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Objectives: To review the ethical problems posed by the participation of psychiatrists in various forms of lay media and propose a method of resolving quandaries in this area.Conclusions: We review the potential ethical problems that arise when psychiatrists make contributions to the lay media, particularly when commentary and opinion reflects the views of the individual rather than the profession. The issues raised by the North American injunction known as the "Goldwater Rule" are pertinent to Australasia, particularly when media statements made by psychiatrists may seem to diminish the profession through politicisation, polemic, or bringing the profession and the field into disrepute. We propose a series of reflective questions to assist psychiatrists in Australasia to deliberate on the potential ethical problems arising from their participation in media activities. We conclude that it is for the Royal Australian and New Zealand College of Psychiatrists to formulate an approach to situations where the media activities of Fellows raise such problems. [ABSTRACT FROM AUTHOR]

Cultures of performativity may contribute to organizational and individual arrogance. Workplace organizations have individuals who at various times will display arrogance, which may manifest in behaviours, such as an exaggerated sense of self-importance, dismissiveness of others, condescending behaviors and an impatient manner. Arrogance is not a flattering label and irrespective of the reason or the position of power, in the context of organizational behaviors, may not be useful and may even be detrimental to the work environment. Thus, it is timely to reflect on the implications of arrogance in the workplace. Advocacy and empowerment can be undermined and relationships adversely impacted, including the achievement of positive consumer outcomes. This paper provides an introduction to arrogance, and then discusses arrogance to promote awareness of the potential consequences of arrogance and its constituent behaviors. [ABSTRACT FROM AUTHOR]

The article focuses on the bullying faced by expatriate health care workers. According to the authors, workplace bullying is common in health care industry, but people working overseas can be particularly vulnerable. Racist bullying can take place anywhere, even at highly ranked universities and health centers.

When the individuals comprising a profession are focused more on competition rather than service to others, and when holding a significant place on the world stage is held in higher esteem than meaningful collaboration with the disempowered, is it possible to be truly consumer-centred? This article considers the notion of humility in the context of recovery and the challenges to the effective implementation of recovery-oriented services that have been identified. Insights are drawn from a case study analysis of the implementation of recovery approaches to health care into a publicly-funded mental health service located in Australia. While challenges to the operationalization of recovery are complex, we argue that the professional quality of humility provides an important means by which genuine and meaningful collaboration can be achieved among health professionals, consumers, carers, and other stakeholders. [ABSTRACT FROM AUTHOR]

The article focuses on a study which explores several issues concerning the emergence of problematic internet use (PIU) in childhood and youth. It uses relevant literature-search methodology as well as using the key terms of PIU, internet addiction, and youth mental health. The use of common internet search engines is discussed.

Objective: To demonstrate the importance of culture in suicide, and provide support for fresh conceptualization of the relationship between culture and suicide. Conclusions: This evidence supports the thesis that culture (the norms and values shared by a group of people living in a defined space) gives rise to recognizable traditions or customs (widely accepted ways of behaving), which come forward in particular circumstances (or "predicaments"), and include suicide. We propose that culture creates "set points" around, which national rates vary. Suicide prevention will only be achieved via strategies, which have a beneficial effect on culture. [ABSTRACT FROM AUTHOR]

The performance-driven culture of universities challenges faculty to meet workplace expectations. In this paper, we draw on the literature to identify key aspects of, and requirements for, promoting integrity in the academic workplace. Integrity is a crucial personal characteristic that can exert a powerful influence in any setting. Any threat to integrity in the workplace can result in a toxic and corrupt environment that may be deleterious to faculty and students. Such an environment can act to prevent faculty from speaking up about ethical issues or workplace concerns, which can result in failure to identify areas for improvement, continuation of suboptimal practices, and problematic professional relationships. The aim of this paper, therefore, is to present an overview of the concept of integrity in the academic workforce and to discuss some of the issues and dimensions, in the hope of creating greater awareness. This is essential if health professional faculties are to recruit and retain staff and create optimal working environments conducive to facilitating high quality outcomes. [ABSTRACT FROM AUTHOR]

Background: Although suicide is commonly linked with mental disorder, the notion that suicide may occur in response to predicaments has been the subject of much recent study and attention. A predicament in this context refers to an uncomfortable situation from which escape is difficult. We aimed to examine the predicaments of people whose suicide was captured on film and displayed on the public record. Methods: The authors’ extensive private library and the web were explored for examples of suicide on film. The authors viewed the films and associated records, and extracted and listed details of the suicides. Results: Six individual cases and two groups (totalling 2200 plus individuals) were identified. The individual cases were Thich Quang Duc (1963), Christine Chubbuck (1974), Budd Dwyer (1987), Daniel Victor Jones (1998), Michael Marin (2012) and Jordon Romero (2012). The two groups were the Japanese Kamikaze pilots of 1944/1995, and those who jumped from the burning “Twin Towers” on September 11, 2001. One of the six individuals has evidence of a mental disorder, and all (individual and group cases) were in potent social/environmental predicaments. Conclusion: Both psychological autopsies and our clinical experience suggest that suicide is often associated with mental disorder. Nevertheless, social/environmental predicaments may lead to suicide. This study suggests that individuals whose suicide is captured on film are often seeking public exposure of their fatal act. [ABSTRACT FROM AUTHOR]

Purpose To descriptively assess medical students' concerns for their mental and emotional state, perceived need to conceal mental problems, perceived level of support at university, knowledge and use of student support services, and experience of stresses of daily life. Study design From March to September 2011, medical students at an Australian university were invited to complete an anonymous online survey. Results 475 responses were received. Students rated study and examinations (48.9%), financial concerns (38.1%), isolation (19.4%) and relationship concerns (19.2%) as very or extremely stressful issues. Knowledge of available support services was high, with 90.8% indicating they were aware of the university's medical centre. Treatment rates were modest (31.7%). Students' concerns about their mental state were generally low, but one in five strongly felt they needed to conceal their emotional problems. Conclusions Despite widespread awareness of appropriate support services, a large proportion of students felt they needed to conceal mental and emotional problems. Overall treatment rates for students who were greatly concerned about their mental and emotional state appeared modest, and, although comparable with those of similarly aged community populations, may reflect undertreatment. It would be appropriate for universities to address stressors identified by students. Strategies for encouraging distressed students to obtain appropriate assessment and treatment should also be explored. Those students who do seek healthcare are most likely to see a primary care physician, suggesting an important screening role for these health professionals. [ABSTRACT FROM AUTHOR]

The article offers information on the strategies to mitigate bullying and other negative behaviors of some employees in work places at the University of Hard Knocks in New South Wales. The authors suggest that workspace bullying can be prevented by awareness campaign and development of code of conduct and ethics. Moreover, they believe that negative workplaces not only violate corporate standards and it also legitimates the ill behavior of some employees.

The authors discuss whether open-access psychiatry journals provide value for money and other benefits. Some of the advantages and disadvantages of providing open-access to psychiatry journals including the integrity of the publishing process, have highly questionable practices and the cost factors are described. However, in terms of impact factor they are likely to gain prestige and become recognized as reputable journals for publication of research by funding agencies/academic institutions.

Background: The prevailing view that the vast majority of those who complete suicide have an underlying psychiatric disorder has been recently challenged by research on the contribution of "predicaments", in the absence of mental illness, to suicide. In this paper, we sought data to support the notion that forced marriage may lead to suicide without the presence of psychiatric disorder. Method: Historical records, newspapers, and the electronic media were searched for examples. Results: Two examples from ancient times and six from the last hundred years were located and described. Conclusion: These cases suggest that forced marriage may lead to suicide and complements earlier findings that loss of fortune, health, liberty, and reputation may lead to suicide in the absence of mental disorder. [ABSTRACT FROM AUTHOR]

The article presents a study the deals over the issue of suicide through fiction and other narrative products. Several accounts of suicide in narrative products have been explored from book member clubs, web-based lists, and to the readers, writers and producers. Noted are 71 depictions of fictional suicidal events wherein 12 suicides appeared to be direct or indirect due to mental disorder, 15 are unknown, and that 44 are due to social and situational factors.

Objective: To conduct a bibliometric analysis of eating disorder journals to guide journal readers and researchers when submitting their manuscripts. Method: Several indices were used to compare journal impact and citations of articles appearing between 1996 and 2010 in six eating disorders journals and six leading general psychiatry journals. Results: The International Journal of Eating Disorders (IJED) had the highest journal impact factor (JIF, 2.278) of the six eating disorders' journals. The general psychiatry journals had higher JIFs and received more citations per eating disorder article than the specialized journals. However, IJED published the highest number of eating disorder articles between 1996 and 2010, and 35 of these articles received at least 100 citations. Discussion: Using the JIF alone to decide where to submit a manuscript is a poor strategy, as this does not take into consideration the impact an article can have within the eating disorder's field over time. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012) [ABSTRACT FROM AUTHOR]

Background: Current clinical wisdom is that the vast majority of those who complete suicide suffer from a mental disorder. Uncritical adherence to this belief may limit our understanding and restrict the full range of prevention activities. We aimed to examine the public record for accounts of suicide by men who had been, or were about to be, investigated or apprehended for "sex only" child sex offences, with a view to presenting a collection of case histories, and identifying examples of suicide in the apparent absence of mental disorder other than pedophilia. Methods: The public record (hard and electronic copy) was examined. Results: Twenty case histories were identified of men with no apparent mental disorder (other than pedophilia) who completed suicide shortly after exposure or threatened public exposure and/or early or potential legal punishment. Conclusion: This evidence strongly suggests that exposure or threatened public exposure of pedophilia and/or early or potential legal punishment creates a predicament, which may lead to completed suicide. [ABSTRACT FROM AUTHOR]

Objective: The aim of this article is to describe the circumstances surrounding the suicide of Adam Czerniakow during the Holocaust. Method: Examination of Czerniakow's (translated) diary and other Holocaust literature. Results: Head of the 'Judenrat' (Jewish Council) in the Warsaw ghetto, Czerniakow had the impossible task of obeying oppressive German orders, while trying to serve and protect his people. Following instruction to have ready for deportation from the ghetto several thousand Jews each day, Czerniakow took his life. Although Czerniakow may not have known the precise destination of those deported (they were sent to death camps), he is believed to have held grave fears for their fate. Conclusions: Suicide in the context of avoiding having to perform an unacceptable task is not commonly recorded, but may have applied in Czerniakow's case and was not infrequent among Judenrat members. [ABSTRACT FROM AUTHOR]

Objective: Inpatient psychiatric care of adolescents should, where possible, be provided in specialized units. However, admission of adolescent patients to adult mental health units does occur. There is a paucity of data about this practice. This study collates information about the experience, attitudes and knowledge of clinical staff regarding the care of adolescent patients in adult psychiatry units within Northern Sydney Central Coast Area Health Service (NSCCHS). Method: A survey was emailed to all clinical staff with employer accessible email addresses in NSCCHS. Results: The response rate was 29% (n == 108). The majority of respondents believed their wards were 'not at all' (30.7%) or 'only a little' (57.4%) equipped to care for adolescent patients. The majority felt 'moderately' (39.6%) or 'very' (16.8%) confident to care for these patients; however, a significant proportion (43.2%) lacked confidence. There was no significant difference across the responses of psychiatrists, psychiatry registrars and nursing staff to these questions. The majority felt the objectives of these admissions were met 'only a little' (47.4%) or 'not at all' (16.5%). Many concerns regarding the admission of adolescents to adult wards were reported. Conclusions: Generally, staff were not in favour of admitting adolescent patients to adult mental health units apart from in exceptional circumstances. Staff harboured concerns about several aspects of care for adolescents in adult wards. [ABSTRACT FROM AUTHOR]

The article discusses the various ranking methods employed in identifying and comparing journals focusing on child and adolescent psychiatry and other related specialist fields within psychiatry. It notes that the ranking of journals was conducted through the use of five bibliographic measures including the journal impact factor (JIF), Scopus to derive citations and the h-index. These methods aid the professionals in identifying journals relevant to their field of specializations and interests.

The authors reflect on various achievements and milestones of the "Journal of the American Academy of Child and Adolescent Psychiatry" as it celebrate its 50th year of publication in 2011. They discuss the most widely used and well-known measurement of citations to a journal through the so-called impact factor. This factor is defined as the number of citations to a journal's articles published in the previous two years divided by the number of articles published during those two years.

Students who transition from high school to college are often excited by the new phase of their lives. However, they are exposed to circumstances and expectations which place them at risk for psychiatric disorders or that may exacerbate pre-existing problems. In this paper, we discuss risk factors and other issues associated with students transitioning to college or university life, identify challenges for health professionals, and suggest possible strategies to improve the mental health of young adults on college campuses. Academic staff and health care providers need to be aware of how best to engage and assist students during an important phase of their life. Processes and care pathways also need to be easily understood, user friendly, and appropriately resourced. It is anticipated that staff, students, and industry health care providers will benefit from a greater awareness of some of the mental health issues that may occur in higher education. [ABSTRACT FROM AUTHOR]

Objective: This paper describes aspects of the child and adolescent benchmarking forums that were part of the National Mental Health Benchmarking Project (NMHBP). These forums enabled participating child and adolescent mental health organizations to benchmark themselves against each other, with a view to understanding variability in performance against a range of key performance indicators (KPIs). Method: Six child and adolescent mental health organizations took part in the NMHBP. Representatives from these organizations attended eight benchmarking forums at which they documented their performance against relevant KPIs. They also undertook two special projects designed to help them understand the variation in performance on given KPIs. Results: There was considerable inter-organization variability on many of the KPIs. Even within organizations, there was often substantial variability over time. The variability in indicator data raised many questions for participants. This challenged participants to better understand and describe their local processes, prompted them to collect additional data, and stimulated them to make organizational comparisons. These activities fed into a process of reflection about their performance. Conclusions: Benchmarking has the potential to illuminate intra- and inter-organizational performance in the child and adolescent context. [ABSTRACT FROM AUTHOR]

Objective: This paper provides an overview of the National Mental Health Benchmarking Project (NMHBP) which explored the value of benchmarking within the four main program areas of public sector mental health (general adult, child and adolescent, older persons and forensic). The NMHBP involved a series of forums which enabled participating organizations to benchmark themselves against each other, with a view to understanding variability in performance against a range of key performance indicators (KPIs). Method: Twenty-three mental health organizations took part in the NMHBP. The forums culminated in each mental health organization documenting its performance against relevant KPIs. The processes, impacts and outcomes of the NMHBP were evaluated via a multi-methods evaluation. Results: There was considerable variability across program streams for many of the KPIs, much of which could be explained by contextual factors. Within program streams there was considerable intra-organization variability. Participants found the examination of intra-organization variability on particular indicators to be useful. Conclusions: The NMHBP has shown that benchmarking is possible. Managers and clinical leaders will need to champion benchmarking and highlight its utility in relation to quality improvement and service development if the accountability goals of the Fourth National Mental Health Plan are to be realized. [ABSTRACT FROM AUTHOR]

Soh NL, Walter G. Tryptophan and depression: can diet alone be the answer? To compare the scientific content of recent general media articles on tryptophan, diet and depression, with recent empirical research into dietary manipulation of tryptophan published in the scientific literature. A review of the recent empirical research into the role of tryptophan in depression, focusing on dietary methods to influence tryptophan levels. In parallel, a review of recent articles in the general English language media regarding tryptophan and mood. Empirical evidence for improving mood through dietary manipulation of tryptophan is lacking, and it is difficult to change plasma tryptophan levels through diet alone. Tryptophan supplementation and depletion studies suggest that altering tryptophan levels may only benefit certain groups of patients who have a personal or family history of depression. Scientific studies also focus on elucidating mechanisms in depression, rather than treating depression by changing tryptophan levels. However, general media articles often recommend diets and foods to increase blood tryptophan levels and raise brain serotonin levels. Such recommendations are not supported by scientific studies. It is very difficult to alter blood tryptophan levels through dietary methods alone, outside of a laboratory or research setting. Only a small number of lay articles provide sound advice, with general media reports on tryptophan often being hyperbolic and misleading. A clinician should be aware of the type of (mis)information a patient may have accessed and have the scientific knowledge to explain the impracticalities of influencing tryptophan levels through diet alone. [ABSTRACT FROM AUTHOR]

Walter G, Byrne S, Griffiths O, Hunt G, Soh N, Cleary M, Duffy P, Crawford G, Krabman P, Concannon P, Malhi G. Can young people reliably rate side effects of low-dose antipsychotic medication using a self-report survey? [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to examine whether advertising in the College journals and at RANZCP Congress, in particular from pharmaceutical companies, gives rise to a conflict of interests, and to discuss how this should be managed. Conclusions: While advertising will often represent a conflict of interests, banning advertising from the College journals or Congress is unlikely to the best way to manage this. Conflicts of interest may be better managed by development of clear policies on advertisements, broadening the advertising base (i.e. beyond pharmaceutical companies), checking the accuracy of advertisements, and, in the case of Congress, ceasing sponsored symposia. [ABSTRACT FROM AUTHOR]

Objective: We aimed to describe medication side effects in a cross-section of young people taking low-dose risperidone, using a self-report measure. Methods: The Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) was completed by 66 patients aged between 6 and 18 years who had been taking low-dose risperidone (alone or in conjunction with other medications) for up to 13 years. Results: Young persons, overall, seemed to tolerate risperidone well, but longer exposure to the medication was associated with higher side effect levels, particularly for the psychic (pertaining to mind and emotion) and extrapyramidal subscales. The most common complaints related to psychic side effects, such as tiredness, difficulty concentrating, difficulty remembering things and increased dreaming. Conclusions: Clinicians need to monitor the side effects of young patients taking low doses of risperidone, and other psychotropics, and maintain vigilance in those who have been taking medication for extended periods. [ABSTRACT FROM AUTHOR]

Objective: To conduct a critical review of recent empirical research regarding mood, behaviour and nutrition factors including essential fatty acids, macronutrients, micronutrients and food additives. Method: A literature search of databases Medline, PsycInfo, CINAHL and Embase up to October 2008. The search emphasised empirical research published in the last 10 years and also included older literature. Studies in both adults and children were addressed. Results: Research into omega-3 fatty acids has been substantial but evidence for their potential in treating mood and behaviour is modest. In comparison, there has been much less research into carbohydrate and protein intakes and little evidence for their ability to influence mood and behaviour. Recent trials with food additives suggest their removal from the diet may benefit susceptible children with hyperactivity disorders. Micronutrient supplementation appears to improve mood only in those who were initially deficient in micronutrients. Conclusions: More stringent research designs such as longitudinal studies and the use of biologically inert placebos within randomised controlled trials are needed before supplemental use of omega-3 fatty acids to treat disorders of mood and behaviour can be recommended. Caution is advised regarding the indiscriminate use of diets free of artificial food additives in managing hyperactivity disorders, as they may place an undue burden on individuals and their families. Should omega-3 fatty acid supplementation or the elimination of certain food additives be established as effective, they may provide cost-effective, accessible and well-tolerated adjuncts to standard psychiatric treatments for mood and behavioural disturbances. [ABSTRACT FROM AUTHOR]

Objectives: The objectives were, first, to determine attitudes towards psychiatry as a career among medical students currently enrolled at the University of Sydney and, second, to establish the immediate impact on those attitudes of a promotional DVD, released by the Royal Australian and New Zealand College of Psychiatrists. Method: Medical students enrolled in the University of Sydney in 2008 were invited to complete a voluntary online questionnaire, in which their attitudes towards psychiatry were explored, and the immediate effects of a 15-minute DVD were ascertained. Results: A total of 123 students participated. Only one student identified psychiatry as their chosen career. Medical students viewed psychiatry as the least attractive specialty for the degree to which patients are helped effectively and in terms of having a reliable scientific foundation. However, it rated well in regard to being intellectually challenging, a rapidly advancing field of medicine, and providing research opportunities and a good lifestyle. Psychiatry is less respected than most other specialties by students and they perceive this discipline to be poorly respected by other medical students and current medical practitioners. After viewing the DVD, there were improved student ratings of the benefits of a career in psychiatry, especially in relation to the specialty being enjoyable, offering effective treatment and having a scientific foundation. There was also enhanced understanding of the role of a psychiatrist in just over half of the participants and increased interest in psychiatry in about 30% of participants. The DVD was most effective in increasing awareness of the diversity of subspecialties available within psychiatry, good lifestyle factors, and the training involved. Conclusion: Among medical students, psychiatry is perceived as unattractive and fails to command the respect afforded other specialties. The viewing of a promotional DVD by medical students was found to be effective in improving their attitudes towards psychiatry and increasing their interest in pursuing a career in the specialty. However, the long-term impact of this modest improvement is unknown and the low survey response rate limits the extent to which the results can be generalized. [ABSTRACT FROM AUTHOR]

Introduction: In the ongoing quest for improved diagnostic markers of bipolar illness, the focus of research has gradually shifted to examining the onset of mood difficulties early in life and investigating the potential corollaries of such early onset such as cognitive impairment, disruption of social and emotional functioning, and constriction of quality of life. This article considers the disruptions to cognitive functioning that accompany bipolar disorder and compares adult and child profiles to ascertain the likelihood of identifying a neurocognitive biomarker of the illness. Methods: A succinct review of the literature pertaining to cognition in both adult and childhood populations is synthesised following Medline and PsychINFO searches using key-terms including 'cognition', 'bipolar disorder', 'neurocognitive' 'child', 'adolescent' and a range of neuropsychological domain names. In addition, literature known to the authors was scrutinised and relevant references further pursued. Results: Findings from the literature are contextualised and key findings are summarised and provide a basis for future recommendations. Conclusion: A number of deficits have been consistently identified in both adolescent and adult populations that perhaps reflect disease traits. Future research needs to focus on these and employ multimodal tests in pristine patient groups, with a view to identifying reliable biomarkers. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy (ECT) has featured in Hollywood films for sixty years. Film depictions continue to exert a powerful and predominantly negative effect on public attitudes towards the treatment. From review of the 22 currently available films that directly refer to ECT the main themes identified are described. While initially portrayed as a dramatic but effective psychiatric intervention, ECT on film has come to stand for something quite different, representing the brutal and generally futile attempts of society to control and suppress the individual, gathering along the way a hackneyed cinematic grammar that emphasizes its inhumane and punitive nature. The film representation now has little in common with ECT as currently practised, such that filmmakers portraying ECT appear influenced more by films such as One Flew Over the Cuckoo's Nest than by evidence of the safety and effectiveness of ECT as a psychiatric treatment. Filmgoers with no personal or professional exposure to the treatment may fail to make the distinction between the demands of film narrative and clinical reality. [ABSTRACT FROM AUTHOR]

The author reflects on the payment of people with mental illness to participate in research. One problem with high levels of payment is the possibility that a person will ignore the potential risks involved in a study, including physical, emotional or psychological consequences. The problems are intensified by the possibility that patients may not understand either the consent process or the diverse implications of participation. Research has shown that schizophrenics consider the risks involved when deciding whether or not to participate.

Objective: The aim of this study was to ascertain the experiences, views and monitoring practices of Australian child psychiatrists regarding the metabolic and other side effects of second-generation antipsychotics (SGAs). Method: A 19-item questionnaire was posted to all members of the RANZCP Faculty of Child and Adolescent Psychiatry living in Australia. Results: Of the 290 eligible members of the Faculty of Child and Adolescent Psychiatry, 126 (43%) returned a useable survey. SGAs are commonly prescribed for a range of disorders. The majority of respondents expressed a high level of concern regarding weight gain and other metabolic side effects. Weight gain was the most frequently observed and monitored side effect in clinical practice. Other side effects were observed and monitored to a variable extent. Notably, monitoring practices did not parallel psychiatrists' reported level of concern or knowledge regarding weight gain and metabolic side effects, nor coincide with published recommendations. Conclusions: Further research is required into the use, efficacy, side effects and monitoring of SGAs in children and adolescents, and there is a need to ensure that monitoring guidelines are implemented in clinical practice. This need is heightened by the likelihood that our data on clinicians' practice, which is based on their perceptions, may overestimate what actually occurs. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's perspectives on complementary and alternative medicine treatment and pediatric psychopharmacology.

Objective: To identify the various potential manifestations of the dual-role dilemma in the psychiatric ethics literature. Method: The terms 'dual role', 'dual agency', 'overlapping roles', and 'double agency' were searched on the electronic databases PubMed, Medline, Embase and PsychInfo. Classic papers in the field of psychiatric ethics and their references were manually searched. Papers were selected for relevance to the topic of the dual-role dilemma in relation to psychiatry. Results: The dual-role dilemma is most explicitly addressed in the literature on forensic psychiatry and military psychiatry. Review of the ethics literature in other fields of psychiatry indicates many instances of the dilemma of psychiatrists facing conflicting obligations akin to the dual-role problem identified in the literature on forensic psychiatry. Many of these dilemmas are characterized by the presence of a powerful third party to whom the psychiatrist has some perceived obligations. Conclusions: In psychiatric ethics, the dual-role dilemma refers to the tension between psychiatrists' obligations of beneficence towards their patients, and conflicting obligations to the community, third parties, other health-care workers, or the pursuit of knowledge in the field. These conflicting obligations transcend a conflict of interest in that the expectations of the psychiatrist, other than the patient's best interests, are so compelling. This tension illustrates how the discourse in psychiatric ethics is embedded in the social and cultural context of the situations encountered. It appears that as society changes in its approach to the value of liberal autonomy and the 'collective good', psychiatrists may also need to change. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to consider two recent approaches to moral philosophy - postmodernism and discourse ethics - and evaluate their potential contribution to psychiatric ethics. Conclusion: Postmodern ethics arose from the perceived moral failures of the grand theories of ethics, as evident in the horrors of the twentieth century. As a result, such approaches to ethics emphasize the individual's moral situation in a particular context, such as the doctor- patient relationship. Postmodern approaches have some relevance to current and future psychiatric practice. Discourse ethics sees ethical norms generated by a process of a discourse procedure, in which all members of a discourse are able to express their views. Discourse ethics allows the generation of moral 'norms', which are universal in as far as all those affected by them can accept their consequences. Applied to professional ethics, psychiatrists are members of a large group engaged in a discourse with diverse parts of society, yet exist within small moral communities in which micro-discourses are compatible with different individual ethical positions. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe the current status of psychiatric ethics as a form of professional ethics and apply this approach to a common clinical situation. Conclusion: Psychiatry is a profession and, like all professions, comprises a set of specific skills and knowledge that are applied for the 'common good' of society. Such a proposition places the psychiatrist in a position of tension between contractarian and Hippocratic ideals of ethical conduct, in that there is an assumption of moral equivalence between the law and ethics. The supposition that legally defensible behaviours are the same as ethically defensible behaviours is integral to the definition of professional ethics. This frequently places psychiatrists at odds with the 'do no harm' principle. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to consider the components of two moral theories - the ethics of virtue and the ethics of care - and their relationship to psychiatry. Conclusions: Although both theories reflect fundamentally desirable human qualities, neither provides a comprehensive account of psychiatric ethics. We are therefore drawn to a similar conclusion as those of Hare (1993) and Bloch and Green (2006), in that these theories offer a complementary approach to other ethical theories in psychiatry. [ABSTRACT FROM AUTHOR]

Objective: To provide some direction for those interested in obtaining funding with the purpose of highlighting opportunities for beginner researchers in the health-care field. Method: Features of a good grant application are described and an audit of seven mental health professional journals was undertaken, the latter to determine, inter alia, whether the paper reported research findings and whether the authors received formal research funding. Result: The audit revealed that many types of papers that are published do not receive formal research funding and describe, for example, services, training issues, clinical practice and education programmes. Conclusion: Innovative and enterprising efforts are required to secure clinical research funding. Submissions must be detailed, comprehensive and relevant, but the onus is also on the researcher to ensure a feasible study, where funding obligations can be fulfilled and findings readily disseminated. Many research studies are conducted without achieving competitive funding, and getting published – and getting started in writing – does not hinge on conducting formal research or receiving research funding. [ABSTRACT FROM AUTHOR]

We aim to increase understanding about issues affecting ‘consumer consultants’ at an Area Mental Health Service level in the hope that consumers and mental health staff are informed of the challenges and changes associated with that role. Anecdotal feedback indicates that consumer consultants are working harder than ever and that their role is more diverse and challenging than before. Increased organizational demands and responsibilities are testing traditional roles and approaches. There is opportunity for greater sharing of expertise and skills among health professional staff and consumer consultants to enhance current work practices, increase workplace satisfaction, and achieve positive patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the contribution of the ‘School-Link’ initiative to an Area Mental Health Service. Method: Surveys and focus groups of school and health service personnel were conducted to examine the three foci of the School-Link initiative, namely prevention, early intervention and service access. Results: Improvements witnessed since the commencement of School-Link include an increase in the number of evidence-based mental health promotion programmes in schools, improvements in the communication between health and education departments, improvements in referral patterns and better practices, such as improved feedback, in both health and education sectors. School counsellors feel more supported in their role by health services and better able to manage certain patients. Conclusions: The actual and potential benefits of School-Link for young persons appear considerable. School-Link has provided opportunities for communication, upgrading of skills and collaborative work on mental health issues, in both education and health settings. [ABSTRACT FROM AUTHOR]

Various lifestyle factors contribute to morbidity and mortality. Health promotion programs have the potential to increase awareness about, and possibly modify, some of these factors. In the workplace, these programs can be accessed by large groups of people. A healthy lifestyles programme was piloted for non-clinical staff in Central Sydney Area Mental Health Service, Australia. The aim of the programme was to provide non-clinical staff working in a mental health setting with education and information on a range of health conditions and topics. A needs analysis survey, along with formal and informal liaison and discussion, informed the programme's development and implementation. A total of 28 sessions were held; attendance ranged from 1 to 51 with a mean of 13.57 and a median of 12.5. Feedback regarding the programme has generally been positive. This pilot demonstrates that nurses, with their colleagues from other disciplines, are well positioned to deliver health promotion and education initiatives that may contribute to increasing awareness, and possibly modification, of lifestyle factors. [ABSTRACT FROM AUTHOR]

Objective: Given that 10 years have elapsed since the implementation of Australia's National Mental Health Strategy, the aim of the paper was to ascertain the views of the country's psychiatrists about changes in mental health services.Methods: A survey was mailed to all Fellows of the Royal Australian and New Zealand College of Psychiatrists living in Australia; 1039 out of 2059 (50%) returned the questionnaire.Results: Private care has not changed much in the last 5 years, but the quality in public psychiatric services has deteriorated. While 67% of private practitioners, 46% of psychiatrists with mixed practice, 39% of exclusively public psychiatrists and 27% of academics believed public practice had deteriorated, only 18% of psychiatrist administrators believed that to be the case. Daily or weekly problems admitting patients to hospital was reported by 40% of psychiatrists working in the public system. Public psychiatrists believed that they now treat more patients who are more disturbed, more acute and more demanding. However, they see their patients less often, provide less psychotherapy and use more medication. Administrative demands have increased.Conclusions: According to psychiatrists, implementation of the National Mental Health Strategy has not yet resulted in better psychiatric care in the public health system. [ABSTRACT FROM AUTHOR]

This article focuses the concept of electroconvulsive therapy (ECT) and its association with the Hollywood movies. While the film industry has demonstrated a particular fascination for depicting psychotherapy, physical treatments including ECT have also been featured. Portrayals of ECT reflect and influence public attitudes toward the treatment. ECT made its film debut in 1948 in Anatole Litvak's Academy Award-winning film "The Snake Pit." The second celluloid appearance is in "Fear Strikes Out" in 1957.

To examine the levels of satisfaction and stress of Australian psychiatrists. A survey was mailed in December 2002 to all Fellows of the Royal Australian and New Zealand College of Psychiatrists residing in Australia; 1039 out of 2059 (50%) returned the questionnaire. The large majority of respondents (79%) were proud of being a psychiatrist. Most (88%) reported being satisfied with their work. Reasons for dissatisfaction varied between public and private psychiatrists. Private psychiatrists nominated litigation/indemnity issues as the most frequent (69%) while the most common for public psychiatrists was lack of beds (47%). The main reason for satisfaction was helping patients get better (72%). Sixty-two percent found their work in the previous 12 months to be stressful. Dissatisfied psychiatrists were 11 times as likely to report being stressed as those satisfied. In the previous 12 months, 34% reported having had a threat of legal action, 39% had to answer a formal complaint, 67% had been verbally or physically abused by patients or relatives and 29% had patients who had suicided. Overall, psychiatrists were more pessimistic about the future than optimistic and 15% said they would not do psychiatry again. There were few differences according to state of origin or type of practice. However, females differed from males in several areas. Helping patients was reported as the main source of satisfaction for Australian psychiatrists while not being able to provide the best care for patients was described as one of the main reasons for dissatisfaction. Although most Australian psychiatrists are satisfied and proud of their profession, they are stressed and often experience verbal or physical abuse and threats of legal action and complaints. They are apprehensive about the future. The increasing number of females in the profession, their higher levels of stress and dissatisfaction, and other differences from males must be taken into account as the profession reshapes its future. There is a need for regular surveys of this kind. [ABSTRACT FROM AUTHOR]

There is limited information about the outcome of young people with school refusal. We aimed to describe the functional outcomes of persons with school refusal presenting to a child and adolescent psychiatric unit. Young people assessed or treated for school refusal between 1994 and 1998 at the Rivendell Unit, Sydney, Australia, were identified. Information was gathered from the medical records, mailed questionnaires and follow-up telephone interviews. Of 192 patients eligible for inclusion in the study, outcome information was available for 118 (61%); 83 had improved functional outcomes (employment and/or education) at 6 months after treatment and 89 at 3 years after treatment. Dysthymia or comorbid diagnoses were associated with poorer functional outcomes 6 months after treatment/assessment, but not at 3 years. The longer term functional outcomes for those treated for school refusal, apart from those with social phobia or academic difficulties, were favourable. Diagnoses of social phobia and learning difficulties were predictive of poorer functional outcomes 3 years after treatment. Longer or more intensive treatment of those with social phobia may improve outcome. KEYWORDS anxiety disorders; depressive disorders; outcome; school refusal. [ABSTRACT FROM AUTHOR]

To ascertain the views of Australian trainee psychiatrists about their training, levels of stress and work satisfaction. A survey was constructed by the authors and mailed in December 2002 to all trainees of the Royal Australian and New Zealand College of Psychiatrists residing in Australia. A total of 317 out of 666 trainees (48%) returned completed questionnaires. The findings were consistent across Australia with few State or Territory differences. The most common reasons for choosing a career in psychiatry were an interest in psychological issues and the promise of intellectual stimulation. The majority of respondents regarded favourably the quality of training in their training programme, clinical placements and supervision. Although approximately three-quarters (73%) were satisfied with their clinical work, a similar proportion (72%) considered their work in the previous 12 months to have been stressful. Formal complaints, threats of legal action, verbal or physical abuse, and the suicide of patients under their care were not uncommonly reported by trainees. Changing mental health services, a revised training programme and the perennial demands of acquiring knowledge and skills in one's chosen specialty pose challenges for psychiatry trainees. Although the majority of trainees seem satisfied with their work and training, addressing their concerns and adverse experiences is essential for the training climate to be optimal and the psychiatry workforce to be content and productive. Particular issues (e.g. the growing proportion of women entering the profession, the ageing trainee workforce) warrant careful attention by those responsible for training and workforce planning. [ABSTRACT FROM AUTHOR]

Explores the relationship between literature and psychiatry. History of the affinity of medicine with literature; Review of relevant literature; Advantages that an interest in literature in offer to psychiatric practice.

Objective: To describe the characteristics of young people presenting with school refusal to a child and adolescent psychiatric unit and examine differences between those admitted for inpatient treatment and the rest. Method: One hundred and ninety-two adolescents who had been assessed or treated for school refusal between 1994 and 1998 at the Rivendell Unit, Sydney, Australia were identified. An instrument was developed and used to gather data from files. Diagnoses were made by the consensus of two of the investigators using DSM IV criteria from all sources of information. Results: The commencement of school refusal generally occurred in the first 2 years of high school. School refusers had a high prevalence not only of anxiety, but also of mood and disruptive behaviour disorders. A family history of psychiatric illness was present in over half the sample. There were no differences between those subsequently admitted as inpatients and the rest in terms of symptom scores, family composition, family conflict, family separation or history of abuse. Those admitted for inpatient treatment were more likely to have a diagnosis of mood disorders and comorbid diagnoses and to have a maternal history of psychiatric illness. Conclusions: School refusal in adolescence can be a symptom of a variety of disorders, particularly anxiety and mood disorder. Treatment programs need to be geared to the range of diagnoses which occur in this patient group and to the various circumstances associated with the onset of the problem. [ABSTRACT FROM AUTHOR]