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Summary: Quetiapine is an antipsychotic medication indicated for schizophrenia and bipolar disorder. However, quetiapine also has hypnotic properties and as such is increasingly being prescribed at low doses 'off‐label' in people with insomnia symptoms. Pharmacologically, in addition to its dopaminergic properties, quetiapine also modulates multiple other transmitter systems involved in sleep/wake modulation and potentially breathing. However, very little is known about the impact of quetiapine on obstructive sleep apnoea (OSA), OSA endotypes including chemosensitivity, and control of breathing. Given that many people with insomnia also have undiagnosed OSA, it is important to understand the effects of quetiapine on OSA and its mechanisms. Accordingly, this concise review covers the existing knowledge on the effects of quetiapine on sleep and breathing. Further, we highlight the pharmacodynamics of quetiapine and its potential to alter key OSA endotypes to provide potential mechanistic insight. Finally, an agenda for future research priorities is proposed to fill the current key knowledge gaps. [ABSTRACT FROM AUTHOR]

Key Clinical Message: COVID‐19 infection may increase the likelihood of neutropenia in patients already on clozapine. In clozapine treated patients experiencing COVID‐19 associated neutropenia, adjunct therapy with lithium can be considered. [ABSTRACT FROM AUTHOR]

Introduction: There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities. Objective: To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce. Design: We descriptively analysed population‐level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare‐subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross‐sectional design. Findings: Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full‐time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium. Discussion: Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare‐subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities. Conclusion: There remains an acute shortage of psychiatrists in many regional and remote areas of Australia, with an increasing proportion of SIMGs and females working in these areas, in the context of future increased demand. [ABSTRACT FROM AUTHOR]

Social care causes of delayed transfer of care (DTOC) from hospital for older people: unpicking the nuances of "provider capacity" and "patient choice". Keywords: Transportation of patients; Hospitals; Critical pathways; Health financing; Health policy; Health planning; Health services; Health systems; Health services for the aged; Disability evaluation EN Transportation of patients Hospitals Critical pathways Health financing Health policy Health planning Health services Health systems Health services for the aged Disability evaluation 298 300 3 04/18/23 20230415 NES 230415 The case for a market mechanism to improve health system flow and patient care The coronavirus disease 2019 (COVID-19) pandemic significantly exacerbated pre-existing emergency department (ED) congestion in Australian hospitals, accompanied by significant ambulance offload delays occurring in every state.[1] We need a national focus on getting people out of hospital when they do not require this level of care, thereby reducing ED congestion. Transportation of patients, Hospitals, Health financing, Health policy, Health planning, Critical pathways, Health systems, Health services for the aged, Disability evaluation, Health services. [Extracted from the article]

Background: ‘Paediatric bipolar disorder’ (PBD) is a controversial diagnosis where often prepubertal children as well as adolescents, who may have a range of psychiatric disorders or symptoms, are diagnosed with a severe mental illness requiring lifelong medication. Clinically, it has often been applied in the United States but rarely in most other countries. A meta‐analysis (Van Meter et al., Journal of Clinical Psychiatry, , 72, 1250) claimed that the prevalence of PBD was similar to adults at 1.8% with no difference between the United States and other countries. This conclusion has been highly cited. Methods: The heterogeneous nature of the original 12 epidemiological surveys warrants a qualitative analysis, rather than statistical meta‐analysis as performed by Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250). Thus, the meta‐analysis and each of the 12 studies (six from the United States; six from other countries) were reexamined. Results: Most of the 12 surveys predated the emergence of the PBD hypothesis. The 12 surveys were mainly of adolescents and at times young adults with few prepubertal children. Prevalence rates in the 12 studies suggest a lower rate of bipolar disorder, especially in non‐US samples. For example, the Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250) meta‐analysis chose a rate of 2.8% by summation of adolescent and parent responses in a Dutch survey, however the rate fell to 0% if requiring concordance of adolescent and parent responses. Indeed, it could be argued that four of the non‐US studies show 0% rates of PBD. Conclusions: Rates of PBD were generally substantially lower than 1.8%, particularly in non‐US surveys, and if both parent and adolescent reports were required to meet the diagnostic threshold they fell to close to zero. The reanalysis suggests that bipolar disorder is rare before the expected age of onset in later adolescence. [ABSTRACT FROM AUTHOR]

'Paediatric bipolar disorder' (PBD) remains controversial; because it is based on the hypothesis that bipolar disorder (BD) often begins in childhood with atypical forms of mania. A meta‐analysis of 12 epidemiological surveys found a high prevalence of PBD among children and adolescents worldwide (1.8%), however, our study of the measurement issues (Child and Adolescent Mental Health, 23, 2018, 14) found that PBD rates were lower than claimed. Our findings are consistent with the developmental trajectory of BD, as described by most longitudinal studies of high‐risk offspring. BD is extremely rare in childhood with nearly all index manic/hypomanic episodes being in midadolescence or later. Treatment for BD should not commence until the first well‐defined manic/hypomanic episode, because children and younger adolescents are extremely sensitive to the side effects of second‐generation antipsychotics including weight gain, metabolic syndrome, extrapyramidal side effects and the risk of cerebral atrophy, as observed in studies of juvenile animals. Read the Editors' introduction at: doi: 10.1111/camh.12315 Read the core debate at: doi: 10.1111/camh.12231; doi: 10.1111/camh.12243; doi: 10.1111/camh.12296 Read more perspectives in this debate at: doi: 10.1111/camh.12318 doi: 10.1111/camh.12317; doi: 10.1111/camh.12316; doi: 10.1111/camh.12313; doi: 10.1111/camh.12310; doi: 10.1111/camh.12314 [ABSTRACT FROM AUTHOR]

Objective To examine how the rates of the use of particular face-to-face primary mental health care services changed in the first 4 years (2006-2010) of the Better Access initiative in both urban and rural regions of South Australia. Design Time-series analysis of the number of psychology session, psychiatry assessment and general practitioner care plan services recorded in Medicare Australia data. Setting South Australia. Pre-existing data set of South Australian residents who accessed Medicare between 2006 and 2010 Main objective measure Number of services per 100 000 population (service rate). Results Psychology session service rates increased in all regions, but continued to follow a 'location gradient', being higher in areas closer to Adelaide and lower in areas more distant from Adelaide. Psychiatry assessment service rates increased in Adelaide but did not change in other regions. Rates in remote areas were subject to substantial variation over time. General practitioner care plan service rates increased in Adelaide and in the Riverland, but declined in the Murray Mallee region. Conclusions Overall, service rates increased in Adelaide and nearby regions, but the results for rural and remote regions were mixed. Possible explanations for the geographical variability include population characteristics (such as socio-economic status), methods of service delivery (visiting practitioners, telepsych), the relative proportion of total health services provided by general practitioners versus other practitioners, or real variations in the need for primary mental health services. [ABSTRACT FROM AUTHOR]

The article examines the impact of reducing the number of beds in a mental health service together with the implementation of a training program designed to improve the effectiveness of a health care team and integrate data-driven practices. According to the authors, the study showed positive link of bed reduction with reduced length of stay, shorter hours of waiting in the emergency department, and lesser referrals from the community. They stress the importance of integrating training programs during the transition to planned bed reduction.

The article focuses on the National Mental Health Commission (NMHC) report released by the Australian federal government in April 2015 with information on the findings of the report. Topics included in the report are the recommended shift from public acute-care hospitals to community mental health programs, the possible reduction in acute-care hospital beds, and its implication to patients.

The article offers information on International Society for Bipolar Disorders (ISBD) has released a Task Force Report that details the research into pediatric bipolar disorder. Topics include the prevalence estimate suggests that millions of young people could have early forms of bipolar disorder that require combined pharmacologic and psychosocial treatment, and the claim deserves further discussion and debate as it has major implications for world psychiatry.

A letter to the editor is presented in response to an article in the previous issue about the role of national leadership in the creation of academic health science centres through partnerships of Australian universities, research institutes and health services.