Cosmetic psychiatry: A concept in urgent need of consideration

OBJECTIVE

To explore the concept of, ethics surrounding, and arguments for and against cosmetic psychiatry.

CONCLUSIONS

Cosmetic psychiatry may be defined as the science and practice of interventions that subjectively enhance the mental states of healthy people. Cosmetic medicine (including surgery) is a professionally and socially accepted part of contemporary medical practice; cosmetic psychiatry is not. Like cosmetic medicine, there are significant risks associated with cosmetic psychiatry. There is an urgent need for a broader conversation about this emerging clinical reality.

Consumer? Views and preferences of people receiving public mental health care in Australia on the terms used to refer to them

OBJECTIVES

To understand: a) whether adults receiving public mental health care were aware they were officially referred to as 'consumers' and, b) their views and preferences on the terms used to refer to them.

METHODS

Single-page, anonymous survey conducted across two community mental health services in Northern New South Wales (NNSW). Ethics approval obtained from the local research office.

RESULTS

108 people completed the survey with a response rate of approximately 22%. The vast majority (77%) of respondents were not aware that they were officially referred to as 'consumers'. 32% of respondents disliked the term 'consumer' and 11% found it offensive. Half preferred the term 'patient', particularly when consulting a psychiatrist (55%). A small minority (5-7%) preferred the term 'consumer' for any care interaction.

CONCLUSION

Most respondents in this survey wished to be referred to as a 'patient' and a large proportion disliked being referred to as a 'consumer' or found it offensive. Further surveys should include broader sociodemographic and diagnostic/treatment variables. Official terms used to refer to people receiving public mental health care should be person-centred and evidence based.

The parable of the Therapeutic Goods Administration approval of esketamine (Spravato) in Australia

OBJECTIVE

To review the sequence of events that led to the Therapeutic Goods Administration (TGA) approval of esketamine in Australia, and to explore the potential ethical and clinical consequences of it.

CONCLUSIONS

Trust in the TGA is of paramount importance to Australian psychiatrists. The approval of esketamine raises serious questions about the processes, independence and authority of the TGA, and therefore the confidence Australian psychiatrists can have in the 'quality, safety and efficacy' of the drugs they offer their patients.

Antipsychotic-induced supersensitivity - A reappraisal

OBJECTIVES

Tardive dyskinesia, psychotic relapse and treatment-refractory psychosis have long been associated. A common underlying mechanism involving antipsychotic-induced 'supersensitivity', albeit in different brain pathways, was proposed as early as 1978. This piece seeks to reappraise the concept and potential implications of antipsychotic-induced supersensitivity.

CONCLUSIONS

Evidence increasingly suggests that chronic antipsychotic exposure induces neuroadaptive physiological changes in dopaminergic, and other, neurotransmitter systems that may render some individuals more vulnerable to psychotic relapse - including those receiving continuous antipsychotic treatment. It is possible that in treating every episode of psychosis with prolonged or indefinite antipsychotic therapy, we paradoxically increase the risk of psychotic relapse in a significant proportion of people. A greater appreciation of supersensitivity may allow us to optimise any potential benefits of antipsychotics while minimising the risk of inadvertent iatrogenic harms. More research is needed to improve our understanding of the underlying neurophysiology of supersensitivity and to better identify which individuals are most vulnerable to its development. It is time we paid more attention to the concept, emerging evidence and potential implications of antipsychotic-induced supersensitivity and, where appropriate, adjusted our practice accordingly.

The biopsychosocial model - history, controversy and Engel

OBJECTIVE

The biopsychosocial (BPS) model remains the predominant theoretical framework underpinning contemporary psychiatric training and practice. Like all models, it has its limitations and its critics. In light of recent censure, The purpose of this article was to (a) review key aspects of the history, development and contemporary utility of the BPS model and, (b) review key contributions of George Engel.

CONCLUSION

An aetiological model for mental disorders that involves psychological, biological and sociocultural factors has existed since at least the 1940s. The term "biopsychosocial" was arguably first coined by Roy Grinker in 1952. Spurred on by his interest in systems theory, Engel expanded upon the model in 1977 and used it to hypothesise about the integration of mind and body. Despite its shortcomings, the BPS model remains relevant and useful.