Shailesh Kumar

Burnout and Job Satisfaction in New Zealand Psychiatrists: a National Study

Objectives: To estimate the prevalence of burnout and the level of job satisfaction among New Zealand psychiatrists, and to ascertain relationships between socio-demographic variables, job satisfaction and burnout in the target population. Method: In phase one of the study a postal survey was mailed out to every practising psychiatrist on record as well as all doctors working in psychiatry without specialist qualifications (MOSS). Three questionnaires were used: a socio-demographic questionnaire, the Maslach Burnout Inventory (MBI) and a Job Diagnostic Survey (JSS). Regression analysis was performed on returned data sets using socio-demographic characteristics as explanatory variables and score components of the MBI and JDS as the outcome measures. Results: The results showed that the prevalence of burnout in New Zealand psychiatrists is cause for concern. Two-thirds of all psychiatrists described moderate to severely high levels of emotional exhaustion, with a similar proportion describing low levels of personal accomplishment. Depersonalisation did not appear to be a major problem in the population. Job satisfaction remained relatively high despite the high prevalence of burnout, although there was a relationship between burnout and job satisfaction scores. Conclusions: This study has demonstrated a high prevalence of burnout and factors associated with it among New Zealand psychiatrists. Further research is needed to ascertain why job satisfaction remains high in the presence of burnout, and factors predisposing to, or protective of, burnout.

Application of Risk Assessment for Violence Methods to General Adult Psychiatry: A Selective Literature Review

OBJECTIVE General adult psychiatrists are required to assess risk of violence as frequently as forensic psychiatrists. Yet most of the literature on risk assessment has originated from forensic settings, has been written by forensic psychiatrists, is applicable to forensic patients but may not apply to general psychiatric settings. Because the patient population and the nature of risk assessed may differ between the two settings, there is a need to consider the relevance of systems of assessment of risk of violence specific to the context of general adult psychiatry. METHODS We searched the literature on the way risk has been conceptualized in different disciplines using Medline database from 1993 to 2003. Keywords used were violence and risk management and risk assessment. Additional papers were identified from cross-references and personal knowledge of authors. RESULTS Seven hundred and nine key papers were identified. We identified three common key concepts that define risk: Uncertainty, weighing up the likelihood of different outcomes arising and, the possibility of benefits as well as harm due to risk assessment. The impact of safety culture - the collection of beliefs, norms, attitudes, roles and practices while making daily activities and management decisions - on psychiatric thinking is examined. We review the two main methods of risk assessment from forensic psychiatric literature (actuarial and clinical) with a view to examine their utility in general adult psychiatric context. CONCLUSIONS In order to develop a system of risk assessment relevant to general adult psychiatry, we note the benefits of shifting from risk prediction to assessment, management and reduction of risk, the need to merge actuarial and clinical approaches, communication of risk and finally the need to involve patients in the process of risk assessment.

Can olanzapine be implicated in causing serotonin syndrome

The present paper describes a case of serotonin syndrome (SS), which developed in a patient with bipolar affective disorder after the addition of olanzapine to her regimen of lithium and citalopram. This appears to be the first report that implicates olanzapine with SS. Clinicians should be aware of the risk of SS when adding atypical antipsychotics, such as olanzapine, to serotonergic agents.

Client Empowerment in Psychiatry and the Professional Abuse of Clients: Where Do We Stand?

Objective: There is a considerable imbalance of power in psychiatry that sits in favor of professionals. The abuse and discrimination of the mentally ill are not just restricted to the mental health system but may also exist in the primary care sector. This article aims to evaluate the effects of power imbalance on discrimination and abuse of people with mental illness by professionals. Methods: A literature search was carried out on MEDLINE using the key words consumerism, client empowerment, abuse, and mental illness. Publications of two leading British consumer organizations: MIND and the Sainsbury Centre for Mental Health were hand searched. Relevant cross-references from the papers reviewed were consulted. Studies with information on the reasons for power imbalance and prevalence of discrimination and abuse of clients were critically reviewed. Explanations are offered as to why abuse and discrimination of clients by professionals may still occur despite the onset of the client empowerment movement. Results and Discussion: The available evidence suggests that reasons for abuse of mental health clients fall under two broad categories: 1) direction from the imbalance of power and 2) those pertinent to the nature of physical or sexual abuse. Different grades of client empowerment and ways of strengthening it are described. Conclusions: There appears to be a link between power imbalance and abuse of clients with mental illness by professionals in all health care sectors. Client empowerment may help rectify the power imbalance. Prospective studies are required to establish whether client empowerment can reduce discrimination and abuse of clients and whether abuse is a consequence of power imbalance. Recommendations for future studies are made.

Anorexia nervosa in an elderly woman

Objective: To demonstrate a case of anorexia nervosa in the elderly and to highlight the need for broadening of current diagnostic criteria. Clinical picture: First onset of anorexia nervosa in a 72-year-old woman following bereavement of her husband. Treatment: Nine treatments of electroconvulsive therapy. Outcome: Treatment resulted in remission of the depressive symptoms and improvement of eating behaviour. Conclusions: Anorexia nervosa does occur in the elderly and can be difficult to detect. Where comorbid depression exists it requires aggressive treatment.

Psychiatrists in New Zealand: are they burning out, satisfied at work and, in any case, who cares?

OBJECTIVE To explore possible contributing or mitigating factors for burnout in New Zealand psychiatrists as well as future research directions in this area. METHOD A selective review of the literature pertaining to burnout and reports regarding New Zealands medical workforce. RESULTS Possible factors contributing to burnout in New Zealand psychiatrists include rapid changes in the countrys health system, the challenge of recruiting and retaining psychiatrists, poor distribution of staff and funds and difficulties in psychiatric training. Potential protective factors against burnout include lifestyle factors, long experience in psychiatry, proposed long lengths of career in New Zealand and potentially positive changes in the health system. Research challenges include subject recruitment, the lack of exploration of personal protective factors and completing longitudinal studies. CONCLUSIONS Given the current state of knowledge, it would be difficult to accurately know whether New Zealand psychiatrists were burnt out or satisfied with their work. Carefully designed studies would help to clarify this issue.

What leads to frequent re-hospitalisation when community care is not well developed?

Background: Treatment programmes are largely hospital based in developing countries and yet research on factors predicting frequent re-hospitalisation remains scarce from them. This cross-sectional study of factors predictive of frequent re-hospitalisation explored whether factors reported from developed countries could apply to India. Methods: Information was collected on four dimensions (socio-demographic, socio-cultural, treatment and illness variables) from 90 patients readmitted to a teaching psychiatric institute in India over a 3 month period. Patients were grouped into Frequently Re-hospitalised (FR) with three or more admissions to hospital in the last 18 months and Less Frequently Re-hospitalised (LFR) with two or fewer admissions in the last 18 months. Results: Support available for treatment, days spent in hospital and cost of treatment had a significant effect on whether the patient was more frequently hospitalised. The place of domicile tended to have an effect on the frequency of hospitalisation. Conclusions: Factors predictive of frequent re-hospitalisation reported in this study differed from those in developed countries. The above variables identify high users of inpatient beds who may be targeted for specific interventions to reduce re-hospitalisation rates.

Can the factors influencing medication compliance reported from Western populations be applied to an eastern Indian context? Part I

Non-compliance to psychotropic medication is a major concern globally. Most research has been carried out in Western countries and may have limited applicability in developing countries where psychotropic medication is the mainstay of treatment. The aim of this study was to investigate if those factors identified as influencing compliance in Western populations can be applied to an eastern Indian context. During a three-month period at a tertiary referral centre in eastern India a sample of 90 clients was achieved. In Western populations four main groups of variables have been identified as important in determining compliance to psychotropic medication, namely socio-demographic, socio-cultural, illness and treatment factors. However, most of these variables were found to have limited significance in this study. Decisions about medication compliance were made by both the client and significant others within their family. Transcultural differences and therapeutic implications of the study in a Western context are discussed.