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In this paper we survey briefly the components of the Holocaust directly relevant to the psychiatric profession and identify the main themes of relevance to contemporary psychiatry. The 'euthanasia' program; the persecution of lesbian, gay, bisexual, transgender, and intersex (LGBTI) citizens; and the complex relationship between the psychiatric profession and Nazi state are the main themes to emerge from this survey. We then compare this period with key themes in the history of Australian psychiatry and link these themes to some of the contemporary ethical challenges the profession faces. [ABSTRACT FROM AUTHOR]

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]

Background: One of the major factors affecting treatment compliance and outcome in patients is the wide range of side effects (SEs) associated with antidepressants. In the present study, we aimed to assess the extent to which Israeli primary care (PC) physicians and psychiatrists discuss the SEs of selective serotonin reuptake inhibitors (SSRIs) with patients prior to the onset of treatment. Methods: A cross-sectional questionnaire survey was conducted among PC physicians (N = 123) and psychiatrists (N = 105). Questionnaires were distributed using a mixed-modality design, combining a web survey and in-person delivery of questionnaires. Results: A significant percentage of our respondents reported that they rarely discuss psychological (60 %) or severe (29 %) SEs of SSRIs. Nearly half (41 %) admitted to avoiding discussion of impact on suicidal ideation. Specialists were noted to discuss and evaluate SEs significantly more than residents, and Psychiatrists more than PC physicians. Specifically, psychiatrists more often discussed the possibility of sexual dysfunction (t (225) = 2.23; p < 0.05) and suicidal ideation (t (225) = 2.11; p < 0.05). Conclusions: It seems that PC physicians and psychiatrists surveyed in this study do not share sufficient information regarding the SEs of SSRIs with their patients at the onset of treatment. In improving this practice, the integration of proper SE management into educational interventions has potential in enhancing compliance and improving expertise and level of care. [ABSTRACT FROM AUTHOR]

Objective: This paper reports on a brief survey of clinicians' judgements when making treatment decisions in the context of diagnostic uncertainty. Specifically, attitudes and opinions were sought from practising consultant psychiatrists regarding two key areas of clinical decision-making in first episode psychosis (FEP), namely, when to initiate medication and, how long to continue treatment. Method: Interviews were conducted with consultant psychiatrists using a combination of structured and semi-structured questions that examined and explored pharmacological treatment decisions in FEP. Results: Twenty-three consultant psychiatrists participated in the interviews. The threshold to initiate pharmacological treatment was lower when a risk to self or others is present, when symptoms are primarily positive, when the patient is in distress, or where there is a family history of mental illness. Atypical antipsychotics are routinely used as front-line medication in FEP and the choice of medication is determined largely by their likely side effect profile. However, the greater the perceived efficacy, the greater the anticipated tolerability burden. The ideal duration of treatment is considered to be 1–2 years in instances of full remission, and 5 years where only a partial response has been achieved or where recovery has not been sustained. Conclusions: The ‘first episode’ represents a unique period in the management of psychosis where by definition there is no history of pattern of illness, diagnostic certainty is rare, and the patient usually does not have any prior exposure to medications. Therefore, each management decision needs to be considered following a risk benefit analysis which takes into account the context of the individual. [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]

Objective: The aim of the present study was to identify the core values of Australian psychiatrists to ascertain how these are reflected in the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Code of Ethics. Method: An ethnomethodological study was conducted on a non-purposive sample of Australian psychiatrists using a non-probabilistic theoretical sampling method. Data obtained at interview were analysed using a qualitative computer-assisted thematic analysis paradigm. The themes generated using this coding strategy were refined into a rich description of the core values held by Australian psychiatrists. Results: Four main values emerged from the data: the value of the patient, the value of sophisticated understanding, the value of reflexivity, and the value of advocacy. Conclusions: The four main values identified in the present study were well reflected in the main principles of the RANZCP Code of Ethics. In the light of the data, some additional annotations to the document are suggested, to better reflect this value system. [ABSTRACT FROM AUTHOR]

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 ethical theories of utilitarianism and the ethics of duty (Kant's ethics) and to evaluate their value as theoretical bases of psychiatric ethics. Conclusions: Utilitarianism is a well-established moral philosophy and has significant instrumental value in dealing with common ethical problems faced by psychiatrists. Despite its capacity to generate solutions to ethical problems, utilitarianism requires a process of what Rawls described as 'reflective equilibrium' to avoid morally repugnant choices, based on utility. The criticisms of utilitarianism, such as the problems of quantifying utility and the responsibility for consequences, are very relevant for psychiatry. Singer's model of utilitarian thinking is particularly problematic for our profession. Kant's ethics provides the pretext for duty bound codes of ethics for psychiatrists, but suffers from problems of flawed claims to the universalizability prescribed by Kant's 'categorical imperative'. Kant's valorization of reason as the core of the autonomy of persons is a valuable insight in understanding psychiatrists' ethical obligations to their patients. [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]

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]

Objective: This study aims to ascertain the experience and views of psychiatrists in relation to St John’s Wort and alternative treatments generally. Method: A questionnaire was posted to all members of the Royal Australian and New Zealand College of Psychiatrists living in Australia or New Zealand. Results: Of the 1910 mailed questionnaires, 862 (45%) were returned. Eighty per cent of respondents had patients who had used the herb. Side-effects and drug interactions were reported by 28% and 8% respectively of these psychiatrists. Some adverse events were described as serious. Psychiatrist attitudes about St John’s Wort and alternative treatments were positive overall and psychiatrists seemed willing to recommend St John’s Wort despite limited evidence of its usefulness. Conclusions: Psychiatrists in Australia and New Zealand regularly manage patients who take St John’s Wort and a considerable number actually recommend the treatment. However, they also report side-effects and drug interactions. Psychiatrists should routinely enquire about their patients’ use of alternative treatments, be mindful of possible side-effects and in particular be aware of the dangers of combining St John’s Wort with other psychotropics. [ABSTRACT FROM AUTHOR]

The article features psychiatrist Frantz Fanon. He was born in Martinique and he served with the Free French Forces during World War II despite the racism he encountered. It is said that the theory of psychiatrist Francois Tosquelles that culture influences psychopathology has affected Fanon's thinking about psychiatry. Based on the entry, the book "The Wretched of the Earth" is Fanon's best work.

Presents childhood experience of the author related to psychiatry. Information about psychiatrist Leopold Bellak; Interest of the author in psychiatry.