ObjectiveThis study aimed to analyse the differences in Emergency Departments (EDs) length of stay (LOS) for mental health (MH) presentations between older patients (aged 65 and above) and younger adults, identifying factors contributing to longer stays.MethodsA retrospective data analysis of MH patients presenting to MHEDs in three Brisbane hospitals between May 2018 and May 2019 was conducted. We dichotomised LOS around the 75th quartile (20 h), given the skewness of the data. Patients remaining in MHED for longer than 20 h were considered as a prolonged length of stay (PLOS).ResultsOlder patients constituted 4.5% ( = 423) of the 9452 MH presentations. They were significantly more likely to experience PLOS ( < .0001). Awaiting admission had an 11-fold increased risk of PLOS (Adjusted OR 9.69-12.48, 95% CI). Additionally, alcohol and drug-related cases were prone to PLOS ( < .0001), though these factors did not explain the extended stays in the elderly.ConclusionOlder MH patients had a significantly longer LOS in MHED compared to younger adults. Neither waiting for admission nor substance-related issues fully accounted for this discrepancy. Further research is needed to explore other potential contributing factors to PLOS, for example, medical comorbidities, psychosocial issues, and systemic-related delays in elderly MH care.

ObjectiveWhile a large body of literature has explored the relationship between peer influence and body dissatisfaction in adolescents, limited research exists in adults. The aim of this study was to investigate the relationship between peer influence and body dissatisfaction in adults and to investigate whether this relationship would be strengthened by one's susceptibility to peer influence.Methods179 adult participants completed an online survey.ResultsMultiple hierarchical regression identified that whilst peer influence was associated with body dissatisfaction, susceptibility to peer influence did not contribute to the strength of this relationship.DiscussionThe current findings identified that peer influence in the form of exposure and engagement with peers surrounding topics of appearance, weight and shape, was a significant contributor of body dissatisfaction. A greater susceptibility to peer influence was not shown to strengthen this relationship suggesting that the effect that susceptibility to peer influence has may differ depending on the scenario and context. The findings have important implications for educating adults on the impact that their appearance and weight related discussions and behaviours may have on their peers.

ObjectiveThis perspective critically examines the impact of capitalism on Australian mental healthcare employing Bronfenbrenner's ecological theory. By analysing systemic challenges across macro-, meso-, and micro-levels, the paper reveals how marketisation prioritises profit over patient welfare. The perspective also highlights solution-based attempts of the Royal Australian and New Zealand College of Psychiatry to address the current crisis.ConclusionThe paper concludes by proposing strategies to restore justice, equity, and continuity in mental healthcare through reinvestment in public services, strengthened governance, workforce support, and a rights-based, socially integrated model of care.

BackgroundAripiprazole is a partial dopamine agonist antipsychotic used for schizophrenia and bipolar disorder. Where most antipsychotics increase prolactin, aripiprazole, due to its novel action, lowers prolactin levels. This novel action can also suppress lactation.AimThe aim of this study was to understand the rates of breastfeeding (exclusive or supplemented) while on aripiprazole.MethodsUsing a retrospective, chart review, electronic prescribing reports were used to identify when aripiprazole was prescribed in maternity units in six hospital sites in Queensland, Australia. Electronic charts were then used to identify cases of breastfeeding whilst on aripiprazole. Rates of breastfeeding were compared to a general population.FindingsThirty-four cases of breastfeeding whilst on aripiprazole were identified. Twenty-three (73.5%) ceased breastfeeding by the last midwife appointment. Eight (23.5%) were supplementing breastfeeding with artificial feeds. Only one mother was able to exclusively breastfeed. The effect may be dose related.ConclusionThis study further supports the current case reports in the literature and suggests that women taking aripiprazole appear to have very low rates of exclusive breastfeeding. This effect appears to be dose related.

ObjectiveWhile physical symptoms are not uncommonly reported by those experiencing burnout, the syndrome is essentially defined by a set of psychological symptoms. We therefore undertook a study to quantify physical symptoms associated with a burnout syndrome.MethodA sample of self-diagnosed individuals with burnout were requested to complete data on representative physical symptoms (i.e. headaches, cardiovascular symptoms and falls), illness course variables (i.e. increased rate of infections, being ill more often and taking longer to recover from sickness) as well as being hospitalised as a consequence.ResultsIn a refined sample of 317 respondents assigned to a 'burning out' stage and 509 to a 'burnt out phase', only headaches had a higher prevalence in the first group. Prevalence rates of all symptoms and of compromised health were high while 10% of the combined group reported that their condition had led to them being hospitalised.ConclusionsCompromised physical functioning would appear to be common in those experiencing a burnout syndrome, and awareness of such a consequence should assist clinical diagnosis of such a condition and might warrant physical symptoms being listed in diagnostic criteria sets as secondary features.

ObjectiveTo assess the compliance of Victorian designated mental health services (DMHS) with mental health and wellbeing principles under section 30 of the (Vic).MethodAn audit of 19 Victorian DMHS' annual reports to assess compliance with a duty to report actions on one or more mental health and wellbeing principles (principles) within the last year.Results16 of 19 (84.2%) of designated mental health services breached their duty to report on how they complied with one or more principles within the last year. The three compliant services provided varied responses to this duty.ConclusionsThe vast majority of Victorian DMHS have failed to comply with a minimum reporting requirement under the MHWA. This data suggests that imprecise legislative drafting, an inadequate commissioning and regulatory framework as well as under-enforcement by the Mental Health and Wellbeing Commission may have contributed to non-compliance. Further research may examine how regulatory oversight agencies can ensure greater compliance with human rights and the MHWA.

ObjectiveMajor depressive disorder (MDD) is a highly prevalent debilitating mental health disorder with a lifetime risk of 11-15% in Australia. The most effective treatment for severe depression is electroconvulsive therapy (ECT), but it is associated with high relapse rates. This review aimed to investigate non-ECT interventions for preventing relapse of MDD after an effective acute course of ECT.MethodThe search covered electronic databases, specifically PubMed, PsycINFO and Embase, and clinical trials registered with clinicaltrials.gov and Cochrane Register of controlled trials up to 1 June 2022. Medical Subject Headings and key words used in the search were 'electroconvulsive therapy', 'depressive disorder', 'continuation', 'maintenance', 'prevention', 'prophylaxis', 'relapse' and 'recurrence'.ResultsA total of fifteen articles were included in the review. Interventions investigated by the studies were lithium, lithium + nortriptyline, escitalopram, imipramine, phenelzine, amitriptyline, venlafaxine and cognitive behavioural therapy (CBT).ConclusionsLithium was investigated the most, demonstrating good outcomes either as monotherapy or combination therapy with nortriptyline or venlafaxine. Imipramine, phenelzine, amitriptyline and CBT demonstrated encouraging results, while escitalopram failed to show a favourable outcome. Clinicians aiming to reduce the risk of relapse after an effective acute course of ECT could consider lithium, nortriptyline, venlafaxine and CBT.

BackgroundGiven the robust association of cognitive deficits (CD) with community functioning in people with schizophrenia and the inconsistent findings from the limited research on CD among people with treatment-resistant schizophrenia (TRS), we evaluated the neurocognitive functions of patients with TRS.MethodsWe retrospectively collated data on cognition and selected demographic and clinical variables of 181 patients with TRS and 59 with treatment-responsive schizophrenia (non-TRS) admitted to a psychiatric rehabilitation facility from 2010 to 2019. The Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate cognitive function. Multivariate analysis was utilised to compare the BACS scores of the two groups.ResultsTRS patients had more severe CD than non-TRS patients, with the BACS composite score ( = .003), verbal memory and learning ( = .003), working memory ( = .043), and psychomotor speed ( = .004) significantly worse in the TRS group. There was no significant difference in the BACS scores between the 60% of the TRS patients who were treated with clozapine and the TRS patients (40%) treated with other antipsychotics.ConclusionCD are more severe among patients with TRS than in non-TRS cohorts. The pathophysiology of CD among people with TRS and efficacy of interventions to ameliorate CD among this cohort warrant greater scrutiny.

Transcranial magnetic stimulation (TMS) is essential for the comprehensive treatment of major depressive disorder (MDD). Around Australia, it is widely available in private practice, but in few Public Mental Health Services. TMS is a revolutionary treatment. Using electromagnetic apparatus, the function of precise local and distant regions of the brain can be modulated, with minimal side effects. Half of patients with MDD do not respond to antidepressant medication. However, a large proportion of medication non-responders can be brought to remission using TMS. This intervention is cost-effective and availability in public practice should be increased.

BackgroundThe first author is a third-year trainee with Queensland Centre of Excellence for Intellectual Disability and Autism Health (QCEIDAH). This perspective stemmed from the experience of working at QCEIDAH and reflecting during supervision on the complexity and confusion that arose being 'within and without' - quote from F. Scott Fitzgerald's 1925 novel, '', depicting the narrator's coming of age.ObjectiveTo explore and outline the perspective of a registrar working in a state-wide intellectual and developmental disability consultation service.MethodThe utility of various psychiatric frameworks within a complex consultation service is discussed, including biopsychosocial model, psychodynamic model, and systems framework.ConclusionTo be 'within and without' not only describes the physical state of being inside a room with the patient in a time-limited consultation service but also mirrors the complexity of stepping into the various system of the patient including their families, support workers, NDIS coordinator, and other health providers in a variety of physical, metaphorical, and metatheatrical sense. This presentation highlights the challenge of a trainee working in a space with high expectations from a variety of systems in a field which lacks the clarity and framework to easily achieve this.