Position statements of the Royal Australian and New Zealand College of Psychiatrists: An historical perspective.

OBJECTIVE: To review the concept, purpose, and subjects of Position Statements of the Royal Australian and New Zealand College of Psychiatrists since their inception in 1971, and to consider changes to enhance their value. METHOD: We scrutinised the procedure in producing, revising, and rescinding Position Statements, and the nature of the subjects covered. RESULTS: Position Statements were initiated by the College Board, various College committees and members. The format and procedures of revising and rescinding them varied considerably. We identified 11 subject areas encompassing professional practice and research, their association with societal developments, and the implications for College policy. CONCLUSION: Position Statements have proved to be a dynamic vehicle to keep abreast of significant changes in psychiatry. Methodical appraisal is required to optimise their objective in conveying College policies to members and relevant stakeholders.

Codes of ethics for psychiatrists: past, present and prospect.

BACKGROUND: Codes of ethics in medicine have an ancient tradition, extending back to the Oath of Hippocrates. Yet it was only in the early 1970s that the speciality of psychiatry developed a specific code to address the unique ethical dilemmas and complexities arising in psychiatric practice. As the 50th anniversary of the publication of psychiatry's first code of ethics approaches, it is timely to reflect on the progress, role, and impact of such codes.Our aim is to provide a historically informed review of codes of ethics in psychiatry - their origins and evolution, the current picture, and the possibilities for future development. METHODS: We conducted a selective review of relevant literature (including all codes of ethics accessible on the websites of World Psychiatric Association members states), analysis of the form and content of codes and related documents in psychiatry, and interviews of psychiatrists who have played central roles in their evolution. RESULTS: Of the 143 WPA member states, only 15 codes of ethics for psychiatrists were identified, and few of these were associated with professional disciplinary processes. We found that these codes are rarely revised and sometimes supplemented with other statements and guidelines. CONCLUSIONS: While there are difficulties in measuring the direct effectiveness of codes of ethics on the practice of psychiatrists, we conclude that these codes help to (1) promote professional solidarity and autonomy, (2) enhance moral sensitivity, and (3) aid in psychiatric education and training.

The 30th anniversary of the code of ethics of the Royal Australian and New Zealand College of Psychiatrists-a worthy milestone.

OBJECTIVE: To appraise the evolution of the RANZCP's Code of Ethics on the occasion of its 30th anniversary. METHOD: We scrutinised its five editions, focussing on the revision procedure and changes made, and reviewed relevant literature. RESULTS: The procedure of revision has remained constant: incorporating feedback from college members, committees and faculties, and consulting professional medical bodies and mental health advocacy organisations. Seven major themes of change have emerged with respect to patient exploitation, recognition of family and carers, the special place of Indigenous Peoples, confidentiality, engaging patients in decision-making, multidisciplinary collaboration and the well-being of psychiatrists. CONCLUSIONS: The code has proved to be a dynamic instrument in keeping abreast of changes in psychiatry and society, and promises to maintain a prominent role in promoting high ethical standards in the profession.

Pathogenic language in psychiatric practice and how to combat it.

OBJECTIVE: Psychiatrists are susceptible intermittently to use dehumanising terms in their clinical practice, which arguably harm patients and their families. Our goal is to shed light on this unwelcome phenomenon and to develop the means to combat it. METHOD: We have examined journal articles, books on the history of psychiatry, and educational material devised for psychiatric patients, for evidence of what we have called 'pathogenic language'. We have also sought colleagues' reflections on the subject. RESULTS: We have identified several terms that are ostensibly pathogenic, tried to illuminate their intrinsic features and devised guidelines to stem their use. CONCLUSIONS: Psychiatrists have the potential to harm patients and their families by using pathogenic language when communicating with them. We conclude that meticulous attention to this risk, coupled with appropriate ethically based and educational strategies, can contribute to the eradication of pathogenic language and prevent its recurrence.

Revising the Royal Australian and New Zealand College of Psychiatrists code of ethics.

OBJECTIVES: To describe the process adopted by the Committee for Professional Practice (CPP) of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in devising the 5th edition of its code of ethics and to outline principal changes. METHODS: CPP members planned, scrutinised and documented the steps taken in preparing the new edition. RESULTS: The process, following that used in all previous updates of the code and which had proved effective and productive on each occasion, comprised consultations with RANZCP committees and relevant external stakeholders. Canvasing the views of so many groups was regarded as essential to ensure that multiple perspectives were considered and any bias of the CPP avoided. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) was examined with two aims: promoting a robust clinician and patient partnership, and acknowledging the psychiatrist's advocacy role. The psychiatrist's duty to be alert to colleagues' wellbeing and to safeguard respectful professional relationships was highlighted. CONCLUSIONS: A comprehensive, rigorous and established review process occurred and was carefully documented resulting in a sound and contemporary revision of the code of ethics. RANZCP members will be duty-bound to adhere to, and apply, the code to optimise their ethical standards.

Ethical use of the media by psychiatrists: towards an antipodean formulation of the "Goldwater Rule".

OBJECTIVES: To review the ethical problems posed by the participation of psychiatrists in various forms of lay media and propose a method of resolving quandaries in this area. CONCLUSIONS: We review the potential ethical problems that arise when psychiatrists make contributions to the lay media, particularly when commentary and opinion reflects the views of the individual rather than the profession. The issues raised by the North American injunction known as the "Goldwater Rule" are pertinent to Australasia, particularly when media statements made by psychiatrists may seem to diminish the profession through politicisation, polemic, or bringing the profession and the field into disrepute. We propose a series of reflective questions to assist psychiatrists in Australasia to deliberate on the potential ethical problems arising from their participation in media activities. We conclude that it is for the Royal Australian and New Zealand College of Psychiatrists to formulate an approach to situations where the media activities of Fellows raise such problems.

Cognitive existential couple therapy (CECT) in men and partners facing localised prostate cancer: a randomised controlled trial.

OBJECTIVES: To assess the efficacy of cognitive existential couple therapy (CECT) for relationship function, coping, cancer distress and mental health in men with localised prostate cancer and in their partners. PATIENTS SUBJECTS AND METHODS: A randomised controlled trial was conducted with 62 couples randomly assigned to the six-session CECT programme or care as usual. The couple's relationship function (primary outcome), and coping, cancer distress and mental health (secondary outcomes) were evaluated at T0 (baseline), T1 (after treatment) and T2 (9 months from T0). A repeated-measures analysis of covariance model, which incorporated T0 measurements as a covariate, was used to compare treatment groups at T1 and T2. RESULTS: After CECT, patients reported significantly greater use of adaptive coping (P = 0.03) and problem-focused coping (P = 0.01). These gains were maintained at follow-up, while relationship cohesion had improved (P = 0.03), as had relationship function for younger patients (P = 0.01). Younger partners reported less cancer-specific distress (P = 0.008), avoidance (P = 0.04), intrusive thought (P = 0.006), and hyperarousal (P = 0.01). Gains were maintained at follow-up, while relationship cohesion (P = 0.007), conflict resolution (P = 0.01) and relational function (P = 0.009) all improved. CONCLUSION: CECT resulted in improved coping for patients and lower cancer-distress for partners. Maintained over time this manifests as improved relationship function. CECT was acceptable to couples, alleviated long-term relationship decline, and is therefore suitable as a preventative mental health intervention for couples facing prostate cancer. Given resourcing demands, we recommend dissemination of CECT be targeted at younger couples, as CECT was more acceptable to the younger group, and they derived greater benefit from it.

Cognitive Existential Couple Therapy for newly diagnosed prostate cancer patients and their partners: a descriptive pilot study.

OBJECTIVE: This paper aims to describe 'Cognitive Existential Couple Therapy' (CECT), a novel couples-based intervention for men with early stage prostate cancer (PCa) and their partners, and to report preliminary findings from a pilot study that investigated the acceptability and feasibility of the intervention and the measures to be used in a subsequent randomised controlled trial. METHODS: A manualised CECT programme was delivered to 12 couples facing a diagnosis of PCa within the previous 12 months by psychiatrists and clinical psychologists. Participants completed measures of psychological distress, marital function and coping pattern before and after CECT. Semi-structured interviews were conducted with nine couples shortly after the completion of CECT. RESULTS: The application of CECT was both feasible and acceptable as indicated by favourable participant compliance (10 of the 12 couples attended all six designated sessions), completion of measures before and after CECT and participation in semi-structured interviews by nine couples. Preliminary results included reduced levels of avoidance and hyperarousal after the programme, with this effect stronger in partners than in patients. Interviews demonstrated that couples valued the therapist's contribution to their overall care. CONCLUSIONS: Previous research suggests that a couple-focused psychological intervention is desirable in the context of early stage PCa. This pilot study has established that CECT is acceptable, feasible and valued by couples facing a recent PCa diagnosis and demonstrates a potential for reduced psychological distress following CECT. A randomised controlled trial is currently being undertaken to validate the efficacy of this novel approach.

Predictors of psychosocial distress 12 months after diagnosis with early and advanced prostate cancer.

OBJECTIVE: To assess psychosocial distress in patients with early (localised) and advanced (metastatic) prostate cancer (PCA) at diagnosis (Time 1) and 12 months later (Time 2), and identify psychosocial factors predictive of later distress. DESIGN, PARTICIPANTS AND SETTING: Observational, prospective study of 367 men with early (211) or advanced (156) PCA recruited as consecutive attendees at clinics at seven public hospitals and practices in metropolitan Melbourne between 1 April 2001 and 30 December 2005. Both groups completed questionnaires at Time 1 and Time 2. MAIN OUTCOME MEASURES: Health-related quality of life as assessed by the Short Form 36-item Health Survey; psychological distress, including depression and anxiety as assessed by the Brief Symptom Inventory; and coping patterns as assessed by the Mini-Mental Adjustment to Cancer scale. RESULTS: Over the 12 months, both the early and advanced PCA group showed reduced vitality and increased depression and anxiety; this effect was greater in the advanced PCA group. Mental health, social functioning and role-emotional functioning also deteriorated in the advanced group. Predictors of depression at Time 2 for the early PCA group were depression, vitality and a fatalistic coping pattern at Time 1; anxiety at Time 2 was predicted by anxiety and vitality at Time 1. In the advanced PCA group, depression at Time 2 was predicted by depression and mental health at Time 1; anxiety at Time 2 was predicted by anxiety, mental health, cognitive avoidance and lower anxious preoccupation at Time 1. CONCLUSIONS: Men with early PCA experience decreasing vitality and increasing psychological distress over the 12 months following diagnosis; this trend is accelerated after diagnosis with advanced PCA. A fatalistic coping pattern at diagnosis of early PCA predicts later depression while cognitive avoidance and lower anxious preoccupation at diagnosis of advanced PCA predict later anxiety.

Coping patterns and psychosocial distress in female partners of prostate cancer patients.

BACKGROUND: With medical advances since the 1990s, a growing proportion of patients are living for many years with prostate cancer (PCA) and the consequences of its treatment. OBJECTIVE: The authors investigated the experience of being diagnosed with cancer and the effects of its treatment on patients' partners. METHOD: The authors conducted an observational, longitudinal study of 103 couples facing the diagnosis of either localized (potentially curable) or metastatic (incurable) PCA at Time 1 and then 6 months later (Time 2). RESULTS: At both Time 1 and Time 2, psychological distress, marital satisfaction, and family functioning were measured in patients and partners; coping was measured in partners only. Partner maladaptive coping patterns of avoidance and self-blame at Time 1 predicted greater partner psychological distress at Time 2, as did "wishful thinking" at Time 2. DISCUSSION: Psychosocial interventions designed to promote adaptive coping in couples facing PCA warrant systematic study.

The effect of group music therapy on quality of life for participants living with a severe and enduring mental illness.

A 10-week group music therapy project was designed to determine whether music therapy influenced quality of life and social anxiety for people with a severe and enduring mental illness living in the community. Ten one-hour weekly sessions including song singing, song writing and improvisation, culminated in each group recording original song/s in a professional studio. The principal outcome measure was the WHOQOLBREF Quality of Life (QoL) Scale; other instruments used were the Social Interaction Anxiety Scale (SIAS) and the Brief Symptom Inventory (BSI). Qualitative data were gathered through focus group interviews and an analysis of lyric themes. Statistically significant improvement was found on five items of the QoL Scale. There were no changes on the BSI indicating that QoL improvement was not mediated by symptomatic change. Themes from the focus groups were: music therapy gave joy and pleasure, working as a team was beneficial, participants were pleasantly surprised at their creativity, and they took pride in their song. An analysis of song lyrics resulted in 6 themes: a concern for the world, peace and the environment; living with mental illness is difficult; coping with mental illness requires strength; religion and spirituality are sources of support; living in the present is healing; and working as a team is enjoyable.

The psychological aftermath of prostate cancer treatment choices: a comparison of depression, anxiety and quality of life outcomes over the 12 months following diagnosis.

OBJECTIVE: To assess the psychological impact of the different treatments for localised prostate cancer (PCA). DESIGN, PARTICIPANTS AND SETTING: Observational, prospective study of consecutive patients with PCA attending clinics in public hospitals and private practices in metropolitan Melbourne between 1 April 2001 and 30 December 2005. Data were collected at initial diagnosis of histologically confirmed localised PCA, and close to the commencement of definitive treatment (Time 1), and 12 months later (Time 2). Patients were stratified according to treatment type (radical prostatectomy [RP], hormone therapy [HT] or other early treatment including radiation therapies [OET]). Patients who elected to undergo active surveillance/watchful waiting (WW) rather than active treatment were treated as a naturalistic control group. MAIN OUTCOME MEASURES: Levels of depression and anxiety were assessed by the Brief Symptom Inventory, and physical and psychosocial aspects of health-related quality of life (HRQOL) were assessed by the 36-item Short-Form Health Survey. RESULTS: 211 patients with PCA were recruited; 193 completed the Time 1 questionnaires (38 RP, 56 HT, 38 OET and 61 WW); and 172 completed the Time 2 questionnaires (33 RP, 51 HT, 33 OET and 55 WW). At Time 1, the three active treatment groups all reported greater dysfunction in work role and daily activities compared with the WW group. The RP group also reported worse social and emotional role functioning, while the HT and OET groups reported poorer vitality levels. The HT group reported significantly higher depression scores. At Time 2, the RP and OET groups did not differ from the WW group on either HRQOL or psychological status. By contrast, the HT group reported significantly worse HRQOL (physical functioning, role-physical and vitality domains) and greater psychological distress compared with the WW group. CONCLUSIONS: Compared with the other active treatments for localised PCA, HT appears to be associated with poorer HRQOL and greater psychological distress 12 months after commencing treatment.

Is there a role for music therapy in the care of the severely mentally ill?

OBJECTIVE: The role of music therapy in psychiatric care in Australia is briefly traced from the early 1990s to the present. With the shift to community-based care, contemporary music therapy practice for the severely mentally ill is reappraised alongside the principles of the recovery model. CONCLUSIONS: Music therapy is a viable option within the creative arts therapies for enhancing quality of life in people with severe and enduring mental illness.

Psychosocial adjustment in newly diagnosed prostate cancer.

OBJECTIVE: To examine the psychological and social adjustment of men with early or advanced stage prostate cancer and to compare them with a matched group of cancer-free community volunteers. METHODS: A longitudinal observational study in which 367 men recently diagnosed with early (n=211) or advanced stage (n=156) prostate cancer were compared to 169 cancer-free men from the community, of similar age and residential area, using self-report measures of psychosocial adjustment. RESULTS: On the mental health subscales of the Short-Form 36-item Health Survey, men with advanced disease had lower vitality and social functioning than the other two groups, and lower mental health scores than the comparison group. Both patient groups had lower role-emotional scores than the comparison group. With regard to the Brief Symptom Inventory, the advanced disease group had higher somatization scores, and lower interpersonal sensitivity and paranoid ideation scores than the early stage group and the community comparison group. In terms of psychiatric morbidity, there were higher rates of anxiety disorders but not depressive disorders in both patient groups although overall diagnosis rates were low. No differences were found in terms of couple or family functioning. CONCLUSIONS: There is impairment in psychosocial function in men with prostate cancer, particularly those with advanced disease, but no increase in the rate of formal psychiatric disorder or adverse effects on the couples and families. This suggests directions for psychosocial interventions with these patient groups.

Publishing ethics in child and adolescent psychiatry: essentials for authors and readers.

The ethics of publishing has received negligible attention in the child and adolescent psychiatry literature. We examine a range of ethical problems, including conflict of interest, bias, publishing fraudulent or inhumane research, redundant publication, plagiarism, concerns about authorship, insensitive use of language, and special issues about publishing research involving minors. Strategies to improve ethical standards of publishing are proposed.

Reforming mental health care in Victoria: a decade later.

OBJECTIVE: From 1994, the Australian State of Victoria began a major transformation of its public mental health service system. In June 2006, St Vincent's Mental Health hosted a conference to reflect on the changes and identify steps to be taken over the next decade. METHOD: Participants came from Victoria's 21 adult mental health services, consumer and carer groups, and psychiatric disability rehabilitation and support organizations. They met in small groups, and discussed pre-set topics. Their observations were pooled in plenary sessions. RESULTS: Participants agreed the changes had had many positive outcomes. People most affected by mental illness had priority for treatment. Services were better structured to meet their needs, and staff were more familiar with community-based care. Negatives included restricted service access for some groups, insufficient resourcing to meet increased service demand and clinical staff not maintaining specialist skills. CONCLUSIONS: The conference enabled experiences to be shared and ideas exchanged about improvements.

Psychological adjustment of men with prostate cancer: a review of the literature.

OBJECTIVE: Prostate cancer (PCA) is the most common malignancy and a major cause of death in men but, importantly, a substantial proportion will live for several years following diagnosis. However, they face the prospect of experiencing symptoms, side-effects of treatment and diminished quality of life. The patient's psychological adjustment is particularly complex, given the potential trajectory of the disease, from the point of diagnosis, with its immediate impact, to the phase of palliative care, with its attendant issue of facing mortality. Since a comprehensive review of the literature on psychological adjustment of men with PCA has not yet been done, we have documented relevant research, integrated findings and drawn conclusions, where possible, in order to map out clinical and research implications. METHOD: We searched 5 databases for the period 1994 - July 2006, during which most of the work in the field has been done. RESULTS: We found few studies of substance among the 60 we examined to draw conclusions about psychological adjustment to prostate cancer and its treatment. This is in marked contrast to the picture in breast cancer. While some patterns have emerged, many gaps remain to be filled. DISCUSSION: Aspects of methodology need attention, particularly longitudinal, prospective designs, incorporation of control groups and the use of valid and reliable measures. There is scope for qualitative studies as a complement to quantitative research.