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Objective: Four Medicare Benefits Schedule item numbers for Transcranial Magnetic Stimulation (TMS) treatment of unresponsive MDD were declared in Australia in 2021. They are accompanied by rules/conditions. The aim is to consider these rules/conditions in light of recent research and real-world experience. Conclusions: While evidence supports some listed rules/conditions, others lack clinical justification and deserve to be reconsidered. These include (a) ineligibility of patients who have previously received TMS, (b) a lifetime total limit of 50 treatments, (c) a second/final course being unavailable for 4 months following the completion of the first course, and (d) the second/final course being limited to 15 treatments. [ABSTRACT FROM AUTHOR]

Following on from the publication of the Royal Australian and New Zealand Journal of Psychiatry Mood Disorder Clinical Practice Guidelines (2020) and criticisms of how these aberrantly addressed repetitive transcranial magnetic stimulation treatment of depression, questions have continued to be raised in the journal about this treatment by a small group of authors, whose views we contend do not reflect the broad acceptance of this treatment nationally and internationally. In fact, the evidence supporting the use of repetitive transcranial magnetic stimulation treatment in depression is unambiguous and substantial, consisting of an extensive series of clinical trials supported by multiple meta-analyses, network meta-analysis and umbrella reviews. Importantly, the use of repetitive transcranial magnetic stimulation treatment in depression has also been subject to a series of health economic analyses. These indicate that repetitive transcranial magnetic stimulation is a cost-effective therapy and have been used in some jurisdictions, including Australia, in support of public funding. An argument has been made that offering repetitive transcranial magnetic stimulation treatment may delay potentially effective pharmacotherapy. In fact, there is considerably greater danger of the opposite happening. Repetitive transcranial magnetic stimulation is as, if not more effective, than antidepressant medication after two unsuccessful medication trials and should be a consideration for all patients under these circumstances where available. There is no meaningful ongoing debate about the use of repetitive transcranial magnetic stimulation treatment in depression – it is a safe, effective and cost-effective treatment. [ABSTRACT FROM AUTHOR]

The article discusses the possibility of psychiatrists dishonestly claiming Continuing Professional Development (CPD) credits for webinars they did not attend. The Medical Board of Australia and the Medical Council of New Zealand require satisfactory compliance with a CPD program for practitioner registration, which is administered by the RANZCP. The CPD program has various requirements, including spending time on a Professional Development Plan, Peer Review Group activities, and Self-Guided Learning. Fellows must list their CPD activities and provide substantiating documents, and organizers of Peer Review Groups must verify attendance. The article suggests that the size and complexity of the task make accurate policing of CPD participation impossible, and proposes an honor system as an alternative. [Extracted from the article]

This letter discusses the Continuing Professional Development (CPD) program required by the Medical Councils of Australia and New Zealand for psychiatrists. The letter raises questions and concerns about the program, particularly regarding the inclusion of the CanMEDS framework and the roles it emphasizes. It also questions the process for marking Professional Development Plans, the availability of high-quality peer review, and the requirements for evidence of practice improvement. The letter concludes by acknowledging the importance of CPD for psychiatrists and commending the RANZCP Committee for CPD for their efforts. [Extracted from the article]

Objectives: National suicide rates fall during times of war. This fits with the notion of the population coming together against a common foe. But, what happens in the case of a war which is not fully supported, which draws the population and families apart? We consider this question by examining the Australian suicide rates during the divisive Vietnam War.Methods: We graphed and examined the Australian suicide figures for 1921-2010.Results: We found clear evidence of a decrease in the suicide rate for World War II (consistent with other studies), but a marked elevation of suicide during the Vietnam War.Conclusions: The elevation of the Australian suicide rate during the Vietnam War is consistent with Durkheim's social integration model - when social integration is lessened, either by individual characteristics or societal characteristics, the risk of suicide rises. [ABSTRACT FROM AUTHOR]

This study sought to explore whether using the structure of the International Classification of Functioning Disability and Health (ICF) for the thematic coding of coroners' reports would provide insights into the array and relative importance of different influential factors in Indigenous and non-Indigenous suicide. A total of 411 coroners' reports from the Northern Territory, Australia, were thematically analyzed according to an adapted ICF structure, using a process established by consensus across authors. Categorized statements were tallied and represented graphically. The ICF structure provided a meaningful way of categorizing factors. Key factors associated with suicide across both Indigenous and non-Indigenous cases comprised the following in order of frequency of identification by coroners. Environmental Factors, namely (a) alcohol and drug abuse, categorized under Products and technology and (b) conflict and relationship breakdown, categorized under Support and relationships. The other major factors were within the category Body functions and structures, namely (c) mental illness and mental health concerns, categorized under Mental functions. Substantial differences were evident between factors for Indigenous and non-Indigenous cases. An array of factors was associated with completed suicide, with considerable variability across populations. There were indications of the relative importance of environmental factors. Implications are noted for suicide prevention and the uti lity of the ICF in psychiatry and the study of suicide. [ABSTRACT FROM AUTHOR]

The article discusses a study on the relationship and suicide and homicide rates in Australia. Researchers examined suicide and homicide rates and Human Development Index (HDI) in 102 countries and territories of Australia. Results showed that there was a weak but statistically inverse relationship between the suicide and homicide rates in 102 countries, with no relationship found in Australian values.

Objective: The aim of the present study was to characterize suicide in the Northern Territory (NT) for the 6 year period 1 January 2001-31 December 2006. Method: Suicide death rates by area (Australia, NT), sex, and Indigenous status for the period of 2001–2006 were obtained from the National Coroners Information System through the Victorian Institute of Forensic Medicine. Population f gures were obtained from the Australian Bureau of Statistics. Results: For this period the suicide rate of NT (21.6 per 100 000) was double the national rate (11), and the rate for NT Indigenous people (36.7) was signif cantly higher (p < 0.001) than that of NT non-Indigenous people (14.7). There was a decline in the suicide rate for Australia of -8.6%; for NT, -6.3%; for NT non-Indigenous, -3.3%; and for NT Indigenous, -9.0%. The sex difference was signif cant (p < 0.001) for both Australia and the NT with male subjects having a higher suicide rate than female subjects. With respect to age group, some evidence suggested an earlier peak for NT Indigenous compared to NT non- Indigenous people. Hanging was more common in NT than in the rest of the country and accounted for 87% of Indigenous suicide. Conclusion: Suicide is more common in NT than in Australia generally, and more common in NT Indigenous than NT non-Indigenous people. There is evidence of a decline in suicide rates across the board. [ABSTRACT FROM AUTHOR]

The article discusses about the views of the author on perspective of sociologist Émile Durkheim on suicide problem in Australia. Topics includes according to Durkheim, suicide is influenced by the culture, customs and disruptions due to external factors. The author states that the concept fits for the period during the Great Depresson but during sixties, the time was of uncertainity and great social change like Aboriginal rights, second wave feminism, and illegal drugs.

Objective: To explore psychiatry in Islam, with a view to informing Western psychiatrists working with Islamic patients, and Islamic medical students studying in Western countries.Methods: The first necessary step was to acquire some understanding of Islam, Sharia and Sharia law, as the basis on which the available psychiatric literature was considered. Standard textbooks on Islam and English-language papers in the psychiatric literature were examined. Discussions with knowledgeable Muslim people were conducted.Results: Islam shares roots with the other Abrahamic, monotheistic religions: Judaism and Christianity. A central issues is unity: the unity of God, unity with God and unity within the Islamic community. Islam is more than a religion, because it informs all aspects of behaviour and has been described as 'a comprehensive way of life'. Individualism is less important than the welfare of the community. The Sharia is a list of rules and regulations derived from authentic sources. Psychiatric services in Islam, according to Western standards, are somewhat limited. This issue is being addressed through epidemiological studies, provision of new services and policy development. Although mental health legislation is not universal, forensic psychiatry has a role, in many ways similar to that in the West.Conclusion: Islam is based on unity and core values of compassion, justice and benevolence. Islamic psychiatry has a proud early history, and advances are occurring. There is an opportunity for the profession of psychiatry to bridge religious, ethnic and cultural boundaries. [ABSTRACT FROM AUTHOR]

Objective: To review the literature for evidence suggestiveof a potential role for the atypical antipsychotics that are availablein Australia in the management of pain. Method: PubMed was searched for appropriate papers,and drug com­panies were invited to provide information. Results: Two preclinical and six clinical reports suggestedthat the atypical antipsychotics may have analgesic properties. Conclusions: There is justification for further trials of atypicalantipsychotic medications in chronic pain. Should such studies bearfruit, psychiatrists are well qualified to use these medicationsin the management of chronic pain. [ABSTRACT FROM AUTHOR]

Reports on the medical case of a 22-year-old student in Australia with a four-year history of bilateral facial pain. Treatment with a course of transcranial magnetic stimulation (TMS) for a concurrent major depressive episode; Family history of facial pain; Description of TMS; Decrease in pain in the second week of TMS treatment; Beck Depression Inventory measurement.

Objectives: First, to conduct a historical review of the evidence for repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder and determine a clinical algorithm. Second, to identify opportunities for research., Methods: Literature searches were conducted of the MEDLINE database, UpToDate and the Australian National University Library SuperSearch from 1 January 2000 to 30 September 2019. The search terms used were 'transcranial magnetic stimulation', 'major depressive disorder' and 'depression'., Results: There were 24 meta-analyses identified, demonstrating a clear clinical effect. Left high-frequency rTMS had the most evidence. Ideal clinical parameters and study design were explored., Conclusion: Use of rTMS for some patients with depression is justified. Open research questions include the comparative efficacy of right low-frequency and bilateral stimulation, the role of rTMS in medication-naïve patients, and maintenance of effect.

Objectives: This study aimed to explore the effects of a four-week course of transcranial magnetic stimulation (TMS) on the following symptoms of major depressive episode (MDE): mood, work activities, health concerns, guilt, anxiety and retardation., Method: Patients underwent 20 daily sessions of 10 Hz TMS (two sets of 10 daily treatments separated by two days of rest). The six-item Hamilton Depression Rating Scale (HAMD-6) was administered before and after treatment. Remission was operationalised as a HAMD-6 score of <4. Descriptive statistics and t -tests were used to compare pre/post scores on HAMD-6 subscales, and logistic regression was used to understand symptoms that predicted remission/non-remission., Results: There were 104 participants (79 female; 76%), with a mean age of 44.6 years ( SD =15.7 years). There was a significant improvement in the whole sample and in remitters ( n =70) on all subscales. However, those who failed to remit did not achieve significant reductions in 'health concerns' and 'retardation'. There were no difference in age and sex between remitters and non-remitters. Also, there were no significant differences between the remitters and non-remitters on the pretreatment depression symptom profiles. No predictors of response were identified, as expected., Conclusions: TMS has the ability to reduce all listed MDE symptoms. No pretreatment MDE symptom profile was identified which might carry prognostic value.

Objective: To examine coroner's reports of completed suicide in Tasmania with the intention of characterizing the influence of gender and other factors., Method: One hundred coroner's reports from Tasmania 2010-2012 were examined and basic demographic details (age, gender), suicide method, medical, psychiatric, psychosocial and drug factors were collected. Data were organized using the Operationalized Predicament of Suicide tool and known risk factors, and analysed using SPSS software., Results: We found an overall male:female ratio of 3:1. When acute mental disorder was identified, the male:female ratio was 1:1. When a history of mental disorder is considered, the ratio becomes 1.44:1. When social/environmental factors triggered the event this changed greatly to 5.57:1., Conclusion: Males suicide more frequently than females; but this difference disappears when only those with mental disorder at the time of death are considered, and almost disappears when a history of mental disorder are considered. Higher suicide rates of males are driven by social/environmental stressors. These results have implications for understanding the key drivers of suicide, and developing appropriate preventative strategies.