Kym Jenkins

Competence to give informed consent in acute psychosis is associated with symptoms rather than diagnosis

To investigate the association between competence to give informed consent to treatment, specific symptomology and diagnostic category, 110 inpatients diagnosed with DSM-IV acute schizophrenia (n = 64), schizoaffective disorder (n = 25) and bipolar affective disorder (n = 21) were interviewed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and the Positive and Negative Syndrome Scale (PANSS). Results indicated no significant difference in competence between the three disorders. Elevated positive, cognitive and excitement PANSS factor scores had lower MacCAT-T scores. Further analyses indicated symptoms that impair cognition; particularly, conceptual disorganisation and poor attention were most consistently related to poor performance on competence tests.

The psychological impact of September 11 terrorism on Australian inpatients

OBJECTIVE To investigate the psychological impact on Australian hospital patients of the media coverage of the September 11 (9/11) terrorist attack. METHODS Thirty psychiatry and 26 matched medical and surgical inpatients were assessed. RESULTS Both reported and observed distress was common. Women reported significantly more distress than men. Individuals with psychiatric illness were significantly more varied in their attribution of cause for 9/11. Seven patients (29%) with pre-existing psychosis became delusional surrounding the events, but there were no significant differences between the psychiatry and the medical and surgical inpatients. CONCLUSIONS Clinical impressions were confirmed, namely, that a large proportion of hospital inpatients were adversely affected by TV footage of the 9/11 terrorist attack. Most vulnerable were those already with a mental disorder, particularly those with a pre-existing psychotic illness.

Doctors and Medical Students Case Managed by an Australian Doctors Health Program: Characteristics and Outcomes

Objective: The aim of this paper is to describe the characteristics and outcomes of participants with an Australian physician health program, the Victorian Doctors Health Program (VDHP), for case management of substance use disorder (SUD) and/or significant mental illness. Method: As part of quality assurance, processes data, including demographic information, care plan components and outcomes, were analysed. Results: Between 2001 and 2008, 115 participants undertook case management plans with the VDHP. The majority (n = 71, 62%) had some involvement with the Medical Practitioners Board of Victoria (MPBV). Case management included facilitating referrals to addiction specialists, psychiatrists, counsellors and peer-based support. Ninety (78%) participants reported SUD, the remainder having mental illness (n = 25, 22%). Alcohol was the main drug reported by the SUD group (n = 44, 49%). Most of the SUD participants undertook biochemical monitoring. On commencement with the VDHP, 39 (34%) participants were on leave due to illness. The majority of participants case managed for 5 years were in medical work (n = 31, 84%). Conclusions: Case management by an independent physician health program may protect the health of the doctor and the community, and could be considered in other jurisdictions.

Access to healthcare by psychiatrists, psychiatric trainees and overseas trained psychiatrists: findings from the RANZCP welfare study

Objective: To understand the challenges faced by psychiatrists and psychiatry trainees in accessing healthcare. Methods: An online survey was distributed to all members (fellows, associates and affiliates) of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and a number of focus groups were held across Australia and New Zealand. Results: A total of 1051 members responded to the survey and nine focus groups were held. Almost all respondents indicated they had a personal general practitioner. However, there were varying factors affecting access to healthcare and the ability to take leave when unwell. Conclusion: There are numerous barriers facing RANZCP members in looking after their own health. Addressing these barriers will require action at multiple points in the system.

The value of a support group for medical professionals with substance use disorders

Objective: The objective of this study was to explore how a support group in Victoria, Australia, that has been set up for doctors and medical students with substance use disorders is perceived by group members. Method: Past and present participants were surveyed anonymously regarding their attitudes to the group and its role in their recovery. Results: Respondents overwhelmingly valued the support group, seeing it as an integral and essential part of their recovery and on-going health. Conclusions: It is recommended that such support groups for doctors who have substance use disorders be more widely available in jurisdictions other than Victoria.

Competence to Give Informed Consent to Research Participation in Persons with Schizophrenia and Related Psychosis

Over the last decade there has been escalating debate regarding the competency of patients with psychoses to give informed consent to participate in research. This debate has been made evermore complex by variations in the definition and evaluation of competency. Importantly, competency must meet both medical and legal standards, although the criteria for each of these are not always consistent and may be mediated by contextual factors. The matter of competency to give informed consent is further complicated in the case of patients with psychoses. As a result of their disorder, patients with psychoses develop a mental state where there is impairment of reality appreciation. The impact on competency however, is highly variable and can frequently be accommodated in the consent process. Establishing associations between particular psychotic symptoms and their severity, with competency to consent at different levels of risk is the central theme of research currently being conducted.

Career satisfaction and work stressors in psychiatrists and psychiatry trainees in Australia and New Zealand

Objective: To assess the level of career satisfaction and factors associated with work stress in members of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Methods: In 2014 an online survey was distributed to members of the RANZCP (including psychiatrists and psychiatry trainees). Results: A total of 1051 members responded to the survey. Almost 85% of respondents indicated that they were satisfied with the work they were doing at the current stage of their career. ‘Too much work to do in too little time’ emerged as a key stressor and was ranked as the number one stressor in last 12 months by over one third of respondents. Where applicable, examinations, prospect of revalidation and training hurdles were all noted to be moderately/extremely stressful by over 50% of respondents. Conclusions: The majority of psychiatrists and trainees appear to be satisfied with their current work. However, there are many factors creating increased work stress and affecting welfare. The role of the college in protecting the welfare of its members should be further considered.