bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.