Australasian Psychiatry

Fitzgerald, Paul; de Castella, Anthony; Arya, Dinesh; Simons, W. Robert; Eggleston, Andrew; Meere, Sharon; Kulkarni, Jayashari

doi: 10.1080/10398560903002998pmid: 19585288

Objective: The aim of this study was to quantify the costs and resource utilization associated with a relapse of schizophrenia or schizoaffective disorder.Methods: The study comprised a retrospective audit of data from 200 patients diagnosed with schizophrenia or schizoaffective disorder who were admitted to hospital for a relapse of their disorder in two mental health services in Australia between 1 June 2001 and 31 May 2002. Resource use and costing data were collected for 12 months before and 12 months after the hospitalization.Results: There was an increase in contacts per month and associated outpatient costs after the index admission which persisted for the full 12 month data collection period (total of AUD $637). There was also a total increase in hospital costs but this did not persist beyond the first 2 months of the follow-up period and is likely explained by the index admission.Conclusions: Increased healthcare resource utilization and costs results from relapse in patients with schizophrenia or schizoaffective disorder. An increase in service use and costs persist for a considerable time period after an episode of relapse.

Milne, Duncan; O'Brien, Anthony; McKenna, Brian

doi: 10.1080/10398560902721572pmid: 19585289

Objective: The aim of this paper is to explore the relationship between civil commitment under a Community Treatment Order (CTO) and competence to consent to treatment.Method: A purposive convenience sample of 10 service users under CTOs were interviewed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Ratings were compared with the ratings of 10 matched voluntary service users.Results: Seventy percent of the CTO sample were found to be incompetent according to the MacCAT-T, compared to 20% of the comparison group (p = 0.004). The proportion of the CTO sample found to be incompetent reduces to 50% if the subscale of appreciation is excluded (p = 0.004). Most people in each group would elect to continue their current treatment if given the choice.Conclusion: Findings of this study suggest that mental health law reform introducing considerations of competence could lead to a substantially different group of people being subject to CTOs. If the CTO is carefully targeted and not used excessively, it is likely to be accorded qualified acceptance for most service users for whom it is used.

Cowling, Vicki; Garrett, Matthew

doi: 10.1080/10398560902840232pmid: 19412879

Objective: The aim of this paper is to describe the Child and Family Inclusive Practice program (CFIP), a pilot program implemented in an adult community mental health centre in Newcastle, New South Wales, which aimed to enhance family relationships through child and family inclusive practice.Conclusions: The CFIP used a family-focused, child-sensitive approach in which two clinicians met together with families where there was parental mental illness. Adults and children were seen together and separately. Work with parents was aimed at validating their concerns for the child, and enhancing their confidence as parents/carers. Children had the opportunity to express their concerns in a safe and protective environment and, where appropriate, were supported in their concerns if these were being put to the adult family members. The project was seen to add value to the service provision of the community mental health team, and demonstrated to clinical staff the benefits of an inclusive and whole of family approach to mental health care.

Mathai, John; Bourne, Angela

doi: 10.1080/10398560902842501pmid: 19585290

Objective: The primary aim of the study was to investigate whether patient characteristics such as age, sex, length of inpatient stay and reason for admission were related to positive or negative treatment outcome at an adolescent inpatient unit.Method: This study employed a prospective cohort design in the form of a clinical audit. Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) pre- and post-admission scores were compared for the whole sample and across diagnoses.Results: While there was a significant reduction overall in symptoms following an inpatient stay, patient characteristics and reason for admission were not related to outcomes at a statistically significant level.Conclusions: This inpatient unit generally functions as a short stay unit and as a result it is difficult to draw any meaningful conclusions as to what sort of patient would benefit most from an admission to the unit.

Mitchell-Lowe, Margaret; Eggleston, Matthew

doi: 10.1080/10398560902862657pmid: 19585291

Objective: This pilot study explored children's perspectives of an initial assessment at outpatient child and adolescent mental health services (CAMHS).Method: A semi-structured qualitative interview was undertaken with nine children aged 7–12 years. Transcribed interviews were analyzed to reveal common themes.Results: Children generally coped well with the interview. They identified themes involving stigma, qualities and approaches of staff, aspects of the CAMHS environment, and anxiety about attending CAMHS as key issues.Conclusions: This pilot study suggests that it is feasible to interview children regarding their perspectives on attending a CAMHS. Children's views of CAMHS are required to help inform developmentally appropriate service delivery.

Tucker, Peter

doi: 10.1080/10398560802657314pmid: 19301164

Objective: This paper sought to review current knowledge about the relationship between substance misuse and early psychosis.Methods: A literature search was conducted using Medline and restricting the search to articles after 1996. Additional articles were sourced from reference lists of relevant articles.Results: There is a high prevalence of substance misuse among persons with early psychosis, with cannabis and alcohol featuring prominently. Substance misuse is associated with earlier onset and possibly more positive symptoms, although apparently not with greater cognitive impairment. Cannabis appears to confer an increased likelihood of developing schizophrenia in biologically vulnerable individuals. Amphetamines also cause psychosis which may become chronic, although specific vulnerability to this effect is less well established. Many cases of so-called ‘drug-induced psychosis’ become diagnosed as schizophrenia in later years. Specific intervention programs report positive outcomes with regard to substance misuse and the course of psychosis.Conclusions: Substance misuse should always be assessed in this patient group, bearing in mind the potential interactive causes of psychopathology. Intervention is of value in improving outcomes.

Nguyen, Dang; Brakoulias, Vlasios; Boyce, Philip

doi: 10.1080/10398560902842519pmid: 19585292

Objective: Treatment with second generation antipsychotics (SGAs) can increase the risk of patients with schizophrenia developing obesity, hyperlipidaemia and diabetes. Routine monitoring is recommended, but clinical practice suggests monitoring is not conducted at a rate necessary for these comorbidities. The aim was to audit what proportion of patients were having their weight, height, girth, body mass index, lipids and blood sugar levels monitored and recorded.Method: An audit of patients with schizophrenia, discharged from three psychiatric wards, was conducted. Two data sheets were recorded for every patient and inter-rater reliability was calculated. Data were then entered into SPSS and statistical significance calculated.Results: The sample consisted of 93 patients; SGAs were taken by 31% of admitted and 88% of discharged patients. Of these, 65% had their weight recorded, 61% height, 31% random blood sugar levels, 3% postprandial blood sugar levels, 2% glycosylated haemoglobin, and 7.5% cholesterol and triglycerides. Girth and BMI were not recorded. Abnormalities were detected in 29% of recorded BSL and 2% of recorded cholesterol.Conclusions: Patients with schizophrenia on antipsychotics have an alarmingly low rate of monitoring of these common adverse effects and comorbidities. Clinicians need to be aware of this, so that they can improve their practice.

Hooper, Stuart; Bruno, Raimondo; Sharpe, Mary; Tahmindjis, Alex

doi: 10.1080/10398560902998626pmid: 19585293

Objective: The population rate of alprazolam prescribing in Tasmania has been more than double that of national rates. Serious adverse events have been observed through co-administration of opioid medications with alprazolam. A two-fold intervention, comprising GP education coupled with changes to prescribing regulations, was designed with the intention to decrease inappropriate prescribing of alprazolam and thereby reduce adverse outcomes. The aim of this study was to assess the impact of the intervention on prescribing rates.Method: We measured the number of alprazolam prescriptions for the years prior to and the year following the intervention. Health Insurance Commission data were utilized to enable comparison of subsidized prescription rates for alprazolam in Tasmania, and compared with national data. Participants were registered medical practitioners in Tasmania who were potential prescribers of alprazolam. The interventions were three GP Education Meetings during June 2007, one in each of the major regions of Tasmania, regarding evidence-based interventions for panic disorder. Changes to regulatory procedures to minimize co-prescription of alprazolam with opioids was implemented in September 2007.Results: A reduction in alprazolam prescribing in Tasmania occurred after the interventions.Conclusion: Education can be an effective strategy to influence prescribing behaviour of doctors. It is likely that this effect can be augmented by adoption of more stringent regulatory requirements.

Lyons, Zaza; Power, Brian; Bilyk, Natalia; Claassen, Johann

doi: 10.1080/10398560902964602pmid: 19585294

Objective: Recruitment of medical graduates into psychiatry has become a growing issue over the last few decades. This paper describes the implementation of an innovative program, based on a Canadian concept, that aimed to promote psychiatry as a career choice to medical students, to immerse them in the ‘world of psychiatry’, and introduce them to potential mentors. The University of Western Australia Institute of Psychiatry for Medical Students was a week-long program that provided medical students with an opportunity to participate in a diverse agenda of interactive seminars on a range of psychiatric subspecialties and the neurosciences. Students were also able to attend elective sessions and meet registrars and psychiatrists on an informal basis. Lunches and social events were also provided.Conclusion: Twenty-one students attended the inaugural Institute. Twenty-seven speakers contributed to the morning seminars and there were 17 clinical elective site visits. Feedback from students was positive and the week was rated highly, both in terms of its organization and from an academic perspective. It is planned to run the Institute annually and, in time, it is hoped that it will increase the numbers of students who choose psychiatry as a career option.

Robertson, Tasha; Walter, Garry; Soh, Nerissa; Hunt, Glenn; Cleary, Michelle; Malhi, Gin

doi: 10.1080/10398560902874298pmid: 19585295

Objectives: The objectives were, first, to determine attitudes towards psychiatry as a career among medical students currently enrolled at the University of Sydney and, second, to establish the immediate impact on those attitudes of a promotional DVD, released by the Royal Australian and New Zealand College of Psychiatrists.Method: Medical students enrolled in the University of Sydney in 2008 were invited to complete a voluntary online questionnaire, in which their attitudes towards psychiatry were explored, and the immediate effects of a 15-minute DVD were ascertained.Results: A total of 123 students participated. Only one student identified psychiatry as their chosen career. Medical students viewed psychiatry as the least attractive specialty for the degree to which patients are helped effectively and in terms of having a reliable scientific foundation. However, it rated well in regard to being intellectually challenging, a rapidly advancing field of medicine, and providing research opportunities and a good lifestyle. Psychiatry is less respected than most other specialties by students and they perceive this discipline to be poorly respected by other medical students and current medical practitioners. After viewing the DVD, there were improved student ratings of the benefits of a career in psychiatry, especially in relation to the specialty being enjoyable, offering effective treatment and having a scientific foundation. There was also enhanced understanding of the role of a psychiatrist in just over half of the participants and increased interest in psychiatry in about 30% of participants. The DVD was most effective in increasing awareness of the diversity of subspecialties available within psychiatry, good lifestyle factors, and the training involved.Conclusion: Among medical students, psychiatry is perceived as unattractive and fails to command the respect afforded other specialties. The viewing of a promotional DVD by medical students was found to be effective in improving their attitudes towards psychiatry and increasing their interest in pursuing a career in the specialty. However, the long-term impact of this modest improvement is unknown and the low survey response rate limits the extent to which the results can be generalized.