Three heads are better than one: Psychiatry trainees' experiences of a psychotherapy written case supervision group with three co-supervisors.

OBJECTIVE: The aim of this project was to evaluate the experiences of Royal Australian and New Zealand College of Psychiatrists (RANZCP) trainees in a regional centre who participated in a psychodynamic psychotherapy written case supervision group with three co-supervisors. METHOD: A web-based survey was sent to RANZCP trainees. Descriptive statistics were performed, and written feedback was analysed. RESULTS: A total of 8 of 10 eligible trainees completed the survey. All respondents stated that the group met their training needs. The average rating of feeling understood by supervisors was 91 (maximum 100). Positive feedback was received about the variety and breadth of experience provided by the co-supervisors. Trainees felt that 1:1 supervision was important to complement group supervision. CONCLUSIONS: The supervision group model with three co-supervisors is competently meeting the training needs of RANZCP trainees as well as providing a deep learning experience. This model may be of use in other services, particularly in regional settings.

Bringing psychiatrists into the picture: Automated measurement of regional MRI brain volume in patients with suspected dementia.

OBJECTIVE: The volumes of various brain regions can be rapidly quantified using automated magnetic resonance imaging tools. While these appear to be useful at face value, their formal clinical utility is not yet understood, particularly for non-neuroradiologists and in patients presenting with suspected dementia. This study investigated the utility of an automated normative morphometry tool on determinations of brain atrophy by psychiatrists and radiologists in a tertiary hospital. METHODS: Consecutive magnetic resonance scans (n = 110) of patients referred with suspected neurodegenerative disorders were obtained retrospectively and rated by two neuroradiologists, two general radiologists and four psychiatrists over two sessions. First, conventional magnetic resonance sequences were shown. Then, morphometry colour-coded maps, which segmented T1-weighted magnetisation prepared rapid gradient echo images into brain regions and visualised these regions in colour according to their volumetric standard deviation from a normative population, were added to the second reading which occurred ⩾6 weeks later. Presence and laterality of atrophy in frontal, parietal and temporal lobes and hippocampal regions were measured using a digital checklist. The primary outcome of inter-rater agreement on atrophy was measured with Fleiss' Kappa (κ). We also evaluated the accuracy of the atrophy ratings for differentiating post hoc diagnosis of subjective cognitive impairment, mild cognitive impairment and dementia. RESULTS: Agreement among all raters was fair in frontal lobe and moderate in other regions with conventional method (κ = 0.362-0.555). With morphometry, higher agreement was seen in all regions (κ = 0.551-0.654), reaching significant improvement in the frontal and temporal lobes. No significant improvement was seen within the various disciplines, except in frontal lobes rated by psychiatrists. Accuracy of atrophy ratings on determining post hoc diagnosis was significantly improved for distinguishing subjective cognitive impairment versus dementia. CONCLUSION: In routine clinical assessment, automated normative morphometry complements the determination of regional atrophy and improves inter-rater agreement regardless of neuroradiology experience.

Functional outcomes in rural Australia of two continuing care teams: a regional town-city comparison of the 16-item Life Skills Profile.

OBJECTIVE: The primary aim was to examine differences in functional health outcomes in consumers entering a regional mental health service compared with a city service. METHOD: A retrospective analysis of consumer outcomes and characteristics was undertaken. Consumer demographics and diagnoses were compared between the two services. Functional outcomes were measured using the 16-item Life Skills Profile (LSP-16). The data analysis plan utilised descriptive statistics. For between-clinic comparisons, relevant inferential statistics was used. RESULTS: Patients attending the regional health service were five times more likely to be in the high impairment category on the LSP-16, independent of demographic factors and diagnosis. Other independent contributions to high impairment were being male, Indigenous and a diagnosis of schizophrenia. Of the four LSP-16 subscales, regional consumers scored relatively higher on withdrawal, compliance and anti-social but not self-care subscales. CONCLUSIONS: There was a greater level of functional impairment in consumers attending the regional service. The independent contributions did not explain the higher impairment; therefore, other factors such as socioeconomic disadvantage may explain the difference. Regional clinicians may need to consider recovery-orientated interventions that address a greater burden of functional impairments in regional services.

Mental health service provision in rural Australia: a regional town-city comparison of two continuing care teams.

OBJECTIVE: The primary aims were to compare the characteristics and health outcomes of consumers entering a regional mental health service compared with a city service. METHOD: A retrospective audit was undertaken of consumers aged 18 and over from a regional town and city mental health service. Consumer demographics, diagnoses and outcomes were compared between the two services. The data analysis plan utilised descriptive statistics. For between-clinic comparisons, relevant inferential statistics was used. RESULTS: Regional service patients had a significantly greater proportion of substance use disorder diagnoses. Outcome rating scales were higher (worse) for regional consumers. There was significantly less overall service utilisation for regional service consumers including shorter duration of episodes of care, less hospitalisations and less people treated under the Mental Health Act. CONCLUSIONS: There were a broader range of patient presentations in the regional town. Regional practitioners may specifically need more training and skills in treating substance use disorders.

Demographics and study practices of psychiatry trainees sitting the RANZCP written examinations.

OBJECTIVES: This study explored trainee preparation for the Royal Australian and New Zealand College of Psychiatrists (RANZCP) written examinations. We examined the relationship between candidates' prior psychiatry experience, preparation techniques and expenses, perceptions of the exam and a pass result. We also examined perceptions of well-being. METHOD: A web-based survey was sent to RANZCP trainees. The association between responses and exam outcome was analysed using SPSS Statistics 23. RESULTS: A total of 23% ( n = 38) of the cohort responded to the survey. Respondents studied for an average of 7.8 months for the essay-style exam and 4.4 months for the multiple-choice questions. The mean months of total psychiatry experience prior to sitting was 36.1 months. Every additional 50 hours of study increased odds of passing by 23%. Respondents who believed that exam preparation would affect outcome had an almost 4-fold higher odds of passing than those who did not. Ratings of well-being before release of results were also positively associated with passing. Conclusions Trainees are sitting the written exams with clinical experience commensurate with RANZCP recommendations. Total study hours and favourable perceptions of exam processes appear to be predictors of success.

Curso terapêutica em gastroenterologia: aula 7: Pancreatite aguda: diagnóstico e terapêutica / Acute pancreatitis: diagnosis and therapeutic

A pancreatite aguda é um processo inflamatória do pâncreas cuja apresentação clínica pode variar desde formas leves e autolimitadas (intersticial) até formas graves, associadas ao acometimento sistêmico (necrosante). Classicamente, o diagnóstico baseia-se em dor abdominal, associada a vômitos, com elevação plasmática de enzimas pancreáticas (amilase e lipase). O melhor conhecimento das formas evolutivas, os avanços obtidos na área de diagnóstico por imagem e as novas opções para terapia farmacológica têm permitido reduzir significativamente a morbimortalidade.