MJA
MJA

    Improving Indigenous health through education

    Michael B Hart, Michael J Moore and Martin Laverty
    Med J Aust 2017; 207 (1): . || doi: 10.5694/mja17.00319
    Published online: 3 July 2017

    Better education may close the life expectancy gap by up to 12 years

    In an inquiry into Indigenous health in 1979, the House Standing Committee on Aboriginal Affairs noted: “When innumerable reports on the poor state of Aboriginal health are released there are expressions of shock or surprise and outraged cries for immediate action. However, the reports appear to have no real impact and the appalling state of Aboriginal health is soon forgotten until another report is released”.1

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      The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders

      David J Castle, Cherrie A Galletly, Frances Dark, Verity Humberstone, Vera A Morgan, Eóin Killackey, Jayashri Kulkarni, Patrick McGorry, Olav Nielssen, Nga T Tran and Assen Jablensky
      Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.01159
      Published online: 19 June 2017

      Abstract

      • Introduction: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines for the management of schizophrenia and related disorders provide evidence-based recommendations for optimising treatment and prognosis. This update to the 2005 RANZCP guidelines has a greater emphasis on psychosocial treatments, physical health comorbidities and vocational rehabilitation.

      • Main recommendations: The guidelines advise a clinical staging approach and deliver specific recommendations for:•comprehensive treatment using second generation antipsychotic agents continuously for 2–5 years;•early treatment of comorbid substance use;•community treatment after initial contact, during crises and after discharge from hospital;•physical health monitoring and management of comorbidities, particularly metabolic health;•interventions to optimise recovery of social function and return to study or work; and•management of schizophrenia in specific populations and circumstances.

      • Changes in management as a result of the guidelines: The guidelines provide benchmarks against which the performance of services and clinical teams can be assessed. Measuring treatment response and clinical outcome is essential. General practitioners have an important role, particularly in monitoring and reducing the high cardiovascular risk in this population. Clinical services focusing on early detection, treatment and recovery need continuous funding to be proactive in implementing the guidelines and closing the gap between what is possible and what actually occurs.


      • 1 St Vincent's Hospital, Melbourne, VIC
      • 2 University of Melbourne, Melbourne, VIC
      • 3 University of Adelaide, Adelaide, SA
      • 4 Northern Mental Health, Adelaide, SA
      • 5 Metro South Health, Brisbane, QLD
      • 6 University of Queensland, Brisbane, QLD
      • 7 Northland District Health Board, Whangarei, New Zealand
      • 8 University of Auckland, Auckland, New Zealand
      • 9 University of Western Australia, Perth, WA
      • 10 Orygen Youth Health, Melbourne, VIC
      • 11 Alfred Health, Melbourne, VIC
      • 12 Monash University, Melbourne, VIC
      • 13 National Centre of Excellence in Youth Mental Health, Melbourne, VIC
      • 14 headspace National Youth Mental Health Foundation, Melbourne, VIC
      • 15 Macquarie University, Sydney, NSW
      • 16 Medical Research Foundation, Royal Perth Hospital, Perth, WA
      • 17 Centre for Clinical Research in Neuropsychiatry, University of Western Australia, Perth, WA


      Correspondence: david.castle@svha.org.au
      Acknowledgements: 

      We thank Susie Hincks, Lived Experience Advisor for her contribution to the guidelines.

      Competing interests:

      No relevant disclosures.

      • 1. Castle DJ, Buckley P. Schizophrenia, 2nd ed. Oxford: Oxford University Press, 2015.
      • 2. Morgan VA, McGrath JJ, Jablensky A, et al. Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychol Med 2014; 44: 2163-2176.
      • 3. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness 2010: report on the Second Australian national survey. Canberra: Commonwealth of Australia; 2011. http://www.health.gov.au/internet/main/publishing.nsf/content/717137a2f9b9fcc2ca257bf0001c118f/$file/psych10.pdf (accessed May 2017).
      • 4. Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust NZ J Psychiatry 2016; 50: 410-472.
      • 5. McGorry P, Killackey E, Lambert T, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust NZ J Psychiatry 2005; 39: 1-30.
      • 6. Galletly CA, Foley DL, Waterreus A, et al. Cardiometabolic risk factors in people with psychotic disorders: the second Australian national survey of psychosis. Aust NZ J Psychiatry 2012; 46: 753-761.
      • 7. National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. 2009. Canberra: NHMRC; 2009. https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf (accessed Nov 2016).
      • 8. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness in 2010: the second Australian national survey of psychosis. Aust NZ J Psychiatry 2012; 46: 735-752.
      • 9. Stafford MR, Jackson H, Mayo-Wilson E, et al. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ 2013; 346: f185.
      • 10. Lubman DI, King JA, Castle DJ. Treating comorbid substance use disorders in schizophrenia. Int Rev Psychiatry 2010; 22: 191-201.
      • 11. Cooper J, Mancuso SG, Borland R, et al. Tobacco smoking among people living with a psychotic illness: the second Australian Survey of Psychosis. Aust NZ J Psychiatry 2012; 46: 851-863.
      • 12. Liu D, Myles H, Foley DL, et al. Risk factors for obstructive sleep apnea are prevalent in people with psychosis and correlate with impaired social functioning and poor physical health. Front Psychiatry 2016; 7.
      • 13. Moore S, Shiers D, Daly B, et al. Promoting physical health for people with schizophrenia by reducing disparities in medical and dental care. Acta Psychiatr Scand 2015; 132: 109-121.
      • 14. Buckley PF, Miller BJ, Lehrer DS, Castle DJ. Psychiatric comorbidities and schizophrenia. Schizophr Bull 2009; 35: 383-402.
      • 15. Shah S, Mackinnon A, Galletly C, et al. Prevalence and impact of childhood abuse in people with a psychotic illness. Data from the second Australian national survey of psychosis. Schizophr Res 2014; 159: 20-26.
      • 16. Morgan VA, Morgan F, Galletly C, et al. Sociodemographic, clinical and childhood correlates of adult violent victimisation in a large, national survey sample of people with psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2016; 51: 269-279
      • 17. Morgan VA, Castle DJ, Jablensky AV. Do women express and experience psychosis differently from men? Epidemiological evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders. Aust NZ J Psychiatry 2008; 42: 74-82.
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        Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial

        Marc M Cohen, De Villiers Smit, Nick Andrianopoulos, Michael Ben-Meir, David McD Taylor, Shefton J Parker, Chalie C Xue and Peter A Cameron
        Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.00771
        Published online: 19 June 2017

        Abstract

        Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain.

        Design: A pragmatic, multicentre, randomised, assessor-blinded, equivalence and non-inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department.

        Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10-point verbal numerical rating scale (VNRS) of at least 4.

        Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units.

        Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non-inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention-to-treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between-group differences.

        Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed.

        Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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        • 1 RMIT University, Melbourne, VIC
        • 2 The Alfred Hospital, Melbourne, VIC
        • 3 Monash Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, VIC
        • 4 Cabrini Hospital, Melbourne, VIC
        • 5 Austin Health, Melbourne, VIC
        • 6 Monash University, Melbourne, VIC


        Correspondence: marc.cohen@rmit.edu.au
        Acknowledgements: 

        The trial was supported by a grant from the National Health and Medical Research Council (#555427).

        Competing interests:

        No relevant disclosures.

        • 1. Grant PS. Analgesia delivery in the ED. Am J Emerg Med 2006; 24: 806-809.
        • 2. Stalnikowicz R, Mahamid R, Kaspi S, Brezis M. Undertreatment of acute pain in the emergency department: a challenge. Int J Qual Health Care 2005; 17: 173-176.
        • 3. Taylor DM, Fatovich DM, Finucci DP, et al. Best-practice pain management in the emergency department: a cluster-randomised, controlled, intervention trial. Emerg Med Australas 2015; 27: 549-557.
        • 4. Shergis JL, Parker S, Coyle ME, et al. Key considerations for conducting Chinese medicine clinical trials in hospitals. Chin Med 2013; 8: 3.
        • 5. Cohen M, Pirotta M, Da Costa C. The integration of complementary therapies in Australian general practice: results of a National Survey. J Altern Complement Med 2005; 11: 995-1004.
        • 6. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 2012; 172: 1444-1453.
        • 7. Madsen MV, Gotzsche PC, Hrobjartsson A. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ 2009; 338: a3115.
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        • 14. Reinstein AS, Erickson LO, Griffin KH, et al. Acceptability, adaptation, and clinical outcomes of acupuncture provided in the emergency department: a retrospective pilot study. Pain Med 2016; 18:169-178.
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        • 16. Wong A, Leong CP, Su TY, et al. Clinical trial of acupuncture for patients with spinal cord injuries. Am J Phys Med Rehabil 2003; 1: 21-27.
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        • 19. Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med 2003; 10: 390-392.
        • 20. Holdgate AK, Kelly, AM. Management of acute migraine (Emergency care evidence in practice series). Melbourne: National Institute of Clinical Studies, 2006. https://www.nhmrc.gov.au/_files_nhmrc/file/nics/programs/Management%20of%20acute%20migraine%20%5BPDF%20190KB%5D.pdf? (accessed Dec 2016).
        • 21. Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based management of acute musculoskeletal pain: a guide for clinicians. Brisbane: Australian Academic Press, 2003. https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp94_evidence_based_management_acute_musculoskeletal_pain_131223.pdf (accessed Dec 2016).
        • 22. Fairbank J, Couper J, Davies JB, O’Brian JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980; 8: 271-273.
        • 23. Santanello NC, Hartmaier SL, Epstein RS, Silberstein SD. Validation of a new quality of life questionnaire for acute migraine headache. Headache 1995; 35: 330-337.
        • 24. Petrella R, Ekman E, Schuller R, Fort J. Efficacy of celecoxib, a COX-2-specific inhibitor, and naproxen in the management of acute ankle sprain: results of a double-blind, randomized controlled trial. Clin J Sport Med 2004; 14: 225-231.
        • 25. Vase L, Baram S, Takakura N, et al. Specifying the nonspecific components of acupuncture analgesia. Pain 2013; 154: 1659-1667.
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          Broken promises and missing steps in mental health reform

          Patrick D McGorry and Matthew P Hamilton
          Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00329
          Published online: 19 June 2017

          We are still seriously failing to resource and integrate mental health into the mainstream of the health care system

          A young colleague recently shared his family’s experience of the Australian health system. His older brother has schizophrenia, an illness that is typically serious, persistent and reduces life expectancy by a minimum of 15–20 years.1,2 He was untreated and seriously ill for 2 years before he gained access — as a result of a life-threatening crisis — to a mental health system that could no longer avoid a response. Expert early intervention services (an Australian innovation), which improve health, social and economic outcomes,3,4 were then and now simply not available in his community and remain embryonic nationally. The inexcusable treatment delay cost him his chance of recovery,4 and he has languished for years with severe symptoms and disability. His care now consists of brief general practitioner visits, non-evidence-based support from a non-government organisation, and stress-laden hospital admissions that achieve nothing more than risk management. He has no meaningful access to specialist expertise or the multidisciplinary team-based approach that is essential to remission and recovery. In 2016, his sister was diagnosed with cancer. The contrast was a revelation to the family. The cancer diagnosis galvanised the same local health system, which this time delivered truly exemplary care. Rapid investigation, effective treatment and widespread support followed, leading to full remission. Not only was the medical care high quality, intensive and sustained, but the young woman was even provided with expert mental health care, of much higher quality than that offered to her brother, for as long as it was needed, with no rationing of sessions or barriers to specialist care.


          • 1 University of Melbourne, Melbourne, VIC
          • 2 Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, VIC


          Correspondence: pat.mcgorry@orygen.org.au
          Competing interests:

          Patrick McGorry is a Director of headspace.

          • 1. Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ 2013; 346: f2539.
          • 2. Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry 2011; 199: 441-442.
          • 3. Tsiachristas A, Thomas T, Leal J, Lennox BR. Economic impact of early intervention in psychosis services: results from a longitudinal retrospective controlled study in England. BMJ Open 2016; 6: e012611.
          • 4. Hegelstad WT, Larsen TK, Auestad B, et al. Long-term follow-up of the TIPS early detection in psychosis study: effects on 10-year outcome. Am J Psychiatry 2012; 169: 374-380.
          • 5. Morgan VA, Waterreus A, Carr V, et al. Responding to challenges for people with psychotic illness: updated evidence from the Survey of High Impact Psychosis. Aust N Z J Psychiatry 2017; 51: 124-140.
          • 6. Castle DJ, Galletly CA, Dark F, et al. The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders. Med J Aust 2017; 206: 501-505.
          • 7. Nielssen O, McGorry PD, Castle D, Galletly C. The RANZCP guidelines for schizophrenia: why is our practice so far short of our recommendations, and what can we do about it? Aust N Z J Psychiatry In press.
          • 8. National Mental Health Commission. Report of the national review of mental health programs and services. Sydney: NMHC; 2015. http://www.mentalhealthcommission.gov.au/our-reports/contributing-lives,-thriving-communities-review-of-mental-health-programmes-and-services.aspx (accessed May 2017).
          • 9. Reavley NJ, Jorm AF. National Survey of Mental Health Literacy and Stigma. Canberra: Department of Health and Ageing, 2011.
          • 10. Australian Institute of Health and Welfare. Mental Health Services in Australia. Expenditure on mental health services: table EXP.32, expenditure on mental health-related services by source of funding, 1992–93 to 2014–15. Canberra: AIHW; 2017. https://mhsa.aihw.gov.au/resources/expenditure (accessed May 2017).
          • 11. Australian Institute of Health and Welfare. Mental Health Services in Australia. Expenditure on mental health services: table EXP.4, recurrent expenditure per capita on state and territory specialised mental health services, constant prices, states and territories, 1992–93 to 2014–15. Canberra: AIHW; 2017. https://mhsa.aihw.gov.au/resources/expenditure (accessed May 2017).
          • 12. Duckett S, Cuddihy M, Newnham H. Targeting zero: supporting the Victorian hospital system to eliminate avoidable harm and strengthen quality of care. Report of the review of hospital safety and quality assurance in Victoria. Melbourne: Victorian Government; 2016.
          • 13. Andrews D. Safety overhaul to put Victorian patients first [press release]. Melbourne: Government of Victoria, 14 October 2016. http://www.premier.vic.gov.au/safety-overhaul-to-put-victorian-patients-first (accessed May 2017).
          • 14. McGorry PD. Back to the future: schizophrenia in retrospect and prospect. Aust N Z J Psychiatry 2017; 51: 431-433.
          • 15. Torrey EF. American psychosis: how the federal government destroyed the mental illness treatment system. Oxford: Oxford University Press; 2013.
          • 16. Harris MG, Hobbs MJ, Burgess PM, et al. Frequency and quality of mental health treatment for affective and anxiety disorders among Australian adults. Med J Aust 2015; 202: 185-189. <MJA full text>
          • 17. Bloom DE, Cafiero ET, Jané-Llopis E, et al. The global economic burden of non-communicable diseases. Geneva: World Economic Forum; 2011. http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf (accessed May 2017).
          • 18. Turnbull M. Address — 2016 Australian Mental Health Prize. Canberra: Australian Government; 2016. http://www.pm.gov.au/media/2016-12-07/address-2016-australian-mental-health-prize (accessed May 2017).
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            Ultrasound as a treatment modality for neurological diseases

            Gerhard Leinenga, Rebecca M Nisbet and Jürgen Götz
            Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.01013
            Published online: 19 June 2017

            Neurological disorders are a particular challenge for therapeutic intervention — ultrasound has emerged as a novel approach with a broad range of applications

            With an ageing population, neurological disorders present an increasing challenge to our health care systems. Although antibodies are increasingly being explored for therapeutic intervention,1 the inefficiency of their uptake by the brain means that the estimated cost of a vaccine to treat neurodegenerative disorders such as Alzheimer disease (AD) will exceed US$25 000 per patient per year.2 Not only is this expected to challenge the health care systems of many countries, it also raises ethical issues associated with making these vaccines available to every patient.


            • Queensland Brain Institute, University of Queensland, Brisbane, QLD


            Correspondence: j.goetz@uq.edu.au
            Competing interests:

            No relevant disclosures.

            • 1. Wisniewski T, Goni F. Immunotherapeutic approaches for Alzheimer’s disease. Neuron 2015; 85: 1162-1176.
            • 2. Golde TE. Open questions for Alzheimer’s disease immunotherapy. Alzheimers Res Ther 2014; 6: 3.
            • 3. Sumbria RK, Hui EK, Lu JZ, et al. Disaggregation of amyloid plaque in brain of Alzheimer’s disease transgenic mice with daily subcutaneous administration of a tetravalent bispecific antibody that targets the transferrin receptor and the Abeta amyloid peptide. Mol Pharm 2013; 10: 3507-3513.
            • 4. Nisbet RM, Polanco JC, Ittner LM, Götz J. Tau aggregation and its interplay with amyloid-beta. Acta Neuropathol 2014; 129: 207-220.
            • 5. Pardridge WM. Drug transport across the blood-brain barrier. J Cereb Blood Flow Metab 2012; 32: 1959-1972.
            • 6. Leinenga G, Langton C, Nisbet R, Götz J. Ultrasound treatment of neurological diseases - current and emerging applications. Nat Rev Neurol 2016; 12: 161-174.
            • 7. Elias WJ, Lipsman N, Ondo WG, et al. A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med 2016; 375: 730-739.
            • 8. Leinenga G, Götz J. Scanning ultrasound removes amyloid-beta and restores memory in an Alzheimer’s disease mouse model. Sci Transl Med 2015; 7: 278ra233.
            • 9. Wrenn SP, Dicker SM, Small EF, et al. Bursting bubbles and bilayers. Theranostics 2012; 2: 1140-1159.
            • 10. Coluccia D, Fandino J, Schwyzer L, et al. First noninvasive thermal ablation of a brain tumor with MR-guided focused ultrasound. J Ther Ultrasound 2014; 2: 17.
            • 11. Carpentier A, Canney M, Vignot A, et al. Clinical trial of blood-brain barrier disruption by pulsed ultrasound. Sci Transl Med 2016; 8: 343re342.
            • 12. Götz J, Ittner LM. Animal models of Alzheimer’s disease and frontotemporal dementia. Nat Rev Neurosci 2008; 9: 532-544.
            • 13. Schneider LS, Mangialasche F, Andreasen N, et al. Clinical trials and late-stage drug development for Alzheimer’s disease: an appraisal from 1984 to 2014. J Intern Med 2014; 275: 251-283.
            • 14. Nisbet RM, van der Jeugd A, Leinenga G, et al. Combined effects of scanning ultrasound and a tau-specific single chain antibody in a tau transgenic mouse model. Brain 2017; doi: 10.1093/brain/awx052 [Epub ahead of print].
            • 15. Hatch RJ, Leinenga G, Götz J. Scanning ultrasound (SUS) causes no changes to neuronal excitability and prevents age-related reductions in hippocampal CA1 dendritic structure in wild-type mice. PLoS One 2016; 11: e0164278.
            • 16. Jordao JF, Thevenot E, Markham-Coultes K, et al. Amyloid-beta plaque reduction, endogenous antibody delivery and glial activation by brain-targeted, transcranial focused ultrasound. Exp Neurol 2013; 248: 16-29.
            • 17. Downs ME, Buch A, Sierra C, et al. Long-term safety of repeated blood-brain barrier opening via focused ultrasound with microbubbles in non-human primates performing a cognitive task. PLoS One 2015; 10: e0125911.
            • 18. Liu HL, Hsu PH, Lin CY, et al. Focused ultrasound enhances central nervous system delivery of bevacizumab for malignant glioma treatment. Radiology 2016; 281: 99-108.
            • 19. Deloitte Access Economics. Dementia across Australia: 2011-2050. Canberra: Deloitte Access Economics, 2011. https://www.fightdementia.org.au/sites/default/files/20111014_Nat_Access_DemAcrossAust.pdf (accessed Apr 2017).
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              Psilocybin-assisted therapy for anxiety and depression: implications for euthanasia

              Nigel Strauss
              Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00081
              Published online: 19 June 2017

              Contemporary research suggests potential benefits of psychedelic drugs in treatment-resistant depression and terminally ill patients

              Despite their stigmatisation, psychedelic drugs are once again being clinically researched in Europe and North America. This long-awaited renaissance is showing very promising results and, unlike the pioneering research that occurred before these drugs were outlawed over 30 years ago, the current methodology is rigorous and of a very high standard.


              • Millswyn Clinic, Melbourne, VIC


              Correspondence: drnigel@bigpond.net.au
              Acknowledgements: 

              I thank Martin Williams for his assistance in the preparation and revision of this manuscript.

              Competing interests:

              No relevant disclosures.

              • 1. Mithoefer MC, Wagner MT, Mithoefer AT, et al. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. J Psychopharmacol 2013; 27: 28-39.
              • 2. Carhart-Harris RL, Bolstridge M, Rucker J, et al. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry 2016; 3: 619-627.
              • 3. Ross S, Bossin A, Guss J, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol 2016; 30: 1165-1180.
              • 4. Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: a randomized double-blind trial. J Psychopharmacol 2016; 30: 1181-1197.
              • 5. Widera E, Block S. Managing grief and depression at the end of life. Am Fam Physician 2012; 86: 259-264.
              • 6. Hasler F, Grimberg U, Benz MA, et al. Acute psychological and physiological effects of psilocybin in healthy humans: a double-blind, placebo-controlled dose-effect study. Psychopharmacology (Berl) 2004; 172: 145-156.
              • 7. Hofmann A. LSD: my problem child. Oxford: Oxford University Press; 2013.
              • 8. Pahnke WM. Drugs and mysticism: an analysis of the relationship between psychedelic drugs and the mystical consciousness. Cambridge, MA: Harvard University Press; 1963.
              • 9. Miller WR. The phenomenon of quantum change. J Clin Psychol 2004; 60: 453-460.
              • 10. Royal Australian and New Zealand College of Psychiatrists. The economic cost of serious mental illness and comorbidities in Australia and New Zealand. Melbourne: RANZCP, 2016. https://www.ranzcp.org/Files/Publications/RANZCP-Serious-Mental-Illness.aspx (accessed Apr 2017).
              • 11. Thienpont L, Verhofstadt M, Van Loon T, et al. Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study. BMJ Open 2015; 5: e007454.
              • 12. Emanuel E. Euthanasia and physician-assisted suicide: focus on the data. Med J Aust 2017; 206: 339-340. <MJA full text>
              Online responses are no longer available. Please refer to our instructions for authors page for more information.

                The disparity between changes in the prevalence of mental illness and disability support rates in Australia

                Harvey A Whiteford
                Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00274
                Published online: 19 June 2017

                Clarifying the type of support needed by people with a psychiatric disability must be a priority

                One major focus of Australia’s national mental health strategy has been to increase access to treatment for those with common mental disorders, particularly anxiety and depressive disorders. Despite indications that treatment rates have increased in Australia,1 there is little evidence that the population prevalence of these disorders has declined, a phenomenon also reported in other high income countries where increased treatment has been made available.2


                • 1 University of Queensland, Brisbane, QLD
                • 2 Queensland Centre for Mental Health Research, Brisbane, QLD
                • 3 Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA


                Correspondence: h.whiteford@sph.uq.edu.au
                Competing interests:

                No relevant disclosures.

                • 1. Whiteford HA, Buckingham WJ, Harris MG, et al. Estimating treatment rates for mental disorders in Australia. Aust Health Rev 2014; 38: 80-85.
                • 2. Jorm AF, Patten SB, Brugha TS, et al. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry 2017; 16: 90-99.
                • 3. Harvey SB, Deady M, Wang M-J, et al. Is the prevalence of mental illness increasing in Australia? Evidence from national health surveys and administrative data, 2001–2014. Med J Aust 2017; 206: 490-493.
                • 4. Slade T, Johnson A, Oakley-Browne MA, et al. 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Aust N Z J Psychiatry 2009; 43: 594-605.
                • 5. Baxter AJ, Scott K, Ferrari AJ, et al. Challenging the myth of an “epidemic” of common mental disorders: trends in the global prevalence of anxiety and depression between 1990 and 2010. Depress Anxiety 2014; 31: 506-516.
                • 6. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness in 2010: the second Australian national survey of psychosis. Aust N Z J Psychiatry 2012; 46: 735-752.
                • 7. Parliament of Australia. The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition. Joint Standing Committee on the NDIS — Mental Health Terms of Reference [webpage]. http://www.aph.gov.au/Parliamentary_Business/Committees/Joint/National_Disability_Insurance_Scheme/MentalHealth (accessed Mar 2017).
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                  Is the prevalence of mental illness increasing in Australia? Evidence from national health surveys and administrative data, 2001–2014

                  Samuel B Harvey, Mark Deady, Min-Jung Wang, Arnstein Mykletun, Peter Butterworth, Helen Christensen and Philip B Mitchell
                  Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.00295
                  Published online: 19 June 2017

                  Abstract

                  Objectives: To assess changes in the prevalence rates of probable common mental disorders (CMDs) and in rates of disability support pensions (DSPs) for people with psychiatric disorders in Australia between 2001 and 2014.

                  Design, setting and participants: Secondary analysis of data from five successive Australian national health surveys of representative samples of the working age population (18–65 years of age) and national data on DSP recipients.

                  Main outcome measures: Prevalence of probable CMDs with very high symptom level (defined by a Kessler Psychological Distress Scale [K10] score of 30 or more) or with high symptom level (K10 score of 22 or more); the proportion of working age Australians receiving DSPs for psychiatric conditions.

                  Results: There was no change in the prevalence rate of probable CMDs with very high symptom levels between 2001 and 2014, but a slight decrease in the prevalence of probable CMDs with high symptoms levels, particularly among those under 45 years of age. Over the same period, the proportion of working age individuals receiving DSPs for psychiatric conditions increased by 51% (for trend, P < 0.001), equivalent to one additional DSP for every 182 working age Australians.

                  Conclusions: Contrary to popular belief, the prevalence of probable CMDs in Australia was stable between 2001 and 2014. However, the proportion of the working age population receiving DSPs for psychiatric conditions increased dramatically over the same period. This conundrum is a major public health problem that should be further examined.

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                  • 1 University of New South Wales, Sydney, NSW
                  • 2 Black Dog Institute, Sydney, NSW
                  • 3 St George Hospital, Sydney, NSW
                  • 4 Norwegian Institute of Public Health, Oslo, Norway
                  • 5 University of Tromsø, Tromsø, Norway
                  • 6 Center for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
                  • 7 Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
                  • 8 Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, VIC


                  Correspondence: s.harvey@unsw.edu.au
                  Competing interests:

                  No relevant disclosures.

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                  • 3. McManus P, Mant A, Mitchell PB, et al. Recent trends in the use of antidepressant drugs in Australia, 1990–1998. Med J Aust 2000; 173: 458-461. <MJA full text>
                  • 4. Middleton N, Gunnell D, Whitley E, et al. Secular trends in antidepressant prescribing in the UK, 1975–1998. J Public Health Med 2001; 23: 262-267.
                  • 5. Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry 2009; 66: 848-856.
                  • 6. Knudsen AK, Øverland S, Aakvaag HF, et al. Common mental disorders and disability pension award: seven year follow-up of the HUSK study. J Psychosom Res 2010; 69: 59-67.
                  • 7. Harvey SB, Henderson M, Lelliott P, Hotopf M. Mental health and employment: much work still to be done. Br J Psychiatry 2009; 194: 201-203.
                  • 8. LaMontagne AD SK, Cocker F. Estimating the economic benefits of eliminating job strain as a risk factor for depression. Melbourne: Victorian Heath Promotion Foundation (VicHealth), 2010. https://www.vichealth.vic.gov.au/media-and-resources/publications/economic-cost-of-job-strain (accessed Mar 2017).
                  • 9. Henderson M, Harvey SB, Overland S, et al. Work and common psychiatric disorders. J R Soc Med 2011; 104: 198-207.
                  • 10. Goldney RD, Eckart KA, Hawthorne G, Taylor AW. Changes in the prevalence of major depression in an Australian community sample between 1998 and 2008. Aust N Z J Psychiatry 2010; 44: 901-910.
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                  • 14. Andrews G, Slade T. Interpreting scores on the Kessler Psychological Distress Scale (K10). Aust N Z J Public Health 2001; 25: 494-497.
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                  • 17. Australian Government, Department of Families, Housing, Community Services and Indigenous Affairs. Characteristics of disability support pension recipients. June 2011. Canberra: DFHCSIA, 2011. https://www.dss.gov.au/sites/default/files/documents/05_2012/dsp_characteristics_june2011.pdf (accessed Mar 2017).
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                    The sugar content of soft drinks in Australia, Europe and the United States

                    Pia Varsamis, Robyn N Larsen, David W Dunstan, Garry LR Jennings, Neville Owen and Bronwyn A Kingwell
                    Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.01316
                    Published online: 5 June 2017

                    Despite recommendations by the World Health Organization and the National Health and Medical Research Council to limit the drinking of sugar-sweetened beverages (SSBs), Australians are particularly high consumers of such products.1 In the report of the Australian Health Survey, 39% of males and 29% of females over 2 years of age had consumed SSBs on the day prior to the interview in 2011–2012,1 and these drinks were the largest sources of sugar in the Australian diet.2

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                    • 1 Baker Heart and Diabetes Institute, Melbourne, VIC
                    • 2 Monash University, Melbourne, VIC
                    • 3 Sydney Medical School, University of Sydney, Sydney, NSW
                    • 4 Swinburne University, Melbourne, VIC


                    Correspondence: pia.varsamis@baker.edu.au
                    Acknowledgements: 

                    This work was funded by a National Health and Medical Research Council Program grant and the Victorian Government Operational Infrastructure Support scheme.

                    Competing interests:

                    No relevant disclosures.

                    • 1. Australian Bureau of Statistics. 4364.0.55.007. Australian Health Survey: Nutrition first results — foods and nutrients, 2011–12. Table 18: Consumption of sweetened beverages. May 2014. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0072011-12?OpenDocument (accessed Mar 2017).
                    • 2. Australian Bureau of Statistics. 4804.0. National Nutrition Survey: foods eaten, Australia, 1995 [website]. Jan 1999. http://www.abs.gov.au/AUSSTATS/abs@.nsf/0/9A125034802F94CECA2568A9001393CE (accessed Mar 2017).
                    • 3. Jameel F, Phang M, Wood LG, Garg ML. Acute effects of feeding fructose, glucose and sucrose on blood lipid levels and systemic inflammation. Lipids Health Dis 2014; 13: 195.
                    • 4. Bantle JP, Raatz SK, Thomas W, Georgopoulos A. Effects of dietary fructose on plasma lipids in healthy subjects. Am J Clin Nutr 2000; 72: 1128-1134.
                    • 5. Chong MF, Fielding BA, Frayn KN. Mechanisms for the acute effect of fructose on postprandial lipemia. Am J Clin Nutr 2007; 85: 1511-1520.
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                      Preparedness for practice: the perceptions of graduates of a regional clinical school

                      Jenny Barr, Kathryn J Ogden, Kim Rooney and Iain Robertson
                      Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00845
                      Published online: 5 June 2017

                      Abstract

                      Objective: To assess graduates’ self-reported preparedness with reference to a range of clinical practice capabilities, including those related to patient-centred care.

                      Design: A retrospective survey of self-reported preparedness for practice, based on a survey developed by the Peninsula Medical School (United Kingdom) and adapted to account for Australian circumstances and to provide more information about patient-centred care-related capabilities.

                      Setting and participants: Launceston Clinical School, a regional clinical school for undergraduate medical students. Medical students who had graduated during 2005–2014 and were contactable by email were invited to participate in the study.

                      Main outcome measures: Graduates’ self-reported preparedness for practice in 44 practice areas, measured on a 5-point Likert scale.

                      Results: Responses from 135 graduates (50% of invited graduates, 38% of the eligible graduate population) were received. Most graduates felt prepared in 41 of the 44 practice areas; 80% felt at least well prepared in 17 areas. After clustering the 44 areas into six thematic groups, no differences were found between men and women who had graduated in the past 4 years. As male graduates become more experienced (5–10 years after graduation), retrospective perceptions of preparedness in some areas differed from those of more recent graduates; this was not found for female graduates.

                      Conclusion: The survey identified strengths and weaknesses in the preparation of doctors for practice. It could be more broadly applied in Australia to obtain longitudinal data for assessing the quality of learning for curriculum planning purposes, and for aligning graduates’ needs and expectations with those of the medical training and health care employment sectors.

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                      • University of Tasmania, Launceston, TAS


                      Correspondence: Jenny.barr@utas.edu.au
                      Acknowledgements: 

                      We acknowledge the contributions of Michelle Horder, research assistant for data collection, and Jessica Woodroffe, research fellow and contributor to methodological discussions.

                      Competing interests:

                      Kim Rooney is an Australian Medical Council Director, and Director of the Launceston Clinical School at the University of Tasmania.

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