Since COVID-19 first emerged internationally, Australia has applied a number of public health measures to counter the disease’ epidemiology. The public heath response has been effective in virus testing, diagnosing and treating patients with COVID-19. The imposed strict border restrictions and social distancing played a vital role in reducing positive cases via community transmission resulting in ‘flattening of the curve’. Now is too soon to assess the impact of COVID-19 on people’s mental health, as it will be determined by both short- and long-term consequences of exposure to stress, uncertainty, loss of control, loneliness and isolation. The authors explored cultural and societal influences on mental health during the current pandemic utilising Geert Hofstede’s multidimensional construct of culture and determined psychological and cultural factors that foster resilience. We also reflected on the psychological impact of the pandemic on the individual and the group at large by utilising Michel Foucault’ and Jacques Lacan’ psychoanalytic theories. Remote Aboriginal Australian communities have been identified as a high-risk subpopulation in view of their unique vulnerabilities owing to their compromised health status, in addition to historical, systemic and cultural factors. Historically, Australia has prided itself in its multiculturalism; however, there has been evidence of an increase in racial microaggressions and xenophobia during this pandemic. Australia’s model of cultural awareness will need to evolve, from reactionary to more reflective, post COVID-19 pandemic to best serve our multicultural, inclusive and integrated society.

Objectives: Retrospective recall of dissociative symptoms has been found to mediate the association between childhood abuse and deliberate self-harm (DSH) in later life. To disentangle the effect of recall bias, we tested whether dissociation symptoms ascertained during an acute DSH presentation mediates this link. Method: All participants with DSH were recruited during emergency presentation. Seventy-one individuals aged 11–17 years with overdose (OD) and/or self-injury (SI) participated in semi-structured interviews and psychiatric assessment to measure abuse and dissociation. An age- and gender-matched comparison group of 42 non-psychiatric patients admitted to the same service were also assessed. Results: The DSH groups reported significantly higher levels of abuse and dissociation compared to comparison group. Dissociation significantly mediated the association between abuse and DSH. Of the four dissociation subtypes, ‘depersonalisation’ was the primary mediator. Adolescents with chronic patterns of DSH and the ‘OD + SI’ self-harm type reported more severe dissociation. Conclusion: Exposure to abuse significantly increased the risk of DSH in adolescence. This association was mediated by dissociation. Our findings suggest a possible dose–response relationship between dissociation with DSH chronicity and the ‘OD + SI’ self-harm type, implicating the importance of evaluating dissociation and depersonalisation symptoms as well as abuse exposure in DSH management.

Child neuropsychiatry encompasses childhood and adolescent psychiatric syndromes of neurobiological origins. It is an evolving discipline without consensus on its exact boundary. Given the inconsistencies, this chapter provides a historical perspective through which different conceptualizations of child neuropsychiatry can be understood and reconciled within the coherent whole. Four specific contrasting conditions are selected in this chapter to illustrate some key principles: attention-deficit/hyperactivity disorder (ADHD) as ‘a diffuse brain disorder’; childhood cranial tumours as ‘a localized brain disorder’; fetal alcohol spectrum disorders (FASD) as ‘a disorder of a specific cause’ represented by toxin exposure; and epilepsy as ‘a disorder of complex aetiology’. ADHD and cranial tumours represent the extremes of the polar divide between ‘a childhood neuropsychiatric disorder’ and ‘the neuropsychiatric manifestation of a childhood neurological disorder’. In contrast, FASD and epilepsy illustrate how specific and complex aetiology can present with a wide spectrum of psychiatric disorders. Atypical presentations of psychiatric symptoms, idiosyncratic treatment response, and ‘diagnostic overshadowing’ are also considered. The chapter emphasizes that child neuropsychiatric conditions are not fixed entities, despite conforming to diagnostic criteria stipulated by authoritative taxonomic systems. Rather, they are the results of the dynamic interplay between environmental factors, developmental maturity, mitigating factors, aberrant neural networks, and innate disease liability.