Keeping military in mind: The Royal Australian & New Zealand College of Psychiatrists' Military and Veterans' Mental Health Network.

OBJECTIVE: The objective of this study is to introduce The Royal Australian & New Zealand College of Psychiatrists (RANZCP) Military and Veterans' Mental Health Network (The Network) and profile its inaugural members. METHODS: We implemented an online survey of demographic, professional and practice characteristics of network members; self-rated knowledge of military and veterans' mental health; reasons for joining The Network; and suggestions as to how The Network could best support members' needs. Quantitative survey responses were analysed descriptively. Qualitative responses were analysed thematically. RESULTS: Thirty-two out of 60 network members returned the survey. The membership was predominately male and 50 years of age or older. One-half had completed their fellowship or specialty 20 or more years ago. A high level of self-rated knowledge with respect to the assessment and management of current and ex-serving military personnel was reported. Knowledge of the assessment and management of current and ex-serving emergency services personnel was lower. CONCLUSION: There are RANZCP members with an active interest, expertise and knowledge in the field of military, veterans' and emergency services personnel mental health; this affirms the significant role the RANZCP can play in this area. There is a need to expand, diversify and ensure sustainability of the workforce.

Dr Google, MD: a survey of mental health-related internet use in a private practice sample.

OBJECTIVE: The aim of this study was to evaluate the use of the internet to access mental health-related information in a private practice sample, and to understand how this influenced health behaviours in this group. METHOD: We undertook a cross-sectional survey of adult outpatients attending two group psychiatric practices. The content included internet usage, types of information located, disclosure with treating psychiatrist, and perceived influence on decision-making. We collected both quantitative and qualitative data. RESULTS: The internet was often used to access mental health-related information. Respondents most commonly looked for information about symptoms, treatment, side effects and diagnoses. Approximately one-third of those who sought mental health information on the internet discussed this with their psychiatrist, and those who did so were more likely to report an influence of this information on their decision-making. Respondents' comments suggested an appreciation of the utility of the internet, combined with an understanding of its limitations. CONCLUSION: Private practice patients frequently access mental health information from the internet. When discussed within the therapeutic setting, it appears more likely to influence health-related decision-making. As part of ongoing therapy, clinicians should actively discuss what patients have read on the internet.

The temporal dynamics of relationships between cannabis, psychosis and depression among young adults with psychotic disorders: findings from a 10-month prospective study.

BACKGROUND: The aim was to examine the temporal relationships over 10 months between cannabis use and symptoms of psychosis and depression in people with schizophrenia and related disorders. The design was a prospective study of 101 patients with schizophrenia and related disorders who were assessed monthly over 10 months on medication compliance, cannabis and other drug use, symptoms of depression and symptoms of psychosis. METHOD: Linear regression methods to assess relationships between cannabis use and symptoms of psychosis and depression while adjusting for serial dependence, medication compliance and other demographic and clinical variables. RESULTS: Cannabis use predicted a small but statistically significant increase in symptoms of psychosis, but not depression, after controlling for other differences between cannabis users and non-users. Symptoms of depression and psychosis did not predict cannabis use. CONCLUSION: Continued cannabis use by persons with schizophrenia predicts a small increase in psychotic symptom severity but not vice versa.

Let's get physical: an audit of medical practice in first episode psychosis.

OBJECTIVES: To assess aspects of medical examination, diagnosis and side-effect monitoring, and to consider the role of routine investigations in this group as recommended by national guidelines. METHOD: A retrospective file audit was performed on young people presenting with first episode psychosis (n = 117) over 12 months of treatment contact. RESULTS: Diagnoses were: first episode psychosis (43%), schizophrenia (16%), drug-induced psychosis (12%), affective psychosis (13%) and brief reactive psychosis (2%). Only four of the 52 (8%) subjects undergoing neuroimaging had any abnormality, with only two of these requiring referral. Three of the 33 (9%) electroencephalograms were obviously abnormal, but without epileptiform activity. There was little documentation of the assessment of involuntary movements (4% of sample) or weight (15% of sample). CONCLUSIONS: The low rates of clinically important abnormal findings in computed tomography/magnetic resonance imaging and electroencephalogram re-open debate about the need for routine neuroimaging and electrophysiology in this population.

Changes in early psychosis service provision: a file audit.

OBJECTIVE: To measure change in services provided to young people with first-episode psychosis following the introduction of specialized early psychosis teams and staff training. METHOD: A standardized tool was developed to audit services provided to young people with first-episode psychosis. The tool initially comprised 27 clinical indicators measuring aspects of optimal care derived from the Australian clinical guidelines for early psychosis. The first 12 months of treatment, as documented in the case records, were audited for all young people receiving their first treatment for psychosis during a 6-month period prior to the introduction of these service developments (n = 47). These subjects were compared with those who received treatment after the implementation of service development strategies (n = 70). A comparison was also made within the second group, between those receiving some treatment from a specialized early psychosis team and those being exclusively treated by other services. RESULTS: Inter-rater reliability was achieved for 24 of the 27 indicators. Improvements were found on 10 indicators which measured psychosocial interventions, prescribing practices, family interventions and continuity of care. There was no significant deterioration on any of the indicators. Clients who attended early psychosis teams were significantly more likely to receive psychoeducation. CONCLUSIONS: The services increased their provision of "guideline concordant" care for early psychosis. The audit proved useful to monitor performance, to demonstrate improvements in care and to identify those areas of service provision and documentation in need of improvement.