality of residence and mental health. The present study investigates the bipolar dimension accessibility/remoteness as a possible correlate of mental health. A continuous area of non-metropolitan Australia was selected to provide a range of scores on the Accessibility/Remoteness Index of Australia (ARIA). A questionnaire measuring demographics, the five-factor model of personality and three aspects of mental health (distress, disability and wellbeing) was mailed to 20 000 adults selected randomly from electoral rolls. Responses were received from 7615 individuals (response rate = 40.5%; 57.1% female). ARIA was not associated with either distress or disability measures, but a small negative association was found between accessibility and two measures of wellbeing. Individuals residing in locales with better access to services and opportunities for interaction reported higher levels of satisfaction with life (SWL) and positive affect (PA). Adjusting statistically for a range of demographic and personality correlates did not alter the effect of ARIA on SWL. The effect on PA remained significant after adjusting for demographics, but not once personality correlates entered the model. By sampling across a single proposed parameter of rurality, a novel profile of correlations was identified. In accord with existing data, accessibility was not associated with distress or disability. In contrast, accessibility was positively associated with the wellbeing aspect of mental health. Further attention to the measurement of rural place and the exploration of accessibility as a parameter with mental health relevance, is warranted. [ABSTRACT FROM AUTHOR]

Objective: High prevalence disorders (anxiety, depressive and substance use) are generally assumed to be more common in urban than rural dwellers. The aims of this paper are (i) to critically review studies measuring prevalence in rural as opposed to urban location, and (ii) to argue the need to look beyond the ‘quantity’ question to the quality question: how does urban or rural place influence mental health? Method: A literature review (Medline and PsychLIT) was carried out using the words ‘rural, urban, mental/psychiatric, illness/disorders and prevalence’, as well as a review of relevant papers and publications known to the authors. Results: Many studies examining urban/rural differences in the rate of high prevalence disorders have been reported. Most use a ‘one size fits all’ definition of urban and rural, which assumes location is the key issue. The majority fail to show the purported difference in prevalence between the two settings. In general, studies have not examined interaction effects, but have simply treated the independent variables as main effects. Available data suggest that a variety of socio-demographic factors are more powerful predictors of difference in prevalence than is the location of residence. Conclusion: Further studies are required to understand if and how rural or urban place contributes to the development of psychiatric morbidity. These studies should mirror the clinical situation by taking into account a variety of individual and community-based (including urban/rural place) risk factors which may be important determinants of mental health and mental illness, and examining the interaction between them. This may then identify the nature of any differences or what issues are specific to, or especially important, in the rural setting. [ABSTRACT FROM AUTHOR]

Objective: Increasingly, epidemiological studies are employing computerized and highly standardized interviews, such as the Composite International Diagnostic Interview (CIDI-Auto), to assess the prevalence of psychiatric illness. Recent studies conducted in specialist units have reported poor agreement between experienced clinicians’ and CIDI-Auto diagnoses. In this study we investigated the concordance rate between clinicians and the CIDI-Auto for the diagnosis of six anxiety disorders and two mood disorders, whereby the CIDI-Auto was treated as the ‘gold standard’. Method: Subjects were 262 patients who were assessed by a clinical psychologist or psychiatrist and completed the CIDI-Auto at a tertiary referral unit for anxiety and mood disorders. Agreement between the clinicians’ diagnoses and the diagnoses generated by the CIDI-Auto according to both DSM-IV and ICD-10 codes, were examined by kappa statistics. Sensitivity and specificity values were also calculated. Results: Agreement between clinicians and the CIDI-Auto (DSM-IV) ranged from poor for social phobia and posttraumatic stress disorder (κ < 0.30) to moderate for obsessive– compulsive disorder (OCD; κ = 0.52). Agreement between clinicians and the CIDI-Auto (ICD-10) ranged from poor for major depressive episode (κ = 0.25) to moderate for OCD (κ = 0.57). With the CIDI diagnosis treated as the gold standard, clinicians’ diagnoses showed low sensitivity (κ < 0.70) for all the disorders except for OCD (for ICD-10), but high specificity (κ > 0.70) for all the disorders. Conclusion: Poor agreements between experienced clinicians and the CIDI-Auto were reported for anxiety and mood disorders in the current study. A major implication is that if diagnosis alone directed treatment, then patients could receive different treatments, depending on whether the computer, or a clinician, made the diagnosis. [ABSTRACT FROM AUTHOR]

Presents a study that established whether problems associated with sexual offenders could be grouped into broad-based constructs and investigated the psychopathological features of paraphilias. Division of the broad based constructs; Design and analysis adopted to solve problems in paraphilic diagnoses; Implications of the results.

Examines the 22 criteria of the DSM-III antisocial personality disorder to obtain various internal consistency indices. Effectivity of criteria to discriminate between the patients with the disorder from those without the disorder; Coherence of criteria; Prediction better in diagnosing absence than the presence of disorder.

How valid are standardized tests in determining school effec tiveness ? The writers argue for a measurement system that rec ognizes the diversity of schools. [ABSTRACT FROM PUBLISHER]

Schizophrenic patients with severe negative symptoms may have an impaired capacity to benefit from social skills training (SST), and their negative symptoms may show little change as a result of SST. The present study, employing a multiple-baseline design across-behaviors with three patients who had prominent negative schizophrenic symptoms, combined nonverbal skills training with the Stacking the Deck social skills game. Further, the study examined changes in both social skills (assessed using role-play and conversation tests) and negative symptoms. Depression, extrapyramidal side effects, and positive symptoms were also monitored. Modest improvements in social skills and negative symptoms were achieved. There was little evidence of a training effect. The unstable baselines may have contributed to this finding. It is important for further research to employ comprehensive patient-assessment procedures. [ABSTRACT FROM PUBLISHER]