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Background: Schizophrenia is a persistent psychotic disorder often accompanied by severe disability and premature mortality. New pharmacological treatments are urgently needed. Sodium benzoate, a common food preservative holds potential to be an effective, accessible treatment for schizophrenia, though the optimal dosing and mechanism of action of the compound requires further investigation.Methods: Individuals with persistent treatment-refractory schizophrenia (n=52) will be recruited. Patients will be randomised in a 1:1:1:1 ratio to receive treatment of one of three active doses (1000, 2000 or 4000 mg daily) of sodium benzoate or placebo for 6 weeks duration. The primary outcome measurement is change in the Positive and Negative Syndrome Scale (PANSS) total score. Secondary outcome measurements are PANSS subscales, Global Assessment of Function (GAF), Clinical Global Impression (CGI) and Patient Global Impression (PGI-I). Change in concentrations of peripheral amino acids (D-alanine, L-alanine, D-serine, L-serine, glycine and glutamate), plasma sodium benzoate, plasma catalase, 3-nitrotyrosine, malondialdehyde and high-sensitivity C-reactive protein (hs-CRP) will be determined as tertiary measures.Discussion: This trial seeks to build upon previous research indicating potential efficacy of sodium benzoate for reduction of symptoms in individuals with treatment-refractory schizophrenia. The trial aims to improve the understanding of the mechanism of action of the compound.Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000327886 . Registered on 23 March 2021. [ABSTRACT FROM AUTHOR]

Objectives To describe the development and use of a quality improvement service self-evaluation tool within Pacific addiction services in New Zealand. Methods The study involved two phases: (i) a development phase; and (ii) a testing phase. In Phase I, a preliminary tool was developed and piloted with two Pacific addiction drugs services. It was modified to reduce the number of statements, aligning the statements with the National Sector Standards and incorporating Pacific concepts, themes and motifs that underlie the practices of Pacific providers. In Phase II the resulting tool, named Potalanoa, was then tested in four Pacific addiction treatment services. All services provided feedback on the user acceptability and feasibility of the tool, usefulness and adaptability of the tool to specific service settings. Results The participating services generally found the evaluation tool to be understandable, acceptable and useful. Each service provider demonstrated varied use or implementation strategies for Potalanoa with a general consensus that incorporating the evaluation process within existing team meetings would be ideal. The involvement of all staff within a group setting was also found to be an essential part of the process and a trained facilitator helped with the flow of discussion. Conclusions The study found that there is a need for an evaluation tool for the provision of quality services. For Pacific services it was important that the tool recognize and capture the Pacific approaches utilized in their service delivery. Overall the tool was found to be acceptable and feasible to use, assisted services to identify areas of achievement and to prioritize areas requiring improvement and was adaptable to 'real world' Pacific addiction treatment settings in New Zealand. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to investigate whether the use of a loading strategy with lithium or valproate followed recommended practice and second, whether this had any impact on indicators of outcome in acutely manic inpatients. Method: A 12 month retrospective review of admissions to two adult psychiatric units in Auckland, New Zealand, was conducted. Demographic, legal status, psychiatric admissions, outcome indicators (length of stay, intensive care and seclusion use) and medication data were collected for all patients with a diagnosis of acute bipolar mania who started mood stabilizer treatment within 3 days of admission (n=93). Serum levels and adverse effects were also recorded. Results: In 46.2% of admissions a loading strategy was prescribed, and lithium was the treatment choice in two-thirds of admissions. Serum levels were taken inconsistently, particularly for valproate. No difference was found between loading and titrating for the assessed outcomes in routine practice; average length of stay was 30.2 days; most patients (71.0%) spent time in intensive care (average 8.4 days) and 33.3% spent time in seclusion. More adverse effects occurred with loading (51.2%) compared to titrating (36.0%), particularly with lithium. Conclusion: The literature supports a strong link between rapidly attained high serum levels and positive outcomes. The present study found inconsistent and infrequent measurement of levels, which was not in accord with recommended practice. Frequent monitoring of serum levels to support dosing decisions is important to inform better clinical decision making, especially when a loading strategy is used. This may explain the less than optimal outcomes (with respect to rapid resolution of mania and hospital discharge) that were found, irrespective of dosing strategy. [ABSTRACT FROM AUTHOR]

Objective: The present accepted classificatory systems (ICD-10 and DSM-IV) represent the culmination of 100 years of post-Kraepelinian evolution. The present paper reports on a study to ascertain the views of New Zealand psychiatrists on their requirements of a classificatory system, and their opinions on those currently in use. Method: An anonymous postal survey of 542 psychiatrists and trainees was undertaken in New Zealand. Results: A total of 235 questionnaires were returned, completed. New Zealand psychiatrists primarily use DSM-IV and do so because that is what they were taught on. They make relatively limited use of the multiaxiality. The purposes of classificatory systems that they value most highly are reliable interclinician communication, and to inform patient management planning. The two purposes they valued least were usefulness for a national statistical base, or to indicate prognosis. Conclusions: New Zealand psychiatrists' views are consistent with some of the stated objectives of ICD-10 and DSM-IV, but there is significant diversity in the former and over-ambition in the latter, with much to be resolved. [ABSTRACT FROM AUTHOR]

Objective: This study describes antipsychotic prescribing practices for outpatients with schizophrenia over a 3 year period in two large mental health catchment areas of Auckland. Methods: All community files were reviewed at three time points. Patient characteristics, diagnosis and antipsychotic treatment information were recorded and analysed. Results: Over the three time periods, the number of outpatients with a diagnosis of schizophrenia or schizoaffective disorder was stable. There was a marked change in the type of antipsychotic prescribed, with an 18.6% increase in atypical antipsychotics and a decrease in both intramuscular and oral typical antipsychotics. Clozapine was the most commonly prescribed antipsychotic in 2003 (35%). Despite the fact that polypharmacy was relatively low (14.6% in 2003), those receiving more than one antipsychotic had a greater likelihood of being prescribed a higher total daily dose. Conclusions: This study describes a change in antipsychotic prescribing towards recommended practice guidelines for the treatment of schizophrenia over a 3 year period. [ABSTRACT FROM AUTHOR]

This paper describes the development and evaluation of the Alcohol and Drug Outcome Measure (ADOM), a brief 18-item, two part, outcome monitoring instrument designed for routine use with clients in the New Zealand Alcohol and Other Drug (AOD) treatment sector. The development of the ADOM was informed by an expert panel of AOD clinicians (n = 6), key informant interviews (n = 14) and a pilot with AOD treatment clients and their respective clinicians (n = 25). The psychometric properties of the ADOM were tested with clients (n = 63) across a range of AOD treatment services. Testing involved clinicians administering the ADOM at treatment admission, one-to-seven days post-admission, and four-to-six weeks post-admission. Analyses of the test-retest reliability, concurrent validity and sensitivity to change of Part A of the ADOM, covering type and frequency of substance use, consistently produced excellent results. Comparable results for Part B of the instrument, covering associated psychosocial issues, were generally satisfactory. The ADOM has the potential to be used as a core AOD outcomes monitoring instrument. [ABSTRACT FROM AUTHOR]

There is increasing concern about the inequalities, overall health outcomes, and mental health of Pacific peoples residing in New Zealand. The New Zealand Mental Health Survey (Te Rau Hinengaro), conducted in 2003/2004, identfied Pacific peoples as having a higher 12-month prevalence of mental disorders than the general population. The burden of mental health amongst Paqfic peoples was identified as high and associated with other socioeconomic correlates. Pacflcpeoples were also more likely not to access professional mental health assistance. The aim of this study was to provide indepth qualitative data that explored Pacflc perceptions and experience of the theory practice, and utilisation of Pacific mental health services in New Zealand This paper documents: (i) the different models of care practiced in the Pacific mental health sector and (ii) the specific components that: (a) make these models uniquely Pacific, and (b) that consumers and families identWed as integral to the recovery process. Pacific peoples 'views of mental health from the following three perspectives were studied: (i) the service provider (ii) the mental health consumer and (iii) the family member, using focus group interviews in Auckland, Hamilton, Wellington, and Christchurch. The results report the different perceptions of the Pacific focus group and interview participants. Our findings indicate that firstly, having appropriate family and community support networks (psycho-social and community), appropriate living environments and meaningful workfor consumers, and secondly, access to culturally competent mental health staff contributes towards consumer recovery and assisting families. In conclusion, Pacific models of care (service delivery) were found to be informed by Pacific models of health belief and existed in implicit rather than explicit forms. To develop clearer or specific articulations of Pacific models of service delivery, the first step for services is to develop written expositions (a theory) of how these models might be framed taking into equal account cultural, clinical, and service management issues.

Aims: To measure the prevalence of routine alcohol assessment; to assess its clinical utility in the general medical wards of a large urban hospital; and to assess medical and nursing staff knowledge with regard to standard drink measures and recommended drinking limits as well as their attitudes towards alcohol assessment., Methods: The prevalence of alcohol assessment and the clinical utility of the resulting information was determined via a retrospective file review (n=109). The knowledge and attitudes of medical and nursing staff were measured via questionnaire (n=106)., Results: The file review data indicated 78% (+/-7.25) of patients admitted to the general medical wards were queried with regard to their alcohol consumption. However, the clinical utility of the recorded information was generally poor and the accuracy questionable. Only 12% of questionnaire respondents were able to accurately identify the standard drink equivalents for beer, wine, and spirits and only 8% were able to accurately identify the recommended drinking limits (per drinking occasion and per week) for both males and females. Attitudes towards alcohol assessment were positive., Conclusions: Patient alcohol consumption is frequently assessed, but the clinical utility of the resulting information is limited. The use of a structured alcohol screen and the provision of appropriate staff training are recommended.

Aim: To provide an overview of the treatment interventions and practices of Pacific alcohol and other drugs (AOD) services in New Zealand., Methods: Face-to-face interviews were conducted with 31 Pacific staff members from 13 services registered with the Alcohol Advisory Council of New Zealand National Directory. Issues around assessment, treatment interventions, outcome measures, service structure, and resources were explored., Results: Overall, the practices in District Health Board (DHB) and Non-Government Organisation (NGO) Pacific services were found to be similar. The clinical concepts of assessment, treatment, and outcome measures were not clearly understood by Pacific workers. This was due to the lack of attention towards Pacific concepts and practices and values. A holistic approach was viewed to be the best approach when working with Pacific clients based on health belief models, such as the Fonofale model., Conclusions: The findings of this study provide baseline data of treatment interventions and service practices of Pacific AOD services. There appears to be a Pacific way of working with Pacific clients. The most effective worker for Pacific people is someone who has sound knowledge of AOD, Pacific cultures and processes, and has the ability to integrate both Palangi (European) and Pacific knowledge to help the client.

Aim: This paper describes demographic and diagnostic data for people admitted to three psychiatric units in Auckland, New Zealand over the year 2000., Methods: A retrospective file review of 932 people involving 1232 admission episodes was conducted in the acute adult inpatient psychiatric units of west, north, and south Auckland. Patient characteristics, diagnosis, and interventions were recorded., Results: Overall, 62% were involuntary admissions and the most common diagnosis was schizophrenia (38%). Based on the community population, Maori admissions were double the expected rate and Asian admissions were lower than expected. Compared to European admissions, Maori, Pacific, and Asian admissions were all more likely to have a diagnosis of a psychotic disorder. In addition, Maori were more likely to be admitted involuntarily than Europeans., Conclusions: Variations in psychiatric inpatient representation, diagnosis, and compulsory treatment were found across ethnic groups. The explanations for ethnic differences in mental health are likely to be many and multifactorial including socioeconomic status, pathways to access of care, levels of family understanding and acceptance, and community capacity to manage less disruptive presentations. The findings provide a benchmark for recently established ethnic specific Maori and Pacific community mental health services. A follow-up study is recommended to review utilisation of community services for patients following an admission.