Abstract
S1 HOLDING THE BATON: LEADERSHIP IN THE DELIVERY OF QUALITY CARE FOR PATIENTS WITH BORDERLINE PERSONALITY DISORDER
Spectrum Personality Disorders Service for Victoria
The quality of leadership provided for clinical teams treating borderline personality disorder can make the difference between a positive outcome, no change, and damaging effects from the treatment endeavour.
Psychiatrists leading clinical teams carry the responsibility for delivering quality leadership – a responsibility which can be difficult to fulfil in the face of the powerful psychodynamic forces operating in relation to these patients. This workshop will examine the psychodynamic forces which most commonly operate in individual clinicians and teams treating BPD.
Impediments to effective leadership will be discussed and suggestions made about how these can be addressed at the coal-face of clinical work.
Case examples from Spectrum and Victorian Area Mental Health Services will be used to illustrate the points made. The audience will be encouraged to contribute case examples or vignettes which can be used to consider other ways of handling the situation in the case concerned.
S2 INTERVIEW WITH KATE GRENVILLE
University of Melbourne
If you were fortunate enough to attend the session with Helen Garner in conversation with Sidney Bloch at the Perth Congress in 2006, you will remember how she illuminated many aspects of the writer's craft and helped us to appreciate the creative imagination's role in developing characters and offering insights into the human psyche. We have another opportunity to meet a celebrated author when KATE GRENVILLE will be in conversation with Sidney Bloch at the Melbourne Congress.
Kate Grenville was born in Sydney. After completing an Arts degree at Sydney University she worked in the film industry before living in the UK and Europe for several years and starting to write. In 1980 she went to the USA and completed an MA in Creative Writing at the University of Colorado. On her return to Australia she wrote her first book, a collection of stories, Bearded Ladies. Since then she has published six novels and four books about the writing process.
The Secret River (2005) has won many prizes, including the Commonwealth Prize for Literature and the Christina Stead Prize, and has been an international best-seller. The Idea of Perfection (2000) won the Orange Prize.
Her other works of fiction have been published to acclaim in Australia and overseas and have won state and national awards. Much-loved novels such as Lilian's Story (1985), Dark Places (1995) and Joan Makes History (1988) have become classics.
S3 CREATING THE FUTURE FOR PSYCHIATRIC SERVICES
1 Barwon Health
2 University of Melbourne
c Melbourne Health
c Peninsula Health
With the move towards a closer relationship between Commonwealth and State Governments and on the eve of a new National Mental Health plan being unveiled, the demands on and opportunities for Clinical Directors and those in other senior management positions responsible for delivering psychiatric services are increasing. In this symposium, issues explored and discussed will include why mental health systems are struggling to meet the mental health service needs of populations they are responsible for, the challenges associated with being a leader in a large complex health organisation, the importance of psychiatric services being aware of and keeping pace with developments in information management in health more broadly and the use of different methodologies to engage staff in major change.
WHY FOCUS ON MENTAL HEALTH SYSTEMS IN TRAINING AND RESEARCH?
LEARNING FROM THE BROADER HEALTH SYSTEM
WORKING AS A SENIOR EXECUTIVE IN COMPLEX HEALTH SERVICE ENVIRONMENTS: FUNCTION, CHALLENGES AND SURVIVAL TECHNIQUES
THE USE OF DIFFERING METHODOLOGIES TO ENGAGE STAFF IN MAJOR CHANGE INCLUDING SIX SIGMA
THE AUSTRALIAN MENTAL HEALTH LEADERSHIP PROGRAM
S4 THE PHYSICAL HEALTH OF PEOPLE WITH A SERIOUS MENTAL ILLNESS
2 SANE Australia
3 Alfred Psychiatry Research Unit
4 Hawthorn Clinic, St Vincent's Mental Health
The physical health of people with a serious mental illness is woeful. The life expectancy of people with schizophrenia, for example, is up to 20 years shorter than the general population, largely because of physical health problems. Cardiovascular disease is the single biggest killer, and risk factors such as smoking, obesity and diabetes are seen at a very high rate in people with seriously affected by mental illness. Furthermore, many of the medications used to control psychotic symptoms are themselves associated with elevated rates of obesity, diabetes and hypertriglyceridaemia. The physical health of this vulnerable group is often sub-optimally monitored and sub-optimally managed, so new strategies and interventions must be adopted.
This symposium will provide a comprehensive overview of the problem and potential solutions, with perspectives from consumers and carers via SANE Australia, as well as clinicians and researchers in the field. Topics will include
S5 SMOKING AND MENTAL ILLNESS: THE PSYCHIATRIST'S ROLE
1 Melbourne Health
2 Executive Director, SANE Australia
3 Special Settings (Mental Health and Prisons), Quit Victoria
4 Department of Psychiatry, School of Medicine, Flinders University
5 Dalhousie University
SMOKING AND MENTAL ILLNESS: COSTS
Executive Director, SANE Australia
Quitting smoking is a major and currently neglected concern for very many people with a mental illness.
Public places, including health facilities in all States and Territories of Australia, are rapidly becoming smoke free, yet there is limited activity of any sort, and no systemic programs at all, to actively help people with a mental illness reduce or quit smoking.
So while smoking rates in the general population continue to drop, people with mental illness continue to smoke at very high rates, with enormous health, social and financial costs to themselves and to the community.
In 2007, SANE commissioned AccessEconomics to research and document these costs and to demonstrate the cost effectiveness of various interventions to help people with mental illness reduce or quit smoking. This research is part of SANE's overall smoke free activities.
This presentation will report on the findings of this research, outline SANE's education, research and advocacy activities in the area and discuss ways in which clinicians can help their patients lead a physically and mentally healthy life.
SMOKING CESSATION – EFFECTIVELY SUPPORTING PEOPLE WITH A MENTAL ILLNESS
Special Settings (Mental Health and Prisons), Quit Victoria
Practitioners across the mental health sector should promote safe smoking cessation. Creating clear policies that govern cessation activities both within the agency and as inter-agency client management will reap benefits for both the client and the agency. Practitioners can provide time effective support using brief intervention techniques such as provision of written resources and a referral to the Quitline. Multiple attempts before success are the norm for all quitters, as they make adjustment to a smoke-free life. However, people with mental health issues may need extra quitting medication and/or support and it is important to assist all smokers address the three aspects of addiction.
SMOKING IN MENTAL HEALTH: A THORNY PUBLIC HEALTH ISSUE
1 Department of Psychiatry, School of Medicine, Flinders University
Almost 50% of all cigarettes smoked in the US are smoked by people with mental illness. Extraordinarily punitive financial, social and health consequences ensue for this highly addicted, vulnerable group, many who allocate a higher order of priority to cigarettes than ensuring core needs. This is clearly an unwanted consequence of current public health policy on smoking.
Smoking is routinely used by psychiatric staff to placate, negotiate and reward patients and to support clinical management of their psychiatric presentations. Whilst this reality is openly acknowledged, there are no easy solutions in sight. This is paradoxical given smoking by patients has been linked to violence and intimidation of staff, other patients and family and increased premature mortality in psychiatric patients. Staff within the mental health sector (and other institutional settings), have higher prevalence of smoking than other workers in the health sector, high risk of exposure to passive smoking on a daily basis and could claim for compensation against health departments from this chronic occupational health hazard.
A paradoxical failure to intervene by responsible health services exists, given the clearly known health hazards, the success of specific Quit programs for psychiatric patients, the successful development of smoke free psychiatric units, and protocols for nicotine replacement therapy that could be modified for acutely ill patients. Unfortunately such programs and protocols are lacking in most treatment systems. Research funding designed to urgently seek answers to these paradoxical policy dilemmas is almost non existent. These issues will be summarized and policy options for the future explored.
A SYSTEMATIC REVIEW OF SMOKING CESSATION THERAPIES IN PSYCHIATRIC ILLNESS: IMPLICATIONS FOR CLINICIANS AND DECISION-MAKERS
Dalhousie University
S6 BOARD OF PROFESSIONAL AND COMMUNITY RELATIONS
Mental health is a global concern, as is climate change and reducing carbon emissions; however what are the long term effects of poor environmental policies within the specialist practice and what measures can be taken to help psychiatry go green? This symposium will detail the joint carbon/environmental policy developed in partnership with the RACP and the small steps practitioners can make in their daily practice.
FAMILIES AS PARTNERS IN MENTAL HEALTH CARE
Working with the families and carers as partners in the mental health care is integral to the provision of high quality specialist mental health care. This workshop will be lead by carers and will enable participants to develop a greater understanding of the day to day experiences of carers and family members, both in Australia and New Zealand; and will provide interactive opportunities to explore the key areas in which families can act as partners in mental health care including the vital role families play in the recovery and relapse prevention process.
Trainees that participate in this workshop will receive a certificate of participation that can be used to assist them in meeting their annual training requirement as per training link 27.
S7 IMPROVING FAMILY FUNCTIONING IN HIGH RISK FAMILIES: THE PARENTS UNDER PRESSURE PROGRAM
1 School of Psychology, Griffith University, Brisbane, QLD
2 University of Newcastle
3 Coral Tree Family Service
There is widespread agreement that improving family functioning in high risk families with parental substance misuse is critical. There are many adverse outcomes seen in children raised in environments characterized by parental psychopathology, substance misuse, poverty, social isolation and poor parenting. However, targeting a subset of problems such as substance misuse, in isolation from the broader family context, does little to improve family functioning. Interventions need to be multifaceted and address many of the risk factors, including the potential for current or probable child abuse and neglect. There have been a number of attempts to intervene in families with multiple risk factors and there has been a striking lack of success in making changes in either parental functioning or child behaviour. It is within this context that the current program of research developing a multisystemic parenting intervention, the Parents Under Pressure program, was undertaken. Some eight years on there have been many successes and equally, many failures. In this workshop, an overview of the PUP program will be provided using a case example to illustrate how the program is put into practice. Issues relating to dissemination and training will be discussed.
S8 NETWORK OF PUBLIC SECTOR PSYCHIATRISTS
1 RANZCP Network of Public Sector Psychiatrists
2 SESIH
The session will be provided by a number of Australian leader public sector psychiatric administrators and looks at what factors need to be in place to initially attract and retain public sector psychiatrists. What is very clear is that it is not remuneration alone which is necessary but leadership, professional support and role clarity amongst other factors.
COMMUNITY PSYCHIATRY – A CRITICAL APPRAISAL OF CONTEMPORARY PRACTICE
SESIH
S9 MENTAL HEALTH PROFESSIONAL'S ASSOCIATION: SUPPORTING A COORDINATED AND COLLABORATIVE FORUM FOR ISSUES AFFECTING MENTAL HEALTH PROFESSIONALS
1 Royal Australian and New Zealand College of Psychiatrists
2 Royal Australian College of General Practitioners
3 Australian College of Mental Health Nurses
4 Australian Psychological Society
The Mental Health Professionals Association (MHPA) was convened in early 2006 by The Royal Australian and New Zealand College of Psychiatrists as a way of supporting a coordinated and collaborative forum for issues affecting the four key professional groups involved in mental health care, particularly in the context of the Council of Australian Governments’ (COAG) mental health package and the federal government's Better Access initiative.
The MHPA includes representation from the Royal Australian and New Zealand College of Psychiatrists, The Royal Australian College of General Practitioners, the Australian Psychological Society and the Australian College of Mental Health Nurses.
As a collaborative of the key representative and standard setting bodies for the mental health professions, the MHPA is ideally placed to liaise with government regarding investment in the mental health workforce and mental health care delivery. The partnership provides an unprecedented level of project sponsorship that aims to deliver high yield, value for money outcomes for the Australian Government. Equally it will provide the basis for highly effective support networks and education for the combined professional groups.
This symposium will discuss the work of the MHPA to date, including details of a multidisciplinary training package being developed to provide psychiatrists, general practitioners, psychologists, paediatricians, social workers and occupational therapists with the support required to use the new (and existing) relevant Medicare Benefits Schedule (MBS) item numbers in an appropriate, effective and efficient manner. The symposium will also detail how the professions can provide input to the work of the group.
THE RANZCP VIEW ON COLLABORATIVE MENTAL HEALTH CARE
Royal Australian and New Zealand College of Psychiatrists
The RANZCP has changed its outlook in recent years to move from an inwardly focussed organisation primarily concerned with the training of psychiatrists and the maintenance of clinical standards to an outwardly focussed organization promoting improved mental health care in Australia and New Zealand. This has required an intrinsic understanding of the value that comes from partnerships and collaboration across the sector. The providers of mental health care, and their professional organizations, are in a unique position which creates opportunity to work with both community and government.
The history of the change in focus, leading to the development of a pro-active policy agenda for RANZCP, will be briefly discussed. This led to the development of the MHPA and a collaborative approach to negotiating increased access to Mental Health providers for all Australians. Further challenges and the development of a political agenda will be discussed.
THE WAY OF THE FUTURE – TEAM-BASED MENTAL HEALTH CARE IN THE COMMUNITY: THE ROLE OF THE GENERAL PRACTITIONER IN RELATION TO THE OTHER KEY MENTAL HEALTH PROFESSIONALS
Royal Australian College of General Practitioners
Since 1 November 2006, psychologists and other allied mental health professionals including social workers and occupational therapists, are now able to access Medicare rebates under the ‘Better Access’ initiative where the client's general practitioner has prepared a GP Mental Health Care plan. Psychiatrists are also being supported to see more new patients under this initiative and are encouraged to involve GPs more in the management of patients where appropriate.
These new arrangements present an opportunity for GPs to work more closely and collaboratively with the other mental health professionals to improve community access to mental health professionals and outcomes for people living with mental disorders in the community.
This presentation from the Royal Australian College of General Practitioners aims to address the importance of ‘team based’ care in the provision of primary mental health care in the community. It will also explore the need for team-based training for the different professional groups, specifically around the knowledge and skill bases and roles and responsibilities of these ‘teams’ in order to recognize and treat mental illness. The presentation will draw upon both statistical data around the ‘burden of disease’ (Beach Data) and existing general practice models of integrated primary and secondary mental health care at a local level.
MENTAL HEALTH NURSES, GPS AND PSYCHIATRISTS – PARTNERS IN CARE FOR PEOPLE WITH SERIOUS MENTAL ILLNESS
Australian College of Mental Health Nurses
Mental health is a significant issue facing the Australian community. There are about ½ a million people living with a severe mental disorder in Australia at any point in time. People with serious mental illness are most at risk of failing to access an appropriate range of services because of their persistent psychiatric symptoms, their level of disability and/or their isolation from family and other social support networks.
In July 2006 the Council of Australian Governments (COAG) agreed to a National Action Plan on mental health 2006–2011, out of which came a number of reform initiatives. To meet the recognised gap in clinical case management of people with severe mental illness treated outside the public health sector, the Mental Health Nurse (MHN) Incentive Program was developed. The program will be rolled-out nationally on 1 July 2007.
The intention of the MHN Incentive Program is for MHN's to develop partnerships with General Practitioners and Psychiatrists, collaborating to deliver better-coordinated care to those in our community with a serious mental illness and complex needs. It is envisaged that such partnerships will increase efficacy of community-based support, reduce the need for acute inpatient services and lead to improved health outcomes for the mental health client.
This paper will discuss the development of the incentive program and its uptake by nurses, GPs and Psychiatrists including policy development, evaluations from nursing reference groups, feedback from GPs and Psychiatrists, and progress to date.
THE CONTRIBUTION OF PSYCHOLOGISTS TO THE TEAM-BASED APPROACH TO MENTAL HEALTH
Australian Psychological Society
The Federal Government's ‘Better Access’ Initiative, which provides consumers with improved access to mental health treatment, particularly through Medicare, has shown enormous demand for psychological services. The initiative fosters a team-based approach involving general practitioners, psychiatrists, paediatricians, psychologists, mental health nurses and allied health professionals working together to deliver mental health services in primary care. This paper will discuss the latest information on the uptake of the Medicare items providing access to psychological services, and the processes and challenges for psychologists involved in the implementation of ‘Better Access’. Discussion will focus on the role of psychologists and their interface with the other mental health professions, within the wider workforce context.
S10 THE MENTAL HEALTH CONSEQUENCES OF SEEKING ASYLUM IN AUSTRALIA
1 Asylum Seeker Resource Centre
2 Glenside Hospital
3 Victorian Foundation for Survivors of Torture Inc
4 Mental Health Research Institute; Northern Psychiatry Research Centre; Dept of Psychiatry Melbourne University; Asylum Seeker Resource Centre
5 Albert Road Clinic
Since Federation Australia has been perceived as a country of possible refuge and opportunity from international strife resulting in a history of asylum seeking from those subject to such adverse circumstances. Recent Australian governments have introduced policies that provide for mandatory detention and temporising visas that do not provide health, welfare or work rights as well as stringent exclusion. These policies and practice have resulted in a set of psychiatric and psychological problems peculiar to the process of asylum seeking in Australia. This symposium will describe these syndromes using a time line approach, namely; during detention, post-detention, protracted asylum seeking and imminent repatriation for failed asylum seekers. The symposium will use clinical material and an illustrative case example to support the delineation of these mental health sequelae.
Many individuals who have fled appalling circumstances overseas have subsequently been exposed to conditions in Australia when seeking asylum that have resulted in or contributed to the development of psychiatric syndromes that appear distinctive to this experience. Further understanding of these clinical presentations may allow better recognition and treatment and ultimately impel policy-makers to implement policies and practices more conducive to improved mental health in asylum seekers in Australia.
Intro and brief overview of asylum seeking process in Aust (Sundram 5 min)
Doubly Detained: Mentally ill Asylum Seekers in an inpatient unit (Hawker or James 12 min)
Psychological sequelae of detention (Coffey 12 min)
The psychiatric consequences of protracted asylum seeking within an Australian context. (Sundram 12 min)
The End of the Immigration Road – Unchartered Territory: Implications of impending deportation/repatriation on mental health (Harvey 12 min)
Intersectoral linkages for the provision of mental health care for asylum seekers (Brous 10 min)
Panel discussion of speakers plus Advocacy (Curr), Legal (Psihogios-Billington).
DOUBLY DETAINED: MENTALLY ILL ASYLUM SEEKERS IN AN INPATIENT UNIT
Glenside Hospital
Glenside Hospital, Adelaide, from 2000 to 2007 treated almost all asylum seekers (51) from Woomera and Baxter Detention centres who required treatment under the detention provisions of the South Australian Mental Health Act.
The presentation will describe: The unique difficulties of asylum seekers that contributed to their mental illnesses. The complex web of legal requirements that affected their management. The syndromes most commonly presenting. The therapeutic difficulties when government policy is both the most frequent underlying cause of illness and its removal most often being the major remedy. Serious ethical dilemmas affecting clinicians in this situation. Case vignettes of typical asylum seekers in a very atypical situation.
PSYCHOLOGICAL SEQUELAE OF DETENTION
Victorian Foundation for Survivors of Torture Inc
Refugees entering Australia under the Special Humanitarian Program, and asylum seekers applying for protection in Australia very often have common histories of trauma and loss. However their experiences in Australia are vastly different. Off shore refugees undertake the challenges of settlement with their permanent residency secured and with the support of settlement services and access to the normal range of government health, welfare and vocational services. Asylum seekers, by contrast, face lengthy periods of uncertainty about their future, limited access to government services, and mandatory detention if they have entered Australia without a visa. The experience of treating off shore refugees and asylum seekers who have been detained demonstrates the extent an insecure and re-traumatising post arrival environment affects the expression of pre-arrival trauma and loss. This paper describes some of the broad differences in the clinical presentations of asylum seekers after their release from detention as compared to off shore refugees. It also identifies how periods spent in immigration detention complicates the treatment of post traumatic conditions. Some case illustrations will be provided.
THE PSYCHIATRIC CONSEQUENCES OF PROTRACTED ASYLUM SEEKING WITHIN AN AUSTRALIAN CONTEXT
Mental Health Research Institute; Northern Psychiatry Research Centre; Dept of Psychiatry Melbourne University; Asylum Seeker Resource Centre
The process of seeking asylum in Australia is for many protracted and invidious. The reasons for this are multiplex and include delayed access to competent legal advice, mistrust of juridical office, loss or absence of supportive documentary evidence in addition to harsh government policies. The experience is compounded for individuals and families who are initially classified as unlawful aliens and subsequently given temporizing visas. As such they may be exposed to detention and in the community will not be able to work, study or access welfare or health care. Such conditions may persist for years. Under such circumstances asylum seekers are reliant on the goodwill and generosity of friends, communities and organizations such as Hotham Mission and the Asylum Seeker Resource Centre for all their needs. This situation of chronic forced helplessness, future uncertainty and dread of repatriation results in a syndromal cluster with some similarities to the demoralization described in the medically ill. The syndrome is characterized by despondency, hopelessness, cognitive constriction, anxiety and may be frequently accompanied by features of major depression with somatic symptoms, a chronic stress disorder and occasionally depersonalization or brief psychotic symptoms. Clinical examples of the syndrome will be presented and points of similarity and difference with relevant extant literature discussed.
THE END OF THE IMMIGRATION ROAD – UNCHARTERED TERRITORY: IMPLICATIONS OF IMPENDING DEPORTATION/REPATRIATION ON MENTAL HEALTH
Asylum Seeker Resource Centre
Many of us are skilled in working with people who are dealing with life threatening illnesses, and there is a plethora of research literature and experience to guide us in our work; as such, the terrain is familiar. For many people seeking asylum, the reasons for seeking Australia's protection are similarly based on real or perceived threats to life, where return to their country of origin means death, or at least persecution. For the clients at the end of the ‘immigration road’, there is not yet a body of knowledge to guide us; as such, the terrain is unfamiliar.
This presentation will outline the Asylum Seeker Resource Centre's somewhat reluctant attempts to work with clients at the ‘end of the immigration road’ – unchartered territory. Where possible, it will identify parallels with work with people with terminal illness, so as to make the terrain seemingly more familiar. It will draw on the documented experience of a small number of people who were unsuccessful in their attempts to gain Australia's protection and who were forced to return to their country of origin. It will also outline some of the raw experience of this work – the clients’ stories, the professional and ethical dilemmas raised by engaging with this client group, the interdisciplinary dilemmas that have emerged in our unique, multi-disciplinary organisation, and the psychological ramifications for our clients who have lived with fear and uncertainty, usually for years, and whose fate can be altered by the stroke of a pen.
MENTAL HEALTH OF ASYLUM SEEKERS
Albert Road Clinic
A clinical case will be presented of Mr. X, an asylum seeker.
His mental health will be explored in the political context of the Government's policies towards asylum seekers; and the mental health services available.
The case will illustrate the unique partnerships that have been developed between the private, public and voluntary sectors to provide mental health services to these vulnerable people
It will also illustrate the collaboration which is occurring between professionals from psychiatry, psychology, general practices and the law, to address relevant medico legal, clinical and advocacy issues.
S11 AFTER THE THESIS: DEVELOPING A CAREER IN RESEARCH
1 University of Western Sydney
2 Board of Research RANZCP
3 La Trobe University
The transition from research ‘student’ to an established career researcher is often challenging to new investigators. The aims of this workshop are to provide young researchers with direction in the development of a personal program of research. Professor Susan Paxton will present an overview of issues in what to seek in a mentor and how mentoring can aid in progressing a research career. There will be an opportunity for small group discussions, facilitated by members of the Board of Research, where participants will be encouraged to pose questions and also bring their own experiences of mentoring and/or being mentored. The workshop will be most relevant to those nearing completion or recently completed an honours or post-graduate research program.
S12 SHOWCASING AUSTRALASIAN RESEARCH IN THE NATURE AND DETERMINANTS OF EATING DISORDERS-RANZCP BOARD OF RESEARCH SYMPOSIUM
1 University of Western Sydney
2 University of Sydney
3 La Trobe University
4 Flinders University
STAGING ANOREXIA NERVOSA: CONCEPTUALIZING ILLNESS SEVERITY
In recent years, there has been increasing attention to the conceptualization of anorexia nervosa (AN) and its diagnostic criteria. Although varying levels of severity within the illness category of AN have long been appreciated, neither a precise definition of severity nor an empirical examination of severity in AN has been undertaken. In this presentation the current state of knowledge in stages of illness will be reviewed, and a new theoretical model for the definition and conceptualization for severity in AN proposed. AN is associated with significant medical morbidity which is related to the ‘severity’ of presentation on such markers as body mass index, eating and purging behaviours. The development of a functional staging system, based on symptom severity, is indicated for reasons similar to those cited by the cancer lobby. Improving case management and making appropriate treatment recommendations have been the primary purpose of staging in other fields, and might also apply to AN. Such a standardized staging system could potentially ease communication between treatment settings, increase the specificity and comparability of research findings in the field of AN, and help resolve some of the present issues in current classification schemes.
PREDICTORS OF DISORDERED EATING AND BODY DISSATISFACTION IN WOMEN IN MIDLIFE
SHARED AND UNIQUE RISK FACTORS BETWEEN LIFETIME PURGING AND OBJECTIVE BINGE EATING: A TWIN STUDY
In press Psychological Medicine
S13 EATING DISORDERS FROM THE COMMUNITY TO THE BEDSIDE: ISSUES IN IDENTIFICATION AND TREATMENT
1 University of Western Sydney
2 University of Sydney
INFLUENCE OF GENDER ON PERCEPTIONS AND BELIEFS ABOUT EATING DISORDERS: A COMMUNITY BASED STUDY
EARLY-ONSET EATING DISORDERS (EOED) IN YOUNG CHILDREN: AN OVERVIEW OF THE FINDINGS OF THE AUSTRALIAN PAEDIATRIC SURVEILLANCE UNIT (APSU) STUDY
PATTERNS OF WEIGHT CHANGES DURING INPATIENT TREATMENT
In a study of energy metabolism in female patients with anorexia nervosa, duration of hospitalisation in a nutritional rehabilitation program was shown to be positively correlated with normalisation of metabolic dysfunction (Heilbronn et al 2007). However weight is often lost again necessitating readmissions for re-feeding. It is unclear as to whether psychological variables follow this trajectory and whether outcome can be predicted by the pattern of weight fluctuations.
Heilbronn L, Milner KL, Kriketos A, Russell J, Campbell L. (2007) Metabolic dysfunction in anorexia nervosa. Obesity Research and Clinical Practice 1: 139–146.
S14 ASSESSMENT OF THE ABILITY TO BE CRITICAL IN RANZCP EXAMINATIONS
RANZCP Committee for Examinations
This workshop is aimed at not only future candidates preparing for the RANZCP written examination but also those helping candidates in their preparation.
Attendees will gain a greater understanding of the skills tested in the Critical Analysis Problems and the Critical Essay Question, and why these are deemed to be important areas of assessment in the training of psychiatrist.
Approaches to answering critical analysis problems and the writing of a critical essay are explained with reference to authentic examples.
Participants should subsequently feel confident in developing their own practice questions.
S15 A FIVE YEAR PROGRAM DEVELOPING EMERGENCY MENTAL HEALTH
1 Flinders Medical Centre
Five years ago the first author decided to take on the Mental Health component of the Emergency Department in the Flinders Medical Centre. This area had a very bad reputation, was seen as “too hard”, dangerous and chaotic.
The director welcomed me. The only condition I applied was that the Psych Service had to be mainstreamed. By this I meant totally located in the general teaching hospital, ED Department and that all ED staff had to take part. Equally it was expected that I and the rest of the Mental Health team would take an active Consultation Liaison role.
Early problems included:
That the nurses appeared to have a great deal of stigma towards psychiatric patients and appeared to greatly dislike managing them. That there was obviously a huge increase in demand from the mental health sector in the Emergency Department. That we were in a situation where we often had patients waiting long periods of time to be admitted to hospital. The capacity of the Community to absorb patients who we wished to discharge, was not strong.
With respect to our nursing staff (who I should point out are almost exclusively not trained in mental health, they were very negative about our patients and indeed appeared frightened of them. An educational program began with the first author taking a nurse for every assessment so that they became familiar with these patients and at the simplest level “how to talk to them”.
With the director and a number of others, we developed a course which was entitled “Emergency Mental Health Alcohol and Drugs” (EMHAD), which was a three day course of a very practical nature aimed at the ED staff and particularly ED nurses. As it turned out, this proved very successful, came to be funded by the state, was set up as a state wide resource for ED Departments and subsequently, was heavily in demand from the Rural & Remote sector and the Indigenous Communities of South Australia.
This course will be described in detail because it was absolutely fundamental to turning around particularly the nursing staff en ED. What looked like stigma, disappeared very quickly. This seemed to be a fundamental step to what we're asserting was a successful intervention.
Early analysis showed that the demand for Mental Health services had increased tenfold in as many years. This trend has continued and last year (2007) there was a further 12% increase in attendances – virtually all of these were in the category of non overdose and self harm patients. These have regularly been evenly split between the psychosis, high prevalence disorders/crisis patients and depression, each of them sharing about 30% of the total attendances. The remaining patients are made up of pure intoxication, personality disorder (including borderline personality disorder), mania and delirium.
Much was learnt in the first 12–18 months. Outcome data will show a major increase in the percentage of patients discharged (from around 48% to 66%) and a major decrease in the percentage of patients admitted to inpatient units (45% −28%). These trends have continued over the five year period.
The factors identify as being associated with these changes (and having identified them actively pursued them as part of our management) included – maximisation of the feeling of safety in ED; encouraging long periods of sleep; responding to aggression by encouraging dependency for brief periods; adopting very acute intensive care approaches whilst patients were in the ED; putting a great deal of time into educating, assisting and supporting the patients intimates (family, spouse and friends); developing a form of very acute psychotherapy; developing specific programs for specific groups including borderline personality disorder, first presentation panic disorder, alcohol withdrawal states; and anorexic patients with metabolic disturbances. We attempted to make good contact with GP's and exploited the capacity of GP's to refer patients on to psychologists. We developed a Hospital @ Home program and developed what in effect is a quasi Short Stay Unit.
These observations and development and their theoretical underpinnings will be described.
Mainstreaming turned out to be greatly in the patient's interest in terms of assessment, diagnosis and ongoing management and in terms the patient satisfaction with their time in the Emergency Department. A great deal of mutual support occurs between the Psychiatric or Mental Health staff and the non psychiatric staff.
The problems of having patients waiting for admission for long periods e.g. 1–5 plus days has not been solved but it is true that we are much more adept at settling such patients and beginning the process of their treatment than we were 3–4 years ago. We have not been able to demonstrate that this shortens their subsequent Inpatient Unit although there is a general trend for them to stay in Inpatient Services to be declining.
Issues of the control of disturbing and out of control patients has been addressed with considerable intensity and there has been considerable improvement in issues such as Code Blacks and other forms of acute intervention. Great emphasis is placed on staff and patient safety.
The Consultation Liaison Service is a success story with excellent professional cooperation by both the ED consultants and the ED Mental Health team. We share assessments and sometimes care for about twenty patients per week.
The issues of drug and alcohol abuse and misuse presentations (most often with considerable comorbidity) has proved complex and the greater share of care currently falls on the Mental Health team. The implications of this will be discussed. It creates problems because there is a decrease likelihood of these patients being taken over by the Drug & Alcohol Services (even though we have our own drug and alcohol nurse), that physicians are often reluctant to admit such patients and the Mental Health inpatient and Community Care teams by and large, do not see such patients as “their work”.
Finally, the idea that Emergency Psychiatry has emerged as a special sub discipline of its own within Psychiatry will be discussed.
S16 PSYCHIATRISTS AS SOCIAL AND POLITICAL ADVOCATES: CONSIDERING SOME OF THE ISSUES
1 NSW Institute of Psychiatry
2 Women's and Children's Hospital, CYWHS, Adelaide
3Director Clinical Services
4 University of NSW
5 University of Newcastle
What is advocacy, particularly in our roles as psychiatrists? Whether as individuals and as a professional group there are key values and principles that inform our lives and our practice. Who does what, why and when in advocacy? What are the motivating and trigger factors? Working from inside or outside the RANZCP; the benefits and constraints of the College mantle On speaking out and being unpopular Ethical issues and other difficult choices
S17 ATTACHMENT TO GOD IN SICKNESS AND IN HEALTH: THEORETICAL CONSIDERATIONS AND CLINICAL APPLICATIONS OF UNDERSTANDING THIS IMPORTANT RELATIONSHIP IN THE LIVES OF OUR PATIENTS/CLIENTS AS AN ATTACHMENT RELATIONSHIP.
1 University of Sydney
2 University of Western Sydney; Australian College of Ministry; Australian Centre for Studies in Spirituality
3 University of Western Sydney
THE RELEVANCE OF ATTACHMENT TO GOD FOR THE STUDY OF THE RELATIONSHIP BETWEEN SPIRITUALITY AND MENTAL HEALTH
University of Western Sydney, Australian College of Ministry, Australian Centre for Studies in Spirituality
Although there is substantial evidence that religion/spirituality impacts mental health, findings of specific studies must be related to penetrating foundational theories if incisive interventions are to be developed. Attachment theory is one such penetrating foundational theory. Within monotheism, and particularly within Christian theology, God is held to be ontologically relational and providing core attachment functions of safe haven, secure base and attunement. Empirical studies show that God is perceived to be an attachment figure in ways that correspond to human parents, but understanding spiritual attachment adds to the prediction of mental health outcomes beyond the effects of parental attachment.
ASSESSING ATTACHMENT TO GOD AND SPIRITUALITY AS AN ASPECT OF PSYCHOLOGICAL HEALTH AND WELLBEING
University of Western Sydney, Australian College of Ministry, Australian Centre for Studies in Spirituality
ATTACHMENT TO GOD: EXPLORATION OF SPIRITUAL ATTACHMENT RELATIONSHIPS IN CLINICAL CARE AND PSYCHOTHERAPY
University of Sydney
ATTACHMENT TO GOD, SPIRITUAL MATURITY AND PSYCHOLOGICAL HEALTH
University of Western Sydney; Australian College of Ministry; Australian Centre for Studies in Spirituality
THE IMPACT OF ATTACHMENT TO GOD STYLE AND NEED SATISFACTION ON CLUSTER C PERSONALITY DISORDER
School of Psychology, University of Western Sydney
S18 PRIMARY MENTAL HEALTH CARE IN AUSTRALIA SINCE 1997: WHAT DIFFERENCE DOES A DECADE MAKE, AND WHERE TO NEXT?
1 Monash University
2 General Practice Mental Health Standards Collaboration
3 National Mental Health Consumer and Carer Forum
4 Royal Australian College of General Practitioners
5 Australian College of Rural and Remote Medicine
6 Australian Psychological Society
Describe primary mental health care in 1997 using national epidemiological data. Describe key stimuli to change from 1997 to the present Describe the developing role and work of the Collaboration. Using data from training providers, Medicare and program evaluations, estimate the separate and combined impacts of key stimuli on population health. Develop suggestions for future strategy.
In 1997 827,000 of 18.5M Australians received psychological care for a mental health problem and 573,000 had significant unmet need for psychological treatments. In 2007, with 20.8M Australians, the figure for this unmet need could be 644,000 people. Recent initiatives in GP training and other support for psychological treatments have been impressive, but sometimes open to criticism for lack of coherence and coordination of conception and implementation. Taken together, recent stimuli may have met up to 30% of the unmet need, but the distribution of activity is probably highly inequitable, leaving the situation in some areas relatively little changed.
S19 THE PSYCHIATRIST AND THE PHARMACEUTICAL INDUSTRY: CONNUBIAL HARMONY OR AN ILLICIT AFFAIR?
1 Clinical Pharmacologist, The University of Adelaide 2 Department of Psychological Medicine, Monash University 3 Department of Medicine, Monash University 4 Consultant Psychiatrist, Melboure
The RANZCP is currently reviewing its ethical guideline on the relationship between psychiatrists and the health care industry. Traditionally, it is the relationship between psychiatrists – as well as other medical practitioners – and the pharmaceutical industry that has received the greatest scrutiny, due to concerns that subtle (and not-so-subtle) pressures and inducements can influence the doctors’ prescribing patterns. This session has been organised under the auspices of the Board of Practice Standards and the Ethical Practice Committee to enable conference participants to hear a range of perspectives on this important question, and to express their views.
The presenters include a clinical pharmacologist, a psychiatrist who has been involved in industry-sponsored research, and a physician with an extensive interest and involvement in clinical ethics who recently chaired a review of the guidelines on the relationship with the pharmaceutical industry for the Royal Australasian College of Physicians.
Ample time will be allowed for discussion, which will be led by a consultant psychiatrist who was recently involved in a survey of the attitudes of RANZCP Fellows to the pharmaceutical industry and the role of the industry in sponsoring educational and other professional events, including conferences such as this annual meeting of the College.
S20 BROUGHT TO YOU BY ANZAPT
Topics to include but not be limited to: publishing issues (jointly presented by The Responder and Australasian Psychiatry) the current review of education provision preparing for life as an early consultant
S21 PSYCHIATRY AND THE CINEMA
1 Mid West Area Mental Health Service
Films are fascinated by doctors in general, and psychiatrists in particular. Meanwhile, psychiatry deals with human beings and their experiences, which are always the centre-point for the majority of films.
This seemingly benign interface takes on a life of its own and creates a concept of “movie/cinema psychiatry” in modern man's vocabulary. For example, complexities and controversies have arisen due to various portrayals of mental health professionals, depiction of ECT treatment, use of drugs by film characters, depictions of psychotherapy (including psychoanalysis), and suicide.
S22 USING SIX SIGMA METHODOLOGY TO REDESIGN A COMMUNITY PSYCHIATRIC SERVICE
1 Peninsula Health
2 JW Group
3 Bayside Health
The redesign led to the closure of separate CAT and case management services and the development of geographically based teams with a population health philosophy. This major redesign has been stressful for the team members and detail around this will be provided. Preliminary numerical data will be presented suggesting the change has had a positive impact on several KPIs.
CONTEXT BEHIND THE SERVICE REDESIGN AT PENINSULA HEALTH
Peninsula Health
AN OVERVIEW OF SIX SIGMA METHODOLOGY
JW Group
THE RESULTS OF A SIX SIGMA BASED EVALUATION OF PENINSULA HEALTH ADULT COMMUNITY PSYCHIATRIC SERVICES
JW Group
Define Measure Analyse Improve Control Evaluation Review of new care model Identify and analyse key consumer pathways Establish key stakeholders expectations Analyse process failures and root causes Identify and trial breakthrough opportunities Standardise key improvements Evaluate aims, process and outcomes
IMPLEMENTING A NEW MODEL OF COMMUNITY PSYCHIATRIC SERVICE, CHALLENGES AND PROCESSES
Peninsula Health
PRELIMINARY EVALUATION OF PHPS SERVICE REDESIGN
Peninsula Health
S23 PRE-PUBERTAL PAEDIATRIC BIPOLAR DISORDER – A CONTROVERSY FROM AMERICA
1 Flinders Medical Centre
There has been a surge in the diagnosis of bipolar disorder (BD) in the paediatric age group in the USA since the mid to late 1990s. The rise in diagnosis has been most marked for the pre-pubertal age group, a group for whom BD has traditionally been considered extremely rare.
The first paper examines possible factors driving this rise in diagnosis.
A second paper presents the results of a survey of Australian and New Zealand child & adolescent psychiatrists on the topic of BD in children and adolescents. There was a divergence of views but a majority of local child & adolescent psychiatrists hold traditional views that the disorder is rare in pre-pubertal children and are sceptical of practices in parts of the USA.
THE PHENOMENAL AND CONTROVERSIAL RISE OF PRE-PUBERTAL BIPOLAR DISORDER IN THE USA
SAHS-CAMHS, Flinders Medical Centre, South Australia
The controversy is nuanced between two quite different constructs-the “narrow phenotype” and the cbroad phenotype”, proponents of whom disagree-and also between those who hold to traditional views and see both phenotypes as lacking validity. The controversy has spilled over into the public media, partly fuelled by the tragic death of a 4 year old girl on 3 psychotropics for BD and ADHD diagnosed at age 28 months.
AUSTRALIAN & NEW ZEALAND CHILD & ADOLESCENT PSYCHIATRISTS' VIEWS ON THE PREVALENCE OF PAEDIATRIC BIPOLAR DISORDER (PBD) AND VIEWS REGARDING HIGH RATES OF PBD IN THE USA
SAHS-CAMHS, Flinders Medical Centre, South Australia
S24 AN OVERVIEW OF NEAR DEATH EXPERIENCES (NDEs)
1 Albert Road Clinic
2 Broadmeadows Adult Mental Health
3 Bendigo Health Care Group
Individuals faced with life threatening situations sometimes report unusual happenings. These are called near death experiences (NDEs). Core symptoms of NDE include out of body experience (OBE), feelings of peace, unpleasant noise, moving through a tunnel, meeting departed others as well as a being of light, a life review, arrival at point of no return and return to the earthly body. They have been reported over many centuries and has engendered debate as to its aetiology.
The prevalence of NDE is estimated at 4–8%in general population studies and varying proportions in special populations. These have varied from none to 100% occurrence in the different studies.
Electrical stimulation of the tempero-parietal areas of the brain has induced OBE. Among many biological factors n-methyl d-aspartate (NMDA) and anoxia are some of the more important factors the have been implicated in their genesis of NDE. Religious, cultural and situational factors too influence the manifestations of NDE.
NDE is considered as an experience rather than a psychiatric disorder. Neurochemi cal substrate as well as non-biological variables mediate the phenomenon. Health professionals need to be aware that some of those whom they seek to help may have been faced with a NDE and permit these individuals to narrate their experience within a non judgmental milieu.
S25 ATTENTION DEFICIT HYPERACTIVITY DISORDER FROM CHILDHOOD TO ADULTHOOD
1 Albert Road Clinic
2 Royal Children's Hospital
Attention Deficit Hyperactivity Disorder (ADHD) is a condition that is being increasingly recognized but engenders considerable debate regarding its management particularly in adolescents and adults. The prevalence rate is variously estimated at around 10% in childhood and in at least 5% of the adults in general populations.
We plan to discuss the diagnosis exploring the different types of presentations both in adults and in children and adolescents. Scientifically proven clinical modalities of treatment will be discussed. The changes that take place as the individual grows older and the co morbid conditions that occur in ADHD will be examined as well as the transition often required from paediatric to mental health services.
The disorder was initially described in the 19th century and has been recognized as a clinical entity since the early 20th century but called by different names. It is present in different parts of the globe. The diagnosis is primarily based on the history and corroborating evidence. The mainstay of treatment is medication with stimulant medicines considered to be most effective. Behavioural and other measures, usually in conjunction with medication help ameliorate its symptoms. The co-morbid conditions need to be managed appropriately along with the ADHD. Illness education for the individual and family or significant others is necessary.
Clinicians need to be aware of the illness and suspect the diagnosis. Appropriate management of the condition helps not only the individual sufferer but those near and dear and even the community at large.
S26 PSYCHIATRIC ASSESSMENT PRIOR TO LATE TERMINATION OF PREGNANCY: CLINICAL, ETHICAL AND LEGAL ISSUES
Princess Alexandra Hospital
S27 PSYCHOTHERAPY WITH PSYCHOTIC PATIENTS
1 Victorian Psychotherapy Section Committee
2 ORYGEN Youth Health
3 Royal Melbourne Hospital
4 University of Melbourne
5 The University of Sydney
In recent years there has been a growing interest in the non-biological treatments of schizophrenia and other psychoses. For some patients, psychotherapy can make a real difference. Nowadays, the challenge for therapists is to match the patient with an appropriate form of treatment, one that is suitable for the patient's needs, taking into account the particular time and stage of the patient's illness.
The Section of Psychotherapy aims to represent and promote all psychotherapies, but most members of the Section work in private practice, seeing patients in their consulting rooms and often working in comparative isolation from mainstream psychiatry. Many colleagues see themselves as not being in a position to work with patients suffering from these kinds of deficiency disorders, believing that such patients are better managed by those who are able to utilise a team approach in which team members can support the therapy though the difficult times when the patient and therapist are under some strain. Unfortunately this means that many talented therapists coming from very different settings, work in isolation from each other.
The Section would like to encourage more Fellows and colleagues to take an interest in working with psychosis.
There is much expertise in the Psychotherapeutic Treatment of Psychosis in Melbourne. The Section takes great pleasure in inviting five key clinicians and researchers to share their perspectives.
In this symposium, the five invited speakers will outline their differing approaches to therapy. We will also hear something about the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses (ISPS).
S28 MIRRORS IN THE BRAIN: THE ENTHRALLING AND MYSTERIOUS WORKINGS OF MIRROR NEURONS
In a series of papers in 1996, Rizzolatti and colleagues of the University of Parma in Italy showed that some premotor neurons in the monkey not only fired when it performed a motor act but also when it observed the act being carried out by others. They called these the ‘mirror neurons’. These neurons, initially described in the premotor and inferior parietal regions in primates and related to movement and perception, have now been demonstrated in humans, and may be involved not simply in imitation learning but in understanding the meanings of others’ actions. These neurons have also been described in the posterior parietal lobe, the superior temporal sulcus and the insula, suggesting important roles in understanding other people's feelings and intentions. They may also have a role in the acquisition of language. Their important role in social cognition is suggested by evidence that the mirror neuron system may be defective in autism. The discovery of mirror neurons has been one of the most exciting developments neuroscience in recent times, with broad implications for understanding the mind and its disorders.
S29 ADDICTION PHARMACOTHERAPIES: A CLINICAL UPDATE
ORYGEN Research Centre
Substance use disorders (SUD) are associated with high rates of physical and psychological morbidity, and are also frequently associated with a wide range of co-occurring mental health conditions. While there are a growing number of psychosocial interventions being developed for both primary and comorbid SUD, few effective pharmacological agents have been available until recently. In this symposium, experienced addiction clinicians and researchers will discuss existing pharmacotherapies for both licit and illicit drugs, as well as their appropriateness for individuals with comorbid mental health conditions. The symposium will provide an update on the utility of both classic and newer addiction pharmacotherapies, as well as a discussion of potential therapeutic targets.
PHARMACOTHERAPY FOR ADDICTION AND CO-MORBIDITY (ILLICIT DRUGS)
Dr Patrick Tolan1, Dr Stephen Jurd2, A/Prof Dan Lubman3
1 St John of God Pinelodge Clinic 2 Northern Sydney Central Coast Health 3 ORYGEN Research Centre
The presentation of management of pharmacotherapies for illicit drugs and associated co-morbidity is proposed as part of an addiction symposium.
PHARAMCOTHERAPY FOR ADDICTION AND CO-MORBIDITY
1 St John of God Pinelodge Clinic
2 Northern Sydney Central Coast Health
3 ORYGEN Research Centre
The presentation of management of pharmacotherapies for illicit drugs and associated co-morbidity is proposed as part of an addiction symposium
Pharmacotherapies may assist in the management of these disorders.
POTENTIAL ADDICTION PHARMACOTHERAPIES: INSIGHTS FROM PRECLINICAL RESEARCH
1 ORYGEN Research Centre
2 The University of Melbourne
S30 THE NEUROPSYCHIATRY OF NMS AND RELATED CATATONIC SYNDROMES
1 Prince of Wales Hospital
2 Royal Melbourne Hospital
This symposium features presentations which explore the understanding of a number of rare but fascinating conditions including catatonia, neuroleptic malignant syndrome and serotonin syndrome. Each presentation will feature a review, highlighting some of the controversies in conceptualization of these interrelated conditions. The talks will also probe clinical aspects of presentation, differential diagnosis and management of these complex conditions.
CK RISES, NMS, 5HT AND CATATONIA: 4 SYNDROMES OR 1?
Neuropsychiatry Unit, Melbourne Neuropsychiatry Centre
The initial excitement that elevated CK was a marker for psychotic illness in the early 70's subsequently gave way to the recognition of a syndrome characterised by CK rises, autonomic dysfunction, fever and motor abnormalities i.e. NMS. The late 1980's saw an explosion of reports of NMS and by the 1990's it was a frequently described and recognised syndrome. The advent of atypical psychotics has been associated with a decline in the prevalence of NMS but has also stimulated debate regarding the criteria required for the diagnosis of NMS. In parallel the widespread use of SSRI's was associated with increased reports of a syndrome associated with CK rises, autonomic instability, fever and motor abnormalities i.e. 5HT syndrome. The overlap between CK elevation, NMS, 5 HT syndrome will be discussed with reference to malignant catatonia and malignant hyperthermia.
ATYPICAL OR NOT? NMS ASSOCIATED WITH ATYPICAL ANTIPSYCHOTICS
Neuropsychiatric Institute Prince of Wales Hospital and Brain & Ageing Program, University of New South Wales
CATATONIA – THE CURRENT STATUS
Brain & Ageing Program & Brain Sciences UNSW, University of New South Wales & Neuropsychiatric Institute, the Prince of Wales Hospital
Catatonia has been classically linked to schizophrenia, but it is increasingly recognised that it is best conceptualised as a syndrome comprising a cluster of motor symptoms that can occur in a range of neuropsychiatric conditions. The classic literature contains a rich description of its psychopathology, with some of the features such as waxy flexibility, ambitendency, automatic obedience, psychological pillow, schnauzkrampf, etc. now rare clinical entities. A contemporary review of catatonia must confront a number of issues: is catatonia truly disappearing? Are there valid subtypes of catatonia? Is NMS a version of malignant catatonia? Does it deserve the status of a distinct disorder? Does the neurology of catatonia help us understand its pathomechanisms? What are the best management strategies? This paper addresses some of these questions from a perspective that draws from the literature and personal experience.
S31 BRAIN STIMULATION: FROM THEORY TO PRACTICE
1 University of New South Wales
2 Alfred Psychiatry Research Centre
There is growing interest in a number of brain stimulation techniques in the treatment of neuropsychiatric disorders. A clinical need for brain stimulation approaches is demonstrated by the significant proportion of patients with major depression who do not respond to standard approaches with antidepressant drugs and the psychotherapies. An increasing knowledge of the pathophysiology of major depression, has, together with this clinical need, provided impetus to apply and refine brain stimulation techniques such as electroconvulsive therapy (ECT), vagus nerve stimulation (VNS) and deep brain stimulation (DBS) to those with non-response to conventional treatments. This symposium will provide an overview of the advances in research and application of these three brain stimulation approaches in the treatment of major depression.
ELECTROCONVULSIVE THERAPY – ALTERNATIVE STRATEGIES AND NEW DEVELOPMENTS
School of Psychiatry, University of New South Wales
VAGUS NERVE STIMULATION IN TREATMENT RESISTANT DEPRESSION: EFFICACY AND CORRELATES
Neuropsychiatric Institute Prince of Wales Hospital and Brain & Ageing Program, University of New South Wales
DEEP BRAIN STIMULATION IN THE TREATMENT OF REFRACTORY DEPRESSION
Alfred Psychiatry Research Centre, the Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine
S32 VALEDICTORY FOR ERIC CUNNINGHAM DAX
Dr Eugen Koh, Ms Belinda Robson, Prof Ken Kirkby, Prof Brian Davies
