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Objective: Four Medicare Benefits Schedule item numbers for Transcranial Magnetic Stimulation (TMS) treatment of unresponsive MDD were declared in Australia in 2021. They are accompanied by rules/conditions. The aim is to consider these rules/conditions in light of recent research and real-world experience. Conclusions: While evidence supports some listed rules/conditions, others lack clinical justification and deserve to be reconsidered. These include (a) ineligibility of patients who have previously received TMS, (b) a lifetime total limit of 50 treatments, (c) a second/final course being unavailable for 4 months following the completion of the first course, and (d) the second/final course being limited to 15 treatments. [ABSTRACT FROM AUTHOR]

This letter discusses the Continuing Professional Development (CPD) program required by the Medical Councils of Australia and New Zealand for psychiatrists. The letter raises questions and concerns about the program, particularly regarding the inclusion of the CanMEDS framework and the roles it emphasizes. It also questions the process for marking Professional Development Plans, the availability of high-quality peer review, and the requirements for evidence of practice improvement. The letter concludes by acknowledging the importance of CPD for psychiatrists and commending the RANZCP Committee for CPD for their efforts. [Extracted from the article]

Objective: To analyse the overseas approval of aducanumab for Alzheimer's disease, in order to derive lessons of potential interest to individuals and groups involved in dementia drug development and regulation in Australia. Conclusions: Opportunities were identified regarding optimising clinical trial design and solidifying regulatory responsibilities. Increased awareness of the attitudes and needs of patients and patient advocacy organisations would likely improve the patient-clinician alliance. Incorporation of these factors into research design has the potential to improve patient satisfaction with outcomes. [ABSTRACT FROM AUTHOR]

Objectives: First, to conduct a historical review of the evidence for repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder and determine a clinical algorithm. Second, to identify opportunities for research.Methods: Literature searches were conducted of the MEDLINE database, UpToDate and the Australian National University Library SuperSearch from 1 January 2000 to 30 September 2019. The search terms used were 'transcranial magnetic stimulation', 'major depressive disorder' and 'depression'.Results: There were 24 meta-analyses identified, demonstrating a clear clinical effect. Left high-frequency rTMS had the most evidence. Ideal clinical parameters and study design were explored.Conclusion: Use of rTMS for some patients with depression is justified. Open research questions include the comparative efficacy of right low-frequency and bilateral stimulation, the role of rTMS in medication-naïve patients, and maintenance of effect. [ABSTRACT FROM AUTHOR]

Over the last quarter century, transcranial magnetic stimulation (TMS) has been researched and applied in clinical practice in the treatment of major depressive disorder (MDD). More than 100 placebo-controlled studies and 20 meta-analyses have shown this treatment to be effective in treatment resistant depression (TRD). This revolutionary modality uses electromagnetism to therapeutically impact brain cortex; it causes few side effects. TMS corrects abnormalities in brain connectivity, and such corrections correlate with changes in mood. TMS is complimentary and not a replacement for electroconvulsive therapy (ECT), a comprehensive service will provide both techniques. The efficacy of TMS is expected to increase with new stimulation protocols. Currently used as a second line treatment, TMS is likely to become a first line option. Currently, expertise is limited to those working in particular clinics – there is a need/call for training to be more widely available. [ABSTRACT FROM AUTHOR]

Objective: First, to review the principles and practice of disaster psychiatry, in light of recent global events. Second, to identify opportunities for research. Method: A literature review of the MEDLINE database, UpToDate and the Cochrane Library was conducted. Reference lists were also reviewed. Results: Psychiatrists are well-positioned to contribute to positive outcomes at all stages of the disaster response. These contributions derive from their roles as doctors, mental illness specialists and clinical leaders. Conclusion: A novel framework for the psychiatrist's contributions was proposed. Specific knowledge of disaster psychiatry may be worthwhile, and establishment of a public disaster psychiatry centre is reasonable. Research should further examine the role of tele-psychiatry and pursue a best practice for community and front-line employee psychological preparedness. [ABSTRACT FROM AUTHOR]

Objectives:: To characterize suicide in early China, as a means of extending knowledge of this behaviour.Methods:: We examined Romance of the Three Kingdoms, and collated and considered relevant details.Results:: In early China, loss of authority/status, loved ones and fortune were triggers for suicide. The expression of the intention to suicide, either by word or action, was observed and elicited a placating response. Less frequent, but nevertheless clearly recorded, were accounts of suicide completed to satisfy the wishes of others.Conclusions:: The suicide and related behaviour of early China shares many features with late Western societies, but one form (to satisfy the wishes of others) is currently undetected. [ABSTRACT FROM AUTHOR]

The belief that suicide was a sinful act was replaced in the early 19th century by the belief that suicide is always a response to a mental disorder (the mental disorder model of suicide). Jacob[[11]] observed that India had a moderately high suicide rate. In comparison with high income countries, they found India had a larger rate of female suicides, and mental illness was less commonly present. It is known that people with a serious mental disorder complete suicide more often than people without mental disorder suggesting that good treatment is important in suicide prevention (more suicides come from the group without mental disorder, because there are more people in that group). [Extracted from the article]

Background. It is popularly believed that all suicide is the result of mental disorder. We have proposed the concept of “predicament suicide" – suggesting that suicide represents escape from intolerable circumstance, and while mental disorder may be one trigger, there are many others, such as social and economic difficulties. Objective. With a view to extending our understanding we explored thinking on this subject by Mao Zedong, one of the most influential figures of the 20th century. Conclusions. Mao strenuously held that suicide is caused by the social environment/society – he was particularly concerned with oppression and institutionalized disadvantage, which he sought to correct via revolution. His belief that “A person's suicide is determined entirely by circumstances" corresponds precisely with the concept of “predicament suicide." [ABSTRACT FROM AUTHOR]

Introduction The health effects for children with incarcerated parents, and methods to improve children's experience of the justice system, are under-researched areas. While some work has been done to illuminate these concerns, practical implementation of a “child-friendly prison” has been slow. Aims A Health Directorate-funded project examining children's interactions with the Australian Capital Territory (ACT) justice system was conducted in 2013, which made a number of recommendations. The current study sought to examine the ongoing impacts of parental incarceration for children in the ACT and follow up on the recommendations. Methods Semi-structured interviews were conducted with seven key stakeholders with a relationship to the research area. The interviews were summarised, and a thematic analysis was carried out to identify relevant ideas. Results from recent Detainee Health and Welfare Surveys were used to estimate the number of children affected. Results The findings from the interviews concluded that little action was taken in response to the original report, that children's rights and agency were compromised, that the prison lacked accessibility, that consistent and individualised information should be provided to affected children, and that a previously operational homework program should be reinstated. Model facilities were identified. Conclusion Three broadly-applicable recommendations were made in response to the data from the surveys: increasing accessibility of public transport, the establishment of a child liaison officer at prisons, and maintaining extended family visits. [ABSTRACT FROM AUTHOR]

Aim: To expand our understanding of suicide by examining reports of this behavior from the Chinese mythical era (commencing circa 1200 BCE) and drawing comparisons with subsequent eras. Method: Four hundred recently published accounts of Chinese myths and folk tales were examined, along with supplementary material. Lists were created including one focused on attempted suicide and another on completed suicide. Comparisons were drawn with the suicide of a later era China and the current west. Results: No evidence was located of suicide resulting from mental disorder. Six accounts of attempted suicide and 13 of completed suicide were located. Triggers included the death of a loved one, the loss of a valued possession, complicated relationships, and the avoidance of guilt and disgrace. These accord with current western behavior. Conclusion: There is at least fair agreement in the triggers of suicide in past eras in China and the current western era. This supports the view that suicide may be, in some instances, a customary response to circumstances. [ABSTRACT FROM AUTHOR]

Background. In the West, beginning in the early 19th century, the belief was published that suicide was always, or almost always, the result of a mental disorder (a medical problem). This belief became established wisdom when psychological autopsies commenced in mid-20th century. However, should this belief be inaccurate, our suicide prevention strategies, which are currently medically orientated, need to change. Aim. To argue the case that metal disorder is not always, or almost always, the cause of suicide, and that suicide may be triggered by a host of other factors. Method. The scientific basis of psychological autopsies and the practice of medicalization were explored. The opinions of non-medical experts were explored, including philosophers, historians, sociologists, economists and ethicists, among others. Epidemiology of rates in different countries and gender differences were examined for evidence. Conclusion. Suicide is not exclusively a medical problem. While suicide is more common in people who have a mental disorder than people without a mental disorder, mental disorder is not a necessary condition. Thus, open discussions about the nature and causes of suicide are required, with a view to involving experts from a range of fields, and the general community, in developing and funding suitable prevention strategies. [ABSTRACT FROM AUTHOR]

Objective: To examine the presentations of suicide and related behaviour in the novels of Dostoyevsky, with a view to understanding suicide in mid-19th Century Russia, and to use this as a point of reference when reading 21st Century western academic suicide literature. Methods: The data collected from Dostoyevsky's three most prominent novels, Crime and Punishment, The Idiot and The Brothers Karamazov were examined for the text events, 1) completed suicide, 2) suicide attempts, 3) suicidal thoughts, and 4) other mentions of suicide. Findings were compared with current orthodox Western medical literature. Results: In Dostoyevsky's Russia suicide occurred not infrequently and the methods were hanging, shooting and drowning. The triggers were predominantly social factors (in contrast to the current time when the triggers are reported to be predominantly mental disorders). Attempted suicide appears to have been less common than suicide, and limited to occasions when others thwarted deadly actions (in contrast to the current time in which overdose and cutting are frequently encountered). Suicidal thoughts were common among the healthy population (which is in agreement with some current findings). Conclusions: Dostoyevsky's novels suggest that in mid-19th Century Russia, suicide was not uncommon and the main methods were similar to those of the current time. The triggers were depicted as mainly social/economic factors (rather than mental disorder). Attempted suicide has changed much. Suicidal thoughts appear common in both time periods, and frequently appears in the absence of mental disorder. [ABSTRACT FROM AUTHOR]

Objective: We aimed to explore aspects of the removal of hanging points from correctional facilities.Conclusion: An argument can be made that individuals have a right to die/suicide. The United Nations holds that except for freedom of movement, prisoners have the same rights as non-prisoners. The rights of the individual and the duty of many custodial institutions are in conflict. This introduces a conundrum; when all hanging points are removed from correctional facilities, prisoners without mental disorder, but with a sustained wish to die, will not be able to achieve that end, while non-prisoners will be well able to do so. [ABSTRACT FROM AUTHOR]

Aim: To explore whether a healthy, successful individual may experience suicidal desires. Method: Examination of ''A Confession'' by Leo Tolstoy. Results: Confirmation that a physically and mentally healthy, well resourced individual may experience suicidal desires. Conclusion: To reduce suicide rates, a broader understanding of the factors which contribute to suicidal desires is required. [ABSTRACT FROM AUTHOR]

Another recent case of SbC describes Mr C (44 years) with a similarly troubled life.[2] SbC was first described in the United States in the 1980s - and, 40 years later in Tasmania. Dear Sir, A coroner's report released in 2019 describes the death of a man in Cooee, Tasmania[1] - an example of "suicide by cop" (SbC), a unique form of suicide. Mr M spoke of having been "ripped off" and being "pissed off".[1] We suggest the police represent authority, and that as a consequence of killing another person, the police will likely be criticised and even penalised. [Extracted from the article]

Background: The predominant, current western view is that all suicide is the result of mental disorder. This view is much too narrow and does not admit extensive information regarding the social, economic, and forensic factors (among many others) which may contribute to completed suicide. A consequence of this narrow view is that prevention strategies mainly focus on the detection and treatment of mental disorder. A preferred approach is to place greater emphasis on public health approaches to suicide prevention. Objective: To develop and suggest a body of information which may be useful in a public health approach to suicide. Conclusion: It is suggested that the following be available to the general public: i) suicide is a fact of life which should be minimised, ii) suicide has many different triggers, iii) most people who take their lives are able to make decisions, and iv) increased public discussion and understanding of suicide is desirable. Five pieces of information that may be useful to those contemplating suicide include: i) don't murder the part of you that wants to live, ii) suicide actions may leave you alive but disabled, iii) suicide hurts other people, iv) suicidal impulses do pass if you hold on, and v) suicide is a waste. [ABSTRACT FROM AUTHOR]

Background. Over the last century, the claim has been made that suicide is always, or almost always, the result of mental disorder. Aim. To explore the beliefs of famous English speaking poets regarding the triggers of suicide. Method. Poetry libraries were explored for poetry giving information regarding the attitude of writers to the triggers of suicide. This material was analysed and categorized. Results. Fifteen poems (separate poets) were identified and examined. The triggers of suicide included mental disorder and socioeconomic stressors (acute and chronic). In a minority of cases (four), categorization could not be made. Conclusions. Poets describe the triggers of suicide as including not only mental disorder, but also socioeconomic (acute and chronic) factors. [ABSTRACT FROM AUTHOR]

Objectives: National suicide rates fall during times of war. This fits with the notion of the population coming together against a common foe. But, what happens in the case of a war which is not fully supported, which draws the population and families apart? We consider this question by examining the Australian suicide rates during the divisive Vietnam War.Methods: We graphed and examined the Australian suicide figures for 1921-2010.Results: We found clear evidence of a decrease in the suicide rate for World War II (consistent with other studies), but a marked elevation of suicide during the Vietnam War.Conclusions: The elevation of the Australian suicide rate during the Vietnam War is consistent with Durkheim's social integration model - when social integration is lessened, either by individual characteristics or societal characteristics, the risk of suicide rises. [ABSTRACT FROM AUTHOR]

Objective: To examine reports of Transcranial Magnetic Stimulation (TMS) during pregnancy for evidence of fetal risk.Method: PubMed was used to locate relevant literature for the years 1998-2020 and reference lists were examined for materials not located electronically.Results: Ten reports were located dealing with 67 births over 20 years. Stimulation was applied is all trimesters, at low and high frequency, and as intermittent theta-burst stimulation. No mother or baby experienced a serious event.Conclusions: Certainty awaits large, standardized studies. However, the available reports provide no evidence that TMS to mother during pregnancy has detrimental effects on the fetus. [ABSTRACT FROM AUTHOR]

Transcranial magnetic stimulation (TMS) is a safe and effective treat- ment of resistant major depressive disorder (MDD). However, MDD is a chronic disorder and relapse is common. The leading method of managing those cases of MDD who respond to TMS, but continue to relapse, is to provide maintenance TMS – short courses of 5 treatments over 2.5 days, repeat at monthly (or greater) intervals. The strategy is to increase the interval between treatment clusters and for patients to be discharged when they have been able to remain well for a couple of months. However, patients and doctors are both frequently apprehensive about increasing the between cluster interval, and patients tend to remain in treatment programs for long periods. We present a protocol and instrument to assist in moving from treatment to discharge, which we have found helpful. [ABSTRACT FROM AUTHOR]