Sivasankaran Balaratnasingam

Mass hysteria revisited.

Purpose of review Instances of mass psychogenic response have occurred throughout history, and across population groups; however, the present-day threat of terrorism and biological warfare is expected to enhance societal vulnerability to epidemics of such events. This paper provides a brief review of the current state of knowledge regarding the conceptualization, diagnosis, and management of mass psychogenic response. Recent findings Various terms are nowadays used to denote mass hysteria, such as ‘mass psychogenic illness’ and ‘mass sociogenic illness’. Recent studies investigating personality types predisposed to mass hysteric reactions are inconclusive with a range of results found. Cognitive models of this condition have been effective in promoting empowerment and adaptation among vulnerable individuals. The actions of governments, medical communities, and the media are pivotal in the management of mass hysteria. Summary The diagnosis of mass hysteria remains contentious, and the mechanisms underlying its perpetuation are similarly ambiguous. The prevalence of ‘threat’ within the modern sociocultural climate is likely to increase the incidence of the condition, and this could result in serious implications for health services. A holistic approach entailing the collaboration of various public sectors performing a range of preventive activities will be required to contain future mass psychogenic reactions.

Missed diagnosis of autism in an Australian Indigenous psychiatric population

Objective: The aim of this paper is to review the diagnosis among adult Indigenous patients from the Kimberley region of Western Australia who had an existing diagnosis of schizophrenia. A visit from a psychiatrist specializing in intellectual disability provided the opportunity for conducting psychiatric assessments from a developmental perspective. Method: Selected patients with schizophrenia were assessed from an intellectual disability perspective from an active case load of 215 patients. Result: Thirteen out of 14 selected patients were considered to have a diagnosis of autism when a developmental history was undertaken. Case studies are presented to illustrate the overlap in symptoms and potential for the diagnosis of autism to be missed. Conclusions: Autism spectrum disorders may be missed in Indigenous population groups. This has implications for treatment and service provision. Clinicians need to be mindful of the diagnostic possibility that an autism spectrum disorder might be masquerading as schizophrenia in the context of intellectual disability and atypical presentation.

Normal personality, personality disorder and psychosis: current views and future perspectives.

Purpose of review The purpose of this article is to review recent literature examining the occurrence of psychotic experiences in normal population and those with personality disorders. Recent findings Up to 15% of individuals in the general population report some type or degree of psychotic experience. Most of these individuals function adequately, do not require psychiatric treatment and do not receive diagnosis of a psychotic illness. A significant number of individuals diagnosed with borderline personality disorder (25–50%) also report psychotic symptoms. These are not easily differentiated from the psychotic symptoms reported by individuals with schizophrenia, nor are they always transient. However, emerging research has confirmed that individuals with schizotypal personality disorder are dimensionally related to those with schizophrenia and are at an increased risk of transition to psychosis. Summary Psychotic symptoms are best considered as ‘trans-diagnostic’ entities on a continuum from normal to pathological. There is a large body of evidence for a dimensional relationship between schizotypal personality disorder and schizophrenia. There is also a significant amount of research showing that psychotic symptoms in borderline personality disorder are frequent, nontransient and represent a marker of illness severity. This review highlights the need to move beyond traditional assumptions and categorical boundaries when evaluating psychotic experiences and psychopathological phenomena.

Towards culturally appropriate assessment of Aboriginal and Torres Strait Islander social and emotional well-being

Objective: Identification of need for specialist assessment and the use of relevant cultural information to inform mental health assessment and care are two key factors in improving Aboriginal and Torres Strait Islander access to and experience of mental health care. This paper describes the Here and Now Aboriginal Assessment tool (HANAA) and the Cultural Information Gathering Tool (CIGT), two instruments developed to be used respectively by non-mental health clinicians and Aboriginal and Torres Strait Islander mental health workers. Method: Following widespread consultations and feedback, two independent groups of mental health clinicians based in Western Australia and Queensland were involved in developing the HANAA and CIGT. Results: Both the HANAA and CIGT fill unmet needs in terms of instruments that can be used by non-specialists working with Aboriginal and Torres Strait Islander people. Conclusions: Preliminary use of the HANAA and CIGT suggests that they are well received, easy to deploy and effective instruments that promote cultural security and communication with Aboriginal and Torres Strait Islander people.

Here and Now Aboriginal Assessment: background, development and preliminary evaluation of a culturally appropriate screening tool

Objective: Assessment of Aboriginal social and emotional wellbeing (SEWB) is a complex and challenging task, in part due to a lack of suitable assessment tools. This paper reports the development and evaluation of a culturally appropriate screening tool called the Here and Now Aboriginal Assessment (HANAA). Method: The initial phase included development of a glossary of Aboriginal terms and concepts relating to SEWB. The glossary was used to identify 10 key HANAA domains, which included physical health, sleep, mood, suicide risk and self harm, substance use, memory, unusual experiences, functioning, life stressors and resilience. Evaluation of the HANAA included exploration of its cultural applicability, feasibility, reliability and validity. Results: The HANAA was well accepted by study participants and easily implemented by assessors. Reliability was good, with inter-rater agreements between Aboriginal and non-Aboriginal assessors measured by Kappa statistics ranging from 0.5 to 1.0. There was also a good agreement between assessors and treating clinicians in identifying the main presenting problem and recommended course of action. Conclusion: The HANAA is a culturally appropriate and useful tool for the screening of SEWB among Aboriginal adults. It can also be used for teaching and training purposes of mental health and other professionals working with Aboriginal people.

Asian/Pacific Rim psychiatrists’ views on aspects of future classifications

Asian/Pacific Rim psychiatrists’ views on aspects of future classifications Graham Mellsop MD FRANZCP, Aleksandar Janca MD MSc FRCPsych FRANZCP, Carlos León-Andrade MD, Daisy Nga Yan Luk MRCPsych FHKAM(Psychiatry), Helen Fung Kum Chiu FRCPsych FHKAM(Psychiatry), Hinemoa Elder FRANZCP, Naotaka Shinfuku MD PhD, Rees Tapsell FRANZCP, Sivasankaran Balaratnasingam MBBS FRANZCP & Wai Chi Chan MRCPsych FHKAM(Psychiatry)

Intellectual disability in Indigenous Australians: issues and challenges.

Objectives: Literature on Indigenous Australians (Aboriginal and Torres Strait Islander people) and intellectual disability (ID) is summarized in order to identify current state of knowledge, gaps, and areas for further research. Methods: A selective review of psychiatric literature using relevant medical databases was undertaken. Key articles were identified and their findings described. Results: ID is reported to be more prevalent in Indigenous Australians. Sociocultural constructs and a lack of validated psychometric measures affect what is considered to be ID in Indigenous communities. Prenatal, perinatal, and postnatal factors impair brain development and contribute to ID in Indigenous communities. Comorbid physical and psychiatric disorders need to be assessed and managed. Conclusions: ID is an emerging area of health concern for general and mental health professionals working with Indigenous Australians. This important area requires further research, appropriate training, and resourcing.

Combining Sertraline and Naltrexone in the Treatment of Adults with Comorbid Depression and Alcohol Dependence

Introduction: Alcohol dependence and depression frequently occur in a comorbid fashion and present a conundrum to the treating clinician [1]. Empirical trials have provided limited information regarding treatment for those suffering from depression in the context of alcohol dependence, with fewer than a dozen well-controlled studies and only one large multicenter study [2]. It is acknowledged that the two disorders are intertwined, with each disorder increasing the risk of development of the other, increasing the severity of the other, and prolonging the clinical course of the other [3]. The health outcomes of comorbid depression and substance use are worse, and the risk of suicide is increased [4]. Meta-analyses have reported a modest effect when antidepressants were used to treat depression in substance dependence [5]. Given the limited findings, this study considered the effect of combining US Food and Drug Administration–approved medication for both depression and alcohol dependence. Naltrexone is an opioid receptor antagonist that has been shown to reduce heavy drinking in alcohol-dependent patients. Sertraline is a selective serotonin reuptake inhibitor antidepressant that has shown efficacy in treating depression and anxiety. Although this is the third such trial in this field using a combination therapy, it seems to be significantly superior to the others in terms of duration and its use of a double-blind, placebocontrolled design. Hence, it has been selected for this report.

Alarming increase of suicide in a remote Indigenous Australian population: an audit of data from 2005 to 2014

Early in 2016, a 10‐year old Indigenous girl committed suicide in a remote desert community of Western Australia1. This tragedy triggered national and international media attention, followed by demands for increased resources to provide effective prevention of suicide in Indigenous Australians. Due to the absence of any reliable reference information regarding suicide trends, we conducted a de‐identified retrospective audit of suicide deaths in this region between 2005 and 2014.

Rising Indigenous suicide rates in Kimberley and implications for suicide prevention

Objectives: This audit examined the demographics of Indigenous Australians dying by suicide in the Kimberley region of Western Australia during the period 2005–2014. Methods: This is a de-identified retrospective audit of reported suicide deaths provided to Kimberley Mental Health and Drug Service during the period 2005–2014. Variables such as age, sex, method of suicide, previous engagement with mental health services, locality and ethnicity were assessed. Results: Indigenous suicide rates in the Kimberley region have dramatically increased in the last decade. There is also an overall trend upwards in Indigenous youth suicide and Indigenous female suicides. Conclusions: These findings highlight the need for culturally informed, and youth focussed, suicide prevention interventions within the Kimberley region.