Abstract
Over recent months the Journal has developed several themes, reflecting serious concerns shared by both the profession and the wider community. These themes weave through the Journal, expressed in viewpoints, articles, editorials and letters. The writers include academics, researchers and clinicians. Many but not all are psychiatrists. Some have contributed data and reviews, whilst others have provided well-argued, informed contributions advocating a particular approach or point of view. The practise of psychiatry requires tolerance of uncertainty and ambiguity, and the ability to appreciate a range of perspectives. Recent editions of the Journal have included papers that challenge prevailing ideologies, present persuasive but directly opposing perspectives, and encourage the reader to critically examine their own beliefs and opinions.
The Healthy Kids Check (HKC) is a good example. Jureidini and Raven (2012) are not convinced of the benefits of population screening, especially for young children. In contrast, Kowalenko (2012) raises some questions about the HKC, but believes it is a good start towards improving the social and emotional wellbeing of pre-schoolers. These papers follow on from a debate, presenting five very different points of view, in the August issue of the Journal.
Frances (2012) was concerned that the HKC might result in children being treated unnecessarily with psychotropic medications. Research in this issue of the Journal (Partridge et al., 2012) indicates that the general community would be most unhappy about this possibility. Partridge et al. (2012) asked a representative community sample about the acceptability of using drugs to treat depression and ADHD. They found that just over half the participants thought drug treatment of depression was acceptable, but drugs for ADHD were more poorly regarded with only a third of participants approving of their use. The Journal has addressed this topic previously, with Whitely (2012) arguing that there is a danger that enthusiastic prescribers may create an epidemic of childhood ADHD, whilst in the same issue Levy (2012) provided data to counter Whitely’s claims.
The moral, ethical and practical aspects of doctors’ active participation in the death of their patients continue to challenge the medical profession. In this issue, MacLeod (2012) argues that psychiatrists should play a greater role in the assessment of patients requesting assistance with dying. Ryan (2012) provides a reflection on MacLeod’s review. This topic was explored earlier by Nitschke and Stewart (2011), Sher (2012) and Goldney (2012).
There has been considerable controversy about the risks and benefits of early intervention for young people with first episode psychosis, or at risk of psychosis, and much of the argument has taken place in this Journal. Castle (2012a) described ‘the truth, and nothing but the truth, about early intervention in psychosis’. McGorry (2012) responded with ‘truth and reality in early intervention’, and Castle (2012b) continued the search for the truth in the July issue. In this month’s issue, Nielssen et al. (2012) examine Castle’s assertions. In addition, opinion pieces by Yung (2012), Raven et al. (2012), and Simmons and Hetrick (2012) in the January issue, Carr (2012) in the April issue and McGrath (2012) in the July issue demonstrate the complexity of this debate, and the lack of agreement within the profession.
Politicians, and the general public, are worried about the increasing numbers of refugees joining our communities. In the current issue, the focus is on the effectiveness of interventions for refugees from Burma, and the results are encouraging (van Wyk et al., 2012). Silove (2012) highlights the need for more research to identify the best therapies for refugees and other survivors of mass conflicts. Rees et al. (2012) address another aspect of transcultural psychiatry, reporting on a study in Vietnam looking at the associations between physical activity and psychological distress.
Comprehensive data about the poor physical health of people living with psychotic disorders has been presented in the SHIP papers (Galletly et al., 2012; Cooper et al., 2012). Mitchell (2012) places these findings in an international context, concluding that Australian patients have the highest reported rates of medical comorbidity, even higher than rates in the USA. This month’s Journal also has two articles on less commonly researched aspects of depression, heart rate variability (Stapelberg et al., 2012) and cognitive function (Bourke et al., 2012)
Finally, Harris et al. (2012) present estimates of the services required to meet the needs of people with mental illnesses in Queensland. As a profession, psychiatry seems to be increasingly marginalised in the planning of services for our patients. It is important that we continue to be informed about the latest developments in this area so that we are able to participate effectively when opportunities do arise.