RANZCP Abstracts.

RANZCP Abstracts

Keynote Presentations

Australian & New Zealand Journal of Psychiatry 2015, Vol. 49(S1) 1–122 DOI: 10.1177/0004867415578344 © The Royal Australian and New Zealand College of Psychiatrists Reprints and permissions: sagepub.co.uk/journalsPermissions.nav anp.sagepub.com

COMPUTATIONAL PSYCHIATRY AND THE MENTALIZATION OF OTHERS R Montague1,2

modeling may bring new diagnostic tools to the important problem of understanding how we understand others and how this can break down.

1Wellcome

Trust Centre for Neuroimaging, University College London, London, UK 2Virginia Tech Carilion Research Institute and Department of Physics, Virginia Tech, Roanoke, USA

WHAT CAN POPULATION-BASED STUDIES BRING TO INSIGHTS ABOUT THE HUMAN AGEING BRAIN AND OUR AGEING SOCIETIES? Background: Developmental disorders, personality disorders, and brain injury can impair the capacity to model C Brayne others around us. This includes the sophisticated ability to do image management – that is, build accurate models of others’ model of us. This capacity is essential in order to appreciate the impact of social gestures we emit toward others. This talk will examine new approaches to modeling these capacities, show the specific way they can break down in Borderline Personality Disorder, and offer a view of how simple forms of social reciprocation might be used to characterize these issues in the future. Objectives: 1. Understand the nature of reciprocal interactions among humans and how these can be used as probes of mental dysfunction; 2. Understand how simple games of economic exchange are being used to probe mentalization capacities; 3. Understand broadly the new approaches being used in computational psychiatry.

Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK

This talk will outline the challenges of our time and the recognition that global ageing is one of these. Dementia is the key brain disorder closely linked to ageing and it remains contentious whether it is age dependent or an age-related disorder. Dementia and cognitive decline are associated with functional decline and loss of independence. The talk will discuss how different research approaches inform our understanding of the dementia syndrome and how population-based studies have contributed specific insights as well as how these insights fit and challenge different research approaches. The potential for primary, secondary and tertiary prevention of dementia will be discussed and the strength of the evidence for these. Integration of approaches is suggested as the way forward to avoid earlier costly blind alleys and future harm.

Methods: Stylized games of reciprocation, computational models of mentalization, and functional brain imaging.

ADVICE FOR MEASURERS AND THINKERS: ANNOUNCING THE NEW Findings: Healthy human subjects show repeatable and SCIENCE OF GAPS characteristic patterns of brain response when reciprocating with others and these capacities can be captured in J Braithwaite simple computational models. These same models can also be used to identify specific deficits in subjects possessing an impaired capacity for mentalization and might one day be turned into diagnostic tools.

Conclusions: Impairments in social exchange characterize a range of mental dysfunction. These impairments can be identified using models of social exchange and mentalization. Early work in this area shows that computational

Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

Background: Psychiatrists are indeed measurers and thinkers, but they are first and foremost people—and they make the same fundamental error that everyone does. That mistake, a function of the way the brain works, is to think about things and concrete entities rather than Australian & New Zealand Journal of Psychiatry, 49(S1)

2 looking in the gaps between these things and entities. Here, we attempt to sort out this problem. Objectives: This keynote address aims to explicate a new science of gaps. Gaps are weightless, colourless and odourless—something you rarely recognise, and don’t give a second thought about when you do. And yet they structure your life, your relationships, your beliefs, and the universe. There are far more gaps than things, and far more gaps between ideas, and concepts, than we ever imagine. Methods: We will look through world history, examining some of the great minds who were gap-thinkers. We will see what we can learn from these intellectual leaders, and look to whether we, too, can become accomplished gap-thinkers. Findings: Looking at gaps where others don’t represents a novel and rewarding way of looking at the world. I hope we will find that such an approach, on detailed inspection, is useful for Congress participants. Conclusions: Welcome to the world of gaps. Becoming a gap-thinker requires a little bit of effort, but, more importantly, a willingness to take a new slant on what is already seen, naturally, because of our hard-wired cognitive architecture. But it might be exceedingly rewarding to make the transition.

BEYOND MARS AND VENUS: NEW SCIENTIFIC UNDERSTANDING OF THE GENDER GALAXY C Fine University of Melbourne, Melbourne, Australia

In recent decades, research from behavioural science and neuroscience has undermined an essentialist “Mars versus Venus” view of the sexes. Four key insights for understanding male/female differences in humans have emerged from this research. These overthrow traditional essentialist assumptions of large, distinct, fixed, timeless and deeprooted behavioural and brain differences between the sexes. Taking their place are the principles of overlapping distributions, “mosaics” of masculine and feminine characteristics in brain and behaviour, contingency of differences

Australian & New Zealand Journal of Psychiatry, 49(S1)

RANZCP Abstracts across time, place and context, and the “entanglement” of the individual’s biology with gendered experiences. I will summarise some of the empirical evidence for these key principles, and discuss their implications for scientific models and research.

AN AGENDA FOR INDIGENOUS EMPOWERMENT N Pearson Cape York Institute, Cairns, Australia

Disempowerment of our people is manifested at the personal level: in the lives of Indigenous individuals, families and communities. But this disempowerment is not just a manifestation of personal history: it is a manifestation of structural disempowerment.

FROM CONSULTING ROOMS TO GLOBAL RESEARCH: CLINICAL PSYCHIATRISTS WHO RESEARCH J Scott1,2 1The

University of Queensland Centre for Clinical Research, Herston, Australia 2Metro North Mental Health, Herston, Australia

It has been consistently shown that services engaging in medical research provide better health care to the patients they serve whilst simultaneously advancing knowledge. Psychiatrists are recognised as clinical leaders in mental health; however, most are not directly involved in clinical research. For many, barriers to research participation include a perceived lack of opportunity for involvement or lack of knowledge as to how to conduct research. Psychiatric research can take many forms and arguably endless opportunities are available to psychiatrists interested in pursuing their fascinating clinical observations. Whilst providing an update on some aspects of Australian research in early psychosis, public health promotion and the burden of disease attributable to childhood mental disorders, this talk will discuss opportunities for psychiatrists and trainees to engage in research.

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RANZCP Abstracts

Pre-Congress Workshops MEDICO-LEGAL REPORT WRITING J Chalk1, N McVie2 1Private

Practice, Brisbane, Australia Health Court Queensland, Brisbane, Australia; Forensic Psychiatry, Hunter New England Local Health District, Newcastle, Australia; Chair, RANZCP Faculty of Forensic Psychiatry

2Mental

system complexities of the discipline. This pre-Congress workshop will provide a forum where such advanced trainees can gather at a binational level, updating their knowledge and understanding of the field.

IS FORMULATION STILL NOTABLE This workshop will cover the general principles of medico- FOR ITS ABSENCE THAN ITS legal report writing, and the specifics of preparing reports OBSERVANCE? in both criminal and civil matters. 1 2, C Greaves3, P Foulkes4, The revised RANZCP Professional Practice Guideline M Daubney5 , J Randles 5 “Developing reports and conducting independent medical P Cammell , R Kalucy examinations in medico-legal settings”, due to be released in early 2015, will be referenced. The workshop is intended to be interactive, with some short report writing-related exercises. Participants are encouraged to bring examples of reports or prepared questions on the topic, for discussion.

CONSULTATION-LIAISON ADVANCED TRAINEE ACADEMIC SESSION P Pun1, J O’Callaghan1, C Gray2 1Princess 2Prince

Alexandra Hospital, Brisbane, Australia Charles Hospital, Brisbane, Australia

Background and objectives: This full-day pre-Congress workshop aims to provide advanced trainees in consultation-liaison psychiatry within Australia and New Zealand with a broad overview of the sub-specialty, meeting the academic objectives of the advanced training certificate. Methods: Expert speakers from Queensland in the fields of transplant assessment, neuropsychiatry, psycho-oncology, chronic pain, hepatitis C, sleep disorders and palliative care will present on these sub-specialist areas during the academic session. The program will conclude with an expert panel discussion on ethical issues in consultationliaison psychiatry, with case vignettes highlighting the complex issues of autonomy in palliative care settings, disclosure in transplant assessments and divided loyalties within multiple systems of health care. Findings and conclusions: The RANZCP sub-specialty of consultation-liaison psychiatry continues to attract trainees who are drawn to the academic stimulation and

1Griffith

University, Logan Campus, Meadowbrook, Australia Practice, Melbourne, Australia 3Private Practice, Brisbane, Australia 4Private Practice, Melbourne, Australia 5Flinders University, Adelaide, Australia 2Private

Background: At the 2009 College Congress, a presentation suggested that formulation is often notable for its absence rather than its observance (Korner et al., 2009). The most recent edition of a textbook of general psychiatry states that formulation skills are for those in specialist training to acquire and have as much relevance to the generalist as a formulation based on the patient’s serotonergic receptor status (Johnstone et al., 2010). A formulation may take different forms, but overall is a multilevel integrative statement that provides an aetiological understanding of factors contributing to the presentation and informs the development of a comprehensive intervention plan. Whilst the use of the formulation is emphasized in psychotherapy literature and training, it has relevance and use in general psychiatry. Objectives: To enhance the understanding of and effectiveness of training in the process of formulation, and to discuss its relevance more broadly in treatment. Methods: Members of the Section of Psychotherapy will present a half-day interactive workshop on formulation, covering: 1. A historical overview of the place of formulation; 2. Formulations will be presented from different perspectives; 3. Discussion of the relevance of the formulation in both psychotherapy and general psychiatry. Findings and conclusions: We hope to maximize the use and effectiveness of formulation in psychiatric practice.


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References Johnstone E, Owens D, Lawrie S, et al. (2010) Companion to Psychiatric Studies, 8th edn. Edinburgh: Elsevier. p. 221. Korner A., Bendit N, Ptok U, et al. (2009) Formulation, conversation and therapeutic engagement. Australian and New Zealand Journal of Psychiatry 43 (Suppl. 1): A32.

Objectives: Mental health can benefit from a critical appraisal of the impact of new funding models in other health sectors. In better understanding these system drivers, we can discuss how the mental health system may best respond to these changes. Methods: Through facilitated discussion, we will discuss how best to respond to the current challenges for the mental health system and what steps we could take now to move towards improved, more integrated service delivery models:

MENTAL HEALTH: NEW ALIGNMENTS FOR A NEW GENERATION SERVICE MODEL N O’Connor1,2, J Crawshaw3, D Butt4, H Whiteford5, Findings: The output of the workshop will be presented S Pontonio6,7,8, R Vine9,10 to wider conference participants (further abstract to be 1Northern

Sydney Local Health District, Sydney, Australia of Psychiatry, University of Sydney, Sydney, Australia 3Ministry of Health, Wellington, New Zealand 4National Mental Health Commission, Canberra, Australia 5Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Herston, Australia 6Health Nexus Pty Ltd, Melbourne, Australia 7National Institute of Organisation Dynamics Australia, Melbourne, Australia 8Pontonio Consulting Group, Melbourne, Australia 9NorthWestern Mental Health, Melbourne Health, Melbourne, Australia 10Department of Psychiatry, University of Melbourne Health, Melbourne, Australia

submitted for this) in a panel discussion.

2Discipline

Conclusions: Participants will be better informed of the implications of mental health and funding reform for best practice patient care. Congress attendees will be invited to join collaboratives/participate in specific initiatives/projects back in the field of practice, to demonstrate the potential benefits and improvements that can be achieved through redesigning systems of care at a local level. Clinical leaders will be engaged to discuss the role that they can play in driving policy and system changes.

Background: In spite of broad agreement around the principles of improved mental health service delivery, there remain a number of challenges related to:

USING ROUTINE OUTCOME MEASUREMENT IN PRACTICE AND SUPERVISION •• Changing funding models; 1 2 3,4 •• Lack of connectivity between sectors involved in R McKay , S Kisely , T Coombs service delivery; •• A lack of coherent care models.

These factors mitigate against significant advances in developing an integrated, ‘whole of health’, ‘whole of government’ approach. Different philosophies of care abound, performance measures are not supporting improvement and innovation, and there is a significant gap between best practice models of care and service delivery. The result is less than optimal care for patients. In recent decades, the Australian mental health system has undergone extensive reform. This reform presents both challenges and opportunities for the mental health system and its clinical leaders. Key challenges for psychiatry include: •• Harnessing influential thought leaders to shape policy; •• Promoting evidence-based practice; •• Developing new ways to achieve continuity of care for optimal patient outcomes.


1School

of Psychiatry, University of New South Wales, Sydney, Australia of Medicine University of Queensland, Brisbane, Australia 3Mental Health Illawarra Shoalhaven Local Health District, Wollongong, Australia 4Fellow Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia 2School

Background: Australia and New Zealand both have mandated systems for routine outcome measurement within public mental health services. A comprehensive 2014 review of the Australian system highlighted both support for routine outcome measurement and a need to spread good practice in the use of the mandated measures in practice. At the same time, the mandated measures are under evaluation in Australia for inclusion within activitybased funding processes. The RANZCP has completed two online modules to assist trainees in improving their knowledge and skills in this important area of practice. Objectives: 1. To familiarise participants with the content and learning objectives of the RANZCP online training.

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RANZCP Abstracts 2. To increase participants’ confidence and skills in using the supervision relationship to attain the competencies outlined in the online training. 3. To share and increase knowledge of successful strategies to practically use the standard mandated measures in clinical practice, service improvement and research. Methods: 1. Participants will be provided with links to pre-reading and external online training resources, but participation will not be dependent upon completion of these. 2. Elements of the RANZCP training resources will be explored and then methods to use in supervision workshopped in small groups with the assistance of additional vignette-type material. 3. Groups will share strategies considered useful in implementing the training. Findings: Strategies identified as useful during the workshop will be made available for wider use.

TRAINING WORKSHOP FOR STATE ASSESSMENT PANEL MEMBERS TO ASSESS SPECIALIST PATHWAY APPLICATIONS M Fogarty1, V Lakra1, A Tsesmelis2 1RANZCP

Committee for Specialist International Medical Graduate

Education 2RANZCP

Assessment Panels will be required to evaluate applications using the new assessment proforma. Based on the total points achieved and any gaps in applicants’ training, they will identify the necessary requirements candidates will be expected to complete to progress towards Fellowship. This workshop will be an opportunity to provide current and new State Assessment Panel members training for assessing applicants for Specialist Pathway. Objective: To provide State Assessment Panel members with a clear understanding of the Specialist Pathway assessment process and ensure they are competent in assessing candidates. The workshop will cover: •• An explanation of the Specialist Pathway eligibility and assessment process and requirements.

Ranzcp 2015 Examination Information Session APPROACHING THE CRITICAL ESSAY QUESTION AND THE MODIFIED ESSAY QUESTIONS IN THE RANZCP WRITTEN EXAMINATION L Lampe1, J Ferguson2 1Chair,

RANZCP Committee for Examinations Written Sub-committee, Member, RANZCP Committee for Examinations

2Member,

Secretariat

Background: Following the successful trial of Phase I of the Substantial Comparability Pathway, the Committee for Specialist International Medical Graduate Education (CSIMGE) opened Phase II of the Substantial Comparability Pathway in July 2014. Applicants for Phase II are assessed based on an assessment proforma developed and tested by the CSIMGE in consultation with all stakeholders, including the OTP Representative Committee. The Phase II assessment proforma incorporates the criteria in current use (pre and post specialist qualifications, training and experiences) as well as additional criteria such as Training Program Standards, Accreditation Criteria, Scope of Practice as a Consultant Psychiatrist and Recognition of Prior Learning. Each criterion is given points in accordance with whether it is substantially, partially or not comparable. Points are also taken off for lack of CPD activities or progress to Fellowship or recurrent failures at the clinical examination (applicable for current Exemptions Candidates). It is the responsibility of the State Assessment Panels to assess applicants for the Specialist Pathway. State

Objective: This workshop is designed to assist candidates to prepare for the Critical Essay Question (CEQ) and the Modified Essay Question (MEQ) components of the RANZCP written examination. Intended audience: These workshops are suitable for Trainees, SIMGs, Supervisors and Directors of Training. Background: The essay-style questions test capacity for clinical reasoning, critical thinking and the ability to communicate this efficiently and effectively in a professional writing style. The paper includes two components, the CEQ and a number of MEQs. The CEQ tests ability for critical reasoning and the capacity to express this in writing, which is considered to be an essential skill for a psychiatrist. In the 2012 Fellowship program the essay-style paper will be decoupled from the multiple choice-style paper, but candidates will be required to pass the CEQ in order to be awarded an overall pass in the essay-style paper. MEQs aim to test the application of knowledge relevant to clinical practice.


6 Methods: Members of the Committee for Examinations will discuss the approach to these question types, the required standard and how to demonstrate it (what the examiners are looking for), and will highlight skills and strategies for successfully passing this question type. Practical exercises will be used where possible. Note that practical exercises will be based on the 2003 Fellowship Program standard. However, as appropriate through the workshop reference will be made to changes that will occur when the essay-style paper is offered in the 2012 Fellowship Program. Please note that this information session is free of charge to all Congress attendees.

PSYCHIATRY AND SPIRITUALITY: AN UPDATE M Wong School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia

Background: While recent advances in philosophy and its interaction with neuroscience and psychiatry have helped psychiatry address its tendency to swing between “brainlessness” and “mindlessness” to a certain extent, many patients, carers and practitioners in the field continue to be concerned that the contemporary practice of psychiatry remains in a state of “spiritual neglect” or “spiritual ambivalence”, resulting in fragmented views of the person, restricted views of mental illness and reductionist rather than whole-person approaches to management. Objectives: This half-day workshop aims at providing an update on the major themes and issues involved in the interface between psychiatry and spirituality. Methods: At this workshop, Associate Professor Wong, a psychiatrist trained in neuropsychiatry with two doctorates in PET and MRI neuroimaging, and philosophy and theology, respectively, will provide a review of the latest research in the field of psychiatry and spirituality and an overview of various current applications of spirituality in the practice of clinical psychiatry and promotion of mental health and wellbeing. Findings: Recent surges of high-quality research and clinical data in the study of psychiatry and spirituality suggest a spirituality-informed approach to psychiatry and mental health has significant impact on prevalence and incidence of mental health problems, diagnosis and formulation, efficacy of intervention, compliance with treatment, relapse prevention, rehabilitation, recovery, health promotion, help-seeking behaviour and cost-effectiveness of service delivery. Australian & New Zealand Journal of Psychiatry, 49(S1)

RANZCP Abstracts Conclusions: The anticipated outcome of this workshop is to enable participants to acquire basic and essential knowledge of the study of spirituality in relation to psychiatry and to develop skills in the application of such knowledge to the practice of psychiatry.

SAFE WORK AUSTRALIA: WORKPLACE BULLYING M Williamson MMed Faculty, Westmead, University of Sydney, Sydney, Australia

Background: Safe Work Australia was established by the Safe Work Australia Act 2008 as a tripartite body funded by Commonwealth States and Territories, and made an Australian Government Statutory Agency on 1 November 2009. Its legislative program has been actively developing responses to workplace bullying with recent notable publications in 2013 (Safe Work Austrlia 2013a). Workplace bullying is an epidemic, its incidence is increasing and its impact on the mental health of employees and management is extreme. This is an area which College members should become familiar with as it will increasingly affect clinical practice. Objectives: •• To provide an update and review of recent Safe Work Australia reports on workplace bullying; •• To raise awareness of the social and clinical significance of workplace bullying; •• To promote understanding of workplace bullying; •• To assist in clinical management of those presenting with complaints of workplace bullying. Methods: •• Review of recent Safe Work Australia publication of draft model codes of safety and work practice in relation to workplace bullying reform; •• Discussion of Safe Work Australia in the clinical context; •• Consideration of clinical cases of reported bullying. Findings: Safe Work Australia is a serious legislative response to workplace bullying. Mental health clinicians need to be competent in assessing, treating and managing the effects of workplace bullying. Safe Work Australia (2013b) is an optimum source of information on workplace bullying. Conclusion: Safe Work Australia continues to respond to workplace bullying and its clinical implications for mental health. College support for the Legislative and Educational Program of Safe Work Australia is recommended.

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RANZCP Abstracts References Safe Work Australia (2013a) Preventing and responding to workplace bullying (27 November 2013). Available at: http://www.safeworkaustralia.gov.au/sites/SWA/about/ Publications/Documents/827/Guide-preventing-respondingworkplace-bullying.pdf Safe Work Australia (2013b) Dealing with workplace bullying: A worker’s guide. Available at: http://www.safeworkaustralia.gov. au/sites/SWA/about/Publications/Documents/828/WorkersGuide-workplace-bullying.pdf

PSYCHOTHERAPY SEMINAR – THINGS AS THEY REALLY ARE M Walters, A Unwin, S Gills Belmont Private Hospital, Brisbane, Australia

Background: The injunction to see things and ourselves as we really are is as old as civilization. Yet everywhere we are subjected to forces that bias our thinking without us being aware of them. We end up not understanding our lives and repeating old solutions to new problems and wondering why things don’t work out well. This seminar introduces a novel therapeutic approach that helps us decode complex clinical information in our patients’ stories and ultimately in the transference and countertransference. We use this knowledge to reveal the truth behind the biases and repetition compulsions that causes blocks in our lives and in therapy. Objectives: At the end of this workshop participants will: 1. Understand the historical and cultural imperatives to authentic knowledge; 2. Understand the theoretical approach to this therapeutic technique; 3. Be able to take a different sort of psychiatric history that identifies patterns and biases; 4. Use this information to help their patients see why they are psychologically ‘stuck’.

Ranzcp 2015 Examination Information Session APPROACHING THE RANZCP OSCE/ MOSCE ASSESSMENT (CLINICAL EXAMINATION) G Robinson Chair, RANZCP OSCE/MOSCE Sub-committee; Member, RANZCP Committee for Examinations

This workshop is designed to assist candidates to understand the nature and standard of the OSCE/MOSCE examination. The workshop will include presentations by the Committee for Examinations members of the common challenges faced by candidates and promote the development of strategies for successfully passing this assessment. This workshop is also considered beneficial for supervisors to develop familiarity with the format and process of the OSCE/MOSCE assessments and develop their understanding of the Committee for Examinations expectations of Trainee and SIMG Candidates. It is suitable for trainees, SIMGs, supervisors and Directors of Training. This workshop will also introduce candidates, supervisors and Directors of Training to: •• The process for developing an OSCE/MOSCE examination; •• The 2012 CBFP marking schema; •• The format of the OSCE/MOSCE examination; •• Approaching the Medicine as related to Psychiatry Station; •• The assessment/marking of the OSCE/MOSCE; •• Tips for passing the OSCE/MOSCE Examination. Please note that this information session is free of charge to all Congress attendees.

BEYOND IMPAIRMENT: USING THE LIVED EXPERIENCE OF MENTAL ILLNESS BY PSYCHIATRISTS TO IMPROVE CARE R McKay1,4, J Liggins2, J McMahon3,4, Findings: This new ‘take’ on therapy makes us more G Roper4 Methods: Candidates will be taken through a new method of history taking. They will be shown how to listen for patterns and to see clinical data as complex codes that conceal all our biases. expert at helping people see their lives and problems as they really are.

Conclusions: This therapy is derived from traditional psychotherapies. It doesn’t replace them. It enhances their efficacy by allowing practitioners to overcome roadblocks in therapy by helping patients see things ‘as they really are’.

1University

of New South Wales, Sydney, Australia Psychiatry, Middlemore Hospital, Auckland, New Zealand 3Private Mental Health Consumer Carer Network (Australia), Australia 4RANZCP Community Collaboration Committee 2Liaison

Background: Psychiatrists are just as vulnerable as the rest of the population to mental illness. The limited literature that exists largely focuses upon impairment and how Australian & New Zealand Journal of Psychiatry, 49(S1)

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this should be managed. There is increasing recognition of the importance of incorporating lessons from individuals with lived experience of mental illness into both direct mental health care and actions to improve the quality of this care; however, there is minimal literature that explores how these concepts apply to psychiatrists with personal experience of mental illness. The RANZCP Community Collaboration Committee is exploring options to redress this gap and look ‘Beyond impairment’. Objectives: 1. Identify key issues that require guidance or further exploration for the lived experience of mental illness by psychiatrists to improve mental health care; 2. Inform the potential development of a position statement regarding utilising the lived experience of psychiatrists; 3. Discuss future actions that may be appropriate; 4. Allow participants to share relevant experiences. Methods: 1. Presentation of literature and issues to consider including in a position statement; 2. Discussion of material in the context of participant experiences: whether from the perspectives of lived experience of mental illness, carer, psychiatrist, or a combination of these. Findings: Feedback will be used to confirm key themes to include in a position statement. This will be followed by discussion of potential future actions; together with potential benefits and risks of such actions. Conclusions: This workshop is seen as a key opportunity to shape how the lived experience of psychiatrists contributes to better mental health care.

Three Case based Discussions (CbDs) are done in the workplace by external Assessors after candidates have attempted a formative Case based Discussion assessment with the supervisor. This is one of a series of training workshops for potential external assessors of Substantial Comparability Pathway candidates. Fellows who are already supervising Specialist International Medical Graduate (SIMG) candidates involved in this pathway are encouraged to attend, as are any Fellows interested in supporting SIMG candidates in general. To be appointed as an Assessor, Fellows must have at least three years post-Fellowship experience and have an interest in and previous experience in supporting SIMG psychiatrists. The viability of the Substantial Comparability Pathway depends on having sufficient trained Assessors and Supervisors to complete all the assessment and supervision tasks. The workshop involves pre-reading and calibration of CbD material. The responsibilities of Supervisors are enhanced in this process and training as a Supervisor is completed via a different process involving review of written and DVD material and a teleconference. This is not suitable for potential candidates, who are encouraged to attend other sessions provided by the Committee for Specialist International Medical Graduate Education (CSIMGE) members. Objective: To achieve competency as an Assessor for the Phase II Substantial Comparability Pathway to RANZCP Fellowship. Methods: The workshop will cover: •• Explanation of the Substantial Comparability Pathway process and requirements; •• Training in the responsibilities of Supervisors and Assessors; •• Training in the use of workplace-based assessment tools including CbD and 360° feedback via calibration exercises.

TRAINING WORKSHOP FOR POTENTIAL ASSESSORS FOR THE SUBSTANTIALLY COMPARABLE PATHWAY TO FELLOWSHIP FOR SIMGS M Fogarty1, V Lakra1, A Tsesmelis2

OUT OF THE HORSE’S MOUTH: A NEW PSYCHOTHERAPEUTIC TREATMENT MODALITY A Kriegeskotten1,2, H Ohlsen2,3

1RANZCP

2Equiliberty

Committee for Specialist International Medical Graduate

Education 2RANZCP Secretariat

Background: The RANZCP Substantial Comparability Pathway to Fellowship involves at least 12 months of supervised and peer-reviewed practice with a significant workplace-based assessment and employer support.


1NCYP

(Northside Child & Youth Psychiatry), Brisbane, Australia Equine Assisted Psychotherapy, Brisbane, Australia 3Horse Sense for Humans, Brisbane, Australia

This is a hands-on workshop introducing you to Equine Assisted Psychotherapy. You will be interacting with horses in an arena under the guidance of a therapeutic team consisting of a psychiatrist and an Equine Specialist trained in the EAGALA model of Equine Assisted

RANZCP Abstracts Psychotherapy, and of course a few horses. We will also discuss the theory of this treatment modality. Equine Assisted Psychotherapy is similar to expressive psychotherapy. It is based on experiencing rather than talking, but here horses help facilitate the psychotherapeutic process. Even difficult to engage clients find that they cannot resist these living, breathing, powerful animals. Horses are prey animals and evolved in the presence of predators. To survive they developed exquisitely tuned senses. They can even sense the heart beat and breathing rate and therefore are able to sense the emotional state of others around them, even when these emotions are subconscious or suppressed. Horses naturally reflect each other’s emotions via behaviour and body language. They are masters of the here and now (mindfulness). These natural skills of horses can be used therapeutically. In a way

9 the horse in therapy is a conscious half-tonne biofeedback machine for the human client. This workshop aims to highlight the potential use and strengths of this type of therapy. In this full-day workshop you can have a range of experiences, from deep relaxation that comes with empathic attunement with the horse, to the excitement of joining with your team and the horses to work on a task together. For this workshop you do not require prior knowledge of horses. There is no riding involved as all the activities take place from the ground. For your own safety you’ll need to wear enclosed shoes or boots to keep your toes safe. This workshop takes place at a Riding for Disabled facility with their well-handled horses. Please dress according to the weather. We have a roof over the arena, but no air-conditioning.


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Symposium Presentations NEUROPSYCHIATRIC ASPECTS OF PARKINSON’S DISEASE PE Mosley1,2,3,4, R Marsh1,2,3, N Dissanayaka1,5,6, H Subramanian1, A Carter7, W Hall8, T Coyne9, P Silburn1,3 1UQ

Centre for Clinical Research, University of Queensland, Herston, Australia 2Department of Psychiatry, Royal Brisbane and Women’s Hospital, Herston, Australia 3Neurosciences Queensland, St Andrew’s War Memorial Hospital, Spring Hill, Australia 4Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Australia 5Neurology Research Centre, Department of Neurology, Royal Brisbane and Women’s Hospital, Herston, Australia 6School of Psychology, University of Queensland, Brisbane, Australia 7School of Psychological Sciences, Monash University, Melbourne, Australia 8Centre for Youth Substance Abuse Research, University of Queensland, Herston, Australia 9BrizBrain & Spine, Spring Hill, Australia

Background: Parkinson’s disease (PD) is the second most common neurological disorder affecting Australians and New Zealanders. Thirty Australians are diagnosed with PD every day, with an annual cost to the Australian economy of $775 million. PD has also been described as the quintessential neuropsychiatric disorder, on account of the numerous psychiatric symptoms that may arise from neurodegeneration, dopaminergic denervation and treatment with dopaminergic therapy. Issues such as depression, anxiety, psychosis, apathy, impulse-control disorders and dementia may lead to additional disability and magnify carer burden. Technologies such as deep brain stimulation (DBS) offer greater symptom relief and improved quality of life but can also be complicated by psychiatric side effects. Personality change due to disease, medication or neurosurgical intervention raises challenging ethical questions of autonomy, authenticity and harm that can be examined in this framework.

Clinicians from the Asia-Pacific Centre for Neuromodulation, the largest DBS centre in Australasia, introduce DBS for PD, what we can learn from psychiatric complications and where our experience in DBS for PD may lead in the treatment of psychiatric syndromes.

Presenter 1 CARE PRIORITIES IN PARKINSON’S DISEASE R Marsh1,2,3 1UQ

Centre for Clinical Research, University of Queensland, Herston, Australia 2Department of Psychiatry, Royal Brisbane and Women’s Hospital, Herston, Australia 3Neurosciences Queensland, St Andrew’s War Memorial Hospital, Spring Hill, Australia

Background: Parkinson’s disease (PD) is historically conceptualized as a movement disorder. Due to the enormous contribution of non-motor symptoms (NMS) to quality of life (QoL) measures in PD, NMS have become an increasing focus of clinical and research attention. The rise in the awareness of NMS, concurrent with increasing treatment options with associated neuropsychiatric risk, has complicated the assessment and management of this heterogeneous syndrome. PD is both a fluctuating and inexorably degenerative disorder. When this is overlaid upon the diagnostic and treatment difficulties inherent in the care of the medically ill, a bewildering matrix of interacting disease and treatment considerations can confront the clinician. Objectives: To describe an approach drawn from psychiatry’s tradition of case-based formulation and the biopsychosocial model, employing simple data visualization.

Objectives: To introduce the field of neuropsychiatry as it pertains to the care of individuals with PD. Taking stock of our knowledge about the link between neurological changes and psychiatric symptoms, to outline how this may assist us in the future treatment of psychiatric syndromes.

Methods: A brief overview of the more common NMS in PD will be presented. I offer an approach to the assessment of the PD patient with an emphasis on ‘burden of disease’, reconciled with current evidence in the treatment of NMS in PD. With the aid of illustrative vignettes and simple data visualization, I demonstrate the utility of a longitudinal, patient- and family-centred, biopsychosocial approach.

Methods: Local experts in the management of PD cover the key aspects in diagnosis and treatment of neuropsychiatric presentations. Leading neuroethicists discuss ethical challenges arising from unwanted effects of treatment.

Findings: More favourable QoL outcomes in both the short- and long-term management of NMS in PD may be possible with serial, comprehensive consideration of patient- and family-centred issues.


11

RANZCP Abstracts Conclusion: The assessment and management of NMS in PD may be amenable to an approach drawn from traditional methods of psychiatric formulation and enhanced by simple data visualization techniques.

show promising outcomes to reduce anxiety and depression in PD.

PRESENTER 3

CLINICAL, ETHICAL AND LEGAL IMPLICATIONS OF IMPULSE PHENOMENOLOGY AND TREATMENT CONTROL DISORDERS IN OF ANXIETY AND DEPRESSION IN PARKINSON’S DISEASE PARKINSON’S DISEASE A Carter1, W Hall2 N Dissanayaka1,2,3 Presenter 2

1UQ

Centre for Clinical Research, University of Queensland, Herston, Australia 2Neurology Research Centre, Department of Neurology, Royal Brisbane and Women’s Hospital, Herston, Australia 3School of Psychology, University of Queensland, Brisbane, Australia

Background: Anxiety and depression contribute to increased disability and poorer quality of life in Parkinson’s disease (PD). There is an overlap of symptoms between PD and anxiety/depression, and the relationship between motor fluctuations and mood and anxiety is complex. Consequently, these non-motor manifestations are often under-diagnosed and under-treated in PD. There is a need to identify PD-specific characteristics of anxiety and depression to improve assessment. Together with pharmacotherapy, psychotherapy interventions addressing PD-specific symptomatology are required for more effective treatment of depression and anxiety in PD. Objectives: To identify subtypes of anxiety and depression in PD, and to develop tailored psychotherapy treatment. Methods: A semi-structured interview was conducted in 90 PD patients to profile DSM-IV and subsyndromal anxiety and depression subtypes. The chronology was investigated in relation to a diagnosis of PD. Several psychotherapy interventions including cognitive behavioural therapy (CBT) and mindfulness were developed targeting PD-specific symptoms of anxiety and depression. Both CBT and mindfulness were trialled in two independent samples of PD patients. Findings: In addition to a DSM-IV diagnosis of anxiety and depressive disorders, a subsyndromal subtype of anxiety unique to PD is characterised in 27% of patients. PD-specific symptomatology was prominent in the subsyndromal anxiety group, and the onset was predominantly seen after a diagnosis of PD. Both CBT and mindfulness interventions significantly reduced anxiety and depression in PD. Conclusions: Identifying PD-specific symptomatology of anxiety and mood disturbances is important when assessing patients. Tailored psychotherapy interventions

1School

of Psychological Sciences, Monash University, Melbourne, Australia 2Centre for Youth Substance Abuse Research, University of Queensland, Herston, Australia

Background: Impulse control disorders (ICDs) are an under-recognised condition in Parkinson’s disease (PD). Almost one in five patients prescribed dopamine agonists for PD will develop an ICD, such as pathological gambling and hypersexuality. The ability for dopamine replacement therapy (DRT) to cause compulsive behaviours raises a number of ethical and clinical questions: Under what circumstances is it ethical to prescribe a medication that may induce harmful compulsive behaviours? Are individuals treated with DRT morally responsible and hence culpable for harmful behaviour related to their medication? Objectives: To determine whether ICDs can be caused by DRT and examine the implications for clinicians treating PD. Methods: We review the clinical literature on ICDs in PD and provide evidence that dopamine agonists play a causal role in ICDs. We consider the ethical and legal implications for professionals dealing with medication-induced ICDs by reflecting on a recent legal case study. Findings: There is strong evidence that dopamine agonists play a causal role in ICDs in PD, although not all patients develop them, suggesting that other factors are implicated. Further research is needed to understand how dopamine agonists cause ICDs and to develop effective treatments that are currently lacking (other than withdrawing a life-saving medication). These conditions also raise significant challenges for the judicial system. Conclusions: These findings highlight the need to prescribe these medications with care, identify those at risk and take steps to minimize the consequences of compulsive behaviour. Collaboration with addiction researchers may assist in the development of more effective treatment.


12

PRESENTER 4 DEEP BRAIN STIMULATION: A WINDOW INTO THE HUMAN BRAIN T Coyne3, P Silburn1,2 1UQ

Centre for Clinical Research, University of Queensland, Herston, Australia 2Neurosciences Queensland, St Andrew’s War Memorial Hospital, Spring Hill, Australia 3BrizBrain & Spine, Spring Hill, Queensland, Australia

Background: Deep brain stimulation (DBS) is a minimally invasive, reversible, functional neurosurgical intervention with increasing application in brain disorders such as Parkinson’s disease (PD), dystonia, epilepsy and chronic pain. It is a promising experimental therapy for intractable psychiatric conditions such as obsessive-compulsive disorder (OCD) and depression. Objectives: To provide an expert introduction to this technology from the perspective of the lead neurosurgeon and lead neurologist at the Asia-Pacific Centre for Neuromodulation, the largest DBS centre in Australasia. Methods: We outline the stereotactic neurosurgical technique, including target localisation, imaging, electrophysiological recording and device programming, in DBS for PD. We also describe how this technology can be used to dynamically study the conscious human brain at a neuronal and neural network level. Findings: We report findings from our research in PD that has revealed how circuits in deep brain nuclei interact in the coordination of human gait. We discuss how we have adapted this methodology to study the neural correlates of obsessive-compulsive behaviour in the first Australasian double-blind, randomised, placebo-controlled trial of DBS for OCD.

PRESENTER 5 IMPULSIVITY AND PERSONALITY CHANGE AFTER DEEP BRAIN STIMULATION FOR PARKINSON’S DISEASE PE Mosley1,2,3,4 1UQ

Centre for Clinical Research, University of Queensland, Herston, Australia 2Department of Psychiatry, Royal Brisbane and Women’s Hospital, Herston, Australia 3Neurosciences Queensland, St Andrew’s War Memorial Hospital, Spring Hill, Australia 4Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Australia


RANZCP Abstracts Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for the motor symptoms of Parkinson’s disease (PD). A minority of patients experience postoperative psychiatric symptoms, temporally linked to the onset or adjustment of neurostimulation. These attenuate the gains in quality of life observed after DBS. One cluster of symptoms includes hypomania, coarsening of personality, lack of empathy, impulsivity and compulsive behaviours, with a postoperative prevalence of 10–20%. Many clinicians are now aware of this post-DBS syndrome, although its phenomenological and neuropsychological aspects, and the connection with stimulation parameters, have not been extensively described. Objectives: To report findings from a longitudinal cohort study examining the characteristics of this post-DBS syndrome from a multidimensional perspective. Methods: Behavioural change was assessed serially using a range of validated instruments. Impulsivity was assessed serially using neuropsychological tools. Compulsive behaviours were identified in a semi-structured interview. The patient’s spouse rated caregiver burden and marital satisfaction. A further semi-structured interview investigated the experience and meaning of postoperative personality change. Stimulation fields were modelled and correlated with the patient’s neuroanatomy using the Medtronic Optivise program and diffusion tensor imaging. Findings: DBS of the STN may be associated with a sustained but reversible personality change, connected to stimulation parameters and the volume of activated tissue. The patient and his spouse may evaluate these changes differently. Conclusions: Post-DBS personality change has biological underpinnings. However, the patient may view them as an opportunity to revisit an “authentic” personality hitherto disrupted by PD.

PRESENTER 6 DEEP BRAIN STIMULATION AND PSYCHIATRIC SYNDROMES IN PARKINSON’S DISEASE: NEURONAL MECHANISMS H Subramanian1 1UQ

Centre for Clinical Research, University of Queensland, Herston, Australia

Background: Parkinson’s disease (PD) presents with a heterogeneous pattern of neurological symptoms and

13

RANZCP Abstracts psychiatric syndromes. These include depression, anxiety, cognitive impairment, and speech and vocalisation deficits. Many of these patients experience severe disease states. These can precede motor symptoms of PD and delay its diagnosis. These psychiatric syndromes may be triggered by alterations to neurotransmission in multiple brain areas and are associated with a range of autonomic disturbances (elevated blood pressure, aberrations in vagal tone, ataxic breathing, stress and urge incontinence). Objectives: To describe the significance of two key brain regions in the pathogenesis of psychiatric symptoms in PD. Methods: I describe the mechanism of action of deep brain stimulation (DBS) in the anterior cingulate cortex and the midbrain periaqueductal gray (PAG) using animal models. The experimental focus is on the effect of DBS on specific psychiatric syndromes such as anxiety and depression and its motor maps.

directions in understanding of their distribution and determinants and new treatments. Professor Zepf will present findings on sex differences in the neuromodulation of appetite via serotonergic action on leptin receptor levels. Professor Hay will present new data on the community prevalence and socio-demographic correlates of DSM-5 eating disorders. Professor Touyz will present recent work on the under-recognition and rising problem of eating disorders in males and approaches to management, and Dr Ward will conclude with an overview of a trial of a novel new therapy, deep brain stimulation, and discussion of putative mechanisms of its use in eating disorders.

PRESENTER 1

INTERACTION BETWEEN THE LEPTIN AXIS AND CENTRAL NERVOUS SEROTONIN SYNTHESIS IN HEALTHY ADULT FEMALES Findings and conclusions: The ACC is implicated in the FD Zepf1,2,3,4,5, VLS Dingerkus1,2, K Helmbold1,2, pathology of many mental disorders and could be the critiS Bubenzer-Busch1,2, CS Biskup1,2, B Herpertzcal mediator of psychiatric syndromes seen in PD, whilst Dahlmann1,2, M Schaab6, J Kratzsch6, A Eisert7, the PAG is the nucleus through which motor and autoL Rink8, U Hagenah1, TJ Gaber1,2 nomic deficits of psychiatric syndromes (including speech and vocalisation deficits) manifest. The findings will refine and enhance the design of neuromodulatory therapeutic interventions for PD in humans.

EATING DISORDERS BENCH TO BEDSIDE: NEW FINDINGS AND NOVEL DIRECTIONS F Zepf1, P Hay2, S Touyz3, W Ward4 1Department

of Child and Adolescent Psychiatry, University of Western Australia, Perth, Australia; Department of Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, Australia 2School of Medicine and Centre for Health Research, University of Western Sydney, Sydney, Australia; School of Medicine, James Cook University, Townsville, Australia 3School of Psychology and Centre for Eating and Dieting Disorders, Sydney, Australia 4Eating Disorders Service, Royal Brisbane and Women’s Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia

Background: Eating disorders are increasing in prevalence. Major challenges continue in the understanding of the neurobiology, determinants and treatment of both classic disorders such as anorexia nervosa and the newly introduced DSM-5 disorders such as binge eating disorder. Objectives: The aim of this symposium is to present a distillation of recent research in eating disorders, new

1Department

of Child and Adolescent Psychiatry. University of Western Australia, Perth, Australia 2Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, Australia 3Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany 4JARA Translational Brain Medicine, Aachen and Jülich, Germany 5Institute for Neuroscience and Medicine, Jülich Research Center, Jülich, Germany 6Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany 7Department of Pharmacy, RWTH Aachen University Hospital, Aachen, Germany 8Department of Immunology, RWTH Aachen University Hospital, Aachen, Germany

Background: Serotonin (5-HT) and the hormone leptin have been linked to the underlying neurobiology of appetite and hunger regulation, and with evidence coming from animal and cellular research. However, direct evidence linking these two separate pathways in humans is still lacking. Objectives: To study the relationship between central nervous synthesis of 5-HT and different parameters of the leptin axis in healthy adult subjects. Methods: We examined the effects of an acutely reduced brain 5-HT synthesis due to acute tryptophan depletion (ATD) on peripheral levels of soluble leptin receptor (sOb-R), the main high-affinity leptin binding protein, in healthy adults, using an exploratory approach.


14 Findings: In the present sample, women, but not men, showed reduced sOb-R concentrations after ATD administration. Conclusions: With females showing reduced baseline levels of central nervous 5-HT synthesis compared to males, diminished brain 5-HT synthesis as induced by ATD administration affected the leptin axis through the sOb-R only in females, thereby potentially influencing their vulnerability to dysfunctional appetite regulation and comorbid mood symptoms. We suggest a model for the interaction between central nervous 5-HT synthesis and the leptin axis, possibly via immunological pathways, which should be the subject of further research.

PRESENTER 2 THE PREVALANCE AND SOCIODEMOGRAPHIC DISTRIBUTION OF DSM-5 EATING DISORDERS IN AUSTRALIA P Hay, F Girosi School of Medicine and Centre for Health Research, University of Western Sydney, Sydney, Australia

Background: New DSM-5 diagnostic criteria for eating disorders were published in 2013. Adolescent cohort studies in the Australian community indicate that the point prevalence of DSM-5 eating disorders may be as high as 15% in females and 3% in males. Objectives: The present study aims were to determine the 3-month prevalence of DSM-5 disorders in a representative sample of Australian older adolescents and adults. Second aims were to explore demographic correlates of these disorders; specifically age, gender, household income and education level distributions. Methods: We conducted and merged sequential crosssectional population survey data of adults (aged over 15 years) collected in 2008 and 2009 (n = 6041). Demographic information and the occurrence of regular (at least weekly over the past 3 months) objective binge eating, extreme dietary restriction, purging behaviours and overvaluation of shape and/or weight were asked. Findings: The 3-month prevalence of anorexia nervosa and of bulimia nervosa were both under 1% but prevalence of binge eating disorder and other specified and unspecified eating disorders was around 5%. The prevalence of people with binge eating disorder that included presence of overvaluation of weight/shape was 1.8%. While people with anorexia nervosa were younger than others, the


RANZCP Abstracts median age was in the third decade and for all other eating disorders was in the fourth or fifth decade. Eating disorders were distributed throughout all income and educational groups and both sexes. Conclusions: The findings support the ‘democratisation’ of eating disorders and the relatively high prevalence of binge eating disorder compared to other eating disorders.

PRESENTER 3 MALES WITH EATING DISORDERS: FROM ANOREXIA NERVOSA TO MUSCLE DYSMORPHIA AND BEYOND S Touyz, S Griffiths, S Murray School of Psychology and Centre for Eating and Dieting Disorders, Sydney, Australia

Background: Eating disorders in males are understudied, under-recognised and misunderstood. Despite evidence that males constitute 25–33% of diagnoses of anorexia and bulimia nervosa, and up to 50% of diagnoses of binge eating disorder, limited research has focused on the “male experience” of eating and body image concerns. Objectives: We present evidence that disordered eating behaviours are increasingly more rapid in men than in women, particularly with regard to binge eating. Methods: We further present a clinical comparison of men with anorexia nervosa and muscle dysmorphia (“reverse anorexia”) and review community-held attitudes and beliefs about people with these conditions. Findings and conclusions: We conclude with a discussion of clinical treatment guidelines for males with eating disorders.

PRESENTER 4 ESTABLISHING A DEEP BRAIN STIMULATION TRIAL FOR PATIENTS WITH ANOREXIA NERVOSA W Ward1,2, P Silburn1,3,4, R Marsh2,4, C Randall2, P Mosley2,3 1University

of Queensland, Brisbane, Australia Brisbane and Women’s Hospital, Brisbane, Australia 3Asia-Pacific Centre for Neuromodulation, Brisbane, Australia 4St Andrews War Memorial Hospital, Spring Hill, Australia 2Royal

Background: Anorexia nervosa has the highest mortality rate of all psychiatric disorders. A significant minority of patients fail to respond to the best available current

15

RANZCP Abstracts evidence-based treatments. Deep brain stimulation (DBS) is an established, efficacious treatment for neurological disorders such as Parkinson’s disease. In the last decade it has been applied as an experimental treatment for intractable psychiatric disorders such as depression and obsessivecompulsive disorder, based on a model of severe psychiatric illness as pathological network dysfunction. Treatment-resistant anorexia nervosa is another candidate disorder, with promising results from two small open trials reported in the scientific literature. Objectives: To report on progress in establishing a trial of DBS for Treatment-resistant Severe and Enduring Anorexia Nervosa at the Asia-Pacific Centre for Neuromodulation. The centre has accumulated significant experience in monitoring efficacy and safety of this treatment in Parkinson’s disease, and has recently had ethics approval for a trial of DBS for obsessive-compulsive disorder. Methods: This presentation will include details on progress of seeking regulatory and ethics committee approval for such a trial, measures for monitoring efficacy and safety, as well as details of candidate deep brain structures for stimulation based on literature to date. Findings and conclusions: Ethical and legal issues, clinical safety and the putative neuromodulatory effects of DBS in people with eating disorders will be discussed.

AUTISM SPECTRUM DISORDER: ESSENTIALS FOR PSYCHIATRISTS C Franklin1, M Gattas2,3, D Dossetor4,5, N Lennox1 1Queensland

Centre for Intellectual and Developmental Disability, MRI/ UQ, University of Queensland, Brisbane, Australia 2Brisbane Genetics, Wesley Medical Centre, Brisbane, Australia 3Genetics Health Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia 4Sydney Children’s Hospital Network, Sydney, Australia 5Sydney Medical School, University of Sydney, Sydney, Australia

Background: Autism Spectrum Disorder is a rapidly evolving and expanding field due to numerous avenues of research across several disciples of medicine and allied health. People with autism are vulnerable to a range of psychiatric disorders throughout their lifetime and psychiatrists are increasingly asked to assess and manage people who present with autism spectrum disorders. Objectives: This symposium examines Autism Spectrum Disorder from a number of perspectives that are relevant to the clinical practice of psychiatry: clinical genetics, developmental psychiatry, and the physical and mental health of people with autism spectrum disorders.

Methods: Experienced specialists in their field will present clinically relevant material: 1. Autism and clinical genetics; 2. Autism: A developmental psychiatry perspective; 3. Physical health in autism: Common conditions and their management; 4. Mental health in autism: An update on the common psychiatric disorders and their treatment. Findings: There are a number of different specialist medical perspectives on autism spectrum disorders that can inform and enhance psychiatric care of people with autism spectrum disorders. Conclusions: Psychiatrists, as medical specialists, have an essential role in the assessment and management of the complex health problems associated with autism spectrum disorder.

PRESENTER 1 GENETICS AND AUTISM SPECTRUM DISODER M Gattas1,2 1Brisbane

Genetics, Wesley Medical Centre, Brisbane, Australia Health Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia 2Genetics

Background: Twin and other family studies have long identified genetic factors as having an important role in the aetiology of autism spectrum disorders (ASD). The technology of gene testing is evolving rapidly, and this is shedding some light on what is a complex issue from a genetic point of view. Objectives: The objective is to provide psychiatrists with a better understanding of the new gene testing technologies that are entering clinical practice, and to review some of the findings from research studies where this technology has already been used. Methods: A brief overview of historical and current methods used in genome analysis will be provided. The perspective will be from a clinical rather than a laboratory point of view. Findings: There is no single gene for autism. On the contrary, many areas of the genome have been implicated as contributing to this phenotype. Systems biology approaches can broadly group some of the genes identified into three broad groups: genes involved in formation of synapses, genes affecting transcription of other genes, and genes affecting chromatin or how the DNA is packaged in cell nuclei.


16

RANZCP Abstracts

Conclusions: Understanding the molecular biology of autism will also assist in treating a range of other adverse neuro-cognitive impairments such as epilepsy, psychosis, neurosis and intellectual impairment. This may not be so surprising to psychiatrists who have long recognized these disorders as common comorbidities in the same patient.

Conclusions: Such a collaborative clinical subspecialty service provision provides a best-practice model and would seem to be clinically highly cost-effective, but may not survive the ‘free market economy’ of the NDIS.

PRESENTER 2

PHYSICAL HEALTH IN AUTISM: COMMON CONDITIONS AND THEIR MANAGEMENT N Lennox

ASD AND DEVELOPMENTAL PSYCHIATRY: EXPERIENCE OF CHILDREN’S HOSPITAL AT WESTMEAD D Dossetor1,2 1Sydney 2Sydney

Children’s Hospital Network, Sydney, Australia Medical School, University of Sydney, Sydney, Australia

Background: Children with developmental disabilities including autism spectrum disorders (ASD) often have complex clinical needs. Traditionally there have not been specialised services, and children and adolescents with ASD have been expected to access generalist services. In this context, a unique developmental psychiatry clinical team was developed at Children’s Hospital Westmead (CHW) and later expanded to include the CHW SchoolLink. This team represents a collaboration between CHW, the Children’s Team of Statewide Behaviour Intervention Service of NSW Disability Services (SBIS) and NSW Department of Education. Objectives: This session will use the description of the existing specialist service built on a collaboration between the health, disability and education sectors and the projects it has achieved to reflect on the complexity of this clinical area. This will lead to a discussion about the service model that is most effective at meeting the complex needs of children and adolescents with developmental disabilities. Methods: Four major projects will be described: an evidence-based developmental framework and multidisciplinary training curriculum to promote the mental health of children and adolescents with intellectual and developmental disabilities, a school-based intervention for children with ASD (Emotion Based Social Skills Training), Stepping Stones (a group intervention targeting mental health promotion), and a clinical review of 150 clinical cases seen by the service. Findings: The positive outcomes from each of these four projects described show the potential for therapeutic gain in this challenging population. Much innovation and clinical benefit can be achieved by multidisciplinary multiagency collaborative partnerships, where skills and resources are shared.


PRESENTER 3

Queensland Centre for Intellectual and Developmental Disability, University of Queensland, Brisbane, Australia

Background: People with autism often have comorbid physical health conditions that can be communicated to others in unusual ways including changes in behaviour. This communication style can be difficult to interpret and, along with other barriers to healthcare, can result in missed diagnosis and consequent absent or inadequate management. Objectives: This presentation aims to present the associated comorbidities experienced by people with autism and to describe the healthcare experiences of people with autism and the perceptions of health professionals who have an interest in this population. Finally, the presenter will discuss how a psychiatrist can improve the healthcare experience of people with autism and increase the recognition and maximize the treatment of potential underlying physical conditions. Methods: We have undertaken a literature search of the grey and academic literature and explored what resources are currently available to physical and mental health professionals. The views of health professionals and adults with autism spectrum disorder have been sought by questionnaires, interviews and the reading of first-hand accounts written by people who live with autism spectrum disorder or those of their family. Findings: To improve the healthcare provided to people with autism spectrum disorder requires an understanding of their neurosensory profile, and how this and other aspects of the disorder influence communication of their needs. In addition, comorbid physical and mental health conditions are common and need to be considered in any healthcare interaction. Conclusions: Providing psychiatric care to people with autism spectrum disorder can be challenging; however, there exists a significant opportunity to improve the physical and mental health of this population, through an understanding of their experience of life, their communication style and a knowledge of common comorbidities and their management.

17

RANZCP Abstracts

PRESENTER 4 MENTAL HEALTH IN ADULTS WITH AUTISM SPECTRUM DISORDER C Franklin Queensland Centre for Intellectual and Developmental Disability, University of Queensland, Brisbane, Australia

Background: The assessment and management of psychiatric disorders can be especially challenging in people with autism spectrum disorder (ASD) due to associated difficulties in communication and social relatedness. There is very little psychiatric training in this area in Australia and New Zealand and many psychiatrists feel ill-equipped to manage patients who present with ASD. Objectives: This presentation aims to update the psychiatrist’s knowledge of the typical presentation and appropriate management of common psychiatric disorders in ASD. Methods: The presentation will focus on clinically relevant material that will help psychiatrists in their own clinical practice. Case material will be used to illustrate common presentations, followed by an update of the current literature, with emphasis on intervention and treatment options. Findings and conclusions: There have been recent innovations and advances in some areas of treatment of psychiatric disorders in ASD, especially for those with ASD Level 1 (previously known as Asperger’s syndrome). Intervention for people with more severe ASD remains an underdeveloped area but current research holds some hope for future improvements. Psychiatrists have an essential role in both the diagnosis of mental illness and appropriate treatment planning for people with ASD.

TRANSITIONS FOR PSYCHIATRISTS: LATER CAREER STAGES MEMBERSHIP ENGAGEMENT COMMITTEE SYMPOSIUM This symposium is an official presentation of the Membership Engagement Committee (MEC), focusing on later career transitions. The symposium will include presentations from four senior Fellows, each of whom has expertise in major career transitions. The focus of the symposium is on issues related to transitioning into a new career phase or towards retirement. Background: In response to needs expressed by members of the College, the MEC has organised this symposium as the first of an ongoing series, helping members

with relevant information and appropriate, practical resources at various stages of their careers. Objectives: The symposium aims to have a practical focus on important issues faced by psychiatrists, providing attendees with an opportunity to explore and discuss major career transitions relevant to latter stages of their careers. Methods: Four senior Fellows will speak on the following topics: •• Successful ageing, with specific reference to psychiatrists and doctors; •• Psychological aspects of transitions and changes later in life, •• Winding down a practice, cutting back or changing roles, •• Cognitive and physical problems that may challenge the ability to continue practice. Following the presentations, there will be a formal panel discussion of questions and issues raised by attendees. Attendees are encouraged to bring questions and contribute their own experiences to the discussion.

PRESENTER 1 WINDING DOWN A PRACTICE, CUTTING BACK OR CHANGING ROLES D Neill PRESENTER 2 COGNITIVE AND PHYSICAL PROBLEMS THAT MAY CHALLENGE THE ABILITY TO CONTINUE PRACTICE C Wijeratne PRESENTER 3 SUCESSFUL AGEING, WITH SPECIFIC REFERENCE TO PSYCHIATRISTS AND DOCTORS C Peisah PRESENTER 4 PSYCHOLOGICAL ASPECTS OF TRANSITIONS AND CHANGES LATER IN LIFE J Randles Australian & New Zealand Journal of Psychiatry, 49(S1)

18

RANZCP Abstracts

WHAT SHOULDTHE NEW GENERATION OF MENTAL HEALTH SERVICES BE AND HOW DO WE GET THERE? N O’Connor1,2, J Crawshaw3, D Butt4, S Pontonio5,6, R Vine7 1Northern

Sydney Local Health District, Sydney, Australia of Psychiatry, University of Sydney, Sydney, Australia 3Ministry of Health New Zealand, Wellington, New Zealand 4National Mental Health Commission, Canberra, Australia 5Pontonio Consulting Group, Melbourne, Australia 6National Institute of Organisation Dynamics Australia (NIODA), Melbourne, Australia 7North Western Mental Health, Melbourne, Australia 2Discipline

Background: The symposium will present the outcomes of the Pre-Congress Workshop that explored the key issues facing mental health service systems in Australia and New Zealand. In spite of broad agreement around the principles of improved mental health service delivery, there remain a number of challenges related to: •• Different levels of government, funding different programs, •• Lack of connectivity between independent sectors involved in service delivery, for example, acute sector, primary care sector, not for profit and other NGO support services, •• A notable lack of standardized care models in different jurisdictions. Key challenges for psychiatry include: •• •• •• ••

Harnessing influential thought leaders to shape policy, Driving an agenda to integrate existing models, Promoting evidence-based practice, Developing new ways to achieve continuity of care for optimal individual/patient outcomes.

panellists will each address the symposium for 10 minutes. This will be followed by a facilitated discussion with audience participation. Findings: Agreed priorities and actions will be documented during the symposium and will inform an article to be submitted to Australasian Psychiatry and to be reported back to the College Board. Conclusions: Psychiatrists have important leadership roles and can influence the mental health reform agenda and its implementation.

PRESENTER 1 WHAT SHOULDTHE NEW GENERATION OF MENTAL HEALTH SERVICES BE AND HOW DO WE GET THERE? J Crawshaw Ministry of Health New Zealand, Wellington, Wellington, New Zealand

Background: John Crawshaw has had a longstanding interest in leadership and management in psychiatry. He has held senior leadership positions in a number of jurisdictions in New Zealand and Australia. Conclusions: Dr Crawshaw will speak about the need to define leadership competencies, develop systems and programs to develop and support psychiatrists as leaders and senior managers, and how we might create the best conditions for ensuring the next generation of psychiatrist leaders.

PRESENTER 2

WHAT SHOULDTHE NEW GENERATION OF MENTAL HEALTH Objectives: The symposium aims to present the ideas generated in the Pre-Congress Workshop for discussion SERVICES BE AND HOW DO WE GET by the expert panel and symposium participants. The THERE? facilitated panel discussion and audience participation will D Butt test the ideas generated in the Pre-Congress Workshop and explore actions required of psychiatrists involved in leadership and management. The symposium is aimed at all psychiatrists and trainees involved or interested in leadership roles at various levels in the mental health system. Methods: The panellists will be asked to present what they see as the leadership priorities in relation to implementing the new generation of mental health services. The


National Mental Health Commission, Canberra, Australia

Background: David Butt has 30 years of experience in the health system at Executive level. Conclusions: David will focus on the national mental health policy within the context of health reform, reflecting on the key drivers of this policy and the implications to mental health service delivery.

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RANZCP Abstracts

PRESENTER 3 WHAT SHOULDTHE NEW GENERATION OF MENTAL HEALTH SERVICES BE AND HOW DO WE GET THERE? S Pontonio1,2 1Pontonio

Consulting Group, Melbourne, Australia Institute of Organisation Dynamics Australia (NIODA), Melbourne, Australia

services for those with severe and often enduring mental illness. Emphasis on de-stigmatising and increasing community awareness of mental health may have perversely lead to greater stigmatisation of those with severe illness and a downgrading of the importance and effectiveness of clinical intervention. Psychiatrists need to find a way of acknowledging the risks associated with severe illness, such as suicide, violence and homelessness, while also reassuring that with effective interventions all three can be mitigated.

2National

Background: Silvio Pontonio has extensive experience working in health systems in Victoria and developing innovative models of care under a range of funding arrangements. Conclusions: The time has come for major change in the national mental health system, but what might act as a circuit breaker or vehicle for this change? Activity Based Funding (ABF) will provide opportunities and potential threats for the mental health sector. Drawing on real world experiences and observations of the impacts of ABF in the Victorian public health system, Silvio will explore: •• The lessons from the Victorian ABF experience and what it may offer other sectors including mental health, •• How ABF in Victoria facilitated clinical, administrative and policy leaders to join forces to drive innovations in models of care, •• Opportunities to develop integrated models by adopting inter-sectoral partnerships.

PRESENTER 4 WHAT SHOULDTHE NEW GENERATION OF MENTAL HEALTH SERVICES BE AND HOW DO WE GET THERE? R Vine North Western Mental Health, Melbourne, Australia

Background: Ruth Vine is Executive Director, North West Mental Health, Melbourne and has previously been the Chief Psychiatrist of Victoria. Conclusions: Ruth will address an emerging issue: Despite the presence of mental health legislation and evidence of increasing acuity and pressure on inpatient services – especially high dependency areas – mental health leaders have struggled to articulate how and why there should be government and community support for clinical

PRESENTER 5 WHAT SHOULDTHE NEW GENERATION OF MENTAL HEALTH SERVICES BE AND HOW DO WE GET THERE? N O’Connor1,2 1Northern 2University

Sydney Local Health District, Sydney, Australia of Sydney, Sydney, Australia

Background: Nick O’Connor is Clinical Director at the North Shore Ryde Mental Health Service and Chair of the RANZCP Bi-national Special Interest Group Leadership and Management. Conclusions: Nick will facilitate the discussion around the issues that arose from the Pre-Congress Workshop, and the priorities identified by the expert panel and symposium participants. The outcome of the symposium will be a clearer idea about what specific actions psychiatrists might take at a range of levels to promote the reform and development required for better mental health outcomes.

TIME, CULTURE AND PSYCHIATRIC DIAGNOSIS S Balaratnasingam1,2, A Janca1, M Chapman1,2 1Kimberley

Mental Health and Drug Service, Broome, Australia of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia 2School

Background: Time is implicit in psychiatric diagnosis and integral to human existence, yet given little explicit attention. Objectives: Enhance awareness of time from a number of theoretical perspectives with a focus on clinical utility. Methods: Personal reflections and review of relevant literature regarding psychiatric aspects of time. Findings: Appreciating the implicit and explicit aspects of time in clinical practice will enhance psychiatric diagnosis and therapeutic interventions. Australian & New Zealand Journal of Psychiatry, 49(S1)

20 Conclusions: The concept of time is central to psychiatric practice and its impact needs to be appreciated to a greater extent.

PRESENTER 1 TIME AND CULTURE S Balaratnasingam1,2 1Kimberley


Background: The concept of time is implicitly and intricately involved in all aspects of clinical work in psychiatry. An awareness of differing views of time across persons, cultures and clinical disorders can significantly enhance the richness of psychiatric practice as well as the effectiveness of clinicians in the field. Objectives: To explore the concepts of time from varying theoretical orientations (phenomenology, physics, psychiatry, psychotherapy) with a focus on Australian aboriginal concepts of time. Methods: The author’s own experience as a psychiatrist in the remote Kimberley region of Western Australia and key literature on the subject are summarized. Findings: As described by Karl Jaspers in 1913, time is a fundamental and universal human experience which is central to our sense of existence and vitality. An understanding of different concepts of time is usefully and clinically relevant, especially in transcultural settings. Conclusions: Notion, perception and definition of the concept of time are often neglected in psychiatric practice. Practising clinicians need to bear this concept of time as it is relevant to both the science and the art of psychiatry.

PRESENTER 2 TIME AND PSYCHIATRIC NOSOLOGY A Janca School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia

Background: Both DSM and ICD classification systems use time as a vehicle to group and classify mental disorders into acute, chronic, episodic etc. Objectives: The author will explore the central concept of time in psychiatric diagnosis. In both DSM and ICD, the time criterion is used as an integral component of inclusion Australian & New Zealand Journal of Psychiatry, 49(S1)

RANZCP Abstracts and exclusion criteria for making specific psychiatric diagnoses. Certain aspects of time such as onset, recency, duration and frequency are often used as diagnostic and/or severity thresholds in clinical psychiatric settings. Finally, the timelines sometimes serve as arbitrary nosological boundaries that delineate normality from psychopathology (e.g. culturally acceptable length of bereavement process). Methods: The author’s own experience in developing sections of the World Health Organization’s ICD-10 diagnostic classificatory system and literature of relevant literature will be discussed. Findings: Time is an integral part of psychiatric diagnosis and more attention needs to be paid to this key criterion. Conclusions: “Linear” and “non-linear” concepts of time have significant impact on the classification, diagnosis and assessment of mental disorders across different cultures and settings, and psychiatrists would benefit from an enhanced awareness of its role.

PRESENTER 3 TIME AS THE GREAT HEALER M Chapman1,2 1Kimberley


Background: ‘Nobody has any time any more’ – a common refrain in today’s technically advanced society, and frequently heard in the clinical setting. A curious paradox in the age of ‘time-saving devices’. Conceptions of time pervade descriptions and experiences across the contemporary spectrum of ‘therapeutic intervention’ in psychiatry, as well as in service provision, measurement and configuration. From ‘brief interventions’ to ‘long cases’, ‘four hour rules’ to ‘numbers of bed-days’, ‘28-day readmission rates’ and ‘7-day follow-ups’, time has become a primary therapeutic measuring stick. Objectives: Explore the role of time in the health lexicon with an emphasis on roles and the meanings of time as a parameter in the realm of therapeutic intervention and resource allocation. Methods: Review of relevant health literature and author’s experience as medical director, clinician, researcher and psychotherapist. Findings: The time dimension is ever more critical in the quest for quantification of therapeutic intervention and this has consequences for our models of care and resource distribution.

21

RANZCP Abstracts Conclusions: Time has become a proxy for ‘cost’. The rise of linear time measurement as an ‘obsessive-compulsive symptom’, whilst covertly embedded in our conceptual, therapeutic and administrative systems, may be seen amongst other things as a prime marker and arbiter, as well as a consequence of our resource limitations and therapeutic models. Its rise is driven by our need to measure and quantify ‘activity’. As such it helps to fabricate our ‘hall of mirrors’ view of how best we should ‘provide care’.

RANZCP ADVOCACY TO IMPROVE THE PHYSICAL HEALTH AND LIFE EXPECTANCY OF PEOPLE WITH SEVERE MENTAL ILLNESS M Patton1, S Kisely2, W Miles3, G Roper4, Facilitator: D Siskind5 1President,

Royal Australian and New Zealand College of Psychiatrists (RANZCP), Melbourne, Australia 2School of Medicine, University of Queensland, Brisbane, Australia 3North Shore Hospital, Auckland, New Zealand 4Community Representative, RANZCP Consumer Collaboration Committee, Melbourne, Australia 5School of Medicine, University of Queensland, Brisbane, Australia

The RANZCP has been aware for some time that mental illness and various comorbid medical conditions, some arising from the treatments we prescribe, are amongst the most serious causes of disability in Australia and New Zealand. Research continues to demonstrate that the poor physical health of people with mental illness seriously impacts upon their quality of life and their life expectancy. The reasons are diverse including lifestyle, psychotropic side effects, stigma and difficulties in access to appropriate medical care. Psychiatrists are responsible not just for the clinical care of consumers but also for providing clinical leadership, teaching and training, researching, and advocating for better psychiatric health in the community. In 2014 the College published the first in a series of reports (available on the RANZCP website) which aim to engage Fellows, government and the wider community with this issue through policy review, economic modelling, case studies and consultation. This session explores the evidence base, clinical concerns, consumer experience and advocacy agenda for the College’s work in this area, and provides an opportunity for members to hear about the ongoing project and provide input for this work going forward. For more information about this project go to www. ranzcp.org/physicalhealth

PSYCHIATRY EDUCATION SYMPOSIUM: FOSTERING THE NEXT GENERATION L McLean1,2,3,4, L Nash1,5, S Kumar1, A Dwyer2,6, C Hickie7,8, B Kelly7 1Brain

and Mind Research Institute, University of Sydney, Sydney, Australia Medical School, University of Sydney, Parramatta, Australia 3Sydney West and Greater Southern Psychiatry Training Network, Parramatta, Australia 4Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, Australia 5Health Education Training Institute, Sydney, Australia 6New South Wales Institute of Psychiatry, Parramatta, Australia 7University of Newcastle, Newcastle, Australia 8Western NSW Local Health District, Orange, Australia 2Sydney

Background: Psychiatry is a great area of medical need, requiring suitable high-quality training in many settings to prepare doctors to deliver this specialized care, and the integration of many kinds of knowledge and skill. Objectives and methods: This symposium will offer talks on aspects of psychiatry training: 1. A discussion of the way philosophy and conceptual frames will be realized in a proposed new Formal Education Course (FEC) for Psychiatry Training in a Master of Medicine (Psychiatry) Programme at the Brain and Mind Research Institute (BMRI); 2. A discussion of active learning in the new BMRI FEC; 3. A report on a research project on teaching in psychiatry describing the design, delivery and evaluation of a module to help trainees prepare for an Entrustable Professional Activity in the CBFP aimed at that fundamental medical skill, particularly honed in psychiatry, the therapeutic alliance; 4. A report on a project that offered research and intervention in psychiatry teaching by junior doctors and trainees.

PRESENTER 1 A NEW PSYCHIATRY FORMAL EDUCATION COURSE: CONCEPTS AND PHILOSOPHIES L McLean1,2,3,4 1Brain

and Mind Research Institute, University of Sydney, Sydney, Australia Medical School, University of Sydney, Parramatta, Australia 3Sydney West and Greater Southern Psychiatry Training Network, Parramatta, Australia 4Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, Australia 2Sydney

This talk will present the underlying philosophy and conceptual frames for a new Formal Education Course, developed as the Master of Medicine (Psychiatry) Australian & New Zealand Journal of Psychiatry, 49(S1)

22 Programme at the Brain and Mind Research Institute (BMRI), University of Sydney The course has been accredited by the Royal Australian and New Zealand College of Psychiatrists. Set in the interdisciplinary/multidisciplinary environment of the BMRI, where researchers, clinicians and consumers collaborate, the course, with several pathways, aims to offer a training that will prepare the next generation of psychiatrists by: enhancing the neuroscientific and integrative medicine basis of psychiatry training; embedding the biopsychosociocultural model of psychiatry into trainees’ thinking and practice, along with the recovery model and trauma-informed care; providing opportunities to form interdisciplinary networks and collaboration through shared units of study with students from other disciplines; enabling students to access academic presentations of the latest research by visiting international and national experts; using learning and teaching methodologies with an emphasis on engaged enquiry, including research-enriched and communityengaged learning and teaching (ReLT and CeLT); providing opportunities for non-Sydney-based and outer metropolitan/shift-affected trainees to participate using online technologies; offering the chance for research training and projects in psychiatry. Samples of course outlines, learning outcomes and teaching formats will be described to illustrate how the philosophies and objectives intend to be realized. Ways of evaluating the overarching educational outcomes of the course are currently under development.

PRESENTER 2 UPDATE ON HIGHER EDUCATION: THE IMPORTANCE OF ACTIVE LEARNING S Kumar Brain and Mind Research Institute, University of Sydney, Sydney, Australia

Background: The world of education has embraced active learning and research. Problem-based learning is well known to recent graduates of medical schools, incorporating collaborative, case-based learning to promote effective thinking in students. The University of Sydney advocates engaged inquiry as a signature learning experience to foster a deep approach to learning. Psychiatry trainees are, however, involuntarily detained in a formal education course, which seems to negate some adult learning principles. Objectives and methods: This paper will report on forays into the world of higher education, philosophies and research to ask the question: How can we best harness the power of active learning strategies to assist trainees in


RANZCP Abstracts developing the competencies required for a reflective, communicative and evidence-based practice? Findings and conclusions: Trainees may need a blended learning approach but this will require active evaluation.

PRESENTER 3 A BRIEF TRAINING MODULE FOCUSING ON THE THERAPEUTIC ALLIANCE: DESCRIPTION AND OUTCOMES A Dwyer1,2,3, L McLean1,3,4,5, M Bowden6, K Egan7 1Sydney

Medical School, University of Sydney, Parramatta, Australia John of God Hospital, Richmond, Australia 3Sydney West and Greater Southern Psychiatry Training Network, Parramatta, Australia 4Brain and Mind Research Institute, University of Sydney, Sydney, Australia 5Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, Australia 6Children’s Hospital Westmead, Westmead, Australia 7Southeast Sydney and Illawarra Psychiatry Training Network, Randwick, Australia 2St

Background: Establishing a therapeutic alliance is one of the fundamental skills in medicine, particularly in psychiatry. This has been recognized in the development of the Competency Based Fellowship Program (CBFP) of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) by the development of an Entrustable Professional Activity (EPA) in the therapeutic alliance. How this skill can best be taught, however, is not clear, particularly considering time and resource constraints in medical education settings. The NSW Institute of Psychiatry (NSWIOP) funded a fellowship in medical education and psychotherapy in 2014 to encourage the development and appraisal of a brief training module in the development of the therapeutic alliance for basic psychiatry trainees. The module’s effectiveness was designed to be measured in an open trial by pre and post teaching scale scores of the Working Alliance Inventory (therapist form) (WAI-T) and the Groningen Reflective Ability Scale (GRAS) for both participants and a control group. Objectives and methods: This presentation will describe the development of the module, barriers to its implementation, and the initial process and outcomes of its implementation. Findings and conclusions: Delivering teaching in the difficult service settings of psychiatry remains a challenge.

23

RANZCP Abstracts

PRESENTER 4 EVALUATION OF A WORKSHOP TO INCREASE TRAINEE TEACHING CAPACITY L Nash1,2, C Hickie3,4, B Kelly3 1Brain

and Mind Research Institute of University of Sydney, Sydney, Australia 2Health Education Training Institute (HETI), Sydney, Australia 3University of Newcastle, Newcastle, Australia 4Western NSW Local Health District, Orange, Australia

Background: A collaborative mixed methods project between University of Newcastle, the NSW Institute of Psychiatry and Western NSW Local Health District was conducted in 2012–2014 to investigate the teaching experience of basic psychiatry trainees and to explore ways to increase their teaching capacity. Objectives and methods: Methods and results of the project will be presented. The respondents identified key areas that needed tuition, with the following rating highly: 1) difficult scenarios with medical students; 2) managing clinical teaching in a time-efficient manner. This led to phase 2 of the project, in which workshops were delivered in rural and metropolitan NSW to address these concerns. In addition, funding was received in 2013 from HETI and Health Workforce Australia to make five short films as workshop teaching aids. The initial research findings informed these films, which can be used to teach psychiatry trainees, junior doctors and consultants to enhance teaching capacity. Evaluation feedback (mixed methods) was collected after each workshop and will be presented. Findings: We found that 96% of trainees had a medical student attached to them on clinical rotation, yet only 20% had received any teaching tuition. The 2013 workshops used difficult scenario role plays and the 2014 workshops used the films and role plays. The 2012 study results have been published and presented at conferences and the films have been presented at national and international conferences. Conclusions: Symposium participants will have the opportunity to view a workshop film and be given details of free online access.

ENGAGING THE NEXT GENERATION OF PSYCHIATRISTS M Tomasic1,2,3, E Halley4, G Byrne5,6, A Willis7, AA Sanchez8, B Jayawardena9 1Chair,

RANZCP Recruitment into Psychiatry Working Party Past President, RANZCP

2Immediate

3Centre

for Disability Health, Department for Communities and Social Inclusion, Adelaide, Australia 4General Manager, Education and Training, RANZCP 5School of Medicine, University of Queensland, Herston, Australia 6Geriatric Psychiatry, Royal Brisbane and Women’s Hospital, Herston, Australia 7Wellington Community Mental Health Team, Wellington, New Zealand 8University of Melbourne, Melbourne, Australia 9University of Western Australia, Perth, Australia

Background: Research shows that psychiatry has had an image problem amongst many medical students and graduates. This presentation highlights work being undertaken by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to turn this around. Objectives: Increasing numbers of medical students graduating presents an opportunity to raise the profile of psychiatry, dispel common misconceptions and position psychiatry as a potential career. Methods: The RANZCP, through its Recruitment into Psychiatry Project, supported by Commonwealth funding, has developed a suite of initiatives to engage with medical students and graduates including: •• The Psychiatry Interest Forum (PIF); •• Student sponsorships to attend the RANZCP Congress; •• Dedicated PIF conference events; •• A bi-national essay competition; •• Introduction to Psychiatry short courses; •• Relationship building with university medical schools; •• New resources for students and their teachers. Findings: The initiatives have been welcomed by students, graduates and universities: •• Over 1,000 students and graduates have joined the PIF; •• Over 30 students have been sponsored to attend Congress; •• 78 attendees participated in the Introduction to Psychiatry courses (over 200 applications were received); •• Course attendees reported a 63% increase in considering psychiatry as a career and a 96% increase in awareness of training pathways. The success of these initiatives is thanks to the involvement of over 70 Fellows and trainees. Conclusions: The Recruitment into Psychiatry Project is successfully raising the profile of psychiatry and providing RANZCP Fellows and trainees the opportunity to engage with and inspire the next generation of psychiatrists.


24

THE RANZCP CLINICAL PRACTICE GUIDELINES AND THEIR IMPLEMENTATION M Oakley Browne1,2, G Smith1,3,4 1Royal

Australian and New Zealand College of Psychiatrists of Psychiatry, School of Medicine, University of Tasmania, Hobart, Australia 3School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia 4Centre for Research into Disability and Society, Curtin University, Perth, Australia 2Department

Background: In 2012, the Clinical Practice Guidelines Project commenced to systematically review and update six Clinical Practice Guidelines (CPGs) previously developed by the Royal Australian and New Zealand College of Psychiatrists in 2005. In addition, consensus-based guidelines on the physical health care of people with enduring psychotic illness have been developed. Objectives: The aims of this symposium are to provide an update on the CPG Project and to discuss the plans for dissemination and implementation of the guidelines once they are released. Methods: The CPGs were put through a robust review and redevelopment process. The consensus-based guidelines on the physical health care of people with enduring psychotic illness were produced using the Delphi method.

1Royal

Australian and New Zealand College of Psychiatrists of Psychiatry, School of Medicine, University of Tasmania, Australia 3 Concord Centre for Cardiometabolic Health in Psychosis, University of Sydney, Sydney, Australia 4Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia 2Department

Background: People with enduring psychotic illness have high mortality rates, with a 1.5–5 times higher risk of developing cardiometabolic risks compared to the general population. The issues are compounded by a dearth of evidence on the efficacy of screening, assessment, monitoring and management approaches for this population. The case for clinical guidance is compelling.

W

Objectives: To develop consensus-based guidelines that are inclusive and respectful of the perspectives of clinicians, people with enduring psychosis, and families and carers.

N


PHYSICAL HEALTH CARE OF PEOPLE WITH ENDURING PSYCHOTIC ILLNESS M Oakley Browne1,2, T Lambert3, N Reavley4, A Jorm4

A

Background: The Clinical Practice Guidelines Project was commenced to systematically review and update six Clinical Practice Guidelines (CPGs) previously developed by the Royal Australian and New Zealand College of Psychiatrists in 2005. The six original CPGs were: Anorexia Nervosa; Bipolar Disorder; Deliberate Self Harm (youth and adult); Depression; Panic Disorder and Agoraphobia;

PRESENTER 2

R

Australian and New Zealand College of Psychiatrists of Psychiatry, School of Medicine, University of Tasmania, Hobart, Australia 2Department

Findings: The Eating Disorders CPG was published in November 2014, with the CPGs for Schizophrenia, Deliberate Self Harm and Mood Disorders expected to be published early in 2015. The key recommendations of each published CPG will be discussed.

D

1Royal

Methods: Five working groups (WGs) were established to review and update the CPGs. Once the WGs had produced a first draft of the CPGs, they went through various rounds of internal and external review before being submitted to the Australian and New Zealand Journal of Psychiatry for publication. Consumer and carer versions of the revised CPGs are also being developed to complement the full guidelines.

H

CURRENT STATUS OF THE RANZCP CLINICAL PRACTICE GUIDELINES PROJECT M Oakley Brown1,2

Objectives: The aims of the CPG Project were to develop usable and accessible resource documents based on the latest international evidence-based practice to enable quality psychiatric and mental health care in Australasia and New Zealand, and to promote and disseminate the developed resources to better inform consumers, carers and mental health clinicians about appropriate, and inappropriate, treatment options for the Australasian and New Zealand psychiatric/mental health care setting.

IT

PRESENTER 1

and Schizophrenia. It was decided to merge the Bipolar Disorder and Depression guidelines into a single guideline covering the spectrum of Mood Disorders. It was also decided to broaden the scope of the Anorexia Nervosa guideline to include the range of Eating Disorders.

W

Findings: The Eating Disorders CPG was published in November 2014, with the CPGs for Schizophrenia, Deliberate Self Harm and Mood Disorders expected to be published early in 2015. The consensus-based guidelines on the physical health care of people with enduring psychotic illness will also be published in 2015.

RANZCP Abstracts

25

RANZCP Abstracts

W

Methods: The Delphi expert consensus method was used. A systematic review of websites, books and journal articles was conducted to develop a 416-item survey containing strategies that health professionals should use to treat, manage and monitor the physical health of people with an enduring psychotic illness. Three panels of Australian experts (55 clinicians, 21 carers and 20 consumers) were recruited and independently rated the items over three rounds, with strategies reaching consensus on importance written into the guidelines

I T

H

D

Findings: Following three rounds of surveys, clinicians endorsed 386 of the 430 items (89%). In the first-round survey, the people with enduring psychotic illness and carers endorsed all 117 items (100%). The endorsed strategies provided information on: engagement and collaborative partnerships; clinical governance; risk factors, morbidity and mortality in people with enduring psychotic illness; assessment, including initial and follow-up assessments; barriers to care; strategies to improve care of people with enduring psychotic illness; education and training; treatment recommendations; medication side-effects; and the role of health professionals.

R

A

W

N

Conclusions: The guidelines are intended to be used by health professionals, people with an enduring psychotic illness, and their families and carers. It is hoped that they may inform policy and practice in organisations supporting people with enduring psychotic illness.

PRESENTER 2 IMPLEMENTATION OF CLINICAL PRACTICE GUIDELINES M Oakley Brown1,2, G Smith1,3,4 1RANZCP

Committee for Therapeutic Interventions and EvidenceBased Practice 2Department of Psychiatry, School of Medicine, University of Tasmania, Hobart, Australia 3School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia 4Centre for Research into Disability and Society, Curtin University, Perth, Australia

Background: On completion, the Clinical Practice Guidelines Project will have systematically reviewed and updated six Clinical Practice Guidelines (CPGs) previously developed by the RANZCP. However, the development and publication of guidelines does not in itself ensure their use in practice and consideration must be given to dissemination and implementation. The success of clinical guidelines in changing practice and patient outcomes depends on factors such as the methods used to develop the guidelines, the dissemination and implementation strategies used, the methods used to evaluate effectiveness, the methods used to update the guidelines and the clinical setting.

Objectives: The RANZCP intends to follow the release of its CPGs with strategies for implantation and evaluation. Methods: The following six key implementation processes have been identified: planning, educating, financing, restructuring, managing quality, and attending to policy context. There is also a need to overcome barriers at the service, patient and illness levels, emphasising the need for service reorganisation, communication enhancement, improved training and education, better incentives, accreditation rigour, and government leadership. Findings: Interventions that could be implemented are: •• Decision-support systems and other reminders; •• Interactive educational meetings (local workshops; workshops at annual congress); •• Clinically focused e-learning modules for CPD; •• Local opinion leaders/local consensus quality improvement audit and feedback tool(s); •• Patient mediated Evaluation surveys should be developed and administered at 6 months and 12 months post-release and dissemination of the CPGs and should assess how well the guidelines are known and valued by users, the extent to which the recommendations are applied and the extent to which the application leads improved care. Conclusions: As passive dissemination methods alone are less likely to lead to changes in professional behaviour, a formal structured implementation process must be developed which draws on the available evidence relating to behaviour change among healthcare professionals and the effectiveness of different dissemination and implementation strategies.

INTEGRATION OF RESEARCH INTO PSYCHIATRIC PRACTICE: A GUIDE FOR NEW INVESTIGATORS AND THE SCHOLARLY PROJECT D Siskind1,2,3,4, S Parker1,2,3,4, S Kisely1,2, M Macfarlane1,5,6 1RANZCP

Committee for Research South Addiction and Mental Health Service, Brisbane, Australia 3School of Medicine, University of Queensland, Brisbane, Australia 4Queensland Centre for Mental Health Research, Wacol, Australia 5Australia Graduate School of Medicine, University of Wollongong, Wollongong, Australia 6Illawarra Shoalhaven Local Health District, Wollongong, Australia 2Metro

Background: Evidence-based mental health is the paradigm for the modern professional practice of psychiatry. With this, there is an increasing role for the clinician scientist in psychiatry. The skills required to undertake research can be acquired at any stage in a career, from trainee to senior Fellow. The research changes to the RANZCP Competency Based Australian & New Zealand Journal of Psychiatry, 49(S1)

26

RANZCP Abstracts

Fellowship Program (CBFP) have introduced a Scholarly Project as a mandatory training requirement. The integrated clinical psychiatrist-scientist is the aspiration for including research training in the RANZCP CBFP. Practically, this means a psychiatrist should have well-developed skills for interpreting, explaining and applying research in practice. Pathways through which Registrars and Fellows can be supported to incorporate research into their training and clinical practice are not always clear. The introduction of the Scholarly Project now requires trainees to gain experience in research methods; there has been a degree of uncertainty expressed by trainees as to how this can be realized. This presentation aims to inform novice researchers about the process of research, pathways to realizing a project, as well as relevant supports including funding opportunities.

Objectives: Attendees will increase their understanding of how to formulate a clear and operationalized research question.

with their clinical practice. It will be of particular assistance to registrars planning their approach to the Scholarly Project. The symposium will provide information about how to survive in research, including addressing the following questions:

1RANZCP

Methods: Individual presentation and facilitated group discussion. Findings: Formulating a research question is a critical component to commencing a successful research project. Conclusions: Through systematic planning, early career researchers and other clinicians can plan and conduct research suitable for the Scholarly Project or other research activity.

PRESENTER 2

HOW TO FIND (AND GET VALUE FROM) A RESEARCH SUPERVISOR? Objectives: This symposium is targeted at both Registrars and 1,2,3,4 Fellows who have an interest in better integration of research S Parker

1. How to write a research question? 2. How to find (and get value from) a research supervisor? 3. How to design a research study, and to collect and analyse data? 4. How to write up research findings with view to publication? Methods: A series of individual presentations will be followed by group discussion with the presenting panel. Findings: Extensive information and experience will be identified to Registrars and other new investigators in designing, implementing and following a research project through to completion. Conclusions: Research can be a highly rewarding activity; the provision of information can demystify the process and create a clear pathway to success.

PRESENTER 1 HOW TO WRITE A RESEARCH QUESTION? D Siskind1,2,3,4 1RANZCP

Committee for Research South Addiction and Mental Health Service, Brisbane, Australia 3School of Medicine, University of Queensland, Brisbane, Australia 4Queensland Centre for Mental Health Research, Wacol, Australia 2Metro

Background: Research can seem daunting, especially for trainees and early career researchers. This paper focuses on how to formulate and begin a research project in the framework of the Scholarly Project. Australian & New Zealand Journal of Psychiatry, 49(S1)

Committee for Research South Addiction and Mental Health Service, Brisbane, Australia 3School of Medicine, University of Queensland, Brisbane, Australia 4Queensland Centre for Mental Health Research, Wacol, Australia 2Metro

Background: Supervision is a critical component required for one to have a good start in research. Trainees considering the Scholarly Project will need to be able to identify and effectively work with a supervisor who fits with both their interests and learning needs. Objectives: Attendees will gain practice knowledge and confidence in the process of identifying, approaching and working with a research supervisor. Methods: Individual presentation and facilitated group discussion. Findings: Supervision is critical component of supporting the successful completion of the Scholarly Project, and there is value in planning the process of identifying and working with a supervisor. Conclusions: Identifying a research supervisor will depend on the interests, learning goals and learning style of the trainee, as well as the interests and skills sets of potential supervisors who are readily accessible.

PRESENTER 3 HOW TO DESIGN A RESEARCH STUDY, AND TO COLLECT AND ANALYSE DATA? S Kisely1,2,3 1RANZCP

Committee for Research South Addiction and Mental Health Service, Brisbane, Australia 3School of Medicine, University of Queensland, Brisbane, Australia 2Metro

Background: It is important to think carefully about your study design before starting research. Being clear about the

27

RANZCP Abstracts hypotheses, methods and the statistical power required will help you make sure the project can answer the research question. Documenting the design will help in the process of ethics approval, an important aspect of the research process that is discussed. Funding is also discussed, including the RANZCP-funded New Investigator Grant.

Findings: Awareness of the processes associated with preparing a paper for publication in a peer-reviewed journal will increase the likelihood of acceptance and reduce the associated frustration. The peer-review process can facilitate iterative improvement in both the quality of a research paper and one’s skills as a researcher.

Objectives: To explore the practical aspects of quantitative study design, including enhanced participant understanding of how to develop relevant hypotheses, identify and implement an appropriate methodology and to consider issues such as statistical power and ethics.

Conclusions: By understanding the process of peer review, early career researchers will be able to better plan and prepare research for publication and dissemination.

THE CONVERSATIONAL MODEL: PERSPECTIVES, PROCESS AND PHENOMENA 1,2,3,4, C Marlborough1,4, C Chapman1,7, Findings: Research design flows logically from the L McLean 1,5 1,6 1,6 research question; careful planning can reduce unexpected A Korner , G Lianos , J Haliburn Methods: Individual presentation and facilitated group discussion.

frustrations in the research process. Conclusions: Through careful planning, based on formulation of a research question, early career researchers can design and conduct quantitative research projects within the framework of the Scholarly Project or in their own independent projects.

PRESENTER 4 HOW TO WRITE UP RESEARCH FINDINGS WITH VIEW TO PUBLICATION? M Macfarlane1,2,3 1RANZCP

Committee for Research South Addiction and Mental Health Service, Brisbane, Australia 2Australia Graduate School of Medicine, University of Wollongong, Wollongong, Australia 3Illawarra Shoalhaven Local Health District, Wollongong, Australia 2Metro

Background: The process of writing up research with view to publication in a peer-reviewed academic journal can be daunting. This is especially so when one lacks familiarity with what is required and the steps that can be taken to increase the likelihood of acceptance. Objectives: This presentation will provide information about the peer-review process, including how to select a journal and how to handle rejection. It will also consider ways that in which attention to study design and the way a paper is drafted might facilitate the acceptance of the final paper. The aim is to demystify the peer-review process and increase participants’ confidence in approaching this. Methods: Individual presentation and facilitated group discussion.

1Westmead

Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Brain and Mind Research Institute, University of Sydney, Sydney, Australia 3Department of Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Australia 4Western Sydney Local Health District (WSLHD), Parramatta and Blacktown, Australia 5Nepean Blue Mountains Local Health District (NBMLHD), Nepean, Australia 6Private Practice, Sydney, Australia 7New South Wales Institute of Psychiatry, Parramatta, Australia

Background: The Conversational Model (CM) emerged around 30 years ago as a synthesis of evidence from research and practice in psychoanalytic approaches, neuroscience, philosophy, development and linguistics to provide a creative base from which to explore how self is formed in connected relationship and conversation, how it is broken down or restricted by trauma and how it is restored through psychotherapy. While initially focused on the treatment of borderline personality disorder in long-term intensive psychodynamic psychotherapy, the model’s perspective on the importance of relational approaches and non-specific therapeutic factors has been applied to acute mental health, both in-patient and community, to short-term dynamic psychotherapy, to group work and to couples work across many diagnoses and presentations for which trauma is a significant factor. Objectives and methods: We will offer several papers on different aspects on work and thinking within the Model that represent conversations between the CM perspective and aspects of theory, research or practice in a number of fields. Findings: As a teaching, research and clinical service, the Westmead Psychotherapy Program reaches out through the Masters of Psychotherapy Program and to local clinicians through its Scholarship Program and liaison activities to encourage the application of the CM’s perspective and to engage in dialogue from within this open model. Australian & New Zealand Journal of Psychiatry, 49(S1)

28 Conclusions: The CM perspective can be applied across many domains to help understand and hone what works for whom and why; its theoretical underpinnings provide a rich field for integrative neuroscience approaches to phenomenology, process and practice.

PRESENTER 1 THE SOUND AND THE STORY: REFLECTIONS UPON THE MUSICALITY OF COMMUNICATION AND THE CONVERSATIONAL MODEL C Marlborough1,2 1Westmead

Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Scholarship Program, Western Sydney Local Health District (WSLHD), Parramatta, Australia

Background: Communication skills are fundamental to human interaction and the therapeutic process. The Conversational Model (CM) pays equal attention to the narrative and affective components of communicative exchanges within the therapeutic dyad, with a view to fostering the emergence of self and the processing of trauma. When trauma occurs, the capacity to communicate coherently and effectively can become fragmented and incoherent. The Theory of Communicative Musicality offers a framework to connect with a client’s affective states through the musical properties of the narrative via the development of the therapist’s ability to identify, acknowledge and respond to changes in the patient’s volume, tone and tempo, with regards to the immediate phrasing and broader context of communicative exchanges.

RANZCP Abstracts

PRESENTER 2 WHAT IS PSYCHOTHERAPY? – A CONVERSATIONAL MODEL ENQUIRY G Lianos1,2, L McLean1,3,4,5 1Westmead

Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Private Practice, Sydney, Australia 3Brain and Mind Research Institute, University of Sydney, Sydney, Australia 4Department of Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Australia 5Sydney West and Greater Southern Psychiatry Training Network, Western Sydney Local Health District (WSLHD), Parramatta, Australia

Background: There are many psychotherapies and many have been shown to be effective, with the relational quality consistently found to be a central predictor of success. In the light of this, and using a Conversation Model-based perspective, how could we now define psychotherapy? Objectives and methods: This paper will aim to explore the phenomenon of psychotherapy through an examination of theory and practice, grounded in case-based examples, offered from the perspective of the Conversational Model. It will then offer the opportunity for discussion with attendees on the nature of psychotherapy. Findings and conclusions: The story of how we grow in relationship and how we examine and track this process is still unfolding, but review, reflection and reappraisal and authenticity are essential to the art and the science of psychotherapy.

PRESENTER 3

IDENTIFYING AND MANAGING Objectives: This presentation will offer an overview of DISSOCIATION the theory of Communicative Musicality applied to the CM C Chapman1,6, L McLean1,2,3,4, A Korner1,2,5, with attention to the way the “musical” aspects of the J Haliburn1,2 encounter are present and develop during therapy.

Methods: After outlining the theoretical frames we will then illustrate the process with case material from therapy conducted in the CM and drawn from audio-taped sessional material that is closely analysed using the Communicative Musicality approach, with particular attention paid to changes in the volume, tone, tempo and phrasing of communicative exchanges. Findings: This approach can enhance the CM’s capacity to help the therapist relate to traumatized clients and foster their sense of self and their reflective capacity. Conclusions: While further research into this area is warranted and underway, the framework is an accessible addition to the therapeutic repertoire. Australian & New Zealand Journal of Psychiatry, 49(S1)

1Cumberland

Hospital, Western Sydney Local Health District (WSLHD), Sydney, Australia 2Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 3Brain and Mind Research Institute, University of Sydney, Sydney, Australia 4Department of Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Australia 5Nepean Blue Mountains Local Health District (NBMLHD), Nepean, Australia 6New South Wales Institute of Psychiatry, Parramatta, Australia

Background: Dissociation refers to experiences that signify a breakdown of integrated consciousness, often involving feeling detached from reality and occurring on a continuum, ranging from benign daydream-like experiences to completely disorientating fugues. Conceptualized at times as the result of trauma, dissociation frequently occurs in patients with complex trauma histories, such as those seeking assistance from the Westmead Psychotherapy Program (WPP).

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RANZCP Abstracts Objectives: This presentation involves case vignettes from a senior psychiatry trainee’s experience identifying and managing patients for whom dissociation is a major symptom, while under supervision in the Special Training Position (STP) at the WPP at Cumberland Hospital. The aim is to give an idea of the types of descriptions that might be used by a patient when describing these dissociative experiences, the impairment that is caused and some methods that have been found useful for alleviating distress associated with these experiences. Methods: De-identified vignettes will be presented drawn from clinical experiences of both inpatients and outpatients who report experiences consistent with dissociation. Findings: Patients with dissociative experiences often hide their symptoms fearing they might be labelled “crazy”. Skills obtained in the STP have provided opportunities for psychoeducation not only with patients but with staff unskilled in managing dissociation, leading to more effective patient management. Conclusions: The STP has allowed an experience in identification and management of dissociation, an area in which trainees often receive scant education in other contexts.

PRESENTER 4 THE MUSIC AND THE DANCE: MEASUREMENT AND CHANGE IN PSYCHOTHERAPY BY ADAPTING USING CARE-INDEX AND AAI MARKERS L McLean1,2,3,4, A Korner1,2,5 1Westmead

Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Brain and Mind Research Institute, University of Sydney, Sydney, Australia 3Department of Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Australia 4Sydney West and Greater Southern Psychiatry Training Network, Parramatta, Australia 5Nepean Blue Mountains Local Health District (NBMLHD), Nepean, Australia

Background: Human beings develop in connected relationships, commencing with the touch, gaze, voice and affective tone of the proto-conversation and the sequencing of activities that tend to care, safety, comfort and play, extending to the therapeutic context where psychotherapy is the base for a healing relationship fostering post-traumatic transformation. Connectivity is constructed at every level of the individual and interpersonal systems: neurons fire and wire together, autonomic nervous systems are in conversation and the “soft wiring” and intrapersonal connections slowly unfold. Languages of words and music and gesture develop and weave through our relational life, becoming connected with our inner voice and musings, tracking the trajectory of

our development: the joy of companionship, the pride of achievement and the vicissitudes of trauma and loss. Parentinfant and attachment research has something to offer in operationalizing the individual and dyadic state and their change over time in our psychotherapeutic conversations. Objectives and methods: This talk aims to illustrate the utility of the CARE-Index, examining the music and dance of dyads, and the Adult Attachment Interview, scored via linguistic markers, markers of reflective functioning, and indicators of states of mind, in assessing the therapeutic interchange and the resolution of trauma. These approaches will be outlined and then applied to an adult psychotherapy context, taking examples from earlier and later sessional material to demonstrate change. Findings and conclusions: These ways of measuring the music and the dance of the dyad are helpful to the therapist seeking to reflectively track process and change.

THE 2014 RANZCP CLINICAL PRACTICE GUIDELINE PROJECT AND CPG FOR EATING DISORDERS G Malhi1, M Oakley-Browne1, P Hay1,2,3, C Galletly1, G Carter1, G Andrews1, D Chinn2,4, D Forbes2,5, S Madden2,6, R Newton2,7, L Surgenor1,8, S Touyz 1,9, W Ward1,10, F Zepf11, C Gray12, N Fagermo13 1RANZCP

2014 CPG Steering Committee Eating Disorders CPG Working Group 3School of Medicine and Centre for Health Research, University of Western Sydney, Sydney, Australia; School of Medicine, James Cook University, Townsville, Australia 4Capital and Coast District Health Board, Wellington, New Zealand 5School of Pediatrics and Child Health, University of Western Australia, Perth, Australia 6Eating Disorders Service, Sydney Children’s Hospital Network, Westmead, Australia; School of Psychiatry, University of Sydney, Sydney, Australia 7Mental Health CSU, Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia 8Department of Psychological Medicine, University of Otago at Christchurch, Christchurch, New Zealand 9School of Psychology and Centre for Eating and Dieting Disorders, Sydney, Australia 10Eating Disorders Service, Royal Brisbane and Women’s Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia 11Department of Child and Adolescent Psychiatry, University of Western Australia, Perth, Australia; Department of Specialised Child and Adolescent Mental Health Services, University of Western Australia, Perth, Australia 12Consultation Liaison Psychiatry, The Prince Charles Hospital, Brisbane, Australia 13Royal Brisbane and Women’s Hospital, Brisbane, Australia 2RANZCP

Background: This clinical practice guideline (CPG) was conducted as part of the RANZCP CGP Project 2013–2014. Australian & New Zealand Journal of Psychiatry, 49(S1)

30 Objectives: To describe the CGP development process, to report on progress and describe and debate the utility of the eating disorder CPG with external experts. Methods: Following a presentation of the guidelines development from the CPG Steering Committee and the eating disorder CPG (from the CPG Working Group) there will be three brief presentations from external discussants. Professor Zepf will discuss the CPG for anorexia nervosa from the perspective of a child and adolescent psychiatrist with an interest in eating disorders, Dr Curt Gray from the perspective of a consultation liaison psychiatrist in a general hospital and Dr Narelle Fagermo from the perspective of an adult physician in a general hospital with and without a specialist eating disorder service. There will then be the opportunity for general discussion.

PRESENTER 1 CLINICAL PRACTICE GUIDELINES PROJECT (CPG PROJECT) OVERVIEW CPG Steering Committee: G Malhi1, M Oakley-Browne1, P Hay1,2,3 1RANZCP

2014 CPG Steering Committee Eating Disorders CPG Working Group 3School of Medicine and Centre for Health Research, University of Western Sydney, Sydney, Australia; School of Medicine, James Cook University, Townsville, Australia 2RANZCP

Background: In 2012, the Clinical Practice Guidelines Project commenced to systematically review and update six Clinical Practice Guidelines (CPGs) previously developed by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in 2005. The six original CPGs were: Anorexia Nervosa; Bipolar Disorder; Deliberate Self Harm (youth and adult); Depression; Panic Disorder and Agoraphobia; and Schizophrenia. It was decided to merge the Bipolar Disorder and Depression guidelines into a single guideline covering the spectrum of Mood Disorders. It was also decided to broaden the scope of the Anorexia Nervosa guideline to include the range of Eating Disorders. Objectives: The aims of the CPG Project were to develop usable and accessible resource documents based on the latest international evidence-based practice to enable quality psychiatric and mental health care in Australasia and New Zealand and to promote and disseminate the developed resources to better inform consumers, carers and mental health clinicians about appropriate, and inappropriate, treatment options for the Australasian and New Zealand psychiatric/mental health care setting. Methods: Five working groups (WGs) were established to review and update the CPGs. Once the WGs had Australian & New Zealand Journal of Psychiatry, 49(S1)

RANZCP Abstracts produced a first draft of the CPGs, they moved through various rounds of internal and external review before being submitted to the Australian and New Zealand Journal of Psychiatry for publication. Consumer and carer versions of the revised CPGs will also be developed to complement the full guidelines. Findings and conclusions: The Eating Disorders CPG was published in November 2014 with the CPGs for Schizophrenia, Deliberate Self Harm and Mood Disorders expected to be published early in 2015.

PRESENTER 2 RANZCP CLINICAL PRACTICE GUIDELINES FOR EATING DISORDERS CPG Working Group: P Hay1,2,3, C Galletly1, G Carter1, G Andrews1, D Chinn2,4, D Forbes2,5 S Madden2,6, R Newton2,7, L Surgenor1,8, S Touyz1,9, W Ward1,10 1RANZCP

2014 CPG Steering Committee Eating Disorders CPG Working Group 3School of Medicine and Centre for Health Research, University of Western Sydney, Sydney, Australia; School of Medicine, James Cook University, Townsville, Australia 4Capital and Coast District Health Board, Wellington, New Zealand 5School of Pediatrics and Child Health, University of Western Australia, Perth, Australia 6Eating Disorders Service, Sydney Children’s Hospital Network, Westmead, Australia; School of Psychiatry, University of Sydney, Sydney, Australia 7Mental Health CSU, Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia 8Department of Psychological Medicine, University of Otago at Christchurch, Christchurch, New Zealand 9School of Psychology and Centre for Eating and Dieting Disorders, Sydney, Australia 10Eating Disorders Service, Royal Brisbane and Women’s Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia 2RANZCP

Background: The clinical practice guideline (CPG) was conducted as part of the RANZCP CGP Project 2013-2014. Objectives: To provide contemporary guidelines for the treatment of people with eating disorders. Methods: In accordance with NHMRC best practice, literature for treatments were sourced from the previous RANZCP CPG reviews (dated to 2009) and updated with a systematic review (dated 2008–2013). A multidisciplinary group prepared draft CPG which then underwent expert, community and stakeholder consultation. Findings: In anorexia nervosa (AN) the CPG recommends outpatient or day patient treatment in most instances, with hospital admission for those at risk

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RANZCP Abstracts of medical and/or psychological compromise, and with consideration of nutritional, medical and psychological aspects, the use of family-based therapies in younger people and specialist therapist-led manualised based psychological therapies in all age groups that include longer term follow-up. Harm minimisation is recommended in chronic AN. In bulimia nervosa (BN) and binge eating disorder (BED) the CPG recommends an individual psychological therapy, for which the best evidence is for therapist-led CBT. There is also a role for CBT adapted for internet delivery, or CBT in a non-specialist guided self-help form. Medications that may be helpful either as an adjunctive or alternative treatment option include an antidepressant, topiramate, or orlistat (the last for people with comorbid obesity). There are no trials to guide treatment of avoidant/restrictive food intake disorder (ARFID). Conclusions: Specific evidence-based psychological and pharmacological treatments are recommended for most eating disorders but more trials are needed for specific therapies in AN and research is urgently needed for all aspects of ARFID assessment and management.

PRESENTER 3 RANZCP GUIDELINES FOR EATING DISORDERS: CLINCAL PRACTICE UTILITY Expert discussion panel: W Ward1,2, F Zepf3, C Gray4, N Fagermo5 1RANZCP

2014 CPG Steering Committee Disorders Service, Royal Brisbane and Women’s Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia 3Department of Child and Adolescent Psychiatry University of Western Australia, Perth, Australia; Department of Specialised Child and Adolescent Mental Health Services, Perth, Australia 4Consultation Liaison Psychiatry, The Prince Charles Hospital, Brisbane, Australia 5Royal Brisbane and Women’s Hospital, Brisbane, Australia 2Eating

Background and objectives: To critically discuss the recommendations of the eating disorders CPG and their clinical utility. Methods: Professor Zepf will discuss the CPG for anorexia nervosa from the perspective of a child and adolescent psychiatrist with an interest in eating disorders, Dr Curt Gray from the perspective of a consultation liaison psychiatrist in a general hospital and Dr Narelle Fagermo from the perspective of an adult physician in a general hospital with and without a specialist eating disorder service.

THE CINEMA OF ADDICTION P Athanasos1,2,5, G Cape3, R Neild1, S Suetani2,4 1Flinders

University, Adelaide, Australia Queen Elizabeth Hospital, Adelaide, Australia 3Community Alcohol and Drug Service, Dunedin, New Zealand 4University of Adelaide, Adelaide, Australia 5Griffith University, Logan City, Australia 2The

Background: Cinematic representations play an essential role in the way society understands substance use, manufacturing and dealing. Traditionally, a character that is portrayed using or dealing in illicit drugs carries the immediate recognition of someone who is deviant, corrupt or untrustworthy. Yet there are other prevalent stereotypes as described by Cape (2003). These include tragic hero, rebellious free spirit, demonized addict/homicidal maniac or humorous/comedic user. Objectives: In the following symposium we will examine addiction in the cinema from US/UK perspectives, Australia/New Zealand perspectives and the representation of women and families. Methods: A selective review of a number of movies and television series prominently portraying alcohol and other drug use building on the work of Cape (2003). Aims for participants will include the identification of stereotypes portrayed in cinema and television and the audience will be encouraged to contrast these findings with their experience in vigorous audience participation. An interactive discussion will lead to enhanced appreciation of the role of media such as cinema in developing social expectations and stigma and the potential effects of these factors on greater health and policy outcomes. Findings: There are specific stereotypes identified in movies of both substance users and substance dealers. These stereotypes vary depending on the prevailing drug policies of the country of origin and have changed over time. Clear societal roles for drug users are identified. Conclusions: Movies, as a medium for mass communication, continue to have a predominant influence on the public and perpetuate popular mythologies regarding alcohol and other drug use. Reference Cape GS (2003) Addiction, stigma and movies. Acta Psychiatr Scand 107: 163–169.

PRESENTER 1 THE CINEMA OF ADDICTION – US/UK PERSPECTIVES G Cape1, P Athanasos2,3, R Neild2, S Suetani3,4 1Community

Alcohol and Drug Service, Dunedin, New Zealand University, Adelaide, Australia 3The Queen Elizabeth Hospital, Adelaide, Australia 4University of Adelaide, Adelaide, Australia 2Flinders

Findings and conclusions: Members of the CPG Steering Committee will chair a general discussion.


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RANZCP Abstracts

Background: This presentation views stereotypes present in UK and US cinema and television series.

including the strength of stereotype portrayals in providing social norms to the community at large.

Objectives: The relationship between portrayals of drug users, drug dealers, current drug treatment and drug control policy is explored. An exploration of the stability of stereotypes over time is undertaken. There is a particular focus on the impact of the television series Breaking Bad, the James Bond film series, narco-culture, recent US changes in cannabis legislation and recent UK changes in opioid maintenance policy.

Findings: Australian and New Zealand movies demonstrate the influence of a harm reduction climate. Individuals are demonstrated accessing harm reduction treatments and these treatments are positively framed. However, there remains an element of a “cautionary tale” in these movies as rehabilitation is not shown to return individuals to life opportunities equivalent to non-drug users.

Methods: A selection of UK and US cinema and television is reviewed. Social context is addressed as a construct for stereotypes of drug users and drug dealers. The prominent role that cinema can play in establishing social norms is discussed. Stereotypes of people who use drugs and others involved in the drug trade are examined and reviewed against the socio-political context at the time the films were made. Historical changes in the policy stance of these countries are superimposed on identified stereotypes. Findings: Stereotypes have remained relatively stable over time and it is proposed this is a reflection of and interaction with the socio-cultural context in which these movies have been made. Discussion and Conclusions: Reflections on the marketing of movies, social expectations and the impact of social tropes are made and this is contrasted with ideas of revelatory film making as a perspective on current culture. An ongoing framework for the evaluation of stereotypes is proposed.

PRESENTER 2 THE CINEMA OF ADDICTION – AUSTRALIA/NEW ZEALAND PERSPECTIVES S Suetani1,2, P Athanasos1,3, G Cape4 R Neild3 1The

Queen Elizabeth Hospital, Adelaide, Australia of Adelaide, Adelaide, Australia 3Flinders University, Adelaide, Australia 4Community Alcohol and Drug Service, Dunedin, New Zealand 2University

Background: This presentation explores the stereotypes present in movies made in Australia and New Zealand. Methods: A selection of Australian and New Zealand cinema and television series (Candy, Boy, Underbelly) is reviewed for representations of people who use drugs and drug dealers. Presentations of people who use drugs and people who market drugs are viewed against the context of the harm reduction policies in place in both countries. The role of cinematic constructs of drug use is explored Australian & New Zealand Journal of Psychiatry, 49(S1)

Conclusions: The enlarging Australasian film industry has included portrayals of drug users and drug dealers. These characterisations are consistent with the socio-political context in which film making occurs. Sensitivity to people who use drugs in Australasian cinema is not conveyed without social comment. These social comments are in keeping with current social norms around drug use.

PRESENTER 3 THE CINEMA OF ADDICTION – WOMEN AND PARENTING R Neild1, P Athanasos1,2, G Cape3, S Suetani2,4 1Flinders

University, Adelaide, Australia Queen Elizabeth Hospital, Adelaide, Australia 3Community Alcohol and Drug Service, Dunedin, New Zealand 4University of Adelaide, Adelaide, Australia 2The

Background: The cinematic presentation of women who use drugs and women who are parents who use drugs is explored. Methods: Movies in which drug use is portrayed are selectively reviewed. The portrayal of female drug users is contrasted with the male drug users. Gender roles and norms are explored as an explanation for these differences. Cultural differences, regional differences and similarities are highlighted. The interaction between the roles of women and drug use are explored with particular reference to parenting. Explanations about how cinema interacts with social context to form social constructs of drug users, parents and women are offered. The significance of cinematic reinforcement of stigma and the potential health and social consequences of this are discussed. Findings: The portrayal of women who use drugs does differ from the depiction of male drug users. Gender roles are consistent with differences seen between male and female people who use drugs in movies. The depiction of parenting by people who use drugs strongly communicates the message that parenting is incompatible with drug use. Conclusions: Movies play an important role in reinforcing gender stereotypes as well as stereotypes about people who use drugs. As a reflection of the society that is portrayed,

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RANZCP Abstracts cinema is a potentially important tool in depicting expected social norms and reinforcing stigma for those who fall outside cultural norms. This has health and social implications

ENGAGING FAMILIES AND CARERS TO SUPPORT RECOVERY J Powell1,2, D Ross3, M Jessop4 1Metro

North Mental Health Service, Chermside, Australia of Queensland, Brisbane, Australia 3Partners in Recovery, Medicare Local, Melbourne, Australia 4Children’s Health Queensland Hospital and Health Service, Brisbane, Australia 2University

Background: Extensive research supports the role of family focused approaches within the adult mental health setting. This includes both families of adult consumers with mental illness and parents with mental illness and their families. This requires the effective engagement of carers and family members to support recovery. This is an important focus when the client is a parent. Challenges within the parenting role can impact significantly on parents’ recovery and need to be considered in treatment planning. Objectives: The presentation will explore the following areas •• Factors that influence successful engagement; •• The importance of engaging families through a lived experience presentation; •• Responding to the parenting role in mental health service delivery; •• Introduction to evidence-based intervention “Let’s Talk about Children”. Methods: The symposium includes a discussion of a study of carer engagement within an AMHS, lived experience by a consumer, case vignettes and video material from online training. Findings: Clinicians and carers both agree on the importance of involving carers and families in the health care provided to consumers. Both groups identify barriers to this involvement and strategies to overcome these. Involving carers and families in a family focused approach can promote effective communication and problem solving within families surrounding mental illness. “Let’s Talk about Children” highlights the benefit of this approach for both parents and their children.

PRESENTER 1 CARER ENGAGEMENT WITHIN MENTAL HEALTH J Powell1,2 1Metro

North Mental Health Service, Chermside, Australia of Queensland, Brisbane, Australia

2University

Background: Policies at a national and state level have resulted in positive attitudes to collaboration with carers; however, this appears not to have translated into major practice change in the mental health setting. Objectives: The aim of the study was to better understand the experience of both mental health service providers and carers of people receiving services from public mental health services with respect to communication between service providers and families and carers. Methods: This was a qualitative study by which data was collected through semi-structured interviews with service providers and carers of people receiving treatment from public mental health services. Findings: Participants in this study strongly endorsed the value and importance of the relationship between families and carers and clinicians. Carers viewed themselves as information sources for professionals, as support for the consumers, and carers’ concerns needed to be acknowledged and accepted. Clinicians identified that carers provided important information relevant to the assessment and effective treatment of the patient and that families are relevant to outcomes and safety of the person with mental illness. Both groups were aware of significant barriers to effective communication. Families and carers were typically more dissatisfied with the quality of communication than were clinicians. There were important differences in what the two groups identified as the main barriers. Both groups identified strategies to assist in overcoming these barriers. Conclusions: This study suggests that effective engagement is time consuming, that service systems may not do enough to support this collaboration and that whilst clinicians recognise that carers are important they are not seen as a priority in settings with multiple competing demands. A number of recommendations are made to address these findings.

PRESENTER 2

NAVIGATING THE PARENTING ROLE WHILE HAVING A MENTAL ILLNESS Conclusions: Focusing on the effective engagement of D Ross consumer and families is often essential for recovery and enables family focused interventions. There are effective family focused interventions that improve outcome for both parents and children that can be used in the AMHS.

Partners in Recovery, Medicare Local, Melbourne, Australia

Background: Parents experiencing mental health problems often face many challenges related to the impact on Australian & New Zealand Journal of Psychiatry, 49(S1)

34 their parenting role. The need for support from family and other carers can be essential in supporting recovery. The presenter will discuss her experience of being a parent with young children at the time of onset of mental illness. Objectives: The presentation will explore: •• Approaches to providing clinical care that have been helpful in her recovery; •• The importance of engaging partners; •• The need to consider the parenting role in treatment planning; •• Understanding and responding to the impact of separation from children through the course of treatment.

RANZCP Abstracts Methods: Case vignettes and video material will be used to highlight aspects of this intervention and the potential role within the adult mental health setting. Findings: The approach utilized within Let’s Talk has been effective in overcoming some of the barriers to engagement in family focused work. It provides a framework for clinicians to support consumers in their parenting role, respond the needs of children and reduce the bidirectional impact of parental mental illness. Conclusions: The experience of these interventions is promising with regard to potential benefit to both the consumer and their family. Factors that will support implementation need further exploration.

Development, implementation and sharing learnings Findings: The presentation highlights the importance of around improved practices consumers “feeling listened to” and understanding their & reflections on future stage recovery in treatment planning. An approach that opportunities in relation considered her needs as a parent and that of her family to use of the framework was essential to her recovery. for mental health in Conclusions: The outcome for parents and their families multicultural Australia can be improved through effectively engaging carers and H Vayani1, R Prasad-Ildes2, H Minas3 Methods: Presentation of lived experience.

other supports people, and providing a family focused approach.

PRESENTER 3 FAMILY FOCUSED PRACTICE WITH PARENTS WITH MENTAL ILLNESS M Jessop Children’s Health Queensland Hospital and Health Service, Brisbane, Australia

Background: There has been increasing evidence of the benefits of family focused interventions when working with parents with mental illness and their families. These interventions address the bidirectional impact of parental mental illness on both parent and child outcome. In response to this, National COPMI has developed a range of resources and online training to support evidence-based family focused approaches. While the evaluation of these initiatives in Australia is in the early stages, the clinical experience is building supporting the benefits of these approaches. Objectives: The presentation will introduce the method, Let’s Talk, and the resources available. The role of this intervention when working with parents with mental illness will be highlighted.


1Mental

Health in Multicultural Australia, Brisbane, Australia Transcultural Mental Health Centre, Brisbane, Australia 3University of Melbourne, Melbourne, Australia 2Queensland

Background: The Mental Health in Multicultural Australia (MHiMA) project provides a national focus for advice and support to service providers and governments on mental health and suicide prevention for people from culturally and linguistically diverse (CALD) backgrounds. The symposium will focus on work undertaken by MHiMA: the development and implementation of a framework to support improvements in the provision of mental health care to CALD consumers in acute inpatient settings and the collection and analysis of data around CALD consumers accessing acute mental health care. Objectives: •• Present an overview of the development of the Framework, its implementation in selected inpatient units across the country and the outcomes in relation to culturally responsive service delivery; •• Present reflections on challenges, learnings and opportunities to utilise the Framework in the future beyond acute inpatient settings. Methods: The symposium will chart the development of the Framework, its implementation into a number of inpatient units across the country, as well as reflect on future opportunities related to its increased use in collaboration

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RANZCP Abstracts with CALD mental health consumers at state/territory, hospital and ward levels. Findings: •• The Framework has been a focal point in getting mental health staff engaged in considering the importance of culturally responsive care, •• Engagement with the Framework has resulted in existing and/or new processes being developed to strengthen the quality of care delivered to CALD mental health consumers. Conclusions: The MHiMA project has made a valuable contribution in supporting mental health services to improve the care of consumers from CALD backgrounds and will continue to provide advice, and support to service providers and government.

Findings: This presentation will outline how successful engagement resulted in initial approval by state and territory mental health branches to engage with the Framework implementation project in 2014/15. Conclusion: This paper will make an important contribution to the understanding of how to effectively engage with state and territory mental health branches in securing buyin for uptake of the new national Framework for Mental Health in Multicultural Australia.

PRESENTER 2 IMPLEMENTATION OF THE FRAMEWORK FOR MENTAL HEALTH IN MULTICULTURAL AUSTRALIA R Prasad-Ildes

PRESENTER 1

Queensland Transcultural Mental Health Centre, Brisbane, Australia

DEVELOPMENT OF THE FRAMEWORK FOR MENTAL HEALTH IN MULTICULTURAL AUSTRALIA H Vayani

Background: The Framework for Mental Health in Multicultural Australia assists services to evaluate their cultural responsiveness via an online self-assessment tool and develop strategies and actions to improve service delivery as part of routine practice. A targeted implementation of the Framework was conducted in selected inpatient units across Australia in 2014/15.

Mental Health in Multicultural Australia, Brisbane, Australia

Background: The Framework for Mental Health in Multicultural Australia (the Framework) was developed in 2013/14 as a quality improvement tool that built on the National Cultural Competency Tool (2010). The Framework is cross-referenced to the National Standards for Mental Health Services (2010) and National Safety and Quality Health Service (NSQHS) Standards. Objectives: •• Describe the process of consultation and development of the Framework; •• Present the process of engaging and developing supporting training to implement the Framework as part of the targeted implementation phase undertaken in 2014/15. Methods: Engagement with the Framework by states and territories across Australia was achieved through formally inviting state and territory Ministers and Mental Health Branches to engage with the Framework through formal correspondence and face to face meetings. This engagement enabled the business case to put forward around using the Framework as a quality improvement tool to drive understanding around service access and ascertain the quality of care delivered to culturally and linguistically diverse (CALD) clients in inpatient units by facilitating linkages with local mental health services that self-selected to engage in implementation of the Framework in 2014/15.

Objectives: •• Describe the process for implementation of the Framework across selected inpatient units in Australia; •• Present the outcomes of the Framework implementation in relation to culturally responsive service delivery. Methods: The Framework was developed and implemented in 9 inpatient sites across Australia. Units conducted an organisational assessment (OCRAS) to determine their current level of cultural responsiveness. The OCRAS scores were then used to guide the development and implementation of an action plan to improve delivery of care for culturally and linguistically diverse (CALD) consumers. Findings: This paper will present case examples of specific actions undertaken by inpatient units and the key success factors and lessons learnt about improving cultural responsiveness. Conclusions: This paper will make an important contribution to the understanding of what cultural responsiveness means in inpatient units based on information obtained from a targeted implementation of the new national Framework for Mental Health in Multicultural Australia.


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PRESENTER 3 INDENTIFICATION OF DATA GAPS HIGHLIGHTED THROUGH IMPLEMENTATION OF THE FRAMEWORK AND WHAT A NEW AUSTRALIA-WIDE MENTAL HEALTH CLASSIFICATION SYSTEM SHOULD ADDRESS TO INFORM UNDERSTANDING AROUND ACCESS AND OUTCOMES OF MENTAL HEALTH CARE FOR PEPOPLE FROM CULTURAL AND LINGUISTICALLY DIVERSE BACKGROUNDS H Minas University of Melbourne, Melbourne, Australia

Background: The Framework for Mental Health in Multicultural Australia assists services to evaluate their cultural responsiveness via an online self assessment tool and develop strategies and actions to improve service delivery as part of routine practice. A targeted implementation of the Framework was conducted in selected inpatient units across Australia in 2014-15. Objectives: •• CALD consumers and carers sharing their reflections on how the Framework has assisted in promoting culturally responsive care. •• CALD consumers and carers sharing their reflections on where use of the Framework could be expanded. •• Reflections and strategic opportunities for use of the Framework post targeted implementation of the framework in acute inpatient settings. Methods: CALD consumers and carers were consulted and involved in the development of the Framework. When the Framework was implemented across acute inpatient units a number of sites focused on improving engagement with CALD consumers and carers as part of their efforts to guide improvements in culturally responsive care. Findings: This paper will present case examples of specific actions undertaken by inpatient units and the key success factors and lessons learnt about improving cultural responsiveness by partnering with CALD consumers and carers. Conclusions: This paper will make an important contribution to the understanding of how the Framework assisted acute inpatients in improving cultural responsiveness and reflect on opportunities for the Framework to be utilised in states and territories where there has been no uptake. It will also outline reflections and strategic opportunities for use of the Framework across the continuum of care in mental health and across human services more broadly. Australian & New Zealand Journal of Psychiatry, 49(S1)

RANZCP Abstracts

THE CONVERSATIONAL MODEL: PSYCHOSOCIOCULTURAL DIALOGUES (OR BUSMAN’S HOLIDAY) L McLean1,2,3, A Korner1,4,5, D Loasby1,6, S Mundy1,7 1Westmead

Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Brain and Mind Research Institute, University of Sydney, Sydney, Australia 3Department of Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Australia 4Western Sydney Local Health District (WSLHD), Parramatta and Blacktown, Australia 5Nepean Blue Mountains Local Health District (NBMLHD), Nepean, Australia 6Children’s Hospital Westmead, Westmead, Australia 7Private Practice, Blue Mountains and Sydney, Australia

Background: The Conversational Model (CM) is a psychodynamic perspective that draws on an integration of work from many fields that underpin interpersonal neurobiology to work the rich seams of self and trauma. It encourages a creative relational approach to psychotherapy for the development of self and its restoration from trauma. Objectives and methods: We will offer several papers on applying the Model creatively: 1) a fresh examination of an old psychoanalytic text (The Strange Case of Dr Jekyll and Mr Hyde); 2) a conversation with Heidegger; 3) an exploration of the model as applied to normal and expansive human development; 4) a brief summary of the CM, and an expositional short film and performance of the theme song of the CM at the Westmead Psychotherapy Program as it seeks to “Give Big Words Away!” Findings and conclusions: The CM’s perspective offers a base from which to dialogue with psychology, society and culture and honour central aims of fostering resonant and playful conversation.

PRESENTER 1 THE STRANGE CASE (OF JEKYLL AND HYDE) A Korner1,2,3 1Westmead

Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Western Sydney Local Health District (WSLHD), Blacktown and Parramatta, Australia 3Nepean Blue Mountains Local Health District (NBMLHD), Nepean, Australia

The uncanny, the realm of alienation, and associated destructive behaviours, are sometimes encountered in psychotherapeutic work. While this range of experience is, in many ways, aversive, it is also often associated with a sense of fascination. While fact is often said to be “stranger than fiction”, in this talk the subject will be approached through the lens of the “double life” with reference to the fictional work of Robert Louis Stevenson, “The Strange Case of Dr Jekyll and Mr Hyde”.

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PRESENTER 2

Findings and conclusions: A conversation with an integrative model of personal development and its vicissitudes, such as the CM, provides guidelines to optimal as well as clinical pathways of human flourishing.

CONVERSATIONS WITH HEIDEGGER: AN INTERSUBJECTIVE EXPERIENCE OF AUTHENTICITY PRESENTER 4 D Loasby1,2 1Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney THE CONVERSATIONAL MODEL Medical School, University of Sydney, Sydney, Australia THEME SONG: IN PURSUIT OF 2Children’s Hospital Westmead, Westmead, Australia PLAYFUL REFLEXIVITY AND CALL Background: One of the challenging aims of a AND RESPONSE Conversational Model (CM) approach to psychotherapy is 1,2,3,4 that of authenticity, a topic on which Heidegger has much L McLean to say. Really being there, “Dasein”, has much in common with the intense “moments of meeting” that are described in contemporary psychodynamic psychotherapy. This is magnified when the conversation about Heidegger becomes a focus for these authentic “moments of meeting” between patient and therapist. Objectives and methods: This paper will explore a CM-inspired conversation with Heidegger, begun initially during a therapy conducted from the CM perspective and developed as a Master’s thesis as a capstone for training within the Program. Findings and conclusions: The dialogue encouraged by the CM perspective between therapist and patient is mirrored by the interchange it can foster across fields of inquiry, a dialogue that is only fruitful, however, if the engagement is truly authentic.

PRESENTER 3 FULLY HUMAN, FULLY ALIVE: A DIALOGUE WITH THE CONVERSATIONAL MODEL ON OPTIMISING HUMAN DEVELOPMNT S Mundy1,2 1Westmead

Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Private Practice, Blue Mountains and Sydney, Australia

Background: The Conversational Model (CM) perspective integrates many bodies of thinking to speak to the impact of trauma on the development and unfolding of self and the restoration of self within a connected relational conversation. However, it may also have something to say about the optimal flourishing of self within the matrix of supportive relationships and an internal reflective and mindful conversation. This connects with literatures and disciplines that suggest pathways to optimize personal human development. Objectives and methods: This paper will explore the way the CM might be applied to the fostering of personal human flourishing.

1Westmead

Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Brain and Mind Research Institute, University of Sydney, Sydney, Australia 3Department of Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Australia 4Sydney West and Greater Southern Psychiatry Training Network, Sydney, Australia

Background: Each year the Westmead Hospital holds its Oscars and asks Hospital Departments to submit a small film that creatively captures their work. In 2014 the Westmead Psychotherapy Program took this as a challenge to demonstrate both content and process, especially the creation of a play space. Objectives and methods: This talk will present a brief summary of the principles of the Conversational Model, the short 5-minute film submitted to the competition in 2014 and then reprise the performance of the main theme song, with an expectation that the audience might join the song/throng and together we will “Give Big Words Away!” Findings and conclusions: Conversation, creativity and communal experience are central to human life and form a key part of the Conversational Model perspective.

MOOD DYSREGULATION AND EXECUTIVE FUNCTION DEFICITS – HOW THE MANAGEMENT OF ADULTS WITH ADHD CAN INFORM GENERAL PSYCHIATRY H Morgan1, R Paterson2, P Bird3, R Edwards4, M Kneebone5 1Mindcare

Centre, Sydney, Australia Practice, Nedlands, Australia 3Gosforth Clinic, Maroochydore, Australia 4Private Practice, Wellington, New Zealand 5Private Practice, Hunters Hill, Sydney, Australia 2Private

Background: Mood dysregulation is a core feature of a number of general psychiatric disorders which can make diagnosis challenging in patients presenting with Mood Disorders, Personality Disorders, Substance Use Australian & New Zealand Journal of Psychiatry, 49(S1)

38 Disorders, ADHD, Intellectual Disability, and Autism Spectrum Disorders. Similarly, executive function deficits occur across these disorders, cause significant impairment and distress, and add to the challenge of assessment and diagnosis. Compounding these diagnostic challenges is that most patients present with comorbid conditions. Following diagnosis, clinicians then need to choose which diagnosis to prioritise for treatment. Adults with ADHD provide a great paradigm for helping psychiatrists to navigate diagnosis and treatment of such patients. Objectives: To provide clinically useful assessment tools and materials with practical clinical advice to improve psychiatrists’ awareness and confidence in assessment, diagnosis, and treatment of patients who present with mood dysregulation and executive function deficits. Methods: The panel all have extensive experience in the assessment and treatment of ADHD and will present informative material relating to different interests in their clinical practice. Findings: Being aware of the differences as well as the similarities in symptoms of mood dysregulation and executive function that exist between general psychiatric disorders is important in determining a diagnosis. Conclusions: General psychiatrists can learn much from working with patients with adult ADHD. These patients have significant problems with emotional dysregulation and executive dysfunction and commonly present with comorbid conditions that may also require treatment.

PRESENTER 1 PRACTICAL TOOLS FOR ASSESSMENT AND DIAGNOSIS OF MOOD DYSREGULATION AND EXECUTIVE DYSFUNCTION H Morgan Mindcare Centre, Sydney, Australia

Psychiatrists have been slow to embrace the use of questionnaires as part of their routine clinical assessment. The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), a scale to assist the diagnosis of autism; The Internal State Scale (ISS v.2), a scale to assess manic and depressive symptoms; and the Adult ADHD Self-Report Scale (ASRS-v1.1), a WHO ADHD screening instrument, will be presented, showing how they have been applied in a case series of patients demonstrating their clinical utility. The questionnaires will be available to members of the audience. Australian & New Zealand Journal of Psychiatry, 49(S1)

RANZCP Abstracts

PRESENTER 2 USE OF STIMULANT MEDICATION IN GENERAL PSYCHIATRY R Paterson Private Practice, Nedlands, Australia

Stimulant medication has been used for decades in psychiatry for treatment of a range of conditions. More recently there has been interest in use of stimulant medication in the treatment of melancholic depression and Bipolar Disorder. The utility of stimulant medication application in general psychiatry will be discussed.

PRESENTER 3 AUTISM SPECTRUM DISORDERS – NEW TREATMENTS P Bird Gosforth Clinic, Maroochydore, Australia

Clinicians are becoming more familiar with the diagnosis of Autism Spectrum Disorders. Whilst the diagnosis of these disorders is becoming more common we lack available evidence-based treatment for these conditions. New treatments currently being trialled for treatment of Autism Spectrum Disorders will be presented.

PRESENTER 4 TREATMENT OF ADULTS WITH ADHD IN PUBLIC HOSPITAL / COMMUNITY HEALTH SETTING R Edwards Private Practice, Wellington, New Zealand

Treatment of adults with ADHD in the public system in Australia is currently very limited. Unlike Australia, New Zealand has a small number of psychiatrists in private practice, and adult patients with ADHD are being treated in the public hospital system. The current assessment and treatment programs offered in a community health setting will be discussed.

PRESENTER 5 TREATMENT OF ADULTS WITH INTELLECTUAL DISABILITY AND ADHD M Kneebone Private Practice, Hunters Hill, Sydney, Australia

Patients with Intellectual Disability are a particularly challenging group of patients to assess and manage. ADHD

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RANZCP Abstracts occurs more commonly in these patients compared to the general population, and the assessment, diagnosis and treatment in this group will be presented.

STP TRAINING POSTS IN PSYCHIATRY: LESSONS LEARNED AND WHAT NEXT? D O’Connor1, K Turner2, C Gee3, V Krigovsky4, R Harvey5, N Jayarajan6 1Chair,

RANZCP STP Reference Committee Coast Mental Health Service, Gold Coast, Australia 3Toowong Private Hospital, Brisbane, Australia 4Top End Mental Health Service, Darwin, Australia 5Barwon Health, Geelong, Australia 6Remote Area Mental Health Service, Cairns and Hinterland Mental Health and ATOD Service, Cairns, Australia 2Gold

Background: The Specialist Training for Psychiatrists (STP) Project is an essential and critical project for the Royal Australian and New Zealand College of Psychiatrists (RANZCP), providing additional training posts across Australia. Commencing in 2009, the RANZCP is currently contracted to the end of 2015 with the Commonwealth Department of Health to manage more than 160 training posts (STP Posts) that provide training experiences beyond traditional public teaching hospital settings. This session will present a range of experiences and lessons learned from private, public and rural health services participating in the STP Project, as well as a trainee perspective of working in an STP Post. Objectives: •• To demonstrate the different and diverse settings that the STP Project is enabling training experience and delivery of patient care; •• To share and discuss lessons learned in how to successfully manage STP Posts that meet the objectives of the Commonwealth and RANZCP training requirements, as well as service needs; •• To discuss the future of the STP beyond 2015. Method: Interactive presentations will demonstrate the diversity of settings, experiences and approaches to STP Posts and provide opportunity for questions and discussion about the STP Project. Findings: •• Presenters will share their findings and lessons learned in hosting an STP Post, including challenges and tips for managing administration, funding and reporting.

•• Presenters will showcase the expanded training settings that the STP Project enables. •• Presenters will discuss the experience of trainees in STP Posts and the impact on health care delivery. Conclusions: Attendees, both experienced and new to the STP Project, will hear a range of approaches and join the discussion on how to make the most of the STP opportunity. Importantly, this session will provide the opportunity for discussion about the future of the STP Project.

CHALLENGES IN PSYCHIATRY ACROSS THE PACIFIC – A SYMPOSIUM FROM THE WEST PACIFIC DIVISION OF THE UK ROYAL COLLEGE OF PSYCHIATRISTS S Kisely1,2, I Soosay3, K George4 1Metro

South Addiction and Mental Health Service, Brisbane, Australia of Medicine, University of Queensland, Brisbane, Australia 3Department of Psychological Medicine, University of Auckland, Auckland, New Zealand 4Eastern Health, Melbourne, Australia 2School

Background: The Royal College of Psychiatrists is the professional medical body responsible for supporting psychiatrists throughout their careers, from training through to retirement, and in setting and raising standards of psychiatry in the United Kingdom. The College is an independent professional membership organisation and registered charity representing over 15,000 psychiatrists in the United Kingdom and internationally. In 2004, the College set up several International Divisions to facilitate the exchange of information and to promote discussion about psychiatry within a specified geographical area outside the United Kingdom and Ireland. This includes a Division for the West Pacific covering Australasia, Oceania and East Asia. Objectives: This symposium aims to illustrate the diversity of psychiatric practice within the region. It features talks on somatisation in East Asia, the role of religion and spirituality in mental health presentations in Pacific Islands, and mental health issues on Niue and other small Pacific nations. Methods: A series of individual presentations will be followed by group discussion with the presenting panel. Findings: Psychiatric practice in the Western Pacific is diverse. Conclusions: Lessons learnt may be applied to other countries in the region. Australian & New Zealand Journal of Psychiatry, 49(S1)

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PRESENTER 1 AN INTERNATIONAL COMPARISON OF SOMATISATION IN EAST ASIA S Kisely1,2 1Metro 2School

South Addiction and Mental Health Service, Brisbane, Australia of Medicine, University of Queensland, Brisbane, Australia

people. This talk aims to outline these challenges and the strategies that are being explored to address them. Objectives: To describe the mental health needs of Niue and the strategies for mental health capacity building. Method: A description of the mental health needs of Niue illustrated by case vignettes.

Background: The relationship between medically explained and unexplained symptoms may vary across countries.

Results: An overview of the mental health plan and strategy to meet these needs.

Objectives: To compare the epidemiology and clinical features of somatoform disorders and medically explained and unexplained somatic symptoms in Japan and China with other cultures and countries.

Conclusions: Small Pacific Island states are re-orientating their health services to meet the needs of their populations. Limited resources, geographic isolation and the need to mitigate the effects of climate change are driving the way they are rising to this challenge and will require new approaches in mental health service delivery.

Method: A two-phase stratified sampling strategy in primary care facilities from 14 different countries (n = 5447, aged between 16 and 65), two of which were in East Asia (Shanghai and Nagasaki) Results: At all sites, the number of current somatic symptoms (whether medically explained or not) was strongly associated with current psychological distress. Although somatic symptoms did cluster into meaningful groups (gastrointestinal, neurological/conversion, autonomic, and musculoskeletal), these symptom groups did not show differential association with psychological distress. Individual somatic symptoms and symptom clusters across sites did not reveal clear patterns of association according to geography or level of economic development. One year later, somatic symptoms in both categories were associated with greater social and psychiatric morbidity Conclusions: These data show a strong association between somatic symptoms and psychological distress, which did not vary across disparate cultures and levels of economic development. Cultural factors, however, may influence the meaning attached to symptoms or the likelihood of presentation for health care.

PRESENTER 2 MENTAL HEALTH ISSUES ON NIUE AND OTHER SMALL PACIFIC NATIONS I Soosay Department of Psychological Medicine, University of Auckland, Auckland, New Zealand

Background: The small island state of Niue (population 1600) shares many of the challenges faced by small Pacific Island nations in meeting the mental health needs of their Australian & New Zealand Journal of Psychiatry, 49(S1)

PRESENTER 3 THE ROLE OF THE CHURCH IN MENTAL HEALTH PRESENTATIONS IN PACIFIC ISLANDS K George Eastern Health, Melbourne, Australia

Background: The Church is very important in the lives of Pacific Islanders and this has an impact when it comes to the presentation of mental health problems and delivery of care. Objectives: The aim of this paper was to gain an understanding of the mental health needs and services in Vanuatu, and examine the importance of the Church in the lives of the local people and the part the Church can play in mental health service delivery. Method: The author visited Vanuatu to gain an understanding of the mental health needs and services in Vanuatu. This was followed by interaction with a number of churches to find out the views of church leaders about mental illness and their interest to learn about mental illness. A questionnaire was completed by 80 individuals, who were also involved in some training. Results: There was widely held view that mental illness was due to a weak faith, sin or demon possession. However, there is a desire and an interest among churches to have a better understanding about mental illness. Conclusions: Churches in Vanuatu can and need to be mobilized to make mental health service delivery successful in the country. This will be the case in most Pacific Island Nations.

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A TRAUMA INFORMED COMMUNITY ACUTE CARE TEAM APPROACH: BLACKTOWN ACCESS & ACUTE MENTAL HEALTH TEAM’S FEELING SAFER PROJECT A Baker1,2, I Cameron1,3, B Moloney1,4, C Winspear1,5, C Chapman1,3, L McLean1,4,5,6 1Westmead

Psychotherapy Program, Western Sydney Local Health District (WSLHD) and Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Blacktown Access & Acute Mental Health Team, WSLHD, Blacktown, Australia 3New South Wales Institute of Psychiatry, Parramatta, Australia. 4Brain and Mind Research Institute, University of Sydney, Sydney, Australia 5Sydney West and Greater Southern Psychiatry Training Network, Western Sydney Local Health District (WSLHD), Parramatta, Australia 6Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Australia

Background: The Feeling Safer Project is an innovative project which has enabled our acute care team to more effectively care for the complex needs of consumers presenting in crisis to Blacktown Mental Health Service. The project has integrated trauma informed and recovery approaches into the team’s well established community crisis care method. The team utilised the Conversational Model (CM), a psychotherapeutic approach for complex trauma. The techniques of the CM have shown initial effectiveness in our clinical work. It is manualised and applicable for use in short and time-limited therapies. It is an approach that values meaningful, individualised and humane relationships that are founded in respect and empathy. It seeks to be conscious of the asymmetrical power of therapy, and the tempo and language of the therapist is adapted to the fluctuating mental capacities of the Consumer. Objectives and methods: With the aim of sharing our process, various members of the multi-disciplinary team and project team will speak to their experiences as the approach has unfolded.

I will discuss how the Conversational Model has been both the model of choice for the clinical work but also for our approach to staff development and supervision. In particular I will explore the methods we drew on to introduce a more reflective and self-responsible clinical practice to our work. It has been truly rewarding experience to support the team in their training, and in the team developing a working understanding of the Conversational Model. I see the results of the project when I hear the staff speaking the language of recovery, and showing a much more sophisticated understanding of the far-reaching effects of trauma.

PRESENTER 2 FEELING SAFER PROJECT: THE PROJECT LEADER’S APPROACH I Cameron1,2,3 1Westmead

Psychotherapy Program, Western Sydney Local Health District (WSLHD) and Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Blacktown Access & Acute Mental Health Team, WSLHD, Blacktown, Australia 3Private Practice, Sydney, Australia

This paper will give an overview of the theoretical underpinnings of the Blacktown Community Acute Care Team’s Feeling Safer Project. This will include outlining our approach to Crisis theory, recovery, trauma-informed care, and the Conversational Model. In particular I will discuss the statistics behind what is our core business in acute community mental health and our goals when we implement a crisis intervention.

PRESENTER 3

FEELING SAFER PROJECT: LISTENING Findings and conclusions: The implementation of the WITH AN EAR FOR TRAUMA AND Feeling Safer project for the Acute Team has been a career REALLY CONNECTING (BEING highlight for many of us. This approach has provided a better THERE) standard of care for the consumer, and rewards the clinician B Moloney1,2 with a greater sense of proficiency and job satisfaction. 1Westmead

PRESENTER 1 FEELING SAFER PROJECT: THE MANAGER’S APPROACH A Baker1,2 1Westmead

Psychotherapy Program, Western Sydney Local Health District (WSLHD) and Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Blacktown Access & Acute Mental Health Team, WSLHD, Blacktown, Australia

This paper will discuss the approach taken as team manager to the implementation of an innovative model of care.


My section of work will discuss the application of our trauma-informed acute care method at the clinical coalface through my experience as a Clinical Nurse Consultant (CNC). I will describe the key elements of our approach including: our particular approach to listening and empathy, the language used by the clinicians, how we explore a client’s traumatic past, our conceptualisation of dissociation, and some ideas on containment. Australian & New Zealand Journal of Psychiatry, 49(S1)

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PRESENTER 4 FEELING SAFER PROJECT: A SENIOR CLINICIAN’S EXPERIENCE C Winspear1,2 1Westmead


I am an experienced and senior clinician in mental health that has worked in the public and private mental systems, and at Blacktown for the past number of years as a Clinical Nurse Specialist (CNS). I will give an account of my mostly positive experiences in adopting this new model of care and some of the key aspects of the model I have found useful in my clinical work.

PRESENTER 5 FEELING SAFER CONVERSATIONS: THE SUPERVISORY APPROACH L McLean1,2,3,4, C Chapman1,5 1Westmead

Psychotherapy Program, Western Sydney Local Health District (WSLHD) and Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia 2Brain and Mind Research Institute, University of Sydney, Sydney, Australia 3Sydney West and Greater Southern Psychiatry Training Network, Western Sydney Local Health District (WSLHD), Parramatta, Australia 4Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Australia 5New South Wales Institute of Psychiatry, Parramatta, Australia

This paper will discuss the supervisory approach for the Feeling Safer project. The Conversational Model (CM) approach is to provide supervision that is compatible with the model: collaborative conversations that foster the development of self and the integration of trauma. Coming from a background in Consultation-Liaison Psychiatry and Psychotherapy, the supervisor considered ways to offer supervision to the project leader and to the team that would allow the co-creation of a space that would foster cohesion amidst an agenda of change and the ongoing challenges of the turbulent clinical environment of acute psychiatric care. In this case this has been realized as fortnightly conversations with the project leader and separately with the team. The latter were videoconferenced and to some extent reflected through writing-up and circulating annotations on these conversations. These “yarns” have offered containment, small doses of didactic learning on the CM, amplification of the positive and much reflective space. This has been a deeply joyful experience of an innovative model of collaborative care that, as the CM suggests, aimed to use “what is given” and watch for “what happens next”. The co-facilitating support of a participant observer in the form of a senior trainee in psychiatry and psychotherapy provided an invaluable second set of ears and eyes and (documenting) hands. Australian & New Zealand Journal of Psychiatry, 49(S1)

RANZCP Abstracts

WHERE ARE YOU IN THE FIGHT AGAINST FAMILY VIOLENCE? M O’Connor1, C Kezelman2, D Walsh3, K Hegarty1 1University

of Melbourne, Melbourne, Australia Surviving Child Abuse, Sydney, Australia 3University of Queensland, Brisbane, Australia 2Adults

Background: The Victorian Branch established a working group to look at the issue of family violence (FV) deaths in September 2014. The aim of the group is to educate health professionals on FV and improve outcomes for people impacted by it. FV is a highly complex social problem with serious health consequences (WHO 2005/2008). One in three women and one in seven men are victims of FV (ABS 2012, 2005). Men and women with all types of mental disorders report a high prevalence and increased odds of domestic violence compared to people without mental disorder. Studies show that despite the common presence of FV among mental health patients, services have been reported to give little consideration to the role of domestic violence in precipitating or exacerbating mental illness (Trevillone 2013, 2014). There is a need for mental health services to establish appropriate strategies, responses and training programs to address FV. Objectives: To stimulate discussion on how psychiatrists can better understand FV and to foster a multidisciplinary platform for health professionals to better understand and respond to patients who are experiencing FV. Methods: A cross sector panel of health professionals with expertise in Family Violence, including social workers will draw on their knowledge and experience in discussing the key objectives for training psychiatrist and other health professionals to better understand FV and refer victims to the support they require (WHO 2013). References Australian Bureau of Statistics (2012) Australian Bureau of Statistics Personal Safety Survey. https://www.google.com. au/search?q=ABS+Personal+Safety+Survey.2012.&rls=com. microsoft:en-au&ie=UTF-8&oe=UTF-8&startIndex=&startPa ge=1&rlz=1I7SKPB_en&gfe_rd=cr&ei=70aVU9HAB8zC8gfht YD4BQ&gws_rd=ssl. Australian Bureau of Statistics & Australian Institute of Health and Welfare (2005) The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. ABS Cat No 4704.0. Australian Bureau of Statistics and Australian Institute of Health and Welfare. Commonwealth of Australia. Trevillion K, Hughes B, Feder G, et al (2014) Disclosure of domestic violence in mental health settings: a qualitative meta-synthesis. Int Rev Psychiatry 26: 430–444. Trevillion K and Agnew-Davies R (2013) Interventions for mental health users who experience domestic violence. In: Howard LM, Feder G and Agnew-Davies R (eds). Domestic violence and mental health. London: Royal College of Psychiatrists. World Health Organization (2008) Intimate partner violence and women’s physical and mental health in the multi-country study

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RANZCP Abstracts on women’s health and domestic violence: an observational study. The Lancet 371: 1165–1172. World Health Organization (2005) WHO multi-country study on women’s health and domestic violence against women: Initial results on prevalence, health outcomes and women’s responses. Geneva: World Health Organization. World Health Organization (2013) Violence against women: a ‘global health problem of epidemic proportions’. Geneva: World Health Organization. http://www.who.int/mediacentre/ news/releases/2013/violence_against_women_20130620/en/

PRESENTER 1 IDENTIFYING AND RESPONDING TO DOMESTIC VIOLENCE IN CLINICAL PRACTICE K Hegarty University of Melbourne, Melbourne, Australia

Background: Domestic or family violence is a common hidden problem in mental health practice. Objectives: To describe the evidence for how to identify and respond to domestic violence in clinical practice.

Objectives: To demonstrate ethnic variations in sociocultural dynamics that underlie DV and are known to precipitate and perpetuate associated social-psychological distress and psychopathology. Methods: In this qualitative study a modified Forum Theater approach captures the voices of women living in the community as they describe how DV contributes to their social, emotional and mental difficulties. Findings: A deep understanding of specific social and cultural data was obtained which can assist in designing prevention and response strategies. Conclusions: DV-induced social and psychological distress can turn into psychopathology, mental illness, suicidal and homicidal behaviours. Migrant communities are particularly vulnerable. Specific understanding of social and cultural data is essential to design accurate response and prevention programs

PRESENTER 3

DEVELOPING A TRAUMA-INFORMED Methods: Overview of systematic reviews conducted by SERVICE RESPONSE TO DOMESTIC VIOLENCE Cochrane and the World Health Organization. Findings: There is limited evidence to guide practice but C Kezelman consensus guidelines suggest that all mental health practitioners should be asking about family violence and responding to such disclosures in a non-judgemental way that assists women on a pathway to safety and support.

Conclusions: Family violence can be addressed in psychiatric settings. All mental health professionals need to be trained to ask and respond to patients experiencing family violence.

PRESENTER 2 SOCIAL-CULTURAL DISTRESS IN DOMESTIC VIOLENCE AND PSYCHOPATHOLOGY- A QUALITATIVE STUDY IN A MIGRANT GROUP M O’Connor University of Melbourne, Melbourne, Australia

Background: Young adult women in many parts of the world have higher levels of common mental disorders than men. The exacerbation of domestic violence (DV) by migration is a salient social determinant of poor mental health. Ecological models describe DV-contributing factors as operating at the individual, family, cultural and societal levels. There is an urgent need to assess the impact of DV, the interplay among the above-mentioned factors and its contribution to mental illness in Australian-Indian families, particularly in view of the 17 suicides/homicides between 2012 and 2014 in this community from Victoria.

Adults Surviving Child Abuse, Sydney, Australia

Background: As co-author for the ASCA Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery and an advocate for the broad-based implementation of trauma-informed policy and practice across health and human service sectors, I feel passionate about the need for a comprehensive trauma-informed service response to family violence. The intersection between domestic violence and child abuse is substantive, with past and current trauma compounding one another for those affected. The impacts are cumulative. When working with such clients, who often have comorbid mental health presentations and challenging psychosocial health issues, it is crucial to use a trauma-informed lens. Objectives: This presentation aims to raise awareness about trauma, traumatic stress and its dynamics, the impacts of trauma and the ways people cope. It will challenge the single diagnostic lens of symptoms and signs and ask practitioners to consider the question: ‘What happened to you?’ rather than solely that of ‘What is wrong with you?’ Methods: It will provide basic information around the neurobiology of trauma and attachment and the principles of trauma-informed practice and consider how to implement them into daily practice. Findings: The presentation will highlight the benefits of trauma-informed practice for both practitioner/worker and patient/client in terms of enhanced outcomes and minimization of the risk for re-traumatisation for clients and vicarious traumatization for practitioners. Australian & New Zealand Journal of Psychiatry, 49(S1)

44 Conclusions: The presentation will provide the basis for further discussion around the opportunities and challenges for introducing trauma-informed models of practice in responding to people impacted by family violence.

PRESENTER 4 BUILDING PATHWAYS BETWEEN DOMESTIC AND FAMILY VIOLENCE SERVICES AND MENTAL HEALTH D Walsh Faculty of Heath and Behavioural Sciences, University of Queensland, St Lucia, Australia

Background: It is a long held view that being a victim of chronic or enduring domestic violence will have significant consequences on a person’s mental health. This paper will discuss service system use by victims of domestic and family violence and report on a project that has been designed to strengthen links between the silos of domestic violence and mental health services. Objectives: The aim of this paper is to describe how women use and don’t use the domestic violence and mental health systems. Understanding entry points, service use and the factors that facilitate and hinder access to services will assist professionals who work with women. Methods: This paper is based on the literature and 20 years’ practice experience in the field. Findings: Being a victim of domestic violence can introduce women to a range of silo service systems. These can include the domestic violence, child protection, housing, legal and mental health systems. When these services work collaboratively on behalf of women it enhances their ability to navigate through a very complex service system, resulting in better mental health outcomes. Conclusions: Leaving a domestically violent relationship is potentially dangerous for your health and mental health. When services understand each other and work collaboratively outcomes for women and children will improve.

PRIVATE PRACTITIONERS NETWORK SPECIAL INTEREST GROUP SYMPOSIUM – BRAVE NEW WORLDS: EVOLVING PARADIGMS OF CARE IN PRIVATE PRACTICE – PART 1 C Simons1,2,3, G Galambos4,5,6,7, S Blair-West2,8, J King2,9,10 1RANZCP

Affiliate of Psychiatry, University of Melbourne, Melbourne, Australia 3Adolescent Services, Albert Road Clinic, Melbourne, Australia 2Department


RANZCP Abstracts 4Young

Adult Mental Health Unit, St Vincent’s Private Hospital, Sydney, Australia 5Deputy Chair, RANZCP Private Practice Network 6The Lawson Clinic, Sydney, Australia 7University of New South Wales, Sydney, Australia 8Anxiety and Depression Program, OCD Program, The Melbourne Clinic, Richmond, Australia 9Chair, RANZCP Private Practitioners Network Special Interest Group 10Professorial Unit, The Melbourne Clinic, Richmond, Australia

Background: This symposium of the Private Practitioners Network Special Interest Group will focus on innovative models of care in private practice. The symposium will discuss different models of care, as well as the lessons learnt through the process of establishing new units or programs. Contrary to popular belief, private psychiatry has many opportunities for developing new models of care for patients and their families. This symposium’s speakers will explore their personal experiences in developing and running some of these, as well as the challenges and pitfalls they have faced along the way. The symposium will feature presentations from private psychiatrists who have established new units or programs. Dr Simons will discuss the establishment of Australia’s only private adolescent psychiatric unit and Dr Galambos the establishment of a private young adult unit, while Dr Blair-West will talk about The Melbourne Clinic’s OCD inpatient program. Dr King will discuss some of the issues relating to having psychiatry trainees in private settings. Objectives: This symposium will feature presentations from private psychiatrists who have worked to implement new models of care including the following: Dr Christine Simons, Child and Adolescent Psychiatrist and Director of the Adolescent Unit at Albert Road Clinic, Victoria Dr Scott Blair-West, Director of the OCD Program, The Melbourne Clinic, Victoria.

PRESENTER 1 THE GOLDILOCKS PRINCIPLE OF ADOLESCENT INPATIENT UNITS: TRYING TO GET IT “JUST RIGHT”. C Simons1,2,3 1RANZCP

Affiliate of Psychiatry, University of Melbourne, Melbourne,

2Department

Australia 3Adolescent Services, Albert Road Clinic, Melbourne, Australia

Background: The Pathways Unit at the Albert Road Clinic in Melbourne is a 10-bed Adolescent Inpatient Unit in the private sector. The inpatient unit is part of an Adolescent Service that also includes several Day Programs and an Outreach service. Inpatients are aged 13–23 years

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RANZCP Abstracts and have a wide range of psychiatric difficulties. As the new Medical Director in 2006, I embarked on a restructure and the implementation of a new program based on Dialectical Behaviour Therapy (DBT). Objectives: From the perspective of involvement in Child and Adolescent Inpatient Units in both public and private settings, including the Warneford Hospital, Oxford, England, the Adelaide Women’s and Children’s Hospital and the Albert Road Clinic, Melbourne, this presentation considers the ideas that influenced the redevelopment and the content of this program. Method: The tasks of initially engaging staff and psychiatrists to the changes and patterns that maintain the intensity and integrity are mentioned. The style of the Unit and the content of the program will be described in detail, both in overview and also as they impact on an individual admission. Findings: Research has identified that inpatient units function better, and offer better outcomes, when they follow a theoretical basis. The choice of DBT is discussed, including its flexibility to incorporate other therapeutic modalities including art therapy, narrative therapy, sensory modulation and family therapy. DBT has shown effectiveness for staff training, enabling increased participation in therapy delivery. Conclusions: The current program based on DBT implemented in the Pathways Adolescent Unit is offering valued outcomes to a varied population of young patients and their families. The benefits are thought to accrue from a perspective based in validation, ways of pacing therapy, training in both self-skills and patterns of problem solving, combined with unit patterns offering containment, consistency and cohesion.

PRESENTER 2 ESTABLISHING A PRIVATE YOUNG ADULT MENTAL HEALTH UNIT IN SYDNEY G Galambos1,2,3,4 1Young

Adult Mental Health Unit, St Vincent’s Private Hospital, Sydney, Australia 2Deputy Chair, RANZCP Private Practice Network 3The Lawson Clinic, Sydney, Australia 4University of New South Wales, Sydney, Australia

The author will provide a qualitative analysis from the perspective of an admitting psychiatrist exploring clinical, administrative and practical issues arising in the initial two years following the establishment of a subspecialty 20-bed

young adult unit in a private hospital in Sydney developed for 16–25 year olds with mood, anxiety and psychotic disorders, utilising a multidisciplinary inpatient and day patient treatment framework.

PRESENTER 3 BRAVE NEW WORLDS: EVOLVING PARADIGMS OF CARE IN PRIVATE PRACTICE S Blair-West1,2 1Department

of Psychiatry, University of Melbourne, Melbourne, Australia 2Anxiety and Depression Program, OCD Program, The Melbourne Clinic, Richmond, Australia

In the 1980s the Behavioural Program was developed at The Melbourne Clinic, a large private psychiatric hospital in Melbourne, as a CBT-based Inpatient Program to treat patients with treatment-resistant anxiety and depressive disorders. Created by the Clinical Psychology Department with input from a psychiatrist Medical Director, the program ran as a four-week intensive inpatient program for 20 years before I was appointed Medical Director in May 2002. It quickly became clear that the program catered poorly for patients with Obsessive-Compulsive Disorder (OCD) given an absence of intensive behavioural and Exposure and Response Prevention (ERP) treatments. In 2003 the then Clinical Director Dr Chris Mogan and I visited the OCD institute at McLean Hospital at the Harvard Medical School in Boston and resolved to develop a similar OCD-specific program to run on alternating fortnights with the current ADP Program for depression. The Program commenced in 2005 and is the only OCD-specific Inpatient Program in Australasia. Careful planning of our program was required to adapt aspects of the McLean program to our own specific circumstances. Two years of detailed planning and lengthy interdisciplinary consultation was required to develop a program featuring psycho-education in groups and ERP in both group and individual settings. The program now runs for approximately 30 weeks per calendar year, accepts referrals Australia-wide, provides second opinions for difficult cases and acts as a final treatment phase prior to consideration for Deep Brain Stimulation (DBS) treatment for severely unwell patients. Discussion will include: •• The role of the private psychiatrist in the planning, set up and implementation of such a program; Australian & New Zealand Journal of Psychiatry, 49(S1)

46 •• Adapting treatment plans from the United States situation to Australia; •• The need to develop a strong and inclusive team culture; •• Managing expectations of patients, families and external treaters; •• Education of other staff in the hospital in OCD and its treatment; •• Managing a group who demand freedom in an increasingly restrictive and security conscious hospital; •• Providing as much direct supervision and coaching as possible; •• Planning for discharge, follow-up and preventing relapse issues; •• Continuing liaison with external treaters. Conclusion: The presentation will provide a historical account of the development of the program as well as discussing the issues in planning, set up and subsequent implementation. Specific issues will be addressed as listed and questions welcomed.

PRIVATE PRACTITIONERS NETWORK SPECIAL INTEREST GROUP SYMPOSIUM – BRAVE NEW WORLDS: EVOLVING PARADIGMS OF CARE IN PRIVATE PRACTICE – PART 2 PRESENTER 4 PSYCHIATRY TRAINEES IN PRIVATE PRACTICE J King1,2,3 1Chair,

RANZCP Private Practitioners Network Special Interest Group 2Professorial Unit, The Melbourne Clinic, Australia 3Department of Psychiatry, The University of Melbourne, Melbourne, Australia

Around 66% of psychiatrists have some form of private practice. Despite this, psychiatry trainees spent most of their training in the public sector, with the majority never having worked in a private practice environment. As such, many trainees are inadequately exposed to mood and anxiety disorders, which are predominantly seen in private psychiatric settings, and the logistical, practical and ethical challenges of private practice. This presentation will focus on experiences having psychiatry trainees in a private psychiatric hospital, the differences from the public sector, and the challenges of making this viable and valuable for all parties.


RANZCP Abstracts

WHERE ARE WE THREE YEARS AFTER THE ‘LOST IN THE LABYRINTH REPORT’? THE NEW PATHWAY TO ACHIEVE FELLOWSHIP FOR OVERSEAS TRAINED PSYCHIATRIST AND THE SUPPORT PROGRAM J Allan1, D Neill2, V Garg3, E Guaia4, S Douglas5 1Chair,

RANZCP Committee for Specialist International Medical Graduate Education (CSIMGE), Brisbane, Australia 2Deputy Chair, RANZCP CSIMGE and Substantial Comparability Assessment/Review Panel (SCARP); Member, Victorian State Assessment Panel (SAP), Melbourne, Australia 3Illawarra, Shoalhaven Local Health District, University of Wollongong, Wollongong, Australia 4Deputy Chair, RANZCP Overseas Trained Psychiatrist Committee (OTPC); Princess Margaret Hospital, Perth, Australia 5Australian International Medical Graduate (IMG) Support, Advice and Advocacy Network, Canberra, Australia

Background: In 2012, the Standing Committee on Health and Ageing tabled its report on the inquiry into Registration Processes and Support for Overseas Trained Doctors entitled Lost in the Labyrinth: Report on the inquiry into registration process and support for overseas trained doctors. This follows significant reforms in the requirements for OTP/ SIMGs gaining fellowship in Australia. At any one time there are over 200 SIMGs on the path to Fellowship and each year up to 30% of new Fellows are SIMGs. Amongst the Specialist Colleges, RANZCP has one of the largest cohorts of SIMGs. The Overseas Trained Psychiatrist Committee (OTPC) is a committee of the RANZCP that directly reports to the General Council on matters pertaining to the overseas trained psychiatrist (OTP) in Australia and New Zealand. The Committee for Specialist International Medical Graduate Education (CSIMGE) is part of the RANZCP Education Committee. The CSIMGE and the OTPC have worked closely with the support of all the other relevant committees to implement new pathways for OTPs wanting to move to work in Australia and New Zealand. The SIMG Upskilling Project uses funds from the Australian Government to provide direct support for SIMGs in obtaining fellowship. Presentations from committee members of CSIMGE, OTPC and SIMG upskilling working party and from the Australian IMG Support, Advice and Advocacy Network will present the new pathways and their alignment with the AMC new standards for specialist registration and the future change towards a more appropriate assessment of OTPs and the alignment to the competence-based fellowship 2012. The support program and the current situation with all the other specialist colleges will also be presented. The involvement of the OTPC and experiences of OTPs will be presented.

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RANZCP Abstracts Objectives: This symposium will present the current achievements but, as well, the difficulties faced by OTPs on their journey. It will also discuss and seek comment on future directions for SIMG pathways to Fellowship and the supports required for this.

•• Consider the goals and objectives of the College in dealing with OTPs/SIMGs; •• Discussion of the reasons why changes were introduced and some background to choices made for State Assessment Panels (SAPs) and Substantial Comparability Pathway (SCP) and supports offered.

Methods: The presenters will: •• Report on the Substantial Comparability Pathway phases one and two, and explain the WBA process; •• Discuss the intentions for new methods of assessment for partially comparable SIMGs; •• Report the journey of the OTPC in the last six years, importantly focusing on the work done post May 2011; •• Consider the WBA obstacles and review implementation in other colleges; •• Report on the SIMG upskilling project and consider the value of supports to SIMGs; •• There will be a panel discussion around the future of SIMGs and the College

PRESENTER 1 RECENT HISTORY OF OTP PATH TO FELLOWSHIP: THE CASE FOR CHANGE J Allan Chair, RANZCP CSIMGE, Brisbane, Australia

Background: The RANZCP has always had a special pathway for OTP/SIMGs to obtain Fellowship, and hundreds of current Fellows have come via this. From the time of “Special Exams” in the 1980s to Modified Clinical Exams of recent times, we have sought a perfect solution. All of these processes have been plagued by a high failure rate (at times >80%) and results which do not bear witness to the skills and training of many of the candidates. Australian and New Zealand Medical Boards and their successors have demanded the demonstration of comparability for registration but the AMC also requires comparability for Fellowship. In the face of concerns about an unfair system which excluded many potential Fellows and protests from OTP/ SIMGs in 2008 the newly created Board of Education sought a new system of comparability assessment. Objectives: •• Provide an overview of changes to entry, support, examinations and other pathways to fellowship of the College focusing on the work of SIMGE in the last 7 years;

Findings: This session will also discuss the SIMG Support programs which have been funded by the Australian Government and other formal and informal mechanisms. Conclusions: The OTP/IMG was in need of reform and required substantial change by from the College and Fellows to achieve this.

PRESENTER 2 THE CHANGING FACE OF COMPARABILITY ASSESSMENT, 2008 – FUTURE D Neill Deputy Chair, RANZCP CSIMGE and SCARP; member, Victorian SAP, Melbourne, Australia

Background: Commencing 2008, CSIMGE reformed the processes of IMG progress to Fellowship to: strengthen education and support for IMGs; expect universal, committed progression to Fellowship by IMGs; broaden the methods and mechanisms of determining comparability of training, qualification and experience; provide an alternative pathway to Fellowship for IMGs determined as substantially comparable – the Substantial Comparability Pathway (SCP). Achievements 2009–2014 are: implementation and consolidation of State Assessment Panels (SAPs); design, trial, evaluation, and expansion of SCP, now in phase II; formation and operation of the Substantial Comparability Assessment/Review Panel (SCARP). Objectives: To summarize the work of SAPs, SCP and SCARP, and scope their future. Methods: Key data will be presented alongside a descriptive narrative of the function of SAPs, SCP and SCARP. Findings: SAP: Has 50 members in six Panels, nominated by Branches, and trained, accredited and mentored by CSIMGE. A three-member Panel is constituted in a monthly schedule. Each application is assessed by audit of application papers, semi structured interview, consensus decision on comparability and gaps, and a comparability score, including weighting for further learning in post specialization training and experience. Final recommendations of


48

RANZCP Abstracts

comparability and any specific training/experience requirements are made to CSIMGE. SCP: Development phase 2009–2010 comprised research, tool selection and development, pathway design, assessor training, accreditation and resource development. Phase I (a) commenced February 2011 with 23 candidates. Phases 1(a)–(c) total, 2011–2014, is 56. Outcomes will be reported. Phase II expands the accepted qualifications and opened September 2014; 42 candidates were accepted; 37 (maximum assessment capacity) commenced in November 2014; 5 start in November 2015. SCARP: Oversights individual candidate progress, and assessment processes and outcomes; manages any problems arising, and confirms the results. Its composition, functions and outcomes will be described. Conclusions: The IMG pathway to Fellowship has been reformed; SAP, SCP and SCARP are the buttresses of the assessment component. Future needs are enabling full integration with the 2012 Fellowship Program, consolidation, and attention to audit and support of Panels.

PRESENTER 3 THE OVERSEAS TRAINED PSYCHIATRIST COMMITTEE: FROM MELBOURNE (2008) TO BRISBANE (2014) E Guaia1, V Garg2 1Deputy

Chair, RANZCP OTPC, Princess Margaret Hospital, Perth,

Australia 2Illawarra Shoalhaven Local Health District, University of Wollongong, Wollongong, Australia

Background: It was realized that Australia and New Zealand had a significant proportion of workforce contributed by OTPs and there was a felt need to include them in the College Governance system, and this committee was formed in 2008. The Overseas Trained Psychiatrist Committee (OTPC) is a committee of the RANZCP that directly reports to the General Council on matters pertaining to the overseas trained psychiatrist (OTP) in Australia and New Zealand. Since its inception, the OTPC has been represented in many Boards and Committees and has contributed extensively through advocacy in many broad matters, and most importantly the Substantial Comparability Pathway.

Findings: The OTPC is formed by OTPs (whether Fellow or Non-Fellow) in Australia and New Zealand. The members represent in many Boards and Committees. The most important representation has been on the Specialist International Medical Graduate Examination Committee (SIMGE) and Board of Education. The most important contribution over the last five years has been working collaboratively with the SIMGE in developing and implementing the Substantial Comparability Pathway that was initially piloted on a restricted group of IMGs and now is being expanded broadly to include wider qualifications. There has been a significant advocacy to get funding and support IMGs in rural and remote areas. Other areas of contribution and advocacy will be highlighted. Conclusions: The OTPC has come a long way over the last six years and the progress made over the last three years is exponentially high, and we hope to contribute more and more in the coming years.

PRESENTER 4 THE WBA OBSTACLES AND IMPLEMENTATION IN OTHER COLLEGES: A REVIEW S Douglas Australian IMG Support, Advice and Advocacy Network, Canberra, Australia

Background: The need for Overseas Trained Specialists (OTSs) to pass fellowship exams has been a major barrier to obtaining Australian qualifications. OTSs are at a disadvantage over Australian trained trainees with regard to passing fellowship exams. First, many are highly experienced doctors who have not had to take exams for many years. Experienced doctors also have a harder time articulating what they know and do, as this knowledge has become deeply integrated in their knowledge. Finally, OTSs often do not have the educational support and the ability to take study leave that is available to Australian and New Zealand trainees. The workplace based assessment (WBA) is a more valid means of assessing professional competence than examinations as it examines the doctor’s real time practice. The Lost in the Labyrinth report recommended that exams should be reserved for new graduates or those for whom there are concerns about their professional performance

Objectives: The main objective of this presentation is to capture the journey of the OTPC in the last six years

Objectives: To determine the scope of the use of WBA for OTSs and the barriers to implementation of WBA across the Colleges.

Methods: We summarize the work done by the OTPC in the last six years, but more importantly focus on the work done post May 2011.

Methods: Colleges will be contacted by mail and phone to determine the extent of the use of WBA as well as the challenges in implementing this form of assessment.


49

RANZCP Abstracts Conclusions: The above information will be presented with a focus on the comparison between the RANZCP and other Colleges.

GENERALISTS AND (SUB)SPECIALISTS: HAS THE BALANCE SWUNG TOO FAR? ARE THE SCALES WEIGHTED EQUALLY IN METROPOLITAN AND REGIONAL SETTINGS? J Reilly, J Lee, M Mohiuddin Mental Health Service Group, Townsville Hospital & Health Service, Townsville, Australia

or planned in other services, including their outcomes. We anticipate this will be of particular relevance to psychiatrists working in rural and remote settings, but believe it is important for all. Conclusion: The symposium will enhance understanding of possible generalist and sub-specialist models of care and encourage discussion about the impact of further sub-specialisation in psychiatry and a possible shift to generalist training with associated training and service delivery requirements.

PRESENTER 1

MEDICAL GENERALISTS AND (SUB)Background: Medical specialisation and its inevitable SPECIALISTS: A BRIEF HISTORY AND hand-maiden, sub-specialisation, has been associated with OVERVIEW OF RECENT APPROACHES significant advances in effectiveness of health service J Reilly delivery, facilitating high-quality assessment and effective evidence-based health care in addition to targeted research. It does come at a potential cost of fragmentation of service delivery with focus on organ systems or service delivery structures rather than holistic care. The balance between generalist care and specialisation is influenced by many factors not necessarily related to most cost-effective clinical service delivery and certainly including training structures. Objectives: •• To stimulate discussion about impacts of subspecialisation on RANZCP training and on service delivery to people with mental illness, particularly in regional settings. •• To consider possible benefits and risks of more generalist psychiatric care, including existing barriers to training in and maintenance of sub-specialist skills for generalists. Methods: The speakers will consider this topic from various perspectives, including historical trends, those of other Medical Colleges, service development and delivery, psychiatric training and particularly addiction, child and adolescent, and old age psychiatry as sub-specialties. They will use their current roles of psychiatric trainee, psychiatrists and service directors from a regional centre to do so and to outline the strategies being used in Townsville and the surrounding area to provide generalist and subspecialty care. The audience will be encouraged to discuss personal experiences of generalist vs sub-specialist psychiatry and of access to sub-specialty knowledge and skills and the relevance of sub-specialty training, and the strategies used by

Mental Health Service Group, Townsville Hospital & Health Service, Townsville, Australia

Background: The harmful consequences of medical specialisation can include inappropriate or unnecessary assessment and treatment and lack of access to services due to associated de-skilling of more generalist health providers and services. At an individual patient level this can lead to inappropriate or unnecessary assessment and treatment and to a lack of clinical oversight of complex cases involving multiple specialties. More systemically, in areas less well served by specialists such as rural and remote regions, application of sub-specialty models of care from metropolitan settings can paradoxically lead to reduced access to services, compounded by the de-skilling of more generalist health providers and services by training and service networks developed to facilitate subspecialty training. Objectives: To understand the wider context of the long-standing and wide-ranging debate on the generalist vs specialist continuum and consider its current impact in RANZCP training, particularly in rural and remote areas. Methods: Targeted review of medical literature in relation to generalist vs specialist care with a particular focus on general physicians, advanced skills for general practitioners and RANZCP generalist training. Findings and conclusions: This presentation will set the scene for more specific focus on generalist and sub-specialist models of service delivery and associated training requirements.


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PRESENTER 2 ENHANCING GENERALIST SKILLS IN RURAL AND REMOTE PSYCHIATRISTS J Lee Rural, Remote and Indigenous MHS, Mental Health Service Group, Townsville Hospital & Health Service, Townsville, Australia

Background: In Australia, 81% of the psychiatric workforce services 66% of the population, while 19% services the remaining 34%, those who live in rural and remote Australia. This serves as a platform for understanding the access barrier to sub-specialty psychiatric services for those who live outside metropolitan centres. Whilst telehealth psychiatry services, nurse practitioners and general practitioners with advanced skills training have been effective in closing this gap, they cannot fully replace the value of face-to-face specialist consultations. Objectives: To stimulate discussion about strategies for enhancing sub-specialty knowledge, skills and practice in clinicians who work in rural and remote settings. Methods: The development of a mental health service across several rural and remote communities within Townsville Hospital and Health Service district will be considered, including needs for service, identified service gaps and strategies to address these, including development of generalist and sub-specialty skills among psychiatrists and other clinicians. Issues encountered thus far will be discussed, including clinical governance and oversight, impact of service structure changes, training needs and formal and informal training opportunities.

RANZCP Abstracts capacity and de-skilling of psychiatrists in addiction, contributing to lack of training pathways in addiction psychiatry. Developing Hospital and Health Service structures in Queensland have supported the reunion of MHS and Alcohol, Tobacco and Other Drugs Services (ATODS). This has necessitated the development of clinical capacity in addictions among psychiatrists and other clinicians in addition to applicable clinical governance processes. ATODS model of care historically has hovered between primary and secondary care, with associated de-skilling of primary care services. Objectives: To stimulate discussion about strategies for enhancing subspecialty knowledge, skills and practice in addictions in clinicians who work in rural and remote settings. Methods: We will consider addictions as a specific example of the issues highlighted by Dr Lee. We will outline existing service delivery structures and gaps in Queensland. We will identify core requirements for psychiatrists to work as clinicians in addiction services, whether as subspecialists or generalists, and consider strategies for upskilling psychiatrists, other mental health clinicians and general practitioners in addictions. Findings and conclusions: Linkages between psychiatry and addictions need further nurturing. RANZCP training and the attitudes of psychiatrists will play a vital role in the reunions and the recognition of addictions as a core component of psychiatry.

PRESENTER 4

DEVELOPING CAPACITY IN ADDICTIONS IN RURAL AND REMOTE Findings and conclusions: To acquire a better under- HEALTH SERVICES: A NORTH standing of the need for a training model to be developed QUEENSLAND PERSPECTIVE for psychiatrists who work in rural and remote settings to M Mohiuddin have a generalist focus, necessitating enhanced subspecialty knowledge and skills, and to propose a potential training model to meet this need.

PRESENTER 3 ADDICTIONS AND MENTAL HEALTH SERVICES: A BRIEF OVERVIEW OF RECENT HISTORY IN QUEENSLAND J Reilly Mental Health Service Group, Townsville Hospital & Health Service, Townsville, Australia

Background: The longstanding breach in many states between public sector mental health services (MHS) and clinical addiction services has been associated with loss of Australian & New Zealand Journal of Psychiatry, 49(S1)

Mental Health Service Group, Townsville Hospital & Health Service, Townsville, Australia

Background: The longstanding breach in many states between public sector mental health services (MHS) and clinical addiction services has been associated with loss of capacity and de-skilling of psychiatrists in addictions, contributing to lack of training pathways in addiction psychiatry. Developing Hospital and Health Service structures in Queensland have supported the reunion of MHS and Alcohol, Tobacco and Other Drugs Services (ATODS). This has necessitated the development of clinical capacity in addictions among psychiatrists and other clinicians in addition to applicable clinical governance processes. Objectives: To identify core requirements for psychiatrists to work as clinicians in addiction services, whether as

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RANZCP Abstracts sub-specialists or generalists, in rural and remote areas, though with possible applicability in some metropolitan areas.

PRESENTER 1

RANZCP EARLY CAREER PSYCHIATRIST AWARD RECIPIENT Methods: Outline the experience of the Rural, Remote RESEARCH PRESENTATION and Indigenous (RRI) MHS of Townsville in modifying previous models of service delivery in addictions. Explain strategies to develop addiction capacity in the psychiatrists and other mental health clinicians of the RRI MHS and their implementation to date. Explain how this process has been incorporated into personal training in Addiction Psychiatry. Findings: Current status of addictions services in the RRI will be outlined. Difficulties experienced in the process will be highlighted in addition to achievements thus far. Conclusion: The process to date and the training package developed for addiction psychiatry in rural and remote settings offers a template for other trainees and other services wishing to develop such capacity.

EARLY CAREER PSYCHIATRISTS SPECIAL INTEREST GROUP SYMPOSIUM N Mills1,2, E Nelson3, J Scott4, J Whitfield1, N Martin1, M Wright1, N Wray2, E Byrne2, J Martin5,6, RANZCP Early Career Psychiatrists Award recipient 1QIMR

Berghofer Medical Research Institute, Brisbane, Australia 2Queensland Brain Institute, University of Queensland, St Lucia, Australia 3Department of Psychiatry, Washington University School of Medicine, St Louis, USA 4University of Queensland Centre for Clinical Research, Herston, Australia 5Moonah Park Residential Aged Care Facility, Mitchelton, Australia 6Toowong Specialist Clinic, Toowong, Australia

Background: This symposium is a presentation of the Early Career Psychiatrists Special Interest Group Committee. In accordance with the terms of reference for the Special Interest Group, the Early Career Psychiatrists Special Interest Group is very supportive of providing opportunities for early career Fellows and the introduction of such a symposium is one key way in which the group is supporting its members. Objectives: The aim of this symposium is to allow early career psychiatrists an opportunity to present their work, experience and research within a dedicated symposium during Congress 2015 and to promote and encourage research amongst Fellows in their early years of Fellowship.

This presentation will be delivered by the recipient of the Early Career Psychiatrist Award. The recipient of this award will be determined in early 2015. The presentation aims to increase the profile of the RANZCP Early Career Psychiatrist Award by providing the recipient an opportunity to present their research during a dedicated Early Career Psychiatrist Symposium at Congress.

PRESENTER 2 INVESTIGATING THE RELATIONSHIP BETWEEN C-REACTIVE PROTEIN GENETIC PROFILE SCORES AND DEPRESSION N Mills1,2, E Nelson3, J Scott4, J Whitfield1, N Martin1, M Wright1, N Wray2, E Byrne2 1QIMR

Berghofer Medical Research Institute, Brisbane, Australia Brain Institute, University of Queensland, St Lucia, Australia 3Department of Psychiatry, Washington University School of Medicine, St Louis, USA 4University of Queensland Centre for Clinical Research, Herston, Australia 2Queensland

Background: C-reactive protein (CRP) levels have been associated with Major Depressive Disorder (MDD) and childhood trauma. Genetic variants associated with CRP have been identified through genome-wide association studies (GWAS). Here we explore the phenotypic and genetic relationship between CRP, MDD and childhood trauma. Methods: Assessment of a total of 18,411 adults, as part of three population-based surveys of twins from the Australian Twin Registry conducted at QIMR Berghofer Medical Research Institute (QIMR) included lifetime diagnosis of MDD (DSM-IV), and an evaluation of trauma (child sexual abuse (CSA) and child physical abuse (CPA) prior to the age of 18 years). Of these, 8,521 individuals had CRP measures, 6,612 had both CRP and GWAS data. CRP GWAS results from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) (Psaty et al., 2009) were used to generate genetic profile scores for CRP in the QIMR sample based on SNPs with p values < 0.001. We tested for association between CRP genetic risk profiles and CRP and MDD phenotypes. Results: The relationship between CRP and MDD was moderated by sex, CSA, and body mass index (BMI). CRP Australian & New Zealand Journal of Psychiatry, 49(S1)

52 profile scores predicted CRP in the QIMR sample, with 18% of the variance of CRP explained. CRP profile scores did not predict MDD status. Conclusion: We replicated published associations between MDD and CRP moderated by sex and CSA. We found no evidence that this relationship reflected genetic differences between individuals in CRP. Reference Psaty BM, O’Donnell CJ, et al. (2009) Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium Design of Prospective Meta-Analyses of Genome-Wide Association Studies From 5 Cohorts. Circulation-Cardiovascular Genetics 2: 73–U128.

PRESENTER 3 TRANSITIONS IN EARLY CAREER PSYCHIATRY J Martin1,2 1Moonah

Park Residential Aged Care Facility, Mitchelton, Australia 2Toowong Specialist Clinic, Toowong, Australia

Background: This presentation will explore challenges faced by many psychiatrists in their early years of fellowship, as well as issues regarding different transitions during this period. The aim of the presentation reflects the College’s strategic priorities around supporting members, enhancing the value of College membership, and considering different membership groups and their respective needs from the College. The symposium aims to have a practical focus on important issues faced by psychiatrists in the early years of their careers, providing attendees with an opportunity to explore and discuss major career transitions. Objectives: Among other topics, the presentation will focus on the following:

RANZCP Abstracts fellows with the aim of imparting to ECPs some important lessons learnt throughout their careers in psychiatry. Presenters will be drawn from eminent fellows who are attending Congress and will be identified once Early Bird Registrations have closed and an idea of those already attending Congress is known.

MENTAL HEALTH IN THE AUSTRALIAN DEFENCE FORCE (ADF) AND THE ROLE OF THE ADF CENTRE FOR MENTAL HEALTH D Morton1, D Wallace2, J Costello2, D Said2 1Department

of Defence, Campbell Park, Canberra, Australia Defence Force Centre for Mental Health, HMAS PENGUIN, Mosman, Australia 2Australian

Background: Over 45,000 members of the ADF have served in conflict areas or peacekeeping operations since 1999. Many more have also served on disaster relief and humanitarian assistance operations across the world. Objectives: This symposium will provide an overview of the potential mental health impacts of operational experience on serving members and those who have transitioned to civilian life, and will review mental health and rehabilitation services provided by the ADF. Methods: It will provide an overview of the prevalence of mental health disorders and discuss the strengths and weaknesses of mental health services in the ADF. It will describe the role of the ADF Centre for Mental Health and some of its programs: in particular, the work of the Second Opinion Clinic, a national, tertiary referral service; and the implementation of the Recognising Early Signs of Emerging Traumatic Stress (RESET) Program, an innovative, psychological skills development program for members considered to be at risk of development of Posttraumatic Stress Disorder.

THE MOST IMPORTANT THINGS I’VE LEARNT IN PSYCHIATRY

Findings: Following the Dunt Review of Mental Health Services, the ADF embarked on a four-year plan to reform services. This included the development of the ADF Mental Health and Wellbeing Strategy, implemented via the Mental Health and Wellbeing Action Plan. Through partnerships with the Department of Veterans’ Affairs (DVA) and key civilian organisations, it has undertaken major research programs to determine the nature and prevalence of mental disorders. A range of key mental health and rehabilitation service delivery programs have been implemented.

Background: This presentation will feature lighthearted, funny and informative discussion by eminent, senior

Conclusions: The ADF and DVA are working to provide high-quality mental health care to serving members and those who transition to civilian life.

•• Transitioning from public to private practice; •• Juggling work and family commitments; •• Achieving work-life balance.

PRESENTER 4


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RANZCP Abstracts

PRESENTER 1 MENTAL HEALTH IN THE AUSTRALIAN DEFENCE FORCE D Morton Department of Defence, Campbell Park, Canberra, Australia

Background: Over 45,000 members of the ADF have served in conflict areas or peacekeeping operations since 1999. Many more have also served on disaster relief and humanitarian assistance operations across the world. Objectives: This presentation will provide an overview of the potential mental health impacts of these duties on serving members and will also describe the reform of ADF mental health services and their provision to personnel. Methods: A description of the reform of ADF Mental Health Services following the Dunt Review is provided. The resultant initiatives included: the growth and up-skilling of mental health personnel; the development of the ADF Centre for Mental Health; major research programs, in partnership with the Department of Veterans Affairs and key civilian organisations, into the prevalence of disorders in serving members and veterans; the development of the ADF Mental Health and Wellbeing Strategy, implemented through the Mental Health and Wellbeing Action Plan; and the delivery of prevention, mental health service delivery and rehabilitation programs. Findings: A range of key mental health and rehabilitation service delivery programs have been implemented. Conclusions: The ADF and DVA are working to provide high-quality mental health care to serving members and those who transition to civilian life.

PRESENTER 2 THE AUSTRALIAN DEFENCE FORCE (ADF) CENTRE FOR MENTAL HEALTH J Costello Australian Defence Force Centre for Mental Health, HMAS PENGUIN, Mosman, Australia

Background: The ADF Centre for Mental Health (ADFCMH) was established in 2010 as part of the mental health reform program initiated by the Dunt Review. The centre’s mandate supports the ADF Mental Health and Well Being Plan 2012– 2015 by enhancing the mental health workforce and improving the quality of mental health care in the ADF. Objectives: This presentation will describe the establishment, mission, roles and responsibilities of the ADFCMH.

Methods: The ADFCMH Clinical Consultancy Services, Mental Health Workforce Clinical Skilling Framework, Clinical Programs and strategic partnerships will be outlined. Findings: The ADFCMH is a national asset that provides mental health consultancy services, trains and up-skills the ADF mental health workforce, and provides expert advice to command, Joint Health Command and the Single Services in the review and management of complex mental health presentations. Conclusions: The ADF is committed to achieving capability through mental fitness; the ADFCMH operationalises this intent by supporting the interaction between ADF members, families, command, and health providers throughout the Force Generation Cycle.

PRESENTER 3 THE AUSTRALIAN DEFENCE FORCE (ADF) CENTRE FOR MENTAL HEALTH SECOND OPINION CLINIC D Wallace Australian Defence Force Centre for Mental Health, HMAS PENGUIN, Mosman, Australia

Background: The ADF Centre for Mental Health was established as part of the Australian Government’s response to the 2009 Dunt Review of Mental Health services in the ADF. The key duties of the Centre include the provision of expert clinical advice, assessment and treatment services for complex mental health cases. The Centre was also tasked to become a hub for telepsychiatry services to the ADF. A second opinion clinic was developed to meet these requirements. Objectives: To describe the establishment and work of a national, military, mental health tertiary referral clinic and to evaluate its performance through surveys of referring medical practitioners and patients. Method: A retrospective file review of the first 50 patients seen at the clinic was performed. Referrer satisfaction was assessed using an in-house questionnaire, based on the Primary Care Assessment Survey developed by The Health Institute of the New England Medical Centre. Patient satisfaction was gauged using the existing Defence Health Service Outpatient Satisfaction Survey. Findings: Patients seen were complex and appropriate referrals. Almost a quarter of patients were assessed by telepsychiatry. Major Depression, Alcohol Disorders, Bipolar II Disorder and PTSD were the most common disorders Australian & New Zealand Journal of Psychiatry, 49(S1)

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RANZCP Abstracts

seen. The diagnosis was changed in half of the patients seen, resulting in significantly different clinical management and administrative outcomes. High levels of satisfaction with the service were reported by referrers and patients.

wide variety of settings; (3) appropriate for Defence personnel returning from deployment; and (4) culturally informed and delivered in a flexible manner with a skills focus rather than pathology focus.

Conclusions: The ADF Centre for Mental Health Second Opinion Clinic provides an important, specialised clinical service, which supports good practice by performing the sort of detailed assessment that may be impractical for referrer doctors. It is well received by referrers and consumers.

THE PHILOSOPHY OF ADDICTIVE DISORDERS N Levy1, D Murphy2, S Rosenman3 (Moderator)

PRESENTER 4 THE RECOGNISING EARLY SIGNS OF EMERGING TRAUMATIC STRESS (RESET) PROGRAM D Said Australian Defence Force Centre for Mental Health, HMAS PENGUIN, Mosman, Australia

Background: Defence personnel are often exposed to potentially traumatic events in the course of their duties. Defence personnel receive training across the continuum of their employment in adaptive coping and resilience. A percentage of Defence personnel experience subsyndromal symptoms following exposure to potentially traumatic events. One of the unique characteristics of Defence personnel is that they are highly trainable and have levels of self-efficacy. Recognising Early Symptoms of Emerging Traumatic Stress (RESET) is a cross-over point between mental health prevention and early intervention that provides Defence personnel with an evidence-informed, skill-based intervention for sub-clinical presentations. Objectives: This symposium will provide an overview of the RESET program. Methods: The six modules of RESET which focus on skill development and self-management of symptoms will be outlined.

1Florey

Institute of Neuroscience and Mental Health, Melbourne, Australia; Oxford Centre for Neuroethics, Oxford, UK 2University of Sydney, Sydney, Australia 3St John of God Health Service, Sydney, Australia; Chair, RANZCP Special Interest Group for History, Philosophy and Ethics in Psychiatry

Background: The concept of addictive behaviours underlies and unifies theorising and practice in relation to behaviours as disparate as substance use, gambling, sex and eating. The validity of this assumed unification needs to be explored lest an invalid concept become a block to progress. Objectives: To examine the current concepts of addictive behaviours and the evidence that allows us to approach them as coherent concept and the evidence that they are incoherent. Methods: A philosophical analysis of the concepts will precede a review of the current behavioural, neurophysiological, and familial evidence for coherence and incoherence. Practitioners will be asked to comment on their practical experience that illuminates these questions and problems. Findings: To be developed in the course of the symposium. Conclusions: To be developed in the course of the symposium.

PRESENTER 1

THE PHILOSOPHY OF ADDICTIVE DISORDERS Findings: The RESET program focuses on delivering sevN Levy eral core empirically derived skill sets that have been shown to help with a variety of mild symptomatology. Research indicates that a skills-building approach is more effective than supportive counselling. RESET is effectively a skills-training model designed to increase self-efficacy. Conclusions: The ADF is working to provide high-quality tailored mental health care to serving members. The principles and techniques of RESET meet four basic standards. They are: (1) consistent with research evidence on risk and resilience following stressful events; (2) applicable in a Australian & New Zealand Journal of Psychiatry, 49(S1)

Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Oxford Centre for Neuroethics, Oxford, UK

Many people, including psychiatrists, find addiction deeply puzzling. Why would a seemingly rational agent who recognizes that they have better reason to abstain from taking drugs nevertheless continue to consume them, sometimes at great personal costs to themselves? Because addiction is puzzling, we are tempted to explain it as the product of dramatic alteration of brain functioning.

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RANZCP Abstracts In this paper, I’ll suggest that the pathological brain alterations underlying addiction represent a dysfunction of a normal brain mechanism. The alterations in behaviour can be seen in all people, addicted or not, under some conditions. Addiction just broadens the range of circumstances in which these behaviours occur.

EXPANDED TREATMENT OPTIONS FOR SCHIZOPHRENIA AND SCHIZOAFFECTIVE DISORDER: evidence from 15 biomarkers S Fryar-Williams1,2,3,4, N Saunders5,6,7, M Mack8,9,10 1University

PRESENTER 2 THE PHILOSOPHY OF ADDICTIVE DISORDERS D Murphy University of Sydney, Sydney, Australia

Many sceptics about the disease model of addiction seemingly share the assumption that chosen behaviour is not pathological; it is a normative violation, but not in the way characteristic of disease. But many mental illnesses seem to configure the motivational structure of sufferers. I suggest that the crucial question about the disease model is whether the motivational structure of the addict is just normally irrational or irrational due to pathology. Addicts often seem to resolve the trade-off between short-term pleasure and long-term harm via wishful thinking, through acting as though the long-term problems are not a consideration. But resolving a conflict between options by just adopting a belief that bad consequences will not follow if I choose one option is seriously irrational in a way that goes beyond ordinary frailties of thought and into magical thinking. This suggests that the neurocognitive rewiring that goes on in addiction takes the subject beyond ordinary irrationality and into something psychotic enough for us to view alcoholism as a distinct disease category rather than something continuous with ordinary irrationality.

of Adelaide, Adelaide, Australia Elizabeth Hospital, Woodville, Australia 3Basil Hetzel Institute for Translational Health Research, Woodville, Australia 4Youth In Mind Research Institute, Norwood, Australia 5University of Sydney, Sydney, Australia 6 Mind and Memory Centre, Tweed Heads, Australia 7Applied Neuroscience Society of Australasia (ANSA), Australia 8Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia 9Monash University, Melbourne, Australia 10Listen and Learn Centre, Melbourne, Australia 2Queen

Overarching abstract and background: Schizophrenia and schizoaffective disorder are allied conditions within the clinical setting. The Mental Health Biomarker Project (2010– 2014) sought to investigate putative markers with a high possibility of being associated with these conditions in neurophysiological tests and proximal and remote biochemical pathways related to neurotransmitter synthesis and metabolism. Methods: A case-control design used highly characterised cases of functional schizophrenia and schizoaffective disorder, combined with commercially available biochemistry tests and easily procurable neurophysiological and cognitive assessment methods that are easily administered in a 45-minute clinic consultation.

St John of God Health Service, Sydney, Australia; Chair, RANZCP Special Interest Group for History, Philosophy and Ethics in Psychiatry

Findings: Quantitative evidence for 15 biomarkers formed a five-domain model of schizophrenia and schizoaffective disorder, with 82% sensitivity and 90% specificity, at 95% level of confidence. The biomarkers themselves were found to be translationally linked in a manner that supports the dysconnectivity theory of schizophrenia. Duration of illness correlates indicated that abnormal biomarkers are present at the first episode of disease presentation, implying that scope exists for strategically sequenced, biomarker-guided remediation in the first-episode phase of schizophrenia and schizoaffective disorder.

This is primarily the moderation of the discussion initiated by the principal speakers. The moderator will introduce the speakers, encourage and manage the discussion between them and with the audience. The moderator himself believes that the discussion of addiction cannot proceed without closer philosophical examination of motivational states, and very subtle discriminations need to be made in management. This is often not made in standard treatment approaches.

Conclusions: Findings relate to a much required advance in psychiatry – a quantified, multi-domain model for serious mental illness that is theoretically understandable, translationally informative and treatment-relevant. The biomarkers have implications for personalised, targeted treatment of schizophrenia and schizoaffective disorder, using an expanded range of currently available treatment options in biochemical and sensory processing domains.

PRESENTER 3 THE PHILOSOPHY OF ADDICTIVE DISORDERS S Rosenman


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PRESENTER 1 POTENTIAL FOR BIOCHEMICAL AND NUTRITIONAL REMEDIATION IN schizophrenia and schizoaffective disorder S Fryar-Williams1,2,3,4 1University

of Adelaide, Adelaide, Australia Elizabeth Hospital, Woodville, Australia 3Basil Hetzel Institute for Translational Health Research, Woodville, Australia 4Youth In Mind Research Institute, Adelaide, Australia

RANZCP Abstracts Objectives: To present research and literature evidence for new treatment methods to enhance working memory and speed of sensory processing. Methods and findings: Literature and research evidence across a number of domains demonstrate the efficacy of targeted brain games, transcranial stimulation and neurofeedback, for working memory and speed of processing enhancement in schizophrenia and affective disorders.

2Queen

Abstract: Nutritional and biochemical correction of biomarker abnormalities in schizophrenia and schizoaffective disorder. Background: The Mental Health Biomarker Project (2010–2014) explored enzymes and vitamin and mineral enzyme cofactors related to pathways linking neurotransmitter synthesis and metabolism in schizophrenia and schizoaffective disorder. Objectives: To explain research and literature evidence for biochemical pathways related to schizophrenia and schizoaffective disorder and the theory linking evidence with biochemical and nutritional treatment options. Findings: Abnormalities in pathways related to monoamine synthesis and metabolism and oxidative stress protection pathways and cofactors for enzymes in these pathways were found to be biomarkers differentiating cases from controls. Conclusions: There is potential for informed, judicious biochemical and nutritional treatment to augment conventional pharmacotherapy for schizophrenia and schizoaffective disorder.

PRESENTER 2 SCOPE FOR BROADER THERAPEUTIC APPROACHES TO IMPROVE WORKINGMEMORY DEFICIT IN SCHIZOPHRENIA AND ITS MOOD COMPONENTS N Saunders1,2,3 1University

of Sydney, Sydney, Australia and Memory Centre, Tweed Heads, Australia 3Applied Neuroscience Society of Australasia (ANSA), Australia 2Mind

Abstract and background: Working memory deficit is a consistent hallmark in schizophrenia, along with delayed auditory and visual speed of processing. These are remediable conditions. Australian & New Zealand Journal of Psychiatry, 49(S1)

Conclusions: There is scope for several new techniques to remediate working memory and sensory speed deficits in schizophrenia and schizoaffective disorder.

PRESENTER 3 DICHOTIC LISTENING AS A FUNCTION OF INTER-HEMISPHERIC INTERACTION AND CONNECTIVITY AND ITS RELATIONSHIP TO SCHIZOPHRENIA TREATMENT. M Mack1,2,3 1Melbourne

Graduate School of Education, University of Melbourne, Melbourne, Australia 2Monash University, Melbourne, Australia 3Listen and Learn centre, Melbourne, Australia

Abstract and background: Dichotic listening disorder is a remediable condition that has been found as a biomarker in schizophrenia along with findings indicating cerebral circuit disconnectivity. The Dichotic Listening Test is a test of lateralized temporal lobe language function as well as a test of auditory inter-hemispheric interaction and connectivity. Objectives: Research and literature review explores the relationship between dichotic listening and schizophrenia and dichotic listening remediation, and demonstrates available techniques for dichotic listening correction. Method: A behavioural test and treatment applications for normalizing hemispheric lateralization of speech sound perception (dichotic listening), whereby two different stimuli are presented to the left and right ears simultaneously which may vary in volume, frequency and timing, and the individual is required to separate the auditory information and perform a task called auditory separation and integration. Findings: Dichotic listening improvement. Conclusions: Dichotic listening remediation techniques are available and have potential to enhance function in schizophrenia and schizoaffective disorder.

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RANZCP Abstracts

Panel Presentations CHANGING MINDS – THE INSIDE STORY OF A DOCUMENTARY ABOUT PSYCHIATRIC CARE AND TREATMENT V Storm1,2,4,5,6, M Cross2, C Jones2, N Vella2, J Yeandel2, A Black3, J Wilks3, P Henty3, K Holden3 1Sydney

Local Health Districts, Camperdown, Australia West Sydney Local Health District, Liverpool, Australia 3Northern Pictures, Moore Park, Australia 4University of Western Sydney, Sydney, Australia 5University of New South Wales, Sydney, Australia 6University of Sydney, Sydney, Australia 2South

Background: In October 2014, during Mental Health Week, the ABC broadcast a three-part documentary “Changing Minds…”. It followed the care of several people through their acute inpatient stay at Liverpool Hospital and in all but one instance their return home. This symposium seeks to describe how this was achieved and with use of some material from the program discuss benefits and any possible negative results from such an exercise. Objective: This symposium will outline the process involved in the development of television documentary following the care of patients in the care of the Liverpool Mental Health Service and discuss aspects of the actual content, from psychiatric, nursing, service user, television production, communication and legal perspectives. Method: Two of the authors (VS and JW) had attempted to develop a similar project some years earlier at another venue. In late 2013, AB approached MC with the object of filming a real life story of the operations of a mental health unit. Complex negotiations ensued with the Health Service management, staff, patients and other regulatory agencies, including the NSW Mental Health Review Tribunal. The footage was filmed throughout the course of care during April–June 2014.The process of obtaining consent and reconfirming consent post filming will be described. Findings: Patients willingly sought to participate in the program. Staff, overall, were initially less willing and some objected on the basis that patients would both be unwilling to be filmed and could not give valid consent. However, the eager interest of patients to participate persuaded staff that this project was a worthwhile venture. The program was aired on ABC Television over three consecutive nights (7–9

October 2014) during Mental Health Week. The national broadcaster ran a series of radio and television programs under the theme of “Mental As…” for the whole week, including fundraising for mental health research. www.abc. net.au/tv/programs/changing-minds-the-inside-story/ Public response was very positive and people living with mental illness felt proud that their stories were being aired and heard. Conclusion: A live television documentary can be filmed with necessary consent procedures in an acute psychiatry unit. The outcome has proved positive for participants and the public. It helps break down misunderstanding and promotes public acceptance of the realities of mental illness. This presentation will include some short excerpts from the program, with Q&A between the presentation panel and the audience.

ASIA PACIFIC MENTAL HEALTH M Patton1, Regional Guests 1The

Royal Australian and New Zealand College of Psychiatrists

Background: The Royal Australian and New Zealand College of Psychiatrists has held Asia Pacific Mental Health Forums in 2013 and 2014. Delegates from 20 regional nations have been represented at these forums and discussions have focused on mental health service delivery, legislation and workforce issues. Objectives: •• To consider the range of issues faced by mental health practitioners and services in the Asia Pacific region. •• To discuss possible initiatives around service and workforce development, the physical health of people with mental illness and community engagement. Methods: This presentation will draw on the issues discussed at previous Asia Pacific Mental Health Forums, along with the experience of the regional guests participating in this symposium. Findings and conclusions: Mental health delivery throughout the Asia Pacific is diverse; however, there is much scope for collaborative work to enhance the work of mental health practitioners in the region.


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WHAT CAN PEOPLE WITH A DIAGNOSIS OF BPD TEACH US? J McMahon1, S Lawn1,2, A Chanen3,4 1RANZCP

Community Collaboration Committee University, Adelaide, Australia 3Helping Young People Early, Melbourne, Australia 4Orygen Youth Health, Melbourne, Australia

RANZCP Abstracts Working Group has been set up and it is a joint working party of the Committee for Training and Committee for Examinations. This session will be led by the Chair and Deputy Chair of the OCA Working Group and will look at the following:

2Flinders

Background: Though people with mental illness often experience stigma, consumers with a diagnosis of borderline personality disorder (BPD) have traditionally endured not only societal stigma but extreme levels of exclusion and disapproval from within psychiatric services themselves. Families have had to fight for services, even for family members in crisis, and there is a great deal of confusion about treatment efficacy. Objectives: To create meaningful discussion on the valuable lessons that can be learned about mental health care generally from reflecting on experiences and attempts to provide effective services and support to people with a BPD diagnosis. Method: A panel will explore relevant personal experiences and relate these to existing literature and guidance. Findings: Providing support and effective treatment to people with a BPD diagnosis can be extremely challenging for psychiatrists, other mental health professionals and families, confronting their core values and efforts on multiple levels. The issues experienced by people with a BPD diagnosis provide the sharp focused lens through which we can learn much about how to respond to and support people with mental illness generally. Conclusions: Attendees will gain an enhanced appreciation of their individual professional practice with patients with a BPD diagnosis and patients with mental illness, more broadly.

IN TRAINING ASSESSMENT AND THE OBSERVED CLINICAL ACTIVITY W Kealy-Bateman, L Lampe, G Cheung, J Cutbush, S Gill, V Pascu, G Robinson, D Tracy The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

The Observed Clinical Activity (OCA) is a RANZCP approved formative assessment tool under the 2012 Training Program. It is a mandatory requirement for each six-month rotation from rotation one, 2015. It covers a range of competencies and requires direct feedback to the trainees to assist them to improve performance. For monitoring and quality improvement of the OCA, the OCA Australian & New Zealand Journal of Psychiatry, 49(S1)

•• The place of the OCA in the 2012 Fellowship Program; •• Standard setting for the OCA across the three stages of training; •• The relationship of the OCA to the In-Training Assessment (ITA) as a global assessment of trainee progress; •• Use of the OCA form. The workshop will also briefly cover: •• Integrating other Workplace Based Activities (WBAs) to inform the global impression of the trainee as part of the ITA; •• Delivery of feedback to trainees who have performed below the standard required to demonstrate competence in a WBA. The session will provide a comprehensive introduction to the new assessment tool and provide supervisors with a better understanding of its importance in relation to training requirements.

DEPARTMENT OF VETERANS’ AFFAIRS (DVA) CLINICAL REFERENCE GROUP: WORKING TOGETHER TO IMPROVE VETERAN MENTAL HEALTH AND PSYCHOLOGICAL WELLBEING D Wallace1, S Hodson2, M Hopwood3 1Australian

Defence Force Centre for Mental Health, Sydney, Australia of Veterans’ Affairs, Canberra, Australia 3University of Melbourne, Melbourne, Australia 2Department

Background: With the drawdown of troops from Afghanistan and a decade of high operational tempo, the Department of Veterans’ Affairs, the Department of Defence and service providers are positioning to meet the challenge of responding to the psychological health needs of contemporary veterans. Currently there are about 46,000 veterans who have an accepted mental health condition and nearly 29,000 of those have a stress disorder, including PTSD. This number does not include current serving members who have not yet commenced the claim process. Objectives: This session will discuss the unique aspects and challenges of dealing with military mental health and the role psychiatry plays in the continuum of support. This continuum ranges from self-help resources, mental health literacy training

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RANZCP Abstracts as well as primary through to tertiary treatment programs. The session will discuss the latest evidence and the cycle of mental health support and treatment from recruitment, service career, to post-discharge. The panel will provide perspectives from the Australian Defence Force, the Department of Veterans’ Affairs and clinical practice.

SITE ACCREDITATION VISITS D McKay1,3, D Alcorn2,3, Trainees of the College

SUSTAINING INDIGENOUS MENTAL HEALTH SERVICES THROUGH SELFCARE S Balaratnasingam1, D Clarke1, M Milne2, D Rangihuna2, K Ryan1, I Trevallion1

Background: The Accreditation Committee (AC) of the Education Committee is responsible for the accreditation of RANZCP training programs in Australia and New Zealand. The AC recognises the critical importance of the accreditation of training programs as a core component in the College delivering a quality training experience to trainees. Site visitor panels, composed of Fellows and Trainees with a strong interest and experience in training issues, are appointed by the AC.

1RANZCP 2RANZCP

Aboriginal and Torres Strait Islander Mental Health Committee Te Kaunihera mo ngā kaupapa Hauora Hinengaro Māori

Background: Clinician burnout is a major issue for psychiatrists, impacting on both physical and emotional wellbeing. This is exacerbated for those working in Indigenous communities, who may be working in isolated locations or conducting fly-in-fly-out work. Objectives: To stimulate discussion around systems of enhancing clinician and team resilience by developing sustainable Indigenous mental health services. The session will also look at maintaining one’s own physical, emotional and spiritual wellbeing with emphasis on the importance of self-care, having good peer support systems and maintaining self-awareness. Methods: A panel of speakers representing Maori and Aboriginal and Torres Strait islander peoples will share personal experiences reflecting on barriers faced whilst working in an Indigenous setting, how these were overcome and the importance of self-care. The session will be interactive, with audience participation encouraged in discussions around constructive actions that could be taken to enhance clinical and team resilience in order to increase sustainability of services. Findings and conclusions: Attendees should gain a deeper understanding of the importance of self-care, how it impacts on services in Indigenous mental health settings and actions individuals can take to maintaining one’s physical, emotional and spiritual wellbeing.

1Chair,

RANZCP Accreditation Committee Chair, RANZCP Accreditation Committee 3The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia 2Deputy

Method: This session will be led by College Trainees accompanied by experienced Fellows and members of the AC. The session will be composed of vignettes and panel discussion. The session is particularly aimed at Trainees interested in the accreditation of training programs, and Fellows are also welcome. Objectives: To explore accreditation issues as follows: •• How an accreditation visit ensures training programs meet the accreditation standards; •• Site visit processes, and how the various elements of a site visit are conducted; •• The importance of each element of a site visit in relation to the accreditation standards; •• Ways in which the compliance and quality elements of accreditation are complementary; •• Assessment of performance against the accreditation standards; •• Provision of constructive feedback to the program; •• Involving accountable stakeholders in a transparent and consistent accreditation process; •• Action taken, and the consequences, in the event that a program fails to meet a standard.


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RANZCP Abstracts

Oral Presentations DISORDERS INBORN: THE NEUROPSYCHIATRY OF NEUROMETABOLIC DISORDERS M Walterfang1,2 1University 2Royal

of Melbourne, Melbourne, Australia Melbourne Hospital, Melbourne, Australia

Background: Metabolic disorders that affect the central nervous system can present in childhood, adolescence or adulthood as a phenocopy of a major psychiatric syndrome such as psychosis, depression, anxiety or mania. An understanding and awareness of secondary syndromes in metabolic disorders is of great importance as it can lead to the early diagnosis of such disorders. Many of these metabolic disorders are progressive and may have illness-modifying treatments available. Earlier diagnosis may prevent or delay damage to the central nervous system and allow for the institution of appropriate treatment and appropriate family and genetic counselling. Objectives: To review the available literature on the prevalence and neurobiology of psychiatric illness in neurometabolic disorders and propose models for understanding progressive and episodic psychiatric illness in these disorders. Methods: Selective literature review and synthesis. Findings: Metabolic disorders appear to result in neuropsychiatric illness either through disruption of late neurodevelopmental processes or via chronic or acute disruption of excitatory/inhibitory or monoaminergic neurotransmitter systems. Treatment considerations include treatment resistance, the increased propensity for sideeffects and the possibility of some treatments worsening the underlying disorder. Conclusions: Identification of neurometabolic disorders that present as secondary psychiatric syndromes is essential, particularly in psychotic disorders associated with cognitive or neurological impairment, or in episodic unexplained psychiatric illness.

THE CATASTROPHIC REACTION: FRESH APPRAISAL OF A USEFUL BUT NEGLECTED CONCEPT S Williams Several NSW Local Health Districts (HNELHD, MLHD, SWSLHD), Australia


Background: Recent textbooks give scant or no attention to the useful clinical phenomenon of the catastrophic reaction. Presentation: A catastrophic reaction can occur when a person is so overwhelmed by physiological arousal that they are temporarily unable to function adequately. It is a common phenomenon, indeed, it does occur without associated brain pathology. Despite commonly held conceptions it is not necessarily an extreme reaction. Observation of a catastrophic reaction during clinical assessment can provide a clue to the presence and nature of underlying brain pathology. It may indicate subcortical microvascular pathology, may lead to a misdiagnosis of anxiety or depressive disorder in late life and is often a significant contributor to behaviours of concern associated with major or minor neurocognitive disorders including the ‘dementias’, vascular cerebral pathology, traumatic brain injury, autism spectrum disorder and intellectual disability. Understanding the nature of this phenomenon can assist family and professional carers to cope with the vicissitudes of caring and may also help in avoiding or managing behaviours of concern with minimal or no pharmacological intervention. Some recent books on neuropsychiatry, psychiatry of old age and dementia are reviewed for material about this phenomenon – and found to be often lacking. A brief history of the concept, first introduced by Goldstein in 1934, will be provided.

MENTAL HEALTH IMPLICATIONS FOR OLDER ADULTS AFTER NATURAL DISASTERS – A SYSTEMATIC REVIEW AND META-ANALYSIS D Siskind1,2,3, G Parker4, D Lie1, M Martin-Khan3, B Raphael5,6, D Crompton1,2, S Kisely1,2,3,7 1Metro

South Division of Mental Health, Brisbane, Australia Health Partners: Centre for Neuroscience Recovery and Mental Health, Brisbane, Australia 3School of Medicine, University of Queensland, Brisbane, Australia 4Royal Brisbane and Women’s Hospital, Brisbane, Australia 5School of Medicine, University of Western Sydney, Sydney, Australia 6School of Medicine, Australian National University, Canberra, Australia 7Griffith Institute of Health, Griffith University, Brisbane, Australia 2Diamantina

Background: Natural disasters affect the health and wellbeing of adults throughout the world. There is some debate in the literature as to whether older persons have increased risk of mental health outcomes after exposure to natural disasters when compared to younger adults. To date, no systematic review has evaluated this.

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RANZCP Abstracts Objectives: We aimed to synthesise the available evidence on the impact of natural disasters on the mental health and psychological distress experienced by older adults. Methods: A meta-analysis was conducted on papers identified through a systematic review. The primary outcomes measured were post-traumatic stress disorder (PTSD), depression, anxiety disorders, and adjustment disorder. Findings: We identified six papers with sufficient data for a random effects meta-analysis. Older adults were 2.11 times more likely to experience PTSD symptoms when exposed to natural disasters when compared to younger adults. Conclusions: Recent decades have seen a global rise in the numbers of older adults affected by natural disasters, implying that an increasing number of the older adults will find themselves “in harm’s way” amid community disruption and distress. Mental health service providers need to be prepared to meet the mental health needs of older persons, and be particularly vigilant after natural disasters to ensure, in particular, early detection and management of PTSD.

RANDOMISED CONTROLLED EVIDENCE FOR THE EFFECT OF COMMUNITY TREATMENT ORDERS ON SOCIAL OUTCOMES AND COERCION: AN UPDATE OF A COCHRANE SYSTEMATIC REVIEW S Kisely1,2,3 1School

of Medicine, University of Queensland, Brisbane, Australia South Health Service, Woolloongabba, Australia 3Griffith Institute of Health, Griffith University, Brisbane, Australia

Results: Three studies provided 652 subjects for the metaanalysis. Two compared compulsory treatment with entirely voluntary care, while the third had controls receiving voluntary treatment for most of the time (medians of 257 vs 8 days respectively for initial randomised legal compulsion and 262 vs 103 over the whole study). Compared to controls, CTOs did not improve social outcomes such as housing or employment (OR = 0.95, 95% CI = 0.74–1.21; n = 652). On the other hand, CTO cases did not report increased coercion (OR = 0.96, 95% CI = 0.63–1.45; n = 598). Only including the two studies comparing compulsory treatment with entirely voluntary care did not alter the results. Conclusions: CTOs do not improve social outcomes but they do not worsen coercion either.

CARER PERSPECTIVES ON THE EXPERIENCE OF CARE: IMPLICATIONS FOR RIGHTS BASED/ RECOVERY ORIENTED MENTAL HEALTH LEGISLATION R Vine1, A Komiti2 1NorthWestern 2Department

Mental Health, Melbourne Health, Melbourne, Australia of Psychiatry, the University of Melbourne, Melbourne, Australia

Background: There is limited evidence for the effectiveness of Community Treatment Orders (CTOs) and their use continues to be subject to debate. Shifts in policy and legislation may lead to use of fewer CTOs of shorter duration. We do not know the impact of such change on the consumer or their carers.

2Metro

Objective: To determine the views and experiences of carers of people with severe mental illness in regard to CTOs.

Background: It is unclear whether community treatment orders (CTOs) for people with severe mental illnesses can reduce health service use, or improve clinical and social outcomes. Randomised controlled trials (RCTs) of CTOs are rare because of ethical and logistical concerns. A previous meta-analysis of the three RCTs to date showed no significant effects on readmission, functioning or symptomatology.

Method: Questionnaires were posted using the mailing lists of two well established carer support organisations in Victoria. The questionnaires included information about the person with a mental illness, the carer and their experience of care (ECI) and knowledge of recovery (RKI).

Objectives: To update an earlier Cochrane systematic review of RCTs on CTOs to include social outcomes and perceived coercion. Method: systematic literature search of the Cochrane Schizophrenia Group Register, Science Citation Index, PubMed/Medline and EMBASE up to September 2014. Inclusion criteria were studies comparing CTOs with standard care, including those where controls received voluntary care for most of the trial. Dichotomous and continuous outcomes were combined using the genericinverse method to calculate odds ratios (OR).

Findings: Two hundred and seventy-eight questionnaires were sent and 63 returned, of which 62 provided valid data. Those who responded were predominantly female (90%) and older (mean age 63 years) and were the carer of a person with a severe and recurrent mental illness. Sixty percent had experience of caring for a person on a CTO. Most felt the CTO had been of benefit and in 89% the person relapsed and needed further treatment when the CTO was stopped. Conclusion: Mental health legislation is shifting to bring a greater focus on rights, individual choice and autonomy in line with recovery oriented care. This study describes the impact of severe mental illness on carers and the need to take their experience into account when considering the impact of determinations regarding treatment under a CTO. Australian & New Zealand Journal of Psychiatry, 49(S1)

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IMPROVING THE QUALITY OF JUNIOR DOCTOR TRAINING EXPERIENCES IN PSYCHIATRY: A NARRATIVE REVIEW A Llewellyn1, A Karageorge1,2, L Nash1,2, B Kelly3, J Edwards1, H Sandhu3, C Maddocks1 1Health

Education and Training Institute NSW, Sydney, Australia and Mind Research Institute, University of Sydney, Sydney, Australia 3University of Newcastle, Newcastle, Australia 2Brain

Background: Prevocational training during the intern (PGY1) and resident (PGY2) years is known to have a strong influence over career choice. Psychiatry is often presented as an optional experience at this stage, meaning that the duration and quality of exposure can vary. Increasing clinical exposure to psychiatry combined with a focus on quality of the experience has been associated with increased recruitment to vocational training programs. Objectives: To review recent literature to identify factors associated with favourable psychiatry training experiences undertaken by prevocational doctors (PGY1/PGY2 and international equivalents) and medical students. This review was intended to inform the content of a future survey evaluating junior doctor experiences of psychiatry rotations in NSW. Methods: Given the range of literature, a narrative synthesis was the method with an iterative process of literature search, review and synthesis employed. Findings: Thirty-two papers were identified for inclusion. From our synthesis, 20 factors were identified as having a positive effect on views of psychiatry as a career and 10 factors identified as having a negative effect. Factors could be grouped under the following themes: patient, training/ education, senior staff support and role definition, with additional themes of autonomy and responsibility staff as role models for positive factors and additional theme of others for negative factors. Conclusions: Several areas of further research emerge from this study. However, the one theme that emerges most consistently is the need to better understand how and in what ways the training experience influences student perceptions of psychiatry.

RANZCP Abstracts health programs and regulatory authorities are faced with the assessment of doctors who for various reasons have had a change in cognitive function and wish to continue to practise medicine. Objectives: To explore factors affecting a doctor’s capacity to be a competent medical practitioner. Methods: The files of all doctors attending the Victorian Doctors’ Health Program, who were recognized as having cognitive problems over the past 7 years, were reviewed: data was collected with respect to presenting symptoms, reasons for and type of change in cognitive function, assessment, management, and outcome. The range of clinical issues, challenges in management and factors affecting outcome are presented and illustrated with case examples. Findings: A wide range of diagnoses caused changes in cognitive functioning, including cerebrovascular accident, traumatic head injury and age-related cognitive decline. Whether a doctor can safely continue to practise medicine depends not only on their cognitive capacity but also on their medical sub-specialty and field of practice. Formal assessment of cognitive functioning can inform management but cannot be relied upon as a predicator of ability to continue to practice medicine. A multi-disciplinary approach to management is essential and successful return to work is best achieved with in supportive workplace. For those unable to return to work, adjustment to not being a doctor can be devastating. Conclusions: A change in cognitive capacity does not necessarily preclude a doctor from competent medical practice. Facilitating a successful return to work requires thorough clinical assessment together with authentic assessment in the workplace setting.

USING C-REACTIVE PROTEIN GENETIC PROFILE SCORES TO PREDICT RISK OF ANXIETY N Mills1,2, J Scott3, J Whitfield1, M Wright1, N Martin1, N Wray2, E Byrne2 1QIMR

COGNITIVE FUNCTION AND THE ABILITY TO PRACTISE MEDICINE: A QUESTION OF COMPETENCE K Jenkins Victorian Doctors’ Health Program, Fitzroy, Australia

Background: Evaluation and management of medical practitioners with cognitive problems is a recognized issue worldwide. Increasingly, treating psychiatrists, doctors’ Australian & New Zealand Journal of Psychiatry, 49(S1)

Berghofer Medical Research Institute, Brisbane, Australia Brain Institute, University of Queensland, Brisbane, Australia 3University of Queensland Centre for Clinical Research, Brisbane, Australia 2Queensland

Background: Anxiety is often comorbid with Major Depressive Disorder (MDD). An association between raised levels of the inflammatory marker C-reactive protein (CRP) and MDD has been demonstrated. Few studies have evaluated whether there is an association between CRP and anxiety, particularly in individuals with comorbid MDD.

63

RANZCP Abstracts Objectives: To investigate the phenotypic relationship between (i) CRP and anxiety disorders (Generalised Anxiety Disorder (GAD), Social Phobia, ObsessiveCompulsive Disorder (OCD), Panic Disorder, and Agoraphobia); and (ii) CRP and anxiety and comorbid MDD. We also explore whether those who carry more genetic variants known to increase CRP are more likely to suffer from an anxiety disorder or MDD. Methods: A total of 2,475 twins and their siblings were assessed for anxiety disorders (GAD, Social Phobia, OCD, Panic Disorder and Agoraphobia), MDD and Dysthymic Disorder (DSM-IV criteria) at QIMR Berghofer Medical Research Institute (QIMR). Of these individuals, 1,985 also had CRP data. CRP genome-wide association studies results from the Cohorts for Heart and Aging Research in Genomic Epidemiology (Psaty et al., 2009) were used to generate genetic profile scores for CRP in the QIMR sample. We tested for an association between CRP genetic risk profiles and CRP and anxiety phenotypes. Findings: CRP was nominally associated with GAD, but the association was not significant after accounting for body mass index. Conclusions: CRP is associated with GAD in this community sample of twins. CRP genetic profile scores did not predict anxiety (or comorbid MDD); however, power may have been a limitation. Reference Psaty BM, O’Donnell CJ, et al. (2009) Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium Design of Prospective Meta-Analyses of Genome-Wide Association Studies From 5 Cohorts. Circulation-Cardiovascular Genetics 2: 73–U128.

THE AUCKLAND REGIONAL YOUTH FORENSIC SERVICE: A CLINICAL AUDIT OF COURT ORDERED EVALUATIONS WITH A FOCUS ON FITNESS TO STAND TRIAL C Armstrong1,2, S Hatters-Friedman2,3 Youth Forensic Service, Auckland District Health Board, Auckland, New Zealand 2University of Auckland, Auckland, New Zealand 3Mason Clinic, Waitemata District Health Board, Auckland, New Zealand

Objectives: To conduct original research in this area which may inform courts, court-appointed assessors and legislators about the issues faced by young people referred for formal assessment by the Courts. Methods: Over a period of one year, between February 2012 and February 2013, a total of 366 individuals between the ages of 12 and 18 were referred for assessment. Of these, 119 were for Court Reports pursuant to Section 333 of the Children, Young Persons and their Families Act 1989 (n = 119, 33.5%). Demographic data, report characteristics, charges and outcomes of reports were collated and analysed. Findings and conclusions: Key findings include a high proportion of male evaluees (88%) and a mean age of 15.6 years. Fourteen youth were opined unfit to stand trial, with a high proportion not engaged in education of any kind. The most common diagnosis amongst those opined unfit was Mental Retardation. A significant proportion of those opined unfit to stand trial did not receive a diagnosis of any mental disorder – in these cases an argument was put forward that the young persons concerned suffered from a constellation of difficulties including cognitive and developmental immaturity.

ARE PSYCHIATRISTS TRAINED IN LEADERSHIP SKILLS? AJM Van Zeist-Jongman Waikato District Health Board, Hamilton, New Zealand

Background: Psychiatrists constantly need leadership skills in their work. Previous literature shows that early career psychiatrists felt inadequately prepared for the leadership aspects of their role. This research bridges a 12-year gap with existing literature. Objectives: To investigate how early career psychiatrists in 2014 value the leadership skill education in their vocational training to become psychiatrists.

1Regional

Background: The demographic and other characteristics of young people referred for assessment by Forensic Mental Health Services are infrequently studied, resulting in a paucity of information about this group, particularly in Australasia. International literature which might provide a useful context for court-appointed evaluators must be treated with caution, as the legal context within which this takes place can vary greatly between jurisdictions.

Methods: Psychiatrists in New Zealand and Australia who graduated from one of the regional institutes of training since 2008 were invited to take part in a survey. Findings: Respondents consider themselves not adequately prepared for the leadership, management and administrative tasks and roles they have as psychiatrists, with preparation for management tasks scoring the lowest. They valued as most useful to have opportunity to practice with a leadership role, to be able to observe ‘leaders at work’, to have a supervisor with special Australian & New Zealand Journal of Psychiatry, 49(S1)

64 interests and skills in leadership and management, and to have a formal teaching program on leadership and management. They stated that formal teaching sessions should be given throughout the entire 5 years of the training program, not just at the end, and should be given by experienced leaders. Conclusions: This research shows that leadership skills training in the education of psychiatrists should contain both practical experience with leadership and management roles and formal teaching sessions on leadership and management skills development. A model for improvement of the leadership and management skills education in the training of psychiatrists in New Zealand and Australia has been formulated.

THE MENTALLY ILL IN CUSTODY: AN INSIDIOUS PUBLIC HEALTH CONCERN E Heffernan University of Queensland, Brisbane, Australia

Background: The prevalence of mental disorder amongst people in custody is markedly higher than it is for the general community. Despite this, across Australia, there appears to be an inconsistency and inadequacy in the available mental health service responses. Objectives: To illustrate the prevalence of mental disorder amongst people in custody in Australia and the mortality and morbidity for this group in the transition back to the community, highlighting why this is a public health problem. Methods: Research findings from Queensland, other relevant Australian literature, national benchmarking and clinical experience will be used to inform the presentation. Findings: Many individuals with serious mental disorders flow through the Australian prison system annually. They suffer high rates of mortality and morbidity in transition to the community, evidenced by suicide, overdose, mental illness relapse and hospital admission rates that are far higher than would be expected for the general community. There are insufficient mental health services provided to meet the needs of these individuals. Conclusions: From a public health perspective it is essential to provide adequately resourced and equitable mental health services to people in custody. This can be readily justified from an individual health, community health, ethical, financial and criminal justice framework. Australian & New Zealand Journal of Psychiatry, 49(S1)

RANZCP Abstracts

GENETIC ANALYSIS IN THE ASSESSMENT OF DEVELOPMENTAL DISORDERS: A SERIES OF CASE REPORTS FROM THE EXPERIENCE OF A METROPOLITAN NEUROPSYCHIATRY CLINIC C Richardson, J Harrison Alfred Child and Youth Mental Health Service, Melbourne, Australia

Background: A chromosome change is identified when there are differences between a person’s DNA and the control DNA. Sometimes, it can be difficult to interpret results. Microarrays are useful in that they are able to detect much smaller changes than routine karyotypes. In general a microarray analysis can be used to learn more precise information about abnormalities that have already been diagnosed by karyotype. The Neuropsychiatry clinic at Alfred Health accepts a wide range of referrals of children who have developmental, neurological and psychiatric disorders. It has been routine in the last four years to request a genetic analysis, including microarray, in order to inform and direct assessment and management. It has been difficult to interpret the results or their clinical significance in this emerging area of study. Of the variations we have observed there has been an extremely low number of cases reported and generally little clinical experience documented. Objectives: The aim of this presentation is to present an upto-date explanation of genetic analysis currently used in clinical practice in the field of developmental disorders. It is our aim to share the case reports and genetic analysis of these cases we have encountered with the hope to add to the broader knowledge base and contribute to a discussion regarding the role of genetics and genetic analysis in the assessment, diagnosis and development of developmental disorders. Methods: The structure of the presentation will include a brief introduction to the area and a presentation of three case reports of children with developmental disorders with the following genetic abnormalities found: a male karyotype with an interstitial duplication from chromosome region 17q12, a male karyotype with a copy number gain of 15q13.3q14 and a female karyotype with interstitial duplication from chromosome 5q14.1. The research in area of each abnormality will be briefly examined and the clinical relevance to our cases will be explored. Findings: All three patients presented were diagnosed with a developmental disorder and it is important to consider the genetic findings when explaining aetiology, diagnosis and ongoing treatment. Conclusions: Genetic analysis is important to consider in developmental disorders and further research in this area is greatly needed.

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RANZCP Abstracts

THE IMPACT OF DSM-5 ON THE DIAGNOSIS OF EATING DISORDERS H Caudle1, C Pang2, R Newton1,2 1Austin

Hospital, Melbourne, Australia of Melbourne, Melbourne, Australia

Objectives: We aimed to determine the effect on AF symptoms and quality of life (QOL) of personality factors (perceived stress, Type D personality and trait anxiety) and symptoms of psychological distress. We studied change over time in AF symptoms and distress.

2University

Background: DSM-IV has previously caused concern due to a large proportion of patients diagnosed with Eating Disorder Not Otherwise Specified (EDNOS) and a reliance on subjective reports of a distortion of body image and fear of weight gain as well as the presence of amenorrhoea. The change in the DSM-5 criteria attempts to address this problem. Objectives: The purpose of this study was to examine the impact of the DSM-5 criteria on the diagnosis of eating disorder patients previously diagnosed under the DSM-IV criteria. Methods: The 285 participants were recruited from a specialised eating disorder clinic in Australia. DSM-IV diagnoses of anorexia nervosa, bulimia nervosa and EDNOS were compared with retrospectively applied DSM-5 diagnoses of anorexia, bulimia and other specified feeding or eating disorder (OSFED). Assessment methods included structured clinical interviews and self-ratings of eating disorder and other psychiatric symptoms. Findings: We observed a 23.5% reduction in an unspecified eating disorder diagnosis with the implementation of DSM-5. The removal of criterion D (amenorrhoea) was the main factor for transition from a DSM-IV EDNOS diagnosis to a DSM-5 anorexia nervosa diagnosis. Conclusions: The DSM-5 diagnostic criteria for eating disorders significantly reduce the incidence of unspecified eating disorders in the eating disorder population. However, there remain problems with the DSM-5 anorexia nervosa criteria that require clarification.

Methods: The 101 participants (24 AF-free (group 1), 57 paroxysmal/early persistent AF (groups 2 and 3), 20 longstanding persistent AF (group 4)) underwent assessment of AF symptom severity (AFSS scores) and QOL (SF-36 PCS & MCS), plus assessments of personality (PSS, Type D scale, STAI-2) and psychological distress (HADS, STAI-1). Assessment of symptoms and distress was repeated at 4, 8 and 12 months. Nineteen participants underwent AF catheter ablation after initial assessment (group 3). Medical management of all participants was optimized. Findings: At baseline, perceived stress, Type D personality, trait anxiety and psychological distress were all strongly associated with more severe AF symptoms and depressed QOL (% of variance in dependent variables accounted for 6–63%, p < 0.01 for all models). 89% remained AF-free after catheter ablation. Over 12 months there was significant improvement in AF symptom and QOL scores only in group 3 (p < 0.01 for all). There was significant improvement in all measures of psychological distress only in the ablation group (p < 0.05 for all). Conclusions: Both personality and psychological distress are associated with severe AF symptoms and impaired QOL. Parallel improvement in AF symptoms and distress after AF ablation indicates personality factors predispose to more severe AF symptoms and thence psychological distress.

A CORRELATION BETWEEN MOOD AND HEART RATE VARIABILITY IN PEOPLE WITH AND WITHOUT CORONARY HEART DISEASE PERSONALITY AND PSYCHOLOGICAL NJC Stapelberg1, DL Neumann2, DHK Shum2, H DISTRESS IN THE EXPERIENCE OF McConnell3, I Hamilton-Craig3 ATRIAL FIBRILLATION SYMPTOMS 1School of Applied Psychology, School of Medicine and Griffith Health K Wick1, T Walters2,3, M Mearns2, G Tan3, Institute, Griffith University, Gold Coast, Australia; The Gold Coast C Bryant1,4, J Kalman2,3 Hospital and Health Service, Gold Coast, Australia 1Centre

for Women’s Mental Health, Royal Women’s Hospital, Melbourne, Australia 2Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia 3Department of Medicine, University of Melbourne, Melbourne, Australia 4School of Psychological Sciences, University of Melbourne, Melbourne, Australia

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia. Psychological factors have been associated with AF symptom severity.

2School

of Applied Psychology and Behavioural Basis of Health Program, Griffith Health Institute, Griffith University, Gold Coast, Australia 3School of Medicine, Griffith University, Gold Coast, Australia

Background: Heart rate variability (HRV) is a potential biological marker for major depressive disorder (MDD) in people with and without coronary heart disease (CHD). Depression has predominantly been examined as a categorical variable and compared to limited numbers of HRV measures. Confounders, particularly gender, methodological


66 differences and small sample size. have previously yielded heterogeneous findings. Objectives: This study aimed to ascertain if linear correlations exist between psychometric test scores and several HRV measures in people with and without CHD. Methods: Multiple linear regression analysis was used to correlate HRV measures with psychometric measures of mood and anxiety as continuous variables, with covariation for age and gender, in 48 participants with CHD, 39 without CHD and the entire cohort of 87 participants. Fortyseven time domain, frequency domain and non-linear HRV measures from 24-hour cardiac recordings were examined. Findings: Mood is correlated with longer term HRV measures, with covariation of age and gender in the entire study cohort. In the CHD cohort, mood is correlated with short and longer term HRV measures with covariation of age. In the non-CHD cohort mood is correlated with longer term HRV measures only, which is not consistent with some findings in the literature. Conclusions: This study is small and gender is unevenly distributed across CHD and non-CHD cohorts. The results obtained for the non-CHD cohort may be confounded by gender. People with CHD are also likely to be in a different stable state of autonomic control from people without CHD, which may also explain differences in the results.

SYSTEMS BIOLOGY IN MAJOR DEPRESSION: FROM PHYSIOME TO PATHOME, FROM THE PSYCHOIMMUNE-NEUROENDOCRINE NETWORK TO CHRONIC ILLNESS NETWORKS NJC Stapelberg1, DL Neumann2, DHK Shum2, H McConnell3, I Hamilton-Craig3 1School

of Applied Psychology, School of Medicine and Griffith Health Institute, Griffith University, Gold Coast, Australia; The Gold Coast Hospital and Health Service, Gold Coast, Australia 2School of Applied Psychology and Behavioural Basis of Health Program, Griffith Health Institute, Griffith University, Gold Coast, Australia 3School of Medicine, Griffith University, Gold Coast, Australia

Background: There are numerous linked physiological pathways which regulate metabolism, energy expenditure and levels of activity in organisms. Collectively they comprise a physiome, which describes the physiological dynamics and functional behaviour of the intact organism. The psycho-immune-neuroendocrine (PINE) network is a


RANZCP Abstracts physiome comprising four systems: immune function, autonomic nervous system function, endocrine function and the central nervous system (CNS). These processes form a network which can be studied using a systems biology approach. Objectives: The aim of this review is to apply a systems biology model to the PINE physiome. Additionally, this work characterizes the PINE pathome, a description of the interrelationships of pathophysiological processes which arise when the PINE physiome is disrupted by chronic stress. Methods: An extensive review of the literature was used to construct topographical maps of the PINE physiome and PINE pathome, and to establish how disruptions in the network of normal physiology can give rise to pathophysiology which links several medical diseases with major depressive disorder (MDD). Findings and conclusions: Homeostasis of the PINE physiome can be disrupted by chronic stress, on a background of genetic and developmental diathesis factors, resulting in the PINE pathome. MDD, coronary heart disease, type 2 diabetes, stroke, hypertension and atherosclerosis can arise within the PINE pathome. These illnesses act to maintain the PINE pathome in a stable pathological state, giving rise to a stable, chronic illness network. Implications of these models and the importance of adopting a systems approach to understanding the relationship between diseases in the chronic illness network are discussed.

A COMPARISON OF ELECTROCONVULSIVE THERAPY BETWEEN RURAL AND URBAN POPULATIONS N Johnston Hunter New England Local Health District, Tamworth, Australia

Background: Mental health outcomes are poorer in rural and remote regions in Australia. This study investigates a novel aspect of this disparity by comparing the use of Electroconvulsive Therapy (ECT) between rural and urban populations. Objectives: To investigate whether there are delays in the time it takes for rural patients to receive ECT compared to urban patients. Methods: This study was a retrospective cohort study. The medical records of all patients (n = 54) that received an acute course of ECT at two rural and two

67

RANZCP Abstracts urban psychiatric hospitals in the year 2010 were reviewed.

identify any changes in the frequency of ice use and its relationship to the onset of psychosis.

Findings: There were significant differences from symptoms onset to when patients received ECT. Urban patients waited 17.61 weeks (SE = 3.86), and rural patients waited 39.60 weeks (p = 0.031). There was a significant delay in the average time it took from when a patient received a diagnosis to when they received ECT, with urban patients waiting 5.08 weeks and rural patients waiting 23.38 weeks (p = 0.014). There were corresponding significant delays in the time it took for rural patients to be admitted to hospital for their illness compared to urban patients. There were no significant differences in the average times it took for urban and rural patients to receive ECT once they had been admitted to the facilities.

Findings: The audit was completed using client lists as of August 2014. At this time, the NEYEPS program had 35 clients, of whom 14 (40%) had used ice within the 28 days prior to their index psychotic episode. The 2008–2010 cohort had a total of 39 eligible clients, of whom just one (2.6%) had used ice within 28 days prior to the onset of their index psychotic episode.

Conclusions: This study shows that patients in rural areas receive ECT later in their acute illness. These delays appear to be related to delays in accessing inpatient admission in rural areas. Once admitted to hospital, there were no differences in treatment progress.

AN EVALUATION OF THE RELATIONSHIP BETWEEN CRYSTAL METHAMPHETAMINE USE AND PSYCHOSIS AMONGST CLIENTS OF A YOUTH-SPECIFIC PSYCHOSIS SERVICE IN NORTH-EASTERN MELBOURNE P Frederick1, L Allen1,2 1University 2Austin

of Melbourne, Melbourne, Australia Health, Heidelberg, Australia

Background: The North-East Youth Early Psychosis Service (NEYEPS) provides an early intervention service for young persons aged 16–25 from the North-Eastern region of Melbourne who have experienced psychosis. This research evaluates the association between crystal methamphetamine (“ice”) use and the onset of psychosis amongst current NEYEPS clients and a previous cohort. Objectives: To determine whether the current cohort of NEYEPS clients are more likely to have used ice in the context of their index psychotic episode than a previous cohort. Methods: Electronic medical records were used to retrospectively identify NEYEPS clients who used ice within 28 days prior to the onset of psychotic symptoms. The current cohort, extending from 2012–2014, and a previous cohort, extending from 2008–2010, were compared to

Conclusions: Over just a four-year period, clients of NEYEPS have become over 15 times more likely to have used ice within 28 days prior to the onset of psychosis, suggesting a growing role for ice as a precipitant of psychosis in this age group.

THE ROLE OF MENTAL ILLNESS IN THE HARASSMENT OF NEW ZEALAND POLITICIANS S Every-Palmer, J Barry-Walsh Capital and Coast District Health Board, Wellington, New Zealand

Background: Due to their public profiles and the nature of their work, politicians are more vulnerable to threats, harassment and assault than the general population. The small, but significantly elevated risk of violence to politicians is predominantly due not to terrorists or politically or criminally motivated extremists, but to fixated individuals with untreated serious mental disorders, usually psychosis (James et al., 2011; Mullen et al., 2009). Objectives: To ascertain the frequency, nature and effect of unwanted harassment of politicians in New Zealand and the role of mental illness plays in this harassment. Methods: 102/121 New Zealand Members of Parliament (MPs) were surveyed. Quantitative and qualitative data was collected on MPs’ experiences of harassing and stalking behaviours. Findings: Eighty-seven percent of respondents reported unwanted harassment ranging from disturbing communication to physical violence, with most experiencing harassment in multiple modalities on multiple occasions. Half of MPs had been personally approached by their harassers. Forty-eight percent of MPs had been threatened and 15% had been attacked. Some of these incidents were serious and involved weapons including guns, Molotov cocktails and blunt instruments. One in three MPs had been targeted at their homes. The majority of those who harassed MPs were judged to be mentally ill and in need of treatment.


68 Conclusions: Psychiatric morbidity may sometimes manifest through harassment of public figures. This harassment has significant psychosocial cost for both the victim and the perpetrator and represents an opportunity for mental health intervention. References James DV, Mullen PE, Meloy JR, et al. (2011) Stalkers and harassers of British royalty: An exploration of proxy behaviours for violence. Behavioural Sciences and The Law 29: 64–80. Mullen PE, James DV, Meloy JR, et al. (2009) The fixated and the pursuit of public figures. Journal of Forensic Psychiatry and Psychology 20: 33–47.

THE INTROVERTED LEADER: OXYMORON OR OPPORTUNITY? M Fryer Child and Adolescent Psychiatrist, Queensland Health, Brisbane, Australia

Personality can be characterised in many ways and across multiple dimensions. One such dimension that is widely and popularly accepted is the Introversion-Extraversion continuum. The classic western ideal of a leader tends to align with the extravert: outgoing, talkative, charismatic, assertive, vibrant, confident, quick to action, dynamic. However, many successful companies are run by introverted leaders, Bill Gates of Microsoft being a classic example. This talk will discuss the strengths and weaknesses of extravert and introvert leaders and put forward the argument that introverted leadership should be valued and encouraged.

CAREGIVER BURDEN AND DEPRESSION AMONG CAREGIVERS OF AUTISM PRESENTING TO A SPECIALIST CHILD MENTAL HEALTH SERVICE IN SRI LANKA V Jayawardena1, S Kisely2, H Perera3 1West

Moreton Hospital and Health Service, Ipswich, Australia of Queensland, Herston, Australia 3Department of Psychological Medicine, University of Colombo, Sri Lanka 2University

Background: Caregivers of children with autism are known to rate themselves with higher caregiver burden than caregivers of children with other developmental disabilities. High caregiver burden can result in psychological distress and depression, which in turn can affect the care of the child with autism. Objectives: To assess the caregiver burden, psychological distress and prevalence of depression in caregivers of Australian & New Zealand Journal of Psychiatry, 49(S1)

RANZCP Abstracts children with autism in comparison with those of children with medical illnesses. Methods: A cross-sectional descriptive study done in a specialist child mental health unit and a specialist paediatric outpatient clinic during January to April 2011. An interviewer administered questionnaire and the GHQ-28 were administered to the caregiver. All caregivers were assessed using ICD-10 diagnostic criteria for depression. Findings: There were 106 caregivers in the study group, and 106 age- and sex-matched caregivers in the control group. The former had a statistically significant higher level of education, family income and work status than the latter group. Burden was perceived by 98.2% and 90.6% of caregivers of children with autistic and medical illnesses, respectively. The prevalence of depression in caregivers was 23.6% and 12.3% in the autistic and medical illness groups, respectively. Caregiver burden (p < 0.001), severe psychological distress (p = 0.003) and prevalence of depression (p < 0.001) were higher in the caregivers of autistic children. Caregiver age and absence of supports had a significant association with depression. Conclusions: One quarter had depression. This was significantly higher compared with caregivers of medically ill children.

A FRAMEWORK FOR A SPECIALIST MENTAL HEALTH SERVICE MODEL FOR ADULTS WITH DEVELOPMENTAL DISABILITIES IN AUSTRALIA C Bennett Victorian Dual Disability Service, St Vincent’s Hospital, Melbourne, Australia

Background: It is increasingly recognised that adults with developmental disabilities (Autism and Intellectual Disability) have high levels of mental health needs which are difficult to meet in the current service system; however, it is not clear how these needs could be better met. This paper reviews how the mental health needs of this population differ from the rest of the population and why it is difficult for the current mental health service system to meet these. The evidence for different service models is also reviewed. Based on these reviews, this paper proposes a framework for a specialist mental health service model for adults with developmental disabilities. Objectives: To describe a framework for a specialist mental health service for adults with developmental disabilities in Australia.

69

RANZCP Abstracts Methods: Selective literature review. Conclusions: A framework for a specialist mental health service for adults with developmental disabilities is described.

MENTAL HEALTH AND WELLBEING IN ADVANCED AGE: LiLACS NZ N Kerse1, M McDonald2, A Rolleston2, K Hayman1, M Muru-Lanning3 1School

of Population Health, University of Auckland, Auckland, New

Zealand Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand 3James Henare Research Centre, University of Auckland, Auckland, New Zealand

Conclusions: Mental wellbeing in advanced age persists despite comorbidities and is impacted by prior events.

PRIVATE PSYCHIATRY AS FUNDED THROUGH MEDICARE CONSIDERED IN TERMS OF SOCIAL EQUITY G Meadows1, J Enticott1, G Russell1, B Inder1, R Gurr2,3 1Monash

University, Melbourne, Australia of New South Wales, Sydney, Australia 3Royal Brisbane Hospital, Brisbane, Australia 2University

2Te

Background: Mental health in ageing may be impacted by previous trauma, current circumstances and health events. Objectives: To describe mental wellbeing in Māori and non-Māori in advanced age, and examine correlates. Methods: Participants: 414 Māori 80–90 years and 523 non-Māori 85 years from a total population cohort, 57% participation rate at inception in 2010; 75% retention. In-depth qualitative interviews provided perspectives of Māori about wellness and written qualitative responses of Māori and non-Māori provided reflections on “What are the highlights of this stage of life for you?”. Quantitative measures included “Have you ever had a major psychological stress event that has affected you in the long term?”; depressive symptoms (GDS), Mental Health Related Quality of Life (MHRQOL SF-12) at baseline, 12, 24 months; covariates: deprivation, gender, age, comorbidities (15 verified diagnoses), living arrangements were completed in a comprehensive health interview. Impact on mental health and wellbeing were examined using regression models. Findings: Qualitative results suggested resilience in advanced age. MHRQOL was good (54 for Māori and nonMāori). 905 of 927 participants answered the prior psychological stress question; 19% (women 22%, men 15%) reported a psychological event; death of loved one and illness of family were common, and discrimination was reported by Māori. At baseline, prior psychological stress was independently associated with worse depressive symptoms (β2 -0.37, p

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