Thread by @CroakeyNews

And, we're off for the second full day of #RANZCP2022. This morning's keynote address is Prof Jayashri Kulkarni AM, director of Monash Alfred Psychiatry research centre, is today’s first keynote speaker @jayashrikulkar1 @maprc1 #RANZCP2022

The focus of her keynote will be women’s mental health #RANZCP2022

Prof Kulkarni starts off by stating she is likely to move around the stage and provoke us with her speech - there is much to be done and "time is up"- @jayashrikulkar1 #RANZCP2022

The past 3 years has seen heightened activity by women to try and end violence against women, to have true equality and to AGAIN have reproductive rights - @jayashrikulkar1 #RANZCP2022

On March 4, 2021 women around the world marched for justice- anger was and still is palpable - general feeling is "time is up". Acknowledges the work of @BrittHiggins_ and @TamePunk in galvanising the "time's up" movement in Australia- @jayashrikulkar1 #RANZCP2022

People with lived experience are saying, "enough." - @jayashrikulkar1 #RANZCP2022

62% of people who submitted evidence to Victoria's Royal Commission into mental health were women - @jayashrikulkar1 #RANZCP2022

Mental disorders place a substantial burden of disease on individuals & communities. 47% (pre-COVID) of Australian women have experienced mental illhealth at some time - @jayashrikulkar1 #RANZCP2022

Pre-COVID financial costs due lost productivity is estimated $32 bill per year - @jayashrikulkar1 #RANZCP2022

Where to now for women's mental health? Prof Kulkarni suggests a redesign of inpatient psych units, change diagnostic categories, focus on women centered neurobiology - all co-designed - just the "simple things we need to do" Kulkarni says - @jayashrikulkar1 #RANZCP2022

Prof Kulkarni emphasises the biopsychosocial model for mental ill-health - @jayashrikulkar1 #RANZCP2022

Still more work required in the impacts of hormone impacts and gender differences - @jayashrikulkar1 #RANZCP2022

On the redesign of inpatient psychiatry units - they need to be safe, private, inpatient areas, REAL trauma work, not just "lip service" -- @jayashrikulkar1 #RANZCP2022

'Right to be safe' document in 2018 pretty much sank - @jayashrikulkar1 #RANZCP2022

But, Kulkarni says very proud to have launched Australia's first women's mental health hospital, with Cabrini Health - @jayashrikulkar1 #RANZCP2022
cabrini.com.au/patients-and-f…

On the second point for change - can we challenge diagnoses that do not help women? - @jayashrikulkar1 #RANZCP2022

Borderline Personality Disorder has substantial challenges - patients say, "I hate the term "personality disorder", as it means their personality doesn't fit with a predescribed notion of what is "normal" - @jayashrikulkar1 #RANZCP2022

Relationship of trauma in early life to borderline PD patients is significant, early traumatisation are frequent & especially prevalent in women - @jayashrikulkar1 #RANZCP2022

Is there an overlap between PTSD and BPD? - Kulkarni says yes! Trauma needs to be defined broadly, emotional trauma is as impactful as physical trauma, particularly in young age - @jayashrikulkar1 #RANZCP2022

Women are angry about being labeled with BPD - the term has many problems - stigma, self-blaming. It doesn't recognise the woman as a survivor - @jayashrikulkar1 #RANZCP2022

Another comment comment made about BPD is that "it is genetic." But, environment shapes whether genetic attributes wax, wane or lie dormant - @jayashrikulkar1 #RANZCP2022

On the third factor for change - gonadal hormones have an impact on women's mental health, which is not news for many women! - @jayashrikulkar1 #RANZCP2022

PMDD, premenstrual dysphoric disorder, is common - in 15% of women has PMDD. Does not necessarily have a clear premenstrual pattern, but tends to have a cyclical onset - @jayashrikulkar1 #RANZCP2022

In managing PMDD, oral contraceptive (OC) pill can be used, but many have depressive side effects. Other hormone strategies include adding SSRI intermittent, zoladex or GnrH agonist - @jayashrikulkar1 #RANZCP2022

PMDD is a brain disorder, Kulkarni says - she sees too many people having oophorectomy or hysterectomy to fix - @jayashrikulkar1 #RANZCP2022

On depression & the Pill - over 75% of Australian women use contraceptive pill at some time, but many discontinue due to depressive side-effects - @jayashrikulkar1 #RANZCP2022

We are still waiting for a good OC for mood and other adverse effects. Implanon and Mirena found to have depressive side effects, which improves after they are removed - @jayashrikulkar1 #RANZCP2022

Last topic Prof Kulkarni talks about is perimenopausal depression, which is a huge issue in a large group of people- @jayashrikulkar1 #RANZCP2022

How do we manage depression in middle aged women? Multi-modal, but which way do we go? Antidepressants or HRT? Psychotherapy or sleep regulation? It really depends who patient sees - @jayashrikulkar1 #RANZCP2022

Perimenopausal depression is in a big group of people & the transition is 10-12 years - it is not good enough to tell patients to wait until menopause is over and "she'll come good" - @jayashrikulkar1 #RANZCP2022

Some current research in women's mental health includes estrogen and "brain estrogen" treatment in women with schizophrenia - @jayashrikulkar1 #RANZCP2022

Kulkarni announces a new women's mental health research centre, a new partnership with Alfred Health and Cabrini Health - @jayashrikulkar1 #RANZCP2022

The current "gender blind" approach is not working - one size does not fit all. We can always improve things - trying to understand women's mental health will be a big step forward - @jayashrikulkar1 #RANZCP2022