A pioneer in the management of Australian psychiatric services: Dr Richard Greenup (1803-1866).

OBJECTIVES: To provide a brief biography of Dr Richard Greenup and to explore the legacy he has left to one of Australia's longest operating psychiatric services. METHODS: This history was obtained by consulting staff working within Cumberland Hospital, New South Wales and by examining primary and secondary sources. RESULTS: Greenup was the second surgeon superintendent of 'The Parramatta Lunatic Asylum' from 1852 until 1866 when he was fatally stabbed with a pair of scissors by a patient. Greenup was involved in establishing The University of Sydney and advocated for expanded and improved services for people diagnosed with mental disorders. CONCLUSIONS: Greenup recognised the needs of the mentally ill and sought to address similar social and demographic determinants of health to those that we face today. The challenges he faced, and his tragic end remind us of the importance of delivering patient-centred care whilst being mindful of associated risks.

Resolution of Othello Syndrome After Subthalamic Nucleus Deep Brain Stimulation in 3 Patients with Parkinson's Disease.

Psychiatric symptoms are historically thought a relative contraindication to DBS for advanced Parkinson's disease (PD). However, in the case of drug-induced mental illness, DBS may provide an acceptable alternative for the treatment of motor symptoms. This allows reduction of pharmacological dopaminergic therapy that might otherwise cause negative psychiatric consequences. For example, DBS is increasingly used to ameliorate specific complications of PD treatment, such as impulse control disorders. We present a series of 3 cases of young male patients who developed Othello syndrome (OS) during treatment with dopamine agonists. In each case, the OS resolved with withdrawal of the offending drug. Subsequent treatment with bilateral STN DBS improved motor symptoms and allowed reduction in their dopaminergic drug regimen. We therefore propose that drug-induced psychopathology may be an indication (rather than a contraindication) for DBS in selected cases.

Aborigines, colonizers and newcomers: the landscape of transcultural psychiatry research in Australia.

The authors present an analysis of transcultural psychiatry research in relation to three main population groups in Australia: Aboriginal Australians, documented immigrants, and refugees. The pioneering reports produced by Western psychiatrists in Aboriginal communities are examined in this article. Additional quantitative and qualitative studies developed with Aboriginal people in the context of a traumatic acculturation process are also reviewed. Subsequently, the authors examine the challenges faced by immigrants with mental disorders in a health care system still unequipped to treat a new array of clinical presentations unfamiliar to the clinical staff. The authors also highlight the development of policies aimed at providing quality mental health care to a mosaic of cultures in an evolving multicultural society. Lastly, the psychiatric manifestations of refugees and asylum seekers are analysed in the context of a series of vulnerabilities and deprivations they have experienced, including basic human rights.

Survivors of self-inflicted stab wounds.

OBJECTIVE: There are a number of studies describing the survivors of self-incised wounds, but few studies have described the psychiatric condition of survivors of self-inflicted stab wounds. We aimed to describe the characteristics of a complete series of patients treated for self-inflicted stab wounds in a major hospital, and to compare the characteristics of patients with psychotic illness to those with other conditions. METHODS: A review of the files of all patients who had a psychiatric evaluation after presenting for treatment following deliberate self-harm. Stab wounds were defined as wounds made by a sharp instrument in which the width was less than the depth. RESULTS: There were 41 survivors of self-inflicted stab wounds among 2119 patients assessed after deliberate self-harm. Of these, 15 were diagnosed with a psychotic illness and the remainder had other conditions, including depression, personality disorder and substance use disorder. There was little difference in the demographic features, clinical variables and in the proportion who were intoxicated between patients diagnosed with psychotic illness and those with other disorders. The patients with psychosis were more likely to have inflicted multiple stab wounds, to have stabbed their chest or abdomen and to have reported the intention of committing suicide. CONCLUSIONS: The results suggest that a significant proportion of patients who present for treatment after stabbing themselves suffer from a psychotic illness. However, there were few differences in the characteristics of the patients who had a diagnosis of psychosis and those with other disorders.

To be the first psychiatrist in the Solomon Islands.

OBJECTIVE: Dr Paul Orotoloa is soon to become the first citizen from the Solomon Islands to complete psychiatry training. During this process, he has spent 12 months studying in Australia. This article retraces his training experiences in the Solomon Islands, Papua New Guinea and Australia. CONCLUSION: Australian psychiatry has much to offer developing psychiatric services throughout the South Pacific and should continue to offer education and material support to those psychiatric trainees studying at the University of Papua New Guinea.

From golden beaches to the heartland: reflections of NSW rural trainees.

OBJECTIVE: To describe the training experiences of rural-based psychiatry trainees in New South Wales. METHOD: Semistructured interviews were conducted with psychiatry trainees, rural psychiatrists and rural mental health administrators. The interviews were, for the most part, conducted face to face. RESULTS: Three factors that make this programme work are the opportunity to start training in a rural centre, a local psychiatrist who can act as guide and mentor and the initiative of this group of registrars. Three obstacles are a perceived lack of flexibility in College guidelines, isolation from peers and insufficient support when relocating to the city for specialty terms. CONCLUSIONS: The NSW rural psychiatry training project is an exciting development. Three years on, it represents the best avenue for creating a locally based rural psychiatrist network. It stands as a model for the rest of the country.

Movement disorder emergencies.

Movement disorders may present acutely, and failure to recognize and exclude important differential diagnoses can result in significant morbidity or mortality. Unfortunately, much of the literature pertaining to this topic is scattered and not easily accessible. This review aims to address this deficit. Movement disorder emergencies are discussed according to their most likely mode of presentation. Diagnostic considerations and early management principles are reviewed, along with appropriate pathophysiology where relevant.