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  1. Article ; Online: Letter to the Editor: Letter to the Editor regarding 'Psychotogenic potential of prescribed drugs'.

    Large, Matthew

    The Australian and New Zealand journal of psychiatry

    2023  Volume 58, Issue 2, Page(s) 188

    Language English
    Publishing date 2023-11-09
    Publishing country England
    Document type Letter
    ZDB-ID 221140-3
    ISSN 1440-1614 ; 0004-8674
    ISSN (online) 1440-1614
    ISSN 0004-8674
    DOI 10.1177/00048674231211501
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    Zs.A 856: Show issues Location:
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  2. Article ; Online: Suicide mortality after suicide attempt.

    Large, Matthew

    The Australian and New Zealand journal of psychiatry

    2022  Volume 56, Issue 12, Page(s) 1676

    MeSH term(s) Humans ; Suicide, Attempted ; Risk Factors
    Language English
    Publishing date 2022-08-03
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 221140-3
    ISSN 1440-1614 ; 0004-8674
    ISSN (online) 1440-1614
    ISSN 0004-8674
    DOI 10.1177/00048674221117066
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  3. Article ; Online: A clinical pathway for the management of people with borderline personality disorder in emergency departments must not include a 'risk assessment'.

    Corderoy, Amy / Huber, Jacqueline / Ryan, Chris / Large, Matthew

    Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists

    2024  , Page(s) 10398562241235032

    Language English
    Publishing date 2024-02-25
    Publishing country England
    Document type Letter
    ZDB-ID 2213198-X
    ISSN 1440-1665 ; 1039-8562
    ISSN (online) 1440-1665
    ISSN 1039-8562
    DOI 10.1177/10398562241235032
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  4. Article: Calibrating violence risk assessments for uncertainty.

    Connors, Michael H / Large, Matthew M

    General psychiatry

    2023  Volume 36, Issue 2, Page(s) e100921

    Abstract: Psychiatrists and other mental health clinicians are often tasked with assessing patients' risk of violence. Approaches to this vary and include both unstructured (based on individual clinicians' judgement) and structured methods (based on formalised ... ...

    Abstract Psychiatrists and other mental health clinicians are often tasked with assessing patients' risk of violence. Approaches to this vary and include both unstructured (based on individual clinicians' judgement) and structured methods (based on formalised scoring and algorithms with varying scope for clinicians' judgement). The end result is usually a categorisation of risk, which may, in turn, reference a probability estimate of violence over a certain time period. Research over recent decades has made considerable improvements in refining structured approaches and categorising patients' risk classifications at a group level. The ability, however, to apply these findings clinically to predict the outcomes of individual patients remains contested. In this article, we review methods of assessing violence risk and empirical findings on their predictive validity. We note, in particular, limitations in calibration (accuracy at predicting absolute risk) as distinct from discrimination (accuracy at separating patients by outcome). We also consider clinical applications of these findings, including challenges applying statistics to individual patients, and broader conceptual issues in distinguishing risk and uncertainty. Based on this, we argue that there remain significant limits to assessing violence risk for individuals and that this requires careful consideration in clinical and legal contexts.
    Language English
    Publishing date 2023-04-28
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2941976-1
    ISSN 2517-729X ; 2517-729X ; 2096-5923
    ISSN (online) 2517-729X
    ISSN 2517-729X ; 2096-5923
    DOI 10.1136/gpsych-2022-100921
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  5. Article ; Online: Comparing suicide and vascular mortality associated with mental illness.

    Large, Matthew / Swaraj, Sascha

    The lancet. Psychiatry

    2022  Volume 9, Issue 11, Page(s) 850–851

    MeSH term(s) Humans ; Mental Disorders ; Suicide
    Language English
    Publishing date 2022-10-13
    Publishing country England
    Document type Journal Article
    ISSN 2215-0374
    ISSN (online) 2215-0374
    DOI 10.1016/S2215-0366(22)00315-7
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  6. Article ; Online: Understanding and addressing racism in clinical encounters.

    Wijeratne, Chanaka / Sharma, Swapnil / Large, Matthew

    The Australian and New Zealand journal of psychiatry

    2023  Volume 58, Issue 4, Page(s) 297–299

    MeSH term(s) Humans ; Racism
    Language English
    Publishing date 2023-12-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 221140-3
    ISSN 1440-1614 ; 0004-8674
    ISSN (online) 1440-1614
    ISSN 0004-8674
    DOI 10.1177/00048674231219854
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  7. Article ; Online: Homicides in psychiatric hospitals: Absence of evidence or evidence of absence?

    Nielssen, Olav / Large, Matthew

    Criminal behaviour and mental health : CBMH

    2022  Volume 32, Issue 1, Page(s) 60–66

    Abstract: Background: Highly publicised cases of homicide in a psychiatric hospital have raised concerns about the safety of such hospitals.: Aims: To identify individual case reports of homicides by inpatients within psychiatric hospitals in order to update a ...

    Abstract Background: Highly publicised cases of homicide in a psychiatric hospital have raised concerns about the safety of such hospitals.
    Aims: To identify individual case reports of homicides by inpatients within psychiatric hospitals in order to update a 2011 study.
    Methods: A systematic search of the academic literature between 2010 and 2020, information seeking from service leaders in each state and territory of Australia and in New Zealand, and a search of public records in Australia and New Zealand.
    Results: The literature search revealed only one recent paper describing a homicide by a patient in a psychiatric ward. Contact with forensic psychiatrists across Australia and New Zealand yielded four cases of inpatient homicide that took place between 2010 and 2017 in Australia, and none in New Zealand. Public record searching did not add to this count. This compares to 11 inpatient homicides by 10 patients between 1985 and 2011.
    Conclusions: Homicides in psychiatric hospitals seem to remain rare, however, there is no consistent central documentation of these events in Australasia so it is hard to be confident about the figures. Internationally, there is similarly little centralisation of evidence. Standardised methods of recording and reporting such deaths might assist the understanding and prevention of homicides in psychiatric hospitals.
    MeSH term(s) Australia/epidemiology ; Homicide/psychology ; Hospitals, Psychiatric ; Humans ; New Zealand/epidemiology
    Language English
    Publishing date 2022-01-15
    Publishing country England
    Document type Journal Article
    ZDB-ID 2042697-5
    ISSN 1471-2857 ; 0957-9664
    ISSN (online) 1471-2857
    ISSN 0957-9664
    DOI 10.1002/cbm.2226
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Factors associated with involuntary mental healthcare in New South Wales, Australia.

    Corderoy, Amy / Large, Matthew Michael / Ryan, Christopher / Sara, Grant

    BJPsych open

    2024  Volume 10, Issue 2, Page(s) e59

    Abstract: Background: There is uncertainty about factors associated with involuntary in-patient psychiatric care. Understanding these factors would help in reducing coercion in psychiatry.: Aims: To explore variables associated with involuntary care in the ... ...

    Abstract Background: There is uncertainty about factors associated with involuntary in-patient psychiatric care. Understanding these factors would help in reducing coercion in psychiatry.
    Aims: To explore variables associated with involuntary care in the largest database of involuntary admissions published.
    Method: We identified 166 102 public mental health hospital admissions over 5 years in New South Wales, Australia. Demographic, clinical and episode-of-care variables were examined in an exploratory, multivariable logistic regression.
    Results: A total of 54% of eligible admissions included involuntary care. The strongest associations with involuntary care were referral from the legal system (odds ratio 4.98, 95% CI 4.61-5.38), and psychosis (odds ratio 4.48, 95% CI 4.31-4.64) or organic mental disorder (odds ratio 4.40, 95% CI 3.85-5.03). There were moderately strong associations between involuntary treatment and substance use disorder (odds ratio 2.68, 95% CI 2.56-2.81) or affective disorder (odds ratio 2.06, 95% CI 1.99-2.14); comorbid cannabis and amphetamine use disorders (odds ratio 1.65, 95% CI 1.57-1.74); unmarried status (odds ratio 1.62, 95% CI 1.49-1.76) and being born in Asia (odds ratio 1.42, 95% CI 1.35-1.50), Africa or the Middle East (odds ratio 1.32, 95% CI 1.24-1.40). Involuntary care was less likely for people aged >75 years (odds ratio 0.68, 95% CI 0.62-0.74), with comorbid personality disorder (odds ratio 0.90, 95% CI 0.87-0.94) or with private health insurance (odds ratio 0.89, 95% CI 0.86-0.93).
    Conclusions: This research strengthens the evidence linking diagnostic, socioeconomic and cultural factors to involuntary treatment. Targeted interventions are needed to reduce involuntary admissions in disadvantaged groups.
    Language English
    Publishing date 2024-03-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 2829557-2
    ISSN 2056-4724
    ISSN 2056-4724
    DOI 10.1192/bjo.2023.628
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  9. Article ; Online: Meta-analysis of clinical risk factors for suicide among people presenting to emergency departments and general hospitals with suicidal thoughts and behaviours.

    Grover, Cameron / Huber, Jacqueline / Brewer, Matthew / Basu, Ashna / Large, Matthew

    Acta psychiatrica Scandinavica

    2023  Volume 148, Issue 6, Page(s) 491–524

    Abstract: Background: Suicidal thoughts and behaviours (STB) are a common reason for presentation to emergency departments and general hospitals. A meta-analysis of the strength of clinical risk factors for subsequent suicide might aid understanding of suicidal ... ...

    Abstract Background: Suicidal thoughts and behaviours (STB) are a common reason for presentation to emergency departments and general hospitals. A meta-analysis of the strength of clinical risk factors for subsequent suicide might aid understanding of suicidal behaviour and help suicide prevention.
    Methods: We conducted a meta-analysis of cohort and controlled studies on clinical risk factors and later suicide among people presenting to emergency departments and general hospitals with STB. Data were extracted from papers meeting inclusion criteria, published in Medline, PsycINFO, and Embase between 1 January 1960 and 10 October 2022 using papers located with the search terms ((suicide*).m_titl AND (emergency* OR accident and emergency OR casualty OR general hospital OR toxicology service).mp) or were indexed in PubMed and had titles located with the search terms (suicide* OR self-harm OR self-harm OR self-injury OR self-injury OR self-poisoning OR self-poisoning OR overdose OR para-suicide OR parasuicide [title/abstract]) AND (Emergency department OR emergency room OR Casualty OR general hospital OR toxicology OR accident and emergency [all fields]). Data about the association between clinical risk factors and suicide extracted from three or more studies were included in a random-effects meta-analysis of the odds of later death by suicide. The study was registered in PROSPERO and conducted according to MOOSE and PRISMA guidelines.
    Results: Seventy-five studies reported on 741,624 people, of which 19,649 died by suicide (2.65%). Male sex (odds ratio (OR) = 1.99) and age (OR = 2.01) were the most consistently reported risk factors. The strongest associations with subsequent death by suicide related to violent self-harm methods at the hospital presentation, including: unspecified violent method (OR = 4.97), any violent method (OR = 4.57) and the specific violent methods of drowning (OR = 4.32), hanging (OR = 4.26), and use of firearms (OR = 10.08). Patients categorised as higher risk using suicide prediction scales or any other method that combined risk factors had moderately increased odds of suicide (OR = 2.58). Younger age, Black and Hispanic ethnicity, overdose, a diagnosis of adjustment disorder, and the absence of any psychiatric diagnosis were protective against suicide.
    Conclusions: Most risk factors for suicide among people who have presented with STB are not strongly associated with later suicide. The strongest risk factors relate to self-harm methods. In the absence of clear indicators of future suicide, all people presenting with suicidality warrant a thorough assessment of their needs, and further research is needed before we can meaningfully categorise people with STB according to suicide risk.
    MeSH term(s) Humans ; Male ; Suicidal Ideation ; Hospitals, General ; Suicide/psychology ; Self-Injurious Behavior/epidemiology ; Self-Injurious Behavior/psychology ; Risk Factors ; Drug Overdose/epidemiology ; Emergency Service, Hospital
    Language English
    Publishing date 2023-10-30
    Publishing country United States
    Document type Meta-Analysis ; Journal Article ; Review
    ZDB-ID 103-x
    ISSN 1600-0447 ; 0001-690X
    ISSN (online) 1600-0447
    ISSN 0001-690X
    DOI 10.1111/acps.13620
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  10. Article ; Online: Suicide risk assessment.

    Large, Matthew M / Soper, C A / Ryan, Christopher J

    The lancet. Psychiatry

    2022  Volume 9, Issue 12, Page(s) 938–939

    MeSH term(s) Humans ; Suicide/prevention & control ; Risk Assessment
    Language English
    Publishing date 2022-11-18
    Publishing country England
    Document type Letter ; Comment
    ISSN 2215-0374
    ISSN (online) 2215-0374
    DOI 10.1016/S2215-0366(22)00314-5
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