Improving the mental health of Australians: A renewed call for primary care psychiatry.

OBJECTIVE: To describe different ways to improve liaison between psychiatrists and general practitioners in Australia. CONCLUSION: Strengthening the links between psychiatry and GPs in primary care is an effective approach to improve the mental health of Australians.

CoMET: a protocol for a randomised controlled trial of co-commencement of METformin as an adjunctive treatment to attenuate weight gain and metabolic syndrome in patients with schizophrenia newly commenced on clozapine.

INTRODUCTION: Clozapine, while effective in treatment refractory schizophrenia, is associated with significant weight gain, heart disease and increased risk of type 2 diabetes mellitus (T2DM). Although there is evidence for weight loss with metformin for people with obesity who are already taking clozapine, there have been no published trials that have investigated the effect of metformin in attenuating weight gain at the time of clozapine initiation. METHODS AND ANALYSIS: A 24-week double-blind placebo-controlled trial of concomitant prescription of metformin at clozapine commencement. Eighty-six people being commenced on clozapine will be randomised to placebo or metformin (variable dose, up to 2 g/day). The primary outcome is comparative end point body weight, between the placebo and metformin groups. Secondary outcomes are comparative rates of conversion to T2DM, alteration of metabolic syndrome parameters, proportion gaining >5% body weight and changes in diet and appetite. We will additionally examine biomarkers associated with change in weight among trial participants. ETHICS AND DISSEMINATION: Ethics approval was granted by the Metro South Human Research Ethics Committee HREC/17/QPAH/538-SSA/17/QPAH/565. We plan to submit a manuscript of the results to a peer-reviewed journal, and present results at conferences, consumer forums and hospital grand rounds. TRIAL REGISTRATION NUMBER: ACTRN12617001547336; Pre-results.

Evaluation of knowledge and attitudes among primary care physicians in Cavan-Monaghan as 'gatekeepers-in-waiting' for the introduction of Carepath for Overcoming Psychosis Early (COPE).

AIM: To investigate general practitioners' current knowledge of and attitudes towards psychosis and its management by Cavan-Monaghan Mental Health Service, Ireland, prior to their involvement in the introduction of an early intervention service. METHODS: As part of a continuing medical education programme for psychosis, delivered to all 32 general practitioners practising in this region, participants were asked to complete a 29-item questionnaire designed to assess their baseline knowledge and attitudes. RESULTS: All 32 general practitioners participated in the study. Although 17% had received no previous psychiatric training, 93% described their knowledge of psychiatric disorders as average or above average. However, only 53% could correctly identify all of a set of psychiatric symptoms related to psychosis. Only 50% felt comfortable initiating treatment for psychotic symptoms. Whereas only 40% had heard of the early intervention model, 89% believed it to be advantageous. Easy accessibility to services and rapid assessment of patients referred were most commonly reported as helpful. However, concerns were expressed about the potential for associated increases in workload. CONCLUSIONS: As 'gatekeepers-in-waiting', these general practitioners will have a vital role in effective implementation of the early intervention service for psychosis. However, their knowledge needs improvement, through regular educational sessions, and this service must be responsive to their needs. In addition, general practitioners' concerns regarding the potential for increased workload must be adequately addressed in order to maintain enthusiasm and collaboration at the interface between primary care and mental health services, particularly in the context of early intervention.