RANZCP Award Winners

Margaret Tobin Oration Abstract: Cultural Changes and Paradigm Shifts – a Challenging but Rewarding Journey

Kathryn Turner¹

¹Gold Coast Mental Health and Specialist Services, Gold Coast Health, Gold Coast, Australia

This Margaret Tobin Oration will describe the transformation of a small regional service to a major teaching hospital and tertiary service. Throughout this transformation, a key focus has been on training, development and support of staff, to facilitate excellence in clinical care within a recovery paradigm. There are times when there is a realization that a focus on incremental improvement does not appear to be addressing the issues that we are confronting and a major paradigm shift is required. This presentation will describe the journey of recognition for the need for a paradigm shift in addressing suicide prevention, the reasons the Zero Suicide framework was chosen to support this, and the challenges and rewards of this approach. A continued focus on staff engagement, development and training has been key to bringing about changes. Also of central importance was the recognition of the need to strive for a Just Culture to support the potential challenges associated with this framework. Just Culture is a frequently misunderstood concept, and at risk of being little more than an abstract idea. There will be a description of the journey to understand and move from principles of backward looking retributive justice, to more forward looking accountability of Restorative Justice, where we are all held accountable to learn, improve and participate in the healing process following adverse incidents. At its core is engagement of all stakeholders (consumers, carers, staff, organization, and community). This approach can ultimately lead to greater learning, improving and healing for all.

Senior Research Award Abstract: Anti-Neuronal Antibodies and Psychosis: What Psychiatrists Need to Know

J G Scott^1,2,3

¹School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia

²Queensland Centre for Mental Health Research, Wacol, QLD, Australia

³Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia

Background: Recently identified encephalitis arising from antibodies to N-Methyl-D-Aspartase receptors, (anti-NMDAR encephalitis) has provided an opportunity for research into autoimmune markers associated with psychosis. It is now apparent that a small proportion of patients presenting with psychosis have inflammatory activity in the central nervous system.

Objectives: To describe a programme of clinical research undertaken in Queensland Mental Health Services examining anti-neuronal antibodies in patients with psychosis and the neuropsychiatric sequelae of anti-NMDAR encephalitis.

Methods: Interdisciplinary research involving psychiatry, neurology, immunology and neuropsychology has examined the prevalence of anti-neuronal antibodies in patients with first episode of psychosis and the clinical outcomes with immunotherapy. Further research has examined the neuropsychological deficits associated with anti-NMDAR encephalitis.

Findings: Over three percent of patients admitted to hospital with first episode psychosis were positive for anti-neuronal antibodies and showed evidence of central nervous system inflammation. All responded favourably to immunotherapy. Some patients treated for anti-NMDAR encephalitis had spent many years in psychiatric care with treatment refractory illness prior to the diagnosis of an autoimmune disorder. Those patients with delays in diagnosis of encephalitis were more likely to have persistent cognitive impairment.

Conclusions: Autoimmune encephalitis presents a clinical interface between the disciplines of psychiatry, neurology and immunology. As a relatively new syndrome, there is much uncertainty regarding investigations, diagnosis and management of autoimmune encephalitis in people living with psychosis. This presents significant opportunities for further research and improvements in clinical care for those with psychosis arising from inflammatory activity in the central nervous system.