Australasian Psychiatry最新文献

The process of medical scientific journal publishing merits further explanation for authors and readers. Prospective authors need to understand the scope of the journal and the article types that are published. We give an overview of the editorial process, including selection of reviewers, peer review and decisions regarding revision, acceptance and rejection of papers for Australasian Psychiatry. We encourage authors and readers to submit papers, and volunteer as peer reviewers, working together with the journal editorial team.

Objective: To describe implementation of the Pathways to Community Living Initiative (PCLI) within an Older People's Mental Health (OPMH) service.

Method: A retrospective observational study was conducted. Implementation comprised partnership with a specialist Residential Aged Care Facility (RACF). Data were obtained from Clinical Advisory Committee (CAC) discussion and minutes, the PCLI database, and consumer medical records.

Results: Eighteen consumers were accepted onto the program between April 2019 and March 2023. Their PCLI and rating scale outcomes alongside interventions facilitating placements are described. Interventions included OPMH case management, wide-reaching liaison, and inservices. Challenges included communication, confusion regarding roles, and differing views on capacity to accommodate complex consumers. Solutions included streamlining communication, including clinical updates in the CAC, facility appointment of a lead PCLI-nurse, and targeted RACF education.

Conclusions: Considered interventions strengthened the OPMH and specialist RACF partnership over time. Clarification of professional roles and intersection with other services was crucial. Successful placement for PCLI consumers required consideration of personalised needs and existing resident mix, liaison with stakeholders, and targeted staff training. These strategies may apply to other health services implementing similar initiatives supporting community placements for OPMH consumers with complex needs.

Objective: Sexual wellbeing is a fundamental component of overall wellbeing and is often impacted by common psychiatric disorders such as depression. Despite this, research suggests it is underexplored in clinical practice. This preliminary study aimed to examine whether this is the case in both psychiatrists and general practitioners (GPs).

Method: GPs and psychiatrists completed a survey examining the exploration of various sexual wellbeing domains with patients. It included open-ended questions regarding factors that influence this exploration, whether clinicians felt this was their responsibility, and their level of training in this area.

Results: Clinicians who felt it was their responsibility to enquire about sexual wellbeing reported exploring it in more patients than those who did not endorse this perspective. Overall, clinicians from both specialties demonstrated a reluctance to explore most sexual wellbeing topics, and this appeared to be due to many factors including views held by clinicians themselves. Most clinicians felt they had not received adequate training in this area.

Conclusions: Domains of sexual wellbeing are largely underexplored by clinicians from both specialties. Educational materials and training for clinicians are needed to facilitate the exploration of this important area with patients, specifically in the context of mental health.

Objective: The RANZCP conducted an anonymous survey of 7200 members (trainees and psychiatrists) in December 2023, receiving 1269 responses, representing the views of roughly 1 in 6 members, and of the respondents, three quarters reported experiencing burnout in the last 3 years. We provide a commentary, citing evidence from relevant previous research, discussing the implications and proposing potential interventions.

Conclusions: Members of the RANZCP reported worsening workforce shortages, with 9 in 10 respondents stating that these negatively impacted patient care, and 7 in 10 experiencing symptoms of burnout. Eighty per cent identified workforce shortages as the top contributing factor to such burnout. The aetiology of workforce shortages and burnout is likely due to operational and structural shortfalls in psychiatric services. However, public and private sector employment information was not included in the report. There are a range of strategic, evidence-based interventions to address the psychiatrist and trainee workforce challenges, comprising general healthcare service as well as specific initiatives. Based on the findings of the report, such interventions are needed, now.

Women with severe mental illness and pregnancy suffer substantial travails in accessing care for mental and perinatal health. Women with psychotic illnesses such as schizophrenia face higher risks of pregnancy and postnatal complications. Similarly, lack of access to holistic psychiatric care presents particular perils for these women and their children. Tailored care for these mothers-to-be and their babies is needed to prevent and ameliorate health complications, mental and physical. This will require targeted funding of services that connect women with and provide continuity of care.

Objective: Bullying is common in medical specialist training in Australia. To understand bullying rates across medical specialist training programs, we analyse the recent Medical Training Survey, administered by the Medical Board of Australia to all registered medical practitioners.

Methods: Medical Training Survey data were extracted and averaged from 2020 to 2023.

Results: Many speciality trainees reported personally experiencing or witnessing bullying. This was lowest in general practice (13% personally experienced and 15% witnessed) and highest in obstetrics and gynaecology (27% and 41%). The highest rate of bullying by supervisors was in surgery: 60% of surgical trainees stated that when they were bullied it was by their supervisor. Within psychiatry, 22% of trainees had personally experienced bullying and 32% of trainees had witnessed bullying. When they were bullied, the perpetrator was less commonly a supervisor (40%). In all specialities, there was a very low percentage of bullying which was reported, and was identified as having a satisfactory outcome: the most satisfactory outcomes (13%) were in general practice.

Conclusion: Current rates of bullying for medical specialist trainees, the reluctance to report, as well as the lack of satisfactory outcomes, is of grave concern for Australian healthcare. This requires urgent attention at a systems level.

Objective: Since the release of ChatGPT, popular demand has driven the use of social chatbots as pseudo-AI psychotherapists. With time, it is inevitable that these technologies will be deployed in some form as dedicated psychotherapy interventions. Here, we attempt to forecast the implications for psychotherapy including the unique benefits to distributive justice as well as concerns for the quality of the therapy and its societal impact.

Conclusion: An AI psychotherapist (APT) has the potential to provide engaging clinical interactions given its capacity for highly realistic interaction as well as its high level cognitive and emotional capabilities. Moreover, it can potentially address financial and workforce limitations on access to therapy. However, an APT may cause significant iatrogenic harm if released without adequate quality control and oversight by trained psychotherapists. If not appropriately designed and regulated, APTs have potential to mislead and reinforce maladaptive coping behaviours. Given societal drivers and possible benefits, these technologies will inevitably be deployed; thus, it is incumbent upon us as a professional body to consider their regulation.