Vikas Garg

Pathways to practice: overseas trained psychiatrists' experiences of the processes involved in commencing professional practice in Australasia.

Objective: There are significant shortages in the psychiatric workforce in Australasia, particularly in the rural and remote regions of Australia and New Zealand. In response to these shortages, mental health services have recruited large numbers of overseas trained psychiatrists (OTP). These are specialist psychiatrists, trained and recognised as such in other countries. Our objective was to ascertain how OTPs experience the processes of commencing professional practice in Australasia. Method: OTPs were surveyed to identify the pathways to obtaining specialist registration and College Fellowship in Australasia and to explore their experiences as they engaged in this process. Results: Although limited by a low response rate, the data does highlight a level of discontentment among those OTPs surveyed. The key issues identified related to the examination process, poor communication between different agencies (including the RANZCP), visa and residency related issues, medical board registration difficulties and notable differences between Australia and New Zealand. Conclusion: There is a negative perception among OTPs regarding the existing pathways to registration as specialist psychiatrists and the attainment of Fellowship. We submit that the RANZCP has a central and important role in resolving some of the underlying issues and supporting OTPs as vital and valued members of the workforce in Australia and New Zealand.

Neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is a potentially life threatening idiosyncratic reaction to the use of psychotropic medications. NMS has an incidence of 0.02−3% in patients in this population [1,2]. According to the DSM-IV, it is defi ned by severe muscle rigidity and elevated temperature as well as two or more other criteria [3]. Early identifi cation plays a signifi cant role in preventing signifi cant morbidity and mortality. There are various recognized risk factors in developing NMS, including psychomotor agitation, prior occurrence of NMS and rapid antipsychotic titration or switching. Concomitant lithium use has also been implicated [4,5]. We are reporting a patient who presented with NMS during the course of her treatment and we intend to identify potential risk factors in this case. A 31year old woman was admitted to our acute inpatient ward with mania in the context of 6 months of medication non-compliance on a background of bipolar disorder. This episode was characterized by religious delusions, disorganization, poor sleep, pressured speech, poor insight and judgement. She had a previous episode of NMS with risperidone one year prior. She was started on lithium (450 mg bd) and quetiapine (600 mg daily). However, there was a signifi cant prolongation of her QTc interval to 486 ms (baseline 420 ms), thus the quetiapine was ceased. Amisulpride was commenced with rapid dose escalation from 200 mg bd to 400 mg bd over three days. She was physically well, with no medication side effects, and was sent on weekend leave. Whilst on leave she deteriorated physically, with mild confusion, tremor and blurred vision. She returned to the ward where on review she was diaphoretic, febrile, weak and mildly confused. She had signifi cant muscle rigidity. Her vital signs were otherwise within normal limits. Her White Cell Count (WCC) was 10.0 and Creatine Kinase (CK) was 924. QTc was 500 ms. A diagnosis of NMS was made, differentials at the time included lithium toxicity and infection. Lithium toxicity was excluded (level 0.5). We rapidly commenced stabili zation measures including bromocriptine 2.5 mg tds and IV hydration. She was transferred for ongoing management to the medical ward where she improved over several days with improved CK (151) and mental state. She was started on sodium valproate monotherapy and discharged home. There were several risk factors in this patient that are known to contribute to NMS, including switching of antipsychotic medications, rapid escalation of doses and the concomitant use of lithium. Rapid diagnosis and appropriate treatment in this case prevented the syndrome from progressing further. This case highlights both the importance of being cautious in commencing antipsychotic medications in patients with a known history of NMS, and in being aware of its presence as a potential complication.

Acute laryngeal dystonia: a persisting psychiatric emergency

Objective: Acute laryngeal dystonia is one of the most life-threatening medication side effects in psychiatry. It is rare and predominately caused by the use of antipsychotics in at-risk individuals. Within days of a patient’s initial presentation, several antipsychotics can be administered for the purposes of acute sedation and ongoing pharmacotherapy. In this case report, we describe a 27-year-old at-risk male, who developed acute laryngeal dystonia in the context of antipsychotic polypharmacy. Conclusion: Clinicians should take into account recent sedation and ongoing antipsychotic use in patients at risk of developing acute laryngeal dystonia. Awareness of this condition and prompt treatment with parenteral anticholinergic medication can be lifesaving.

The overseas trained psychiatrist committee: from Melbourne (2008) to Brisbane (2014)

Background: Natural disasters affect the health and wellbeing of adults throughout the world. There is some debate in the literature as to whether older persons have increased risk of mental health outcomes after exposure to natural disasters when compared to younger adults. To date, no systematic review has evaluated this. Objectives: We aimed to synthesise the available evidence on the impact of natural disasters on the mental health and psychological distress experienced by older adults. Methods: A meta-analysis was conducted on papers identified through a systematic review. The primary outcomes measured were post-traumatic stress disorder (PTSD), depression, anxiety disorders, and adjustment disorder. Findings: We identified six papers with sufficient data for a random effects meta-analysis. Older adults were 2.11 times more likely to experience PTSD symptoms when exposed to natural disasters when compared to younger adults. Conclusions: Recent decades have seen a global rise in the numbers of older adults affected by natural disasters, implying that an increasing number of the older adults will find themselves “in harm’s way” amid community disruption and distress. Mental health service providers need to be prepared to meet the mental health needs of older persons, and be particularly vigilant after natural disasters to ensure, in particular, early detection and management of PTSD.Abstract of a poster presentation at the RANZCP 2015 Congress, Brisbane, Australia, 3-7 May 2015. Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Dawes, K., Lethbridge, A. & Pai, N. (2015). Does clinical placement location affect medical student exam performance in psychiatry?. Australian and New Zealand Journal of Psychiatry, 49 (Suppl. 1), 107-108. This journal article is available at Research Online: http://ro.uow.edu.au/smhpapers/2780 Poster Presentations RANZCP 2015 CONGRESs, Brisbane Convention and Exhibition Centre, 3–7 May 2015 Does Clinical Placement Location Affect Medical Student Exam Performance in Psychiatry? K Dawes, A Lethbridge, N Pai University of Wollongong, Wollongong, Australia Background: One of the many challenges in managing student clinical placements is trying to ensure equity of opportunity and experience in regards to meeting the curriculum objectives. Students often complain that they have been disadvantaged by their clinical placement due to variations in patient population and acuity, the availability of consultants, registrars and other health care staff to guide learning, and the presence of other students from all disciplines who compete for opportunities. Objectives: To identify if there is a relationship between psychiatry placement location in the Illawarra Shoalhaven Local Health District (ISLHD) and end of year psychiatry exam results for medical students from the University of Wollongong. Methods: We compared psychiatry oral and written exam results for six cohorts of students, from 2009 to 2014, across four different placement locations in the ISLHD (N = 450) using one-way multivariate analysis of variance. Findings: The multivariate effect of placement location was not significant (Pillai’s Trace = .013, F(6,892) = .994, p = .428). Univariate ANOVAs on the individual outcome variables were also non-significant (written exam scores, F(3, 446) = 1.373, p = .250; oral exam scores F(3,446) = .789, p = .501). Conclusions: Maintaining the quality and consistency of clinical placements will always be a challenge due to limited and varied opportunities, student numbers, and the dynamic nature of both the workforce and the patient populations. However, based on our findings, within our region there is no difference in placement location in regards to end of year psychiatry exam results.Background Australia and New Zealand both have mandated systems for routine outcome measurement within public mental health services. A comprehensive 2014 review of the Australian system highlighted both support for routine outcome measurement and a need to spread good practice in the use of the mandated measures in practice. At the same time, the mandated measures are under evaluation in Australia for inclusion within activity based funding processes. The RANZCP has completed two online modules to assist trainees in improving their knowledge and skills in this important area of practice.

Where are we three years after the 'Lost In The Labyrinth Report'? The new pathway to achieve fellowship for overseas trained psychiatrist and the support program

Background: Natural disasters affect the health and wellbeing of adults throughout the world. There is some debate in the literature as to whether older persons have increased risk of mental health outcomes after exposure to natural disasters when compared to younger adults. To date, no systematic review has evaluated this. Objectives: We aimed to synthesise the available evidence on the impact of natural disasters on the mental health and psychological distress experienced by older adults. Methods: A meta-analysis was conducted on papers identified through a systematic review. The primary outcomes measured were post-traumatic stress disorder (PTSD), depression, anxiety disorders, and adjustment disorder. Findings: We identified six papers with sufficient data for a random effects meta-analysis. Older adults were 2.11 times more likely to experience PTSD symptoms when exposed to natural disasters when compared to younger adults. Conclusions: Recent decades have seen a global rise in the numbers of older adults affected by natural disasters, implying that an increasing number of the older adults will find themselves “in harm’s way” amid community disruption and distress. Mental health service providers need to be prepared to meet the mental health needs of older persons, and be particularly vigilant after natural disasters to ensure, in particular, early detection and management of PTSD.Abstract of a poster presentation at the RANZCP 2015 Congress, Brisbane, Australia, 3-7 May 2015. Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Dawes, K., Lethbridge, A. & Pai, N. (2015). Does clinical placement location affect medical student exam performance in psychiatry?. Australian and New Zealand Journal of Psychiatry, 49 (Suppl. 1), 107-108. This journal article is available at Research Online: http://ro.uow.edu.au/smhpapers/2780 Poster Presentations RANZCP 2015 CONGRESs, Brisbane Convention and Exhibition Centre, 3–7 May 2015 Does Clinical Placement Location Affect Medical Student Exam Performance in Psychiatry? K Dawes, A Lethbridge, N Pai University of Wollongong, Wollongong, Australia Background: One of the many challenges in managing student clinical placements is trying to ensure equity of opportunity and experience in regards to meeting the curriculum objectives. Students often complain that they have been disadvantaged by their clinical placement due to variations in patient population and acuity, the availability of consultants, registrars and other health care staff to guide learning, and the presence of other students from all disciplines who compete for opportunities. Objectives: To identify if there is a relationship between psychiatry placement location in the Illawarra Shoalhaven Local Health District (ISLHD) and end of year psychiatry exam results for medical students from the University of Wollongong. Methods: We compared psychiatry oral and written exam results for six cohorts of students, from 2009 to 2014, across four different placement locations in the ISLHD (N = 450) using one-way multivariate analysis of variance. Findings: The multivariate effect of placement location was not significant (Pillai’s Trace = .013, F(6,892) = .994, p = .428). Univariate ANOVAs on the individual outcome variables were also non-significant (written exam scores, F(3, 446) = 1.373, p = .250; oral exam scores F(3,446) = .789, p = .501). Conclusions: Maintaining the quality and consistency of clinical placements will always be a challenge due to limited and varied opportunities, student numbers, and the dynamic nature of both the workforce and the patient populations. However, based on our findings, within our region there is no difference in placement location in regards to end of year psychiatry exam results.Background Australia and New Zealand both have mandated systems for routine outcome measurement within public mental health services. A comprehensive 2014 review of the Australian system highlighted both support for routine outcome measurement and a need to spread good practice in the use of the mandated measures in practice. At the same time, the mandated measures are under evaluation in Australia for inclusion within activity based funding processes. The RANZCP has completed two online modules to assist trainees in improving their knowledge and skills in this important area of practice.

Repecting patient autonomy

 Hexcrete tower technology update by the research team  Expert panel discussion, led by Jason Cotrell of NREL, on tall towers and their foundations and erection  Discussion on Prototyping of a Hexcrete tower 2 2 Learn about the:  Hexcrete tower technology  Benefits of tall towers  Opportunities for prototyping  Commercial viability of this precast concrete technology

Androgens and mental health

 Hexcrete tower technology update by the research team  Expert panel discussion, led by Jason Cotrell of NREL, on tall towers and their foundations and erection  Discussion on Prototyping of a Hexcrete tower 2 2 Learn about the:  Hexcrete tower technology  Benefits of tall towers  Opportunities for prototyping  Commercial viability of this precast concrete technology

Neuropsychiatric manifestation of Prader Willi Syndrome and Angelman Syndrome - a comparative analysis

 Hexcrete tower technology update by the research team  Expert panel discussion, led by Jason Cotrell of NREL, on tall towers and their foundations and erection  Discussion on Prototyping of a Hexcrete tower 2 2 Learn about the:  Hexcrete tower technology  Benefits of tall towers  Opportunities for prototyping  Commercial viability of this precast concrete technology

Abnormal EEG in routine psychiatry practice

 Hexcrete tower technology update by the research team  Expert panel discussion, led by Jason Cotrell of NREL, on tall towers and their foundations and erection  Discussion on Prototyping of a Hexcrete tower 2 2 Learn about the:  Hexcrete tower technology  Benefits of tall towers  Opportunities for prototyping  Commercial viability of this precast concrete technology

Mental health legislation in Australia

 Hexcrete tower technology update by the research team  Expert panel discussion, led by Jason Cotrell of NREL, on tall towers and their foundations and erection  Discussion on Prototyping of a Hexcrete tower 2 2 Learn about the:  Hexcrete tower technology  Benefits of tall towers  Opportunities for prototyping  Commercial viability of this precast concrete technology