Psychiatry

Elizabeth Coombes
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According to the NHS, as many as one in eight children aged five to 19 faces a mental health challenge. And a significant number of these cases are related to some form of anxiety. Of course, a degree of anxiety or worry may be a normal state of affairs for young people – particularly when moving schools, or around exam time. But for some, anxiety can affect every aspect of their daily lives. One effective method of providing support for this anxiety is music therapy, where music becomes the main tool the therapist uses to connect and work with the patient. This kind of therapy has been shown to be effective when treating children and young people living with anxiety based disorders.

Dr Linda Calabresi
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A patient’s potential to suicide haunts most GPs at some stage in their working life. Many patients will endure incredibly stressful periods in their lives, and while you can offer all the support in the world there will always be the question of whether they need more. In such situations, help offered by a person who can say “I understand – I’ve been there” can be invaluable. That’s where this resource comes into its own.

Dr Linda Calabresi
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Improving a young person’s diet might be the key to helping them overcome their depressive symptoms, according to new Australian research. In a randomised controlled trial of just over 100 people with elevated levels of depression symptoms and a regular diet that was assessed as poor, researchers found that those allocated to the ‘diet change’ group, on average improved to the point of having no clinically significant symptoms after just three weeks. This was in stark contrast to the ‘habitual diet control group’ who unsurprisingly, showed no improvement in symptoms over the duration of the study.

Dr Michelle H Lim
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More than one in three young adults aged 18 to 25 reported problematic levels of loneliness, according to a new report from Swinburne University and VicHealth. We surveyed 1,520 Victorians aged 12 to 25, and examined their experience of loneliness. We also asked about their symptoms of depression and social anxiety. Overall, one in four young people (aged 12 to 25) reported feeling lonely for three or more days within the last week. Among 18 to 25 year olds, one in three (35%) reported feeling lonely three or more times a week. We also found that higher levels of loneliness increases a young adult’s risk of developing depression by 12% and social anxiety by 10%. Adolescents aged 12 to 17 reported better outcomes, with one in seven (13%) feeling lonely three or more times a week. Participants in this age group were also less likely to report symptoms of depression and social anxiety than the 18 to 25 year olds.

Samantha Kitchen
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The usual medical focus in articles about ADHD is on how to support the family that is coping with a child with ADHD. Another common focus is about the misdiagnosis of ADHD, and how medication is overprescribed. This article is different. I want to emphasise, from personal experience, the importance of empowering the child or young adult who has ADHD. I also appreciate the chance to explain to others how it feels to have ADHD so they understand the difficulties people like me have.

Dr Linda Calabresi
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Even primary school children know a good diet and proper nutrition is important if you want to be physically healthy. Eat the wrong things or insufficient of the good things and chances are you’re destined to develop heart problems, diabetes or cancer. But what about a person’s psychological health? How important is diet and nutrition in mental health? And is there any evidence that people treat or prevent mental illness by taking particular nutrients, supplements or vitamins?

Prof Wayne Warburton
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This article outlines the research findings about the impact of playing online video games and advises on healthy video game use.

Dr Linda Calabresi
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Physical activity not only helps prevent depression, but should be considered an effective therapeutic option for patients who already have the condition, researchers say. According to a review published recently in Current Sports Medicine Reports, major depressive disorder is an exceedingly common, disabling condition with prevalence estimates ranging from 6% to 18% across different countries worldwide.

Dr Linda Calabresi
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Managing patients with mental health issues is a common recognised challenge for Australian GPs. Managing families and carers is a common often unrecognised challenge for Australian GPs. Knowing someone with a mental health issue, living with them, working with them or caring for them can be extremely difficult and exhausting, never knowing what the right thing is to say or do. Mental Health First Aid is a perfect resource that you can recommend in just these circumstances. The not-for-profit organisation behind this charity is on a mission to train all Australians in the best evidenced-based approach to helping people with a psychological problem. So on the website, people can find authoritative and practical advice on topics such as when should you suspect someone is psychotic and what should you do if you fear someone is contemplating suicide. In addition there are courses that anybody can undertake that actually train you in mental health first aid. How empowering that must be for all those friends and carers who are struggling to help someone they care about who is ill. The information is also available in a range of languages, and also has specific resources for some of the unique issues experienced by Aboriginal and Torres Strait Islander people. This excellent resource is likely to prove valuable not only for patients, but health professionals as well.   >> Access the resource here Recommended at the Sydney Annual Women’s and Children’s Health Update in February, 2019 by Dr Claire Kelly, Director of Curriculum at Mental Health First Aid Australia.

Daryl Efron and Harriet Hiscock
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The rate of medications dispensed for attention-deficit hyperactivity disorder (ADHD) in children aged 17 and under increased by 30% between 2013-14 and 2016-17. The Australian Atlas for Healthcare Variation, released today, shows around 14,000 prescriptions were dispensed per 100,000 children aged 17 and under in 2016-17, compared with around 11,000 in 2013-14. The atlas for 2016-17 also showed some areas had a high dispensing rate of around 34,000 per 100,000 while the area with the lowest rate was around 2,000 per 100,000 – a 17-fold difference. This difference is much lower than in 2013-14, when the highest rate was 75 times the lowest. For decades people have been concerned too many children could be diagnosed with ADHD and treated with medications. We are conducting a study called the Children’s Attention Project, following 500 children recruited through Melbourne schools. So far, we have found only one in four children who met full ADHD criteria were taking medication at age ten. So it looks like, if anything, more children with ADHD should be referred for assessment and consideration of management options.

How many kids are medicated?

ADHD is the most common neurodevelopmental disorder of childhood – the prevalence is around 5% in Australia. Children with ADHD have great difficulty staying focused, are easily distracted and have poor self-control. Many are also physically hyperactive, especially when they are young. To be diagnosed, children need to have major problems from their ADHD symptoms both at home and school. These include learning difficulties, behavioural problems and trouble making friends. Young people with ADHD are more likely to fail school, have lower quality of life, experience substance abuse issues and teenage pregnancy, or end up in prison. Medication can make a big difference to these children’s lives. While there are many ways to help children with ADHD, stimulant medication is the most effective treatment. All international clinical guidelines recommend it for children with significant ADHD that persists after non-medication approaches have been offered. Our previous research found that about 80% of children diagnosed with ADHD by a paediatrician (the main medical specialty that manages ADHD) in Australia are treated with medication. The atlas shows the proportion of children and adolescents who had at least one ADHD medication prescription dispensed was 1.5% in 2013-14 and 1.9% in 2016-7. This is similar to the prevalence of stimulant medication prescription in previous Australian studies in the past 15 years. It sits between the US (high) and Europe (low) and is not excessive given the prevalence of the condition. The Children’s Attention Project found those with the most severe symptoms were more likely to be prescribed medications, as were those from families of lower socioeconomic status. Other Australian studies have found similar results. This is not surprising as ADHD does appear to be more common in children from socioeconomically disadvantaged families. Our research suggests that disadvantaged families in Australia appear to be able to access services for ADHD, at least in metropolitan centres.

Why does it vary between areas?

The atlas finding that there is considerable regional variation in prescribing of stimulant medications in Australia has been identified in previous studies and needs to be better understood. Some variation in health care is normal and good, but too much suggests there may be a problem with the quality of care or access to care. For example, greater prescribing in regional areas may reflect lack of timely access to non-pharmacological services. We do need to keep watching this space, monitoring rates and regional variation of medication use. A landmark study in the US, published in 1999, compared medication with intensive parent and teacher behaviour training. The children who received medication had a much greater reduction in ADHD symptoms. But medication is only one consideration in ADHD. Other supports are also important. Behavioural therapies can help reduce anxiety and behaviour problems in children with ADHD and improve relationships with parents and teachers. However, accessing psychologists can be hard for many families. While Medicare rebates are available for up to ten sessions per year, costs can still be a barrier. In our research, Victorian parents reported out-of-pocket costs of up to A$200 per session with a psychologist. ADHD is not considered a disability under the National Disability Insurance Scheme, so families are not eligible for funding packages. Further research is needed to better understand the factors influencing access to care for Australian children with ADHD, and why there is such variation in rates of prescribing between regions. We also need to ensure children across Australia get equitable access to non-medication management. We need evidence-based clinical guidelines relevant to the Australian healthcare system, which is quite different from places such as the UK and US. This work must include adult ADHD, which is an emerging area with a raft of clinical and service system complexities.The Conversation This article is republished from The Conversation under a Creative Commons license. Read the original article.
Dr Michelle H Lim
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One in four Australians are lonely, our new report has found, and it’s not just a problem among older Australians – it affects both genders and almost all age groups. The Australian Loneliness Report, released today by my colleagues and I at the Australian Psychological Society and Swinburne University, found one in two (50.5%) Australians feel lonely for at least one day in a week, while more than one in four (27.6%) feel lonely for three or more days. Our results come from a survey of 1,678 Australians from across the nation. We used a comprehensive measure of loneliness to assess how it relates to mental health and physical health outcomes. We found nearly 55% of the population feel they lack companionship at least sometime. Perhaps unsurprisingly, Australians who are married or in a de facto relationship are the least lonely, compared to those who are single, separated or divorced. While Australians are reasonably connected to their friends and families, they don’t have the same relationships with their neighbours. Almost half of Australians (47%) reported not having neighbours to call on for help, which suggests many of us feel disengaged in our neighbourhoods.

Impact on mental and physical health

Lonely Australians, when compared with their less lonely counterparts, reported higher social anxiety and depression, poorer psychological health and quality of life, and fewer meaningful relationships and social interactions. Loneliness increases a person’s likelihood of experiencing depression by 15.2% and the likelihood of social anxiety increases by 13.1%. Those who are lonelier also report being more socially anxious during social interactions. This fits with previous research, including a study of more than 1,000 Americans which found lonelier people reported more severe social anxiety, depression, and paranoia when followed up after three months. Interestingly, Australians over 65 were less lonely, less socially anxious, and less depressed than younger Australians. This is consistent with previous studies that show older people fare better on particular mental health and well-being indicators. (Though it’s unclear whether this is the case for adults over 75, as few participants in our study were aged in the late 70s and over). Younger adults, on the other hand, reported significantly more social anxiety than older Australians. The evidence outlining the negative effects of loneliness on physical health is also growing. Past research has found loneliness increases the likelihood of an earlier death by 26% and has negative consequences on the health of your heart, your sleep, and levels of inflammation. Our study adds to this body of research, finding people with higher rates of loneliness are more likely to have more headaches, stomach problems, and physical pain. This is not surprising as loneliness is associated with increased inflammatory responses.

What can we do about it?

Researchers are just beginning to understand the detrimental effects of loneliness on our health, social lives and communities but many people – including service providers – are unaware. There are no guidelines or training for service providers. So, even caring and highly trained staff at emergency departments may trivialise the needs of lonely people presenting repeatedly and direct them to resources that aren’t right. Increasing awareness, formalised training, and policies are all steps in the right direction to reduce this poor care. For some people, simple solutions such as joining shared interest groups (such as book clubs) or shared experienced groups (such as bereavement or carers groups) may help alleviate their loneliness. But for others, there are more barriers to overcome, such as stigma, discrimination, and poverty. Many community programs and social services focus on improving well-being and quality of life for lonely people. By tackling loneliness, they may also improve the health of Australians. But without rigorous evaluation of these health outcomes, it’s difficult to determine their impact. We know predictors of loneliness can include genetics, brain functioning, mental health, physical health, community, work, and social factors. And we know predictors can differ between groups – for example, young versus old. But we need to better measure and understand these different predictors and how they influence each other over time. Only with Australian data can we predict who is at risk and develop effective solutions. There are some things we can do in the meantime. We need a campaign to end loneliness for all Australians. Campaigns can raise awareness, reduce stigma, and empower not just the lonely person but also those around them. Loneliness campaigns have been successfully piloted in the United Kingdom and Denmark. These campaigns don’t just raise awareness of loneliness; they also empower lonely and un-lonely people to change their social behaviours. A great example of action arising from increased awareness comes from the Royal College of General Practitioners, which developed action plans to assist lonely patients presenting in primary care. The college encouraged GPs to tackle loneliness with more than just medicine; it prompted them to ask what matters to the lonely person rather than what is the matter with the lonely person. Australia lags behind other countries but loneliness is on the agenda. Multiple Australian organisations have come together after identifying a need to generate Australian-specific data, increase advocacy, and develop an awareness campaign. But only significant, sustained government investment and bipartisan support will ensure this promising work results in better outcomes for lonely Australians.
Prof Andrew Whitehouse
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New Australian autism guidelines, released today, aim to provide a nationally consistent and rigorous standard for how children and adults are assessed and diagnosed with autism, bringing to an end the different processes that currently exist across the country. There is no established biological marker for all people on the autism spectrum, so diagnosis is not a straightforward task. A diagnosis is based on a clinical judgement of whether a person has autism symptoms, such as social and communication difficulties, and repetitive behaviours and restricted interests. This is an inherently subjective task that depends on the skill and experience of the clinician. This judgement is made even more difficult by the wide variability in symptoms, and the considerable overlap with a range of other developmental conditions such as attention deficit/hyperactivity disorder (ADHD), intellectual disability, and developmental language disorder. Further complicating autism diagnosis in Australia is the lack of consistent diagnostic practices both within and between states and territories. This leads to patchy and inconsistent rules around who can access public support services, and the types of services that are available. It is not uncommon in Australia for a child to receive a diagnosis in the preschool years via the health system, for instance, but then require a further diagnostic assessment when they enter the education system. This is a bewildering situation that has a significant impact on the finite financial and emotional resources of families and the state. The new guidelines aim to address these inconsistencies and help people with autism and their families better navigate state-based support services. It also brings them into line with the principles of the National Disability Insurance Scheme (NDIS), which seeks to determine support based on need rather than just a diagnosis.

National guidelines

In June 2016, the National Disability Insurance Agency (NDIA) and the Cooperative Research Centre for Living with Autism (Autism CRC), where I’m chief research officer, responded to these challenges by commissioning the development of Australia’s first national guidelines for autism assessment and diagnosis. We undertook a two-year project that included wide-ranging consultation and extensive research to assess the evidence. The guidelines do not define what behaviours an individual must show to be diagnosed with autism. These are already presented in international manuals, such as the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) and the World Health Organisation’s International Classification of Diseases (ICD-11). What the new guidelines provide is a detailed description of the information that needs to be collected during a clinical assessment and how this information can be used to inform the ongoing support of that person, including through a diagnosis of autism. The guidelines include 70 recommendations describing the optimal process for the assessment and diagnosis of autism in Australia.

Understanding strengths and challenges

A diagnostic assessment is not simply about determining whether a person does or doesn’t meet criteria for autism. Of equal importance is gaining an understanding about the key strengths, challenges and needs of the person. This will inform their future clinical care and how services are delivered. In essence, optimal clinical care is not just about asking “what” diagnosis an individual may have, but also understanding “who” they are and what’s important to their quality of life. We know diagnosis of autism alone is not a sound basis on which to make decisions about eligibility for support services such as the NDIS and state-based health, education and social support systems. Some people who meet the diagnostic criteria for autism will have minimal support needs, while other individuals will have significant and urgent needs for support and treatment services but will not meet diagnostic criteria for autism at the time of assessment. Some people may have an intellectual disability, for example, but not show the full range of behaviours that we use to diagnose autism. Others may present with the latter, but not the former. In the context of neurodevelopmental conditions such as autism, it is crucial that a persons’s needs – not the presence or absence of a diagnostic label – are used to determine eligibility and prioritisation of access to support services.

What may influence an autism assessment?

The guidelines also detail individual characteristics that may influence the presentation of autism symptoms. Gender is one key characteristic. Males are more commonly diagnosed with autism than females. But there is increasing evidence that autism behaviours may be different in males and females. Females may be better able to “camouflage” their symptoms by using compensatory strategies to “manage” communication and social difficulties. It is similarly important to consider the age of the person being assessed, because the presentation of autism symptoms changes during life. The guidelines provide information on how gender and age affect the behavioural symptoms of autism. This will ensure clinicians understand the full breadth of autistic behaviours and can perform an accurate assessment. The next step is for all clinicians and autism service providers across Australia to adopt and implement the guidelines. This will ensure every child and adult with autism can receive the optimal care and support.