bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Propofol and Methohexitone in Anaesthesia for ECT: Effect on Seizure Duration and Outcome
Authors: Kirkby Kenneth Clifford , Beckett Warren Grant , Matters Ruth Mima , King T. E.
Published: December 2009

The effect of the induction agents propofol and methohexitone on seizure duration and clinical outcome was assessed in a prospective, randomised, double blind study in 32 depressed patients receiving electroconvulsive therapy (ECT). Assessments comprised Hamilton rating scales pre-ECT, weekly during the course, and at one month follow-up. Patients showed a significant improvement in depression as measured by the Hamilton rating scale across the course of the ECT treatment. This improvement was not significantly different in the propofol and methohexitone groups. Nor was the amount of improvement related to either the total duration of seizure experienced by the patient during the ECT series or the use of tricyclic antidepressants by some patients.
The Paper Trail to Mental Health
Authors: Ellard John
Published: December 2009

Objective: The aim of this article was to examine the concept of mental health and the policies that have been advanced to improve the wellbeing of the population.

Conclusions: In the last century there have been many changes in the phenomena of psychiatric disorder, the management of those disorders and the outcomes. All of the changes have largely been due to the efforts of those working pragmatically at the coalface. There is little to suggest that the plans and programs advanced in the last half century have achieved more than enhancing the status of those who advance them.

Conclusion: It is difficult to define mental health and equally difficult to develop a comprehensive program that will benefit the whole field.
The Blue Card: A Hand-Held Health Record Card for Mental Health Consumers with Comorbid Physical Health Risk
Authors: Brunero Scott , Lamont Scott , Myrtle Lucy , Fairbrother Greg
Published: December 2009

Objective: We aimed to determine the effectiveness of a hand-held record (the ‘Blue Card’) for seriously mentally ill consumers by investigating effects on consumer knowledge of physical health risk factors, consumer involvement in care and communication with healthcare professionals.

Method: Consumers were given and educated in the use of the Blue Card, which contained information regarding their physical health. Consumers completed a pre- and post-knowledge questionnaire and commented on the effectiveness of the Blue Card with respect to their knowledge of physical health risks.

Results: Statistically significant improvements in consumer knowledge were shown at the 3-month follow-up, with high retention of the Blue Card being demonstrated. Consumers that used the card described their use of the card positively.

Conclusions: The results are very encouraging. Further studies of this low-cost intervention are warranted to establish its effectiveness and utility.
Hallucinations in Adolescent Inpatients with Post-Traumatic Stress Disorder and Schizophrenia: Similarities and Differences
Authors: Jessop Mary , Scott James , Nurcombe Barry
Published: December 2009

Objective: This study compares the phenomenology of hallucinations in a series of hospitalized adolescents diagnosed with post-traumatic stress disorder (PTSD) and schizophrenia.

Methods: Subjects admitted to a tertiary adolescent inpatient unit were screened for hallucinations. Those reporting hallucinations were asked standardized questions relating to these experiences. Hallucinations in subjects with a primary diagnosis of schizophrenia or PTSD were compared.

Results: Hallucinations in both schizophrenia and PTSD have similar form and content. Frequent, vivid, realistic, external hallucinations occurred in both disorders. Hallucinations in PTSD were usually derogatory and related to self-harm, but not direct reflections of traumatic events. Patients with PTSD reported greater emotional distress, self-harm and suicidal ideation than those with schizophrenia.

Conclusions: This case series suggests that the phenomenology of hallucinations in adolescents with schizophrenia and PTSD is similar.
The Wild West: Rural and Remote Psychiatry Training in North Western Australia
Authors: Balaratnasingam Sivasankaran
Published: December 2009

Objective: The author reflects on his rural psychiatric training in North Western Australia, having gained over 2 years’ experience as a basic and advanced trainee in this setting. The unique rewards and benefits of rural training are discussed along with the challenges of working in an isolated setting with resource constraints.

Conclusions: Rural and remote training remains a stimulating and professionally satisfying experience that is under-utilized by many trainees. In spite of most training requirements being able to be met in this setting, trainees are reluctant to undertake this valuable and enjoyable training experience. Trainees are encouraged to consider this opportunity to be upskilled and getting involved on a more personal level with patients, families and general practitioners, thereby enhancing their clinical skills and shaping their professional identity as future psychiatrists.
The Brain and Mind Research Institute: A Unique Campus for the Integration of Clinical and Basic Neurosciences in Australia
Authors: Hickie Ian , Bennett Maxwell
Published: December 2009

Objective: The aim of this paper is to describe the conceptual and practical development of the Brain and Mind Research Institute (BMRI) at the University of Sydney.

Method: The key conceptual framework of the BMRI is reviewed and contrasted with other biomedical institutes. The major timelines for appointment of key personnel, development of infrastructure and implementation of clinical capacities are presented.

Results: The BMRI has developed over 15000 square metres of designated basic research and clinical space. This is thanks to major investments by the University of Sydney, the Australian and NSW governments and the wider community.

Conclusion: Amelioration of the burden of disease due to disorders of the brain and mind may result from a conceptual and practical move away from the traditional emphasis on single disorders or narrow research platforms.
Developing Integrated Models of Care Within the Youth Alcohol and Other Drug Sector
Authors: Lubman Dan I. , Hides Leanne , Elkins Kathryn
Published: December 2009

Objective: The aim of this paper is to describe an initiative in Victoria, Australia, aimed at improving the detection and management of co-occurring mental health issues within the youth Alcohol and Other Drug (AOD) sector.

Conclusions: Over the past 4 years, in partnership with local youth AOD services, we have developed a successful service model that addresses co-occurring mental health issues within the youth AOD sector. However, such capacity-building requires the full support of workers and senior management, and a cultural shift whereby the assessment and management of mental health issues are seen as a priority and core service issue. The capacity-building process was facilitated by embedding experienced mental health clinicians within each service to support and implement the initiative. This model offered learning opportunities through the modelling of relevant skills and the provision of ‘on-the-job’ training. Such approaches demonstrate that integrated models of care can be delivered within youth AOD services, although further research is needed to determine their effectiveness.
Patient and Staff Perspectives on the Use of Seclusion
Authors: El-Badri Selim , Mellsop Graham
Published: December 2009

Objectives: This paper investigates the perceptions and experience of patients and staff on the use of seclusion in psychiatric services.

Method: A purpose designed questionnaire was distributed to staff and patients in a general adult mental health service.

Results: Staff and patients both attributed more negative than positive feelings to patients’ experience of seclusion.

Conclusions: Monitoring and evaluation of the use of seclusion may be insufficient to prevent or ameliorate its emotional impact. More comfortable alternatives to seclusion need to be utilized whenever possible.
Suicide and Reputation Damage
Authors: Pridmore Saxby , McArthur Milford
Published: December 2009

Aim: This paper uses the public record to explore the relationship between reputation damage and suicide.

Method: The public record of the last 20 years was examined for examples of individuals without evidence of mental disorder who suffered actual or threatened reputation damage and suicided shortly thereafter.

Results: Fifteen individual cases were identified; 18 additional cases, less comprehensively detailed, were mentioned in reports of The Wood Royal Commission and Operation Auxin. All cases were male. Of the 15 individual cases, the average age was 55 years, with a range of 40 to 76 years. The available details of the 18 additional cases were consistent with these findings.

Conclusion: Middle-aged males without clear evidence of mental disorder, who suffer actual or threatened reputation damage, may be at increased risk of suicide. Naming and shaming needs to be conducted with caution.
Set up to Fail? Consumer Participation in the Mental Health Service System
Authors: Stewart Sarah , Watson Sandy , Montague Roslyn , Stevenson Caroline
Published: December 2009

Objective: The aim of this paper is to present the findings of a survey of consumers of mental health services who are working (in either paid or unpaid positions) in NSW Health and in the Non Government Organisation sector in NSW.

Method: A survey was distributed through the NSW Consumer Advisory Group newsletter to elicit the roles and assess the training needs of consumer employees, as well as those who were working in voluntary capacities as consumer representatives, within the mental health system in NSW.

Results: Many mental health consumers have been placed in the untenable position of being engaged in representation and/or advocacy roles with unclear job descriptions and no training. The majority of consumers want a code of ethics and performance standards for consumer workers.

Conclusions: The rhetoric of consumer participation is not matched by effective and timely strategies that ensure that consumer involvement is underpinned by relevant training and supportive infrastructure. The goal of meaningful consumer participation in mental health services, as outlined in policy, is yet to be achieved.
Personality, Gender and Medico-Legal Matters in Medical Practice
Authors: Nash Louise , Daly Michele , Johnson Maree , Coulston Carissa , Tennant Chris , van Ekert Elizabeth , Walter Garry , Willcock Simon , Walton Merrilyn
Published: December 2009

Objectives: The aim of this paper was to explore the relationship between the personality traits of Australian General Practitioners (GPs) and their gender, work practice arrangements, and history of medico-legal matters.

Methods: A cross-sectional self report survey was mailed to 1239 GPs. There were 566 respondents (45.7% response rate to survey). The survey assessed personality traits (using the Eysenck Personality Questionnaire), demographic and practice information, and history of medico-legal matters with any medical defence organization. The number and type of medico-legal matters was also extracted from the UNITED Medical Protection database.

Results: Male respondents had significantly higher psychoticism scores than females (p<0.001), and females had significantly higher neuroticism scores than males (p<0.01), as in community samples. However, for GPs who worked more than 48 hours per week, there were no gender differences in personality trait scores. Solo practitioners and non-solo practitioners did not differ on personality scores. Proceduralists and non-proceduralists did not differ on personality scores. However, a higher proportion of proceduralists experienced a medico-legal matter than non-proceduralists (p<0.001). There was a positive correlation between extraversion scores and doctors who attended peer review (p<0.001). There was no difference in the numbers of medico-legal matters for doctors who attended peer review. Males who self reported a medico-legal matter had higher neuroticism scores than the males who did not report medico-legal matters. This was not the case for females. For males, this pattern was not replicated when considering data from UNITED.

Conclusions: The known demographic and practice factors that differ for doctors having a medico-legal matter are replicated here – being male, a proceduralist and working longer hours. There is not a consistent pattern regarding personality traits and medico-legal matters.
SSRIs and Depression in Children and Adolescents: The Imperative for Shared Decision-Making
Authors: Hetrick Sarah , Simmons Magenta , Merry Sally
Published: December 2009

Objective: In the context of controversy and uncertainty about the role of selective serotonin reuptake inhibitors (SSRIs) for the treatment of depressive disorders in children and adolescents, we consider the evidence of the benefits and risks of this class of medication and the possible role of shared decision-making as a practical way to guide clinicians, young people and their families through treatment decisions.

Conclusion: We suggest that there is an imperative for clinicians to engage young people in a process of shared decision-making, given the uncertainties about SSRI medication in this age group. Shared decision-making provides a way for clinicians to engage young people and ensure they receive the treatment required for this disorder, the potential outcomes of which are severe.
The Employment of Consumers in Mental Health Services: Politically Correct Tokenism or Genuinely Useful?
Authors: Nestor Paul , Galletly Cherrie
Published: December 2009

Objective: The aim of this paper is to examine the role of consumers as service providers and to describe the successful employment of peer support workers in a public mental health service.

Conclusions: The Peer Support Worker program in Adelaide, South Australia is consistent with evidence obtained from previous research in demonstrating the successful training and employment of consumers as peer workers in a public mental health service.
Dissemination and Implementation of the Royal Australian and New Zealand College of Psychiatrists’ Clinical Practice Guidelines
Authors: Codyre David , Wilson Andrew , Begg Juliette , Barton David
Published: December 2009

Objective: The aim of this paper is to summarize information about the dissemination and implementation of the Royal Australian and New Zealand College of Psychiatrists’ clinical practice guidelines (CPGs) since their completion in 2003, and assess the effectiveness of these activities.

Method: The dissemination and implementation activities undertaken from 2003 to the present are described. Data regarding the dissemination of the clinician and consumer-carer versions of the CPGs are presented. The results of a series of implementation pilots are summarized.

Results: Available data suggest the CPGs have been widely disseminated through both the clinician and consumer-carer communities in Australia and New Zealand, and that the consumer-carer versions in particular continue to be in high demand. Evaluation of CPG implementation pilots, using tools that assist in bringing summary evidence into clinical practice, have suggested that such tools are acceptable, are a useful aid to implementing evidence-based practice, and have a positive impact on practice. Common barriers to implementing the evidence are highlighted.

Conclusions: Summary consumer-carer versions of CPGs seem to be acceptable and useful to both consumer-carers and non-government mental health providers. Locally led implementation of CPGs using tools that summarize evidence and support its use in everyday practice has a positive impact, but also highlights system-level barriers to implementing evidence-based practice.
Being Bleuler: The Second Century of Schizophrenia
Authors: Kaplan Robert M.
Published: December 2009

Objective: The aim of this paper is to examine the background to the emblematic psychiatric term, schizophrenia, the historical, cultural and social factors affecting the two men who defined modern psychiatric practice, and anticipate what lies ahead in the next century.

Conclusions: The term schizophrenia was created by Swiss psychiatrist Eugene Bleuler and first used on 24 April 1908. The condition was first described by German psychiatrist Emil Kraepelin and called dementia praecox. After a century, it is impossible to think of the practice of psychiatry without schizophrenia.
The Experiences of Trainee Psychiatrists Learning a Psychodynamic Psychotherapy Model: A Grounded Theory Study
Authors: Cohen Zeeva , Hatcher Simon
Published: December 2009

Objective: This study aimed to investigate the experience of trainee psychiatrists learning a psychodynamic psychotherapy model.

Method: An audio taped, semi-structured interview of 12 participants was conducted, and a grounded theory, qualitative methodology used to analyse the interviews.

Results: The central concept of ‘a daunting task’ was developed and linked to the major categories of ‘trainee: shock and awe’, ‘patient: protected and feared’, ‘supervisor: disappointing or admired/revered’ and the ‘wider context: doing and learning psychiatry in the 21st century’.

Conclusions: The study identified several factors in each of the major categories that contributed to the experience of the psychodynamic psychotherapy training case as daunting. Despite this, the participants in the study universally identified the importance of psychiatrists being psychodynamically informed, and the importance of the training case in facilitating this.
Consumer Participation in Mental Health in Australia: What Progress is Being Made?
Authors: Browne Graeme , Hemsley Martin
Published: December 2009

Objective: Historically, people living with mental illness have had limited chance to participate in mental health services other than as patients. This has led to serious negative consequences for their health and wellbeing. Recent public policy has aimed at redressing this situation. This paper sets out to investigate the ‘state of play’ regarding consumer participation in mental health services.

Conclusions: Consumer participation is not a common topic in the recent literature, despite the significant public policy push to promote it. Although the vision of public policy is for consumers to be at the centre of decision making, the changes are understandably slow in coming. The implications for the practice of psychiatry, and therefore mental health services, of the demands for meaningful participation are profound. They challenge some of the social covenants under which mental health services have historically been delivered. Traditionally, people living with a mental illness have not had their rights respected. In recent times, the College has developed policies that aim to ensure that the rights of people living with a mental disorder are respected. These policies also acknowledge that effective health care requires collaboration with consumers.
Theory of Mind and Psychiatry: An Introduction
Authors: Ang Giap Kian , Pridmore Saxby
Published: December 2009

Objective: ‘Theory of mind’ (ToM) arose from the study of primates and their social organization, and scholars in many fields – philosophy, anthropology, psychology, psychiatry and neuroscience – have contributed to this expanding topic. In this paper, we provide an overview of aspects of ToM of relevance to psychiatry. We briefly describe the origins of ToM in primates and humans and some relevant neurobiology, and then touch on possible contributions to psychopathology.

Method: We searched for articles on PubMed and Medline, using the terms ‘theory of mind’, ‘mirror neuron system’ and ‘psychiatry’.

Conclusion: There is evidence that ToM deficits are important in certain psychiatric disorders. While more research is required, an appreciation of ToM will have an impact on our further understanding and management of at least some mental disorders, including autism and schizophrenia.
Coming on Board: The Assessment of Overseas Trained Psychiatrists by the Royal Australian and New Zealand College of Psychiatrists
Authors: Vamos Marina , Watson Nerilie
Published: December 2009

Objective: The aim of this paper was to investigate key concerns of overseas trained psychiatrists (OTPs) in Australia and New Zealand surrounding the assessment of their qualifications and their experience of the Fellowship examination process.

Method: A survey of OTPs progressing towards Fellowship of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) was conducted using an online survey instrument. The survey aimed to explore OTPs’ views regarding the key issues encountered in their progression to Fellowship and to gauge their level of satisfaction with a range of RANZCP support initiatives.

Results: Important areas of concern were elicited across a variety of domains, including the examination process itself, issues around immigration, and differences in professional culture and language. The message to the RANZCP was that there were still important areas of dissatisfaction relating to measures taken to address these concerns.

Conclusions: The authors recommend specific courses of action to address areas where more support is required, and suggest additional areas where more research is needed.
The Resource Team: An Innovative Service Delivery Support Model for Mental Health Services
Authors: O'Sullivan Julie , Powell Jacinta , Gibbon Peter , Emmerson Brett
Published: December 2009

Objective: This paper outlines the development of the Resource Team, an innovative service delivery model supporting clinical services at the Inner North Brisbane Mental Health Service, Royal Brisbane and Women's Hospital Health Service District. The team aims to provide a base for specialist mental health support staff, improve knowledge management and support the development of meaningful community partnerships.

Method: Development of the team included a literature review and consultation with internal and external stakeholders. From this, the objectives, roles and functions of the team were clarified and disseminated to stakeholders.

Results: The team currently encompasses 12 positions and has initiated a number of programs and service developments. These include improved IT management of clinical resources and the development of partnerships with the community and non-government sectors.

Conclusions: The Resource Team effectively coordinates specialist clinical support positions, addresses knowledge management issues and facilitates meaningful engagement with the community and non-government sectors. The model could easily be applied in other mental health and general health services.
Psychiatrically Impaired Medical Practitioners: Better Care to Reduce Harm and Life Impact, with Special Reference to Impaired Psychiatrists
Authors: Rosen Alan , Wilson Andrew , Randal Patte , Pethebridge Andrew , Codyre David , Barton David , Norrie Peter , McGeorge Peter , Rose Lynette
Published: December 2009

Objective: The aims are to briefly review treatment outcomes for impaired practitioners, and to explore how preventive and early intervention, and the accessing of and retention within treatment systems for impaired medical practitioners, and particularly psychiatrists, could be improved to maximize the doctors’ chances of full recovery and to minimize danger to self and others.

Methods: The literature on the treatment and care of medical practitioner impairment due to mental illness, and substance use, with special reference to impaired psychiatrists is briefly reviewed. The implications of deficiencies of usual clinical management of doctors impaired by mental illness and opportunities for improvement in services for them are explored, including the impact of the experience of being an impaired medical practitioner under psychiatric treatment. The roles of medical boards and advisory services are examined.

Results: Medical practitioner impairment due to mental illness has a severe impact on doctors’ lives and the lives of their families due to both the effects of the disorder and the experience of communal, professional and self stigma and discrimination. Deficiencies in usual practice in the treatment and rehabilitation of such individuals are identified, and alternatives explored.

Conclusions: Prevention, early detection, intervention, and treatment programs that are more continuous more sensitive to the needs of impaired practitioners, that are more continuous, better structured, and rehabilitation and recovery focused, may be more likely to produce a positive outcome.
ECT: Shocked Beyond Belief
Authors: Morrison Lisa
Published: December 2009

Objective: The aim of this paper is to consider electroconvulsive therapy (ECT) in the 21st century and whether it should be a treatment of last resort from the perspective of someone who has received the treatment in recent years.

Conclusion: It seems that informed consent, the introduction of advance directives and the improved delivery of ECT have done little to ease people's fear, with a lot of people still believing ECT to be an extreme form of treatment and only a last resort option. The idea of any treatment being considered ‘last resort’ in mental health care gives the impression that it is the most radical and worst treatment available – thus we leave it until last to try. Yet for many people, including myself, the treatment is a valid and preferred option with minimal side effects.
Suicide and Western Culture
Authors: Pridmore Saxby , McArthur Milford
Published: December 2009

Objective: The aim of this paper is to examine the cultural roots and transmission of Western suicide and suicidal behaviour.

Method: We explored a period of antiquity (mythical Greece − 61 CE) and selected accounts of 10 prominent suicides. The precipitating circumstances were tabulated and an assessment made of the most likely attendant emotions. The same process was followed for a recent period (1994–2008), from which 10 suicides were identified. The precipitating circumstances and the attendant emotions were compared. These circumstances and emotions were then compared to statements commonly encountered in clinical practice from people demonstrating suicidal behaviour. Finally, we looked for evidence that these stories (and the response models) had entered Western culture.

Results: Precipitating circumstances, loss of a loved one, actual or imminent execution or imprisonment, other losses and public disgrace, and the negative emotions of shame, guilt, fear, anger, grief and sorrow were common to both historical periods. These circumstances and emotions are similar to those commonly expressed by people who have demonstrated suicidal behaviour. There was a clear record (literature, visual arts) of these stories forming part of our cultural heritage.

Conclusion: Models of maladaptive responses to certain adverse circumstances are part of Western culture. Suicide as a response to certain circumstances and negative emotions can be traced back more than 2000 years. Cultural change will be necessary to minimize suicide.
RANZCP Experiences in Establishing and Progressing an Externally Focussed Mental Health Policy and Partnership Agenda
Authors: Brownie Sharon , Freidin Julian
Published: December 2009

Objective: This paper traces the background of involvement and increasing external activity of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in the policy and project area.

Conclusions: Throughout 2008, representatives of the RANZCP paused to review progress and celebrate successes in the implementation of the College's stated aim to develop an externally focussed policy agenda. A summary of key activities across the past 4–5 years is outlined, including the key leadership role undertaken by the RANZCP in the recent formation of the Mental Health Professionals Association's partnership. Tracing the history of the establishment of the RANZCP externally focussed policy functions, the paper provides details of the extensive range of projects and activities undertaken to date. Also highlighted is the broad range of resources that have been developed and are now available for College members including trainees. The progress achieved to date is reflective of RANZCP's deliberate strategic actions and intent to work more closely with others and take an increasingly active role in the development of mental health policy and service delivery standards across the Australian and New Zealand landscape. The functions are now embedded with the College's newly revised Strategic Plan.
Possibilities and Realities: South Australia's Asylums in the 19th Century
Authors: Piddock Susan
Published: December 2009

Objective: To provide a brief overview of the provisions for the mentally ill in the 19th century in South Australia, and to highlight how this history and the provisions made have affected the design of modern psychiatric hospitals in the State.

Conclusions: In the 19th century, new ideas about treatment of the mentally ill led to a focus on the provision of care within the setting of the lunatic asylum. Although there were opportunities to provide the best possible asylum environment, the reality was that the provisions made fell far short of what was needed, and in turn reflects the effects of economics on the care provided for the mentally ill. These 19th century asylums provided the basis of many modern psychiatric hospitals, and the design problems found in these earlier buildings continue, offering limited physical spaces for the patients residing in these places.
Parenting is a Mental Health Issue
Authors: Fudge Elizabeth , Falkov Adrian , Kowalenko Nick , Robinson Philip
Published: December 2009

Objective: Increasing numbers of adults with a psychiatric disorder are also parents of dependent children. The present article aims to outline ways in which Fellows of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) can assist in enhancing psychiatric care when a person with a mental illness also has parenting responsibilities.

Methods: The national Children of Parents With A Mental Illness (COPMI) initiative undertook consultations with consumers, carers, young people and a range of professionals to assist in development of documents and resource materials to enhance policy and practice. Communication and interaction with key psychiatrists' professional bodies to seek their advice and participation has been maintained throughout the project.

Results: The RANZCP Fellows have assisted the COPMI project in the development and dissemination of draft principles and recommended actions for services and people working with children of parents with a mental illness and their families, and in the development of associated resource materials. They are now considering a College position statement on this issue.

Conclusions: If children of parents with a mental illness are to benefit from proposed enhancements to practice relating to services provided to their families, it is essential that psychiatrists themselves are involved in the development, implementation and review of good practice in this area.
Anna O and Hanna Q
Authors: Middleton Warwick
Published: December 2009

Objective: To review the case of Anna O in light of perspectives offered by Dr Kaplan in his paper ‘O Anna: being Bertha Pappenheim — historiography and biography’ and to compare it with a contemporary case, that of Hanna Q.

Conclusions: Josef Breuer's initial diagnoses do not need revision. However, the aetiology of such diagnoses is informed by subsequent research and by comparison with contemporary cases that can quite closely resemble that of Anna O's. Her symptomatology was not unique.
Forgiveness as a Secondary Prevention Strategy for Victims of Interpersonal Crime
Authors: Spiers Alistair
Published: December 2009

Objective: The number of violent crimes against people is increasing. The present paper aimed to review (i) the association between ‘unforgiveness’ among victims and psychiatric disease; and (ii) evidence that encouraging forgiveness can help to prevent psychiatric disease.

Conclusions: Unforgiveness correlates strongly with the development of psychiatric disease. Encouraging forgiving attitudes and emotions leads to decreased anxiety and depression.
Use of Seclusion in a Psychiatric Acute Inpatient Unit
Authors: Tunde-Ayinmode Mosunmola , Little John
Published: December 2009

Objective: To examine the rate and characteristics of seclusion among a group of patients admitted to an adult acute psychiatric unit as a precursor to planning an audit cycle and quality improvement project.

Methods: A retrospective chart review of all inpatient admissions to an adult acute unit over a 12 month period was undertaken with the use of a specially developed proforma. A comparison of secluded and non-secluded patients was described, and, where possible, statistically analysed.

Results: Four hundred and fifty admissions occurred during the study period, resulting in 140 episodes of seclusion. This represented a seclusion rate of 31% per admission. In contrast to patients who were not secluded, those secluded were more likely to be young, admitted involuntarily and with a diagnosis of schizophrenia. The most common indicator of seclusion was risk to others (74%) followed by risk to self (61%) and risk of absconding (55%). Length of time in seclusion ranged from 1 to 49 h with a mean of 9 h. Thirty-nine per cent of secluded patients were secluded on two or more occasions. Interventions including counselling, time out and medication were used in 71% prior to seclusion; however, in 29% no intervention was documented. Seclusion was more likely to occur in the evenings, when staff/patient ratios were lower.

Conclusion: Seclusion remains an important part of psychiatric practice. As expected, the use of seclusion in an adult acute unit reflected indirect measures of illness severity. Its use needs to be carefully reviewed and monitored, representing as it does the greatest restriction on a person's freedom.
Review of New Compounds Available in Australia for the Treatment of Attention-Deficit Hyperactivity Disorder
Authors: Hazell Philip
Published: December 2009

Objective: To examine the pharmacodynamic and pharmacokinetic properties, efficacy, safety and cost of Ritalin LA, Concerta and Strattera, three compounds recently released in Australia for the treatment of attentiondeficit hyperactivity disorder (ADHD).

Methods: MEDLINE was searched for relevant review articles and primary treatment studies. Data were augmented by product information supplied by the respective manufacturers. Costing information was obtained by surveying five community pharmacy outlets in Newcastle-Lake Macquarie, New South Wales.

Results: The three compounds reviewed have similar tolerability and efficacy to immediate-release methylphenidate, with the advantage of once daily dosing. The properties of these agents, particularly Strattera, make them less able to be abused. Ritalin LA may be superior to Concerta in controlling symptoms of ADHD in the first 4 h following ingestion, but the data should be interpreted with caution.

Conclusions: The newer treatments for ADHD offer advantages over immediate-release methyphenidate in dosing schedule and duration of action that may be of particular benefit to adolescent and adult patients. Prescription of these medications may be limited by their expense to the patient.
Pilot Study Investigating the Effect of Intercessory Prayer in the Treatment of Child Psychiatric Disorders
Authors: Mathai John , Bourne Angela
Published: December 2009

Objective: To investigate whether intercessory prayer had an effect on the outcomes of a group of children with psychiatric conditions, using a triple blind randomized study design.

Conclusion: This study was unable to show any additional benefits for patients who received intercessory prayer compared to those who received treatment as usual.
Gundhu Adolescent Wing: Providing Adolescent Beds in a Rural Acute Mental Health Unit
Authors: Tan Elizabeth , Hannah Dominique , Chant David , Martin Graham
Published: December 2009

Objective: To describe the evolution, structure and outcomes of Gundhu Adolescent Wing, Toowoomba, Queensland, which comprises six dedicated beds set aside during development of a new rural acute mental health unit.

Methods: All adolescents discharged from Gundhu in its first 7 months were included in the study. Data pertaining to patient characteristics, model of service delivery, length of inpatient stay and outcome at 7 months were obtained.

Results: Thirty-three adolescents with mental illness living in the rural area were discharged from Gundhu in the first 7 months. For the 23 adolescents who stayed on the unit <14 days, outcome at 7 months after discharge was generally favourable. Six adolescents with length of stay of ≥30 days did less well, but made similar progress to patients in tertiary units.

Conclusions: From the authors’ experience, designating a small number of beds as adolescent within a rural acute mental health unit is an effective intervention for short-stay patients and is valued by adolescents and their families. Keeping the adolescent unit separate is beneficial even at the expense of foregoing access to space and facilities enjoyed by adult patients. Involving families early to provide off-ward fun, exercise and socialization with peers is important. Rural services tend to have high staff turnover. Involving rural general practitioners in follow-up plans may ensure better continuity of care after discharge.
Quality, Risk Management and Governance in Mental Health: An Overview
Authors: Callaly Tom , Arya Dinesh , Minas Harry
Published: December 2009

Objective: To consider the origin, current emphasis and relevance of the concepts of quality, risk management and clinical governance in mental health.

Conclusions: Increasingly, health service boards and management teams are required to give attention to clinical governance rather than corporate governance alone. Clinical governance is a unifying quality concept that aims to produce a structure and systems to assure and improve the quality of clinical services by promoting an integrated and organization-wide approach towards continuous quality improvement. Many psychiatrists will find the reduction in clinical autonomy, the need to consider the welfare of the whole population as well as the individual patient for whom they are responsible, and the requirement that they play a part in a complex systems approach to quality improvement to be a challenge. Avoiding or ignoring this challenge will potentially lead to conflict with modern management approaches and increased loss of influence on future developments in mental health services.
Reflections on Clinician Leadership and Management in Mental Health
Authors: Callaly Tom , Minas Harry
Published: December 2009

Objective: To review the role of clinician leadership in the management of mental health services.

Conclusions: The literature suggests that clinician leadership is increasingly regarded as an essential element in the effective introduction of innovation and improved quality of clinical care by those who manage mental health services. Psychiatrist leaders have a role to play in ensuring that service change and innovation is based on sound clinical values, is developed in partnership with clinicians and is understood and supported by psychiatrist colleagues. Clinician leaders require clear vision, commitment and courage. The support of their colleagues is essential if the psychiatric profession is to have influence on future development of mental health services.
Owning the Past, Claiming the Present: Perspectives on the Treatment of Dissociative Patients
Authors: Middleton Warwick
Published: December 2009

Objective: From the early 1990s there has been a growing awareness in Australia of dissociative processes and dissociative disorders. The objective in this paper is to provide a selective overview of the context and process of treatment based on the substantive dissociative disorders literature, ongoing clinical experience and research, and over 8 years as director of a trauma and dissociation unit at Belmont Hospital, Brisbane.

Conclusions: The construct of individual selfhood is of direct relevance in illustrating the psychological damage sustained by patients who have relied on dissociative defences to survive, and in highlighting issues and areas that are a particular focus of informed treatment.
Depression in the Young, Parental Depression and Parenting Stress
Authors: Tan Susan , Rey Joseph
Published: December 2009

Objective: To examine the relationship between depression in children and adolescents, parental depression and parenting stress.

Methods: Fifty-three depressed youths, 9-16 years, were matched for age and gender and compared with S3 non-depressed controls. Depression was diagnosed using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). Parents completed questionnaires on depression and parenting stress.

Results: Parents of depressed children reported higher parenting stress and were more likely to perceive their children as ‘difficult’. Univariate analysis demonstrated a relationship between children's depression and maternal depression but not with paternal depression. This became non-significant with multivariate analysis, implying that maternal depressive symptoms may have been due to caring for a depressed, thus ‘difficult’ child.

Conclusions: Depressed youth were more likely to be perceived by mothers as ‘difficult’ and caused them significant parenting stress. The same phenomenon did not occur among the fathers. Clinicians need to consider the presence of depression among ‘difficult’ children and look for early depression in mothers of depressed youth.
Strategic Planning and Public Mental Health Services
Authors: Goding Margaret
Published: December 2009

Objectives: To provide an overview of approaches to strategic planning and to examine issues in relation to their applicability to public mental health services.

Conclusions: Strategic planning is important for optimal functioning of mental health services in an increasingly complex environment. Although each approach will have advantages depending on context, the overall principles of the learning organization developed by Senge have particular relevance for mental health services.
Organizational Change Management in Mental Health
Authors: Callaly Tom , Arya Dinesh
Published: December 2009

Objective: To discuss change management as applicable to mental health.

Conclusions: As mental health care grows increasingly complex, and the network of accountability widens, change is both inevitable and necessary. Strategies to introduce change effectively are essential. Resistance by medical staff to change often has a sound basis and must be acknowledged and explored. Change in clinical systems and practice is facilitated by careful planning and preparation, and by engaging clinicians in all phases of the change process; change will fail if this is not achieved. A number of management models facilitate the understanding and process of change.
A Survey of Alcohol and Drug Services to General Hospitals in Australia
Authors: Yeatman Richard
Published: December 2009

Objective: To determine the structure and function of alcohol and drug services to general hospitals in Australia, and to examine the role psychiatry plays in those services.

Method: A survey of 15 large metropolitan hospitals was conducted.

Results: Services differed considerably between hospitals, and psychiatric involvement was not prominent in most.

Conclusions: One of the challenges is to structure the administration of services so that they have a profile within the general hospital as well as close connectionwith community services. Psychiatrists must become more proactive in the area to reinforce what they have to offer these patients and to provide mentorship and training to psychiatric trainees in the field.
Helping Carers Care: An Education Programme for Rural Carers of People with a Mental Illness
Authors: Hayman Faye
Published: December 2009

Objective: To provide descriptive information about a short-term educational programme for rural carers of people with a mental illness, living in the Loddon Campaspe Southern Mallee region.

Method: The Carers Education Exchange Programme is a flexible, needsbased model that can be modified to cater for individual groups. It consists of a number of sessions on topics relevant to caring for someone with a mental illness, held over a period of several weeks. The programme is offered at locations throughout the region, making it accessible to carers in isolated, rural areas.

Results: Feedback indicates that the benefits of participating in the programme include the reduction of isolation and stigma, increased understanding of mental illness, development of skills relevant to the caring role and the formation of supportive networks, both professional and personal.

Conclusions: Educational group programmes for carers are an effective way of providing both education and support. This programme can assist in reducing some of the distress and difficulties inherent in caring for someone with a mental illness. Carer well-being is enhanced by the promotion of self-care and a positive outlook.
Beyond the Chalkboard: The Interacting Domains in Undergraduate Psychiatric Teaching
Authors: Claassen Johann , Kruger Estie
Published: December 2009

Objective: To identify and describe interacting domains that are present during undergraduate psychiatric teaching and impress on educators the roles of these domains.

Conclusions: Undergraduate psychiatric teaching is an essential part of general family physicians' training and practice. Undergraduate students' exposure to psychiatry might be inadequate. Curricular goals, teaching and evaluation of students need to be aligned. Research and information technology can play a bigger role in teaching. Validation of patients, students and teachers during the teaching process is important, but not always emphasized. Educators should be aware of society's unwritten expectations, judgements and opinions of mental illness sufferers. Identifying and facilitating the various interacting domains during psychiatric teaching may contribute to better education in psychiatry, better retention of knowledge for students and an improved recruitment of students to a psychiatric career.
Hospital Admission in Adolescents with acute Psychiatric Disorder: How Long should it be?
Authors: Swadi Harith , Bobier Candace
Published: December 2009

Objective: To determine the length of stay in hospital for youth with acute psychiatric illness, and the treatment outcome.

Methods: Diagnostic and Statistical Manual of Mental Disorders(4th edn;DSM-IV) psychiatric diagnosis, clinical outcome and the length of stay were sys-tematically gathered for admissions over an 18month period at the Christchurch Youth Inpatient Unit (YIU). Clinical outcome data were collected at admission,3 weeks after admission and at discharge, using the Health of the Nation Out-come Scale for Children and Adolescents (HoNOSCA). The length of stay was determined retrospectively. Discharge was decided on clinical grounds.

Results: During the 18 months of the investigation, 72 subjects were admitted for the treatment of acute mental illness. The most common diagnostic category was mood disorder (n = 39, 54%), followed by anxiety or adjustment disorder (n = 18, 25%), and major psychosis (n = 15, 21%). The mean length of admission for the whole population was 27.3 days, 23.7 days for mood disorders, 18.9 days for anxiety disorders and 46.9 days for the major psychosis diagnostic groups. According to HoNOSCA clinician ratings, the major portion of the improvement occurred during the first 3 weeks of admission.

Conclusions: For the majority of youth with acute psychiatric illness, a relatively short stay in hospital is feasible, because most health gains tend to occur early during an admission.