The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder.

OBJECTIVE: The objective of this article was to provide an overview of the development and recommendations from the Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). The guideline aims to promote accurate and timely identification and diagnosis, and optimal and consistent treatment of ADHD. METHODS: Development integrated the best available evidence with multidisciplinary clinical expertise and the preferences of those with lived experience, underpinned by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The 23 guideline development group members included psychiatrists, paediatricians, general practitioners, psychologists, speech pathologists, occupational therapists, educators, Indigenous psychologists, and people with a lived experience; with two independent chairs and a methodologist. Where appropriate, evidence reviews from the National Institute for Health and Care Excellence (NICE) 2018 'Attention Deficit Hyperactivity Disorder: Diagnosis and Management' guideline were updated. Fifty prioritised clinical questions were addressed in 14 systematic reviews (new and updated from NICE 2018) and 28 narrative reviews. RESULTS: The 113 clinical recommendations apply to young children (5 years and under), children, adolescents and adults. They provide guidance for clinicians on identification, screening, diagnosis, multimodal treatment and support, including pharmacological and non-pharmacological interventions. The guideline and supporting information are available online: https://adhdguideline.aadpa.com.au/. CONCLUSIONS: The guideline was approved by the National Health and Medical Research Council (NHMRC) of Australia and relevant medical and allied health professional associations. It is anticipated that successful implementation and uptake of the guideline by organisations, health care providers and other professionals will increase delivery of evidence-based treatment and improve health outcomes for the more than 800,000 Australians with ADHD.

Emergency department visits for psychiatric care during the first lockdown in Melbourne.

OBJECTIVE: We investigated the nature of patients presenting to an emergency department (ED) during the first lockdown in Melbourne. METHOD: This study compared adult patients in the North West Area Mental Health Service catchment area who presented to the local ED during the lockdown (16 March-12 May 2020) and the control (16 March-12 May 2019) periods. RESULTS: The control and lockdown periods included 321 and 332 patients, respectively. Compared to the control period, patients with non-English speaking backgrounds and presenting complaints of suicidal behaviour were lower, whereas patients with anxiety symptoms and needing compulsory assessments were higher in the lockdown period. Diagnostically, the lockdown period included more patients with anxiety disorders, substance use disorders and psychotic disorders. CONCLUSIONS: ED access for acute psychiatric care can vary depending upon certain patient characteristics during lockdowns.

Quality of written informed consent forms for electroconvulsive therapy in Australia: a comparative analysis.

OBJECTIVES: We compared the quality of the written informed consent forms for electroconvulsive therapy (ECT) in Australian jurisdictions. METHOD: For this comparative audit-type study, a checklist was developed to compare informed consent forms from different jurisdictions. The main information sources for consent forms were government health department websites and Google. The directors of clinical services were contacted if a consent form was not available through a web source. RESULTS: Majority of the informed consent forms covered information about ECT, general anaesthesia and alternative treatments, supports available for decision making, and a reference to the right to withdraw consent. Missing information affected information areas such as likely outcome if no ECT, lack of guaranteed response and cultural and linguistic supports. CONCLUSIONS: A standardised consent form that can be used across all jurisdictions can help improve the ECT practice.

When should we image our patients? Appropriate use of imaging in inpatient psychiatry.

OBJECTIVE: Injudicious use of medical imaging may be associated with harm to patients and increased downstream healthcare costs. Guidance on the use of imaging in common psychiatric inpatient scenarios is inconsistent or absent. This paper explores three common clinical scenarios facing adult psychiatrists and provides guidance about the appropriate use of imaging. CONCLUSION: Psychiatrists and their junior colleagues would benefit from considering both pre- and post-test probability in each presentation.

COVID-19 and ECT - a Victorian perspective.

OBJECTIVES: (i) to describe the operational strategies implemented to practise electroconvulsive therapy (ECT) safely, and (ii) to explore the effect of the lockdown and operational strategies on the characteristics of patients who received ECT during the initial 6 months of the COVID-19 lockdown. METHODS: At first, the operational strategies that were implemented at the Broadmeadows ECT suite were summarised. Subsequently, the characteristics of patients who received ECT in the lockdown period (16 March-16 September 2020) and in the comparison period (16 March-16 September 2019) were compared. RESULTS: Many safety measures were implemented, and there was no COVID-19 infection among mental health staff and patients. In the lockdown period, the number of patients (23.9%) and the total number of ECTs (29.4%) were less. This pattern was more prominent among the aged patients. CONCLUSION: Safe practices are essential to provide ECT during lockdowns even when the community transmission of COVID-19 is high.

Short-term and 1-year outcome of patients' with borderline personality admitted to a short-term recovery-oriented residential service.

OBJECTIVES: Given the paucity of literature, this study investigated whether a prevention and recovery care (PARC) service supported recovery in patients with borderline personality disorder (BPD). METHOD: This retrospective study included patients with BPD who had their first (index) admission to North West PARC between 2011 and 2016. Patient medical records and the state-wide database were the sources of information. RESULTS: Of the 67 patients included, over 70% attended group activities. All patients achieved their recovery goals, either fully or partially. Compared to admission, the frequency of substance use and the Health of the Nation Outcome Scale (HoNOS) scores at discharge were significantly less. A significantly smaller number of patients needed inpatient treatment during the 12 months following their PARC admission. CONCLUSION: The PARC service appears to promote clinical and psychosocial recovery in patients with BPD.

Is There a Change in Electroconvulsive Therapy Practice Following the New Mental Health Act 2014 in Victoria?: A Study at a Metropolitan Mental Health Service.

OBJECTIVES: The main objective of our study was to examine whether there has been any change to electroconvulsive therapy (ECT) practice since the new Mental Health Act 2014 (MHA) in a public metropolitan mental health service in Victoria. METHODS: This retrospective study examined any change in ECT rate following the new MHA. We compared sociodemographic, clinical, and ECT-related variables for patients treated before (July 1, 2013, and June 30, 2014) and after (1st July 2014 and the 30th June 2015) the new MHA. RESULTS: A reduction of 11.15% in ECT use per 1000 admissions and 16.4% in ECT use per 100,000 persons was observed subsequent to the new MHA. Hospital legal status at admission positively predicted the chance of starting ECT treatment under involuntary consent. Hospital legal status at admission and discharge, history of involuntary ECT, and final Clinical Global Impression-Severity scores positively predicted, but the year of treatment negatively predicted the chance of completing ECT treatment under involuntary consent. CONCLUSIONS: The new MHA appeared to have been associated with reduced ECT use and lower rate of completing ECT under involuntary consent.

A 6-month study on the pattern of emergency department presentations for schizophrenia and other psychotic disorders during COVID-19 lockdown.

This study investigated the characteristics of patients with schizophrenia and other psychotic disorders presenting to emergency departments (ED) for psychiatric treatment during the first six months of the COVID-19 lockdown in Melbourne. This cross-sectional data-base study included adult patients in the North West Area Mental Health Service's catchment area who had visited two emergency departments (EDs) during the study period (March 16-September 16, 2020) and the control period (March 16-September 16, 2019). Compared to the control period (n = 467), the lockdown period (n = 451) had a 6.8% more psychotic disorders. This increase was particularly noted for schizophrenia and acute transient psychosis. In a sub-analysis of psychotic disorder group alone, compared to the control period, more patients were discharged to the community in the lockdown period. In another sub-analysis, compared to the mood disorder group, psychotic disorder group included more patients in 26-35 and 46-55 age groups, men, emergency triage category, and hospital admissions and higher mean duration of ED stay in the lockdown period. Overall, patients with psychotic disorders had increased ED presentations and appeared to be in an emergency state when they present to ED during the lockdown.

COVID-19 and psychiatric admissions: An observational study of the first six months of lockdown in Melbourne.

Research on the effect of a prolonged lockdown on inpatient admissions is limited. In this background, this study was planned, and it included patients admitted to inpatient units of a large mental health network in Melbourne during the lockdown (March 16-September 16, 2020) and a similar time period in 2019. The results showed a 12% decrease in admissions. The lockdown period included patients with lower mean age and more patients with never married status, higher education status, students and patients with home duties, and certain psychiatric diagnoses. Overall, the patients needing inpatient treatment during a prolonged lockdown are different.

A comparative study of access to inpatient psychiatric treatment in a public mental health service in Melbourne during COVID-19.

INTRODUCTION: Given the paucity of research on how COVID-19 pandemic-associated lockdowns have affected the access to inpatient treatment, the present study was carried out. AIMS: This study aims to describe (1) the characteristics of patients who accessed inpatient treatment, (2) the length of inpatient stay and readmissions, and (3) the quality and safety of care as indicated by the type of admission (voluntary/compulsory) and seclusion use during the lockdown period. MATERIALS AND METHODS: For this comparative database study conducted at North West Area Mental Health Service, the study group included patients who had an admission between March 16, 2020 (starting of social distancing measures in Victoria) and May 12, 2020 (when easing [Stage 1] of social restrictions started). The control group included patients admitted between March 16, 2019, and May 12, 2019. The hospital databases were sources of information. RESULTS: The study and control groups included 104 and 109 patients, respectively. Compared to the control group, the study group had significantly more patients with separated relationship status, a lower number of severe mental illnesses (SMIs), a higher number of substance use disorders, and lower readmissions. A subanalysis within the lockdown period showed more voluntary admissions in the initial phase whereas more compulsory admissions in the later phase at trend significance. CONCLUSION: Patients with a separated relationship status and a substance use disorder sought inpatient treatment more than others. Aside from exploring the reasons for these findings, it is also important to investigate why SMIs and readmissions decreased during the lockdown period through further studies.

Phenomenology of near-death experiences: a cross-cultural perspective.

Near-death experiences (NDEs) include a set of subjective experiences encountered by people who were close to death or were faced with life-threatening situations. Reports have suggested that the phenomenology of NDE might differ across cultures. This article is aimed at providing an updated phenomenological perspective by comparing NDEs in a cross-cultural context. We compared the various descriptions of NDEs from a phenomenological perspective. There were similarities between particular cultures, which differed from typical western European experiences. This article concludes that although there are common themes, there are also reported differences in NDEs. The variability across cultures is most likely to be due to our interpretation and verbalizing of such esoteric events through the filters of language, cultural experiences, religion, education and their influence on our belief systems either shedding influence as an individual variable or more often perhaps by their rich interplay between these factors.