Psychiatry

Through the prism darkly: how do others see psychiatrists?

by Martin Webber

The First Year Examination

by Christopher Ryan

De Moore, G., P. Morse, C. J. Ryan, and J. Snars. 1999. The First Year Examination. Australasian Psychiatry 7 (4): 211.

Thank you for giving us the opportunity to review Dr Alder’s paper ‘Through the glass darkly: Towards options for... more Thank you for giving us the opportunity to review Dr Alder’s paper ‘Through the glass darkly: Towards options for training, examination and continuing education’ [1]. The article makes many useful and creative points about training options for the future. As a group of psychiatrists involved in the education of trainees for many years, we would like to endorse your comments about the excessive number of assessments.

Disturbed dreaming and sleep quality: altered sleep architecture in subjects with frequent nightmares

by Klára Horváth

Co-authored with Péter Simor, Ferenc Gombos, Krisztina Takács, Róbert Bódizs
Published in European Archives of Psychiatry and Clinical Neuroscience, 2012

Nightmares are intense, emotionally negative mental experiences that usually occur during late-night sleep and result... more Nightmares are intense, emotionally negative mental experiences that usually occur during late-night sleep and result in abrupt awakenings. Questionnaire-based studies have shown that nightmares are related to impaired sleep quality; however, the polysomnographic profile of nightmare subjects has been only scarcely investigated. We investigated the sleep architecture of 17 individuals with frequent nightmares and 23 control subjects based on polysomnographic recordings of a second night spent in the laboratory after an adaptation night. Nightmare subjects in comparison with control subjects were characterized by impaired sleep architecture, as reflected by reduced sleep efficiency, increased wakefulness, a reduced amount of slow wave sleep, and increased nocturnal awakenings, especially from Stage 2 sleep. While these differences were independent of the effects of waking psychopathology, nightmare subjects also exhibited longer durations of REM sleep that was mediated by heightened negative affect. Our results support that nightmares are related to altered sleep architecture, showing impaired sleep continuity and emotion-related increase in REM propensity.

How I became a historian of psychiatry

by Hans Pols

Blog post

Why ask why? Just do it! Why ask why? Just do it!

Kant Concept Art

by Mark Singer

Tandem works include: "Seminal Ethics," "More Seminal Ethics Implications," "Addendum - More Seminal Ethics Implications" - also on this site.

The artist is P. Patten (USA).

Seminal Ethics

by Mark Singer

Tandem works include: "Kant Concept Art," "More Seminal Ethics Implications," "Addendum - More Seminal Ethics Implications" - also on this site.

Additional implications include: moral, epistemology, love, happiness, time and space, psychological, art, education, medical, economic, war, capital punishment, abortion, and possibility.

Portraits in the Mind

by Mark Singer

"Portraits in the Mind" - composed mostly of art - is based on research at Kendall College of Art & Design (USA) in which this new link was discovered:

> 1:10 art students reported synaesthesia

> 1:3 of the above demographic reported co-consciousness.

Discovering Your Ethical Core

by Mark Singer

Related works include: "Seminal Ethics," "Kant Concept Art," "More Seminal Ethics Implications," "Addendum - More Seminal Ethics Implications" - also on this site.

It's All About Love (Synopsis)

by Mark Singer

A Randomized, Controlled Trial With 6Month Follow-Up of Repetitive Transcranial Magnetic Stimulation and Electroconvulsive Therapy for Severe Depression

by Graham Pluck

A randomized controlled trial with 4-month follow-up of adjunctive repetitive transcranial magnetic stimulation of the left prefrontal cortex for depression

by Graham Pluck

So you’re going to design a mental health facility? How to make it future-proof.

by Jan Golembiewski

Golembiewski, J. (2012). So you’re going to design a mental health facility? How to make it future-proof. World Health Design Scientific Review, 5(2), 74-79.

The prevailing model of psychiatric design (the world over) does not fulfil its potential in supporting the healing... more The prevailing model of psychiatric design (the world over) does not fulfil its potential in supporting the healing process. In order to design for future usability, design teams must have a vision beyond current paradigms and understand the direction healthcare is going.  More importantly still, models of care that will actually improve mental health outcomes instead of just managing patient behaviour must be considered. 

To create this vision, a methodological salutogenic approach can be employed for the project development and management phases – from design of the buildings through to the design of the models of care. This approach advocates taking an interdisciplinary and collaborative approach to actively improve a sense of coherence for all users including patients and staff. This can be done at every decision point by choosing to foster manageability, comprehensibility and most importantly meaning.

Methohexitone, propofol and etomidate in electroconvulsive therapy for depression: A naturalistic comparison study

by Graham Pluck

Overview of psychiatric ethics III: principles-based ethics

by Christopher Ryan

Robertson, M., C. J. Ryan, and G. Walter. 2007. Overview of psychiatric ethics III: principles-based ethics. Australasian Psychiatry 15  (4): 281-286.

Objective: The aim of this paper is to consider the application of principlebased medical ethics to psychiatry. more Objective: The aim of this paper is to consider the application of principlebased medical ethics to psychiatry.

Conclusions: Principles-based medical ethics is a useful tool for resolving ethical dilemmas in psychiatry in that clinical aspects of ethical dilemmas can be better articulated than in other methods. The ethical dilemmas unique to psychiatry, such as those related to impairment of autonomy, present a challenge to the method. After considering a case example, we conclude that psychiatrists can best utilise a principles based approach to ethical dilemmas when they combine this with a level of critical reflection in the light of other ethical theories, such as virtue ethics, as well as close consideration of the clinical and social context of the ethical dilemma.

Helpful and unhelpful risk assessment practices [Letter]

by Christopher Ryan

Large, Matthew M., Christopher J. Ryan, and Olav B. Nielssen. 2010. Helpful and unhelpful risk assessment practices [Letter]. Psychiatric Services 61 (5): 530.

Snowden and associates’ (1) report in the November 2009 issue on a validation study of the Classification of Violence... more Snowden and associates’ (1) report in the November 2009 issue on a validation study of the Classification of Violence Risk (COVR) is an example of a worrying trend toward the promotion of unhelpful risk assessment practices in mental health services (2).

Clinical decisions in psychiatry should not be based on risk assessment

by Christopher Ryan

Ryan, Christopher, Olav Nielssen, Michael Paton, and Matthew Large. 2010. Clinical decisions in psychiatry should not be based on risk assessment. Australasian Psychiatry 18 (5): 398-403.

Objective: Risk assessments that place patients in high or low risk categories have been widely adopted by mental... more Objective: Risk assessments that place patients in high or low risk categories have been widely adopted by mental health services in an attempt to reduce the harms associated with psychiatric disorders. This paper examines the effects of categorization based on the results of a risk assessment.

Methods: The violence prediction instrument derived from the MacArthur Study of Mental Disorder and Violence was used to illustrate the nature and effects of risk assessment and the consequent categorization of patients.

Results: The majority of patients categorized as being at high risk will not commit any harmful acts.

Conclusions: Patients who are classified as high risk share the cost of efforts to reduce harm in the form of additional treatment and restrictions, although the majority will not go on to commit a harmful act. Clinical decisions made on the basis of risk assessment also divert resources away from patients classified as low risk, even though a significant proportion do go on to a commit harmful act. We argue that psychiatric professionals should discuss the risks of treatment and of non-treatment with patients (or with their substitute decision-makers) and should maintain a duty to warn about the consequences of not having treatment. However, assessment of risk of harm should not form the basis for clinical decision making. We should aim to provide optimal care according to the treatment needs of each patient, regardless of the perceived risk of adverse events.

College activities and the ethics of advertising

by Christopher Ryan

Ryan, Christopher, Garry Walter, and Michael Robertson. 2010. College activities and the ethics of advertising. Australasian Psychiatry 18 (2): 101-105.

Objectives: The aim of this paper is to examine whether advertising in the College journals and at RANZCP Congress, in... more Objectives: The aim of this paper is to examine whether advertising in the College journals and at RANZCP Congress, in particular from pharmaceutical companies, gives rise to a conflict of interests, and to discuss how this should be managed.

Conclusions: While advertising will often represent a conflict of interests, banning advertising from the College journals or Congress is unlikely to the best way to manage this. Conflicts of interest may be better managed by development of clear policies on advertisements, broadening the advertising base (i.e. beyond pharmaceutical companies), checking the accuracy of advertisements, and, in the case of Congress, ceasing sponsored symposia.

Ethics, psychiatry and end-of-life issues

by Christopher Ryan

Ryan, Christopher J. 2010. Ethics, psychiatry and end-of-life issues. Psychiatric Times 27 (6): 26-27.

At the end of life, psychiatrists are often asked to assess a patient’s capacity to refuse treatment, but the role of... more At the end of life, psychiatrists are often asked to assess a patient’s capacity to refuse treatment, but the role of the psychiatrist in this situation is much broader. Even when a person’s mental capacity is not at issue, subtle and not-so-subtle psychological forces can weigh heavily on life-and-death decisions that may be elucidated with a psychiatric assessment. In an ideal world envisaged by supporters of physician-assisted death, patients ask for assistance to die because they have weighed the pros and cons of continued existence; finding the option of prolonging life unsatisfactory, they opt for death at a time of their own choosing—an exit with dignity and grace. Although this scenario may happen, it is far from universal. Often, a request for physician-assisted dying or for withdrawal of life-sustaining treatment results more from a fear of the unknown, a need to maintain control, or a misunderstanding of what the future may bring.

Legal and ethical aspects of refusing medical treatment after a suicide attempt: the Wooltorton case in the Australian context

by Christopher Ryan

Ryan, Christopher J., and Sascha Callaghan. 2010. Legal and ethical aspects of refusing medical treatment after a suicide attempt: the Wooltorton case in the Australian context. Medical Journal of Australia 193: 239-242.

• When a patient presents to hospital after a suicide attempt and appears to refuse treatment, clinicians should first... more • When a patient presents to hospital after a suicide attempt and appears to refuse treatment, clinicians should first assess if he or she should be treated under mental health legislation, regardless of competence to refuse treatment.

• When it is not possible or is inappropriate to treat under mental health legislation, the person’s competence to refuse treatment should be assessed. If the patient is definitely competent, his or her decision to refuse treatment should probably be honoured.

• If an incompetent patient carries a document refusing treatment, clinicians must determine the validity of that document as an advance care directive — including whether or not the patient was competent at the time it was written.

• The law around the right to refuse treatment after a suicide attempt remains unclear and, if uncertain of what to do, clinicians should provide urgently required life-saving treatment and simultaneously seek an urgent court order to clarify how they should proceed.

• In all but extraordinary circumstances, a patient who refuses treatment after a suicide attempt can and should be given life-saving treatment, under either mental health legislation or the common law concept of necessity.

Proposed changes to the function of the Mental Health Act will erode patient rights

by Christopher Ryan

Ryan, Christopher James, Sascha Callaghan, and Matthew Large. 2010. Proposed changes to the function of the Mental Health Act will erode patient rights. Newsletter of the NSW Branch of the Royal Australian and New Zealand College of Psychiatrists (April): 10-11.

Imagine for a moment you find yourself arrested in some foreign clime – Queensland, for example. You are told you have... more Imagine for a moment you find yourself arrested in some foreign clime – Queensland, for example. You are told you have transgressed some northern law and are looking at several weeks inside. You are anxious, to be sure, but not dismayed. You know you are innocent and you’re sure you’ll be able to persuade a judge that there has been a miscarriage of justice. You also know that under Queensland law the police must present you to court “as soon as reasonably practicable” and you know that, like all Australian jurisdictions, this time frame is normally interpreted as being within 24 hours, 365 days of the year.