Eating Disorder and Other Psychiatric Hospitalizations in New Zealand During the COVID-19 Pandemic.

OBJECTIVE: An unprecedented rise in eating disorder presentations has been documented in several countries during the COVID-19 pandemic. We explored this phenomenon by analyzing nationwide psychiatric admissions over 5 years, controlling for demographic variables. METHODS: We retrospectively analyzed all hospitalizations in New Zealand with a primary psychiatric diagnosis from 2017 to 2021, using Poisson regression to calculate admission rates by diagnosis, before and during the pandemic. Using Fisher's exact test and Poisson modeling, national data were validated against a manually collected sample of eating disorder admissions. RESULTS: Eating disorder admissions rose significantly during the pandemic (RR 1.48, p < 0.0001), while other diagnoses remained unchanged or decreased slightly. Anorexia nervosa in 10 to 19-year-old females drove increases, with persistent elevations noted in the 10-14 age group. Pandemic-associated increases were more striking for Maori (RR 2.55), the indigenous Polynesian population, compared with non-Maori (RR 1.43). CONCLUSIONS: Eating disorder hospital presentations increased during the COVID-19 pandemic, while other psychiatric presentations to hospital remained relatively unchanged. Possible drivers include disrupted routines, barriers to healthcare access, altered social networks, and increased social media use. Clinical services require additional resources to manage the increased disease burden, especially in vulnerable pediatric and indigenous populations. Ongoing monitoring will be required to establish the time-course of pandemic-related clinical demand.

Psychedelic medicines for end-of-life care: Pipeline clinical trial review 2022.

OBJECTIVES: People with terminal illnesses often experience psychological distress and associated disability. Recent clinical trial evidence has stimulated interest in the therapeutic use of psychedelics at end of life. Much uncertainty remains, however, mainly due to methodological difficulties that beset existing trials. We conducted a scoping review of pipeline clinical trials of psychedelic treatment for depression, anxiety, and existential distress at end of life. METHODS: Proposed, registered, and ongoing trials were identified from 2 electronic databases (ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform). Recent reviews and both commercial and non-profit organization websites were used to identify additional unregistered trials. RESULTS: In total, 25 studies were eligible, including 13 randomized controlled trials and 12 open-label trials. Three trials made attempts beyond randomization to assess expectancy and blinding effectiveness. Investigational drugs included ketamine (n = 11), psilocybin (n = 10), 3,4-methylenedioxymethamphetamine (n = 2), and lysergic acid diethylamide (n = 2). Three trials involved microdosing, and fifteen trials incorporated psychotherapy. SIGNIFICANCE OF RESULTS: A variety of onging or upcoming clinical trials are expected to usefully extend evidence regarding psychedelic-assisted group therapy and microdosing in the end-of-life setting. Still needed are head-to-head comparisons of different psychedelics to identify those best suited to specific indications and clinical populations. More extensive and rigorous studies are also necessary to better control expectancy, confirm therapeutic findings and establish safety data to guide the clinical application of these novel therapies.

Brief intervention reduces prescription of sodium valproate in women of childbearing age.

OBJECTIVE: Sodium valproate's teratogenicity has prompted increasing restrictions to its use. Our initial audit 2 years prior demonstrated continuing hazardous prescription to women of childbearing age in a New Zealand psychiatric inpatient unit, consistent with nationwide dispensing data. METHOD: Following a service-wide educational intervention and application of "black box" warnings, we conducted a follow-up audit of valproate prescription in the same inpatient unit by reviewing records of women admitted over a 10-month period (March 2020-January 2021). Results were compared with local and international guidelines, and against data from our initial audit. RESULTS: Two hundred and sixty-one women of childbearing age were admitted over the sampling period, 26 of whom (10%) were prescribed valproate on discharge. Over three quarters (77%) of these patients had diagnoses other than bipolar affective disorder, valproates only approved psychiatric indication in New Zealand. Following intervention, significant improvements were observed in several key indicators of prescribing quality: pregnancy testing, documentation of contraception status, and discussion of teratogenic risk. CONCLUSIONS: Following intervention, re-audit demonstrated reduced prescription of valproate and improved management of its teratogenic risk in women of childbearing age receiving inpatient psychiatric care. These results demonstrate the value of a systematic approach to improve prescribing practice.

The prescriber's guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression.

This article is a clinical guide which discusses the "state-of-the-art" usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion-this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy-while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward "bridging" methods that may be used to transition simply and safely from other antidepressants to MAOIs.

Sodium valproate prescription to women of childbearing age in a New Zealand inpatient psychiatric unit.

OBJECTIVE: Sodium valproate's teratogenicity has prompted increasing restriction in its use. It is still widely prescribed to women of childbearing age in New Zealand. To examine this problem, we audited the prescribing pattern of sodium valproate in a psychiatric inpatient unit in New Zealand. METHOD: We reviewed the clinical records of women admitted over a 2-year period (2016-2018). Results were analysed and compared with local and international guidelines. RESULTS: Five hundred and thirty-four women of child-bearing age were admitted over the sampling period, 96 of whom (18%) were prescribed valproate on discharge. Half of these patients had diagnoses other than bipolar affective disorder, valproate's only approved psychiatric indication in New Zealand. Pregnancy testing and contraception status were documented in a minority (29 and 10 cases, respectively). Teratogenic risk discussion was documented in only 11 cases. CONCLUSIONS: Prescription of valproate to women of childbearing age in our sample currently falls well short of best practice. Urgent action at both clinician and organisational levels is required to address this risk.

What Does 'Unpaid Consultant' Signify? A Survey of Euphemistic Language in Conflict of Interest Declarations.

BACKGROUND AND OBJECTIVE: Inadequate competing interest declarations present interpretive challenges for editors, reviewers, and readers. We systematically studied a common euphemism, 'unpaid consultant,' to determine its occurrence in declarations and its association with vested interests, authors, and journals. METHODS: We used Google Scholar, a search engine that routinely includes disclosures, to identify 1164 occurrences and 787 unique biomedical journal publications between 1994 and 2014 that included one or more authors declaring themselves as an "unpaid consultant." Changes over time were reckoned with absolute and relative yearly rates, the latter normalized by overall biomedical publication volumes. We further analyzed declarations according to author, consultancy recipient, and journal. RESULTS: We demonstrate increases in the use of "unpaid consultant" since 2004 and show that such uninformative declarations are overwhelmingly (801/865, 92.6%) associated with for-profit companies and other vested interests, most notably in the pharmaceutical, device, and biotech industries. CONCLUSIONS: Disclosing 'unpaid' relationships with for-profit companies typically signals but does not explain competing interests. Our findings challenge editors to respond to the increasing use of language that may conceal rather than illuminate conflicts of interest.

Ethnic youth and sexual identity: the role of clinical and social support for 'double minorities'.

OBJECTIVES: Sexual-minority youth exhibit increased rates of psychiatric morbidity, subject to various social factors. We examine the impact of ethnicity and culture on these phenomena, with particular reference to Asian youth living in Western societies. CONCLUSIONS: Youth from minority ethnic groups who do not identify with their native gender and/or who are not exclusively heterosexual are known as 'double minorities'. Available evidence suggests that such individuals are at particularly increased risk of depression and suicide, but that this may be mitigated by social support. More research is needed to understand the challenges faced by 'double minorities', notably their perception of and ability to access available clinical and social supports.

What affects completion of the scholarly project? A survey of RANZCP trainees.

OBJECTIVE: To explore trainee perception of what facilitates or delays completion of the RANZCP Scholarly Project (SP). METHOD: Of 182 currently registered New Zealand trainees, 33 (18%) completed an online questionnaire and three open-ended questions. RESULTS: Most trainees agreed or strongly agreed that having protected time for research (87.5%) and access to an appropriate supervisor (87.9%) would facilitate the completion of their SP. Other college requirements were identified by most trainees (87.9%) as a factor delaying completion. CONCLUSIONS: Identifying and protecting research time and ensuring adequate supervision appear essential to improve the uptake and completion of this training requirement.