Lisa Lampe

Clinical practice recommendations for bipolar disorder

Objective:  To provide clinically relevant evidence‐based recommendations for the management of bipolar disorder in adults that are informative, easy to assimilate and facilitate clinical decision‐making.

Social phobia in the Australian National Survey of Mental Health and Well-Being (NSMHWB)

BACKGROUND This article reports data on social phobia from the first large scale Australian epidemiological study. Prevalence rates, demographic correlates and co-morbidity in the sample that met criteria for social phobia are reported and gender differences examined. METHOD Data were obtained from a stratified sample of 10641 participants as part of the Australian National Survey of Mental Health and Well-Being (NSMHWB). A modified version of the Composite International Diagnostic Interview (CIDI) was used to determine the presence of social phobia, as well as other DSM-IV anxiety, affective and substance use disorders. The interview also screened for the presence of nine ICD-10 personality disorders, including anxious personality disorder, the equivalent of DSM-IV avoidant personality disorder (APD). RESULTS The estimated 12 month prevalence of social phobia was 2.3%, lower than rates reported in several recent nationally representative epidemiological surveys and closer to those reported in the Epidemiological Catchment Area study (ECA) and other DSM-III studies. Considerable co-morbidity was identified. Data indicated that the co-morbidity with depression and alcohol abuse and dependence were generally subsequent to onset of social phobia and that the additional diagnosis of APD was associated with a greater burden of affective disorder. Social phobia most often preceded major depression, alcohol abuse and generalized anxiety disorder. CONCLUSIONS Social phobia is a highly prevalent, highly co-morbid disorder in the Australian community. Individuals with social phobia who also screen positively for APD appear to be at greater risk of co-morbidity with all surveyed disorders except alcohol abuse or dependence.

Clinical practice recommendations for depression

Objective:  To provide clinically relevant evidence‐based recommendations for the management of depression in adults that are informative, easy to assimilate and facilitate clinical decision making.

Who picks psychiatry? Perceptions, preferences and personality of medical students

Objectives: This study aimed to characterise the personality profiles of junior medical students most likely to choose psychiatry as a career, determine aspects of psychiatry that most attract potential recruits, and identify misperceptions about psychiatry that may dissuade students from pursuing this specialism. Method: A total of 580 second-year medical students from the University of New South Wales, Australia completed a set of questionnaires that measured the likelihood with which various medical specialties were being considered as careers, personality traits using the NEO Five-Factor Inventory (NEO-FFI), and the degree to which students perceived each specialty as attractive across a number of parameters. Results: Only 86 students (15%) indicated a strong likelihood of choosing psychiatry, compared to other specialties which attracted higher proportions of students (range 19–49%). These 86 students had significantly higher openness scores than those who indicated a lesser likelihood of pursuing psychiatry. Students who were highly interested in psychiatry ranked it as very attractive in respect to providing interesting and challenging subject matter, and relatively attractive in respect to financial reward, work enjoyment, good lifestyle, having a bright and interesting future, and association with colleagues. However, psychiatry remained less attractive with respect to prestige, perceived low effectiveness of treatments, degree to which it draws upon aspects of medical training, and lack of reliable scientific foundation. Within the entire sample, psychiatry was ranked most unattractive compared to the other specialties across eight of the 13 parameters assessed. Conclusions: Students interested in psychiatry are more likely to be ‘open’ and view the specialty as interesting and challenging. Such characteristics should be promoted more widely along with countering myths that as a specialty, psychiatry lacks a scientific foundation or is somehow different from mainstream medicine in terms of training and outcomes. Championing psychiatry in this manner may attract more recruits and enhance its prestige.

Familiarity breeds respect: attitudes of medical students towards psychiatry following a clinical attachment

Objective: The aim of this paper was to examine the influence of a clinical attachment in psychiatry on medical students’ attitudes to psychiatry as a specialty and potential career. Method: Medical students at Sydney Medical School were surveyed following an 8-week clinical attachment in psychiatry. Secondary analyses sought to identify associations with variables such as age, gender and level of clinical experience as a medical student. Results: Following a clinical attachment in psychiatry, 80% of students rated their attitude to psychiatry as more positive. Approximately 32% rated themselves as likely or very likely to choose a career in psychiatry. No differences were seen with respect to gender, age or stage of training. The quality of the teaching, enthusiasm of the clinical teachers, the holistic approach and scientific basis of psychiatry were cited by students as factors influencing attitudes. Conclusions: The clinical rotation in psychiatry is a significant factor influencing medical student attitudes towards psychiatry.

Psychological management of unipolar depression

To be used in conjunction with ‘Pharmacological management of unipolar depression’ [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6–23] and ‘Lifestyle management of unipolar depression’ [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38–54]. To provide clinically relevant recommendations for the use of psychological treatments in depression derived from a literature review.

Up Close and Personal: Medical Students Prefer Face-To-Face Teaching in Psychiatry

Objective: The aim of this paper was to determine the teaching activities most valued by medical students in the psychiatry rotation and to examine whether this varies with age, gender or stage of training. Method: Medical students at Sydney Medical School were surveyed following an 8-week clinical attachment in psychiatry. Differences in ratings between activities were examined by means of ANOVA and post hoc contrasts. Results: The learning activities involving face-to-face teaching received the highest ratings. The most valued tutorial was that given weekly by a dedicated academic clinician. No differences were seen with respect to age and gender. Inconsistent differences were seen between stages of training for skills sessions, but no other learning activities. Conclusions: Face-to-face clinical teaching should be a priority in clinical attachments in psychiatry as it is highly valued by students and contributes to positive attitudes towards psychiatry.

Diagnostic processes in mental health: GPs and psychiatrists reading from the same book but on a different page.

Objective: To explore the clinical reasoning processes underpinning diagnostic and management decision-making in treating patients presenting with psychological distress in general practice. Method: Practising GPs were invited to attend small-group workshops in which two case histories were presented. Discussion was GP-facilitated and recorded for thematic analysis. GPs provided demographic data, completed personality and attitudinal questionnaires, and answered a series of multiple-choice questions embedded in the cases. Results: GPs recognize the possibility of psychiatric disorders early in the clinical reasoning process, but are cautious about applying definitive diagnoses. GPs perceive that patients may be resistant to a psychiatric diagnosis and instead emphasize the need to build rapport and explore and exclude physical comorbidities. GPs see patients with a broad spectrum of distress, illness and impairment, in whom the initial presentation of psychological symptoms is often poorly differentiated and somatically focused, requiring elucidation over time. GPs therefore adopt a longitudinal strategy for diagnosis rather than investing heavily in cross-sectional assessment. Conclusion: GPs appear cognizant of possible psychiatric disorders and management strategies, but employ diagnostic strategies and decision-making processes that, in addition to experience and expertise, likely reflect key differences between the primary care and specialist practice settings.

Computerized assessment of communication for cognitive stimulation for people with cognitive decline using spectral-distortion measures and phylogenetic inference

Therapeutic communication and interpersonal relationships in care homes can help people to improve their mental wellbeing. Assessment of the efficacy of these dynamic and complex processes are necessary for psychosocial planning and management. This paper presents a pilot application of photoplethysmography in synchronized physiological measurements of communications between the care-giver and people with dementia. Signal-based evaluations of the therapy can be carried out using the measures of spectral distortion and the inference of phylogenetic trees. The proposed computational models can be of assistance and cost-effectiveness in caring for and monitoring people with cognitive decline.

Getting depression clinical practice guidelines right: time for change?

As part of a series of papers [‘Chronobiology of mood disorders’ Malhi & Kuiper. Acta Psychiatr Scand 2013;128(Suppl. 444):2–15; and ‘Its time we managed depression: The emerging role of chronobiology’ Malhi et al. Acta Psychiatr Scand 2013;128(Suppl. 444):1] examining chronobiology in the context of depression, this article examines recent western clinical practice guidelines (CPGs) for the treatment of depression with respect to the recommendations they make, in particular as regards chronobiological treatments, and briefly considers the implications of their methodology and approach.