Suicidality Among Hong Kong Nurses: Prevalence and Correlates
T Cheung1, PSF Yip2
1School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
2Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong SAR, China
Background: Suicide rates among middle-aged employed groups have been increasing over the past few decades, especially in times of economic hardship. Nonetheless there are still few population-based studies of suicide among working-age professionals.
Objectives: The study estimates the prevalence and examines the socio-economic and psychological correlates of suicidality among professional nurses in Hong Kong.
Design: The study was conducted using a descriptive, cross-sectional self-administrative survey design.
Method: The data were collected in Hong Kong over a four-week period from October to November 2013. A web-based anonymous survey was used to estimate the prevalence rates of past-year suicidality in nurses. The study ran descriptive analysis and correlational, univariate and multivariate cumulative logit modelling.
Findings: A total of 850 purposive samples were collected at a response rate of 5.3%. A total of 14.9% of participants had contemplated suicide while 2.9% had attempted suicide at least once in the past year. Women reported suicidal thoughts or attempts more often than men. Religion, poor health, deliberate self-harm, depressive symptoms and poor self-perceived physical and mental health were significantly associated with nurses’ suicidality.
Conclusions: Nurse professionals are not immune from mental health issues. Hong Kong’s local health authority should put in place a raft of suicide prevention initiatives to promote mental wellness in the healthcare profession in Asia.
Dental Disease in Malaysians With Chronic Schizophrenia: A Neglected Public Health Burden
S Kisely1,2, MC Wey3, SY Loh4, JG Doss5, AK Abu Bakar6
1School of Medicine, The University of Queensland, Brisbane, Australia
2Griffith University, Gold Coast, Australia
3Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
4Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
5Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
6Permai Psychiatry Institution, Tampoi, Johor Bahru, Johore, Malaysia
Background: People with chronic schizophrenia have high rates of physical ill-health such as heart disease. However, there has been less attention to poor oral health including dental caries and periodontal (gum) diseases even though these have consequences for both quality of life and systemic physical health. There are no data from middle-income Asian countries.
Objectives: To measure tooth decay and gum disease in Malaysians with schizophrenia.
Methods: We recruited long-stay in-patients with schizophrenia in late 2014. Four dental specialists assessed oral health using the decayed–missing–filled teeth (DMFT) index, the Community Periodontal Index of Treatment Needs (CPITN) and Debris Index of the Simplified Oral Hygiene Index. Results were compared with the 2010 Oral Health Survey of the general Malaysian population.
Findings: A total of 543 patients participated [66.7% males, 33.3% females; mean age 54.8 years (standard deviation (SD) = 16.0)] with a mean illness duration of 18.4 years (SD = 17.1). The mean DMFT was 20.5 (SD = 9.9), almost double that of the general population (11.7). Bivariate analyses showed an association between both older age (p < 0.001) and longer duration of illness (p = 0.048), and higher DMFT scores. Only 1% (n = 6) had healthy gums. Levels of decay and periodontal disease were greatest in those aged between 45 and 64 years, and this coincided with the onset of tooth loss.
Conclusions: The management of comorbid dental disease in people with schizophrenia deserves the same attention as that of other comorbidities. Interventions include oral health assessments using standard checklists fillable by non-dental personnel, help with oral hygiene, management of iatrogenic dry mouth and early dental referral.
An Empirical Study Utilising Data from a Survey of Clinicians Regarding Stigma and the Term ‘Dementia’: would an Alternative Name Improve the Acceptability of the Diagnosis of Dementia?
U Ali1, G Byrne2, L Arnold2, K Hollingsworth2
1Royal Brisbane and Women’s Hospital, Brisbane, Australia
2University of Queensland, Brisbane, Australia
Background: The prevalence of clinically significant cognitive impairment increases significantly with advancing age. The syndrome of cognitive deterioration has been labelled ‘dementia’, which is a non-specific term covering a number of syndromes with a range of prognoses and treatments. The word ‘dementia’ has become associated with unintended negative connotations both within and outside of healthcare and carries stigmatizing potential. Reluctance to disclose the diagnosis of dementia has been reported by both general practitioners and specialists across many countries.
Objectives: To determine whether clinicians involved in caring for people with dementia experience stigma relating to the word ‘dementia’. The study also aims to assess clinicians’ opinions of changing the name of dementia and their opinions of particular alternative names.
Methods: The study utilized a survey-based design and was conducted during the Annual State-wide Older Person’s Seminar at the Royal Brisbane and Women’s Hospital. A total of 80 clinicians caring for people with dementia attended the meeting.
Findings: Out of 67 respondents, approximately 28% reported that they avoid telling patients the diagnosis of dementia. More than half of the clinicians (59%) felt their patients had been discriminated by other health professionals because of the label ‘dementia’, and the majority of clinicians were in favour of utilizing a different name for dementia. ‘Memory disorder’ and ‘cognitive disorder’ were the most popular alternatives; brain failure was the least acceptable.
Conclusions: This study shows that the label ‘dementia’ is a disliked, stigmatizing term, which may be delaying the disclosure of dementia by clinicians.
Partner Violence Among Women Seeking Psychiatric Outpatient Care: A Preliminary Survey
P Dasanayake1
1The Melbourne Clinic, Richmond, Australia
Background: Partner violence (PV) is a common phenomenon that crosses all social, racial and ethnic boundaries. Though widespread and not a new phenomenon, the subject of PV is relatively underexplored in Sri Lanka. The literature points towards a high correlation of PV with psychological distress, mental illness and suicidal attempts. So far no research has been performed on PV in a psychiatric population in Sri Lanka.
Objectives: Identify the nature and extent of PV among females seeking psychiatric outpatient care and impact on the mental health of the victims.
Methods: Twenty-five consecutive patients giving a history of PV were interviewed by the author. They were identified by direct questioning from among attendees who presented to a metropolitan community psychiatric clinic in Sri Lanka.
Findings: All participants had experienced significant physical and emotional abuse and three alleged sexual abuse as well. The majority of the respondents were depressed and somatisation was a common presentation. Six women attempted suicide with two attempts that were nearly fatal. Posttraumatic stress Disorder was the major problem for one. All of them had endured the abuse stoically despite their negative feelings towards their partner.
Conclusions: PV with psychiatric sequel is prevalent in Sri Lanka. Direct inquiry in this regard is important especially in developing countries.
The Moderating Effect of Authoritative Parenting on the Relationship between Neuroticism and Maladaptive Perfectionism
LHW Yu1, BCY Lo1
1The University of Hong Kong, Hong Kong SAR, China
Background: Maladaptive perfectionism is a specific vulnerability to psychological distress (especially anxiety disorders) in adolescence. Previous research has found a strong correlation between neuroticism and maladaptive perfectionism (e.g. Dunkley, Blankenstein & Berg, 2012). However, the underlying mechanism to this link remains unclear. Several theorists suggest that this robust relationship might be influenced by a family context, where parenting styles come into play (e.g. Enns, Cox & Clara, 2002).
Objectives: The present study aims to investigate the moderating effect of authoritative parenting on the relationship between neuroticism and maladaptive perfectionism.
Methods: A total of 164 students were recruited from seven local secondary schools to participate in this study. Students were invited to complete a questionnaire package concerning basic demographic information, family relations, personality and perfectionism.
Findings: Authoritative parenting significantly buffered the relationship between neuroticism and maladaptive perfectionism. When the level of authoritative parenting increased, the effect of neuroticism on maladaptive perfectionism decreased.
Conclusions: The family context in which maladaptive perfectionism develops is explored. Findings from the present study imply that neurotic children do not always develop maladaptive perfectionistic tendency if their parents express higher warmth and nurturance. When a higher level of authoritative parenting is adopted, the relationship between neuroticism and maladaptive perfectionism becomes weaker. Practical applications on risk prevention programs will be discussed.
Light in the Time of Shadows
V Stanganelli1,2, M Gingell, B Hansen, A Heywood, B Zelenka, S Spillman, P Sutton, A Howe, N France, J Travers
1Child and Youth Mental Health Services, Queensland Health, Mackay, Australia
2School of Medicine, James Cook University, Mackay, Australia.
Background: Youth suicides can appear in point clusters of both time and space in a small geographical area. These clusters create cumulative harm on the life of the youth population and perpetuate the risk of re-incidence. Objectives: The aim of this presentation is a retrospective analysis of the impact on our adolescents of the first, 2008 youth-suicide cluster.
Methods: Mackay is a 180,400 inhabitant-region in Queensland (Australia) with 25.8% aged 0–19 years. Over the past years, unemployment, family relocation, hopelessness and financial issues have affected the region. Our sample includes 737 hospital admissions of people between 0 years and 19 years of age for suicidal gestures from 2004 to 2015. An interdisciplinary mental health team treated the population of 66% females and 34% males with continuity outpatient care. Crisis intervention plans with suicidal prevention were successfully implemented.
Findings: Youth suicide behaviours have risen following the first, 2008 youth-suicide cluster with another peak in 2015. Adolescent females duplicated admissions while males remained steady. Their impulsive behaviours were driven by crises, losses, learning and legal problems, bullying, discrimination or lack of communication. Poisoning and hanging were high among them. A background of attachment and mood disorders, disabilities, substance abuse and personality traits were found in our sample.
Conclusions: About 2–5% of youth suicides appear in clusters and complicate the grief among adolescents with guilt, despair, identification and idealization. Social media was always used to communicate feelings of criticism, despair, death of peers and connections between them. A whole range of community approaches has been promising but long-term outcomes are still debatable. Somehow, it seems like searching for light in the time of shadows.
Could you Listen to me? Suicidal Attempts in Children
V Stanganelli1,2, M Gingell, B Hansen, A Heywood, B Zelenka, S Spillman, P Sutton, A Howe, N France,J Travers
1Child and Youth Mental Health Services, Queensland Health, Mackay, Australia
2School of Medicine, James Cook University, Mackay, Australia.
Background: Suicidal attempts among children are rare. It is still controversial whether or not they are considered attempts, gestures or behaviours.
Objectives: We share a 10–year-retrospective analysis of suicidal attempts among children in Mackay (Australia), considering their complex presentations in our individual approaches.
Methods: Our sample comprises 31 admissions for suicidal gestures (38.7% females and 61.3% males), of children between the ages of 0 and 12 years. A crisis intervention plan was tailored by an interdisciplinary team with a continuity outpatient care and family therapy approach.
Findings: Youth self-harming behaviours have risen following our 2008 youth-suicide cluster. High lethality suicidal attempts increased among children. There were impulsive behaviours driven by crisis, facing bullying, school problems, discrimination and lack of family communication. Hanging was the most popular method among males and poisoning in females. A background of severe attachment and mood disorders, disabilities and complex family dynamics were found in our sample.
Conclusions: Understanding suicidality among children requires listening to their intent and meanings of death, despite their inability to recognize lethality and outcomes. Family dynamics need to be unfolded and attachment based-family therapy seemed to have favourable results in these cases but in the context of an entire community compromise.
“Changing Lenses”: Communitarian Approaches in Suicidal Adolescents
V Stanganelli1, V Picon2
1James Cook University, School of Medicine, Mackay, Australia
2ESALCU NGO, Montevideo, Uruguay
Youth suicide is disturbingly growing around the world. Governmental and private resources are being allocated to understanding and preventing this phenomenon focused on information, mental health treatment and social support networks.
We reflect on similar narratives among adolescents across Aboriginal and multicultural Australia and ESALCU non-government organisation programs in the Americas (present in Argentina, Brazil, Chile, Haiti and Uruguay) working with restorative circle approaches in an array of social problems.
Preliminary research shows that among youth, beyond cultures, family violence, parental distress and separation, lack of connections, depression and substance abuse are causal factors that account for 90% of suicides.
Restorative-based interventions among families and communities can play an important role in suicide prevention and treatment. Restorative circles help heal trauma and grieving family members, providing them with a safe environment to share their story, address their values system, prevent further harm, lift the isolation and give people the space for meaningful interactions.
Further research on this subject is needed to evaluate results in order to further sanitary legislation to advance family conferencing as a cost-effective tool in suicide prevention and treatment.
Shall we Pour Lithium into the Water Supply? A Psychiatrist/Psychotherapist Reflects upon Neuroprotection
P Brous1
1Phoenics Health, Melbourne, Australia.
Background: Lithium salts have a valued role in the treatment of established psychiatric illnesses, such as bipolar illness. More recently, the anti-suicidal role of lithium is considered as being separate from its other therapeutic effects. Neuroprotection is now being explored in many areas of neurology and, to some degree, in psychiatry.
Objectives: This presentation aims to explore such evidence as exists, for the possible neuroprotective role of sub-therapeutic doses of lithium in mental disorders. It will also highlight some shortcomings of traditional methods of psychiatric practice.
Methods: A literature review will be presented.
The material will be explored from biological, systemic and psychodynamic perspectives. In particular, the nature of the transmission of psychological trauma in very closely cross-linked social groups will be highlighted. Its significance for adolescent suicides will be explored.
Current therapeutic approaches in high-risk communities will be outlined.
Findings: The limited literature raises the intriguing possibility that lithium, as providing neuroprotection in vulnerable general population groups, could be researched further. Factors promoting and hindering such research will also be discussed.
Conclusions: Lateral thinking is required to address the considerable difficulties that exist to meet the huge need for effective psychiatric services, particularly in high-risk populations.
Translating Research Knowledge in Dementia Care Organisations
H Alyami1, K Perry2, J Vanderpyl3, G Cheung4
1Auckland Regional Psychiatry Training Programme, Auckland, New Zealand
2School of Nursing, University of Auckland, Auckland, New Zealand
3Research and Evaluation, Te Pou, Auckland, New Zealand
4Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
Objectives: To evaluate dementia care organisations’ capacity to acquire, assess, adapt and apply dementia research.
Methods: We used the Canadian Health Services Research Foundation’s survey, ‘Is research working for you?’ by inviting the members of the New Zealand National Dementia Cooperative to participate in the online survey.
Findings: A total of 146 (32%) members responded and indicated that, although the workforce had the skills to engage in research and implement evidence into practice, there was limited organisational support in terms of the time, resources and access to external support.
Conclusions: We propose a number of strategies to improve knowledge translation in dementia care.
Barriers to Consultation-Liaison Psychiatry Referral: Referrals Prospective
KY Chen1,2, S Larkins2
1Townsville Hospital Health Service, Queensland, Australia
2James Cook University, Queensland, Australia
Introduction: Consultation-liaison psychiatry (CLP) is a subspecialty of psychiatry that provides care to general hospital. Despite mounting evidence for involvement of CLP for inpatients with psychiatric comorbidities, referral rates from treating doctors remain low. This narrative review aims to understand barriers to CLP referral.
Methods: Medline, PsychINFO, CINAHL and SCOPUS were searched using keywords for articles published between 1 Jan 1965 to 30 Sep 2015. 36 eligible articles were found that contribute to this topic and they were grouped into 3 categories: (1) Systemic factors; (2) Referrer factors; (3) Patient factors.
Discussion: This is the first narrative review of its kind that examines barriers to CLP referral. Interplay of these factors may need further research.
Conclusion: CLP clinicians should use the knowledge gained in this review to increase referral rates and bring about psychiatric care to non-psychiatric inpatients.
The Cinderella Specialty: It is Time to Talk About Recruitment Into Psychiatry from the Qualitative Evidence
K Leung1, T Awani2, C Chima3, I Udo4
1Surrey and Borders Partnership NHS Foundation Trust, Surrey, UK
2Michael Carlisle Centre, Sheffield, UK
3Birmingham and Solihull Mental Health NHS Foundation Trust, Solihull, UK
4University Hospital of North Tees, Stockton-on-Tees, UK
Background: Recruitment into psychiatry has been an important public health concern. Studies on recruitment problems in psychiatry have been mostly quantitative. However, these studies are limited in their ability to reflect the day-to-day influences and individual perspectives that may be affecting recruitment.
Objectives: This literature search aimed to identify the factors on recruitment into psychiatry by appraising available qualitative studies. By reviewing current evidence, policy can be better directed.
Methods: A literature search of databases was completed on Medline, PsycINFO and Embase using the Health Database Advanced Search (HDAS) tool on NHS Evidence. Inclusion criteria were qualitative studies and English language published papers. Ten qualitative studies were reviewed and appraised. Their common themes were identified.
Findings: The 10 qualitative studies used thematic analysis, phenomenology and narrative study methods. Populations studied were medical students, foundation doctors, residents/trainees, psychiatrists and undergraduate psychiatry teachers from the USA, UK, Australia, Canada and Ghana. The importance of role models, mentorship and supervision in improving recruitment are highlighted by these studies. There are additional factors including stigmatization in mental illness, satisfaction rates, interactive nature and academic interest within psychiatry.
Conclusions: The appraised studies are shown to be limited in their number and methodology. Available studies have limitations. The importance of teachers, mentors and role models in improving recruitment has been highlighted by the studies appraised. More qualitative studies are necessary to inform policy on recruitment into psychiatry.
The Perception of Recovery Among Patients With Schizophrenia: A Systematic Review and a Narrative Synthesis
SH Yip1, SF Leung2, K Cheung2, M Valimaki3
1Kowloon Hospital, Hong Kong SAR, China
2The Hong Kong Polytechnic University, Hong Kong SAR, China
3University of Turku, Turku, Finland
Background: Schizophrenia is a complex and chronic condition that significantly affects individuals’ psychological, social and occupational functions. The traditional concept of recovery from the illness was focused on symptom remission and functioning improvement. However, attention has been shifted beyond remission to personal recovery and its implication on recovery-oriented mental health services.
Objectives: The aim of this review was to describe the perception of recovery in patients with schizophrenia by understanding the concept of recovery from their point of view and exploring the realization of patient recovery on daily bases.
Methods: A systematic review was conducted for all qualitative studies published between January 2000 and September 2015. We searched six electronic databases – MEDLINE, PsycINFO, PsyArticles, CINAHL, Science Direct and PubMed – using the following keywords: recovery, schizophrenia, patient, client, service user, customer, consumer, peer, perception, view, understanding, belief, opinion, interpretation, description and experience. All quality of all included qualitative papers was appraised by using the Critical Appraisal Skills Programme (CASP) checklist and the findings were synthesized using narrative synthesis.
Findings: Electronic and hand searches identified 706 potentially relevant studies. Thirteen studies met the inclusion criteria. The themes identified were: process of recovery and its turning point; the role of self; family; social support; illness management; and spirituality. In addition, facilitators and barriers of recovery were revealed from the narrative synthesis.
Conclusions: The systematic review identified various perspectives in patients with schizophrenia’s perception of their recovery. The findings are important in assisting patients’ recovery and providing an insight for mental health professionals to develop a recovery-oriented service.
Zolpidem in Resistant Catatonia: Review of the Literature
G Asokan1, A Nelson2, A Gupta2
1James Cook University, Townsville, Queensland, Australia
2Flinders Medical Centre, Bedford Park, SA, Australia
Background: The role of benzodiazepines in catatonia is well known. There has been some evidence base with respect to the use of zolpidem, a selective gamma-aminobutyric acid A agonist, in patients presenting with resistant catatonia. We present a patient who responded well to a combination of zolpidem and electroconvulsive therapy (ECT). We also present a review of the literature regarding zolpidem’s efficacy in this group of patients.
Objectives: Review of the evidence related to zolpidem’s use in patients with resistant catatonia.
Methods: A PubMed search related to zolpidem and catatonia and an evaluation of peer-reviewed articles in relation to this topic.
Findings: There is evidence that zolpidem has selective benefits in patients with catatonia given its unique mechanism of action.
Conclusions: Due to the short-term release of catatonia observed in patients with zolpidem, there is a possibility of its use with ECT for resistant catatonia.
Reference: Tomas P, Rascle C, Mastain B, Maron M, Vaiva G. Test for catatonia with zolpidem. Lancet. 1997;349:702
Family Mental Health: Global Prospects for Improving The Focus on Families in Mental Health Services
A Falkov1
1Westmead and Royal North Shore Hospitals, Sydney, Australia
Background: Mental illness has profound implications for the affected individual and for that individual’s network of family and social relationships. The impact on families is therefore a significant public health issue with implications for affected individuals (children, young people and parents), for families, as well for service design and delivery. However, significant barriers to identifying parents in mental health (MH) services persist at the individual, service and system level, which hampers implementation of Family Focused Practice (FFP).
Objectives: This paper will use the interdependence between psychiatric symptoms in individuals and their core (family) relationships as the basis for comparing two-generation approaches in MH services in different countries. This is part of ongoing work by the ‘systems subgroup’ of the Prato initiative to enhance global efforts to improve FFP, encompassing evidence enhancements, policy refinement and practice improvement.
Methods: Presentation of key information as well as cross-national findings from a forthcoming paper on systems change.
Findings and conclusions: Creating an integrated, family-focused, MH ‘system of care’ requires broader reform. This includes sustained effort on many fronts, including development and use of evidence – from quantitative population-based public health (how many families? how much impact?) to treatment and prevention (what works, for whom, and how?); to alliances and partnerships for advocacy with consumers and carers across the spectrum of health and social care agencies. Inter-country alliances and partnerships will be an important addition to existing initiatives.
A Factor Analytic Study of the Adult Symptom Rating Scale (ASRS) for Attention Deficit Hyperactivity Disorder
M Perera1, G Hammond2, P Dassanayake3
1University of Melbourne, Melbourne, Australia
2North Metropolitan Health Service-Mental Health, Mt Lawley, Australia
3The Melbourne Clinic, Richmond, Australia
Background: Attention deficit hyperactivity disorder (ADHD) is recognized as having two major dimensions: inattentiveness and hyperactivity. There is a paucity of information on the factorial structure of the Adult Symptom Rating Scale (ASRS) in adults with ADHD, and the available research showing evidence for a weakly defined impulsivity specific factor.
Objectives: To determine the underlying dimensions of ASRS, using factorial analysis, in a sample of patients diagnosed with ADHD. To measure invariance across age (above and below 40 years), gender, and the interaction of the two.
Methods: Data from responses of the patients with ADHD to the 18-item ASRS were analysed. Seven main models incorporating second order and bi-factor structures were trialled using categorical Confirmatory Factor Analysis (CFA). Analyses were carried out using MPLUS 6.12. The model of fit was assessed using absolute (chi-squared) and relative fit indices (Comparative Fit Index) and (Trucker-Lewis Index). Measurements were made of invariance across age (above and below 40 years), gender and the interaction of the two.
Findings: Optimal model fit was observed for a bi-factor model with a general ADHD factor and three specific factors representing inattentiveness, hyperactivity and impulsivity. The use of a sum score was psychometrically appropriate and there was sufficient evidence for the endorsement of a separate impulsivity factor. Measurement equivalence was not achieved across age groups, with differential functioning observed for those above and below 40 years of age.
Conclusions: The ASRS remains a validated tool for use in Australian clinical populations. Impulsivity, along with hyperactivity and impulsivity, are separate dimensions. An ADHD presentation shows variation in later life.
Management Guidelines for Food Addiction
NB Pai1, I Goluza2, SC Vella3
1University of Wollongong, Wollongong, Australia
2Illawarra Shoalhaven Local Health District, Wollongong, Australia
3University of Wollongong, Wollongong, Australia
Background: Interest in the phenomenon of food addiction (FA) has increased recently, having gained further momentum since the inclusion of the first behavioural addiction, gambling disorder, in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5). Although the phenomenon of FA remains controversial, with some contending the phenomenon to be real and others denying its existence, clinically a need exists for the treatment of such symptomology. In addition to the impetus for treatment guidelines clinicians need to be alerted to the accompanying health risks associated with FA.
Objectives: Considering the potential magnitude of the problem of FA in the general population and the lack of clear and specific management guidelines for the disorder; we propose a set of clinical guidelines for management of the disorder.
Methods: Following a review of literature on FA, a systematic approach to management of FA is proposed.
Findings: In addition to providing a road map for the treatment of FA this research will also assist with clarifying the true nature of the phenomenon of FA including the course of the illness.
Conclusions: More research is therefore needed that focuses on the measurement, treatment and course of FA; as well as the clinical guidelines proposed. Better methods for assessment of psychological, behavioural and psychosocial variables that may be related to FA are needed. Further, a particular emphasis should be placed upon special population segments such as race, ethnicity and socioeconomic status.
Continuously Improving: the Peter Beumont Eating Disorders Service
L Chiem1, J Ross1, J Russell1,2
1Peter Beumont Eating Disorders Service, Royal Prince Alfred Hospital, Sydney, Australia
2University of Sydney, Sydney, Australia
Background: The Peter Beumont Eating Disorders Service is a state-wide tertiary eating disorders service that delivers a stepped model of care, located at the Royal Prince Alfred Hospital in Sydney, Australia. In the context of the New South Wales Health Service Plan for People with Eating Disorders, the Service has undergone significant enhancement over the past 12 months, including the opening of a dedicated inpatient unit in March 2015.
Objectives: Our objectives are to evaluate the patient demographics, their clinical parameters and outcomes as well as qualitative consumer feedback for the inpatient unit to guide continuous service improvement at a local and state-wide level.
Methods: Patient demographics and clinical information were sourced from both the electronic and paper medical records. Qualitative consumer feedback is routinely collected at time of discharge through a purpose-designed survey and this anonymous feedback was accessed from a central database.
Findings: A study of the preliminary data shows that the average age of the patient cohort is 27 years with a large proportion being female and not engaged in work or study. A total of 72% of patients were involuntarily admitted. The body mass index range on admission was 9–21 with average weight gain achieved per week of 850 g. There were no episodes of full-blown, re-feeding syndrome. There was a mixed response gathered from qualitative consumer feedback including requests for more group-based therapy (particularly occupational therapy groups) and frustration with nutrition intervention, food and weighing.
Conclusion: Ongoing quantitative and qualitative evaluation is vital in informing continuous improvement of a new tertiary service at both local and state levels.
Development of a Supported Employment Linkage Intervention for People with Schizophrenia at a Mental Health Unit: A Pilot Study
A Solar1,2
1University of Western Australia, Perth, Australia.
2Sir Charles Gairdner Hospital, Perth, Australia
Background: The author interviewed 10 multidisciplinary staff and 20 patients with schizophrenia to create an intervention linking people with schizophrenia, who want to work, to supported employment (SE) from a mental health unit (MHU).
Objectives: Pilot author’s proposed voluntary SE linkage intervention.
Method: Inductive analysis of serial interviews by the author with two mental health nurses about their experiences in implementing the six-month intervention on six patients.
Findings: The intervention was demonstrated to be feasible. The intervention further improved by: 1) the patient meeting the intervention nurse early in admission to build the relationship; 2) flexible follow-up phone calls once weekly or less often for six months post discharge; 3) the patient having support for obtaining the treating doctor’s report from the general practitioner and completing a job capacity assessment from Centrelink while in hospital. Positive staff experiences were: 1) providing a message of hope for patients, their families and MHU staff; 2) creating a stepwise structure for patients to find meaning; 3) increasing opportunity choice for patients in the MHU; 4) involving staff in continued improvement post discharge. With respect to job outcomes: patients 1 and 2 experienced an unsuccessful linkage with intervention because it was started too late in their admission for rapport; patient 3 started working in a warehouse using an old contact at two months post discharge and requested that intervention cease at four months; patient 4 left Technical and Further Education and requested support to link with SE at 3.5 months post discharge; patient 5 moved to closed employment; and patient 6 was proceeding with an SE linkage.
Conclusion: The improved intervention is practicable through offering greater choices to people with schizophrenia in the context of hope and a therapeutic relationship.
Chlamydia Infection in Youth who use Drugs and Alcohol: A Good Opportunity for Early Intervention
W Akosile1, B McDermott2
1University of Queensland, Brisbane, Australia2Princess Alexandra Hospital, Brisbane, Australia
Background: The rate of Chlamydia infection among young people with substance misuse problems is high compared to the general population. Only a few studies have estimated the risk factors associated with a positive diagnosis of Chlamydia infection.
Objectives: This study estimates the prevalence of Chlamydia infection among a vulnerable population of teenage substance users and also investigates risk factors associated with a positive diagnosis of Chlamydia infection.
Methods: Data were collected from the medical files of adolescents who attended a drug and alcohol treatment facility during a three-year period commencing June 2011. The total sample size was 149 consecutive patients of whom 127 (85.2%) met the inclusion criteria.
Findings: Chlamydia was significantly more often detected in female participants (12/64, 18.7%) compared with male (3/63, 4.8%, χ2 = 5.969, p = 0.01). The group with the highest rate of Chlamydia detection (18.0%) were the group positive for a past history of abuse, a psychiatric diagnosis and had ‘dropped out’ of school.
Conclusion: This study demonstrated that adolescents attending a drug and alcohol withdrawal service with a comorbid psychiatry diagnosis, a past history of trauma and who had dropped out of school had significantly higher rates of Chlamydia detection. Adolescents with drug and alcohol presentations are a suitable group for a targeted sexually transmissible infection screening initiative and subsequent early treatment of identified pathology. Public health initiatives should include provision of targeted interventions for at-risk youths in schools and adolescent psychiatry facilities.
Smartphone Application for Behavioural Intervention with at-Risk Drinkers
C Choo1, A Burton2, M Zhang3, R Ho4
1Central Queensland University, Queensland, Australia
2Murdoch University, Perth, Australia
3Institute of Mental Health, Singapore
4National University of Singapore, Singapore
Background: Problem drinking is a worldwide concern and is often a comorbid health problem for psychiatric illness. With the rising trend in e-mental health interventions, the advancement of smartphone technology has ushered in an era where smartphone applications can be used for behavioural intervention in problem drinking.
Objectives: The aim of the study is to contribute towards the development of a novel smartphone application for use with problem drinkers based on behavioural modification principles.
Methods: Seven postgraduate students in the School of Health Professions at Murdoch University were interviewed about the use of a novel smartphone application for behavioural intervention with problem drinking and the interview transcripts were subjected to thematic analysis.
Findings: Themes that emerged include: accessibility, milestones and commitment.
Conclusions: These findings shed light on the development of a novel e-mental health intervention for problem drinking. The implications for clients from diverse cultures and various age groups are discussed.
Psychosis in Methamphetamine Abusers - 3-Year Experience in Kowloon East Substance Abuse Clinic
JCW Leung1, WC Lam1, A Man1, S Lo2, NW Sezto2, A Sin3, P Kong4
1Department of Psychiatry, Kowloon East Cluster, Hong Kong
2Department of Occupational Therapy, United Christian Hospital, Hong Kong
3Medical Social Services Unit, Social Welfare Department, Hong Kong
4Department of Clinical Psychology, Kowloon East Cluster, Hong Kong
Background: A clinical presentation of psychosis in the context of substance abuse could be one of the main motivational factors for treatment
Objectives: To report the spectrum of psychotic illness and treatment patterns of methamphetamine users.
To describe different treatment strategies to address clients’ needs and improve the treatment concordance.
Methods: A total of 293 patients seen as new cases from 2012 to 2014 were recruited for analysis.
Age, gender, primary drug of abuse (DOA), principal psychiatric diagnosis, attendance rate, medication and multidisciplinary input were collected. Individual cases were discussed in multidisciplinary team meetings and health records were further reviewed for the updated psychiatric condition. The main outcome measures were the spectrum of psychotic illness and treatment patterns.
Findings: The mean age was 32 years (range 16–58 years). A total of 85 cases (versus 30 cases during another three-year period from 2009 to 2011) were identified with methamphetamine as their primary DOA. A current psychiatric diagnosis of psychotic disorder was formulated in 75% of methamphetamine users (64 out of 85 cases), of which 45% were diagnosed with substance-induced psychotic disorder and 24% with a dual diagnosis. In addition, 14% were recorded as presenting in an intoxicated state right upon our medical attention, while 6% were diagnosed with affective psychosis as their principal psychiatric diagnosis.Treatment strategies were adopted for motivational enhancement, which included mindfulness and positive emotion group programs by occupational therapists. Individual comprehensive neurocognitive assessments for clients were presented with cognitive problems by a clinical psychologist. These treatments helped to enhance the attendance rate and the regularity of ongoing follow-up.
Conclusions: An increasing trend for methamphetamine users to seek psychiatric treatment has been identified in the last three years. Psychosis is the main presenting illness. It is important to coordinate an integrated care plan to address the complex clinical needs of this group of patients.
Tweeting Links to Cochrane Schizophrenia Group Reviews: A Randomised Controlled Trial
M Jayaram1,2, C Adams3, A Bodart3, S Sampson3, S Zhao4, A Montgomery5
1Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
2Melbourne Health, Melbourne, Australia
3Institute of Mental Health, University of Nottingham, Nottingham, UK
4Systematic Review Solutions, Shanghai, China
5Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
Background: Social media is increasingly used to disseminate healthcare information; however, there are no trials to evaluate its effectiveness.
Objectives: To evaluate the impact of tweeting précis of Cochrane Schizophrenia Group systematic reviews on website activity.
Methods: A randomised controlled parallel group superiority trial with one-week follow-up was conducted (ISRCTN84658943) online by randomising 170 Cochrane Schizophrenia Group full reviews with an abstract and plain language summary web page. The intervention arm of 85 reviews received three random Tweets or Weibo messages, each containing a short URL to the freely accessible summary page sent on specific times on one single day. The control arm of 85 reviews received no messaging. The primary outcome was web page visits at one week; secondary outcomes were other metrics of web activity at one week.
Findings: Google Analytics allowed 100% follow-up. Intervention and control reviews received 1162 and 449 visits respectively (interrater reliability 2.7, 95% confidence interval 2.2–3.3). Fewer intervention reviews had single-page only visits (16% versus (vs) 31%, odds ratio (OR) 0.41, 0.19–0.88) and users spent more time viewing intervention reviews (geometric mean 76 vs 31 minutes, ratio 2.5, 1.3–4.6). Other secondary metrics all showed strong evidence in favour of the intervention.
Conclusions: Tweeting in this limited area of healthcare increases ‘product placement’ of evidence with the potential for that to influence care. This paves the way for similar trials using social media to evaluate most effective means for wider dissemination of evidence and influence policy making.
Autoluminescence or Self-directed Decay? Stigma, Internalization and the Future of Psychiatry
P Brous1
1Phoenics Health, Melbourne, Australia
Background: The need for mental health services has never been greater in Australia. The need for service provision has led to non-psychiatrists increasingly assessing and treating mental health disorders. This has coincided with the increased prescription of medications; the labelling of patients without ever making a diagnosis or formulation; the rise in ‘fashionable’ conditions such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD); and clashes between health ideologies and evidence-based practices. Often psychiatry is practised in major cities, let alone in rural Australia, without psychiatrists at all, or even without any psychiatric knowledge. How did a wealthy country like Australia get to this?
Objectives: This presentation will explore these issues, to highlight the role of stigma, its origins and extent; and its subtle impact. This affects the effective management of patients.
Methods: The presenter will draw upon her clinical experiences in her practice of youth psychiatry; from evaluations of current mental health services for youth; with examples from popular culture, media and film; and from ethology, evolution and marine biology.
Thus, this issue will be explored from some unusual, but hopefully illuminating, viewpoints.
Findings: Stigma is ever present in the community and in mental health services; and its relevance is underestimated and subtle.
Conclusions: Stigma required reflective thought. Mindless enactments or reactive responses can have destructive consequences.
Junior Registered Psychiatric Nurses’ Attitudes Towards Patient Violence and its Management in Hong Kong
CY Lam1, WT Chien1, SF Leung1
1School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
Background: Psychiatric nurses are at high risk of being exposed to workplace violence. With a shortage of nursing staff and training in the 2000s, junior psychiatric nurses in Hong Kong are required to make clinical decisions on the management of patient violence. However, there is a lack of research on these junior nurses’ attitudes towards patient violence and their preferred strategies to handle the violence.
Objectives: This aim was to investigate junior psychiatric nurses’ attitudes towards patient violence and the preferred management strategies at their workplace.
Methods: A cross-sectional, descriptive survey design was adopted. The Management of Aggression and Violence Attitude Scale (MAVAS) was mailed to junior psychiatric nurses (⩽ 5 years of post-registration experience) working in mental hospitals; and three open-ended questions were asked about the difficulties in, and important considerations for, management of violence.
Findings: The response rate was 49.5%. Participants (n = 104) generally agreed that internal, external and situational (interactional) factors could contribute to patient violence. The participants agreed relatively more that medication, de-escalation and physical restraint were more preferred than seclusion to manage violence. Most reported that insufficient staffing, skills and knowledge were the major hindrance to patient violence and its management. When the psychiatric nurses handled violent patients, they would consider patient and staff safety and de-escalation of patient anger and aggression, as well as the patient’s health condition and expressed needs.
Conclusion: This study indicates that junior psychiatric nurses perceived that multiple factors contributed to patient violence in psychiatric hospitals. The findings emphasize the needs for specialized training and sufficient staffing in violence management.
