Potential promises and perils of artificial intelligence in psychotherapy -The AI Psychotherapist (APT).

OBJECTIVE: Since the release of ChatGPT, popular demand has driven the use of social chatbots as pseudo-AI psychotherapists. With time, it is inevitable that these technologies will be deployed in some form as dedicated psychotherapy interventions. Here, we attempt to forecast the implications for psychotherapy including the unique benefits to distributive justice as well as concerns for the quality of the therapy and its societal impact. CONCLUSION: An AI psychotherapist (APT) has the potential to provide engaging clinical interactions given its capacity for highly realistic interaction as well as its high level cognitive and emotional capabilities. Moreover, it can potentially address financial and workforce limitations on access to therapy. However, an APT may cause significant iatrogenic harm if released without adequate quality control and oversight by trained psychotherapists. If not appropriately designed and regulated, APTs have potential to mislead and reinforce maladaptive coping behaviours. Given societal drivers and possible benefits, these technologies will inevitably be deployed; thus, it is incumbent upon us as a professional body to consider their regulation.

Collective pause: improving staff performance in acute medicine through a brief mindfulness-based group programme.

BACKGROUND: Hospital wards are a complex and dynamic environment that rely on optimal staff performance. However, there is little research evaluating group interventions to improve staff attention and teamwork. AIMS: To evaluate whether a regular, short and guided group mindfulness practice for staff in an acute general medicine team improves attention and teamwork. METHODS: A 10-min programme comprising mindfulness exercises and techniques was delivered daily to a multidisciplinary general medicine team based in a tertiary hospital for 4 weeks. This was undertaken immediately prior to the team's interdisciplinary ward round. We used a mixed-method design, with self-rated surveys to measure mindfulness and staff perception of hospital safety culture, and a focus group to understand participants' experiences. We estimated mean differences using Kruskal-Wallis tests across 10 time-points and thematically analysed recorded transcripts. RESULTS: There was an increase in staff attention to the team meeting as measured by the decentering domain across time (P < 0.001). There was a trend to greater staff openness with a non-significant increase in curiosity (P = 0.14). We identified two overarching qualitative themes: feasibility of the programme and impact on staff and workplace. The programme was a calming circuit breaker to staff's day, which aided in feeling more connected to the group and subjectively better ward round experience. The logistics of the programme, including timing, and the facilitator developing trust with the participants, appear important in implementation. CONCLUSION: A brief mindfulness-based intervention delivered to a general medical team improves staff attention at a multidisciplinary team meeting and team functioning.

Mindfulness-based intervention to reduce burnout and psychological distress, and improve wellbeing in psychiatry trainees: a pilot study.

BACKGROUND: Healthcare professionals including psychiatry trainees experience high amounts of occupational stress. This pilot study aims to assess the impacts and feasibility of a mindfulness-based intervention program as an occupational intervention in a metropolitan hospital. METHOD: Psychiatry trainees participated in an mindfulness-based intervention training program consisting of 1-h weekly sessions over 8 weeks. Levels of psychological distress and mindfulness were measured pre and post-intervention. Qualitative data through an open-ended feedback survey were also collected. RESULTS: There was an improved level of mindfulness and a decreased level of burnout among trainees post-intervention. Advantages of the program included having a compassionate facilitator and the program being tailored to healthcare staff. Limiting factors included time restraints and clinical responsibilities. CONCLUSION: Psychiatry trainees can benefit from an occupational MBI program. This can positively impact their health as well as improve their work performance. A number of factors important for implementation of a mindfulness-based intervention program were also identified.

Reflections of a CEQ Examiner.

The Critical Essay Question (CEQ) tests some of the key skills necessary for the practice of psychiatry. Many candidates find the CEQ a challenge but there are some basic rules of writing which can help.

The effects of utilizing a near-patient e-learning tool on medical student learning.

CONTEXT: This study aimed to develop a near-patient, e-learning tool and explore student views on how utilization of such a tool influenced their learning. METHODS: Third year medical students from Monash University in Melbourne, Australia were invited to trial a novel, near-patient, e-learning tool in two separate pilots within the ward environment. All participating students were invited to contribute to focus groups which were audio-recorded, transcribed verbatim and thematically analyzed. RESULTS: Four focus groups were conducted with a total of 17 participants. The emerging themes revealed influences on the students' learning both prior to and during a clinical encounter, as well as following completion of an e-learning module. The unifying concept which linked all six themes and formed the central feature of the experience was patient-centered learning. This occurred through the acquisition of contextualized knowledge and the facilitation of workplace integration. CONCLUSIONS: Utilization of a near-patient e-learning tool influences medical student learning in a number of complex, inter-related ways. Clinical e-learning tools are poised to become more commonplace and provide many potential benefits to student learning. However, incorporation of technology into clinical encounters requires specific skills which should form an integral part of primary medical training.

Twelve tips for performing well in vivas.

The viva examination is a common method of assessment in medical education. It is, in essence a performance given by candidates to examiners, and as such, candidates would be well advised to optimize their performance. Knowledge and skills are essential to passing the viva, but they alone are not sufficient. The process of the performance is also important, but it is not often made explicit in feedback during viva practice. Moreover, there are many aspects to the performance process that can be worked on to improve candidates' chances of passing. Here we present 12 tips focused on performance processes, for use by supervisors and their trainees.

Teaching psychological processes and psychotherapy to medical students.

OBJECTIVE: Psychiatrists are in a key position to teach medical students about psychotherapy. Whilst at first it may appear a formidable task, it need not be so. It should however, have applicability to the bulk of students, who will not go on to psychiatry training. CONCLUSIONS: We outline some potentially useful strategies to help clinicians teach aspects of psychotherapy to students: making it easy and relevant, illustrating the broad applications of psychological concepts, introducing cultural references, as well as appreciating that assessment can drive learning.

Formulation for beginners.

OBJECTIVE: Developing a formulation is an important method of understanding the people we treat. Writing a formulation need not be seen as burdensome or difficult. Our objective is to provide a framework for the formulation process to make it more accessible for beginners. CONCLUSION: We describe a method that beginners can adopt easily and then build upon as their experience and knowledge broadens.

Improving patient return to general practice after specialist assessment.

OBJECTIVE: The aim of this study was to evaluate the impact of a two-pronged, letter intervention strategy to improve the follow-up after referral (FAR) rate to general practitioners of patients referred for a psychiatric assessment. METHODS: The FAR rate of patients referred to the Inner South East Primary Mental Health Team (PMHT) between June 2007 and June 2008 was examined via telephone call, before and after the implementation of a process sending letters to patients and practice managers advising them to make an appointment to discuss recommendations resulting from the psychiatric assessment. RESULTS: A statistically significant improvement (χ² (1, n = 44) = 5.81, p = 0.016) in FAR rate was observed for patients post-intervention, with 11/25 (44%) pre-intervention patients not returning to their referring general practitioner within 1 month of assessment, compared to 2/19 (10.5%) patients post-intervention. CONCLUSIONS: The implementation of two simple and inexpensive measures resulted in a fourfold improvement in the return rate of patients to their referring general practitioner post-psychiatric assessment.

Twelve tools for teaching medical students.

OBJECTIVE: The aim of this paper is to outline strategies for teaching psychiatry to medical students. The background is that today's medical students are tomorrow's doctors. Undergraduate psychiatry teaching provides us a unique opportunity to instil positive attitudes, knowledge and skills in the medical workforce of the future. Moreover, teaching has many positives for the individual clinician, their service and the community. CONCLUSIONS: We outline 12 strategies that we find makes teaching not only enjoyable for us, but engaging, memorable and relevant for students.

Mailing GP reply letters after psychiatric assessment - a pilot randomised controlled trial.

BACKGROUND: Patients are not always fully aware of the details of their assessment and management plan detailed in the letter sent from the specialist to the general practitioner following referral. One approach to solving this problem is for the specialist to copy the GP reply letter to the patient. OBJECTIVE: To determine whether receiving a copy of the GP reply letter improves outcomes in patients referred by their GP for a psychiatric assessment. METHODS: A single blinded randomised control trial comparing outcomes following a one-off consultation for a depressive and/or anxiety disorder in patients who received the GP reply letter sent from a community mental health service, to patients who did not. RESULTS: Data was collected for 21 letter recipients and 18 control participants. A significant group by time interaction found total DASS-21 scores improved to a greater extent for the letter recipient group, no significant difference in adherence was found.

What do GPs want from a psychiatrist's letter?

OBJECTIVE: The aim of this study was to investigate the preferences of general practitioners (GPs) in reply letters for patients referred for a one-off psychiatric assessment. METHOD: A sample of GPs referring to a primary mental health team service were mailed a questionnaire inquiring into the usefulness of 21 different letter items. RESULTS: The response rate was 51%. Many of the items in our routine reply letters were rated highly, but others such as developmental history, supplementary information and a comprehensive report were not. Sending a copy of the letter to the patient was rated as useful by only 42.5%. CONCLUSIONS: The Royal Australian and New Zealand College of Psychiatrists' guidelines for reply letters are endorsed. There are, however, some additional items that GPs may find useful.

Depression and anxiety: pharmacological treatment in general practice.

BACKGROUND: Depression and anxiety are common presentations in general practice and medications are one of the key treatment strategies. OBJECTIVE: This article provides an overview of important practical issues to consider when prescribing medications for anxiety and depression. DISCUSSION: Key questions for the general practitioner to consider are: Are medications the best option? Which is the best medication for this patient? What are the practical aspects of prescribing this medication? What is the next step if it doesn't work?

Primary care psychiatry: taking consultation-liaison psychiatry to the community.

OBJECTIVE: To assist psychiatrists who work closely with general practitioners (GPs) at the primary/secondary care interface. CONCLUSION: The role of primary care psychiatrists can be enhanced by a sound appreciation of the general practice context, knowledge of the local mental health services and an understanding of the educational and clinical support needs of GPs.