336 results on '"Bastiampillai T"'
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2. The Necessity of Leave One Subject Out (LOSO) Cross Validation for EEG Disease Diagnosis
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Kunjan, Sajeev, primary, Grummett, T. S., additional, Pope, K. J., additional, Powers, D. M. W., additional, Fitzgibbon, S. P., additional, Bastiampillai, T., additional, Battersby, M., additional, and Lewis, T. W., additional
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- 2021
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3. Changes for clozapine monitoring in the United States
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Bastiampillai, T, Gupta, A, Chan, S K W, and Allison, S
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- 2016
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4. Making sense of health care delivery Where does the close to community health care worker fit in? – The case for congestive heart failure
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Iyngkaran, P., Biddargardi, N., Bastiampillai, T., and Beneby, G.
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- 2015
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5. When should governments increase the supply of psychiatric beds?
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Allison, S, primary, Bastiampillai, T, additional, Licinio, J, additional, Fuller, D A, additional, Bidargaddi, N, additional, and Sharfstein, S S, additional
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- 2017
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6. When should governments increase the supply of psychiatric beds?
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Allison, S, Bastiampillai, T, Licinio, J, Fuller, D A, Bidargaddi, N, and Sharfstein, S S
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Low numbers of hospital-based psychiatric beds create problems for people with severe mental illness (SMI), when they face extended emergency department (ED) waits, higher thresholds for admission to an acute bed, and short revolving-door stays with high rates of rehospitalisation. Limited access to inpatient treatment has been associated with higher suicide risk, premature mortality, homelessness, violent crime and incarceration. Ultimately, people with SMI can be transinstitutionalised to the criminal justice system. In the USA, for example, prisons have replaced mental hospitals as the largest institutions housing people with SMI. There is no international consensus on the safe minimum numbers of acute, forensic and rehabilitation beds needed to reduce these risks. As a consequence, Organisation for Economic Cooperation and Development (OECD) countries have wide variations in the mix of hospital beds with an average of 71 beds per 100?000 population. Policymakers face difficult choices with few studies to guide decisions on supplying beds. The UK Royal College of Psychiatrists offered a policy framework, which was adapted for Australia. The government of the State of South Australia increased the supplies of crisis, acute and forensic beds to meet a mandatory target to safely reduce mental health boarding in the EDs.
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- 2018
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7. Making sense of health care deliveryWhere does the close to community health care worker fit in? – The case for congestive heart failure
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Iyngkaran, P., Biddargardi, N., Bastiampillai, T., and Beneby, G.
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Close to community health care workers (CTC-HCW) is an increasingly used term to describe the emergence of a new partner in health services delivery. In strengthening arguments for this part of the health workforce the authorities, health staffers, supporters, sceptics and perhaps clients will look to the academicians and the evidence base to determine the fate of this group. There is no doubt, CTC-HCW are a vital resource, whose importance is tied to socio-demo-geographic variables. Regardless of what the common perceptions of its importance are, the evolving evidence base could suggest either way. In this short commentary we would like to highlight the importance of a balanced and common sense approach in these arguments. An important example is heart failure where the majority have an associated comorbidity and one in four would also suffer with cognitive or mood disturbances. It is unclear how the CTC-HCW would fare for this devastating syndrome. In moving forward it is important we understand there are: strengths and limitations in the evidence gathering processes; indecision as to the questions; uncertainty of the starting points to gather evidence; and sociodemogeographic biases, which have to be factored before determining the fate of this much needed health care resource.
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- 2015
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8. Impact of a psychiatric unit's daily discharge rates on emergency department flow.
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Bastiampillai T, Schrader G, Dhillon R, Strobel J, and Bidargaddi N
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- 2012
9. The long-term effectiveness of clozapine and lamotrigine in a patient with treatment-resistant rapid-cycling bipolar disorder.
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Bastiampillai, T. J., Reid, C. E., and Dhillon, R.
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BIPOLAR disorder , *THERAPEUTICS , *PATIENTS , *CLOZAPINE , *LAMOTRIGINE - Abstract
The challenges in the management of treatment-resistant rapid-cycling bipolar disorder are multifaceted and represent a significant burden to the patient. There is a need for more exploration into the potential utility of various combination therapies in the setting of severe affective states. A 52-year-old woman with a history of severe treatment-resistant rapid-cycling bipolar affective disorder (BPAD) was hospitalized for the treatment of a severe mixed episode. The introduction of lamotrigine and clozapine in combination proved remarkably effective and well tolerated in both the acute management and in subsequent maintenance. The patient has remained asymptomatic during the 5-year follow-up without any further mood disturbance. Lamotrigine and clozapine are among the less-prescribed agents for BPAD and there is as yet little research into their use in combination. It is possible that these agents have complementary modes of action on various facets of the affective pathology, resulting in superior mood stabilization in this patient. [ABSTRACT FROM PUBLISHER]
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- 2010
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10. Exacerbation of tics secondary to clozapine therapy.
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Bastiampillai T, Dhillon R, and Mohindra R
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- 2008
11. Clozapine use in treatment-resistant agitation in the setting of dementia.
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Bastiampillai T, Dhillon R, and French TH
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- 2009
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12. Clozapine-withdrawal catatonia.
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Bastiampillai T, Forooziya F, and Dhillon R
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- 2009
13. Successful re-challenge with clozapine following development of clozapine-induced cardiomyopathy.
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Floreani J and Bastiampillai T
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- 2008
14. Olanzapine-induced pancytopenia.
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Pattichis A, Bastiampillai T, and Nataraj N
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- 2008
15. Catatonia resolution and aripiprazole.
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Bastiampillai T and Dhillon R
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- 2008
16. Psychosocial workplace safety in mental health services - Commentary and considerations to improve safety.
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Looi JC, Maguire PA, Kisely S, Allison S, and Bastiampillai T
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Objectives: Psychosocially unsafe workplaces are related to burnout, especially amongst trainees and psychiatrists. Burgeoning research on psychosocial workplace safety indicates the importance of organisational governance to reduce adverse professional, and consequently patient, outcomes in healthcare by balancing job demands and resources. We provide a brief commentary on the relevance of the concept of the Psychosocial Safety Climate model for mental health services and healthcare workers, and considerations for action., Conclusions: Based on the Extended Job Demand-Resource model, the Psychosocial Safety Climate model has been developed and validated in community and healthcare environments. Psychosocial safety is also an Australian workplace safety requirement. An important direction to improve working conditions, reduce adverse outcomes, and improve recruitment and retention of healthcare workers, may be to adopt and formalise psychosocial workplace safety as a key performance indicator of equal importance to productivity for mental healthcare services., Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: he authors declare the following: JCLL, PAM, SK, SA & TB are all members of the journal editorial team and were not involved in the peer review process. The paper was independently peer-reviewed.
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- 2024
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17. Mostly harmless? Clinical practice guidelines need further consideration of psychotherapy adverse effects.
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Allison S, Looi JC, Kisely S, and Bastiampillai T
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The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines on mood disorders recommend psychotherapy as foundational care for patients with acute depression with minimal discussion of any potential adverse effects. Randomised controlled trial evidence on psychotherapy adverse effects is limited. This is problematic because clinicians must balance the benefits of treatment against the harms, and clinical decisions become skewed without data on adverse effects. We suggest that clinical practice guidelines should be more guarded about recommending psychotherapy and add consensus statements on adverse effects for informed consent and clinical decision-making., Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: TB has received Honoraria from CSL Sequirus for a lecture. Authors are editorial board members for this journal – they had no involvement in the editorial and peer review process.
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- 2024
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18. Deprescribing antidepressants for depression - what is the evidence for and against?
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Looi JC, Allison S, Bastiampillai T, Kisely S, Maguire PA, Woon LS, Anderson K, and Malhi GS
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Objective: Recent guidelines suggest that the overall quantity and duration of antidepressant prescriptions should be reduced. In this paper, we comment on the evidence both for and against this view., Methods: We critically review the arguments proposed by proponents of antidepressant deprescribing in the context of the evidence-base for the treatment of depression., Results: Proponents of deprescribing do not address the substantive issues of whether inappropriate prescribing has been demonstrated, and when prescribing is needed. Their arguments for deprescribing are rebutted in this context., Conclusions: Whether or not to deprescribe antidepressant medication needs to take into consideration the risk-benefit profile of the decision, the responsibility for which needs to be shared and based on the context of the patient's depression, their preferences, experiences and perspectives., Competing Interests: DisclosureJL, SA, TB, SK, PM, LW and GSM are editorial team members for the journal. JL, SA, TB, SK, PM, LW and KA declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. GSM was lead author of the RANZCP Clinical Practice Guidelines for Mood Disorders 2105 and 2020. He is also the Royal College of Psychiatrists (UK) College Editor and Editor-in-Chief of The British Journal of Psychiatry. He has received grant or research support from the National Health and Medical Research Council, Australian Rotary Health, NSW Health, The American Foundation for Suicide Prevention, and the Ramsay Research and Teaching Fund. He has received funding in the past and been a consultant for Elsevier, AstraZeneca, Janssen, Lundbeck, Otsuka and Servier. He presently holds an investigator-initiated grant from Janssen (PoET Study), and has joint grant funding from The University of Sydney and National Taiwan University (Ignition Grant) and grant funding from The North Foundation. He is presently a collaborator on GALENOS and an expert advisor on PRADA – studies and research funded by The Wellcome Foundation, UK.
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- 2024
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19. Reflection on the RANZCP position on the adverse effects of psychotherapy.
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Allison S, Looi JC, Kisely S, and Bastiampillai T
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Objective: In this perspective, we investigate how the Royal Australian and New Zealand College of Psychiatrists' (RANZCP) position statement on psychotherapy takes the potential for adverse effects into account., Conclusions: Psychotherapy has two critical outcomes - efficacy and adverse effects. Evidence-based psychotherapy is significantly more effective than care-as-usual for about one in 10 psychotherapy patients. However, a similar proportion also reports adverse effects. Despite this, the RANZCP position statement on psychotherapy focuses on efficacy with minimal discussion of the adverse effects. This is an oversight because psychiatrists have legal and ethical obligations to consider the adverse effects as well as the benefits of any treatment. We therefore reflect on the RANZCP's six recommendations in light of the adverse effects of psychotherapy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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20. Australian specialised mental healthcare labour shortages: Potential interventions for consideration and further research.
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Looi JC, Allison S, Bastiampillai T, Hensher M, Kisely S, and Robson SJ
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Objective: Specialised mental healthcare delivery is highly labour intensive, and the COVID-19 pandemic has exacerbated workforce shortfalls. We explore the information on the mental healthcare labour supply in Australia from a health policy viewpoint. Our purpose is to stimulate discussion, further research and development of interventions., Conclusions: The mental healthcare labour market has a number of features that make it prone to shortages and other distortions. These include: the labour-intensive nature of healthcare work;, long-training periods; that traditional policy levers like pay are only partially effective; as well as other challenges in retaining and recruiting mental health nurses and psychiatrists, especially in public mental health services. Further research is needed to develop and evaluate effective interventions., Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JL, SA, TB and SK are editorial team members for the journal – they were not involved in the independent peer review process.
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- 2024
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21. Respectful scientific debate in Australasian Psychiatry .
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Looi JC, Amos A, Bastiampillai T, Loi S, Miller E, and Reutens S
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- 2024
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22. The 2024-2025 Commonwealth Budget for Mental Health: Funding unproven initiatives and stings in the tail.
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Looi JC, Allison S, Bastiampillai T, and Kisely S
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We discuss the ramifications of the Commonwealth of Australia Budget allocations for mental healthcare for 2024-2025. There is funding for population-based mental health initiatives for milder anxiety and depression but no direct funding of services for the most severe and disabling forms of mental illness, other than pre-existing state/territory disbursements from the Commonwealth for state-based health services. There are substantial concerns that the Commonwealth funding has potentially been misallocated to ineffective interventions that are unlikely to reduce the population prevalence of mild anxiety and depression in Australia. Funds may have been better allocated to provide effective care for those with the most severe and disabling illnesses including schizophrenia, bipolar disorder and severe depression., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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23. Comparing the trends of MBS telepsychiatry and consultant physician telehealth services from 2017 to 2022: A retrospective study.
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Woon LS, Allison S, Bastiampillai T, Kisely S, Maguire P, Pring W, Reay R, and Looi JC
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Objective: The Medicare Benefit Schedule (MBS) telehealth items were expanded in March 2020 during the COVID-19 pandemic. We measured the use of MBS telepsychiatry items compared to consultant physician telehealth items within the context of these item changes, to understand differences in telepsychiatry and physician telehealth utilisation., Methods: Monthly counts of face-to-face and telehealth (videoconferencing and telephone) MBS items for psychiatrists and physicians from January 2017 to December 2022 were compiled from Services Australia MBS Item Reports. Usage levels were compared before and after telehealth item expansion. Usage trends for MBS telepsychiatry and physician telehealth items were compared in time-series plots., Results: Telehealth item expansion resulted in a greater rise of telepsychiatry services from 3.8% beforehand to 43.8% of total services subsequently, compared with physician telehealth services (from 0.6% to 20.0%). More physician telehealth services were by telephone compared with telepsychiatry services. Time-series of both telehealth services displayed similar patterns until mid-2022, when physician telehealth services declined as telephone items were restricted. Telepsychiatry services consistently comprised a greater proportion of total services than physician telehealth services., Conclusions: MBS psychiatrist services showed a more substantial and persistent shift to telehealth than physician services, suggesting a greater preference and use of telepsychiatry., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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24. Psychotherapy electronic health record data of 33,000 breached in Finland: Tragically realised risks of harm to patients.
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Looi JC, Allison S, Bastiampillai T, Maguire PA, and Looi RC
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- Humans, Finland, Confidentiality, Electronic Health Records, Psychotherapy
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- 2024
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25. Healthcare provider data breaches - framework for crisis communication and support of patients and healthcare workers in mental healthcare.
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Looi JC, Allison S, Bastiampillai T, Maguire PA, Kisely S, and Looi RC
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- Humans, Communication, Confidentiality standards, SARS-CoV-2, COVID-19 prevention & control, Health Personnel, Computer Security standards, Mental Health Services standards, Mental Health Services organization & administration
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Increasing numbers of healthcare data breaches highlight the need for structured organisational responses to protect patients, trainees and psychiatrists against identity theft and blackmail. Evidence-based guidance that is informed by the COVID-19 pandemic response includes: timely and reliable information tailored to users' safety, encouragement to take protective action, and access to practical and psychological support. For healthcare organisations which have suffered a data breach, insurance essentially improves access to funded cyber security responses, risk communication and public relations. Patients, trainees and psychiatrists need specific advice on protective measures. Healthcare data security legislative reform is urgently needed., Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare that JCLL, SA. TB, PAM, and SK are editorial team members for the journal – they were not involved in the independent peer review process.
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- 2024
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26. The corrosion of adult mental healthcare in Australia: Can we meet the needs of those who need the most?
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Looi JC, Allison S, Reutens S, Loi S, Bastiampillai T, and Kisely S
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- Humans, Australia, Adult, Health Services Needs and Demand, Mental Disorders therapy, Mental Health Services organization & administration
- Abstract
Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. This article was not peer-reviewed as it is an expression of the views of the Editorial Team who have co-authored the paper.
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- 2024
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27. Questionable evidence and argumentation regarding alleged misuse of Medicare.
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Looi JCL, Allison S, Bastiampillai T, Maguire PA, and Robson SJ
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- Humans, Australia, National Health Programs
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What is known about this topic? We discuss a recently published paper that alleges clinicians are causal agents of non-compliant billing of Medicare. What does this paper add? The paper's arguments are partially supported by unreferenced assertions, potential logical fallacies, inaccurate reporting of referenced material and unsubstantiated rhetoric. What are the implications for practitioners? Due to the lack of substantive evidence, it cannot be concluded that clinicians are the causal agents of non-compliant billing of Medicare.
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- 2024
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28. Behind the curtain of Australasian Psychiatry : The practice of a medical journal and a call for reviewers.
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Looi JC, Amos A, Bastiampillai T, Loi S, Miller E, and Reutens S
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The process of medical scientific journal publishing merits further explanation for authors and readers. Prospective authors need to understand the scope of the journal and the article types that are published. We give an overview of the editorial process, including selection of reviewers, peer review and decisions regarding revision, acceptance and rejection of papers for Australasian Psychiatry . We encourage authors and readers to submit papers, and volunteer as peer reviewers, working together with the journal editorial team., Competing Interests: DisclosureThis paper is not peer-reviewed as it is an expression of the views of the Editorial team co-authors.
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- 2024
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29. The RANZCP Workforce Report: Action is needed, now.
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Looi JCL, Wilkes F, Allison S, Maguire PA, Kisely S, and Bastiampillai T
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Objective: The RANZCP conducted an anonymous survey of 7200 members (trainees and psychiatrists) in December 2023, receiving 1269 responses, representing the views of roughly 1 in 6 members, and of the respondents, three quarters reported experiencing burnout in the last 3 years. We provide a commentary, citing evidence from relevant previous research, discussing the implications and proposing potential interventions., Conclusions: Members of the RANZCP reported worsening workforce shortages, with 9 in 10 respondents stating that these negatively impacted patient care, and 7 in 10 experiencing symptoms of burnout. Eighty per cent identified workforce shortages as the top contributing factor to such burnout. The aetiology of workforce shortages and burnout is likely due to operational and structural shortfalls in psychiatric services. However, public and private sector employment information was not included in the report. There are a range of strategic, evidence-based interventions to address the psychiatrist and trainee workforce challenges, comprising general healthcare service as well as specific initiatives. Based on the findings of the report, such interventions are needed, now.
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- 2024
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30. Trace amine associated receptor 1: predicted effects of single nucleotide variants on structure-function in geographically diverse populations.
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Shajan B, Marri S, Bastiampillai T, Gregory KJ, Hellyer SD, and Nair PC
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- Humans, Structure-Activity Relationship, Genotype, Ligands, Trace Amine-Associated Receptors, Receptors, G-Protein-Coupled genetics, Polymorphism, Single Nucleotide genetics
- Abstract
Trace Amine Associated Receptor 1 (TAAR1) is a novel pharmaceutical target under investigation for the treatment of several neuropsychiatric conditions. TAAR1 single nucleotide variants (SNV) have been found in patients with schizophrenia and metabolic disorders. However, the frequency of variants in geographically diverse populations and the functional effects of such variants are unknown. In this study, we aimed to characterise the distribution of TAAR1 SNVs in five different WHO regions using the Database of Genotypes and Phenotypes (dbGaP) and conducted a critical computational analysis using available TAAR1 structural data to identify SNVs affecting ligand binding and/or functional regions. Our analysis shows 19 orthosteric, 9 signalling and 16 micro-switch SNVs hypothesised to critically influence the agonist induced TAAR1 activation. These SNVs may non-proportionally influence populations from discrete regions and differentially influence the activity of TAAR1-targeting therapeutics in genetically and geographically diverse populations. Notably, our dataset presented with orthosteric SNVs D103
3.32 N (found only in the South-East Asian Region and Western Pacific Region) and T1945.42 A (found only in South-East Asian Region), and 2 signalling SNVs (V1253.54 A/T2526.36 A, found in African Region and commonly, respectively), all of which have previously demonstrated to influence ligand induced functions of TAAR1. Furthermore, bioinformatics analysis using SIFT4G, MutationTaster 2, PROVEAN and MutationAssessor predicted all 16 micro-switch SNVs are damaging and may further influence the agonist activation of TAAR1, thereby possibly impacting upon clinical outcomes. Understanding the genetic basis of TAAR1 function and the impact of common mutations within clinical populations is important for the safe and effective utilisation of novel and existing pharmacotherapies., (© 2024. The Author(s).)- Published
- 2024
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31. Free expression and open discourse in Australasian Psychiatry .
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Looi JCL, Reutens S, Loi S, and Bastiampillai T
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- Humans, Australasia, Periodicals as Topic, Psychiatry
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Competing Interests: DisclosureJL, SR, SL and TB are all editorial team members of the journal. This paper was not peer-reviewed as it is an expression of the editorial commitment to free speech within the journal.
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- 2024
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32. Rivastigmine for treatment-refractory posttraumatic stress disorder: a systematic review.
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Maguire PA, Bastiampillai T, Allison S, Wilkes F, and Looi JCL
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- Humans, Neuroprotective Agents therapeutic use, Cholinesterase Inhibitors therapeutic use, Rivastigmine therapeutic use, Stress Disorders, Post-Traumatic drug therapy
- Abstract
We conducted a systematic review evaluating the efficacy of rivastigmine augmentation for treatment-refractory posttraumatic stress disorder (PTSD). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The databases Ovid MEDLINE, PubMed, CINAHL, and EMBASE were searched using key words: 'rivastigmine' OR 'Exelon' OR 'rivastigmine augmentation' OR 'Exelon augmentation' AND 'posttraumatic stress disorder*' OR 'post-traumatic stress disorder*' OR 'PTSD' OR 'combat disorder*' OR 'post-traumatic symptoms'. The asterisk specified plural forms of the relevant word. Four papers were identified, comprising one double-blind randomised controlled trial, one non-controlled open trial, one case series (presenting three case studies), and one paper with two case studies. The randomised controlled trial found no statistically significant difference in efficacy, using the PTSD CheckList-Military Version as the relevant outcomes measure, between the active add-on rivastigmine interventions and placebo or treatment as usual. The open trial, although reporting relatively positive outcomes, had a weak study design and lacked reporting of key information, including participant sex and age and pre-rivastigmine PTSD measures. The assessment of efficacy was based on participants' reporting of subjective benefits, and clinician-rating using a Clinical Global Impression, rather than established PTSD assessments scales. Although the five case studies reported improvement in PTSD symptoms, there were confounding factors and limitations in clinical and demographic data, warranting caution regarding attributed benefits. There is a lack of methodologically robust evidence supporting the efficacy of add-on rivastigmine for the treatment of refractory PTSD. Additional research may help in further evaluating its possible clinical efficacy., Competing Interests: All authors have disclosed no conflicts of interest.
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- 2024
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33. Comparison of the out-of-pocket costs of Medicare-funded telepsychiatry and face-to-face consultations: A descriptive study.
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Woon LS, Allison S, Bastiampillai T, Kisely S, Maguire P, Pring W, Reay R, and Looi JC
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- Humans, Australia, COVID-19 economics, Medicare economics, Mental Health Services economics, National Health Programs economics, Telemedicine economics, Health Expenditures statistics & numerical data, Psychiatry economics
- Abstract
Objective: Telepsychiatry items in the Australian Medicare Benefits Schedule (MBS) were expanded following the COVID-19 pandemic. However, their out-of-pocket costs have not been examined. We describe and compare patient out-of-pocket payments for face-to-face and telepsychiatry (videoconferencing and telephone) MBS items for outpatient psychiatric services to understand the differential out-of-pocket cost burden for patients across these modalities., Methods: out-of-pocket cost information was obtained from the Medical Costs Finder website, which extracted data from Services Australia's Medicare claims data in 2021-2022. Cost information for corresponding face-to-face, video, and telephone MBS items for outpatient psychiatric services was compared, including (1) Median specialist fees; (2) Median out-of-pocket payments; (3) Medicare reimbursement amounts; and (4) Proportions of patients subject to out-of-pocket fees., Results: Medicare reimbursements are identical for all comparable face-to-face and telepsychiatry items. Specialist fees for comparable items varied across face-to-face to telehealth options, with resulting differences in out-of-pocket costs. For video items, higher proportions of patients were not bulk-billed, with greater out-of-pocket costs than face-to-face items. However, the opposite was true for telephone items compared with face-to-face items., Conclusions: Initial cost analyses of MBS telepsychiatry items indicate that telephone consultations incur the lowest out-of-pocket costs, followed by face-to-face and video consultations., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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34. Newly identified structures of trace-amine associated receptor-1 (TAAR1) will aid discovery of next generation neuropsychiatric drugs.
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Nair PC, Shajan B, and Bastiampillai T
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- Humans, Psychotropic Drugs pharmacology, Animals, Receptors, G-Protein-Coupled metabolism, Drug Discovery methods
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- 2024
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35. Near-death experiences after cardiac arrest: a scoping review.
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Kovoor JG, Santhosh S, Stretton B, Tan S, Gouldooz H, Moorthy S, Pietris J, Hannemann C, Yu LK, Johnson R, Reddi BA, Gupta AK, Wagner M, Page GJ, Kovoor P, Bastiampillai T, Maddocks I, Perry SW, Wong ML, Licinio J, and Bacchi S
- Abstract
Background: This scoping review aimed to characterise near-death experiences in the setting of cardiac arrest, a phenomenon that is poorly understood and may have clinical consequences., Method: PubMed/MEDLINE was searched to 23 July 2023 for prospective studies describing near-death experiences in cardiac arrest. PRISMA-ScR guidelines were adhered to. Qualitative and quantitative data were synthesised. Meta-analysis was precluded due to data heterogeneity., Results: 60 records were identified, of which 11 studies involving interviews were included from various countries. Sample size ranged from 28-344, and proportion of female patients (when reported) was 0-50%, with mean age (when reported) ranging 54-64 years. Comorbidities and reasons for cardiac arrest were heterogeneously reported. Incidence of near-death experiences in the included studies varied from 6.3% to 39.3%; with variation between in-hospital (6.3-39.3%) versus out-of-hospital (18.9-21.2%) cardiac arrest. Individual variables regarding patient characteristics demonstrated statistically significant association with propensity for near-death experiences. Reported content of near-death experiences tended to reflect the language of the questionnaires used, rather than the true language used by individual study participants. Three studies conducted follow-up, and all suggested a positive life attitude change, however one found significantly higher 30-day all-cause mortality in patients with near-death experiences versus those without, in non-controlled analysis., Conclusions: From prospective studies that have investigated the phenomenon, near-death experiences may occur in as frequent as over one-third of patients with cardiac arrest. Lasting effects may follow these events, however these could also be confounded by clinical characteristics., (© 2024. The Author(s).)
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- 2024
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36. Effects of the antipsychotic quetiapine on sleep and breathing: a review of clinical findings and potential mechanisms.
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Fauska C, Bastiampillai T, Adams RJ, Wittert G, Eckert DJ, and Loffler KA
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- Humans, Respiration drug effects, Quetiapine Fumarate pharmacology, Quetiapine Fumarate therapeutic use, Antipsychotic Agents pharmacology, Antipsychotic Agents therapeutic use, Sleep drug effects, Sleep physiology, Sleep Apnea, Obstructive drug therapy
- Abstract
Quetiapine is an antipsychotic medication indicated for schizophrenia and bipolar disorder. However, quetiapine also has hypnotic properties and as such is increasingly being prescribed at low doses 'off-label' in people with insomnia symptoms. Pharmacologically, in addition to its dopaminergic properties, quetiapine also modulates multiple other transmitter systems involved in sleep/wake modulation and potentially breathing. However, very little is known about the impact of quetiapine on obstructive sleep apnoea (OSA), OSA endotypes including chemosensitivity, and control of breathing. Given that many people with insomnia also have undiagnosed OSA, it is important to understand the effects of quetiapine on OSA and its mechanisms. Accordingly, this concise review covers the existing knowledge on the effects of quetiapine on sleep and breathing. Further, we highlight the pharmacodynamics of quetiapine and its potential to alter key OSA endotypes to provide potential mechanistic insight. Finally, an agenda for future research priorities is proposed to fill the current key knowledge gaps., (© 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)
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- 2024
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37. Can lithium be used in the setting of clozapine commencement in patients with COVID-19 associated neutropenia: A case report.
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Tan JQE, Dawson JL, and Bastiampillai T
- Abstract
COVID-19 infection may increase the likelihood of neutropenia in patients already on clozapine. In clozapine treated patients experiencing COVID-19 associated neutropenia, adjunct therapy with lithium can be considered., (© 2024 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
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- 2024
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38. The changing psychiatry workforce in Australia: Still lacking in rural and remote regions.
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Hayter CM, Allison S, Bastiampillai T, Kisely S, and Looi JCL
- Subjects
- Humans, Female, Australia, Male, Workforce trends, Workforce statistics & numerical data, Rural Population statistics & numerical data, Cross-Sectional Studies, Health Workforce trends, Health Workforce statistics & numerical data, Adult, Rural Health Services statistics & numerical data, Psychiatry
- Abstract
Introduction: There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities., Objective: To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce., Design: We descriptively analysed population-level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare-subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross-sectional design., Findings: Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full-time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium., Discussion: Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare-subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities., Conclusion: There remains an acute shortage of psychiatrists in many regional and remote areas of Australia, with an increasing proportion of SIMGs and females working in these areas, in the context of future increased demand., (© 2024 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)
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- 2024
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39. Australasian psychiatry - for the art and science of psychiatry.
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Looi JC, Amos A, Loi S, Bastiampillai T, Reutens S, Woon L, Maguire PA, Kisely S, Miller E, Benipal A, and Wilkes F
- Subjects
- Humans, Psychiatry
- Abstract
Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: On the basis that we are providing an introduction to the renewal of the Australasian Psychiatry Editorial Executive Team and the journal itself, this Editorial has not been formally peer reviewed – it reflects our collective views and commitment to College members, Editorial Committee Members, reviewers, and the readership of the journal.
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- 2024
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40. Unpeeling the onion: Digital triage and monitoring of general practice, private psychiatry, and psychology.
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Allison S, Bastiampillai T, Kisely S, and Looi JC
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- Humans, Onions, Australia, Patient Compliance, Private Practice, Triage, Psychiatry
- Abstract
Objective: The Australian federal government is considering a 'digital front door' to mental healthcare. The Brain and Mind Centre at the University of Sydney has published a discussion paper advocating that the government should adopt a comprehensive model of digital triage and monitoring (DTM) based on a government-funded initiative Project Synergy ($30 million). We critically examine the final report on Project Synergy, which is now available under a Freedom of Information request., Conclusion: The DTM model is disruptive. Non-government organisations would replace general practitioners as care coordinators. Patients, private psychiatrists, and psychologists would be subjected to additional layers of administration, assessment, and digital compliance, which may decrease efficiency, and lengthen the duration of untreated illness. Only one patient was deemed eligible for DTM, however, during the 8-month regional trial of Project Synergy (recruitment rate = 1/500,000 across the region). Instead of an unproven DTM model, the proposed 'digital front door' to Australian mental healthcare should emphasise technology-enabled shared care (general practitioners and mental health professionals) for the treatment of moderate-to-severe illness., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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41. Psychiatric electronic health records in the era of data breaches - What are the ramifications for patients, psychiatrists and healthcare systems?
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Looi JC, Looi RC, Maguire PA, Kisely S, Bastiampillai T, and Allison S
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- Humans, Australia, Confidentiality, Delivery of Health Care, Electronic Health Records, Psychiatrists
- Abstract
Objective: To update psychiatrists and trainees on the realised risks of electronic health record data breaches., Methods: This is a selective narrative review and commentary regarding electronic health record data breaches., Results: Recent events such as the Medibank and Australian Clinical Labs data breaches demonstrate the realised risks for electronic health records. If stolen identity data is publicly released, patients and doctors may be subject to blackmail, fraud, identity theft and targeted scams. Medical diagnoses of psychiatric illness and substance use disorder may be released in blackmail attempts., Conclusions: Psychiatrists, trainees and their patients need to understand the inevitability of electronic health record data breaches. This understanding should inform a minimised collection of personal information in the health record to avoid exposure of confidential information and identity theft. Governmental regulation of electronic health record privacy and security is needed., Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Authors JCLL, PAM, SK, TB and SA are all editorial team members for the journal - they were not involved in peer review of the paper.
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- 2024
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42. Seven decades of antipsychotic drugs: Why is the life of Australians with schizophrenia still so suboptimal?
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Castle D, Copolov D, Singh B, and Bastiampillai T
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- Humans, Australia, Antipsychotic Agents therapeutic use, Schizophrenia drug therapy, Psychotic Disorders drug therapy, Australasian People
- Abstract
The advent of dopamine (D2) receptor-blocking medications over 70 years ago, ushered in a new era of biological treatment for schizophrenia. However, we argue that little subsequent progress has been made in translating this into fulfilled and fulfilling lives for people with schizophrenia. This Viewpoint asks why this is the case, and suggests ways forward for capitalising on extant and emerging new treatments for psychotic disorders, to the betterment of the lives of people living with schizophrenia., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: David Castle has received grant monies for research from NHMRC, MRFF, Barbara Dicker Foundation, CIHR (Canada), Brain Canada, Servier, Boehringer Ingelheim; Travel Support and Honoraria for Talks and Consultancy from Servier, Seqirus, Lundbeck, Mindcafe, Psychscene, Inside Practice. He is a founder of the Optimal Health Program (OHP) and holds 50% of the IP for OHP; and is part owner (5%) of Clarity Healthcare. DC receives royalties for books from Allen and Unwin, Elsevier, Oxford University Press and Cambridge University Press. He is an unpaid Chair of an Advisory Board of Psychae, an Australian not-for-profit institute specialising in psychedelic medicines research; and is a Board Member of the Australian Multidisciplinary Association for Psychedelic Practitioners. He is a member of the Royal Australian and New Zealand College of Psychiatrists Psychedelic Assisted Therapy Working Group. He does not knowingly have stocks or shares in any pharmaceutical company. The other authors declare no conflicts of interest.
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- 2024
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43. Seasonal Surge for Mental Health Demand in Emergency Departments.
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Della DF, Smith D, L JC, Allison S, and Bastiampillai T
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- Male, Female, Adolescent, Humans, Aged, Australia epidemiology, Seasons, Emergency Service, Hospital, Retrospective Studies, Mental Health, Mental Health Services
- Abstract
Objective: To analyze emergency department (ED) mental health presentations over a 7-year period to estimate the timing and magnitude of the seasonal effect across Australia., Methods: We analyzed data collected by the Australian Institute of Health and Welfare (AIHW) from 2014-2015 to 2020-2021, which included all public hospital ED presentations in Australia that received a mental health diagnosis per the Australian Modification of ICD-10 . The data were divided into 4 sequential quarters (Q1 = July-September, Q2 = October-December, Q3 = January-March, Q4 = April-June) and analyzed by sex and age (youth: 18-24 years, adult: 25-64 years, and older adult: > 65 years). Regression analysis was used to assess seasonal variation., Results: On average, mental health ED presentations were 9% higher in October-December than April-June, which had the lowest rates of mental health ED presentations for males and females. The peak continued into January-March, most prominently for females. Seasonality was evident in the 18-24 and 25-64 age groups. There were increased ED psychiatry presentations in October-December of 14.4% (males) and 9% (females) in the group aged 18-24, as well as increases of 10.3% (males) and 10.1% (females) in those aged 25-64. In January-March, there was an increase in presentations for females of 7% (aged 18-24) and 10.3% (aged 25-64). For adults aged > 65, there were increased presentations in July-September compared to April-June of 4.9% (males) and 3.9% (females)., Conclusions: We found strong, statistically significant peaks in mental health ED presentations in spring and summer. Mental health services need to plan for significantly higher ED mental health demand during these seasons. Further research is required to estimate the size of the mental health seasonal effect in acute hospital settings., Prim Care Companion CNS Disord 2024;26(1):23m03629 ., Author affiliations are listed at the end of this article., (© Copyright 2024 Physicians Postgraduate Press, Inc.)
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- 2024
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44. Mitigating the consequences of electronic health record data breaches for patients and healthcare workers.
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Looi JCL, Allison S, Bastiampillai T, Maguire PA, Kisely S, and Looi RCH
- Subjects
- Humans, Australia, Computer Security, Patients, Electronic Health Records, Health Personnel
- Abstract
Electronic health records (EHRs) have been widely adopted in Australian public sector healthcare and will remain an ongoing, essential data system. However, recent substantial data breaches from hacked business data systems in Australian enterprises, as well as international healthcare providers, mean that EHR data breaches are increasingly likely in Australia. Risks include medical identity theft and extortion attempts based on threats to release sensitive patient information. Hacking is now a foreseeable additional risk of medical treatment. Risk mitigation for the consequences of data breaches needs to be considered, as well as support for patients (and families) and healthcare workers. This includes identity theft protection services, cybersecurity insurance, and psychological support.
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- 2024
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45. Medicare Benefits Schedule (MBS) Review Advisory Committee post-implementation review of MBS telehealth items: abolition of initial telehealth consultations for non-general practitioner specialists.
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Looi JCL, Allison S, Bastiampillai T, Kisely S, and Pring W
- Subjects
- Humans, Aged, Australia, National Health Programs, Referral and Consultation, Pandemics, Advisory Committees, Telemedicine
- Abstract
In 2022, the Australian Federal Minister for Health and Aged Care commissioned the Medicare Benefits Schedule (MBS) Review Advisory Committee (MRAC) to conduct a post-implementation review of MBS telehealth services, including settings of video and telephone consultations. The MRAC has made a series of administrative recommendations for telehealth practice that appear at cross-purposes to the evidence-base on medical consultations and that would limit patient access to medical specialist assessment in Australia. These recommendations particularly underestimate the role of telehealth in rural and remote Australia and did not take into account high patient satisfaction with telehealth assessment and treatment during the ongoing coronavirus disease 2019 (COVID-19) pandemic. They also appear to contradict the Medical Board of Australia's guidance on telehealth. On this basis, the recommendations for telehealth principles and abolition of reimbursement for telehealth for all initial non-general practitioner medical specialist consultations should be withdrawn.
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- 2024
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46. Practical psychiatry: Taking gaming seriously - a primer for psychiatrists on gamers and gaming culture.
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Looi JC, Wilkes FA, Bastiampillai T, and Allison S
- Subjects
- Adolescent, Humans, Psychiatrists, Quality of Life, Video Games, Gambling psychology, Psychiatry, Behavior, Addictive
- Abstract
Objective: Up to three billion, of the eight billion people in the world, play videogames. Gaming is a significant global sociocultural influence. This primer will aid psychiatrists in understanding sociocultural milieux of gamers, who include patients and their communities., Method: A rapid narrative review., Results: Benefits include expression of personality, identity and culture through social aspects of gaming. Improved physical health, neurocognition, self-efficacy and quality of life are associated with gaming in those with certain mental health disorders including schizophrenia. Harms may include in-game discrimination, disordered gaming, as well as encouragement of online gambling. There is no longitudinal association between violent games and youth aggression., Conclusions: Psychiatrists should enquire about gaming as part of the sociocultural milieux of patients' lives, and the perceived mental health benefits and harms of gaming., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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47. Practical psychiatry: On therapeutic equipoise - Principles of a balanced approach to psychiatric treatments.
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Looi JC, Allison S, Woon L, and Bastiampillai T
- Subjects
- Humans, Psychotherapy, Caregivers, Therapeutic Equipoise, Psychiatry
- Abstract
Objective: There are many burgeoning treatments, and a large range of therapeutic options for 21
st century psychiatry. This paper briefly comments upon considerations for balancing treatment to suit the patient, their illness, and their milieu., Conclusions: Therapeutic equipoise, for psychiatric care, is an aspiration rather than a position easily achieved. In day-to-day clinical practice, there will be unexpected demands and barriers that cannot always be accommodated or surmounted. Psychiatrists can work collaboratively with patients, carers, and colleagues in conceptualising and care-planning to avoid extremes of therapeutic hubris and despair, and to adapt evidence-based care more effectively so that it is suited to the patient and their circumstances., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.- Published
- 2024
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48. Recurrent Mental Health Presentations to Public Hospital Services: A Focus on Borderline Personality Disorder.
- Author
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Smith D, Cammell P, Battersby M, Bartsch D, Stevenson J, and Bastiampillai T
- Subjects
- Humans, Male, Female, Retrospective Studies, Mental Health, Hospitalization, Hospitals, Public, Borderline Personality Disorder complications, Borderline Personality Disorder diagnosis, Borderline Personality Disorder epidemiology
- Abstract
Objective: To investigate associations between patients with borderline personality disorder (BPD)-related symptoms and their hospital presentations as well as the effect of inpatient length of stay (LOS) on time to hospital re-presentation., Methods: A retrospective cohort design was used to investigate mental health emergency department (ED) visits and inpatient admissions. The cohort comprised 13,320 men and 12,290 women with a follow-up period between January 1, 2014, and December 31, 2019., Results: Across all presentations in the study period, approximately 4% of mental health patients were discharged from ED or inpatient admission with primary diagnosis of BPD. Both male and female patients with BPD were at higher risk of hospital re-presentation when compared to patients with any other type of mental disorder ( P < .01). Patients with BPD who had LOS > 14 days in their first inpatient admission were, on average, more likely to experience a repeat ED or inpatient presentation 58 days sooner than patients who had LOS < 2 days ( P = .036)., Conclusions: Findings suggest the need for ( a ) more accurate recording of BPD and related presentations, ( b ) more in-depth investigations of BPD care pathways, and ( c ) identifications of subpopulations who may benefit from a specific inpatient length of stay., Prim Care Companion CNS Disord 2024;26(1):23m03559 ., Author affiliations are listed at the end of this article., (© Copyright 2024 Physicians Postgraduate Press, Inc.)
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- 2024
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49. Letter to the Editor: Letter to the Editor regarding 'Early impacts of the "National Suicide Prevention Trial" on trends in suicide and hospital admissions for self-harm in Australia'.
- Author
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Bastiampillai T, Wu A, Giam A, and Tibrewal P
- Subjects
- Humans, Suicide Prevention, Hospitalization, Hospitals, Suicide, Self-Injurious Behavior prevention & control
- Abstract
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
- Published
- 2024
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50. The unfulfilled promises of electronic health records.
- Author
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Looi JCL, Kisely S, Allison S, Bastiampillai T, and Maguire PA
- Subjects
- Humans, Feedback, Electronic Health Records
- Abstract
We provide a brief update on the current evidence on electronic health records' benefits, risks, and potential harms through a rapid narrative review. Many of the promised benefits of electronic health records have not yet been realised. Electronic health records are often not user-friendly. To enhance their potential, electronic health record platforms should be continuously evaluated and enhanced by carefully considering feedback from all stakeholders.
- Published
- 2023
- Full Text
- View/download PDF
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