Aripiprazole in young people with early psychosis: a systematic review and meta-analysis of weight gain

Objective: Aripiprazole is often prescribed to young people, although there remain unanswered questions about its effects on weight gain. This study undertook a meta-analysis of weight gain occurring in young people with early psychosis who were prescribed aripiprazole. Method: A systematic search was conducted for studies reporting on aripiprazole and weight change in young people with a psychotic disorder. A meta-analysis integrated the data into an estimate of effect size. Results: Eleven studies met the inclusion criteria amounting to 886 participants (mean age 18 years). The results showed significant weight gain averaging 2.7 kg. These increases were associated with a longer duration of exposure to aripiprazole but not a higher dosage. Conclusions: The results highlight the importance of regular patient monitoring and the early implementation of interventions to manage antipsychotic-related weight gain.

Maternal Depression and Early Parenting: A Comparison Between Culturally and Linguistically Diverse and Australian born Mothers

Objective: To examine the risk of perinatal depression, parenting stress and infant sleep practices in Australian culturally and linguistically diverse (CaLD) women. Method: Within the Mercy Pregnancy and Emotional Wellbeing Study, we examined 487 pregnant women of whom 52 were CaLD and 435 non-CaLD. Depression was measured using the Structured Clinical Interview for DSM-IV and the Edinburgh Postnatal Depression Scale. In addition, Parenting Stress Index and infant sleep measures were collected. Results: Fewer CaLD women had a depression diagnosis but there were no differences between CaLD and non-CaLD women for perinatal mental health symptoms. More mothers in the CaLD group were bed sharing with their infant during the night at six months; however, bedsharing was only associated with higher parenting stress for non-CaLD mothers. Conclusions: Findings suggest both differences in infant sleep parenting practices and in parenting stress but not general emotional wellbeing. Future research is required to replicate these findings.

The 30th anniversary of the code of ethics of the Royal Australian and New Zealand College of Psychiatrists–a worthy milestone

Objective To appraise the evolution of the RANZCP’s Code of Ethics on the occasion of its 30th anniversary. Method We scrutinised its five editions, focussing on the revision procedure and changes made, and reviewed relevant literature. Results The procedure of revision has remained constant: incorporating feedback from college members, committees and faculties, and consulting professional medical bodies and mental health advocacy organisations. Seven major themes of change have emerged with respect to patient exploitation, recognition of family and carers, the special place of Indigenous Peoples, confidentiality, engaging patients in decision-making, multidisciplinary collaboration and the well-being of psychiatrists. Conclusions The code has proved to be a dynamic instrument in keeping abreast of changes in psychiatry and society, and promises to maintain a prominent role in promoting high ethical standards in the profession.

The evidence for introducing case-finding for delirium and dementia in older medical inpatients in a New Zealand hospital

Objective The aim of this project was to make the case to the managers of a large urban teaching hospital in New Zealand for the introduction of systematic case-finding for pre-existing cognitive impairment/dementia in older hospital inpatients that screen positive for delirium. Method Two hundred consecutive acute admissions aged 75+ in four medical wards were assessed using the 4AT assessment tool for delirium and the Alzheimer Questionnaire (AQ) for pre-existing cognitive impairment/dementia. Length of stay and mortality at 1 year were also collected. Results Over a third of the sample screened positive for delirium and nearly two-thirds of these also screened positive for dementia. The median length of stay was 5 days for delirium without dementia and 7 days for delirium with dementia, compared to 3 days for those who screened negative for both. After adjustment for age, gender and ethnic group, people who screened positive for delirium (with or without dementia) had 50% longer length of stay ( p < 0.05) and at least double the risk of death ( p < 0.05). Conclusion Older hospital inpatients that screen positive for delirium and dementia using 4AT and AQ have longer lengths of stay and higher mortality. Identification may lead to more timely interventions that help to improve health outcomes and reduce hospital costs.

Strategies to Prevent Elderly Suicide: A Delphi consensus study

Objectives In the next decades, many countries will become ‘ageing societies’. This combined with the current high rates of suicide in later life suggests that many older adults may die by suicide before clinical trials can be conducted to demonstrate the best approaches to prevent late-life suicide. Methods A New Zealand (NZ) ‘expert panel’ has reviewed key considerations for suicide prevention interventions in older adults based on existing evidence, where available, and expert opinion. The key considerations were extracted from the current literature. The Delphi survey method was used to reach consensus for identifying interventions to be recommended as part of a national strategy for older adults’ suicide prevention. Results A set of 20 key recommended considerations are presented. The major addition to existing recommendations is the need for ‘A suicide prevention strategy for the elderly…’ to enhance the national all-ages suicide prevention strategy. Conclusion The recommended statements are offered for consideration by stakeholder groups preparing new interventions, large-scale public healthcare planning and governmental policy.

Towards Zero Suicide for older adults: implications of healthcare service use for implementation

Objective: Implementing the Towards Zero Suicide (TZS) approach to suicide prevention in older adults requires evidence-based adaptation. This paper aims to highlight important differences and opportunities in healthcare service use by older adults relevant to implementation. Conclusion: The TZS approach may prevent suicide in older adults, but only if implementation aligns with systemic differences in healthcare utilisation by older people. Of greatest importance in older adults are (1) most mental healthcare is delivered outside of specialist mental health services; (2) physical conditions and disability are major modifiable contributors to suicide that must be addressed within TZS; and (3) older people have very low use of Medicare-funded psychological services. Primary healthcare providers, who may be seeing older people at risk of suicide, are often neither equipped to provide expert assessment and care planning for often complex needs, nor may see this as their role. However, they are essential in providing pathways to care, which may prevent suicide. Leaders must recognise TZS for older people will usually involve multiple transitions. This requires engagement of key services with clear roles, targeted training, rapid access to specialist older persons mental health support and development of a new TZS element: the navigator.

Demographic and clinical factors associated with psychiatric inpatient admissions during the COVID-19 pandemic

Objective: The COVID-19 pandemic may cause a major mental health impact. We aimed to identify demographic or clinical factors associated with psychiatric admissions where COVID-19 was attributed to contribute to mental state, compared to admissions which did not. Methods: A retrospective cohort study was undertaken of inpatients admitted to Northern Psychiatric Unit 1, Northern Hospital in Melbourne, Victoria, Australia during 27/02/2020 to 08/07/2020. Data were extracted for participants who identified COVID-19 as a stressor compared to participants who did not. Fisher’s exact test and Mann-Whitley rank sum test were used. Results: Thirty six of 242 inpatients reported the COVID-19 pandemic contributed to mental ill health and subsequent admission. Reasons given included social isolation, generalized distress about the pandemic, barriers to support services, disruption to daily routine, impact on employment, media coverage, re-traumatization, cancelled ECT sessions, loss of loved ones, and increased drug use during the lockdown. Chronic medical conditions or psychiatric multimorbidity were positively associated and smoking status was negatively associated with reporting the COVID-19 pandemic as a contributor to mental ill health. Conclusion: Screening and identifying vulnerable populations during and after the global disaster is vital for timely and appropriate interventions to reduce the impact of the pandemic worldwide.

Effect of a mindfulness programme training on mental toughness and psychological well-being of female athletes

Objectives Research has shown that mindfulness in athletes is associated with positive outcomes. We therefore assessed the effect of mindfulness training on increasing mental toughness (MT) and psychological well-being (PWB). Methods This was a parallel-group, pre-and post-test, randomised controlled pilot trial. Forty-five female athletes from Iranian universities in Tehran were randomly assigned into experimental ( n = 23) and control groups ( n = 22). Forty-two completed the trial. The mindfulness training group received the Mindfulness–Acceptance–Commitment programme for 7 weeks. All subjects completed the Mindfulness Inventory for Sport (MIS), Sports Mental Toughness Questionnaire and PWB Scale. Data were analysed using mixed analysis of variance. Results Mindfulness training increased mindfulness in the experimental group ( p < 0.01). In turn, increased mindfulness led to increased MT and PWB at 2-month follow-up ( p < 0.05). Conclusions Given that mindfulness training may increase the MT and PWB of athletes, these techniques should be considered for inclusion in sports coaching.