INTRODUCTION AND OBJECTIVES:Clozapine is the antipsychotic medication with the greatest efficacy in treatment-resistant schizophrenia (TRS). Unfortunately, clozapine is ceased in approximately 0.2% to 8.5% of people due to concerns about clozapine-associated myocarditis (CAM). The opportunity for clozapine rechallenge is important for people with TRS and CAM, due to limited alternative treatments. However, there is a lack of consensus regarding the optimal process, monitoring, and dose titration to achieve successful clozapine rechallenge. The study aimed to review the process, monitoring, and dose titration within cases of clozapine rechallenge after CAM, to identify features associated with successful rechallenge. METHODS:A systematic review of clozapine rechallenge cases following CAM was conducted. PubMed, EMBASE, Cinahl, and PsycINFO were searched for cases. Reference lists of retrieved articles and field experts were consulted to identify additional studies. RESULTS:Forty-five cases were identified that described clozapine rechallenge, 31 of which were successful. Successful rechallenge cases generally used a slower dose titration regime with more frequent monitoring than standard clozapine initiation protocols; however, this data was not always completely recorded within cases. Six cases referred to published rechallenge protocols to guide their rechallenge. CONCLUSIONS:The process, monitoring, and dose titration of clozapine rechallenge are inconsistently reported in the literature. Despite this, 69% of case reports detailed a successful rechallenge post CAM; noting limitations associated with reliance on case data. Ensuring published clozapine rechallenge cases report standardised data, including titration speed and monitoring frequencies, is required to guide the development and validation of guidelines for clozapine rechallenge.

This observational study compared the outcomes of consumers receiving community-based residential mental health rehabilitation support in Australia under a clinical staffing model and an integrated staffing model where Peer Support Workers are the majority component of the staffing profile. Reliable and clinically significant (RCS) change between admission and discharge in functional and clinical assessment measures were compared for consumers receiving care under the clinical (n = 52) and integrated (n = 93) staffing models. Covariate analyses examined the impact of known confounders on the outcomes of the staffing model groups. No statistically significant differences in RCS improvement were identified between the staffing models. However, logistic regression modelling showed that consumers admitted under the integrated staffing model were more likely to experience reliable improvement in general psychiatric symptoms and social functioning. The findings support the clinical and integrated staffing models achieving at least equivalent outcomes for community-based residential rehabilitation services consumers.

Background: The Breakfast Club is a peer review group consisting of registrars and early career psychiatrists (ECPs) with interest in academic psychiatry in Brisbane, Queensland. The Club meets every 2 months for breakfast. At each meeting, we invite a ‘Pancake Prince’ or ‘Princess’ – an established academic psychiatrist – as a guest of honour to share his or her wisdom and foster intergenerational transmission of the research culture. Objectives: This is an update to the last year’s symposium. We aim to showcase the diverse research that is being conducted by members of the Breakfast Club. Methods: Six members of the Breakfast Club will present their research. The symposium will be chaired by Associate Professor John Allan (Pancake Prince) and Doctor Catherine Franklin (Pancake Princess). There will be an interactive discussion with the audience about how research can be incorporated into clinical practice throughout the symposium. Findings: Members of the Breakfast Club are involved in a wide range of research using many different research methods. Some topics are service related (e.g. setting up a new service model) while others are clinically orientated (e.g. physical activity in a rehabilitation setting). We will also discuss the challenges and difficulties associated with conducting clinical research in the public mental health services. Conclusions: The Breakfast Club continues to be successful in fostering research culture and mutual learning among registrars, ECPs and established academic psychiatrists in Brisbane, Queensland. We believe that a similar approach can be successful in many other areas of Australasia.

OBJECTIVE:To compare the acceptability of three distinct physical activity measurement tools in people with psychosis: an objective measurement tool, a self-report measure, and an exercise capacity test.METHODS:We measured the completion rate for each measurement tool. Participants rated the ease/difficulty of each measure using a 7-point Likert scale. Participants were also asked to rank the three tools in order of the ease of use.RESULTS:Sixty-six per cent (46/69) of participants completed all three assessment tools, and 60.9% (42/69) completed the acceptability questionnaire. The majority of the participants found it easy to complete all three measurement tools. The majority (52.8%) of the participants ranked the objective measurement tool as the easiest to use.CONCLUSION:All three measures were acceptable to people with psychosis, but objective measurement tools may be easier to use.

Abstract Aims Community care units (CCUs) are a model of residential psychiatric rehabilitation aiming to improve the independence and community functioning of people with severe and persistent mental illness. This study examined factors predicting improvement in outcomes among CCU consumers. Methods Hierarchical regression using data from a retrospective cohort (N = 501) of all consumers admitted to five CCUs in Queensland, Australia between 2005 and 2014. The primary outcome was changed in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes were disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Potential predictors covered service, consumer, and treatment characteristics. Group-level and individualised change were assessed between the year pre-admission and post-discharge. Where relevant and available, the reliable and clinically significant (RCS) change was assessed by comparison with a normative sample. Results Group-level analyses showed statistically significant improvements in mental health and social functioning, and reductions in psychiatry-related bed-days, emergency department (ED) presentations and involuntary treatment. There were no significant changes in disability or accommodation instability. A total of 54.7% of consumers demonstrated reliable improvement in mental health and social functioning, and 43.0% showed RCS improvement. The majority (60.6%) showed a reliable improvement in psychiatry-related bed-use; a minority demonstrated reliable improvement in ED presentations (12.5%). Significant predictors of improvement included variables related to the CCU care (e.g. episode duration), consumer characteristics (e.g. primary diagnosis) and treatment variables (e.g. psychiatry-related bed-days pre-admission). Higher baseline impairment in mental health and social functioning (β = 1.12) and longer episodes of CCU care (β = 1.03) increased the likelihood of RCS improvement in mental health and social functioning. Conclusions CCU care was followed by reliable improvements in relevant outcomes for many consumers. Consumers with poorer mental health and social functioning, and a longer episode of CCU care were more likely to make RCS improvements in mental health and social functioning.

Schizophrenia is a severe neuropsychiatric disorder characterized by a diverse range of symptoms that can have profound impacts on the lives of patients. Currently available antipsychotics target dopamine receptors, and while they are useful for ameliorating the positive symptoms of the disorder, this approach often does not significantly improve negative and cognitive symptoms. Excitingly, preclinical and clinical research suggests that targeting specific muscarinic acetylcholine receptor subtypes could provide more comprehensive symptomatic relief with the potential to ameliorate numerous symptom domains. Mechanistic studies reveal that M1, M4, and M5 receptor subtypes can modulate the specific brain circuits and physiology that are disrupted in schizophrenia and are thought to underlie positive, negative, and cognitive symptoms. Novel therapeutic strategies for targeting these receptors are now advancing in clinical and preclinical development and expand upon the promise of these new treatment strategies to potentially provide more comprehensive relief than currently available antipsychotics.

Background: Incomplete remission rates for traditional pharmacological and psychotherapeutic treatments have led to consideration of diverse strategies to improve health outcomes for people with severe mental illness (SMI). While there is evidence that exercise interventions improve mental and physical health of people with SMI, the optimal type and intensity of exercise interventions is unclear. High-intensity interval training (HIIT) has emerged as a promising intervention in other chronic disease populations. However, impact of this novel intervention on mental and physical health of people with SMI remains uncertain. Objectives: This session aims to describe the purpose of a study to systematically review the literature regarding the feasibility, and mental and physical health outcomes of HIIT for people with SMI. Methods: A literature search was conducted to identify journal articles published up to October 2018 that described intervention studies using HIIT to improve mental and/or physical health outcomes in adults (18–65 years) with SMI. Methodological quality was assessed using PEDRO, a quality assessment tool for exercise interventions. Findings: Five unique articles were identified involving 195 participants. Preliminary findings revealed feasibility and tolerability, with improvements in total symptoms and mood. However, studies were heterogeneous, and quality of studies was poor, limiting conclusions. Conclusions: Based on a small number of available studies, HIIT appears to be a feasible type of exercise intervention for people with SMI, and few safety concerns. However larger studies comparing HIIT to other types of exercise, designed with more robust methodology and conducted over a longer duration are required to understand the effect of HIIT as a therapy for people with SMI.