Australasian Psychiatry

Mother–baby units are innovative and important models of care that allow inpatient treatment of postpartum maternal mental disorders whilst preserving and promoting the attachment relationship with their young infants.

To report data across five public mother–baby units in Australia in order to explore similarities and distinguishing features of each model.

Each unit also provided 12 months of data on key characteristics of their unit.

Despite the geographic differences, the diagnostic profiling, length of stay, and child protection involvement were similar across the units.

Acute care for perinatal mental illness offered in public mother–baby units in Australia shows consistency across units, raising concerns for where such treatment is unavailable.

The objective of this study was to explore attitudes and decision-making by pregnant women regarding antidepressant and anxiolytic use during pregnancy.

An observational study at an outer metropolitan hospital in Brisbane, Queensland. Pregnant women presenting for their first antenatal clinic visit were invited to complete a questionnaire. Participants were asked about current or previous antidepressant/anxiolytic use, influences on drug decision-making and the adequacy of information received. Perceptions were measured on a 7-point Likert scale.

A total of 503 pregnant women were surveyed. The background prevalence of anxiety and depression was 30.0% (151), with 9.3% (47) respondents using antidepressant or anxiolytic medications during the current pregnancy. Of these 47 women, 68% ceased these medications during or while trying to become pregnant, most commonly due to potential side effects to the baby (16), health professional advice (8) and symptomatology that was under control (7). While the effect was modest, decision-making was most strongly influenced by general practitioners, family and the internet.

Most women cease antidepressant/anxiolytic medication before and during pregnancy for reasons other than stability of condition. This study reveals an unmet need for accessible reliable information to guide pregnant women and their care providers.

To describe characteristics and treatments of mother-baby dyads affected by postpartum psychosis admitted to a specialist mother-baby inpatient psychiatric unit in Australia.

A retrospective review of medical records for all mothers with postpartum psychosis and their babies admitted to a mother-baby unit over a 5-year period was conducted.

A total of 25 dyads met the study criteria. Affected women were found to be severely ill with a high rate of involuntary status (64%). They waited an average 4.7 days for a bed in the mother-baby unit. All received an atypical antipsychotic, with 16% receiving lithium augmentation. Infants were found to have generally normative growth and development, with relationship concerns noted in 5. A total of 36% of the cohort maintained some breastfeeding, and all had their infants in their care at discharge.

The mother-baby unit enabled severely ill women to remain with their infants during treatment. While a minority of infants showed developmental concerns, appropriate development was noted in most. Future efforts should focus on determining the most effective treatments and further defining the risks and benefits for infants in mother-baby units.

To describe prescription of sodium valproate (SV) for bipolar mood disorder to potentially child-bearing women within one public mental health service and describe risks of fetal exposure, and safe prescribing practices among psychiatrists.

A 24-month retrospective chart review with descriptive analysis; narrative review of literature and guidelines.

Review of 383 charts demonstrated prescription of valproate to 20% of 98 women aged 15–45, with little evidence of advice regarding risk and contraception. Robust evidence of teratogenic and neurodevelopmental risk underpins increased regulation, and recommendations that valproate not be prescribed to this cohort.

The significant risks associated with SV oblige all prescribers to proactively access authoritative guidelines such as those published by the Centre of Perinatal Excellence.

Psychiatrists may become involved in circumstances where a child is seeking termination of pregnancy. Potential roles include capacity advice and advocacy, but ethical and legal uncertainties abound. This paper uses illustrative cases, in an Australian jurisdiction, to exemplify the issues.

Termination of pregnancy at the youthful extreme raises unique challenges for all involved.

Mobile device use is a rapidly growing, socially acceptable interactional habit. The impact of mobile device use on social interactions, including between parents and young children, is uncertain. The aim was to describe, synthesise and evaluate the evidence about parents’ mobile device use, caregiving and children’s social and emotional development.

Seven medical and social sciences databases were searched using keywords and subject headings. Screening for eligibility used PRISMA guidelines and scientific and reporting quality were assessed with standardised checklists.

Eight studies met the inclusion criteria (four surveys, three qualitative and one mixed-method investigation). This small group of studies is of diverse quality, but there is evidence of associations between parents’ mobile device use, attention to caregiving and changes in child behaviour. Use of mobile devices during parenting activities may be infrequent and brief, but it can be a potent distraction that reduces caregiver responsiveness to children.

An emerging body of research suggests mobile devices are associated with altered attention and responsivity to children by their caregivers and may change caregiver/child interactions. The evidence precludes questions about causality or discussion of impacts on child development. Knowledge gaps have been identified and they require future targeted research.

This preliminary study explored whether an adapted approach to the Alert Program, that uses sensorimotor strategies, might assist with management of tic disorders in children.

The Alert Program, a program that uses sensorimotor strategies for self-regulation in children with neurodevelopmental disorders, had not been trialled with children with tic disorders.

Ten children with tic disorder were assessed using the Dunn Sensory Profile 2 (SP2), the Yale Global Tic Severity Scale (YGTSS) and the Parent Tic Questionnaire (PTQ). Participants attended three 60–90-minute appointments with an occupational therapist and clinical psychologist for implementation of the adapted Alert Program.

The YGTSS showed tic reduction in all participants. The total YGTSS pre-intervention mean score of 46.5 improved to 17.7 post-therapy. Five participants reported no impairment post-therapy. PTQ scores reduced in nine participants. On the SP2, 30% of participants scored as having sensory sensitivities that impaired daily function.

This exploratory study found trialling an adapted approach to the Alert Program that uses sensorimotor-based approach decreased tic severity in children with tic disorders. A randomised controlled trial is needed to establish the effectiveness and feasibility of this approach.

The current study’s aim was to measure anxiety, depression and quality of life in parents of children referred for developmental evaluation.

The Hospital Anxiety and Depression Scale and the Short Form 36 Health Survey were used to assess anxiety, depression and quality of life, respectively.

One hundred and thirty parents participated in the study, 95 with a child referred for evaluation and 35 with healthy children. Parents of developmentally impaired children reported increased anxiety (p=0.002) and depression (p<0.001) and worse social functioning (p=0.002) and mental health (p=0.017). Mothers of developmentally impaired children reported significantly increased anxiety symptoms (p=0.012) and bodily pain (p=0.046) and lower levels of vitality (p=0.009), social functioning (p=0.005) and mental health (p=0.008). More children in the family correlated with increased anxiety scores (p=0.021), while higher child age was associated with more anxiety symptoms (p=0.002), more role limitations due to emotional problems (p=0.003) and worse mental health (p=0.002).

Parenting children with developmental difficulties is associated with significant psychological distress and disturbed quality of life.

Men present with complex, diverse and often contradictory expressions of masculinity that are relevant to their health status. This article argues for the inclusion of masculinity into mental health curricula in Australia. Masculinity mediates health outcomes by influencing help seeking and engagement with treatment.

An online curricula audit of publicly available information from Australian medical programs and their professional bodies reveals increasing awareness of the needs, but limited practical inclusion of masculinity models in training and practice. Described are the elements essential to training and subsequent clinical practice to curb the poor mental health outcomes of Australian men.

We examine the use of combination long-acting injectable (LAI) antipsychotic medication for adolescents with severe psychosis and aggression. We discuss benefits and risks with this approach, for a highly challenging small group of young people.

A clinical summary is given of three adolescents admitted to a secure adolescent forensic inpatient unit, and the literature is reviewed.

In these adolescents with severe psychosis, aggression and violent offending, combination LAI antipsychotics effectively treated psychosis and enabled transfer to less restrictive settings. Brief Psychiatric Rating Scale (BPRS) scores decreased significantly with treatment, without any severe adverse effects.

Combination LAI antipsychotics may be an effective treatment for adolescents with severe psychosis and aggression where clozapine is not a realistic therapeutic option. Close monitoring for side-effects, clear documentation of clinical reasoning and appropriate safeguards are important.

We describe the use of responsive art therapy in an inpatient child and adolescent mental health services unit, including its acceptability rated through a satisfaction questionnaire.

A patient satisfaction questionnaire was developed to collect feedback from 46 adolescents. Images from therapy were photographed and collated looking for patterns across diagnoses and stages of treatment.

Adolescents reported that art therapy helped them learn how to express themselves safely (80%) and understand how their thoughts related to their feelings (78%).

Responsive art therapy was a useful strategy to support the safe expression of distress and was seen as a positive experience by adolescents in inpatient mental health care.

To examine willingness to adopt protective behaviours, and perceived barriers, during a pandemic influenza, in people with schizophrenia.

A cross-sectional study using a questionnaire was conducted exploring the responses of 71 adults with schizophrenia and 238 adults without schizophrenia attending a general practice setting, regarding willingness and perceived barriers to adopting protective measures against the 2009 swine influenza pandemic in Australia.

The majority of participants with schizophrenia reported that they would be at least moderately willing to be vaccinated (74.2%), isolate themselves (73.2%), wear a face mask (54.9%) and increase hand washing (88.6%). However, 71.8% were concerned about “catching” flu from vaccination. Predictors of willingness to adopt protective actions included self-efficacy (vaccination, face mask, isolation), perceived likelihood of contracting swine flu (vaccination), educational status (face mask) and perceived overall risk from swine flu (face mask). Key modifiable perceived barriers to adopting protective measures were identified, including cost and need for transport assistance for vaccination.

People with schizophrenia report being generally willing to adopt protective measures, especially increased hand washing, during a pandemic influenza. Understanding perceived barriers may enable development of effective interventions to increase uptake of protective measures.

To examine the prevalence of metabolic syndrome and its association with clinical, demographic and lifestyle factors in patients with mental illness participating in residential rehabilitation.

A physical health audit of all consumers (n = 364) in publicly funded residential rehabilitation programs in Queensland was carried out in late 2016. Data collection focused on clinical, demographic and lifestyle factors associated with physical health.

Central obesity was identified in 80% of males and 89% of females and half of the patients (49.4%) met criteria for metabolic syndrome (MetS). The prevalence of MetS in Indigenous patients (66.1%) was 20% higher than the rate found in non-Indigenous patients (46.1%). Smoking, substance abuse, gender, Indigenous background, length of stay and rarely eating fruit and vegetables were individually associated with MetS.

The prevalence of MetS in this cohort is almost double that of the general population, while the rate in Indigenous patients is among the highest reported for those with mental illness. Rehabilitation staff are encouraged to engage more fully in the monitoring of physical health status, sharing this information with consumers and primary care providers, and encouraging consumers to play a greater role in managing their physical health.

The aim of the study was to determine the diagnostic yield of computed tomography (CT) of the brain for the investigation of psychosis.

CT brain requests describing psychosis over a 7-year period at a 500-bed major metropolitan hospital were identified retrospectively. Patients were excluded if they were aged greater than 50 years or if the CT request described focal neurological findings on examination, trauma/falls or known brain tumour, demyelinating disorder, encephalopathy, seizure disorder, congenital brain anomaly, stroke or traumatic brain injury.

A total of 805 patients meeting the inclusion and exclusion criteria were identified, representing the largest published study on this topic. Only 0.4% of patients (3 out of 805) had a potential cause for psychosis demonstrated on CT. None of these patients had their management altered as a result. An additional 0.6% of patients (5 out of 805) had significant pathology that was deemed unrelated to their psychosis.

The diagnostic value of CT in the setting of psychosis was found to be extremely low in patients meeting the inclusion and exclusion criteria. Given the risk of ionising radiation and the expenditure of time and cost, more judicious use of CT is suggested.

The Scholarly Project is a relevant task to support building a culture of research in psychiatry across Australia and New Zealand. However, there are several impediments to trainees’ confident completion of this project. The authors review recent literature on the challenges voiced by trainees, as well as solutions posed by clinician-researchers and medical educators. Relevant strategies are highlighted, and several practical solutions to support the completion of the Scholarly Project are proposed.

There are several pathways available to alleviate barriers to trainees’ timely commencement and completion of the Scholarly Project, including enhancing research capacity within services, familiarity with the requirements, access to supervisors and additional support for trainees.

This paper outlines the current status of the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) Continuing Professional Development (CPD) programme, its main drivers and influences, and outlines potential future changes.

The three features that appear to be essential for an effective CPD programme are the presence of high internal motivation for CPD participation, membership valuing workplace learning, and to ensure that the content for learning remains largely work-focused. The need to incorporate best learning evidence has witnessed the international trend to include peer, reflective and interactive learning tasks into the CPD programme. For this latter change to be successful, members need to be informed about the value of these new and different learning methodologies.