Gary Cheung

Medical examiner and coroner reports: uses and limitations in the epidemiology and prevention of late-life suicide

Late‐life suicide is a growing public health concern in many parts of the world. Understanding the contributory factors to completed suicide is essential to inform the development of effective suicide risk assessment and management. The aim of this study is to synthesise the findings in studies that used coroner or medical examiner records to determine these contributory factors.

Performance of three cognitive screening tools in a sample of older New Zealanders.

BACKGROUND With the ubiquitous Mini-Mental State Exam now under copyright, attention is turning to alternative cognitive screening tests. The aim of the present study was to investigate three common cognitive screening tools: the Montreal Cognitive Assessment (MoCA), the Rowland Universal Dementia Assessment Scale (RUDAS), and the recently revised Addenbrookes Cognitive Assessment Version III (ACE-III). METHODS The ACE-III, MoCA and RUDAS were administered in random order to a sample of 37 participants with diagnosed mild dementia and 47 comparison participants without dementia. The diagnostic accuracy of the three tests was assessed. RESULTS All the tests showed good overall accuracy as assessed by area under the ROC Curve, 0.89 (95% CI = 0.80-0.95) for the ACE-III, 0.84 (0.75-0.91) for the MoCA, and 0.86 (0.77-0.93) for RUDAS. The three tests were strongly correlated: r(84) = 0.85 (0.78-0.90) between the ACE-III and MoCA, 0.70 (0.57-0.80) between the ACE-III and RUDAS; and 0.65 (0.50-0.76) between the MoCA and RUDAS. The data derived optimal cut-off points for were lower than the published recommendations for the ACE-III (optimal cut-point ≤76, sensitivity = 81.1%, specificity = 85.1%) and the MoCA (≤20, sensitivity = 78.4%, specificity = 83.0%), but similar for the RUDAS (≤22, sensitivity = 78.4%, specificity = 85.1%). CONCLUSIONS All three tools discriminated well overall between cases of mild dementia and controls. To inform interpretation of these tests in clinical settings, it would be useful for future research to address more inclusive and potentially age-stratified local norms.

Few older people in New Zealand who commit suicide receive specialist psychogeriatric services

Objective: Suicide in older people is a growing public health concern in many parts of the world. The literature on this issue is lacking in New Zealand. The aim of this study is to ascertain whether this group is accessing specialist psychogeriatric services. A retrospective case series study of completed suicides in older people (≥65 years) during a three-year period from January 2010 to December 2012 was performed. Method: An online survey detailing demographic and clinical information was completed by psychiatrists in 15 of the 20 District Health Boards in New Zealand. Results: Only about 15% of older people who committed suicide were accessing specialist psychogeriatric services and the group with the highest suicide rate (men≥85 years) did not feature in specialist services. Depression (61%) was the most common diagnosis and nearly half (35%) had had contact with specialist services within three days prior to the suicide. Over half (52%) had a history of past suicide attempt(s). Conclusions: Older people who complete suicide are infrequently accessing specialist services. In those that do, there are questions to be answered regarding suicide prediction and prevention for this high-risk group of vulnerable individuals. More research is required targeting those not accessing specialist services, in particular the high risk group of older men. The role of general practitioner, community care, the assessment and management of depression and whether there is any access issue to specialist psychogeriatric services require elucidation.

Death wishes among older people assessed for home support and long-term aged residential care

Death wishes in older people are common and may progress to suicidal ideation and attempts. This study used routinely collected data from the interRAI Home Care assessment to examine the prevalence and clinical predictors of death wishes in older New Zealanders assessed for home support and long‐term aged residential care.

Understanding the Progression from Physical Illness to Suicidal Behavior: A Case Study Based on a Newly Developed Conceptual Model

ABSTRACT Suicide in older people is a significant public health issue given the aging population and increasing suicide rates with age in many parts of the world. Depression and physical illness are two factors consistently associated with suicidal behavior in older people; however, their inter-relationships are not well understood. We present here a case study based on a newly developed conceptual model illustrating the various medical, psychological, social and resilience factors involved in the progression of physical illness to suicidal behavior. This model provides a framework for clinicians to understand protective factors and address late-life suicide risk.

Clinical teaching and supervision in postgraduate psychiatry training: the trainee perspective

Objective: We aimed to explore psychiatry trainees’ perspectives on clinical teaching and supervision as well as how this might be improved. Method: New Zealand trainees (n=51) completed online the Maastricht Clinical Teaching Questionnaire (MCQT) and three open-ended questions. Results: The majority rated ‘agree’ or ‘strongly agree’ to all items of the MCQT. Weaknesses in the feedback process including observation, feedback provision, and formulating learning goals were highlighted. College training requirements and workplace environment were identified as factors impacting on clinical teaching and supervision. Conclusions: A model was proposed to enhance awareness of the various factors involved in the feedback process.

Supervising trainees in research: what does it take to be a scholarly project supervisor?:

Objectives: Scholarly projects (SPs) are a compulsory component of psychiatry training in Australasia. This article outlines the role of a research supervisor in supporting a trainee to complete an SP. Methods: A total of 10 old age and forensic psychiatry SPs were reviewed with regard to aims, methodology, supervisor input, trainee tasks and additional resources. Results: The main supervisor tasks are described and discussed. They include practical advice on study design, ethics applications, critical appraisal, data analysis, academic writing and publication. Conclusions: Supervising SPs can bring significant rewards in awakening a trainee’s interest in research. Key competencies for research supervision are discussed and further recommendations for supervisor support and training are provided.

Transforming an idea into a scholarly project

Objectives: This article describes components of a workshop designed to orientate psychiatric trainees to the task of conducting a scholarly project. The aims are: to promote an approach that incorporates principles of adult learning to guide trainees who are undertaking research; to allow trainees to transform their ideas into more tangible research questions; and to enable supervisors to reflect on delivering similar content in scholarly project workshops. Methods: The workshop comprised: creating a safe space to explore ideas; discussing the process of posing a question or hypothesis; using group interactions to generate concepts; and considering personal values that influence the choice of research methodology to answer a question. Results: Examples are provided from the workshop. The process enabled trainees to generate and distil ideas into more concrete questions and methods in three phases: introductory, exploratory and tangible. Conclusions: Adult learning principles may assist trainees to develop their ideas for a scholarly project into research questions that are relevant to clinical practice. Harnessing the creative potential of a peer collective may encourage deeper inquiry, shifts to a tangible output and a sustained interest in research.

Supervision: ‘a random bag of arrangements’? Perspectives from psychiatrists on how to improve clinical teaching:

Objective: The aim of this study was to explore psychiatrists’ perspectives on how clinical teaching and supervision can be improved in postgraduate psychiatric training. Method: All New Zealand members of the Royal Australian and New Zealand College of Psychiatrists (fellows: n=367; affiliates: n=167) were invited to participate in an online survey that collected responses to two open-ended questions. The responses were then analysed qualitatively. Results: A total of 27% psychiatrists responded. Two major themes emerged: supervisor competencies and the workplace educational environment, with subthemes of supervisor training, feedback and culture change. Conclusions: Suggestions to improve clinical teaching and supervision included defining supervisor teaching competencies, instituting evidence-based faculty development, a feedback structure and strengthening leadership support for workplace-based education.

Enhancing suicide risk assessment: a novel visual metaphor learning tool

Objective: Suicide risk assessment is variably taught and learnt by health professionals. The literature indicates that training programs of this fundamental competency need to be enhanced. To facilitate teaching and learning of this core clinical skill, we propose a novel visual metaphor in order to conceptualize suicide risk factors. The design of the proposed visual metaphor was informed by the Cognitive Load Theory to enhance deep learning of the various suicide risk factors. Conclusion: The visual metaphor depicting suicide risk factors can potentially improve memory and recall. It activates prior knowledge and is based on educational theory informed design principles.